Developmental venous anomaly in the newborn brain.

INTRODUCTION: Cerebral developmental venous anomaly (DVA) is considered a benign anatomical variant of parenchymal venous drainage; it is the most common vascular malformation seen in the adult brain. Despite its assumed congenital origin, little is known about DVA in the neonatal brain. We report here the first cohort study of 14 neonates with DVA. METHODS: Fourteen infants (seven preterm) with DVA diagnosed neonatally using cranial ultrasound (cUS) and magnetic resonance imaging (MRI) from three tertiary neonatal units over 14 years are reviewed. RESULTS: DVA was first detected on cUS in 6 and on MRI in 8 of the 14 infants. The cUS appearances of DVA showed a focal fairly uniform area of increased echogenicity, often (86 %) adjacent to the lateral ventricle and located in the frontal lobe (58 %). Blood flow in the dilated collector vein detected by Doppler ultrasound (US) varied between cases (venous flow pattern in ten and arterialized in four). The appearance on conventional MRI was similar to findings in adults. Serial imaging showed a fairly constant appearance to the DVAs in some cases while others varied considerably regarding anatomical extent and flow velocity. CONCLUSIONS: This case series underlines that a neonatal diagnosis of DVA is possible with carefully performed cUS and MRI and that DVA tends to be an incidental finding with a diverse spectrum of imaging appearances. Serial imaging suggests that some DVAs undergo dynamic changes during the neonatal period and early infancy; this may contribute to why diagnosis is rare at this age.

Early-versus-Late Endovascular Stroke Treatment: Similar Frequencies of Nonrevascularization and Postprocedural Cerebrovascular Complications in a Large Single-Center Cohort Study.

BACKGROUND AND PURPOSE: Endovascular treatment of acute ischemic stroke is now performed more frequently in the late window in radiologically selected patients. However, little is known about whether the frequency and clinical impact of incomplete recanalization and postprocedural cerebrovascular complications differ between early and late windows in the real world. MATERIALS AND METHODS: We retrospectively reviewed all patients with acute ischemic stroke receiving endovascular treatment within 24 hours from 2015 to 2019 and included in the Acute STroke Registry and Analysis of Lausanne. We compared rates of incomplete recanalization and postprocedural cerebrovascular complications (parenchymal hematoma, ischemic mass effect, and 24-hour re-occlusion) in the early (<6 hours) versus late window (6-24 hours, including patients with unknown onset) populations and correlated them with the 3-month clinical outcome. RESULTS: Among 701 patients with acute ischemic stroke receiving endovascular treatment, 29.2% had late endovascular treatment. Overall, incomplete recanalization occurred in 56 patients (8%), and 126 patients (18%) had at least 1 postprocedural cerebrovascular complication. The frequency of incomplete recanalization was similar in early and late endovascular treatment (7.5% versus 9.3%, adjusted P =.66), as was the occurrence of any postprocedural cerebrovascular complication (16.9% versus 20.5%, adjusted P = .36). When analyzing single postprocedural cerebrovascular complications, rates of parenchymal hematoma and ischemic mass effect were similar (adjusted P = .71, adjusted P = .79, respectively), but 24-hour re-occlusion seemed somewhat more frequent in late endovascular treatment (4% versus 8.3%, unadjusted P = .02, adjusted P = .40). The adjusted 3-month clinical outcome in patients with incomplete recanalization or postprocedural cerebrovascular complications was comparable between early and late groups (adjusted P = .67, adjusted P = .23, respectively). CONCLUSIONS: The frequency of incomplete recanalization and of cerebrovascular complications occurring after endovascular treatment is similar in early and well-selected late patients receiving endovascular treatment. Our results demonstrate the technical success and safety of endovascular treatment in well-selected late patients with acute ischemic stroke.

Short-term evolution of spinal cord damage in multiple sclerosis: a diffusion tensor MRI study.

