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Tascón Padrón L, Emrich N, Strizek B, Gass A, Link C, Hilbert T, Klaschik S, Meissner W, Gembruch U, Jiménez Cruz J. Implementation of a piritramide based patient-controlled analgesia (PCA) as a standard of care for pain control in late abortion induction: A prospective cohort study from a patient perspective. Eur J Obstet Gynecol Reprod Biol X 2023; 20:100251. [PMID: 37876769 PMCID: PMC10590719 DOI: 10.1016/j.eurox.2023.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/12/2023] [Revised: 09/30/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
Objective To assess whether the implementation of patient-controlled analgesia (PCA) with piritramide using an automatic pump system under routine conditions is effective to reduce pain in late abortion inductions. Study design Prospective observational cohort study. Setting Patients requiring medically indicated abortion induction from 14 weeks of pregnancy onwards between July 2019 and July 2020 at the department of Obstetrics and Prenatal Medicine of the Bonn University Hospital in Germany. Methods Evaluation of pain management after implementation of a PCA system compared with previous nurse-controlled tramadol-based standard under routine conditions. Patients answered a validated pain questionnaire and requirement of rescue analgesics was assessed. Pain intensity and satisfaction were measured on a ten-point numeric rating scale. Main Outcome Measure Maximal pain intensity. Results Forty patients were included. Patients using Piritramide-PCA complained of higher pain sores than those in the standard group (6.90 (± 2.34) vs. 4.83 (± 2.87), (p < 0.05)). In both groups the level of satisfaction with the analgesia received was comparable (8.00 (± 2.45) vs 7.67 (± 2.62), (p = 0.7)). Patients in the PCA group suffered more nausea (63.2 % vs 30 % respectively, OR 4.0, 95 % CI 1.05-15.20, p < 0.05) and expressed more the desire for more analgesic support compared to the control group (OR 5.7 (1-33.25), p = 0.05). Conclusion Women with abortion induction after 14 weeks of gestation suffer from relevant severe pain, which requires adequate therapy. However, addition of PCA does not seem to bring any advantage in patients undergoing this procedure.
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Affiliation(s)
- L. Tascón Padrón
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - N.L.A. Emrich
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - B. Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - A. Gass
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - C. Link
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - T. Hilbert
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - S. Klaschik
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - W. Meissner
- Department for Anesthesiology and Intensive Care Medicine/Department of Palliative Care, University Hospital of Jena, 07740 Jena, Germany
| | - U. Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - J. Jiménez Cruz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Rzechorzek W, Malik A, Bandyopadhyay D, Goel A, Levine E, Gupta CA, Lanier G, Gass A, Pan S. Outcomes of Heart Transplant Recipients That Had a Percutaneous Coronary Intervention. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.460] [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: 04/05/2023] Open
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Isath A, Gass A, Pan S, Levine E, Gupta C, Lanier G, Spielvogel D, Kai M, Ohira S. Impella 5.5 with Veno-Arterial Extracorporeal Membrane Oxygenation Support as Ecpella 5.5. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1531] [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: 04/05/2023] Open
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Isath A, Ohira S, Hoch E, Frenkel D, Jacobson J, Lanier G, Kai M, Gass A, Levine E. Escalation of Mechanical Circulatory Support in a Patient with an Acute Myocardial Infarction, Cardiogenic Shock and Refractory Ventricular Tachycardia. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.801] [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: 04/05/2023] Open
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Ohira S, Okumura K, Isath A, Abhay D, Lanier G, Levine E, Pan S, Aggarwal Gupta C, Gass A, Spielvogel D, Kai M. Utilization of Hepatitis C Virus Infected Donor in Heart Transplant Recipients with Elevated Meld-Xi Score. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.661] [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: 04/05/2023] Open
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6
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Khan S, Seplowe M, Vemulakonda L, Shakil F, Aggarwal-Gupta C, Lanier G, Levine E, Ohira S, Spielvogel D, Gass A, Kai M, Pan S. Early Recurrence of Cardiac Sarcoidosis after Orthotopic Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.471] [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: 04/05/2023] Open
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Isath A, Ohira S, Levine E, Pan S, Lanier G, Gupta C, Wolfe K, Spielvogel D, Gass A, Kai M. Ex-Vivo Heart Perfusion for Cardiac Transplantation: An Initial Experience in the United States. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.516] [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: 04/05/2023] Open
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Emmert D, Szczypien N, Bender TTA, Grigull L, Gass A, Link C, Klawonn F, Conrad R, Mücke M, Sellin J. A diagnostic support system based on pain drawings: binary and k-disease classification of EDS, GBS, FSHD, PROMM, and a control group with Pain2D. Orphanet J Rare Dis 2023; 18:70. [PMID: 36978184 PMCID: PMC10053427 DOI: 10.1186/s13023-023-02663-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/14/2022] [Accepted: 03/11/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The diagnosis of rare diseases (RDs) is often challenging due to their rarity, variability and the high number of individual RDs, resulting in a delay in diagnosis with adverse effects for patients and healthcare systems. The development of computer assisted diagnostic decision support systems could help to improve these problems by supporting differential diagnosis and by prompting physicians to initiate the right diagnostic tests. Towards this end, we developed, trained and tested a machine learning model implemented as part of the software called Pain2D to classify four rare diseases (EDS, GBS, FSHD and PROMM), as well as a control group of unspecific chronic pain, from pen-and-paper pain drawings filled in by patients. METHODS Pain drawings (PDs) were collected from patients suffering from one of the four RDs, or from unspecific chronic pain. The latter PDs were used as an outgroup in order to test how Pain2D handles more common pain causes. A total of 262 (59 EDS, 29 GBS, 35 FSHD, 89 PROMM, 50 unspecific chronic pain) PDs were collected and used to generate disease specific pain profiles. PDs were then classified by Pain2D in a leave-one-out-cross-validation approach. RESULTS Pain2D was able to classify the four rare diseases with an accuracy of 61-77% with its binary classifier. EDS, GBS and FSHD were classified correctly by the Pain2D k-disease classifier with sensitivities between 63 and 86% and specificities between 81 and 89%. For PROMM, the k-disease classifier achieved a sensitivity of 51% and specificity of 90%. CONCLUSIONS Pain2D is a scalable, open-source tool that could potentially be trained for all diseases presenting with pain.
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Affiliation(s)
- D Emmert
- Center for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Bonn, Germany
- Institute for Virology, University Hospital Bonn, Bonn, Germany
| | - N Szczypien
- Institute for Information Engineering, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany
- Biostatistics Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Tim T A Bender
- Center for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Bonn, Germany
| | - L Grigull
- Center for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Bonn, Germany
| | - A Gass
- Clinic for Anesthesiology and Operative Intensive Care Medicine, Department of Pain Medicine, University Hospital Bonn, Bonn, Germany
| | - C Link
- Clinic for Anesthesiology and Operative Intensive Care Medicine, Department of Pain Medicine, University Hospital Bonn, Bonn, Germany
| | - F Klawonn
- Institute for Information Engineering, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany
- Biostatistics Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - R Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany.
| | - M Mücke
- Institute for Digitalization and General Medicine, University Hospital RWTH Aachen, Aachen, Germany.
- Center for Rare Diseases Aachen (ZSEA), University Hospital RWTH Aachen, Aachen, Germany.
| | - J Sellin
- Institute for Digitalization and General Medicine, University Hospital RWTH Aachen, Aachen, Germany.
