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2. Association of Fluid Balance and Hemoglobin Decline With Neurological Outcome After Aneurysmal Subarachnoid Hemorrhage

Author

Truckenmueller, Peter, Wolf, Stefan, Wasilewski, David, Vajkoczy, Peter, Früh, Anton, Baro, Norbert, Bauer, Miriam, Barner, Christoph, Dengler, Nora F., von Dincklage, Falk, Finger, Tobias, Francis, Roland, Hotter, Benjamin, Hunsicker, Oliver, Jussen, Daniel, Jüttler, Eric, Pohrt, Anne, Salih, Farid, Schaumann, Andreas, Witsch, Jens, Nagel, Christoph, Lemcke, Johannes, Meier, Ullrich, Podlesik, Dino, Schackert, Gabriele, Juratli, Tareq A., Huttner, Hagen, Schwab, Stefan, Staykov, Dimitre, Hagedorn, Sabine, Müller, Daniela, Müller, Oliver, Sarge, Robert, Sure, Ulrich, Bardutzky, Jürgen, Niesen, Wolf-Dirk, Lange, Katharina, Malinova, Vesna, Mielke, Dorothee, Rohde, Veit, Päsler, Dennis, Reinhardt, Stephanie, Schroeder, Henry W.S., Czorlich, Patrick, Regelsberger, Jan, Sauvigny, Thomas, Westphal, Manfred, Ehlert, Angelika, Gremmer, Rudolf, Beyer, Christian, Beyer, Desiree, Huthmann, Alexandra, Kerz, Thomas, Landscheidt, Julia, Schürer, Ludwig, Schul, David B., Meyer, Bernhard, Ryang, Yu-Mi, Toeroek, Elisabeth, Wostrack, Maria, Arouk, Wasim, Al-Jehani, Hosam, Fritsch, Michael, Al-Jehani, Hosam, Alturk, Abdulrahman Y., Sinclair, David B., Beck, Jürgen, Fung, Christian, Soell, Nicole, Engel, Doortje C., Hildebrandt, Gerhard, Huscher, Karen, Lange, Heidrun, Hutchinson, Peter, and Tseng, Ming-Yuan

Published
2024
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4. Versorgungssituation von CIDP-Patienten in neun deutschen Zentren des Neuritis Netzes

Author

Fisse, Anna Lena, Motte, Jeremias, Grüter, Thomas, Kohle, Felix, Kronlage, Cornelius, Stahl, Jan-Hendrik, Winter, Natalie, Seeliger, Tabea, Gingele, Stefan, Stascheit, Frauke, Hotter, Benjamin, Klehmet, Juliane, Kummer, Karsten, Enax-Krumova, Elena K., Sturm, Dietrich, Skripuletz, Thomas, Schmidt, Jens, Yoon, Min-Suk, Pitarokoili, Kalliopi, Lehmann, Helmar C., and Grimm, Alexander

Published
2023
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5. Biomarkers to improve functional outcome prediction after ischemic stroke: Results from the SICFAIL, STRAWINSKI, and PREDICT studies

Author

Montellano, Felipe A, primary, Rücker, Viktoria, additional, Ungethüm, Kathrin, additional, Penalba, Anna, additional, Hotter, Benjamin, additional, Giralt, Marina, additional, Wiedmann, Silke, additional, Mackenrodt, Daniel, additional, Morbach, Caroline, additional, Frantz, Stefan, additional, Störk, Stefan, additional, Whiteley, William N, additional, Kleinschnitz, Christoph, additional, Meisel, Andreas, additional, Montaner, Joan, additional, Haeusler, Karl Georg, additional, and Heuschmann, Peter U, additional

Published
2024
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8. Machine learning using multimodal and autonomic nervous system parameters predicts clinically apparent stroke-associated pneumonia in a development and testing study

Author

Nelde, Alexander, primary, Krumm, Laura, additional, Arafat, Subhi, additional, Hotter, Benjamin, additional, Nolte, Christian H., additional, Scheitz, Jan F., additional, Klammer, Markus G., additional, Krämer, Michael, additional, Scheib, Franziska, additional, Endres, Matthias, additional, Meisel, Andreas, additional, and Meisel, Christian, additional

Published
2023
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12. Correction to: Incidence of severe sepsis and septic shock in German intensive care units: the prospective, multicentre INSEP study

