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1. [Not Available]

Author: M A, Ritter and E B, Ringelstein
Published: 2016

2. An Unusual Case of Neuralgic Amyotrophy Presenting with Bilateral Phrenic Nerve and Vocal Cord Paresis

Author: E B Ringelstein, Thomas Duning, A Kemmling, F Holtbernd, and A Am Zehnhoff-Dinnesen
Subjects: Parsonage–Turner syndrome, medicine.medical_specialty, Electromyography, lcsh:RC346-429, Diaphragmatic palsy, medicine, lcsh:Neurology. Diseases of the nervous system, Paresis, Phrenic nerve, Brachial Plexus Neuritis, medicine.diagnostic_test, business.industry, Neuralgic amyotrophy, medicine.disease, Neuropathy, Surgery, Published: February 2011, Aphonia, medicine.anatomical_structure, Parsonage-Turner syndrome, Laryngeal palsy, Upper limb, Neurology (clinical), medicine.symptom, Vocal cord paresis, business
Abstract: a Neurology, b Phoniatrics and Pedaudiology and c Radiology, Abstract Background: Neuralgic amyotrophy (brachial plexus neuropathy, brachial plexus neuritis, or Parsonage-Turner syndrome) is an uncommon inflammatory condition typically characterized by acute and severe shoulder pain followed by paresis with muscle weakness and atrophy of the upper limb or shoulder girdle. We report an unusual clinical manifestation of neuralgic amyotrophy, namely bilateral phrenic nerve palsy with concomitant laryngeal paresis. Case Report: A 55-year-old male presented with orthopnea and aphonia after an episode of bilateral shoulder pain preceded by an upper respiratory tract infection. Spirometry, chest X-ray and videolaryngoscopy revealed bilateral and simultaneous paresis of the diaphragm and the vocal cords. Clinical examination at admission and at the 2-month follow-up did not show upper limb weakness or atrophy, except for a mild atrophy of the right supraspinatus muscle. An electromyography of the upper limb muscles and nerve conduction studies did not reveal signs of denervation. Analysis of the cerebrospinal fluid and an MRI of the neuraxis were unremarkable. After treatment with prednisolone, vocal cord function markedly improved within 8 weeks, whereas paresis of the diaphragm persisted. Conclusion: Shoulder pain followed by diaphragmatic paralysis with dyspnea and hoarseness may be a manifestation of neuralgic amyotrophy even if upper limb or shoulder girdle palsies are absent.
Published: 2011

3. Activated monocytes capture platelets for heterotypic association in patients with severe carotid artery stenosis

Author: Martin A. Ritter, Carsten Schriek, H. Van Aken, Dirk W. Droste, E. B. Ringelstein, Kerstin Jurk, and Beate E. Kehrel
Subjects: Blood Platelets, Male, Pathology, medicine.medical_specialty, Inflammation, Cell Separation, Asymptomatic, Monocytes, Thrombospondin 1, Pathogenesis, Carotid artery disease, medicine, Humans, Carotid Stenosis, Platelet, Platelet activation, Cells, Cultured, Aged, CD11b Antigen, business.industry, Monocyte, Hematology, Middle Aged, Flow Cytometry, Platelet Activation, medicine.disease, Thrombosis, Stroke, P-Selectin, medicine.anatomical_structure, Female, medicine.symptom, business, Biomarkers
Abstract: SummaryInflammation and thrombosis, two processes influencing each other, are involved in the pathogenesis of cerebrovascular disease. We showed that in patients with acute ischaemic stroke circulating platelets are activated and exhausted. To identify whether activated haemostasis might be cause or effect, we investigated the role of leukocyte and platelet activation in patients with severe asymptomatic and symptomatic carotid artery disease. Flow cytometry analysis demonstrated that monocytes from symptomatic (acute stroke aetiology) and asymptomatic patients were highly activated, shown by significantly enhanced presentation of inflammatory markers CD11b and thrombospondin-1 (TSP-1) on the surface. Both correlated positively with monocyte-platelet association rate. However, increased monocyte activation and elevated levels of monocyte-platelet associates in asymptomatic patients were restricted to patients with echo-lucent plaques, providing a close link between monocyte activation and plaque morphology. Circulating single as well as monocyte-bound platelets from symptomatic patients showed significantly enhanced surface expression of P-selectin and TSP-1, whereas platelets from asymptomatic patients were not significantly activated. These results indicate that monocytes activated by inflammation rather than platelets might be the candidates to initiate platelet-monocyte rosetting during the pathogenesis of atherothrombotic cerebral ischaemia and that haemostasis might be activated secondarily by the first occurring inflammation.
Published: 2010

4. Facilities available in French hospitals treating acute stroke patients: comparison with 24 other European countries

Author: D, Leys, C, Cordonnier, S, Debette, W, Hacke, E B, Ringelstein, M, Giroud, J L, Mas, M, Kaste, and Danilo, Toni
Subjects: Diagnostic Imaging, medicine.medical_specialty, Pediatrics, Stroke patient, Stroke care, Health Services Accessibility, Odds Ratio, medicine, Humans, Stroke, Neuroradiology, Acute stroke, business.industry, French, medicine.disease, Hospitals, language.human_language, Europe, Ecg monitoring, Neurology, Emergency medicine, language, France, Neurology (clinical), Level of care, Emergency Service, Hospital, business, Hospital Units
Abstract: The purpose of this study was to compare the proportion of French hospitals meeting criteria for primary (PSC) or comprehensive (CSC) stroke centres, with that of 24 other European countries. We surveyed 121 randomly selected hospitals admitting stroke patients routinely in France and 765 in other European countries. We determined the proportion of hospitals meeting criteria for CSC and PSC according to the EUSI experts definition. The 121 selected hospitals had treated 37,778 patients in 2005 (mean 312), i.e. approximately 25% of all strokes supposed to have occurred in France. Eleven hospitals had an acute stroke care unit, versus 448 of 765 other Hospitals (OR 0.07; 95% CI, OR 0.04-0.13). rt-PA was given to 622 patients (2.2% of ischaemic strokes, versus 3.3% for the other countries). No hospital met criteria for CSC, and only 2 (1.7%) met criteria for PSC. Many facilities considered as necessary by experts were less available, especially personnel, brain CT-scan, ECG monitoring and rt-PA protocols. However, CT angiography 24 h/24, and air ambulance were more often available. Only a few French hospitals offer an optimal level of care for stroke patients. This result contrasts with the high cost of stroke care in France, suggesting an inappropriate use of resources. Conclusions useful for health administrators are: (i) to offer more facilities in reasonably equipped hospitals; (ii) to prevent admission of stroke patients in small under-equipped hospitals; (iii) to promote specific stroke nurse instruction; and (iv) to promote a better organisation of stroke care over the territory.
Published: 2009

5. Angiologische und prognostische Beurteilung von Hirnstamminsulten: Klinische, dopplersonographische und neuroradiologische Befunde

Author: H. Zeumer, Meya U, E. B. Ringelstein, and R. Hündgen
Subjects: medicine.medical_specialty, medicine.diagnostic_test, business.industry, Vertebral artery, General Medicine, medicine.disease, Vascular occlusion, Thrombosis, symbols.namesake, Doppler sonography, Stenosis, medicine.anatomical_structure, medicine.artery, Angiography, symbols, Medicine, Radiology, medicine.symptom, business, Doppler effect, Artery
Abstract: Due to suspect vascular occlusion characterized by disorders of brainstem function 183 patients were investigated using Doppler sonography of the vertebrobasilary vascular system. Extracranial vascular lesions were diagnosed in 32 patients (basilary steal syndrome, vertebral artery branching stenosis), 11 patients showed bilateral vertebral artery occlusion or basilary thrombosis, nine unilateral intracranial vertebral artery occlusion and 131 patients showed no abnormal findings. The prognostically worse intracranial lesions were all confirmed by angiography. Twenty-five patients with normal Doppler findings were also controlled. Of these, three patients showed macroangiopathy presenting as megadolichobasilary artery and haemodynamically ineffective stenosis of the basilary artery (one patient). In the majority of cases neurological disorders associated with normal Doppler sonography findings were however considered as representative of cerebral microangiopathy, characterized by a favourable prognosis.
Published: 2008

6. Notarzteinsätze für Schlaganfallpatienten im Raum Münster: Eine Querschnittsstudie der regionalen Versorgungsqualität

Author: J. Dieckmann, R. Kleine-Zander, Birgitta Weltermann, D. vom Eyser, T. Riedel, and E. B. Ringelstein
Subjects: Medical treatment, Stroke patient, Cross-sectional study, business.industry, Retrospective cohort study, General Medicine, medicine.disease, Medical care, Blood pressure, medicine, Medical emergency, business, Stroke, Competence (human resources)
Abstract: BACKGROUND AND OBJECTIVE: Advances in understanding the pathophysiology and treatment of stroke have led to changed requirements, including the prehospital phase, for the care of patients with acute stroke. Rapid transport to a regional stroke centre is nowadays considered to be the standard for optimal quality of care. A retrospective cross-sectional analysis was undertaken in 1996 in the region of the town of Munster to test the quality of medical care provided by physicians on emergency call. PATIENTS AND METHODS: 250 of 3001 protocols (8.3%) filled in by emergency call physicians were selected in which the initial diagnosis of transitory ischaemic attack, stroke or cerebral haemorrhage had been made. Quality of patient care was assessed according to the following criteria; (1) complete medical treatment (blood sugar, blood pressure, cardiac rhythm and arterial oxygen saturation, including relevant treatment of any abnormality) (2) action time (arrival of emergency doctor within 12 min and arrival at hospital within 50 min); (3) type of the admission hospital (stroke centre defined as a hospital experienced in the treatment of stroke, with neurological and medical departments, as well as 24-hour cover for computed cranial tomography). A summated indicator of "optimal care" was used to determine whether the three stated criteria were met. RESULTS: Mean age of the stroke patients was 72.3 years. While the above mentioned quality criteria for the action time were met in 93.5% of patients, only 56.0% were admitted to a stroke centre, and this was significantly more often the final destination for patients under the age of 65 years than for older ones (p = 0.049). The quality indicator "complete medical treatment" was met for 27.2% of the transported patients. Measured according to present-day criteria, only 18.6% of patients received such optimal treatment. CONCLUSION: This analysis indicates that modern prehospital treatment of stroke patients does not reach adequate standards. In particular, it is not comprehensive. While the "action time" is usually adequate, there are deficiencies regarding the quality of medical care and the choice of the admission hospital. Further education for emergency physicians with respect to the management of stroke syndrome should be an integral part of any regional quality programme. The number of hospitals with adequate competence in the acute management of stroke cases is still insufficient.
Published: 2008

7. Die Diagnostik des Schlaganfalls bei jungen Erwachsenen

Author: H. G. Dizinger and E. B. Ringelstein
Subjects: High probability, Pediatrics, medicine.medical_specialty, business.industry, General Medicine, medicine.disease, Disseminated lupus erythematosus, Etiology, Diagnostic program, Medicine, Endocarditis, Medical diagnosis, business, Stroke
Abstract: 42 patients aged up to 35 years who had suffered a stroke were analysed according to etio-pathogenetic and prognostic criteria. The cause of the stroke could be explained with certainty only in ten patients and with high probability in a further eight. In a quarter of the cases the aetiology was completely obscure. Diagnostic gaps exist especially in haemostatic, virological and cardiological areas. Three patients died from the stroke. Follow-up showed that 40% of patients were able to resume their previous occupation. Relapses were observed in cases with disseminated lupus erythematosus and endocarditis. The relatively low rate of clarified cases (42%) is partly due to selection but also to the gaps in diagnostic knowledge. Accordingly, a stepwise diagnostic program was set up, based upon urgency and technical expenditure, that took into account not only the minimal needs for a sound initial diagnosis but also the extensive differential diagnoses for less common causes of stroke.
Published: 2008