- Center for Rare Diseases Aachen (ZSEA), University Hospital RWTH Aachen, Aachen, Germany.
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Kanwal A, Ohira S, Levine A, Isath A, Pan S, Dhand A, Aggarwal-Gupta C, Lanier GM, Gass A, Spielvogel D, Kai M. Survival and renal outcomes of direct heart transplant from veno-arterial extracorporeal membrane oxygenation support. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2156] [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: 11/15/2022] Open
Abstract
Abstract
Backgrounds
Patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support are given the highest priority for cardiac transplantation (OHT) in the new UNOS heart allocation policy adopted in October 2018. Although patients may receive an organ quicker there may not be enough time to recover end-organ function. To date, little is known about survival and renal outcomes of direct OHT in patients that have been supported with VA-ECMO as a bridge to transplant due to limited experience in most transplant centers.
Purpose
The aim of this study was to investigate survival and renal outcomes of direct OHT in patients supported with VA-ECMO prior to transplant.
Methods
From January 2010 to February 2022, 23 patients who received single organ OHT alone directly from VA-ECMO support were retrospectively analyzed (16 patients after the new allocation policy). Kaplan-Meier analysis was used to estimate event-free survival.
Results
The median age of recipients was 48 years. The median length of pre-transplant VA-ECMO support was 5 days. Additional pre-transplant support with intra-aortic balloon pump or Impella was utilized in 15 patients (65.2%) and 2 patients (9%) respectively. There was a trend toward improvement of serum creatinine after initiation of VA-ECMO support (Pre-ECMO: 1.66±1.22 mg/dl vs. Pre-OHT: 1.20±0.74 mg/dl, P=0.084). Four patients required preoperative renal replacement therapy (RRT); three were on RRT at the time of OHT. The median ischemic time of donor hearts was 168 minutes. VA-ECMO support was continued in 10 patients (43.5%) after OHT.
Hospital mortality was 8.7% (2 patients). Post-transplant RRT was required in 9 patients (39.1%), and, of these, 5 patients were transitioned to permanent dialysis. Among the 14 patients who did not require post-transplant RRT, none required RRT during the follow-up period (median, 21.5 months). Kaplan-Meier survival analysis showed that estimated survival at 1 year and 3 years were 86.1%, and 77.5%, respectively (Figure 1A). The freedom from dialysis rate was 82.4% at 1 year, and 74.9% at 3 years (Figure 2A). Both survival (100% vs. 66.7%, P=0.008, Fig.1B) and dialysis free rate (100% vs. 55.6%, P=0.002, Figure 2B) at one-year were significantly worse in patients who required postoperative RRT.
Conclusions
To our knowledge this is the largest single center study of OHT in patients that were supported with VA-ECMO. VA-ECMO as a bridge to end-organ recovery and OHT resulted in excellent outcomes. Patients who required post-transplant RRT more likely to require long-term dialysis, while those that did not receive RRT showed favorable outcomes. Overall survival in this patient population is comparable to patients that were not on VA-ECMO prior to transplant.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Kanwal
- Westchester Medical Center , New York , United States of America
| | - S Ohira
- Westchester Medical Center , New York , United States of America
| | - A Levine
- Westchester Medical Center , New York , United States of America
| | - A Isath
- Westchester Medical Center , New York , United States of America
| | - S Pan
- Westchester Medical Center , New York , United States of America
| | - A Dhand
- Westchester Medical Center , New York , United States of America
| | - C Aggarwal-Gupta
- Westchester Medical Center , New York , United States of America
| | - G M Lanier
- Westchester Medical Center , New York , United States of America
| | - A Gass
- Westchester Medical Center , New York , United States of America
| | - D Spielvogel
- Westchester Medical Center , New York , United States of America
| | - M Kai
- Westchester Medical Center , New York , United States of America
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Yurutkina A, Klaschik S, Kowark P, Gass A, Link C, Randau TM, Jiménez-Cruz J, Coburn M, Hilbert T. Pain levels and patient comfort after lower limb arthroplasty comparing i.v. patient-controlled analgesia, continuous peripheral nerve block and neuraxial analgesia: a retrospective cohort analysis of clinical routine data. J Orthop Surg Res 2022; 17:381. [PMID: 35962409 PMCID: PMC9373442 DOI: 10.1186/s13018-022-03277-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Insufficient pain control after lower limb arthroplasty results in delayed recovery and increased risk for pain chronicization. The ideal kind of analgesia is still discussed controversially. We conducted a retrospective analysis of single-center routine data from a German university hospital, including patients receiving either total hip (THA) or knee arthroplasty (TKA). METHODS All patients received general anesthesia. Patients undergoing THA received either continuous epidural ropivacaine infusion (0.133%, Epi) or patient-controlled analgesia (PCA) with the Wurzburg Pain Drip (tramadol, metamizole and droperidol, WPD) or with piritramide (Pir). After TKA, patients received either continuous femoral nerve block (ropivacaine 0.2%, PNB) or Pir. RESULTS The analyzed cohort comprised 769 cases. Use of WPD after THA (n = 333) resulted in significantly reduced Numeric Rating Scale (NRS) values at rest, compared to Epi (n = 48) and Pir (n = 72) (.75 [IQR 1.14] vs. 1.17 [1.5], p = .02 vs. 1.47 [1.33], p < .0001) as well as maximum NRS scores (2.4 [1.7] vs. 3.29 [1.94], p < .001 vs. 3.32 [1.76], p < .0001). Positive feedback during follow-up visits was significantly increased in patients with a WPD PCA (p < .0001), while negative feedback (senso-motoric weakness/technical problems/nausea/dizziness/constipation) was particularly increased in Epi patients and lowest in those with WPD (p < .0001). After TKA, Pir (n = 131) resulted in significantly reduced NRS values at rest, compared to PNB (n = 185) (1.4 [1.4] vs. 1.6 [1.68], p = .02). Positive feedback was increased in patients with a Pir PCA in comparison with PNB (p = .04), while negative feedback was increased in PNB patients (p = .04). Overall, WPD presented with the lowest rate of any complications (8.7%), followed by Pir (20.2%), PNB (27.6%) and Epi (31.3%) (p < .001). CONCLUSIONS In the assessed population, the use of a WPD PCA after THA offered better pain control and patient comfort in comparison with continuous epidural or piritramide-based analgesia. After TKA, the use of a Pir PCA provided superior analgesia and a lower complication rate compared to continuous PNB.
