29 results on '"Zingler, VC"'
Search Results
2. Correlation of nicotine-induced nystagmus, vertigo, nausea and imbalance with nicotine plasma concentrations
- Author
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Denecke, K, Zingler, VC, Strupp, M, von Meyer, L, Krams, M, Elfont, R, and Brandt, T
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- 2024
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3. The effect of a combined mitoxantrone and methylprednisolone therapy in primary compared to secondary progressive multiple sclerosis – an interim analysis after five years
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Zingler, VC, Strupp, M, Jahn, K, Gross, A, Hohlfeld, R, and Brandt, T
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- 2024
- Full Text
- View/download PDF
4. Correlation of nicotine-induced nystagmus, vertigo, nausea and imbalance with nicotine plasma concentrations
- Author
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Denecke, K, primary, Zingler, VC, additional, Strupp, M, additional, von Meyer, L, additional, Krams, M, additional, Elfont, R, additional, and Brandt, T, additional
- Published
- 2004
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5. Assessment of potential cardiotoxic side effects of mitoxantrone in patients with multiple sclerosis - an interim analysis after five years
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Gross, A, primary, Strupp, M, additional, Zingler, VC, additional, Näbauer, M, additional, Jahn, K, additional, Hohlfeld, R, additional, and Brandt, T, additional
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- 2004
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- View/download PDF
6. The effect of a combined mitoxantrone and methylprednisolone therapy in primary compared to secondary progressive multiple sclerosis - an interim analysis after five years
- Author
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Zingler, VC, primary, Strupp, M, additional, Jahn, K, additional, Gross, A, additional, Hohlfeld, R, additional, and Brandt, T, additional
- Published
- 2004
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- View/download PDF
7. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis.
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Strupp M, Zingler VC, Arbusow V, Niklas D, Maag KP, Dieterich M, Bense S, Theil D, Jahn K, and Brandt T
- Published
- 2004
8. Superficial cerebral and spinal haemosiderosis caused by secondary tethered cord syndrome after resection of a spinal lymphoma.
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Zingler VC, Grau S, Tonn J, Jahn K, Linn J, Brandt T, Strupp M, Zingler, Vera C, Grau, Stefan, Tonn, Jörg-Christian, Jahn, Klaus, Linn, Jennifer, Brandt, Thomas, and Strupp, Michael
- Abstract
Superficial haemosiderosis results from chronic subarachnoid haemorrhage during which haemosiderin is deposited in the leptomeninges around the brain, spinal cord and cranial nerves. We describe an exceptional case of superficial haemosiderosis characterised by two special aspects. (1) The cause was a secondary tethered cord syndrome due to dural adhesions which had developed 8 years after resection of a thoracic lymphoma and (2) an explorative neurosurgical procedure with complete untethering caused normalisation of the cerebrospinal fluid and stopped disease progression. [ABSTRACT FROM AUTHOR]
- Published
- 2007
9. Long-term course and relapses of vestibular and balance disorders.
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Brandt T, Huppert T, Hüfner K, Zingler VC, Dieterich M, and Strupp M
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- Disease Progression, Humans, Meniere Disease drug therapy, Meniere Disease physiopathology, Recovery of Function physiology, Secondary Prevention, Time, Time Factors, Vertigo etiology, Vertigo physiopathology, Vertigo therapy, Vestibular Diseases therapy, Vestibular Neuronitis drug therapy, Vestibular Neuronitis physiopathology, Vestibule, Labyrinth drug effects, Postural Balance physiology, Vestibular Diseases physiopathology, Vestibule, Labyrinth physiopathology
- Abstract
The long-term course and the frequency of relapses for various peripheral vestibular disorders and somatoform phobic postural vertigo are discussed with respect to the clinically most important questions for thus afflicted patients. This review is mainly based on our own long-term follow-up studies and takes into consideration the most relevant literature. The following syndromes are discussed in detail. Vestibular neuritis: the recovery rate of peripheral vestibular function lies between 40-63% depending on early-onset treatment with corticosteroids; the recurrence rate within 10 years is 2%. Menière's disease} loss of auditory and vestibular function occurs mainly in the first 5 to 10 years; frequency of vertigo attacks may decline after 5 to 10 years; bilateral involvement increases with increasing duration of the condition in up to 30-50%; vestibular drop attacks may occur early or late within the course, mostly with spontaneous remission; high-dose and long-term treatment with betahistine significantly reduces attack frequency in Menière's disease, Benign paroxysmal positioning vertigo: the recurrence rate is 50% within 10 years (in females 58%, in males 39%), most recurrences (80%) being observed within the first year after initial relief; recurrence rate in the seventh decade is half of that in the sixth decade. Vestibular paroxysmia: medical treatment with carbamazepine or oxcarbazepine leads to a continuous significant reduction in attack frequency, intensity, and duration of 10-15% of baseline. Bilateral vestibulopathy: recovery of vestibular function is limited to single cases depending on their etiology. Phobic postural vertigo: within 5 to 16 years 27% of the patients are symptom-free, 48% improve, 22% remain unchanged, and 3% worsen; a detailed explanation of the mechanisms that cause and the factors that provoke attacks is imperative, as well as instructions for self-controlled desensitization within the context of behavioral therapy.
