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1.
Eur J Neurol ; 14(6): 690-3, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17539952

ABSTRACT

Positron emission tomography with 11C-N-methyl-4-piperidyl-acetate (MP4A) was applied in eight healthy volunteers and two patients with mild Alzheimer's disease (AD) to assess acetylcholine esterase (AChE) activity in magnetic resonance imaging-identified brainstem nuclei. Uptake ratios in lateral dorsal tegmental and pedunculopontine nuclei relative to cerebellum yielded reproducible values for the AChE activity in controls and reduced values in AD, more marked in a patient with complaints of disturbed sleep. Cortical AChE activity was related to the extent of cognitive impairment which was more severe in the AD patient without sleep disturbance. This preliminary observational study demonstrates the feasibility to image and assess AChE activity in small nuclei of the brain stem. This approach may be helpful to investigate the interaction of various nuclei in the complex network regulating sleep and wakefulness in representative patient groups with documented sleep disturbance.


Subject(s)
Acetylcholinesterase/metabolism , Alzheimer Disease , Brain Stem/enzymology , Sleep/physiology , Wakefulness/physiology , Aged , Aged, 80 and over , Alzheimer Disease/enzymology , Alzheimer Disease/pathology , Alzheimer Disease/physiopathology , Female , Humans , Male , Positron-Emission Tomography
2.
Brain Lang ; 82(1): 87-94, 2002 Jul.
Article in English | MEDLINE | ID: mdl-12174818

ABSTRACT

In this prospective study we analyzed the prognostic value of topographical quantitative EEG (qEEG) in poststroke aphasia. Twenty-three right-handed patients (ages 56 +/- 12 years) with different types of aphasia were studied. Quantitative EEG under resting conditions and an aphasia test battery were applied twice, 2 and 8 weeks after a stroke. EEG power fast Fourier transform was performed for delta (2-3.5 Hz), theta (4-7.5 Hz), alpha (8-13 Hz), and beta (13.5-20 Hz) frequency bands. EEG abnormalities within and outside speech relevant areas are related to restitution of poststroke aphasia. In the ischemic regions they indicate local disturbances; outside they reflect failures in neuronal networks involved in the generation and propagation of the alpha rhythm.


Subject(s)
Aphasia/etiology , Brain Mapping , Electroencephalography , Stroke/complications , Adult , Aged , Alpha Rhythm , Aphasia/diagnosis , Aphasia/physiopathology , Brain/physiopathology , Fourier Analysis , Humans , Middle Aged , Nerve Net/physiopathology , Prospective Studies , Stroke/physiopathology , Theta Rhythm
3.
Int J Clin Pharmacol Ther ; 39(4): 152-7, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11332870

ABSTRACT

OBJECTIVE: Electroencephalographic and clinical effects of piracetam in post-stroke aphasia were evaluated in a prospective, randomized, double-blind, placebo-controlled trial. METHODS: In 24 patients with mild to moderate aphasia after ischemic stroke, quantitative topographic EEG at rest was studied before and after a 6-week treatment period. RESULTS: In the active treatment group, a significant shift in the alpha-rhythm from frontal to occipital regions was observed which may be due to a restitution of corticothalamic circuits involved in the generation of alpha-activity. CONCLUSION: Neuropsychological scores improved significantly and markedly in various domains of speech during piracetam treatment, whereas improvements were less marked and restricted to a few categories in the placebo group.


Subject(s)
Aphasia/drug therapy , Neuroprotective Agents/therapeutic use , Piracetam/therapeutic use , Adult , Aged , Analysis of Variance , Aphasia/etiology , Brain Mapping/methods , Double-Blind Method , Electroencephalography/drug effects , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Prospective Studies , Stroke/complications , Treatment Outcome
4.
Eur J Neurol ; 7(4): 393-400, 2000 Jul.
Article in English | MEDLINE | ID: mdl-10971598

