[Bilateral subdural hematomas due to idiopathic cerebral spinal fluid leak treated by radiologically guided blood patch]. / Hygromes sous-duraux bilatéraux sur fuite de liquide céphalo-rachidien idiopathique traitée par «blood patch¼ radio-guidé.

We report a case of cerebral hypotension due to an idiopathic cerebral spinal fluid leak associated with bilateral sub-dural hygromas. The symptoms were not relieved despite of multiple lumbar, thoracic and cervical «blind¼ blood patches. The check-up led to a scopic controlled cervical blood patch directly on the leak by a paramedian approach with a complete clinical and radiological response to treatment.

Nous rapportons un cas d'hypotension cérébrale sur une fuite de liquide céphalo-rachidien d'origine idiopathique associée à la présence d'hygromes sous-duraux bilatéraux. La symptomatologie n'est pas soulagée malgré plusieurs «blood patchs¼ lombaires, thoraciques et cervicaux dits à l'aveugle. Le bilan a conduit à la réalisation d'un «blood patch¼ sous contrôle radiologique, ciblée sur le niveau de fuite par un abord paramédian avec réponse complète clinique et radiologique après cette procédure.

[Hiccups, not always unremarkable]. / Les hoquets : pas toujours banals.

Hiccups are most often benign and of short duration. However, they may also be persistent (superior to 48h) or even refractory (superior to 1 month). In such cases, they markedly alter the quality of life and can lead to severe impairment of health. We here review hiccups pathophysiology, etiologies, work up and treatment. We suggest that hiccups should be considered as a non-epileptic myoclonic movement disorder.

Le hoquet est le plus souvent bénin et de courte durée, mais il peut aussi être persistant (sup�rieur a 48h), voire réfractaire (sup�rieur a 1 mois). Dans ces cas, il altère la qualité de vie et peut avoir des conséquences graves sur la santé. Nous en revoyons ici la physiopathologie, les étiologies, la mise au point diagnostique et les traitements. Nous concluons par une réflexion sur la nature du hoquet que nous considérons comme un mouvement anormal appartenant au groupe des myoclonies non épileptiques.

Pneumonectomy combined with SU5416 induces severe pulmonary hypertension in rats.

The SU5416 + hypoxia (SuHx) rat model is a commonly used model of severe pulmonary arterial hypertension. While it is known that exposure to hypoxia can be replaced by another type of hit (e.g., ovalbumin sensitization) it is unknown whether abnormal pulmonary blood flow (PBF), which has long been known to invoke pathological changes in the pulmonary vasculature, can replace the hypoxic exposure. Here we studied if a combination of SU5416 administration combined with pneumonectomy (PNx), to induce abnormal PBF in the contralateral lung, is sufficient to induce severe pulmonary arterial hypertension (PAH) in rats. Sprague Dawley rats were subjected to SuPNx protocol (SU5416 + combined with left pneumonectomy) or standard SuHx protocol, and comparisons between models were made at week 2 and 6 postinitiation. Both SuHx and SuPNx models displayed extensive obliterative vascular remodeling leading to an increased right ventricular systolic pressure at week 6 Similar inflammatory response in the lung vasculature of both models was observed alongside increased endothelial cell proliferation and apoptosis. This study describes the SuPNx model, which features severe PAH at 6 wk and could serve as an alternative to the SuHx model. Our study, together with previous studies on experimental models of pulmonary hypertension, shows that the typical histopathological findings of PAH, including obliterative lesions, inflammation, increased cell turnover, and ongoing apoptosis, represent a final common pathway of a disease that can evolve as a consequence of a variety of insults to the lung vasculature.

[How I treat? complex regional pain syndrome]. / Comment je traite ... le syndrome douloureux régional complexe (SDRC).

Complex regional pain syndrome (CRPS), formerly known as algoneurodystrophy, is a painful condition of a part of the body, associated with vasomotor, motor and trophic dysfunctions that can occur after trauma. The epidemiology, diagnostic criteria and advances in physiopathology of CRPS will be briefly described. Then the different therapeutic approaches available today will be clarified.

Le syndrome douloureux régional complexe (SDRC), anciennement connu sous le nom d'algoneurodystrophie, est un état douloureux d'une région du corps, souvent un membre, associé à des troubles vasomoteurs, moteurs et trophiques, qui peut survenir après un traumatisme. Nous décrivons brièvement l'épidémiologie, les critères diagnostiques et les avancées dans la physiopathologie. Nous explicitons ensuite les différents schémas thérapeutiques disponibles actuellement.