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Chorea (#R: -4; #F: 5)
Extra-pyramidal-motorische Erkrankungen
- hyperkinetisches Syndrom
- psychische Auffälligkeiten
- Spätfolge: Demenz

Chorea major Huntington
- Häufigkeitsgipfel um das 40. Lebensjahr
- Autosomal-dominante Trinukleotid-Repeat-Vergrößerung (CAG-Repeat)
- irreversibler Untergang von GABA-ergen Neuronen im Striatum durch Ablagerungen von Huntingtin

Chorea minor Sydenham
- 6-13 Jahre
- häufig Mädchen
- im Rahmen eines rheumatischen Fiebers (ß-hämolysierenden Streptokokken der Gruppe A)
- Ablagerung von Immunkomplexe im Striatum

Symptome bei Chorea major
- Plötzlich einschießende Hyperkinesien(Grimassieren, Chamäleonzunge und Klavierspielerbewegungen)
- Dysarthrophonie und ruckartige Hyperlordosierung
- Vegetative Symptome (Hyperhidrosis, Harninkontinenz)
- Mutismus
- Blepharospasmus
- Kachexie
- demenzielle Entwicklung

Therapie Corea major
- Riluzol gegen Glutamatausschüttung
- Tiaprid oder Sulpirid gegen Hyperkinesien
- Atypische Neuroleptika bei psychotischen Zuständen
- SSRI bei depressiven Zuständen

Prognose
- Chorea major: schlecht
- chorea minor: gut
Spastische Spinalparalyse (#R: -1; #F: 3)
nicht-entzündliche, neurodegenerative Erkrankung
- Untergang der Pyramidenbahn und des Gyrus praecentralis.
- autosomal dominant vererbt

Symptome
- spastischen Paresen
- Hohlfußbildung
- Dysarthrie
- Harnblaseninkontinenz
- kognitiven Störungen

Therapie
keine kausale Therapie
meist nur langsam progredient
Juvenile myoklonische Epilepsie (#R: 0; #F: 3)
= Impulsiv-Petit-mal = Janz-Syndrom

- Beginn der Erkrankung: 12.-20. Lebensjahr

- Astatischer Anfall mit plötzlichem Tonusverlust
- blitzartiges Hinfallen
- Bilateral symmetrische Myoklonien
- Wegschleudern der Extremitäten
- Meist zeitlich in der Nähe des Aufwachens
- Photosensibilität

- Immer ohne Bewusstseinsstörung

EEG:
- 3-5/s spikes and waves
- Poly-spikes-and-waves
Charcot-Marie-Tooth-Krankheit (#R: -1; #F: 2)
Hereditäre motorisch-sensible Neuropathien (Typ I)

- Distal symmetrische sensomotorische Polyneuropathie
- Atrophie der Wadenmuskulatur (Storchenbeine)
M. Fabry (#R: 0; #F: 2)
lysosomale Sphingolipidose
- X-chromosomal-rezessiv
- Mangel an α-Galaktosidase A

- im Kindesalter

- akrodistale Parästhesien
- gastrointestinale Beschwerden
- Anhidrose
- Angiokeratome
- Vortexkeratopathie
Medikamentöse Therapieoption - Absencen (#R: 0; #F: 2)
- Valproat
- Ethosuximid
Kearns-Sayre-Syndrom (#R: 1; #F: 2)
Das Kearns-Sayre-Syndrom gehört zu den mitochondrialen Myopathien, die maternal über die Mitochondrien vererbt werden. Es geht mit Ophthalmoplegie, Retinopathia pigmentosa und Störungen des Herzreizleitungssystems einher.
Bulbospinale Muskelatrophie (#R: 0; #F: 2)
= Kennedy-Syndrom

Degeneration des 2. Motorneurons
- X-chromosomal-rezessiv
- junges Erwachsenenalter

- Infertilität
- Gynäkomastie

- Atrophie und Faszikulationen proximaler Extremitätenabschnitte (Schultergürtel), der Zungen- und Schlundmuskulatur
- Atrophien des M. temporalis
Hirntumor - WHO-Grad III (#R: 0; #F: 2)
Mittlere Überlebenszeit: 2-3 Jahre

- Astrozytom Grad III = Anaplastisches Astrozytom
- Oligodendrogliom
Denny-Brown-Syndrom (#R: 0; #F: 2)
Paraneoplastische Polyneuropathie
- bei kleinzelligem Bronchialkarzinoms

- Distal-symmetrische Parästhesien
- Störungen der Propriozeption
- Störungen der vegetativen Regulation
Spinale Muskelatrophien - hereditär Typ III (#R: 1; #F: 1)
= Kugelberg-Welander

- Manifestation: Zwischen dem 2. und 18. Lebensjahr
- autosomal rezessiv oder autosomal dominant

Symptome
- Symmetrische atrophische Paresen (Beckenmuskulatur/unteren Extremität)
-> Watschelgang
-> Treppensteigen und Aufstehen erschwert
- Später auch Befall der oberen Extremität
- Muskelfaszikulationen

Lebenserwartung ist kaum eingeschränkt
Myotone Syndrome (#R: 1; #F: 1)
Tonische Verlängerung der Muskelkontraktion über den Innervationszeitraum hinaus

Symptome
- Muskuläre Startschwierigkeiten nach einer Ruhephase

Klassifikation
1) Nichtdystrophen Myotonien
- Myotonia congenita Thomson
- Paramyotonia congenita Eulenburg
-> Erste Lebensdekade
-> Keine Therapie notwendig

2) Dystrophe Myotonien
- Typ Curschmann-Steinert/DM1 - häufigstes myotones Syndrom!
- Proximaler Typ/DM2
-> Zweite Lebensdekade
-> Lebenserwartung häufig eingeschränkt

Keine Heilung möglich
Meige-Syndrom (#R: 0; #F: 1)
Blepharospasmus + oromandibulärer Dystonie

- Vornehmlich Frauen im 7. Lebensjahrzehnt
Segawa-Krankheit (#R: 0; #F: 1)
= L-Dopa-sensitive Dystonie

- Junge Mädchen

- Gangstörungen
- Flexions- und Innenrotationsstellung der Füße

- Starke Schwankungen der Symptome im Tagesverlauf
- Dystonie nimmt im Laufe des Lebens an Intensität zu

Therapie
- Therapeutisches Ansprechen auf L-Dopa-Gabe
N. XII (#R: 0; #F: 1)
Nervus hypoglossus

Zunge herausstrecken
- Abweichung zur kranken Seite bei Nervenausfall durch ein Überwiegen der Muskulatur der gesunden Seite.

Zunge von innen in die Wange drücken lassen und Kraftprüfung von außen
Trizepssehnenreflex (TSR) (#R: 1; #F: 1)
C6-C8

Der Untersucher hält den Arm des Patienten im angewinkelten Zustand und klopft mit dem Reflexhammer auf die Trizepssehne, wodurch eine Extension im Ellebogengelenk ausgelöst wird.
Adduktorenreflex (#R: 1; #F: 1)
L2-L4

Zu einer Adduktionsbewegung der Beine kommt es beim Beklopfen der Sehnen oberhalb des Condylus medialis femoris.
Kortikobasale Degeneration (#R: 1; #F: 1)
- Hemiparkinson-Syndrom
- eine Extremität vom Patienten als fremd wahrgenommen (alien limb)
Lewy-Body-Demenz (#R: 1; #F: 1)
Neurodegenerative Demenz mit histopathologischem Korrelat kortikaler und limbischer Lewy-Einschluss-Körperchen

- niedriges Alter bei Erkrankungsbeginn
- rasche Progredienz
- Kognitive, demenzielle Defizite
- Visuelle Halluzinationen und paranoide Episoden
- Extrapyramidalmotorische Symptome (Bradykinese, Rigor)

KEINE Neuroleptika!
Segawa-Syndrom (#R: 1; #F: 1)
Dopa-responsive Dystonie
- Sonderform einer generalisierten Dystonie
- phasenweise, unkontrollierbare Muskelkontraktionen
- junge Mädchen im ersten Lebensjahrzehnt

- Gangstörung
- Flexions- und Innenrotationsstellung der Füße
- starke Schwankungen im Tagesverlauf

- spricht gut auf L-Dopa-Gabe an
Refsum-Syndrom (#R: 1; #F: 1)
hereditäre motorisch-sensible Neuropathie (HMSN)

- Ataxie
- Retinopathia pigmentosa
- Ichthyosis
- Taubheit
Curschmann-Steinert-Erkrankung (#R: 1; #F: 1)
Myotone Dystrophien
- autosomal-dominant
- Trinukleotid-Repeat-Erkrankung -> Antizipationseffekt
- Defekt der Myotonin-Proteinkinase
-> in Skelett- und Herzmuskulatur, Gonaden und Gehirn

1) Kongenitale Form: Säuglingsalter
2) Adulte Form: 20.-30. LJ.

Lokalisation
- Distale Extremitäten
- Gesicht
- Nacken

- Stirnglatze
- Hodenatrophie/Ovarialinsuffizienz
- Demenz
Stiff-Person-Syndrom (#R: 1; #F: 1)
Das Stiff-Person- oder auch Stiff-Man-Syndrom ist eine Autoimmunerkrankung mit Antikörpern gegen die Glutamat-Decarboxylase (in 60-90% der Fälle) oder gegen Amphiphysin.
Louis-Bar-Syndrom (#R: 1; #F: 1)
Phakomatose
- im Kindesalter

- Ataxie
- faziale und konjunktivale Teleangiektasien
- okulomotorische Störungen
- kognitiven Störungen
- verminderte Immunkompetenz
Opsoklonus-Myoklonus-Syndrom (#R: 0; #F: 1)
Enzephalitis des Hirnstamms

- Opsoklonien (unwillkürliche Zuckungen der Augen)
- Myoklonien (Muskelzuckungen)
- Ataxie äußert

häufig paraneoplastisch
- bei Kindern: Hirntumore
- bei Erwachsenen: Mamma- und Bronchialkarzinome
Mittelhirnsyndrom (#R: 2; #F: 1)
Ausfall der Formatio reticularis und Einklemmung der Zentren für den visuellen Lichtreflex

- Überstreckung von Rumpf und allen Extremitäten, Arme adduziert und innenrotiert, Finger gebeugt→ sogenannte Dezerebrationshaltung
- Erhöhter Muskeltonus mit gelegentlichem Opisthotonus
- Pupillenreflexe träge oder nicht mehr vorhanden
- Lebhafte Muskeleigenreflexe
- Pathologische Reflexe
- Tachypnoe (Maschinenatmung)
Rolando-Epilepsie (#R: 0; #F: 1)
- Häufigste Epilepsie des Kindesalters
- Altersgipfel: 5.-9. Lebensjahr

- Meist schlafgebundene
- tonische Gesichtskrämpfe
- vermehrte Salivation
- Sprachunfähigkeit

EEG
- Zentrotemporale sharp waves

- Heilt in der Regel mit Erreichen der Pubertät aus
N. IV (#R: 0; #F: 1)
- M. obliquus superior

- Schräg stehende, vertikale Doppelbilder
- stärkste Doppelbilder beim Blick nach nasal unten (z.B. beim Lesen)

Bielschowsky-Phänomen
- Größte Schielabweichung bei Kopfneigung zur Seite des paretischen Muskels
-> Kompensatorisch Kopfneigung zur Gegenseite
Foramen rotundum (#R: 1; #F: 1)
Schädigung des N. maxillaris (2. Ast des Nervus trigeminus)
Creutzfeldt-Jakob-Krankheit (#R: 0; #F: 1)
Nicht-entzündliche, degenerative Enzephalopathie
- fehlgefaltete Proteine (Prionen)
- Latenz nach Infektion bis zu 30 Jahren
- Rasch letal, keine kausale Therapie verfügbar