ABSTRACT

The significance of benzodiazepine receptor (BZR) concentration in comparison with hippocampal metabolism and volumetry was assessed in 14 patients diagnosed with temporal lobe epilepsy (TLE) without hippocampal signal change on T2-weighted magnetic resonance imaging (MRI) scans. Focus lateralization was achieved by clinical, electroencephalographic and neuropsychological examinations. Three-dimensional positron emission tomography (PET) and MRI scans were coregistered for determination of hippocampal 11C-flumazenil (FMZ) binding, normalized to average cortical values for glucose metabolism (rCMRglc) and volume. The hippocampi were individually outlined on T1-weighted MRI. Volumes of interest (VOI) were used for calculation of asymmetries between clinically affected and unaffected sides. Eleven out of 14 TLE patients presented a significant reduction in hippocampal volume. In nine of these 11 patients hippocampal FMZ binding and in seven cases hippocampal CMRglc was also reduced. In two patients without hippocampal volume asymmetry FMZ binding was markedly reduced in the mesial temporal lobe appropriately to the clinically diagnosed side. In our study volumetry is therefore the most sensitive tool for the detection of hippocampal abnormality in TLE. However, in cases without hippocampal atrophy the reduction of FMZ may indicate functional impairment of BZR before neuronal loss becomes evident. Our results emphasize the complementary nature of these tests in TLE patients.


Subject(s)
Epilepsy, Temporal Lobe/metabolism , Hippocampus/metabolism , Receptors, GABA-A/metabolism , Adult , Epilepsy, Temporal Lobe/pathology , Epilepsy, Temporal Lobe/physiopathology , Female , Glucose/metabolism , Hippocampus/pathology , Hippocampus/physiopathology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Tomography, Emission-Computed
5.
Clin Neurophysiol ; 110(4): 615-20, 1999 Apr.
Article in English | MEDLINE | ID: mdl-10378729

ABSTRACT

OBJECTIVE: In patients with vascular dementia (VD), the relationship between the EEG power within the 4 frequency bands and the regional metabolic disturbances was investigated. METHODS: Twenty-eight patients (age 69.0+/-6.54 years) with VD according to NINDS-AIREN criteria underwent quantitative EEG recording, according to the 10-20 system, and fluodeoxyglucose F18 positron emission tomography (PET) at resting condition within 24 h. EEG power FFT-analysis was performed for delta (2-3.5 Hz), theta (4-7.5 Hz), alpha (8-13 Hz) and beta (13.5-20 Hz) frequency bands. Regional EEG power bands were related to regional glucose metabolism in anatomically defined regions corresponding to locations of the 10-20 system. RESULTS: Correlation between slow frequency band power and glucose metabolism was found. A widespread inverse relationship of delta power to metabolism was found between various regions; additionally, delta power was negatively correlated to cerebral glucose metabolism in individual regions. Frontal theta power correlated especially with thalamic CMRglc. Alpha power correlated directly with metabolism in the occipital lobe. No significant relationships were found between beta power and metabolism. CONCLUSION: We conclude that EEG power in VD is linked to glucose metabolism, indicating specific regional dependencies.


Subject(s)
Brain/physiopathology , Dementia/diagnostic imaging , Dementia/physiopathology , Glucose/metabolism , Aged , Analysis of Variance , Brain/metabolism , Cerebrovascular Circulation/physiology , Electroencephalography , Female , Humans , Male , Middle Aged , Tomography, Emission-Computed
6.
J Neurosurg Anesthesiol ; 11(1): 17-24, 1999 Jan.
Article in English | MEDLINE | ID: mdl-9890381

ABSTRACT

Regional cerebral glucose metabolism (rCMRglc) was investigated with 18F-2-fluoro-2-deoxy-D-glucose (FDG) and positron emission tomography (PET) in 24 patients with acute (AVS, duration <1 month, n=11) or persistent (PVS, duration >1 month, n=13) vegetative state (VS) following prolonged anoxia due to cardiorespiratory arrest. After a follow-up period of twelve months, 8 patients had died, 13 remained in a permanent vegetative state and three showed moderate improvement of consciousness, without however regaining independence for activities of daily life. As expected, overall glucose utilization (CMRglc) was significantly reduced in VS in comparison to age matched controls. Infratentorial structures showed a less distinct hypometabolism. Differences in metabolic rates between patients who died or remained in a PVS were small and insignificant and probably reflect different age structures of the two groups. A statistically significant correlation between the degree of evoked potential or EEG alterations in VS and the reduction of global or regional cortical metabolic rates for glucose could not be established. Cortical metabolic rates in patients with PVS were significantly reduced when compared to patients studied in AVS (p<0.05 for all cortical regions of interest except the frontal lobe). This phenomenon reflects the progressive loss of residual cortical function following anoxic brain injury that corresponds to the neuropathological findings of progressive Wallerian and transsynaptic degeneration as sequelae of anoxic brain injury in PVS.


