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22 Normaldruckhydrozephalus [chapter]

Hans-Christoph Diener, Helmuth Steinmetz, Oliver Kastrup, Benjamin Stahl, Anja Staiger
2019 Referenz Neurologie  
Gangstörung, kognitive Defizite und Harninkontinenz sind die typischen Symptome des idiopathischen Normaldruck-Hydrozephalus. Die Inzidenz der Erkrankung nimmt mit höherem Alter zu und mit der operativen Einlage einer Liquorableitung besteht auch bei älteren Patienten eine effektive Therapieoption. Einführung Der Normaldruck-Hydrozephalus (NPH) ist ein aktuelles und zugleich altes Thema. Das Syndrom wurde erstmals 1957 von Salomón Hakim im Spital «San Juan de Dios» in Bogotá identifiziert [1].
more » ... ie erstmalige Beschreibung in der englischsprachigen Literatur erfolgte 1965 von Hakim und Adams (daher auch als Hakim-Adams-Syndrom beschrieben) [2, 3]. Es gibt allerdings auch Erkrankungen, in deren der NPH als Folge resultieren kann (z.B. nach stattgehabter Subarachnoidalblutung, posttraumatisch, nach Meningitis, usw.). Typischerweise erfolgt daher in der Praxis eine Unterscheidung in den idiopathischen NPH (iNPH) und den NPH als sekundäre Folge einer Vorerkrankung ist [3]. In dieser Übersichtsarbeit fokussieren wir uns, sofern nicht anders beschrieben, auf den iNPH. Die typische klinische Symptom-Triade (Hakim-Trias), bestehend aus einer Gangstörung, Demenz und Urininkontinenz, ist nur bei ca. 48% der Patienten vorhanden. Nahezu bei allen Patienten bestehen eine Gangstörung und kognitive Defizite [4]. Pathognomonisch ist eine Erweiterung der inneren Liquorräume. Für die Diagnosestellung eines wahrscheinlichen iNPH sind zwei Leitsymptome der Hakim-Trias, ein allmählicher Beginn mit einer Symptomdauer von mehr als 3 Monaten, die oben beschriebene Erweiterung der Hirnventrikel in der Computertomographie (CT) oder Magnet-Resonanz-Bildgebung (MRI) und der Ausschluss wichtiger Differentialdiagnosen gefordert [4, 5]. Epidemiologie Die Inzidenz des iNPH ist altersabhängig. In der Gesamtpopulation zeigte eine norwegische Studie eine Inzidenz von 0,01% (5,5/100 000) [6]. Eine populationsbasierte schwedische Untersuchung ergab Häufigkeiten von 0,2% (200/100 000) bei den 70-bis 79-Jährigen und 5,9% (5900/100 000) bei den über 80-Jährigen [7]. Die Untersuchung legte den Schluss nahe, dass die Inzidenz bei älteren Patienten weitaus höher als die Rate der Behandlungen für einen iNPH ist. Pathophysiologie Die Ursachen des iNPH sind nicht restlos geklärt. Neuere Studien weisen darauf hin, dass es sich um eine Erkrankung des Hirnparenchyms und vermutlich nicht primär um eine Störung der Liquorresorption handelt [8]. Es konnte gezeigt werden, dass bei Patienten mit iNPH der zerebrale Blutfluss aufgrund einer verminderten venösen Compliance gestört und der Perfusionsdruck in der paraventrikulären Wasserscheidenregion vermindert ist. Letzteres führt zu einer progredienten Schädigung der betroffenen Hirnareale [8]. Im Umkehrschluss stellen somit vaskuläre Erkrankungen, wie z.B. die arterielle Hypertonie, einen Risikofaktor für das Auftreten eines iNPH dar [9]. Die Liquorresorptionsstörung ist letztendlich nur das Resultat aller dieser Faktoren. Der Ausschluss anderer Differentialdiagnosen (z.B. vaskuläre Demenz) ist daher schwierig, die Grenzen sind fliessend und eine klare Trennung der Ursachen ist oft nicht möglich.
doi:10.1055/b-0039-170526 fatcat:lubk2ubxoratlkiinfkzzap3cu