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Affiliation(s)
- Alina Yurutkina
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sven Klaschik
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Pascal Kowark
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Annette Gass
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Carolina Link
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Thomas Martin Randau
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Jorge Jiménez-Cruz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Mark Coburn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tobias Hilbert
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Penner IK, Gass A, Schreiber H, Wattjes MP. [Neuropsychological and MRI diagnostics in secondary progressive multiple sclerosis]. Nervenarzt 2021; 92:1293-1301. [PMID: 33891150 PMCID: PMC8648628 DOI: 10.1007/s00115-021-01118-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/24/2022]
Abstract
Hintergrund Die Multiple Sklerose ist im longitudinalen Verlauf oft ein Krankheitskontinuum mit initial schubförmig-remittierender Phase (RRMS) und späterer sekundärer Progredienz (SPMS). Die meisten bisher zugelassenen Therapien sind bei SPMS nicht ausreichend wirksam. Die frühe Erkennung der SPMS-Konversion ist daher entscheidend für die Therapiewahl. Wichtige Entscheidungshilfen können dabei die Testung kognitiver Teilleistungen und die Magnetresonanztomographie (MRT) sein. Ziel der Arbeit Darstellung der Bedeutung kognitiver Testungen und von MRT-Untersuchungen für Prädiktion und Erfassung der SPMS-Konversion. Ausarbeitung von Strategien der Verlaufsbeobachtung und Therapiesteuerung in der Praxis, insbesondere in der ambulanten Versorgung. Material und Methoden Übersichtsarbeit auf Basis einer unsystematischen Literaturrecherche. Ergebnisse Standardisierte kognitive Testung kann für die frühe SPMS-Diagnose hilfreich sein und die Verlaufsbewertung erleichtern. Eine jährliche Anwendung sensitiver Screeningtests wie Symbol Digit Modalities Test (SDMT) und Brief Visual Memory Test-Revised (BVMT‑R) oder der Brief International Cognitive Assessment for MS (BICAMS)-Testbatterie ist empfehlenswert. Persistierende inflammatorische Aktivität im MRT in den ersten drei Jahren der Erkrankung sowie das Vorhandensein kortikaler Läsionen sind prädiktiv für eine SPMS-Konversion. Ein standardisiertes MRT-Monitoring auf Merkmale einer progressiven MS kann den klinisch und neurokognitiv begründeten SPMS-Verdacht stützen. Diskussion Die interdisziplinäre Versorgung von MS-Patienten durch klinisch versierte Neurologen, unterstützt durch neuropsychologische Testung und MRT, hat einen hohen Stellenwert für die SPMS-Prädiktion und Diagnose. Letztere erlaubt eine frühe Umstellung auf geeignete Therapien, da bei SPMS andere Interventionen als für die RRMS notwendig sind. Nach erfolgter medikamentöser Umstellung erlaubt die klinische, neuropsychologische und bildgebende Vigilanz ein stringentes Monitoring auf neuroinflammatorische und -degenerative Aktivität sowie Therapiekomplikationen.
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Affiliation(s)
- I-K Penner
- Klinik für Neurologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland. .,COGITO Zentrum für angewandte Neurokognition und neuropsychologische Forschung, Merowingerplatz 1, 40225, Düsseldorf, Deutschland.
| | - A Gass
- Neurologische Klinik, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - H Schreiber
- Nervenärztliche Gemeinschaftspraxis, Neuropoint Akademie und NTD, Ulm, Deutschland
| | - M P Wattjes
- Institut für diagnostische und interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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Grassl N, Bunse L, Beutel T, Klockziem M, Gass A, Platten M, Eisele P. Nivolumab for treatment of progressive multifocal leukoencephalopathy in Sézary syndrome. Eur J Neurol 2020; 27:2373-2374. [DOI: 10.1111/ene.14433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/29/2020] [Indexed: 01/12/2023]
Affiliation(s)
- N. Grassl
- Department of Neurology Universitätsmedizin MannheimUniversity of Heidelberg Mannheim Germany
| | - L. Bunse
- Department of Neurology Universitätsmedizin MannheimUniversity of Heidelberg Mannheim Germany
| | - T. Beutel
- Department of Neurology Universitätsmedizin MannheimUniversity of Heidelberg Mannheim Germany
| | - M. Klockziem
- Department of Neurology Universitätsmedizin MannheimUniversity of Heidelberg Mannheim Germany
| | - A. Gass
- Department of Neurology Universitätsmedizin MannheimUniversity of Heidelberg Mannheim Germany
| | - M. Platten
- Department of Neurology Universitätsmedizin MannheimUniversity of Heidelberg Mannheim Germany
| | - P. Eisele
- Department of Neurology Universitätsmedizin MannheimUniversity of Heidelberg Mannheim Germany
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Hoyer C, Ebert A, Pooyeh A, Eisele P, Gass A, Platten M, Szabo K. Shedding light on the clinical recognition process of transient global amnesia. Eur J Neurol 2020; 27:1821-1824. [DOI: 10.1111/ene.14371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- C. Hoyer
- Department of Neurology Mannheim Center of Translational Neuroscience University Medical Centre Mannheim Medical Faculty Mannheim Heidelberg University Heidelberg Germany
| | - A. Ebert
- Department of Neurology Mannheim Center of Translational Neuroscience University Medical Centre Mannheim Medical Faculty Mannheim Heidelberg University Heidelberg Germany
| | - A. Pooyeh
- Department of Neurology Mannheim Center of Translational Neuroscience University Medical Centre Mannheim Medical Faculty Mannheim Heidelberg University Heidelberg Germany
| | - P. Eisele
- Department of Neurology Mannheim Center of Translational Neuroscience University Medical Centre Mannheim Medical Faculty Mannheim Heidelberg University Heidelberg Germany
| | - A. Gass
- Department of Neurology Mannheim Center of Translational Neuroscience University Medical Centre Mannheim Medical Faculty Mannheim Heidelberg University Heidelberg Germany
| | - M. Platten
- Department of Neurology Mannheim Center of Translational Neuroscience University Medical Centre Mannheim Medical Faculty Mannheim Heidelberg University Heidelberg Germany
| | - K. Szabo
- Department of Neurology Mannheim Center of Translational Neuroscience University Medical Centre Mannheim Medical Faculty Mannheim Heidelberg University Heidelberg Germany
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Paech D, Kuder TA, Roßmanith C, Griebe M, Eisele P, Platten M, Ladd ME, Schlemmer HP, Gass A, Szabo K. What remains after transient global amnesia (TGA)? An ultra-high field 7 T magnetic resonance imaging study of the hippocampus. Eur J Neurol 2019; 27:406-409. [PMID: 31573112 DOI: 10.1111/ene.14099] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/10/2019] [Accepted: 09/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to study whether ultra-high field 7 T magnetic resonance imaging (MRI) can demonstrate chronic focal defects in the hippocampus corresponding to the former acute diffusion-weighted imaging (DWI) lesions and to assess chronic T2-hyperintense hippocampal lesion load in transient global amnesia (TGA) patients. METHODS Follow-up of 7 T MRI of the hippocampus was performed in 13 patients with documented hippocampal DWI lesions (detected via 3 T MRI) after acute TGA. The location of the DWI lesions was transformed to 7 T T2 images after data co-registration. Additionally, the T2-hyperintense lesion load was estimated in each patient and compared with that of 13 healthy controls. RESULTS Magnetic resonance imaging (7 T) was performed after a median of 4 months. No structural abnormality at the site of the previous TGA lesion was observed in any case. None of the controls showed DWI lesions. There was no significant difference between patients and controls concerning the number (P = 0.67) or volume (P = 0.45) of T2-hyperintense hippocampal lesions. CONCLUSIONS Diffusion-weighted imaging lesions in patients with TGA do not provoke any visible sequelae and do not result in hippocampal cavities. The occurrence of incidental hippocampal T2 lesions after TGA is not more frequent than in controls.
