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Abstract
BACKGROUND While Covid-19 predominantly affects the respiratory system, neurological manifestations including encephalitis occur in some patients, possibly affecting the course and outcome of the disease. Here, we describe a unique case of a young man with Covid-19 and transient MOG-positive encephalitis, with a benign course. CASE PRESENTATION A 22-year-old male, with PCR confirmed Covid-19 infection was admitted because of persistent headache. The clinical examination was normal. Neuropsychological testing revealed distinct executive deficits. Brain MRI and cerebrospinal fluid (CSF) analysis were suggestive for encephalitis. Further laboratory examination revealed a serum MOG antibody titre. The headache improved with analgetic treatment and i.v. methylprednisolone. Consequently, the MOG antibody titer decreased and MRI lesions were resolving. The patient made a full recovery, with no signs of deterioration over the following months. CONCLUSIONS Covid-19 manifestations in the CNS include encephalitis with variable course and prognosis. This case highlights a possible association between inflammation due to COVID-19 and transient secondary autoimmunity with transient MOG antibodies and atypical clinical presentation.
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Affiliation(s)
- Ervin Durovic
- Department of Neurology, Klinik für Neurologie und klinische Neurophysiologie, St. Josef Krankenhaus Moers, Asbergerstr. 4, 47441, Moers, Germany
| | | | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Bielefeld University, Medical School, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Stefan Isenmann
- Department of Neurology, Klinik für Neurologie und klinische Neurophysiologie, St. Josef Krankenhaus Moers, Asbergerstr. 4, 47441, Moers, Germany.
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2
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Isenmann S, Haehner A, Hummel T. [Chemosensory disorders in Covid-19: Pathomechanisms and clinical relevance]. Fortschr Neurol Psychiatr 2021; 89:281-288. [PMID: 33621990 DOI: 10.1055/a-1375-0761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this review article, current information on the frequency and relevance of chemosensory disorders in Covid-19 was recorded, assigned pathophysiologically and statements on prognostic significance were derived. The results are based on a comprehensive literature search of all literature on this topic and our own experience in the treatment of patients with smell and taste disorders since the beginning of the pandemic.Current study results indicate that clinically less affected Covid-19 patients without inpatient treatment and who do not require ventilation often have disorders of the chemosensory system. In young patients and women in particular, they seem to be an indicator of a favorable prognosis for the course of the disease. Smell disorders can appear early, as the sole symptom or together with other symptoms of Covid-19 disease. It has not yet been clarified whether ageusia can occur independently or whether it is also felt in the context of anosmia. In the pandemic, the new occurrence of anosmia without congestion / obstruction/runny nose is probably an expression of an infection with SARS-CoV-2 and should always give rise to quarantine and testing for SARS-CoV-2. The smell disorder in Covid-19 mostly seems to be temporary; It is not yet possible to conclusively assess whether there is usually a full restitution. The therapeutic approaches already established for other postviral olfactory disorders (e. g. olfactory training) are also used here.
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Affiliation(s)
- Stefan Isenmann
- Klinik für Neurologie und klinische Neurophysiologie, St. Josef Krankenhaus Moers
| | - Antje Haehner
- Interdisziplinäres Zentrum für Riechen und Schmecken, Klinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - Thomas Hummel
- Interdisziplinäres Zentrum für Riechen und Schmecken, Klinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
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3
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Berlit P, Bösel J, Gahn G, Isenmann S, Meuth SG, Nolte CH, Pawlitzki M, Rosenow F, Schoser B, Thomalla G, Hummel T. "Neurological manifestations of COVID-19" - guideline of the German society of neurology. Neurol Res Pract 2020; 2:51. [PMID: 33283160 PMCID: PMC7708894 DOI: 10.1186/s42466-020-00097-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/28/2022] Open
Abstract
Infection with the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to a previously unknown clinical picture, which is known as COVID-19 (COrona VIrus Disease-2019) and was first described in the Hubei region of China. The SARS-CoV-2 pandemic has implications for all areas of medicine. It directly and indirectly affects the care of neurological diseases. SARS-CoV-2 infection may be associated with an increased incidence of neurological manifestations such as encephalopathy and encephalomyelitis, ischemic stroke and intracerebral hemorrhage, anosmia and neuromuscular diseases. In October 2020, the German Society of Neurology (DGN, Deutsche Gesellschaft für Neurologie) published the first guideline on the neurological manifestations of the new infection. This S1 guideline provides guidance for the care of patients with SARS-CoV-2 infection regarding neurological manifestations, patients with neurological disease with and without SARS-CoV-2 infection, and for the protection of healthcare workers. This is an abbreviated version of the guideline issued by the German Neurological society and published in the Guideline repository of the AWMF (Working Group of Scientific Medical Societies; Arbeitsgemeinschaft wissenschaftlicher Medizinischer Fachgesellschaften).
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Affiliation(s)
- Peter Berlit
- Secretary General of the German Society of Neurology, Berlin, Germany
| | - Julian Bösel
- Department of Neurology, Klinikum Kassel, DGNI, Kassel, Germany
| | - Georg Gahn
- Department of Neurology, Klinikum Karlsruhe, DGNI, Karlsruhe, Germany
| | - Stefan Isenmann
- Department of Neurology and Clinical Neurophysiology, St. Josef Hospital Moers, Moers, Germany
| | - Sven G. Meuth
- Department of Neurology, University Hospital Düsseldorf, Düsseldorf,, Germany
| | - Christian H. Nolte
- Department of Neurology with Experimental Neurology and Center for Stroke Research Berlin (CSB) Charité-University Berlin, Berlin, Germany
| | - Marc Pawlitzki
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhein-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Benedikt Schoser
- Friedrich Baur Institute at the Neurological Department, LM-University Munich, Munich, Germany
| | - Götz Thomalla
- Department of Neurology, Head and Neurocenter, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Hummel
- Interdisciplinary Center for Smelling and Tasting, University ENT Hospital Dresden, German Society for ENT Medicine, Dresden, Germany
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4
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Isenmann S. 52/w mit zunehmenden Paresen. DGNeurologie 2020. [PMCID: PMC7471516 DOI: 10.1007/s42451-020-00231-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S. Isenmann
- Klinik für Neurologie und klinische Neurophysiologie, St. Josef Krankenhaus Moers, Asberger Str. 4, 47441 Moers, Deutschland
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5
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Jacobsen M, Dembek T, Ziakos A, Kobbe G, Kollmann M, Heinemann L, Sause A, Deubner N, Isenmann S, Seyfarth M. Reliable detection of atrial fibrillation with a medical wearable under inpatient conditions (CoMMoD-A-fib). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3481] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (A-fib) is the most common arrhythmia; however, detection of A-fib is a challenge due to irregular occurrence.
Purpose
Evaluating feasibility and performance of a non-invasive medical wearable for detection of A-fib.
Methods
In the CoMMoD-A-fib trial admitted patients with a high risk for A-fib carried the wearable and an ECG Holter (control) in parallel over a period of 24 hours under not physically restricted conditions. The wearable with a tight-fit upper arm band employs a photoplethysmography (PPG) technology enabling a high sampling rate. Different algorithms (including a deep neural network) were applied to 5 min PPG datasets for detection of A-fib. Proportion of monitoring time automatically interpretable by algorithms (= interpretable time) was analyzed for influencing factors.
Results
In 102 inpatients (age 71.0±11.9 years; 52% male) 2306 hours of parallel recording time could be obtained; 1781 hours (77.2%) of these were automatically interpretable by an algorithm analyzing PPG derived intervals. Detection of A-Fib was possible with a sensitivity of 92.7% and specificity of 92.4% (AUC 0.96). Also during physical activity, detection of A-fib was sufficiently possible (sensitivity 90.1% and specificity 91.2%). Usage of the deep neural network improved detection of A-fib further (sensitivity 95.4% and specificity 96.2%). A higher prevalence of heart failure with reduced ejection fraction was observed in patients with a low interpretable time (p=0.080).
