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SOP Kompressionssyndrome peripherer Nerven Christian Bischoff, Wilhelm Schulte-Mattler, Ulf Schminke Nervenkompressionssyndrome gehören zu den häufigsten neurologischen Störungen. ...doi:10.1055/a-1022-2263 fatcat:xehm4uvbfbcdrmoiygq3525434
ZusammenfassungDie Sonografie peripherer Nerven hat sich in den vergangenen Jahren zu einem wichtigen Baustein der Diagnostik von Erkrankungen des peripheren Nervensystems entwickelt. Kenntnisse über morphologische Veränderungen peripherer Nerven und deren umgebendes Gewebe ergänzen die mittels Elektrophysiologie gewonnen Information über eine gestörte Funktion der Nerven, wodurch sich die Sicherheit einer Diagnosestellung erhöht. Der Artikel gibt eine Übersicht über die allgemeine Methodikdoi:10.1055/a-0594-1351 fatcat:5cetsqzwqjcsxeomep3ig3pvku
more »... usive der Anforderungen an Hardware und Software der Ultraschallgeräte. Er gewährt außerdem eine detaillierte Einführung in die Untersuchungstechnik und gibt Empfehlungen zur Dokumentation und Auswertung der Untersuchung.
KEYWORDS Ultrasonography; Entrapment neuropathy; Nerve sheath tumor; Traumatic nerve lesion; Polyneuropathy Summary Over the past two decades, high-resolution ultrasonography of peripheral nerves has been evolved as an adjunctive examination technique in clinical neurophysiology laboratories providing complementary information to electrodiagnostic studies. In addition to the information on nerve function, which are typically obtained by nerve conduction studies and electromyography,doi:10.1016/j.permed.2012.03.012 fatcat:fqtvr2uhjzdsrht6r2ct2extfu
more »... phy permits direct assessment of pathologic changes in nerve structure and/or in the adjacent tissue, as well. This article reviews the clinical significance of ultrasonography for the diagnostic evaluation of focal neuropathies, particularly entrapment neuropathies, traumatic nerve lesions, nerve sheath tumors, and several types of polyneuropathies. Ultrasonography offers neuromuscular clinicians a unique opportunity to conduct both complementary examination modalities by themselves without referring patients to another laboratory.
Brain and Behavior
Objectives: Dalfampridine exerts beneficial effects on walking ability in a subgroup of patients with multiple sclerosis (MS). These patients are termed "responders". Here, we investigated whether the responder status with respect to mobility measures would determine whether dalfampridine treatment exerts a beneficial effect on other MS symptoms. We therefore assessed walking ability, upper limb function, cognition, fatigue, visual evoked potentials (VEPs), depression, and quality of life indoi:10.1002/brb3.559 pmid:28127507 pmcid:PMC5256171 fatcat:trgsvyz4pjapfpmwyntgv253ja
more »... ients before and after dalfampridine treatment. Methods: Patients with MS and impaired mobility were recruited. Maximal walking distance, timed 25 Foot Walk, nine hole peg test, paced auditory serial addition test (PASAT), fatigue severity scale (FSS), VEPs, Beck Depression Inventory (BDI), EuroQol five dimensional questionnaire, and quality of life visual analogue scale were determined before and after 12-14 days of dalfampridine treatment. Repeated measures analysis of variance was applied to determine the effect of dalfampridine treatment. Results: Of the 34 patients who completed the study, 22 patients were responders and 12 patients nonresponders, according to their performance in mobility measures. Treatment effects for the entire patient cohort were observed for PASAT (p = .029) and BDI (p = .032). Belonging to the responder cohort did not predict the response to treatment in these tests. For the FSS, response to dalfampridine treatment was dependent on the responder status (p = .001) while no effects in the total patient cohort were observed (p = .680). Other neurological functions remained unaltered. For VEP latencies, no significant improvements were detected. Conclusion: In this study, we observed beneficial effects of dalfampridine on cognition, depression, and fatigue. These effects were not limited to patients who responded to dalfampridine with improved mobility measures. These findings underscore the need to assess the beneficial effects of dalfampridine on neurological deficits in MS patients in additional randomized clinical trials. K E Y W O R D S cognition, dalfampridine, dexterity, fatigue, multiple sclerosis, symptomatic therapy, visual evoked potentials 1
