Swiss Archives of Neurology, Psychiatry and Psychotherapy

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Manfred Gerlach, Heinz Reichmann, Peter Riederer: Die Parkinson-Krankheit. Grundlagen, Klinik, Therapie

by C. Bassetti

Swiss Arch. Neurol. Psychiatry Psychother. 2004, 155(4), 198; https://doi.org/10.4414/sanp.2004.01492 - 1 Jan 2004

Abstract

Es gibt kaum ein anderes Gebiet in der Neurologie, in welchem unser Wissen so rasch zunimmt, wie bei den zentralen Bewegungsstörungen («movement disorders») [...]
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Andreas Hufschmid, Carl Hermann Lücking: Neurologie compact. Leitlinien für Klinik und Praxis

by C. Bassetti

Swiss Arch. Neurol. Psychiatry Psychother. 2004, 155(4), 198; https://doi.org/10.4414/sanp.2004.01491 - 1 Jan 2004

Abstract

Das Lehrbuch Neurologie compact von Hufschmid und Lücking wird seinem Namen gerecht. Es vermittelt auf engstem Raum eine Fülle von Grundlagenwissen, das das gesamte Spektrum der Neurologie von der Beschreibung von Krankheiten und Syndromen, diagnostischen Methoden und Therapien bis hin zum Gutachtenwesen abdeckt [...] Read more.

Das Lehrbuch Neurologie compact von Hufschmid und Lücking wird seinem Namen gerecht. Es vermittelt auf engstem Raum eine Fülle von Grundlagenwissen, das das gesamte Spektrum der Neurologie von der Beschreibung von Krankheiten und Syndromen, diagnostischen Methoden und Therapien bis hin zum Gutachtenwesen abdeckt [...]
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Hugh Markus: Stroke Genetics

by C. Bassetti

Swiss Arch. Neurol. Psychiatry Psychother. 2004, 155(4), 198; https://doi.org/10.4414/sanp.2004.01490 - 1 Jan 2004

Abstract

Zerebrovaskuläre Krankheiten stellen auf der ganzen Welt eine häufige und wichtige Ursache von Invalidität und die dritthäufigste Todesursache dar [...]
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Frühjahrstagung der Schweizerischen Neurologischen Gesellschaft Réunion de la Société Suisse de Neurologie Luzern, 13.–15. Mai 2004

by EMH Swiss Medical Publishers Ltd.

Swiss Arch. Neurol. Psychiatry Psychother. 2004, 155(4), 193; https://doi.org/10.4414/sanp.2004.01488 - 1 Jan 2004

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Cerebrovascular disease and epilepsy – a retrospective study on 2022 patients [...] Full article

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Open AccessTutorial

Neurologist-in-training

by Patrik Michel

Swiss Arch. Neurol. Psychiatry Psychother. 2004, 155(4), 191-192; https://doi.org/10.4414/sanp.2004.01481 - 1 Jan 2004

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Neurological MCQ [...] Full article

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8. Jahrestagung der Zerebrovaskulären Arbeitsgruppe der Schweiz (ZAS)

by EMH Swiss Medical Publishers Ltd.

Swiss Arch. Neurol. Psychiatry Psychother. 2004, 155(4), 180; https://doi.org/10.4414/sanp.2004.01487 - 1 Jan 2004

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Neglect in the first six hours of stroke [...] Full article

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Open AccessArticle

Stroke unit management in the absence of an exclusive stroke ward

by S. T. Engelter, S. Papa, A. J. Steck, S. Marsch and P. Lyrer

Swiss Arch. Neurol. Psychiatry Psychother. 2004, 155(4), 173-179; https://doi.org/10.4414/sanp.2004.01485 - 1 Jan 2004

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Abstract

Background: Several forms of stroke units improve outcome after acute ischaemic stroke. In the absence of a ward exclusively for stroke patients (“stroke ward”), intensive monitoring and management of acute stroke patients who fulfilled predefined criteria can well be performed on an intensive [...] Read more.