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- 2010
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10. Causative factors, epidemiology, and follow-up of bilateral vestibulopathy.
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Zingler VC, Weintz E, Jahn K, Huppert D, Cnyrim C, Brandt T, and Strupp M
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- Adult, Aged, Causality, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Vestibular Diseases epidemiology, Vestibular Diseases physiopathology, Vestibular Diseases etiology
- Abstract
Bilateral vestibulopathy (BV) is characterized by impaired or lost function of both peripheral labyrinths or of the eighth nerves. In a review of 255 patients (mean age +/- SD, 62 +/- 16 years) with BV diagnosed in the authors' dizziness unit between 1988 and 2005, 62% of the patients were male. Previous vertigo attacks had occurred in 36%, indicating a sequential manifestation. The definite cause of BV was determined in 24% and the probable cause in 25%. The most common causes were ototoxic aminoglycosides (13%), Ménière's disease (7%), and meningitis (5%). Strikingly, 25% exhibited cerebellar signs. Cerebellar dysfunction was associated with peripheral polyneuropathy in 32% compared with 18% in BV patients without cerebellar signs. In a follow-up study on 82 BV-patients (mean age at the time of diagnosis 56.3 +/- 17.6 years), the frequency and degree of recovery or worsening of vestibular function over time were determined. The patients were reexamined 51 +/- 6 months after the first examination. Electronystagmography with bithermal caloric irrigation was analyzed by measurement of the mean peak slow-phase velocity (SPV) of the induced nystagmus. Statistical analysis of the mean peak SPV revealed a nonsignificant worsening over time (initial mean peak SPV 3.0 +/- 3.5 degrees/s vs. 2.1 +/- 2.8 degrees/s). Only patients with BV due to meningitis exhibited an increasing, but nonsignificant SPV (1.0 +/- 1.4 degrees/s vs. 1.9 +/- 1.6 degrees/s). Forty-three percent of patients subjectively rated the course of their disease as stable, 28% as worsened, and 29% as improved.
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- 2009
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11. Bilateral vestibular failure as an early sign in Creutzfeldt-Jakob disease.
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Jahn K, Arbusow V, Zingler VC, Strupp M, Kretzschmar HA, and Brandt T
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- Blotting, Western, Creutzfeldt-Jakob Syndrome pathology, Creutzfeldt-Jakob Syndrome physiopathology, Female, Humans, Middle Aged, Reflex, Vestibulo-Ocular, Vestibular Diseases pathology, Vestibular Diseases physiopathology, Creutzfeldt-Jakob Syndrome complications, Vestibular Diseases etiology
- Abstract
Bilateral vestibular failure causes dysfunction of the vestibulo-ocular reflex with consecutive symptoms like apparent movements of the visual environment during head movements (oscillopsia) and unsteady gait in darkness or on uneven ground. A definite case of Creutzfeldt-Jakob disease in which bilateral vestibular loss was one of the first clinical signs is reported. Further, in a series of 9 consecutive patients with Creutzfeldt-Jakob disease (6 probable, 3 definite), 3 had bilateral vestibular loss at initial presentation. The vestibular nuclei are known to be severely affected in animal spongiform encephalopathies. They might also be a vulnerable target in human prion diseases.
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- 2009
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12. Mitochondrial 12S rRNA susceptibility mutations in aminoglycoside-associated and idiopathic bilateral vestibulopathy.
