Publications by authors named "Donald Lobsien"

49 Publications

Approaching the Boundaries of Endovascular Treatment in Acute Ischemic Stroke : Multicenter Experience with Mechanical Thrombectomy in Vertebrobasilar Artery Branch Occlusions.

Clin Neuroradiol 2020 Oct 27. Epub 2020 Oct 27.

Department of Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Langendreer, Ruhr-University Bochum, Bochum, Germany.

Purpose: Little is known about catheter-based endovascular treatment of vertebrobasilar artery branch occlusion (VEBABO) in acute ischemic stroke (AIS). Nonetheless, the experience of mechanical thrombectomy (MT) in distal small sized arteries of the anterior circulation seems promising in AIS. In this multicenter study, we report the feasibility, efficacy and safety of MT in VEBABO.

Methods: Retrospective analysis of consecutive AIS patients treated with MT due to VEBABO including posterior and anterior inferior cerebellar artery (PICA, AICA) and superior cerebellar artery (SCA) occlusions at seven tertiary care centers between January 2013 and May 2020. Baseline demographics and angiographic outcomes including recanalization success of the affected cerebellar arteries and procedural complications were recorded. Clinical outcomes were evaluated by the modified Rankin scale (mRS) at discharge and 90 days.

Results: Out of 668 endovascularly treated posterior circulation strokes we identified 16 (0.02%) cases with MT for VEBABO. Most frequently, MT of the SCA was done (13/16, 81%). Most VEBABOs occurred after MT of initial basilar/posterior cerebral artery occlusion (9/16, 56%). In 10/16 (63%) procedures, the affected VEBABO was successfully recanalized. Out of four patients three (75%) with isolated VEBABO had benefited from endovascular therapy. Subarachnoid hemorrhage was observed in 3/16 (19%) procedures. The rate of favorable outcome (mRS ≤2) was 40% at discharge and 47% at 90-day follow-up. Mortality was 13% (2/15).

Conclusion: The use of MT for VEBABO is rare but appears to be feasible and effective; however, the comparatively high rate of procedure-related hemorrhage highlights that the indications for MT in these occlusion sites should be carefully weighed up.
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http://dx.doi.org/10.1007/s00062-020-00970-7DOI Listing
October 2020

Individual differences in anxiety and automatic amygdala response to fearful faces: A replication and extension of Etkin et al. (2004).

Neuroimage Clin 2020 18;28:102441. Epub 2020 Sep 18.

Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, 04103 Leipzig, Germany. Electronic address:

Trait anxiety refers to the stable tendency to attend to threats and experience fears and worries across many situations. According to the widely noticed, pioneering investigation by Etkin et al. (2004) trait anxiety is strongly associated with reactivity in the right basolateral amygdala to non-conscious threat. Although this observation was based on a sample of only 17 individuals, no replication effort has been reported yet. We reexamined automatic amygdala responsiveness as a function of anxiety in a large sample of 107 participants. Besides self-report instruments, we administered an indirect test to assess implicit anxiety. To assess early, automatic stages of emotion processing, we used a color-decision paradigm presenting brief (33 ms) and backward-masked fearful facial expressions. N = 56 participants were unaware of the presence of masked faces. In this subset of unaware participants, the relationship between trait anxiety and basolateral amygdala activation by fearful faces was successfully replicated in region of interest analyses. Additionally, a relation of implicit anxiety with masked fear processing in the amygdala and temporal gyrus was observed. We provide evidence that implicit measures of affect can be valuable predictors of automatic brain responsiveness and may represent useful additions to explicit measures. Our findings support a central role of amygdala reactivity to non-consciously perceived threat in understanding and predicting dispositional anxiety, i.e. the frequency of spontaneously occurring anxiety in everyday life.
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http://dx.doi.org/10.1016/j.nicl.2020.102441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522800PMC
September 2020

Changes of central noradrenaline transporter availability in immunotherapy-naïve multiple sclerosis patients.

Sci Rep 2020 09 4;10(1):14651. Epub 2020 Sep 4.

Department of Neurology, University of Leipzig, Leipzig, Germany.

The neurotransmitter noradrenaline (NA) mediates arousal, attention and mood, and exerts anti-inflammatory and neuroprotective effects. Alterations of monoamine signalling were reported in multiple sclerosis (MS) and psychiatric illness and may account for the high prevalence of comorbid depression and fatigue in MS patients. We assessed central noradrenaline transporter (NAT) availability using positron emission tomography (PET) and the NAT selective radiotracer S,S-[C]O-methylreboxetine in immunotherapy-naïve patients with relapsing-remitting MS (RRMS; n = 11) compared to healthy controls (HC; n = 12), and its association to lesion load, time since manifestation, the expanded disability status scale (EDSS), the fatigue scale Würzburger Erschöpfungsinventar bei MS (WEIMuS) and Beck Depression Inventory (BDI). We found NAT availability to be increased in the thalamus, amygdala, putamen and pons/midbrain of MS patients. No relation to clinical or psychometric variables was found. These first data indicate higher NAT availability in subcortical brain regions of immunotherapy-naïve RRMS patients. If these changes of noradrenergic neurotransmission predispose to psychiatric symptoms or associate with disease activity needs to be investigated in longitudinal studies or a larger sample which allows subgroup analyses.
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http://dx.doi.org/10.1038/s41598-020-70732-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7474089PMC
September 2020

Primary Multivessel Occlusions Treated With Mechanical Thrombectomy: A Multicenter Analysis and Systemic Literature Review.

Stroke 2020 09 13;51(9):e232-e237. Epub 2020 Jul 13.

Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum (S.F., V.M.).

Background And Purpose: Acute ischemic stroke caused by primary multivessel occlusions (pMVO) is a rare but devastating disease. Whether multi-target mechanical thrombectomy for pMVO is beneficial remains unknown.

Methods: Multicenter retrospective review of patients treated with multi-target mechanical thrombectomy. The following pMVO sites were included: basilar artery, internal carotid artery, and middle cerebral artery (M1 and M2). Baseline characteristics were reported together with interventional technique, technical efficacy, and safety parameters. Clinical outcomes were evaluated applying the National Institutes of Health Stroke Scale and modified Rankin Scale. A systematic literature review was performed to summarize previous reports on pMVO mechanical thrombectomy.

