Incidental white-matter foci on MRI in "healthy" subjects: evidence of subtle cognitive dysfunction.

The clinical significance of incidental white-matter foci seen on MRI is controversial. Mainly using a computer-assisted neuropsychological test battery, we tested the hypothesis that there is a clinical correlate of these foci. We studied 41 individuals aged 45-65 years with no history of neurological or psychiatric disorder, in whom no indication of central nervous system abnormalities was found on standardised neurological examination. A computer-assisted neuropsychological test battery, with the advantage of precise measuring of both time and deviation (e.g. in position memory tests), and rating scales for emotional dysfunction were administered; selected soft neurological signs were assessed. In 16 subjects (39%) MRI showed high-signal foci in the white matter on spin-echo sequences. White-matter foci not adjacent to the lateral ventricles were found to be related to performance on immediate visual memory/visuoperceptual skills, visuomotor tracking/psychomotor speed and, to a lesser degree, learning capacity and abstract and conceptual reasoning skills. Subtle cognitive dysfunction would appear to be a clinical correlate of punctate white-matter foci on MRI of otherwise "healty" individuals.

Periventricular plaques in multiple sclerosis: irreversible? An MRI follow-up study.

Follow-up MRIs over a period of 2-3 years in 50 patients with multiple sclerosis demonstrate that, in contrast to the circumscribed nonperiventricular lesions of the cerebral white matter, the periventricular plaques only show a remission in exceptional cases as ovoid lesions adjacent to the pars centralis of the lateral ventricles. 90% of the patients exhibited at least one new or enlarged nonperiventricular lesion. 72% had more pronounced periventricular lesions in the second scan. With the help of serial MRIs, inferences can be drawn about the histopathological stage of individual demyelination plaques.

Initial experience with SPECT examinations using [123I]IBZM as a D2-dopamine receptor antagonist in Parkinson's disease.

[123I]IBZM is a new radioactive labelled ligand which has a high affinity and specificity to D2-dopamine receptors. The in vivo kinetics of [123I]IBZM were studied in patients with unilateral and bilateral accentuated idiopathic Parkinson's disease. The uptake in the basal ganglias and the imaging properties of this D2 receptor antagonist as a radiopharmaceutical for SPECT examinations had to be investigated. 5 patients, aged 42-66 years, (2 m/3 f) were examined. Each patient received 185 MBq [123I]IBZM intravenously. Blood samples were taken 0-120 min post injection (p.i.) and time activity curves were plotted. Three SPECT examinations were performed (I: 30-50 min; II: 50-70 min; and III: 70-90 min p.i.). The count rates (counts/pixel) in the basal ganglias and the cerebellum were measured for each SPECT series on transverse slices using the region-of-interest technique. The time-activity curve of [123I]IBZM shows a rapid decline in plasma during the first 10 min followed by a plateau until 120 min after injection. The SPECT examinations demonstrate the highest count rate in the basal ganglia during SPECT series III (i.e., 70-90 min p.i.). The side-to-side difference of the count rates were in the range of 3% in four patients, and 10% in one patient. The biokinetic data of [123I]IBZM make this substance capable as a radiopharmaceutical for SPECT examinations. The basal ganglia are best visualized 70-90 min p.i., thus [123I]IBZM seems to be a promising imaging agent for diseases of the D2-dopaminergic receptor system.

Long-term follow-up of MS: disease activity detected clinically and by MRI.

Prospective clinical and magnetic resonance imaging (MRI) studies were performed over a period of 2-3 years on 51 MS patients. Comparing cerebral MRI and neurological evaluation for sensitivity in detecting disease activity, follow-up MRI turned out to be superior to standardized clinical assessment. In particular, an interval during which the clinical findings remain stable may not necessarily indicate that there is no florid inflammatory activity during this time. The morphological progression demonstrated a preference towards periventricular localization around the posterior horns of the lateral ventricles, and non-periventricularly in the frontal white matter. Longitudinal MRI studies of the disease activity can be an aid in obtaining a more definite diagnosis. Patients having had the disease for a longer period showed a more rapid clinical and morphological progression. Clinical progression and an increase in periventricular involvement were observed more often in the primary unremitting-progressive form of MS than in the relapsing-remitting form.

Multiple sclerosis: relations between MRI and CT findings, cerebrospinal fluid parameters and clinical features.

Cerebral MRI and CT findings were compared with various cerebrospinal fluid (CSF) parameters and clinical features in 75 patients with multiple sclerosis (MS). There were positive correlations between CSF albumin as a parameter of blood-brain barrier function and morphological parameters, namely the number of nonperiventricular foci and periventricular involvement demonstrated by MRI and ventricular enlargement as shown by CT. Apart from positive correlations between the number of nonperiventricular foci and CSF levels of IgA and IgG, including the IgG synthetic rate, no other correlations were found between CSF parameters (leucocyte count and immunoglobulin concentrations) and morphological findings. The unremitting-progressive type of MS was distinguished from the relapsing-remitting form by a lower CSF leucocyte count and a higher degree of disability, but there was no difference between the morphological findings in the two forms. Positive correlations were found between degree of disability and both periventricular involvement in the MRI and CT evidence of ventricular enlargement. In terms of correlations with the duration of disease, cerebral MRI proved to be far superior to CSF evaluations.