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Elstner M, Schmidt C, Zingler VC, Prokisch H, Bettecken T, Elson JL, Rudolph G, Bender A, Halmagyi GM, Brandt T, Strupp M, and Klopstock T
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- Adult, Aged, Aged, 80 and over, Base Sequence, Conserved Sequence, Female, Humans, Male, Middle Aged, Mutation, RNA, Mitochondrial, Sequence Analysis, DNA, Young Adult, Aminoglycosides adverse effects, Anti-Bacterial Agents adverse effects, Genetic Predisposition to Disease, RNA genetics, RNA, Ribosomal genetics, Vestibular Neuronitis chemically induced, Vestibular Neuronitis genetics
- Abstract
The mitochondrial 12S rRNA is considered a hotspot for mutations associated with nonsyndromic (NSHL) and aminoglycoside-induced hearing loss (AIHL). Although aminoglycoside ototoxicity is the most common cause of bilateral vestibular dysfunction, the conceivable role of 12S rRNA mutations has never been systematically investigated. We sequenced the 12S rRNA of 66 patients with bilateral vestibulopathy (BV) with (n=15) or without (n=51) prior exposure to aminoglycosides, as well as 155 healthy controls with intact vestibular function (sport pilots), and compared these to 2704 published sequences (Human Mitochondrial Genome Database). No mutations with a confirmed pathogenicity were found (A1555G, C1494T), but four mutations with a hitherto tentative status were detected (T669C, C960del, C960ins, T961G). Due to their predominant occurrence in patients without aminoglycoside exposure, their detection in controls and a weak evolutionary conservation, their pathogenic role in vestibulocochlear dysfunction remains provisional.
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- 2008
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13. Saccular function less affected than canal function in bilateral vestibulopathy.
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Zingler VC, Weintz E, Jahn K, Bötzel K, Wagner J, Huppert D, Mike A, Brandt T, and Strupp M
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- Acoustic Stimulation methods, Adult, Aged, Aged, 80 and over, Analysis of Variance, Brain physiopathology, Caloric Tests methods, Electronystagmography methods, Female, Humans, Magnetic Resonance Imaging methods, Male, Middle Aged, Nystagmus, Physiologic physiology, Reaction Time physiology, Saccades physiology, Semicircular Canals physiopathology, Vestibular Diseases diagnosis, Vestibular Diseases etiology, Vestibular Function Tests methods, Young Adult, Evoked Potentials, Auditory physiology, Reflex, Vestibulo-Ocular physiology, Saccule and Utricle physiopathology, Vestibular Diseases physiopathology
- Abstract
Bilateral vestibulopathy (BV) is characterized by impaired or lost function of both labyrinths or eighth nerves. The diagnosis is routinely established by the head-thrust test, caloric irrigation and rotational testing with electronystagmography to determine the high- and low-frequency deficit of the vestibulo-ocular reflex. All three methods evaluate semicircular canal function only. Vestibular-evoked myogenic potentials (VEMPs) provide a measure of saccular otolith function. The aim of this study was to evaluate the frequency and extent of saccular dysfunction in patients with BV and to correlate saccular with horizontal semicircular canal dysfunction. A total of 84 BV-patients (23 females, mean age 62 +/- 15 (SD) years at the time of diagnosis assessment) were examined with VEMPs, electronystagmography with caloric irrigation and a standardized neuro-ophthalmological and -otological examination; 47 healthy subjects (18 females, mean 56 +/- 19 years) served as controls. Amplitudes P1-N1 were significantly lower in patients with BV compared to controls (mean P1-N1 of all ears 82.1 +/- 50.7 microV in the patients vs. 130.8 +/- 85.9 microV in healthy volunteers). VEMPs were absent unilaterally in four patients with BV and in none bilaterally. In contrast, caloric responses were absent bilaterally in 40 patients. There was no correlation between amplitude P1-N1 and caloric-induced nystagmus. The latencies P1 and N1 were not significantly different between patients and controls. Thus, in our study population saccular function appeared to be less affected than horizontal semicircular canal function.
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- 2008
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14. Nicotine-induced nystagmus correlates with midpontine activation.