Conclusion
Detection of A-fib by means of an upper arm non-invasive medical wearable with a high resolution is reliably possible under inpatient conditions.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Internal grant program (PhD and Dr. rer. nat. Program Biomedicine) of the Faculty of Health at Witten/Herdecke University, Germany. HELIOS Kliniken GmbH (Grant-ID 047476), Germany
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Affiliation(s)
- M Jacobsen
- University of Witten/Herdecke, Witten, Germany
| | - T.A Dembek
- University of Cologne, Neurology, Cologne, Germany
| | - A.P Ziakos
- Helios Clinic Wuppertal, Cardiology, Wuppertal, Germany
| | - G Kobbe
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Kollmann
- Heinrich Heine University, Duesseldorf, Germany
| | - L Heinemann
- Institute for Metabolic Research GmbH, Neuss, Germany
| | - A Sause
- Helios Clinic Wuppertal, Cardiology, Wuppertal, Germany
| | - N Deubner
- Helios Clinic Wuppertal, Cardiology, Wuppertal, Germany
| | - S Isenmann
- University of Witten/Herdecke, Witten, Germany
| | - M Seyfarth
- Helios Clinic Wuppertal, Cardiology, Wuppertal, Germany
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6
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Jacobsen M, Dembek TA, Ziakos AP, Gholamipoor R, Kobbe G, Kollmann M, Blum C, Müller-Wieland D, Napp A, Heinemann L, Deubner N, Marx N, Isenmann S, Seyfarth M. Reliable Detection of Atrial Fibrillation with a Medical Wearable during Inpatient Conditions. Sensors (Basel) 2020; 20:s20195517. [PMID: 32993132 PMCID: PMC7583973 DOI: 10.3390/s20195517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 01/19/2023]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and has a major impact on morbidity and mortality; however, detection of asymptomatic AF is challenging. This study sims to evaluate the sensitivity and specificity of non-invasive AF detection by a medical wearable. In this observational trial, patients with AF admitted to a hospital carried the wearable and an ECG Holter (control) in parallel over a period of 24 h, while not in a physically restricted condition. The wearable with a tight-fit upper armband employs a photoplethysmography technology to determine pulse rates and inter-beat intervals. Different algorithms (including a deep neural network) were applied to five-minute periods photoplethysmography datasets for the detection of AF. A total of 2306 h of parallel recording time could be obtained in 102 patients; 1781 h (77.2%) were automatically interpretable by an algorithm. Sensitivity to detect AF was 95.2% and specificity 92.5% (area under the receiver operating characteristics curve (AUC) 0.97). Usage of deep neural network improved the sensitivity of AF detection by 0.8% (96.0%) and specificity by 6.5% (99.0%) (AUC 0.98). Detection of AF by means of a wearable is feasible in hospitalized but physically active patients. Employing a deep neural network enables reliable and continuous monitoring of AF.
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Affiliation(s)
- Malte Jacobsen
- Faculty of Health, University Witten/Herdecke, 58448 Witten, Germany; (A.-P.Z.); (N.D.); (S.I.); (M.S.)
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany; (D.M.-W.); (A.N.); (N.M.)
- Correspondence: ; Tel.: +49-173-560-6980
| | - Till A. Dembek
- Department of Neurology, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany;
| | - Athanasios-Panagiotis Ziakos
- Faculty of Health, University Witten/Herdecke, 58448 Witten, Germany; (A.-P.Z.); (N.D.); (S.I.); (M.S.)
- Department of Cardiology, Helios University Hospital of Wuppertal, 42117 Wuppertal, Germany
| | - Rahil Gholamipoor
- Department of Computer Science, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany;
| | - Guido Kobbe
- Department of Hematology, Oncology, and Clinical Immunology, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany;
| | - Markus Kollmann
- Department of Biology, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (M.K.); (C.B.)
| | - Christopher Blum
- Department of Biology, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (M.K.); (C.B.)
| | - Dirk Müller-Wieland
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany; (D.M.-W.); (A.N.); (N.M.)
| | - Andreas Napp
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany; (D.M.-W.); (A.N.); (N.M.)
| | | | - Nikolas Deubner
- Faculty of Health, University Witten/Herdecke, 58448 Witten, Germany; (A.-P.Z.); (N.D.); (S.I.); (M.S.)
- Department of Cardiology, Helios University Hospital of Wuppertal, 42117 Wuppertal, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany; (D.M.-W.); (A.N.); (N.M.)
| | - Stefan Isenmann
- Faculty of Health, University Witten/Herdecke, 58448 Witten, Germany; (A.-P.Z.); (N.D.); (S.I.); (M.S.)
- Department of Neurology, St. Josef Hospital, 47441 Moers, Germany
| | - Melchior Seyfarth
- Faculty of Health, University Witten/Herdecke, 58448 Witten, Germany; (A.-P.Z.); (N.D.); (S.I.); (M.S.)
- Department of Cardiology, Helios University Hospital of Wuppertal, 42117 Wuppertal, Germany
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7
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Abstract
HISTORY A 56-year-old, previously healthy male and long distance runner noticed short episodes of parosmia, followed by anosmia. Few days later, he monitored an increase in his resting heart rate. This was followed by a dry cough, fatigue, and myalgia. At the same time, symptoms occurred in all four family members. CLINICAL FINDINGS The patient had a dry cough. The medical examination was normal. Heart rate was 60/min, sinus rhythm, body temperature 36.6 °C. Complete anosmia was present. The RT-PCR for SARS-CoV-2 from a deep pharyngeal swab was positive in all five family members. THERAPY AND COURSE Symptoms were present for almost two weeks. All family members had anosmia, that started earlier and lasted longer than the other symptoms, and myalgia. Reduced taste sensation, fatigue, dry cough and sore throat were present in four of five persons. Shortness of breath at rest or gastrointestinal symptoms were absent. Four affected persons had sleep disturbances in the later course of the disease. None of the affected persons had raised temperature at any time during the disease. Specific medical or drug treatment was not necessary. All patients made full recoveries without signs of organ dysfunction, and with full restitution of physical strength. DISCUSSION We describe a family of 5 previously healthy persons with a mild course of COVID-19 disease. The symptoms and course are described in detail. Anosmia can precede other symptoms by several days and can indicate an early phase of infection. An increase in resting heart rate can occur in the absence of raised temperature or fever. The symptoms and course are discussed in the context of the ongoing pandemic, and efforts to control infection chains.
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Affiliation(s)
- Anna Isenmann
- University of Southampton, Kassel School of Medicine
| | - Stefan Isenmann
- Klinik für Neurologie und klinische Neurophysiologie, St.-Josef-Krankenhaus GmbH Moers
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8
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Wagner A, Schebesch KM, Isenmann S, Steinbrecher A, Kapapa T, Zeman F, Baldaranov D, Grauer O, Backhaus R, Linker RA, Schlachetzki F. Interdisciplinary Decision Making in Hemorrhagic Stroke Based on CT Imaging-Differences Between Neurologists and Neurosurgeons Regarding Estimation of Patients' Symptoms, Glasgow Coma Scale, and National Institutes of Health Stroke Scale. Front Neurol 2019; 10:997. [PMID: 31616360 PMCID: PMC6775244 DOI: 10.3389/fneur.2019.00997] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/02/2019] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose: Acute intracerebral hemorrhage (ICH) requires rapid decision making toward neurosurgery or conservative neurological stroke unit treatment. In a previous study, we found overestimation of clinical symptoms when clinicians rely mainly on cerebral computed tomography (cCT) analysis. The current study investigates differences between neurologists and neurosurgeons estimating specific scores and clinical symptoms. Methods: Overall, 14 neurologists and 15 neurosurgeons provided clinical estimates and National Institutes of Health Stroke Scale (NIHSS) as well as Glasgow Coma Scale (GCS) based on cCT images and basic information of 50 patients with hypertensive and lobar ICH. Subgroup analyses were performed for the different professions (neurologists vs. neurosurgeons) and bleeding subtypes (typical location vs. atypical). The differences between the actual GCS and NIHSS scores and the cCT-imaging-based estimated scores were depicted as Bland–Altman plots and negative and positive predictive value (NPV and PPV) for prediction of clinical relevant items. ΔNIHSS points (ΔGCS points) were calculated as the difference between actual and rated NIHSS (GCS) including 95% confidence interval (CI). Results: Mean ΔGCS points for neurosurgeons was 1.16 (95% CI: −2.67–4.98); for neurologists, 0.99 (95% CI: −2.58–4.55), p = 0.308; mean ΔNIHSS points for neurosurgeons was −2.95 (95% CI: −12.71–6.82); for neurologists, −0.33 (95% CI: −9.60–8.94), p < 0.001. NPV and PPV for stroke symptoms were low, with large differences between different symptoms, bleeding subtypes, and professions. Both professions had more problems in proper rating of specific clinic–neurological symptoms than rating scores. Conclusion: Our results stress the need for joint decision making based on detailed neurological examination and neuroimaging findings also in telemedicine.
