[Indentation sign in the sylvian sulcus and the arterial origin of an acute subdural hematoma. Contribution of computerized tomography]. / Le signe de l'indentation dans la vallée sylvienne et l'origine artérielle d'un hématome sous-dural aigu. Apport du diagnostic tomodensitométrique.

Thirty-two traumatic subdural haematomas were operated between 1984 and 1990. In 16 cases (50%), we encountered, after removal of the heamorrhage, a bleeding from a cortical artery at the lateral sulcus (middle cerebral artery). Four mechanisms of arterial bleeding have been reported: a) rupture of a cortico-dural bridging artery, b) "fire-hose" rupture, c) rupture at the level of an arachnoid attachment and d) rupture at the level of a dural adhesion. The characteristic finding of such haematomas on computerized tomography (CT-scan) was an indentation towards the lateral sulcus. This was called the "double brackets sign". In seventy-nine percent of subdural haematomas of arterial origin, the "double brackets sign" was demonstrated on CT-scan on at least two slices (9 mm). In 9% of subdural haematomas of non-arterial origin, this sign was absent or present in only one CT image. The characteristic "double brackets sign", when present on 3 or 4 CT-scan images, seems to have a very high specificity for an arterial origin of the haematoma.

[Epidemiologic survey of the cysticercosis endemic on Réunion Island]. / Enquête épidémiologique sur l'endémie cysticerquienne à la Réunion.

The high incidence of cysticercosis was underestimated in Reunion Island before computed tomography (January, 1984). In 1974, Soulayrolles et Boyer-Vidal found that cysticercosis was responsible for 0.5 p. 100 of the cases of epilepsy. In hospitalized people, routine cranial and muscles radiographies detected: 1/among 242 epileptics: 183 men: 36 positive (19.67 p. 100); 59 women: 9 positive (15.25 p. 100), 2/among 166 non epileptic-related neurological disorders: 106 men, 6 positive (5.66 p. 100), 60 women: 6 positive (8.33 p. 100); 3/among 219 hospitalized patients with no neurological diseases: 124 men: 18 positive (14.5 p. 100), 95 women: 2 positive (2.10 p. 100). The clinical features of cysticercosis are so various that it appears impossible to define a typical clinical presentation. On the other hand the diagnosis is easy with CT scan and a serodiagnostic test (Elisa). In 98 patients, clinical symptoms and signs, CT scan and serology (Elisa) have been evaluated. Praziquantel was introduced in 1984 with good results as judged by serial CT scans. A human and animal investigation has been set up to define more clearly the relationship between the human parasitosis and rearing of domestic pigs to try to eradicate human and animal cysticercosis in Reunion Island.

[Contrast medium turnover in discography (author's transl)]. / Valeur diagnostique de la durée du contraste dans la discographie lombaire.

Discography seems to have lost some interest for diagnosis in froomt of the new methods of myelo and radiculography with Metrizamide. But it remains still usefull before operation in some cases of lumbo-sciatic and cervico brachial pains. Beside the already known morphological disturbances of the disks it appeared very important to follow up the turnover of the contrast medium in the vertebral interspace. The turnover study of the contrast was performed by successives X ray views taken 12 hours, 24 hours and 48 hours after discography and also in some cases by the analysis of the half-life curve of a radioactive isotope (Technetium) injected jointly with the contrast in the disk. In the normal lumbar disk the contrast medium remains still visible after a delay of 24 hours, while it disappears completely at this time in cases of discopathy. This fact was also confirmed by isotope turnover. In cervical disk this information remains valuable but with a little shorter delay. This radiological sign remains trusty for the great majority of operated discopathies.

[Monitoring of intracranial pression in acute neurotrauma by extra-dural screw (author's transl)]. / Monitorage de pression intra-crânienne en neuro-traumatologie aiguë par capteur extra-dural.

These data emphasize the interest of the study, in acute traumatic comatose, of the brain-stem reflexes and level of coma (Plum, Posner, Perez-Dominguez, Barge, Espagno) and the monitoring of the intracranial pression (ICP) by extra-dural screw (Vries, de Rougemont, J. Brunon). It is possible to describe: 1)The bilateral hemispherical contusions: with cortico-subcortical level and bilateral decorticate comatose. The normal brain-stem reflexes (N.B.S.R.) are presents. The monitoring of ICP allows to separate the reversible bilateral hemispherical contusions (ICP can present unstable recording during 3 days with pressure-waves--B waves--or to be stable (between 10--15 mm Hg)), from the severe bilateral contusions with rostro-caudal evolution and "plateau-waves". 2) The brain-stem contusions: the clinical level is often a mesencephalic level with decerebrate rigidity and N.B.S.R. +/- (Automatic Eye Movements). In severe injury the ICP is increased and unstable with A waves. In reversible brain-stem contusions the ICP is often stable and low with arteriography and ventriculography insignificant. 3) The associated contusions: In general, the head injuries of this group are alternatively decorticate or on decerebrate rigidity ("ambiguous reaction"). In the severe associated contusions the ICP shows A waves. In reversible contusions ICP is stable with normal supratentorial angiogramm and ventriculography.