INTRODUCTION: The potential of diffusion tensor imaging (DTI) to detect spinal cord abnormalities in patients with multiple sclerosis has already been demonstrated. The objective of this study was to apply DTI techniques to multiple sclerosis patients with a recently diagnosed spinal cord lesion, in order to demonstrate a correlation between variations of DTI parameters and clinical outcome, and to try to identify DTI parameters predictive of outcome. METHODS: A prospective single-centre study of patients with spinal cord relapse treated by intravenous steroid therapy was made. Patients were assessed clinically and by conventional MRI with DTI sequences at baseline and at 3 months. RESULTS: Sixteen patients were recruited. At 3 months, 12 patients were clinically improved. All but one patient had lower fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values than normal subjects in either inflammatory lesions or normal-appearing spinal cord. Patients who improved at 3 months presented a significant reduction in the radial diffusivity (p = 0.05) in lesions during the follow-up period. They also had a significant reduction in the mean ADC (p = 0.002), axial diffusivity (p = 0.02), radial diffusivity (p = 0.02) and a significant increase in FA values (p = 0.02) in normal-appearing spinal cord. Patients in whom the American Spinal Injury Association sensory score improved at 3 months showed a significantly higher FA (p = 0.009) and lower radial diffusivity (p = 0.04) in inflammatory lesion at baseline compared to patients with no improvement. CONCLUSION: DTI MRI detects more extensive abnormalities than conventional T2 MRI. A less marked decrease in FA value and more marked decreased in radial diffusivity inside the inflammatory lesion were associated with better outcome.

Predictors of Endovascular Treatment Procedural Complications in Acute Ischemic Stroke: A Single-Center Cohort Study.

BACKGROUND AND PURPOSE: Procedural complications occur in 4%-29% of endovascular treatments in acute ischemic stroke. However, little is known about their predictors and clinical impact in the real world. We aimed to investigate the frequency and clinical impact of procedural complications of endovascular treatment and identify associated risk factors. MATERIALS AND METHODS: From 2015-2019, we retrospectively reviewed all patients with acute ischemic stroke receiving endovascular treatment within 24 hours included in the Acute STroke Registry and Analysis of Lausanne. We identified patients having an endovascular treatment procedural complication (local access complication, arterial perforation, dissection or vasospasm, and embolization in a previously nonischemic territory) and performed logistic regression analyses to identify associated predictors. We also correlated procedural complications with long-term clinical outcome. RESULTS: Of the 684 consecutive patients receiving endovascular treatment, 113 (16.5%) had at least 1 procedural complication. The most powerful predictors were groin puncture off-hours (OR = 2.24), treatment of 2 arterial sites (OR = 2.71), and active smoking (OR = 1.93). Patients with a complication had a significantly less favorable short-term clinical outcome (Δ-NIHSS score of -2.2 versus -4.33, P-value adjusted < .001), but a similar long-term clinical outcome (mRS at 3 months = 3 versus 2, P-value adjusted = .272). CONCLUSIONS: Procedural complications are quite common in endovascular treatment and lead to a less favorable short-term but similar long-term outcome. Their association with treatment off-hours and at 2 arterial sites requires particular attention in these situations to optimize the overall benefit of endovascular treatment.

Microvascular leakage and contrast enhancement as prognostic factors for recurrence in unfavorable low-grade gliomas.