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Affiliation(s)
- Andrea Wagner
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | | | | | - Andreas Steinbrecher
- Department of Neurology, General Hospital Helios Klinikum Erfurt, Erfurt, Germany
| | - Thomas Kapapa
- Department of Neurosurgery, University Medical Center Ulm, Ulm, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - Dobri Baldaranov
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Oliver Grauer
- Neurology, Department of Neurology and Institution for Translational Neurology, Münster, Germany
| | - Roland Backhaus
- Stroke Center Hirslanden, Klinik Hirslanden Zurich, Zurich, Switzerland
| | - Ralf A Linker
- Department of Neurology, University of Regensburg, Regensburg, Germany
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9
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Wagner A, Schebesch KM, Zeman F, Isenmann S, Steinbrecher A, Kapapa T, Baldaranov D, Backhaus R, Schlachetzki F. Primary cCT Imaging Based Clinico-Neurological Assessment-Calling for Addition of Telestroke Video Consultation in Patients With Intracerebral Hemorrhage. Front Neurol 2018; 9:607. [PMID: 30093878 PMCID: PMC6071543 DOI: 10.3389/fneur.2018.00607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/19/2018] [Accepted: 07/09/2018] [Indexed: 11/26/2022] Open
Abstract
Background and Purpose: Intracerebral hemorrhage (ICH) requires rapid decision making to decrease morbidity and mortality although time frame and optimal therapy are still ill defined. Ideally, specialized neurologists, neurosurgeons, and (neuro-) radiologists who know the patient's clinical status and their cerebral computed tomography imaging (cCT) make a joint decision on the clinical management. However, in telestroke networks, a shift toward cCT imaging criteria used for decision making can be observed for practical reasons. Here we investigated the “reverse correlation” from cCT imaging to the actual clinical presentation as evaluated by the Glasgow Coma Scale (GCS) and the National Institutes of Health Stroke Scale (NIHSS). Methods: CCT images and basic information (age, sex, and time of onset) of 50 patients with hypertensive and lobar ICH were presented to 14 experienced neurologists and 15 neurosurgeons. Based on this information, the NIHSS and GCS scores were estimated for each patient. The differences between the actual GCS and NIHSS scores and the cCT-imaging-based estimated scores were plotted in a bland-Altman plot. Results: The average estimated GCS score mainly based on cCT imaging was 12. 4 ± 2.8 (actual value: 13.0 ± 2.5; p = 0.100), the estimated NIHSS score was 13.9 ± 9.1 (actual value: 10.8 ± 7.3; p < 0.001). Thus, in cCT-imaging-based evaluation, the neurological status of patients especially employing the NIHSS was estimated poorer, particularly in patients with lobar ICH. “Reverse clinical” evaluation based on cCT-imaging alone may increase the rate of intubation and secondary transferal and neurosurgical treatment. Telestroke networks should consider both, videoassessment of the actual clinical picture and cCT-imaging findings to make appropriate acute treatment decisions.
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Affiliation(s)
- Andrea Wagner
- Department of Neurology, University Regensburg, Regensburg, Germany
| | | | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan Isenmann
- Department of Neurology, HELIOS University Hospital Wuppertal-University Witten/Herdecke, Wuppertal, Germany
| | - Andreas Steinbrecher
- Department of Neurology, General Hospital HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Thomas Kapapa
- Department of Neurosurgery, University Medical Center Ulm, Ulm, Germany
| | - Dobri Baldaranov
- Department of Neurology, University Regensburg, Regensburg, Germany
| | - Roland Backhaus
- Stroke Center Hirslanden, Klinik Hirslanden Zurich, Zurich, Switzerland
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10
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Abstract
ZusammenfassungNeben der Liquor-chemischen, immunologischen und mikrobiologischen Analyse gehört die liquorzytologische Diagnostik wesentlich zur Analyse
des Liquors – insbesondere für die Diagnostik und Differenzialdiagnostik Liquorraum-naher entzündlicher, infektiöser, hämorrhagischer und
neoplastischer Prozesse. Dieser Artikel fasst Voraussetzungen, Vorgehensweise, Techniken und typische Befundkonstellationen zusammen.
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11
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Nordmeyer H, Webering N, Chapot R, Hadisurya J, Heddier M, Stracke P, Berger K, Isenmann S, Weber R. The association between collateral status, recanalization and long term outcome in stroke patients treated with stent retrievers – Are there indications not to perform thrombectomy based on CT angiography? J Neuroradiol 2017; 44:217-222. [DOI: 10.1016/j.neurad.2016.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/27/2016] [Accepted: 12/02/2016] [Indexed: 11/26/2022]
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12
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Isenmann S, Hübscher A. [Not Available]. Fortschr Neurol Psychiatr 2017; 85:136. [PMID: 28320021 DOI: 10.1055/s-0043-101561] [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: 06/06/2023]
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13
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Bien CG, Mirzadjanova Z, Baumgartner C, Onugoren MD, Grunwald T, Holtkamp M, Isenmann S, Kermer P, Melzer N, Naumann M, Riepe M, Schäbitz WR, von Oertzen TJ, von Podewils F, Rauschka H, May TW. Anti-contactin-associated protein-2 encephalitis: relevance of antibody titres, presentation and outcome. Eur J Neurol 2016; 24:175-186. [DOI: 10.1111/ene.13180] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/16/2016] [Indexed: 12/14/2022]
Affiliation(s)
- C. G. Bien
- Epilepsy Center Bethel; Krankenhaus Mara; Bielefeld Germany
| | | | - C. Baumgartner
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology; 2nd Neurological Department; General Hospital Hietzing with Neurological Center Rosenhügel; Sigmund Freud University; Vienna Austria
| | - M. D. Onugoren
- Epilepsy Center Bethel; Krankenhaus Mara; Bielefeld Germany
- Department of Neurology; University Hospital Erlangen; Erlangen Germany
| | - T. Grunwald
- Swiss Epilepsy Center; Clinic Lengg and Department of Neurology; University Hospital Zurich; Zurich Switzerland
| | | | - S. Isenmann
- Department of Neurology; Center for Research in Clinical Medicine (CCM); HELIOS-Universitätsklinikum Wuppertal; University of Witten/Herdecke; Wuppertal
| | - P. Kermer
- Department of Neurology; Nordwest-Krankenhaus Sanderbusch; Sande
| | - N. Melzer
- Department of Neurology; University of Münster; Münster
| | - M. Naumann
- Department of Neurology and Clinical Neurophysiology; Klinikum Augsburg; Augsburg
| | - M. Riepe
- Department of Psychiatry II Ulm University at Bezirkskrankenhaus Günzburg; Mental Health & Old Age Psychiatry; Günzburg
| | - W. R. Schäbitz
- Department of Neurology; Evangelisches Krankenhaus Bielefeld; Bielefeld Germany
| | - T. J. von Oertzen
- Department of Neurology 1; Neuromed Campus; Kepler Universitätsklinikum; Linz Austria
| | - F. von Podewils
- Department of Neurology; Universitätsmedizin Greifswald; Greifswald Germany
| | - H. Rauschka
- Karl Landsteiner-Institute for Neuroimmunological and Neurodegenerative Disorders; Danube Hospital/Donauspital; Vienna Austria
| | - T. W. May
- Society for Epilepsy Research; Epilepsy Centre Bethel; Bielefeld Germany
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14
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Abstract
Cytology is an integral part of cerebrospinal fluid (CSF) analysis. It is relevant for the diagnostics and differential diagnosis of inflammatory, hemorrhagic and neoplastic central nervous system (CNS) processes. This article summarizes the recommended procedures and typical clinical patterns. In addition, modern immunocytochemical and flow cytometry methods for CSF cytology are presented. In particular, the diagnostic contribution and clinical relevance in several CNS conditions are discussed.
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Affiliation(s)
- M Wick
- Institut für Laboratoriumsmedizin, Klinikum der LMU München, München, Deutschland
| | - C C Gross
- Liquor- und Labordiagnostik Neurologie, Department für Neurologie, Universitätsklinikum Münster, Münster, Deutschland
| | - S Isenmann
- Klinik für Neurologie und klinische Neurophysiologie, HELIOS Universitätsklinikum Wuppertal, Zentrum für Forschung in der klinischen Medizin (ZFKM) und Lehrstuhl Neurologie, Fakultät für Gesundheit, Universität Witten/Herdecke, Wuppertal, Deutschland
| | - H Strik
- Neurologische Klinik, Philipps Universität, 35043, Marburg, Deutschland.
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15
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Hübscher A, Isenmann S. Delir: Konzepte, Ätiologie und klinisches Management. Akt Neurol 2016. [DOI: 10.1055/s-0042-114410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- A. Hübscher
- Klinik für Neurologie und klinische Neurophysiologie, HELIOS Universitätsklinikum Wuppertal, Zentrum für Forschung in der klinischen Medizin (ZFKM) und Lehrstuhl Neurologie der Universität Witten/Herdecke
| | - S. Isenmann
- Klinik für Neurologie und klinische Neurophysiologie, HELIOS Universitätsklinikum Wuppertal, Zentrum für Forschung in der klinischen Medizin (ZFKM) und Lehrstuhl Neurologie der Universität Witten/Herdecke
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16
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Minnerup J, Wersching H, Teuber A, Wellmann J, Eyding J, Weber R, Reimann G, Weber W, Krause LU, Kurth T, Berger K, Homberg V, Petrovitch A, Heuser L, Mönnigs P, Krogias C, Wallner B, Hennigs S, Ahlers A, Sahl H, Ranft A, Dobis C, Brassel F, Nolden-Koch M, Schmitt H, Chapot R, Nordmeyer H, Schlamann M, Weimar C, Busch F, Busch E, Sigges E, Ruf H, Wohlfahrt K, Karatschai R, Klein B, Höhle T, Haass A, Nasreldein A, Büchele B, Gahn G, Sterker M, Hantel T, Krämer C, Henningsen H, Adelt I, König M, Schmidt C, Hofmann A, Niederstadt T, Unrath M, Rehfeldt T, Fauser B, Pfeiffer A, Lowens S, Stögbauer F, Staudacher T, Erdmann P, Grotemeyer K, Spüntrup E, Bücke P, Wienecke P, Faiss J, Wolzik-Großmann M, Brune N, Isenmann S, Thomas C, Mucha D. Outcome After Thrombectomy and Intravenous Thrombolysis in Patients With Acute Ischemic Stroke. Stroke 2016; 47:1584-92. [DOI: 10.1161/strokeaha.116.012619] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/28/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
In patients with ischemic stroke, randomized trials showed a better functional outcome after endovascular therapy with new-generation thrombectomy devices compared with medical treatment, including intravenous thrombolysis. However, effects on mortality and the generalizability of results to routine clinical practice are uncertain.