Subject(s)
Brain/metabolism , Glucose/metabolism , Persistent Vegetative State/metabolism , Activities of Daily Living , Adolescent , Adult , Age Factors , Aged , Brain/diagnostic imaging , Case-Control Studies , Cerebellum/diagnostic imaging , Cerebellum/metabolism , Cerebral Cortex/diagnostic imaging , Cerebral Cortex/metabolism , Consciousness/physiology , Electroencephalography , Evoked Potentials, Somatosensory/physiology , Female , Fluorodeoxyglucose F18 , Follow-Up Studies , Frontal Lobe/diagnostic imaging , Frontal Lobe/metabolism , Heart Arrest/complications , Humans , Hypoxia, Brain/diagnostic imaging , Hypoxia, Brain/etiology , Hypoxia, Brain/metabolism , Male , Middle Aged , Nerve Degeneration/metabolism , Nerve Degeneration/physiopathology , Persistent Vegetative State/diagnostic imaging , Persistent Vegetative State/physiopathology , Radiopharmaceuticals , Survival Rate , Tomography, Emission-Computed
7.
J Neural Transm (Vienna) ; 105(8-9): 821-37, 1998.
Article in English | MEDLINE | ID: mdl-9869321

ABSTRACT

Normal aging of the brain is predominantly characterized by metabolic changes in the prefrontal cortex. While in middle age there is a trend to hyperfrontality, PET demonstrates in old age a decline of regional cerebral glucose metabolism in frontal areas. In progeric diseases, clinically apparent as premature aging, the metabolic pattern is similar like in normal aging but qualitatively more severe. In patients with the diagnosis of probable Alzheimer's disease (AD) hypometabolism in early dementia is typically present in heteromodal association areas. Hypometabolism then spreads to other cortical and subcortical regions suggesting a characteristic pattern of degeneration that reflects selective vulnerability within limbic-cortical networks. Synaptic plasticity, clinically apparent as cognitive reserve capacity, can be assessed by PET under specific cognitive activation. In AD it is reduced in comparison to age-matched normals and may be influenced by drugs giving trophic support to neurochemical systems.


Subject(s)
Aging/physiology , Brain Diseases/diagnostic imaging , Brain/diagnostic imaging , Tomography, Emission-Computed , Alzheimer Disease/diagnostic imaging , Alzheimer Disease/physiopathology , Brain/metabolism , Glucose/metabolism , Humans , Myotonic Dystrophy/diagnostic imaging , Neuronal Plasticity/physiology , Reference Values , Synapses/physiology
8.
Med Klin (Munich) ; 93(5): 307-10, 1998 May 15.
Article in German | MEDLINE | ID: mdl-9630815

ABSTRACT

CASE REPORT: A 49-year-old male was admitted for left-side headache and mild speech defect. Clinical examination showed a pansystolic murmur of mitral regurgitation and mild Wernicke aphasia. In laboratory studies ESR and CRP were increased. Computed tomography of brain revealed a left temporoparietal hematoma. Echocardiographic examination demonstrated vegetations and mitral valve perforation. In blood cultures grew alpha-streptococci. Cerebral angiography was performed and a fusiform aneurysm on a distal branch of the left middle cerebral artery was identified. Follow-up angiography showed a total resolution of the aneurysm after 6 weeks of intravenous antibiotics. CONCLUSION: This case demonstrate that patients with intracerebral hematomas associated with infectious endocarditis should be investigated for mycotic intracranial aneurysm.


Subject(s)
Aneurysm, Infected/etiology , Cerebral Hemorrhage/etiology , Endocarditis, Subacute Bacterial/complications , Mitral Valve Insufficiency/complications , Streptococcal Infections/etiology , Streptococcus sanguis , Aneurysm, Infected/diagnosis , Cerebral Hemorrhage/diagnosis , Diagnostic Imaging , Endocarditis, Subacute Bacterial/diagnosis , Follow-Up Studies , Humans , Male , Middle Aged , Mitral Valve Insufficiency/diagnosis , Streptococcal Infections/diagnosis
9.
J Neurol Sci ; 154(1): 76-82, 1998 Jan 21.
Article in English | MEDLINE | ID: mdl-9543326

