Publications by authors named "Rolf Kern"

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a rare relapsing autoimmune disease of the central nervous system, affecting mainly optic nerves and spinal cord. NMOSD pathophysiology is associated with anti-aquaporin-4 (AQP4) immunoglobulin G (IgG) autoantibodies. Rapid extracorporeal elimination of autoantibodies with apheresis techniques, such as immunoadsorption (IA), was proven to be an effective treatment of NMOSD attacks.

View Article and Find Full Text PDF
Article Synopsis
  • The study investigates the treatment of cerebral venous thrombosis (CVT) caused by vaccine-induced immune thrombotic thrombocytopenia (VITT) following adenovirus-based COVID-19 vaccinations.
  • Researchers analyzed data from 99 patients across 17 countries to assess adherence to recommended treatments, including immunomodulation and avoiding certain anticoagulants.
  • While overall adherence to these treatment guidelines did not significantly impact mortality, patients who received immunomodulation showed lower mortality rates compared to those who did not.
View Article and Find Full Text PDF
Article Synopsis
  • - The study focuses on patients who developed cerebral venous sinus thrombosis (CVST) after receiving SARS-CoV-2 vaccines, specifically ChAdOx1 (Oxford-AstraZeneca) and Ad26.COV2.S (Johnson & Johnson), particularly looking at those with thrombosis with thrombocytopenia syndrome (TTS) versus those without.
  • - Data was gathered from an international registry from 81 hospitals spanning 19 countries, highlighting the clinical characteristics and mortality rates of patients with CVST in relation to their vaccination status.
  • - Of 116 postvaccination CVST patients, 67.2% had TTS, predominantly after the ChAdOx1 vaccine, with a notable percentage of female patients and
View Article and Find Full Text PDF

Widespread quick access to mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is one of the main challenges in stroke care. It is unclear if newly established MT units are required 24 h/7 d. We explored the diurnal admission rate of patients with AIS potentially eligible for MT to provide a basis for discussion of daytime-adapted stroke care concepts.

View Article and Find Full Text PDF

Background: Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran reversing its anticoagulant effects within minutes. Thereby, patients with acute ischemic stroke who are on dabigatran treatment may become eligible for thrombolysis with recombinant tissue-type plasminogen activator (rt-PA). In patients on dabigatran with intracerebral hemorrhage idarucizumab could prevent lesion growth.

View Article and Find Full Text PDF

Background: Changes in cerebral perfusion during migraine with aura (MA) have been assessed mainly using dynamic susceptibility contrast (DSC) magnetic resonance perfusion imaging. A contrast agent-free method to assess these changes would be desirable. We assessed changes in cerebral perfusion during MA using arterial spin labeling (ASL) perfusion magnetic resonance imaging.

View Article and Find Full Text PDF

Introduction: Based on data from the Baden-Wuerttemberg stroke registry, we aimed to explore the diurnal variation of acute ischemic stroke (IS) care delivery.

Materials And Methods: 92,530 IS patients were included, of whom 37,471 (40%) presented within an onset-to-door time ≤4.5 h.

View Article and Find Full Text PDF

Background: While the precise timing and intensity of very early rehabilitation (VER) after stroke onset is still under discussion, its beneficial effect on functional disability is generally accepted. The recently published randomized controlled AVERT trial indicated that patients with severe stroke might be more susceptible to harmful side effects of VER, which we hypothesized is contrary to current clinical practice. We analyzed the Baden-Wuerttemberg stroke registry to gain insight into the application of VER in acute ischemic stroke (IS) and intracerebral hemorrhage (ICH) in clinical practice.

View Article and Find Full Text PDF

Objective: To assess the influence of preexisting disabilities, age, and stroke service level on standardized IV thrombolysis (IVT) rates in acute ischemic stroke (AIS).

Methods: We investigated standardized IVT rates in a retrospective registry-based study in 36,901 patients with AIS from the federal German state Baden-Wuerttemberg over a 5-year period. Patients admitted within 4.

