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Pikija S, Kunz AB, Nardone R, Enzinger C, Pfaff JA, Trinka E, Seifert-Held T, Sellner J. Spontaneous spinal cord infarction in Austria: a two-center comparative study. Ther Adv Neurol Disord 2022; 15:17562864221076321. [PMID: 35299778 PMCID: PMC8921761 DOI: 10.1177/17562864221076321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Spinal cord infarction (SCI) is a neurological emergency associated with high rates of persistent neurological deficits. Knowledge about this rare but potentially treatable condition needs to be expanded. Objective: To describe the characteristics of spontaneous SCI in a large retrospective series of patients treated at two tertiary care centers in Austria. Methods: We performed a descriptive and comparative analysis of spontaneous SCI treated at the University Hospitals of Salzburg and Graz between the years 2000 and 2020. The analysis included pre- and in-hospital procedures, clinical presentation, etiology, diagnostic certainty, reperfusion therapy, and functional outcome at discharge. Results: We identified 88 cases, 61% were ascertained in the second half of the study period. The median age was 65.5 years [interquartile range (IQR) = 56–74], 51.1% were women. Anterior spinal artery infarction was the predominant syndrome (82.9%). Demographics, vascular comorbidities, and clinical presentation did not differ between the centers. The most frequent etiology and level of diagnostic certainty were distinct, with atherosclerosis (50%) and definite SCI (42%), and unknown (52.5%) and probable SCI (60%) as front runners in Salzburg and Graz, respectively. Patients arrived after a median of 258.5 min (IQR = 110–528) at the emergency room. The first magnetic resonance imaging (MRI) of the spinal cord was performed after a median of 148 min (IQR = 90–312) from admission and was diagnostic for SCI in 45%. Two patients received intravenous thrombolysis (2.2%). The outcome was poor in 37/77 (48%). Conclusion: Demographics, clinical syndromes, and quality benchmarks for spontaneous SCI were consistent at two Austrian tertiary care centers. Our findings provide the foundation for establishing standards for pre- and in-hospital care to improve outcomes.
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Affiliation(s)
- Slaven Pikija
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Alexander B. Kunz
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Raffaele Nardone
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Johannes A.R. Pfaff
- University Institute for Neuroradiology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria Neuroscience Institute, Christian Doppler Medical Center and Center for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | | | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstr. 67, 2130 Mistelbach, Austria
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany
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2
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Nardone R, Langthaler PB, Schwenker K, Kunz AB, Sebastianelli L, Saltuari L, Trinka E, Versace V. Visuomotor integration in early Alzheimer's disease: A TMS study. J Neurol Sci 2022; 434:120129. [PMID: 34998240 DOI: 10.1016/j.jns.2021.120129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Cortical visuomotor integration is altered in Alzheimer's disease (AD), even at an early stage of the disease. The aim of this study was to assess the connections between the primary visual (V1) and motor (M1) areas in patients with early AD using a paired-pulse, twin-coil transcranial magnetic stimulation (TMS) technique. METHODS Visuomotor connections (VMCs) were assessed in 13 subjects with probable AD and 16 healthy control subjects. A conditioning stimulus over the V1 phosphene hotspot was followed at interstimulus intervals (ISIs) of 18 and 40 ms by a test stimulus over M1, to elicit motor evoked potentials (MEPs) in the contralateral first dorsal interosseous muscle. RESULTS Significant effects due to VMCs, consisting of enhanced MEP suppression at ISI of 18 and 40 ms, were observed in the AD patients. Patients with AD showed an excessive inhibitory response of the right M1 to inputs travelling from V1 at given ISIs. CONCLUSIONS This study provides neurophysiological evidence of altered functional connectivity between visual and motor areas in AD.