[EEG findings during the course of HIV infection]. / EEG-Befunde im Verlauf der HIV-Infektion.

Clinical neurological complications in HIV-infection (Human Immunodeficiency Virus) are seen in later stages of the disease. EEGs of 186 patients in different stages of HIV-infection and of 44 HIV-seronegative volunteers (total of 566 recordings) were evaluated visually; this revealed an increasing appearance of CNS-dysfunction (slowing of background activity, focal and diffuse CNS-dysfunction) associated with a progression of the disease. Slowing of background activity was already found in early stages of HIV-infection. Additional focal and diffuse changes in the electrical activity of the brain are also seen with progression of the infection (LAS/ARC-AIDS). The correlation between these electroencephalographic changes and HIV related clinical symptoms are non specific however, EEG recordings can be a valuable aid in following CNS-dysfunction during the course of HIV-infection.

[Early detection of multiple sclerosis: MR findings in the initial manifestations of multiple sclerosis]. / Früherkennung der multiplen Sklerose: MR-Befunde bei der Erstmanifestation der multiplen Sklerose.

The MR results in 21 patients showing the initial manifestations of multiple sclerosis (MS) were compared with those in 45 patients with a long history of MS. As in the old cases, MR proved a very sensitive technique during the early manifestations, with abnormal findings in 20 out of the 21 patients. The relatively characteristic MR findings in long-standing MS (predominant peri-ventricular involvement with a relatively typical pattern) was seen in the early stages is only rare cases. The value of MR during the initial manifestations of MS is in cases where the clinical findings are not conclusive and laboratory diagnosis (evoked potentials, CSF findings) are indefinite. In these patients the findings of multiple lesions in the brain can confirm the suspected diagnosis of MS.

Detection of brainstem lesions in multiple sclerosis: comparison of brainstem auditory evoked potentials with nuclear magnetic resonance imaging.

Topographical information provided by brainstem auditory evoked potentials (BAEPs) was investigated in 43 patients by comparison with cerebral nuclear magnetic resonance imaging (NMR). Lesions in the region of the brainstem auditory pathways were demonstrated by BAEPs in 44.2%, and in 39.5% by NMR. As regards brainstem levels, in 15/21 (71.4%) with abnormal findings at least one lesion was verified by NMR-matched BAEP results. The study confirms the topographical information provided by the BAEPs on the different levels of the brainstem, but not the assumption that generation of the BAEPs is predominantly ipsilateral. BAEPs retain their importance for the detection of disseminated lesions in the diagnosis of multiple sclerosis (MS) in the era of expensive imaging methods.

[Initial manifestation of disseminated encephalomyelitis: MRT comparative study with established disseminated encephalomyelitis]. / Erstmanifestation der Encephalomyelitis disseminata: MRT-Vergleichsstudie gegenüber gesicherter Encephalomyelitis disseminata.

40 patients with a definite diagnosis and 16 patients with an initial manifestation of multiple sclerosis were investigated by cerebral nuclear magnetic resonance imaging (NMR) and compared. The initial manifestation is predominantly characterized in the NMR by significantly less periventricular involvement, especially within the region of the occipital horns, by significantly rarer appearance of confluent, periventricular lesions within the region of the pars centralis and the temporal horns of the lateral ventricles and by significantly rarer appearance of circumscribed non-periventricular lesions. Unlike those in definite multiple sclerosis, the morphology and distribution of the initial lesions do not show a stereotypical and diagnostically characteristic pattern. The importance of the cerebral NMR for the early diagnosis of multiple sclerosis lies primarily in the indication of disseminated lesions.

[Significance of magnetic resonance tomography in disseminated encephalomyelitis]. / Zur Bedeutung der Magnetischen Resonanz-Tomographie bei Encephalomyelitis disseminata.

23 out of 24 patients with multiple sclerosis showed multiple, distinct lesions on investigation with cerebral nuclear magnetic resonance imaging (NMR). Arguments for the specific relationship of these lesions to demyelinating foci are: 1. Morphology and pattern of distribution agree to the known pathological observations. 2. Single lesions shown by computerized tomography (CT) were similarly located to lesions shown by NMR. The morphology and distribution of the lesions in the NMR show a common pattern largely independent of the individual neurological deficits. The nuclear magnetic resonance imaging is a method of high sensitivity and specificity for the diagnosis of multiple sclerosis. It offers valuable additional information in particular for early diagnosis and in cases of diagnostic uncertainty.

[Clinical picture of multiple sclerosis in the magnetic resonance tomogram]. / Das Erscheinungsbild der multiplen Sklerose im magnetischen Resonanztomogramm.