Author

Marx, Gernot, Litmathe, Jens, Schulz, Jörg B., Dafotakis, Manuel, Möllhoff, Thomas, Stalljohann, Carolin, Engels, Jonas, Sauerzapfe, Barbara, Stolzenberg, Barbara, Jonas, Engels, Möllhoff, Thomas, Carolin, Stalljohann, Thorben, Beeker, Gernot, Marx, Melanie, Schäfer, Tobias, Schürholz, Ertunc, Altiok, Marx, Nikolaus, Alexander, Kersten, Hannah, Dückers, Alexander, Koch, Trautwein, Christian, Scharf, Alexander, Kreuzer, Ilse, Jaschinski, Ulrich, Kreuzer, Ilse, Jaschinski, Ulrich, Niklas, Markus, Kulzer, Michael, Schlott, Martin, Iberer, Thomas, Stella, Oelert, Thorsten, Löhr, Vandana, Pillai, Praeger, Damaris, Knebel, Fabian, Baumann, Gert, Rosseau, Simone, Schlenk, Florian, Hoffmeister, Bodo, Compton, Friederike, Hoffmann, Clemens, Rademacher, Sibylle, Vietzke, Michael, Jörres, Achim, Meisel, Andreas, Hotter, Benjamin, Mengel, Annerose, Goldmann, Anton, Nöther, Frank, Keh, Didier, Schmidt, Katrin, Angermair, Stefan, Kaffarnik, Magnus, Bubser, Florian, Gummelt, Immo, Vedder, Ina, Bach, Friedhelm, Winter, Markus, Weißer, Frank, Roederer, Marc, Martini, Stefan, Bergmann, Lars, Adamzik, Michael, Baumann, Andreas, Wolf, Britta, Zahn, Peter K., Lehnhardt, Marcus, Daigeler, Adrien, Andreas, Andreas Hohn, Reinhold, Katrin, Adolf, Michael, Altenbeck, Nicole, Gussone, Christoph, Dietrich, Johannes Wolfgang, Köditz, Roland, Putensen, Christian, Schewe, Jens-Christian, Muders, Thomas, Soukup, Jens, Skitek, Kornel, Geisser, Wolfgang, Alber, Andreas, Düthorn, Ludwig, Demund, Josef, Düthorn, Ludwig, Criegern, Isabel v., Nowak, Andreas, Morgenstern, Toralf, Gliniorz, Christoph, Meisner, Michael, Dexel, Melanie, Schütte, Jan Karl, Huppertz-Thyssen, Markus H., Schröder, Stefan, Kowalzik, Ralf, Guel, Cansu, Terhorst, Rainer, Nießen, Peter, Hauschild, Rolf, Mutzek, Elisabeth-Maria, Kogelmann, Klaus, Drüner, Matthias, Jarczak, Dominik, Forster, Christian, Willam, Carsten, Eckardt, K. U., Clemenz, Rüdiger, Siemonsen, Sven, Pauschinger, Matthias, Baumgärtel, Matthias, Muschner, Dorothea, Christ, Michael, Wenzl, Martin, Höhl, Rainer, Junger, Axel, Wöhrle, Armin, Kanthak, Henry, Leschke, Matthias, Kanthak, Henry, Wöhrle, Armin, Leschke, Matthias, Kessler, Paul, Souquet, Jochen, Holfeld, Andreas, Habler, Oliver, Thörner, Markus, Vogt, Oliver, Meybohm, Patrick, Zacharowski, Kai, Lindau, Simone, Lenk, Marcus, Weis, Florian, Schubert, Hermann, Kemnitz, Jürgen, Reckort, Sven, Weikert, Martina, Sudhues, Ulrich, Möller, Stefan, Stefan, Pinger, Domke, Andrea, Wiesenack, Christoph, Schmidt, Florian, Döbel, Kai-Uwe, Moerer, Onnen, Schäper, Jörn, Kernchen, Andrea, Gründling, Matthias, Bollmann, Jan, Kuhn, Sven-Olaf, Kemming, Gregor, Einfeld, Carsten, Sommerer, Thomas, Kemming, Gregor, Einfeld, Carsten, Sommerer, Thomas, Köntges, Philipp, Hinz, Burkhard, Jauch, Lars-Oliver, Selonke, Lutz, Kluge, Stefan, Nierhaus, Axel, de Heer, Geraldine, Gruß, Marco, Köhler, Katja, Brinkmann, Alexander, Fuchs, Thomas, Köberer, Andreas, Geuting, Markus, Weigt, Henry, Baltus, Thomas, Scheltz, Claudia, Bloos, Frank, Reinhart, Konrad, Jegen, Rudolf, Flucht, Marcus, Jürgen, Gburek, Flucht, Marcus, Jegen, Rudolf, Stumm, Anne, Rossenbach, Jannik, Stumm, Anne, Haller, Mathias, Stumm, Anne, Rossenbach, Jannik, Lynch, John, Kempkens, Martin, Buechner, Volkmar, Molitor, Dieter, Klasen, Gerda, Rahmen, Bruno, Muhr, Petra, Canaviri, Patricia, Fiedler, Fritz, Lutz, Jürgen, Kaiser, Marc, Klünter, Simon, Krep, Henning, Anders, Helge, Aduckathil, Sanjay, Sakka, Samir, Reessing, Jan Hinnerk, Aabaid, Sabrina, Löbe, Mathias, Bogatsch, Holger, Löffler, Marcus, Engels, Christoph, Molter, Gerd Peter, Stunz, Michael, Mitrenga, Anja, Geldner, Götz, Bürle, Monica, Klasen, Robert, Werner, Steffanie, Wilhelm, Wolfram, Silke, Frenzel, Juliane, Illert, Jana, Schuttpelz, Briegel, Josef, Möhnle, Patrick, Knorr, Adrian, Hartl, Wolfgang, Ney, Ludwig, Stemmler, Hans-Joachim, Pfister, Hans-Walter, Angstwurm, Matthias, Frey, Lorenz, Irlbeck, Michael, Huge, Volker, Weis, Marion, Kilger, Erich, Hofmann-Kiefer, Klaus, Felbinger, Thomas, Kaufmann, Ines, Goeschl, Julia, Brettner, Franz, Hamm, Heiner, Eife, Claudia, Peckelsen, Claus, Findeisen, Michael, Schmidt-Schridde, Patrick, Kuner, Andreas, Walz, Thomas, Kuner, Barbara, Schrauzer, Thomas, Nentwich, Jens, John, Stefan, Byhahn, Christian, Kretschmer, Thomas, Bergold, Martin N., Weyland, Andreas, Jelschen, Florian, Diers, Anja, Knebel, Frieder G., Kupfer, Thomas, Oppert, Michael, Rohde, Steffen, Möllemann, Angela, Oehmichen, Uwe, Renner, Theresa, Bone, Hans-Georg, Freyhoff, Jörg, Holst, Dana, Birken, Thomas, Henschel, Jörg, Gloger, Martin, Brock, Peter, Klösel, Stephan, Albuszies, Gerd, Schumacher, Detlef, Meierhenrich, Rainer, Schöpp, Alexej, Kuhn, Harald, Riessen, Reimer, Haap, Michael, Ziegler, Silvia, Fastnacht-Böttcher, Jana, Schröder, Rolf Jürgen, Weiss, Manfred, Frank, Katrin, Georgieff, Michael, Weiss, Manfred, Barth, Eberhard, Bracht, Henrik, Ehmcke, Heidrun, Francke, Astrid, Ott, Stefan, Köpcke, Jens, Meyer, Andreas, Jokiel, Gunnar, Freund, Thomas, Schick, Guido, Karassimos, Evagelos, and SepNet Critical Care Trials Group