Symptomen
- Appetit- und Schlaflosigkeit
- Rasche Demenzentwicklung
- Myoklonien
- zerebellären Störungen (Ataxie)
- psychiatrischen Auffälligkeiten
- akinetischer Mutismus

Histologie
- Spongiöses Hirngewebe

EEG
- triphasische Sharp-wave-Komplexe
Elsberg-Syndrom (#R: 0; #F: 1)
- Radikulomyelitis
- ähnlich Konus-Kauda-Syndrom

Es ist fraglich, ob hier eine eigene Krankheitsentität vorliegt.
Meralgia paraesthetica (#R: 1; #F: 1)
Eine Reizung des N. cutaneus femoralis lateralis führt charakteristischerweise zu einer hypästhetischen Zone im Versorungsgebiet des Nervs. Meist sind davon adipöse Menschen oder Schwangere betroffen.
Ependymom (#R: 2; #F: 1)
Aus den Ependymzellen der Hirnventrikel wachsender Tumor (WHO I-IV)
- Kinder bis junge Erwachsene

Lokalisation
- ⅔ im 4. Ventrikel

Symptome
- Dauerkopfschmerz
- Evtl. Verschlusshydrozephalus

CT
- Hyperdenser Tumor nach KM-Gabe

Histologie
- Perivaskuläre Tumorzellgruppierungen = Pseudorosetten

Lumbalpunktion
- Abtropfmetastasen

Therapie
- Resektion
- Radiatio
Meningokokken-Impfung (#R: 1; #F: 1)
Totimpfstoff

Polysaccharid oder Konjugatimpfstoff
- Subtypen A, C, W135 und Y

Konjugatimpfstoff g
- Subtyp C (zweithäufigster Typ in Deutschland)

Routinemäßig im 2. Lebensjahr: Einmalige Impfung gegen Typ C
Capsula interna - Infarkt (#R: 1; #F: 1)
- Kontralaterale Hemiparese
- kontralaterale Hirnnervenausfälle
Vertebrobasiläre Insuffzienz (#R: 0; #F: 1)
- Drehschwindel
- drop-attacks
- Tinnitus
- Sehstörungen
Migräne (#R: 0; #F: 1)
- 60% einseitiger Kopfschmerz
- insbesondere frontal, frontotemporal, retroorbital
- Dauer: 4-72 Stunden

- Verstärkt bei körperlicher Aktivität
- Übelkeit, Erbrechen
- Phonophobie
- Photophobie

Aura-Phänomenen (15%)
- Gesichtsfeldausfälle (Flimmerskotome) von parazentral nach peripher wandernd
- Paresen

Akut-Therapie
- NSAR (ASS, Ibuprofen, Paracetamol)
- Triptane (Sumatriptan, Almotriptan) -> Agonist des 5-HT₁-Rezeptors -> Vasokonstriktion
- Metoclopramid / Domperidon -> Übelkeit

Prophylaxe
- Betablocker (Metoprolol , Bisoprolol)
- Topiramat (Antikonsulsivum)
- Flunarizin (Ca-Antagonist)
Nervus suprascapularis (#R: 1; #F: 1)
Motorik
- M. infraspinatus
- M. supraspinatus

Symptomatik
- Adduktion
- Abduktion
- Außenrotation
Nervus fibularis communis-Läsion (#R: 1; #F: 0)
L4-S2

Ätiologie
- zu engen Gipsverband
- Fibulafraktur

Sensibilität
- Spatium interosseum 1 (Bereich zwischen erster und zweiter Zehe)
- lateraler Unterschenkel
- Fußrücken

Motorik
- Fuß- und Zehenheber (Steppergang)
- Gestörte Pronation
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Nervus saphenus-Läsion (#R: 1; #F: 0)
Rein sensibler Ast des N. femoralis

Sensibilität
- infrapatellare Region
- medialer Unterschenkel
- medialer Fußrand
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"Jinan is a safe choice, as we are a conservative city, so officials are confident the trial can proceed without incident," said taxi driver Liu Jinsen. "Here in Shandong we provide more soldiers to the army than any other province, and they are the most obedient."
Nervus suralis-Läsion (#R: 1; #F: 0)
Rein sensibler Ast (aus Nn. tibialis und fibularis)

Sensibilität
- lateraler Unterschenkel
- lateraler Fußrandes
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Nervus radialis-Lähmung (#R: 1; #F: 0)
C6-Th1

Motorik
- Strecker von Arm, Hand und Finger

Sensorik
- dorsale Finger I-III

Proximale Schädigung
- Parkbanklähmung
- Humerusschaftfraktur
-> Fallhand
-> Sensibilitätsstörung radiale Seite des Handrückens

Distale Schädigung
- Radiusfrakturen (Ramus profundus)
- Luxation des Radiuskopfes (Ramus profundus)
-> Strecker der Finger fallen aus (keine richtige Fallhand!)

- Straffe Armbanduhr (Ramus superficialis = Cheiralgia paraesthetica)
-> Sensibilitätsstörung radiale Seite des Handrückens

Reflexe
- Brachioradialisreflexes (Radiusperiostreflexes)
- Trizepssehnenreflexes bei hoher Schädigung (Axilla)
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Nervus ulnaris-Lähmung (#R: 2; #F: 0)
C8 - Th1

Proximale Nervenläsion (im Sulcus nervi ulnaris)
- Krallenhand (in Grundgelenk überstreckt, im Mittel- & Endgelenk gebeugt)
- Sensibilitätsstörungen: Finger 4+5 (ulnar)
- Nach 3 Monaten: Atrophie der Mm. interossei + Hypothenaratrophie

Mittlerer Nervenläsion (in der Guyon-Loge)
- wie proximal (Krallenhand)
- Ausnahme: Hypothenarregion nicht betroffen

Distale Nervenläsion (in der Hohlhand)
- Krallenhand
- Keine Sensibilitätsausfälle

Klinische Zeichen
- Froment-Zeichen (Daumen nicht mehr Adduzieren)
- Jeanne-Zeichen (Hyperextension im Daumengrundgelenk)
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Nervus-medianus-Lähmung (#R: 1; #F: 0)
C6 - Th1

Proximale Schädigung
- Flexoren von Daumen, Zeige-, und Mittelfinger -> Schwurhand
- Fehlende Opponierbarkeit des Daumens
- Pronationsschwäche
- Thenarmuskelatrophie
- Sensibilitätsstörungen: radiale Handinnenfläche + Fingerkuppen I-III

Distale Schädigungen (im Bereich des Handgelenks)
1) Interosseus-anterior-Syndrom (Kiloh- Nevin- Syndrom)
- M. flexor digitorum profundus von Finger II
- M. flexor pollicis longus
→ Fehlende Beugung der Endglieder von Daumen und Zeigefinger
- Keine Sensibilitätsausfälle

2) Karpaltunnelsyndrom
- Keine Schwurhand
- Sensibilitätsstörungen
- Thenarmuskelatrophie

Klinische Zeichen
- Flaschenzeichen

- Hoffmann-Tinel-Zeichen (Karpaltunnelsyndrom)
- Phalen-Zeichen (Karpaltunnelsyndrom)

- Pinch Sign (Interosseus-anterior-Syndrom)
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Neuralgische Schulteramyotrophie (#R: 1; #F: 0)
Einseitige Lähmung des Plexus brachialis

- akute heftigste Schulterschmerzen
- typischerweise nachts

- Nach Tagen: Lähmungserscheinungen + Atrophie der Schulter-Arm-Muskulatur
- Scapula alata

Therapie
- Glukokortikoide

Prognose
- Meist Rückbildung innerhalb 1 Jahres
Periphere Fazialisparese (#R: 1; #F: 0)
Komplette mimische Muskulatur paretisch
- inklusive Stirnrunzeln und Augenschließen DD zentrale Fazialisparese

Ätiologie
- Idiopathisch (80%)

- Borrelien: Häufigste Ursache beim Kind - meist beidseits
- Herpes zoster / oticus

- Bei Resektion der Glandula parotis
- Bei Resektion der Glandula submandibularis (Ramus marginalis )

- Parotistumor
- Akustikusneurinom

- Otitis media
- Cholesteatom

- Melkersson-Rosenthal-Syndrom
- Sarkoidose (Heerfordt-Syndrom)

Klinische Zeichen
- Bell-Phänomen (Weiße der Sklera bei Augenschluss sichtbar)
- Signe de cils
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Akute Pandysautonomie (#R: 1; #F: 0)
Variante des Guillain-Barré-Syndrom
- Störung sämtlicher autonomer Funktionen

- Kreislaufregulation
- Schweiß-, Tränen- und Speichelsekretion
- Lähmungen der inneren Augenmuskeln
- Blasen- und Mastdarmstörungen
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Vitamin-B12-Mangel (#R: 1; #F: 0)
Vitamin-B12 dient der Regeneration der Folsäure
-> megaloblastäre Anämie
-> makrozytäre, hyperchrome Anämie

Ätiologie
- Mangelernährung (chronischem Alkoholabusus, Anorexie, Veganern)
- Perniziöse Anämie (Autoantikörper zerstören die Parietalzellen -> Intrinsic-Faktor-Mangel)
- Sprue, Morbus Crohn

Symptome
- Blässe, Abgeschlagenheit
- Ikterus
- Hunter-Glossitis (Atrophie der Zungenschleimhaut -> rot, brennend)

Diagnostik
- Vitamin-B12-Serumspiegel
- Schilling-Test (Vitamin-B12-Resorptionstest)
- Retikulozyten↓
- Eisen↑
- Thrombozytopenie und Leukopenie (Panzytopenie)

Therapie
- Parenterale Vitamin-B12-Substitution
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International directory enquiries http://onlinelevitra.in.net/ buy levitra online It was around that time that the kill switch idea firststarted to gain momentum. At an SEC roundtable in October,exchanges generally endorsed the concept of deploying killswitches to stop trading so that errors could not be unleashedonto the broader marketplace.
Funikuläre Myelose (#R: 2; #F: 0)
Neurodegenerative demyelinisierende Erkrankung durch Vitamin-B12-Mangel

- Hinterstränge
- Pyramidenbahnseitenstränge
- Optikusnerv
- Später PNS + ZNS

Symptome
- Distal symmetrische, aufsteigende Hypästhesien
- spinale Ataxie
- Spastische Paraparese
- paranoide Symptomatik

Therapie
- Parenterale Vitamin-B12-Substitution
Amyotrophe Lateralsklerose (#R: 2; #F: 0)
Degenerative Erkrankung des 1. und des 2. Motoneurons
-> Zeitgleiches Auftreten spastischer (1. Motoneuron) UND schlaffer Paresen (2. Motoneuron = Vorderhornzelle)

- Altersgipfel > 70 Jahre

- Sensibilität NICHT betroffen
- Blasen- und Mastdarmfunktion NICHT betroffen

Frühsymptome
- atrophische, schlaffe Paresen (Hand-, Schulter-, Wadenmuskeln)
- Faszikulationen

Spätsymptome
- spastischer Paresen (Vorderhornzellen)
- bulbären Symptomatik (Hirnnervenkerne)
-> Dysarthrie, Dysphagie und Sialorrhoe
-> Atrophie der Zungenmuskulatur
-> Pathologisches Lachen und Weinen

- Erhöhung der Kreatinkinase (CK) im Serum

Elektromyelographie (EMG)
- Pathologische Spontanaktivität
- großamplitudiges, aber gelichtetes Aktivitätsmuster

Therapie
- Riluzol (Glutamat-Antagonist)
- Baclofen (gegen Spastik)
- Atropin (Gegen Hypersalivation)
- Opiate und Benzodiazepine

Prognose
- Versterben meist nach 3-5 Jahre an Ateminsuffizienz / Pneumonie
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Progressive Bulbärparalyse (#R: 1; #F: 0)
Degeneration der motorischen Hirnnervenkerne im Bulbus der Medulla oblongata

- Bei amyotrophen Lateralsklerose oder Poliomyelitis

- Dysarthrie (sog. bulbäre Sprache)
- Dysphagie
- Pathologisches Lachen und Weinen
- Amimie
- Atrophische Zungenparese
- Fibrillationen
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Spinale Muskelatrophien (#R: 1; #F: 0)
Nicht-entzündliche Degeneration des 2. Motoneurons

Ätiologie
- hereditär -> im Kindesalter
- sporadisch -> im Erwachsenenalter

- atrophischen Paresen
- Areflexie
- Faszikulationen

Elektromyographie (EMG)
- pathologische Spontanaktivität
- Riesenpotentiale

Muskelbiopsie
- Faseratrophie
- Hypertrophie der verbliebenen Fasern
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Spinale Muskelatrophien - hereditär Typ I (#R: 1; #F: 0)
= Werdnig-Hoffmann

- Manifestation: Innerhalb des 1. Lebensjahres
- Autosomal-rezessiv

Symptome
- Symmetrische atrophische Paresen
- Initial am Beckengürtel (floppy infant)
- Später symmetrische Fazialisparesen

Mittlere Überlebenszeit: 1,5 Jahre
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Spinale Muskelatrophie - Typ Duchenne-Aran (#R: 1; #F: 0)
- Häufigste SMA
- Manifestationsalter: Um das 30. Lebensjahr

- sporadisch (NICHT hereditär!)

