Clinical pictures neurozentrum stuttgart

Disease patternsEvery year, about 200,000 people in Germany suffer a stroke. After cardiovascular diseases and cancer, stroke is the third most frequent cause of death in the Federal Republic of Germany. It is also the most important cause of disability. One in four disabled persons suffers from the consequences of a stroke.

A stroke is a sudden lack of blood supply (ischemia) to the brain. In about 80% of cases, the cause is a reduction in blood flow (because a blood vessel leading to the brain is suddenly blocked), in about 15% an intracerebral hemorrhage due to the rupture of a blood vessel, and in 5% a subarachnoid hemorrhage.

There are other terms for a stroke, such as apoplexy or insult.

Theoretically, anyone can suffer a stroke. Half of all those affected are of working age, ca. 10 percent of them even under the age of 40. However, the likelihood of stroke increases with age. At least 5 percent of all people over 65 are affected by circulatory disorders of the brain. In those over 75, the rate is more than 10%.

The occurrence of a stroke is favored by a number of risk factors:

Risk factors Relative risk
High blood prere 6-8 Smoking 1.5-2 Cardiac arrhythmia 6-18 Diabetes 2-3 Elevated cholesterol level 2 Obesity 1-2 Alcohol abuse 2-3 Hypercysteinaemia 2 Coronary heart disease 2-3 Lack of exercise

People in whose family a stroke has already occurred are also at risk, because the predisposition to stroke is hereditary.

Warning symptoms

A stroke does not strike like a bolt from the blue. Often preceded by short-lasting early warning symptoms.

Seeing double images Brief blindness or visual disturbances in one eye Temporary hemiplegia Numbness in the arms or legs Brief disturbances of speech Torsional vertigo and unsteadiness of gait First-onset and sudden, raging headache

Acute stroke is often life-threatening. Therefore, action must be taken as soon as possible. Even if the failure symptoms were only temporary, the patient must be taken as soon as possible to the nearest hospital equipped to treat acute strokes. The earlier an acute stroke is treated, the greater the chances that the patient will be left without lasting disabilities. The greater the chances of survival. The first four to six hours after a stroke are crucial.

In the case of an acute stroke, the first priority is to accurately diagnose the causes. With a computer tomography, the doctor can see whether the stroke was caused by a lack of blood flow or a burst vein. A careful neurological examination, ECG, X-ray of the lungs and ultrasound of the carotid arteries give further important clues.

Therapy

Therapy is tailored to the individual patient. If the stroke is only a few hours old, the blood clot can be dissolved by a drug (lysis). However, this therapy cannot be used for certain conditions such as gastric ulceration. In some cases, surgery is performed. Not infrequently a stay in the intensive care unit becomes necessary. In order to prevent further strokes, treatment of the risk factors is of central importance. In addition, blood thinning medications prevent further circulatory disorders. Anticoagulant drugs such as Marcumar are used for cardiac arrhythmias.

After completion of the acute treatment, a neurological rehabilitation measure should be carried out in case of persistent functional restrictions in order to keep the symptoms of failure as low as possible. It can take place as an inpatient in a rehabilitation clinic or as an outpatient treatment. Physiotherapy, speech therapy, occupational therapy and neuropsychological treatment methods are used. The goal is the professional and social reintegration of the stroke patient.

Parkinson's disease

Parkinson's disease is one of the most common neurological disorders. The first symptoms usually appear after the age of fifty. The incidence of the disease increases steeply after the age of sixty, so that approx. 1 to 1.5 % of people over 60 are affected. In Germany about 250 000 people suffer from this disease.

Parkinson's disease is caused by a progressive loss (degeneration) of nerve cells in the deep regions of the brain. In particular, nerve cells in a part of the brain stem, the substantia nigra, perish. These nerve cells produce the neurochemical transmitter dopamine, which is significantly involved in the control and coordination of involuntary and automatic movements. This leads to a lack of dopamine in the so-called basal ganglia. A predominance of other chemical transmitter substances. The body can compensate for an imbalance between the messenger substances for a long time. Only when more than half of the dopamine-producing nerve cells have perished do movement processes become impaired.