Published
2017
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15. Positionspapier Schlaganfallnachsorge der Deutschen Schlaganfall-Gesellschaft – Teil 2: Konzept für eine umfassende Schlaganfallnachsorge

Author

Hotter, Benjamin, Ikenberg, Benno, Kaendler, Stephen, Knispel, Petra, Ritter, Martin, Sander, Dirk, Schwarzbach, Christopher, Büdingen, Hans Joachim Von, Wagner, Markus, Meisel, Andreas, and Mitglieder Kommission Nachsorge Der Deutschen Schlaganfall-Gesellschaft

Subjects
Versorgungsforschung, Schlaganfall, Sekundärprävention, Secondary prevention, General Medicine, Comprehensive Care, ddc, Stroke, Long-term care, Psychiatry and Mental health, Neurology, Delivery of health care, Neurology (clinical), Nachsorge, Konsensuspapiere, Comprehensive health care, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
Abstract

Long-term management after stroke has not been standardized in contrast to acute and rehabilitative stroke care. The fragmented outpatient sector of healthcare allows a high degree of flexibility but also variability in the quality of care provided. The commission on long-term stroke care of the German Stroke Society developed a concept on how to provide standardized multiprofessional long-termstroke carewith a focus on patient-centered comprehensive care. We propose a diagnostic work-up in stages, with an initial patient-reported screening, followed by an adapted in-depth assessment of affected domains. This includes internistic domains (management of risk factors) and also genuine neurological domains (spasticity, cognitive deficits etc.) that must be considered. This information is then merged with patient expectations and prioritization to a standardized treatment plan. Special challenges for the implementation of such a comprehensive care system are the intersectoral and intrasectoral communication between healthcare providers, patients and relatives, the need to create a compensation system for providers and the establishment of appropriate quality management services. Digital health applications are helpful tools to provide aspects of diagnostics, treatment and communication in long-term stroke care., Die Schlaganfallnachsorge ist im Gegensatz zur akuten und rehabilitativen Versorgung des Schlaganfalls wenig standardisiert. Der fragmentierte ambulante Sektor erlaubt hierbei ein hohes Maß an Flexibilität, leidet aber folglich an variabler Qualität der Nachsorge. Die Kommission Nachsorge der Deutschen Schlaganfall-Gesellschaft formuliert in diesem Positionspapier ein inhaltliches Konzept, um eine strukturierte Nachsorge mit multiprofessionellem Ansatz zu entwickeln. Diese soll im Sinne einer „Comprehensive-care“-Versorgung und patientenzentriert erfolgen. Dazu schlagen wir ein diagnostisches Stufenkonzept mit Screening und ggf. weitergehender Untersuchung vor, das in Absprache mit den Betroffenen zu einem standardisierten Therapieplan führt, der im Langzeitverlauf entsprechend angepasst werden muss. Inhaltlich sind sowohl internistische Domänen (Management von Risikofaktoren) als auch genuin neurologische Domänen (Spastik, kognitive Defizite etc.) zu berücksichtigen. Besondere Herausforderungen an dieses Konzept sind die sektorenübergreifende (inter- und intrasektorale) Kommunikation zwischen den Akteuren im Gesundheitswesen untereinander sowie mit den Patienten und Angehörigen, die Notwendigkeit zur Schaffung eines Vergütungsmodells für eine solche Nachsorge und letztlich die Etablierung eines entsprechenden Qualitätsmanagements. Digitale Lösungen erachten wir als hilfreiche Werkzeuge für Aspekte der Diagnose, Therapie und Kommunikation in der Schlaganfallnachsorge.

Published
2021

21. Location matters – Genotype-phenotype correlation in LRSAM1 mutations associated with rare Charcot-Marie-Tooth neuropathy CMT2P

Author

Reilich, Peter, primary, Schlotter, Beate, additional, Montagnese, Federica, additional, Jordan, Berit, additional, Stock, Friedrich, additional, Schäff-Vogelsang, Mario, additional, Hotter, Benjamin, additional, Eger, Katherina, additional, Diebold, Isabel, additional, Erdmann, Hannes, additional, Becker, Kerstin, additional, Schön, Ulrike, additional, and Abicht, Angela, additional

Published
2021
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24. Multimodales MRT bei transitorischen cerebrovaskulären Ereignissen

Author

Hotter, Benjamin

Subjects
Stroke, Perfusion Imaging, TIA, DWI, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit, MRI
Abstract

Im Zuge der eigenen Arbeiten in dieser Habilitationsschrift ist es gelungen, zur Validierung des Post-Processings von Perfusionsbildgebung zur Nutzung im Rahmen multimodaler MRT-Bildgebung bei akuten cerebrovaskulären Ereignissen beizutragen. Die Erkenntnisse der eigenen Arbeiten integrieren sich hierbei gut in die zunehmende Validierung von Tmax als standardisiertem Perfusionsparameter zur Bestimmung der Penumbra in klinischen Studien. Ein einfacher klinischer Parameter zur Triage von MRT bei TIA-Patienten konnte weder in dieser Arbeit noch durch andere Arbeitsgruppen validiert werden. In Anbetracht der hohen Anzahl von TIA-Patienten, die ischämische Läsionen in der DWI aufweisen, und dem Wissen, dass das Rezidivrisiko bei Nachweis solcher Läsionen deutlich höher ist, rechtfertigt sich der Einsatz von multimodaler MRT bei TIA-Patienten. Das vormals als benigne eingeschätzte bildgebende Syndrom „total mismatch“ zeigt eine Rate von 39% ischämischer Läsionen im Verlauf, und sollte entsprechend behandelt werden. Umgekehrt kann bei selbstlimitierter Klinik und initial unauffälliger DWI auf eine Verlaufsbildgebung verzichtet werden.

