[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.

[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.

[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.

[Homonymous lateral hemianopsia revealing cerebral thrombophlebitis. Role of a deficiency of protein S induced by l-asparaginase]. / Hémianopsie latérale homonyme révélant une thrombophlébite cérébrale. Rôle d'un déficit en protéine S induit par la l-asparaginase.

BACKGROUND: Cerebral thrombosis associated with protein S deficiency is very rare and is mainly related to hereditary form of protein S deficiency. CASE REPORT: A 19-year-old girl with acute lymphoblastic leukemia presented hemianopsy within a few days after the first administration of L-asparaginase. Magnetic resonance of the brain showed a cortical infarct. A marked decrease of the level of protein S was documented. Few days later, the patient was free of symptoms and protein S level was restored to the normal suggesting that the cerebral thrombosis was caused by transient protein S deficiency induced by L-asparaginase administration. DISCUSSION: Patients with neurological complication caused by L-asparaginase should be tested for protein S and other anticoagulant deficiencies.

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.

[Cauda equina tumors in adults]. / Tumeurs de la queue de cheval chez l'adulte.

Large series of cauda equina tumors in adults are seldom reported. This study was based on the 231 cases collected in the French neurosurgery units for the congress of the Société Française de Neurochirurgie in October 1996. Schwannomas were the most frequent benign tumor in this series, followed by ependymomas. Very few malignant tumors were recorded, usually malignant neurinomas nearly always arising in patients with neurofibromatosis. Some other rare tumors were also observed including paragangliomas. This series confirms the contribution of pre-therapeutic neurological status to functional prognosis. All schwannomas can be cured while ependymomas and paragangliomas may recur after a very long delay. Surgery must be as complete as possible since adjuvant therapies have proven to have little efficacy. This type of tumor requires a very long follow-up. Prognosis is good for hemangioblastoma. When present, abnormal sphincter function is an argument for poor prognosis. It may appear after primary surgery or more often after treatment of recurrence.

[Imaging aspects of primary cerebral lymphoma]. / Aspects par imagerie des lymphomes cérébraux primitifs.

Th CT and MRI appearance of 196 lymphomatous histologically proved lesions were rewied in 127 patients. A post contrast study was performed in all patients studied with CT; 118 lesions were also assessed before an iodine contrast injection. 40 lesions were both studied with CT and MRI, and 12 only with MRI. There is a single lesion in 86% of the cases with a supratentorial location in 87%. The lesion size is over 1 cm in 90% and 87% of the lesions appear with regular and sharp demarcation. A mild edema is associated in 86%. Most of the lesions display an infiltrative pattern with a soft mass effect on the surrounding cerebral parenchyma. The basal ganglion, corpus callosum and trigone location, or an infiltration of the periventricular ependyma, or a mirror pattern, appear strongly suggestive for a lesion of lymphomatous origin. The CT post contrast enhancement of the lesion is present in 99% and homogeneous in 82%.

Strategy for identifying primary malignancies with inaugural bone metastases.

The diagnosis of primary tumors with inaugural bone metastases is a serious and difficult problem commonly encountered in rheumatology. Helpful information can be derived from the radiologic appearance of the metastases, history of the patient, clinical findings, chest film, standard laboratory tests, imaging studies, serum marker assays, and histologic findings. Based on our personal experience and on previously published data, we have developed a decision tree aimed at enhancing the efficacy of the diagnostic process while ensuring optimal patient comfort and containing costs.

[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.

[MRI in infectious and spontaneous tumoral epidural hemorrhagic pathology]. / IRM et pathologie épidurale tumorale infectieuse et hémorragique spontanée.

Several studies have served to underline the interest of MRI in the diagnosis and assessment of epidural abscess and malignant extradural spinal tumors. In our work, one of the quantitatively greatest published to this day, 64 patients presenting epidural pathology were evaluated by means of MRI. All the explorations were brought about through weighted multiplaned sequences T1, T2 and gadolinium injection. The pathological spectrum encountered is comprised of: metastatic extradural spinal tumors (58%), primary extradural spinal tumors (7%), epidural localizations of hematological diseases (9%), epidural abscess (25%), and one case of epidural hematoma. Assessment was brought to bear upon behavior in relation to type of sequence, spread of disease, medullary effects, type of enhancement following gadolinium injection. Degree of correlation with clinical data and surgical findings was also appraised. As concerns tumourous epidural pathology, positive diagnosis due to a lesion hinges upon the T1 and T2 sequences. Gadolinium's contribution is restricted to analysis of perivertebral and vertebral spreading; it also facilitates recognition of the spinal cord in circumferential epiduritis. So much said, gadolinium appears to be essential in frequently less compressive forms of infectious epiduritis; it plays a pronounced role in both follow-up of their evolution and recognition of acute epidural hematoma.

[Adamantinoma of the tibia. X-ray computed tomographic and MRI study. Apropos of a case]. / Adamantinome du tibia. Etude tomodensitométrique et par IRM. A propos d'un cas.