8. Ultraschalldiagnostik am vertebrobasilären Kreislauf - Teil II: Transnuchale Diagnose intrakranieller vertebrobasilärer Stenosen mit Hilfe eines neuartigen Impulsschall-Doppler-Systems

Author: E. B. Ringelstein
Subjects: Foramen magnum, medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Vertebral artery, Ultrasound, medicine.disease, symbols.namesake, medicine.anatomical_structure, medicine.artery, Angiography, Fibrinolysis, cardiovascular system, medicine, Basilar artery, symbols, Radiology, Nuclear Medicine and imaging, Radiology, Vertebrobasilar insufficiency, business, Doppler effect
Abstract: This report deals with the non-invasive detection of haemodynamically non-significant stenoses of the intracranial part of the vertebrobasilar system. A new Doppler device transmitting pulsed 2 MHz ultrasound was used. Among 67 patients with transient or stable neurological deficits of the posterior circulation area, five were found to have stenoses of the distal vertebral artery or basilar artery, respectively. Transnuchal approach via the foramen magnum was used. The findings were confirmed by angiography. Twelve subjects with normal Doppler findings also underwent angiography. Three of them presented irregularities and plaquing of the vertebrobasilar trunk without circumscribed stenosing lesions. Transcranial pulsed Doppler sonography permits non-invasive detection of intracranially located stenoses of the vertebrobasilar system which, up to now, could not be diagnosed with the help of extracranial conventional continuous-wave Doppler alone. This new method allows early detection of basilar artery occlusive disease. The effectiveness of anticoagulation and fibrinolysis can be assessed non-invasively.
Published: 2008

9. CTP-Based Tissue Outcome: Promising Tool to Prove the Beneficial Effect of Mechanical Recanalization in Acute Ischemic Stroke

Author: V. Heßelmann, S. Ligges, Rainer Dziewas, Thomas Niederstadt, A Kemmling, Walter Heindel, E. B. Ringelstein, M. Ritter, and F. Drewer-Gutland
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Perfusion scanning, Sensitivity and Specificity, Brain Ischemia, Young Adult, Text mining, Modified Rankin Scale, medicine, Humans, Radiology, Nuclear Medicine and imaging, Stroke, Acute ischemic stroke, Aged, Aged, 80 and over, medicine.diagnostic_test, Cerebral Revascularization, business.industry, Reproducibility of Results, Middle Aged, medicine.disease, Prognosis, Cerebral Angiography, Treatment Outcome, Angiography, Infarct volume, Feasibility Studies, Female, Radiology, business, Tomography, X-Ray Computed, Parent vessel
Abstract: To prove the tissue-protecting effect of mechanical recanalization, we assessed the CT perfusion-based tissue outcome ("TO") and correlated this imaging parameter with the 3-month clinical outcome ("CO").159 patients with large intracranial artery occlusions revealing mechanical recanalization were investigated by CCT, CT angiography (CTA) and CT perfusion (CTP) upon admission. For the final infarct volume, native CCT was repeated after 24 h. The "TO" ("percentage mismatch loss" = %ML) was defined as the difference between initial penumbral tissue on CTP and final infarct volume on follow-up CCT. We monitored the three-month modified Rankin Scale (mRS), age, bleeding occurrence, time to recanalization, TICI score and collateralization grade, infarct growth and final infarct volume. Spearman's correlation and nominal regression analysis were used to evaluate the impact of these parameters on mRS. Significant correlations were found for %ML and mRS (c = 0.48, p 0.001), for final infarct volume and mRS (c = 0.52, p 0.001), for TICI score and mRS (c = - 0.35, p 0.001), for initial infarct core and mRS (c = 0.14, p = 0.039) as well as for age and mRS (c = 0.37, p 0.001). According to the regression analysis, %ML predicted the classification of mRS correctly in 38.5 % of cases. The subclasses mRS 1 and 6 could be predicted by %ML with 86.4 % and 60.9 % reliability, respectively. No correlations were found for time to recanalization and mRS, for collateralization grade and mRS, and for post-interventional bleeding and mRS. Better than the TICI score, CT-based TO predicts the clinical success of mechanical recanalization, showing that not recanalization, but reperfusion should be regarded as a surrogate parameter for stroke therapy.• %ML as well as the final infarct volume can make a direct point about the immediate effect of successful mechanical recanalization.• The clinical outcomes after mechanical recanalization are reliably predicted by %ML, reflecting the benefit of escalation therapy including interventional reopening of parent vessel occlusions.• Not recanalization but rather reperfusion should be regarded as a surrogate parameter for successful stroke therapy.
Published: 2015

10. Etiological Classification of Ischemic Strokes: Evidence from CT and SPECT Imaging1

Author: E. B. Ringelstein and C. Weiller
Subjects: medicine.medical_specialty, business.industry, Internal medicine, Stroke prevention, Ischemic strokes, medicine, Etiology, Cardiology, business
Published: 2015

11. Schlaganfallbehandlung im deutschen DRG-System 2006

Author: N. Roeder, E. B. Ringelstein, and W. Fiori
Subjects: business.industry, Treatment method, Diagnosis-related group, General Medicine, medicine.disease, language.human_language, German, Psychiatry and Mental health, Neurology, language, Medicine, Neurology (clinical), Medical emergency, business, Stroke, Acute stroke
Abstract: The 2006 version of the German diagnosis-related group (DRG) system distinguishes for the first time between different forms of treatment for acute stroke. This was made possible through cooperation of the German Stroke Society (Deutsche Schlaganfall Gesellschaft) in further development of the German procedure classification (OPS) and G-DRG system. The 2005 procedure codes for complex neurologic treatment of acute stroke (OPS 8-981) collated treatment methods for the first time in a data base. Their consideration in the 2006 German DRG system was made possible by further data collection from participating hospitals. Hence the complex neurologic treatment of acute stroke now serves as a qualifying criterion for seven higher weighted DRGs. Even though this might not lead directly to a rise in a given hospital's total revenue, it can ease adjustments to the DRG price system and present a more realistic picture of the relationships between the various departments within a hospital.
Published: 2006

12. Inzidenz zerebraler Ischämien bei Patienten mit dem Verdacht einer spontanen Dissektion der extrakraniellen Arterien: Erste Ergebnisse einer prospektiven Studie

Author: C. Stehling, R. Bachmann, G. Kuhlenbäumer, Thomas Niederstadt, E. B. Ringelstein, R. Dittrich, I. Nassenstein, Walter Heindel, and Stefan Krämer
Subjects: medicine.medical_specialty, medicine.diagnostic_test, Cervical Artery, business.industry, Ischemia, Fluid-attenuated inversion recovery, medicine.disease, Dissection, Angiography, medicine, Radiology, Nuclear Medicine and imaging, Radiology, Scad, Prospective cohort study, business, Stroke
Abstract: Purpose: Aim of this prospective study was to investigate the incidence of spontaneous cervical artery dissection (sCAD) and cerebral ischemia in patients with suspected sCAD by using a combined head-neck MR-imaging protocol. Materials and Methods: 51 consecutive patients (24 m, 27 f, mean age 39.5 years, range 18 - 55 yrs) admitted to our stroke unit with suspected sCAD according to clinical criteria and age < 55 years underwent a combined head and neck MR examination within 24 hours of admission (Gyroscan Intera 1.5 T, Philips). Head MRI included ax FLAIR, ax T 1 , ax DWI and TOF angiography (imaging time 12 min). Neck MRI consisted of ax T1w-TSE, T2w-TSE, contrast enhanced T1w-TSE and CE-MRA (imaging time 17 min). Three radiologists assessed both studies in consensus with regard to the presence of sCAD and acute ischemia. Results: One patient had to be excluded because of motion artefacts. In 17 of 50 patients sCAD was diagnosed, and in 20 of 50 patients cerebral ischemia. In 5 patients cerebral ischemia was caused by sCAD. Conclusion: The proposed combined MR protocol allows imaging work-up of patients with suspected sCAD within approximately 30 min, resulting in conclusive information about the status of the extracranial vasculature and the presence of ischemia. The high incidence of patients with definite sCAD and the low incidence of cerebral ischemia indicates the necessity of an early definite diagnosis in order to start timely anticoagulation to prevent development of stroke.
Published: 2005

13. Time is brain — Competence is brain

Author: Martin Grond, E. B. Ringelstein, and Otto Busse
Subjects: Gynecology, Psychiatry and Mental health, medicine.medical_specialty, Neurology, business.industry, medicine, Neurology (clinical), General Medicine, business
Abstract: Das angelsachsische Stroke-Unit-Konzept entwickelte sich zunachst als eine rehabilitative Einrichtung mit akutmedizinischer Versorgung, wahrend in Deutschland beim Aufbau der Stroke Units das multimodale Monitoring des Schlaganfallpatienten als neurovaskularer Notfall und die zunehmende Anwendung der Lysetherapie konzeptionell bestimmend waren. In den angelsachsischen Stroke Units wurde die eindrucksvolle Prognoseverbesserung der Schlaganfallpatienten durch die Stroke-Unit-Behandlung evidenzbasiert bewiesen. Dem therapeutischen Erfolg liegen zwei wesentliche Prinzipien zugrunde, (1) die ausschliesliche Behandlung von Schlaganfallpatienten in dieser Einheit und (2) der Team-Approach, d. h. die multiprofessionelle Expertengruppe als Therapeuten. Beide Prinzipien wurden in den deutschen Stroke Units konsequent umgesetzt. Zwei Entwicklungen in Richtung einer Komplettierung und Vereinheitlichung der Stroke-Unit-Behandlung zeichnen sich inzwischen in Europa ab: In England und Skandinavien wird in den Stroke Units zunehmend akzeptiert, dass das multimodale apparative Monitoring notwendig ist und die Prognose zusatzlich verbessert. In den deutschen Stroke Units wird die Schnittstelle zwischen der 3- bis 4-tagigen Stroke-Unit-Behandlung und der nachbehandelnden Allgemeinstation durch Einbeziehung der bereits vorhandenen Ressourcen in eine “erweiterte Stroke Unit” uberwunden. Diese erweiterte Stroke Unit kommt dem britischen Konzept der “Comprehensive Stroke Unit”, d. h. der Akutbehandlung mit fruh einsetzenden Rehabilitationstherapie aus einer Hand, sehr nahe.
Published: 2005

14. Zentraler Deafferenzierungsschmerz: Klinisches Bild und Therapie

Author: A. Frese and E. B. Ringelstein
Subjects: Central pain, business.industry, Physiology (medical), Anesthesia, Neuropathic pain, Medicine, Neurology (clinical), business
Published: 2004

15. A Method for the Automated Assessment of Temporal Characteristics of Functional Hemispheric Lateralization by Transcranial Doppler Sonography