Perfusion estimates and microvascular leakage (MVL) were recently correlated with glioma angiogenesis and aggressiveness, but their role in predicting outcome of patients (pts) with unfavorable low-grade gliomas (ULGG) is unclear. Their prognostic value was then investigated, versus conventional factors such as age, neurological status, tumor size, and contrast enhancement (CE). Clinical and anatomical magnetic resonance imaging (MRI) criteria of a cohort of ULGG pts were prospectively evaluated. A dynamic T2*-weighted MR sequence was included to detect high-perfusion areas, using the maximal value of the relative cerebral blood volume (rCBV) estimate, and MVL. Conventional and microvascular characteristics were correlated with progression-free survival (PFS). Among the 46 pts included, the following features were present in 61%, 26%, 67%, and 26%, respectively: age >or=40 years, neurological deficits, tumor size >or=6 cm, and CE. High perfusion value was noted in 30% of cases and MVL in 52%. With median follow-up of 22 months (range 4-46 months), median PFS was 32 months [95% confidence interval (CI) 17-45 months]. On univariate analysis, CE, rCBV, and MVL were significantly correlated with PFS. On multivariate analysis, only CE and MVL were unfavorable factors, with hazard ratio of 3.0 and 7.3 and P value of 0.04 and 0.02, respectively. Different prognostic subgroups were identified, with 2-year PFS of 86%, 57%, and 19% for pts with no MVL, MVL without CE, and MVL with CE, respectively. MVL and CE seem to predict short-term outcome in ULGG pts.

A comparative study of perfusion measurement in brain tumours at 3 Tesla MR: Arterial spin labeling versus dynamic susceptibility contrast-enhanced MRI.

PURPOSE: To prove the feasibility of arterial spin labeling (ASL) to explore brain tumors by comparing dynamic susceptibility contrast-enhanced MRI to ASL at 3T MR. MATERIALS AND METHODS: Twenty-seven patients were included presenting 9 gliomas, 10 metastases and 8 meningiomas. All were explored by a pseudo-continuous ASL and dynamic susceptibility contrast-enhanced T2* perfusion sequence. Two neuroradiologists analyzed the cerebral blood flow (CBF) maps to assess feasibility, examination quality and quantitative comparison. The Spearman nonparametric correlation test and the Bland-Altman graphic test were used to analyze our quantitative results. RESULTS: 92% of ASL CBF maps were informative. ASL detected all lesions as well as dynamic susceptibility contrast-enhanced MRI. Both sequences provide relative quantitative CBF values closely correlated. CONCLUSION: On a 3T MR unit, ASL is a good alternative to dynamic susceptibility contrast-enhanced MRI when contrast medium is contraindicated or intravenous injection is not possible. Its results on relative CBF parameters are similar to contrast-injected perfusion.

[Vertebroplasty: 10 years clinical and radiological follow-up]. / Vertébroplastie: évaluation clinique et radiologique à plus de dix ans.

OBJECTIVES: Ten years follow-up of the first patients treated with percutaneous vertebroplasty. PATIENT AND METHODS: Eighteen patients were retrospectively reviewed having undergone vertebroplasty in our centre between 1989 and 1998. Eight were treated for angioma, eight for osteoporotic compression and two followed for myeloma. They all underwent clinical and radiological evaluation in 2007 (standard X-rays, CT scan and MRI). These examinations were compared to prior baseline pre- and post-therapeutic images. RESULTS: Radiological characteristic of cement remained unchanged in the long term and there was no modification of anatomical structures in contact with it. Even if the distribution of cement was asymmetrical there was no fracture of the treated vertebras at distance. Degenerative changes of discs facing the vertebroplasty were not more pronounced than for distant discs. We found no significant signal or density anomaly of disc in contact direct with cement. 38.8 % of the patients presented new fractures (n=30). Seventy percent of the fractures were multiple and contiguous. In the long term, all patients reported improvement of pain after the procedure. CONCLUSION: In our series, we found a good stability of treatment over time. This study shows the long-term safety of percutaneous acrylic vertebroplasty, in particular harmlessness of cement for bone and discs in contact.

[Bithalamic infarct: is there an evocative aspect? Radioclinical study]. / Accident vasculaire ischémique bithalamique: existe-t-il un tableau évocateur ? Etude radioclinique.

