Matthias Reinhard

Matthias Reinhard
Klinikum Esslingen · Department of Neurology and Clinical Neurophysiology

Prof. Dr. med.
Head of the Dept. of Neurology and Clinical Neurophysiology, Medical Center Esslingen, Academic Teaching Hospital

About

155
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Introduction
PLEASE NOTE: For reprint requests or questions/suggestions please contact me directly via email instead of using the RG site: m.reinhard@klinikum-esslingen.de

Publications

Publications (155)
Article
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Background In order to identify risk periods with an increased demand in technical and human resources we tried to determine patterns and associations in the incidence of acute ischemic stroke due to embolic large vessel occlusions (eLVO) requiring mechanical thrombectomy (MT). Methods We conducted a time series analysis over a nine‐year period (2...
Article
Full-text available
Abstract Background: In order to identify risk periods with an increased demand in technical and human resources we tried to determine patterns and associations in the incidence of acute ischemic stroke due to embolic large vessel occlusions (eLVO) requiring mechanical thrombectomy (MT). Methods: We conducted a time series analysis over a nine-ye...
Article
Introduction Long-term survivors of craniospinal irradiation have an increased risk for stroke which increases with radiation dose and follow-up time. Radiotherapy induces structural changes of the cerebral vasculature, affecting both, large, and small vessels. It is unknown how these structural changes affect functional mechanisms of cerebral bloo...
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Background: The tourniquet ischemia test (IT) is a hitherto rarely used tool for the diagnostic work-up of patients with suspected complex regional pain syndrome (CRPS). This analysis aims to determine the sensitivity and specificity of this test, and elucidate factors that can influence the test result. Methods: Consecutive data on clinical pre...
Chapter
A 66-year-old male patient sustained blunt trauma to the head and neck during a seizure following alcohol withdrawal. Two days later, he developed massive subarachnoid hemorrhage (SAH) and was found to have a ruptured left vertebral artery dissecting aneurysm (V4 segment). He was successfully treated with the insertion of telescoping p48MW HPC flow...
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Background A wide variety of metabolic changes, including an increased incidence of diabetes mellitus (DM) and dyslipidaemia, has been described in amyotrophic lateral sclerosis (ALS). The aim of this study was to investigate the associations of statin use and history of DM with onset of disease and survival in patients with ALS. Methods 501 patie...
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Measuring the strength of directed functional interactions between brain regions is fundamental to understand neural networks. Functional near-infrared spectroscopy (fNIRS) is a suitable method to map directed interactions between brain regions but is based on the neurovascular coupling. It, thus, relies on vasomotor reactivity and is potentially b...
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Objectives: Preeclampsia is a pregnancy-related hypertensive disorder with endothelial dysfunction. Impaired cerebral autoregulation may lead to symptomatic cerebral hyperperfusion, which sometimes manifests not until after delivery. This study investigated, whether cerebral autoregulation was altered after delivery in healthy and preeclamptic wom...
Article
Cerebral amyloid angiopathy (CAA) might disturb the sensitive mechanism of cerebral pressure autoregulation. This study examines whether dynamic cerebral autoregulation (CA) is impaired in the posterior or anterior circulation of CAA patients. Fifteen patients with known CAA on magnetic resonance imaging (MRI) and 14 age-matched controls were exami...
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Pathological yawning is rarely observed in cerebral or spinal diseases. A 67-year-old woman was admitted with a seven-day progressive hemisyndrome with left-sided limb ataxia and hypesthesia. The patient yawned with a high frequency, partially in salve-like episodes. MRI showed a cervical myelitis over more than three vertebral segments up to the l...
Data
Figure S1. The relative pulse slope index (RPSI) and maximum blood flow acceleration (ACCmax).
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Introduction: Intracerebral structures and pathologies such as intracerebral hemorrhages (ICH) can be displayed sufficiently by transcranial sonography (TCS). In some patients with ICH clot evacuation via surgery or catheter drainage to reduce secondary parenchymal injuries may be necessary. We hypothesized that bedside-placement of drainage-cathet...
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Background External counterpulsation improves cerebral perfusion velocity in acute stroke and may stimulate collateral artery growth. However, whether (non‐acute) at‐risk patients with high‐grade carotid artery disease may benefit from counterpulsation needs to be validated. Methods Twenty‐eight patients (71±6.5 years, 5 women) with asymptomatic u...
Article
Introduction: Preeclampsia is a pregnancy-related hypertensive disorder with strongly impaired cerebral autoregulation in the acute stage. A history of preeclampsia is an independent cardiovascular and cerebrovascular risk factor. It is unclear whether impaired cerebral autoregulation persists after preeclampsia and thus contributes to the known i...