129 Lambert-Eaton-Myastheniesyndrom [chapter]

Hans-Christoph Diener, Helmuth Steinmetz, Oliver Kastrup, Benjamin Stahl, Anja Staiger
2019 Referenz Neurologie  
doi:10.1055/b-0039-170633 fatcat:sa6bi5iqsba4zos7pclpcldzmu

Hand Skill Asymmetry in Professional Musicians

Lutz Jäncke, Gottfried Schlaug, Helmuth Steinmetz
1997 Brain and Cognition  
training interacts with the cortical organization of hand motor dominance leading to improved performance of the nondominant hand (Kerr, 1975; Müller & Hömberg, 1992; Schlaug, Jäncke, Huang, Staiger, & Steinmetz  ... 
doi:10.1006/brcg.1997.0922 pmid:9292190 fatcat:67zjktebjbg2vo3seeszfbizqi

Leitlinienimplementierung und Kommentierung – entscheidend ist der Dialog

Christian Gerloff, Harald Prüß, Helmuth Steinmetz, Peter Berlit
2021 DGNeurologie  
Steinmetz, Sprecher der Leitlinienkommission der DGN P. Berlit, Generalsekretär der DGN Interessenkonflikt. C. Gerloff, H. Prüß, H. Steinmetz und P.  ... 
doi:10.1007/s42451-021-00354-2 fatcat:ohf7dn7o7rbojj6cqcyt7pqvva

Morphological brain differences between adult stutterers and non-stutterers

Lutz Jäncke, Jürgen Hänggi, Helmuth Steinmetz
2004 BMC Neurology  
The neurophysiological and neuroanatomical foundations of persistent developmental stuttering (PDS) are still a matter of dispute. A main argument is that stutterers show atypical anatomical asymmetries of speech-relevant brain areas, which possibly affect speech fluency. The major aim of this study was to determine whether adults with PDS have anomalous anatomy in cortical speech-language areas. Methods: Adults with PDS (n = 10) and controls (n = 10) matched for age, sex, hand preference, and
more » ... ducation were studied using high-resolution MRI scans. Using a new variant of the voxel-based morphometry technique (augmented VBM) the brains of stutterers and non-stutterers were compared with respect to white matter (WM) and grey matter (GM) differences. Results: We found increased WM volumes in a right-hemispheric network comprising the superior temporal gyrus (including the planum temporale), the inferior frontal gyrus (including the pars triangularis), the precentral gyrus in the vicinity of the face and mouth representation, and the anterior middle frontal gyrus. In addition, we detected a leftward WM asymmetry in the auditory cortex in non-stutterers, while stutterers showed symmetric WM volumes. Conclusions: These results provide strong evidence that adults with PDS have anomalous anatomy not only in perisylvian speech and language areas but also in prefrontal and sensorimotor areas. Whether this atypical asymmetry of WM is the cause or the consequence of stuttering is still an unanswered question.
doi:10.1186/1471-2377-4-23 pmid:15588309 pmcid:PMC539354 fatcat:djtnupmbzzbo3celh2domzdb2y

Child Age and Planum Temporale Asymmetry

Sabine Preis, Lutz Jancke, Jan Schmitz-Hillebrecht, Helmuth Steinmetz
1999 Brain and Cognition  
Thus, five MR imaging studies showed reduced leftward (but not inverted) PT asymmetry in normal adult left-handers compared to right-handers (Steinmetz et al., 1991 (Steinmetz et al., , 1995 Jäncke et  ...  Left-larger-than-right asymmetry of the planum temporale (PT) is found in approximately 70-80% of unselected adult brains studied in vivo or postmortem (von Economo & Horn, 1930; Geschwind & Levitsky, 1968; Steinmetz  ... 
doi:10.1006/brcg.1998.1072 pmid:10415130 fatcat:lz5srmllunfn7fpsjoidweigau

Corpus callosum size in children with developmental language disorder

Sabine Preis, Helmuth Steinmetz, Uwe Knorr, Lutz Jäncke
2000 Cognitive Brain Research  
Steinmetz, The relationship between corpus callosum size and forebrain volume, Cereb. Cortex 7 (1997) 48-56. [19] L. Jancke, S. Preis, H. Steinmetz, The relation between forebrain  ... 
doi:10.1016/s0926-6410(00)00020-3 pmid:10978690 fatcat:5banqy62xnaihovoyxo6gewghe