Clinical symptoms

The first symptoms of Parkinson's disease are often general stiffness and pain in the spine and muscles, usually on one side of the body. As the disease progresses, it is characterized by 4 main symptoms: rest tremor (tremor of hands, arms, legs or head), akinesia, rigor, and gait and postural disturbances. These 4 symtoms are not present in the same way in all affected individuals. Akinesia is understood as a slowing down. Decrease of voluntary u. automatic movements, which can be manifested by a reduced swinging of the arms when walking, a reduction in mimic expression (hypomimia), a fine motor disturbance, a reduction in handwriting (micrographia), a small-step gait pattern or start-stop difficulties. Rigor means a stiffness or increase in muscular resistance during passive movements. Occurs due to simultaneous tension of antagonistic muscles. In addition to the cardinal symptoms, vegetative symptoms (increased salivation u. sebaceous secretion, constipation, incontinence, weight loss), and muscle and limb pain. Psychological symptoms such as depression (20-60%), slowed thinking, nightmares, anxiety, sleep disturbances and dementia (in 15-40% of patients) may also occur.

Diagnosis

If Parkinson's disease is suspected, a thorough neurological and psychiatric examination, computer or magnetic resonance imaging of the skull, and EEG are performed to confirm the diagnosis. In individual cases, additional examinations such as the L-dopa test, lumbar puncture for CSF examination and blood tests of special values (copper, coeruloplasmin, calcium, inflammation parameters, immunological parameters) become necessary. Early diagnosis of the disease is possible with the help of newer imaging techniques (positron emission tomography and single photon emission computed tomography), which already show abnormalities in the preclinical (without symptoms) phase.

Causes (etiology)

The causes and development of the disease are still largely unknown. Currently, a multifactorial cause is amed, which could most likely consist of a hereditary (genetic) disorder and chronic intoxication . The loss of dopamine-containing neurons in the substantia nigra is probably accompanied by a disturbance of energy production and increased formation of cell toxins.

Treatment (therapy)

To date, there is no cure for Parkinson's disease. However, effective therapy is possible through the use of drugs that compensate for the dopamine deficiency. By means of this symptomatic treatment, an improvement in motor functions can be achieved for a period of 5 to 10 years. However, the course of the disease, i.e., the speed of degeneration of the dopaminergic neurons, cannot currently be influenced.

Basically, several different classes of drugs are available in the therapy of PD. The main ones are designed to compensate for the dopamine deficit. This can be achieved by administration of the natural precursor of dopamine (L-DOPA), direct dopamine agonists or drugs that inhibit the breakdown of dopamine. Other important medications include inhibitors of the transmitter glutamate, z. B. Amantadine. Anticholinergics, which were frequently used in the past, are now recommended by most authors only in exceptional cases because of the known side effects.

Side effects of treatment

The most important early side effects are nausea, vomiting, fatigue and circulatory problems (orthostatic dysregulation). However, with increasing duration of therapy with dopamimetics, the duration of action of the L-DOPA single dose decreases. In addition, characteristic over-movements (hyperkinesias or biphasic dystonias) and painful muscle spasms (off-dystonias) occur as a late complication after several years in more than 50% of patients. The latency between the start of therapy and the occurrence of these late complications depends on the age of onset. The younger the patients, the faster they will also experience the effect fluctuations or dyskinesias. A further complication is the occurrence of psychoses under dopaminergic medication. These drug-induced psychoses first manifest themselves in unusual vivid dreams, illusionary misperceptions, and later in visual, and more rarely, auditory hallucinations and delusions.

Deep brain stimulation

If drug treatment is not effective enough, it is also possible to perform so-called stereo-tactical operations, in which limited areas of the brain are surgically stimulated, in particular to combat the tremor.

Non-drug treatment

Further measures include physiotherapy, occupational therapy to promote fine motor skills and logotherapy for language training. Psychological measures can help the affected person to cope with the disease and the associated disabilities.

Patients with Parkinson's disease should not take their medication directly after protein-rich foods and should eat a balanced diet rich in fiber.