Article
BACKGROUND AND PURPOSE The differentiation of primary intracerebral hemorrhage (ICH) from parenchymal hemorrhagic transformation within an ischemic infarction (PHI) is crucial in order to adapt therapeutic measures. We hypothesized that a distinction of ICH and PHI can be made at bedside via transcranial gray‐scale and perfusion sonography. METHOD...
Article
BACKGROUND Chronic posthemorrhagic hydrocephalus necessitating shunt placement is a common complication of subarachnoid hemorrhage (SAH). OBJECTIVE To evaluate the role of external ventricular drainage (EVD) weaning on risk of shunt dependency after SAH. METHODS Two German university hospitals with different EVD management regimes (rapid weaning...
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IntroductionIn patients with acute ischemic stroke, penumbral perfusion is maintained by collateral flow and so far is maintained by normal mean arterial pressure (MAP) levels. Since MAP is dependent on cardiac function, optimization of cardiac output might be a valuable hemodynamic goal in order to optimize cerebral perfusion (CP).Methods Cerebral...
Article
OBJECTIVE An asymmetry of the A 1 segments (A1SA) of the anterior cerebral arteries (ACAs) is an assumed risk factor for the development of anterior communicating artery aneurysms (ACoAAs). It is unknown whether A1SA is also clinically relevant after aneurysm rupture. The authors of this study investigated the impact of A1SA on the clinical course...
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Background: Increasing numbers needed to treat within the first hours after ischemic stroke onset indicate a strong time dependency of the viability of brain tissue. However, this time dependency is not reflected in recent randomized controlled trials of endovascular stroke treatment. This study evaluates whether and to which extent a time depende...
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Objective: To report a case of a patient with multiple cerebral cavernous malformations (CCM). Observation: A 22year old man with mild von Willebrand disease presented with two occipital CCM, one of them with acute hemorrhage. Genetic testing for CCM1-3 did not reveal a mutation. Over a period of 54months, the patient suffered 26 new CCM hemorrh...
Chapter
Cerebral arterial time constant (τ) estimates how quickly the cerebral arterial bed distal to the point of insonation is filled with arterial blood following a cardiac contraction. It is not known how τ behaves in different vascular territories in the brain. We therefore investigated the differences in τ of two cerebral arteries: the posterior infe...
Article
Regulation of cerebral blood flow serves to protect the brain in the face of changing perfusion pressure. In acute subarachnoid hemorrhage (SAH), this autoregulation faces challenges both from reduced local cerebral perfusion pressure caused by cerebral vasospasm and from reductions in global cerebral perfusion pressure due to hydrocephalus. Early...
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In patients with ischemic stroke of unknown cause cerebral vasculitis is a rare but relevant differential diagnosis, especially when signs of intracranial artery stenosis are found and laboratory findings show systemic inflammation. In such cases, high-resolution T1w vessel wall magnetic resonance imaging (MRI; 'black blood' technique) at 3 T is pr...
Article
Background: Cerebral vasospasm usually develops several days after subarachnoid hemorrhage (SAH) and is generally acknowledged as a strong outcome predictor. In contrast, much less is known about the nature and eventual consequences of early angiographic vasospasm (EAVS) seen on admission digital subtraction angiography (DSA). Therefore, we aimed...
Article
Introduction: Identifying factors associated with short term outcome following carotid endarterectomy (CEA) is important to improve patient selection. There are limited data assessing 30-day major adverse cardiac and cerebrovascular events (MACCE: stroke, myocardial infarction (MI) and death) in clinical practice. Hypothesis: We hypothesized that p...
Article
Background: Intraventricular hemorrhage is known to complicate the course and outcome of aneurysmal subarachnoid hemorrhage. Aims: To identify independent risk factors for intraventricular hemorrhage development and its severity during aneurysm rupture. Methods: Six hundred and twenty-five subarachnoid hemorrhage patients treated at our instit...
Article
BACKGROUND Along with subarachnoid hemorrhage (SAH), a ruptured aneurysm may also cause an intracerebral hematoma (ICH), which negatively impacts the functional outcome of SAH. OBJECTIVE To identify independent risk factors of aneurysmal ICH. METHODS Six hundred thirty-two consecutive patients with aneurysmal SAH treated at our institution from J...
Article
Background: Currently, there are 2 strategies to increase the effect of systemic thrombolysis with alteplase (rtPA) in acute major stroke: endovascular treatment via stent retrieval and ultrasound enhancement (sonothrombolysis). This study compares these 2 approaches in patients with proximal intracranial occlusion of the anterior circulation. Me...