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Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.
| | - Patrick B Langthaler
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Department of Mathematics, Paris Lodron University of Salzburg, Austria
| | - Kerstin Schwenker
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Alexander B Kunz
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria; Centre for Cognitive Neuroscience Salzburg, Salzburg, Austria; University for Medical Informatics and Health Technology, UMIT, Hall in Tirol, Austria
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
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Schulte EC, Hauer L, Kunz AB, Sellner J. Systematic review of cases of acute myelitis in individuals with COVID-19. Eur J Neurol 2021; 28:3230-3244. [PMID: 34060708 PMCID: PMC8239542 DOI: 10.1111/ene.14952] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/27/2021] [Indexed: 12/13/2022]
Abstract
Background and purpose An incremental number of cases of acute transverse myelitis (ATM) in individuals with ongoing or recent coronavirus disease 2019 (COVID‐19) have been reported. Methods A systematic review was performed of cases of ATM described in the context of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection by screening both articles published and in preprint. Results Twenty cases were identified. There was a slight male predominance (60.0%) and the median age was 56 years. Neurological symptoms first manifested after a mean of 10.3 days from the first onset of classical, mostly respiratory symptoms of COVID‐19. Overall, COVID‐19 severity was relatively mild. Polymerase chain reaction of cerebrospinal fluid for SARS‐CoV‐2 was negative in all 14 cases examined. Cerebrospinal fluid findings reflected an inflammatory process in most instances (77.8%). Aquaporin‐4 and myelin oligodendrocyte protein antibodies in serum (tested in 10 and nine cases, respectively) were negative. On magnetic resonance imaging, the spinal cord lesions spanned a mean of 9.8 vertebral segments, necrotic‐hemorrhagic transformation was present in three cases and two individuals had additional acute motor axonal neuropathy. More than half of the patients received a second immunotherapy regimen. Over a limited follow‐up period of several weeks, 90% of individuals recovered either partially or near fully. Conclusion Although causality cannot readily be inferred, it is possible that cases of ATM occur para‐ or post‐infectiously in COVID‐19. All identified reports are anecdotal and case descriptions are heterogeneous. Whether the condition and the observed radiological characteristics are specific to SARS‐CoV‐2 infection needs to be clarified.
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Affiliation(s)
- Eva C Schulte
- Institute of Virology, Technische Universität München/Helmholtz Zentrum München, Munich, Germany.,Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Larissa Hauer
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Alexander B Kunz
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Gunther Ladurner Nursing Home, Salzburg, Austria
| | - Johann Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.,Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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4
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Wutzl B, Golaszewski SM, Leibnitz K, Langthaler PB, Kunz AB, Leis S, Schwenker K, Thomschewski A, Bergmann J, Trinka E. Narrative Review: Quantitative EEG in Disorders of Consciousness. Brain Sci 2021; 11:brainsci11060697. [PMID: 34070647 PMCID: PMC8228474 DOI: 10.3390/brainsci11060697] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023] Open
Abstract
In this narrative review, we focus on the role of quantitative EEG technology in the diagnosis and prognosis of patients with unresponsive wakefulness syndrome and minimally conscious state. This paper is divided into two main parts, i.e., diagnosis and prognosis, each consisting of three subsections, namely, (i) resting-state EEG, including spectral power, functional connectivity, dynamic functional connectivity, graph theory, microstates and nonlinear measurements, (ii) sleep patterns, including rapid eye movement (REM) sleep, slow-wave sleep and sleep spindles and (iii) evoked potentials, including the P300, mismatch negativity, the N100, the N400 late positive component and others. Finally, we summarize our findings and conclude that QEEG is a useful tool when it comes to defining the diagnosis and prognosis of DOC patients.
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Affiliation(s)
- Betty Wutzl
- Graduate School of Information Science and Technology, Osaka University, Suita 565-0871, Japan; (B.W.); (K.L.)
- Symbiotic Intelligent Systems Research Center, Osaka University, Suita 565-0871, Japan
| | - Stefan M. Golaszewski
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, 5020 Salzburg, Austria
- Neuroscience Institute, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Kenji Leibnitz
- Graduate School of Information Science and Technology, Osaka University, Suita 565-0871, Japan; (B.W.); (K.L.)
