[Cerebral infarction related to intracranial radiation arteritis twenty-four years after encephalic radiation therapy]. / Infarctus cérébral secondaire à une artériopathie radique intracrânienne, vingt-quatre ans après une irradiation encéphalique.

We report a case of a resolutive late cerebral ischemic event, related to radiation induced vasculopathy of the left posterior cerebral artery, documented by MRI, situated in the irradiated volume 24 years before, for an astrocytome with malignant potential.

[Subthalamic stimulation in a patient with multiple system atrophy: a clinicopathological report]. / Stimulation des noyaux sous-thalamiques dans l'atrophie multi-systématisée: à propos d'un cas anatomo-clinique.

INTRODUCTION: Efficacy of high frequency subthalamic nucleus (STN) stimulation has been demonstrated in idiopathic Parkinson's disease (IPD). However, since it may be difficult to differentiate IPD from multiple system atrophy with parkinsonian presentation (MSA-P), a few cases of MSA-P has been treated by deep brain stimulation (DBS) and showed no sustained improvement of clinical signs. We report a patient with a clinical misdiagnosed MSA-P, later confirmed by neuropathological study, who was improved by DBS for one year. CASE REPORT: A 63-year-old parkinsonian patient had been treated by levodopa for 6 years with a persistent good response. Over one year he progressively developed disabling fluctuations with severe axial syndrome and vegetative non motor symptoms in off periods. After checking usual contraindications, he was included in surgical procedure protocol (bilateral STN stimulation). During the first year after surgery, the clinical status improved with disappearance of non motor fluctuations, a 45 percent decrease of the OFF UPDRS III score, and a 39 percent reduction of the treatment. However after one year, axial symptoms reappeared with recurrent falls, as well as increasing dysarthry and swallowing difficulties which were only slightly improved by levodopa. He developed severe urinary disorders increased by a prostatic adenoma which led to surgical treatment. During the post operative period, 2 years after DBS, he died suddenly from an unexplained cause. A cerebral autopsy was performed and showed a good position of the two electrodes in the STN. Microscopic studies revealed severe neuronal depletion in the substantia nigra but no Lewy bodies. Immunohistochemical methods demonstrated numerous argyrophilic glial cytoplasmic inclusions positive for alpha-synuclein and ubiquitin in the STN, putamen, globus pallidus, pontine nuclei and cerebellar white matter, significant of MSA. CONCLUSION: This case shows that DBS can improve parkinsonian signs in MSA-P with persistent dopa sensitivity. However, probably because of striatal degeneration progression, this improvement is time limited and STN DBS cannot be recommended in MSA.

[The role of magnetic resonance angiography in the follow-up of intracranial arteriovenous malformations treated by an intravascular approach]. / Rôle de l'Angio-IRM dans la surveillance des malformations artério-veineuses intra-crâniennes traitées par abord endo-vasculaire.

The purpose of our work was to measure the accuracy and reliability of MR-Angiography in the study and follow-up of intracranial arteriovenous malformations, and in particular to evaluate the results of endovascular treatment. Over an 18-month period 4 patients with such malformations were examined by MR-Angiography. There was an angioma of the corpus callosum, a left parieto-rolandic angioma, a posterior thalamic angioma and a cerebellar angioma. All examinations were performed with a Magneton-Impact 1 Tesla machine (Siemens, Erlangen, Germany), using a head coil, MR-Angiography with time-of-flight sequences and differential arterial and venous saturations. Each patient was examined by MR-Angiography first at the beginning of treatment, then when ambulatory after embolization. The morphological study applied to the afferent vessels, the nidus and the efferent veins. MR-Angiography proved to be very good in identifying the arteries feeding the malformation, and this made it easier to evaluate the reduction of their input after treatment, without having recourse to any arteriography. Beside, analysis of the nidus was facilitated by the judicious arrangement of arterial and venous saturations. In fact, the systematic use of MR-Angiography in the follow-up of intracranial arteriovenous malformations makes it possible to measure, with full reliability, the efficacy of the endovascular treatment under conditions of comfort unequalled in these out-patients, and selective angiography sequences need to be performed only during therapeutic phases.

[Multiple intracranial aneurysms associated with coarctation of the aorta. Apropos of a case surgically treated under controlled hypotension]. / Anévrysmes intracrâniens multiples associés à une coarctation de l'aorte. A propos d'un cas opéré sous hypotension contrôlée.

A 17 year old girl presenting with multiple intracranial aneurysms and coarctation of aorta was treated surgically under controlled hypotension. Blood pressure distal to the stenosis was monitored to avoid risk of medullary ischemia.

[The neurosurgical forms of Hurst's acute hemorrhagic leukoencephalitis]. / Les formes neurochirurgicales de la leucoencéphalite aiguë hémorragique de Hurst

Within the group of acute encephalitis, H.A.H.L. is individualized mostly by its post mortem pathology. But several cases of recovery were recently published, the diagnostic being based on biopsy material. In 4 of our 8 cases, a comparison between the biopsy and post mortem examinations was possible : in/the diagnostic of H.A.H.L. was unequivocally confirmed, in 2 H.A.H.L. is nearly certain, in 1 it is doubtful. These considerations do not contradict the necessity of an emergency brain decompression in many instances of acute encephalitic states.

