Publications by authors named "Christian Boßelmann"

8 Publications

  • Page 1 of 1

Delirium REduction after administration of melatonin in acute ischemic stroke (DREAMS): A propensity score-matched analysis.

Eur J Neurol 2021 Mar 3. Epub 2021 Mar 3.

Department of Neurology & Stroke, Eberhard-Karls University of Tübingen, Tübingen, Germany.

Background And Purpose: Poststroke delirium (PSD) comprises a common and severe complication after stroke. However, treatment options for PSD remain insufficient. We investigated whether prophylactic melatonin supplementation may be associated with reduced risk for PSD.

Methods: Consecutive patients admitted to the Tübingen University Stroke Unit, Tübingen, Germany, with acute ischemic stroke (AIS), who underwent standard care between August 2017 and December 2017, and patients who additionally received prophylactic melatonin (2 mg per day at night) within 24 h of symptom onset between August 2018 and December 2018 were included. Primary outcomes were (i) PSD prevalence in AIS patients and (ii) PSD risk and PSD-free survival in patients with cerebral infarction who underwent melatonin supplementation compared to propensity score-matched (PSM) controls. Secondary outcomes included time of PSD onset and PSD duration.

Results: Out of 465 (81.2%) patients with cerebral infarction and 108 (18.8%) transient ischemic attack (TIA) patients, 152 (26.5%) developed PSD (median time to onset [IQR]: 16 [8-32] h; duration 24 [8-40] h). Higher age, cerebral infarction rather than TIA, and higher National Institutes of Health Stroke Scale score and aphasia on admission were significant predictors of PSD. After PSM (164 melatonin-treated patients with cerebral infarction versus 164 matched controls), 42 (25.6%) melatonin-treated patients developed PSD versus 60 (36.6%) controls (odds ratio, 0.597; 95% confidence interval, 0.372-0.958; p = 0.032). PSD-free survival differed significantly between groups (p = 0.027), favoring melatonin-treated patients. In patients with PSD, no between-group differences in the time of PSD onset and PSD duration were noted.

Conclusions: Patients prophylactically treated with melatonin within 24 h of AIS onset had lower risk for PSD than patients undergoing standard care. Prospective randomized trials are warranted to corroborate these findings.
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http://dx.doi.org/10.1111/ene.14792DOI Listing
March 2021

Neuro-Sweet syndrome - a rare differential diagnosis in aseptic meningoencephalitis.

Neurol Res Pract 2019 21;1:36. Epub 2019 Nov 21.

Department of Epileptology, University Hospital for Neurology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.

Acute febrile neutrophilic dermatosis (Sweet's syndrome) is a dermatological entity, which may be associated with malignancies, drugs, and infections and which is characterized by high fever, elevated neutrophils, and tender erythematous skin lesions. Involvement of the nervous system - Neuro-Sweet syndrome (NSS) - is rare, manifesting most commonly with an encephalitic syndrome in addition to fever and dermal lesions. Here, we report an unusual case of NSS in a Caucasian male patient in the setting of B-cell-lymphocytosis, with encephalitis preceding dermal lesions. Symptoms resolved completely in response to corticoids. NSS is a rare, but important differential diagnosis in the work-up of febrile aseptic meningoencephalitis unresponsive to anti-infectious treatment. Due to its rarity and clinical variability, diagnosis of NSS might be challenging. Knowledge of this entity may facilitate proper diagnosis and differentiation from conditions with similar clinical presentation, especially Neuro-Behçet's disease. It may further lead to early detection of a potentially underlying malignancy and help in initiating adequate therapy.
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http://dx.doi.org/10.1186/s42466-019-0041-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7650048PMC
November 2019

Papillary tumor of the pineal region: a single-center experience.

Neurooncol Pract 2020 Jul 3;7(4):384-390. Epub 2020 Apr 3.

Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Germany.

Papillary tumor of the pineal region (PTPR) is a rare entity. Its clinical presentation is diverse, and establishing an accurate and timely diagnosis may be challenging. Treatment recommendations are based on the evidence level of case series. Recently, several key advances have been made for immunohistochemical characterization, molecular diagnostics, and neurosurgical treatment of PTPR. Here, we describe our single-center experience.
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http://dx.doi.org/10.1093/nop/npaa014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571506PMC
July 2020

Sonographic features of carotid artery dissection due to extension of aortic dissection: a case report.

Ultrasound J 2019 Dec 2;11(1):32. Epub 2019 Dec 2.

Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.

Background: Carotid artery dissection due to extension of aortic dissection (CAEAD) is a severe complication of acute aortic dissection. The risk of ischemic stroke is increased. Early sonographic detection and repeat evaluation are necessary to guide clinical management.

Case Presentation: A 58-year-old male patient presents with sudden, tearing retrosternal pain. Point-of-care carotid ultrasound is used to establish the diagnosis of CAEAD. We describe a number of sonographic features and compare ultrasound to other imaging modalities.

Conclusions: Bedside carotid ultrasound enables rapid, sensitive and safe hemodynamic assessment, especially in critically ill patients.
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http://dx.doi.org/10.1186/s13089-019-0147-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6888778PMC
December 2019

Delirium Screening in Aphasic Patients With the Intensive Care Delirium Screening Checklist (ICDSC): A Prospective Cohort Study.

