35 research outputs found
The effect of CSF drain on the optic nerve in idiopathic intracranial hypertension
Background: Elevation of intracranial pressure in idiopathic intracranial hypertension induces an edema of the prelaminar section of the optic nerve (papilledema). Beside the commonly observed optic nerve sheath distention, information on a potential pathology of the retrolaminar section of the optic nerve and the short-term effect of normalization of intracranial pressure on these abnormalities remains scarce.
Methods: In this exploratory study 8 patients diagnosed with idiopathic intracranial hypertension underwent a MRI scan (T2 mapping) as well as a diffusion tensor imaging analysis (fractional anisotropy and mean diffusivity). In addition, the clinical presentation of headache and its accompanying symptoms were assessed. Intracranial pressure was then normalized by lumbar puncture and the initial parameters (MRI and clinical features) were re-assessed within 26 h.
Results: After normalization of CSF pressure, the morphometric MRI scans of the optic nerve and optic nerve sheath remained unchanged. In the diffusion tensor imaging, the fractional anisotropy value was reduced suggesting a tissue decompression of the optic nerve after lumbar puncture. In line with these finding, headache and most of the accompanying symptoms also improved or remitted within that short time frame.
Conclusion: The findings support the hypothesis that the elevation of intracranial pressure induces a microstructural compression of the optic nerve impairing axoplasmic flow and thereby causing the prelaminar papilledema. The microstructural compression of the optic nerve as well as the clinical symptoms improve within hours of normalization of intracranial pressure
Longitudinal Testing of Olfactory and Gustatory Function in Patients with Multiple Sclerosis
Background The aim of the study was to investigate changes of the olfactory
and gustatory capacity in patients with multiple sclerosis (MS). Methodology
20 MS patients were tested longitudinally for 3 years after initial testing.
The Threshold Discrimination Identification test (TDI) was used for subjective
olfactometry. Objective olfactometry was performed by registering olfactory
evoked potentials (OEP) by EEG. The Taste Strip Test (TST) was used for
gustatory testing. Results 45% of the patients showed olfactory dysfunction in
the follow-up TDI test and 50% showed delayed OEPÂŽs. 20% of the patients
showed gustatory dysfunction on follow-up visit. The patients showed mild
disease activity with 0,3 ± 0,5 relapses over the testing period and no
significant change of their olfactory and gustatory capacity. The olfactory
capacity for the discrimination of odors correlated inversely with the number
of relapses (r = -0.5, p †0.05). The patients were aware of their olfactory
deficit. Conclusions Olfactory and gustatory dysfunction is a symptom in MS
patients and may be a useful parameter to estimate disease progression in MS
patients. As the discrimination of odors is processed in higher central
regions of the central nervous system (CNS), the results suggest that
olfactory dysfunction could be due to CNS damage
Emotional experience in patients with clinically isolated syndrome and early multiple sclerosis
Background and purpose:
Evidence suggests that there are changes in the processing of emotional information (EP) in people with multiple sclerosis (MS). It is unclear which functional domains of EP are affected, whether these changes are secondary to other MS-related neuropsychological or psychiatric symptoms and if EP changes are present in early MS. The aim of the study was to investigate EP in patients with early MS (clinically isolated syndrome and early relapsing/remitting MS) and healthy controls (HCs).
Methods:
A total of 29 patients without neuropsychological or psychiatric deficits and 29 matched HCs were presented with pictures from the International Affective Picture System with negative, positive or neutral content. Participants rated the induced emotion regarding valence and arousal using nine-level Likert scales. A speeded recognition test assessed memory for the emotional stimuli and for the emotional modulation of response time. A subgroup of participants was tested during a magnetic resonance imaging (MRI) session.
Results:
Patients in the MRI subgroup rated the experience induced by pictures with positive or negative emotional content significantly more weakly than HCs. Further, these patients were significantly less aroused when watching the pictures from the International Affective Picture System. There were no effects in the non-MRI subgroup or effects on emotional memory or response times.