BACKGROUND: Prospective randomized data for comparison of endoscopic and open decompression methods are lacking. OBJECTIVE: To compare the long-and short-term results of endoscopic and open decompression in cubital tunnel syndrome. METHODS: In a prospective randomized double-blind study, 54 patients underwent ulnar nerve decompression for 56 cubital tunnel syndromes from October 2008 to April 2011. All patients presented with typical clinical and neurophysiological findings and underwentdoi:10.1227/neu.0000000000000981 pmid:26595347 fatcat:5ewlysupmnevloz4jqrvivline
more »... ative nerve ultrasonography. They were randomized for either endoscopic (n = 29) or open (n = 27) surgery. Both patients and the physician performing the follow-up examinations were blinded. The follow-up took place 3, 6, 12, and 24 months postoperatively. The severity of symptoms was measured by McGowan and Dellon Score, and the clinical outcome by modified Bishop Score. Additionally, the neurophysiological data were evaluated. RESULTS: No differences were found regarding clinical or neurophysiological outcome in both early and late follow-up between both groups. Hematomas were more frequent after endoscopic decompression (P = .05). The most frequent constrictions were found at the flexor carpi ulnaris (FCU) arch and the retrocondylar retinaculum. We found no compressing structures more than 4 cm distal from the sulcus in the endoscopic group. The outcome was classified as "good" or "excellent" in 46 out of 56 patients (82.1%). Eight patients did not improve sufficiently or had a relapse and underwent a second surgery. CONCLUSION: The endoscopic technique showed no additional benefits to open surgery. We could not detect relevant compressions distal to the FCU arch. Therefore, an extensive far distal endoscopic decompression is not routinely required. The open decompression remains the procedure of choice at our institution.
Objective-Chemerin has been shown to be associated with inflammation and metabolic syndrome, which are in turn leading risk factors for atherosclerosis. A few clinical studies have concentrated on the role of chemerin in atherosclerosis but revealed divergent findings. Therefore, we aimed to investigate the association of plasma chemerin levels with different subclinical measurements of atherosclerosis in a population-based sample. Approach and Results-Linear and logistic regression models withdoi:10.1161/atvbaha.118.311219 pmid:29853566 pmcid:PMC6039419 fatcat:u2mtvt2xfjcnzf6oodq7si2cj4
more »... different atherosclerotic parameters as subclinical outcomes were applied to analyze data from 4003 subjects of the SHIP (Study of Health in Pomerania). After adjustment for metabolic and inflammatory parameters, these models revealed no association of chemerin with carotid intima-media thickness, carotid plaque, or carotid stenosis but a significant inverse association between chemerin and ankle-brachial index. In detail, logistic regression analysis showed that a 25-ng/mL increase in chemerin was associated with a 30% higher odd (95% confidence interval, 1.20-1.41) of having an ankle-brachial index value below the 25th age-and sex-specific quartile. Conclusions-Our analyses revealed a modest inverse association between chemerin and ankle-brachial index that remained consistent after adjustment for metabolic and inflammatory parameters. The association of chemerin with carotid intimamedia thickness, carotid plaque, or carotid stenosis was not significant after adjustment for the same confounder set. The investigated subclinical atherosclerotic parameters are representative for the atherosclerotic burden of different arterial regions and different disease stages. Thus, our results might suggest that the value of chemerin as a marker of higher atherosclerotic risk differs depending on the affected arterial region and disease stage. Visual Overview-An online visual overview is available for this article.
