[Neuroradiologic therapy of stroke]. / Zur neuroradiologischen Therapie des Schlaganfalls.

Cerebrovascular disease with consecutive stroke is the third leading cause of death, behind only heart disease and cancer. The cost to society, both directly in health care and indirectly in lost income, amounts to 15 billion Dollar in the USA. The leading cause of stroke is focal cerebral ischemia. The general approach to the acute stroke patient remains one of therapeutic nihilism, despite effective interventional neuroradiological methods such as local intraarterial fibrinolysis and percutaneous transluminal angioplasty. These methods can be applied in a narrow timeframe only. One case of successful treatment is presented. The effort should be the development of regionalized systems of early transfer to "stroke units" capable of providing the modern spectrum of acute care to stroke patients.

[Intra-arterial thrombolysis of vessels supplying the brain]. / Intraarterielle Thrombolyse hirnversorgender Gefässe.

Intraarterial thrombolytic therapy can be life-saving in patients with vertebrobasilar occlusion. Thrombotic occlusions of the internal carotid artery or middle cerebral artery often result in disabling ischemic cerebral infarctions. Local fibrinolysis may help to minimize the neurological sequelae. Indications and contraindications for such a therapy are not yet well established, and more discussion is needed. During the last 2 years we have treated 18 patients with occlusions of vessels supplying the brain by means of local intraarterial thrombolytic therapy with urokinase. These included 5 patients who presented with internal carotid/middle cerebral artery occlusions, 3 of whom left the hospital with only minor neurological deficits while 2 died despite therapy. The other 13 patients had acute vertebrobasilar occlusion: 6 patients survived, 3 with a good general condition and 2 with locked-in syndrome. Technique, dosage of urokinase and patient selection are discussed as well as the outcome.

[Whole-body MRT studies--the results of the "Multicenter study on the evaluation of magnetic resonance tomography"]. / MRT-Untersuchungen im Ganzkörperbereich--Ergebnisse der "Multicenterstudie zur Evaluierung der Kernspintomographie".

In a nation-wide multicentre study, the use of MRI was examined in its clinical context and in relation to other imaging methods and as a routine examination. It was found that examinations of the brain and spine were predominant. MRI is accurate for certain problems affecting the extremities, the pelvis and the liver. The findings also show that there are still technical limitations. A high degree of accuracy can only be obtained if there is adequate information concerning individual problems. Technical limitations include the frequent appearance of artifacts. In its present state, MRI can only supply additional information, concerning the trunk only, in certain situations. The study also outlines the development of MRI and the role of other conventional diagnostic procedures.

[Cervical myelopathy in mucopolysaccharidosis type II (Hunter's syndrome). Neuroradiologic, clinical and histopathologic findings]. / Zervikale Myelopathie bei Mucopolysaccharidose Type II (Hunter-Syndrom). Neuroradiologische, klinische und histopathologische Befunde.

A moderately severe spasticity affecting all four limbs, but especially the legs and the right side, developed in a 36-year-old man with mucopolysaccharidosis II (Hunter syndrome) who for 6 months had suffered from pain in the neck radiating into the shoulder. Myelography, computed tomography and magnetic resonance imaging revealed thickening of the cervical meninges as the cause of the symptoms. A laminectomy was performed and the foramen magnum enlarged by an occipital craniotomy. At operation dorsal thickening of the dura was evident; thickened tissue was also palpable in front of the dural sac. Histological examination of a tissue sample revealed deposition of acid mucopolysaccharides. The gait of the patient was improved after the operation and the neck pain disappeared. Similar findings were present in other family members.

[Obstacles to the routine use of magnetic resonance imaging--results of a multicenter study for evaluating nuclear magnetic resonance tomography]. / Beeinträchtigende Faktoren in der MR-Routineanwendung--Ergebnisse der "Multicenterstudie zur Evaluierung der Kernspintomographie".