Conclusions:
Emotional processing changes may be present in early MS in the form of flattened emotional experience on both the valence and arousal dimensions. These changes do not appear to be secondary to neuropsychological or psychiatric deficits. The fact that emotional flattening was only found in the MRI setting suggests that EP changes may be unmasked within stressful environments and points to the potential yet underestimated impact of the MRI setting on behavioral outcomes
Structural Olfactory Nerve Changes in Patients Suffering from Idiopathic Intracranial Hypertension
BACKGROUND: Complications of idiopathic intracranial hypertension (IIH) are usually caused by elevated intracranial pressure (ICP). In a similar way as in the optic nerve, elevated ICP could also compromise the olfactory nerve system. On the other side, there is growing evidence that an extensive lymphatic network system around the olfactory nerves could be disturbed in cerebrospinal fluid disorders like IIH. The hypothesis that patients with IIH suffer from hyposmia has been suggested in the past. However, this has not been proven in clinical studies yet. This pilot study investigates whether structural changes of the olfactory nerve system can be detected in patients with IIH. METHODOLOGY/PRINCIPAL FINDINGS: Twenty-three patients with IIH and 23 matched controls were included. Olfactory bulb volume (OBV) and sulcus olfactorius (OS) depth were calculated by magnetic resonance techniques. While mean values of total OBV (128.7±38.4 vs. 130.0±32.6 mm(3), p=0.90) and mean OS depth (8.5±1.2 vs. 8.6±1.1 mm, p=0.91) were similar in both groups, Pearson correlation showed that patients with a shorter medical history IIH revealed a smaller OBV (r=0.53, p<0.01). In untreated symptomatic patients (n=7), the effect was greater (r=0.76, p<0.05). Patients who suffered from IIH for less than one year (n=8), total OBV was significantly smaller than in matched controls (116.6±24.3 vs. 149.3±22.2 mm(3), p=0.01). IIH patients with visual disturbances (n=21) revealed a lower OS depth than patients without (8.3±0.9 vs. 10.8±1.0 mm, p<0.01). CONCLUSIONS/SIGNIFICANCE: The results suggest that morphological changes of the olfactory nerve system could be present in IIH patients at an early stage of disease
Optic Nerve Head Quantification in Idiopathic Intracranial Hypertension by Spectral Domain OCT
Objective: To evaluate 3D spectral domain optical coherence tomography (SDOCT) volume scans as a tool for quantification of optic nerve head (ONH) volume as a potential marker for treatment effectiveness and disease progression in idiopathic intracranial hypertension (IIH). Design and Patients: Cross-sectional pilot trial comparing 19 IIH patients and controls matched for gender, age and body mass index. Each participant underwent SDOCT. A custom segmentation algorithm was developed to quantify ONH volume (ONHV) and height (ONHH) in 3D volume scans. Results:Whereas peripapillary retinal nerve fiber layer thickness did not show differences between controls and IIH patients, the newly developed 3D parameters ONHV and ONHH were able to discriminate between controls, treated and untreated patients. Both ONHV and ONHH measures were related to levels of intracranial pressure (ICP). Conclusion: Our findings suggest 3D ONH measures as assessed by SDOCT as potential diagnostic and progression markers in IIH and other disorders with increased ICP. SDOCT may promise a fast and easy diagnostic alternative to repeated lumba
Relevance of obesity to select neurological diseases
Die vorliegende kumulative Habilitationsschrift setzt sich mit der Bedeutung
von Adipositas und den damit einhergehenden metabolischen Risikofaktoren
auseinander. Dabei wird ein Zusammenhang zu verschiedenen neurologischen
Krankheitsbildern aufgezeigt. Nach einer EinfĂŒhrung ĂŒber die Epidemiologie von
Ăbergewicht und Adipositas werden eigene BeitrĂ€ge zur idiopathischen
intrakraniellen Hypertension (IIH), zu arteriosklerotischen Stenosen der
Arteria carotis interna (ICA) sowie zur Bedeutung der Blockade von
SUR1-Rezeptoren in der Akutphase des ischÀmischen Schlaganfalls vorgestellt
und diskutiert. Die IIH gehört zu den Kopfschmerzerkrankungen, deren
Hauptmerkmal ein erhöhter Liquordruck ist. In der Habilitationsschrift wird
die Bedeutung einer erstmals nachgewiesenen Störung des olfaktorischen Systems
