[Cerebral vasculitis secondary to Varicella-Zoster virus infection]. / Vasculite cérébrale secondaire à une infection à VZV.

INTRODUCTION: Central nervous system infection by the varicella-zoster virus (VZV) can be responsible for myelitis, meningitis, ventriculitis and large and small-vessels encephalitis. CASE REPORT: We report the case of a 57-year-old-man hospitalized for deteriorating general health. Physical examination revealed likely encephalitis associated with headache without meningeal syndrome. Successive cerebral MRIs showed bilateral necrosis of the amygdaloid bodies and multiple deep and sub-cortical infarcts suggestive of vasculitis. Cerebral arteriography was normal. Three cerebral fluid examinations disclosed mononuclear pleiocytosis with few red blood cells. PCR analysis for VZV was only positive at the third time. DISCUSSION: The diagnosis of VZV encephalitis is difficult without the rash typical of zoster and because of the low sensitivity of PCR VZV in comparison with PCR HSV. CONCLUSION: In active viral disease, where the prognosis depends on early treatment, we highlight the usefulness of repeated PCR analysis and the search for antibodies in blood and cerebrospinal fluid.

[Carcinomatous meningitis presenting with isolated headache]. / Céphalées isolées révélatrices d'une méningite carcinomateuse.

INTRODUCTION: Carcinomatous meningitis reveals a solid cancer in 10 percent of cases. OBSERVATION: Our patient developed isolated headache which progressively worsened. Cranial Computerized Tomography (CT) was normal. Brain MRI showed multiples areas of contrast enhancements meningeal tissue associated with small nodulars deposits. Repeated cerebrospinal fluid (CSF) examinations revealed elevated tumor markers suspect cells. The diagnosis of pulmonary adenocarcinoma was established during systematic follow-up. CONCLUSION: The diagnosis of carcinomatous meningitis can be difficult to establish because of the non-specific clinical presentation and the absence of suggestive context; negative CSF-cytology is frequent. MRI and elevated tumor markers in the CSF compared with the serum level contribute significantly to diagnosis.

[Cerebral angiography: a study of complications in 450 consecutive procedures]. / Angiographie cérébrale: étude des complications sur 450 examens consécutifs.

PURPOSE: To evaluate all types of complications, both minor and major, associated with modern cerebral angiography. MATERIALS AND METHODS: A prospective study of 450 consecutive cerebral angiographic procedures is reported. RESULTS: One patient (0.2%) died from a cholesterol embolus. In seven patients (1.6%), thromboembolic events occurred within 24 hours after the procedure, leading to transient ischemic symptoms in six and permanent hemiplegia in one. Two patients suffered from acute renal failure (0.4%). Transient cardiac arrhythmias were observed in three patients without consequence on the clinical outcome. Most complications of angiography occurred in patients referred from the neurology department for work-up of stroke syndrome. CONCLUSION: Our results show that morbidity and mortality rates related to the angiographic procedure did not decrease in spite of major improvement of angiographic materiel. Atherosclerosis is the main risk factor for complication. Most of the complications could be avoided by appropriate selection of indications and by using non-invasive techniques such as magnetic resonance angiography or helical CT angiography.