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- 저자 : Julian Teufel (검색결과 2 건)
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Conjugate Eye Deviation in Unilateral Lateral Medullary Infarction
Julian Teufel,Michael Strupp,Jennifer Linn,Roger Kalla,Katharina Feil 대한신경과학회 2019 Journal of Clinical Neurology Vol.15 No.2
Background and Purpose The initial diagnosis of medullary infarction can be challenging since CT and even MRI results in the very acute phase are often negative. Methods A retrospective, observer-blinded study of horizontal conjugate eye deviation was performed in 1) 50 consecutive patients [age 58±15 years (mean±SD), 74% male, National Institutes of Health Stroke Scale 2±1] with acute unilateral lateral medullary infarction as seen in MRI (infarction group), 2) 54 patients with transient brainstem symptoms [transient ischemic attack of brainstem (TIA) group; age 69±16 years, 59% male], and 3) 53 patients (age 59±20 years, 49% male) with diagnoses other than stroke (control group). Results Conjugate eye deviation was found in all patients in the infarction group [n=47 (94%) with ipsilesional deviation and n=3 (6%) with contralesional deviation] compared to 41% (n=22) in the brainstem TIA group and 15% (n=8) in the control group (p<0.0001). Within all groups mean deviation and range were similar for both sides (to the right vs. to the left side 26.6°±12.3 vs. 26.1°±12.3 in the infarction group, 10.5°±5.8 vs. 8.4°±6.3 in the brainstem TIA group and 4.5°±3.2 vs. 7.5°±3.2 in the control group). The extent of eye deviation was significantly greater in the infarction group (p<0.05). Conclusions All patients with MRI-demonstrated unilateral medullary infarction showed conjugate eye deviation. Therefore, conjugate eye deviation in patients with suspected acute lateral medullary infarction is a helpful sensitive sign for supporting the diagnosis, particularly if the deviation is >20°.
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Hagen, Ralf Matthias,Frickmann, Hagen,Ehlers, Julian,Krü,ger, Andreas,Margos, Gabriele,Hizo-Teufel, Cecilia,Fingerle, Volker,Rakotozandrindrainy, Raphael,Kalckreuth, Vera von,Im, Justin,Pak, Gi De Elsevier 2018 Acta tropica Vol.177 No.-
<P><B>Abstract</B></P> <P>The occurrence of tick-borne relapsing fever and leptospirosis in humans in Madagascar remains unclear despite the presence of their potential vectors and reservoir hosts.</P> <P>We screened 255 <I>Amblyomma variegatum</I> ticks and 148 <I>Rhipicephalus microplus</I> ticks from Zebu cattle in Madagascar for <I>Borrelia</I>-specific DNA. <I>Borrelia</I> spp. DNA was detected in 21 <I>Amblyomma variegatum</I> ticks and 2 <I>Rhipicephalus microplus</I> ticks. One <I>Borrelia</I> found in one <I>Rhipicephalus microplus</I> showed close relationship to <I>Borrelia theileri</I> based on genetic distance and phylogenetic analyses on 16S rRNA and <I>flaB</I> sequences. The borreliae from <I>Amblyomma variegatum</I> could not be identified due to very low quantities of present DNA reflected by high cycle threshold values in real-time-PCR. It is uncertain whether these low numbers of <I>Borrelia</I> spp. are sufficient for transmission of infection from ticks to humans.</P> <P>In order to determine whether spirochaete infections are relevant in humans, blood samples of 1009 patients from the highlands of Madagascar with fever of unknown origin were screened for <I>Borrelia</I> spp. − and in addition for <I>Leptospira</I> spp. − by real-time PCR. No target DNA was detected, indicating a limited relevance of these pathogens for humans in the highlands of Madagascar.</P> <P><B>Highlights</B></P> <P> <UL> <LI> <I>Borrelia</I> spp. DNA was detected in <I>Amblyomma (A.) variegatum</I> ticks and <I>Rhipicephalus (R.) microplus</I> ticks in Madagascar. </LI> <LI> DNA of a <I>Borrelia (B.) theileri</I>-related borreliae was detected in <I>R. microplus</I> for the first time in Madagascar. </LI> <LI> Only low amounts of <I>Borrelia</I> spp. DNA were detected in the assessed ticks, indicating low numbers of organisms and indicating an at the most limited risk of transmission to humans. </LI> <LI> <I>Borrelia</I> spp. DNA was absent in the blood of fever patients from the highlands in Madagascar. </LI> <LI> <I>Leptospira</I> (<I>L.</I>) spp. DNA was absent in the blood of fever patients from the highlands in Madagascar. </LI> </UL> </P>
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