Objectives To investigate spatial heterogeneity of white matter lesions or hyperintensities (WMH). Methods MRI scans of 1,836 participants (median age 52.2 ± 13.16 years) encompassing a wide age range (22-84 years) from the cross-sectional Study of Health in Pomerania (Germany) were included as discovery set identifying spatially distinct components of WMH using a structural covariance approach. Scans of 307 participants (median age 73.8 ± 10.2 years, with 747 observations) from the Baltimoredoi:10.1212/wnl.0000000000006116 pmid:30076276 pmcid:PMC6139818 fatcat:26j4otbdo5catgglup6oj3cj4a
more »... ngitudinal Study of Aging (United States) were included to examine differences in longitudinal progression of these components. The associations of these components with vascular risk factors, cortical atrophy, Alzheimer disease (AD) genetics, and cognition were then investigated using linear regression. Results WMH were found to occur nonuniformly, with higher frequency within spatially heterogeneous patterns encoded by 4 components, which were consistent with common categorizations of deep and periventricular WMH, while further dividing the latter into posterior, frontal, and dorsal components. Temporal trends of the components differed both cross-sectionally and longitudinally. Frontal periventricular WMH were most distinctive as they appeared in the fifth decade of life, whereas the other components appeared later in life during the sixth decade. Furthermore, frontal WMH were associated with systolic blood pressure and with pronounced atrophy including AD-related regions. AD polygenic risk score was associated with the dorsal periventricular component in the elderly. Cognitive decline was associated with the dorsal component. Conclusions These results support the hypothesis that the appearance of WMH follows age and diseasedependent regional distribution patterns, potentially influenced by differential underlying pathophysiologic mechanisms, and possibly with a differential link to vascular and neurodegenerative changes. ‡These authors contributed equally to this work. Glossary AD = Alzheimer disease; BLSA = Baltimore Longitudinal Study of Aging; deep = deep white matter; dors. = dorsal periventricular; fron. = frontal periventricular; post. = posterior periventricular; SHIP = Study of Health in Pomerania; WMH = white matter hyperintensities; WMHC = white matter hyperintensities component. Academy of Neurology. Unauthorized reproduction of this article is prohibited. , education, and SHIP subcohorts. d Models were adjusted for age, sex, education, and SHIP subcohorts.
Cigarette smoking and cerebral microvasculature in patients with type 1 diabetes: a pilot study ABSTRACT Introduction. A decrease in vasomotor reactivity reserve (VMRr) or an increase in pulsatility index (PI) are the early signs of cerebral microangiopathy in type 1 diabetes. Cigarette smoking is a risk factor for microvascular complications of type 1 diabetes, but cigarette smokers are routinely excluded from studies on VMRr or PI in type 1 diabetes (T1DM) and there is no evidence of anydoi:10.5603/fmc.2015.0012 fatcat:mstvqeni4vd2llxo6opvpoq7we
more »... ficant impact of smoking on these variables in T1DM. Therefore, we aimed to assess the impact of cigarette smoking on VMRr and PI in these patients. Methods. VMRr and PI of the middle cerebral artery were measured with Transcranial Doppler in 79 patients with T1DM (median age 33.0 years, range 20-51, 44% males) without a history of cerebrovascular events, coronary heart disease or carotid stenosis. The relationship between cigarette smoking (n = 20, mean pack-years 9.4 ± 6.1) and VMRr, PI, concomitant risk factors, medications and the presence of systemic microvascular complications were analysed. Results. Smokers and non-smokers did not differ in terms of their clinical characteristics, with an exception of higher circadian insulin demand in smokers (60 ± 12.9 v. 49.2 ± 14.2 units; p = 0.004). A correlation between pack-years and PI (r = 0.6, p = 0.004), but not with VMRr, was found in smokers. However, no significant differences between smokers and non-smokers were found regarding either VMRr (mean 85.9 ± 20% v. 84.1 ± 20.1%; p = 0.74) or PI (median 0.85, range 0.61-1.09 v. 0.88, range 0.48-1.52; p = 0.2). Conclusions. We did not prove any significant impact of smoking on VMRr in T1DM patients, but the association between pack-years and PI may indicate the negative impact of intensive cigarette smoking on the cerebral microvasculature in type 1 diabetes.
Background. The relationship between structural and functional integrity of descending motor pathways can predict the potential for motor recovery after stroke. The authors examine the relationship between brain imaging biomarkers within contralesional and ipsilesional hemispheres and hand function in well-recovered patients after subcortical stroke at the level of the internal capsule. Objective. Measures of functional activation and integrity of the ipsilesional corticospinal tract mightdoi:10.1177/1545968311427706 pmid:22140195 fatcat:wztqmyas35bazouped2wk4x6hi
more »... ct paretic hand function. Methods. A total of 14 patients in the chronic stable phase of motor recovery after subcortical stroke and 24 healthy age-matched individuals participated in the study. Functional MRI was used to examine BOLD contrast during passive wrist flexion-extension and paced or maximum-velocity active fist clenching. Functional integrity of the corticospinal pathway was assessed by transcranial magnetic stimulation to obtain motor-evoked potentials (MEPs) in the first dorsal interosseus muscle of the paretic and nonparetic hands. Fractional anisotropy and the proportion of traces between hemispheres in the posterior limb of both internal capsules were quantified using diffusion-weighted MRI. Results. Patients with smaller MEPs had a weaker paretic hand and more primary motor cortex activation in their affected hemisphere. Asymmetry between white matter tracts of either hemisphere was associated with reduced precision grip strength and increased BOLD activation within the contralesional dorsal premotor cortex for demanding hand tasks. Conclusion. There may be beneficial reorganization in contralesional secondary motor areas with increasing damage to the corticospinal tract after subcortical stroke. Associations between clinical, functional, and structural integrity measures in chronic stroke may lead to a better understanding of motor recovery processes.