- Center for Information and Neural Networks, National Institute of Information and Communications Technology, Suita 565-0871, Japan
| | - Patrick B. Langthaler
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Department of Mathematics, Paris Lodron University of Salzburg, 5020 Salzburg, Austria
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Alexander B. Kunz
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, 5020 Salzburg, Austria
| | - Stefan Leis
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Kerstin Schwenker
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, 5020 Salzburg, Austria
- Neuroscience Institute, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, 5020 Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Neuroscience Institute, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, 5020 Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Jürgen Bergmann
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Neuroscience Institute, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, 5020 Salzburg, Austria
- Neuroscience Institute, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, 5020 Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +43-5-7255-34600
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Angerer M, Schabus M, Raml M, Pichler G, Kunz AB, Scarpatetti M, Trinka E, Blume C. Actigraphy in brain-injured patients - A valid measurement for assessing circadian rhythms? BMC Med 2020; 18:106. [PMID: 32393256 PMCID: PMC7216424 DOI: 10.1186/s12916-020-01569-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/19/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Actigraphy has received increasing attention in classifying rest-activity cycles. However, in patients with disorders of consciousness (DOC), actigraphy data may be considerably confounded by passive movements, such as nursing activities and therapies. Consequently, this study verified whether circadian rhythmicity is (still) visible in actigraphy data from patients with DOC after correcting for passive movements. METHODS Wrist actigraphy was recorded over 7-8 consecutive days in patients with DOC (diagnosed with unresponsive wakefulness syndrome [UWS; n = 19] and [exit] minimally conscious state [MCS/EMCS; n = 11]). The presence and actions of clinical and research staff as well as visitors were indicated using a tablet in the patient's room. Following removal and interpolation of passive movements, non-parametric rank-based tests were computed to identify differences between circadian parameters of uncorrected and corrected actigraphy data. RESULTS Uncorrected actigraphy data overestimated the interdaily stability and intradaily variability of patients' activity and underestimated the deviation from a circadian 24-h rhythm. Only 5/30 (17%) patients deviated more than 1 h from 24 h in the uncorrected data, whereas this was the case for 17/30 (57%) patients in the corrected data. When contrasting diagnoses based on the corrected dataset, stronger circadian rhythms and higher activity levels were observed in MCS/EMCS as compared to UWS patients. Day-to-night differences in activity were evident for both patient groups. CONCLUSION Our findings indicate that uncorrected actigraphy data overestimates the circadian rhythmicity of patients' activity, as nursing activities, therapies, and visits by relatives follow a circadian pattern itself. Therefore, we suggest correcting actigraphy data from patients with reduced mobility.
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Affiliation(s)
- Monika Angerer
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Salzburg, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Salzburg, Austria
| | - Marion Raml
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Gerald Pichler
- Apallic Care Unit, Albert Schweitzer Clinic, Geriatric Health Centres of the City of Graz, Graz, Austria
| | - Alexander B. Kunz
- Department of Neurology, Paracelsus Medical University, Christian Doppler Medical Center, Salzburg, Austria
- Gunther Ladurner Nursing Home, Salzburg, Austria
| | - Monika Scarpatetti
- Apallic Care Unit, Albert Schweitzer Clinic, Geriatric Health Centres of the City of Graz, Graz, Austria
| | - Eugen Trinka
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Salzburg, Austria
- Department of Neurology, Paracelsus Medical University, Christian Doppler Medical Center, Salzburg, Austria
| | - Christine Blume
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
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Blume C, Angerer M, Raml M, Del Giudice R, Santhi N, Pichler G, Kunz AB, Scarpatetti M, Trinka E, Schabus M. Healthier rhythm, healthier brain? Integrity of circadian melatonin and temperature rhythms relates to the clinical state of brain-injured patients. Eur J Neurol 2019; 26:1051-1059. [PMID: 30770613 PMCID: PMC6766891 DOI: 10.1111/ene.13935] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/12/2019] [Indexed: 11/30/2022]
Abstract
Background Healthy circadian rhythmicity has been suggested to relate to a better state of brain‐injured patients and to support the emergence of consciousness in patient groups characterized by a relative instability thereof such as patients with disorders of consciousness (DOC). Methods Going beyond earlier studies, a systems‐level perspective was adopted and, using multilevel modelling, the joint predictive value of three indices of circadian rhythm integrity derived from skin temperature variations, melatoninsulfate secretion, and physical activity (wrist actigraphy) patterns was evaluated for the behaviourally assessed state [Coma Recovery Scale ‐ Revised (CRS‐R) score] of DOC patients [13 unresponsive wakefulness syndrome; seven minimally conscious (exit) state]. Additionally, it was assessed in a subset of 16 patients whether patients’ behavioural repertoire (CRS‐R score) varied (i) with time of day or (ii) offset from the body temperature maximum (BTmax), i.e. when cognitive performance is expected to peak. Results The results reveal that better integrity of circadian melatoninsulfate and temperature rhythms relate to a richer behavioural repertoire. Moreover, higher CRS‐R scores are, by trend, related to assessments taking place at a later daytime or deviating less from the pre‐specified time of occurrence of BTmax. Conclusions In conclusion, the results suggest that therapeutic approaches aimed at improving circadian rhythms in brain‐injured patients are promising and should be implemented in hospitals or nursing homes. Beyond this, it might be helpful to schedule diagnostic procedures and therapies around the (pre‐assessed) BTmax (≈4 pm in healthy individuals) as this is when patients should be most responsive.