View Article and Find Full Text PDF

Background: The efficacy of intravenous thrombolysis (IVT) is sufficiently proven in ischemic stroke patients of middle and older age by means of randomized controlled trials and large observational studies. However, data in young stroke patients ≤50 years are still scarce. In this study, we aimed to evaluate the effectiveness and safety of IVT in young adults aged 18-50 years.

View Article and Find Full Text PDF

Background And Purpose: There are few in vivo data on the pathophysiology of reperfusion during systemic thrombolysis. We monitored the time course of cerebral perfusion changes in patients during thrombolysis with repeated arterial spin labeling perfusion magnetic resonance imaging.

Methods: Ten patients with proximal arterial occlusion within 4.

View Article and Find Full Text PDF

Background: The prognosis of stroke patients admitted to intensive care units (ICU) is commonly regarded to be poor. However, only limited data regarding outcome predictors are available.

Patients And Methods: Out of 4,958 consecutive patients admitted to our stroke unit with the diagnosis of acute stroke, after analysis we identified 347 patients (164 male) in need of ICU management.

View Article and Find Full Text PDF

In the last several years, great progress has been made in ultrasound perfusion imaging of the brain. Different approaches have been assessed and shown to be capable of the early detection of cerebral perfusion deficits in stroke patients. Real-time low-mechanical index imaging simplifies the acquisition of perfusion parameters and alleviates many of the previous imaging problems related to shadowing, uniplanar analysis, and temporal resolution.

View Article and Find Full Text PDF

Background And Purpose: Arterial spin labeling (ASL) MRI provides information on tissue perfusion by consecutive readout of labeled blood captured in arteries or the microvasculature without using contrast agents.

Methods: We used a single-shot 3D acquisition and readout technique for ASL with multiple inflow times (TI) to evaluate hemodynamic compromise and dynamics of arterial blood inflow expressed by the bolus arrival time (BAT). Thirty-six patients with ischemic stroke were examined with a standard multimodal MRI protocol including dynamic susceptibility contrast (DSC) and multi-TI ASL perfusion imaging.

View Article and Find Full Text PDF

Objective: To study the time dependent effectiveness of thrombolytic therapy for acute ischaemic stroke in daily clinical practice.

Design: A retrospective cohort study using data from a large scale, comprehensive population based state-wide stroke registry in Germany.

Setting: All 148 hospitals involved in acute stroke care in a large state in southwest Germany with 10.

View Article and Find Full Text PDF

Background: Different aspects of acute stroke management and strategies for stroke prevention derive from two viewpoints: specific traditional and historical backgrounds and evidence-based medicine from modern randomized controlled trials (RCTs), meta-analysis and authorized clinical practice guidelines (GLs). Regarding intracerebral hemorrhage (ICH), Cerebrovascular Diseases published the 2006 European stroke initiative recommendations for the management of ICH. In 2009, the revised Japanese GLs for the management of stroke, including that of ICH, appeared in Japanese.

View Article and Find Full Text PDF

Background: Different aspects of acute stroke management and strategies for stroke prevention derive from two viewpoints: specific traditional and historical backgrounds and evidence-based medicine from modern randomized controlled trials (RCTs), meta-analysis and authorized clinical practice guidelines (GLs). Regarding stroke, GLs have been published by national and international organizations in different languages, most frequently in English. Cerebrovascular Diseases published the European GLs for the management of ischemic stroke and transient ischemic attacks in 2003, with an update in 2008.

View Article and Find Full Text PDF

Early recanalisation and an increase in collateral blood supply are predictors of favourable outcome in acute ischaemic stroke. Since individual responses to intravenous treatment with alteplase are heterogeneous, additional intra-arterial thrombolytic and mechanical endovascular treatment is increasingly given. Despite encouraging findings from single-centre studies, data from randomised clinical trials have not proven the hypothesis that interventional recanalisation leads to a better outcome.