Author: M. Deppe, S. Knecht, H. Lohmann, and E. B. Ringelstein
Subjects: Radiology, Nuclear Medicine and imaging, Neurology (clinical)
Published: 2004

16. Chirotherapie und Vertebralisl�sion

Author: A. Refisch, M. Schilgen, and E. B. Ringelstein
Subjects: Complementary and Manual Therapy, Gynecology, medicine.medical_specialty, Complementary and alternative medicine, business.industry, Medicine, Physical Therapy, Sports Therapy and Rehabilitation, business
Abstract: Im Rahmen einer fragebogenbasierten prospektiven Studie wurde die Haufigkeit stationarer Krankenhausbehandlungen in Nordrhein-Westfalen wegen Lasionen der Halsarterien im zeitlichen Zusammenhang mit Chirotherapie an der Halswirbelsaule erfasst. Analysiert wurden 15 Falle fur 1997 und 1998 bei 86 befragten neurologischen oder neurochirurgischen Kliniken. In 4 Fallen war die A. carotis betroffen. Das einzige Einschlusskriterium war der zeitliche Zusammenhang von Chirotherapie und stationarer Behandlung wegen neurologischer Symptome ohne oberes zeitliches Limit fur die Latenzphase. Die Problematik des Kausalzusammenhangs zwischen Lasion und Chirotherapie angesichts von Spontandissektionen und die schwierige Bestimmung der tatsachlichen Haufigkeit werden diskutiert.
Published: 2004

17. Der juvenile isch�mische Insult

Author: A. Allroggen, E. B. Ringelstein, and D. G. Nabavi
Subjects: Gynecology, Secondary prevention, Psychiatry and Mental health, medicine.medical_specialty, Neurology, business.industry, medicine, Neurology (clinical), General Medicine, business
Abstract: Der juvenile ischamische Insult (Alter bis 45 Jahre) stellt eine diagnostische und therapeutische Herausforderung unter den Schlaganfallsyndromen dar. Atiologisch kommen eine Vielzahl von z. T. seltenen Krankheiten in Betracht. Vor allem mussen nichtatherosklerotische Arteriopathien — mit der Gefasdissektion als Hauptvertreter —, paradoxe Embolien und Thrombophilien berucksichtigt werden. Bei fluchtigen Insulten ohne Nachweis struktureller Lasionen kann eine Abgrenzung zu nichtvaskularen Krankheiten (sog. Pseudoinsulten) v. a. einer Migraneaura, einem epileptischen Anfall und einer dissoziativen Storung schwierig sein. Daher fuhren juvenile Insulte zu einem erheblichen diagnostischen Mehraufwand, der die evidenzbasierten Mindestanforderungen weit ubersteigt. Zahlreiche Therapiestrategien beruhen nicht auf grosen randomisierten Studien und mussen auf individueller Basis gestaltet werden. Trotz guter Patientencompliance betragt das jahrliche Risiko fur Reinsulte etwa 2–3% und fur Myokardinfarkte etwa 1%.
Published: 2004

18. Prästationäre Versorgung von Schlaganfallpatienten1 - Eine Querschnittsstudie von Notarzteinsätzen

Author: R. Kleine-Zander, T. Riedel, D. vom Eyser, Birgitta Weltermann, J. Dieckmann, and E. B. Ringelstein
Subjects: medicine.medical_specialty, business.industry, Internal medicine, Emergency Medicine, medicine, Cardiology, Critical Care and Intensive Care Medicine, medicine.disease, business, Stroke
Published: 1999

19. Neuronale Plastizität am Beispiel des somatosensorischen Systems

Author: S. Knecht and E.-B. Ringelstein
Subjects: Gynecology, Psychiatry and Mental health, medicine.medical_specialty, Neurology, business.industry, medicine, Neurology (clinical), General Medicine, business
Abstract: Das menschliche Gehirn ist zu massiver funktioneller Reorganisation fahig. Anhand von Ergebnissen der eigenen Arbeitsgruppe und einer Literaturubersicht werden die Grundlagen und Mechanismen dieser Plastizitat am Beispiel des somatosensorischen Systems beschrieben. Sensible Bahnen mit ihren Relais-Stationen verlaufen in einander uberlappenden Projektionen von der Peripherie zur Hirnrinde. Durch Veranderung synaptischer Gewichtungen konnen sich funktionelle Hirnkarten umorganisieren und dementsprechend veranderte Wahrnehmungen hervorrufen. Einerseits konnen z.B. nach einer Gliedmasenamputation die benachbarten Reprasentanzen des somatosensorischen Homukulus in den deafferenzierten Kortexabschnitt “einwandern”. Andererseits fuhrt sensomotorisches Training einer Gliedmase zu einer Vergroserung der zugehorigen kortikalen Reprasentation. Diese Plastizitat kann kurzlebig oder anhaltend und damit irreversibel sein. Plastizitat ist daruber hinaus modulierbar. So konnen Schmerzen aber auch Pharmaka zu einer Verstarkung der funktionellen Umorganisation fuhren. Die Kombination von physiotherapeutischem Training und pharmakologischer Modulation kann die Funktionserholung nach Gehirnlasionen steigern.
Published: 1999

20. Mutation analysis of a putative sialyltransferase gene, theSFRS2splicing factor gene and thec-mybET-locus in two families with hereditary neuralgic amyotrophy (HNA)

Author: Christine Van Broeckhoven, F. Stoegbauer, Anja Schirmacher, Manfred Wehnert, J. Meuleman, E. B. Ringelstein, Maria Hoeltzenbein, Vincent Timmerman, and Gregor Kuhlenbaeumer
Subjects: Male, Candidate gene, Sialyltransferase, DNA Mutational Analysis, Locus (genetics), Hereditary neuralgic amyotrophy, Proto-Oncogene Proteins c-myb, Splicing factor, Proto-Oncogene Proteins, Complementary DNA, Genetics, medicine, Brachial Plexus Neuritis, Humans, Gene, Genetics (clinical), Polymorphism, Genetic, Models, Genetic, Serine-Arginine Splicing Factors, biology, Nuclear Proteins, medicine.disease, Sialyltransferases, Pedigree, Ribonucleoproteins, Trans-Activators, biology.protein, Mutation testing, Female, Polymorphism, Restriction Fragment Length
Abstract: HNA is an autosomal dominant recurrent focal neuropathy involving the brachial plexus. The etiology of HNA is unknown but the genetic defect most likely affects a non-neuronal tissue. We previously described linkage to chromosome 17q24-q25 in two HNA-families. Here we report the mutation analysis of two candidate genes: a cDNA encoding a putative sialyltransferase and the SFRS2 splicing factor including the c-myb ET-locus which is encoded on the opposite strand of the SFRS2 gene. The complete protein coding regions of both genes were studied by direct DNA sequencing. We did not find a disease associated mutation indicating that these genes are most likely not involved in the pathogenesis of HNA. However, we identified and characterized a rare AvaII polymorphism in the SFRS2 gene and detected a sequencing error, leading to an amino acid change (Val11Leu) in the published sequence of the putative sialyltransferase.
Published: 1998

21. Dissektionen der A. vertebralis durch chirotherapeutische Behandlung

Author: E. B. Ringelstein
Subjects: Complementary and Manual Therapy, Gynecology, medicine.medical_specialty, Complementary and alternative medicine, business.industry, Medicine, Physical Therapy, Sports Therapy and Rehabilitation, business
Abstract: Die fur Patient und Therapeut gefahrlichen Folgen liegen auf der Hand: Richtige(re) Differentialdiagnosen werden nicht bedacht, d. h. geeignete, fruhzeitige Behandlungsmoglichkeiten verfehlt. Chirotherapie an der HWS wird auch dann durchgefuhrt, wenn kein pathophysiologischer Zusammenhang zwischen manualtherapeutisch behandelbaren Storungen des zervikalen Bewegungsapparats und den Beschwerden des Patienten besteht. Chirotherapeutische Manipulationen werden vor allem bei jungen Menschen durchgefuhrt, wo ein erhohtes Verletzungsrisiko der A. vertebralis vorliegt. Chirotherapie wird u. U. in der Akutphase einer nicht erkannten, spontan aufgetretenen Dissektion der A. vertebralis durchgefuhrt, was zu lebensbedrohlichen Thromboembolien des vertebrobasilaren Kreislaufs fuhren kann.
Published: 1997

22. Prolongierte Muskelschwäche des Intensivpatienten unter besonderer Berücksichtigung der sog. Intensiv-Polyneuromyopathie

Author: P Lüdemann, S Hinder, H. Van Aken, Frank Hinder, and E. B. Ringelstein
Subjects: medicine.medical_specialty, Weakness, Critical Illness Myopathy, business.industry, Generalized muscle weakness, Muscle weakness, General Medicine, Intensive care unit, law.invention, Anesthesiology and Pain Medicine, law, Intensive care, medicine, Physical therapy, medicine.symptom, Critical illness polyneuropathy, Intensive care medicine, business, Myopathy
Abstract: Generalized muscle weakness in critically ill patients can result in prolonged periods of artificial ventilation and longer stays in the intensive care unit. Both neuropathic (critical illness polyneuropathy) and myopathic (critical illness myopathy) abnormalities seem to play an important role for this prolonged weakness. This article reviews its complex differential diagnosis with special emphasis on the current understanding of the neuromuscular syndromes. An efficient diagnostic plan is necessary for the exclusion of other curable causes of prolonged muscle weakness even in the presence of polyneuromyopathic changes. Psychological support of the patient and prophylaxis of secondary complications of prolonged immobilization are crucial when specific therapy is not possible.
Published: 1997

23. [Interdisciplinary neurovascular network: a new structure for treatment of stroke and other cerebrovascular diseases in Germany]

Author: O, Busse, J, Röther, J, Faiss, G F, Hamann, T, Hupp, O, Jansen, J, Meixensberger, T, Neumann-Haefelin, G, Schackert, and E B, Ringelstein
Subjects: Patient Care Team, National Health Programs, Neurosurgery, Regional Medical Programs, Telemedicine, Stroke, Cerebrovascular Disorders, Germany, Neuroradiography, Humans, Interdisciplinary Communication, Cooperative Behavior, Hospital Units, Vascular Surgical Procedures, Societies, Medical, Quality Indicators, Health Care
Published: 2013

24. Die Genetik der Migr�ne

Author: T. Wieser, E. B. Ringelstein, and Stefan Evers
Subjects: Gynecology, Psychiatry and Mental health, medicine.medical_specialty, Neurology, Political science, medicine, Neurology (clinical), General Medicine
Abstract: Nachdem bereits in historischen Beschreibungen eine genetische Verursachung der Migrane vermutet worden war, haben epidemiologische und molekularbiologische Forschungen in den letzten Jahren differenzierte Ergebnisse uber genetische Faktoren in der Atiopathogenese der familiaren Migrane geliefert. Aufgrund von Familien- und Segregationsanalysen und von Zwillingsstudien wird dargestellt, das genetische Faktoren mit groster Wahrscheinlichkeit eine Rolle in der Pathogenese der typischen Migrane spielen. Inwieweit extragenetische Faktoren auf die Atiopathogenese der Migrane Einflus nehmen, ist weitgehend offen. Linkageanalysen haben in jungster Zeit gezeigt, das moglicherweise mehrere verschiedene Gene fur diese Erkrankung verantwortlich sind. Fur die Familiare Hemiplegische Migrane (FHM), der einzigen Migraneform, fur die ein autosomal-dominanter Erbgang nachgewiesen ist, konnte ein Genlocus auf Chromosom 19p13 gefunden werden, gleichzeitig wurde aber auch genetische Heterogenitat nachgewiesen. Verschiedene andere Formen der Migrane zeigten keine Linkage zu diesem Locus. Weitere Forschungen sollten neben der Identifizierung des FHM-Gens auch Linkageanalysen fur Kandidatengene und Genomanalysen an grosen informativen Familien zum Ziel haben. Letztlich werden die Ergebnisse genaueren Einblick in die Pathophysiologie der Migrane liefern und damit therapeutisch relevant sein.
Published: 1996