Within the framework of this study, the factors that impair the value of MR scans were also investigated and analysed. It was found that artifacts occurred in a large number of examinations that exercised a negative effect on the results. Artifacts are particularly seen in the thorax (54%) and upper abdomen (57%), but they have also been reported in 23% of the CNS examinations. The sources of such artifacts were mainly movements in the investigated layer, whereas other causes were negligible. In the 21,633 examined patients no undesirable effects caused by the examination were noted that would have impaired the patient or the course of the study. On an average, 88% of the examinations were performed with normal tolerance of the examination. In the remaining cases there was motor unrest or claustrophobia requiring special measures, thus hampering the course of the examination.

[NMR studies of the whole body--results of a multicenter study for evaluating nuclear magnetic resonance tomography]. / NMR-Untersuchungen im Ganzkörperbereich--Ergebnisse der "Multicenterstudie zur Evaluierung der Kernspintomographie".

Within the framework of a national multi-centre study the spectrum of application and the ranking of magnetic resonance tomography were investigated. Although scans of the brain and vertebral column still dominate the scene, it has become evident that whole body scanning via MR can be very accurate for certain indications. This is particularly true for examinations of gynaecological diseases (95%) and for lesions of the liver (97%). However, the number of problems in which MR can provide answers to diseases in the whole body range is still limited, and hence it would be most desirable to achieve further instrumental and methodical improvements.

[Evaluating magnetic resonance tomography studies of the extremities--results of a multicenter study for evaluating nuclear magnetic resonance tomography]. / Bewertung von MRT-Extremitätenuntersuchungen--Ergebnisse der "Multicenterstudie zur Evaluierung der Kernspintomographie".

MR examinations of the extremities occupy the first place in whole body examinations via MR. Highest accuracy quotas in this area with an average of 93.8% were obtained for tumours, trauma and necroses of the bones. These high accuracy quotas, however, were achieved only if sufficient preliminary information was available. Other statistically significant factors were found to be the field strength, the combined use of spin echo and fast imaging sequences and the use of the multislice technique.

[Dilatation of the supra-aortic arteries--a catheter with blockade and rinsing potential]. / Dilatation supra-aortaler Gefässe--Katheter mit Blockade und Spülmöglichkeit.

Percutaneous transluminal angioplasty (PTA) of supra-aortic arteries is not generally accepted, mainly because of the fear of brain embolism. The design of a new catheter offers four conduits and permits (1) guidewire conduct, (2) tip occlusion; (3) PTA; and (4) rinsing between occluded tip and dilational balloon. Thus, any particles that might otherwise cause brain embolism could be washed out after PTA and before opening of the tip occlusion. The prototype has already been manufactured. The catheter is easy to handle.

MRI in cranial tuberculosis.

A case of multiple intracranial tuberculomas is presented. CT and MRI findings are discussed and compared. MRI showed multiple tuberculomas characterised by the same signal intensity as the surrounding brain parenchyma. Differentiation could be achieved only by the perifocal oedema of high signal intensity. Changes of the lesions during chemotherapy were monitored by CT and MRI and the results are presented.

[Plain imaging of meningioma in NMR tomography--retrospective contrast optimization by image synthesis]. / Nativdarstellung von Meningiomen in NMR-Tomogramm-retrospektive Kontrastoptimierung durch Bildsynthese.

Synthetic images of the tumour region were computed in the case of ten meningiomas for the purpose of determining retrospectively pulse sequences and sequence parameters supplying an optimal contrast between tumour and adjacent tissue in plain imaging. It was found that best results were obtained via the partial saturation/spin-echo sequence with a long recovery time (TR approximately greater than 2,000 msec) and a long maximum echo delay (TE max approximately greater than 200 msec). A comparable contrast quality can be attained by using the inversion-recovery sequence with an inversion time T1 approximately 450 msec. Nevertheless, it was not possible in our study to identify two small meningiomas with a diameter of just below one centimetre by studying the MR tomogram.

[Can transcranial Doppler sonography replace cerebral angiography?]. / Kann die transkranielle Doppler-Sonographie die cerebrale Angiographie ersetzen?

Transcranial Doppler ultrasound is a noninvasive method of recording the flow velocity of larger intracranial vessels. The impact on diagnosis of cerebravascular occlusive disease is not yet evaluated. We present 15 patients, age range 39-73 years, who suffered from completed stroke. The findings of transcranial Doppler ultrasound and of cerebral angiography are presented. The value of both methods in treatment strategy is discussed.

