Early hypopituitarism following cavernous sinus thrombosis: total recovery within 1 year.

Hypopituitarism related to cavernous sinus thrombosis is a very rare event which usually occurs at least 1 year after the acute stage. We report a case which distinguished itself from the previously reported cases through (i) its occurrence during the acute stage and (ii) its total recovery within 1 year. Early anterior hypopituitarism is probably more frequent than expected on the basis of reported cases and it may contribute to the high rate of mortality in cavernous sinus thrombosis. This underscores the need to consider hypopituitarism in every patient with cavernous sinus thrombosis.

[Postero-medial bulbar hematoma with a favorable outcome. Study of dysautonomia]. / Hématome bulbaire postéro-médian d'évolution favorable. Etude de la dysautonomie.

A case of postero-medial medullary hematoma in a 21 year-old woman is reported. An initial neurovegetative severe disregulation had a favorable outcome after surgery. Late deficits, characterizing the postero-medial medullary syndrome have been studied: paresis of the tongue, suppression of the nauseous reflex, instability with retropulsion, and downbeating nystagmus in primary position of the eyes were noted. Heart rate and arterial blood pressure analysis showed explosive tachycardic reactions and transitory disappearance of oculo-cardiac reflexes, suggesting the involvement of the efferent parasympathetic system coming from the dorsal motor nucleus of the vagus nerve.

[Bulbar hematoma of the olivary area. An analysis of the autonomic syndrome]. / Hématome bulbaire dans la région olivaire. Analyse du syndrome autonome.

The consequences of an anterolateral medullary hematoma in a 50 year old patient are reported. The lesions principally involved the inferior olive nuclei, the lateral reticular nucleus, and, partially, the nucleus ambiguus. Long-lasting postural control deficit and hypotonia were observed, associated with alpha motoneurons hyperexcitability. Analysis of the heart rate regulation showed a severe reduction of the normal accelerating reactions and a relative preservation of slowing down reactions that suggested a deficit of the ortho-sympathetic control. Unilateral palsy of the tongue and pharynx was also observed without sensory or sensorial deficit. The long term course was favourable.

[Bilateral cavernous sinus syndrome: Burkitt's lymphoma]. / Syndrome du sinus caverneux bilatéral: lymphome de Burkitt.

Bilateral cavernous sinus syndrome is usually due to a vascular disease, such as thrombophlebitis or arteriovenous malformation. In a 29-year old woman this syndrome revealed a malignant non-Hodgkin's lymphoma of the Burkitt type. In this case, the physiopathological mechanism was metastatic extension to the dura mater of a systemic lymphoma. The contribution of MRI to the diagnosis is emphasized.

[Mood disorders and right hemisphere infarction]. / Troubles de l'humeur et infarctus de l'hémisphère droit.

Persistent depression of mood following stroke and acute psychiatric disturbances in conjunction with infarcts in the right hemisphere has been well reported. Sometimes its psychiatric features were most salient although neurological signs could not be elicited. We treated two patients with infarcts in the right hemisphere. The first developed depression with melancholia, the second a bipolar disorder. We question whether aprosodia or mood neglect may give a melancholic profile of depression following right hemisphere damage.

[Prevention of risk in stereotaxic biopsy of various tumors of the pineal region. Apropos of 3 cases]. / De la prévention des risques de la biopsie stéréotaxique de certaines tumeurs de la région pinéale. A propos de 3 observations.

During the last ten years, the authors have performed 750 stereotactic biopsies with 6 deaths. In 3 cases, the lesion was a pinealoblastoma, with comparable symptomatology and CT scan image. Safety measures are discussed.

[Intracranial ependymomas. Experience with 86 cases]. / Les épendymomes intracrâniens. Expérience de 86 cas.

The authors report a series of 86 intracranial ependymomas. The origin of the tumor was supratentorial in 53 cases, infratentorial in 33. All patients underwent surgery and most of them had also radiation therapy. The operative mortality rate was 25%. Five year survival rate was 31%. Better prognosis was recorded for low grade tumors. The location of the tumor, total or incomplete surgical excision had no influence concerning long-term survival. The five year survival rate for the 28 children in the series was 42%, against 19% for adults. Local recurrence occurred in 39% of patients, and spinal metastases were recorded in only 2 cases. The authors emphasize the need for systematic radiation therapy, with different protocols according to age of patient, location and histological type of tumor.

[Lhermitte-Duclos disease. Apropos of a case]. / Maladie de Lhermitte-Duclos. A propos d'une observation.

The authors report a case of dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease). This woman's first neurosurgical admission was in 1970 at the age of 15 years. Hydrocephalus related to aqueduct-stenosis was diagnosed and a ventriculo atrial shunt was inserted. Ten years later, she underwent partial resection of a third ventricle tumor which was identified as a pilocytic astrocytoma. In 1986, computerized tomography revealed a non-enhancing left cerebellar mass lesion. Surgical excision was performed, and pathological examination disclosed dysplastic gangliocytoma of the cerebellum.