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Deutschländer A, Stephan T, Riedel E, Zingler VC, Hüfner K, Wiesmann M, Pierrot-Deseilligny C, Strupp M, and Brandt T
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- Adult, Female, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Middle Aged, Brain Mapping, Ganglionic Stimulants pharmacology, Nicotine pharmacology, Nystagmus, Pathologic chemically induced, Pons drug effects, Pons physiology
- Abstract
The pathomechanism of nicotine-induced nystagmus (NIN) is unknown. The aim of this study was to delineate brain structures that are involved in NIN generation. Eight healthy volunteers inhaled nicotine in darkness during a functional magnetic resonance imaging (fMRI) experiment; eye movements were registered using video-oculography. NIN correlated with blood oxygen level-dependent (BOLD) activity levels in a midpontine site in the posterior basis pontis. NIN-induced midpontine activation may correspond to activation of the dorsomedial pontine nuclei and the nucleus reticularis tegmenti pontis, structures known to participate in the generation of multidirectional saccades and smooth pursuit eye movements.
- Published
- 2008
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15. Long-term prophylactic treatment of attacks of vertigo in Menière's disease--comparison of a high with a low dosage of betahistine in an open trial.
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Strupp M, Hupert D, Frenzel C, Wagner J, Hahn A, Jahn K, Zingler VC, Mansmann U, and Brandt T
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- Adolescent, Adult, Aged, Aged, 80 and over, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Follow-Up Studies, Humans, Male, Middle Aged, Betahistine administration & dosage, Meniere Disease prevention & control, Vasodilator Agents administration & dosage
- Abstract
Conclusion: Despite the considerable limitations of an open, non-masked trial, particularly in Menière's disease (MD), a higher dosage of betahistine-dihydrochloride and a long-term treatment seems to be more effective than a low dosage and short-term treatment., Objective: To evaluate the prophylactic effects of a low versus high dosage long-term treatment with betahistine-dihydrochloride on the number of attacks in MD., Patients and Methods: We performed an open, non-masked trial, in which patients with MD received either a low dosage of betahistine-dihydrochloride (16 or 24 mg tid) or a higher dosage of 48 mg tid for at least 12 months. The outcome measure was the number of attacks per month during a 3-month period. Non-parametric tests and a random effects model were used for statistical analysis., Results: A total of 112 patients were included in the analysis: 50 received betahistine-dihydrochloride in a low dosage (16 mg tid, n=21, 24 mg, n=29) and 62 received 48 mg tid. Follow-up examination every 3 months showed that the number of attacks per month decreased in both groups over time. For instance, after 12 months the mean (median) number of attacks dropped from 7.6 (4.5) to 4.4 (2.0) (p<0.0001) in the low-dosage group, and from 8.8 (5.5) to 1.0 (0.0) (p<0.0001) in the high dosage group. The number of attacks after 12 months was significantly lower in the high dosage group than in the low dosage group (p(12M)=0.0002). The treatment was well tolerated in both groups.
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- 2008
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16. Follow-up of vestibular function in bilateral vestibulopathy.
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Zingler VC, Weintz E, Jahn K, Mike A, Huppert D, Rettinger N, Brandt T, and Strupp M
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- Age Distribution, Causality, Cerebellar Diseases epidemiology, Comorbidity, Disease Progression, Electronystagmography, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Male, Medical History Taking, Middle Aged, Physical Examination, Quality of Life, Sex Distribution, Vertigo epidemiology, Vestibular Neuronitis chemically induced, Vestibular Neuronitis epidemiology, Vestibular Neuronitis diagnosis
- Abstract
Objective: Bilateral vestibulopathy (BV) leads to a bilateral deficit of the vestibulo-ocular reflex and has various aetiologies. The main goal of this study was to determine the frequency and degree of recovery or worsening of vestibular function over time., Methods: 82 patients (59 males, 23 females; mean age at the time of diagnosis 56.3 (SD 17.6) years) were re-examined 51 (36) months after the first examination. All patients underwent a standardised neuro-ophthalmological and neuro-otological examination. Electronystagmography with bithermal caloric irrigation was analysed by measurement of the mean peak slow phase velocity (SPV) of the induced nystagmus. Patients evaluated the course of their disease in terms of balance, gait unsteadiness and health related quality of life., Results: Statistical analysis of the mean peak SPV of caloric induced nystagmus revealed a non-significant worsening over time (initial mean peak SPV 3.0 (3.5) degrees/s vs 2.1 (2.8) degrees/s). With respect to subgroups of aetiology, only patients with BV due to meningitis exhibited an increasing, but non-significant SPV (1.0 (1.4) degrees/s vs 1.9 (1.6) degrees/s). Vestibular outcome was independent of age, gender, time course of manifestation and severity of BV. Single analysis of all patients showed that a substantial improvement > or = 5 degrees/s occurred in two patients on both sides (idiopathic n = 1, Sjögren's syndrome n = 1) and in eight patients on one side (idiopathic n = 6, meningitis n = 1, Menière's disease n = 1). In 84% of patients there was impairment of their health related quality of life (42% slight, 24% moderate, 18% severe). Forty-three per cent of patients rated the course of their disease as stable, 28% as worsened and 29% as improved., Conclusions: Our data support the view that more than 80% of patients with BV do not improve. Thus the prognosis of BV is less favourable than assumed.