Symptome
- Zunächst atrophische Paresen der Handmuskulatur (Bild der sog. Krallenhand)
- Später Ausbreitung nach proximal, insbesondere auf Schulter

Keine Einschränkung der Lebenserwartung
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Myasthenia gravis (#R: 1; #F: 0)
Störung der Signalübertragung an der motorischen Endplatte
- in der Synapse zwischen Neuron und Muskel
- Autoantikörper gegen den postsynaptischen Acetylcholin-Rezeptor (ACh-R) (85%)
- Häufig assoziiert mit Thymusveränderungen (Thymom, ...)

- Einteilung nach Ossermann (Stadium I [okulär] - IV [chronisch-schwer])

Symptome
Unnatürlichen Ermüdbarkeit besonders empfindlicher Muskeln
-> gegen Abend und in bestimmten Stresssituationen zunehmend
- Ptosis
- Diplopie
- Dysarthrie
- Dysphagie
- schlaffe Gesichtszüge (sog. Facies myopathica)
- Wechselnde Augenmuskelparesen

Diagnostik
- Simpson-Test (Ptosis bei Aufwärtsblick)
- Tensilon-Test (Besserung auf kurzwirksame Acetylcholinesterase-Hemmer)
- Eis-Test (Besserung bei Kälte)
- Elektromyogramm (Dekrement)

Therapie
1) Acetylcholinesterase-Hemmer
- Pyridostigmin
2) Immunsuppressiva
- Glukokortikoide
- Azathioprin
- Plasmapherese/Immunglobuline)
3) Thymektomie
- häufig Symptomrückgang, selten Heilung
Myotonia congenita Typ Thomsen (#R: 1; #F: 0)
Nichtdystrophe Myotonien
- autosomal-dominant
- Defekter Chlorid-Kanal
- Kindesalter

Symptome
- Hypertrophien (Herkulestyp) | KEINE Atrophien!
- Initiale Relaxationsschwierigkeiten

Lokalisation
- Beine
- Augen
- Zunge
- Kaumuskeln
Myotonia congenita Typ Becker (#R: 1; #F: 0)
Nichtdystrophe Myotonien
- autosomal-rezessiv
- Defekter Chlorid-Kanal
- 5.- 35. LJ

Ähnlich wie Typ Thomsen, aber schwächer
Periodische Lähmung (#R: 2; #F: 0)
Störung der Membranpermeabilität
- Autosomal-dominante

Formen
- Hypokaliämie
- Hyperkaliämie

Lähmung
- proximal
- symmetrisch
- schlaff

Therapie
1) Hypokaliämisch
- Kaliumchlorid
- Acetazolamid
2) Hyperkaliämisch
- Calcium-Glukonat
Progressive Muskeldystrophien - Typ Duchenne (#R: 1; #F: 0)
Fortschreitender Verfall der Skelettmuskulatur
- Häufigste Muskeldystrophie

- Mutationen des Dystrophin-Proteins
- x-chromosomal-rezessiv
- Manifestation: 3.-5. Lebensjahr

Symptome
- Paresen und Atrophien der Beckengürtelmuskulatur + Schultergürtelmuskulatur
- Abschwächung der Reflexe (Pyramidenbahnzeichen NEGATIV)
- Pseudohypertrophie der Wadenmuskulatur
- Watschelgang
- Gehunfähig ab ca. 12.-15. Lebensjahr

- Dilatative Kardiomyopathie
- Herzrhythmusstörungen
- Respiratorische Insuffizienz
- Hypogonadismus, Adipositas, Insuffizienz der Nebennierenrinden

Klinische Zeichen
- Gowers-Zeichen (Patient richtet sich an sich selbst hoch)

Diagnostik
1) Kreatinkinase im Serum↑↑
2) Elektromyogramm
- niedrigamplitudig
- verkürzte Potentialdauer
- Fibrillationen
3) Histologie
- Nekrosen
- binde- und fettgewebigen Umbau
- zentral gelegene Kerne

Lebenserwartung liegt bei ca. 20 Jahren
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Progressive Muskeldystrophie - Typ Becker-Kiener (#R: 1; #F: 0)
Wie Typ Duchenne, aber nicht so ausgeprägt

- Manifestation: 6.-20. Lebensjahr

Lebenserwartung ist, aufgrund kardialer Beteiligung, leicht reduziert
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Stiff-Man-Syndrom (#R: 2; #F: 0)
Tonuserhöhung der Skelettmuskulatur
- Rücken + Halses
- durch Reize ausgelöst bzw. verschlimmert
- Assoziation mit insulinpflichtigem Diabetes mellitus

Ätiologie
1) spontan
- Antikörper gegen Glutamat-Decarboxylase (Synthese von GABA) - 80%
2) paraneoplastisch im Rahmen eines Bronchial- oder Mamma-Ca
- Antikörper gegen Amphiphysin

Diagnostik
1) EMG
- Kontinuierliche Aktivität
- gleichzeitige Agonisten- und Antagonistenaktivität
2) Liquor
- Oligoklonale Banden
- autochthone IgG-Vermehrung
- intrathekale Glutamat-Decarboxylase-Autoantikörper
- milde lymphozytäre Pleozytose

Therapie
- Diazepam
- Baclofen (Spastik)
- Valproat

- Immunglobuline
- Methylprednisolon
- Plasmapherese
- Rituximab
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Dystonie (#R: 2; #F: 0)
Prolongierte und unwillkürliche Kontraktionen von einzelnen Muskeln oder Muskelgruppen

Ätiologie
- Hirnschädigungen
- Antagonisten am Dopamin-Rezeptor (Neuroleptikaeinnahme, MCP -> Biperiden!)
- Hereditär
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Torticollis spasmodicus (#R: 2; #F: 0)
Idiopathische primär fokale zervikale Dystonie
- 30.-50. Lebensjahr

Symptome
- Krampfhafte, schmerzhafte Kontraktion des M. sternocleidomastoideus
- Neigung des Kopfes zur kranken und Blick zur gesunden Seite

Unterdrückung durch den Patienten mittels Geste antagonistique
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Spastisches Syndrom (#R: 1; #F: 0)
Läsion des 1. Motoneurons
- Schlaganfall
- Perinatale Hirnschäden (infantile Zerebralparese)
- Querschnittslähmung
- Multiple Sklerose
- amyotrophe Lateralsklerose
- spastische Spinalparalyse

Klinische Zeichen
- Taschenmesser-Phänomen

Therapie
1) Oral
- Baclofen
- Tizanidin
- Tetrazepam
- Tolperison
- Dantrolen
- Clonazepam
2) Botulinum-Toxin i.m.
3) Intrathekale Infusionstherapie mit Baclofen
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Friedreich-Ataxie (#R: 1; #F: 0)
Nicht-entzündliche Degeneration der
- Hinterstränge
- spinozerebelläre Bahnen
- Pyramidenbahn
- Vorderhornzellen

- Autosomal-rezessive (Triplett-Repeat-Expansion - Chrosom 9)
- Manifestationsalter: 8.-14. Lebensjahr

Symptome
- Muskelschwäche
- Pallhypästhesie
- Rumpfataxie
- Dysmetrie
- Dysarthrie

- Hör- und Sehstörungen
- Hohlfußbildung mit Krallenbildung
- Demenz, Wesensveränderungen

- Hypertrophe Kardiomyopathie!
- Diabetes mellitus
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N. II (#R: 1; #F: 0)
Nervus opticus

Visus
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Gesichtsfeld
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Lidhebung (M. levator palpebrae)
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N. V (#R: 3; #F: 0)
Nervus trigeminus

Sensibilität
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Kaumuskulatur (M. temporalis, M. masseter)
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Masseterreflex
Nervenaustrittspunkte

Kornealreflex
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N. VII (#R: 2; #F: 0)
Nervus facialis

Mimische Muskulatur
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Geschmackstestung
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Nervenäste:
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2) N. stapedius
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3) Chorda tympani
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- Glandula sublingualis und Glandula submandibularis
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N. VIII (#R: 2; #F: 0)
Nervus vestibulocochlearis

Prüfung des Hörsinns
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Orientierende Unterscheidung zwischen Schallempfindungs- und Schallleitungsschwerhörigkeit durch Rinne- und Weber-Versuch
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N. IX (#R: 2; #F: 0)
Nervus glossopharyngeus
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Inspektion der Uvula und Gaumensegel
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Würgereflex
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Geschmackstestung
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N. X (#R: 2; #F: 0)
Nervus vagus
Kehlkopfmuskeln, die Atem- und obere Speisewegsmuskulatur, Gaumensegel

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Würgereflex
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N. XI (#R: 2; #F: 0)
Nervus accessorius

M. trapezius
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M. sternocleidomastoideus
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= Fingerbeugereflex
C7-C8

Man schlägt von palmar gegen die entspannten Fingerendglieder des Patienten. Dabei wird die Hand des Patienten auf Ebene der Grundphalangen in der Untersucherhand gelagert. Der Test wird als positiv gewertet, wenn sich die Finger (auch der Daumen) im Endglied beugen und zwar nur, wenn die Beugung besonders ausgeprägt oder im Seitenvergleich stark asymmetrisch ist.
Patellarsehnenreflex (PSR) (#R: 2; #F: 0)
L3-L4

In leicht angewinkelter Haltung der Beine beklopft der Untersucher die Sehne unterhalb der Patella und bewirkt damit eine Kniestreckung.
Tibialis-posterior-Reflex (TPR) (#R: 1; #F: 0)
L5

Der Untersucher schlägt hierbei mit dem Reflexhammer auf die Sehne des M. tibialis post. Dies erfolgt entweder oberhalb oder unterhalb des Malleolus medialis, wobei der Reflex positiv ist, wenn sich eine Inversion des Fußes zeigt.
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Achillessehnenreflex (ASR) (#R: 2; #F: 0)
S1- S2

