[Reduplication of an event after right caudate nucleus haemorrhage]. / Paramnésie De Réduplication D'évènement Après Hémorragie Du Noyau Caudé Droit.

BACKGROUND: Environmental reduplication which is characterized by reduplication of places has been reported in right hemispheric lesions, particularly but not only in the right frontal region. However, spatial delirium may follow right sub-cortical lesions. METHODS: We describe a 53 years-old man who had a reduplicative paramnesia for event alone after an intracerebral haematoma of the right caudate nucleus. RESULTS: MRI Scan showed also an extension of the right caudate nucleus haemorrhage into the ventricular system. Regional cerebral blood flow studied with 99Tcm-HMPAO showed a decrease of perfusion in the right dorso-lateral frontal cortex. To our knowledge, we reported the first case of reduplicative paramnesia of event associated with a right caudate nucleus injury. Similar right frontal deactivation was observed in two cases of reduplicative paramnesia for place, one of them after an infarction of the retro-lenticular portion of the right internal capsulae, the other after a right thalamo-capsular haemorrhage. CONCLUSION: We suggest that reduplicative paramnesia for event, like the previous cases reported of reduplicative paramnesia for place, may be linked to a subcortical lesion of the frontal lobe inducing a right functional frontal deactivation.

[Contribution of neuroradiology to the evaluation of peripheral nerves]. / Apport de l'imagerie dans l'évaluation des nerfs périphériques.

The evaluation of peripheral nerve impairment can use echography, MRI and CT. The alteration of the nerves in tunnel syndromes, especially if symptoms are not sufficiently contributive, is clearly visualized with MRI. Echography is very useful in the diagnosis of nerve tumors and neuromas. Plexus brachial palsies need to be evaluated using MRI. Progress in neuroimaging has improved clinical practice so that the most relevant treatment can be chosen for some pathologies such as infiltration performed under CT scanner guidance. The authors report which exam to use and the results to be expected for each pathology.

[High resolution MRI of carotid atherosclerosis: looking beyond the arterial lumen]. / IRM haute résolution de l'athérosclérose carotidienne: au-delà de la lumière artérielle.

Despite advances in diagnosis and treatment, atherosclerosis remains the second cause of death in the world. Due to technical advances, high resolution MRI (HR-MRI) allows depiction of the wall of cervical arteries, especially carotid atherosclerosis. HR-MRI allows visualization of the different components of atherosclerosis: necrotic lipid core, intraplaque hemorrhage, calcifications and fibrous cap. Global plaque volume as well as the volumes of individual plaque components can be calculated. Atherosclerotic plaque structure analysis, along with stenosis measurement, contribute to the stratification of the stroke risk. HR-MRI may also be used to assess treatment efficacy aimed at stabilizing or reducing plaque progression. Beyond the arterial lumen, direct evaluation of vessel wall should modify the management of atherosclerosis in the years to come.

[Solitary intracerebral langerhans cell histiocytosis: report of one case and literature review]. / Histiocytose langerhansienne encéphalique isolée à forme pseudotumorale: une observation et revue de la littérature.

INTRODUCTION: Langerhans cell histiocytosis is a multivisceral pathology. Neurological manifestations are rare. EXEGESIS: We report the case of a 31 year old man hospitalized for left partial motor seizure revealing a right frontal tumor with criteria for histiocytosis X. The histological and biological examination found criteria for Langerhans cell histiocytosis (CD1a and S100 reactivity). The check-up for extracerebral localisations of the disease was negative. The outcome was favourable after a total surgical resection. The review of the literature and a discussion on neurological manifestations of this disease were carried out. CONCLUSION: A neurological manifestation can be the first and only symptom of a Langerhans cell histiocytosis.

Recurrent intracerebral hemorrhage.