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Affiliation(s)
- D Paech
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - T A Kuder
- Medical Physics in Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - C Roßmanith
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - M Griebe
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - P Eisele
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - M Platten
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - M E Ladd
- Medical Physics in Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany.,Faculty of Physics and Astronomy and Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - H-P Schlemmer
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - A Gass
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - K Szabo
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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15
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Farr M, Lindower J, Taylor S, Jorde U, Chen L, Gass A, Truby L, DeLair S, Pinney S. Increase in DCD Donation in the United States May Adversely Impact DBD Heart Transplantation: Retrospective Analysis of a Limited UNOS Dataset. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.108] [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: 11/26/2022] Open
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16
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Affiliation(s)
- R. Aminbakhsh
- Geriatrics, University of California, San Diego, California,
- VA Health care System, San Diego, California
| | - A. Gass
- VA Health care System, San Diego, California
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17
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Aminbakhsh R, Chau D, Gass A. USING CROSS-CULTURAL AND INTERNATIONAL EXPERIENCES IN DESIGNING AND IMPLEMENTING FUTURE ELDER CARE PLANS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3448] [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: 11/13/2022] Open
Affiliation(s)
| | - D. Chau
- VA San Diego Health Care System, San Diego, California
| | - A. Gass
- VA San Diego Health Care System, San Diego, California
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18
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Hoyer C, Eisele P, Ebert A, Schneider S, Gass A, Fatar M, Szabo K, Alonso A. Blood-CSF-barrier dysfunction is a marker for encephalitic involvement in patients with aseptic meningitis/meningoencephalitis. J Clin Virol 2016; 84:82-86. [DOI: 10.1016/j.jcv.2016.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/28/2016] [Accepted: 10/05/2016] [Indexed: 11/16/2022]
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19
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Pardini M, Botzkowski D, Müller S, Vehoff J, Kuhle J, Ruberte E, Würfel J, Gass A, Valmaggia C, Tettenborn B, Putzki N, Yaldizli Ö. The association between retinal nerve fibre layer thickness and N-acetyl aspartate levels in multiple sclerosis brain normal-appearing white matter: a longitudinal study using magnetic resonance spectroscopy and optical coherence tomography. Eur J Neurol 2016; 23:1769-1774. [PMID: 27591406 DOI: 10.1111/ene.13116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 02/08/2016] [Accepted: 06/27/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE N-acetyl aspartate (NAA) assessed using proton magnetic resonance spectroscopy (1 H MRS) has a high pathological specificity for axonal density. Retinal nerve fibre layer thickness (RNFLT) measured by using optical coherence tomography is increasingly used as a surrogate marker of neurodegeneration in multiple sclerosis (MS). Our aim was to investigate the relation between RNFLT and NAA/creatine in brain normal-appearing white matter (NAWM), their dynamics over time and the association with clinical outcome measures in relapsing MS. T2 WM lesions served as control tissue. METHODS Forty-three MS patients underwent standardized neurological examination including the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Functional Composite (MSFC) score, optical coherence tomography and magnetic resonance imaging including 1 H MRS at baseline and after 1 year. RESULTS At baseline, NAA/creatine level was lower in T2 WM lesions than in NAWM (1.64 ± 0.16 vs. 1.88 ± 0.24, P < 0.001). Lowest levels were found in secondary progressive MS (SPMS). Mean RNFLT was higher in clinically isolated syndrome than in the combined group of relapsing-remitting MS and SPMS (99.8 ± 12.3 μm vs. 92.4 ± 12.8 μm, P = 0.038). In all patients, mean RNFLT decreased by 1.4% during follow-up. At baseline, MSFC z-scores correlated with NAA/creatine levels both in NAWM (r = 0.42; P = 0.008) and T2 WM lesions (r = 0.52, P = 0.004). NAWM NAA/creatine variation correlated with the RNFLT change over 1 year (ρ = 0.43, P = 0.046). CONCLUSIONS N-acetyl aspartate/creatine level reduction correlated with RNFLT thinning over 1 year in an EDSS stable MS cohort suggesting that these techniques might be sensitive to detect subclinical disease progression.
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Affiliation(s)
- M Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoaand IRCCS S.Martino-IST, Genoa, Italy
| | | | - S Müller
- Department of Neurology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - J Vehoff
- Department of Neurology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - J Kuhle
- Department of Neurology, University Hospital Basel, Basel, Switzerland.,Departments of Medicine, Biomedicine and Clinical Research, Basel, Switzerland
| | - E Ruberte
- Medical Image Analysis Center, Basel, Switzerland
| | - J Würfel
- Medical Image Analysis Center, Basel, Switzerland
| | - A Gass
- Department of Neurology, University Hospital Mannheim, Mannheim, Germany
| | - C Valmaggia
- Department of Ophthalmology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - B Tettenborn
- Department of Neurology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Ö Yaldizli
- Department of Neurology, University Hospital Basel, Basel, Switzerland
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20
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Szabo K, Gass A. Neue Aspekte zur Pathophysiologie der transienten globalen Amnesie. Akt Neurol 2015. [DOI: 10.1055/s-0034-1387630] [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)
- K. Szabo
- Neurologische Klinik, Universitätsmedizin Mannheim
| | - A. Gass
- Neurologische Klinik, Universitätsmedizin Mannheim
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21
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Eisele P, Griebe M, Szabo K, Wolf ME, Alonso A, Engelhardt B, Hennerici MG, Gass A. Investigation of leptomeningeal enhancement in MS: A postcontrast FLAIR MRI study. Neurology 2015; 84:770-5. [DOI: 10.1212/wnl.0000000000001286] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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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22
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Maeurer M, Wiendl H, Heesen C, Gass A, Wernsdoerfer C, Kieseier B, Zingler V, Wettmershausen C. Natalizumab long-term therapy for relapsing MS in clinical routine: Final results of the prospective observational multicenter study Tysabri® 24 plus. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1379] [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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23
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Griebe M, Bähr C, Ahlsdorf E, Ebert A, Gass A, Hennerici M, Szabo K. Initiation of regular physical activity promotes quality of life in healthy elderly people. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.2462] [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: 11/25/2022]
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24
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Chabriat H, Maeder P, Gass A, Michel P, Bracoud L, Hennerici MG. Results of the PERFORM magnetic resonance imaging study. J Neurol 2013; 260:3071-6. [DOI: 10.1007/s00415-013-7111-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 09/10/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
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25
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Barakos J, Sperling R, Salloway S, Jack C, Gass A, Fiebach JB, Tampieri D, Melançon D, Miaux Y, Rippon G, Black R, Lu Y, Brashear HR, Arrighi HM, Morris KA, Grundman M. MR imaging features of amyloid-related imaging abnormalities. AJNR Am J Neuroradiol 2013; 34:1958-65. [PMID: 23578674 DOI: 10.3174/ajnr.a3500] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE AD is one of the few leading causes of death without a disease-modifying drug; however, hopeful agents are in various phases of development. MR imaging abnormalities, collectively referred to as amyloid-related imaging abnormalities, have been reported for several agents that target cerebral Aβ burden. ARIA includes ARIA-E, parenchymal or sulcal hyperintensities on FLAIR indicative of parenchymal edema or sulcal effusions, and ARIA-H, hypointense regions on gradient recalled-echo/T2* indicative of hemosiderin deposition. This report describes imaging characteristics of ARIA-E and ARIA-H identified during studies of bapineuzumab, a humanized monoclonal antibody against Aβ. MATERIALS AND METHODS Two neuroradiologists with knowledge of imaging changes reflective of ARIA reviewed MR imaging scans from 210 bapineuzumab-treated patients derived from 3 phase 2 studies. Each central reader interpreted the studies independently, and discrepancies were resolved by consensus. The inter-reader κ was 0.76, with 94% agreement between neuroradiologists regarding the presence or absence of ARIA-E in individual patients. RESULTS Thirty-six patients were identified with incident ARIA-E (17.1%, 36/210) and 26 with incident ARIA-H (12.4%, 26/210); of those with incident ARIA-H, 24 had incident microhemorrhages and 2 had incident large superficial hemosiderin deposits. CONCLUSIONS In 49% of cases of ARIA-E, there was the associated appearance of ARIA-H. In treated patients without ARIA-E, the risk for incident blood products was 4%. This association between ARIA-E and ARIA-H may suggest a common pathophysiologic mechanism. Familiarity with ARIA should permit radiologists and clinicians to recognize and communicate ARIA findings more reliably for optimal patient management.