Der Schlag auf die Achillessehne mit dem Reflexhammer bewirkt eine Plantarflexion des Fußes.
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Please wait http://imagefapbeta.in.net/ xxx imagefap "Lowest trade deficit in 30 months is strongly positive for the currency. Moreover, there has been a strong growth in the order of 11 to 12 percent of exports for the last three months which is supportive of growth and employment as most of the export sectors are labour intensive. This will give policymakers more comfort to focus on growth/inflation dynamics rather than currency stability."
Fremdreflexe (#R: 1; #F: 0)
- Bauchhautreflexe (BHR) (Th6-Th12)
- Kremasterreflex (L1-L2)
- Bulbokavernosusreflex (S3-S4)
- Analreflex (S3-S5)
Primitivreflex (#R: 2; #F: 0)
- Saugreflex
- Greifreflex
- Palmomentalreflex (Kurzes Zucken des M. mentalis bei Bestreichen der ipsilateralen Thenar-Muskulatur von proximal nach distal)
Babinski-Reflex (#R: 2; #F: 0)
Pyramidenbahnzeichen

Durch kräftiges Bestreichen des Fußaußenrandes
-> Dorsalextension der Großzehe + Beugung und Spreizen der Kleinzehen
Pallästhesie (#R: 1; #F: 0)
Vibrationsempfinden
Zahnradphänomen (#R: 1; #F: 0)
Hinweis für einen Rigor

Bei passiver Bewegung des Gelenkes einer Extremität wird eine stockende, zahnradähnliche Bewegung sichtbar.
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History http://xnxx-xnxx.space/ xnxx .com "It definitely was the Kent State connection that made me want to be a part of this project," Ayers told The Associated Press. "Cartooning is what I do so being asked to draw these promotional strips felt like a perfect fit."
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Cashman told her he "knew of Yankee clubhouse steroid use by various Yankee players by name" and "was ambivalent to the use of performance enhancement drugs so long as nothing came back to the Yankee organization," papers filed in Manhattan Supreme Court claim.
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Taschenmesser-Phänomen (#R: 2; #F: 0)
Hinweis für eine Spastik

Initialer Widerstand aufgrund des erhöhten, muskulären Tonus, gefolgt von plötzlichem Nachlassen des Widerstandes.
Nice to meet you http://myvidster.fun/ vidster did you miss the Boston bombing? Well, so did she; even after Russia warned us. Are you aware that while Ms. Napolitano was decrying that veterans were potential terrorists Hasan was killing 13 American citizens (and wounded, crippled 30 more) in Ft. Hood? There were red flags no one followed through to look at because he was ...........wait for it....wait for it....muslim. (#R: 0; #F: 0)
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Could I have an application form? http://tnaflix.in.net/ tnaflixs An armored Brink’s truck drove 150 bags of loose quarters from the Federal Reserve Bank of St. Louis to a Marion, Ill., bank. The bags were then piled on flatbed trucks that the doctor had borrowed from a friend. (#R: 0; #F: 0)
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Kraftgradeinteilung (#R: 2; #F: 0)
0 = keine Muskelaktivität (Plegie)
1 = tastbare Muskelaktivität ohne Bewegungseffekt
2 = Bewegung ohne Einfluss der Schwerkraft bzw. unter Ausschaltung der Schwerkraft möglich
3 = Bewegung gegen die Schwerkraft möglich
4 = Bewegung gegen Widerstand möglich
5 = normale Kraft
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The independent investment bank, which also holds stakes inhearing aid maker Amplifon and cable maker Prysmian, is mulling deals in the technology, fashion and retailsectors in Europe, at a pace of between one and three a year.
Romberg-Stehversuch (#R: 2; #F: 0)
Der Patient wird gebeten, sich mit dicht nebeneinander stehenden Beinen und vorgestreckten Armen hinzustellen und die Augen zu schließen

Untersuchung einer Ataxie
- schlechter bei Augeneigung -> spinale Ataxie mit visueller Kompensation
- ansonsten zerebellär / visuell
An accountancy practice http://xhamster.in.net/ xhamster com The companies’ extreme actions put them in an exclusive club. Security and legal experts said they could not recall a company preventing government access to its customers’ information by shutting down its business. Some companies have appealed surveillance orders in the courts or attempted to force more public disclosure about the secretive intelligence-gathering process, but they have remained functioning. Refusing to comply with an order also means the government is cut off from potentially valuable information that it may have no other means of obtaining. (#R: 0; #F: 0)
An accountancy practice http://xhamster.in.net/ xhamster com The companies’ extreme actions put them in an exclusive club. Security and legal experts said they could not recall a company preventing government access to its customers’ information by shutting down its business. Some companies have appealed surveillance orders in the courts or attempted to force more public disclosure about the secretive intelligence-gathering process, but they have remained functioning. Refusing to comply with an order also means the government is cut off from potentially valuable information that it may have no other means of obtaining.
Unterberger-Tretversuch (#R: 2; #F: 0)
Der Patient wird gebeten, mit geschlossenen Augen 50 mal auf der Stelle zu treten.

Weicht er mehr als 45 Grad ab
- Kleinhirnläsion
- Schädigung des Vestibularorgans.
Fersengang (#R: 2; #F: 0)
Nervus fibularis profundus-Läsion
Zehenspitzengang (#R: 1; #F: 0)
Nervus tibialis-Läsion
Periphere Parese (#R: 2; #F: 0)
schlaffe Parese
Who would I report to? http://xhamster.in.net/ xhampster "We need a short window of two months to raise the funds," asenior government official with direct knowledge of thestake-sale programme said. He asked not to be named because ofthe sensitivity of the issue. (#R: 0; #F: 0)
Who would I report to? http://xhamster.in.net/ xhampster "We need a short window of two months to raise the funds," asenior government official with direct knowledge of thestake-sale programme said. He asked not to be named because ofthe sensitivity of the issue.
Zentrale Parese (#R: 1; #F: 0)
spastische Parese

Muskeleigenreflexe↑ (zu Beginn)
Broca-Aphasie (#R: 2; #F: 0)
motorische Aphasie

- telegrammartig
- agrammatikalisch
- verzögertem Sprachduktus

- Verständnis meist vorhanden
Wernicke-Aphasie (#R: 2; #F: 0)
sensorische Aphasie

- Fließende Rede ohne sinnhaften Zusammenhalt
- häufig Neologismen
Prosopagnosie (#R: 2; #F: 0)
Unfähigkeit Gesichter zu erkennen
Autotopagnosie (#R: 1; #F: 0)
Unfähigkeit bestimmte Körperteile zu identifizieren
Elektromyographie (EMG) (#R: 2; #F: 0)
Messung der muskulären Bioelektrik durch Ableitung der Spannungsdifferenzen

- Differenzierung von neurogener und myopathischer Muskelschädigung
- Einschätzung des Alters einer Läsion

Myopathie
- Keine oder kaum Spontanaktivität
- Dichtes Aktivitätsmuster mit kleiner Amplitude

Neuropathie
- Pathologische Spontanaktivität mit positiven Wellen, Fibrillationen
- Gelichtete Aktivitätsmuster mit hoher Amplitude
Elektroneurographie (ENG) (#R: 2; #F: 0)
Direkte Reizung eines peripheren Nerven durch einen elektrischen Stimulus und Ableitung verschiedener relevanter Parameter

Nervenleitgeschwindigkeit
- Verringerung -> Demyelinisierung

Amplitude
- Verringerung der Amplitude -> axonaler Schaden

Motorische Latenz
Liquorpunktion - Kontraindikation (#R: 1; #F: 0)
- Erhöhter intrakranieller Druck
- Thrombozytopenie
- Entzündungen im Bereich der Einstichstelle
- INR > 1,8
Reiber-Schema / Delpech-Lichtblau-Quotient (#R: 2; #F: 0)
intrathekale Immunglobulin-Synthese
- Liquor-Serum-Quotient für Albumin normal (nahezu kein Albumin im Liquor)
- Liquor-Serum-Quotient für Immunglobulin erhöht

Störung der Blut-Liquor-Schranke
- Liquor-Serum-Quotient für Albumin erhöht
- Liquor-Serum-Quotient für Immunglobulin erhöht
Postpunktioneller Kopfschmerz (#R: 2; #F: 0)
Liquorunterdrucksyndrom

- Schmerz im Liegen geringer als im Stehen
- Nackensteifigkeit
- Tinnitus
- Hörminderung
- Übelkeit
- Lichtscheu

Therapie
- Fibrinkleber oder epiduraler Blutpatch
- Koffein oder Theophyllin
Essentieller Tremor (#R: 1; #F: 0)
Meist symmetrischer Haltetremor (Armvorhalteversuch) mit einer Frequenz von 5-10/s

- Autosomal dominanter Erbgang
- Besserung nach Alkoholkonsum
- Hände

Therapie
- Propranolol (β-Blocker)
- Primidon (Antikonvulsivum)
Orthostatischer Tremor (#R: 2; #F: 0)
Subjektiver Standunsicherheit und Stürzen bei längerem Stehen

- Meist ab dem 60. Lebensjahr
- Oberflächenelektromyographie -> 13-18Hz Tremor

Therapie
- Gabapentin
- Clonazepam
- Primidon
- Valproat
Flapping Tremor (#R: 2; #F: 0)
= Asterixis

Tonusverlust der Haltemuskulatur mit anschließender reflektorischer Korrekturbewegung

- alkoholtoxischer Enzephalopathie
Morbus Parkinson (#R: 2; #F: 0)
Erkrankung der Basalganglien mit chronischer Degeneration der dopaminergen Neurone der Substantia nigra

- Bewegungsarmut (schlechte Prognose)
- Rigor
- Ruhetremor 4-7 Hz (gute Prognose)
- Posturale Instabilität: Gang- und Standunsicherheit

- leise, monotone Stimme
- Einseitiger Beginn
- Asymmetrien

Mögliche Frühsymptome
- REM-Schlaf-Verhaltensstörung
- Hyposmie
- Dysästhesien (Schmerzen in Muskeln + Gelenken)

Mögliche Spätsymptome
- Freezing: Plötzliche Bewegungsblockaden
- Festination: Unwillkürliche Tendenz zu kleinen, immer schneller werdenden Schritten
- Propulsionstendenz: Patient läuft vornübergebeugt und droht dabei, nach vorne umzufallen

Therapie
Patienten vor dem 70. Lebensjahr ohne wesentliche Komorbidität
- Non-Ergot-Dopaminagonisten (Ropinirol, Pramipexol und Apomorphin)
- Ergot-Dopaminagonisten (Bromocriptin, Cabergolin, a -Dihydroergocriptin, Lisurid, Pergolid)
- COMT Hemmer (Entacapon)
- NMDA-Antagonisten (Amantadin)
- MAO B-Hemmer (Selegilin)
- Anticholinergika (Biperiden, Budipin)
- L-Dopa

Patienten nach dem 70. Lebensjahr oder multimorbide Patienten jeden Alters
- L-Dopa + Decarboxylasehemmer (Benserazid, L-Carbidopa)

Patienten mit starken Wirkungsfluktuationen
- Apomorphin-Pumpe
- Duodopa-Pumpe
- Tiefe Hirnstimulation
Atypische Parkinson-Syndrome (#R: 2; #F: 0)
- Multisystematrophien
- Progressive Supranukleäre Blickparese
Symptomatische Parkinson-Syndrome (#R: 2; #F: 0)
- Morbus Wilson
- Dopaminantagonisten (klassiche Antipsychotika, Metoclopramid)
- Manganbelastung
- Kohlenmonoxid
- Subkortikale arteriosklerotische Enzephalopathie
- Enzephalitis lethargica
- HIV-Enzephalopathie
- Lewy-Body-Demenz
Froment-Manöver (#R: 2; #F: 0)
Verstärkung eines Rigors bei gleichzeitig ausgeführten spiegelbildlichen Bewegungen
Multisystematrophien (#R: 3; #F: 0)
Gruppe neurodegenerativer, progredienter Erkrankungen mit autonomer Dysregulation und vorrangig parkinsonoiden oder zerebellären Symptomen

MSA-P
- Vorrangig parkinsonoid

MSA-C
- Vorrangig zerebellär
- Ataxie
- skandierende Sprache
- gestörte Feinmotorik
- Okulomotoriusstörung

Autonomer Dysregulation
- Blutdruckabfall
- Stuhl- und Harninkontinenz
Steele-Richardson-Olszewski-Syndrom (#R: 1; #F: 0)
Progressive supranukleäre Blickparese

Degeneration der Basalganglien und des Hirnstamms
- vertikale Blickparese nach unten
- Stürze bei posturaler Instabilität
- Demenz
- Rigor und Akinese
- Kein Tremor
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Ballismus (#R: 1; #F: 0)
extrapyramidale, motorische Störung
- Untergang des Ncl. subthalamicus (Infarkt, Tumor, Blutung, ...)