bei dieser Erkrankung dargestellt. Zudem wird darauf eingegangen, wodurch eine
Riechstörung bei der IIH verursacht sein könnte. Es wird belegt, dass
Patienten mit Stenosen der ICA meist TrÀger mehrerer metabolischer
Risikofaktoren sind. Durch die eigenen Arbeiten wurden wichtige
DestabilitÀtsmerkmale von ICA-Stenosen identifiziert. Im Anschluss wird
dargestellt, wie durch diese Erkenntnisse innovative bildgebende Verfahren
entwickelt wurden. Durch Blockade des SUR1-Rezeptors scheinen Diabetiker in
der Akutphase eines ischÀmischen Schlaganfalls zu profitieren. Das wird durch
die aufgefĂŒhrten Publikationen des Verfassers belegt. Die Bedeutung der
Erkenntnisse wird aufgrund der daraufhin initialisierten prospektiven
randomisierten multizentrischen Phase II Studien belegt. Die bisher
publizierten Ergebnisse dieser Studien stĂŒtzen die ReliabilitĂ€t der
eingebrachten BeitrÀge. Sollten die vorgestellten Erkenntnisse ihre
ReliabilitÀt, ValiditÀt und klinische Anwendbarkeit weiter belegen, stellen
sie einen zusĂ€tzlichen Nutzen fĂŒr Patienten mit Ăbergewicht und metabolischen
Risikofaktoren dar.The current work deals with obesity and obesity-related metabolic risk factors
in the context of neurological diseases. After giving an overview on the
epidemiology of obesity and the metabolic syndrome, I present and discuss my
work on idiopathic intracranial hypertension (IIH), atherosclerotic stenosis
of the internal carotid artery (ICA) and the sulfonylurea receptor (SUR)-1 in
the acute phase of ischemic stroke. IIH is typically characterized by elevated
cerebrospinal fluid pressure and by headache. The work presented here
establishes that IIH also affects the olfactory system. Based on my data,
potential mechanisms underlying olfactory impairments in IIH are discussed.
Patients suffering from carotid stenosis frequently display metabolic risk
factors. Here, my work centers on markers of plaque instability and how these
were defined by innovative new imaging techniques. Finally, I present results
from clinical studies in type-2 diabetics indicating that blockade of the SUR1
receptor by sulfonylureas may exert beneficial effects in ischemic stroke.
Based on this clinical data, prospective trials have been launched. It will be
interesting to probe further whether SUR1 receptor antagonism might provide
benefits to patients suffering from acute stroke
Patients' Perceptions of Opioid Replacement Therapy: a Comparison of Diamorphine and Methadone/Levomethadone
Diamorphine was first legalized as a novel treatment option for heroin dependence in Germany in 2009. Today, specialized clinics in ten German cities provide diamorphine to heavily addicted patients. As the medical and societal context of diamorphine-assisted therapy is evolving, continued research into patientsâ perceptions of opioid replacement therapy remains important. From February 2018 to June 2018, we conducted a survey study of outpatients on maintenance treatment with either diamorphine (n = 85) or methadone/levomethadone (n = 126). Patients were asked to complete a self-report questionnaire querying, besides socio-demographic information, the study participantâs satisfaction with the substitute drug, relapse with illicit drugs, patterns of craving, and alcohol consumption. Duration of opioid dependence did not differ significantly between groups. Patients on diamorphine were approximately 3 years younger than patients on methadone/levomethadone. They also had a higher frequency of daily intake of their substitute drug and had had their dosage adjusted more often during the preceding 6 months. Still, diamorphine patients reported greater satisfaction with their substitute drug in tandem with significant reductions in relapse-related behaviors and cravings. While the most common relapse reported by patients on methadone replacement was heroin relapse (68%), most instances of illicit drug use in the diamorphine group involved cocaine (48%). Although self-reported alcohol consumption did not differ significantly between groups, a higher percentage of diamorphine patients than methadone patients endorsed decreased alcohol consumption since entering therapy. Taken together, these findings point to meaningful differences between diamorphine and methadone/levomethadone in opioid replacement therapy