Published
2020
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29. Transfer RNA fragments replace microRNA regulators of the cholinergic post-stroke immune blockade

Author

Winek, Katarzyna, primary, Lobentanzer, Sebastian, additional, Nadorp, Bettina, additional, Dubnov, Serafima, additional, Dames, Claudia, additional, Moshitzky, Gilli, additional, Hotter, Benjamin, additional, Meisel, Christian, additional, Greenberg, David S, additional, Shifman, Sagiv, additional, Klein, Jochen, additional, Shenhar-Tsarfaty, Shani, additional, Meisel, Andreas, additional, and Soreq, Hermona, additional

Published
2020
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30. Withholding or withdrawing life support in long-term neurointensive care patients: a single-centre, prospective, observational pilot study

Author

Stefanou, Maria-Ioanna, primary, Sulyok, Mihaly, additional, Koehnlein, Martin, additional, Scheibe, Franziska, additional, Fleischmann, Robert, additional, Hoffmann, Sarah, additional, Hotter, Benjamin, additional, Ziemann, Ulf, additional, Meisel, Andreas, additional, and Mengel, Annerose Maria, additional

Published
2020
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33. IL-6 Plasma Levels Correlate With Cerebral Perfusion Deficits and Infarct Sizes in Stroke Patients Without Associated Infections

Author

Hotter, Benjamin, Hoffmann, Sarah, Ulm, Lena, Meisel, Christian, Fiebach, Jochen B., and Meisel, Andreas

Subjects
IL-6, Neurology, biomarker, cardiovascular diseases, Neurology (clinical), stroke, Original Research, MRI, neuroinflammation
Abstract

Introduction: We aimed to investigate several blood-based biomarkers related to inflammation, immunity, and stress response in a cohort of patients without stroke-associated infections regarding their predictive abilities for functional outcome and explore whether they correlate with MRI markers, such as infarct size or location. Methods: We combined the clinical and radiological data of patients participating in two observational acute stroke cohorts: the PREDICT and 1000Plus studies. The following blood-based biomarkers were measured in these patients: monocytic HLA-DR, IL-6, IL-8, IL-10, LBP, MRproANP, MRproADM, CTproET, Copeptin, and PCT. Multiparametric stroke MRI was performed including T2*, DWI, FLAIR, TOF-MRA, and perfusion imaging. Standard descriptive sum statistics were used to describe the sample. Associations were analyzed using Fischer's exact test, independent samples t-test and Spearmans correlation, where appropriate. Results: Demographics and stroke characteristics were as follows: 94 patients without infections, mean age 68 years (SD 10.5), 32.2% of subjects were female, median NIHSS score at admission 3 (IQR 2–5), median mRS 3 months after stroke 1 (IQR 0–2), mean volume of DWI lesion at admission 5.7 ml (SD 12.8), mean FLAIR final infarct volume 10 ml (SD 14.9), cortical affection in 61% of infarctions. Acute DWI lesion volume on admission MRI was moderately correlated to admission/maximum IL-6 as well as maximum LBP. Extent of perfusion deficit and mismatch were moderately correlated to admission/maximum IL-6 levels. Final lesion volume on FLAIR was moderately correlated to admission IL-6 levels. Conclusion: We found IL-6 to be associated with several parameters from acute stroke MRI (acute DWI lesion, perfusion deficit, final infarct size, and affection of cortex) in a cohort of patients not influenced by infections. Clinical Trial Registration: www.ClinicalTrials.gov, identifiers NCT01079728 and NCT00715533

Published
2019
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34. Additional file 1: of Social work support and unmet social needs in life after stroke: a cross-sectional exploratory study

Author

Lehnerer, Sophie, Hotter, Benjamin, Padberg, Inken, Knispel, Petra, Dike Remstedt, Liebenau, Andrea, Grittner, Ulrike, Wellwood, Ian, and Meisel, Andreas

Abstract

Cross table: Prevalence and time of contact with social worker (n = 56, 1 missing). This file shows in a cross table the numbers and percentages of patients who have or have not had contact with social workers during and/or after stay in hospital or rehabilitation. The McNemar Test shows a significant result (p

Published
2019
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35. Additional file 2: of Social work support and unmet social needs in life after stroke: a cross-sectional exploratory study

Author

Lehnerer, Sophie, Hotter, Benjamin, Padberg, Inken, Knispel, Petra, Dike Remstedt, Liebenau, Andrea, Grittner, Ulrike, Wellwood, Ian, and Meisel, Andreas

Abstract

English version of the Nikolaus Score [26] translated by the authors. We explicitly declare that this is neither an official nor a verified translation. (DOCX 20 kb)

Published
2019
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36. Withholding or withdrawing life support in long-term neurointensive care patients: a single-centre, prospective, observational pilot study

Author

Stefanou, Maria-Ioanna, Sulyok, Mihaly, Koehnlein, Martin, Scheibe, Franziska, Fleischmann, Robert, Hoffmann, Sarah, Hotter, Benjamin, Ziemann, Ulf, Meisel, Andreas, and Mengel, Annerose Maria