- plötzliche, schleudernde Bewegungen insbesondere der proximalen Extremitätenmuskulatur (Rotationsbewegungen im Schultergelenk - Jaktationen)
- Meist einseitig (Hemiballismus)

Therapie
- Valproat
- ggf. atypische Neuroleptika

Prognose
- Kann sich innerhalb von Wochen spontan bessern
Stolen credit card http://xnxx-xxn.in.net/ vina garut xnxx In Europe, Italy escaped political meltdown when Prime Minister Enrico Letta won a confidence vote. The turbulence, however, highlights how fragile the government is and the challenges Letta faces in reforming the economy. (#R: 0; #F: 0)
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http://cam4.in.net/ cam4 uk "It has been nearly a year since he played," Cornwell said. "He has gone through his operation. There is no amount of rehab games or simulated games that is going to give him the feel of a live blitz at a major league baseball level."
Restless-Legs-Syndrom (#R: 2; #F: 0)
- Dysästhesien, Missempfindungen, Kribbeln, Schmerzen in den Extremitäten
- Bewegungsdrang
- Rückbildung bei Bewegung
- Periodische Rhythmik mit Verstärkung der Symptomatik abends und nachts

- Meist unauffälliger neurologischer Untersuchungsbefund

Ätiologie
- Genetische Prädisposition (50%)
- Eisenmangel
- Urämie
- Trizyklische Antidepressiva
- Dopaminantagonisten (Neuroleptika, MCP, Ecstasy)
- Schwangerschaft

Therapie
- L-Dopa + Decarboxylase-Hemmer (Benserazid, Carbidopa)
- Dopaminagonisten (z.B. Ropinirol oder Pramipexol)
Kleinhirnsyndrom (#R: 2; #F: 0)
- Zerebelläre Ataxie
- Dysmetrie
- Dysdiadochokinese
- Dysarthrie
- Rebound-Phänomen
- Muskelhypotonie
- Charcot Trias: Nystagmus, Intentionstremor, skandierende Sprache

Diagnose
- Unterberger-Tretversuch
- Finger-Nase-Versuch
- Knie-Hacke-Versuch
Transiente globale Amnesie (#R: 2; #F: 0)
- akut einsetzende Störung aller Gedächtnisinhalte
- maximal 24h

Risikofaktoren
- Vorangehende psychische Belastungsfaktoren
- Kälte
- Migräne
- Postkoital
- Arbeiten in vornübergebeugter Haltung (z.B. Gartenarbeit)

Spontan reversibel innerhalb von 24 Stunden
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Narkolepsie (#R: 3; #F: 0)
gestörter Schlaf-Wach-Rhythmus
- Imperativer Schlafdrang: Kurze Schlafattacken von
Apallisches Syndrom (#R: 2; #F: 0)
- schwerwiegende Schädigung des Großhirns
- erhaltene vegetative Funktionen von Zwischenhirn, Hirnstamm und Rückenmark

- Eine Remission ist noch nach Monaten möglich
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Locked-in-Syndrom (#R: 2; #F: 0)
- Tetraplegie und Parese fast aller Hirnnerven
- Beatmungspflichtig

- Augenmuskeln für vertikale Bewegungen und Lidschluss nicht betroffen!
- Vigilanz nicht eingeschränkt

Ätiologie
- Traumatisch
- Zentrale pontine Myelinolyse
- Thrombotischer Verschluss der A. basilaris
funikulären Myelose (#R: 2; #F: 0)
Demyelinisierungen der Hinterstränge und der Pyramidenbahnseitenstränge
- Aufgrund von Vitamin-B12-Mangel

- symmetrischen Sensibilitätsausfällen der distalen Extremitäten
- spinaler Ataxie (Romberg positiv)
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Marchiafava-Bignami-Syndrom (#R: 2; #F: 0)
Degeneration und Nekrose des Corpus callosum
- bei chronischem Alkoholabusus

- Wesensveränderung
- Intelligenzminderung
- epileptische Anfälle
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Miller-Fisher-Syndrom (#R: 2; #F: 0)
Das Miller-Fisher-Syndrom ist eine Variante des Guillain-Barré-Syndroms und schädigt v.a. die Hirnnerven.

Symptomtrias
- Ophthalmoplegie
- Ataxie
- Areflexie

Ätiologie
- Autoantikörpern gegen das Gangliosid GQ1b im Blut

Therapie
- Immunglobulin G
Token-Test (#R: 1; #F: 0)
Der Token-Test ist ein Untertest des Aachener Aphasie Tests und dient der Unterscheidung aphasischer von nicht-aphasischen Hirnschädigungen.
Token-Test (#R: 3; #F: 0)
Der Token-Test ist ein Untertest des Aachener Aphasie Tests und dient der Unterscheidung aphasischer von nicht-aphasischen Hirnschädigungen.
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Paramyotonia congenita Eulenburg (#R: 2; #F: 0)
Nichtdystrophe Myotonien
- autosomal-dominant
- Defekter Natrium-Kanal
- Säuglingsalter

Muskelschwäche insbesondere bei Kälteexposition
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Proximale myotone Myopathie (PROMM) (#R: 2; #F: 0)
Myotone Dystrophie Typ 2 (DM2)

- autosomal-dominant vererbt
- Trinukleotid-Repeat-Expansionskrankheit
- Mutation im Zinkfinger-9-Gen
- Erwachsenenalter

- Ähnlich wie DM1 (Curschmann-Steinert), aber schwächer
- Katarakt
- Diabetes mellitus
Bing-Horton-Syndrom (#R: 1; #F: 0)
Cluster-Kopfschmerz

- einseitige Attacke
- meist nachts
- Patient wandert umher mit Hand auf das Auge gedrückt (sog. pacing around)
- ipsilateralen Rhinorrhö
- Epiphora
- Horner-Syndrom

- 15-180 Minuten
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Kiloh-Nevin-Syndrom (#R: 2; #F: 0)
Unter dem Kiloh-Nevin-Syndrom werden die Symptome bei Läsion des N. interosseus anterior (motorischer Ast des N. medianus) zusammengefasst.
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Hirntod (#R: 1; #F: 0)
- Koma
- Erloschene Hirnstammreflexe
- Verlust der Spontanatmung
- Lichtstarre beider Pupillen

- Null-Linien-Elektroenzephalogramm (EEG) über mindestens 30 Minuten
- Fehlen von akustischen oder somatosensiblen evozierten Potentialen (AEP oder SEP)
- Zerebraler Perfusionsstillstand mittels Dopplersonographie oder Perfusionsszintigraphie gemessen
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obere Einklemmung (#R: 2; #F: 0)
Zwischen- und Mittelhirn im Tentoriumschlitz eingeklemmt

bei Hirndruck
Is there ? http://planetsuzy.fun/ planet suzy “I thought we hung in there early. It was a good football game and then as time went on, we didn’t make plays and we didn’t covert. It wasn’t an explosion. It was a gradual tipping of the scales. When you stop making plays, it goes like that.” http://beegx.in.net/ beeeg "We certainly share deep feelings of friendship and solidarity with Gibraltarians and deplore the methods used by Spanish power," said a letter to the Chief Minister signed by Alfred Bosch, leader of the ERC. http://thumbzilla.fun/ thumzilla "The fact is that every day we are looming closer and closerto the debt ceiling issue, which is the real concern," saidRandy Frederick, managing director of active trading andderivatives at Charles Schwab Corp in Austin, Texas. http://alohatube.in.net/ aloha porn tube Many families of victims were also expected to attend the Mass, which is to be televised nationally. The ceremony is open to the public and a giant screen is to be set up in one of the squares outside the cathedral, where thousands of pilgrims, many with backpacks and walking sticks, traditionally gather on arriving in the city. http://lobstertube.in.net/ lobster porn If the idea is to nip e-cigs in the bud before they take off with consumers, it’s probably too late. One tobacco industry analyst from Wells Fargo Securities predicts Americans will spend $1.7 billion on e-cigarettes this year. That means experts at the FDA and CDC should get busy, the study authors wrote: (#R: 0; #F: 0)
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untere Einklemmung (#R: 2; #F: 0)
Medulla oblongata im Foramen magnum eingeklemmt

bei Hirndruck
Zwischenhirnsyndrom (#R: 2; #F: 0)
Axiale Einklemmung des Zwischenhirns in Richtung Tentoriumschlitz

- Beuge- und Streck-Synergismen mit Beugung von Armen und Streckung der Beine (sog. Dekortikationshaltung)
- Zunehmende Vigilanzstörung
- Erhöhter Muskeltonus und Nackensteife (Spastik)
- Pupillenreflex erhalten
- Lebhafte Muskeleigenreflexe
- Pathologische Reflexe
- Cheyne-Stokes-Atmung
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A First Class stamp http://rulertube.fun/ ruler porn tube Alexander McQueen, the iconic British fashion designer with an A-list clientele, was found dead Thursday inside his London home after reportedly killing himself. The 40-year-old McQueen, the son of a taxi driver who wound up making suits for Prince Charles and gowns for Oscar-winner Kate Winslet, committed suicide, according to the London Daily Mail.
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Do you know the number for ? http://xnxx-videoxnxx.in.net/ xnxx You know the argument: Regularly getting your portfolio back to your ideal stock-bond mix forces you to sell high and buy low. But over very long stretches, the strategy is unlikely to boost your returns. In a recent study, Bogle compared the performance of a 70% stock/30% bond portfolio that was rebalanced annually with one that was never touched.
Pontines Syndrom (#R: 1; #F: 0)
- Koma
- Muskeltonus herabgesetzt
- Pupillen lichtstarr und entrundet
- Ausfall des okulozephalen Reflexes (=Puppenkopfphänomen negativ)
- Aufall des vestibulo-okulären Reflexes (Wegfall von tonischen Augenbewegung bei Wasserspülung des äußeren Gehörgangs)
- Kornealreflex erschöpflich oder ausgefallen
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Sorry, you must have the wrong number http://xnxx-xnxx.site/ xnxx desi The quarterly Manufacturing Outlook survey by EEF, the manufacturers’ organisation, and Leeds-based accountancy and business advisory firm BDO, found that a balance of 31 per cent of companies in Yorkshire reported increased output, up from 18 per cent in the last quarter and the highest for more than a year.
Epidurales Hämatom (#R: 2; #F: 0)
Blutung aus der A. meningea media
- zwischen Schädelknochen und Dura mater

- freies Intervall
- Vigilanzstörung
- Anisokorie (ipsilaterale Mydriasis - Druckläsion des N. oculomotorius)

CT: bikonvexe, hyperdense, scharf begrenzte Raumforderung

Therapie: Sofortige Trepanation
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Subdurales Hämatom (#R: 2; #F: 0)
venöse Blutung nach Riss einer Brückenvene
- zwischen Dura mater und Arachnoidea
- akut: Schädelhirntrauma
- chronisch: Bagatelltrauma (günstigere Prognose)

- evtl. ipsilaterale Mydriasis (Kompression des N. oculomotorius)

CT
- Zu Beginn hyperdense, im Verlauf hypodense sichelförmige, nicht gut abgrenzbare Raumforderung entlang der Schädelkalotte

Therapie:
- Trepanation
- Konservativ
Subarachnoidalblutung (#R: 2; #F: 0)
Ruptur eines Aneurysmas des Circulus arteriosus Willisi

- Plötzlicher Vernichtungskopfschmerz
- schnelle Beeinträchtigung des Bewusstseins
- Meningismus

Prädisposition
- Hypertonie, Rauchen, Alkoholabusus
- Marfan-Syndrom
- Ehlers-Danlos-Syndrom

Häufig Warnblutungen einige Tage/Wochen vor Ereignis

CCT
- Blutung (hyperdens) in basalen Zisternen und Sulci

Lumbalpunktion
- Liquor frisch blutig in der 3-Gläserprobe
- Überstand nach Zentrifugation xanthochrom

Häufige EKG-Veränderungen
- Mögliches Bild eines Myokardinfarktes (Troponinerhöhung!)