25. Cerebral hemodynamics in pre-eclampsia/eclampsia syndrome

Author: Wolfgang Holzgreve, P. Zunker, G. Schuierer, E. B. Ringelstein, J. Ley-Pozo, and Frank Louwen
Subjects: Hypertensive encephalopathy, Eclampsia, Radiological and Ultrasound Technology, HELLP syndrome, business.industry, Cerebral arteries, Obstetrics and Gynecology, Vasospasm, General Medicine, Blood flow, medicine.disease, Cerebral autoregulation, Blood pressure, Reproductive Medicine, Anesthesia, medicine, Radiology, Nuclear Medicine and imaging, business, reproductive and urinary physiology
Abstract: Pre-eclampsia and eclampsia represent a syndrome with progressive pregnancy-induced hypertension. They are associated with considerable morbidity and mortality. The pre-eclampsia/eclampsia syndrome has been hypothesized to reflect a subtype of hypertensive encephalopathy. Additionally, an endothelial dysfunction with impaired cerebral autoregulation has been proposed. Neurological symptoms in hypertensive encephalopathy have been attributed to marked vasospasm or forced vasodilatation. This study was undertaken to evaluate the changes in cerebral hemodynamics due to this syndrome. Twelve patients with pre-eclampsia/eclampsia syndrome, five of them with a concomitant syndrome involving hemolysis, elevated liver enzymes and low platelets (HELLP syndrome), were investigated. Mean blood flow velocities of the middle, anterior and posterior cerebral arteries were assessed bilaterally by means of a 2-MHz, pulsed Doppler ultrasound device. After the initial diagnosis, follow-up examinations were performed twice a week until delivery, and then weekly over a 4-week period postpartum. Intracranial arterial blood flow velocities were elevated in ten out of 12 patients. Values of up to twice the normal flow velocities were observed in individual cases. Flow velocities correlated with the systemic arterial blood pressure (r = 0.75, p = 0.008). Eight patients showed pathologically increased flow velocities despite a mean arterial blood pressure below 150 mmHg. Our preliminary findings suggest that a forced vasodilatation, probably due to passive overdistension of cerebral arterioles and vasogenic edema rather than vasospasm, is responsible for the observed high cerebral flow velocities. We hypothesize that endothelial dysfunction plays a crucial role in the altered cerebral hemodynamics in the pre-eclampsia/eclampsia syndrome.
Published: 1995

26. Variability of Doppler Microembolic Signal Counts in Patients With Prosthetic Cardiac Valves

Author: M. Kahl, B. Diehl, M. Siebler, M. Kaps, M. König, P. Zunker, J. Berg, Dimitrios Georgiadis, E. B. Ringelstein, and M. Hill
Subjects: Advanced and Specialized Nursing, medicine.medical_specialty, business.industry, Microembolic signal, medicine.disease, Transcranial Doppler, Surgery, symbols.namesake, Embolus, Embolism, Internal medicine, Cardiac valve, Cardiology, medicine, symbols, In patient, Neurology (clinical), Implant, Cardiology and Cardiovascular Medicine, business, Doppler effect
Abstract: Background and Purpose The purpose of this study was the evaluation of intraobserver, interobserver, and intrasubject variability in the Doppler detection of microembolic signals in patients with mechanical prosthetic valves. Simultaneously, the feasibility of automated embolus detection by means of a neuronal network was investigated. Methods From 25 patients with mechanical prosthetic heart valves, single transcranial Doppler monitoring sessions of 30 minutes’ duration were recorded on videotape, randomized, and subsequently analyzed by eight independent trained observers from three centers. Three observers evaluated these tapes on three separate occasions, blinded to their previous results. An additional 48 patients with prosthetic heart valves were repetitively monitored with transcranial Doppler ultrasonography for 30 minutes three times within 1 year to examine the long-term variability in the occurrence of microembolic signals. Finally, in an effort to assess the short-term intrasubject variability, 20 patients were examined for 90 minutes, and the results of the three 30-minute periods were compared. The interobserver, intraobserver, and intrasubject (both short- and long-term) variability was evaluated. Results No significant differences in microembolic signal counts were found among the different observers, between the human observers and the neuronal network, or among the three separate evaluations of stored data by the same observer. The same was true for repeat examinations of the same patient ( P >.05, Student’s two-paired t test and Friedman’s test). Conclusions The detection of microembolic signals in patients with prosthetic cardiac valves is a reproducible technique. The reliable performance of the neuronal network argues for a broader use of this device. The intrasubject stability of the microembolic rate over 1 year supports the concept that the underlying emboligenic process is associated with intrinsic mechanical properties of the valve implant and not due to a thromboembolic process in the heart.
Published: 1995

27. Morphometrische Differenzierung subkortikaler zerebraler Infarkte

Author: O. Kastrup, C. Weiller, and E. B. Ringelstein
Subjects: Neurology (clinical)
Published: 1995

28. Einfluß morphologischer Veränderungen auf Durchblutung und Stoffwechsel bei zerebraler Mikroangiopathie

Author: E. B. Ringelstein, A. Thron, U. Büll, v. Hinckeldey, K. Willmes, M. Mull, R. Schneider, C. Doherty, H. J. Kaiser, D. Hellwig, and O. Sabri
Subjects: Positronen emissions tomographie, business.industry, Medicine, Radiology, Nuclear Medicine and imaging, General Medicine, business, Nuclear medicine
Abstract: Zusammenfassung51 Patienten mit zerebraler Mikroangiopathie wurden mittels Kernspintomographie, 18FDG-PET und 99mTc-HMPAO-SPECT untersucht. Die genaue Zuordnung funktioneller zu den morphologischen Befunden wurde durch ein spezielles Kopf-halterungssystem für PET, SPECT- und KST-Untersuchungen hergestellt. Patienten mit weniger als vier lakunären Infarkten (LI) und ohne bis geringfügigen Deep White Matter Lesions (DWML) im KST wiesen keine signifikant veränderten Werte für rMRGIu und rCBF in grauer oder weißer Substanz auf im Vergleich zu Patienten mit vier oder mehr LI und ausgedehnten DWML. Eine semiquantitative Einteilung der Atrophie (A: keine bis geringfügige; B: mäßige bis schwere) erbrachte für B) im Vergleich zu A) signifikant erniedrigte rCBF- und rMRGIu-Werte in grauer und weißer Substanz. Somit sind bei Patienten mit ZMA nur die Hirnatrophie, jedoch nicht die charakteristischen LI und DWML mit einer meßbaren Erniedrigung von rCBF und rMRGIu korreliert.
Published: 1995

29. [Regional and national stroke units in Germany: amended certification criteria]

Author: D G, Nabavi, E B, Ringelstein, J, Faiss, C, Kessler, J, Röther, and O, Busse
Subjects: Stroke, Certification, National Health Programs, Neurology, Germany, Humans, Guidelines as Topic, Regional Medical Programs, Hospital Units
Abstract: Stroke units (SU) have been certified for many years by the German Stroke Society (DSG) and the German Stroke Aid Foundation (SDSH). Since 2009 this is now undertaken in the third generation by the LGA InterCert of the Technical Surveillance Society of Rhineland (TÜV Rheinland). This article presents the amended certification criteria which came into effect in 2012. Many criteria and definitions could be further defined and specified and residual grey areas and fields of conflict could be reduced. For the first time a distinction has been made between the minimum requirements relevant for certification and additional recommendations by the SU Commission of the DSG. In this manner the authors are aiming to motivate SU operators not just to align quality assurance measures to the minimum requirements but to deliberately go beyond them. There is a great deal of evidence to indicate that this will not only serve to increase the motivation of personnel and the quality of treatment but simultaneously the economic situation can also be improved.
Published: 2012

30. Zwei Jahre interventionelle Therapie zerebraler Infarkte: Häufigkeiten, Rekanalisationsraten, Verlauf und Komplikationen bei Verschlüssen der A. carotis, A. cerebri media und A. basilaris

Author: Rainer Dziewas, M. Ritter, D Maintz, Volker Hesselmann, A Kemmling, Harald Seifarth, E. B. Ringelstein, Thomas Niederstadt, and Walter Heindel
Subjects: Radiology, Nuclear Medicine and imaging
Published: 2012

31. [Concept for allocation of acute stroke patients: evaluation of the quality of diagnosis reached by the emergency medical services of Münster]

Author: M, Schilling, M, Kros, M, Ritter, M, Ohms, W R, Schäbitz, W, Kusch, E B, Ringelstein, T P, Weber, U, Harding, and A, Bohn
Subjects: Adult, Aged, 80 and over, Male, Emergency Medical Services, Health Care Rationing, Quality Assurance, Health Care, Reproducibility of Results, Sensitivity and Specificity, Stroke, Young Adult, Risk Factors, Germany, Prevalence, Humans, Female, Diagnostic Errors, Aged
Abstract: Acute stroke is a time- and expertise-critical emergency. An immediate and correct diagnosis by emergency medical services (EMS) in the prehospital phase and patient transfer to the nearest adequate hospital with a stroke unit is required for early treatment of acute stroke.We evaluated all patients who were admitted by the EMS of Münster to one of the two stroke units in the town between October 2008 and December 2010 with a diagnosis of acute stroke. Furthermore all patients were critically analyzed who were admitted without a diagnosis of acute stroke by the EMS but nonetheless had a stroke and the correct diagnosis was not found until examination in the neurological department.We analyzed 615 patients who were admitted to the stroke units with the diagnosis of acute stroke. In 561 cases (91%) this diagnosis could be confirmed, but in 54 patients (9%) the diagnosis by the EMS was incorrect. Epileptic seizure was the most frequent false-positive diagnosis in this group of patients (39%; n = 21). Although the acute symptoms were caused by a stroke, the correct diagnosis was not defined by the EMS in 127 patients. This accounted for 18% of all patients admitted to the emergency departments by the EMS where ultimately a stroke was diagnosed. In 24% of these cases (n = 30) the emergency doctor missed the correct diagnosis, which meant 4% of all patients admitted by the EMS, finally diagnosed with an acute stroke. In all other cases in the group with a false-negative diagnosis (76% or 97 patients) an emergency doctor was not involved in the referral by the EMS.Emergency medical services should be involved in the establishment of admission programs for acute stroke patients to provide the fastest means of transportation to a stroke unit. Coma, symptoms of posterior cerebral circulation and epileptic seizures cause difficulties in ensuring an immediate and correct diagnosis. Sending an emergency doctor to the scene increases diagnostic certainty which is essential to initiate early treatment.
Published: 2012