Measuring Patient Safety Climate in Acute Stroke Therapy

Ferdinand O. Bohmann, Joachim Guenther, Katharina Gruber, Tanja Manser, Helmuth Steinmetz, Waltraud Pfeilschifter
2021 Frontiers in Neurology  
Treatment of acute stroke is highly time-dependent and performed by a multiprofessional, interdisciplinary team. Interface problems are expectable and issues relevant to patient safety are omnipresent. The Safety Attitudes Questionnaire (SAQ) is a validated and widely used instrument to measure patient safety climate. The objective of this study was to evaluate the SAQ for the first time in the context of acute stroke care.Methods: A survey was carried out during the STREAM trial (NCT 032282)
more » ... seven university hospitals in Germany from October 2017 to October 2018. The anonymous survey included 33 questions (5-point Likert scale, 1 = disagree to 5 = agree) and addressed the entire multiprofessional stroke team. Statistical analyses were used to examine psychometric properties as well as descriptive findings.Results: 164 questionnaires were completed yielding a response rate of 66.4%. 67.7% of respondents were physicians and 25.0% were nurses. Confirmatory Factor Analysis revealed that the original 6-factor structure fits the data adequately. The SAQ for acute stroke care showed strong internal consistency (α = 0.88). Exploratory analysis revealed differences in scores on the SAQ dimensions when comparing physicians to nurses and when comparing physicians according to their duration of professional experience.Conclusion: The SAQ is a helpful and well-applicable tool to measure patient safety in acute stroke care. In comparison to other high-risk fields in medicine, patient safety climate in acute stroke care seems to be on a similar level with the potential for further improvements.Trial registration:www.ClinicalTrials.gov Identifier: NCT032282.
doi:10.3389/fneur.2021.686649 pmid:34659080 pmcid:PMC8517443 fatcat:4pgqk6pas5gqvdcngzanxc2lha

Gender differences in cortical complexity

Eileen Luders, Katherine L Narr, Paul M Thompson, David E Rex, Lutz Jancke, Helmuth Steinmetz, Arthur W Toga
2004 Nature Neuroscience  
Cortical complexity, a measure that quantifies the spatial frequency of gyrification and fissuration of the brain surface, has not been thoroughly characterized with respect to gender differences in the human brain. Using a new three-dimensional (3D) analytic technique with magnetic resonance imaging, we found greater gyrification in women than men in frontal and parietal regions. Increased complexity implies more cortical surface area, which may offset gender differences in brain volume and account for behavioral gender differences.
doi:10.1038/nn1277 pmid:15338563 fatcat:phegyx3f4zfghgk2wv72monory

Brain size and grey matter volume in the healthy human brain

Eileen L??ders, Helmuth Steinmetz, Lutz J??ncke
2002 NeuroReport  
Magnetic resonance imaging was used to evaluate the in£uence of sex and brain size on compartmental brain volumes (grey matter, white matter, CSF) in a large and well-matched sample of neurologically normal women (n ¼ 50) and men (n ¼ 50). As expected, we found a signi¢cant sex di¡erence for the absolute volumes of total brain, grey matter, white matter and CSF, with greater volumes for men. Relating these compartmental volume measures to brain volume resulting in proportional volume measures
more » ... vealed a higher proportion of grey matter in women. No signi¢cant sex di¡erences were found for white matter and CSF proportions. However, when the in£uence of sex was partialized out by regression analyses, brain volume explained 40^81% of the variance of the absolute grey matter, white matter and CSF volumes. Performing these regression analyses for the proportional volume measures revealed that brain volume explained B16% of the variance in grey matter proportion. Sex or the interaction between sex and brain volume revealed no additional predicitve values. Interestingly, the correlation between brain volume and grey matter proportion was negative, with larger brains exhibiting relatively smaller proportions of grey matter. Thus, sex is not the main variable explaining the variability in grey matter volume. Rather, we suggest that brain size is the main variable determining the proportion of grey matter. NeuroReport 13:2371^2374
doi:10.1097/00001756-200212030-00040 pmid:12488829 fatcat:is3tdpw2zvdgjachxoznzfblwa