Between 1984 and 1994, of the 375 patients admitted to our department for intracerebral hemorrhage (ICH), 24 (6.4%) had a recurrent ICH. There were 15 women and nine men and the mean age of the patients was 64.7 +/- 9.4 years (range 49-81) at the first bleeding episode and 68.7 +/- 7.5 years (range 57-83) at the second. The mean interval between the two bleeding episodes was 47.5 +/- 30.5 months (range 3 months to 14.8 years). Nine patients presented with more than one recurrence of ICH. Seventy-one percent of the patients were hypertensive. The site of the first hemorrhage was lobar in 17 patients, ganglionic (putamen, thalamus, or caudate nucleus) in six patients, and subdural in one. The recurrent hemorrhage occurred at a different location from the previous ICH. The most common pattern of recurrence was "lobar-lobar" (14 patients) and more rarely "ganglionic-ganglionic" (five patients), which was always observed in hypertensive patients. The outcome after the recurrent hemorrhage was usually poor, with severe cognitive impairment. By comparison with 81 patients followed up to 24 months (47.9 +/- 22.2 months) with isolated ICH without recurrence, only lobar hematoma and a younger age were risk factors for recurrences whereas sex and previous hypertension were not. The mechanisms of recurrence of ICH were multiple (hypertension, cerebral amyloid angiopathy). Control of blood pressure after the first hemorrhage may prevent ICH recurrences.

Primary intracerebral malignant lymphoma: report of 248 cases.

OBJECT: The authors present a retrospective analysis of 248 immunocompetent patients with primary intracerebral lymphoma treated at 19 French and Belgian medical centers between January 1980 and December 1995. METHODS: This study involved 127 female and 121 male patients with a median age of 61 years (range 2-88 years). All tumors available for review were classic diffuse non-Hodgkin's lymphoma, for which the phenotype was determined in 220 patients: 212 (96.4%) were B-cell and eight (3.6%) were T-cell type tumors. According to the Revised European-American classification of lymphoid neoplasms, most lesions were diffuse large cell tumors (62%). A total of 196 tumors were reviewed in 127 patients for whom preoperative computerized tomography and magnetic resonance studies were available. There was a single lesion in 66% of the cases, with a supratentorial location in 87%. Tumor location in the basal ganglia, corpus callosum, or fornix, infiltration of the periventricular ependyma, or a mirror pattern, were strongly suggestive of a lesion of lymphomatous origin. The histological diagnosis was obtained after surgical resection in 116 patients, with the remainder undergoing biopsy sampling only. Of the 248 patients studied, 129 (52%) received chemotherapy plus radiation therapy, 60 (24%) received radiation therapy alone, 35 (14%) received chemotherapy alone, and 24 (10%) received no postsurgical treatment. CONCLUSIONS: Using univariate analysis, the authors determined prognostic factors that were significantly associated with a favorable impact on survival including age younger than 60 years, radiation therapy (without evidence of a dose-response relationship), radiation therapy combined with chemotherapy, and chemotherapy consisting of anthracycline. Partial surgical resection was an unfavorable prognostic factor. Multivariate analysis was used to confirm the independent prognostic value of radiation therapy, age, chemotherapy consisting of anthracyclines or methotrexate, and partial surgical resection. This European survey provides a reasonable basis for the treatment of primary intracerebral lymphoma with the following sequence: stereotactic biopsy sampling, chemotherapy with a methotrexate- and anthracycline-based regimen, followed by cranial irradiation.

[Improvement in swallowing difficulties treated by subcutaneous apomorphine infusion after deep brain stimulation in Parkinson's disease]. / Amélioration des troubles de la déglutition par l'apomorphine en perfusion sous cutanée au décours de la mise en place d'électrodes de stimulation cérébrale profonde, dans la maladie de Parkinson.

In Parkinson's patients, swallowing difficulties may result in inhalation pneumonia, with a potentially serious prognosis. They may be revealed by withdrawal of L-dopa, especially after deep brain stimulation surgery. The following two cases illustrate the usefulness of apomorphine.