32. Fourth meeting of the European Neurological Society 25–29 June 1994 Barcelona, Spain

Author: H. Hattig, C. Delli Pizzi, M. C. Addonizio, Michelle Davis, A. R. Giovagnoli, L. Florensa, M. Roth, J. de Kruijk, Francisco Lacruz, Ph. Dewailly, A. Toygar, C. Avendano, P.P. De Deyn, J. F. Hurtevent, F. Lomeila, T. W. Wong, Gordon T. Plant, M. Bud, H. J. Willison, DH Miller, D. W. Langdon, R. Cioni, J. Servan, A. Kaygisiz, E. Racadot, D. B. Schens, E. Picciola, L. Falip, C. Bouchard, J. Jotova, A. Jorge-Santamaria, P. Misra, A. Dufour, C. P. Panagopoulos, A. Venneri, B. Sredni, B. Angelard, M. Janelidze, M. Carreno, J. Obenberger, J. Pouget, H. W. Moser, R. Kaufmann, J. A. Molina, D. Linden, A. Martin Urda, E. Uvestad, A. Krone, J. P. Cochin, J. Mallecourt, A. Cambon-Thomsen, K. Violleau, P. Osschmann, A. M. Durocher, E. Bussaglia, D. M. Danielle, H. Efendi, C. Van Broeckhoven, K. G. Jordan, W. Rautenberg, C. Iniguez, J. M. Delgado, Graham Watson, M. Lawden, Gareth J. Barker, K. Stiasny, James T. Becker, G. Campanella, E. Peghi, A. Poli, A. Haddad, T. Yamawaki, Giacomo P. Comi, S. Sotgiu, B. Ersmark, A. Pomes, M. Ziegler, P. Ferrante, P. Ruppi, H. KuÇukoglu, R. Bouton, U. K. Rinne, P. Vieregge, M. Dary, P. Giunti, Peter J. Goadsby, S. Jung, E. Secor, A. Steinberg, N. Vila, M. A. Hernandez, M. Cursi, A. Enqelhardt, A. Engelhardt, J. Veitch, F. Di Silverio, F. Arnaud, B. Neundörfer, R. Brucher, Dominique Caparros-Lefebvre, B. Meyer, Marianne Dieterich, M. H. Snidaro, R. Gomez, R. Cerbo, M. Ragno, J. M. Vance, S. Nemni, A. Caliskan, F. Barros, I. Velcheva, D. Ceballos-Baumann, V. Barak, A. Avila, N. Antonova, F. Resche, S. Pappata, L. Varela, S. R. Silveira Santos, A. Cammarota, L. Naccache, Y. Nara, E. Tournier-Lasserves, R. Mobner, T. Chase, A. Ensenyat, J. Ulrich, G. Giegerich, M. Rother, M. Revilla, N. Nitschke, K. Honczarenko, E. Basart Tarrats, J. Blin, B. Jacob, J. Santamaria, S. Knezevic, J. L. Castillo, M. Antem, J. Colomer, O. Busse, Didier Hannequin, S. Carrier, J. B. Ruidavets, C. Rozman, J. Bogoussslavsky, J. Pascual Calvet, E. Monros, J. M. Polo, M. Zucconl, Javier Muruzabal, R. R. Allen, R. Rivolta, K. Haugaard, A. Nespolo, K. Hoang-Xuang, G. Bussone, T. Avramidis, E. Corsini, Christiana Franke, T. Vinogradova, H. Boot, K. Vestergaard, G. H. Jansen, N. Argentino, M. Raltzig, W. Linssen, Mark B. Pepys, P. Roblot, L. Lauritzen, E. Fainardi, D. Morin, T. X. Arbizu Urdiain, J. Wollenhaupt, S. Bostantjopoulou, G. Pavesi, A. D. Forman, Giovanni Fabbrini, D. Jean, J. J. Archelos, M. I. Blanchs, M. Del Gobbo, Anna Carla Turconi, Ch. Derouesné, Elio Scarpini, A. Visbeck, P. Castejon, J. P. Renou, F. Mounier-Vehier, G. Potagas, Ch. Duyckaerts, A. Filla, R. Schneider, G. Ronen, K. Nagata, J. P. Vedel, A. Henneberg, G. van Melle, C. Baratti, H. Knott, M. C. Prevett, A. Bes, B. Metin, Jos V. Reempts, L. Martorell, Mefkure Eraksoy, H. O. Handwerker, D. S. Younger, O. Oktem, D. Frongillo, C. Soriano-Soriano, L. Niehaus, F. Zipp, A. Tartaro, S Newman, R. H. Browne, P. Davous, R. Sanchez, M. Muros, M. E. Kornhuber, A. Lavarone, M. Mohr, M. R. Garcia, S. Russell, H. Kellar-Wood, M. R. Tola, B. Ostermeyer, Ch. Tzekov, K. Sartor, E. B. Ringelstein, P. P. Gazzaniga, Paul Krack, H. Fidaner, H. Rico, T. Dbaiss, F. Alameda, E. Torchiana, L. Rumbach, I. Charques, J. M. Bogaard, C. D. Frith, L. J. Rappelle, R. Brenner, A. Joutel, K. Fuxe, G. HÄcker, M. J. Blaser, J. Valls-SolÇ, G. Ulm, M. Alberdi, A. Bock, F. W. Bertelsmann, U. Wieshmann, J. Visa, J. R. Lupski, D. D'Amico, L. M. P. Ramos, A. A. Vanderbark, R. Horn, M. Warmuth, Dietmar Kühne, Mark S. Palmer, C. Ehrenheim, E. Canga, S. Viola, O. Scarpino, P. Naldi, R. Almeida, A. A. Raymond, J. Gamez, Stephan Arnold, A. DiGiovanni, J. Dalmau, C. C. Chari, H. F. Beer, J. C. Koetsier, J. Iriarte, E. Yunis, J. Casadevall, E. Le Guern, E. Stenager, S. R. Benbadis, J. M. Warter, F. Burklin, I. Theodorou, L. Johannesen, G. A. Graveland, X. Leclerc, I. Vecchio, L. Ozelius, G. Nicoletti, R. K. Gherardi, E. Esperet, M. L. Delodovici, F. Cattin, F. Paiau, Giorgio Sacilotto, C. A. J. Broere, D. Chavdarov, J. P. Willmer, C. H. Hawkes, Th. Naegele, E. Ellie, E. Dartigues, M. J. Guardiola, S. Hesse, Z. Levic, Marco Rovaris, P. Saugeir-Veber, B. A. Yaqub, H. F. Durwen, R. Larumbe, J. Ballabrina, M. Sendtner, J. Röther, M. Horstink, C. Kluglein, M.P. Montesi, H. Apaydin, J. Montoya, E. Waubant, Ch. Verellen-Dunoulin, A. Nicolai, J. Lopez-Delval, R. Lemon, G. Cantinho, E. Granieri, A. Zeviani, Wolfgang H. Oertel, U. Ficola, V. Di Piero, V. Fragola, K. Sabev, M. V. Guitera, I. Turki, F. Bolgert, P. Ingrand, J. M. Gobernado, L. M. E. Grimaldi, S. Baybas, B. Eymard, Y. Rolland, Y. Robitaille, Ta. Pampols, P. J. Koehler, A. Carroacedo, J. Vilchez, S. Di Vittorio, I. R. Rise, T. Nagy, M. Kuffner, E. Palazzini, A. Ott, J. Pruim, T. X. Arbizu, E. Manetti, C. Cervera, S. Felber, G. Gursoy, J. Scholz, G. A. Buscaino, M. S. Chen, A. Pascual, J. Hazan, J. U. Gajda, J. G. Cea, G. Bottini, G. Damalik, F. Le Doze, G. Bonaldi, J. M. Hew, C. Messina, A. M. Kennedy, J. M. Carney, N. M. F. Murray, M. Parent, M. Koepp, V. Dimova, D. De Leo, K. Jellinger, G. Salemi, S. Mientus, M. L. Hansen, F. Mazzucchelli, J. Vieth, M. Mauri, E. Bartels, L. Johannsen, C. Humphreys, J. Emile, D. N. Landon, E. Kansu, R. Sanchez-Pernaute, Rsj Frackowiak, M. Gonzalez Torres, L. Oller, C. Machedo, J. Kother, M. Billiard, H. Durak, T. Schindler, A. Frank, A. Uncini, A. Sbriccoli, C. Farinas, D. W. Paty, N. Fast, A. T. Zangaladze, A. Kerkhofs, J. M. Pino Garcia, I. De la Fuente, B. Marini, L. Gomez, I. Rubio, Alessandra Bardoni, C. Brodie, P. Acin, U. Sliwka, S. A. Hawkins, S. Tardieu, F. Vitullo, J. M. Pereira Monteino, R. Gagliardi, T. Jezewski, A. Cano, T. Lempert, F. Abad Alegria, G. Rotondo, D. Ince, C. Martinez Parra, Y. Huang, H. Luders, Y. Steinvil, F. G. A. Van Der Meche, R. Bianchi, A. Sanchez, T. Sevilla, J. M. Ketelslegers, A. Domzal-Stryga, M. Pandolfo, M. O. Josse, K. W. Neff, I. Blanco, G. W. Bruyn, O. W. Witte, J. L. Thibault, G. Andersen, J. Pariset, A. Marcone, R. J. M. Lane, A. Hofman, M. Verin, T. Matilla, P. Bedoucha, J. Roche, M. Lai, M. Collard, A. Ugarte, F. Gallecho, D. Silbersweig, C. Kennard, J. P. Azulay, T. W. Ho, P. L. I. Dellemijn, R. Girardello, F. Baas, B. Voss, F. Rozenberg, E. M. Brocker, V. Stanev, A. A. J. Soeterboek, A. Marra, A. Rey, E. Ertem, M. Sawradewicz-Rybak, J. De Keyser, P. Cavallari, F. Proust, Y. Chevalier, H. C. Hansen, D. Leys, C. A. Davie, K. Hoang-Xuan, C. Bairati, H. van Crevel, Thomas T. Warner, B. Bompais, A. Dobbeleir, T Campbell, C. Macko, C. J. M. Klijn, M. Dussallant, T. P. Berlit, W. Rozenbaum, M. J. van den Bent, W. A. Rocca, M. Muller, H. Hundemer, U. Zifko, M. Campera, F. Drislane, D. Ranoux, T. M. Kloss, Anil Kumar, I. Ruolt, C. Bargnani, B. Marescau, N. A. Losseff, S. Notermans, B. Kint, E. T. Burke, C. Aykut, J. Matias Guiu, P. Maquet, T. Drogendijk, M. Leone, K. von Ammon, M. Pepeliarska, C. Prados, L. DiGiamberardino, T. Logtenberg, G. Lenoir, I. Castaldo, Damhaut, M. Radionova, G. Sirabian, R. Navon, Giovanni Antonini, K. Al Moutaery, E. Chamas, R. Schönhuber, M. Giannini, B. Debilly, I. Labatut, H. Henon, J. A. Egido, M. Baudrimont, J. N. Lorenzo, J. E. C. Bromberg, R. Antonacci, J. J. Vilchez, T. Moulin, B. Rautenstrauss, Giovanni Meola, J. Noth, S