We performed magnetic resonance tomography (MRT) on 22 patients with multiple sclerosis (MS) using varying scan sequences. In 21 patients MRT produced abnormal findings demonstrating multiple lesions, giving varying signals. The MRT appearances of MS have the following characteristics: circular configuration and homogeneous structure of individual lesions, multiple foci, with involvement of all parts of the brain, but with preference for the periventricular region and white matter. This constellation of MRT features is characteristic for MS, but is largely independent of the varying clinical symptoms. The appearance of the individual lesions and the distribution pattern of the foci is sufficiently characteristic to support the clinical diagnosis of MS in younger patients.

[EEG findings in patients with aortocoronary bypass--a visual-morphologic analysis in comparison with clinical data]. / EEG-Befunde bei Patienten mit aorto-koronarem Bypass--Eine visuell-morphologische Analyse im Vergleich mit klinischen Daten.

In course of a catamnesis during a period of 1,5 up to 5 years after operation we made electroencephalographic examinations in 140 patients submitted to an aorto-coronary-veins-bypass (ACVB). Compared with a control group of corresponding age we observed a significant frequency of focal disturbances, being interpreted as expression of an increased functional lability due to vascular effects. 14 percent of these patients showed evident signs of cerebrovascular insufficiency. 33 percent suffered from symptoms of the unspecific pseudoneurasthenic syndrome, often to be found in the preliminary region of cerebrovascular insufficiency. Compared with the control group we found among the EEG of alpha-type within the ACVB-group a significantly increased number of subvigilant patterns. There were no relations between the extent of these patterns and the clinical syndromes of cerebrovascular insufficiency and pseudoneurasthenia. The increased appearance of fluctuations of vigilance within the group showing a higher vascular morbidity can be regarded as a first step of limited regulative dynamics. The results of this study confirm the necessity of an interdisciplinary medical treatment of patients suffering from arteriosclerosis.

[Doppler ultrasound studies of the extracranial cerebral vessels in migraine patients after ergotamine tartrate administration]. / Dopplersonographische Untersuchungen der extrakraniellen Hirngefässe bei Migräne-Patienten nach Gabe von Ergotamintartrat.

Doppler ultrasound investigations were done in 20 patients with migraine during the symptom-free interval after oral administration of 2 mg and 6 mg ergotamine tartrate. The observed changes of end-diastolic flow velocity as a measure of peripheral total resistance permit simultaneous assessment of the vasoconstrictor effect of ergotamine in the perfusion area of the internal and external carotid arteries. A dosage of 2 mg led to an exclusive increase of resistance in the external carotid artery area without significant changes in the internal carotid area. A maximal therapeutic dosage of 6 mg ergotamine tartrate did not lead to a significant increase of the vasoconstrictor effect in the external carotid circulation. In addition, a barely registrable increase of resistance in the internal carotid area could now be observed.

[EEG in Parkinson's disease and cerebral hypoxia (author's transl)]. / "Parkinson-EEG" und zerebrale Hypoxie.

EEG-findings of a group of 95 patients suffering from Parkinson's disease were related to accompanying diseases inducing cerebral hypoxic hypoxidosis. The EEG in 59 to 74 per cent of our patients was abnormal but the changes were not specific. There was a correlation between age and EEG-abnormalities. On the other hand no association could be seen between EEG-changes and duration of the Parkinson's disease. At least 74 per cent of the patients suffered from concomitant cardiovascular complications and 36 of them had a severe pathologic EEG as well as a pathologic ECG. The results lead to the conclusion that in treatment of parkinsonian patients attention is to be paid to accompanying diseases as heart failure, angiopathy or anemia.

[Influence of the Benzodiazepine-derivative Ro 06-9098/000 on choreo-athetotic syndromes (author's transl)]. / Beeinflussung choreo-athetotischer Syndrome mit dem Benzodiazepin-Derivat Ro 06-9098/000.

Five patients suffering from choreo-athetotic syndromes of different genesis were treated with the benzodiazepine-derivative Ro 06-9098/000 (7-Nitro-1(methylmethoxy)-1,3-dihydro-5-phenyl-2 H-1,4-benzodiazepin-2-one). The existing hyperkinesias could be well influenced in four cases of male patients, sufficiently in one case of a female patient. The sedative effect, accompanied by a muscle hypotonia appearing simultaneously under the medication, did not represent and essential limiting factors at the chosen dose of 5--20 mg/die. The observed successes in therapy point at the result and effect of benzodiazepine derivatives on extra-pyramidalmotoric hyperkinesias which got little attention until now.

Impairment of vigilance and performance under lithium-treatment. Studies in patients and normal volunteers.

Subtle changes of adaptive behaviour under lithium treatment may possess interest not only as side-effects, but also as a possible explanation for the mechanism of action of lithium salts. - In 18 patients under long-term lithium treatment and 10 normal volunteers before and after one week of lithium application the EEG was recorded and performance as well as psychophysiological tests were carried out. The results, particularly of the d-2-test point to a considerably reduced performance in patients and normal volunteers. The EEG data in both groups suggest reduced vigilance until stage B3 or C (in the sense of Head of Bente); CFF was significantly elevated only during the first days of lithium application in the normal volunteers. Whereas EEG changes persist, other symptoms as CFF reduction, fine hand tremor, or reduced performance resolved at least partially 7 days after lithium withdrawal in the normal volunteers.