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Affiliation(s)
- J Barakos
- California Pacific Medical Center, San Francisco, California
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26
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Weier K, Naegelin Y, Amann M, Magon S, Mueller-Lenke N, Radue EW, Kappos L, Stippich C, Gass A, Sprenger T. Six-year follow-up of a case series with non-communicating syringomyelia in multiple sclerosis. Eur J Neurol 2012; 20:578-583. [PMID: 23252517 DOI: 10.1111/ene.12052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 10/31/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Non-communicating syringomyelia (NCS) has occasionally been described in case reports and small case series as an incidental finding of spinal cord (SC) pathology in patients with multiple sclerosis (MS), but only little is known on the clinical course and progression of NCS, and in more general terms on the prognosis of patients with MS and NCS. METHODS Nine patients with MS with known NCS at baseline and a control group of 18 age-, sex- and disease course-matched patients with MS without NCS were recruited for a follow-up visit after 6 years. All 27 patients underwent clinical examination and brain magnetic resonance imaging (MRI), and 8/9 patients with NCS were additionally studied with MRI of the SC. MRI data were analysed for changes in length and maximal cross-sectional area of the NCS, lesion volumes of the brain and cord as well as for volumetric metrics of the whole brain (using SIENAX), the cerebellum and medulla oblongata (using ECCET). RESULTS NCS did not significantly change in size when corrected for multiple comparisons. The clinical data (annual relapse rate, EDSS and disease duration) and MRI metrics (T2 and T1 lesion load; whole brain, cerebellar and medulla oblongata volumes as well as their percentage volume change per year) did not significantly differ between patients with MS with or without NCS. CONCLUSION The stable findings regarding size and shape of the syrinx and lack of distinguishing MRI and clinical features support the assumption that NCS is not defining a prognostically or pathogenetically distinct subgroup of patients with MS.
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Affiliation(s)
- K Weier
- Department of Neurology, University Hospital Basel, Switzerland
| | - Y Naegelin
- Department of Neurology, University Hospital Basel, Switzerland
| | - M Amann
- Department of Neurology, University Hospital Basel, Switzerland.,Division of Diagnostic and Interventional Neuroradiology, Department of Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - S Magon
- Department of Neurology, University Hospital Basel, Switzerland
| | - N Mueller-Lenke
- Medical Image Analysis Center (MIAC), University Hospital Basel, Switzerland
| | - E-W Radue
- Medical Image Analysis Center (MIAC), University Hospital Basel, Switzerland
| | - L Kappos
- Department of Neurology, University Hospital Basel, Switzerland
| | - C Stippich
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - A Gass
- Department of Neurology, University Hospital Basel, Switzerland.,MR Research Neurology, University Hospital Mannheim, Germany
| | - T Sprenger
- Department of Neurology, University Hospital Basel, Switzerland.,Division of Diagnostic and Interventional Neuroradiology, Department of Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
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28
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Eisele P, Szabo K, Griebe M, Rossmanith C, Förster A, Hennerici M, Gass A. Reduced diffusion in a subset of acute MS lesions: a serial multiparametric MRI study. AJNR Am J Neuroradiol 2012; 33:1369-73. [PMID: 22576893 DOI: 10.3174/ajnr.a2975] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MRI studies have focused on newly developing MS lesions to characterize the early pathology of the disease. DWI is highly sensitive to acute and chronic tissue changes in MS. We characterized the development of acute MS lesions by using DWI in a multiparametric MRI protocol. MATERIALS AND METHODS Seventy-two consecutive patients presenting with a new symptom with definite MS or a CIS suggestive of central nervous system demyelination were screened with MRI. Patients who showed an acute MRI lesion with a reduction of ADC were studied with serial MRI for up to 4 months after presentation. RESULTS Ten of 72 screened patients who showed a lesion with a reduced ADC were each examined 4-7 times, resulting in 52 examinations in total. We identified a characteristic sequence of signal-intensity changes: 1) days 0-7: slight T2 hyperintensity and prominent ADC reduction (maximum, -66%), faint or no enhancement on postcontrast T1-weighted images; 2) days 7-10: prominent T2 hyperintensity and contrast enhancement, ADC normalization/pseudonormalization; 3) up to 4 weeks: elevated ADC values, prominent enhancement on postcontrast images; 4) after 4 weeks: partial reversibility of T2 hyperintensity, ADC elevation, and resolution of contrast enhancement. CONCLUSIONS In a subgroup of patients with MS presenting soon after new symptom onset, a transient reduction of the ADC delineated a short and very early phase of MS lesion evolution. Subsequent pseudonormalization of the ADC occurred along with signs of the development of vasogenic edema.
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Affiliation(s)
- P Eisele
- Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg, Mannheim, Germany
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29
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Yousry T, Pelletier D, Cadavid D, Gass A, Richert N, Radue EW, Filippi M. PML MRI Patterns in MS Patients Treated with Natalizumab: An Update of Natalizumab PML-MRI Guidelines (P07.057). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.057] [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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30
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Förster A, Gass A, Kern R, Ay H, Chatzikonstantinou A, Hennerici MG, Szabo K. Brain imaging in patients with transient ischemic attack: a comparison of computed tomography and magnetic resonance imaging. Eur Neurol 2012; 67:136-41. [PMID: 22261538 DOI: 10.1159/000333286] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 09/06/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Brain imaging in stroke aims at the detection of the relevant ischemic tissue pathology. Cranial computed tomography (CT) is frequently used in patients with transient ischemic attack (TIA) but no data is available on how it directly compares to magnetic resonance imaging (MRI). METHODS We compared detection of acute ischemic lesions on CT and MRI in 215 consecutive TIA patients who underwent brain imaging with either CT (n = 161) or MRI (n = 54). An MRI was performed within 24 h in all patients who had CT initially. RESULTS An initial assessment with CT revealed no acute pathology in 154 (95.7%) and possible acute infarction in 7 (4.3%) patients. The acute infarct on CT was confirmed by diffusion-weighted imaging (DWI) in only 2 cases (28.6%). DWI detected an acute infarct in 50 of the 154 patients with normal baseline CT (32.5%). Among 54 patients without baseline CT, DWI showed acute ischemic lesions in 19 (35.2%). The ischemic lesions had a median volume of 0.87 cm(3) (range: 0.08-15.61), and the lesion pattern provided clues to the underlying etiology in 13.7%. CONCLUSION Acute MRI is advantageous over CT to confirm the probable ischemic nature and to identify the etiology in TIA patients.
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Affiliation(s)
- A Förster
- Department of Neurology, Universitätsklinikum Mannheim, University of Heidelberg, Mannheim, Germany.
