[Cervical medullar infarction in multileveled discopathy]. / Infarctus médullaire cervical dans un contexte de discopathie pluri-étagée.

Spinal cord infarction is a rare but devastating pathology causing acute neurological deficits. The incidence has been estimated to 1% of all strokes. In that case report, our patient has presented anterior spinal artery infarction in C5-C6. The only risk factor founded was a multileveled discopathy wich is known to be an uncommon cause of anterior spinal artery syndrome.

Li-Fraumeni syndrome: multiple distinct brain tumours in two brothers.

Li-Fraumeni syndrome is a rare autosomal dominant cancer-prone condition characterized by the occurrence of a large set of different types of cancer in a patient and their family. A germline disease-causing mutation of the gene encoding the p53 protein is associated with the syndrome. We report on a family in which segregation of a TP53 mutation in two generations was associated with two brain tumours, a leiomyosarcoma and a thyroid carcinoma in four male patients. The main patient presented with seizures revealing several primary brain tumours. We review recent views on its molecular basis and discuss management of the condition as well as a review of the literature.

Pituitary apoplexy after aortic abdominal aneurysm surgery: a case report.

Pituitary apoplexy (PA) occurring after surgery is a rare but life-threatening acute clinical situation following extensive haemorrhage or necrosis within a pituitary adenoma. Pituitary apoplexy has been reported to occur spontaneously in the majority of cases or in association with various inducing factors. One of the pathophysiological mechanism that has been postulated is the fall of arterial blood pressure inducing ischaemia followed by infarction of the pituitary gland. We report a case of pituitary apoplexy following aortic abdominal surgery. To our knowledge, this has not been previously reported. A 73-year old man complained of headache and diplopia. At clinical examination, he presented a right oculomotor nerve palsy. Magnetic resonance imaging (MRI) showed a haemorrhagic sellar mass. In our case, intraoperative hypotension could have been the precipitating factor. Diagnostic and therapeutic measures are discussed.

[Doppler study of gluteal arteries. A useful tool for excluding gluteal arterial pathology snd an important adjunct to lower limb Doppler studies]. / Le Doppler des artères fessières. Un outil efficace pour exclure une pathologie artérielle fessière et un complément important du Doppler des membres inférieurs.

PURPOSE: 1) To determine the negative predictive value (VPN) of duplex scan in patients complaining of buttock or hip pain and thereby to distinguish vascular claudication from other musculoskeletal or neurological diseases. 2) To show its complementarity in doppler investigation of lower limb arteries. MATERIALS AND METHODS: Prospective study by duplex scan and arteriography of 60 gluteal arteries in 30 consecutive patients referred to check up for lower limb arteriopathy or sexual impotence. Duplex scan was performed by posterior approach. Correlation between doppler ultrasound and arteriography was studied. RESULTS: The study of normal arteries was possible in all cases and only one normal gluteal artery could not be detected in a diabetic overweight patient. On 60 arteries, sensitivity of duplex was 100 percent, specificity 96 percent and VPN 100 percent. Significant obstructive lesions were always associated with pathological velocimetric waveform or were not detected. CONCLUSIONS: Buttock claudication can appear like a typical vascular claudication or mimic neurological or musculoskeletal diseases. It is very useful to rule out a vascular causality responsible for buttock or hip pain by simple, non-invasive and cheap exploration. A normal doppler ultrasound of gluteal arteries can rule out vascular disease responsible for buttock or hip pain thereby avoiding arteriography. The strategy of diagnostic or therapy can be modified by such additional information as shown in two case reports.

[Isolated idiopathic amyloid tumor of the sacrum. An important differential diagnosis]. / Amyloïdome solitaire idiopathique du sacrum. Un diagnostic différentiel important.

Primary amyloidosis may present as a pseudotumoral mass. Often associated with myeloma or paraproteinemia, it may also be isolated, without preexisting or associated disease. Isolated pseudotumoral bone involvement is rare and especially in the spine. Differential diagnosis is very important, because the prognosis of primary amyloidoma is excellent after surgical removal.

[Diagnostic strategies for ischemic enteropathies]. / Stratégies diagnostiques des entéropathies ischémiques.

Mesenteric ischemia is a life threatening event instead of colic ischemia which recovers in 90% of cases. Three points will be investigated: chronic mesenteric ischemia; acute mesenteric ischemia; colic ischemia.

Unusual occurrence of a pseudo-aneurysm of the middle cerebral artery in a patient with fibromuscular dysplasia.

Our patient is the first reported case of pseudo-aneurysm due to the rupture of an intracranial artery in the context of fibromuscular dysplasia (FMD). As we assume that our case is probably not unique, we conclude that this diagnosis may be sometimes overlooked for lack of confirmation either by surgery or autopsy. The retrospective study of the arteriograms suggests some clues that should be taken into account to foresee the existence of an intracranial pseudo-aneurysm in order to avoid unexpected peroperative difficulties: 1.) the rapid growth of the lesion within a few weeks and 2.) the unusual location of the aneurysmal neck at some distance from a arterial bifurcation.

