[Choreic syndrome following intramuscular exhibition of a contraceptive preparation (author's transl)]. / Ein choreatisches Syndrom nach intramuskulärer Applikation eines Kontrazeptivums.

PIP: A 32 year old woman with an IQ of 67 was under treatment for a post-partum psychosis characterized by a manic paranoic condition and confused thinking. An injection preparation consisting of medroxyprogesterone acetate was administered as a contraceptive. 2 days later the patient was suffering from a choreatic syndrome involving twitching in the upper extremities. Treatment with 5 mg haloperidol i.v. caused some improvement. Besides a fever, laboratory tests showed no definite results which would indicate the cause of the choreatic disturbance or the manic paranoic condition.^ieng

[EEG changes in abuse and addiction of bromide hypnotics [author's transl)]. / EEG-Veränderungen bei Missbrauch und Abhängigkeit von bromhaltigen Schlafmitteln.

With bromism we stated a slow EEG-activity. Such alterations of the electro-encephalogram can be caused by urea of bromine, its metabolites and by the inorganic bromide ion. We tried to find out the real effect of the bromide ion which is not bound in the serum. Therefore we only examined the EEG and the bromine serum after the acute influence of the urea of bromine had faded (> 5 days). Patients suffering of disturbances of metabolism or system-diseases, tumors and infections or patients undergoing a medicamentous therapy were excluded from these tests. During the years 1971, 1972 and 1977 we found 26 patients (bromine in serum > 5 mg%) who corresponded to the above mentioned conditions and on whose data the results of our studies are based. 16 patients had very high bromine values (> 24,6 mg%). Most of these patients (10 out of 16) showed paranoid-hallucinatory symptoms. We also stated delirious and depressive attacks. No one suffered of mental dullness. The EEG of 7 patients showed general alterations. With lower bromine values (< 24,6 mg%) we could neither state general alterations of the EEG nor psychotic or delirious symptoms. We didn't observe any paroxysmal disturbance of the EEG. We also didn't notice a acceleration of the EEG, as it was stated with other medical preparations.

[Miniaturized methods to monitor intracranial pressure. Technical and clinical results (author's transl)]. / Miniaturisierte Methoden zur Uberwachung des intrakraniellen Druckes. Techniken und klinische Ergebnisse.

The prognosis of numerous diseases of the central nervous system is essentially determined by the intracranial pressure (ICP) and its therapeutic influencing. Long-term monitoring of the ICP must therefore be the objective in neurological and neurosurgical patients at risk. For this purpose, miniaturized methods were tested and developed. To monitor the intracranial pressure in patients who were not operated on, a miniature pressure transducer the size of a match head was used which was directly implanted 'percutaneously' in the intensive care unit: After a stab wound had been made in the skin, a 5-mm burrhole is made; the specially constructed miniature coaxial burr which disengages as soon as it touches the dura automatically enables coplanar epidural implantation of the transducer by means of an adapter capsule. The skin is closed without tension. For monitoring the pressure after trepanation, a spiralled miniature pressure transducer is implanted. The equally flattened receiver with lateral membranes is placed intracranially as desired, e.g., epidurally or subdurally, durin the operation. The zero point can be checked from outside without danger of infection. After the end of the measurements the recorder is easily extracted. Up to the present time, the epidural pressure has been reliably monitored for several weeks by this method in 86 patients. Ten comparative measurements showed corresponding cerebrospinal fluid pressures to within a few mm Hg with very good reproduction of frequency and amplitude. Small zero drift and the external zero control give an accuracy of measurement +/- 5 mm Hg independently of the time of measurement. The measurement permits early recognition of progressive intracranial space-occupying lesions. In 14 patients (16%) a measured rise in intracranial pressure was an essential basis for indication for neurosurgical operations. In addition, the pressure measurement provides an objective assessment of the effect of measures to lower the ICP; progressive increases in intracranial pressure which cannot be influenced conservatively can be brought for surgical decompression in good time before the brain has been irreversibly damaged by pressure. In craniocerebral traumata, monitoring the intracranial pressure permits the differentiation of primary damage to the brain stem with uniform, normal intracranial pressure from secondary constrictions of the brain stem with considerable rise of intracranial pressure and disturbed autoregulation. Only in chronic subdural haematomata are considerable displacements of intracranial masses to be seen with only slightly increased ICP ( less than 30 mm Hg). Besides space-occupying lesions, the measurement of pressure also detects generalised epileptic attakcs due to a considerable rise in intracranial pressure caused by hyperemia. Also disorders of respiration are recognised by supervision of ICP. The procedures described seem suitable for routine monitoring of ICP in patients at risk, with little operative effort and minimum danger...

Effect of furosemide (lasix) on acute severe experimental cerebral edema.