ABSTRACT

To evaluate efficacy, safety, metabolic and clinical effects of propentofylline in Alzheimer's disease (AD), a prospective, randomized, double-blind, placebo-controlled trial was performed in 30 patients with mild to moderate AD who underwent pretreatment and posttreatment 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography under resting conditions and during stimulation with an auditory memory paradigm. Twenty-eight subjects completed the 3-month study. The drug was well tolerated. In the active treatment group, a significant increase of cerebral metabolic response to the memory task was observed (multiple measurement ANOVA P = 0.02). The placebo group showed a significantly decline in the MMSE score (P = 0.02) while there was no change in the treatment group. This suggests a protective role for propentofylline in slowing the progression of AD.


Subject(s)
Alzheimer Disease/prevention & control , Brain/drug effects , Glucose/metabolism , Memory/drug effects , Neuroprotective Agents/therapeutic use , Xanthines/therapeutic use , Acoustic Stimulation , Adult , Aged , Aged, 80 and over , Alzheimer Disease/diagnostic imaging , Alzheimer Disease/metabolism , Alzheimer Disease/physiopathology , Analysis of Variance , Brain/metabolism , Double-Blind Method , Female , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Humans , Male , Middle Aged , Prospective Studies , Psychometrics , Tomography, Emission-Computed
10.
Invest Radiol ; 32(9): 575-7, 1997 Sep.
Article in English | MEDLINE | ID: mdl-9291046

ABSTRACT

The authors report on the occurrence of a focal demyelination showing a mass effect around a developmental venous anomaly in the cerebellum. Because the latter presented as a single lesion, the differentiation from intraparenchymal neoplasms or infarction was difficult. Follow-up magnetic resonance imaging and histology from a biopsy specimen give useful information to find the appropriate diagnosis.


Subject(s)
Cerebellum/blood supply , Demyelinating Diseases/diagnosis , Intracranial Arteriovenous Malformations/diagnosis , Magnetic Resonance Imaging , Acute Disease , Angiography , Biopsy , Demyelinating Diseases/drug therapy , Diagnosis, Differential , Female , Follow-Up Studies , Glucocorticoids/therapeutic use , Humans , Middle Aged
11.
Epilepsia ; 38(3): 370-3, 1997 Mar.
Article in English | MEDLINE | ID: mdl-9070601

ABSTRACT

PURPOSE: To study benzodiazepine receptor (BZR) density and functional deficits in occipital lobe epilepsy. METHODS: A 39-year-old man who had simple partial visual seizures after neurosurgical transtentorial extirpation of a pinealoma was studied by EEG, magnetic resonance imaging (MRI), and positron emission tomography (PET) of [18F]2-fluoro-2-deoxy-D-glucose (FDG) at rest and during visual activation task and[11C]flumazenil (FMZ). RESULTS: Electroencephalographic recordings were nonspecific, and MRI did not reveal any morphologic anomaly in the occipital lobe. Flumazenil-PET demonstrated a small epileptogenic region in the right visual association cortex and FDG-PET showed hypometabolism in a corresponding location and thalamic diaschisis. Stimulation of occipital metabolism by a continuous visual recognition task improved significantly the contrast between the dysfunctional zone and its surround. CONCLUSIONS: As BZR deficits are restricted to a small region, widespread hypometabolism in networks involved in visual information processing indicates an extensive functional deactivation by the epileptogenic focus.


Subject(s)
Epilepsies, Partial/diagnosis , Occipital Lobe/physiopathology , Tomography, Emission-Computed , Visual Pathways/metabolism , Adult , Carbon Radioisotopes , Deoxyglucose/analogs & derivatives , Electroencephalography , Epilepsies, Partial/diagnostic imaging , Epilepsies, Partial/metabolism , Epilepsies, Partial/physiopathology , Female , Flumazenil , Fluorodeoxyglucose F18 , Functional Laterality , Humans , Magnetic Resonance Imaging , Male , Occipital Lobe/diagnostic imaging , Occipital Lobe/pathology , Receptors, GABA-A/chemistry , Receptors, GABA-A/metabolism , Thalamus/diagnostic imaging , Thalamus/metabolism , Visual Cortex/diagnostic imaging , Visual Cortex/pathology , Visual Cortex/physiopathology , Visual Pathways/diagnostic imaging
12.
J Neurol Sci ; 147(1): 27-34, 1997 Mar 20.
Article in English | MEDLINE | ID: mdl-9094057