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31
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Förster A, Griebe M, Gass A, Kern R, Hennerici MG, Szabo K. Diffusion-weighted imaging for the differential diagnosis of disorders affecting the hippocampus. Cerebrovasc Dis 2011; 33:104-15. [PMID: 22179485 DOI: 10.1159/000332036] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 08/17/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The human hippocampus can be affected in a large variety of very different neurological diseases, of which acute ischemic stroke, transient global amnesia, epilepsy, and limbic encephalitis are the most common. Less frequent etiologies include various infections and encephalopathy of different origins. Clinical presentation notably comprises confusional state, altered vigilance, memory deficits of various extent and seizures. While in hypoxic or hypoglycemic encephalopathy, clinical presentation and surrounding circumstances provide some clues to reach the correct diagnosis, in the above-listed more common disorders, signs and symptoms might overlap, making the differential diagnosis difficult. This review presents recent studies using the diffusion-weighted imaging (DWI) technique in diseases involving the hippocampus. METHODS References for the review were identified through searches of PubMed from 1965 to January 2011. Only papers published in English were reviewed. Full articles were obtained and references were checked for additional material where appropriate. RESULTS All pathologies affecting the hippocampus are associated with distinct lesion patterns on magnetic resonance imaging, and especially DWI has the ability to demonstrate even minute and transient hippocampal lesions. In acute ischemic stroke in the posterior cerebral artery territory, involvement of the hippocampal formation occurs in four distinct patterns on DWI that can be easily differentiated and correspond to the known vascular anatomy of the hippocampus. In the subacute phase after transient global amnesia (TGA), dot-like hyperintense lesions are regularly found in the lateral aspect of the hippocampus on DWI. The DWI lesions described after prolonged seizures or status epilepticus include unilateral or bilateral hippocampal, thalamic, and cortical lesions of various extent, not restricted to vascular territories. In limbic encephalitis, DWI lesions are only infrequently found and usually affect the hippocampus, uncus and amygdala. Furthermore, in some rare cases DWI lesions of different etiology may coexist. CONCLUSION In patients with diseases affecting the hippocampus, DWI appears to be useful in differentiating between underlying pathologies and may facilitate a definite diagnosis conducive to an optimal treatment. With a careful clinical examination, experience with the interpretation of DWI findings and knowledge of associated phenomena, it is indeed possible to differentiate between ischemic, ictal, metabolic, and TGA-associated findings.
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Affiliation(s)
- A Förster
- Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg, Mannheim, Germany.
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32
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Wolf ME, Held VE, Forster A, Griebe M, Szabo K, Gass A, Hennerici MG, Kern R. Pearls & Oy-sters: Dynamics of altered cerebral perfusion and neurovascular coupling in migraine aura. Neurology 2011; 77:e127-8. [DOI: 10.1212/wnl.0b013e31823a0ceb] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [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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33
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Rigotti DJ, Gass A, Achtnichts L, Inglese M, Babb JS, Naegelin Y, Hirsch J, Amann M, Kappos L, Gonen O. Multiple Sclerosis Severity Scale and whole-brain N-acetylaspartate concentration for patients' assessment. Mult Scler 2011; 18:98-107. [PMID: 21921070 DOI: 10.1177/1352458511415142] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The ability to predict the course of multiple sclerosis (MS) is highly desirable but lacking. OBJECTIVE To test whether the MS Severity Scale (MSSS) and global neuronal viability, assessed through the quantification of the whole-brain N-acetylaspartate concentration (WBNAA), concur or complement the assessment of individual patients' disease course. METHODS The MSSS and average WBNAA loss rate (ΔWBNAA, extrapolated based on one current measurement and the assumption that at disease onset neural sparing was similar to healthy controls, obtained with proton magnetic resonance (MR) spectroscopy and magnetic resonance imaging (MRI)) from 61 patients with MS (18 male and 43 female) with long disease duration (15 years or more) were retrospectively examined. Some 27 patients exhibited a 'benign' disease course, characterized by an Expanded Disability Status Scale score (EDSS) of 3.0 or less, and 34 were 'non-benign': EDSS score higher than 3.0. RESULTS The two cohorts were indistinguishable in age and disease duration. Benign patients' EDSS and MSSS (2.1 ± 0.7, 1.15 ± 0.60) were significantly lower than non-benign (4.6 ± 1.0, 3.6 ± 1.2; both p < 10(-4)). Their respective average ΔWBNAA, 0.10 ± 0.16 and 0.11 ± 0.12 mM/year, however, were not significantly different (p > 0.7). While MSSS is both sensitive to (92.6%) and specific for (97.0%) benign MS, ΔWBNAA is only sensitive (92.6%) but not specific (2.9%). CONCLUSION Since the WBNAA loss rate is similar in both phenotypes, the only difference between them is their clinical classification, characterized by MSSS and EDSS. This may indicate that 'benign' MS probably reflects fortuitous sparing of clinically eloquent brain regions and better utilization of brain plasticity.
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Affiliation(s)
- D J Rigotti
- Department of Radiology, New York University School of Medicine, New York, USA
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34
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Gass A. Early Iron Age Burials in Southeastern Zhetysu: The Geoarchaeological Evidence. Archaeology, Ethnology and Anthropology of Eurasia 2011. [DOI: 10.1016/j.aeae.2011.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Abstract
OBJECTIVE Migrainous infarction is considered a rare complication of migraine. Although several studies reported silent brain lesions on neuroimaging in patients with migraine with aura, knowledge about lesion patterns in acute migrainous infarction is scarce. We investigated clinical and MRI characteristics in a series of patients with migraine-associated acute cerebral ischemia. METHODS Seventeen patients among 8,137 stroke patients over an 11-year period were included. All had undergone a dedicated stroke workup including diffusion-weighted imaging (DWI) and a detailed assessment of clinical features and of vascular risk factors. RESULTS The majority of patients presented with prolonged aura symptoms (visual aura 82.3%, sensory dysfunction 41.2%, and aphasia 5.9%; median NIH Stroke Scale score 2). Presentation at hospital was significantly delayed after symptom onset (mean 33 hours). A total of 70.6% had acute ischemic lesions in the posterior circulation; the middle cerebral artery territory was affected in 29.4%. Small lesions were present in 64.7%; multiple lesions were found in 41.2%. No overlapping ischemic lesions of different vascular territories were found. The prevalence of a patent foramen ovale was high (64.7%). CONCLUSIONS This study supports previous observations that migrainous infarction mostly occurs in the posterior circulation, and in younger women with a history of migraine with aura. Acute ischemic lesions were often multiple and located in distinct arterial territories. As there were no overlapping ischemic lesions, hemodynamic compromise during the development of migraine is unlikely the cause of infarction. Differentiation between migrainous infarction and prolonged migraine aura is difficult and associated with delayed admission of patients.
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Affiliation(s)
- M E Wolf
- Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg, Mannheim, Germany.