Article
This study investigates the diagnostic value of optic nerve sheath diameter (ONSD) assessed by transorbital sonography for estimation of intracranial pressure (ICP) in patients with aneurysmal subarachnoid hemorrhage (SAH). Simultaneous measurements of the ONSD and ICP in 27 patients suffering from SAH and acute hydrocephalus after placement of an...
Article
To assess the accuracy of ocular B-mode sonography and of standard head computed tomography (CT) as screening tools for intraocular hemorrhages related to subarachnoid hemorrhage (SAH). 46 patients with spontaneous SAH were examined using ocular B-mode sonography and underwent funduscopy as gold standard for detection of ocular hemorrhages (OH). Ad...
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-We explored the safety of intravenous thrombolysis (IVT) or intra-arterial treatment (IAT) in ischemic stroke patients on novel oral anticoagulants (NOAC, last intake <48hours) compared to patients (i) taking vitamin K-antagonists (VKA) or (ii) without prior anticoagulation (no-OAC). -Multicenter cohort pilot study. Primary outcome measures were (...
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Indexes PRx and Mx have been formerly introduced to assess cerebral autoregulation and have been shown to be associated with 3-month clinical outcome. In a mixed cohort of neurocritical care patients, we retrospectively investigated the impact of selected clinical characteristics on this association. Forty-one patients (18–77 years) with severe tra...
Article
Contrary to aneurysmal bleeding, non-aneurysmal non-traumatic subarachnoid hemorrhage (NASAH) is rarely associated with unfavorable clinical outcome, cerebral infarction and vasospasm. We aimed to identify independent predictors for a poor clinical course and outcome after NASAH. All patients with NASAH treated at our institution between January 20...
Article
Cerebral infarction (CI) is a crucial complication of aneurysmal subarachnoid hemorrhage (SAH) associated with poor clinical outcome. We aimed at developing an early risk score for CI based on clinical characteristics available at the onset of SAH. Out of a database containing 632 consecutive patients with SAH admitted to our institution from Janua...
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Objective: Substantia nigra (SN) hyperechogenicity can be detected by transcranial sonography (TCS) to assist the early diagnosis of idiopathic Parkinson's disease (IPD). This study prospectively investigated whether SN hyperechogenicity is also present in Huntington's disease (HD) patients with symptoms of hypokinesia and/ or rigidity. Method: All...
Article
Cerebral infarction is a frequent and serious complication of aneurysmal subarachnoid hemorrhage (SAH). This study aimed to identify independent predictors of the timing of cerebral infarction and clarify its impact on disease course and patients' outcome. All consecutive patients with SAH admitted to our institution from January 2005 to December 2...
Article
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Substantia nigra (SN) hyperechogenicity can be detected by transcranial sonography (TCS) to assist the early diagnosis of idiopathic Parkinson’s disease (IPD). This study prospectively investigated whether SN hyperechogenicity is also present in Huntington’s disease (HD) patients with symptoms of hypokinesia and/or rigidity. All patients recruited...
Article
Monitoring der zerebralen Autoregulation zur Prognose des klinischen Outcomes Schmidt B, Lezaic V, Reinhard M, McLeod DD, Weinhold M, Schwarze JJ, Klingelhöfer J Klinik für Neurologie, Klinikum Chemnitz Klinik für Neurologie, Universitätsklinikum Freiburg Fraunhofer Institut für Zelltherapie und Immunologie, Leipzig Einleitung: Zwei vor mehreren...
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The impulse response based autoregulation index (ARI) allows for continuous monitoring of cerebral autoregulation using spontaneous fluctuations of arterial blood pressure and cerebral flow velocity (FV). We compared three methods of autoregulation assessment in 288 TBI patients managed in the Neurocritical Care Unit: 1) Impulse Response-based ARI;...
Article
Background and purposeHormonal and mechanical factors might increase the risk for cervical artery dissection (CAD) during pregnancy and the puerperium. There is uncertainty how to counsel women with a previous CAD regarding the risk of CAD recurrence during pregnancy and the puerperium.Methods In an observational study of four stroke centers, all w...
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Background and purpose: Mechanical thrombectomy by using a single stent retriever system has demonstrated high efficacy for recanalization of large-artery occlusions in acute stroke. We aimed to evaluate the feasibility, safety, and efficacy of a novel double Solitaire stent retriever technique as an escalating treatment for occlusions that are re...
Article
Objective: To assess the usefulness of transcranial Doppler CO2 reactivity (CO2R) for prediction of ipsilateral ischemic stroke in carotid artery stenosis and occlusion with a meta-analysis of prospective studies based on individual patient data. Methods: We searched Medline, Biosis Previews, Science Citation Index, The Cochrane Library, and EMB...