ABSTRACT

A high sensitivity and specificity has been shown for magnetic resonance imaging (MRI) and angiography (MRA) in the diagnosis of internal carotid (ICAD) and vertebral (VAD) artery dissections, where arteriography has been and still is the gold standard. Five patients (three with ICAD, two with VAD; age range 42-56 years) are presented, in whom diagnosis and follow-up management were exclusively based on non-invasive measures. In all patients, MRI demonstrated a typical intramural hematoma and MRA in 3D phase contrast technique showed loss or diminished flow. After anticoagulation (heparin) for 3 to 4 weeks follow-up, MRI showed a regression of the mural hematoma and MRA revealed reperfusion or improvement of flow. Depending on the extent of MRI-/MRA-pathology, three patients were put on antiplatelet therapy and two on Coumadin until normalization of MRI and MRA findings, which are assessed in 3-months intervals. We suggest, that with, (I) a suspicious history, symptoms and signs for cervical artery dissection (CAD), (II) typical MR-findings proven to indicate CAD, (III) improving or resolving at follow-up, (IV) in unusual location for atherosclerotic involvement, (V) in the absence of coexisting atherosclerotic lesions, the diagnosis has not to be confirmed with conventional arteriography. Therefore, safe MRI- and MRA-guided anticoagulation and antiplatelet therapy during serial follow-up measurements are possible.


Subject(s)
Aortic Dissection/diagnosis , Carotid Artery Diseases/diagnosis , Carotid Artery, Internal/pathology , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Vertebral Artery/pathology , Adult , Aortic Dissection/complications , Aortic Dissection/therapy , Carotid Artery Diseases/complications , Carotid Artery Diseases/therapy , Female , Hematoma/etiology , Hematoma/therapy , Humans , Male , Middle Aged
13.
Med Klin (Munich) ; 92(2): 112-6, 1997 Feb 15.
Article in German | MEDLINE | ID: mdl-9139210

ABSTRACT

BACKGROUND: Monoclonal gammopathies-including so-called monoclonal gammopathies of undetermined significance-MGUS-may cause polyneuropathies, even if immunoglobulin concentrations are within a normal range. CASE REPORT: We report on a patient with a rapidly progressive polyneuropathy with severe motor disturbances in whom a small amount of a monoclonal IgM kappa cryoglobulin was found. Only by extensive, repeatedly performed diagnostic procedures could scattered lymphoma cells be detected. Nonspecific immunosuppression had been unsuccessful but eventually a more specific chemotherapy led to an almost complete, sustained recovery. CONCLUSION: This case shows that in patients with a polyneuropathy of uncertain etiology monoclonal immunoglobulins should be looked for and that a MGUS can precede a lymphoma. Therefore these, patients with a MGUS and clinical deterioration despite conventional immunosuppressive treatment should undergo large-scale diagnostic check-up to make sure that the chance for an adequate chemotherapy is taken.


Subject(s)
Immunoglobulin M/blood , Immunoglobulin kappa-Chains/blood , Lymphoma, Non-Hodgkin/diagnosis , Paraneoplastic Syndromes/diagnosis , Paraproteinemias/diagnosis , Aged , Bone Marrow/pathology , Cryoglobulinemia/diagnosis , Cryoglobulinemia/immunology , Cryoglobulinemia/pathology , Diagnosis, Differential , Humans , Lymphoma, Non-Hodgkin/immunology , Lymphoma, Non-Hodgkin/pathology , Magnetic Resonance Imaging , Male , Paraneoplastic Syndromes/immunology , Paraneoplastic Syndromes/pathology , Paraproteinemias/immunology , Paraproteinemias/pathology
14.
Clin Endocrinol (Oxf) ; 45(5): 563-9, 1996 Nov.
Article in English | MEDLINE | ID: mdl-8977753