Background: Several forms of stroke units improve outcome after acute ischaemic stroke. In the absence of a ward exclusively for stroke patients (“stroke ward”), intensive monitoring and management of acute stroke patients who fulfilled predefined criteria can well be performed on an intensive care unit (ICU). However, resources on intensive care unit are limited and needed mostly by others than stroke patients.Thus, intensive care unit admission criteria for stroke patients were modified to focus on high-risk patients and possible therapeutic options. Objective: To study the consequences of the modification of intensive care unit admission criteria as quality control. Methods: We performed a standardised observational comparison of clinical characteristics, medication and outcome of ICU-stroke patients prior and after modification of intensive care unit admission criteria between a one-year period in 1997/98 (initial criteria) and in 1999/2000 (modified criteria). Results: In 1999/2000, 121 out of 482 acute stroke patients (25%) were admitted on intensive care unit compared to 88 out of 323 (27%) in 1997/98. The frequency of lacunar syndromes decreased (27 to 6%; p <0.001) whereas that of posterior circulation syndromes increased (11 to 24%; p = 0.03) from 1997/98 to 1999/2000. Median NIH Stroke Scale score was 12 in 1999/2000 and 8 in 1997/98 (p <0.05). Median time on intensive care unit was shorter in 1999/2000 (26 h) than in 1997/98 (40 h; p = 0.06). Thrombolysis was more often (15 versus 4.5%; p <0.02) used in 1999/2000 than in 1997/98. After in-hospital rehabilitation, the rates for “living at home” versus “institutionalised or dead” were 72 versus 28% in 1999/2000 compared to 78.5 versus 21.5% in 1997/98, respectively (p >0.1). Conclusions:The modification of intensive care unit admission criteria was associated with (1) a higher number of ICU-stroke patients who showed a trend to a shorter intensive care unit stay, with (2) increased odds for thrombolysis and with (3) a change in case mix towards more severely affected patients. Despite the latter, the rate of patients living at home after in-hospital rehabilitation remained high. These data may illustrate that efforts to optimise stroke services are feasible and medically important. Full article

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Open AccessReview

Häufigkeit und Behandlung von zerebralen Anfällen und Epilepsie nach Schlaganfall

by Barbara Tettenborn

Swiss Arch. Neurol. Psychiatry Psychother. 2004, 155(4), 169-172; https://doi.org/10.4414/sanp.2004.01486 - 1 Jan 2004

Cited by 2 | Viewed by 38

Abstract

Cerebrovascular events are an important and wellknown cause of seizures in adults. In an elderly population the incidence ranges from 2 to 43% in various studies, depending on seizure type, duration of follow-up and study design. The incidence rates for epilepsies have two [...] Read more.

Cerebrovascular events are an important and wellknown cause of seizures in adults. In an elderly population the incidence ranges from 2 to 43% in various studies, depending on seizure type, duration of follow-up and study design. The incidence rates for epilepsies have two peaks regarding age: one in the first decade of life, a second at higher age with a steep increase between age 70 and 80. Cerebral ischaemia is the single most common cause of first seizures and epilepsy in later life above the age of 60 years. The leading type of stroke-related seizures is focal with a high rate of secondary generalisation. In general, early onset seizures are differentiated from late onset seizures after stroke. However, this is only of clinical relevance if both groups are associated with different prognosis which is discussed controversially in the literature. Also, a variety of definitions for early seizures have been used regarding the time span following stroke. Large cortical infarctions in the anterior circulation have a high risk of developing seizures. Results of recent studies revealed early seizures as independent risk factor for late seizures and development of epilepsy. Despite the importance of the problem there are few data on the natural history of stroke-related seizures and no good guideposts to suggest when to initiate anticonvulsant therapy after stroke.The exact statistical risk of further seizures after a first poststroke seizure is not known, therefore, it has to be a case-by-case decision when to start medication. After a single early seizure longterm anticonvulsant therapy is usually not recommended even though recent studies could not reproduce the previously thought good prognosis of early seizures. There is also still debate about treatment after a first late seizure. After a second seizure the diagnosis of symptomatic epilepsy can be made and long-term anticonvulsant therapy is usually recommended. Poststroke seizures are in most patients well controlled with a single anticonvulsant drug. The choice of drug is given by the general recommendations of anticonvulsant medication in patients with focal seizures. In these mainly elderly patients interactions with other medications and cognitive side effects have to be considered especially. Whether the new anticonvulsants have advantages as compared to the standard medication with carbamazepine, oxcarbazepine or valproic acid is still open and under investigation. Full article

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Open AccessReview

Abciximab in acute stroke

by Ralf W. Baumgartner

Swiss Arch. Neurol. Psychiatry Psychother. 2004, 155(4), 164-168; https://doi.org/10.4414/sanp.2004.01484 - 1 Jan 2004

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Abstract

The glycoprotein (GP) IIb/IIIa receptor is a platelet-specific adhesion receptor, which is the final pathway of platelet aggregation. It is blocked by abciximab, a chimeric (murine-human) Fab fragment of a monoclonal antibody. Animal studies have shown that GP IIb/IIIa antagonists improve blood flow [...] Read more.