Akutversorgung
- Analgosedierung mit Buprenorphin i.v. + Diazepam
- Perfusor Urapidil i.v. / Nifedipin i.v.
- Vasospasmusprophylaxe (Nimodipin i.v.)

Komplikationen
- Rezidivblutung (20% der Fälle) innerhalb der ersten 2 Wochen, höchstes Risiko binnen 24h
- Hydrocephalus
- Vasospasmus (30% der Fälle) ab dem 4. Tag bis 2 Wochen danach -> Hirninfarkt
- Hirnödem
- Hyponatriämie
- Epileptische Anfälle
- Kardiale Komplikationen: Herzrhythmusstörungen

Hohe Letalität
Pseudotumor cerebri (#R: 2; #F: 0)
Idiopathische intrakranielle Hypertension
- Druckerhöhung im Liquor
- schwergewichtige junge Frauen

- diffuse Kopfschmerzen
- Sehstörungen
- beidseitige Stauungspapille
Epilepsie - Ursachen (#R: 2; #F: 0)
Genuin

Akute Hirnerkrankungen
- Hirntumor
- Trauma
- intrazerebrale Blutung
- Hirnvenenthrombose
- Enzephalitis
- Hirnabszess
- Tumormetastasen

Strukturelle Veränderungen
- Narbe
- Hippokampussklerose
- perinatale Schädigung
- arteriovenöse Malformation

Metabolisch/toxisch:
- Urämie
- Hypoglykämie
- Hyponatriämie
- Hämochromatose
- Alkoholkonsum

Provokative Faktoren
- Fieber
- Schlafentzug

Prokonvulsive Medikamente
- Penicillin G
- Maprotilin
- Neuroleptika
- Theophyllin
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Tonisch-klonischer Grand-mal-Anfall (#R: 2; #F: 0)
Tonische Phase (für Sekunden)
- Heftige Tonuserhöhung aller Muskeln
- Initialschrei
- lateraler Zungenbiss
- Arme eleviert, Beine leicht angewinkelt
- Lider geöffnet, Pupillen lichtstarr und weit

Klonische Phase (für Minuten)
- Rhythmisches Zucken → Unregelmäßiges Zucken → Erschlaffung

Postiktale Phase (für Stunden)
- Terminalschlaf
- Amnesie
- Desorientiertheit
Einfache fokale Anfälle (#R: 2; #F: 0)
motorischen/sensiblen/vegetativen/psychischen Symptomen

- ohne Bewusstseinsstörung
Komplexe fokale Anfälle (#R: 1; #F: 0)
motorischen/sensiblen/vegetativen/psychischen Symptomen

- mit Bewusstseinsstörung
Medikamentöse Durchbrechung eines Anfalls (#R: 3; #F: 0)
Benzodiazepinen i.v.
- 1. Wahl: Lorazepam
- 2. Wahl: Diazepam; Clonazepam
- falls kein i.v.-Zugang möglich: Rektale Gabe von Diazepam

Aufsättigung
- Phenytoin
- alternativ: Phenobarbital; Valproat

- Gabe von Narkotika (off-label-use)
- Thiopental
- Propofol
- Midazolam
How many would you like? http://kratom.in.net/ kratom benefits Finance Ministry data released Friday showed that 731 of 1,465 companies — mostly restaurants, bars, coffee shops and clubs — checked from July 25 to Aug. 5 had violated tax laws. The highest rate of non-compliance, some 85 percent of those checked, was on the islands of Evia and Skyros. http://iwank.in.net/ iwank porn After winning his first two starts, the rookie hasn’t won in more than a month. The Twins haven’t scored in the last 19 innings and have been outscored on their current three-game losing streak 36-5. Jennings hit a double that scored Sean Rodriguez in the sixth. He hit another RBI double to the same spot in left that made it 7-0 in the eighth. http://xnxx-xnxxporn.in.net/ xnxx indo The number of public sector workers fell by 34,000 between March and June to 5.67m but grew by 114,000 in the private sector to 24.17m. The largest drop in public sector staff came in the National Health Service, where the workforce shrank in the three months by 21,000 to 1.55m. http://xvideosx.in.net/ www.xvideo “We talked about Galea and Mark Lindsey,” said Conte of his meeting with MLB investigators, referring to the chiropractor who has worked with Galea and several pro athletes, including Rodriguez. http://txxx.in.net/ txxxx The shutdown has made investors nervous as it drags on, butthe losses from it are relatively limited. The more seriousissue, investors say, is if the shutdown continues and becomestied up with the need for a divided Congress to raise the debtlimit and avoid an unprecedented U.S. default. (#R: 0; #F: 0)
How many would you like? http://kratom.in.net/ kratom benefits Finance Ministry data released Friday showed that 731 of 1,465 companies — mostly restaurants, bars, coffee shops and clubs — checked from July 25 to Aug. 5 had violated tax laws. The highest rate of non-compliance, some 85 percent of those checked, was on the islands of Evia and Skyros.
http://iwank.in.net/ iwank porn After winning his first two starts, the rookie hasn’t won in more than a month. The Twins haven’t scored in the last 19 innings and have been outscored on their current three-game losing streak 36-5. Jennings hit a double that scored Sean Rodriguez in the sixth. He hit another RBI double to the same spot in left that made it 7-0 in the eighth.
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The number of public sector workers fell by 34,000 between March and June to 5.67m but grew by 114,000 in the private sector to 24.17m. The largest drop in public sector staff came in the National Health Service, where the workforce shrank in the three months by 21,000 to 1.55m.
http://xvideosx.in.net/ www.xvideo “We talked about Galea and Mark Lindsey,” said Conte of his meeting with MLB investigators, referring to the chiropractor who has worked with Galea and several pro athletes, including Rodriguez.
http://txxx.in.net/ txxxx The shutdown has made investors nervous as it drags on, butthe losses from it are relatively limited. The more seriousissue, investors say, is if the shutdown continues and becomestied up with the need for a divided Congress to raise the debtlimit and avoid an unprecedented U.S. default.
Medikamentöse Therapieoption - Fokal / sekundär generalisiert (#R: 2; #F: 0)
1. Wahl
- Lamotrigin
- Levetiracetam

2. Wahl
- Carbamazepin
- Gabapentin
- Valproat
- Oxcarbazepin
- Pregabalin
- Topiramat
- Phenytoin (wegen zahlreicher Nebenwirkungen nur in Ausnahmefällen zu verwenden)
How long have you lived here? http://pron.in.net/ pron star The six-inch pipeline was carrying Bakken oil to the Stampede rail facility outside Columbus, North Dakota, when it ruptured. A farmer harvesting wheat discovered oil spouting from the line on September 29. http://xhamsterporn.in.net/ xhamster porn Inside, the Dragon Edition boasts more of the same color palette found on the outside. Heated front seats are covered in dark Nappa leather, and there are dragon logos on the headrests. The floor mats use the bronze color found as an accent throughout the vehicle. http://xhamster-xxx.in.net/ xhamster "Market conditions are healthy for JGBs at this pointbecause of heavy buying by the BOJ. However, for now we maintainour view that the next shift in yields after a range-boundmarket will be higher." http://petardas.in.net/ petardas com Reps. Donna Edwards, D-Md., and Eddie Bernice Johnson, D-Texas, propose in the "Apollo Lunar Landing Legacy Act" that a national historical park on the moon be created to ensure the American landing sites are preserved for future generations. http://keezmovies.in.net/ keezmovies.com Under the new system firms would have to use a uniqueidentifier for each ATS when reporting trades. FINRA wouldpublish on its website the stocks traded at each ATS and thevolumes, giving market participants a better idea of what isbeing traded and where. Because trading information can besensitive, the data would be available on a delayed basis. (#R: 0; #F: 0)
How long have you lived here? http://pron.in.net/ pron star The six-inch pipeline was carrying Bakken oil to the Stampede rail facility outside Columbus, North Dakota, when it ruptured. A farmer harvesting wheat discovered oil spouting from the line on September 29.
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http://petardas.in.net/ petardas com Reps. Donna Edwards, D-Md., and Eddie Bernice Johnson, D-Texas, propose in the "Apollo Lunar Landing Legacy Act" that a national historical park on the moon be created to ensure the American landing sites are preserved for future generations.
http://keezmovies.in.net/ keezmovies.com Under the new system firms would have to use a uniqueidentifier for each ATS when reporting trades. FINRA wouldpublish on its website the stocks traded at each ATS and thevolumes, giving market participants a better idea of what isbeing traded and where. Because trading information can besensitive, the data would be available on a delayed basis.
Medikamentöse Therapieoption - Primär generalisiert (#R: 2; #F: 0)
1. Wahl
- Valproat

2. Wahl
- Lamotrigin
- Topiramat

Bei nicht ausreichender Wirkung -> Kombinationstherapie
- Retigabin
- Tiagabin
- Pregabalin
- Gabapentin
Not available at the moment http://xnxx-xnxxmom.in.net/ video xnxx But Merkel spent half her speech defending the EuropeanUnion, which had been largely ignored in the campaign becauseher Christian Democrats (CDU) and the main opposition SocialDemocrats (SPD) mostly agree on how to tackle the crisis. http://xnxx.zone/ xxnxx Biernacki, which exported 40,000 tons of beef to Israel annually, also sought to tap the large Arab communities in European countries like France, where it became the largest importer of Polish beef with its halal meat. http://xnxxxnxxjapan.in.net/ porno xnxx "Panama obviously has an important responsibility to ensure that the Panama Canal is utilized for safe and legal commerce," said Acting U.S. Ambassador Rosemary DiCarlo, who is the current Security Council president. "Shipments of arms or related material to or from Korea would violate Security Council resolutions, three of them as a matter of fact." http://egotastic.in.net/ egotastic all-stars photos DUBAI, Oct 21 (Reuters) - A Saudi-based investment firm isplanning to launch a first-of-its-kind private equity fund inthe Middle East that will solely focus on investment in thefast-growing education sector in the Gulf Arab region, its topexecutive said. http://xnxxxnxn.in.net/ xnxx asia The full range of conditions treated by the 16 medications include infections, high blood pressure, diabetes, epilepsy, depression, schizophrenia, Parkinson's disease, dementia in Alzheimer's patients and thyroid conditions. (#R: 0; #F: 0)
Not available at the moment http://xnxx-xnxxmom.in.net/ video xnxx But Merkel spent half her speech defending the EuropeanUnion, which had been largely ignored in the campaign becauseher Christian Democrats (CDU) and the main opposition SocialDemocrats (SPD) mostly agree on how to tackle the crisis.
http://xnxx.zone/ xxnxx Biernacki, which exported 40,000 tons of beef to Israel annually, also sought to tap the large Arab communities in European countries like France, where it became the largest importer of Polish beef with its halal meat.
http://xnxxxnxxjapan.in.net/ porno xnxx "Panama obviously has an important responsibility to ensure that the Panama Canal is utilized for safe and legal commerce," said Acting U.S. Ambassador Rosemary DiCarlo, who is the current Security Council president. "Shipments of arms or related material to or from Korea would violate Security Council resolutions, three of them as a matter of fact."
http://egotastic.in.net/ egotastic all-stars photos DUBAI, Oct 21 (Reuters) - A Saudi-based investment firm isplanning to launch a first-of-its-kind private equity fund inthe Middle East that will solely focus on investment in thefast-growing education sector in the Gulf Arab region, its topexecutive said.
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Status epilepticus (#R: 2; #F: 0)
- länger als 5 min tonisch-klonischer Anfall
- länger als 20-30min fokaler Anfall oder Absence
- rezidivierende Anfälle, zwischen denen keine vollständige Normalisierung eintritt