[Operations to improve hearing in auricular malformations. A catamnestic study of 89 operations]. / Gehörverbessernde Operationen bei Ohrmuschelmissbildungen. Eine katamnestische Untersuchung bei 89 Operationen.

In the last 20 years 89 middle ear operations were performed on 71 patients with unilateral or bilateral microtia (grade II or III). The methods and the results are described and discussed. In 79.5% we produced a wide auditory canal and achieved an overall hearing gain of 17 dB. We usually do not carry out middle ear surgery in unilateral atresia. In bilateral atresia the child is fitted with a bone conduction hearing aid as soon as possible and is operated on at the age of 4 or 5 years. After middle ear surgery we reconstruct the auricle at an age of 5 or 6 years. If necessary these children are then fitted with an air conduction hearing aid.

[Clinical aspects and diagnosis of acoustic neurinomas]. / Klinik und Diagnostik der Akustikusneurinome.

The application of microsurgical techniques for the removal of acoustic neuromas has evidenced greatly improved postoperative results. Therefore the early detection of an acoustic neuroma is a special need for every neurologist. The development of new electrophysiological and radiological procedures now allows a far better approach in the diagnosis of acoustic neuromas. Brain stem auditory evoked potentials as well as acoustic reflex testing have shown to be rather sensitive tools in the diagnosis of retrocochlear pathology. Other electrophysiological procedures have been widely replaced by these techniques. Gasmeatocisternography in combination with cranial computed tomography is the method of choice in the detection of small acoustic neuromas. The current status in the application of different techniques for the diagnosis of acoustic neuromas is reviewed.

The growth rate of acoustic neuromas: a report of three cases.

Until the present time, only a few CT air-cisternographic studies have been done to define the growth rate of acoustic neuromas. By using this method of study, we were able to observe a slow growth rate fo acoustic neuromas in a 41- and a 50-year-old woman over periods of 6-10 months. In contrast, we were unable to find any increase in tumor size during a period of 22 months in a 70-year-old woman.

[Thin-layer NMR-imaging with a new T2-weighted 3-D-procedure]. / Dünnschicht-NMR-Imaging mit einem neuen T2-gewichteten 3-D-Verfahren.

Presentation of first experience with a new 3-dimensional data acquisition method. The new method yields sets of 120 continuous images of the head and brain in all 3 dimensions (slice thickness and spatial resolution both being 1.7 mm.) with a data acquisition time of 15 minutes. Depending on pulse sequences T1- or T2-images are available. Advantages and disadvantages are discussed.

Neuro-otological findings in patients with small acoustic neuromas.

The method of choice for the diagnosis of even the smallest acoustic neuromas is CT gas cisternography. Lumbar puncture and gas insufflation, however, is an intervention demanding strict indication. Neuro-otological examinations should lead to this indication. The aim of this paper is to demonstrate neuro-otological findings on 19 patients presenting small acoustic neuromas. These neuro-otological findings are not necessarily comparable to earlier reports in the literature dealing with mainly larger tumours at a time when early diagnosis was not so advanced.

[Clinical NMR tomography with sequential T2 images (Carr-Purcell spin-echo sequences)]. / Klinische NMR-Tomographie mit sequentiellen T2-Bildern (Carr-Purcell-Spin-Echosequenzen).

Advantages of the Carr-Purcell spin-echo sequence in NMR tomography are discussed. It is pointed out that this method generates complete information about relaxation time T2 with only one measurement per slice as compared with the classic spin-echo method.

Percutaneous transluminal angioplasty in arteriosclerotic internal carotid artery stenosis.

Percutaneous transluminal angioplasty (PTA) of carotid arteries has been rarely reported. Dilatation of internal carotid artery stenosis has so far been performed only for fibromuscular dysplasia. Because of the risk of cerebral embolization the technique has not been used for arteriosclerotic stenosis, particularly since endarterectomy is known as a safe procedure. Three cases are reported of successful dilatation of arteriosclerotic internal carotid artery stenosis. A neurologic complication occurred in one patient. The primary indication for performing PTA in such cases is limited operability for medical reasons.