10 results on '"Hans Rolf Jäger"'
Search Results
2. Antiphospholipid antibodies and neurological manifestations in acute COVID-19: A single-centre cross-sectional study
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Laura A. Benjamin, Ross W. Paterson, Rachel Moll, Charis Pericleous, Rachel Brown, Puja R. Mehta, Dilan Athauda, Oliver J. Ziff, Judith Heaney, Anna M. Checkley, Catherine F. Houlihan, Michael Chou, Amanda J. Heslegrave, Arvind Chandratheva, Benedict D. Michael, Kaj Blennow, Vinojini Vivekanandam, Alexander Foulkes, Catherine J. Mummery, Michael P. Lunn, Stephen Keddie, Moira J. Spyer, Tom Mckinnon, Melanie Hart, Francesco Carletti, Hans Rolf Jäger, Hadi Manji, Michael S. Zandi, David J. Werring, Eleni Nastouli, Robert Simister, Tom Solomon, Henrik Zetterberg, Jonathan M. Schott, Hannah Cohen, and Maria Efthymiou
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Medicine (General) ,R5-920 - Abstract
Background: A high prevalence of antiphospholipid antibodies has been reported in case series of patients with neurological manifestations and COVID-19; however, the pathogenicity of antiphospholipid antibodies in COVID-19 neurology remains unclear. Methods: This single-centre cross-sectional study included 106 adult patients: 30 hospitalised COVID-neurological cases, 47 non-neurological COVID-hospitalised controls, and 29 COVID-non-hospitalised controls, recruited between March and July 2020. We evaluated nine antiphospholipid antibodies: anticardiolipin antibodies [aCL] IgA, IgM, IgG; anti-beta-2 glycoprotein-1 [aβ2GPI] IgA, IgM, IgG; anti-phosphatidylserine/prothrombin [aPS/PT] IgM, IgG; and anti-domain I β2GPI (aD1β2GPI) IgG. Findings: There was a high prevalence of antiphospholipid antibodies in the COVID-neurological (73.3%) and non-neurological COVID-hospitalised controls (76.6%) in contrast to the COVID-non-hospitalised controls (48.2%). aPS/PT IgG titres were significantly higher in the COVID-neurological group compared to both control groups (p
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- 2021
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3. Delayed diagnosis of spinal cord schistosomiasis in a non-endemic country: A tertiary referral centre experience.
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Angus de Wilton, Dinesh Aggarwal, Hans Rolf Jäger, Hadi Manji, and Peter L Chiodini
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Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
BackgroundNeuroschistosomiasis is a severe complication of schistosomiasis, triggered by the local immune reaction to egg deposition, with spinal cord involvement the most well recognised form. Early treatment with praziquantel and high dose steroids leads to a reduction of neurological sequelae. The rarity of this condition in returning travellers to high income countries can result in delayed diagnosis and treatment. We aimed to evaluate the diagnosis and management of neuroschistosomiasis in a UK national referral centre.Materials/methodsA retrospective review of confirmed clinical cases of spinal schistosomiasis referred to the Hospital for Tropical Diseases, UK, between January 2016 and January 2020 was undertaken. Electronic referral records were interrogated and patient demographic, clinical, laboratory, and radiological data collected.ResultsFour cases of neuroschistosomiasis were identified. The median age at diagnosis was 28 (range 21 to 50) with three male patients. All patients had epidemiological risk factors for schistosomiasis based on travel history and freshwater exposure; two in Uganda (River Nile), one in Malawi and one in Nigeria. All patients presented with features of transverse myelitis including back pain, leg weakness, paraesthesia and urinary dysfunction. The mean time from presentation to health services to definitive treatment was 42.5 days (range 16-74 days). Diagnosis was confirmed with CSF serology for schistosomiasis in all cases. Radiological features on MRI spine included enhancement focused predominantly in the lower thoracic spinal cord in three cases and the conus in one patient. All patients received a minimum of three days of oral praziquantel and high dose steroids. At three-month follow-up, one patient had complete resolution of symptoms and three had residual deficit; one patient was left with urinary and faecal incontinence, another had urinary retention, and the final patient has persistent leg pains and constipation.ConclusionWe observed a marked delay in diagnosis of neuroschistosomiasis in a non-endemic country. We advocate undertaking a thorough travel history, early use of imaging and CSF schistosomal serology to ensure early diagnosis of neuroschistosomiasis in patients presenting with consistent symptoms. If schistosomal diagnostics are not immediately available, presumptive treatment under the guidance of a tropical medicine specialist should be considered to minimize the risk of residual disability. We advocate for consensus guidelines to be produced and reporting to be performed in a uniform way for patients with spinal schistosomiasis.