[Corticotropic macroadenoma: clinical, hormonal, radiological and immunocytochemical study of 6 cases]. / Le macroadénome corticotrope: étude clinique, hormonale, radiologique et immunocytochimique de 6 observations.

We report 6 cases of corticotroph macroadenomas which show heterogeneity of clinical and biological features (from Cushing's syndrome to silent adenoma) and heterogeneity of immunocytochemical staining. One patient reported on had skin hyperpigmentation and ACTH hypersecretion without clear abnormal adrenocortical function; we believe that this patient's plasma contained ACTH with very low bioactivity.

[Esophageal duplication in adults and x-ray computed tomography]. / Duplication oesophagienne de l'adulte et aspect tomodensitométrique.

One case of esophageal duplication cyst in adult. Hydric hypodensity of the posterior mediastinum from the apex to the dome of the diaphragm without connection with descending aorta.

[Duodenal leiomyoma. Contribution of imaging apropos of a case]. / Léiomyome duodénal. Apports de l'imagerie à propos d'un cas.

A leiomyoma of the duodenum was revealed by chronic anaemia. Radiography, echography and computed tomography provided images leading to the diagnosis of a 11 cm regular, homogenous sub-serous tumour of the duodenum without loco-regional or distant extension. The radiographic images suggested a benign tumour confirmed by the pathology examination.

[The value of tomodensitometric studies in the diagnosis of the herniated lumbar disk. Apropos of 155 operated disks]. / Valeur de l'examen tomodensitométrique dans le diagnostic des hernies discales lombaires. A propos de 155 disques opérés.

Correlation of radiological and pathological findings in 155 cases of operated herniated discs emphasizes the value of a CT scan in the diagnosis of these lesions. Imaging by the scanner is a safe and relatively low-cost procedure and its reliability is identical to that of other conventional exploratory methods. It should, therefore, become the initial examination conducted during investigation of sciatica thought to be of discal origin. Reliability of results has varied between 85 and 90 p. 100, according to the author, for this essentially simple and atraumatic method. Confirmation of the presence of a hernia requires the observance of clear signs: material of discal density amputating the spinal canal and spreading over the dural sheath. False negatives or positives usually occur in borderline cases or in previously operated patients. Differences in clinical and computed tomography findings, with undoubted absence of signs on the scan image, require further investigation by radiculography.

[Low-dose chest CT with millimetric thin slices: myth or reality?]. / Scanner thoracique basse dose en coupes millimétriques: mythe ou réalité?

PURPOSE: To evaluate the diagnostic accuracy of millimetric thin slices low dose chest CT. MATERIALS AND METHODS: Forty one patients underwent a chest CT thin slices (1 mm every 10 mm) exploration using both a 170 milliamperage and a low dose acquisition using 80 mA. The examination were read by 2 senior radiologists specialized in chest imaging without knowledge of acquisition parameters and in a random order. A statistical analysis of interobserver agreement was performed using Kappa analysis. Doses of both acquisition were estimated by compagning the dose length product calculated by the CT software and be using a simulation software. RESULTS: Excellent interobserver and intermodalities agreements were found. A 53% decrease in dose was estimated with the low dose modality compare to the normal dose. CONCLUSION: Low dose thin slice chest CT using 80 mA has a similar diagnosis accuracy as standard dose thin slice chest CT and delivers half dose of irradiation.

[Hematoma of the psoas. Comparative diagnostic contributions of ultrasonography and x-ray computed tomography]. / Hématomes du psoas. Apports diagnostiques comparés à l'ultra-sonographie et de la scannographie.

A 11 cases study of hematoma of the iliacus muscle underlines better results obtained by C.T. Scanner compared to those of ultrasonography examination in term of definite diagnoses. Comparison of density values and repeated examination were useful to assert diagnosis and to appreciate the course of the illness. Only C.T. Scanner was able to show which portion of the muscle was concerned. Authors correlated the C.T. Scanner results to the nature of the entrapment neuropathy clinically found: an isolated femoral nerve palsy or association with an obturator nerve dysfunction.

