Pure motor hemiparesis in a case of vertebrobasilar arterial ectasia.

A case of pure motor hemiparesis due to a pontine lacunar infarct is reported. Infarction was related to vertebrobasilar ectasia identified on CT, MRI and MR angiography. MR studies provide accurate information on anatomical location, residual lumen, partial thrombosis, mass effect on brain stem and CSF pathways and vascular complications.

Modified plasma exchange in life-threatening Guillain-Barre syndrome - abstract

Modified plasma exchange (MPE), a simpler procedure than a conventional plasmapheresis which uses automated equipment and expensive replacement fluids, has recently been recommended for use in hospitals with limited resources in the management of patients with Guillain-Barre Syndrome (GBS). We have performed MPE in 7 patients with life-threatening respiratory failure due to GBS, using fresh frozen plasma as replacement fluid. In 5 out of 6 patients, in whom MPE was started at the onset of mechanical ventilation, rapid improvement inconsistent with the natural history of the disease was noted. In 2 of these patients, due to severity of illness, more plasma per day than previously recommended was safely removed. In one patient, MPE was started with a peak expiration flow rate of 2.2 litres per minute and assisted ventilation was unnecessary due to rapid improvement. Death occurred in one patient from respiratory complications and was not directly due to MPE. Our study confirms the safety and efficacy of MPE and suggests that more plasma can be safely exhanged by this method than previously recommended (AU)

[Gadolinium-DTPA in the study of intracranial tumors in the adult]. / Apport du gadolinium-DTPA à l'étude des tumeurs intracrâniennes de l'adulte.

Thirty intracranial tumours were explored by MRI, using T1- and T2-weighted sequences, before and after intravenous injection of Gd-DTPA. Two-thirds of the intra-axial tumours were accurately detected on one section plane by MRI without Gd-DTPA, but in one quarter of the cases Gd-DTPA only delineated precisely the tumour. On the other hand, Gd-DTPA failed to detect certain tumours (benign gliomas) or showed only a small part of them (mixed grade gliomas), while they were detected by MRI without contrast injection. However, in such cases Gd-DTPA was useful for the stereotaxic biopsy of the tumour. Gd-DTPA appears of lesser interest in extra-axial tumours. Gd-DTPA is thus valuable for the neuroradiological diagnosis of brain tumours, particularly to evaluate the grade of gliomas and to confirm the diagnosis of recurrent growths.

Capsular ataxic hemiparesis. Early diagnosis with MRI.

The Authors report a case of ataxic hemiparesis caused by a lacunar infarct involving the posterior limb of the right internal capsule, in a 64-year-old hypertensive man who completely recovered in about two weeks. The lesion was detected by MRI four days after the onset of illness, when the CT scan was normal. In patients presenting with ataxic hemiparesis, MRI is the most accurate tool in locating very small causative infarcts of the brainstem or the subcortical white matter.

Spontaneous dissection of both extracranial internal carotid arteries.

Neurological examination and Doppler sonography of a 50-year-old patient were suggestive of a spontaneous dissection of the left internal carotid artery (left-sided headaches, amaurosis fugax, Horner's syndrome and hemispheric stroke). Four-vessel angiogram performed several days after the onset of the symptoms showed dissection of both extracranial carotid arteries, more pronounced on right side where the dissection was clinically asymptomatic. Angiogram follow-up demonstrated a recanalization of both carotid arteries. A review of 15 other documented reports indicates that bilateral internal carotid dissection is usually associated with fibromuscular dysplasia. A large majority of cases does not clinically differ from unilateral carotid artery dissection.