[Chronic sciatalgia caused by sensitive deafferentiation following surgery for lumbar disk hernia: clinical and therapeutic aspects. Apropos of 110 patients]. / Sciatalgies chroniques par désafférentation sensitive après chirurgie de la hernie discale lombaire: aspects cliniques et thérapeutiques. A propos de 110 patients.

Sensitive deafferentation is a well recognized entity which has changed the therapeutic approach of some kinds of chronic post operative sciatalgia. It mainly occurs related with a long story of radicular pain and the responsibility of so-called epidural fibrosis has to be discussed. The case records of 110 consecutive patients with deafferentation sciatalgia were reviewed and the clinical data precised: chronic and lasting burning pain with acute nightly paroxysms and sensitive alterations at objective examination. Neuroradiological explorations eliminated the possibility of recurrent disc herniation and neurophysiological tests assessed the chronic radicular suffering and the degree of lemniscal degeneration. After medical treatment (analgesic drugs with central tropism), a strict clinical assessment of pain intensity allowed optimal choice of the technique of neurostimulation: transcutaneous electrical stimulation (51 patients) and/or spinal cord stimulation (59 patients). The efficacy of transcutaneous stimulation (40 excellent and good results) was most often related to its continuous utilisation with a short post-effect. Its side-effects and the frequency of multiradicular involvement lead to spinal cord stimulation. With a mean follow-up period of 37 months, the pain relief was considered as excellent in 51.5%, good in 38% and poor in 8.5% of the patients. One patient had a negative test and was not definitively implanted. Another case failed to respond to stimulation. The clinical and technical complication of the method are reported.

[Intracerebroventricular morphine therapy. Apropos of 79 patients]. / La morphinothérapie intracérébro-ventriculaire. A propos de 79 patients.

The authors report their experience in the treatment of 79 patients suffering from intractable cancer pain with intra-cerebro-ventricular morphine. They obtain a long-lasting analgesia (34.2 hours at the beginning of treatment and 27.9 hours at the end; mean follow-up of 65 days) with a very low daily morphine consumption. The results obtained, good and very good in 95% of the cases, could be explained by patients' selection criteria and quality of the follow-up (prospective sheet given to the patients, regular phone calls and consultations in the pain clinic). The authors discuss the indications of this technique in relation with other neurosurgical procedures, taking into account the neurophysiological mechanism of action of morphine.

[Opticochiasmatic apoplexy]. / Apoplexie opto-chiasmatique.

A 26-year-old patient presented with acute chiasmal syndrome. Computerized Tomography and Magnetic Resonance Imaging demonstrated an intrachiasmal hematoma which was evacuated via a right subfrontal approach. Histological examination revealed an arteriovenous malformation. In 21 similar cases in the literature, surgery generally resulted in the improvement of ophthalmological signs. In 3/4 of the cases, histology identified a subjacent lesion (arteriovenous malformation, cavernoma, venous angioma, glioma).

[Distal intracranial arterial aneurysms. Apropos of a case of giant aneurysm of the right angular gyrus artery]. / Les anévrysmes artériels intracrâniens distaux. A propos d'un cas d'anévrysme géant de l'artère du pli courbe.

A 57 year old man presented with a giant, fusiform, partially thrombosed aneurysm, located distally to the right angular gyrus artery, and revealed by a subarachnoïd hemorrhage. There was no history of head trauma, endocarditis or systemic infection, and physical examination was normal. The treatment consisted in simple trapping of the aneurysm, responsible for a transient ischemic parietal syndrome. After a short review of the pathogenesis of peripheral aneurysm of the C.N.S., and previously reported cases of distally located aneurysms of the middle cerebral artery, only one similar case was found concerning a posterior temporal artery aneurysm involving to a giant serpentine aneurysm. The case presented is believed to be a segmentary form of cerebral arterial dolicho ectasia; relations between arterial ectasia or fusiform aneurysms and serpentine aneurysms are discussed.

[Cystic meningioma. 3 cases]. / Les méningiomes kystiques. 3 observations.

The association of a meningioma and an arachnoid cyst is one of the many association of cyst and meningioma. The diagnosis could be difficult by CT scan. We report three cases of parameningiomal cysts and discuss their different mechanism of formation before stressing practical problems.

The stereotactic approach to brain stem lesions: a follow-up of 29 cases.

Stereotactic biopsy is the safest and most reliable method for the histological diagnosis of intraaxial brain stem lesions. The definitive pathological diagnosis permits the selection of adequate therapy. No operative and/or adjuvant therapy must be proposed without a previous histological diagnosis. This approach avoids the complication of inappropriate therapy and provides valuable prognostic information.

Upbeat and downbeat nystagmus occurring successively in a patient with posterior medullary haemorrhage.

In a patient with posterior medullary haemorrhage, first upbeat and later downbeat nystagmus occurred in the primary position. The lesion was limited to the posterior and medial part of the medulla. Clinical and electro-oculographic examination first showed upbeat nystagmus in the primary position and upgaze, with downbeat nystagmus in downgaze. Two and a half months later, there was downbeat nystagmus in the primary position and downgaze and upbeat nystagmus in upgaze.