Autoimmunreaktionen und Paraneoplasien

Clinical issue

Autoimmune disorders of the central nervous system (CNS) are common but are also a heterogeneous group of diseases. The most common form is multiple sclerosis (MS), others are clinically isolated syndrome (CIS), acute demyelinating encephalomyelitis (ADEM) and neuromyelitis optica spectrum disorders (NMOSD). Paraneoplastic syndromes are rare and tumor-associated, they are not induced by direct invasion of tumor tissue but by tumor-associated autoantibodies mostly against specific CNS proteins, e.?g. limbic encephalitis and paraneoplastic cerebellar ataxia or degeneration.

Diagnostics, standard radiological methods, performance and achievements

The correct diagnosis of autoimmune and paraneoplastic syndromes can still be challenging. In addition to the patient history, clinical examination and blood as well as cerebrospinal fluid (CSF) tests, magnetic resonance imaging (MRI) is gaining importance in the diagnostics. It is important not only in primary diagnostics but also in follow-up and therapy monitoring, especially in MS with specific therapies to detect therapy complications, such as progressive multifocal leukoencephalopathy as early as possible. In paraneoplastic syndromes MRI can also be an important component in the diagnostics but can also initially be negative and typical signal changes become visible only in follow-up scans.

Practical recommendations

In paraneoplastic syndromes the correct diagnosis is based on laboratory tests for specific autoantibodies in serum and CSF.

Treatment

The treatment of autoimmune and paraneoplastic disorders of the CNS ranges from steroids and immunosuppressive agents to plasmapheresis, depending on the specific disorder.

     

Normvarianten und Pitfalls rund um den Ellenbogen

The elbow joint is comprised of three different bones with a combined hinge and a ball joint. Several nerves, tendons and muscles cross the joint. Anatomical variations at the elbow are common and may be the cause of certain pathologies. Despite the high quality of modern cross-sectional imaging, certain normal findings on CT or MRI have the risk of being misinterpreted. This article describes more common but also rare, normal variants around the elbow joint. Classic pitfalls are illustrated and compared to similar pathological findings.     

Entrapment- und Non‑Entrapment-Syndrome am Ellenbogen

Clinical/methodical issue

Entrapment syndromes of peripheral nerves at the elbow are common and are often diagnostically challenging disorders. Difficulties consist in lesion localization and recognition of complex spatial lesion patterns as well as in differentiation of focal and multifocal disorders.

Standard diagnostic methods

Medical history taking, neurological examination and neurophysiological tests represent the gold standard in the diagnosis of peripheral nerve lesions at the elbow, but have known methodical limitations.

Methodical innovations

Additional diagnostic imaging tools recently developed for high-resolution visualization of extended peripheral nerve segments include 3?T magnetic resonance neurography (MRN) and neurosonography.

Performance

MRN and neurosonography can directly visualize and thus precisely localize focal and nonfocal peripheral nerve lesions of various origins with high spatial resolution at the anatomical level of nerve fascicles.

Achievements

MRN can cover peripheral nerve structures at the elbow, evaluate spatial nerve lesion patterns and partly disclose underlying causes.

Practical recommendations

Imaging of peripheral nerves is a valuable addition in the diagnostic work-up of entrapment syndromes at the elbow and provides important assistance in the differentiation of nonfocal differential diagnoses, especially in cases that cannot be clarified using standard diagnostic methods. The evaluation of spatial nerve lesion pattern may give additional information on the origin of the underlying disease, which is essential for further treatment.

     

Intubation und Sedierung bei der endovaskulären Therapie des akuten Hirninfarkts

In the past complex intracranial treatments demanded intubation and general anesthesia of the patient. With increasing rate of endovascular local treatment of acute stroke more and more neurointerventionalists report that recanalisation techniques can be performed in sedation of the patient without the need of additional intubation. Although prospective studies are lacking retrospective studies have shown that the risk of iatrogeneous vessel injuries without global anesthesia is not increased but outcomes in case of conscious sedations are better compared with intubation and general anesthesia.     

Anatomie und Fehlbildungen der hinteren Schädelgrube

Many important structures are located in the confined space within the posterior cranial fossa. This article describes the main aspects of the anatomy. As a uniform classification of malformations of the posterior cranial fossa does not exist the main syndromes, such as Chiari malformations, zerebellar hypoplasia and dysplasia are discussed separately.     

Potential Mechanisms of Vascular Thrombosis after Microwave Ablation in an in Vivo Liver

Purpose

To evaluate potential biologic and thermal mechanisms of the observed differences in thrombosis rates between hepatic vessels during microwave (MW) ablation procedures.

Notwendigkeit und Anforderungen an die station?re Krankenhausbehandlung

Die Krankenhausbehandlungsbedürftigkeit setzt voraus, dass die Behandlung den Einsatz der besonderen Mittel des Krankenhauses erforderlich macht. Ist eine andere Behandlungsform, insbesondere eine ambulante Behandlung, nicht ausreichend, besteht die Krankenhausbehandlungsbedürftigkeit. (Leitsatz der Bearbeiterin)     

Entwicklung der Inzidenz und Mortalität an Brustkrebs

In Germany, breast cancer is still the most frequent cancer site with approximately 45.000 incident cases and 18.000 deaths annually. After a continuous increase of mortality for decades and a short period of stagnation, a decline can be observed since a couple of years. However, this turnaround has not been preceded by an analogous evolution of breast cancer incidence. A similar development can also be observed in other countries. The conditions under which this changing trend has occurred indicate that it might have been caused mainly by better treatment and only to a low extent by altered prevalence of risk factors or the implementation of screening programmes. Due to the expected latency, an influence of organized screening on mortality can be expected only at the end of the 1990s, i.e., at the end of the period for which data is available or later. In the discussion about implementation of quality-controlled screening in Germany, it should be kept in mind that the quality of the entire programme--starting with screening and ending with therapy--will decide to what extent breast cancer mortality can be reduced.     

Über mikroskopisch sichtbare Bewegungserscheinungen an menschlichen und tierischen gedehnten,superkontrahierten und erhitzten Haaren

Ohne Zusammenfassung