Abstract

PurposeScarce evidence exists regarding end-of-life decision (EOLD) in neurocritically ill patients. We investigated the factors associated with EOLD making, including the group and individual characteristics of involved healthcare professionals, in a multiprofessional neurointensive care unit (NICU) setting.Materials and methodsA prospective, observational pilot study was conducted between 2013 and 2014 in a 10-bed NICU. Factors associated with EOLD in long-term neurocritically ill patients were evaluated using an anonymised survey based on a standardised questionnaire.Results8 (25%) physicians and 24 (75%) nurses participated in the study by providing their ‘treatment decisions’ for 14 patients at several time points. EOLD was ‘made’ 44 (31%) times, while maintenance of life support 98 (69%) times. EOLD patterns were not significantly different between professional groups. The individual characteristics of the professionals (age, gender, religion, personal experience with death of family member and NICU experience) had no significant impact on decisions to forgo or maintain life-sustaining therapy. EOLD was patient-specific (intraclass correlation coefficient: 0.861), with the presence of acute life-threatening disease (OR (95% CI): 18.199 (1.721 to 192.405), p=0.038) and low expected patient quality of life (OR (95% CI): 9.276 (1.131 to 76.099), p=0.016) being significant and independent determinants for withholding or withdrawing life-sustaining treatment.ConclusionsOur findings suggest that EOLD in NICU relies mainly on patient prognosis and not on the characteristics of the healthcare professionals.

Published
2022
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37. Automated vs manual delineations of regions of interest- a comparison in commercially available perfusion MRI software

Author

Galinovic Ivana, Ostwaldt Ann-Christin, Soemmer Carina, Bros Helena, Hotter Benjamin, Brunecker Peter, and Fiebach Jochen B

Subjects
Magnetic resonance imaging, Perfusion MRI, Acute ischemic stroke, Medical technology, R855-855.5
Abstract

Abstract Background In perfusion magnetic resonance imaging a manual approach to delineation of regions of interest is, due to rater bias and time intensive operator input, clinically less favorable than an automated approach would be. The goal of our study was to compare the performances of these approaches. Methods Using Stroketool, PMA and Perfscape/Neuroscape perfusion maps of cerebral blood flow, mean transit time and Tmax were created for 145 patients with acute ischemic stroke. Volumes of hypoperfused tissue were calculated using both a manual and an automated protocol, and the results compared between methods. Results The median difference between the automatically and manually derived volumes was up to 210 ml in Perfscape/Neuroscape, 123 ml in PMA and 135 ml in Stroketool. Correlation coefficients between perfusion volumes and radiological and clinical outcome were much lower for the automatic volumes than for the manually derived ones. Conclusions The agreement of the two methods was very poor, with the automated use producing falsely exaggerated volumes of hypoperfused tissue. Software improvements are necessary to enable highly automated protocols to credibly assess perfusion deficits.

Published
2012
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39. Sphenopalatine Ganglion Stimulation to Augment Cerebral Blood Flow