INTRODUCTION: Bithalamic paramedian infarcts are uncommon. This stroke results in a complex clinical syndrome. CASE REPORT: We report four cases of bithalamic paramedian infarcts with a presumed mechanism of occlusion of a single thalamic paramedian artery. DISCUSSION: This normal anatomic variant corresponds to an asymmetrical common trunk for the two thalamosubthalamic paramedian arteries arising from a P1 segment (type IIb in the G. Percheron classification dating from 1977). A literature analysis (from 1985 to 2006) allowed us to identify the most widely reported clinical signs. Four main clinical findings are described: vertical gaze palsy (65%), memory impairment (58%), confusion (53%) and coma (42%). We also found these symptoms in our patients but rarely associated; however, all four patients had exhibited episodes of drowsiness. In this article, we discuss the anatomy-function correlation responsible for such clinical variability. CONCLUSION: Clinicians should be aware of this diagnosis to better understand the imaging results which provide confirmation. Although the literature describes frequently severe consciousness disorders such as coma, this diagnosis must also be considered in patients presenting a simple fluctuation of consciousness, e.g. hypersomnia.

Dynamic contrast-enhanced T2*-weighted MR imaging: a peritumoral brain oedema study.

BACKGROUND AND PURPOSE: Glioma and meningioma are the two most common types of primary brain tumor. The aim of the present study was to analyze, using dynamic susceptibility contrast MR perfusion imaging, the effect of angiogenesis on peritumoral tissue. METHODS: In this prospective study, conducted from December 2003 to March 2005, out of 18 patients recruited, 12 were included (six with meningioma, six with glioblastoma). Using rates of maximum signal drop (MSD), we drew regions of interest (ROI) starting near the lesion, and gradually moving outwards to areas of distant edema in axial and sagittal planes at 10, 20 and 30 mm from the tumor. We also drew ROI on the contralateral brain white matter to obtain a normal baseline for comparison (relative MSD; rMSD). RESULTS: In regions of peritumoral T2 hypersignals, we observed a decrease in rMSD with distance from glioblastoma due to reduced angiogenesis, and an increase in rMSD with distance from meningioma, probably due to a reduced mass effect. CONCLUSION: In our study, dynamic susceptibility contrast MR perfusion imaging, using MSD as a parameter, revealed differences between meningioma and glioblastoma peritumoral tissue due to changes in angiogenesis.

[Acute CSF changes in the mesencephalon aqueduct after subarachnoid hemorrhage as measured by PC-MRI]. / Caractérisation des perturbations du flux de LCS dans l'aqueduc du mésencéphale par IRM-CP à la phase aiguë de l'hémorragie méningée.

PURPOSE: Determining acute intracranial hydrodynamic changes after subarachnoid hemorrhage through an analysis of the CSF stroke volume (SV) as measured by phase-contrast MRI (PC-MRI) in the mesencephalon aqueduct. METHOD: A prospective study was performed in 33 patients with subarachnoid hemorrhage. A PC-MRI imaging study was performed n the acute phase (< 48 hours). CSF flow was measured in the aqueduct. The appearance of acute hydrocephalus (HCA) was then compared with data on CSF flow, and the location of the intraventricular and perimesencephalic bleeding. RESULTS: CSF analysis was performed on 27 patients, 11 of whom presented with an acute HCA. All 11 patients had an abnormal SV in the aqueduct: patients with a communicating HCA had an increased SV (n=8); and patients with a noncommunicating HCA had a nil SV (n=3). Patients with a normal SV in the aqueduct did not develop an acute HCA. Intraventricular bleeding significantly led to HCA (P=0.02), which was of the communicating type in 70% of cases. CONCLUSION: Subarachnoid hemorrhage leads to intracranial CSF hydrodynamic modifications in the aqueduct in the majority of patients. CSF flow can help us to understand the mechanism of the appearance of acute HCA. Indeed, hydrocephalus occurred - of the communicating type in most cases - even in the presence of intraventricular bleeding.

[Arterial spin labeling: state of the art]. / Etat de l'art sur le Marquage de Spin Artériel ou ASL.