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Affiliation(s)
- C Blume
- Department of Psychology, University of Salzburg, Laboratory for Sleep, Cognition, and Consciousness Research, Salzburg, Austria.,University of Salzburg, Centre for Cognitive Neuroscience, Salzburg, Austria
| | - M Angerer
- Department of Psychology, University of Salzburg, Laboratory for Sleep, Cognition, and Consciousness Research, Salzburg, Austria
| | - M Raml
- Department of Psychology, University of Salzburg, Laboratory for Sleep, Cognition, and Consciousness Research, Salzburg, Austria
| | - R Del Giudice
- Department of Psychology, University of Salzburg, Laboratory for Sleep, Cognition, and Consciousness Research, Salzburg, Austria
| | - N Santhi
- Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - G Pichler
- Geriatric Health Centres of the City of Graz, Albert Schweitzer Clinic, Apallic Care Unit, Graz, Austria
| | - A B Kunz
- Department of Neurology, Paracelsus Medical University, Christian Doppler Medical Center, Salzburg, Austria.,Gunther Ladurner Nursing Home, Salzburg, Austria
| | - M Scarpatetti
- Geriatric Health Centres of the City of Graz, Albert Schweitzer Clinic, Apallic Care Unit, Graz, Austria
| | - E Trinka
- University of Salzburg, Centre for Cognitive Neuroscience, Salzburg, Austria.,Department of Neurology, Paracelsus Medical University, Christian Doppler Medical Center, Salzburg, Austria
| | - M Schabus
- Department of Psychology, University of Salzburg, Laboratory for Sleep, Cognition, and Consciousness Research, Salzburg, Austria.,University of Salzburg, Centre for Cognitive Neuroscience, Salzburg, Austria
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Pikija S, Mutzenbach JS, Kunz AB, Nardone R, Leis S, Deak I, McCoy MR, Trinka E, Sellner J. Delayed Hospital Presentation and Neuroimaging in Non-surgical Spinal Cord Infarction. Front Neurol 2017; 8:143. [PMID: 28446898 PMCID: PMC5388752 DOI: 10.3389/fneur.2017.00143] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/29/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lack of timely recognition and neuroimaging may be a barrier to reperfusion efforts in acute spinal cord infarction. METHODS We performed a retrospective study of patients diagnosed with acute non-surgical spinal cord infarction at our tertiary academic center from 2001 to 2015. We studied parameters associated with time from symptom onset to initial hospital presentation and magnetic resonance imaging (MRI) of the spinal cord. RESULTS We identified 39 patients among whom anterior spinal artery syndrome was the most frequent presentation (87.2%) and atherosclerosis the most common etiology (56.4%). Nearly, half of the patients presented to the emergency department on the same day of symptom onset (48.7%) but only nine (23.1%) within the first 6 h. Average time from symptom onset to spinal cord MRI was 3.2 days. We could not identify clinical, radiological, or outcome patterns associated with early vs. delayed presentation and imaging. DISCUSSION Our study found a time lag from symptom onset to hospital presentation and spinal cord MRI in patients with acute spinal cord infarction. These findings point at low clinical suspicion of spinal cord syndromes and limited recognition as a potentially treatable medical emergency.