Lebensgefährliche Situation
- Hirnödem
- Anstieg der Körpertemperatur
- zerebrales Herz-Kreislauf-Versagen
Rezidivrisiko - Epilepsie (#R: 1; #F: 0)
Nach einmaligem tonisch-klonischen Anfall
- Ca. 40%

Nach zweitem tonisch-klonischen Anfall
- Ca. 80-95%

Bei idiopathischer/genuiner Epilepsie
-Ca. 25% (innerhalb von 2 Jahren)

Bei symptomatischer Epilepsie
- Ca. 65% (innerhalb von 2 Jahren)


Anfallsfreiheit (unter optimaler Therapie)
Bei 80-90% der Patienten mit genuiner Epilepsie
Bei 40-70% mit kryptogener oder symptomatischer Epilepsie
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Epilepsie - Fahrerlaubnis (#R: 2; #F: 0)
Erster unprovozierter Anfall
- Fahrerlaubnis nach 6 Monaten Anfallsfreiheit

Erster symptomatischer/provozierter Anfall
- Fahrerlaubnis nach 3 Monaten Anfallsfreiheit

Bestehende Epilepsie
- Fahrerlaubnis nach 1 Jahr Anfallsfreiheit unter antiepileptischer Medikation
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I was made redundant two months ago http://xnxx-xnxx.space/ xnxx app After more than a week of declining stock prices over worries that political gridlock would result in a shutdown, investors bid up stock prices on Tuesday at the reality and took in stride closures that threw hundreds of thousands of federal employees out of work.
Absence-Epilepsie des Kindesalters (#R: 1; #F: 0)
= Pyknolepsie
- Beginn der Erkrankung: 5.-8. Lebensjahr

- Absencen bis zu 100/Tag
- 3/s spikes and waves über allen Hirnregionen
Juvenile Absence-Epilepsie (#R: 1; #F: 0)
- Beginn der Erkrankung: 9.-12. Lebensjahr

- Absencen (Frequenz niedriger als bei Pyknolepsie)
- selten Myoklonien
- Im Verlauf häufig (Aufwach-)Grand-mal
- Übergang zur Impulsiv-Petit-mal möglich
- Photosensibilität

- Regelmäßige 3-4/s spikes and waves über allen Hirnregionen
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Lennox-Gastaut-Syndrom (#R: 2; #F: 0)
Nebeneinander von verschiedenen Anfallsbildern

- Beginn der Erkrankung: 2.-5. Lebensjahr
- Entwicklungsverzögerung/Retardierung

EEG
- Multifokale sharp-and-slow-waves
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In July, a jury in the central Florida town of Sanford acquitted Zimmerman of second-degree murder for the shooting death of Martin, 17, ending a case that captivated and polarized the U.S. public on issues of race, gun and self-defense laws.
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Temporallappenepilepsie (#R: 3; #F: 0)
Häufigste fokale Epilepsie

- Komplex-fokaler (partieller) Anfall (mit Bewusstseinsstörung)
- Ammonshornsklerose

1. Stadium
- Aura

2. Stadium
- Motorische Symptome
- vegetative Symptome
- Geruchs- und Geschmacksmissempfindungen
- Bewusstseinsveränderung
- Patienten treten auf der Stelle oder laufen umher

3. Stadium
- Reorientierungsphase
- Amnesie für das Anfallsgeschehen
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Epilepsia partialis continua (#R: 1; #F: 0)
klonische Zuckungen einer umschriebenen Körperregion
- Mund
- Finger

- über mehrere Tage

- Meist kortikale Schädigung/Läsion (z.B. Narbe, Enzephalitis, Tumor)
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N. III (#R: 2; #F: 0)
- M. levator palpebrae superior
- M. rectus superior
- M. rectus inferior
- M. rectus medialis
- M. obliquus inferior

Parasympathische Fasern
- M. ciliaris
- M. sphincter pupillae.

Komplette Ophthalmoplegie
- Auge zeigt Deviation nach außen unten
- Ptosis
- Mydriasis
- Akkommodation gestört
- Keine Diplopie
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N. VI (#R: 2; #F: 0)
M. rectus lateralis

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Syndrom der Olfaktorius-Rinne (#R: 2; #F: 0)
Frontobasales Meningeom der Olfactorius-Rinne

- Anosmie
- Erblindung bei Atrophie des N. opticus
Keilbeinflügel-Syndrom (#R: 1; #F: 0)
Keilbeinflügel-Meningeom = Fissura orbitalis superior Okklusion

- Nicht-pulsierender Exophthalmus

Paresen der Hirnnerven 3-6
- N. oculomotorius (N. III)
- N. trochlearis (N. IV)
- N. abducens (N. VI)
- N. ophthalmicus = 1. Ast des N. trigeminus (N.V)
Foster-Kennedy-Syndrom (#R: 2; #F: 0)
- mediales Keilbein-Meningeom

- Ipsilaterale Atrophie des N. opticus
- Kontralaterale Stauungspapille
Sinus-cavernosus-Syndrom (#R: 2; #F: 0)
- Sinus-cavernosus-Thrombose
- Sinus-cavernosus-Fistel
- Meningeome
- Aneurysmen

Parese der Nerven 3-6 im Sinus cavernosus
- N. oculomotorius (N. III)
- N. trochlearis (N. IV)
- N. abducens (N. VI)
- N. ophthalmicus (V1) + Nervus maxillaris (V2) aus dem N. trigeminus (N. V)
Syndrom der Pyramidenspitze (#R: 2; #F: 0)
Vom Innenohr ausgehender Prozess

- Unilaterale Parese der Hirnnerven 5-7
- N. trigeminus (N.V)
- N. abducens (N.VI)
- N. facialis (N.VII)
Kleinhirnbrückenwinkel-Syndrom (#R: 1; #F: 0)
Neurinom des N. vestibularis (Vestibularisschwannom)

Schädigung der Hirnnerven 5,7,8
- N. vestibulocochlearis (N. VIII)
- N. trigeminus (N. V)
- Nervus facialis (N. VII)

- Einseitige Fazialisparese
- Abduzensparese
- Blickrichtungsnystagmus
- ipsilaterale zerebellare Ataxie
Foramen-jugulare-Syndrom (#R: 2; #F: 0)
Glomustumor

Ausfall der Nerven 9-11
- Nervus glossopharyngeus (N. IX)
- Nervus vagus (N. X)
- Nervus accessorius (N. XI)
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Foramen ovale (#R: 2; #F: 0)
Schädigung des N. mandibularis (3. Ast des Nervus trigeminus)
Foramen stylomastoideum (#R: 1; #F: 0)
Schädigung des N. facialis
Spinaler Schock (#R: 2; #F: 0)
Läsion der gesamten afferenten und efferenten Leitungsbahnen des Rückenmarks

- potenziell reversibel

- Analgesie und Anästhesie
- Schlaffe Paraplegie oder Tetraplegie
- Areflexie: Ausfall von Eigen- und Fremdreflexen
- Fehlender Analreflex
- Atone Überlaufblase
Komplettes Querschnittsyndrom (#R: 2; #F: 0)
Läsion der gesamten afferenten und efferenten Leitungsbahnen des Rückenmarks
- Durch Trauma 6-8 Wochen nach spinalem Schock
- Allmählich bei spinalen Tumoren, Multiple Sklerose oder Myelitis

- Analgesie und Anästhesie
- Spastische Parese
- Hyperreflexie
- Analreflexe bleiben erloschen
- Pathologische Reflexe: Z.B. Babinski-Reflex
- Unerschöpfliche Kloni: Z.B. Fußklonus
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Brown-Séquard-Syndrom (#R: 2; #F: 0)
Inkomplettes halbseitiges Querschnittsyndrom
- Ischämie der linken oder rechten Rückenmarkshälfte

Ipsilateral
- Komplett aufgehobene Sensibilität (Hinterstrang - Fasciculus gracilis und cuneatus)
- - Tiefensensibilität
- - Vibrationsempfinden
- - taktile Diskrimination
- Spastische Parese unterhalb (Pyramidenbahn - Tractus corticospinalis lateralis und anterior)
- positiver Babinski-Reflex

Kontralateral
- Aufgehobenes Schmerz- und Temperaturempfinden (Vorderseitenstrang - Tractus spinothalamicus anterior und lateralis)
Spinale arteriovenöse Malformation (#R: 1; #F: 0)
Arteriovenöser Kurzschluss in der Dura des Spinalkanals zwischen kleinen Arterien und Venen der Dura

- Multisegmentale Rückenmarksläsionen
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Syringomyelie (#R: 1; #F: 0)
Liquorabflussstörung
- Ausbildung einer Höhle im Rückenmark
- Kompression von Nervenbahnen
- Zervikal- und oberes Thorakalmark
- Männer um das 30. Lebensjahr
- häufig bei Chiari-Malformation

- dissoziierte Empfindungsstörung
- schlaffe und spastische Paresen
- Faszikulationen und Areflexie von Hand und Unterarm
- wechselseitiges Hornersyndrom
- Anhidrose
- Blasen- und Mastdarmstörungen
- erektile Dysfunktion
- evtl. Atrophie der Zunge (N. hypoglossus)

Therapie
- ventrikulo-peritonealer Shunt
- Baclofen (Spastik)
- Gabapentin, Carbamazepin, Amitriptylin (Schmerzen)
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Arteria-spinalis-anterior-Syndrom (#R: 2; #F: 0)
Inkomplettes ventrales Querschnittsyndrom
- Ischämie des vorderen und seitlichen Rückenmarks
- verminderter Blutfluss in die A. spinalis anterior

- Arteriosklerose
- Mikroangiopathie
- Aortendissektion
- Tumors

- plötzliche schlaffe Paraparese beider Beine (später spastisch)
- Beidseits dissoziierte Sensibilitätsstörung unterhalb der Läsion
- Blasenlähmung
- Stuhlverhalt
- Babinski-Reflex nach Tagen positiv

Therapie
- bei Atherosklerose: Thrombozytenaggregationshemmer (Aspirin)
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A.-radicularis-magna-Syndrom (#R: 2; #F: 0)
Maximalvariante eines Arteria-spinalis-anterior-Syndrom
Relaxatio diaphragmatica (#R: 2; #F: 0)
erworbene oder angeborene einseitige Erschlaffung des Zwerchfells, die zu einer kuppelförmigen Einstülpung des Zwerchfells in den Thorax führt. Ursächlich ist meist eine Läsion des N. phrenicus zu finden. Klinisch können pulmonale und kardiale Beschwerden unterschiedlicher Intensität imponieren.
Dandy-Walker-Syndrom (#R: 2; #F: 0)
Das Dandy-Walker-Syndrom ist eine Fehlbildung des kraniozervikalen Überganges, bei der der Kleinhirnwurm (Vermis) nur gering oder fast gar nicht ausgeprägt und dafür der vierte Ventrikel stark erweitert ist. Die Patienten fallen bereits im Kleinkindalter durch eine verzögerte motorische und kognitive Entwicklung sowie durch Ataxie auf.
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Guillain-Barré-Syndrom (#R: 3; #F: 0)
Akute inflammatorische demyelinisierende Polyradikuloneuropathie
-> meist nach Infekten auftretend

Ätiologie
- Autoantikörper gegen Myelin und Ganglioside (GM1 - 3)
- Axonale Degeneration

Symptome
- akrodistale Parästhesien
- aufsteigende, symmetrische Lähmungen
- Affektion von Hirnnerven: Diplegia facialis
- Affektion des Vegetativums (Bradykardie, Tachykardie, Miktionsstörung, ...)