UNLABELLED: Arterial spin labeling (ASL) perfusion MR imaging is a technique by which water from circulating arterial blood is magnetically labeled and acts as a diffusible tracer allowing non-invasive measurement of cerebral blood flow. In this paper, the technique and current applications in neuroimaging will be reviewed. CURRENT STATUS: First, the technical principles of ASL will be reviewed and both available techniques (continuous and pulsed ASL) explained. A review of the literature will demonstrate advances with the techniques of ASL and its clinical impact. Clinical research involves normal volunteers and patients with ischemic and tumoral pathologies. CONCLUSION: Recent technical advances have improved the sensitivity of ASL perfusion MR imaging. The routine clinical use of ASL at 3.0 Tesla should increase over the next few years.

[Sinonasal cavities: CT imaging features of anatomical variants and surgical risk]. / Cavités sinusiennes de la face: aspect scanographique des variantes anatomiques et leur risque chirurgical.

Anatomical variants of the sinonasal cavities are common. About 15 major variants are described (nasal septal deviation is present in up to 62% of the population). Because the may lead to complications at the time of endovascular procedures or endoscopic sinonasal surgery (vascular, nervous, or osseous injury), there detection has medicolegal implications. Knowledge of anatomical variants by radiologists and ENT surgeons is thus required. We will describe these variants, their imaging features, frequency, implications and associated risk of potential complication.

Lymphographic-Like Technique for the Treatment of Microcystic Lymphatic Malformation Components of <3 mm.

BACKGROUND AND PURPOSE: The treatment of microcystic lymphatic malformations remains challenging. Our aim was to describe the lymphographic-like technique, a new technique of slow bleomycin infusion for the treatment of microcyst components of <3 mm, performed at our institution. MATERIALS AND METHODS: A retrospective analysis of a prospectively collected lymphatic malformation data base was performed. Patients with at least 1 microcystic lymphatic malformation component demonstrated on MR imaging treated by lymphographic-like technique bleomycin infusion were included in the study. Patient interviews and MR imaging were performed to assess subjective and objective (microcystic lymphatic malformation size decrease of >30%) clinical improvement, respectively. Patients were reviewed 3 months after each sclerotherapy session. Lymphographic-like technique safety and efficacy were assessed. RESULTS: Between January 2012 and July 2016, sixteen patients (5 males, 11 females; mean age, 15 years; range, 1-47 years) underwent the bleomycin lymphographic-like technique for microcystic lymphatic malformations. Sixty sclerotherapy sessions were performed, with a mean of 4 sessions per patient (range, 1-8 sessions) and a mean follow-up of 26 months (range, 5-58 months). We observed no major and 3 minor complications: 1 eyelid infection, 1 case of severe postprocedural nausea and vomiting, and 1 case of skin discoloration. One patient was lost to follow-up. Overall MR imaging objective improvement was observed in 5/16 (31%) patients; overall improvement of clinical symptoms was obtained in 93% of treated patients. CONCLUSIONS: The bleomycin lymphographic-like technique for microcystic lymphatic malformations is safe and feasible with objective improvement in about one-third of patients. MR signal intensity changes after the lymphographic-like technique are associated with subjective improvement of the patient's symptoms.

Diagnosis and treatment of dural carotid-cavernous fistulas: a consecutive series of 27 patients.

