42 research outputs found
Immundiagnostik der Tuberkulose mittels rascher durchflusszytometrischer Detektion antigenspezifischer T-Zellen bei latenter Infektion und aktiver Erkrankung
Get PDFIntravenous thrombolysis with tPA and cortical involvement increase the risk of early poststroke seizures: results of a case-control study
No full textThe aim of this study was to identify the risk factors for early poststroke seizures (PSS) in patients with acute ischemic stroke. We undertook a case-control study at a single stroke center. Patients with seizure occurring during the first 7 days following ischemic stroke admitted between 2010 and 2016 were retrospectively identified and matched with controls (patients with stroke without early PSS) for age and sex. We included 79 cases and 158 controls. Blood sugar levels on admission, stroke localization, National Institutes of Health Stroke Scale (NIHSS) and Rankin score, and intravenous (i.v.) thrombolysis with recombinant tissue plasminogen activator (rtPA) were statistically associated with early PSS in univariate analysis. Multiple logistic regression after forward and backward variable selection identified cortical stroke localization (odds ratio (OR): 2.49; 95% confidence intervals (CI): 1.35 to 4.59; p = 0.003) and i.v. thrombolysis (OR: 2.26; 95% CI: 1.16 to 4.43; p = 0.008) as variables independently associated with early PSS. Cortical involvement and i.v. thrombolysis are independent risk factors associated with the occurrence of early PSS. This association is not explained by age or sex, concomitant drugs, diabetes or alcoholism, sodium and cholesterol levels, blood pressure on admission, stroke etiology or severity, and hemorrhage following i.v. thrombolysis. Further studies are required to fully elucidate the association between different reperfusion therapies and early PSS. This article is part of the Special Issue "Seizures & Stroke
Sonography of optic nerve sheath diameter identifies patients with middle cerebral artery infarction at risk of a malignant course: a pilot prospective observational study
No full textIntroduction: To assess the value of optic nerve sheath diameter (ONSD) measurements at different time points to predict the malignant evolution in middle cerebral artery (MCA) infarction and to investigate the relationship between ONSD and infarct volume on follow-up computed tomography (CT). Methods: In a single-center prospective observational study, we recruited patients with MCA infarction and age- and sex-matched controls. Clinical characteristics including NationaI Institutes of Health Stroke Scale (NIHSS) and ONSD measurement were assessed during the first five days after symptom onset. Volumetric analysis of the infarction was performed by a neuroradiologist, who was blinded to results of ONSD measurement and clinical examinations, based on CT scans. Results: We enrolled 29 patients with MCA infarction, including 10 with malignant MCA (mMCA) infarction and 14 controls. Mean ONSD on admission was already larger in patients who had developed an mMCA (5.99 ± 0.32 mm) compared to patients with MCA infarction (4.98 ± 0.53 mm; P = 0.003), and to control patients (4.57 ± 0.29 mm; P < 0.001). Correlation was observed between the ONSD mean value bilateral measures per individual and volumetric evaluation of cerebral infarction in the CT scan after one day (r = 0.623; P = 0.002). An ONSD value of 5.6 mm predicted an mMCA with a sensitivity of 100% and specificity of 90% yielding a positive predictive value of 83% and negative predictive value of 100%. Conclusions: ONSD measurement might be accurate for the noninvasive detection of increased ICP and for the recognition of patients being likely to develop mMCA
PLWH treated with modern ART and high CD4 T cell counts: no evidence of HIV-associated vasculopathy measured by extra- and intracranial ultrasound
No full textPLWH treated with modern ART and high CD4 T cell counts: no evidence of HIV-associated vasculopathy measured by extra- and intracranial ultrasound
Get PDF(...
Short-chain fatty acids and intestinal inflammation in multiple sclerosis: modulation of female susceptibility by microbial products?
Get PDFBackground: Multiple Sclerosis (MS) is an autoimmune-mediated disease of the central nervous system. Experi mental data suggest a role of intestinal microbiota and microbial products such as short-chain fatty acids (SCFAs) in
the pathogenesis of MS. A recent clinical study reported benefcial efects (mediated by immunomodulatory mecha nisms) after oral administration of the SCFA propionate in MS patients. Based on available evidence, we investigated
whether SCFAs and the fecal infammation marker calprotectin are altered in MS.
