[Retropharyngeal tendinitis. Differential diagnosis in the management of acute neck pain]. / Retropharyngeale Tendinitis. Differenzialdiagnose des akuten Zervikalsyndroms.

Neck pain is frequent and can be a symptom of numerous differential diagnoses with quite different diagnostic and therapeutic consequences. A 37-year-old woman reported acute neck pain aggravated by movements of the cervical spine and head and by swallowing. Clinical examination showed pronounced neck stiffness. T2-weighted MRI demonstrated high-intensity edema and effusion localized prevertebrally in the area of the superior part of the longus colli muscle. Computed tomography of this region demonstrated prevertebral calcification leading to the diagnosis of retropharyngeal tendinitis. Nonsteroidal antiphlogistic drugs led to rapid improvement of clinical signs and symptoms. Retropharyngeal tendinitis should be considered in patients with acute neck pain.

Taste in dementing diseases and parkinsonism.

Like with many sensory abilities a reduction of taste and smell occurs during aging. Since there are hints to an additional reduction in dementing diseases, we assessed 52 patients, 26 women and 26 men, who were presented to a memory clinic, using the Sniffin' Sticks, Whole Mouth and Taste Strip Tests. While smoking, alcohol consumption, intake of drugs and sex exerted only minor impact, age and the severity of cognitive impairment were of major importance. There was a moderate but significant correlation between the severity of dementia, taste and smell, even if the age effect was partialled out. Notably, patients with Parkinson syndrome showed worse taste and smell abilities than those without. Here the differences were indeed marked enough to play a possible role in making the diagnosis. This exploratory study confirms a mild reduction of gustatory function in dementing diseases over and beyond that of normal aging which--in addition to a reduction of smell--seems to be especially marked in Parkinson syndromes.

Neurological causes of taste disorders.

In caring for patients with taste disorders, the clinical assessment should include complete examination of the cranial nerves and, in particular, gustatory testing. Neurophysiological methods such as blink reflex and masseter reflex allow the testing of trigeminofacial and trigeminotrigeminal pathways. Modern imaging methods (MRI and computed tomography) enable the delineation of the neuroanatomical structures which are involved in taste and their relation to the bony skull base. From a neurological point of view, gustatory disorders can result from damage at any location of the neural gustatory pathway from the taste buds via the peripheral (facial, glossopharyngeal and vagal nerve) and central nervous system (brainstem, thalamus) to its representation within the cerebral cortex. Etiopathogenetically, a large number of causes has to be considered, e.g. drugs and physical agents, cerebrovascular disorders including dissection of the carotid artery and pontine/thalamic lesions, space-occupying processes - in particular tumors compressing the cerebellopontine angle and the jugular foramen of the skull base - head trauma and skull base fractures, isolated cranial mononeuropathy (e.g. Bell's palsy) or polyneuropathy, epilepsy, dementia, multiple sclerosis and major depression. In addition to this, aging can also lead to diminished taste perception. Due to the broad differential diagnostic considerations, it is essential to look for additional, even mild, neurological signs and symptoms. Treatment must relate to the underlying cause. Zinc may be tried in idiopathic dysgeusia.

Apnea testing for the diagnosis of brain death.

OBJECTIVES: A review is given on various methods, preconditions and pitfalls of apnea testing for the diagnosis of brain death. MATERIALS AND METHODS: An extensive medical data base search was implemented by information gathered from books and our own experience with more than 2000 apnea tests. RESULTS: While testing for apnea (AT) is considered indispensable worldwide, recommendations and handling differ. Rather than relying on elapsed time, a specific target value for the partial arterial pressure of carbon dioxide (PaCO2) should be aimed at being the maximum physiological stimulus for respiration. Methodological points are elaborated upon in detail for apneic oxygenation and hypoventilation. CONCLUSION: AT is an indispensable element of diagnosing brain death. Although with proper handling and adequate precautions AT is safe, it should be performed as a last resort. An international agreement on target values for the PaCO2 is desirable.

[Dementia with argyrophilic grains]. / Demenz mit argyrophilen Granula.

Dementia with argyrophilic grains (AG) is a neuropathologically defined potentially dementing disease of advanced age which was first described by H. and E. Braak in 1987. It is often combined with histopathological signs of Alzheimer's disease but has nevertheless to be considered as a distinct entity since pure bona fide cases have been reported. Clinically it may resemble either Alzheimer's or Pick's disease; it is almost exclusively confined to patients older than 60 years and progresses slowly but relentlessly. Repeatedly prominent behavioral disorders were pointed out. Useful therapeutic regimens are not available at present but acetylcholinesterase inhibitors have proven effective in some cases and amantadines as well as dopamine agonists hold some promise from a theoretical perspective, too. The diagnosis can be ascertained only by histopathological examination. For the clinician it is important to know that this disease is to be considered as an additional and differential diagnosis of both Alzheimer's disease and the frontotemporal dementias. It must be counted among the tauopathies. This review is supplemented by a detailed case report.