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- 2008
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17. The effect of nicotine on perceptual, ocular motor, postural, and vegetative functions at rest and in motion.
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Zingler VC, Denecke K, Jahn K, von Meyer L, Krafczyk S, Krams M, Elfont R, Brandt T, Strupp M, and Glasauer S
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- Administration, Intranasal, Adult, Analysis of Variance, Dizziness chemically induced, Dizziness physiopathology, Dose-Response Relationship, Drug, Female, Humans, Male, Middle Aged, Motion, Nausea chemically induced, Nausea physiopathology, Nicotine blood, Nicotinic Agonists blood, Nystagmus, Optokinetic drug effects, Posture physiology, Random Allocation, Rest, Nicotine administration & dosage, Nicotinic Agonists administration & dosage, Perceptual Disorders chemically induced, Perceptual Disorders physiopathology, Sensation Disorders chemically induced, Sensation Disorders physiopathology, Vestibular Diseases chemically induced, Vestibular Diseases physiopathology
- Abstract
Nicotine has wellknown, unpleasant side effects, e.g., transient dizziness, nausea, and nicotine-induced nystagmus (NIN). To investigate factors influencing these effects, we addressed three questions: (1) Is the intensity of dizziness, nausea, NIN, and unsteadiness dependent on nicotine dosage? (2) Does the intensity of perceptual, ocular motor, vegetative effects, and postural imbalance correlate? (3) Do visual or vestibular motion stimuli produce and/or aggravate distressing dizziness and nausea? Sixty healthy non-smokers or occasional smokers participated; 40 were tested once before and six times after application of a nicotine nasal spray in doses of 1 mg or 2 mg with or without motion stimulation; 20 received a placebo nasal spray. Plasma nicotine concentrations were significantly related to nicotine dosage. Dizziness, nausea, NIN, and unsteadiness also depended on the nicotine dosage (p < 0.01).Nicotine blood concentration was a better predictor for the temporal dependence of nystagmus than nicotine dosage. Dizziness correlated highly with nausea (R = 0.63, p < 0.001). The degree of nicotine-induced nausea significantly correlated with postural imbalance. The time course of postural sway differed according to nicotine dosage and gender: for women, there was no clear relationship between sway magnitude and nicotine dosage, while men showed increased sway with higher dosage. Motion stimulation increased nicotine-induced dizziness and nausea, but did not significantly influence NIN or postural imbalance. Our data support the view that all measured adverse effects reflect dose-dependent nicotine-induced vestibular dysfunction. Additional motion stimulation aggravates dizziness and nausea, i.e., nicotine increases sensitivity to motion sickness.
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- 2007
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18. Causative factors and epidemiology of bilateral vestibulopathy in 255 patients.
- Author
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Zingler VC, Cnyrim C, Jahn K, Weintz E, Fernbacher J, Frenzel C, Brandt T, and Strupp M
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- Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Aminoglycosides adverse effects, Autoantibodies blood, Causality, Cerebellar Diseases physiopathology, Child, Comorbidity, Disease Progression, Female, Germany epidemiology, Hearing Disorders blood, Hearing Disorders immunology, Humans, Male, Middle Aged, Retrospective Studies, Sex Distribution, Syndrome, Vestibular Diseases etiology, Cerebellar Diseases epidemiology, Hearing Disorders epidemiology, Meniere Disease epidemiology, Meningitis epidemiology, Vestibular Diseases epidemiology, Vestibular Diseases physiopathology
- Abstract
Objective: To determine the causative factors and epidemiology of bilateral vestibulopathy (BV)., Methods: This is a retrospective review of 255 patients (mean age, 62 +/- 16 years) with BV diagnosed in our dizziness unit between 1988 and 2005. All patients had undergone a standardized neurophthalmological and neurootological examination, electronystagmography with caloric irrigation, cranial magnetic resonance imaging or computed tomography (n = 214), and laboratory tests., Results: Sixty-two percent of the study population were male subjects. Previous vertigo attacks had occurred in 36%, indicating a sequential manifestation. The definite cause of BV was determined in 24% and the probable cause in 25%: The most common causes were ototoxic aminoglycosides (13%), Menière's disease (7%), and meningitis (5%). Strikingly, 25% exhibited cerebellar signs. Cerebellar dysfunction was associated with peripheral polyneuropathy in 32% compared with 18% in BV patients without cerebellar signs. Hypoacusis occurred bilaterally in 25% and unilaterally in 6% of all patients. It appeared most often in patients with BV caused by Cogan's syndrome, meningitis, or Menière's disease., Interpretation: The cause of BV remains unclear in about half of all patients despite intensive examinations. A large subgroup of these patients have associated cerebellar dysfunction and peripheral polyneuropathy. This suggests a new syndrome that may be caused by neurodegenerative or autoimmune processes.