The glycoprotein (GP) IIb/IIIa receptor is a platelet-specific adhesion receptor, which is the final pathway of platelet aggregation. It is blocked by abciximab, a chimeric (murine-human) Fab fragment of a monoclonal antibody. Animal studies have shown that GP IIb/IIIa antagonists improve blood flow in the cerebral microcirculation. Angiographic studies performed in patients with acute myocardial infarction have demonstrated that abciximab on top of aspirin and adjusted-dose heparin reopens about 40–50% of thrombosed coronaries to Thrombolysis in Myocardial Infarction (TIMI) flow grades II or III. Systemic abciximab was studied in a prospective, placebocontrolled, randomised, dose escalation safety and pilot efficacy trial, which was performed in 74 patients with acute ischaemic stroke who were treated within 24 hours after symptoms onset. Patients of the active group suffered no symptomatic intracranial haemorrhage and showed a trend to have more often a minimal disability. In the “Abciximab in Emergent Stroke Treatment Trial”, a randomised, double-blind study, 400 patients with acute ischaemic stroke were treated within the 6-hour time window with systemic abciximab or placebo. The unpublished study data suggest that abciximab may improve the clinical outcome also in patients with acute ischaemic stroke who were treated within the 3–6-hour time window and that it has an acceptable safety. A case report and a small series have reported that systemic abciximab successfully revascularised reocclusion occurring during or immediately after successful thrombolysis of the middle cerebral artery, intracranial vertebral or basilar arteries. Ongoing and planned trials investigate the safety and efficacy of systemic abciximab in acute ischaemic stroke within the 6-hour time window, in wake-up stroke and in carotid artery disease, or its combination with systemic or local intraarterial fibrinolysis. New strategies such as combining systemic GP IIb/IIIa inhibitors with fibrinolysis might improve the insufficient recanalisation rates of systemic fibrinolysis or avoid the need for local intraarterial fibrinolysis. Full article

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Open AccessReview

Différentes applications cliniques des signaux microemboliques détectés par Doppler transcrânien et leur contribution potentielle dans la prise de décision thérapeutique

by Roman Sztajzel, H. Gröetzsch and J. Loulidi

Swiss Arch. Neurol. Psychiatry Psychother. 2004, 155(4), 152-163; https://doi.org/10.4414/sanp.2004.01483 - 1 Jan 2004

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Abstract

Given the fact that most strokes are due to thromboembolism, transcranial Doppler (TCD) detection of cerebral microemboli offers the opportunity to study the pathogenesis of cerebral ischaemia and may allow identification of patients who are at highest risk of stroke and in most [...] Read more.

Given the fact that most strokes are due to thromboembolism, transcranial Doppler (TCD) detection of cerebral microemboli offers the opportunity to study the pathogenesis of cerebral ischaemia and may allow identification of patients who are at highest risk of stroke and in most urgent need of treatment. Various studies have shown that emboli detection may be very useful in different clinical situations. Studies focusing on the acute phase of stroke demonstrated that the overall frequency of microembolic signals (MES) varies very widely. Differences in the intervals from stroke onset and TCD recordings, in the duration of recordings, in the criteria used to define MES and the small size of the study groups may explain these variations. MES are mostly found among patients with potential arterial or cardiac embolic sources and are very rarely encountered among patients with lacunar stroke. These findings favour the assumption that MES correspond to brain embolism and also that embolisation does not constitute the predominant mechanism of lacunar stroke. The presence of MES detected during the acute phase of stroke also predicts increased risk of further events. The prevalence of MES has also been extensively studied in the setting of carotid artery disease. Soon after the observation of the presence of MES during endarterectomy, similar signals occurring spontaneously were recognised in patients with symptomatic carotid artery disease. Furthermore, since MES almost completely disappear after carotid endarterectomy, it was assumed that the atherosclerotic plaque in the carotid artery was the source of MES. Overall the frequency of MES is more important among symptomatic than asymptomatic patients. However, most of the studies report a higher frequency of MES in the presence of higher degrees of stenosis in the ipsilateral internal carotid artery. In fact, the more severe the narrowing, the more MES are detected. The beneficial effects of carotid endarterectomy in symptomatic and asymptomatic patients with high-grade carotid artery stenosis have been demonstrated in various studies. However, the risks of carotid surgery are not negligible and overall approximately 3 to 5% of the patients undergoing surgery may suffer a stroke or death during or just after surgery.The safety of the surgical procedureis therefore of considerable importance and it is therefore essential to improve the prevention of neurological complications. Several studies have shown that TCD monitoring of embolism and haemodynamic changes in the middle cerebral artery may in fact provide important information to the surgeon instantaneously during endarterectomy. The four following transcranial Doppler variables are independently associated with occurrence of stroke during or after the procedure: microemboli during dissection and wound closure; >90% decrease in MCA peak systolic velocity during cross-clamping and >100% increase of the pulsatility index at clamp release. Various studies also demonstrate that MES are detected in almost 70% of the cases during the first hours postoperatively and are strong predictors of ischaemic neurological deficits in the territory of the insonated middle cerebral artery. Furthermore, emboli detection during coronary bypass surgery has increasingly been recognised during these last years as potential markers for the occurrence of cognitive impairment, despite changes performed in the surgical technique, such as the introduction of arterial-line filters and membrane oxygenators. Finally, the contribution of MES detection to the therapeutical decision has been determined in various clinical situations. Rapid disappearance of MES after administration of a certain number of medications such as antiplatelets, GP IIb/IIIa antagonists receptors, S-nitrosoglutathione, a nitric oxyde donor or dextran 40, suggests that MES constitute potential markers allowing assessment of treatment efficacy and thereby reducing the risk of further cerebrovascular complications. Full article