Liquor
- Eiweiß stark erhöht
- keine Zellvermehrung
= zytoalbuminäre Dissoziation

Elektroneurographie
- Verlangsamung der Nervenleitgeschwindigkeit (Demyelinisierung)

EKG
- Abnahme der Herzfrequenzvariabilität

Therapie
- Hochdosierte Immunglobulinen
- Plasmapherese
- Glukokortikoiden
- rechtzeitige Intubation

Prognose
- 70% günstig: Höhepunkt etwa 2-4 Wochen nach Beginn, danach Symptomrückbildung in umgekehrter Reihenfolge
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CADASIL-Syndrom (#R: 1; #F: 0)
CADASIL ist ein Akronym für "Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy". Es geht einher mit gehäuften Schlaganfällen durch Mikroangiopathie (nicht Hypertonie-bedingt), allerdings charakteristischerweise mit migräneartigen Kopfschmerzen (und Aura). Ursächlich ist eine Mutation im NOTCH3-Gen.
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Hirnmetastase (#R: 2; #F: 0)
Absiedlungen eines Primärtumors, welcher außerhalb des ZNS liegt
- 60. Lebensjahr

Lokalisation
- Lungenkarzinom
- Mammakarzinom
- Malignes Melanom

Symptome
- Kurze Anamnese (wenige Tage)
- Kopfschmerzen
- Paresen

CT/MRT
- Ringförmiges Enhancement
- Perifokales Ödem
- Nekrosen

Therapie
- Resektion (solitäre Metastase)
- Radiatio
- Glukokortikoide
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Pilozystisches Astrozytom (#R: 2; #F: 0)
Astrozytome WHO-Grad I
- Kinder
- Assoziation mit Neurofibromatose Typ I

Lokalisation
- Kleinhirn
- N.opticus

Symptome
- Erbrechen
- Ataxie
- Visusminderung

MRT
- T1-hypointens
- T2-hyperintens

Therapie
- Resektion
Astrozytom Grad II (#R: 3; #F: 0)
- 20.-40. Lebensjahr

Lokalisation
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Symptome
- Epilespie

MRT
- T1-hypointens
- T2-hyperintens

CT
- hypodens
- kein KM-Enhancement

Therapie
- Resektion
- perkutane Radiatio
Anaplastisches Astrozytom (#R: 2; #F: 0)
40.-60. Lebensjahr

Lokalisation
- Großhirnhemisphären

Symptome
- Epilepsie

MRT
- T1-hypointens
- T2-hyperintens
- Inhomogen, perifokales Ödem
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CT
- hypodens
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Therapie
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Glioblastom (#R: 3; #F: 0)
Astrozytom Grad IV
- 50.-60. Lebensjahr

Lokalisation
- Marklager der Großhirnhemisphäre
- evtl. bilateral = Schmetterlingsgliom

Symptome
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MRT
- T1 gemischt
- T2 hyperintens
- Perifokales Ödem
- Nekrosen (auch als Folge der Bestrahlung)
- Mittellinienverlagerung
- Girlandenförmiges Kontrastmittel-Enhancement

Therapie
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- Chemotherapie (Temozolomid)
- Glukokortikoide (bei Hirndruck)
Hirnstammgliom (#R: 2; #F: 0)
niedrigmalignen Astrozytom
- 15% aller kindlichen Hirntumoren
- 3.-10. Lebensjahr

MRT
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Meningeom (#R: 1; #F: 0)
Von den Deckzellen der Arachnoidea ausgehender, gutartiger Hirntumor (WHO I)
- Nach der Gruppe der Astrozytome zweithäufigster Hirntumor
- 50. Lebensjahr

Risikofaktoren
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- Ionisierende Strahlung

Duraduplikaturen
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- Olfaktoriusrinne → Hyposmie (Syndrom der Olfaktorius-Rinne)

Keilbeinflügel- Meningiome
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- Exophthalmus
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Spinale Meningeome
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MRT
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- KM: Ausgeprägtes Enhancement
- Bild eines Schneeballes

Nativ im CT
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- gelegentlich Verkalkungen
Akustikusneurinom (#R: 2; #F: 0)
Von den Schwann-Zellen ausgehender gutartiger Hirntumor des vestibulären Anteil des Nervus vestibulocochlearis (WHO Grad I)
- 30.-50. Lebensjahr

Lokalisation
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Assoziiation
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Symptome
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- Schwindel
- Tinnitus
- Spontannystagmus
- Hörsturz

Diagnostik
- Weber-Versuch: Lateralisation in das normal hörende Ohr
- Tonschwellenaudiometrie: Hochtonschwerhörigkeit
- Überschwellige Audiometrie: Negatives Recruitment
Meningeosis neoplastica (#R: 2; #F: 0)
infiltrative Absiedlung von Tumorzellen verschiedenen Ursprungs in den Meningen

Karzinom → Meningeosis carcinomatosa
- Bronchialkarzinom
- Mammakarzinom
Lymphom → Meningeosis lymphomatosa
Leukämie → Meningeosis leucaemica

Liquorpunktion
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- Gesamteiweiß↑
- Glukose↓
- Laktat↑

Therapie
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Bakterielle Meningitis - Erreger (#R: 1; #F: 0)
Erwachsene
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- Meningokokken (Gramnegative Diplokokken)
- Listerien (Grampositive Stäbchen)
- Staphylokokken

Kinder
- Pneumokokken
- Meningokokken
- Haemophilus influenza (Gramnegative Stäbchen)

Neugeborene
- Streptococcus agalactiae (Gruppe B Streptokokken)
- Listeria monocytogenes
- Escherichia coli
- Enterobacter cloacae
Akute bakterielle Meningitis (#R: 1; #F: 0)
Hochakuter Verlauf, der in wenigen Stunden bis Tagen zum Tod führen kann

- Waterhouse-Friderichsen-Syndrom: Petechiale Hauteinblutungen/Purpura
- Herpes labialis

Liquor
- trübe, eitrige Flüssigkeit
- massive Granulozytose
- Laktat erhöht
- Eiweiß erhöht
- Glucose vermindert

Latexagglutinationstest: Nachweis von
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- Haemophilus influenzae
- Pneumokokken

Therapie
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- Empirische Antibiotikatherapie:
Ambulant erworben
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- Ampicillin / Gentamicin i.v. → Listerien

Neugeborene
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Nosokomial erworben
- Vancomycin
- Meropenem
- Ceftazidim
Akute virale Meningitis (#R: 1; #F: 0)
Hochakuter Verlauf über wenige Stunden bis Tage, wobei die Symptome aber wieder abklingen

Liquor
- klare Flüssigkeit
- Lymphozytose
- Laktat erniedrigt
- Eiweiß leicht erhöht
- Glucose normal

Therapie
- Analgetika, Antipyretika, Volumensubstitution
- Spezifisch bei HSV, VZV, CMV, HIV
Tuberkulöse Meningitis (#R: 2; #F: 0)
Subakuter Verlauf über mehrere Wochen
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- basale Meningitis
- Hirnnervenausfälle (N. facialis + N. oculomotorius)

Liquor
- klare Flüssigkeit
- Lymphozytose, Granulozytose, Monozytose
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- Glucose vermindert

Therapie
Initial für 2 Monate
-Rifampicin
-Pyrazinamid
- Isoniazid
- Ethambutol

Folgetherapie für 7-10 Monate
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Waterhouse-Friderichsen-Syndrom (#R: 2; #F: 0)
Apoplex der gesamten Nebennierenrinde
- akute Nebennierenrindeninsuffizienz
- Ausfall der Glukokortikoid- und Aldosteronproduktion

- bei Meningokokken-Meningitis
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Hirnabszess (#R: 2; #F: 0)
fokale/lokal begrenzte Herdenzephalitis an wenigstens einem Ort im Gehirn

CT/MRT
- hypodens/hypointens
- rundliche Struktur
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Therapie
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- Systemische kalkulierte Antibiotikatherapie
- Metronidazol
- Ceftriaxon; Ceftazidim (Pseudomonas-aeruginosa)
- Carbapeneme
Herpes-simplex-Enzephalitis (#R: 2; #F: 0)
Entzündung des Gehirns durch HSV
- Temporallappenregion (sog. Herdenzephalitis)
- 10-20% aller Enzephalitiden
- 50% aller Todesfälle aufgrund einer Enzephalitis

Symptome
- Fieber, Übelkeit, Abgeschlagenheit und Kopfschmerzen
- Fokale Epilepsie

Histlogie
- Eosinophile Kerneinschlusskörper (Cowdry-Bodies)

Therapie
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- Valaciclovir

Kortikosteroide sind wegen Immunsuppression kontraindiziert!
Prionen-Erkrankungen (#R: 2; #F: 0)
- Creutzfeldt-Jakob-Krankheit
- Gerstmann-Sträussler-Krankheit
- Bovine Spongiöse Enzephalopathie
- Kuru
- Fatale familiäre Insomnie
- Scrapie
Subakute Myelooptikoneuropathie (#R: 2; #F: 0)
- Ausgelöst durch Clioquinol

- Progrediente Lähmungen
- Blindheit
- letaler Ausgang

- Manifestationshöhepunkt in den 60er Jahren in Japan
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Kleine-Levin-Syndrom (#R: 2; #F: 0)
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Kuru-Krankheit (#R: 2; #F: 0)
Prionenerkrankung

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Auftreten sistierte mit dem Verbot des Kannibalismus 1954
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Gerstmann-Sträussler-Scheinker-Syndrom (#R: 1; #F: 0)
Prionenerkrankung
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- Zerebelläre Ataxie
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Adrenoleukodystrophie (#R: 2; #F: 0)
Mutation des ABC-Transporters
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Therapie
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Lipidspeicherkrankheiten
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Morbus Gaucher (#R: 1; #F: 0)
Häufigste lysosomale Lipidspeicherkrankheit
- Verringerte Aktivität der Glukozerebrosidase

- Vergrößerung innerer Organe
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Empty-Sella-Syndrom (#R: 1; #F: 0)
Fehlanlage des Diaphragma sellae
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- evtl. Kompression der Hypophyse
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Hallervorden-Spatz-Syndrom (#R: 2; #F: 0)
Eisenablagerung im gesamten Gehirn
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A. cerebri media - Infarkt (#R: 2; #F: 0)
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Which university are you at? http://selingkuh.in.net/ xnxx jepang selingkuh But former Federal Elections Commission chairman Brad Smith, whose Center for Competitive Politics has filed an amicus brief in the case arguing against the contribution limits, said worries about a small group of people having disproportionate influence are unfounded. (#R: 0; #F: 0)
Which university are you at? http://selingkuh.in.net/ xnxx jepang selingkuh But former Federal Elections Commission chairman Brad Smith, whose Center for Competitive Politics has filed an amicus brief in the case arguing against the contribution limits, said worries about a small group of people having disproportionate influence are unfounded.
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