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36
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Audebert HJ, Singer OC, Gotzler B, Vatankhah B, Boy S, Fiehler J, Lansberg MG, Albers GW, Kastrup A, Rovira A, Gass A, Rosso C, Derex L, Kim JS, Heuschmann P. Postthrombolysis hemorrhage risk is affected by stroke assessment bias between hemispheres. Neurology 2011; 76:629-36. [PMID: 21248275 DOI: 10.1212/wnl.0b013e31820ce505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Stroke symptoms in right hemispheric stroke tend to be underestimated in clinical assessment scales, resulting in greater infarct volumes in right as compared to left hemispheric strokes despite similar clinical stroke severity. We hypothesized that patients with right hemispheric nonlacunar stroke are at higher risk for secondary intracerebral hemorrhage after thrombolysis despite similar stroke severity. METHODS We analyzed data of 2 stroke cohorts with CT-based and MRI-based imaging before thrombolysis. Initial stroke severity was measured with the NIH Stroke Scale (NIHSS). Lacunar strokes were excluded through either the presence of cortical symptoms (CT cohort) or restriction to patients with prestroke diffusion-weighted imaging (DWI) lesion size >3.75 mL (MRI cohort). Probabilities of having a parenchymal hematoma were determined using multivariate logistic regression. RESULTS A total of 392 patients in the CT cohort and 400 patients in the MRI cohort were evaluated. Although NIHSS scores were similar in strokes of both hemispheres (median NIHSS: CT: 15 vs 13, MRI: 14 vs 16), the frequencies of parenchymal hematoma were higher in right hemispheric compared to left hemispheric strokes (CT: 12.4% vs 5.7%, MRI: 10.4% vs 6.8%). After adjustment for potential confounders (but not pretreatment lesion volume), the probability of parenchymal hematoma was higher in right hemispheric nonlacunar strokes (CT: odds ratio [OR] 2.3; 95% confidence interval [CI] 1.08-4.89; p = 0.032) and showed a borderline significant effect in the MRI cohort (OR 2.1; 95% CI 0.98-4.49; p = 0.057). Adjustment for pretreatment DWI lesion size eliminated hemispheric differences in hemorrhage risk. CONCLUSIONS Higher hemorrhage rates in right hemispheric nonlacunar strokes despite similar stroke severity may be caused by clinical underestimation of the proportion of tissue at bleeding risk.
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Affiliation(s)
- H J Audebert
- Center for Stroke Research, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200 Berlin, Germany.
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Katan M, Nigro N, Fluri F, Schuetz P, Morgenthaler NG, Jax F, Meckel S, Gass A, Bingisser R, Steck A, Kappos L, Engelter S, Müller B, Christ-Crain M. Stress hormones predict cerebrovascular re-events after transient ischemic attacks. Neurology 2011; 76:563-6. [PMID: 21228295 DOI: 10.1212/wnl.0b013e31820b75e6] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND TIA is a strong predictor of subsequent stroke. The hypothalamic stress hormone copeptin is an accurate prognostic marker in acute ischemic stroke. This study assessed prognostic reliability of 2 distinct stress hormones, copeptin and cortisol, for the risk stratification of re-events in patients with TIA. METHODS We conducted a prospective study in patients admitted to the emergency department with a TIA. Clinical risk scoring using the ABCD2 score was determined and both hormones were measured in plasma on admission. The primary endpoint was a cerebrovascular re-event within 90 days. RESULTS We included 107 consecutive patients with TIA. Re-events occurred in 10 patients (9%). Copeptin levels were higher in patients with a re-event compared with patients without re-event (p = 0.02), in contrast to cortisol (p = 0.53). Copeptin revealed a higher area under the receiver operating characteristics curve (AUC) to predict re-events compared to the ABCD2 score (AUC of 0.73 vs 0.43; p < 0.01) and improved its prognostic accuracy (AUC of combined model of 0.77; p = 0.002). CONCLUSION Measurement of plasma copeptin but not cortisol levels in patients with TIA provides additional prognostic information beyond the ABCD2 clinical risk score alone. If confirmed in future studies, routine copeptin measurement may be an additional tool for risk stratification and targeted resource allocation after TIA.
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Affiliation(s)
- M Katan
- Department of Endocrinology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
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Geurts JJG, Roosendaal SD, Calabrese M, Ciccarelli O, Agosta F, Chard DT, Gass A, Huerga E, Moraal B, Pareto D, Rocca MA, Wattjes MP, Yousry TA, Uitdehaag BMJ, Barkhof F. Consensus recommendations for MS cortical lesion scoring using double inversion recovery MRI. Neurology 2011; 76:418-24. [PMID: 21209373 DOI: 10.1212/wnl.0b013e31820a0cc4] [Citation(s) in RCA: 218] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Different double inversion recovery (DIR) sequences are currently used in multiple sclerosis (MS) research centers to visualize cortical lesions, making it difficult to compare published data. This study aimed to formulate consensus recommendations for scoring cortical lesions in patients with MS, using DIR images acquired in 6 European centers according to local protocols. METHODS Consensus recommendations were formulated and tested in a multinational meeting. RESULTS Cortical lesions were defined as focal abnormalities on DIR, hyperintense compared to adjacent normal-appearing gray matter, and were not scored unless ≥ 3 pixels in size, based on at least 1.0 mm(2) in-plane resolution. Besides these 2 obligatory criteria, additional, supportive recommendations concerned a priori artifact definition on DIR, use of additional MRI contrasts to verify suspected lesions, and a constant level of displayed image contrast. Robustness of the recommendations was tested in a small dataset of available, heterogeneous DIR images, provided by the different participating centers. An overall moderate agreement was reached when using the proposed recommendations: more than half of the readers agreed on slightly more than half (54%) of the cortical lesions scored, whereas complete agreement was reached in 19.4% of the lesions (usually larger, mixed white matter/gray matter lesions). CONCLUSIONS Although not designed as a formal interobserver study, the current study suggests that comparing available literature data on cortical lesions may be problematic, and increased consistency in acquisition protocols may improve scoring agreement. Sensitivity and specificity of the proposed recommendations should now be studied in a more formal, prospective, multicenter setting using similar DIR protocols.
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Affiliation(s)
- J J G Geurts
- VU University Medical Center, Department of Anatomy & Neuroscience, MF G-116, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
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Förster A, Gass A, Kern R, Griebe M, Hennerici M, Szabo K. Thrombolysis in Posterior Circulation Stroke: Stroke Subtypes and Patterns, Complications and Outcome. Cerebrovasc Dis 2011; 32:349-53. [DOI: 10.1159/000330346] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 06/01/2011] [Indexed: 11/19/2022] Open
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Maeder P, Bracoud L, Chabriat H, Gass A, Michel P, Hennerici M. Design, data management, and population baseline characteristics of the PERFORM magnetic resonance imaging project. J Neurol 2010; 258:795-803. [PMID: 21128081 PMCID: PMC3090565 DOI: 10.1007/s00415-010-5841-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 08/12/2010] [Revised: 10/22/2010] [Accepted: 11/15/2010] [Indexed: 11/29/2022]
Abstract
Quantitative information from magnetic resonance imaging (MRI) may substantiate clinical findings and provide additional insight into the mechanism of clinical interventions in therapeutic stroke trials. The PERFORM study is exploring the efficacy of terutroban versus aspirin for secondary prevention in patients with a history of ischemic stroke. We report on the design of an exploratory longitudinal MRI follow-up study that was performed in a subgroup of the PERFORM trial. An international multi-centre longitudinal follow-up MRI study was designed for different MR systems employing safety and efficacy readouts: new T2 lesions, new DWI lesions, whole brain volume change, hippocampal volume change, changes in tissue microstructure as depicted by mean diffusivity and fractional anisotropy, vessel patency on MR angiography, and the presence of and development of new microbleeds. A total of 1,056 patients (men and women ≥ 55 years) were included. The data analysis included 3D reformation, image registration of different contrasts, tissue segmentation, and automated lesion detection. This large international multi-centre study demonstrates how new MRI readouts can be used to provide key information on the evolution of cerebral tissue lesions and within the macrovasculature after atherothrombotic stroke in a large sample of patients.