Mammi, P. Laforet, F. Lopez, C. Gehring, S. Bort, G. Rancurel, D. Decamps, S. Kostadinova, Y. Shapira, B. Neundoerfer, D. Chavrot, M. Solimena, J. P. Salier, W. Deberdt, R. Hoff-Jörgensen, A. Messina, S. Meairs, G. Rosoklija, E. Nelis, I. Bertran, C. Ertekin, J. Lohmeyer, Mitermayer Galvao dos Reis, L. Calo, E. Maccagnano, A. P. Hays, J. Verlooy, M. G. Forno, T. Blanco, L. Bail, Gabriella Silvestri, J. Montero, F. Bertrand, R. T. Ghnassia, C. Besses, T. Sereghy, F. Shalit, G. Bogliun, S. Braghi, St. Baykouchev, C. Franke, A. Lasa, L. C. Archard, J. Kriebel, S. Shaunak, M. Nocito, Alexander Tsiskaridze, E. Manfredini, T. Seigal, David G. Gadian, M. Barlas, J. D. Degos, C. Seeber, J. Caemert, J. L. Mas, R. B. Pepinsky, M. G. D'Angelo, N. Baumann, S. Yorifuji, H. P. Endtz, M. A. Cassatella, R. A. C. Hughes, V. Golzi, A. Bittencourt, A. Ferreira, M. Sanson, C. Alper, M. Vermeulen, M. A. A. van Walderveen, E. Alexiou, C. H. Lucas, M. Fiorelli, Y. N. Debbink, R. Gil, S. Congia, T. Banerjee, J. M. Bouchard, A. N. Pinto, A. Ceballos-Baumann, G. Grollier, P. I. M. Schmitz, M. D. Catata, N. Lahat, N. S. Rao, P. Papathanasopoulos, J. Valls-Solé, D. Claus, G. Schroter, A. Castro, C. Videbaek, R. Martinez Dreke, A. D. Platts, M. Hermesl, A. C. PeÇanha-Martins, M. Cardoso Silva, P. Masnou, M. J. A. Tanner, Ch. Confavreux, B. Mishu, H. Rasmussen, L. Valenciano, Carlo Pozzilli, S. W. Li, V. Salzman, Y. Vashtang, Massimo Franceschi, M. Severo, G. Deuschl, S. Setien, G. Mariani, A. Protti, J. Castillo, M. J. B. Taphoorn, M. Frontali, I. Milonas, D. Decoq, J. A. Navarro, S. Castellvi-Pel, C. Ertikin, M. Urtasun, Y. Lajat, B. E. Kendall, E. Verdu, B. Gueguen, E. Boisen, R. Couderc, A Danek, JM Stevens, F. Nicoli, L. Feltri, M. L. Vazquez-Andre, J. A. Morgan-Hughes, L. D'Angelo, F. Y. Liew, L. F. Pascual, J. Patrignani Ochoa, Vittorio Martinelli, J. Cophignon, L. Zhang, S. Martin, J. F. Meder, H. C. Buschmann, L. Bertin, J. van Gijn, A. Barreiro, A. Cools, C. Leon, A. Berod, E. A. Anllo, E. Zanette, L. Petrov, R. Barona, B. Gallicchio, P. J. Cozzone, N. Diederich, G. Cancel, L. Schelosky, P. Orizaola, K. Yulug, S. Ozer, Valeria A. Sansone, B. Guiraud-Chaumeil, K. Voigt, P. Labauge, M. Eoli, J. Zhu, J. Aguirre, M. Ferrarini, B. Zyluk, E. Planas, A. Cadilha, C. Tortorella, H. Bismuth, C. E. Counsell, A. Laun, A. Ferlini, Rio J. Montalban, N. Biary, L. Becker, M. Fardeau, M. Poloni, V. M. S. de Bruin, C. Fornada, J. Barros, E. Ganzmann, E. Touze, D. Wallach, J. Peila, H. Fujimura, M. T. Iba-Zizen, G. Macchi, C. Villoslada, R. Gouider, Ph. Rondepierre, P. Grummich, P. Chiodi, C. Conte, M. Michels, P. Annunziata, G. Semana, C. Sommer, J. Vajsar, D. Zekin, J. Kulisevsky, David G. Munoz, B. Jacotot, M. 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Santoro, J. Roda, A. Bordoni, D. J. Taylor, S. Ertas, H. H. Emmen, J. Vichez, V. BesanÇon, R. E. Passingham, M. L. Malosio, A. Vérier, M. Bamberg, A. W. Hansen, E. Mostacero, G. Gaudriault, Marie Vidailhet, B. Birebent, K. Strijckmans, F. Giannini, T. Kammer, I. Araujo, J. Nowicki, E. Nikolov, A. Hutzelmann, R. Gherardi, J. Verroust, L. Austoni, A. Scheller, A. Vazquez, S. Matheron, H. Holthausen, J. M. Gerard, M. Bataillard, S. Dethy, V. H. Patterson, V. Ivanez, N. P. Hirsch, F. Ozer, M. Sutter, C. Jacomet, M. Mora, Bruno Colombo, A. Sarropoulos, T. H. Papapetropoulos, M. Schwarz, D. S. Dinner, N. Acarin, B. Iandolo, J. O. Riis, P. R. J. Barnes, F. Taroni, J. Kazenwadel, L. Torre, A. Lugaresi, I. L. Henriques, S. Pauli, S. Alfonso, Pedro Quesada, A. S. T. Planting, J. M. Castilla, Thomas Gasser, M. Van der Linden, A. Alfaro, E. Nobile-Orazio, G. Popova, W. Vaalburg, F. G. A. van der Mech, L. Williams, F. Medina, J. P. Vernant, J. Yaouanq, B. Storch-Hagenlocher, A. Potemkowski, R. Riva, M. H. Mahagne, M. Ozturk, Ve. Drory, N. Konic, C. Jungreis, A. Pou Serradell, J. L. Gauvrit, G. J. Chelune, S. Hermandez, T. Dingus, L. Hewer, Ch. Koch, M. N. Metz-Lutz, G. Parlato, M. Sinaki, Charles Pierrot-Deseilligny, H. C. Diener, J. Broeckx, J. Weill-Fulazza, M. L. Villar, M. Rizzo, O. Ganslandt, C. Duran, N. A. Fletcher, G. Di Giovacchino, Susan T. Iannaccone, C. Kolig, N. Fabre, H. A. Crockard, Rita Bella, M. Tazir, E. Papagiannuli, K. Overgaard, Emma Ciafaloni, I. Lorenzetti, F. Viader, P. A. H. Millac, I. Montiel, L. H. Visser, M. Palomar, P. L. Murgia, H. Pedersen, Rafael Blesa, S. Seddigh, W. O. Renier, I. Lemahieu, H. M. L. Jansen, L. Rosin, J. Galofre, K. Mattos, M. Pondal, G. M. Hadjigeorgiou, D. Francis, L. Cantin, D. Stegeman, M. Rango, A. B. M. F. Karim, S. Schraff, B. Castellotti, I. Iriarte, E. Laborde, T. J. Tjan, R. Mutani, D. Toni, B. Bergaasco, J. G. Young, C. Klotzsch, A. Zincone, X. Ducrocq, M. Uchuya, O. J. Kolar, A. Quattrone, T. Bauermann, Nereo Bresolin, J. Vallée, B. C. Jacobs, A. Campos, Werner Poewe, J. A. Villanueva, A. W. Kornhuber, A. Malafosse, E. Diez-Tejedor, G. Jungreia, M. J. A. Puchner, A. Komiyama, O. Saribas, V. Volpini, L. Geremia, S. Bressi, A. Nibbio, Timothy E. Bates, T. z. Tzonev, E. Ideman, G. A. Damlacik, G. Martino, G. Crepaldi, T. Martino, Kjell Någren, E. Idiman, D. Samuel, J. M. Perez Trullen, Y. van der Graaf, J. O. Thorell, M. J. M. Dupuis, E. Sieber, R. D'Alessandro, C. Cazzaniga, J. Faiss, A. Tanguy, A. Schick, I. Hoksergen, A. Cardozo, R. Shakarishvili, G. K. Wennlng, J. L. Marti-Vilalta, J. Weissenbach, I. L. Simone, Amalia C. Bruni, Darius J. Adams, C. Weiller, A. Pietrangeli, F. Croria, C. Vigo-Pelfrey, Patricia Limousin, A. Ducros, G. Conti, O. Lindvall, E. Richter, M. Zuffi, A. Nappo, T. Riise, J. Wijdenes, M. J. Fernandez, J. Rosell, P. Vermersh, S. Servidei, M. S. C. Verdugo, F. Gouttiere, W. Solbach, M. Malbezin, I. S. Watanabe, A. Tumac, W. I. McDonald, D. A. Butterfield, P. P. Costa, F. deRino, F. Bamonti, J. M. Cesar, C. H. Lahoz, I. Mosely, M. Starck, M. H. Lemaitre, K. M. Stephan, S. Tex, R. Bokonjic, I. Mollee, L. Pastena, M. Gutierrez, F. Boiler, M. C. Martinez-Para, M. Velicogna, O. Obuz, A. Grinspan, M. Guarino, L. M. Cartier, E. Ruiz, D. Gambi, S. Messina, M. Villa, Michael G. Hanna, J. Valk, Leone Pascual, M. Clanet, Z. Argov, B. Ryniewicz, E. Magni, B. Berlanga, K. S. Wong, C. Gellera, C. Prevost, F. Gonzalez-Huix, R. Petraroli, J. E. G. Benedikz, I. Kojder, C. Bommelaer, L. Perusse, M. R. Bangioanni, Guy M. McKhann, A. Molina, C. Fresquet, E. Sindern, Florence Pasquier, M. J. Rosas, M. Altieri, O. Simoncini, M. Koutroumanidis, C. A. F. Tulleken, M. Dary-Auriol, S. Oueslati, H. Kruyer, I. Nishisho, C. R. Horning, A. Vital, G. V. Czettritz, J. Ph. Neau, B. Mihout, A. Ameri, M. Francis, S. Quasthoff, D. Taussig, S. Blunt, P. Valentin, C. Y. Gao, O. Heinzlef, H. d'Allens, C. Coudero, M. Erfas, G. Borghero, P. J. Modrego Pardo, M. C. Patrosso, N. L. Gershfeld, P. A. J. M. Boon, O. Sabouraud, M. Lara, J. Svennevig, G. L. Lenzi, A. Barrio, H. Villaroya, JosÇ M. Manubens, O. Boespflug-Tanguy, M. Carreras, D. A. Costiga, J. P. Breux, S. Lynn, C. Oliveras Ley, A. G. Herbaut, J. Nos, C. Tornali, Y. A. Hekster, J. L. Chopard, J. M. Manubens, P. Chemouilli, A. Jovicic, F. Dworzak, S. Smirne, S. E. Soudain, B. Gallano, D. Lubach, G. Masullo, G. Izquierdo, A. Pascual Leone Pascual, A. Sessa, V. Freitas, O. Crambes, L. Ouss, G. W. Van Dijk, P. Marchettini, P. Confalonieri, M. Donaghy, A. Munnich, M. Corbo, and M. E. L. van der Burg
Subjects: Neurology, business.industry, Media studies, Library science, Medicine, Neurology (clinical), business
Published: 1994