OBJECTIVES: To report clinical characteristics, angiographical findings and results of endovascular treatment of patients presenting with dural carotid-cavernous fistulas (DCCFs). METHOD: Retrospective analysis of 27 consecutive patients with DCCF referred to a specialised interventional neuroradiology department. RESULTS: Orbital and neuro-ophthalmological symptoms were the most common clinical presentation at diagnosis (n = 25). The venous drainage of the fistula involved the ipsilateral superior ophthalmic vein in 24 patients, the contralateral cavernous sinus in 6 and a leptomeningeal vein in 5 patients. Thrombosis of at least one petrosal sinus was found in 23 patients. 7 patients did not receive endovascular treatment: 3 had spontaneous DCCF obliteration, and 4 had only minor clinical symptoms and no leptomeningeal venous drainage on an angiogram. 20 patients received endovascular treatment via either a transvenous (n = 16) or a transarterial approach (n = 4). Complete occlusion of the fistula was obtained in 14 of 16 (87%) patients treated by the transvenous approach and in 1 of 4 (25%) patients treated by the transarterial approach. 16 patients had early clinical improvement after endovascular treatment. One patient had a cerebral haemorrhage after transvenous embolisation of a DCCF with leptomeningeal drainage. On follow-up, all patients treated by the transarterial route remained symptomatic, whereas 10 of 14 (71%) patients cured by the transvenous route were asymptomatic. CONCLUSIONS: Transvenous embolisation is a safe and efficient endovascular approach to treat patients with DCCF. However, this technique requires a long learning curve.

[Ankle and foot sprains: conventional radiography aspects]. / Aspects radiographiques des lésions ostéo-articulaires et ligamentaires des entorses de pied et de cheville.

Emergency departments frequently encounter pathology resulting from injury to the foot and ankle, with approximately 6000 case per day in France. In an ankle sprain, 85% of the lesions involve the lateral collateral ligament. Many other, much rarer, types of lesion with different therapeutic consequences can present, however. Interpretation of the initial conventional radiographs is vital to establishing the type lesion and to proposing adapted and rapid treatment. The objective of this article is to review the various osteoarticular and ligament injuries encountered in the foot and the ankle.

Role of preoperative embolization of intramedullary hemangioblastoma.

OBJECT: Hemangiobastomas (HB) are rare lesions accounting for 1 to 5% of all spinal cord tumors. Due to their hypervascular nature, an angiography may be proposed preoperatively in order to identify tumoral vascular anatomy. Preoperative embolization may be indicated to reduce intraoperative bleeding, thus facilitating tumor resection and minimizing surgical risk. The aim of this paper is to report our experience of preoperative embolization in intramedullary hemangioblastomas. METHODS: We performed a retrospective analysis of all patients operated on for intramedullary hemangioblastomas between 1995 and 2014 who had undergone embolization before surgery. RESULTS: Seven patients were analyzed: there were 6 females and 1 male, mean age 43years, 6 patients had Von Hippel-Lindau disease. Four tumors were located in the cervical spine and three in the dorsal spine. The average maximum sagittal diameter was 19mm (range 8-32mm), while the average maximum axial diameter was 11.5mm (range 6-21mm). The embolic agent used was Histoacryl (NBCA). Endovascular embolization was routinely performed the day before surgery. One patient experienced a major preoperative complication with a vertebrobasilar infarctus with consequent unilateral cerebellar syndrome and gait instability. Minor extravasation of embolic agent was observed in two cases. In one of these two cases, there was also the penetration of the embolic agent in the tumor; the resection was impossible due to the hard consistency of the tumor. In the other 6 patients, the resection was total. Six patients had identical preoperative and postoperative McCormick score and one patient shifted to a better score at follow-up. CONCLUSION: Preoperative endovascular embolization is an effective adjunct treatment. It is useful in reducing the surgical bleeding and thus the operative risks. The procedure is not always safe and complications could occur. We recommend preoperative embolization in selected cases.

[The law of March 4, 2002: how to implement it with regards to informed consent in radiology]. / La loi du 4 mars 2002: comment l'appliquer en matière d'information des patients en radiologie.

The duty of providing information to patients makes it possible to obtain an informed consent. Information must be complete and relate to the health of the patient and not only to the risks of a medical procedure. From jurisprudence initially, and then from the law of March 4, 2002, it is a right for patients. It is the physician's burden to prove that he or she informed his patient well. This provision raises difficulties in radiology because of the particular nature of this practice. The radiologist intervenes after a fellow-physician has prescribed the examination. This relation involves three individuals: the requesting physician, the radiologist and the patient. Both physicians have a duty to provide information. As such, should consultations with radiologists prior to specific invasive procedures be obtained? This article aims at clarifying the concept of informed consent in radiology, based on the law of March 4, 2002, examples of jurisprudence, and the recent regulation specific to radiology in the decrees of March 2003.

