Diagnosis and follow-up evaluation of central nervous system vasculitis: an evaluation of vessel-wall MRI findings

Journal of Neurology - To approach the clinical value of MRI with vessel wall imaging (VWI) in patients with central nervous system vasculitis (CNSV), we analyzed patterns of VWI findings both at...     

Angiographic and clinical results in 316 coil-treated basilar artery bifurcation aneurysms

OBJECT: The aim of this study was to analyze the effect of the endovascular treatment of basilar artery (BA) bifurcation aneurysms and to compare the results with those published by other neuroendovascular teams. METHODS: The authors performed a retrospective analysis of 316 aneurysms of the BA bifurcation that had been treated using endovascular coil occlusion between November 6, 1992, and February 12, 2005. After the initial embolization procedure, a 90 to 100% occlusion rate was achieved in 86% of the aneurysms. No complication was evident in 80% of the lesions, although periprocedural aneurysm rupture (3.2%) and thromboembolic events (12.3%) were the most frequent complications. Clinical outcome according to the Glasgow Outcome Scale (GOS) was a score of 5 or 4 in 77%, 3 in 11%, 2 in 5%, and 1 in 7% of patients. Initial follow-up angiography studies were obtained in 56% of patients at a mean of 19 months posttreatment and demonstrated a 90 to 100% occlusion rate in 70%. No recurrence was seen on 65% of the aneurysms. Coil compaction was evident on 24% of the follow-up angiograms. A second treatment was performed on 48 aneurysms (15%) a mean of 27 months after the first therapeutic session and resulted in 90 to 100% occlusion in 83% of the lesions. Complications were encountered in 19% of the aneurysms. Rupture did not occur during any of the procedures. Clinical outcome was rated as GOS Score 5 or 4 in 83% of the patients and Grade 3 in 17%. During a cumulative clinical follow up of 821 years in 237 patients, 182 patients (81%) were independent (GOS Score 5 or 4), 33 (14%) were dependent (GOS Score 3), eight (3%) were in a vegetative state, and two (1%) had died. Clinical outcome was significantly worse after previous aneurysm rupture and following procedural complications. CONCLUSIONS: These results are within the range of published data for coil treatment of BA tip aneurysms and confirm both the safety and efficacy of this endovascular treatment method.     

Treatment of intracranial atherosclerotic stenoses with balloon dilatation and self-expanding stent deployment (WingSpan)

The endovascular treatment of atherosclerotic intracranial arterial stenoses has previously been based on balloon dilatation or the deployment of a balloon expandable stent. Both methods have advantages (balloon: flexibility; balloon expandable stent: high radial force) and drawbacks (balloon: risk of elastic recoil and dissection; balloon expandable stent: limited flexibility, risk of injury to the vessel due to excessive straightening, overexpansion at ends of stent). A new combination of balloon dilatation, followed by the deployment of a self-expanding microstent has been applied in 15 patients with atherosclerotic arterial stenoses, symptomatic despite medical treatment. An anatomically and clinically adequate result was achieved in all patients. The initial degree of stenosis was 72% (mean). Balloon dilatation resulted in an average residual stenosis of 54% (mean), reduced further to a mean of 38% after stent deployment. Arterial dissection, occlusion of the target artery or symptomatic distal emboli was not encountered. In one patient, a side branch occlusion occurred after dilatation of a M1 stenosis, with complete neurological recovery. All patients were either stable or improved 4 weeks after the treatment. Recurrent TIA did not occur in any patient. Balloon dilatation and subsequent deployment of a self-expandable stent for the treatment of symptomatic intracranial arterial stenoses combines the advantages of both techniques and allows a rapid, clinically effective and technically safe treatment of these frequently challenging lesions.     

The muscular compliance of the auditory tube: a model-based survey

OBJECTIVES: The role of the paratubal muscles, especially the medial pterygoid muscle, still is unclear. The aim of this study was to define the function of the medial pterygoid muscle concerning the muscular compliance of the auditory tube. METHODS: High-resolution cross-sectional T1 magnetic resonance imaging data of one of the authors' paratubal structures were used, a new functional 3-D model of the auditory tube and its related structures visualized by the Hamburg VOXEL-MAN digital image system. RESULTS: Functional 3-D reconstructions of the paratubal structures reveal that the medial pterygoid muscle is acting as a movable hypomochlion of the tensor veli palatini muscle. Contraction of the medial pterygoid muscle increases and relaxation decreases the force of the tensor veli palatini muscle on the distal part of the auditory tube. Hence, the opening pressure of the auditory tube is moderated by the action of the medial pterygoid muscle. CONCLUSION: The influence of the medial pterygoid muscle on the opening pressure of the auditory tube may have an impact on the diagnosis and therapy in patients with patent auditory tube as well as the middle ear pathology in patients with cleft palate.     

Early rehabilitation in the hospital--time for structural changes]

Although it has long been undisputed that successful rehabilitation outcomes require early-onset, comprehensive rehabilitative intervention, research findings show that major shortcomings exist concerning the provision of rehabilitative care in hospitals. Contrary to the statutory premises at hand, a majority of hospitals continue to consider rehabilitation a treatment phase scheduled to set in only after completion of acute care. "Rehabilitation of the first day", a long-standing demand among the professional community, is hardly taking place at all. The rank of hospital-integrated early rehabilitation has now been confirmed in the framework of a model facility supported by the Federal ministry of labour and social order, with the recently completed scientific follow-along of the Ingolstadt Klinikum department for transdisciplinary early rehabilitation having made available research evidence of the effectiveness and efficiency of early-onset, comprehensive rehabilitation interventions in the hospital, and presented in this article for the first time.     

Die Beeinflussung der experimentellen Atherosklerose durch Jodbehandlung

Zusammenfassung Bei 19 mit Cholesterin-Leinöl mehrere Monate lang gefütterten Kaninchen fanden sich schwerste Gefäßveränderungen, die in ihrem Ausmaße ungefähr der einverleibten Cholesterinmenge entsprachen und der menschlichen Atherosklerose weitgehend ähnelten. Von 9 in der gleichen Weise gefütterten, aber gleichzeitig mit Dijodyl in höheren Dosen behandelten Tieren waren 7 vollkommen oder fast vollkommen frei von Gefäßschädigungen. Es fanden sich demnach bei den Kontrolltieren in 100% atherosklerotische Gefäßveränderungen, während bei rund 75% der mit Dijodyl behandelten Tiere ein Heilerfolg erzielt wurde.Die Arbeit wurde mit Unterstützung der Notgemeinschaft der Deutschen Wissenschaft und der Firma J. D. Riedel-E. de Haën, die mir in liebenswürdiger Weise Cholesterin und Dijodyl zur Verfügung stellte, ausgeführt, wofür ich auch an dieser Stelle meinen ergebensten Dank ausspreche.Mit 5 Textabbildungen.Die Arbeit wurde in Breslau begonnen und wird seit Juli 1929 an der Medizinischen Klinik zu Münster fortgesetzt.