[The significance of quantitative computerized tomography in the long-term prognosis of ischemic stroke]. / Die Bedeutung der quantitativen Computertomographie für die Langzeitprognose von ischämischen Grosshirninsulten.

The courses of 118 patients who had suffered a supratentorial ischaemic infarction were observed over a mean follow-up period of 4 years. One goal of this study was to assess the prognostic value of quantitative cranial computerized tomography (CT). The infarct volume was determined using CT and expressed quantitatively as a percentage of the total brain volume. The infarct volume correlated negatively with the global outcome as estimated by the Barthel Index. It correlated positively with the occurrence of psychiatric alterations, disturbances of consciousness or alterations in the EEG. Nicotine, alcohol consumption and hyperuricaemia were the most frequent risk factors identified for men, while for women, especially those over 60, cardiac diseases were the most relevant risk factors. In looking only at the older patients, age, psychiatric alterations and cardiac disease at the time of the stroke were unfavourable prognostic factors. CT lesions in the basal ganglia were also unfavourable prognostic factors. Infarcts in the posterior cerebral artery region were seen as prognostically favourable. During the 4-year follow-up period, the reinfarction rate was 26%. Nearly 50% of the total patient population died. This group was significantly older, had more psychiatric alterations as well as multiple infarct areas in CT.

[Gliomatosis cerebri: the diagnostic potential of MRT]. / Gliomatosis cerebri: Diagnostisches Potential der MRT.

Gliomatosis cerebri is a rare tumor of neuroepithelial origin in middle aged persons presented by deterioration of cognitive functions, psychomotor retardation and cerebral convulsions. MRI predominantly shows a bilateral and diffuse infiltration of midline adjacent brain structures including medulla. Areas with focal anaplasia occasionally reveal an accumulation of contrast media. The diffuse tumor manifestation requires a differentiation from encephalitis and demyelinating diseases with a similar distribution pattern of lesions. Three cases have been examined. In conclusion the performance of MRI including control and brain biopsy are indicated to establish an in vivo diagnosis.

[Headache of unknown origin: brain tumor? Indications for computer tomography]. / Kopfschmerz unklarer Genese: Hirntumor?

Headache is the most frequent initial as well as the principle symptom of brain tumours. In 25 patients with brain tumours, in whom the initial symptom was headache, a further symptom of cerebral origin did not appear until after an interval of 40 months on average (median 11.5 months, 95% confidence limits of the median 4 and 60 months). Whereas tumours associated with short case-histories of headache are mostly glioblastomas, previously unrecognised tumours associated with long-standing headache are predominantly slow-growing, in the main easily operable, brain tumours. Pure headache-tumours occur predominantly in "silent" regions: in the subdominant (right) hemisphere and also in the frontal lobes as well as mid-basal in the sella area. In comparison with electroencephalography, X-ray of the skull, scintigraphy and sonography, computerised tomography is the superior non-invasive diagnostic procedure. A tumour-excluding headache does not exist. A typical migraine attack, when appearing for the first time in middle-age, can be the first indication of a brain tumour. Any reservations on the use of computerised tomography in regard to headache, when this has not been present since childhood as intermittent migraine, are, even from the point of view of cost, no longer tenable.

Language and cognitive deficits resulting from medial and dorsolateral frontal lobe lesions.

A total of 36 patients with chronic unilateral circumscribed medial and dorsolateral frontal lobe lesions were investigated with a range of neuropsychological tests. Lateralized deficits in tasks depending on language functions were found with dorsolateral but not with medial lesions. The specific role of Broca's area could not be confirmed. Lesions of the supplementary motor area led to mild deficits in tests of "concept formation". Frontomedial lesions situated more deeply in the interhemispheric fissure resulted in memory deficits. The results are discussed on the basis of recent neurophysiological theories of brain function.