Localization of cerebral lesions in aphasia--a computer aided comparison between men and women.

It is still a matter of debate whether there are differences between men and women concerning the localization of higher cerebral functions. To further elucidate this problem we conjointly evaluated the aphasia protocols and corresponding computer-assisted tomography (CT) scans of 49 men and 35 women who presented with unilateral ischemic cerebral lesions. Both, the aphasia tests and CT scans, were fed into computer programs warranting a high degree of objectivity. Comparing the four main aphasic syndromes we found differences for each of them displaying a more posterior extension of lesions with global and amnestic aphasia in men and larger lesions with Broca and Wernicke aphasia in women. When all templates were compared, men displayed a wider extension within the left hemisphere than women whose lesions were more focused in the perisylvian area. This study confirms earlier findings claiming that aphasic men and women differ regarding the anterior-posterior extension and the frequency of lesions within the classical language zones. However, while the predominance of men's lesions in the posterior areas was in accordance with previous findings, the greater overall scatter within the left hemisphere contradicts published studies.

[Dementias with Lewy bodies]. / Demenzen mit Lewy-Körperchen.

Dementias with Lewy bodies are no rare cause of cognitive and motor impairments in old age. Neuropathologically, they must be distinguished into diffuse Lewy body disease resp. dementia with Lewy bodies, Parkinson's disease with concomitant Alzheimer's pathology, and the Lewy body variant of Alzheimer's disease according to extent and concomitant pathology. The most reliable diagnostic features of dementia with Lewy bodies are fluctuating disturbances of cognition and consciousness, visual disorders (hallucinations, visuoperceptive and visuoconstructive impairments), and early extrapyramidal signs of the hypokinetic-rigid type with a propensity to frequent falls. The pertinent diagnostic criteria are the consensus criteria according to McKeith et al. Additional contributions are to be expected by functional neuroimaging (SPECT, PET) and CSF examination (homovanillic acid). However, even assuming the most favorable conditions a diagnostic accuracy of 85 % is presently hard to achieve. Particularly, as is demonstrated using a case example, reliable antemortem diagnosis of Lewy body variant of Alzheimer's disease is hardly possible. Clinically, this group of diseases is important, since increased neuroleptic sensitivity must be taken into account and modern central cholinergic agents seem to be a promising therapeutic option.

[Why patients with simple cervical vertebral sprains may develop persistent neurological symptoms]. / Warum Patienten mit einfacher Halswirbelsäulendistorsion persistierende Beschwerden auf neurologischem Gebiet entwickeln können.

Possible causative mechanisms and sequelae of neck strain, the so-called whiplash injury, are reviewed critically and evaluated regarding their influence on the persistence of symptoms in the neurological field. In the light of contemporary knowledge monistic or dualistic models have proven inefficient to come up for the multifaceted aspects of this complex problem. We propose a multidimensional biopsychosocial model whose impact on an adequate understanding as well as a better and more efficient therapy of these patients is elaborated.

[Screening for neuropsychological deficits--a screening test also for dementias?]. / Neuropsychologisches Defizit-Screening--ein Suchtest auch für Demenzen?

To assess further the psychometric features of neuropsychological deficit screening (NDS), three groups of patients (41 demented, 23 not demented but cognitively impaired, and 50 controls) were examined and the results compared with two older tests, the Mattis dementia rating scale (MDRS) and the mini mental status test (MMST). As a result, the discriminating ability of NDS (modified for this study) was comparable to both other tests without surpassing them in either demented or cognitively impaired groups. An abbreviated version allowed for an improvement in economy without sacrificing discriminating properties. The advantage of NDS thus lies in the diversity of functions assessed, while its screening power is comparable to the two other tests used for comparison.

Transcutaneous and intra-arterial blood gas monitoring--a comparison during apnoea testing for the determination of brain death.

Intra-arterial (i.a.) and transcutaneous (t.c.) blood gas monitoring were compared with in vitro blood gas analysis (abg) during apnoea testing for the determination of brain death in a prospective observational study. All three methods were used simultaneously in 19 patients in whom brain death was suspected. Brain death was confirmed in each case adhering to the recommendations of the Scientific Advisory Board of the German Federal Chamber of Physicians which demand a PCO2 of at least 60 mmHg. In vitro parameters ranged from 23.2 to 80.4 mmHg (PCO2), 52.7 to 509.9 mmHg (PO2), and 7.072 to 7.591 (pH). The intra-individual correlations between both monitoring methods (rPCO2=0.958, rPO2=0.859) and between each of them and abg (r>0.960) were high. Absolute deviations from abg for the corrected as well as uncorrected measurements were similar for both methods, except with regard to group bias where an advantage for the i.a. values emerged. Since many of the i.a. measurements failed and the disposable i.a. probes cost much more than the t.c. electrodes, the i.a. technique at present holds no advantage over t.c. measurements in testing for apnoea in suspected brain death except where simultaneous monitoring of pH and temperature are desired.