Author

Bornstein, Natan M., primary, Saver, Jeffrey L., additional, Diener, Hans-Christoph, additional, Gorelick, Philip B., additional, Shuaib, Ashfaq, additional, Solberg, Yoram, additional, Devlin, Thomas, additional, Leung, Thomas, additional, Molina, Carlos A., additional, Skoloudik, David, additional, Fiksa, Jan, additional, Krieger, Derk, additional, Andersen, Grethe, additional, Berrouschot, Joerg, additional, Hobohm, Carsten, additional, Schneider, Dietmar, additional, Griewing, Bernd, additional, Endres, Matthias, additional, Hausler, Karl-Georg, additional, Kimmig, Hubert, additional, Ringleb, Peter, additional, Weimar, Christian, additional, Schilling, Matthias, additional, Kohrmann, Martin, additional, Hetzel, Andreas, additional, Kaps, Manfred, additional, Cheung, Raymond, additional, Sobolewski, Piotr, additional, Nyke, Walenty, additional, Czlonkowska, Anna, additional, Stepien, Adam, additional, Waldemar, Brola, additional, Słowik, Agnieszka, additional, Zbigniewem, Stelmasiakiem, additional, Lubiński, Ignacy, additional, Portela, Pedro, additional, Segure, Tomas, additional, Marti-Fabregas, Joan, additional, Alonso, Maria, additional, Nunez, Antonio, additional, Miguel, Miguel Blanco, additional, Campello, Anna, additional, Arenillas, Joaquin, additional, Marshall, Nash, additional, Chiu, David, additional, Shownkeen, Harish, additional, Rymer, Marilyn, additional, Sen, Souvik, additional, Roubec, Martin, additional, Kuliha, Martin, additional, Lakomý, Ctirad, additional, Tyl, David, additional, Kemlink, David, additional, Doležal, Ondřej, additional, Rekova, Petra, additional, Krejčí, Veronika, additional, Christensen, Anders, additional, Belhage, Bo, additional, Maschmann, Christian, additional, Kruse Larsen, Christian, additional, Pott, Frank, additional, Christensen, Hanne, additional, Marstrand, Jakob, additional, Nielsen, Jens Kjellberg, additional, Meden, Per, additional, Prytz, Svend, additional, Rosenbaum, Sverre, additional, Hedemann Sorensen, Jens Christian, additional, Stenhoj Meier, Kaare, additional, Schmift Ettrup, Kare, additional, Dupont Hougaard, Kristina, additional, Von Wietzel, Paul, additional, Stoll, Anett, additional, Schwetlick, Hans, additional, Pradel, Hendirk, additional, Hemprich, Alexander, additional, Schulz, Andreas, additional, Frerich, Bernhard, additional, Weise, Christopher, additional, Michalski, Dominik, additional, Schaller, Felix, additional, Schiefke, Franziska, additional, Helmrich, Jens, additional, Pelz, Johann, additional, Schnieder, Martin, additional, Schneider, Martin, additional, Matzen, Peter, additional, Langos, Rudiger, additional, Müller-Duerwald, Stephan, additional, Lukhaup, Sven, additional, Bauer, Ute, additional, Kloppig, Wolfgang, additional, Hiermann, Erich, additional, Mucha, Gregor, additional, Soda, Hassan, additional, Weinhardt, Renate, additional, Mucha, Teresa, additional, Ziegler, Volker, additional, Abbushi, Alexander, additional, Hotter, Benjamin, additional, Winter, Benjamin, additional, Anthofer, Birgit, additional, Noack, Cornelia, additional, Laubisch, Dinah, additional, Heldge Schneider, Gerd, additional, Jan Jungehulsing, Gerhard, additional, Mueller, Heiko, additional, Dreier, Jens, additional, Fiebach, Jochen, additional, Flechsenhar, Julia, additional, Villringer, Kersten, additional, Ebinger, Martin, additional, Rozanski, Michael, additional, Vajkoczy, Peter, additional, Klingebiel, Randolf, additional, Steinicke, Robert, additional, Pittl, Sandra, additional, Hoffmann, Sarah, additional, Maul, Stephan, additional, Krause, Thomas, additional, Liman, Thomas, additional, Plath, Thomas, additional, Nowe, Tim, additional, Schmidt, Wolf, additional, Fritzsch, Carsten, additional, Haas, Christopher, additional, Will, Hans-Gerd, additional, Haußmann-Betz, Katja, additional, Bayat, Mohsen, additional, Pordzik, Tomazs, additional, Hug, Andreas, additional, Staff, Christian Jürgen, additional, Lichy, Christoph, additional, Eggers, Georg, additional, Kloss, Manja, additional, Bendszus, Martin, additional, Herrmann, Oliver, additional, Seeberger, Robin, additional, Schwarting, Soenke, additional, Rhode, Stefan, additional, Rizos, Timolaos, additional, Hacke, Werner, additional, Frank, Benedikt, additional, Bozkurt, Bessi, additional, Holle, Dagny, additional, Mueller, Daniel, additional, Koch, Dirk, additional, Shanib, Hind, additional, Sudendey, Joachim, additional, Brenck, Johannes, additional, Busch, Kolja, additional, Gartzen, Kristina, additional, Gasser, Thomas, additional, Hagenacker, Tim, additional, Buerke, Boris, additional, Prigge, Gudrun, additional, Minnerup, Jens, additional, Albers, Johannes, additional, Wermker, Kai, additional, Schwindt, Wolfram, additional, Kallmünzer, Ringlestein, Bernd, additional, Hauer, Eva, additional, Breuer, Lorenz, additional, Schellinger, Peter, additional, Kollmar, Rainer, additional, Sauer, Roland, additional, Schwab, Stefan, additional, Struffert, Tobias, additional, Funfack, Anette, additional, Stechmann, Anne, additional, Schlaeger, Axel, additional, Laeppchen, Claus, additional, Schuchardt, Florian, additional, Klingler, Jan-Helge, additional, Reis, Janine, additional, Lambeck, Johann, additional, Friedrich, Mirko, additional, Laible, Mona, additional, Wellermeyer, Philip, additional, Beck, Sandra, additional, Rutsch, Sebastian, additional, Niesen, Wolf-Dirk, additional, Tanislav, Christian, additional, Schaaf, Heidrun, additional, Kerkmann, Heiko, additional, Schirotzek, Ingo, additional, Allendörfer, Jens, additional, Wolff, Stephanie, additional, Yuk-Lun Lau, Alexander, additional, Yin Yan Chan, Anne, additional, Siu, Deyond, additional, Wong, Edward HC, additional, Chu Wong, George Kwok, additional, Leung, Howan, additional, Wong, Lawrence K.S., additional, Zhu, Xian Lun, additional, Yan Soo, Yannie Oi, additional, Ting Tse, Alan Choi, additional, Kit Leung, Gilberto Ka, additional, Leung, Kar Ming, additional, Ngai Hung, Kwan, additional, Wai Mei Kwan, May, additional, Man Yu Tse, Mona, additional, Tse, Philip, additional, Hon Chan, Ping, additional, Lee, Raymand, additional, Shek Kwan Chang, Richard, additional, Yin Yu Pang, Shirley, additional, Fong Kwong Hon, Sonny, additional, Cheng, Tat Sun, additional, Lui, Wai Man, additional, Wo Mak, Windsor Wai, additional, Sobota, Anna, additional, Wiater, Baeta, additional, Loch, Barbara, additional, Wolak, Genowefa, additional, Łabudzka, Irena, additional, Dabal, Jan, additional, Grzesik, Marcin, additional, Sledzinska, Monika, additional, Hatalska-Żerebiec, Renata, additional, Szczuchniak, Wiktor, additional, Gójska, Anna, additional, Nałęcz, Dariusz, additional, Gasecki, Dariusz, additional, Kozera, Grzegorz, additional, Dylewicz, Łukasz, additional, Niekra, Marcin, additional, Kwarciany, Mariusz, additional, Chomik, Piotr, additional, Skowron, Piotr, additional, Kobayashi, Adam, additional, Chabik, Grzegorz, additional, Makowicz, Grzegorz, additional, Bembenek, Jan, additional, Jędrzejewska, Julia, additional, Karlinski, Michal, additional, Czepiel, Wojciech, additional, Brodacki, Bogdan, additional, Staszewski, Jacek, additional, Kosek, Jarosław, additional, Jadczak, Marcin, additional, Durka-Kęsy, Marta, additional, Kaluzny, Krzysztof, additional, Ziomek, Małgorzata, additional, Fudala, Małgorzata, additional, Sosnowski, Zbigniew, additional, Ferens, Antoni, additional, Szczygieł, Elżbieta, additional, Banaszkiewicz, Krzysztof, additional, Ziomek, Maciej, additional, Wnuk, Marcin, additional, Szczepańska-Szerej, Anna, additional, Jach, Ewa, additional, Maslanko, Grazyna Elzbieta, additional, Wojczal, Joanna, additional, Luchowski, Piotr, additional, Kowalczyk, Andrzej, additional, Jakubiak, Jerzy, additional, Kopcewicz, Joanna, additional, Gajda, Maciej, additional, Wichlinska-Lubinska, Malgorzata, additional, Rodriguez, David, additional, Santamarin, Estevo, additional, Pagola, Jorge, additional, Lorente Guerrero, Juan, additional, Ribo, Marc, additional, Rubiera, Marta, additional, Maisterra, Olga, additional, Pinero, Soccoro, additional, Catalina Iglesias, Valera, additional, Plans, Gerard, additional, Quesada, Helena, additional, Aparicio Caballero, Marco Alberto, additional, Portela, Pedro Cardona, additional, De Diego, Antonio Belinchon, additional, Garay, David Sopelana, additional, García Rodriguez, Máximo Rafael, additional, Martin, Oscar Ayo, additional, Braña, Silvia Crusat, additional, Garcia, Jorge, additional, Hernandez, Fernando Munoz, additional, Catala, Ignasi, additional, Marti-Vilalta, Josep Lluis, additional, Delgado Mederos, Rachel, additional, de Quintana, Schmid Cristian, additional, Martinez-Ramirez, Sergi, additional, Valcarcel Gonzalez, Jaime, additional, Masjuan Vallejo, Jaime, additional, Diamantopoulus, Jorge, additional, Del Alamo, Marta, additional, Poveda, Pedro Domingo, additional, Pastor, Andres Garcia, additional, Carballal, Calros Fernandez, additional, Diaz, Fernando, additional, Garcia Leal, Roberto, additional, Juretschke, Ruiz, additional, Echabe, Eduardo Arán, additional, Sanchez, Jose Castillo, additional, Yanez, Manuel Rodriguez, additional, Garcia, Ramon Serramito, additional, Muino, Rogelio Leira, additional, Rivas, Susana Arias, additional, Lopez Gonzalez, Demian Manzano, additional, Cuadrado, Elisa, additional, Giralt, Eva, additional, Villalba, Gloria, additional, Roquer, Jaime, additional, Angel, Ois, additional, Jimenez, Maria, additional, Cedeño, René Robles, additional, Salinas, Ruy, additional, Lejarreta, Saioa, additional, Silva, Yolanda, additional, Fraile, Adela, additional, Calleja, Ana, additional, Cepeda Landínez, Guillermo Arturo, additional, Tellez, Nieves, additional, Garcia Bermejo, Pablo, additional, Santos, Pérez Jaime, additional, Herranz, Rosa Fernandez, additional, Hunt, Peter, additional, Browning, Donald, additional, Violette, Michael, additional, Hoddeson, Robert, additional, Rose, James, additional, Zhang, Jonathan, additional, Mazumdar, Avi, additional, Echiverri, Henri, additional, Chow, James, additional, Lovick, Darren, additional, Coleman, Martin, additional, Akhtar, Naveed, additional, Sugg, Rebecca, additional, Zanation, Adam, additional, Germanwala, Anand, additional, Senior, Brent, additional, Huang, David, additional, Aucutt-Walter, Natalie, additional, Kasner, Scott, additional, LeRoux, Peter, additional, von Kummer, Rüdiger, additional, and Palesch, Yuko, additional