Methods—
In a prospective observational register-based study patients with ischemic stroke treated either with thrombectomy, intravenous thrombolysis, or their combination were included. Primary outcome was the modified Rankin scale score (0 [no symptoms] to 6 [death]) at 3 months. Ordinal logistic regression was used to estimate the common odds ratio as treatment effects (shift analysis). Propensity score matching was applied to compare patients treated either with intravenous thrombolysis alone or with intravenous thrombolysis plus thrombectomy.
Results—
Among 2650 recruited patients, 1543 received intravenous thrombolysis, 504 underwent thrombectomy, and 603 received intravenous thrombolysis in combination with thrombectomy. Later time-to-treatment was associated with worse outcomes among patients treated with thrombectomy plus thrombolysis. In 241 pairs of propensity score–matched patients with a proximal intracranial occlusion, thrombectomy plus thrombolysis was associated with improved functional outcome (common odds ratio, 1.84; 95% confidence interval, 1.32–2.57), and reduced mortality (15% versus 33%;
P
<0.0001) compared with intravenous thrombolysis alone. Results were similar in various sensitivity analyses accounting for missing outcome data and different analytic methods.
Conclusions—
Results from this large prospective registry show that also in routine clinical care thrombectomy plus thrombolysis compared with thrombolysis alone improved functional outcome and reduced mortality in patients with ischemic stroke. Earlier treatment was associated with better outcomes.
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Affiliation(s)
- Jens Minnerup
- From the Department of Neurology (J.M.) and Institute of Epidemiology and Social Medicine (H.W., A.T., J.W., K.B.), University of Münster, Münster, Germany; Department of Neurology (J.E.) and Institute of Radiology, Neuroradiology, and Nuclear Medicine (W.W.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany (R.W.); Department of Neurology, Städtisches Klinikum Dortmund, Dortmund, Germany
| | - Heike Wersching
- From the Department of Neurology (J.M.) and Institute of Epidemiology and Social Medicine (H.W., A.T., J.W., K.B.), University of Münster, Münster, Germany; Department of Neurology (J.E.) and Institute of Radiology, Neuroradiology, and Nuclear Medicine (W.W.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany (R.W.); Department of Neurology, Städtisches Klinikum Dortmund, Dortmund, Germany
| | - Anja Teuber
- From the Department of Neurology (J.M.) and Institute of Epidemiology and Social Medicine (H.W., A.T., J.W., K.B.), University of Münster, Münster, Germany; Department of Neurology (J.E.) and Institute of Radiology, Neuroradiology, and Nuclear Medicine (W.W.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany (R.W.); Department of Neurology, Städtisches Klinikum Dortmund, Dortmund, Germany
| | - Jürgen Wellmann
- From the Department of Neurology (J.M.) and Institute of Epidemiology and Social Medicine (H.W., A.T., J.W., K.B.), University of Münster, Münster, Germany; Department of Neurology (J.E.) and Institute of Radiology, Neuroradiology, and Nuclear Medicine (W.W.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany (R.W.); Department of Neurology, Städtisches Klinikum Dortmund, Dortmund, Germany
| | - Jens Eyding
- From the Department of Neurology (J.M.) and Institute of Epidemiology and Social Medicine (H.W., A.T., J.W., K.B.), University of Münster, Münster, Germany; Department of Neurology (J.E.) and Institute of Radiology, Neuroradiology, and Nuclear Medicine (W.W.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany (R.W.); Department of Neurology, Städtisches Klinikum Dortmund, Dortmund, Germany
| | - Ralph Weber
- From the Department of Neurology (J.M.) and Institute of Epidemiology and Social Medicine (H.W., A.T., J.W., K.B.), University of Münster, Münster, Germany; Department of Neurology (J.E.) and Institute of Radiology, Neuroradiology, and Nuclear Medicine (W.W.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany (R.W.); Department of Neurology, Städtisches Klinikum Dortmund, Dortmund, Germany
| | - Gernot Reimann
- From the Department of Neurology (J.M.) and Institute of Epidemiology and Social Medicine (H.W., A.T., J.W., K.B.), University of Münster, Münster, Germany; Department of Neurology (J.E.) and Institute of Radiology, Neuroradiology, and Nuclear Medicine (W.W.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany (R.W.); Department of Neurology, Städtisches Klinikum Dortmund, Dortmund, Germany
| | - Werner Weber
- From the Department of Neurology (J.M.) and Institute of Epidemiology and Social Medicine (H.W., A.T., J.W., K.B.), University of Münster, Münster, Germany; Department of Neurology (J.E.) and Institute of Radiology, Neuroradiology, and Nuclear Medicine (W.W.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany (R.W.); Department of Neurology, Städtisches Klinikum Dortmund, Dortmund, Germany
| | - Lars Udo Krause
- From the Department of Neurology (J.M.) and Institute of Epidemiology and Social Medicine (H.W., A.T., J.W., K.B.), University of Münster, Münster, Germany; Department of Neurology (J.E.) and Institute of Radiology, Neuroradiology, and Nuclear Medicine (W.W.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany (R.W.); Department of Neurology, Städtisches Klinikum Dortmund, Dortmund, Germany
| | - Tobias Kurth
- From the Department of Neurology (J.M.) and Institute of Epidemiology and Social Medicine (H.W., A.T., J.W., K.B.), University of Münster, Münster, Germany; Department of Neurology (J.E.) and Institute of Radiology, Neuroradiology, and Nuclear Medicine (W.W.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany (R.W.); Department of Neurology, Städtisches Klinikum Dortmund, Dortmund, Germany
| | - Klaus Berger
- From the Department of Neurology (J.M.) and Institute of Epidemiology and Social Medicine (H.W., A.T., J.W., K.B.), University of Münster, Münster, Germany; Department of Neurology (J.E.) and Institute of Radiology, Neuroradiology, and Nuclear Medicine (W.W.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany (R.W.); Department of Neurology, Städtisches Klinikum Dortmund, Dortmund, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - A. Haass
- Universitätsklinikum Homburg/Saar
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Abstract
Delirium is a common condition: up to 35 percent of non-ICU- and 80 percent of ICU-patients experience delirium - particularly the elderly suffering from cerebral dysfunction accompanied by acute infection, surgery, or change of medication. Medical staff should be alert for decrease (within hours) of concentration, memory, orientation, and consciousness - especially when agitation appears and symptoms are fluctuating. Vegetative lapses and seizures may complicate the course, in particular in delirium in withdrawal (of alcohol or drugs). Treatment comprises neuroleptic and sedative medication (be careful with benzodiazepines because of their delirogenic potential) as well as alpha-2-agonists for vegetative derangements and anti-epileptics in case of seizures. As usual: start with low doses, and keep the medical treatment as short as possible. Additionally, take care in the · search and solution of delir-causes,. · termination of unnecessary medication (in particular, anticholinergic agents),. · comfort, intimacy and orientation,. · cognitive training and mobilization.. Avoiding a delirium is the best medicine. For that reason, identification of patients at risk, early detection of signs of delirium and prevention are most important. Beside factors 2 to 4, personalized treatment has been proved to be very helpful.
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18
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Dogan Onugoren M, Deuretzbacher D, Haensch CA, Hagedorn HJ, Halve S, Isenmann S, Kramme C, Lohner H, Melzer N, Monotti R, Presslauer S, Schäbitz WR, Steffanoni S, Stoeck K, Strittmatter M, Stögbauer F, Trinka E, von Oertzen TJ, Wiendl H, Woermann FG, Bien CG. Limbic encephalitis due to GABAB and AMPA receptor antibodies: a case series. J Neurol Neurosurg Psychiatry 2015; 86:965-72. [PMID: 25300449 DOI: 10.1136/jnnp-2014-308814] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/18/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND Two novel antibodies (abs) directed to γ-aminobutyric acid B receptor (GABA(B)R) and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) in patients with limbic encephalitis (LE) were first described by the Philadelphia/Barcelona groups and confirmed by the Mayo group. We present a novel series for further clinical and paraclinical refinement. METHODS Serum and cerebrospinal fluid samples from a diagnostic laboratory were selected if found to be positive for GABA(B)R or AMPAR abs within a broad antineuronal ab panel. Data were retrospectively compiled. RESULTS In 10 patients, we detected abs to GABA(B)R. Median age was 70 years. Five of them were diagnosed with small cell lung cancer (SCLC). Intrathecal GABA(B)R ab synthesis was found in all six patients with sufficient data available (median ab-index: 76.8). On MRI, we found bilateral mediotemporal and in two cases cortical abnormalities. EEG revealed encephalopathy, partly with epileptiform discharges. Five patients received immunotherapy, two patients tumour treatment and three both therapies. Three patients died, in five patients cognitive functions declined, one patient improved slightly and one patient fully recovered. AMPAR abs were detected in three patients with mnestic disturbances. Median age was 60.7 years. The only female patient was diagnosed with ovarian cancer. None of the patients had intrathecal ab synthesis. MRI findings showed bilateral mediotemporal abnormalities. EEG was normal in all patients. Two of the three immunologically treated patients improved, one patient stabilised on a low level. DISCUSSION GABA(B)R and AMPAR abs are well associated with LE. GABA(B)R abs lead to severe clinical, neuroradiological and EEG abnormalities with poorer outcome.