Article
Ziel der Studie: Die Messung des regionalen zerebralen Glukosemetabolismus mittels der [¹⁸F]Fluorodeoxyglukose-Positronen-Emissions-­Tomografie (FDG-PET) sowie die Beurteilung struktureller Auffälligkeiten des Hirnstammes und der Basalganglien mittels transkranieller ­B-mode ­Sonografie (TCS) können zur bildgebenden ­Differenzialdiagnostik des Park...
Article
The exact spatial distribution of impaired cerebral autoregulation in carotid artery disease is unknown. In this pilot study, we present a new approach of multichannel near-infrared spectroscopy (mcNIRS) for noninvasive spatial mapping of dynamic autoregulation in carotid artery disease. In 15 patients with unilateral severe carotid artery stenosis...
Article
Purpose: To assess the diagnostic accuracy of contrast material-enhanced magnetic resonance (MR) imaging of superficial cranial arteries in the initial diagnosis of giant cell arteritis ( GCA giant cell arteritis ). Materials and methods: Following institutional review board approval and informed consent, 185 patients suspected of having GCA gia...
Article
Backround: The extent of hemodynamic disturbances following subarachnoid hemorrhage (SAH) varies. We aim to determine the prognostic implications of unilateral and bilateral autoregulatory failure on delayed cerebral ischemia (DCI) and outcome. Methods: Ninety-eight patients with aneurysmal SAH were recruited. Autoregulation was assessed using s...
Article
Background and purpose: This study investigated whether a short testing of neurovascular coupling during midterm pregnancy could identify women at risk for subsequent preeclampsia. Methods: Transcranial Doppler sonography of the posterior cerebral artery during a brief visual stimulation was analyzed in 68 women at midterm pregnancy, the primary...
Article
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Background The differential diagnosis of pseudo-neurological symptoms often represents a clinical challenge. The Diagnostic and Statistical Manual of Mental Disorders, DSM-5, made an attempt to improve diagnostic criteria of conversion disorder (functional neurological symptom disorder). Incongruences of the neurological examination, i.e. positive...
Article
Fragestellung: Die Evaluierung des regionalen zerebralen Glukosemetabolismus mit der F-18-FDG PET und die Beurteilung struktureller Auffalligkeiten des Hirnstammes und der Basalganglien mittels Transkranieller B-mode Sonografie (TCS) eignen sich zur bildgebenden Differentialdiagnostik des Parkinson-Syndromes. Wir untersuchten die diagnostische Wert...
Article
Background and purposeBrain imaging with positron emission tomography using [18F]fluorodeoxyglucose (FDG-PET) and transcranial B-mode sonography (TCS) improves the differential diagnosis of parkinsonism. The diagnostic merits of these approaches in identifying and differentiating atypical parkinsonian syndromes (APS) are compared. Methods Data were...
Article
Reducing cerebral perfusion pressure (CPP) below the lower limit of autoregulation (LLA) causes cerebral blood flow (CBF) to become pressure passive. Further reductions in CPP can cause cessation of CBF during diastole. We hypothesized that zero diastolic flow velocity (FV) occurs when diastolic blood pressure becomes less than the critical closing...
Article
Preeclampsia may affect severely the cerebral circulation leading to impairment of cerebral autoregulation, edema, and ischemia. It is not known whether impaired autoregulation occurs before the clinical onset of preeclampsia, and whether this can predict the occurrence of preeclampsia. Seventy-two women at 25 to 28 weeks of gestation were studied....
Article
Cerebral autoregulation (CA) is not universally impaired in acute intracerebral hemorrhage (ICH); however, the dynamic components of CA are probably more vulnerable. This study, therefore, evaluates the time course of dynamic CA in acute ICH and its relationship to clinical outcome. Twenty-six patients with ICH were studied on days 1, 3, and 5 afte...
Article
Cerebrovascular manifestations in Klippel-Trenaunay Syndrome (KTS) have been reported but are extremely rare. Case reports describe brain embolism in KTS-associated coagulopathy as well as bleeding due to arteriovenous malformations. We describe a 45-year-old patient with KTS and both acute ischemic stroke and repeated cerebral haemorrhage. The und...
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Background and purpose: To provide evidence whether mechanical thrombectomy with stent-retrievers in the treatment of acute ischemic stroke causes intimal damage. Methods: This study analyzed thrombi retrieved by mechanical thrombectomy from cerebral arteries in 48 consecutive patients with acute ischemic stroke for the presence of endothelial c...
Article
Background: Critical closing pressure (CCP) denotes a threshold of arterial blood pressure (ABP) below which brain vessels collapse and cerebral blood flow ceases. Theoretically, CCP is the sum of intracranial pressure (ICP) and arterial wall tension (WT). The aim of this study is to describe the behavior of CCP and WT during spontaneous increases...