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- 2007
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19. [Polysomnographic as a therapeutic aid in of psychogenic-functioning paraplegia].
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Jahn K, Arnold S, Zingler VC, Strupp M, and Brandt T
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- Adult, Humans, Male, Psychophysiologic Disorders diagnosis, Treatment Outcome, Biofeedback, Psychology methods, Cognitive Behavioral Therapy methods, Paraplegia diagnosis, Paraplegia therapy, Polysomnography methods, Psychophysiologic Disorders therapy
- Abstract
The case of a patient with complete sensory and motor paraplegia for more than 1 year is presented. Leg movements were documented during sleep by video and electromyographic recording because a psychogenic cause of the symptoms was suspected. We showed the video to the patient, which illustrated that leg movements were possible. This resulted in fast and complete resolution of the neurologic symptoms. The patient has now been free of them for more than 3 years. This example suggests that the achievement of consciousness of normal motor function is a therapeutic approach for long-standing improvement of psychogenic paralysis.
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- 2006
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20. A clinical test of otolith function: static ocular counterroll with passive head tilt.
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Zingler VC, Kryvoshey D, Schneider E, Glasauer S, Brandt T, and Strupp M
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- Adult, Analysis of Variance, Female, Humans, Male, Ophthalmology instrumentation, Ophthalmology methods, Posture physiology, Vision, Binocular, Eye Movements physiology, Head Movements physiology, Otolithic Membrane physiology, Rotation
- Abstract
When roll-tilted around the naso-occipital axis, humans exhibit compensatory torsional rotation of the eyes in the opposite direction owing to the torsional vestibulo-ocular reflex. In the static condition (sustained head roll), the utricles act as responsible sensors for 'static ocular counterroll'. Contributions of cervico-ocular reflexes remain unknown. To find an easy, clinically useful test of utricular function, we induced ocular counterroll in 10 healthy study participants (two men, mean age 27+/-2 years) under three stimulation conditions (active/passive head tilt and passive whole body tilt in roll plane), used three-dimensional video-oculography to measure it, and compared values. Active head-tilt-induced ocular counterroll varied most and was thus less reliable than passive head and body tilt-induced ocular counterroll. Utricular function can thus be tested simply by measuring passive head tilt with video-oculography.
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- 2006
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21. [The effect of combined mitoxantrone and methylprednisolone therapy in primary and secondary progressive multiple sclerosis. An applied study in 65 patients].
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Zingler VC, Strupp M, Jahn K, Gross A, Hohlfeld R, and Brandt T
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- Adult, Aged, Analgesics administration & dosage, Disease Progression, Drug Combinations, Female, Humans, Male, Middle Aged, Prognosis, Secondary Prevention, Treatment Outcome, Methylprednisolone administration & dosage, Mitoxantrone administration & dosage, Multiple Sclerosis, Chronic Progressive drug therapy, Multiple Sclerosis, Chronic Progressive prevention & control, Recovery of Function drug effects
- Abstract
Mitoxantrone (mitox) has been shown to be effective for secondary progressive (SP) and relapsing-remitting multiple sclerosis (MS). The aim of this open trial was to evaluate the effects of combined mitox and methylprednisolone (MP) therapy on patients with primary progressive (PP)-MS or with SP-MS. We present here the results of an interim analysis done after the study had lasted 5 years. Sixty-five patients (20 with PP-MS and 45 with SP-MS) have been included so far. The treatment involved ten cycles of combined mitox and MP. The intervals between the individual cycles were systematically prolonged from 3 months initially to 12 months, so the complete treatment took a total of 57 months. Conclusion This interim analysis indicates that mitox combined with MP beneficially reduces the progression of disability in patients with PP-MS and SP-MS. Therefore, this therapy regimen can also be considered a feasible option for PP-MS.