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Affiliation(s)
| | - D Deuretzbacher
- Department of Neurology, Landeskrankenhaus, Bruck/Mur, Austria
| | - C A Haensch
- Department of Neurology, Maria Hilf Kliniken GmbH Mönchengladbach, University of Witten/Herdecke, Mönchengladabch, Germany
| | | | - S Halve
- Evangelic Hospital Unna, University of Duisburg-Essen, Unna, Germany
| | - S Isenmann
- Department of Neurology, Helios Klinikum Wuppertal, Center for Clinical Research, and University Witten/Herdecke, Wuppertal, Germany
| | - C Kramme
- Krankenhaus Mara, Epilepsy Center Bethel, Bielefeld, Germany
| | - H Lohner
- Department of Neurology, RoMed Kliniken Rosenheim, Rosenheim, Germany
| | - N Melzer
- Department of Neurology, University of Münster, Münster, Germany
| | - R Monotti
- Department of Internal Medicine, Ospedale La Carità, Locarno, Switzerland
| | - S Presslauer
- Department of Neurology, Wilhelminenspital der Stadt Wien, Wien, Austria
| | - W R Schäbitz
- Department of Neurology, Bethel-EvKB, Bielefeld, Germany
| | - S Steffanoni
- Department of Internal Medicine, Ospedale La Carità, Locarno, Switzerland
| | - K Stoeck
- Department of Neurology, Georg-August-University, Göttingen, Germany
| | - M Strittmatter
- Department of Neurology, Klinikum Merzig, Merzig, Germany
| | - F Stögbauer
- Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany
| | - E Trinka
- Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - T J von Oertzen
- Department of Neurology, Wagner-Jauregg Neuroscience Centre, Linz, Austria
| | - H Wiendl
- Department of Neurology, University of Münster, Münster, Germany
| | - F G Woermann
- Krankenhaus Mara, Epilepsy Center Bethel, Bielefeld, Germany
| | - C G Bien
- Krankenhaus Mara, Epilepsy Center Bethel, Bielefeld, Germany
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Langenbruch C, Muhl C, Krummenauer F, Hirsch J, Isenmann S. Systemische Thrombolyse beim akuten ischämischen Schlaganfall: Retrospektiver Vergleich von Patienten mit Indikationsstellung innerhalb vs. außerhalb der Zulassungskriterien. Akt Neurol 2015. [DOI: 10.1055/s-0035-1555937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Langenbruch
- Klinik für Neurologie und klinische Neurophysiologie, Helios Klinikum Wuppertal, Zentrum für Forschung in der klinischen Medizin (ZFKM) und Lehrstuhl Neurologie der Universität Witten/Herdecke
| | - C. Muhl
- Klinik für Neurologie und klinische Neurophysiologie, Helios Klinikum Wuppertal, Zentrum für Forschung in der klinischen Medizin (ZFKM) und Lehrstuhl Neurologie der Universität Witten/Herdecke
| | - F. Krummenauer
- Institut für Medizinische Biometrie und Epidemiologie (IMBE), Department Humanmedizin Fakultät für Gesundheit der Universität Witten/Herdecke, Witten
| | - J. Hirsch
- Institut für Medizinische Biometrie und Epidemiologie (IMBE), Department Humanmedizin Fakultät für Gesundheit der Universität Witten/Herdecke, Witten
| | - S. Isenmann
- Klinik für Neurologie und klinische Neurophysiologie, Helios Klinikum Wuppertal, Zentrum für Forschung in der klinischen Medizin (ZFKM) und Lehrstuhl Neurologie der Universität Witten/Herdecke
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20
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Abstract
BACKGROUND Germany is confronted with a lack of medical doctors and an increasing need for neurologists in particular. In order to recruit future doctors in neurology it is essential to attract young students when still at university. OBJECTIVES This article presents the first German national survey of medical students' acceptance of teaching methods in neurology. The participants evaluated teaching methods and examination formats and were asked about their preferences. MATERIAL AND METHODS The survey was based on a questionnaire distributed to 22 German medical schools and 1245 participating students. RESULTS Interactive teaching methods, especially courses in practical examinations, clinical internships and bedside teaching were highly rated among the students. In contrast, multiple choice tests, as one of the most widespread examination methods, were poorly rated compared to practical and oral examinations. For most of the students it was not decisive, in which semester teaching of neurology took place, while the majority asked for additional and more intensive neurological education. CONCLUSION The data give an overview of teaching of neurology in Germany and students' assessment of various approaches. The results should be utilized towards reorientation of future curricula that should aim at innovative and even more practically oriented teaching.
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Affiliation(s)
- A-S Biesalski
- Klinik für Neurologie und klinische Neurophysiologie, Zentrum für Forschung in der Klinischen Medizin (ZFKM), Lehrstuhl Neurologie, Helios Klinikum Wuppertal, Universität Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Deutschland,
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21
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Haensch CA, Tosch M, Katona I, Weis J, Isenmann S. Small-fiber neuropathy with cardiac denervation in postural tachycardia syndrome. Muscle Nerve 2014; 50:956-61. [PMID: 24647968 DOI: 10.1002/mus.24245] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Postural tachycardia syndrome (POTS) is a disorder of orthostatic intolerance characterized by excessive tachycardia of unknown etiology. Our objective in this study was to evaluate the correlation between C-fiber involvement as shown by skin biopsy and adrenergic cardiac metaiodobenzylguanadine (MIBG) uptake in POTS patients. METHODS Skin biopsies of 84 patients with POTS were examined by Protein Gene Product 9.5 (PGP9.5) immunohistochemistry and were compared with MIBG myocardial scintigraphy imaging data. RESULTS Mean intraepidermal nerve fiber (IENF) density was in the lower normal age-adjusted range, 7.2 ± 2.9/mm (normal ≥ 7/mm), and was slightly below the normal range in 45% of POTS patients. MIBG uptake was reduced in 21% of patients. Low IENF density correlated with reduced cardiac MIBG uptake (r = 0.39, P = 0.001). CONCLUSIONS A subset of neuropathic POTS patients may harbor mild small fiber neuropathy with abnormalities of unmyelinated nerve fibers in the skin associated with reduced myocardial postganglionic sympathetic innervation.
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Affiliation(s)
- Carl-Albrecht Haensch
- Department of Neurology, Kliniken Maria Hilf Mönchengladbach, Faculty of Health, University of Witten/Herdecke, Viersenerstrasse 450, D-41063, Mönchengladbach, Germany
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22
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Mallien J, Isenmann S, Mrazek A, Haensch CA. Sleep disturbances and autonomic dysfunction in patients with postural orthostatic tachycardia syndrome. Front Neurol 2014; 5:118. [PMID: 25071706 PMCID: PMC4083342 DOI: 10.3389/fneur.2014.00118] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 12/12/2013] [Accepted: 06/23/2014] [Indexed: 11/13/2022] Open
Abstract
Many patients with postural tachycardia syndrome (PoTS) suffer from fatigue, daytime sleepiness, and sleeping disturbances. The objective of this study was to compare subjective and objective sleep quality of PoTS patients with a group of healthy controls. All patients completed a Pittsburgh Sleep Quality Index questionnaire and the Epworth Sleepiness Scale. The patients sleep architecture, heart rate, and heart rate variability (HRV) measurements were taken during one night at the sleep laboratorium. All data was collected at the Sleep Unit, at Helios Klinikum Wuppertal. Thirty-eight patients diagnosed with PoTS were compared to 31 healthy controls, matched in age and gender. Patients with PoTS reached significantly higher scores in sleep questionnaires, which means that they were more sleepy and had a lower sleep quality. Polysomnography showed a significantly higher proportion of stage 2 sleep. The results of HRV analysis in different sleep stages confirmed changes in autonomic activity in both groups. PoTS patients, however, showed a diminished variability of the low-frequency (LF) band, high-frequency (HF) band, and LF/HF ratio in different sleep stages. It can therefore be gathered that PoTS could be considered as potential differential diagnosis for sleep disturbances since PoTS patients had a subjective diminished sleep quality, reached higher levels of daytime sleepiness, and showed a higher proportion of stage 2 sleep. PoTS patients showed furthermore a reduction of LF/HF ratio variability in different sleep stages.