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- 2021
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4. Cognitive Impairment Before Atrial Fibrillation–Related Ischemic Events: Neuroimaging and Prognostic Associations
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Gargi Banerjee, Edgar Chan, Gareth Ambler, Duncan Wilson, Lisa Cipolotti, Clare Shakeshaft, Hannah Cohen, Tarek Yousry, Rustam Al‐Shahi Salman, Gregory Y. H. Lip, Keith W. Muir, Martin M. Brown, Hans Rolf Jäger, and David J. Werring
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atrial fibrillation ,brain ischemia ,cerebral small vessel disease ,cognitive impairment ,vascular dementia ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background It is likely that a proportion of poststroke cognitive impairment is sometimes attributable to unidentified prestroke decline; prestroke cognitive function is also clinically relevant because it is associated with poor functional outcomes, including death. We investigated the radiological and prognostic associations of preexisting cognitive impairment in patients with ischemic stroke or transient ischemic attack associated with atrial fibrillation. Methods and Results We included 1102 patients from the prospective multicenter observational CROMIS‐2 (Clinical Relevance of Microbleeds in Stroke 2) atrial fibrillation study. Preexisting cognitive impairment was identified using the 16‐item Informant Questionnaire for Cognitive Decline in the Elderly. Functional outcome was measured using the modified Rankin scale. Preexisting cognitive impairment was common (n=271; 24.6%). The presence of lacunes (odds ratio [OR], 1.50; 95% CI, 1.03–1.05; P=0.034), increasing periventricular white matter hyperintensity grade (per grade increase, OR, 1.38; 95% CI, 1.17–1.63; P2; adjusted OR, 2.43; 95% CI, 1.42–4.20; P=0.001). Conclusions Preexisting cognitive impairment in patients with atrial fibrillation–associated ischemic stroke or transient ischemic attack is common, and associated with imaging markers of cerebral small vessel disease and neurodegeneration, as well as with longer‐term functional outcome. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02513316.
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- 2020
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5. Publisher Correction: Sensitivity and specificity of blood-fluid levels for oral anticoagulant-associated intracerebral haemorrhage
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Abeer Almarzouki, Duncan Wilson, Gareth Ambler, Clare Shakeshaft, Hannah Cohen, Tarek Yousry, Rustam Al-Shahi Salman, Gregory Y. H. Lip, Henry Houlden, Martin M. Brown, Keith W. Muir, Hans Rolf Jäger, and David J. Werring
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Medicine ,Science - Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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- 2021
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6. Cerebral metabolism and perfusion in MR-negative individuals with refractory focal epilepsy assessed by simultaneous acquisition of 18F-FDG PET and arterial spin labeling
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Ilaria Boscolo Galazzo, Maria Vittoria Mattoli, Francesca Benedetta Pizzini, Enrico De Vita, Anna Barnes, John S. Duncan, Hans Rolf Jäger, Xavier Golay, Jamshed B. Bomanji, Matthias Koepp, Ashley M. Groves, and Francesco Fraioli
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Epilepsy ,Arterial spin labeling ,Positron emission tomography ,Simultaneous PET/MR ,Glucose ,Cerebral blood flow ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
The major challenge in pre-surgical epileptic patient evaluation is the correct identification of the seizure onset area, especially in MR-negative patients. In this study, we aimed to: (1) assess the concordance between perfusion, from ASL, and metabolism, from 18F-FDG, acquired simultaneously on PET/MR; (2) verify the utility of a statistical approach as supportive diagnostic tool for clinical readers. Secondarily, we compared 18F-FDG PET data from the hybrid PET/MR system with those acquired with PET/CT, with the purpose of validate the reliability of 18F-FDG PET/MR data. Twenty patients with refractory focal epilepsy, negative MR and a defined electro-clinical diagnosis underwent PET/MR, immediately followed by PET/CT. Standardized uptake value ratio (SUVr) and cerebral blood flow (CBF) maps were calculated for PET/CT-PET/MR and ASL, respectively. For all techniques, z-score of the asymmetry index (zAI) was applied for depicting significant Right/Left differences. SUVr and CBF images were firstly visually assessed by two neuroimaging readers, who then re-assessed them considering zAI for reaching a final diagnosis. High agreement between 18F-FDG PET/MR and ASL was found, showing hypometabolism and hypoperfusion in the same hemisphere in 18/20 patients, while the remaining were normal. They were completely concordant in 14/18, concordant in at least one lobe in the remaining. zAI maps improved readers' confidence in 12/20 and 15/20 patients for 18F-FDG PET/MR and ASL, respectively. 18F-FDG PET/CT-PET/MR showed high agreement, especially when zAI was considered. The simultaneous metabolism-perfusion acquisition provides excellent concordance on focus lateralisation and good concordance on localisation, determining useful complementary information.
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- 2016
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7. Investigating the oxygenation of brain arteriovenous malformations using quantitative susceptibility mapping.
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Emma Biondetti, Alvaro Rojas-Villabona, Magdalena J. Sokolska, Francesca Benedetta Pizzini, Hans Rolf Jäger, David L. Thomas, and Karin Shmueli
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- 2019
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8. Enantiomorphic normalization of focally lesioned brains.