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Affiliation(s)
- Slaven Pikija
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | | | - Alexander B Kunz
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - Stefan Leis
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Ildiko Deak
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Mark R McCoy
- Division of Neuroradiology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - Johann Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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8
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Schabus M, Heib DP, Lechinger J, Griessenberger H, Klimesch W, Pawlizki A, Kunz AB, Sterman BM, Hoedlmoser K. Enhancing sleep quality and memory in insomnia using instrumental sensorimotor rhythm conditioning. Biol Psychol 2014; 95:126-34. [DOI: 10.1016/j.biopsycho.2013.02.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 02/05/2013] [Accepted: 02/20/2013] [Indexed: 12/16/2022]
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9
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Marschallinger R, Golaszewski SM, Kunz AB, Kronbichler M, Ladurner G, Hofmann P, Trinka E, McCoy M, Kraus J. Usability and potential of geostatistics for spatial discrimination of multiple sclerosis lesion patterns. J Neuroimaging 2013; 24:278-86. [PMID: 23384318 DOI: 10.1111/jon.12000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 08/21/2012] [Accepted: 10/01/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE In multiple sclerosis (MS) the individual disease courses are very heterogeneous among patients and biomarkers for setting the diagnosis and the estimation of the prognosis for individual patients would be very helpful. For this purpose, we are developing a multidisciplinary method and workflow for the quantitative, spatial, and spatiotemporal analysis and characterization of MS lesion patterns from MRI with geostatistics. METHODS We worked on a small data set involving three synthetic and three real-world MS lesion patterns, covering a wide range of possible MS lesion configurations. After brain normalization, MS lesions were extracted and the resulting binary 3-dimensional models of MS lesion patterns were subject to geostatistical indicator variography in three orthogonal directions. RESULTS By applying geostatistical indicator variography, we were able to describe the 3-dimensional spatial structure of MS lesion patterns in a standardized manner. Fitting a model function to the empirical variograms, spatial characteristics of the MS lesion patterns could be expressed and quantified by two parameters. An orthogonal plot of these parameters enabled a well-arranged comparison of the involved MS lesion patterns. CONCLUSIONS This method in development is a promising candidate to complement standard image-based statistics by incorporating spatial quantification. The work flow is generic and not limited to analyzing MS lesion patterns. It can be completely automated for the screening of radiological archives.
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Golaszewski SM, Bergmann J, Christova M, Kunz AB, Kronbichler M, Rafolt D, Gallasch E, Staffen W, Trinka E, Nardone R. Modulation of motor cortex excitability by different levels of whole-hand afferent electrical stimulation. Clin Neurophysiol 2012; 123:193-9. [DOI: 10.1016/j.clinph.2011.06.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 06/06/2011] [Accepted: 06/14/2011] [Indexed: 11/16/2022]
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Broussalis E, Kunz AB, Luthringshausen G, Klein S, McCoy MR, Trinka E, Killer-Oberpfalzer M. Treatment of vertebral artery origin stenosis with a Pharos stent device: a single center experience. Interv Neuroradiol 2011; 17:316-22. [PMID: 22005693 DOI: 10.1177/159101991101700306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 04/24/2011] [Indexed: 11/15/2022] Open
Abstract
Atherosclerotic stenosis of vertebral artery (VA) origin exceeding 70% severity accounts for one third of all vertebrobasilar strokes. For a period of one year the results of endovascular treatment of VA stenosis with the new Pharos stent device were assessed.Twenty-two patients with symptomatic VA stenosis were treated with the Pharos stent. Clinical status and stenosis grade were documented before treatment and 24 hours, one, three and twelve months after treatment via ultrasound and magnetic resonance tomography.All procedures proved to be technically successful without the occurrence of intra-procedural complications. During the observation period of more than one year, 55% of patients were documented with a mean stenosis degree of 60%: two (10%) of these patients showed a residual stenosis after angioplasty and nine patients (45%) an in-stent restenosis, whereas only two patients were documented with a hemodynamically relevant in-stent restenosis of 80%. These two patients were retreated with balloon dilatation. None of the patients showed neurological deterioration or new abnormalities at magnetic resonance tomography examination. Neither VA occlusion nor restenosis of the contralateral VA negatively affected the clinical outcome. An in-stent restenosis was developed by more female than male patients.VA origin stenting with the Pharos stent device is an effective treatment of stenosis. The good clinical results compared to the high restenosis rates have to be examined in further studies. Pin particular, it has to be determined whether the Pharos stent allows the vessel time for collateralization, whether double antiplatelet treatment prevents recurrent cerebrovascular events or whether merely the low restenosis degree is causative for the clinical outcome.