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Affiliation(s)
- Julia Mallien
- Sleep Unit, Department of Neurology and Neurophysiology, HELIOS Klinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Stefan Isenmann
- Sleep Unit, Department of Neurology and Neurophysiology, HELIOS Klinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Anne Mrazek
- Sleep Unit, Department of Neurology and Neurophysiology, HELIOS Klinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Carl-Albrecht Haensch
- Department of Neurology, Kliniken Maria Hilf GmbH, University of Witten/Herdecke, Mönchengladbach, Germany
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23
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Isenmann S, Biesalski A, Zupanic M, Gerloff C. [University teaching in clinical neurology: present situation and future requirements]. Nervenarzt 2014; 84:1220-7. [PMID: 24036703 DOI: 10.1007/s00115-013-3870-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND In German Hospitals there is a lack of medical personnel and doctors in particular. Clinical specialities and hospitals are in competition for students and young doctors and these, in turn, have clear cut demands regarding working conditions and professional training. To date there is considerable heterogeneity regarding clinical teaching in neurology between different German universities. There are no data available for systematic comparison. MATERIAL AND METHODS This article presents for the first time data from a survey on academic teaching in neurology in German university hospitals. RESULTS AND CONCLUSION The data show that many faculties are dedicated to modern and practical teaching methods and have employed state of the art examinations and progress tests. Further and ongoing efforts will be needed in order to inspire medical students and young doctors for this interesting clinical speciality. Connecting individual formats and networking between universities, teaching hospitals, including novel developments together with the young neurologists will help to structure our efforts and increase sustained attractiveness of clinical neurology for the following generations of young doctors.
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Affiliation(s)
- S Isenmann
- Klinik für Neurologie und klinische Neurophysiologie, HELIOS Klinikum Wuppertal, Lehrstuhl Neurologie der Universität Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Deutschland,
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24
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Pfeiffer G, Pfeifer R, Isenmann S. Cerebral hypoxia, missing cortical somatosensory evoked potentials and recovery of consciousness. BMC Neurol 2014; 14:82. [PMID: 24720818 PMCID: PMC3991862 DOI: 10.1186/1471-2377-14-82] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 08/04/2013] [Accepted: 03/17/2014] [Indexed: 11/22/2022] Open
Abstract
Background Bilaterally absent N20 components of the sensory evoked potentials (SEP) from the median nerve are regarded as accurately predicting poor outcome after cardiac arrest. Case presentation We are reporting on a patient, who regained consciousness despite this ominous finding. Early after cardiac arrest, MRI showed signal alterations in diffusion weighted imaging (DWI) bilaterally in the primary visual and sensorimotor cortex and in the basal ganglia. SEP were repeatedly absent. The patient survived shut out form sensory and visual experience and locked in for voluntary movements, but kept her verbal competence in several languages. Conclusion SEP inform about integrity only of a narrow cortical strip. It is unguarded, but common practice, to conclude from absent SEP, that a patient has suffered diffuse cortical damage after cardiac arrest. Cerebral MRI with DWI helps to avoid this prognostic error and furthers understanding of the sometimes very peculiar state of mind after cardiac arrest.
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Affiliation(s)
- Gustav Pfeiffer
- Abteilung weiterführende Neurorehabilitation, Fachklinik Bad Liebenstein, Kurpromenade 2, 36448 Bad Liebenstein, Germany.
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Somasundaram S, Henke C, Neumann-Haefelin T, Isenmann S, Hattingen E, Lorenz MW, Singer OC. Dysphagia Risk Assessment in Acute Left-Hemispheric Middle Cerebral Artery Stroke. Cerebrovasc Dis 2014; 37:217-22. [DOI: 10.1159/000358118] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022] Open
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Stuebner E, Vichayanrat E, Low D, Mathias C, Isenmann S, Haensch CA. Nocturnal blood pressure, non-dipping and psychosis in Parkinson's disease. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pfeifer R, Weitzel S, Günther A, Berrouschot J, Fischer M, Isenmann S, Figulla HR. Investigation of the inter-observer variability effect on the prognostic value of somatosensory evoked potentials of the median nerve (SSEP) in cardiac arrest survivors using an SSEP classification. Resuscitation 2013; 84:1375-81. [DOI: 10.1016/j.resuscitation.2013.05.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 05/21/2013] [Accepted: 05/21/2013] [Indexed: 11/25/2022]
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Stuebner E, Vichayanrat E, Low D, Mathias C, Isenmann S, Haensch C. Nocturnal blood pressure, non-dipping and psychosis in Parkinson’s Disease. Auton Neurosci 2013. [DOI: 10.1016/j.autneu.2013.05.114] [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: 10/26/2022]
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Stuebner E, Vichayanrat E, Low DA, Mathias CJ, Isenmann S, Haensch CA. Twenty-four hour non-invasive ambulatory blood pressure and heart rate monitoring in Parkinson's disease. Front Neurol 2013; 4:49. [PMID: 23720648 PMCID: PMC3654335 DOI: 10.3389/fneur.2013.00049] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [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: 03/15/2013] [Accepted: 04/23/2013] [Indexed: 11/18/2022] Open
Abstract
Non-motor symptoms are now commonly recognized in Parkinson's disease (PD) and can include dysautonomia. Impairment of cardiovascular autonomic function can occur at any stage of PD but is typically prevalent in advanced stages or related to (anti-Parkinsonian) drugs and can result in atypical blood pressure (BP) readings and related symptoms such as orthostatic hypotension (OH) and supine hypertension. OH is usually diagnosed with a head-up-tilt test (HUT) or an (active) standing test (also known as Schellong test) in the laboratory, but 24 h ambulatory blood pressure monitoring (ABPM) in a home setting may have several advantages, such as providing an overview of symptoms in daily life alongside pathophysiology as well as assessment of treatment interventions. This, however, is only possible if ABPM is administrated correctly and an autonomic protocol (including a diary) is followed which will be discussed in this review. A 24-h ABPM does not only allow the detection of OH, if it is present, but also the assessment of cardiovascular autonomic dysfunction during and after various daily stimuli, such as postprandial and alcohol dependent hypotension, as well as exercise and drug induced hypotension. Furthermore, information about the circadian rhythm of BP and heart rate (HR) can be obtained and establish whether or not a patient has a fall of BP at night (i.e., "dipper" vs. non-"dipper"). The information about nocturnal BP may also allow the investigation or detection of disorders such as sleep dysfunction, nocturnal movement disorders, and obstructive sleep apnea, which are common in PD. Additionally, a 24-h ABPM should be conducted to examine the effectiveness of OH therapy. This review will outline the methodology of 24 h ABPM in PD, summarize findings of such studies in PD, and briefly consider common daily stimuli that might affect 24 h ABPM.
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Affiliation(s)
- Eva Stuebner
- Autonomic Laboratory, Department of Neurology and Clinical Neurophysiology, Faculty of Health, HELIOS-Klinikum Wuppertal, University of Witten/HerdeckeWuppertal, Germany
| | - Ekawat Vichayanrat
- Autonomic and Neurovascular Medicine Unit, Division of Brain Sciences, Faculty of Medicine, Imperial College London at St Mary’s HospitalLondon, UK
- Autonomic Unit, Queen Square/Division of Clinical Neurology, National Hospital for Neurology and Neurosurgery, Institute of Neurology, University College LondonLondon, UK
| | - David A. Low
- Autonomic and Neurovascular Medicine Unit, Division of Brain Sciences, Faculty of Medicine, Imperial College London at St Mary’s HospitalLondon, UK
- Autonomic Unit, Queen Square/Division of Clinical Neurology, National Hospital for Neurology and Neurosurgery, Institute of Neurology, University College LondonLondon, UK
| | - Christopher J. Mathias
- Autonomic and Neurovascular Medicine Unit, Division of Brain Sciences, Faculty of Medicine, Imperial College London at St Mary’s HospitalLondon, UK
- Autonomic Unit, Queen Square/Division of Clinical Neurology, National Hospital for Neurology and Neurosurgery, Institute of Neurology, University College LondonLondon, UK
| | - Stefan Isenmann
- Autonomic Laboratory, Department of Neurology and Clinical Neurophysiology, Faculty of Health, HELIOS-Klinikum Wuppertal, University of Witten/HerdeckeWuppertal, Germany
| | - Carl-Albrecht Haensch
- Autonomic Laboratory, Department of Neurology and Clinical Neurophysiology, Faculty of Health, HELIOS-Klinikum Wuppertal, University of Witten/HerdeckeWuppertal, Germany
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Funk F, Ceuterick-de Groote C, Martin JJ, Meinhardt A, Taratuto AL, De Bleecker J, Van Coster R, De Paepe B, Schara U, Vorgerd M, Häusler M, Koppi S, Maschke M, De Jonghe P, Van Maldergem L, Noel S, Zimmermann CW, Wirth S, Isenmann S, Stadler R, Schröder JM, Schulz JB, Weis J, Claeys KG. Morphological spectrum and clinical features of myopathies with tubular aggregates. Histol Histopathol 2013; 28:1041-54. [PMID: 23479431 DOI: 10.14670/hh-28.1041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tubular aggregates (TAs) are aggregates of densely packed tubules in human skeletal muscle fibers with particular histochemical and ultrastructural features that most probably arise from the sarcoplasmic reticulum. Some studies have shown an additional mitochondrial origin of TAs. We studied the histopathological spectrum and clinical features in a large cohort of patients with TAs in their muscle biopsy (106 biopsies), derived from our muscle biopsy archive (15,412 biopsies in total). In particular, we examined light microscopic, enzyme histochemical, immunohistochemical and ultrastructural features in the muscle biopsies, as well as the patients' clinical data. We found TAs in 0.5% of all muscle biopsies. Based on the size of TAs, we identified two sub-groups: (1) myopathies with large TAs (29 biopsies) in type 2 fibers and sometimes also in type 1 fibers, absence of any other associated disorder, and a familial history in half of the cases, and (2) myopathies with small TAs (77 biopsies), exclusively in type 2 fibers, presence of another associated disease in the majority of patients and mostly no familial history. In the sub-group with large TAs, we observed a high variability of ultrastructural changes. The most frequent clinical symptom in both groups was limb muscle weakness. No significant differences in clinical presentation, age at onset or disease duration at the time of biopsy were found between the two groups. In conclusion, myopathies with TAs can be sub-divided into a group with large TAs, probably corresponding to the so-called primary TA myopathies, and into a group with small TAs as a feature of another underlying condition.
