Die neuropathische Komponente beim chronischen Rückenschmerz

2012 ◽  
Vol 31 (03) ◽  
pp. 147-153 ◽  
Author(s):  
M. Förster ◽  
F. Mahn ◽  
R. Baron
Keyword(s):  
Chronische Rückenschmerzen ◽  
Evidenzbasierte Therapie ◽  
Mixed Pain ◽  
Bedside Tests

ZusammenfassungDas aktuelle Konzept für chronische Rückenschmerzen postuliert ein Nebeneinander von nozizeptiven und neuropathischen Schmerzkomponenten (Mixed-Pain-Konzept). Die charakteristischen neuropathischen Symptome mit negativen und positiven Phänomenen helfen bei der Diagnosestellung. Durch weitgehend objektive Verfahren wie Bedside-Tests und Fragebögen kann die neuropathische Komponente valide identifiziert werden. Für die therapeutischen Optionen stehen nur Daten für den nozizeptiven Rückenschmerz zur Verfügung. In Anlehnung an klassische neuropathische Schmerzsyndrome versucht man einen Ansatz mit Medikamenten, ohne dass eine spezifische evidenzbasierte Therapie empfohlen werden kann.

Prospektive Evaluierung zweier „Bedside-Tests“ zur Diagnose der Spontan bakteriellen Peritonitis

2008 ◽  
Vol 46 (09) ◽  
Author(s):  
R Neuwirth ◽  
H Farnik ◽  
J Hausmann ◽  
O Ackermann ◽  
D Bergis ◽  
...  
Keyword(s):  
Bedside Tests

Evidenzbasierte Therapie des idiopathischen Normaldruckhydrozephalus

2017 ◽  
Vol 36 (03) ◽  
pp. 173-176
Author(s):  
S. Rot ◽  
U. Meier ◽  
J. Lemcke
Keyword(s):  
Klinische Forschung ◽  
Evidenzbasierte Therapie ◽  
Non Invasive

ZusammenfassungDie klinische Forschung zum idiopathischen Normaldruckhydrozephalus erfolgt auf steigendem methodischem Niveau und ermöglicht die evidenzbasierte Therapie der Patienten. Die jährliche Inzidenz von Patienten mit einem diagnostizierten und therapierten idiopathischen Normaldruckhydrozephalus beträgt in den westlichen Ländern nach epidemiologischen Untersuchungen ca. 1/100 000 Einwohner. Non-invasive Methoden spielen in der Diagnostik eine zunehmend wichtigere Rolle, können allerdings die invasiven Methoden noch nicht ersetzen. Die grundsätzliche Effektivität von Liquorshunts zur Therapie des idiopathischen Normaldruckhydrozephalus konnte nachgewiesen werden. In weiteren Untersuchungen konnte gezeigt werden, dass die Komplikationsrate durch die Implantation von programmierbaren Ventilen mit Gravitationsventilen deutlich minimiert wird. Programmierbare Gravitationseinheiten wurden im Rahmen einer prospektiven Studie untersucht. Ihre Effektivität wird in einer prospektiv randomisierten Studie geprüft.

Starke chronische Rückenschmerzen

CME ◽  
2015 ◽  
Vol 12 (4) ◽  
pp. 42-42
Author(s):  
Keyword(s):  
Chronische Rückenschmerzen

scholarly journals Bedside examination of the vestibular and ocular motor system in patients with acute vertigo or dizziness

2019 ◽  
Vol 3 (2) ◽  
pp. 2514183X1988615
Author(s):  
Alexander A Tarnutzer ◽  
Marianne Dieterich
Keyword(s):  
Diagnostic Testing ◽  
Initial Assessment ◽  
Head Impulse Test ◽  
Motor Deficits ◽  
Ocular Motor ◽  
Bedside Examination ◽  
Life Threatening ◽  
Ocular Motor System ◽  
Bedside Tests ◽  
The Brain

In the initial assessment of the patient with acute vertigo or dizziness, both structured history-taking and a targeted bedside neuro-otological examination are essential for distinguishing potentially life-threatening central vestibular causes from those of benign, self-limited peripheral labyrinthine origin and thus for deciding on further diagnostic testing. In this article, the key elements of the vestibular and ocular motor examination, which should be obtained at the bedside in these acutely dizzy patients, will be discussed. Specifically, this will include the following five domains: ocular stability for (I) nystagmus and for (II) eye position (skew deviation), (III) the head-impulse test (HIT), (IV) postural stability, and (V) ocular motor deficits of saccades, smooth pursuit eye movements, and optokinetic nystagmus. We will also discuss the diagnostic accuracy of specific combinations of these bedside tests (i.e. HIT, testing for nystagmus and vertical divergence, referred to as the H.I.N.T.S. three-step examination), emphasizing that the targeted neuro-otological bedside examination is more sensitive for identifying central causes in acute prolonged vertigo and dizziness than early MRI of the brain.

scholarly journals A pilot study of performance among hospitalised elderly patients on a novel test of visuospatial cognition: the letter and shape drawing (LSD) test

2016 ◽  
Vol 34 (3) ◽  
pp. 169-175 ◽  
Author(s):  
D. White ◽  
O. A. Williams ◽  
M. Leonard ◽  
C. Exton ◽  
D. Adamis ◽  
...  
Keyword(s):  
Elderly Patients ◽  
University Hospital ◽  
Strong Positive Correlation ◽  
Visuospatial Ability ◽  
Visuospatial Function ◽  
Conventional Tests ◽  
Medical Inpatients ◽  
Significant Impairment ◽  
Bedside Tests ◽  
Moca Score

ObjectivesConventional bedside tests of visuospatial function such as the clock drawing (CDT) and intersecting pentagons tests (IPT) are subject to considerable inconsistency in their delivery and interpretation. We compared performance on a novel test – the letter and shape drawing (LSD) test – with these conventional tests in hospitalised elderly patients.MethodsThe LSD, IPT, CDT and the Montreal Cognitive Assessment (MoCA) were performed in 40 acute elderly medical inpatients at University Hospital Limerick The correlation between these tests was examined as well as the accuracy of the visuospatial tests to identify significant cognitive impairment on the MoCA.ResultsThe patients (mean age 81.0±7.71; 21 female) had a median MoCA score of 15.5 (range=1–29). There was a strong, positive correlation between the LSD and both the CDT (r=0.56) and IPT (r=0.71). The correlation between the LSD and MoCA (r=0.91) was greater than for the CDT and IPT (both 0.67). The LSD correlated highly with all MoCA domains (ranging from 0.54 to 0.86) and especially for the domains of orientation (r=0.86), attention (0.81) and visuospatial function (r=0.73). Two or more errors on the LSD identified 90% (26/29) of those patients with MoCA scores of ⩽20, which was substantially higher than for the CDT (59%) and IPT (55%).ConclusionThe LSD is a novel test of visuospatial function that is brief, readily administered and easily interpreted. Performance correlates strongly with other tests of visuospatial ability, with favourable ability to identify patients with significant impairment of general cognition.

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