Objective: Several studies revealed relations between low or high insulin-like growth factor I (IGF-I) levels and risk of cardiovascular diseases or mortality whereas the mechanisms behind these associations are still unknown. Design: The study aimed to explore relations between IGF-I and changes in surrogate markers of cardiovascular disease including carotid intima-media thickness (IMT), left ventricular mass index (LVMI) and N-terminal pro-brain natriuretic peptide (NT-proBNP). Methods:doi:10.1530/eje-19-0470 pmid:31705797 fatcat:fkp2qbcw3rfvnkfsfnuqgn4aqi
more »... tudinal data of the population-based cohort Study of Health in Pomerania (SHIP) were used. IMT was measured by ultrasonography and LVMI was determined based on echocardiography. IGF-I and IGF-binding protein-3 (IGFBP-3) levels were measured by chemiluminescent immunoassays and the IGF-I/IGFBP-3 ratio was calculated. Mixed linear regression models adjusted for known cardiovascular confounders were performed. Results: Statistical analyses demonstrated relations between low baseline IGF-I levels [beta for ΔIMT per standard deviation increase -0.044 (standard error 0.012)] or IGF-I/IGFBP-3 ratio [beta -0.045 (0.012)] and a long-term IMT increase. No associations between IGF-I, IGFBP-3 or IGF-I/IGFBP-3 ratio and changes in LVMI were detected. With respect to NT-proBNP sex-specific associations with IGF-I were found. In women, higher baseline IGF-I levels [beta for ΔNT-proBNP per standard deviation increase 5.92 (2.2)] or IGF-I/IGFBP-3 ratio [beta 4.48 (2.2)] were related to an increase in NT-proBNP levels. Among men, U-shaped relations of baseline levels of IGF-I, IGFBP-3 and the IGF-I/IGFBP-3 ratio with an increase in NT-proBNP were found. Conclusions: The study detected significant relations between IGF-I and long-term changes in IMT and NT-proBNP but not LVMI. These findings argue for different effects of the IGF-I axis with respect to various cardiovascular entities.
It is still controversial if increased hepatic fat independently contributes to cardiovascular risk. We aimed to assess the association between hepatic fat quantified by MRI and various subclinical vascular disease parameters. We included two cross-sectional investigations embedded in two independent population-based studies (Study of Health in Pomerania (SHIP): n=1341; Cooperative Health Research in the Region of Augsburg (KORA): n=386). The participants underwent a whole-body MRI examination.doi:10.1136/bmjgast-2021-000709 pmid:34593525 pmcid:PMC8487174 fatcat:epeyz7upazblrltbcmdh2dfojq
more »... Hepatic fat content was quantified by proton-density fat fraction (PDFF). Aortic diameters in both studies and carotid plaque-related parameters in KORA were measured with MRI. In SHIP, carotid intima-media thickness (cIMT) and plaque were assessed by ultrasound. We used (ordered) logistic or linear regression to assess associations between hepatic fat and subclinical vascular disease. The prevalence of fatty liver disease (FLD) (PDFF >5.6%) was 35% in SHIP and 43% in KORA. In SHIP, hepatic fat was positively associated with ascending (β, 95% CI 0.06 (0.04 to 0.08)), descending (0.05 (0.04 to 0.07)) and infrarenal (0.02 (0.01 to 0.03)) aortic diameters, as well as with higher odds of plaque presence (OR, 95% CI 1.22 (1.05 to 1.42)) and greater cIMT (β, 95% CI 0.01 (0.004 to 0.02)) in the age-adjusted and sex-adjusted model. However, further adjustment for additional cardiometabolic risk factors, particularly body mass index, attenuated these associations. In KORA, no significant associations were found. The relation between hepatic fat and subclinical vascular disease was not independent of overall adiposity. Given the close relation of FLD with cardiometabolic risk factors, people with FLD should still be prioritised for cardiovascular disease screening.
