False positive-false negative CT scan in late epileptic seizure: a meningioma-glioblastoma association.

A false-negative finding on initial CT is reported in a case of supratentorial glioma. This observation was peculiar because the first CT revealed a meningioma which might initially have been related to the clinical symptoms. The term false positive-false negative CT is proposed. The reasons for such CT failures are discussed. The accuracy of clues as to the localization of the glioma provided by EEG is emphasized.

An intramedullary ependymal cyst in a 71-year-old woman.

An intraspinal ependymal cyst of the thoracolumbar spinal cord was found in a 71-year-old woman with a history of right side abdominal pain since the age of 18. The late discovery of the cyst is related to the extremely slow evolution of this type of cyst in the absence of spinal trauma. Etiopathogenic problems are discussed after a review of the literature.

Traumatic extradural hematomas in infancy and childhood. Experience with 144 cases.

The authors report a series of 144 children with traumatic extradural hematomas operated on at the Lille Department of Neurosurgery between 1969 and 1982. The patients are divided into different groups according to age, and clinical findings were recorded for each age group. The overall mortality rate was 9%. The authors demonstrate that prognosis is related to age, neurological status at time of surgery, and duration of postoperative coma.

Cerebellar medulloblastoma: results of multidisciplinary treatment. Report of 120 cases.

The authors report a series of 120 cerebellar medulloblastomas. All patients were operated on between 1953 and 1982. Among them, 88 completed the treatment with radiotherapy, and 32 had additional chemotherapy. The operative mortality was 22.5%. The 5-year survival rate was 30% in the whole series. Recurrences occurred in 35 patients, associated with supratentorial or spinal metastasis in 60% of cases.

[Late posttraumatic syringomyelic syndromes. Pathogenetic theories apropos of 3 cases]. / Syndromes syringomyéliques post-traumatiques tardifs. Théories pathogéniques à propos de trois observations.

Three patients with a post-traumatic spinal cord cavity are described: clinical signs are identical to those of syringomyelia, but pain is more frequent. Diagnosis is made easier by magnetic resonance imaging (MRI) and a syringoperitoneal shunt is proposed for treatment. Nevertheless, if results are good, they seem worse than in idiopathic syringomyelia. The main pathogenic theories are discussed: the rupture and coalescence of microcysts developed at a distance of 1 or 2 mm from the transected spinal cord, subsequently leads to syrinx formation; haemorrhagic or ischemic post-traumatic areas could also lead to syrinx formation. Hydrodynamic factors could be expected and make the pathogenesis not far from syringomyelic one.

[61 years' survival of Koch's bacillus in a closed focus. Disclosure in a case of spinal cord compression caused by sequelae of Pott's disease]. / Soixante et un ans de survie d'un bacille de Koch dans un foyer clos. Découverte lors d'une compression médullaire par séquelles de mal de Pott.

A 68 year-old woman presented with a spinal cord compression from an angular kyphosis due to Pott's disease at age 7. Clinical, radiological and pathological studies of the vertebral lesions did not demonstrate an evolutive lesion. However, culture yielded some viable Koch's bacilli. This bacteriologic confirmation 61 years later exemplifies the importance of host immunity reactions, that may prevent the development of KB, and the remarkable capacity of survival of the bacillus.

[Regressing median peduncular infarction]. / Infarctus pédonculaire médian d'évolution régressive.

A case of a medial and caudal infarction of the midbrain in a 56 years old woman is reported. The clinical syndrome included a rapidly recovering sleepiness, an ophthalmoplegia related to damage to the caudal part of the oculomotor nuclear complex, a slow extrapyramidal dysarthria and a severe ataxia. The latter was characterized by the prevalent involvement of posture control, resulting from an axial hypotonia and the lack of balance reflexes. The CT scan showed a low density area in the central part of the midbrain. Electrophysiological investigations were carried out to study the impairment of the sensory and auditory tracts in the brainstem. In spite of the gravity of initial signs, recovery was good and the patient led a normal life 8 months later.

