[A case of digestive epilepsy with late diagnosis: a disease not to be disregarded]. / Un cas d"épilespie digestive de diagnostic tardif: une pathologie à ne pas méconnaître.

Digestive epilepsy is a rare disease, poorly recognized by gastroenterologists. Its diagnosis requires a compatible clinical presentation, the absence of concomitant organic digestive disease, and an effective and long-lasting response to specific anticonvulsant agents. We report a case of digestive epilepsy due to a meningioma of the right parietal lobe in a 79-year-old woman suffering from headaches, vertigo, sweating and abdominal pain for at least 14 years. Initial diagnosis was irritable bowel syndrome. A meningal syndrome led to neurological work-up showing cerebral meningioma. The recurrent paroxysmal abdominal pain was interpreted as manifestations of digestive epilepsy, and effective and long-lasting treatment was obtained with carbamazepine. After analysis of the determining elements in this case, the epidemiology, pathophysiology, diagnostic work-up, therapy, and differential diagnosis of digestive epilepsy are discussed.

[The causes of intracranial hemorrhagic complications induced by antivitamins K]. / Conditions de survenue des accidents hémorragiques intracrâniens des antivitamines K.

Cerebral haemorrhage is the main life-threatening complication of oral anticoagulant therapy. In order to identify a means of prevention, the authors undertook a retrospective study of 68 consecutive cases of anticoagulant-related intracerebral haemorrhage. The mortality was 38.5%. The respective frequency of intracerebral haemorrhage, subarachnoid haemorrhage, acute and chronic subdural haematomas was 63.2, 16.2, 10.3 and 10.3%, respectively. On admission, nearly half the patients (53%) had prothrombin ratios inferior to 25%. A predisposing factor was found in 58% of cases: hypertension (30.6%), head injury (14.5%), alcoholism or drug interaction (11.2%), and one case of intracerebral aneurysm. A history of a transient ischaemic attack or of a cerebrovascular accident was found in 10.2% of cases and 11.7% had a previous anticoagulant related extracranial haemorrhage. The initial indications for oral anticoagulation were ischaemic heart disease (32%), atrial fibrillation (20.5%), secondary prevention of venous thromboembolic disease (17.6%) and primary prevention of venous thrombosis (11.7%). The duration of treatment for isolated ischaemic heart disease was over 6 months in all cases: the average duration of treatment was 12.4 months in phlebitis and pulmonary embolism. A critical review of the indications of treatment in the light of recent recommendations showed that if inappropriate indications were rare, the sometimes unnecessary prolongation of treatment was more common. Nearly half of these cases were receiving anticoagulants when the potential benefits were questionable at the time of the haemorrhagic complication. Clinical and biological follow-up is necessary for patients on anticoagulants; minor bleeding complications may be the prelude to major haemorrhage. Biological follow-up is based on control of the international normalised ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

[Transmission of neurosurgical medical records through computers. Simple reality, considerable progress]. / Transfert de dossiers neurochirurgicaux par numeris. Une réalité simple, un progrès considérable.

Tests on the transmission of view data processing images were undertaken for 5 months from two experimental micro-processing sites specialized in medical imagery and linked to the R.N.I.S. network. The aim of the research was to validate the equipment and the software, and to find a way of working with regard problems related to long-distance diagnosis. Using an everyday equipment like Apple Macintosh II fx, 75 files were transferred corresponding in 375 images (1% conventional X-ray, 5% digital angiography, 31% scanner and 63% M.R.I.). It has been found that the transfer of medical data is reliable (the images do not deteriorate), easy (less than 3 hours to be familiar with the program) and above all fast (actual transfer time: 8.72 Ko per second). Neurosurgeon and neuroradiologist writers talk about their experience in this field.

Twelve cases of pituitary apoplexy.

In 12 cases of pituitary apoplexy, a preexisting unsuspected adenoma was found. The initial manifestations were sudden onset of headache (12 patients), signs of meningeal irritation (10) with fever (four), altered consciousness (12), and ophthalmologic disturbances (eight). The diagnosis was retrospective in three cases. Radiologic investigations were always suggestive if carefully considered. The plain skull roentgenograms, in particular, showed an enlarged sella turcica in 11 cases. Three patients had prolactin adenomas, and nine had nonfunctional adenomas. Medical treatment was successful in only three patients; surgery was performed in 10 cases by means of a sublabial transseptal microsurgical approach. Postoperative neurologic complications were serious in two cases. Endocrine insufficiencies were common: eight cases of permanent panhypopituitarism, two cases of pluritropic anterior pituitary dysfunction, and three cases of persistent hyperprolactinemia.

[Nimodipine and cerebrovascular circulation. Initial results apropos of 4 cases of subarachnoid hemorrhage]. / Nimodipine et vascularisation cérébrale. Données préliminaires à propos de quatre observations d'hémorragie méningée.

Nimodipine was included in the treatment of four patients who had previously presented subarachnoid hemorrhage; cerebral circulation has been assayed by means of "Tomophygmographie cérébrale ultra-sonore". In all four patients, use of Nimodipine has led to an improvement of cerebral circulation and then of the neurological status. Nimodipine is characterized by its very low therapeutic inertion. Data obtained both at the initiation and on interruption of the administration of this drug points to its original properties regarding cerebral circulation: indeed, the present observations suggest that Nimodipine behaves as a true vasoregulator.

[Intradural spinal metastasis from visceral neoplasms. Apropos of 4 cases. Review of the literature]. / Métastases spinales intradurales de néoplasies viscérales. A propos de 4 cas. Revue de la littérature.

