[Craniocerebral gunshot wounds: a study of outcome predictors]. / Les plaies crâniocérébrales d'origine balistique: recherche d'arguments pronostiques.

BACKGROUND AND PURPOSE: A retrospective study about craniocerebral gunshot wounds was done to better identify outcome predictors. METHODS: We reported and analyzed the clinical and radiological data of 18 patients admitted to Le Kremlin-Bicêtre institute for a craniocerebral gunshot wound between January 2000 and December 2005. The Glasgow Outcome Scale (GOS) was used to analyze patient outcome. RESULTS: There were 17 men and one woman, mean age 43 years (range 17-84). Fifteen patients died, two had a GOS equal to 2 and one GOS equal to 3. There were 16 suicides and two murders. All patients with areactive bilateral mydriasis and all patients with Glasgow Coma Scale (GCS) less than seven died except one. The 10 patients with intraventricular hemorrhage died. The bullet crossed the midline for 13 patients and all of them died. None of the patients underwent emergency surgery for the treatment of craniocerebral gunshot wounds because of low Glasgow Coma Scale. CONCLUSIONS: This study shows some interesting prognosis patterns: bilateral areactive mydriasis, GCS less or equal to 7 and bullet trajectory (if crossing the midline) are the most important factors predicting a fatal outcome.

Effects of surgery on the sensory deficits of syringomyelia and predictors of outcome: a long term prospective study.

OBJECTIVE: To quantify the effects of surgery on the thermal deficits of syringomyelia and assess the predictors for such effects. METHODS: The subjects were 16 consecutive patients (12 men, 4 women; mean (SD) duration of sensory symptoms, 5.1 (4.5) years) presenting with the typical symptoms of syringomyelia related to Chiari I malformation or trauma, and requiring surgical treatment. They were evaluated before surgery, then at six months and two years. Sensory evaluation included determination of the extent of thermal deficits and quantitative assessment of thermal, mechanical, vibration detection, and pain thresholds. Neuropathic pain intensity was evaluated on visual analogue scales. Magnetic resonance imaging was done before and after surgery to measure syrinx dimensions. RESULTS: The magnitude and extent of thermal deficits improved in a subgroup of patients and this was best predicted by the duration of sensory symptoms: patients operated on less than two years after the onset of their symptoms tended to improve, while those operated on later were stabilised or deteriorated slightly. The effect of surgery on thermal deficits was correlated with the duration of sensory symptoms. Surgery also affected vibration deficits in patients with the Chiari malformation, neuropathic pain on effort, and syrinx dimensions. CONCLUSIONS: The duration of sensory deficits is the best predictive factor of the efficacy of surgery for the thermal symptoms of syringomyelia. Early surgery is required if these deficits are to be minimised.

[Imaging of syringomyelia]. / L'imagerie des syringomyélies.

This review reports the value of current imaging techniques in the diagnosis of syringomyelia excluding tumoral causes. The value of imaging techniques for evaluation of extension, detection of associated anomalies, and pre- and postoperative evaluation are detailed.