Results: Of 6081 patients screened, 21 patients met the inclusion criteria (0.35% [95% CI, 0.23%-0.53%]). In 70% (14/20) a cardioembolic cause was reported. A successful reperfusion of Thrombolysis in Cerebral Infarction scale score ≥2b was achieved in 95.2% (20/21) for the first and 76.1% (16/21) for the second target vessel. In those who survived the acute hospital stay (n=10/21), median admission National Institutes of Health Stroke Scale improved from 21 (interquartile range, 13-27) to 8 (interquartile range, 2-20) at discharge (=0.006). Mortality was 60% (12/20) at 90 days and only 20% (4/20) of patients reached modified Rankin Scale score ≤2. Acceptable outcomes were almost exclusively observed in pMVO patients presenting with at least one M2 occlusion.

Conclusions: Multi-target mechanical thrombectomy for pMVOs is rarely performed; however, the procedure appears to be feasible and safe with high reperfusion rates for both occlusion sites. More than half of all treated patients deceased early and favorable outcomes may only be expected for pMVO patients including at least one M2 occlusion.
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http://dx.doi.org/10.1161/STROKEAHA.120.029629DOI Listing
September 2020

[Double vision and a wrong track].

Fortschr Neurol Psychiatr 2020 May 18;88(5):331-336. Epub 2020 May 18.

Klinik für Neurologie, HELIOS Klinikum Erfurt.

A 72-year-old woman presented to our emergency centre with acute horizontal diplopia. Neurological examination revealed an isolated abducens nerve paresis on the left. Hilar enlargement seen on the chest x-ray and an elevated serum ACE level led us to suspect sarcoidosis, but the patient declined further evaluation. In the following days, her visual acuity decreased steadily, and she developed cervicothoracic pain, left sided ptosis, weakness of the right arm, and general asthenia. When she was readmitted as an emergency case, neurological examination revealed decreased visual acuity, external ophthalmoplegia and ptosis on the left and a C8 radicular lesion on the right. Imaging studies showed multilocular lesions, e. g. in the left orbital space, spinal epidural manifestations and lymphoma nodular involvement, including retroperitoneally. Laboratory chemistry showed elevated serum levels of ACE, sIL2 receptor and an elevated CD4 / CD8 ratio while bronchoalveolar lavage indicated lymphocytic alveolitis. The biopsy performed under the left M. masseter with a presumptive diagnosis of sarcoidosis, showed a diffuse large-cell B-cell lymphoma. We initiated immuno-chemotherapy following the R-CHOP schema with a curative approach. The case shows the lack of specificity of clinical, imaging and laboratory findings and thus underlines the need for histology in the differential diagnosis of sarcoidosis.
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http://dx.doi.org/10.1055/a-0985-4088DOI Listing
May 2020

Repeated mechanical thrombectomy in short-term large vessel occlusion recurrence: multicenter study and systematic review of the literature.

J Neurointerv Surg 2020 Dec 6;12(12):1186-1193. Epub 2020 May 6.

Department of Radiology, Neuroradiology and Nuclear Medicine, University Medical Center Langendreer, Bochum, Germany.

Background: Data on the frequency and outcome of repeated mechanical thrombectomy (MT) in patients with short-term re-occlusion of intracranial vessels is limited. Addressing this subject, we report our multicenter experience with a systematic review of the literature.

Methods: A retrospective analysis was conducted of consecutive acute stroke patients treated with MT repeatedly within 30 days at 10 tertiary care centers between January 2007 and January 2020. Baseline demographics, etiology of stroke, angiographic outcome and clinical outcome evaluated by the modified Rankin Scale (mRS) at 90 days were noted. Additionally, a systematic review of reports with repeated MT due to large vessel occlusion (LVO) recurrence was performed.

Results: We identified 30 out of 7844 (0.4%) patients who received two thrombectomy procedures within 30 days due to recurrent LVO. Through systematic review, three publications of 28 participants met the criteria for inclusion. Combined, a total of 58 participants were analyzed: cardioembolic events were the most common etiology for the first (65.5%) and second LVO (60.3%), respectively. Median baseline NIHSS (National Institutes of Health Stroke Scale) was 13 (IQR 8-16) before the first MT and 15 (IQR 11-19) before the second MT (p=0.031). Successful reperfusion was achieved in 91.4% after the first MT and in 86.2% patients after the second MT (p=0.377). The rate of functional independence (mRS 0-2) was 46% at 90 days after the second procedure.

Conclusion: Repeated MT in short-term recurrent LVO is a rarity but appears to be safe and effective. The second thrombectomy should be pursued with the same extensive effort as the first procedure as these patients may achieve similar good outcomes.
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http://dx.doi.org/10.1136/neurintsurg-2020-015938DOI Listing
December 2020

A Safe and Effective Magnetic Labeling Protocol for MRI-Based Tracking of Human Adult Neural Stem Cells.

Front Neurosci 2019 11;13:1092. Epub 2019 Oct 11.

Translational Center for Regenerative Medicine, Fraunhofer Institute for Cell Therapy and Immunology, University of Leipzig, Leipzig, Germany.

Magnetic resonance imaging (MRI) provides a unique tool for visualization and tracking of stem cells in the brain. This is of particular importance when assessing safety of experimental cell treatments in the preclinical or clinical setup. Yet, specific imaging requires an efficient and non-perturbing cellular magnetic labeling which precludes adverse effects of the tag, e.g., the impact of iron-oxide-nanoparticles on the critical differentiation and integration processes of the respective stem cell population investigated. In this study we investigated the effects of very small superparamagnetic iron oxide particle (VSOP) labeling on viability, stemness, and neuronal differentiation potential of primary human adult neural stem cells (haNSCs). Cytoplasmic VSOP incorporation massively reduced the transverse relaxation time T2, an important parameter determining MR contrast. Cells retained cytoplasmic label for at least a month, indicating stable incorporation, a necessity for long-term imaging. Using a clinical 3T MRI, 1 × 10 haNSCs were visualized upon injection in a gel phantom, but detection limit was much lower (5 × 10 cells) in layer phantoms and using an imaging protocol feasible in a clinical scenario. Transcriptional analysis and fluorescence immunocytochemistry did not reveal a detrimental impact of VSOP labeling on important parameters of cellular physiology with cellular viability, stemness and neuronal differentiation potential remaining unaffected. This represents a pivotal prerequisite with respect to clinical application of this method.
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http://dx.doi.org/10.3389/fnins.2019.01092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6797601PMC
October 2019

Implicitly and explicitly assessed anxiety: No relationships with recognition of and brain response to facial emotions.