ABSTRACT

OBJECTIVES: Sleep apnoea is common in active acromegaly. It is associated with increased morbidity and mortality but can be treated effectively. The objective of this study was to determine the largely unknown relative frequency of, and the predictive factors for, sleep apnoea in treated acromegalic patients. DESIGN: Retrospective cohort study. SETTING: Tertiary referral hospital. PATIENTS: Fifty-four of 100 patients with treated acromegaly. If sleep apnoea had been diagnosed before acromegaly, the patient was excluded. MEASUREMENTS: Sleep studies (using the MESAM-4 device measuring oxyhaemoglobin saturation, heart rate, snoring sounds and body position to determine presence and severity of sleep apnoea); GH and IGF-I levels; body mass index, neck and index-finger circumference; daytime symptoms of sleep apnoea, duration of acromegaly before treatment, shoe and neck-size difference since beginning of acromegaly; age, sex and treatment modes of acromegaly. RESULTS: The relative frequency of sleep apnoea was 39% in the 54 patients with sleep studies and at least 21% in the entire study population of 100 patients. In patients with sleep apnoea, statistically significant higher values were observed for GH (P = 0.002), IGF-I (P = 0.029), age (P = 0.014) and neck circumference (P = 0.016). An index-finger circumference of > or = 8.5 cm was associated with a significantly higher desaturation index (P = 0.012, Mann-Whitney U-test). Adenomectomy had been performed significantly less frequently in patients with sleep apnoea (P < 0.001, X2 test). The body mass index was non-significantly higher in the patients with sleep apnoea. CONCLUSIONS: The relative frequency of sleep apnoea in patients with treated acromegaly is at least 21%. Parameters of predictive value for the presence of sleep apnoea in this population are neck and index-finger circumference as measures of soft tissue hypertrophy, age, GH and IGF-I levels, and whether or not operative therapy was applied.


Subject(s)
Acromegaly/complications , Sleep Apnea Syndromes/complications , Acromegaly/blood , Acromegaly/surgery , Adult , Age Factors , Female , Fingers/anatomy & histology , Growth Hormone/blood , Humans , Insulin-Like Growth Factor I/analysis , Male , Neck/anatomy & histology , Retrospective Studies , Risk Factors , Sleep Apnea Syndromes/blood
15.
J Neurol Sci ; 141(1-2): 59-64, 1996 Sep 15.
Article in English | MEDLINE | ID: mdl-8880694

ABSTRACT

In a double-blind, placebo-controlled trial in thirty patients with mild to moderate vascular dementia (VD) according to DSM-III-R criteria, the effects of the adenosine uptake blocker propentofylline (HWA 285) on regional cerebral glucose metabolism (rCMRGl) was studied using positron emission tomography of 2-[18F]fluoro-2-deoxy-D-glucose (FDG). 25 subjects completed the 3-months study. Propentofylline significantly improved relative rCMRGl in the motor cortex, while relative rCMRGl in the placebo treated group worsened significantly. Neuropsychologically, visual information processing was improved in the propentofylline group and we observed a trend towards a slowing of the progression of cognitive deterioration in patients with VD. The results of the longitudinal analysis showed further that neuropsychological and metabolic changes are closely related. These findings justify a large-scale clinical trial to prove therapeutic efficacy.


Subject(s)
Anti-Ulcer Agents/therapeutic use , Cerebral Cortex/metabolism , Dementia, Vascular/drug therapy , Glucose/metabolism , Xanthines/therapeutic use , Aged , Dementia, Vascular/diagnosis , Disease Progression , Female , Humans , Male , Mental Status Schedule , Middle Aged , Neuropsychological Tests , Tomography, Emission-Computed
16.
Neuroimage ; 3(2): 109-18, 1996 Apr.
Article in English | MEDLINE | ID: mdl-9345482