- Published
- 2005
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22. Upbeat nystagmus as the initial clinical sign of Creutzfeldt-Jakob disease.
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Zingler VC, Strupp M, Jahn K, Glaser M, Herberger S, Kretzschmar HA, and Brandt T
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- Aged, Blotting, Western, Creutzfeldt-Jakob Syndrome genetics, Fatal Outcome, Humans, Male, PrPSc Proteins genetics, PrPSc Proteins metabolism, Brain pathology, Creutzfeldt-Jakob Syndrome complications, Creutzfeldt-Jakob Syndrome diagnosis, Nystagmus, Pathologic etiology
- Published
- 2005
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23. Diagnostic pitfalls in patients with hypoxic brain damage: three case reports.
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Zingler VC and Pohlmann-Eden B
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- Cardiopulmonary Resuscitation, Female, Heart Arrest complications, Humans, Hypoxia, Brain therapy, Male, Middle Aged, Prognosis, Treatment Outcome, Hypoxia, Brain diagnosis, Hypoxia, Brain etiology, Persistent Vegetative State etiology
- Abstract
Objective: Our aim was to assess the possible diagnostic pitfalls in three patients with hypoxic brain damage who had partly conflicting clinical, biochemical, and electrophysiological data and were in a persistent vegetative state (PVS) following cardiac arrest (CA)., Methods: Serum concentrations of the destruction proteins, neuron-specific enolase (NSE) and protein S-100B (S-100B), were measured on days 1-3, and 7; somatosensory evoked potentials (SEPs) were recorded within 48 h and on day 7 after CA., Results: Two patients had significantly increased concentrations of NSE and S-100B during the first 3 days after CA, a finding that indicates ongoing neuronal destruction. In contrast, the SEPs of these patients were normal or showed only a diminished amplitude configuration. In the third patient the SEPs demonstrated a bilateral loss of cortical responses repeatedly, but both destruction proteins were only slightly above the upper normal values on all study days., Conclusion: Our findings demonstrate that a poor prognosis can only be established if either SEPs, NSE, or S-100B are very abnormal. The conflicting results in our patients indicate that variable values may reflect different patterns of neuropathological damage caused by diffuse hypoxia. We, therefore, favour a multi-modal approach with a combination of clinical, biochemical, and electrophysiological investigations in order to predict neurological outcome after CA reliably.
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- 2005
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24. Assessment of potential cardiotoxic side effects of mitoxantrone in patients with multiple sclerosis.
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Zingler VC, Nabauer M, Jahn K, Gross A, Hohlfeld R, Brandt T, and Strupp M
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- Adult, Aged, Anti-Inflammatory Agents therapeutic use, Drug Therapy, Combination, Echocardiography, Female, Humans, Male, Methylprednisolone therapeutic use, Middle Aged, Heart drug effects, Heart Diseases chemically induced, Immunosuppressive Agents adverse effects, Mitoxantrone adverse effects, Multiple Sclerosis drug therapy
- Abstract
Previous studies showed that mitoxantrone can reduce disability progression in patients with multiple sclerosis (MS). There is, however, concern that it may cause irreversible cardiomyopathy with reduced left ventricular (LV) ejection fraction (EF) and congestive heart failure. The aim of this prospective study was to investigate cardiac side effects of mitoxantrone by repetitive cardiac monitoring in MS patients. The treatment protocol called for ten courses of a combined mitoxantrone (10 mg/m(2) body surface) and methylprednisolone therapy. Before each course, a transthoracic echocardiogram was performed to determine the LV end-diastolic diameter, the end-systolic diameter and the fractional shortening; the LV-EF was calculated. Seventy-three patients participated (32 males; age 48 +/- 12 years, range 20-75 years; 25 with primary progressive, 47 with secondary progressive and 1 with relapsing-remitting MS) who received at least four courses of mitoxantrone. Three of the 73 patients were excluded during the study (2 patients discontinued therapy; 1 patient with a previous history of ischemic heart disease developed atrial fibrillation after the second course of mitoxantrone). The mean cumulative dose of mitoxantrone was 114.0 +/- 33.8 mg. The mean follow-up time was 23.4 months (range 10-57 months). So far, there has been no significant change in any of the determined parameters (end-diastolic diameter, end-systolic diameter, fractional shortening, EF) over time during all follow-up investigations. Mitoxantrone did not cause signs of congestive heart failure in any of the patients. Further cardiac monitoring is, however, needed to determine the safety of mitoxantrone after longer follow-up times and at higher cumulative doses., ((c) 2005 S. Karger AG, Basel)
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- 2005
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25. Hemihypomimia in Parkinson's disease.