Paraneoplastic cerebellar degeneration associated with lymphoepithelial carcinoma of the tonsil

Christian Henke, Johannes Rieger, Sylvia Hartmann, Marcus Middendorp, Helmuth Steinmetz, Ulf Ziemann
2013 BMC Neurology  
Paraneoplastic cerebellar degeneration (PCD) is a classical tumor-associated, immune-mediated disease typically associated with gynecological malignancies, small-cell lung-cancer or lymphoma. Case presentation: Here we present the case of a 38-year old male with an over 12 months rapidly progressive cerebellar syndrome. Extensive diagnostic workup revealed selective hypermetabolism of the right tonsil in whole-body PET. Histological examination after tonsillectomy demonstrated a
more » ... carcinoma of the tonsil and the tongue base strongly suggesting a paraneoplastic cause of the cerebellar syndrome. To the best of our knowledge this is the first case of an association of a lymphoepithelial carcinoma, a rare pharyngeal tumor, with PCD. Conclusions: In cases of classical paraneoplastic syndromes an extensive search for neoplasms should be performed including whole-body PET to detect tumors early in the course of the disease.
doi:10.1186/1471-2377-13-147 pmid:24134642 pmcid:PMC4016266 fatcat:yoyewgp6rvchhk2gd5ywkjmuxe

Planum temporale, planum parietale and dichotic listening in dyslexia

Einar Heiervang, Kenneth Hugdahl, Helmuth Steinmetz, Alf Inge Smievoll, Jim Stevenson, Anders Lund, Lars Ersland, Arvid Lundervold
2000 Neuropsychologia  
Jäncke and Steinmetz [22] reported the same in a study of normal subjects. This lack of correlation may have many reasons.  ...  One child with an arachnoidal cyst was The MR morphometry technique followed the same principles as have been described previously by Steinmetz and colleagues [23, 15, 24] .  ... 
doi:10.1016/s0028-3932(00)00085-3 pmid:11099728 fatcat:6byell5wuffdhkgj3b45tuf75e

Recanalization results after carotid stent placement

Joachim Berkefeld, Bernd Turowski, Andreas Dietz, Heinrich Lanfermann, Matthias Sitzer, Thomas Schmitz-Rixen, Helmuth Steinmetz, Friedhelm E Zanella
2002 American Journal of Neuroradiology  
The details of stent reconstruction in the vascular lumen and of the adaptation of carotid stents, the vessel wall, and the vascular anatomy are only occasionally reported. The purpose of this study was to determine the immediate and longer-term anatomic results after implantation of self-expanding carotid stents. In a retrospective study, pre- and postprocedural angiograms and duplex sonograms from 40 consecutive carotid stent procedures in 39 patients (22 men, 17 women; mean age, 67 years;
more » ... range, 53-84 years) with high-grade (> or =70 %) internal carotid artery (ICA) stenoses were evaluated to assess the expansion of the vascular lumen, apposition of the stent, and geometric changes in the ICA after the implantation of rolling-membrane and carotid Wallstents (n = 22) or Easy Wallstents (n = 18). Optimal widening of the lumen and apposition of the stent were achieved in 11 (28%) of 40 arteries. Residual stenoses (n = 16), free stent filaments not attached to the vessel wall (n = 21), and stent-induced kinking of the ICA (n = 6) were minor shortcomings of stent reconstruction. Because of one death, peri-interventional morbidity and mortality rates were 3%. During follow-up (median, 24 months), one high-grade restenosis, one ipsilateral stroke, and two ipsilateral transient ischemic attacks were observed. Suboptimal anatomic results frequently occur after endovascular treatment of atherosclerotic carotid artery stenosis with self-expanding Wallstents. With the exception of one symptomatic restenosis, no major complications or longer-term sequelae were clearly related to these findings, but further controlled follow-up studies of larger samples are required.
pmid:11827883 pmcid:PMC7975512 fatcat:docqgnrzgjexdcj46f6cnheqsi

Sphingosine 1-phosphate levels in cerebrospinal fluid after subarachnoid hemorrhage