[Fractures and dislocations of the lumbar vertebrae (author's transl)]. / Les fractures et luxations du rachis lombaire bas.

The authors report 6 cases of fracture and dislocation of the lower lumbar vertebrae (L3, L4, L5) and note that they were usually lesions following violent trauma usually in hyperflexion. The following were treated 1 dislocation L3-L4, 2 dislocations L4-L5, 2 comminuted fractures of L4, 1 fracture of L5, and included in all cases intersomatic arthrodesis at one (five cases) level or two levels (one case) and one posterior internal fixation with Kempf's material. The simplicity of the follow up and the stability of the fixation, permit us to propose the method for all unstable lesions of the lower lumbar vertebrae.

[Enlarged operations for atypical lombo-sciatic pain from disk origin (author's transl)]. / Interventions élargies pour lombo-sciatiques discales atypiques.

In certain forms of atypical sciatic pain the surgical treatment of the affection cannot be accomplished exclusively upon the disk. This study was done on 120 patients operated upon during a two year period. The major technics used had an action upon the articular processes and facets with or without removal of the disk. In 60 cases a desensibilisation of the region was equally done. The principal reason of the surgical treatment remains still to permit the decompression of the sick root. In certain circumstances a more important surgical treatment is required: laminectomy is performed in cases of stenosis or in other cases an inter body fusion by posterior approach (60 patients). The term atypical lombo-sciatic pain is applied essentially when there exists discordancy in the clinical and neuroradiological examination. Surgical cure is applied when the medical treatment has failed. The best results have been obtained in atypical sciatic pain when facet rhizolysis has been associated with root decompression. However great care was taken to prevent the act from being destructive.

[Inseparable prognostic value of spinothalamic and corticospinal functions in severe spinal cord injuries]. / Valeur pronostique indissociable des fonctions spinothalamique et corticospinale dans les traumatismes médullaires graves.

In severe spinal cord trauma with initial complete paraplegia or tetraplegia, even the smallest recovery of sensibility to pain or motor function has an obvious prognostical value as it results from the study of 112 spinal injuries. For the motor aspect it is well known from experimental work and in man that even a small part of a single pyramidal tract in the spinal cord can take in charge the bilateral motricity of the limbs. It remains exceptional in severe spinal cord injury that recovery of motricity is not followed by a return of pain sens. In the lateral funiculus of the cord the sensitive and pyramidal tracts belongs to a same anastomotic vascular area between the central and peripherical circulatory streams. In physiological conditions this intermediate circulatory stream is poorly functional. But in severe spinal cord trauma with reduction of central blood flow the adjacent spinothalamic and corticospinal tracts survive in couple on the basis of the same anastomotic vascular area: from this results the prognostical unity that belongs to pain sens and motricity.

[Complementary procedures to the Sjoqvist operation in cancerous cervico-facial pain]. / Gestes complémentaires à l'opération de Sjoqvist dans les algies cancéreuses cervico-facilaes

The trigeminal spinal tractotomy of Sjoqvist can be enlarged and give a very good result on cancer pain of face and throat. When pain is also cervical, it is usefull to associate with the Sjoqvist operation two important procedures: 1 degree--Instead of a simple posterior cervical radicotomy it seems best to practise a selective posterior radicellotomy. This technic has the advantage to preserve the sensory proprioceptive capacity of the superior limb, while being perform even until C6 and C7 roots. Also in case of recurrence of cervico brachial pain, it remains easy to apply a posterior spinal stimulation. 2--The spinal nerve has not only a motor function but also a sensory one. The sensory fibers travelling through small anastomosis between "LARUELLE Ganglion" and cervical roots must be separated to obtain a more complete analgesia.

[Prognostic elements at early stapes of severe spinal cord injuries (value of pain sensitivity]. / Eléments de pronostic à la phase précoce des traumatismes vertébro-médullaires graves (valeur de la sensibilité à la douleur

The prognosis in serious spinal cord injury remains difficult. The neurologist has a large number of elements at his disposal, but their reliability is uncertain. Clinical information, experimental work and recent data on medullar vascularization makes it possible to isolate diagramatically in the spinal cord a medium layer which contains the pyramidal and spino-thalamic tracts. The neighbourhood of these two fasciculi confers them a similar vulnerability to severe injury. Thus when an injured tetraplegic or paraplegic patient recovers his sensitivity to pain, he finally must recover his motor function and on the contrary, the recovery of motility is impossible without a return of pain sens. Clinical observation is in consequence of major importance as it shows that the recovery of sensitivity to pain, in the case of a patient with a serious spinal cord injury, is an argument for a favourable prognosis, whereas the recovery of an isolated tact perception does not in itself makes it possible to hope for eventual recovery of motor power.