Neuroscience 2019 06 3;408:1-13. Epub 2019 Apr 3.

Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstr, 10, Leipzig 04103, Germany.

Trait anxiety, the disposition to experience anxiety, is known to facilitate perception of threats. Trait anxious individuals seem to identify threatening stimuli such as fearful facial expressions more accurately, especially when presented under temporal constraints. In past studies on anxiety and emotion face recognition, only self-report or explicit measures of anxiety have been administered. Implicit measures represent indirect tests allowing to circumvent problems associated with self-report. In our study, we made use of implicit in addition to explicit measures to investigate the relationships of trait anxiety with recognition of and brain response to emotional faces. 75 healthy young volunteers had to identify briefly presented (67 ms) fearful, angry, happy, and neutral facial expressions masked by neutral faces while undergoing functional magnetic resonance imaging. The Implicit Association Test, the State-Trait Anxiety Inventory and the Beck Anxiety Inventory were applied as implicit and explicit measures of trait anxiety. After corrections for multiple testing, neither implicitly nor explicitly measured anxiety correlated with recognition of emotional facial expressions. Moreover, implicitly and explicitly assessed anxiety was not linked to brain response to emotional faces. Our data suggest links between discrimination accuracy and brain response to facial emotions. Activation of the caudate nucleus seems be of particular importance for recognizing fear and happiness from facial expressions. Processes of somatosensory resonance appear to be involved in identifying fear from facial expressions. The present data indicate that, regardless of assessment method, trait anxiety does not affect the recognition of fear or other emotions as has been proposed previously.
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http://dx.doi.org/10.1016/j.neuroscience.2019.03.059DOI Listing
June 2019

[Perfusion and spectroscopy of progressive multifocal leucencephalopathy].

Rofo 2019 May 25;191(5):398-400. Epub 2018 Oct 25.

Neuroradiologie, Universität Leipzig, Germany.

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http://dx.doi.org/10.1055/a-0753-0494DOI Listing
May 2019

Lesional and perilesional tissue characterization by automated image processing in a novel gyrencephalic animal model of peracute intracerebral hemorrhage.

J Cereb Blood Flow Metab 2019 12 21;39(12):2521-2535. Epub 2018 Sep 21.

Clinic for Nuclear Medicine, University of Leipzig, Leipzig, Germany.

Intracerebral hemorrhage (ICH) is an important stroke subtype, but preclinical research is limited by a lack of translational animal models. Large animal models are useful to comparatively investigate key pathophysiological parameters in human ICH. To (i) establish an acute model of moderate ICH in adult sheep and (ii) an advanced neuroimage processing pipeline for automatic brain tissue and hemorrhagic lesion determination; 14 adult sheep were assigned for stereotactically induced ICH into cerebral white matter under physiological monitoring. Six hours after ICH neuroimaging using 1.5T MRI including structural as well as perfusion and diffusion, weighted imaging was performed before scarification and subsequent neuropathological investigation including immunohistological staining. Controlled, stereotactic application of autologous blood caused a space-occupying intracerebral hematoma of moderate severity, predominantly affecting white matter at 5 h post-injection. Neuroimage post-processing including lesion probability maps enabled automatic quantification of structural alterations including perilesional diffusion and perfusion restrictions. Neuropathological and immunohistological investigation confirmed perilesional vacuolation, axonal damage, and perivascular blood as seen after human ICH. The model and imaging platform reflects key aspects of human ICH and enables future translational research on hematoma expansion/evacuation, white matter changes, hematoma evacuation, and other aspects.
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http://dx.doi.org/10.1177/0271678X18802119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893983PMC
December 2019

Delayed Post-hypoxic Leukoencephalopathy (DPHL)-An Uncommon Variant of Hypoxic Brain Damage in Adults.

Front Neurol 2018 27;9:708. Epub 2018 Aug 27.

Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.

Delayed post-hypoxic leukoencephalopathy (DPHL) is an uncommon, potentially under-recognized, cause of hypoxia induced white matter injury. It characteristically follows a biphasic course: After an initial phase of altered neurologic status a recovery occurs which is then followed by a recurring phase of neurologic deterioration, typically 2-4 weeks after the initial event. At this time white matter changes can be identified on MRI, which are the hallmark of DPHL. The characteristics and the typical MR-imaging signs of DPHL are discussed in this case report.
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http://dx.doi.org/10.3389/fneur.2018.00708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119709PMC
August 2018

[Morphological patterns of hypoxic brain damage in MRI].

Rofo 2019 02 5;191(2):103-105. Epub 2018 Jul 5.

Department for neuroradiology, University-Hospital Leipzig, Leipzig, Germany.

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http://dx.doi.org/10.1055/a-0647-2208DOI Listing
February 2019

Volumetric Associations Between Amygdala, Nucleus Accumbens, and Socially Anxious Tendencies in Healthy Women.

Neuroscience 2018 03 31;374:25-32. Epub 2018 Jan 31.

Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany. Electronic address:

Socially anxious individuals report higher social fears and feelings of distress in interpersonal interactions. Structural neuroimaging studies indicate brain morphological abnormalities in patients with social anxiety disorder (SAD), but findings are heterogeneous and partially discrepant. Studies on structural correlates of socially anxious tendencies in participants without clinical diagnoses are scarce. Using structural magnetic resonance imaging, the present study examined the relationship between social interaction anxiety and gray matter (GM) volume in 38 healthy women. The amygdala and nucleus accumbens (NAcc) were defined as a priori regions of interest. Moreover, exploratory whole-brain analyses were conducted. Higher levels of social anxiety significantly predicted increased GM volume in the right amygdala [k = 262 voxels, voxel-level threshold at p < .05 (uncorrected), with a cluster-corrected significance level of p = 0.05 calculated by Monte Carlo Simulations] and bilateral NAcc [left: k = 52 voxels, right: k = 49 voxels; at p < .05 (corrected for search volume)]. These relationships remained significant when controlling for a potential influence of trait anxiety. Additionally, socially anxious tendencies were associated with an enlarged striatum [i.e., putamen and caudate; left: k = 567 voxels, right: k = 539 voxels; at p < .001 (uncorrected)]. Our findings indicate that higher social interaction anxiety in healthy individuals is related to amygdalar and striatal volumetric increases. These brain regions are known to be involved in social perception, anxiety, and the avoidance of harm. Future studies may clarify whether the observed morphological alterations constitute a structural vulnerability factor for SAD.
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http://dx.doi.org/10.1016/j.neuroscience.2018.01.034DOI Listing
March 2018

Endovascular Stroke Treatment on Single-Plane vs. Bi-Plane Angiography Suites : Technical Considerations and Evaluation of Treatment Success.

Clin Neuroradiol 2019 Jun 2;29(2):303-309. Epub 2018 Jan 2.

Department of diagnostic and interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.

Introduction: Endovascular stroke therapy is mostly available in comprehensive stroke centers with state of the art bi-plane angiography suites. The aim of the present study was to analyze if it is justifiable to treat patients with alternative x‑ray machines in the case of capacity constraints, or if it is mandatory to refer patients in such cases. Secondly, we wanted to draw conclusions for the feasibility of different logistic approaches in stroke treatment, such as a "helistroke" concept.

Methods: This was a retrospective dual center analysis of all patients treated on a single-plane angiography suite between 2009 and 2017. A propensity scored matching analysis at a 1:3 ratio was performed with patients treated on a bi-plane angiography suite to receive homogeneous groups.

Results: A total of 42 patients were treated on a single-plane angiography suite and were compared to 126 patients treated on a bi-plane angiography suite. No significant differences in technical parameters, procedure times, recanalization success and complications could be detected. Also, there was no difference in the clinical outcome between the two groups. The only significant difference was the higher amount of radiation dose used on the bi-plane angiography machines to achieve the final results (205,660 mGy × cm vs. 114,565 mGy × cm; p < 0.001).

Discussion: In an era of an ever-changing stroke infrastructure and an increasing demand in thrombectomy procedures, it is feasible and safe for experienced neurointerventionalists to perform endovascular stroke procedures on single-plane angiography units.
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http://dx.doi.org/10.1007/s00062-017-0655-zDOI Listing
June 2019

Stent-Assisted Coiling of Ruptured and Incidental Aneurysms of the Intracranial Circulation Using Moderately Flow-Redirecting, Braided Leo Stents-Initial Experience in 39 Patients.

Front Neurol 2017 14;8:602. Epub 2017 Nov 14.

Department of Neuroradiology, Leipzig University Hospital, Leipzig, Germany.

Background: Flow diversion (FD)-a young technique using stents with highly increased surface coverage-was introduced to treat complex aneurysms without intra-aneurysmal material placement and has amended the spectrum of endovascular techniques such as stent-assisted coil occlusion considerably. However, ischemic complications, a common side effect in FD, occur more frequently compared with the conventional endovascular approaches and certainly limit the indication of this technique. Our study aimed to investigate the feasibility and efficacy of stent-assisted coiling using low profile self-expandable stents, which exhibit only moderate flow-redirecting properties and therefore represent a combination of hemodynamic endovascular and occlusive endosaccular therapy.

Materials And Methods: 39 Patients were included in our retrospective study. Occlusion rates were assessed 6 months after the procedure in a total of 27 cases using the Raymond scale.

Results: Complete occlusion (Raymond I) was achieved in 24/27 aneurysms. Small neck remnants (Raymond II) were evident in 3/27 aneurysms. There were no cases with sac remnant or complete persistence of aneurysmal filling (Raymond III and IV).

Conclusion: Our study demonstrates interventional treatment of intracranial aneurysms using flow-redirecting stent-assisted coiling to be technically feasible and highly effective in aneurysmal occlusion. We believe that this approach is outstanding in the prevention of long-term aneurysmal reperfusion and exhibits a more acceptable risk profile than highly efficient FD techniques.
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http://dx.doi.org/10.3389/fneur.2017.00602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5694479PMC
November 2017

Endovascular Stroke Treatment: How Far Downstream Should We Go?

Cardiovasc Intervent Radiol 2018 Jan 26;41(1):55-62. Epub 2017 Oct 26.

Department of diagnostic and interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 80675, Munich, Germany.

Background: Endovascular thrombectomy has become the de facto standard in the treatment of large vessel occlusion. Previously, a correlation between good outcome and the occlusion site, measured by the 'distance to thrombus' (DT)-as the distance from the carotid T to the beginning of the thrombus-after thrombolysis could be shown. In the present study, we analyze the differences between the chances of a good outcome in respect of DT between patients treated endovascularly or intravenously.

Methods: A dual-center database analysis including patients with stroke due to occlusion of the middle cerebral artery (MCA) was performed. Inclusion criteria were a completed treatment and full documentation of the clinical course. DT was measured in pre-treatment images. DT was correlated with the mRS at 90 days stratified according to the different treatment methods.

Results: A total of 280 patients could be included. We were able to show a correlation between the chances of good clinical outcome and the occlusion site measured by DT after i.v. thrombolysis. The outcome after endovascular treatment showed no correlation with DT (p = 0.227). After a DT of 26 mm, the chances of a good outcome after i.v. thrombolysis exceeded those after endovascular treatment.

Conclusion: In patients with MCA occlusion, the probability for a good outcome after endovascular treatment is independent of the occlusion site in contrast to the treatment with i.v. thrombolysis. If the occlusion occurred in the periphery of the M2 region (DT > 26 mm), i.v. thrombolysis alone was superior to endovascular treatment in achieving a good outcome.
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http://dx.doi.org/10.1007/s00270-017-1830-yDOI Listing
January 2018

Automatic processing of emotional facial expressions as a function of social anhedonia.