33. The outer arterial wall layers are primarily affected in spontaneous cervical artery dissection

Author: J. Z. Willey, R. Dittrich, G. Kuhlenbaeumer, and E. B. Ringelstein
Subjects: Male, Vertebral Artery Dissection, Connective Tissue, Humans, Female, Neurology (clinical), Arteries, Carotid Artery, Internal, Dissection
Published: 2011

34. [Silent brain infarcts]

Author: M A, Ritter, R, Dittrich, and E B, Ringelstein
Subjects: Brain Infarction, Male, Neurologic Examination, Comorbidity, Middle Aged, Magnetic Resonance Imaging, Diagnosis, Differential, Stroke, Intracranial Embolism, Risk Factors, Image Processing, Computer-Assisted, Humans, Female, Cognition Disorders, Dominance, Cerebral, Aged
Abstract: Silent brain infarctions are frequently found by modern cerebral imaging. Up to 30% of persons without a clinical history of stroke were found to have silent brain infarction in epidemiological studies. "Silent" refers to ischemic brain lesions for which no matching clinical syndrome can be found based on history or clinical investigation. Age, education, and ethnic background have a strong impact on noticing and reporting stroke symptoms. The current clinical definition of stroke is insensitive for cognitive deficits which can also be caused by brain infarctions. The majority of silent brain infarctions are localized in the subcortical white matter of the brain; however, about 10% of silent brain infarctions are cortical. Silent brain infarctions are strongly associated with stroke risk factors and comorbidities that are known to cause clinically overt stroke. Silent brain infarctions are 5 to 10 times more frequent than clinically overt strokes. Silent brain infarctions as defined by DWI lesions on MRI imaging are a frequent finding during operative or interventional procedures and their monitoring may help improve the respective techniques in order to decrease the risk of periprocedural stroke.
Published: 2011

35. [Susac syndrome: an interdisciplinary challenge]

Author: J, Dörr, S, Jarius, B, Wildemann, E B, Ringelstein, W, Schwindt, M, Deppe, K P, Wandinger, J, Promesberger, F, Paul, and I, Kleffner
Subjects: Neurologic Examination, Susac Syndrome, Retinal Artery Occlusion, Hearing Loss, Sensorineural, Prognosis, Magnetic Resonance Imaging, Corpus Callosum, Diagnosis, Differential, Diffusion Magnetic Resonance Imaging, Image Processing, Computer-Assisted, Humans, Interdisciplinary Communication, Cooperative Behavior, Fluorescein Angiography, Immunosuppressive Agents
Abstract: Susac syndrome, named after John Susac, the first to describe this condition, is characterized by the clinical triad of encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss. Although certainly a rare disease, Susac syndrome needs to be considered in the differential diagnosis of a broad variety of diseases. The pathogenesis is not yet clear. Autoimmune processes leading to damage and inflammation-related occlusion of the microvessels in brain, retina, and inner ear are thought to play a causal role. The diagnosis is based primarily on the clinical presentation, the documentation of branch retinal artery occlusion by fluorescence angiography, and characteristic findings on cerebral MRI. Usually, immunosuppressive therapy is required, though controlled therapy trials are missing so far. The intention of this review article is to raise awareness of this disease among neurologists, psychiatrists, ophthalmologists, and ENT specialists as a high number of unreported cases probably exists. Accordingly, the focus is on the clinical presentation and the diagnostic approach.
Published: 2011

36. [Comprehensive stroke unit]

Author: E B, Ringelstein, A, Müller-Jensen, D G, Nabavi, K-H, Grotemeyer, and O, Busse
Subjects: Stroke, Neurology, Germany, Rehabilitation, Hospital Departments, Stroke Rehabilitation, Humans
Abstract: The concept of a "comprehensive stroke unit" (in German: Erweiterte Stroke-Unit) is an additional structural option for those stroke units already certified in Germany. Its aim is to complement the semi-intensive management of stroke unit patients in Germany by early mobilisation and neuropsychological rehab procedures. This concept is recommended in many European countries as well. It is based on the proof of efficacy of the combined treatment package in several randomised controlled trials. According to the Helsingborg Declaration, every stroke patient in Europe should have access to a chain of care best provided by a comprehensive stroke unit. Both early mobilisation and rehabilitation treatment can be integrated and continued without creating an interface between the acute stroke unit and the general neurological or medical ward. The monitoring beds of the acute stroke unit and the non-monitoring "enhanced care" beds are located within the same geographical area of the hospital and are run as a comprehensive stroke care entity. Continuous management of the acute stroke patients by the same team on the same unit means an increase in quality of care, better usage of staff resources and an additional gain in time. The scientific background of the advantages of a comprehensive stroke unit is described as are the structural and staff requirements. The clientel particularly benefiting from treatment on wards with enhanced care beds is described, and the spectrum of treatment services is defined. This concept will be used as the basis for an add-on qualification of already certified German stroke units. An important step was to fit the requirements of the comprehensive stroke unit to the already existing facilities and their infrastructures. From an economic point of view, the comprehensive stroke unit is expected to be cost-effective, either balanced or even positive.
Published: 2011

37. Vaskuläre Erkrankungen

Author: Peter Berlit, C. Klötzsch, J. Röther, M. Grond, J. Rudolf, E. B. Ringelstein, H.-C. Koennecke, W. Kurre, R. Chapot, H.-C. Nahser, and C. P. Stracke
Published: 2011

38. 18FDG-PET and Electroencepha- lographic Findings in a Patient Suffering from Musical Hallucinations

Author: W. Reiche, F. Kachel, E. B. Ringelstein, H. Sass, U. Büll, H. Ebel, and R. Erkwoh
Subjects: Temporal cortex, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Hearing deficit, General Medicine, Electroencephalography, Audiology, Surgery, International literature, Musical hallucinations, Medicine, Radiology, Nuclear Medicine and imaging, Abnormality, medicine.symptom, 18fdg pet, business, Complication
Abstract: SummaryThe majority of reports on the phenomenon of musical hallucinations suggests that this abnormality is a complication of a progressive peripheral hearing deficit. The present case report and a review of the international literature would, however, indicate that this syndrome may be the result of a dysfunction of the temporal cortex.
Published: 1993

39. [Clinical relevance of normal and enlarged Virchow-Robin spaces]

Author: B, Gess, T U, Niederstadt, E B, Ringelstein, and W R, Schäbitz
Subjects: Cerebral Cortex, Age Factors, Brain, CADASIL, Extracellular Fluid, Cerebral Arteries, Cerebral Veins, Magnetic Resonance Imaging, Basal Ganglia, Subarachnoid Space, Cerebrovascular Disorders, Mesencephalon, Pons, Hypertension, Humans, Pia Mater, Tomography, X-Ray Computed, Aged, Dilatation, Pathologic, Hydrocephalus
Abstract: Virchow-Robin spaces ensheathe the penetrating vessels of the brain. They communicate with the subpial space, are filled with interstitial fluid and contain a specific population of macrophages.Virchow-Robin spaces are a common finding in both CT and MR imaging. Recent radiologic studies have led to a concise definition of Virchow-Robin spaces.Virchow-Robin spaces appear isointense to cerebrospinal fluid on all imaging sequences. They are typically localised in the basal ganglia, subcortically or in the midbrain and pons. Enlarged Virchow-Robin spaces may appear as a single or multiple lesion(s). They may cause hydrocephalus in rare cases. Some studies indicate that enlarged Virchow-Robin spaces occur more frequently in elderly patients, in patients with arterial hypertension or CADASIL.In this review we illustrate the diagnostic criteria of normal and enlarged Virchow-Robin spaces and discuss their clinical relevance. Furthermore, we present an overview of the current knowledge on the anatomy, physiology and pathology of Virchow-Robin spaces.
Published: 2010

40. [Cardiac workup after cerebral ischemia. Consensus paper of the Working Group on Heart and Brain of the German Cardiac Society and German Stroke Society]

Author: U, Laufs, U C, Hoppe, S, Rosenkranz, P, Kirchhof, M, Böhm, H-C, Diener, M, Endres, M, Grond, W, Hacke, T, Meinertz, E B, Ringelstein, J, Röther, and M, Dichgans
Subjects: Ticlopidine, Aspirin, Embolism, Anticoagulants, Brain Ischemia, Clopidogrel, Cardiovascular Diseases, Echocardiography, Risk Factors, Atrial Fibrillation, Electrocardiography, Ambulatory, Exercise Test, Humans, Drug Therapy, Combination, Warfarin, Platelet Aggregation Inhibitors
Published: 2010

41. Evaluation of Cerebral Vasomotor Reactivity by Various Vasodilating Stimuli: Comparison of CO2 to Acetazolamide

Author: Irene Mertens, E. B. Ringelstein, and Sabine Van Eyck
Subjects: Adult, Carotid Artery Diseases, Male, Cerebral arteries, Arterial Occlusive Diseases, Asymptomatic, Hypocapnia, medicine.artery, Humans, Medicine, Aged, Aged, 80 and over, Vasomotor, business.industry, Carbon Dioxide, Middle Aged, medicine.disease, Transcranial Doppler, Acetazolamide, Vasodilation, Vasomotor System, Cerebrovascular Disorders, Neurology, Anesthesia, Middle cerebral artery, Female, Neurology (clinical), Internal carotid artery, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Carotid Artery, Internal, medicine.drug
Abstract: To evaluate the role of different vasomotor stimuli for the measurement of cerebrovascular vasomotor reactivity (VMR), 47 patients (i.e., 93 hemispheres) with various degrees of internal carotid artery (ICA) occlusive disease were studied. Patients were divided into clinical [asymptomatic, transient ischemic attack (TIA) or completed stroke] as well as angiological subgroups. Low-grade or high-grade unilateral ICA lesions were compared to bilateral ICA occlusive disease. Relative flow velocity changes within the middle cerebral artery were measured by means of transcranial Doppler during hyper- and hypocapnia (VMRTOT), during hypercapnia alone, and after injection of 1 g acetazolamide (VMRACE). VMR was expressed as the percentage change in flow velocity after stimulus application as compared with flow velocity at rest. There was a close and statistically highly significant correlation of CO2-induced with acetazolamide-induced VMR ( r = 0.69 in VMRTOT versus VMRACE and 0.79 in versus VMRACE; p < 0.0001; linear regression), indicating a strong similarity of the vasodilatative effects of CO2 and acetazolamide on cerebral arteries. Both stimulation techniques highly significantly differentiated between asymptomatic patients and those with TIA or completed stroke. Angiological subgroups were separated best by the acetazolamide test. Reclassification of patients into angiological subgroups by linear discriminant analysis was equally good with all three methods. We conclude that both acetazolamide- and CO2-induced stimulation of the cerebral vasomotors are valid techniques to measure reduction in perfusion reserve due to extracranial cerebrovascular occlusive disease. Acetazolamide has the advantage of being independent of the patient's cooperation. However, it has the disadvantage of increasing the intracranial pressure and not permitting evaluation of the vasoconstrictor capabilities of the cerebral vasculature.
Published: 1992

42. [Quality assuring, clarifying documentation in manipulation medicine for the spine. Frankfurt Workshop, 4-5 July 2003]

Author: T, Graf-Bau mann and E B, Ringelstein
Subjects: Manipulation, Spinal, Spinal Injuries, Germany, Humans, Documentation, Registries, Mandatory Reporting
Published: 2009

43. [Arterial hypertension and cognitive deficts]

Author: Martin A, Ritter and E B, Ringelstein
Subjects: Aged, 80 and over, Risk Factors, Hypertension, Age Factors, Humans, Blood Pressure, Amnesia, Middle Aged, Neuropsychological Tests, Cognition Disorders, Antihypertensive Agents, Aged
Published: 2009