Published
2019
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42. Prospective study on the mismatch concept in acute stroke patients within the first 24 h after symptom onset - 1000Plus study

Author

Endres Matthias, Martus Peter, Xu Chao, Brunecker Peter, Schmidt Wolf U, Rozanski Michal, Kudo Kohsuke, Jegzentis Kati, Oepen Gabriele, Ebinger Martin, Pittl Sandra, Hotter Benjamin, Jungehülsing Gerhard J, Villringer Arno, and Fiebach Jochen B

Subjects
Neurology. Diseases of the nervous system, RC346-429
Abstract

Abstract Background The mismatch between diffusion weighted imaging (DWI) lesion and perfusion imaging (PI) deficit volumes has been used as a surrogate of ischemic penumbra. This pathophysiology-orientated patient selection criterion for acute stroke treatment may have the potential to replace a fixed time window. Two recent trials - DEFUSE and EPITHET - investigated the mismatch concept in a multicenter prospective approach. Both studies randomized highly selected patients (n = 74/n = 100) and therefore confirmation in a large consecutive cohort is desirable. We here present a single-center approach with a 3T MR tomograph next door to the stroke unit, serving as a bridge from the ER to the stroke unit to screen all TIA and stroke patients. Our primary hypothesis is that the prognostic value of the mismatch concept is depending on the vessel status. Primary endpoint of the study is infarct growth determined by imaging, secondary endpoints are neurological deficit on day 5-7 and functional outcome after 3 months. Methods and design 1000Plus is a prospective, single centre observational study with 1200 patients to be recruited. All patients admitted to the ER with the clinical diagnosis of an acute cerebrovascular event within 24 hours after symptom onset are screened. Examinations are performed on day 1, 2 and 5-7 with neurological examination including National Institute of Health Stroke Scale (NIHSS) scoring and stroke MRI including T2*, DWI, TOF-MRA, FLAIR and PI. PI is conducted as dynamic susceptibility-enhanced contrast imaging with a fixed dosage of 5 ml 1 M Gadobutrol. For post-processing of PI, mean transit time (MTT) parametric images are determined by deconvolution of the arterial input function (AIF) which is automatically identified. Lesion volumes and mismatch are measured and calculated by using the perfusion mismatch analyzer (PMA) software from ASIST-Japan. Primary endpoint is the change of infarct size between baseline examination and day 5-7 follow up. Discussions The aim of this study is to describe the incidence of mismatch and the predictive value of PI for final lesion size and functional outcome depending on delay of imaging and vascular recanalization. It is crucial to standardize PI for future randomized clinical trials as for individual therapeutic decisions and we expect to contribute to this challenging task. Trial Registration clinicaltrials.gov NCT00715533