Peripheral nerve disease

This term covers diseases and injuries of the nerves in the arms and legs. Diseases of the nerve roots – i.e., the origin of the nerves at the spinal cord – are also included in this category.

herniated discs and narrowing of the spinal canalIn both diseases, one or more nerve roots can be mechanically compressed. In addition to pain, there are shooting sensations, often numbness or paralysis. Whether the nerve root is damaged can be clarified with a neurological examination and with an electromyography. Bottleneck syndromes: In the course of a peripheral nerve, there are sog. Physiological bottlenecks in which the nerve passes in close proximity to other structures, often skeletal components. The nerve can be easily compressed at these bottlenecks. One speaks therefore of bottleneck or compression syndromes. The most important constriction syndromes include carpal tunnel syndrome, ulnar groove syndrome, and tarsal tunnel syndrome. PolyneuropathiesNumbness in the toes, soles of the feet or lower legs, and more rarely in the hands, is often an important feature of polyneuropathy. Discomfort is often accompanied by sensation of discomfort in the corresponding limbs. In some cases, there may also be a weakness of the muscles. Several nerves are always affected. The diagnosis is made clinically and with the help of electroneuro- and -myography. Nerve pain: Many diseases of the nervous system cause severe chronic pain. Neuralgic pain, such as z.B. in the case of trigeminal neuralgia, are sudden flashes of pain. The pain of polyneuropathies is often described as burning. The cause of nerve pain cannot always be eliminated. In these cases, we offer multimodal pain management with established non-drug and drug treatments.

multiple sclerosis

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (brain and spinal cord). In multiple sclerosis, foci of inflammation develop at one or more sites in the brain, often remote from each other. The affected nerve fibers are then unable to transmit their impulses as well. There is neurological loss of function such as sensory disturbances, visual disturbances, paralysis, coordination disorders.

The foci of inflammation can scar without anti-inflammatory therapy, similar to scarring after a skin injury. The scarring is also known as "sclerosis". The many, irregularly distributed foci of scarring have given the disease the name "multiple sclerosis".

Inflammation often occurs suddenly at one or more sites. The resulting loss of function is called a relapse. The most effective treatment for an episode is anti-inflammatory therapy with cortisone. For the treatment of relapses, cortisone is administered in high doses over 5 days.

The suspicion of multiple sclerosis is often based on the description of the symptoms and the physical examination findings. The most important additional technical examination is magnetic resonance imaging. Examination of the cerebrospinal fluid (CSF) is also important. Certain proteins indicate a particular form of inflammation in the central nervous system, although they are not absolutely conclusive of MS. The diagnosis cannot always be made with certainty when the first symptoms of the disease appear. But then the disease can be diagnosed from the course observation. Today, magnetic resonance imaging also plays a decisive role in this process.

Course of disease

The course of MS is very different. Many patients experience no further relapses for years after an initial episode, or only mild relapses without disability. Rarer forms of progression with frequent and severe episodes. One of the biggest problems remains the unpredictability of MS. As a rule, no reliable statements can be made about the course of the disease at the time of diagnosis. In about 90% of those affected, the course is relapsing. After an initial relapsing course, after 10-15 years about 30-40% change into a secondary chronic progressive course.

Using the immunotherapies now available, the course of the disease can be significantly improved. Severe courses with early onset of disability are rare today. Many patients with MS have a benign course. You remain efficient in everyday life. Also maintain their earning capacity.

See here a sequence of alpha& Omega on the subject of multiple sclerosis, in which Dr. Autumn was a guest.

Alternative treatment options

Restless Legs Syndrome

The term, taken from English, stands for a feeling of restlessness in the legs. The feeling of restlessness is particularly pronounced after lying down in bed. Not infrequently, there are also unpleasant, pulling sensations in the depth of the legs. The feeling of restlessness is associated with a strong urge to move. Immediately subsides after walking a few steps. Treatment usually requires drug therapy.

Dementia / Alzheimer's dementia

Dementia is the generic term for diseases with a loss of mental capacity. The disorders include remembering, orientation, language or linking of thought content. The symptoms of the disease often mean that everyday activities can no longer be carried out independently. In Germany, about 1.2 million people suffer from dementia – with a rapidly increasing tendency. The most common form of dementia is Alzheimer's dementia. It accounts for about 2/3 of all dementias.

