Publications by authors named "Masuhr F"

Article Synopsis
  • - New guidelines on cerebral venous and dural sinus thrombosis (CVT) have emerged, focusing on risk factors, treatment options including direct oral anticoagulants, and interventional treatments, based on expert consensus from Germany, Austria, and Switzerland.
  • - Key recommendations highlight that CVT may relate to severe thrombocytopenia post-SARS-CoV-2 vaccination, D-dimer testing is not advised for routine use, and thrombophilia screening should be considered under specific conditions.
  • - Treatment recommendations suggest using low molecular weight heparin in the acute phase, with endovascular interventions for patients not responding adequately, and oral anticoagulation for 3 to 12 months afterward to reduce the risk of recurrence.
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Purpose: The Harlequin syndrome may occur in patients treated with venoarterial extracorporal membrane oxygenation (VA-ECMO), in whom blood from the left ventricle and the ECMO system supply different parts of the body with different pCO-levels. The purpose of this study was to compare two variants of pCO-analysis to account for the Harlequin syndrome during apnea testing (AT) in brain death (BD) determination.

Materials And Methods: Twenty-seven patients (median age 48 years, 26-76 years; male n = 19) with VA-ECMO treatment were included who underwent BD determination.

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Background: Computed tomography angiography (CTA) has been investigated as a confirmatory study (CS) for the diagnosis of brain death (BD). International consensus regarding its use, study parameters, and evaluation criteria is lacking. In the German BD guideline, a CTA protocol was first introduced in 2015.

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Background: The 4th update of the guidelines of the German Medical Association on the diagnosis of irreversible loss of brain function (brain death, BD) has introduced important new regulations regarding the required qualification of the examiners, approved procedures for ancillary testing, and a clarification regarding the sequencing of diagnostic steps.

Objective: Investigation of the implementation and practical effects on the diagnosis of brain death.

Method: Descriptive evaluation of the routine documentation of the German Organ Procurement Organization, comparing the periods July 2011-June 2015 (3rd update) and July 2015-June 2019 (4th update).

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Background: In Germany, postmortem organ donation requires a diagnosis of irreversible brain death (BD) in strict compliance with the guidelines of the German Medical Association.

Objective: Identification of factors that have a limiting effect on the initiation and execution of BD diagnostics. Identification of potential for improvement.

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Aims: The Berlin Atrial Fibrillation Registry was designed to analyse oral anticoagulation (OAC) prescription in patients with atrial fibrillation (AF) and acute ischaemic stroke.

Methods And Results: This investigator-initiated prospective multicentre registry enrolled patients at all 16 stroke units located in Berlin, Germany. The ongoing telephone follow-up is conducted centrally and will cover 5 years per patient.

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The prevalence of atrial fibrillation (AF), the most common cardiac arrhythmia, increases with age, predisposing elderly patients to an increased risk of embolic stroke. With an increasingly aged population the number of people who experience a stroke every year, overall global burden of stroke, and numbers of stroke survivors and related deaths continue to increase. Anticoagulation with vitamin K antagonists (VKAs) reduces the risk of ischemic stroke in patients with AF; however, increased bleeding risk is well documented, particularly in the elderly.

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Background And Purpose: Here, we studied the safety of apnea testing (AT) for the determination of brain death with regard to intracranial pressure (ICP), cerebral perfusion and arterial blood gas parameters. We hypothesized that ICP only increases when cerebral perfusion pressure (CPP) remains positive during AT.

Methods: A total of 34 patients who fulfilled brain death criteria were identified by chart review (2009-2017).

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Background: According to the current update of the German guideline on brain death (BD), participation of paediatricians is now mandatory for the examination of BD in patients younger than 14 years. The present analysis focuses on the previous practice and highlights the challenges that arise from the current update.

Methods: Retrospective evaluation of the patient registry of the German organ procurement organisation (north-eastern bureau) between January, 2001 and December, 2010 with specified paediatric age groups according to the 4th update of the German guideline on BD from the 1st of July 2015.

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The current proposal for cerebral venous thrombosis guideline followed the Grading of Recommendations, Assessment, Development, and Evaluation system, formulating relevant diagnostic and treatment questions, performing systematic reviews of all available evidence and writing recommendations and deciding on their strength on an explicit and transparent manner, based on the quality of available scientific evidence. The guideline addresses both diagnostic and therapeutic topics. We suggest using magnetic resonance or computed tomography angiography for confirming the diagnosis of cerebral venous thrombosis and not screening patients with cerebral venous thrombosis routinely for thrombophilia or cancer.

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Background And Purpose: Current guidelines on cerebral venous thrombosis (CVT) diagnosis and management were issued by the European Federation of Neurological Societies in 2010. We aimed to update the previous European Federation of Neurological Societies guidelines using a clearer and evidence-based methodology.

Method: We followed the Grading of Recommendations, Assessment, Development and Evaluation system, formulating relevant diagnostic and treatment questions, performing systematic reviews and writing recommendations based on the quality of available scientific evidence.