Psychiatry Res Neuroimaging 2017 Dec 10;270:46-53. Epub 2017 Oct 10.

Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany. Electronic address:

Anhedonia is an important feature of major depression and schizophrenia-spectrum disorders. Few neuroimaging studies have investigated neural alterations in high anhedonia, isolated from other psychopathological variables, by including only participants without clinical diagnoses. The present study examined healthy individuals scoring high (N = 18) vs. low (N = 19) in social anhedonia, who were carefully selected from a sample of N = 282 participants. To examine differences in automatic brain responses to social-affective stimuli between high vs. low social anhedonia participants, we used functional magnetic resonance imaging. To assess early, automatic stages of emotion processing, we administered a paradigm presenting brief (33ms), backward-masked happy, sad, and neutral facial expressions. Individuals high in social anhedonia demonstrated increased activation in the bilateral thalamus and left red nucleus in response to masked sad faces relative to individuals low in social anhedonia. No significant group differences in brain activation emerged in other regions known to be involved in emotion and reward processing, including the amygdala and nucleus accumbens. Our results suggest that high social anhedonia in otherwise healthy individuals is associated with exaggerated automatic reactivity in the thalamus, which is a brain structure that has been implicated in the mediation of attentional processes.
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http://dx.doi.org/10.1016/j.pscychresns.2017.10.002DOI Listing
December 2017

FLAIR vascular hyperintensities and 4D MR angiograms for the estimation of collateral blood flow in anterior cerebral artery ischemia.

PLoS One 2017 24;12(2):e0172570. Epub 2017 Feb 24.

Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.

Purpose: To assess FLAIR vascular hyperintensities (FVH) and dynamic (4D) angiograms derived from perfusion raw data as proposed magnetic resonance (MR) imaging markers of leptomeningeal collateral circulation in patients with ischemia in the territory of the anterior cerebral artery (ACA).

Methods: Forty patients from two tertiary care university hospitals were included. Infarct volumes and perfusion deficits were manually measured on DWI images and TTP maps, respectively. FVH and collateral flow on 4D MR angiograms were assessed and graded as previously specified.

Results: Forty-one hemispheres were affected. Mean DWI lesion volume was 8.2 (± 13.9; range 0-76.9) ml, mean TTP lesion volume was 24.5 (± 17.2, range 0-76.7) ml. FVH were observed in 26/41 (63.4%) hemispheres. Significant correlations were detected between FVH and TTP lesion volume (ρ = 0.4; P<0.01) absolute (ρ = 0.37; P<0.05) and relative mismatch volume (ρ = 0.35; P<0.05). The modified ASITN/SIR score correlated inversely with DWI lesion volume (ρ = -0.58; P<0.01) and positively with relative mismatch (ρ = 0.29; P< 0.05). ANOVA of the ASITN/SIR score revealed significant inter-group differences for DWI (P<0.001) and TTP lesion volumes (P<0.05). No correlation was observed between FVH scores and modified ASITH/SIR scores (ρ = -0.16; P = 0.32).

Conclusions: FVH and flow patterns on 4D MR angiograms are markers of perfusion deficits and tissue at risk. As both methods did not show a correlation between each other, they seem to provide complimentary instead of redundant information. Previously shown evidence for the meaning of these specific MR signs in internal carotid and middle cerebral artery stroke seems to be transferrable to ischemic stroke in the ACA territory.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0172570PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325299PMC
August 2017

Central noradrenaline transporter availability in highly obese, non-depressed individuals.

Eur J Nucl Med Mol Imaging 2017 Jun 9;44(6):1056-1064. Epub 2017 Jan 9.

Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany.

Purpose: The brain noradrenaline (NA) system plays an important role in the central nervous control of energy balance and is thus implicated in the pathogenesis of obesity. The specific processes modulated by this neurotransmitter which lead to obesity and overeating are still a matter of debate.

Methods: We tested the hypothesis that in vivo NA transporter (NAT) availability is changed in obesity by using positron emission tomography (PET) and S,S-[C]O-methylreboxetine (MRB) in twenty subjects comprising ten highly obese (body mass index BMI > 35 kg/m), metabolically healthy, non-depressed individuals and ten non-obese (BMI < 30 kg/m) healthy controls.

Results: Overall, we found no significant differences in binding potential (BP) values between obese and non-obese individuals in the investigated brain regions, including the NAT-rich thalamus (0.40 ± 0.14 vs. 0.41 ± 0.18; p = 0.84) though additional discriminant analysis correctly identified individual group affiliation based on regional BP in all but one (control) case. Furthermore, inter-regional correlation analyses indicated different BP patterns between both groups but this did not survive testing for multiple comparions.

Conclusions: Our data do not find an overall involvement of NAT changes in human obesity. However, preliminary secondary findings of distinct regional and associative patterns warrant further investigation.
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http://dx.doi.org/10.1007/s00259-016-3590-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538358PMC
June 2017

Distance to Thrombus in acute middle cerebral artery stroke predicts basal ganglia infarction after mechanical thrombectomy.

Oncotarget 2016 Dec;7(52):85813-85818

Department of diagnostic and interventional Neuroradiology, Klinikum rechts der Isar, Munich, Germany.

Background And Purpose: This study examines if involvement of the lenticulostriate arteries (LSAs) in MCA stroke and consecutive infarction of the basal ganglia can be predicted by the exact occlusion site, as determined in pre-interventional CT or MRI imaging.

Methods: Retrospective analysis of 212 patients with acute isolated MCA occlusions treated with mechanical thrombectomy. The occlusion site was assessed using the Distance to Thrombus (DT). Affection of LSAs by the occlusion was determined by analysis of pre- and post-interventional DSA runs. Infarction of the striatocapsular region was evaluated in post-interventional imaging.

Results: DT showed a highly significant correlation with the affected LSA group (ρ = 0.747; P < 0.001). In a ROC analysis, DT could predict affection of the LSAs with an area under the curve (AUC) of 0.903. Additionally, DT could predict an infarction of the striatocapsular region with an AUC of 0.824. In a stepwise regression analysis for striatocapsular infarction including DT, age, time from symptom onset to recanalization and recanalization success, only DT proved to be an independent predictor.