Four patients were referred during the last year for treatment of an intradural metastasis. Primary sites were a bronchogenic carcinoma (one case), a prostatic carcinoma (one case) and in the two other cases the primary tumor was not found. In all cases Noot pain had lasted 1 to 5 months, despite CT examination during this painful period. Except in case n.4, diagnosis was not established until the onset of myelopathy. Surgical removal was complete in one case and subtotal in the three other cases, with complete postoperative relief of the pain in all cases and significative improvement of neurological status. The authors emphasize the importance of root pain as an early sign in these patients as well as the difficulty in establishing diagnosis. They discuss the different pathogenic mechanisms and the methods of treatment.

[Recurrences of supratentorial meningiomas. Apropos of 17 cases]. / Récidives de méningiomes sus tentoriels. A propos de 17 cas.

17 cases of recurrent meningiomas observed during a 10 years period are reviewed. Meningiomas with a second localisation different from the first were excluded from the study. The tumor recurrence occurred mostly during the first five years after the surgical procedure. One case with femoral and pulmonary metastasis is described. Several factors may play a role in the genesis of the recurrence: age, sex, the tumor localisation, CT scan, the importance of the tumor ablation, the histology. In almost all cases a radiotherapy was carried out after the second surgical procedure. This retrospective study suggests the need for multifactorial prospective analysis with clinical, paraclinical and fundamental factors. Such a study would be useful to precise the natural history of meningiomas.

[Surgical excision of meningioma of the posterior fossa in a dog after detection by x-ray computed tomography]. / Exérèse chirurgicale d'un méningiome de la fosse postérieure chez un chien après détection par un examen tomodensitométrique.

Following the progressive occurrence of a central vestibular syndrome in a 9 year old female dog, the diagnosis of a compressive lesion was confirmed by cerebrospinal fluid analysis (C.S.F.) and by computerized axial tomography (C.T.). The C.T.Scan revealed a large tumor occupying two thirds of the posterior fossa on the right side. A direct surgical approach to the right side of the posterior fossa revealed a large, friable mass, consistent with a meningioma, underneath the cerebellum, over the brain stem. Microscopic surgical dissection permitted the removal of the major part of the tumor. The nature of the intracranial neoplasm was confirmed histopathologically as a meningioma. No post operative complication arose and the dog returned to normal. Three months later, clinical signs reappeared and a control C.T.Scan showed recurrence of the tumor. The dog was euthanized four months postsurgically. Intracranial tumors are common in the dog, but rarely diagnosed and operated. However, a direct surgical approach to the posterior fossa for a tentative curative removal of an intracranial tumor has never been described in a dog. The localization and description of the lesions demonstrate the utility of C.T.Scans in the canine species. Recurrence of the tumor following surgery confirms the importance of complete excision of intracranial meningiomas when possible.

Anatomical basis of the microsurgical approach to the pineal gland.

The microanatomic study of the pineal region was made from 18 cadaver brains. The purpose of this paper is to describe the surgical anatomy needed to approach this area, which is deeply located and in the midline, by analysing the different methods of approach.

[Multiple metastases during the course of a pineal germinoma]. / Métastases multiples au cours de l'évolution d'un germinome pinéal.

The clinical findings and course of a patient with a germinoma of the pineal region is presented. After a surgical procedure and radiation treatment, ten months after, the patient develops successively peritoneal, ventricular, spinal metastasis. Effective treatment was either radiation treatment or chemotherapy. The frequency of metastasis with germinomas of the posterior part of the third ventricle are discussed, following a review of the literature, prevention and treatment are discussed.

[Excision of a glomus jugulare tumor after embolization]. / Exérèse d'une tumeur du glomus jugulaire après embolisation.

The authors report the case of a patient with a glomus jugulare tumor. After embolization of the external carotid artery branches feeding the tumor, a complete removal had been performed by a combined otoneurological approach. Although clearly defined and cleavable at the jugulare foramen, the chemodectoma had invasive characteristics in its intrapetrous extension, indicative post operative radiotherapy. In addition a review of publications support preoperative embolization and otoneurosurgical cooperation.

[Thrombosed carotid aneurysm and CT scan. Report on three cases]. / Anévrysme thrombosé carotidien et TDM. A propos de 3 cas.

Thrombosed intracranial aneurysms are always large aneurysms with a diameter superior to 25 mm. They are easily detected by computed tomography, but their diagnosis when they are located in the sphenoidosellar region may cause problems. Three cases of giant aneurysms have been discovered by CT scan over a period of 27 months.

[Cerebellopontine angle chondroma. A report of one personal case (author's transl)]. / Les chondromes de l'angle ponto-cérébelleux. A propos d'une observation personnelle.

The authors report 1 case of cerebellopontine angle chondroma. In the World literature 12 cases are already described. They insist on the difficulty of the diagnosis and on the length of clinical evolution (12 years). The CT Scan will certainly transform this pathology by early detection of small tumors at extra dural stage.

[Spinal cord compression caused by malignant non-Hodgkin lymphomas. 13 cases]. / Compressions médullaires par les lymphomes malins non Hodgkinens. A propos de 13 observations.

The authors report 13 cases which permitted them to discuss the clinical signs, which were multiple, completed by further investigations of which the most important was lipiodol myelography. The treatment included usually surgical operation accompanied by radiotherapy, chemotherapy and sometimes immunotherapy. This combined treatment gave a better prognosis espeically in patients operated at stages I, II and III, and we obtained 25% favourable results.