Front Neurol 2019 12;10:1198. Epub 2019 Nov 12.

Department of Neurology and Stroke, Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany.

Ten to thirty percent of stroke patients suffer from post-stroke delirium. This leads to a longer hospital stay and increased mortality. Therefore, early detection and treatment are needed. All established delirium screening tools require some degree of language function. We sought to investigate whether the Intensive Care Delirium Screening Checklist (ICDSC) is suitable for delirium screening in patients with post-stroke aphasia. A prospective cohort study was carried out in adult patients consecutively admitted to the Stroke Unit of University Hospital Tuebingen, between July 2017 and December 2018. The index test, ICDSC, was compared with the DSM-V diagnostic criteria as reference standard. Measures of diagnostic precision and the degree of agreement were obtained. Three hundred and forty six patients were included in the analysis. Aphasia was present in 231 (66.8%) and absent in 115 (33.2%) patients. Delirium was present in 83 out of 231 (36%) patients with aphasia and 32 out of 115 (27.8%) patients without aphasia ( = 0.132). For patients without aphasia, sensitivity and specificity at the established cut-off value of ≥ 4 points were 100% and 78%, respectively. For patients with aphasia, the test demonstrated inferior performance, with a sensitivity and specificity of 98% and 55%, respectively. It was necessary to increase the cut-off value to ≥ 5 points. Through this, sensitivity was 90% (95% CI, 81.9-95.8%) and specificity was 75% (95% CI, 67.2-81.8%). The degree of agreement to the DSM-V criteria was "substantial" (Cohen's κ = 0.61). For the purpose of delirium screening in patients with aphasia, increasing the ICDSC cut-off value to ≥ 5 points enables effective screening. Further studies are necessary to characterize post-stroke delirium.
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http://dx.doi.org/10.3389/fneur.2019.01198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861445PMC
November 2019

African trypanosomes and brain infection - the unsolved question.

Biol Rev Camb Philos Soc 2017 Aug 14;92(3):1675-1687. Epub 2016 Oct 14.

Department of Natural Sciences, Interfaculty Institute of Biochemistry, University of Tübingen, Tübingen, 72076, Hoppe-Seyler-Str. 4, Germany.

African trypanosomes induce sleeping sickness. The parasites are transmitted during the blood meal of a tsetse fly and appear primarily in blood and lymph vessels, before they enter the central nervous system. During the latter stage, trypanosomes induce a deregulation of sleep-wake cycles and some additional neurological disorders. Historically, it was assumed that trypanosomes cross the blood-brain barrier and settle somewhere between the brain cells. The brain, however, is a strictly controlled and immune-privileged area that is completely surrounded by a dense barrier that covers the blood vessels: this is the blood-brain barrier. It is known that some immune cells are able to cross this barrier, but this requires a sophisticated mechanism and highly specific cell-cell interactions that have not been observed for trypanosomes within the mammalian host. Interestingly, trypanosomes injected directly into the brain parenchyma did not induce an infection. Likewise, after an intraperitoneal infection of rats, Trypanosoma brucei brucei was not observed within the brain, but appeared readily within the cerebrospinal fluid (CSF) and the meninges. Therefore, the parasite did not cross the blood-brain barrier, but the blood-CSF barrier, which is formed by the choroid plexus, i.e. the part of the ventricles where CSF is produced from blood. While there is no question that trypanosomes are able to invade the brain to induce a deadly encephalopathy, controversy exists about the pathway involved. This review lists experimental results that support crossing of the blood-brain barrier and of the blood-CSF barrier and discuss the implications that either pathway would have on infection progress and on the survival strategy of the parasite. For reasons discussed below, we prefer the latter pathway and suggest the existence of an additional distinct meningeal stage, from which trypanosomes could invade the brain via the Virchow-Robin space thereby bypassing the blood-brain barrier. We also consider healthy carriers, i.e. people living symptomless with the disease for up to several decades, and discuss implications the proposed meningeal stage would have for new anti-trypanosomal drug development. Considering the re-infection of blood, a process called relapse, we discuss the likely involvement of the newly described glymphatic connection between the meningeal space and the lymphatic system, that seems also be important for other infectious diseases.
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http://dx.doi.org/10.1111/brv.12301DOI Listing
August 2017

The lane to the brain: how African trypanosomes invade the CNS.

Trends Parasitol 2014 Oct 2;30(10):470-7. Epub 2014 Sep 2.

Interfaculty Institute of Biochemistry, University of Tübingen, Hoppe-Seyler-Str. 4, 72076 Tübingen, Germany. Electronic address:

African trypanosomes induce sleeping sickness. Although it is clear that this parasite moves from the blood to the central nervous system (CNS) to induce the second stage of the disease, little is known about the molecular details of this process. Considering new findings of the trypanosome localization, this opinion paper will summarize the current knowledge about CNS infection, propose a different perception of the invasion process, and discuss possible consequences for drug development.
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http://dx.doi.org/10.1016/j.pt.2014.08.002DOI Listing
October 2014