Conclusion: In MCA stroke, the exact site of the occlusion as measured by DT independently predicts the involvement of LSAs and subsequent striatocapsular infarction with high sensitivity and specificity.
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http://dx.doi.org/10.18632/oncotarget.13280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349876PMC
December 2016

Subthalamic nucleus volumes are highly consistent but decrease age-dependently-a combined magnetic resonance imaging and stereology approach in humans.

Hum Brain Mapp 2017 02 11;38(2):909-922. Epub 2016 Oct 11.

Faculty of Medicine, Institute of Anatomy University of Leipzig, Leipzig, Germany.

The subthalamic nucleus (STN) is a main target structure of deep brain stimulation (DBS) in idiopathic Parkinson's disease. Nevertheless, there is an ongoing discussion regarding human STN volumes and neuron count, which could potentially have an impact on STN-DBS. Moreover, a suspected functional subdivision forms the basis of the tripartite hypothesis, which has not yet been morphologically substantiated. In this study, it was aimed to investigate the human STN by means of combined magnetic resonance imaging (MRI) and stereology. STN volumes were obtained from 14 individuals (ranging from 65 to 96 years, 25 hemispheres) in 3 T MRI and in luxol-stained histology slices. Neuron number and cell densities were investigated stereologically over the entire STN and in pre-defined subregions in anti-human neuronal protein HuC/D-stained slices. STN volumes measured with MRI were smaller than in stereology but appeared to be highly consistent, measuring on average 99 ± 6 mm (MRI) and 132 ± 20 mm (stereology). The neuron count was 431,088 ± 72,172. Both STN volumes and cell count decreased age-dependently. Neuron density was different for the dorsal, medial and ventral subregion with significantly higher values ventrally than dorsally. Small variations in STN volumes in both MRI and stereology contradict previous findings of large variations in STN size. Age-dependent decreases in STN volumes and neuron numbers might influence the efficacy of STN-DBS in a geriatric population. Though the study is limited in sample size, site-dependent differences for the STN subregions form a morphological basis for the tripartite theory. Hum Brain Mapp 38:909-922, 2017. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/hbm.23427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6867036PMC
February 2017

The Cerebral Surfactant System and Its Alteration in Hydrocephalic Conditions.

PLoS One 2016;11(9):e0160680. Epub 2016 Sep 22.

Department of Neurosurgery, University Leipzig, Germany.

Introduction: Pulmonary Surfactant reduces surface tension in the terminal airways thus facilitating breathing and contributes to host's innate immunity. Surfactant Proteins (SP) A, B, C and D were recently identified as inherent proteins of the CNS. Aim of the study was to investigate cerebrospinal fluid (CSF) SP levels in hydrocephalus patients compared to normal subjects.

Patients And Methods: CSF SP A-D levels were quantified using commercially available ELISA kits in 126 patients (0-84 years, mean 39 years). 60 patients without CNS pathologies served as a control group. Hydrocephalus patients were separated in aqueductal stenosis (AQS, n = 24), acute hydrocephalus without aqueductal stenosis (acute HC w/o AQS, n = 16) and idiopathic normal pressure hydrocephalus (NPH, n = 20). Furthermore, six patients with pseudotumor cerebri were investigated.

Results: SP A-D are present under physiological conditions in human CSF. SP-A is elevated in diseases accompanied by ventricular enlargement (AQS, acute HC w/o AQS) in a significant manner (0.67, 1.21 vs 0.38 ng/ml in control, p<0.001). SP-C is also elevated in hydrocephalic conditions (AQS, acute HC w/o AQS; 0.87, 1.71 vs. 0.48 ng/ml in controls, p<0.001) and in Pseudotumor cerebri (1.26 vs. 0.48 ng/ml in controls, p<0.01). SP-B and SP-D did not show significant alterations.

Conclusion: The present study confirms the presence of SPs in human CSF. There are significant changes of SP-A and SP-C levels in diseases affecting brain water circulation and elevation of intracranial pressure. Cause of the alterations, underlying regulatory mechanisms, as well as diagnostic and therapeutic consequences of cerebral SP's requires further thorough investigations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5033422PMC
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0160680PLOS
September 2016

Feasibility and acceptance of simultaneous amyloid PET/MRI.

Eur J Nucl Med Mol Imaging 2016 Nov 19;43(12):2236-2243. Epub 2016 Jul 19.

Department of Nuclear Medicine, Leipzig University Hospital, Liebigstr. 18, 04103, Leipzig, Germany.

Purpose: Established Alzheimer's disease (AD) biomarker concepts classify into amyloid pathology and neuronal injury biomarkers, while recent alternative concepts classify into diagnostic and progression AD biomarkers. However, combined amyloid positron emission tomography/magnetic resonance imaging (PET/MRI) offers the chance to obtain both biomarker category read-outs within one imaging session, with increased patient as well as referrer convenience. The aim of this pilot study was to investigate this matter for the first time.

Methods: 100 subjects (age 70 ± 10 yrs, 46 female), n = 51 with clinically defined mild cognitive impairment (MCI), n = 44 with possible/probable AD dementia, and n = 5 with frontotemporal lobe degeneration, underwent simultaneous [F]florbetaben or [C]PIB PET/MRI (3 Tesla Siemens mMR). Brain amyloid load, mesial temporal lobe atrophy (MTLA) by means of the Scheltens scale, and other morphological brain pathologies were scored by respective experts. The patients/caregivers as well as the referrers were asked to assess on a five-point scale the convenience related to the one-stop-shop PET and MRI approach.