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Affiliation(s)
- Fabian Funk
- Institute of Neuropathology, RWTH Aachen University, Aachen, Germany
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Ickenstein GW, Ambach H, Klöditz A, Koch H, Isenmann S, Reichmann H, Ziemssen T. Static posturography in aging and Parkinson's disease. Front Aging Neurosci 2012; 4:20. [PMID: 22888319 PMCID: PMC3412413 DOI: 10.3389/fnagi.2012.00020] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [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: 02/10/2012] [Accepted: 07/09/2012] [Indexed: 11/26/2022] Open
Abstract
Introduction: In clinical practice, evaluation of postural control is based on the neurological examination, including Romberg's test, examination of gait and performance of pull test as part of the Unified Parkinson's Disease Rating Scale (UPDRS). The goal of our study was to identify posturographic parameters since quantitative technical methods for the measurement of postural control are not established in clinical routine yet. Methods: In this cross-sectional study design we examined patients with Parkinson's disease (PD) (Hoehn and Yahr < 3; PD n = 12) on a static posturographic platform (eyes open and eyes closed), performing a standard Romberg's test during neurological examination and compared the results with an age-matched healthy adult control (HAC n = 10) and a healthy young control (HYC n = 21). Results: In the platform Romberg's test with open eyes, the patients with PD showed a significantly greater mean sway [PD: 14.98 vs. HAC: 8.77 (mm), p < 0.003 vs. HYC 7.80 (mm)], greater mean radius [PD: 28.31 vs. HAC: 16.36 (mm), p < 0.008 vs. HYC: 14.19 (mm)] and greater marked area [PD: 2.38 vs. HAC: 0.88 (cm2), p < 0.016 vs. HYC: 0.78 (cm2)] compared to the HAC. The Romberg's test with closed eyes revealed a significantly greater mean sway [PD: 13.83 vs. HAC: 10.12 (mm), p < 0.033 vs. HYC: 5.82 (mm)] and greater mean radius [PD: 25.03 vs. HAC: 18.15 (mm), p < 0.045 vs. HYC: 9.11 (mm)] compared to both groups. Conclusions: The platform Romberg-test with closed eyes detected significant differences in elderly people and patients with Parkinson's disease, which could be objectively quantified with static posturography testing. Age alone showed significant changes, only detectable with closed eyes. Therefore, balance testing with a new computerized approach could help to identify balance problems in a geriatric assessment in clinical routine, especially with the parameters marked area and mean sway.
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Affiliation(s)
- Guntram W Ickenstein
- Department of Neurology and Stroke Unit, HELIOS General Hospital Aue, University of Dresden Dresden, Germany
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Wagner C, Isenmann S, Ringendahl H, Haensch CA. [Anxiety in patients with postural tachycardia syndrome (POTS)]. Fortschr Neurol Psychiatr 2012; 80:458-62. [PMID: 22692879 DOI: 10.1055/s-0031-1299106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The postural tachycardia syndrome (POTS) is a condition of the autonomic nervous system with symptoms of orthostatic intolerance. In POTS patients, orthostatic stress leads to an overshoot of heart rate increase without a fall in blood pressure. The purpose of this study is to distinguish between anxiety disorders and anxiety as a concomitant phenomenon of orthostatic stress. METHODS 50 patients fulfilling the diagnostic criteria (orthostatic symptoms, heart rate increase of > 30 bpm or up to > 120 bpm by testing with tilt-table) were included. The study design included a thorough medical history as well as standardised questionnaires about anxiety. RESULTS The average heart rate increase was 36 bpm after ten minutes of standing and 42 bpm after maximal standing time (max. 45 minutes). POTS patients scored significantly higher than a comparison group in a range of anxiety disorders by using anxiety questionnaires like "Beck Angst-Inventar" (BAI) and trait test of "State-Traits-Angstinventar" which include autonomic items. When questionnaires were used that exclude autonomic items (anxiety sensitivity index: ASI; Interaktions-Angst-Fragebogen: IAF) there was no difference. CONCLUSION POTS patients do not exhibit signals of anxiety disorders more often than control groups, provided that questionnaires without autonomic items are used.
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Affiliation(s)
- C Wagner
- Klinik für Gefäßchirurgie, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, Berlin.
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Ickenstein G, Isenmann S, Ende F, Müller R, Bodechtel U, Reichmann H, Meisel A. Neurogene Dysphagie im Rahmen der Neurologischen Komplexbehandlung und strukturelle Komponenten eines Dysphagieprogrammes. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1309037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- G. Ickenstein
- Klinik für Neurologie & Stroke Unit, HELIOS Klinikum Aue, Technische Universität Dresden, Aue
| | - S. Isenmann
- Klinik für Neurologie und klinische Neurophysiologie, HELIOS Klinikum Wuppertal der Universität Witten-Herdecke, Wuppertal
| | - F. Ende
- Klinik für Neurologie & Stroke Unit, HELIOS Klinikum Aue, Technische Universität Dresden, Aue
| | - R. Müller
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - U. Bodechtel
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - H. Reichmann
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - A. Meisel
- Klinik für Neurologie, Centrum für Schlaganfallforschung, Charité Universitätsmedizin Berlin, Berlin
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Wohl SG, Schmeer CW, Isenmann S. Neurogenic potential of stem/progenitor-like cells in the adult mammalian eye. Prog Retin Eye Res 2012; 31:213-42. [DOI: 10.1016/j.preteyeres.2012.02.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 02/04/2012] [Accepted: 02/06/2012] [Indexed: 11/26/2022]
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Haensch CA, Mallien J, Isenmann S. Sleep Disturbances in Postural Orthostatic Tachycardia Syndrome (POTS): A Polysomnographic and Questionnaires Based Study (P05.206). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.206] [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: 11/15/2022] Open
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36
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Knosalla M, Haensch CA, Brune N, Ekamp H, Isenmann S. Man-in-the-barrel-Syndrom durch Neuroborreliose. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301567] [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: 10/28/2022]
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Abstract
Visual impairment severely affects the quality of life of patients and their families and is also associated with a deep economic impact. The most common pathologies responsible for visual impairment and legally defined blindness in developed countries include age-related macular degeneration, glaucoma and diabetic retinopathy. These conditions share common pathophysiological features: dysfunction and loss of retinal neurons. To date, two main approaches are being taken to develop putative therapeutic strategies: neuroprotection and cell replacement. Cell replacement is a novel therapeutic approach to restore visual capabilities to the degenerated adult neural retina and represents an emerging field of regenerative neurotherapy. The discovery of a population of proliferative cells in the mammalian retina has raised the possibility of harnessing endogenous retinal stem cells to elicit retinal repair. Furthermore, the development of suitable protocols for the reprogramming of differentiated somatic cells to a pluripotent state further increases the therapeutic potential of stem-cell-based technologies for the treatment of major retinal diseases. Stem-cell transplantation in animal models has been most effectively used for the replacement of photoreceptors, although this therapeutic approach is also being used for inner retinal pathologies. In this review, we discuss recent advances in the development of cell-replacement approaches for the treatment of currently incurable degenerative retinal diseases.
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Affiliation(s)
- Christian W Schmeer
- Hans Berger Clinic of Neurology, University Hospital Jena, Erlanger Allee 101, 07747 Jena, Germany.
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Theiss S, Günzel F, Storm A, Hausn P, Isenmann S, Klisch J, Ickenstein GW. Using routine data for quality assessment in NeuroNet telestroke care. J Stroke Cerebrovasc Dis 2012; 22:984-90. [PMID: 22365711 DOI: 10.1016/j.jstrokecerebrovasdis.2012.01.012] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/17/2012] [Accepted: 01/20/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Systematic clinical trials are often unavailable to evaluate and optimize operational telestroke networks. In a complementary approach, readily available routine clinical data were analyzed in this study to evaluate the effect of a telestroke network over a 4-year period. METHODS Routine clinical data from the HELIOS hospital information system were compared before and after implementation of the NeuroNet concept, including neurologic acute stroke teleconsultations, standard operating procedures, and peer review quality management in 3 hospital cohorts: 5 comprehensive stroke centers, 5 NeuroNet hospitals, and 5 matched control hospitals. RESULTS During the study period, the rate of thrombolytic therapy increased by 4.8% in NeuroNet hospitals, while ischemic stroke in-hospital mortality decreased (relative risk reduction ~29% in NeuroNet and control hospitals). The odds ratio for thrombolytic therapy in comprehensive stroke centers compared to NeuroNet hospitals was reduced from 3.7 to 1.3 between 2006 and 2009. Comprehensive stroke care coding according to German Diagnosis Related Groups definitions increased by 45% in NeuroNet (P < .0001) and by 18% in control hospitals. CONCLUSIONS Routine clinical data on in-hospital mortality, the rate of thrombolytic therapy, and comprehensive stroke care coding reflect different aspects of acute stroke care improvement related to the implementation of the telemedical NeuroNet concept and unified quality management (standard operating procedure teaching concept, peer review process). Similar evaluation processes could contribute to quality monitoring in other telestroke networks.