[Tomodensitometry and pancreatic pathology]. / Tomodensitométrie et pathologie pancréatique.

Computed tomography is currently the most effective method for investigating the pancreas. Though far from superseding ultrasonography, which should always precede it, possible insufficiences of this examination can be corrected and doubtful images clarified. Its greatest usefulness is in acute pancreatitis, as the size of the lesion can be defined as well as subsequent therapeutic measures. It also appears to be the most reliable examination for chronic pancreatitis or cancer of the pancreas at the present time, but their differential diagnosis can raise problems when certain localized hypertrophic lesions exist. However, diagnosis of a pancreatic lesion is only possible when it deforms the gland or modifies its density, and it is illusory to expect early detection of lesions less than 2 or 3 cm in diameter, particularly in cancer cases.

[Pelvic cystic lymphangioma. Apropos of a case in an adult]. / Lymphangiome kystique pelvien. A propos d'un cas chez un adulte.

The authors report about the observation of a subperitoneal pelvic cystic lymphangioma in an adult patient: ultrasound and CT dat had yet never been described for the rare pelvic form, and are the same as with the other locations of cystic lymphangioma in adults.

[Luxation of a hypoplastic posterior arch of the atlas. Report of a case]. / Luxation sur hypoplasie d'un hémi-arc postérieur de l'atlas. A propos d'un cas.

A rare case of sagittal dislocation of the hypoplastic right semi-posterior arch of the atlas, complicating a cervical trauma, is described. The authors specify its radiographic and CT appearance. This is a congenital abnormality discovered accidentally, for which no specific surgical treatment was implemented.

[Aneurysm of an aberrant right subclavian artery. Original contribution of x-ray computed tomography and digital subtraction angiography]. / Anévrysme de l'artère sous-clavière droite aberrante. Apport original de la tomodensitométrie et de l'angiographie numérisée.

An original aspect of a case of atheromatous aneurysm of an aberrant right subclavian artery was the evaluation of the complementary diagnostic value of CT scan and intravenous digital subtraction angiography imaging. The vascular anomaly was clearly identified, the CT scan visualizing the aneurysm sac more effectively and the angiography providing a vascular cartography. These two non-invasive exploratory examinations provide complementary data for the preoperative diagnosis and investigation of the aberrant right subclavian artery aneurysm.

[Reversible cerebral lesions in eclampsia. Clinical and x-ray computed tomographic study]. / Lésions cérébrales réversibles dans l'éclampsie. Etude clinique et tomodensitométrique.

The appearance observed with CT during and following eclampsia seem to be related to edema, hemorrhagic lesions and ischemic lesions. The authors report on a reversible appearance of hypodense central grey nuclei and of the calcarine cortex fitting into this new context.

[X-ray computed tomography and primary thoracic seminoma]. / Tomodensitométrie et séminome primitif thoracique.

The primitive thoracic seminoma is a rare tumor. Given their low frequency, these tumour have rarely been the object of C.T. exploration. It determines the compressive effect on neighbouring organs, the volume and extensive character of the tumor. C.T. exploration allows proper surveillance after therapeutic.

[X-ray computed tomographic study of the ethmoid bone and middle meatus. III. Application to chronic infectious sinus pathology]. / Exploration tomodensitométrique de l'ethmoïde et du méat moyen. III. Application à la pathologie infectieuse sinusienne chronique.

As nasal endoscopy, high resolution CT is a part of the chronic rhinosinusitis pre-operative assessment. It shows, thanks to a precise and anatomical study of the ethmoid and sinusal draining, the extension of the diseases and the local morphological variations which predispose to chronic diseases. The main aspects of chronic sinusitis, nasal polyposis and fungal maxillary sinus diseases are reported. The frequency of individual morphological variations and the mucosal changes due to a nasal cycle require a great care in the interpretation of the diseases.