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Affiliation(s)
- P Maeder
- Centre Hospitalier Universitaire Vaudois, Service de Radiologie, Lausanne, Switzerland.
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Förster A, Gass A, Kern R, Wolf ME, Hennerici MG, Szabo K. MR imaging-guided intravenous thrombolysis in posterior cerebral artery stroke. AJNR Am J Neuroradiol 2010; 32:419-21. [PMID: 21127143 DOI: 10.3174/ajnr.a2300] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PCA stroke was under-represented in or excluded from the clinical trials examining thrombolysis based on the PWI-DWI mismatch concept. We present 6 patients with PCA stroke treated with thrombolysis in an extended time window by using MR imaging criteria. Symptoms included aphasia, sensorimotor hemiparesis, hemineglect, and homonymous hemianopia. Initial MR imaging demonstrated circumscribed ischemic lesions in the thalamus or hippocampus; MR angiography showed PCA occlusion with corresponding hypoperfusion. Follow-up MR imaging showed partial/complete recanalization in 4 patients with minor infarction growth, while in 1 patient, PCA occlusion persisted, resulting in a large PCA infarction. Three patients improved within 2 hours; at discharge, homonymous hemianopia had resolved in 3 patients. At 3-month follow-up, 4 patients had an mRS score of 0 or 1. These results support the approach to treat patients with PCA stroke with thrombolysis based on the mismatch concept. Because rehabilitation options for hemianopia are limited, thrombolysis may enhance the chance of a favorable outcome.
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Affiliation(s)
- A Förster
- Department of Neurology, Universitäts Medizin, University of Heidelberg, Mannheim, Germany.
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De Stefano N, Giorgio A, Battaglini M, Rovaris M, Sormani MP, Barkhof F, Korteweg T, Enzinger C, Fazekas F, Calabrese M, Dinacci D, Tedeschi G, Gass A, Montalban X, Rovira A, Thompson A, Comi G, Miller DH, Filippi M. Assessing brain atrophy rates in a large population of untreated multiple sclerosis subtypes. Neurology 2010; 74:1868-76. [DOI: 10.1212/wnl.0b013e3181e24136] [Citation(s) in RCA: 237] [Impact Index Per Article: 16.9] [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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Habermeyer B, Weier K, Feil B, Fuhr P, Gass A, Müller-Spahn F. Progression of bilateral striopallidal calcinosis and parkinsonism in a case of Gorlin syndrome. J Neuropsychiatry Clin Neurosci 2010; 21:233-5. [PMID: 19622705 DOI: 10.1176/jnp.2009.21.2.233] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Amann M, Doessegger L, Hirsch J, Penner I, Raselli C, Weier K, Duyar H, Kappos L, Radue E, Gass A. 16. Functional adaption to working memory tasks is altered in patients with relapsing–remitting multiple sclerosis. Clin Neurophysiol 2009. [DOI: 10.1016/j.clinph.2009.07.020] [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: 11/17/2022]
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Kraemer M, Schormann T, Dabringhaus A, Hirsch J, Gass A. Chronic changes in brain volume in MS patients: individual analysis and group data as assessed using Voxel-Guided Morphometry. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)70453-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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46
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Bendfeldt K, Blumhagen JO, Kuster P, Traud S, Egger H, Naegelin Y, Gass A, Hirsch J, Kappos L, Matthews PM, Nichols TE, Radue EW, Borgwardt SJ. Spatiotemporal relations between longitudinal gray matter and white matter lesion changes in multiple sclerosis – A combined parametric and non-parametric voxel-based morphometry study. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)70124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Gass A. Der Beitrag neuer MRT-Untersuchungs- und Analysetechniken. KLIN NEUROPHYSIOL 2009. [DOI: 10.1055/s-0029-1216106] [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: 10/21/2022]
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Singer OC, Berkefeld J, Lorenz MW, Fiehler J, Albers GW, Lansberg MG, Kastrup A, Rovira A, Liebeskind DS, Gass A, Rosso C, Derex L, Kim JS, Neumann-Haefelin T. Risk of symptomatic intracerebral hemorrhage in patients treated with intra-arterial thrombolysis. Cerebrovasc Dis 2009; 27:368-74. [PMID: 19218803 DOI: 10.1159/000202427] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Accepted: 11/25/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In intra-arterial (IA) thrombolysis trials, higher rates of symptomatic intracerebral haemorrhage (sICH) were found than in trials with intravenous (IV) recombinant tissue plasminogen activator (tPA); this observation could have been due to the inclusion of more severely affected patients in IA thrombolysis trials. In the present study, we investigated the rate of sICH in IA and combined IV + IA thrombolysis versus IV thrombolysis after adjusting for differences in clinical and MRI parameters. METHODS In this multicenter study, we systematically analyzed data from 645 patients with anterior-circulation strokes treated with either IV or IA thrombolysis within 6 h following symptom onset. Thrombolytic regimens included (1) IV tPA treatment (n = 536) and (2) IA treatment with either tPA or urokinase (n = 74) or (3) combined IV + IA treatment with either tPA or urokinase (n = 35). RESULTS 44 (6.8%) patients developed sICH. sICH patients had significantly higher scores on the National Institutes of Health Stroke Scale (NIHSS) at admission and pretreatment DWI lesions. The sICH risk was 5.2% (n = 28) in IV thrombolysis, which is significantly lower than in IA (12.5%, n = 9) or IV + IA thrombolysis (20%, n = 7). In a binary logistic regression analysis including age, NIHSS score, time to thrombolysis, initial diffusion weighted imaging lesion size, mode of thrombolytic treatment and thrombolytic agent, the mode of thrombolytic treatment remained an independent predictor for sICH. The odds ratio for IA or IV + IA versus IV treatment was 3.466 (1.19-10.01, 95% CI, p < 0.05). CONCLUSION In this series, IA and IV + IA thrombolysis is associated with an increased sICH risk as compared to IV thrombolysis, and this risk is independent of differences in baseline parameters such as age, initial NIHSS score or pretreatment lesion size.
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Affiliation(s)
- O C Singer
- Klinik für Neurologie, Goethe-Universität, Frankfurt, Germany.
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Kraemer M, Schormann T, Dabringhaus A, Hirsch J, Stephan K, Hömberg V, Kappos L, Gass A. 186. Individual assessment of chronic brain tissue changes in MRI – The role of focal lesions for brain atrophy development. A voxel-guided morphometry study. Clin Neurophysiol 2009. [DOI: 10.1016/j.clinph.2008.07.184] [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: 11/26/2022]
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Sailer M, Fazekas F, Gass A, Kappos L, Radue EW, Rieckmann P, Toyka K, Wiendl H, Bendszus M. Zerebrale und spinale MRT-Untersuchung bei Patienten mit klinisch isoliertem Syndrom oder gesicherter Multipler Sklerose. ROFO-FORTSCHR RONTG 2008; 180:994-1001. [DOI: 10.1055/s-2008-1027817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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