44. Noninvasive evaluation of vertebrobasilar insufficiency

Author: Shlomo Torem, Eugene F. Bernstein, M E Rossman, P A Schneider, E B Ringelstein, and Shirley M. Otis
Subjects: Carotid Artery Diseases, Male, medicine.medical_specialty, Vertebral artery, Subclavian Artery, Arterial Occlusive Diseases, Internal medicine, medicine.artery, Carotid artery disease, Vertebrobasilar Insufficiency, medicine, Basilar artery, Humans, Radiology, Nuclear Medicine and imaging, Vertebrobasilar insufficiency, Pulse, Vertebral Artery, Subclavian artery, Radiological and Ultrasound Technology, business.industry, Middle Aged, medicine.disease, Echoencephalography, Transcranial Doppler, Surgery, body regions, Stenosis, Carotid Arteries, medicine.anatomical_structure, Regional Blood Flow, Basilar Artery, cardiovascular system, Cardiology, business, Blood Flow Velocity, Artery
Abstract: The diagnosis of vertebrobasilar insufficiency (VBI) is a clinical challenge because its manifestations are subjective and difficult to quantify. We evaluate 61 patients with the clinical diagnosis of VBI and 30 control patients with other medical problems. We used duplex scanning to study the extracranial carotid, vertebral, and subclavian arteries, and a 2-MHz transcranial Doppler (TCD) to examine the intracranial vertebral and basilar arteries. Extracranial lesions were more common in VBI patients than among controls, including stenosis of the subclavian artery with and without subclavian-vertebral steal and stenosis of the vertebral artery. Intracranial abnormalities identified in the vertebrobasilar circulation included stenosis and occlusion of the intracranial vertebral artery and basilar artery steal. Overall, significant lesions were detected in 32.8% of VBI patients and 3.0% of controls (P less than 0.05). Systolic artery velocity (cm/sec) in the extracranial vertebral artery was higher in controls (65.9 +/- 23.3) than in VBI patients who had no evidence of vertebrobasilar steal (43.0 +/- 17.4, P less than 0.05). Patients with a steal mechanism had an intracranial vertebral artery systolic velocity of 90.0 +/- 38.9, compared with 53.0 +/- 15.0 in controls (2P less than 0.050). Intracranial vertebral artery systolic velocity was higher among VBI patients with significant carotid artery disease (greater than 50%, 76.7 +/- 28.8) than in those with less severe disease (less than 50%, 47.3 +/- 13.8, P less than 0.05). Evaluation and quantitation of the vertebrobasilar circulation using both intra- and extracranial noninvasive studies may afford further insight as to the pathophysiology of vertebrobasilar insufficiency and provide a readily available, direct, and simple method of initial and serial assessment of VBI patients.
Published: 1991

45. Vergleich von MRT- und SPECT-Befunden bei Patienten mit zerebraler Mikroangiopathie

Author: W. Reiche, U. Büll, C. Weiller, H. J. Kaiser, R. Schneider, E. B. Ringelstein, and R. Weigmann
Subjects: nervous system, business.industry, Diagnostico diferencial, Medicine, Radiology, Nuclear Medicine and imaging, General Medicine, business, Nuclear medicine, nervous system diseases
Abstract: Lacunar infarctions and periventricular hypodensity are assumed to be typical CT patterns of cerebral microangiopathy (MA). In 17 patients with such findings and in 6 controls without any signs of central nervous system disease cranial CT, MRT and 99mTc-HMPAO-SPECT were employed. In 7 patients with CT findings of minor MA demonstrated in comparison to controls no significant difference. In 10 cases with CT findings of pronounced MA periventricular rCBF was significantly reduced compared to controls. rCBF of temporal and parietal cortex were not diminished compared to controls. In 14 patients studied with MRT deep white matter lesions were found which appeared solitary, multiple or confluent. Employing 99mTc-HMPAO-SPECT, cerebral MA revealed rCBF reduction in periventricular brain tissue by cerebellar standardization.
Published: 1991

46. Increased prevalence of obstructive sleep apnoea in patients with Charcot-Marie-Tooth disease: a case control study

Author: Angelika Okegwo, Hyon Hor, Rainer Dziewas, T Müller, M Böntert, Peter Young, N Waldmann, and E B Ringelstein
Subjects: Adult, Male, medicine.medical_specialty, Neuromuscular disease, Polysomnography, Body Mass Index, Central nervous system disease, Cohort Studies, stomatognathic system, Charcot-Marie-Tooth Disease, Risk Factors, Internal medicine, medicine, Humans, Sleep Apnea, Obstructive, medicine.diagnostic_test, business.industry, Respiratory disease, Case-control study, Age Factors, Sleep apnea, Middle Aged, medicine.disease, nervous system diseases, respiratory tract diseases, Surgery, Psychiatry and Mental health, Case-Control Studies, Female, Neurology (clinical), business, Body mass index, Cohort study
Abstract: Obstructive sleep apnoea (OSA) has previously been described in a large family suffering from Charcot-Marie-Tooth disease type 1 (CMT1). In the present study, we used a case control design to establish whether this suggested link between OSA and CMT1 may also be found when studying genetically non-related patients. 12 patients with CMT1 and 24 control patients matched for age, sex and body mass index (BMI) were included in the study. Neurological disability was graded with a previously established 6 point score. All patients underwent overnight polysomnography. The mean apnoea-hypopnoea index (AHI) of patients with CMT1 was 10.5 (16.3) which was significantly higher than that of the control group (1.5 (1.3)). Five out of 12 patients with CMT1 had an AHI > or =10/h compared with 1 of 24 control patients (p
Published: 2008

47. [New developments in German stroke units]

Author: J H, Faiss, O, Busse, and E B, Ringelstein
Subjects: Patient Care Team, Stroke Rehabilitation, Length of Stay, Combined Modality Therapy, Stroke, Germany, Humans, Thrombolytic Therapy, Comprehensive Health Care, Emergencies, Intermediate Care Facilities, Hospital Units, Early Ambulation, Forecasting
Published: 2008

48. Noninvasive detection of occlusive disease of the carotid siphon and middle cerebral artery

Author: E. B. Ringelstein and Juan Ley-Pozo
Subjects: Adult, Carotid Artery Diseases, Male, medicine.medical_specialty, Ischemia, Occlusive disease, Arterial Occlusive Diseases, Carotid siphon, Predictive Value of Tests, medicine.artery, medicine, Humans, Statistical analysis, Stroke, Aged, Ultrasonography, business.industry, Middle Aged, medicine.disease, Cerebral Angiography, Stenosis, Neurology, Cerebrovascular Circulation, Middle cerebral artery, Intracranial lesions, Female, Cerebral Arterial Diseases, Neurology (clinical), Radiology, business, Blood Flow Velocity
Abstract: Recently, transcranial Doppler sonography has been introduced into clinical practice for noninvasive investigation of the large intracranial arteries. To determine its accuracy for detection of stenosing or occluding lesions, 133 consecutive patients were studied by both transcranial Doppler sonography and selective cerebral arteriography. Statistical analysis of findings was done separately for various arterial segments. High values for sensitivity and specificity were found for detecting obstruction of the carotid siphon and main stem of the middle cerebral artery. Diagnostic reliability of transcranial Doppler sonography was also confirmed by the calculation of a chance-corrected measure of agreement (kappa), which was close to + 1 in all subanalyses. Transcranial Doppler sonography seems to be a valuable tool for noninvasive detection of intracranial lesions of the middle cerebral artery and carotid siphon.
Published: 1990

49. Bestimmung der regionalen, zerebrovaskulären Perfusionsreserve (rCPR) mit der quantitativen Fluß/Volumen (F/V)-SPECT

Author: Kersting A, C. Weiller, Reiche W, H. J. Kaiser, U. Büll, and E. B. Ringelstein
Subjects: medicine.diagnostic_test, business.industry, technology, industry, and agriculture, Ischemia, Hemodynamics, medicine.disease, Lesion, medicine.anatomical_structure, Cerebral blood flow, Positron emission tomography, Cortex (anatomy), Concomitant, mental disorders, medicine, Radiology, Nuclear Medicine and imaging, medicine.symptom, Nuclear medicine, business, Perfusion
Abstract: NPS (aphasia or neglect) are a regular concomitant symptom of cortical, and, occasionally, subcortical ischemic lesions. In 19 patients with subcortical lesions (eight with NPS, 11 without NPS), F/V-SPECT was employed to search for changes in rCPR in both, lesions and ipsilateral cortex. Results were correlated with NPS and MRI findings. Compared to the unaffected hemisphere, all subcortical lesions showed reduced regional cerebral blood flow (rCBF) (-16 to -23%), increased regional cerebral blood volume (rCBV) (+34 to +62%), and decreased or missing rCPR (-27 to -28%). Compared to MRI, there was no difference in lesion size in the thromboembolic lesions. Hemodynamic low-flow infarcts, however, were greater with SPECT than in MRI. In patients without NPS, the adjacent cortex was normal in SPECT and MRI. In addition, patients with NPS revealed reduced rCBF (-18%), increased rCBV (+19%), and decreased rCPR (-22%) in the adjacent cortex. MRI was normal in the same cortical area. These results indicate that NPS in subcortical lesions may be caused by a hemodynamic mechanism causing reduction of rCPR in the adjacent cortex.
Published: 1990

50. Sensitivity of neurovascular ultrasound for the detection of spontaneous cervical artery dissection

Author: D. Maintz, Darius G. Nabavi, I. Nassenstein, E. B. Ringelstein, R. Dittrich, J. Nebelsieck, C. Sengelhoff, and G. Kuhlenbäumer
Subjects: Adult, Male, medicine.medical_specialty, Cervical Artery, Dissection (medical), Carotid Artery, Internal, Dissection, Sensitivity and Specificity, Magnetic resonance angiography, Young Adult, Physiology (medical), medicine.artery, medicine, Humans, Vertebral Artery, Aged, Retrospective Studies, Vertebral Artery Dissection, Ultrasonography, Doppler, Duplex, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, General Medicine, Middle Aged, Neurovascular bundle, medicine.disease, Magnetic Resonance Imaging, Stenosis, Neurology, Surgery, Female, Neurology (clinical), Radiology, Internal carotid artery, Scad, business, Carotid Artery, Internal, Magnetic Resonance Angiography
Abstract: The reported sensitivity of neurovascular ultrasound (nUS) for detecting spontaneous cervical artery dissection (sCAD) varies from 80% to 96% in the internal carotid artery (ICA) and from 70% to 86% in the vertebral arteries (VA). The aim of this study was to assess the sensitivity of nUS compared to MRI of the neck and MR angiography for the detection of sCAD. Forty consecutive patients with sCAD proven by 1.5 T MRI were investigated by nUS within 48 hours of admission. A total of 52 cases of sCAD were detected by MRI, equally distributed (n = 26, 50%) in the ICA and VA territories. Two sCADs affecting the ICA (n = 2, 8%) and two sCADs of the VA (n = 2, 8%) had normal initial nUS findings. The sensitivity of nUS in detecting sCAD is high, about 92% for both vascular territories. However, intramural hematomas may be missed either when they are located outside the arterial segments directly visible by nUS or if they are too small to cause hemodynamically significant stenosis.
Published: 2007

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