[Spinal cord compression caused by dorsal disk hernia. Complication of Scheuermann's disease]. / Compression médullaire par hernie discale dorsale. Une complication de la maladie de Scheuermann.

Association of Scheuermann's disease with a thoracic herniated disc compressing the spinal cord is rare but is clearly demonstrated in the case reported here. This confirms the non-fortuitous nature of this association also suggested by the analysis of published cases. The interest of spinal cord angiography and of surgery through a postero-lateral approach are emphasized.

[Cerebral abscesses disclosing pulmonary angioma. Rendu-Osler disease]. / Abcès cérébraux révélateurs d'un angiome pulmonaire. Maladie de Rendu-Osler.

A 50-year old male patient presented with two successive cerebral abscesses over a 9-month period. Rendu-Osler-Weber disease was diagnosed on the basis of recurrent epistaxis and telangiectasis of the mucosae and skin. In addition, many members of the patient's family had a history of epistaxis and one had a cerebral angioma of unusual location. Our patient's chest was normal on physical and radiological examination, but pulmonary angiography disclosed a small angioma. Removal of the angioma prevented further cerebral infections. The prevalence of pulmonary arterio-venous fistulae in Rendu-Osler-Weber disease and their clinical manifestations (especially in the central nervous system) are reviewed, together with the value of family studies and the therapeutic approach.

[Intradural spinal arachnoid diverticula and cysts. 6 cases]. / Diverticules et kystes arachnoïdiens rachidiens intraduraux. 6 observations.

3 communicating diverticula and 3 arachnoid symptomatic cyst in intradural situation are presented. In two cases, this pathology is slowly developing, in patients with Von Recklinghausen neurofibromatosis. A congenital malformative process may be evoked. In two other cases, myelography and surgery favor a frank or discreet arachnoïditis. Those establishments show the diversity of mechanisms underlying intradural arachnoïd cysts. They are in most cases in a postero medullary and dorsal situation, but cervical as well as lumbar position are possible. One must insist on the frequency and importance of local and cordonal pain, accompanying in most cases sensory and motor deficits in inferior limbs. A rapid revelation or decompensation is most rare. Prognosis must be reserved, as post operative arachnoïditis and relapse are not rare.

[Arteriovenous malformations in deep cerebral area. Topographic classification. Therapeutic possibilities and results about 46 cases (authors' translation)]. / Les malformations artério-veineuses cérébrales profondes Classification topographique. Possibilités et résultats thérapeutiques à propos de 46 observations.

The authors study the clinical dispositions of 46 arteriovenous malformations developed in deep cerebral area and detected in 41 cases by an haemorrhagic accident and after make a radiological classification. They class the M.A.V. of nucleus centralis with the localizations of the nucleus caudate's head, the insula and lentiformis nucleus and the capsulo thalamic area; the ventriculo-cisternalis M.A.V., the corpus callosum M.A.V. and complicated forms. With this classification they analyse the different operative technics that permit to obtain a complete extirpation in 26 cases about 39 operated patients. The results are excellent in 19 cases, good for 8 cases and mediocre in 4 cases. Eight patients are died during post operative time. The most important factors for the final result are the disturbance of consciousness before operative time and the malformations developed about several anatomical area. At last the authors insist on the fact that, if during next years, the embolism technics are not effective, the operation will be indicate in spite of the technical difficulties because the spontaneous evolution is always dangerous.

[Lhermitte-Duclos disease. Granulomolecular hypertrophy of the cerebellum]. / Maladie de Lhermitte-Duclos. Hypertrophie granulo-moléculaire du cervelet.

A case of Lhermitte-Duclos disease is reported. The onset is unusually sudden in a 16 years-old girl. However cerebellar lesions and hydrocephalus are of long duration as showed the skull base anomalies. This slow evolution is the rule in many cases previously reported, which suggests that the disease is due to a dysplasic disorder, perhaps one of cellular differentiation of the cerebellar cortex.