Results: In three subjects, MRI revealed temporal lobe abnormalities other than MTLA. According to the National Institute on Aging-Alzheimer's Association classification, the combined amyloid-beta PET/MRI evaluation resulted in 31 %, 45 %, and 24 % of the MCI subjects being categorized as "MCI-unlikely due to AD", "MCI due to AD-intermediate likelihood", and "MCI due to AD-high likelihood", respectively. 50 % of the probable AD dementia patients were categorized as "High level of evidence of AD pathophysiological process", and 56 % of the possible AD dementia patients as "Possible AD dementia - with evidence of AD pathophysiological process". With regard to the International Working Group 2 classification, 36 subjects had both positive diagnostic and progression biomarkers. The patient/caregiver survey revealed a gain of convenience in 88 % of responders as compared to a theoretically separate PET and MR imaging. In the referrer survey, an influence of the combined amyloid-beta PET/MRI on the final diagnosis was reported by 82 % of responders, with a referrer acceptance score of 3.7 ± 1.0 on a 5-point scale.

Conclusion: Simultaneous amyloid PET/MRI is feasible and provides imaging biomarkers of all categories which are able to supplement the clinical diagnosis of MCI due to AD and that of AD dementia. Further, patient and referrer convenience is improved by this one-stop-shop imaging approach.
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http://dx.doi.org/10.1007/s00259-016-3462-xDOI Listing
November 2016

Primary Intradural Extramedullary Spinal Melanoma in the Lower Thoracic Spine.

Case Rep Oncol Med 2016 5;2016:3815280. Epub 2016 Apr 5.

Department of Radiotherapy and Radiation Oncology, Leipzig University, Liebigstrasse 20, 04103 Leipzig, Germany.

Unlabelled: Background Context. Up to date, only four cases of primary intradural extramedullary spinal cord melanoma (PIEM) have been reported. No previous reports have described a case of PIEM located in the lower thoracic spine with long-term follow-up. Purpose. Demonstrating an unusual, extremely rare case of melanoma manifestation. Study Design.

Case Report: Methods. We report a case of a 57-year-old female suffering from increasing lower extremity pain, left-sided paresis, and paraesthesia due to spinal cord compression caused by PIEM in the lower thoracic spine. Results. Extensive investigation excluded other possible primary melanoma sites and metastases. For spinal cord decompression, the tumor at level T12 was resected, yet incompletely. Adjuvant radiotherapy was administered two weeks after surgery. The patient was recurrence-free at 104 weeks after radiotherapy but presents with unchanged neurological symptoms. Conclusion. Primary intradural extramedullary melanoma (PIEM) is extremely rare and its clinical course is unpredictable.
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http://dx.doi.org/10.1155/2016/3815280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835629PMC
April 2016

Comment on the article What constitutes the M1 segment of the middle cerebral artery?

J Neurointerv Surg 2017 05 26;9(5):524. Epub 2016 Feb 26.

Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany.

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http://dx.doi.org/10.1136/neurintsurg-2016-012325DOI Listing
May 2017

Evaluation of software tools for automated identification of neuroanatomical structures in quantitative β-amyloid PET imaging to diagnose Alzheimer's disease.

Eur J Nucl Med Mol Imaging 2016 Jun 7;43(6):1077-87. Epub 2016 Jan 7.

Department of Nuclear Medicine, Leipzig University Medical Centre, Liebigstraße 18, 04103, Leipzig, Germany.

Introduction: For regional quantification of nuclear brain imaging data, defining volumes of interest (VOIs) by hand is still the gold standard. As this procedure is time-consuming and operator-dependent, a variety of software tools for automated identification of neuroanatomical structures were developed. As the quality and performance of those tools are poorly investigated so far in analyzing amyloid PET data, we compared in this project four algorithms for automated VOI definition (HERMES Brass, two PMOD approaches, and FreeSurfer) against the conventional method. We systematically analyzed florbetaben brain PET and MRI data of ten patients with probable Alzheimer's dementia (AD) and ten age-matched healthy controls (HCs) collected in a previous clinical study.

Methods: VOIs were manually defined on the data as well as through the four automated workflows. Standardized uptake value ratios (SUVRs) with the cerebellar cortex as a reference region were obtained for each VOI. SUVR comparisons between ADs and HCs were carried out using Mann-Whitney-U tests, and effect sizes (Cohen's d) were calculated. SUVRs of automatically generated VOIs were correlated with SUVRs of conventionally derived VOIs (Pearson's tests).

Results: The composite neocortex SUVRs obtained by manually defined VOIs were significantly higher for ADs vs. HCs (p=0.010, d=1.53). This was also the case for the four tested automated approaches which achieved effect sizes of d=1.38 to d=1.62. SUVRs of automatically generated VOIs correlated significantly with those of the hand-drawn VOIs in a number of brain regions, with regional differences in the degree of these correlations. Best overall correlation was observed in the lateral temporal VOI for all tested software tools (r=0.82 to r=0.95, p<0.001).

Conclusion: Automated VOI definition by the software tools tested has a great potential to substitute for the current standard procedure to manually define VOIs in β-amyloid PET data analysis.
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http://dx.doi.org/10.1007/s00259-015-3300-6DOI Listing
June 2016

Central serotonin transporter availability in highly obese individuals compared with non-obese controls: A [(11)C] DASB positron emission tomography study.

Eur J Nucl Med Mol Imaging 2016 Jun 18;43(6):1096-104. Epub 2015 Nov 18.

Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany.

Purpose: The role of the central serotonin (5-hydroxytryptamine, 5-HT) system in feeding has been extensively studied in animals with the 5-HT family of transporters (5-HTT) being identified as key molecules in the regulation of satiety and body weight. Aberrant 5-HT transmission has been implicated in the pathogenesis of human obesity by in vivo positron emission tomography (PET) and single-photon emission computed tomography (SPECT) imaging techniques. However, results obtained thus far from studies of central 5-HTT availability have been inconsistent, which is thought to be brought about mainly by the low number of individuals with a high body mass index (BMI) previously used. The aim of this study was therefore to assess 5-HTT availability in the brains of highly obese otherwise healthy individuals compared with non-obese healthy controls.

Methods: We performed PET using the 5-HTT selective radiotracer [(11)C] DASB on 30 highly obese (BMI range between 35 and 55 kg/m(2)) and 15 age- and sex-matched non-obese volunteers (BMI range between 19 and 27 kg/m(2)) in a cross-sectional study design. The 5-HTT binding potential (BPND) was used as the outcome parameter.