Alzheimer's dementia

In Alzheimer's dementia, nerve cells die in certain areas of the brain. An early symptom is impaired memory, especially the retention of newly learned information. Often there is also a temporal or local disorientation. Many sufferers do not notice the mental performance disorders. It is not uncommon for family members to notice behavioral changes that then lead to closer examination.

For the diagnosis of Alzheimer's dementia (as well as for the other forms of dementia), a careful description of the symptoms is crucial. Often the report of another person (spouse, children, other caregivers) is essential for it. Neuropsychological tests are also important.Alzheimer's dementia is not curable. The course of the disease can be favorably influenced by certain medications. New drugs are currently being tested in numerous clinical trials.

Dizziness

Dizziness is a common symptom in neurological practice. A distinction is made between so-called. peripheral vertigo, z.B. in case of disturbances in the inner ear, from a central vertigo, z.B. In cases of strokes and circulatory disorders of the brain. Especially in old age, the cause of dizziness is complex.

In the apparative diagnostics can be used: EEG, Doppler, evoked potentials. Depending on the diagnosis of the cause and the severity of the condition, therapy is carried out with medication, physiotherapy and, if necessary. High tone therapy, acupuncture, biofeedback.

Migraine and headaches

Migraine is the most common manifestation of chronic recurrent headaches. The predisposition to migraine attacks is often inherited. It is amed that the cause of migraine lies in the serotonin metabolism in the brain or in the brain's metabolism. is due to irregularities in the blood vessels inside the skull.

Nerve endings that affect these blood vessels may also be involved in the development of migraine. A deterioration can z.B. caused by strong nervousness, stress, anxiety or other stressful situations. However, why migraine often occurs periodically cannot be explained today.

Necessary examinations for migraine

Since there are different forms of migraine and the disease must be differentiated from other headache disorders, the following examinations are performed: Anamnesis (exact description of the headache attacks, their frequency and duration, if necessary. based on a migraine calendar, trigger factors), a general physical and neurological-psychiatric examination, a Doppler sonography of the cervical vessels and/or transcranial ultrasound examination.

An EEG or. Imaging (computer tomogram or NMR of the head) to localize pathological processes in the brain (inflammations, tumors, etc).) induces.

Treatment of migraine

Migraine treatment is based on various measures. Permanent use of pain medication is usually not indicated and even dangerous.

General measures: Avoidance of triggering factors (z.B. certain foods, alcohol), sufficient sleep, stress reduction (autogenic training), possibly. Change of hormone preparations etc.. Treatment of acute migraine attack includes: Rest, darkening the room, anti-nausea medication, z.B. in suppository form in combination with medication against the pain, z.B. Aspirin, Paracetamol, in severe cases also other drugs, which u.U. have to be injected ("triptans"). This can often mitigate the maximum severity of the pain or shorten the attack Prevention of migraine attacks occurs in addition to the o.g. general measures in case of frequently repeated attacks by regular intake of certain medications (b-blockers, flunarizine or other substances).

Epilepsy

Epilepsies are diseases of the brain that result from sudden overexcitation, or. are based on increased electrical activity in the brain that spreads unchecked. Visible to the outside it comes z.B. to a sudden loss of consciousness with strong muscle twitching and cramping (so called "muscle spasm"). Seizure), but also short "absent-mindedness", dizziness, or twitching of an extremity with preserved consciousness can be an expression of epilepsy.

Epilepsies are usually associated with childhood, but they can also recur in adulthood, especially at older ages. Causes of epilepsies can be malformations or brain damage in early childhood, but they can also occur as a result of injuries (craniocerebral trauma), circulatory disorders, strokes, tumors or inflammations. A variety of medications (antiepileptic drugs) are available today for treatment and ca. 2/3 of the patients become seizure-free while taking a medication.

Muscle diseases

Neuromuscular diseases affect the peripheral nerves and/or the musculature. They lead to paralysis or muscle wasting to varying degrees. They may be congenital or acquired through various causes during life. The neurologist determines the conductivity of the body's nerves and derives the muscle currents.

Apparative diagnostics such as electroneurography, electromyography, evoked potentials, lumbar puncture can be used in this context. In this way, the diagnostic classification of the disease can be narrowed down and if necessary.

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