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Affiliation(s)
- E Broussalis
- Department of Neurology, Paracelsus Medical University, Christian Doppler Klinik, Salzburg, Austria.
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Broussalis E, Kraus J, Kunz AB, Luthringshausen G, McCoy M, Muss W, Hutarew G, Ladurner G, Trinka E, Killer-Oberpfalzer M. Cerebral localized marginal zone lymphoma presenting as hypothalamic-pituitary region disorder. Case Rep Neurol 2011; 3:129-35. [PMID: 21720530 PMCID: PMC3124448 DOI: 10.1159/000329342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Marginal zone B-cell lymphoma is a rare disease which can be considerably difficult to recognize and diagnose when signs of systemic involvement are absent. Case Presentation We report the case of a 57-year-old woman with initial olfactory disturbance, followed by psychosis, diabetes insipidus and hypothalamic eating disorder as an uncommon clinical presentation of marginal zone B-cell lymphoma. Conclusion Marginal zone B-cell lymphoma should be considered as a potential differential diagnosis in patients with hypothalamic disturbances.
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Affiliation(s)
- E Broussalis
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
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Broussalis E, Luthringshausen G, Kunz AB, McCoy M, Weiss S, Killer-Oberpfalzer M, Trinka E, Kraus J. Isolated facial palsy and ophthalmoplegia--first symptoms of a cerebral granulomatous vasculitis with giant cells--a diagnostic challenge. Clin Neurol Neurosurg 2011; 113:686-8. [PMID: 21616584 DOI: 10.1016/j.clineuro.2011.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 03/29/2011] [Accepted: 04/19/2011] [Indexed: 10/18/2022]
Affiliation(s)
- E Broussalis
- Paracelsus Medical University, Christian Doppler Klinik, Department of Neurology, Ignaz Harrer Str. 79, A-5020 Salzburg, Austria.
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Nardone R, McCoy M, Kunz AB, Kraus J, Staffen W, Ladurner G, Golaszewski SM. Hyponatremic encephalopathy mimicking hypoxic-ischemic encephalopathy. Clin Neuroradiol 2010; 20:243-6. [PMID: 20628710 DOI: 10.1007/s00062-010-0017-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 06/04/2010] [Indexed: 11/25/2022]
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Killer M, Ladurner G, Kunz AB, Kraus J. Current endovascular treatment of acute stroke and future aspects. Drug Discov Today 2010; 15:640-7. [PMID: 20457274 DOI: 10.1016/j.drudis.2010.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 03/08/2010] [Accepted: 04/23/2010] [Indexed: 11/17/2022]
Abstract
Acute ischemic stroke remains a condition of high morbidity and mortality. Until now, the only established therapy has been intravenous (IV) tissue-type plasminogen activator (tPA). Only 3-10% of patients with acute ischemic stroke receive this treatment. On the basis of data from part 3 of the European Collaborative Acute Stroke Study (ECASS III), the time window for beneficial treatment of ischemic stroke with IV tPA has been extended from 3 to 4.5h after the onset of stroke symptoms. Beyond that window of opportunity, and additionally to IV treatment, interventional stroke therapy has assumed an important role for the treatment of acute ischemic stroke. Currently, new promising pharmacological and mechanical treatment options are being established as routine procedures to achieve a further improved outcome for stroke patients.
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Affiliation(s)
- Monika Killer
- Christian Doppler University Clinic Salzburg, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria.