Results: On a group level, there was no significant difference in 5-HTT BPND in various cortical and subcortical regions in individuals with the highest BMI compared with non-obese controls, while statistical models showed minor effects of age, sex, and the degree of depression on 5-HTT BPND.

Conclusion: The overall finding of a lack of significantly altered 5-HTT availability together with its high variance in obese individuals justifies the investigation of individual behavioral responses to external and internal cues which may further define distinct phenotypes and subgroups in human obesity.
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http://dx.doi.org/10.1007/s00259-015-3243-yDOI Listing
June 2016

Distance to Thrombus in Acute Middle Cerebral Artery Occlusion Predicts Target Mismatch and Ischemic Penumbra.

J Stroke Cerebrovasc Dis 2016 Feb 2;25(2):298-305. Epub 2015 Nov 2.

Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.

Background And Purpose: In patients with occlusion of the middle cerebral artery (MCA) treated by intravenous thrombolysis (IVT), the distance to thrombus (DT) has been proposed as a predictor of outcome. The purpose of the present study was to investigate how DT relates to dynamic susceptibility contrast perfusion metrics.

Methods: Retrospective analysis was undertaken of patients who were diagnosed with acute MCA occlusion by magnetic resonance imaging and treated with IVT. Volumes of time-to-maximum (Tmax) perfusion deficits and diffusion-weighted imaging (DWI) lesions, diffusion-perfusion mismatch volumes, and the presence of target mismatch were determined. Correlations between the above stoke measures and DT were then calculated.

Results: Fifty-five patients were included. DT showed significant inverse correlations with Tmax greater than 4, 6, 8, and 10 seconds, respectively, and mismatch volumes. Using the DT group median (14 mm) as a separator, significant intergroup differences were observed for Tmax greater than 4, 6, and 8 seconds, respectively, and for mismatch volumes. Grouping DT into quartiles showed significant intergroup differences regarding mismatch volumes and Tmax values greater than 4 and 6 seconds. Binary logistic regression identified DT (odds ratio [OR] = .89; 95% confidence interval [CI], .81-.99) and DWI lesion volumes (OR = .92; 95% CI, .86-.97) as independent predictors of target mismatch. A low DT predicted target mismatch with an area under the curve of .69.

Conclusions: DT correlates inversely with Tmax perfusion deficits and mismatch volumes and acts as an independent predictor of target mismatch.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2015.09.032DOI Listing
February 2016

Critical Comparison of Different Biomarkers for Alzheimer's Disease in a Clinical Setting.

J Alzheimers Dis 2015 ;48(2):425-32

Department of Psychiatry, University of Leipzig, Leipzig, Germany.

Background: Biomarkers of neuronal injury and amyloid pathology play a pivotal role in the diagnosis of Alzheimer's disease (AD). The degree of AD biomarker congruence is still unclear in clinical practice.

Objective: Diagnosis of AD with regard to the congruence of the clinical diagnosis and different biomarkers.

Methods: In this prospective cross-sectional observational study, 54 patients with mild cognitive impairment or dementia due to AD or not due to AD were investigated. Biomarkers of neuronal injury were medial temporal lobe atrophy (MTA) on magnetic resonance imaging (MRI) and tau concentration in the cerebrospinal fluid (CSF). CSF Aβ(1-42) and amyloid-targeting positron emission tomography (PET) were considered as biomarkers of amyloid pathology.

Results: Forty cases were diagnosed as AD and 14 cases were diagnosed as non-AD based on clinical and routine MRI assessment. AD cases had higher MTA scores, higher levels of CSF tau and lower levels of CSF Aβ(1- 42), and higher amyloid load on PET compared to the non-AD group. In the AD group, completely consistently pathological biomarkers were found in 32.5% , non-pathological in 5% . In 62.5% the findings were inconsistent. Congruence of biomarkers was 67.5% for neuronal injury and for amyloid dysfunction, respectively. In two patients, clinical diagnosis switched to non-AD due to completely consistent non-pathological biomarker findings. The criteria of the international working group were met in 75.0% .

Conclusion: Surprisingly, the number of completely congruent biomarkers was relatively low. Interpretation of AD biomarkers is complicated by multiple biomarker constellations. However, the level of biomarker consistency required to reliably diagnose AD remains uncertain.
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http://dx.doi.org/10.3233/JAD-150229DOI Listing
June 2016

Mechanical thrombectomy versus systemic thrombolysis in MCA stroke: a distance to thrombus-based outcome analysis.

J Neurointerv Surg 2016 Sep 7;8(9):878-82. Epub 2015 Sep 7.

Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.

Background: Acute ischemic stroke due to occlusion of the middle cerebral artery (MCA) has a poor outcome. The distance to thrombus (DT) from the carotid T can predict the outcome after intravenous thrombolysis (IVT). With a DT <16 mm, fewer than 50% of patients treated with IVT have a favorable outcome.

Objective: To compare stent retriever-based endovascular mechanical thrombectomy (MT) plus additional IVT (IVT-MT) with IVT alone.

Materials And Methods: Patients with MCA occlusion proved by CT angiography with a DT <16 mm, treated with either IVT alone or with stent retriever-based endovascular IVT-MT, were included in this study. Changes in National Institutes of Health Stroke Scale (NIHSS), the 7-day NIHSS, and the 90-day modified Rankin Scale (mRS) scores were analyzed by treatment modality.

Results: Of 621 patients, 87 fulfilled all inclusion criteria. Fifty-nine patients were treated with IVT and 28 with IVT-MT. Although patients treated with IVT-MT had had significantly more severe strokes than those treated with IVT alone (initial NIHSS 16 (7-18) vs 14 (5-22); p=0.032), both the short- and long-term outcomes were significantly better in this patient group (NIHSS improvement on day 7: 10.9±6.3 vs 6.7±6.7; p=0.008/90-day mRS: 2 (0.75-2.5) vs 4 (2-6); p=0.003).

Conclusions: In patients with an acute MCA occlusion and a DT <16 mm, IVT-MT leads to a significantly better outcome than in patients treated with IVT alone.
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http://dx.doi.org/10.1136/neurintsurg-2015-011964DOI Listing
September 2016