[Treatment of arterio-venous aneurysms (AVA) in language areas. About 18 cases (author's transl)]. / Traitement des anévrysmes artério-veineux (AAV) des zones du langage: a propos de 18 cas.

This study, about 18 cases of AVA strictly in language areas (posterior end of the inferior frontal gyrus (Broca), posterior third of T1 and T2, supra-marginalis and angularis gyri), prepose to specify the possibilities and the legitimacy of surgical management as well as the technical parts of removal. Malformations may divided in to : 1 arterio-venous fistula, 3 medium AVAS, 8 important AVA, 6 cirsoïdum aneurysms. 15 patients presented one or several intracranial hemorrhage (ICH). 3 others were admitted before this complication : 2 epileptic seizures, 1 left hemicrania. 2 patients died because of important ICH before any surgical treatment. The 16 others were operated. Two died during post-operative course : one because of prior ICH with deep coma, the other third month after a good period. In one case upon 14, a disabling handicap concerning language is noted after an important ICH. Except an ethylic patient with post-operative acalculia, minor language handicaps were observed only in patients with hemorrhagic seizure, permissing always satisfactory life. The best results on vital and functional prognosis were obtained for patients with no prior important ICH. So we must indicate the radical removal of all known AVA or cirsoïd aneurysms. The opinion that these last malformations generally do not bleed, may produced mistakes with their weighty consequences.

[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.

[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.

[Peritoneal csf pseudocysts. Rare complication of ventriculo-peritoneal shunts]. / Pseudo-kystes péritonéaux de L.C.R.. Complication rare des dérivations ventriculo-péritonéales.

The authors report 6 cases of abdominal CSF pseudo-cysts as a complication of ventriculo-peritoneal shunts. The clinical picture and diagnosis confirmation by radiology and echography are reviewed. Histogenesis and pathogenesis are discussed.

[Craniopharyngioma in the same family]. / Craniopharyngiome dans une même fratrie.

Within 2 years, two sisters, aged 23 and 33, were operated on for a craniopharyngioma. With regard to this exceptional feature, relation between neuroectodermal affections and craniopharyngiomas is discussed, and genetic determination of the occurrence of those tumors is evoked.

[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.

[Extradural spinal hematoma without traumatic bone lesion. Apropos of 9 cases]. / Hématomes extra-duraux rachidiens sans lésion osseuse traumatique. A propos de 9 cas.

Extradural spinal hematomas observed in 9 cases over a period of 11 years developed in the absence of blood coagulation disorders in 3 cases, during anticoagulant therapy in 5 cases, and during the course of a megaloblastic anemia in one patient. The presence of marked associated myelomalacia was confirmed at postmortem in one case. Etiopathogenic factors remain obscure, particularly in spontaneously developing forms, and careful histologic examination of all clots is necessary to determine possible vascular malformations at the origin of the hematoma.

[Familial forms of intracranial cavernous hemangioma. Apropos of 5 cases in 2 families]. / Formes familiales des hémangiomes caverneux intracrâniens. A propos de 5 cas dans deux familles.

The authors report five cases of cavernous hemangioma belonging to two families. In the first family, an 8 year old child was operated on in 1970 for a left frontal location. His mother, aged 39, was operated on in december, 1981, with stereotaxic approach, for two locations: one was frontal location, the other one was in the pineal region. Among the second family, a 21 year old woman was operated on in december 1976, for a cerebellar cavernous hemangioma. Her sister, aged 18, presented with subarachnoid hemorrhage in january 1980. C.T. scan showed a right temporal high attenuation area. This patient was not operated on. The aunt to those two sisters was operated on in october, 1981, for a left temporal cavernous hemangioma. Those five cases represent about half of the intracranial cavernous hemangiomas operated on in the Lille Neurosurgery Department since 1967. Even, unusual, the familial occurrence of this affection must be admitted. It shows a nosological interest, but also allows prevention by searching and surveying the asymptomatic cases, or genetic evaluation of disease risk.