Published
2009
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43. The phenomenon of total mismatch in acute stroke MRI

Author

Hotter, Benjamin

Subjects
DWI, cardiovascular diseases, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit, stroke, MRI
Abstract

Introduction: We conducted a longitudinal Stroke-MRI study to evaluate the phenomenon of „total mismatch“: a rare state of missing proof of tissue infarction by diffusion-weighted MRI (DWI) while a more or less extensive perfusion deficit is depicted in perfusion MRI. We hypothesized that the extent of hypoperfusion as measured by the hypoperfusion intensity ratio (HIR), the severity of the clinical syndrome at admission and proof of artery occlusion would predict infarction on follow-up imaging. Methods: The 1000Plus stroke MRI study recruited patients presenting with an acute cerebrovascular event between September 2008 and October 2012. Subjects underwent multimodal MRI at admission and during early follow-up. We recorded basic demographic information and stroke characteristics. Stroke severity was measured using the National Institute of Health Stroke Scale (NIHSS). Criteria for inclusion in this sub-study were presence of total mismatch in the admission MRI and availability of a follow-up MRI. Results: Twenty-three patients were included in this analysis presenting at a median age of 70 (IQR 66-78). Ten subjects were female (43.5%). Proof of infarction was shown in 9 subjects (39.1%) during follow-up with a median infarction volume of 1.3 ml. Proof of infarction was associated with severity of stroke as measured by NIHSS at admission (p=0.026) and intensity of hypoperfusion as measured by HIR (p=0.015), but not with occlusion of the supplying artery on imaging. Clinical follow-up of patients with an infarction during follow-up was significantly worse as measured by last recorded NIHSS and modified Rankin scale. Conclusion: Cerebral infarctions are frequently found in the follow-up of total mismatch. Severity of stroke and extent of hypoperfusion, but not proof of artery occlusion are predictive of tissue fate., Einleitung: In dieser longitudinalen Schlaganfall-MRT-Studie untersuchten wir Patienten, die sich akut mit einem “Total Mismatch” – also einer fehlenden Infarktdemarkation in diffusionsgewichtetem MRT (DWI), aber einem vorliegenden Perfusionsdefizit im MRT – vorstellten. Wir postulierten, dass die Hypoperfusions-Intensitäts-Ratio (HIR), der Schweregrad des Schlaganfalls, und ein darstellbarer Gefäßverschluss die Demarkierung eines Infarktes im Verlauf vorhersagen. Methodik: Patienten, die sich zwischen September 2008 und Oktober 2012 mit Verdacht auf TIA oder Schlaganfall in der Ersten Hilfe unseres Hauses vorstellten, wurden in die 1000Plus-Studie eingeschlossen. Im Rahmen dieser erfolgten eine akute multimodale MRT, sowie eine weitere MRT im Verlauf der nächsten Tage. An klinischen Daten wurden unter anderem demographische Parameter und Charakteristika des Schlaganfalls erhoben, wobei der Schweregrad anhand der National Institute of Health Stroke Scale (NIHSS) gemessen wurde. Einschlusskriterien für diese Substudie waren das Vorliegen eines „Total Mismatch“ bei der akuten Bildgebung und das Vorliegen eines MRTs im Verlauf. Ergebnisse: Wir identifizierten 23 Patienten mit “Total Mismatch”. Das mediane Alter betrug 70 Jahre (IQR 66-78), 10 Teilnehmer waren weiblich (43,5%). Eine Infarktdemarkation mittels DWI stellte sich bei 9 Patienten (39,1%) im Verlauf dar, die mediane Läsionsgröße betrug 1,3 ml. Der Nachweis eines Infarkts war assoziiert mit dem Schweregrad des Schlaganfalls gemessen anhand NIHSS bei Aufnahme (p=0.026) und der HIR (p=0.015), aber nicht mit nachweisbaren Gefäßverschlüssen. Der klinische Verlauf der Patienten mit Infarkt im Verlauf war gemessen an letztem erhobenen NIHSS und modifizierter Rankin Skala signifikant schlechter. Schlussfolgerung: Bei Patienten mit “Total Mismatch” sind im Verlauf häufig Infarkte nachzuweisen. Das klinische Bild bei Aufnahme und der Schweregrad der Hypoperfusion, nicht aber der Nachweis von Gefäßverschlüssen prädizieren die Entstehung von Infarkten.

Published
2017

47. Adult hemophagocytic lymphohistiocytosis causing multi organ dysfunction in a patient with multiple autoimmune disorders: when the immune system runs amok

Author

Fleischmann, Robert, primary, Böhmerle, Wolfgang, additional, Laffert, Maximilian, additional, Jöhrens, Korinna, additional, Mengel, Annerose, additional, Hotter, Benjamin, additional, Lindenberg, Robert, additional, Scheibe, Franziska, additional, Köhnlein, Martin, additional, Bahr Greenwood, Tatiana, additional, Henter, Jan Inge, additional, and Meisel, Andreas, additional

Published
2015
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