View Article and Find Full Text PDF

We investigated whether real-time ultrasound perfusion imaging (rt-UPI) is able to detect perfusion changes related to arterial recanalization in the acute phase of middle cerebral artery (MCA) stroke. Twenty-four patients with acute territorial MCA stroke were examined with rt-UPI and transcranial color-coded duplex ultrasound (TCCD). Ultrasound studies were consecutively performed within 24 h and 72-96 h after stroke onset.

View Article and Find Full Text PDF

Acute ischemic lesions of the posterior optic nerve and optic tract can produce a variety of visual field defects. A 71-year-old woman presented with acute hemianopia, which led to rt-PA thrombolysis for suspected posterior cerebral artery ischemia. 3-Tesla cMRI, however, revealed the cause to be an acute posterior ischemic optic neuropathy.

View Article and Find Full Text PDF

Purpose: To investigate blood to tissue water transfer in human brain, in vivo and spatially resolved using a T2-based arterial spin labeling (ASL) method with 3D readout.

Materials And Methods: A T2-ASL method is introduced to measure the water transfer processes between arterial blood and brain tissue based on a 3D-GRASE (gradient and spin echo) pulsed ASL sequence with multiecho readout. An analytical mathematical model is derived based on the General Kinetic Model, including blood and tissue compartment, T1 and T2 relaxation, and a blood-to-tissue transfer term.

View Article and Find Full Text PDF

Introduction: A vascular right-to-left shunt (r/l shunt) is a well-known risk factor for the development of decompression sickness (DCS). No studies to date have examined whether divers with a history of DCS with or without a r/l shunt have a reduced risk of suffering recurrent DCS when diving more conservative dive profiles (CDP).

Methods: Twenty-seven divers with a history of DCS recommended previously to dive more conservatively were included in this study and retrospectively interviewed by phone to determine the incidence of DCS recurrence.

View Article and Find Full Text PDF

Rapid advances in microbubble pharmacology together with novel ultrasound technologies for contrast-specific imaging of the macro- and microcirculation have led to a number of new applications for assessment of stroke patients. In particular, ultrasound perfusion imaging has added new perspectives for diagnosis and monitoring of both ischemic and hemorrhagic stroke. Recently, real-time brain perfusion imaging of middle cerebral artery infarctions has been introduced and new quantitative algorithms for evaluation of regional cerebral blood flow are being applied for the first time in humans.

View Article and Find Full Text PDF

Cerebral infarctions in the anterior cerebral artery (ACA) territory account for only up to 3-5% of strokes. Subject to the affected ACA branches, different clinical patterns can be defined. We report a case series of patients with isolated infarctions of the pericallosal (PC) artery territory.

View Article and Find Full Text PDF

Background: Hemorrhagic transformation (HT) after acute ischemic stroke is frequently detected using magnetic resonance imaging (MRI), in particular in patients treated with tissue plasminogen activator (tPA). Knowledge about causes and early clinical consequences of HT mostly arises from computed tomography-based studies. We analyzed potential predictors and early outcome of HT after stroke detected by MRI with T(2)*-weighted gradient echo sequences (T(2)*-MRI).

View Article and Find Full Text PDF

A PHP Error was encountered

Severity: Warning

Message: fopen(/var/lib/php/sessions/ci_sessionfepeo2ujslco0o2q5epve0e5ft7omddj): Failed to open stream: No space left on device

Filename: drivers/Session_files_driver.php

Line Number: 177

Backtrace:

File: /var/www/html/index.php
Line: 316
Function: require_once

A PHP Error was encountered

Severity: Warning

Message: session_start(): Failed to read session data: user (path: /var/lib/php/sessions)

Filename: Session/Session.php

Line Number: 137

Backtrace:

File: /var/www/html/index.php
Line: 316
Function: require_once