Decreased Superior Sagittal Sinus Diameter and Jugular Bulb Narrowing Are Associated with Poor Clinical Outcome in Vein of Galen Arteriovenous Malformation.

BACKGROUND AND PURPOSE: Few clinical and imaging findings are known to be associated with poor outcome in neonates and infants with vein of Galen arteriovenous malformations. In the present consecutive series of 35 patients, we evaluated both the diameter of the superior sagittal sinus at onset and the diameter of the jugular bulb on follow-up as potential factors related to poor outcome. MATERIALS AND METHODS: Thirty-five consecutive neonates and infants who were prospectively collected in a single-center data base were included in this review. Outcome was assessed by using the Bicêtre Outcome Score. Both the absolute diameter of the superior sagittal sinus and its ratio to the biparietal diameter were measured at onset, compared with age-matched controls, and correlated to patient outcome. RESULTS: The diameter of the superior sagittal sinus at onset and its ratio to the biparietal diameter were significantly smaller in the vein of Galen arteriovenous malformation population compared with the matched population (P = .0001) and were correlated significantly with a risk of poor clinical outcome (P = .008). Development of jugular bulb narrowing was also related to poor clinical outcome (P < .0001). CONCLUSIONS: Decreased superior sagittal sinus diameter may reflect a decrease of cerebral blood flow due to cerebral arterial steal and intracranial hydrovenous disorders. This finding may be considered cerebral blood flow deterioration and thus taken into consideration in the management decisions for patients with vein of Galen arteriovenous malformations. Likewise, our data suggest that progressive jugular bulb narrowing may indicate earlier intervention to prevent severe narrowing.

[Isolated occlusion of a cilioretinal artery]. / Occlusion isolée d'une artère cilio-rétinienne.

PURPOSE: Isolated cilioretinal artery occlusion is uncommon but has characteristic features. Based on a case report and a review of the literature, we present the clinical findings and angiographic particularities of this syndrome and discuss controversial pathophysiological data. CASE REPORT AND METHOD: A 56-year-old man had sudden visual loss in the right eye estimated at 3/10 P10. Fundus examination showed areas of retinal interpapillomacular infarction due to cilioretinal artery occlusion. Fluorescein angiography demonstrated delayed filling and emptying of this artery. Left fundus examination was normal. RESULTS: Systemic examinations revealed severe hypertension (240/130) rapidly controlled with a two-drug regimen. The clinical course was good with normalization of fundus and angiography, and visual recovery to 8/10 P3 with a small absolute paracentral scotoma. DISCUSSION: The few cases described would offer an explanation of the low prevalence of cilioretinal arteries and the more frequent association with central retina venous obstruction which can mask arterial occlusion. A relative reversible occlusion explains the generally good prognosis especially if the capillary network is not affected by the occluded artery as was observed in our case. CONCLUSION: Although diagnosis of isolated cilioretinal artery occlusion is made without difficulty, the underlying pathogenic mechanism remains difficult to explain due to the various phenomena revealed by the increased arterial pressure.

[Macular complications of synthetic antimalarials. Apropos of a case]. / Complications maculaires des antipaludéens de synthèse. A propos d'une observation.

The clinico-pathological findings in a 17-year-old girl with an "oeil de boeuf" maculopathy are reported together with the aetiological elements involved (hereditary or toxic maculopathy). The case was a second stage typical maculopathy due to antimalarial drugs. These patients were particularly susceptible, probably because of impaired renal function, since the total dose absorbed (140 g. chloroquine) was low. Ophthalmologic monitoring is required to prevent intoxication. Clinical examination, angiography and automatic perimetry and contrast sensitivity test are needed to detect the first effect of toxicity.