Fortschritte der Neurologie-Psychiatrie
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Fortschr Neurol Psychiatr · Apr 2013
Case Reports[First occurrence of an organic manic schizophreniform syndrome followed by catatonia induced by anti-NMDA-receptor encephalitis].
We report on a 39-year-old female patient who developed catatonia after there had been schizomanic symptoms in the six months before. At admission the patient exhibited catatonia, a tetraspastic syndrome and focal epileptic seizures. The cranial MRI revealed bilateral subcortical hyperintense lesions which took up contrast agent. ⋯ Therefore we assume an autoimmune, not paraneoplastic, encephalitis in our patient. The symptoms improved significantly after an immunosuppressive therapy - initially with glucocorticoids followed by rituximab - had been initiated. This case illustrates that an autoimmune encephalitis should be looked for when first psychotic symptoms occur.
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Cerebral amyloid angiopathy (CAA) belongs to the group of amyloidoses and is characterised by the deposition and accumulation of beta-amyloid (Aβ) in small arterial vessels of the brain. Hereditary forms of CAA exist but sporadic CAA is much more frequent. Deposition of Aβ induces degenerative changes of the cerebral vascular system (thickening of the vessel wall, constriction of vascular lumen, microaneurysms, dissection) that trigger the development of the typical clinical presentation of CAA, that is spontaneous intracerebral haemorrhage. ⋯ Currently, no specific causal therapy exists. Although CAA is located in the range of neurological diseases psychiatric symptoms might occur. In the review, we discuss epidemiological, pathogenetic, clinical and diagnostic aspects and possible psychiatric implications of CAA.
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Fortschr Neurol Psychiatr · Jun 2012
Review[Innovations in neuro-monitoring using transcranial ultrasound].
This review describes transcranial ultrasound-based neuromonitoring by assessing changes of brain structures or cerebral blood flow over time. Some of the presented ultrasound techniques are still experimental. They are advantageous as they provide non-invasive and bed-side imaging. ⋯ An assessment of increased cerebral pressure can be achieved by repeated determination of individual pulsatility index, cerebral venous blood flow, midline shift and transorbital optic sheath measurements. Moreover, transcranial duplex sonography offers the possibility to detect intracranial haemorrhage and to guide neurosurgical interventions. Finally, the value of measuring cerebral autoregulation and the current state of the art regarding sonothrombolysis in acute intracranial arterial thrombosis is presented.