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Open AccessArticle

Prise en charge des attaques cérébrales à l’aide du CT de perfusion

by P. Michel, M. Reichhart, M. Wintermark, P. Maeder, R. Meuli and J. Bogousslavsky

Swiss Arch. Neurol. Psychiatry Psychother. 2004, 155(4), 148-151; https://doi.org/10.4414/sanp.2004.01489 - 1 Jan 2004

Cited by 2 | Viewed by 33

Abstract

Given the high variability of stroke mechanisms, size, localisation and degree of the penumbra, clinicians treating acute stroke patients need tools in addition to clinical information to match the individual patient with different available treatment strategies. Among the two types of perfusion CTs [...] Read more.

Given the high variability of stroke mechanisms, size, localisation and degree of the penumbra, clinicians treating acute stroke patients need tools in addition to clinical information to match the individual patient with different available treatment strategies. Among the two types of perfusion CTs the dynamic perfusion CT is preferable over the whole-brain technique as it can generate truly quantitative regional cerebral blood volume and cerebral blood-flow values and threshold maps that may differentiate reversible from non-reversible ischaemia. Some drawbacks of perfusion CTs, such as the impossibility of serial examinations (amount of contrast, radiation) or failure to show lacunar or posterior fossa lesions, are counterbalanced by the availability of CTs in most emergency rooms, its easy accessibility, simple monitoring of patients and the possibility to quantify perfusion deficits. Perfusion CT has a sensitivity and positive predictive value above 90% for territorial infarcts in the supratentorial regions, even in the earliest phase of stroke. Dynamic perfusion CT reliably identifies penumbra and core tissue and closely predicts final stroke volume. The final stroke size is usually close to the initial core volume if early arterial recanalisation occurs, and close or equal to the initial core plus penumbra size if early recanalisation does not occur (with or without thrombolysis). TIAs or migraine, but not focal seizures or transient global amnesia, may rarely show minor focal hypoperfusion. In regard to information about supratentorial brain perfusion, it appears at least equivalent to MRI perfusion methods. Regarding treatment decisions, the degree of penumbra on perfusion CTs as well as an arterial occlusion on the angio CT could help to select between intraarterial and intravenous thrombolysis. Further studies might show that the current time windows thrombolyses are too long for patients with little penumbra and too short for patients with a persistent penumbra.Therefore, perfusion imaging may allow to replace a rigid time window for acute interventions and the saying “time is brain” might be replaced by “penumbra is brain”. Thus, even patients with unknown onset of stroke, waking up with a stroke or having an epileptic seizure at stroke onset may become candidates for treatment based on the demonstration of a significant penumbra on perfusion imaging. In case neuroprotective treatment becomes available, only patients with a significant penumbra involving the brain matter for which the substance is active (grey versus white brain matter) may be exposed to benefits, costs and side effects of these treatments. When testing new acute stroke therapies, a potential treatment effect may be better shown thanks to selecting patients with perfusion CTs who are more likely to respond to the treatment strategy. In such a study it could be the amount of salvage of the initial radiological penumbra on perfusion CTs that may be used as a surrogate marker to test the efficacy of a new intervention, rather than final infarct size. Full article

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Open AccessEditorial

Hirnschlag

by Philippe Lyrer

Swiss Arch. Neurol. Psychiatry Psychother. 2004, 155(4), 147; https://doi.org/10.4414/sanp.2004.01482 - 1 Jan 2004

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Abstract

In der vorliegenden Nummer des Schweizer Archivs für Neurologie und Psychiatrie finden die Leser und Leserinnen eine Artikelserie rund um das Thema Hirnschlag [...] Full article

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Swiss Arch. Neurol. Psychiatry Psychother., Volume 155, Issue 4 (01 2004) – 12 articles

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