Due to conflicting scientific evidence for an increased risk of dementia by intake of proton pump inhibitors (PPIs), this study investigates associations between PPI use and brain volumes, estimated brain age, and cognitive function in the general population. Two surveys of the population-based Study of Health in Pomerania (SHIP) conducted in Northeast Germany were used. In total, 2653 participants underwent brain magnetic resonance imaging (MRI) and were included in the primary analysis. Theydoi:10.1007/s00228-020-03068-8 pmid:33442768 pmcid:PMC8184524 fatcat:vkvwyu5awzgwnmmmp223wopeji
more »... ere divided into two groups according to their PPI intake and compared with regard to their brain volumes (gray matter, white matter, total brain, and hippocampus) and estimated brain age. Multiple regression was used to adjust for confounding factors. Cognitive function was evaluated by the Verbal Learning and Memory Test (VLMT) and the Nuremberg Age Inventory (NAI) and put in relation to PPI use. No association was found between PPI use and brain volumes or the estimated brain age. The VLMT score was 1.11 lower (95% confidence interval: - 2.06 to - 0.16) in immediate recall, and 0.72 lower (95% CI: - 1.22 to - 0.22) in delayed recall in PPI users than in non-users. PPI use was unrelated to the NAI score. The present study does not support a relationship between PPI use and brain aging.
tors, stroke aetiology, presence of white matter hyperintensities (WMH) and cerebral microbleeds (CMB) between patients with ischaemic posterior circulation stroke (PCS) and those having suffered from anterior circulation stroke (ACS) based on cerebral MRI. Results: We diagnosed PCS in 612 patients (29.1%, 407 men, 205 women) and ACS in 1,489 patients (70.9%). Their age (median 46 vs. 47 years, p = 0.205) and stroke severity (modified Rankin Scale: both 2, p = 0.375, Barthel Index 90 vs. 85, pdoi:10.1159/000454840 pmid:28088807 fatcat:5l7yucw6lzb7zj7krspejmbqmy
more »... 0.412) were similar. PCS was found to be more frequent among the male gender (66.5 vs. 60.1% with ACS, p = 0.003). Vertebral artery (VA) dissection Abstract Background: Although 20-30% of all strokes occur in the posterior circulation, few studies have explored the characteristics of patients with strokes in the posterior compared to the anterior circulation so far. Especially data on young patients is missing. Methods: In this secondary analysis of data of the prospective multi-centre European sifap1 study that investigated stroke and transient ischemic attack (TIA) patients aged 18-55 years, we compared vascular risk fac-
We sought to investigate associations of regional white matter hyperintensities (WMHs) within white matter (WM) tracts with cardiovascular risk and brain aging-related atrophy throughout adulthood in the general population, leveraging state of the art pattern analysis methods. We analyzed a large sample (n = 2367) from the Study of Health in Pomerania, Germany (range 20-90 years). WMHs were automatically segmented on T1-weighted and fluid-attenuated inversion recovery magnetic resonance images,doi:10.1016/j.dadm.2018.02.002 pmid:29644327 pmcid:PMC5889709 fatcat:a7ks2adn45d3lou3ywprlccs7i
more »... and WMH volumes were calculated in WM regions defined using the John Hopkins University WM tractography atlas. Regions with the highest average WMH volume were selected. We calculated a subject-specific index, Spatial Pattern of Alteration for Recognition of Brain Aging, to measure age-related atrophy patterns. The Framingham cardiovascular disease risk score summarized the individual cardiovascular risk profile. We used structural equation models, independently for each region, using Spatial Pattern of Alteration for Recognition of Brain Aging as a dependent variable, age as an independent variable, and cardiovascular disease risk score and regional WMH volumes as mediators. Selected 12 WM regions included 75% of the total WMH burden in average. Structural equation models showed that the age effect on Spatial Pattern of Alteration for Recognition of Brain Aging was mediated by WMHs to a different extent in the superior frontal WM, anterior corona radiata, inferior frontal WM, superior corona radiata, superior longitudinal fasciculus, middle temporal WM, posterior corona radiata, superior parietal WM, splenium of corpus callosum, posterior thalamic radiation, and middle occipital WM (variance explained between 2.8% and 10.3%, P < .0001 Bonferroni corrected), but not in precentral WM. Our results indicate that WMHs, in most WM tracts, might accelerate the brain aging process throughout adulthood in the general population as a result of vascular risk factors, but also independent of them. Preventive strategies against WMHs (such as controlling vascular risk factors or microglia depletion) could delay brain aging.
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