ABSTRACT

In temporal lobe epilepsy (TLE) patients without lesions, major hippocampal sclerosis, or atrophy on magnetic resonance imaging (MRI), the localizing power of [11C]flumazenil (FMZ) and 2-[18F]fluoro-2-deoxy-D-glucose (FDG) was compared using high-resolution positron emission tomography (PET) studies and individually coregistered MRI scans. Following complete clinical, neuropsychological, and electrophysiological evaluation, benzodiazepine receptor density was assessed using the FMZ equilibrium method. Thirty minutes later, interictal FDG-PET was performed under resting conditions. PET images were matched to three-dimensionally coregistered, T1-weighted MRI. Each temporal lobe (TL) was divided into 12 volumes of interest. The regional FMZ data were normalized with respect to average cortical values. For each patient the right-left asymmetries of rCMRGlc and normalized FMZ data were calculated. In 7 to 10 patients, mesial TL structures showed reduced FMZ binding, with a decrease by at least 10% in the affected TL. Reductions of 10% or more of rCMRGlc usually were more widespread than FMZ reductions and often involved lateral temporal cortex. The regions of most pronounced disturbances are not necessarily identical in both methods. Three patients had a complex correspondence of lateralization with PET, neuropsychological, and EEG data. In 4 patients, lateralization was less clear from EEG or neuropsychological results but was still consistent with lateralization by PET. In 3 of 10 patients, however, major discrepancies were found. These data suggest that the combination of neuropsychological testing, EEG, and MRI-guided FMZ- and FDG-PET will help to select patients with clearly defined epileptogenic foci especially in mesial TLE. Even in cases without MRI lesions, TL epileptic foci can be lateralized with consistency across the methods; FMZ-PET shows the pathologic focus more circumscribed than FDG-PET.


Subject(s)
Blood Glucose/metabolism , Brain Mapping , Epilepsy, Temporal Lobe/physiopathology , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Receptors, GABA-A/physiology , Tomography, Emission-Computed , Adult , Epilepsy, Temporal Lobe/diagnosis , Female , Flumazenil , Fluorodeoxyglucose F18 , GABA Modulators , Hippocampus/physiopathology , Humans , Male , Middle Aged , Prognosis , Temporal Lobe/physiopathology
17.
Dtsch Med Wochenschr ; 121(11): 331-5, 1996 Mar 15.
Article in German | MEDLINE | ID: mdl-8681722

ABSTRACT

HISTORY AND CLINICAL FINDINGS: A 43-year-old woman was admitted with a 14-day history of general malaise, subfebrile temperature, radicular dysaesthesias in the "riding breeches" area, severe pain in the lumbar region and progressive disorders of bladder and rectal emptying. Physical examination showed a conus-cauda syndrome. Differential diagnosis was between myelitis (inflammatory or infectious), space-occupying intraspinal mass or vascular lesion. INVESTIGATIONS: Cerebrospinal fluid contained 1700/3 cells and there was intrathecal antibody synthesis against varicella zoster virus (VZV) and positive VZV-DNA analysis in the polymerase chain reaction. Magnetic resonance imaging of the lumbar spine revealed an inflamed enlarged conal and epiconal area with small haemorrhagic spots. There was no evidence of an underlying immune-modulated disease. TREATMENT AND COURSE: With the diagnosis of varicella zoster myelitis with cutaneous changes having been established the clinical signs and symptoms regressed almost completely with aciclovir administration (10mg/kg intravenously for 14 days). CONCLUSION: VZV without cutaneous involvement should be considered in the differential diagnosis of the radicular pain syndrome. When clinical signs of beginning myelitis or encephalitis are present, immediate investigations and therapy are necessary.


Subject(s)
Herpes Zoster/diagnosis , Myelitis/diagnosis , Pain/diagnosis , Spinal Nerve Roots , Acyclovir/administration & dosage , Adult , Antiviral Agents/administration & dosage , Diagnosis, Differential , Female , Hemorrhoids/diagnosis , Herpes Zoster/cerebrospinal fluid , Herpes Zoster/drug therapy , Humans , Myelitis/cerebrospinal fluid , Myelitis/drug therapy , Pain/cerebrospinal fluid , Pain/drug therapy , Remission Induction , Sacrococcygeal Region , Syndrome
18.
J Neural Transm Suppl ; 47: 183-91, 1996.
Article in English | MEDLINE | ID: mdl-8841965

ABSTRACT

Positron emission tomography (PET) has elucidated basic pathophysiological mechanism that produce the cognitive decline in vascular dementia (VD). The typical pattern of glucose metabolism seen in VD with scattered areas of focal cortical and subcortical hypometabolism differs from that in AD with marked hypometabolism affecting the association areas. The total volume of metabolically inactive tissue is significantly related to severity of dementia. Rather than the quantity of tissue destruction, the critical effect may be the quantity of cortical hypometabolism caused by subcortically induced disconnection. Studies with HMPAO SPECT have shown focal deficits in VD and AD patients that are comparable to those seen with FDG PET. In mildly demented patients performance for the classification AD versus VD is much better by PET because it might be more sensitive for imaging small functional pathological changes. A longitudinal analysis of rCMRGl in VD showed that the progression of dementia can be delayed by the adenosine uptake blocker propentofylline and that neuropsychological and metabolic changes are closely related.