Methods: 76 subjects (41 patients with relapsing–remitting MS and 35 age-matched controls) were investigated in
this case–control study. All subjects underwent clinical assessment with established clinical scales and provided fecal
samples for a quantitative analysis of fecal SCFA and fecal calprotectin concentrations. Fecal markers were com pared between MS patients and controls, and were analyzed for an association with demographic as well as clinical
parameters.
Results: Median fecal calprotectin concentrations were within normal range in both groups without any group-spe cifc diferences. Fecal SCFA concentrations showed a non-signifcant reduction in MS patients compared to healthy
subjects. Female subjects showed signifcantly reduced SCFA concentrations compared to male subjects.
Conclusions: In our cohort of MS patients, we found no evidence of an active intestinal infammation. Yet, the vast
majority of the investigated MS patients was under immunotherapy which might have afected the outcome meas ures. The sex-associated diference in fecal SCFA concentrations might at least partially explain female predominance
in MS. Large-scale longitudinal studies including drug-naïve MS patients are required to determine the role of SCFAs
in MS and to distinguish between disease-immanent efects and those caused by the therapeutic regime
Is It Lupus? Is It Neuromyelitis Optica Spectrum Disorder (NMOSD)? : Why Not Both?
Get PDFMultiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are among
the commonly considered differential diagnoses in patients with inflammatory central nervous system (CNS)-diseases. Formerly diagnosed competing autoimmune diseases might impair diagnostics
and treatment. Here, we report on a 41-year-old woman admitted to our hospital with primary
manifestation of NMOSD (paresthesia, paralysis of the lower extremities, and urinary incontinence)
while undergoing treatment for a diagnosed systemic lupus erythematosus (SLE) with hydroxychloroquine. CNS manifestation of the disease was considered. Magnetic resonance imaging (MRI)
of the cranium and spinal cord showed multiple supratentorial lesions of the white matter and
massive intramedullary lesions with contrast enhancement. Cerebrospinal fluid (CSF) showed pleocytosis (20/µL), positive antinuclear antibodies (ANA), antiphospholipid antibodies, and SSA/Ro
antibodies, while formerly positive dsDNA antibodies were negative. Further diagnostics revealed
a 1:10,240 serum titer of Aquaporine-4 antibodies. The patient received intravenous methylprednisolone for three days (2 g per day), which led to an escalation to plasmapheresis and to an improved
EDSS from 8.0 to 4.0. Because of the comorbidity, a combined relapse prophylaxis with satralizumab
and mycophenolate mofetil was established. Rehabilitation and continued treatment improved
EDSS to 1.0 with no impairment of mobilization. Although formerly diagnosed SLE could have
explained the symptoms, it is important to reconsider competitive diseases in order to establish
adequate immunotherap
Abnormal galactosylation of immunoglobulin G in cerebrospinal fluid of multiple sclerosis patients
No full text
Apheresis treatment in autoimmune neurological diseases: Predictors of good clinical outcome and success of follow-up therapy with B-cell depletion
Get PDFObjective: Apheresis treatment (AT) is an established standard of treatment in various neurological autoimmune
diseases. Since not all patients equally benefit from AT, we saw the need to investigate the effect of different
clinical, paraclinical and technical-apparative factors on the clinical outcome. Additionally, we wanted to find
out whether patients who improved due to AT continue to be clinically stable under B-cell depletion (BCD).
Methods: We screened all patients (n = 358) with neurological diseases who received AT at the Medical center of
the University of the Saarland in the past 20 years. Different factors (e.g., age, sex, duration until onset of AT,
type of AT, number of cycles, csf parameters) were analyzed retrospectively. Clinical disability was measured
using the modified Rankin scale (mRS), visual acuity and the Expanded Disability Status Scale (EDSS).
Results: 335 patients, categorized into 11 different autoimmune diagnosis groups, received a total of 2669
treatment cycles and showed a statistically significant improvement in mRS with AT (p < 0.001). Patients in
American Society for Apheresis (ASFA) categories I (p = 0.013) and II (p = 0.035) showed a significantly greater
benefit under AT than those in category III. The clinical outcome was better with shorter duration until AT onset,
more cycles of AT, and more plasma volume exchanged and the presence of an autoimmune antibody. Patients
who initially profited had a significantly more stable course of the disease after 1-Year-BCD (p = 0.039).
Discussion: In the present study, we were able to identify various significant factors influencing the outcome of
patients due to AT. Furthermore, we could show that patients with a response to AT can benefit from BCD followup therapy
