[Determining the status of the cervical spine after whiplash injury]. / Standortbestimmung zum Zustand nach Beschleunigungsmechanismus an der Halswirbelsäule.

The results of medical investigations following acceleration mechanism to the cervical spine (so called "soft tissue neck injury") are to be described in common diagnostic terms. Biomechanical and legal considerations are beyond medical competence. In certain cases, the clinical examination must be completed in cooperation with specialists. Within the entire medical context, the neuropsychological and neuropsychiatric assessment may contribute to a comprehensive understanding of the consequences. In cases of litigation, the full array of facts, like the patients' previous history, and differential diagnoses, have to be drawn to attention. At present, compensation takes place only exceptionally and in a limited range, if an impairment by an accompanying brain injury is excluded.

[Local therapeutic fibrinolysis in ischemic cerebrovascular insults: initial findings in 6 patients]. / Lokale therapeutische Fibrinolyse bei ischämischen zerebrovaskulären Insulten: erste Ergebnisse bei 6 Patienten.

Local therapeutic fibrinolysis is considered an efficient and established treatment for peripheral arterial occlusive disease. The introduction of newer fibrinolytics along with the development of interventional catheterization techniques have extended its use to previously untreated events such as cerebrovascular occlusions. Between 1989-1991 six patients with basilar and/or middle cerebral artery thrombosis were treated at the University Hospital, Basel, by superselective local intraarterial infusion of 400,000 U/h urokinase for 1-2 hours. Two of four patients with basilar artery occlusion showed complete remission one year after the intervention. The third showed no neurological improvement despite angiographic recanalization, and 48 h later suffered a fatal brainstem haemorrhage, while the fourth did not recover from coma and succumbed. Both patients with occlusion of the middle cerebral artery showed complete recanalization, but one had complete and the other partial neurological remission. Signs of slight systemic fibrinolysis were present but never attained the intensity of systemic therapeutic fibrinolysis as the antiplasmin and fibrinogen values showed. In summary, local therapeutic fibrinolysis contributes to the reduction of mortality and to remission of symptoms in occlusions of basilar artery, and offers some advantage in occlusions of the middle cerebral artery. A definite benefit from the latter will be proved only through large-scale randomized trials. The indication for local therapeutic fibrinolysis for thromboses of cerebral arteries requires a careful benefit-risk evaluation, an experienced angiography team and a special infrastructure for computed tomography and digital subtraction angiography.