[Should the aneurysms of Osler's disease be investigated and operated on prior to hemorrhage?]. / Faut-il rechercher et opérer les anévrismes de la maladie d'Osler avant l'hémorragie?

Neurologic accidents are today the first cause of mortality following bacterial endocarditis through ischemia or mycotic aneurysm rupture. Authors propose a protocol management by complete cerebral angiography and CT scan as soon as the least neurologic sign appears. A headache is the most frequent of these signs. 35 patients were explored during 3 years and 10 treated surgically. These authors conclude that: mycotic aneurysm must be detected aneurysm with subarachnoid haemorrhage must be operated on as soon as possible. With unruptured aneurysm, surgical decision is more difficult: sequential angiography after excision of the most dangerous aneurysm, demonstrates that an aneurysm can appear, enlarge, diminish or spontaneously resolve. Carrying on with this protocol should allow an answer to this question.

[Mucoid pseudocyst of the common peroneal nerve. Value of MRI (report of a case)]. / Pseudo-kyste mucoïde du sciatique poplité externe. Intérêt de l'IRM (rapport d'un cas).

The authors report a new case of ganglion cyst of the peroneal nerve. The rarity of this entity induced the authors to report this new case, emphasizing the value of MRI which constitutes a reliable non-invasive examination for the visualization of this lesion.

[French neurosurgical practice in Neuro-Oncology (national survey--part I)]. / Neurochirurgie et neuro-oncologie: état des lieux (I). Généralités, plan cancer, enquête nationale.

OBJECTIVE: The aim of this work is to summarize the elements of the "Cancer Plan" applicable to neurosurgical practice, and to give the results of a national inquiry concerning the daily practice of Neuro-Oncology from the neurosurgical point of view. METHOD: The Neuro-Oncology Group of the French Society of Neurosurgery has submitted a questionnaire to every department of Neurosurgery in France. RESULTS: The response rate of the public centers was 96.5%. Moreover, responses were available from 7 private centers. The results are detailed in the text. CONCLUSION: This national survey highlights the interest and implication of French neurosurgeons in the field of Neuro-Oncology. But also, to be in accordance with the guidelines for good clinical practice, the importance of developing official neuro-oncological networks in order to offer the best access to clinical and fundamental data and hence optimise patient's care. The publication of the "Cancer Plan", the creation of a National Neuro-Oncology Group, and the results of this survey (actual multidisciplinary approach, better information and transparency, individualized care of the patients), are in the line with updating our daily practice, even though discrepancies remain among centers. French neurosurgeons must continue along the same path, but at the same time there is a need for additional help to definitely reach a truly, and homogeneous, optimized care of neuro-oncological patients.

[SMART syndrome: case report of a rare complication after cerebral radiation therapy]. / SMART Syndrome : à propos d'un cas d'une complication rare après radiothérapie cérébrale et revue de la littérature.

The authors report a 71-year-old woman case who developed, 7 years after a cerebral radiation therapy for a parietooccipital glioblastoma, a stroke-like migraine attacks after radiotherapy syndrome (SMART syndrome), a rare complication characterized by reversible neurologic deficits with migraine described after cerebral irradiation. Transient gyriform reversible enhancement is found on MRI during crises. This case report allows discussing the clinical, iconographic presentation and the clinical outcome of this syndrome at the light of the literature publication.

[Surgical treatment of cerebellar infarction: Five case studies]. / Le traitement chirurgical des accidents vasculaires ischémiques du cervelet : à propos de cinq cas.

BACKGROUND AND PURPOSE: Surgical management of cerebellar infarction remains controversial. What surgical procedure should be performed when a patient presents neurological deterioration? When is the right moment to operate? Different treatments were proposed including decompressive suboccipital craniotomy, external ventricular drainage, or endoscopic third ventriculostomy. METHODS: We retrospectively reviewed five cases of cerebellar infarction treated with suboccipital craniotomy, excision of necrotic tissue, and duraplasty within a period of six months. RESULTS: The five patients were evaluated with regard to presenting symptoms, Glasgow Coma Scale (GCS) before surgery, timing of surgery, computed tomographic scans and magnetic resonance imaging (MRI), neurological improvement, and outcome within a follow-up period of one year. Four patients made a good recovery, one patient died three days after surgery without neurological improvement. CONCLUSION: These results suggest that decompressive suboccipital craniotomy may be an effective solution for good recovery if the patient is operated early, at the moment of the neurological deterioration.

[Curable ECHO 5 virus encephalitis. Clinical, electroencephalographic, virologic and ultrastructural study]. / Encéphalite curable à virus ECHO 5. Etude clinique, électroencéphalographique, virologique et ultrastructurale.

A 10 1/2 years old boy fell brutally ill with a fit followed by confusion, and then by deep coma, with 40 degrees C fever and morbilliform rash. Consciousnesse came back within ten days, with transient Parkinson-like tremor. Myoclonus persisted for about six months. Complete recovery was followed up for six years. A diagnosis of encephalitis was considered on early EEG evidence (stereotyped repetitive sharp wave bursts) and was confirmed by isolation of ECHO 5 virus from brain specimen, and ultrastructural observation of characteristic cytopathic effect (disappearance of organelles, proliferation of smooth membranes) and of probable viral particules in astrocytes, without any inflammatory process.