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Parashkev Nachev, Elizabeth J. Coulthard, Hans Rolf Jäger, Christopher Kennard, and Masud Husain
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- 2008
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9. The diagnostic challenges of neuroparasitological infections: The experience of the Hospital for Tropical Diseases (London) neuroparasitology multidisciplinary team between 2015–2020
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Emily Martyn, Laura Nabarro, Gauri Godbole, Hadi Manji, Hans Rolf Jager, and Peter L. Chiodini
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Infectious and parasitic diseases ,RC109-216 - Abstract
Introduction: In the UK, neuroparasitological infections are rare but important diagnoses. Diagnostic delay can result in significant morbidity. The Hospital for Tropical Diseases (HTD) runs a neuroparasitology multidisciplinary team meeting (MDT) consisting of two consultant parasitologists, neurologist and neuroradiologist, both with specialist interests in neuroinfection, and registrars, working closely with the reference parasitology service. Clinical history, imaging and laboratory results are reviewed to recommend a differential diagnosis and management plan. Methods: We reviewed MDT records between 1st October 2015 and 31st August 2020. We collected data on demographics, referring specialties, travel history and exposures, final diagnoses and MDT outcomes. Results: Overall, 162 patients were discussed in 51 MDTs. Referrals were made by 54 different hospitals, 3 outside the UK. The median age was 40 (IQR 29,53) and 45% were female. Parasitic infections accounted for 43%, including neurocysticercosis (75%, 52/69), hydatid (9%, 6/69), neuroschistosomiasis (6%, 4/69) and non-HIV associated cerebral toxoplasmosis (3%, 2/69). Non-parasitological diagnoses included other infection (e.g. HSV, cryptococcus), ADEM and malignancy. The MDT recommended further investigation in 28% (45/162) including imaging, serological tests or brain biopsy. For 8% (13/162) treatment was recommended under the home team, 9% (15/162) were treated as an HTD outpatient, 4% (7/162) were admitted for anti-parasitic treatment at HTD. In 5 patients with neurocysticercosis, unnecessary brain biopsy was avoided. Discussion: The HTD neuroparasitology MDT consults on complex neuroinfections from around the UK. Specialist review helps establish or exclude parasitological diagnoses, leading to appropriate parasitological treatment, saving patients from invasive procedures such as brain biopsy.
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- 2022
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10. Neuroanatomical correlates of prion disease progression - a 3T longitudinal voxel-based morphometry study
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Enrico De Vita, Gerard R Ridgway, Mark J White, Marie-Claire Porter, Diana Caine, Peter Rudge, John Collinge, Tarek A Yousry, Hans Rolf Jager, Simon Mead, John S Thornton, and Harpreet Hyare
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Prion disease ,Structural MRI ,Longitudinal voxel based morphometry ,3T MRI ,CJD ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Purpose: MRI has become an essential tool for prion disease diagnosis. However there exist only a few serial MRI studies of prion patients, and these mostly used whole brain summary measures or region of interest based approaches. We present here the first longitudinal voxel-based morphometry (VBM) study in prion disease. The aim of this study was to systematically characterise progressive atrophy in patients with prion disease and identify whether atrophy in specific brain structures correlates with clinical assessment. Methods: Twenty-four prion disease patients with early stage disease (3 sporadic, 2 iatrogenic, 1 variant and 18 inherited CJD) and 25 controls were examined at 3T with a T1-weighted 3D MPRAGE sequence at multiple time-points (2–6 examinations per subject, interval range 0.1–3.2 years). Longitudinal VBM provided intra-subject and inter-subject image alignment, allowing voxel-wise comparison of progressive structural change. Clinical disease progression was assessed using the MRC Prion Disease Rating Scale. Firstly, in patients, we determined the brain regions where grey and white matter volume change between baseline and final examination correlated with the corresponding change in MRC Scale score. Secondly, in the 21/24 patients with interscan interval longer than 3 months, we identified regions where annualised rates of regional volume change in patients were different from rates in age-matched controls. Given the heterogeneity of the cohort, the regions identified reflect the common features of the different prion sub-types studied. Results: In the patients there were multiple regions where volume loss significantly correlated with decreased MRC scale, partially overlapping with anatomical regions where yearly rates of volume loss were significantly greater than controls. The key anatomical areas involved included: the basal ganglia and thalamus, pons and medulla, the hippocampal formation and the superior parietal lobules. There were no areas demonstrating volume loss significantly higher in controls than patients or negative correlation between volume and MRC Scale score. Conclusions: Using 3T MRI and longitudinal VBM we have identified key anatomical regions of progressive volume loss which correlate with an established clinical disease severity index and are relevant to clinical deterioration. Localisation of the regions of progressive brain atrophy correlating most strongly with clinical decline may help to provide more targeted imaging endpoints for future clinical trials.
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- 2017
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