Adamantinoma of the long bones in a very rare tumor that mainly affects the tibia. Its diagnosis is difficult both radiologically, as the lesion appears as a poorly specific metaphyseal lacuna with or without periosteal reaction, and histologically. Its prognosis used to be guarded because of recurrence and of possible metastatic diffusion, but it has been considerably improved by wide resection with reconstruction. On the occasion of a new case, the authors describe the appearance observed with MRI and the merits of this examination for the preoperative assessment.

[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.

[Radiological consequences of lumbar disk surgery. Evaluation by MRI after 3 months]. / Conséquences radiologiques de la chirurgie discale lombaire. Evaluation par I.R.M. au 3e mois.

Radiologic effects of the surgery for lumbar disc herniation: a study with MRI at the end of the third post-operative month. The results of patients operated for lumbar disc herniation are good in 83%, fair in 10% and poor in 7. The poor results are considered to be the consequence of post operative fibrosis. A prospective study in 67 patients has been performed to study the post operative appearance of the operated lumbar spine, three months after surgery. 45 days after surgery the recovery of patients was assessed by the score of Staufer and Coventry and patients were entered in the study independently of their clinical state. The MRI was performed at the end of the third month postoperatively and patient recovery assessed according to the score of Senegas and Lavignolle. All the clinical and radiologic data were statistically analysed... the chi-square test, a p. value less than 0.05 was considered statistically non significant. The correlation between the clinical recovery and the MRI was realized.

[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.

[Leiomyosarcoma of the inferior vena cava. Diagnostic difficulties]. / Léiomyosarcomes de la veine cave inférieure. Difficultés diagnostiques.

As leiomyosarcomas of the inferior vena cava are extremely infrequent, the preoperative diagnosis of such tumors is rarely established. We report two cases in which the diagnosis was suggested by modern imaging prior to surgery. Three examination techniques allo contemplating this diagnosis. Ultrasound and cavography show either an intraluminal, multilobulated, roughly hyperechogenic lacuna on one of the segments of the vena cava, without any remote thrombosis image, or a complete obstruction of the vena cava with collateral circulation and a hyperechogenic right paraaortic mass. Computed tomography demonstrates the extraluminal extension. It reveals the presence of a right lateroaortic tumor with heterogeneous tissue density, in which the vena cava is concealed. The association of an intraluminal lacuna and of a tumoral syndrome on CT is highly suggestive. These three techniques are equally essential for the assessment of this tumor, which is primarily based on vascular findings. Exeresis is always difficult and the prognosis very poor.

[Calcifications after intra-disk injection of triamcinolone hexacetonide in lumbar disk hernia. Evaluation of therapeutical results in 3 years]. / Etude des calcifications apparues après injection intradiscale d'hexacétonide de triamcinolone dans les hernies discales lombaires. Evaluation des résultats thérapeutiques à 3 ans.

The development of disk or epidural calcifications is a frequent possibility following intra-disk injection of triamcinolone hexacetonide. It was found 10 times in 26 follow-up CT scans obtained 2 to 3 years after the injection. These calcifications are often clinically silent, but they sometimes accompany a recurrence of the initial painful symptomatology. Furthermore, evaluation at 3 years of therapeutic results in a previously published series of patients who had received an intra-disk injection of triamcinolone hexacetonide showed a marked decrease in favourable results (30% vs 67% at 6 months). These two arguments: disappointing long term results and possibility of disk calcifications, are felt by the authors to justify abandoning the technique of triamcinolone hexacetonide by intra-disk injection in the treatment of lumbar disk prolapse.

[X-ray computed tomographic study of the ethmoid and middle meatus. II. Radio-anatomy (axial incidence) and morphological variations]. / Exploration tomodensitométrique de l'ethmoïde et du méat moyen. II. Radio-anatomie (incidence axiale) et variations morphologiques.

Chronic rhinosinusitis endoscopic surgery needs an accurate evaluation of diseases and paranasal sinus anatomic variations. High resolution CT by thin section (2 mm) allow this pre-operative assessment. An anatomical study of the ethmoid air cell system is always possible in axial plane. The bidimensional CT exploration (axial and coronal plane) displays the anatomic variations of ostiomeatal unit, that have been reported to predispose sinusitis. They are nasal septal deviation, pneumatization and paradoxical curvature of the middle turbinate, pneumatization of unciform process, Haller's cells, prominent agger nasi cell and ethmoid bulla. The endoscopic endonasal surgery landmarks, the individual morphologic variations, the topographic relations to the orbit and to the brain are also well shown by CT.

[X-ray computed tomographic study of the ethmoid and middle meatus. I. radioanatomy (coronal plane)]. / Exploration tomodensitométrique de l'ethmoïde et du méat moyen. I. Radio-anatomie (incidence coronale).

The advance of endoscopic endonasal surgery allows limited surgical resection in chronic rhinosinusitis. An accurate topographic evaluation of diseases and individual morphologic variation are necessary for this functional surgery. The preoperative radiological investigations require a precise knowledge of ethmoid and osteo-meatal unit anatomy. Thin sections by high resolution CT were performed in coronal plane. The anatomical land marks and the ethmoidal bony roots, which allow a study of the osteo-meatal unit and ethmoid air cells system, are showed. Like endoscopic view, coronal slices better display the different grooves for paranasal sinus draining and their relations with the ethmoid.