Emergency endovascular treatment of an acute traumatic rupture of the thoracic aorta complicated by a distal low-flow syndrome.

We report the case of a patient who suffered major trauma following a motorcycle accident that resulted in multiple fractures, bilateral hemopneumothorax, pulmonary contusions, and an isthmic rupture of the aorta with a pseudoaneurysm compressing the descending aorta. This compression was responsible for distal hypotension and low flow, leading to acute renal insufficiency and massive rhabdomyolysis. Due to the critical clinical status of the patient, which prevented any type of open thoracic surgery, endovascular treatment was performed. An initial stent-graft permitted alleviation of the compression and the re-establishment of normal hemodynamic conditions, but its low position did not allow sufficient coverage of the rupture. A second stent-graft permitted total exclusion of the pseudoaneurysm while preserving the patency of the left subclavian artery.

[Spiral computed tomography of the renal arteries]. / CT spiralé des artères reénales.

With the recent advent of spiral or helical CT, the ability to acquire large volume of imaging has become possible. Fast scanning of both kidneys, the aorta and the renal vessels can be accomplished during one breathhold. Early reports of CT angiography in the evaluation of renal artery stenosis indicated a sensitivity of 92% utilizing the MIP projection method and 59% utilizing the shaded surface display method. Specificity for both method was approximately 82%. More recent articles reports for hemodynamically relevant renal artery stenosis a sensitivity/sensibility of 96/99%. The introduction of a new multidetector CT technology will probably increase those results and the indication of CT angiography.

[Intermittent claudication in a young patient. A case of isolated fibromuscular dysplasia of the external iliac artery]. / Claudication intermittente chez le sujet jeune. A propos d'un cas de dysplasie fibromusculaire isolée de l'artère iliaque externe.

Effort-linked intermittent claudication of arterial origin in sportsmen is often attributed to endofibrosis of the external iliac artery. Some knowledge of possible differential diagnoses, in particular the fibrodysplasia, is of importance regarding the therapy involved. Angioplasty treatment of external iliac endofibrosis may be controversial. However, the same does not apply to fibrodysplasia angioplasty, particularly if the latter is accomplished by inserting an endoprothesis. A case of fibromuscular dysplasia of external iliac artery in a 37 year old woman, treated with endoluminal angioplasty and stent, is reported.

Cerebral venous thrombosis and procoagulant factors--a case study.

Cerebral venous thrombosis is a polymorphic clinical entity for which diagnosis has become more frequent with the advent of neuroradiology. The superior sagittal and transverse sinuses are frequently involved, whereas cavernous sinus thrombosis is much less frequent. Inherited resistance to the anticoagulant action of activated protein C (APC resistance), antithrombin deficiency, protein C and S deficiencies, and hyperhomocysteinemia seem to represent major causes of thrombophilia when unusual thromboembolic events (ie, before the age of 45 years) are observed. The authors present the combined occurrence of protein C and protein S deficiencies in a 32-year-old woman, manifested by extensive cerebral venous thrombosis.

Catheter migration of a Port-a-cath system.

A patient with axillary venous thrombosis caused by lymph node compression and the presence of a displaced catheter in the vascular lumen is presented. In this case, percutaneous interventional radiological procedures (balloon angioplasty and snare loop method) in conjunction with medical treatment were effective in limiting the post-thrombotic syndrome and restoring the proper positioning of the catheter, thereby saving the central venous access.

[Carotid dissection during childbirth]. / Dissection carotidienne au cours d'un accouchement.

A 33-year-old woman presented transient ischemic attach (hemiparesis of the left arm and right amaurosis), 14 days after childbirth, due to dissection of the right carotid that occurred probably during delivery as suggested by right earache at that time. Carotid dissection during pregnancy or after childbirth is rare an exceptional during delivery. Neurological symptoms and arterial lesions were followed by duplex ultrasound.

[Agenesis of the right lobe of the liver. Apropos of a case]. / Agénésie du lobe droit du foie. A propos d'un cas.

The authors report a case of agenesis of the right lobe of the liver, only thirty two cases of which have been reported in the literature since 1870. The differential diagnosis consists of advanced cirrhosis, portal hypertension, neoplastic infiltration of the porta hepatis, gallstones or surgical resection. Agenesis is due to arrest of hepatic development during foetal life. It is generally symptomatic, but may sometimes present in the form of biliary type pain in the right hypochondrium or portal hypertension and may be associated with other anomalies (retrohepatic gallbladder, common bile duct cyst, aplasia of part of the diaphragm, intrathoracic kidney).