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With the introduction of edoxaban last year in Germany, four nonvitamin K antagonist oral anticoagulants are now available for stroke prevention in patients with nonvalvular atrial fibrillation. These novel oral anticoagulants (NOAC) represent an attractive new option compared to vitamin K antagonists (e.g.

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Background And Purpose: The influence of temporal patterns of intracerebral haemorrhage (ICH) on the outcome of heparin-treated patients with cerebral venous sinus thrombosis (CVST) has not been examined systematically.

Methods: Temporal patterns of ICH and their influence on survival without disability (modified Rankin Scale score ≤1 point) at hospital discharge were examined in 141 consecutive hospital-admitted patients with acute CVST who were treated with intravenous unfractionated heparin.

Results: Of all 141 patients (median age 40 years; 73% women), 59 (42%) had ICH at the time of diagnosis (early ICH).

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Purpose: We investigated whether a critical rise of intracranial pressure (ICP) leading to a loss of cerebral perfusion pressure (CPP) could serve as a surrogate marker of brain death (BD).

Materials And Methods: We retrospectively analyzed ICP and CPP of patients in whom BD was diagnosed (n = 32, 16-79 years). Intracranial pressure and CPP were recorded using parenchymal (n = 27) and ventricular probes (n = 5).

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Background: According to the German Medical Council guidelines, the proof of irreversible brain death can be carried out using clinical investigations alone or can necessitate the use of ancillary tests (ATs), depending on the patient age and type of brain injury.

Methods: Retrospective evaluation of the diagnostics of irreversible brain death, which were carried out using ATs according to the third edition of the guidelines between January 2001 and December 2010 in Berlin, Brandenburg and Mecklenburg-Western Pomerania and were registered at the German National Foundation for Organ Transplantation.

Results: In 1401 patients (aged 0-94 years) a total of 1636 ATs were carried out.

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Background: In the absence of primary infratentorial brain lesions, the German guideline on brain death (BD) permits diagnosis based on two clinical assessments separated by a defined observational period or by one clinical assessment and an ancillary test.

Methods: Retrospective analysis of patients fulfilling the clinical criteria of BD registered with the organ procurement organization of northeastern Germany during a 10-year period.

Results: 2,745 patients were included.

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Background And Objectives: In Germany the diagnosis of brain death must strictly adhere to the expert guidelines of the German chamber of physicians. For patients with primary supratentorial or hypoxic brain injury aged 2 years or more, repeat clinical examinations or one complete examination combined with an ancillary test are equally accurate. This study aimed to identify factors with potential impact on whether and by which means a formal brain death examination is pursued.

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Dural sinus or cerebral venous thrombosis (CVT) is a frequently unrecognized cause of stroke affecting predominantly young women. Typical clinical signs include headache, visual problems and seizures. Both computed tomography and magnetic resonance venous angiography are suitable for the detection of CVT, although magnetic resonance angiography is more sensitive to detect small cortical venous thrombosis.

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Despite considerable advances in acute stroke therapy, stroke prevention remains the most promising approach for reducing the burden of stroke. A healthy lifestyle and the treatment of cardiometabolic risk factors are the cornerstones of both primary and secondary stroke prevention. Due to a proportionately higher risk of bleeding complications, platelet inhibitors are not recommended for primary stroke prevention.

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The objective of the study was to use 320-detector row 4D CT angiography (CTA) for measuring cerebral circulation times (CCT) and to assess early venous drainage (EVD) and shortening of CCT in arteriovenous malformations (AVM) and to compare with DSA. CCT of 12 physiological patients and five AVM patients were acquired using a 4D CTA protocol by recording cerebrovascular bolus passage time. In the AVM patients EVD time (EVDT) was measured.

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320-row CT enables dynamic CT angiography (4D CTA) of the entire intracranial circulation and whole-brain perfusion imaging (CTP). Sixty acute patients with neurological symptoms underwent various 320-row CT-specific protocols, including combined 4D CTA and CTP. Clinical and neuroradiological records were assessed for presumptive diagnoses, final diagnoses, supplementary and follow-up imaging studies.

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Background: Cerebral venous and sinus thrombosis (CVST) is a rather rare disease which accounts for <1% of all strokes. Diagnosis is still frequently overlooked or delayed as a result of the wide spectrum of clinical symptoms and the often subacute or lingering onset. Current therapeutic measures which are used in clinical practice include the use of anticoagulants such as dose-adjusted intravenous heparin or body weight-adjusted subcutaneous low-molecular-weight heparin (LMWH), the use of thrombolysis and symptomatic therapy including control of seizures and elevated intracranial pressure.

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Background And Purpose: A low ankle-brachial blood pressure index (ABI) is an established risk marker for cardiovascular disease and mortality in the general population, but little is known about its prognostic value in individuals with acute ischemic stroke or transient ischemic attack (TIA).

Methods: An inception cohort of 204 patients with acute ischemic stroke or TIA was followed up for a mean of 2.3 years.

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