Anika Männer, Dominique Thomas, Marlies Wagner, Jürgen Konczalla, Helmuth Steinmetz, Robert Brunkhorst, Waltraud Pfeilschifter
2020 Neurological Research and Practice  
Background and purpose Sphingosin-1-phosphate (S1P) plays a crucial role as a signaling molecule in the immune system and the vasculature. Previous studies suggested a role as a vasoconstrictor of cerebral arteries via the S1P3-Receptor. Cerebral vasospasm (VS) following aneurysmal subarachnoid hemorrhage (SAH) is a major cause of disability and poor neurological outcome. Early detection of vasospasm could facilitate the prevention of cerebral ischemia in SAH patients. The aim of this
more » ... e case-control study was to characterize the dynamics of S1P in the cerebrospinal fluid (CSF) of patients with SAH in relation to hemorrhage volume, the occurrence of VS, and neurological outcome. Methods S1P levels in CSF of 18 control subjects and 18 SAH patients with placement of an external ventricular drainage (EVD) were determined by high sensitivity mass spectrometry from day 1 through 14 after SAH onset. Hemorrhage volume, development of asymptomatic vasospasm (aVS) and symptomatic vasospasm (sVS), and neurological outcome were correlated to day 1 S1P levels. Results The intrathecal S1P levels of SAH patients were higher than those of the control subjects, and correlated with hemorrhage volume. There was no significant difference in S1P levels between patients with aVS and those with sVS. S1P levels significantly correlated with neurological outcome on a sliding modified Rankin scale. Conclusion S1P levels were highest directly after placement of the EVD and correlated strongly with hemorrhage volume, which may be caused by the intrathecal clot and subsequent lysis of red blood cells, an important source of S1P. We did not detect a second peak of S1P release over the course of the intensive care period.
doi:10.1186/s42466-020-00093-x pmid:33324946 pmcid:PMC7684722 fatcat:ult4mkonhvdlboq7skdhgm3vsa

COVID-19 vaccine-associated cerebral venous thrombosis in Germany [article]

Joerg B. Schulz, Peter Berlit, Hans-Christoph Diener, Christian Gerloff, Andreas Greinacher, Christine Klein, Gabor C. Petzold, Marco Piccininni, Sven Poli, Rainer Roehrig, Helmuth Steinmetz, Thomas Thiele (+1 others)
2021 medRxiv   pre-print
Objective: Reports of cerebral sinus and venous thrombosis (CVT) after ChAdOx1 vaccination against SARS-CoV-2 have raised safety concerns. We aimed to estimate the incidence of CVT within one month from first dose administration and the frequency of vaccine-induced immune thrombotic thrombocytopenia (VITT) as the underlying mechanism after vaccination with BNT162b2, ChAdOx1, and mRNA-1273, in Germany. Methods: A web-based questionnaire was e-mailed to all Departments of Neurology. We asked to
more » ... port cases of CVT within one month of a COVID-19 vaccination. Other cerebral events could also be reported. Incidence rates of CVT were calculated by using official statistics of nine German States. Results: A total of 45 CVT cases were reported. In addition, 9 primary ischemic strokes, 4 primary intracerebral hemorrhages, and 4 other neurological events were recorded. Of the CVT patients, 35 (77.8%) were female, and 36 (80.0%) were below the age of 60 years. Fifty-three events were observed after vaccination with ChAdOx1 (85.5%), 9 after BNT162b2 (14.5%), and none after mRNA-1273 vaccination. After 7,126,434 first vaccine doses, the incidence rate of CVT within one month from first dose administration was 6.5 (95% CI, 4.4-9.2) per 100,000 person-years for all vaccines and 17.9 (11.8-26.1) for ChAdOx1 (after 2,320,535 ChAdOx1 first doses). The adjusted incidence rate ratio was 9.68 (3.46-34.98) for ChAdOx1 compared to mRNA-based vaccines and 3.14 (1.22-10.65) for women compared to non-women. In 26/45 patients with CVT (57.8%), VITT was graded highly probable. Conclusions: Given an incidence of 0.22-1.75 per 100,000 person-years for CVT in the general population, these findings point towards a higher risk for CVT after ChAdOx1 vaccination, especially for women.
doi:10.1101/2021.04.30.21256383 fatcat:axk7s5qr2fhpbmdojc6pvcs3dq
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