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Zingler VC, Strupp M, Jahn K, and Brandt T
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- Female, Functional Laterality, Humans, Middle Aged, Parkinson Disease physiopathology, Hypokinesia etiology, Parkinson Disease complications
- Published
- 2005
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26. Does alcohol cancel static vestibular compensation?
- Author
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Zingler VC, Strupp M, Krafczyk S, Karch C, and Brandt T
- Subjects
- Adult, Aged, Eye Movements drug effects, Female, Humans, Male, Middle Aged, Postural Balance drug effects, Adaptation, Physiological, Ethanol pharmacology, Vestibular Neuronitis physiopathology
- Published
- 2004
- Full Text
- View/download PDF
27. Stent grafting resolved brachial plexus neuropathy due to cervical arteriovenous fistula.
- Author
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Zingler VC, Strupp M, Brandt T, Herrmann K, and Mayer TE
- Subjects
- Angiography methods, Arteriovenous Fistula pathology, Blood Vessel Prosthesis Implantation methods, Brachial Plexus Neuropathies pathology, Female, Humans, Magnetic Resonance Imaging methods, Middle Aged, Neurologic Examination, Arteriovenous Fistula complications, Brachial Plexus Neuropathies etiology, Brachial Plexus Neuropathies therapy, Cerebral Cortex, Stents
- Published
- 2004
- Full Text
- View/download PDF
28. Recurrent exertion-induced spinal cord ischemia due to infrarenal aortic occlusion.
- Author
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Zingler VC, Strupp M, Brüning R, Lauterjung L, Waggershausen T, Brückmann H, and Brandt T
- Subjects
- Adult, Aortography methods, Humans, Magnetic Resonance Imaging methods, Male, Aortic Diseases complications, Arterial Occlusive Diseases complications, Spinal Cord Ischemia etiology
- Published
- 2003
- Full Text
- View/download PDF
29. Early prediction of neurological outcome after cardiopulmonary resuscitation: a multimodal approach combining neurobiochemical and electrophysiological investigations may provide high prognostic certainty in patients after cardiac arrest.
- Author
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Zingler VC, Krumm B, Bertsch T, Fassbender K, and Pohlmann-Eden B
- Subjects
- Adult, Aged, Aged, 80 and over, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac etiology, Coma diagnosis, Coma etiology, Evoked Potentials, Somatosensory physiology, Female, Glasgow Coma Scale, Humans, Male, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction etiology, Predictive Value of Tests, Prospective Studies, Time Factors, Brain metabolism, Cardiopulmonary Resuscitation methods, Heart Arrest complications, Heart Arrest metabolism, Heart Arrest therapy, Phosphopyruvate Hydratase blood, Protein S metabolism
- Abstract
A reliable and reproducible method for precisely predicting the neurological outcome of patients with hypoxic-ischemic encephalopathy after cardiac arrest is urgently needed in neurological intensive care units. We prospectively investigated the predictive power of serum concentrations of neuron-specific enolase (NSE) and protein S-100B (S-100B) measured on days 1, 2, 3 and 7 as well as somatosensory-evoked potentials (SEPs) recorded within 48 h and on day 7 after cardiopulmonary resuscitation (CPR) in 27 patients (14 females, 13 males; mean age 61.3 +/- 17.3 years) with hypoxic-ischemic encephalopathy. During the first 7 days after CPR, median values of NSE and S-100B were increased in patients who remained unconscious after CPR compared to those patients who regained consciousness (significance up to < or =0.001). The best predictor of negative outcome was an NSE cutoff point > or =43 microg/l on day 2; this had a sensitivity of 90.9% and a specificity of 100%. Additional use of S-100B on day 2 did not increase sensitivity, but this could be markedly increased by combining NSE and S-100B on days 1, 3 and 7. SEPs showing bilateral loss of cortical responses identified patients who did not regain consciousness with a specificity of 100%., (Copyright 2003 S. Karger AG, Basel)
- Published
- 2003
- Full Text
- View/download PDF
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