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Kunz AB, Tschernatsch M, Blaes F, Wipfler P, Pilz G, Golaszewski SM, Lesicky O, Staffen W, Ladurner G, Kraus J. Detailed report of an overlap syndrome of Systemic lupus erythematosus with positive neuromyelitis optitica-antibodies. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Golaszewski SM, Kunz AB, McCoy M, Nardone R, Broussalis E, Ladurner G, Staffen W, Kraus J. Hyponatriemic encephalopathy which failed to present episodes of hypoxia or respiratory failure – a case report. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kunz AB, Collins TC. Development of non-local one-particle excitation Hamiltonian for atomic, molecular and solid state systems. ACTA ACUST UNITED AC 2001. [DOI: 10.1088/0022-3700/7/3/020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Beck DR, Kunz AB. Excitation energies for the lowest triplets and singlet-triplet splittings in gas-phase methane including many-body effects. ACTA ACUST UNITED AC 1999. [DOI: 10.1088/0022-3700/17/11/010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Kunz AB. Ab initio investigation of the structure and electronic properties of the energetic solids TATB and RDX. Phys Rev B Condens Matter 1996; 53:9733-9738. [PMID: 9982530 DOI: 10.1103/physrevb.53.9733] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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34
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Zuo J, Pandey R, Kunz AB. Embedded-cluster study of Cu+-induced lattice relaxation in alkali halides. Phys Rev B Condens Matter 1992; 45:2709-2711. [PMID: 10001818 DOI: 10.1103/physrevb.45.2709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Zuo J, Pandey R, Kunz AB. Embedded-cluster study of the lithium trapped-hole center in magnesium oxide. Phys Rev B Condens Matter 1991; 44:7187-7191. [PMID: 9998626 DOI: 10.1103/physrevb.44.7187] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Jaffe JE, Pandey R, Kunz AB. Electronic structure of the rocksalt-structure semiconductors ZnO and CdO. Phys Rev B Condens Matter 1991; 43:14030-14034. [PMID: 9997271 DOI: 10.1103/physrevb.43.14030] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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37
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Pandey R, Jaffe JE, Kunz AB. Ab initio band-structure calculations for alkaline-earth oxides and sulfides. Phys Rev B Condens Matter 1991; 43:9228-9237. [PMID: 9996593 DOI: 10.1103/physrevb.43.9228] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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38
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Seel M, Wadiak DT, Kunz AB, Hill SE. Stokesian dynamics simulation of polyether-coated particles in a shear flow. Phys Rev A 1990; 42:2248-2254. [PMID: 9904274 DOI: 10.1103/physreva.42.2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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39
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Mason MG, Tan YT, Miller TJ, Kwawer GN, Brown FC, Kunz AB. Partial densities of states for silver bromide and silver iodobromide. Phys Rev B Condens Matter 1990; 42:2996-3003. [PMID: 9995791 DOI: 10.1103/physrevb.42.2996] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Pandey R, Seel M, Kunz AB. Ab initio study of localization and excitation of an excess electron in alkali halide clusters. Phys Rev B Condens Matter 1990; 41:7955-7956. [PMID: 9993113 DOI: 10.1103/physrevb.41.7955] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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41
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Groh DJ, Kunz AB, Givens CR. Method for the calculation of excitonic effects in the absorption spectra of some metals. Phys Rev B Condens Matter 1990; 41:8037-8046. [PMID: 9993122 DOI: 10.1103/physrevb.41.8037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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42
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43
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Woodward C, Kunz AB. Ab initio study of the x-ray edge in alkali metals and alloys. Phys Rev B Condens Matter 1989; 39:7955-7962. [PMID: 9947479 DOI: 10.1103/physrevb.39.7955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Meng J, Pandey R, Vail JM, Kunz AB. Cu+ diffusion and interionic potentials for Cu+ in alkali halides. Phys Rev B Condens Matter 1988; 38:10083-10086. [PMID: 9945846 DOI: 10.1103/physrevb.38.10083] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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Meng J, Kunz AB, Woodward C. Electronic structure and optical properties of the impurity Cu+ in NaF. Phys Rev B Condens Matter 1988; 38:10870-10873. [PMID: 9945944 DOI: 10.1103/physrevb.38.10870] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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Kunz AB, Vail JM. Quantum-mechanical cluster-lattice interaction in crystal simulation: Hartree-Fock method. Phys Rev B Condens Matter 1988; 38:1058-1063. [PMID: 9946359 DOI: 10.1103/physrevb.38.1058] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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49
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Kunz AB, Meng J, Vail JM. Quantum-mechanical cluster-lattice interaction in crystal simulation: Many-body effects. Phys Rev B Condens Matter 1988; 38:1064-1066. [PMID: 9946360 DOI: 10.1103/physrevb.38.1064] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Seel M, Kunz AB, Wadiak DT. Ab initio study of the interaction of polyoxymethylene with polyoxymethylene, ammonium perchlorate, and the aluminum (100) surface. Phys Rev B Condens Matter 1988; 37:8915-8922. [PMID: 9944262 DOI: 10.1103/physrevb.37.8915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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