The effect of furosemide (Lasix) therapy on a standardized experimental cerebral edema, induced in rats by applying a cooling stamp to the right side of the skull over the right coronal suture by means of a stereotactic instrument, was examined. The hemispherically separated water and electrolyte contents of the brain were analyzed after 24 h. Following furosemide therapy, the behavior of these edema parameters was compared statistically with dexamethasone, glycerol and albumin. An increase of the water and sodium content, and a decrease of potassium was observed 24 h after the trauma, especially in the right hemisphere. Furosemide did not improve either the water content or the electrolyte balance. By contrast, the administration of dexamethasone, glycerol and albumin was followed by a significant improvement of the edema. In experiments with cats, the course of the edema and the effect of furosemide on the cold brain injury of the right hemisphere were observed by measuring the intracranial pressure (ICP) values, and by continuous monitoring of the EEG. The ventricular CSF pressure and epidural pressures were also recorded. The electrical brain activity was continuously compared with the course of the ICP by means of computer analysis. In addition, the blood osmolality and diuresis were monitored. The ICP increased rapidly after the trauma, establishing considerable pressure gradients, and the EEG power intensities decreased markedly on the right side. Histologically, there was an extended edema of the white matter of both hemispheres. The ICP was not lowered by single injections or high dose infusions of furosemide, and the EEG power intensities also did not improve. Infusions of large volumes of furosemide even resulted in an increase of ICP, but infusion of 40% sorbitol effected a rapid decrease of ICP and EEG recovery over the left hemisphere. Sorbitol infusion also caused a marked rise in the blood osmolality, whereas furosemide had no such effect. The results raise considerable doubts as to the propriety of the exclusive use of furosemide for cases of acute cerebral edema with raised ICP. The diuretic effect is insufficient to establish an osmotic gradient, and its general dehydrating effect does not acutely influence the ICP. The absence of effect on the experimental tissue edema would not appear to commend furosemide as basic therapy for cases of traumatic cerebral edema.

Prognostic information from EEG and ICP monitoring after severe closed head injuries in the early post-traumatic phase. A clinical and experimental study.

Neither the EEG investigations on the first post-traumatic day after severe enclosed brain injury nor evaluation of the clinical finding on the first day permit a pronosis. Measurement of intracranial pressure is necessary for monitoring of intracranial complications, but can only make a contribution to prognosis when a critical intracranial pressure is reached. There is a slight correlation between the severity of the EEG alteration and the later outcome on the second day. If an alpha EEG is found on the first day, the prognosis in all cases is not so poor as assumed by other authors.

Comparison of the effects of surgical decompression and resection of local edema in the therapy of experimental brain trauma. Investigation of ICP, EEG and cerebral metabolism in cats.

The effect of decompressive trepanation was compared to that of surgical resection of the traumatized tissue in the course of traumatic brain edema in standardized experimental brain trauma. Following a right parietal cold injury, the following parameters were monitored continuously in 12 cats: ventricular pressure, epidural pressure over both hemispheres, arterial and central venous pressure and heart rate. The EEG was evaluated continuously, using a computer (power spectra). After catheterization of the superior sagittal sinus, cerebral arteriovenous differences of glucose, lactate, O2 and CO2 were calculated. 6 animals were treated surgically when showing elevated intracranial pressure ICP and markedly altered EEG. In 3 animals, the right hemisphere was decompressed by extensive resection of bone and dura. In 3 further animals, the softened brain tissue of the cold lesion was resected and the skull defect closed. 6 untreated animals were used in controls. A decompression by skull hemiresection for ablation of the injured cortex abolished the high intracranial pressure, but only the latter method seemed to prevent further damage. This could be demonstrated by the EEG registration, and by the normalization of arteriovenous metabolite differences. Only animals treated with edema resection had a normal arousal reaction and survived the trauma. The results indicate, that only an ablation of the local injury will prevent further damage to the brain. After decompressive trepanation alone, the progression of tissue edema is not interrupted. As can be seen from the literature, the poor results obtained even from extensive decompressive operations in traumatic brain edema, indicate that the further development of edema is independent of the intracranial pressure, whereas the favorable results of resection of lobar contusions show an interruption of the spread of dysbolism.

A new miniaturized system for monitoring the epidural pressure in children and adults.

A new miniaturized epidural pressure transducing system for monitoring intracranial pressure (ICP) has been developed. The system is of the as yet smallest known dimensions. The transducer is implanted automatically coplanar to the dura via a burr hole of 4 mm diameter in the conscious patient without special surgical equipment. Application is possible in adults, children and infants. We have achieved a maximal resolution of 10(-3) mm of Hg. At a full scale range of 100 mm of Hg the zero-point drift is less than 1 mm of Hg/24 h.