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Affiliation(s)
- Stephan Theiss
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany; Faculty of Economics and Management, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Wohl SG, Schmeer CW, Friese T, Witte OW, Isenmann S. In situ dividing and phagocytosing retinal microglia express nestin, vimentin, and NG2 in vivo. PLoS One 2011; 6:e22408. [PMID: 21850226 PMCID: PMC3151247 DOI: 10.1371/journal.pone.0022408] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 06/21/2011] [Indexed: 11/18/2022] Open
Abstract
Background Following injury, microglia become activated with subsets expressing nestin as well as other neural markers. Moreover, cerebral microglia can give rise to neurons in vitro. In a previous study, we analysed the proliferation potential and nestin re-expression of retinal macroglial cells such as astrocytes and Müller cells after optic nerve (ON) lesion. However, we were unable to identify the majority of proliferative nestin+ cells. Thus, the present study evaluates expression of nestin and other neural markers in quiescent and proliferating microglia in naïve retina and following ON transection in adult rats in vivo. Methodology/Principal Findings For analysis of cell proliferation and cells fates, rats received BrdU injections. Microglia in retinal sections or isolated cells were characterized using immunofluorescence labeling with markers for microglia (e.g., Iba1, CD11b), cell proliferation, and neural cells (e.g., nestin, vimentin, NG2, GFAP, Doublecortin etc.). Cellular analyses were performed using confocal laser scanning microscopy. In the naïve adult rat retina, about 60% of resting ramified microglia expressed nestin. After ON transection, numbers of nestin+ microglia peaked to a maximum at 7 days, primarily due to in situ cell proliferation of exclusively nestin+ microglia. After 8 weeks, microglia numbers re-attained control levels, but 20% were still BrdU+ and nestin+, although no further local cell proliferation occurred. In addition, nestin+ microglia co-expressed vimentin and NG2, but not GFAP or neuronal markers. Fourteen days after injury and following retrograde labeling of retinal ganglion cells (RGCs) with Fluorogold (FG), nestin+NG2+ microglia were positive for the dye indicating an active involvement of a proliferating cell population in phagocytosing apoptotic retinal neurons. Conclusions/Significance The current study provides evidence that in adult rat retina, a specific resident population of microglia expresses proteins of immature neural cells that are involved in injury-induced cell proliferation and phagocytosis while transdifferentiation was not observed.
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Affiliation(s)
- Stefanie G Wohl
- Hans Berger Clinic of Neurology, Jena University Hospital, Jena, Germany.
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Kamper L, Meyn H, Rybacki K, Nordmeyer S, Kempkes U, Piroth W, Isenmann S, Haage P. Workflow Optimization in Vertebrobasilar Occlusion. Cardiovasc Intervent Radiol 2011; 35:491-7. [DOI: 10.1007/s00270-011-0222-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 06/16/2011] [Indexed: 11/29/2022]
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Knosalla M, Weis J, Isenmann S, Haensch CA. L-Dihydroxyphenylserin in der Therapie des seltenen Pure autonomic failure. KLIN NEUROPHYSIOL 2011. [DOI: 10.1055/s-0031-1275652] [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: 10/18/2022]
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Krempler K, Schmeer CW, Isenmann S, Witte OW, Löwel S. Simvastatin Improves Retinal Ganglion Cell Survival and Spatial Vision after Acute Retinal Ischemia/Reperfusion in Mice. ACTA ACUST UNITED AC 2011; 52:2606-18. [DOI: 10.1167/iovs.10-6005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Katja Krempler
- From the Institute of General Zoology and Animal Physiology and
| | - Christian W. Schmeer
- the Hans Berger Clinic of Neurology, Friedrich-Schiller University, Jena, Germany; and
| | - Stefan Isenmann
- the Department of Neurology, Helios Klinikum Wuppertal and Witten/Herdecke University, Wuppertal, Germany
| | - Otto W. Witte
- the Hans Berger Clinic of Neurology, Friedrich-Schiller University, Jena, Germany; and
| | - Siegrid Löwel
- From the Institute of General Zoology and Animal Physiology and
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Haensch CA, Isenmann S. Das Posturale Tachykardiesyndrom (POTS): Aktuelle Konzepte zur Pathophysiologie, Diagnose und Therapie. Fortschr Neurol Psychiatr 2011; 79:117-22; quiz 123-5. [DOI: 10.1055/s-0029-1245991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Haensch CA, Wehe J, Jigalin A, Isenmann S. Gastroparesis in myotonic dystrophy 1. Clin Auton Res 2010; 21:125-6. [DOI: 10.1007/s10286-010-0097-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 11/09/2010] [Indexed: 11/28/2022]
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46
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Cornely C, Fischer M, Ingianni G, Isenmann S. Greater Occipital Nerve Neuralgia Caused by Pathological Arterial Contact: Treatment by Surgical Decompression. Headache 2010; 51:609-12. [DOI: 10.1111/j.1526-4610.2010.01802.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Wohl SG, Schmeer CW, Witte OW, Isenmann S. Proliferative Response of Microglia and Macrophages in the Adult Mouse Eye after Optic Nerve Lesion. ACTA ACUST UNITED AC 2010; 51:2686-96. [DOI: 10.1167/iovs.09-4537] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Stefanie G. Wohl
- From the Hans Berger Department of Neurology, Friedrich-Schiller University, Jena, Germany; the 2University of Witten/Herdecke, Witten, Germany; and
| | - Christian W. Schmeer
- From the Hans Berger Department of Neurology, Friedrich-Schiller University, Jena, Germany
| | - Otto W. Witte
- From the Hans Berger Department of Neurology, Friedrich-Schiller University, Jena, Germany
| | - Stefan Isenmann
- From the Hans Berger Department of Neurology, Friedrich-Schiller University, Jena, Germany; the 2University of Witten/Herdecke, Witten, Germany; and the 3Department of Neurology HELIOS Klinikum, Wuppertal, Germany
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48
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Knosalla M, Haensch CA, Wehe J, Lerch H, Weis J, Isenmann S. Efficiency of droxydopa in pure autonomic failure. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1250883] [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: 10/19/2022]
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49
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Haensch CA, Lerch H, Schlemmer H, Jigalin A, Isenmann S. Cardiac neurotransmission imaging with 123I-meta-iodobenzylguanidine in postural tachycardia syndrome. J Neurol Neurosurg Psychiatry 2010; 81:339-43. [PMID: 19687022 DOI: 10.1136/jnnp.2008.168484] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Postural orthostatic tachycardia syndrome (POTS) is a disorder of orthostatic intolerance characterised by excessive tachycardia of unknown aetiology. Whether this condition involves abnormal cardiac sympathetic innervation or function remains elusive. Meta-iodobenzylguanidine (MIBG) resembles guanethidine and is a pharmacologically inactive analogue of norepinephrine, which is similarly metabolised in noradrenergic neurons. MIBG myocardial scintigraphy is used clinically to estimate local myocardial sympathetic nerve damage in some forms of heart disease and autonomic neuropathy. The objective of this study was to evaluate cardiac sympathetic innervation in patients with POTS. METHODS 20 patients with POTS were studied using (123)I-MIBG-single photon emission computed tomography, standardised autonomic testing, assessment of catecholamine plasma levels and sympathetic skin response. RESULTS In four POTS patients (20.0%), myocardial MIBG uptake was markedly decreased. The mean heart to mediastinum ratio was reduced to 1.22+/-0.08 compared with the normal range of >1.7. No correlation was found between myocardial MIBG uptake and degree of postural tachycardia, baroreflex sensitivity, catecholamine plasma levels or other autonomic parameters. Sympathetic skin responses were normal in all patients. CONCLUSIONS These findings suggest that POTS may be, in part, a manifestation of autonomic cardiac neuropathy. MIBG myocardial scintigraphy may be helpful to distinguish patients with neuropathic POTS from patients with orthostatic intolerance of other origin.
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Affiliation(s)
- Carl-Albrecht Haensch
- Department of Neurology, Autonomic Laboratory, HELIOS Klinikum Wuppertal, University of Witten/Herdecke, Heusnerstr 40, D-42283 Wuppertal, Germany.
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Abstract
We present a case with recurrent orbital myositis sequentially affecting both lateral rectus muscles separately. In the first episode, the absence of the required symptoms for the diagnosis of orbital myositis led to the erroneous diagnosis of sixth nerve palsy. Eventually, the correct diagnosis was established with cerebral MR imaging. Orbital myositis should be included in the differential diagnosis of what appears clinically to be abducens palsy, and MR imaging with a focus on the orbita is mandatory in such patients.
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Affiliation(s)
- M Fischer
- Department of Neurology and Clinical Neurophysiology, HELIOS Klinikum, University of Witten/Herdecke, Wuppertal, Germany
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