Subject(s)
Brain/metabolism , Dementia, Vascular/diagnostic imaging , Glucose/metabolism , Humans , Tomography, Emission-Computed
19.
J Neurol Sci ; 130(1): 77-81, 1995 May.
Article in English | MEDLINE | ID: mdl-7650534

ABSTRACT

In 45 patients (aged 48-85 years) with probable Alzheimer's disease (AD) according to current research criteria (NINCDS-ADRDA) with different stages of dementia severity (Mini Mental Status Examination (MMSE) 7-27) the auditory evoked P300 waves were mapped and regional cerebral metabolic rates of glucose were measured by positron emission tomography of 2-[18F]fluoro-2-deoxy-D-glucose. Age adjusted P300 latency was significantly correlated to dementia severity (r = -0.33, p = 0.028), but no significant relationships were found for P300 amplitudes. Dependencies existed among cortical glucose metabolic rates and MMSE with the highest correlation coefficient for the metabolic ratio of regions typically affected and non-affected in AD (r = 0.75, p = 0.0001). A significant correlation was also calculated between P300 latency and metabolic ratio (r = -0.44, p = 0.002), but no relationships were observed among P300 amplitudes and glucose metabolic rates of individual brain regions. These results indicate that P300 latency and metabolic rates but not P300 amplitudes qualify as measures of severity in AD. The lack of regional correlations among P300 amplitudes and glucose metabolism is not consistent with a cortical contribution to P300 generation.


Subject(s)
Alzheimer Disease/physiopathology , Electroencephalography , Glucose/metabolism , Aged , Aged, 80 and over , Alzheimer Disease/metabolism , Alzheimer Disease/psychology , Brain Chemistry/physiology , Deoxyglucose/analogs & derivatives , Female , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Humans , Male , Middle Aged , Tomography, Emission-Computed
20.
Presse Med ; 23(26): 1203-8, 1994.
Article in English | MEDLINE | ID: mdl-7831213

ABSTRACT

It has long been known, that irregular, heavy snoring and daytime sleepiness are common features of acromegaly. Only recently has the high incidence (30-60%) and clinical relevance of the sleep apnoea underlying these symptoms been recognized. Both diseases have a group of common symptoms and prognostic features: Increased cardiovascular and respiratory mortality, elevated incidence of hypertension, daytime sleepiness, decreased vitality, headaches and depression. These are very prominent in sleep apnoea and often reversible under treatment. In acromegaly their etiology has been widely unexplained and they commonly persist even when human growth hormone (hGH) levels remain normal after operative treatment. We report on 2 patients presenting with excessive daytime sleepiness and severe obstructive sleep apnoea caused by acromegaly. Both had macroglossia and hypertrophy of hypopharyngeal tissues regressive after surgical therapy. The average hGH-levels were 20 and 31 ng/ml before and 3 and 1.7 ng/ml several months after operation respectively. Apnoea indices and minimal oxygen saturations (SO2) were 59/h and 55/h, and 60% and 58% initially and improved postoperatively to 40/h and 50/h, and 72% and 70%. Polysomnographic parameters were normalized by NCPAP-therapy pre- and postoperatively and daytime sleepiness improved dramatically. In one patient the NCPAP-pressure could be decreased postoperatively. Since patients with sleep apnoea have an increased perioperative risk of hypoxia and because transsphenoidal operation and postoperative nasal tamponade were performed, both patients were tracheostomized perioperatively.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Acromegaly/complications , Adenoma/complications , Pituitary Neoplasms/complications , Sleep Apnea Syndromes/etiology , Acromegaly/blood , Acromegaly/drug therapy , Adenoma/blood , Adenoma/diagnosis , Adenoma/surgery , Growth Hormone/analysis , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Octreotide/therapeutic use , Oxygen Inhalation Therapy/methods , Pituitary Neoplasms/blood , Pituitary Neoplasms/diagnosis , Pituitary Neoplasms/surgery , Recurrence , Sleep Apnea Syndromes/blood , Sleep Apnea Syndromes/physiopathology , Sleep Apnea Syndromes/therapy , Tracheostomy
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