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PURPOSE OF THE REVIEW: Percutaneous closure of sinus venosus atrial septal defects (ASD) using covered stent implantation is a new and promising minimally invasive technique. New imaging tools are used to ensure preoperative anatomical characterization and preoperative guidance, which are key procedural success factors. Here we will describe and analyze these recent developments. RECENT FINDINGS: Sinus venosus ASDs present a wide variety of anatomical features which must be described and analyzed using various imaging tools, including 3D technology. Percutaneous closure is challenging, but can hasten clinical recovery compared to the gold-standard conventional open-heart surgery. The feasibility of percutaneous closure relies on precise preoperative anatomical study and on real-time guidance using a multimodal fusion imaging process. Three-dimensional modeling of sinus venosus ASD is essential to understand the large anatomical panel encountered in this pathology. Multimodal fusion imaging guidance is very useful for performing sinus venosus ASD percutaneous closure in selected patients.
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Procedimentos Cirúrgicos Cardíacos , Comunicação Interatrial , Cateterismo Cardíaco , Ecocardiografia Transesofagiana , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Humanos , Imagem Multimodal , Stents , Resultado do TratamentoRESUMO
Percutaneous treatment of para-prosthetic valve leaks (PVL) is an alternative to redo surgery. Based on the clinical case of an unusual aortic para-prosthetic leak closure (PVLc), are presented successively the diagnostic difficulties of PVL, the modalities of therapeutic choice, the main technical steps of PVLc followed by a review of results and complications.
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Literature concerning transcutaneous symptomatic para valvular cardiac leaks closure (PVLC) after trans aortic valve implantation (TAVI) is relatively scarce. Hereby we present 2 clinical cases, one on an Edwards® Sapien 3 valve and the other one on a Medtronic® Evolut R valve. We present also the preliminary results of the 7 PVLC on TAVI included in our prospective FFPP registry during the 2 first years of enrolment (2017-2018), for a total of 158 inclusions for all valves. Seven procedures were performed on 8 leaks, using a majority of vascular plugs (3 Abbott® Amplatzer Vascular Plugs 2 (AVP2), 3 AVP3, 1 AVP4, and 1 muscular Ventricular Septal Defect (VSD) occluder). All procedures were successful without complication. At 1-month follow-up, all patients became asymptomatic. One-year follow-up was already available for 4 patients: 3 of them were symptoms free, and one-who had a second leak not suitable for PVLC-, underwent a « TAVI in TAVI ¼ procedure 2 months after PVLC. This short experience demonstrates the feasibility, the efficacy and the safety of PVLC on TAVI. We expect to be able to offer more in depth information at the end of our prospective ongoing study.
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Fístula Anastomótica/cirurgia , Estenose da Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Fístula Anastomótica/diagnóstico por imagem , Fístula Anastomótica/etiologia , Feminino , Humanos , Masculino , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Estudos Prospectivos , Desenho de Prótese , Dispositivo para Oclusão SeptalRESUMO
AIM OF THE STUDY: To establish efficacy and security of invasive treatments for chronic thromboembolic pulmonary hypertension (CTEPH) in elderly patients (≥80 years old): pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA). PATIENTS AND METHODS: Between 2014 and 2017, 549 CTEPH patients were addressed to our hospital for PEA (364 patients) or BPA (225). From this total, patients 80 years old and over were: 17 treated by PEA and 21 by BPA. Demographic characteristics as well as hemodynamic parameters, results and complications were compared for both groups (Young - Y - versus Old - O). RESULTS: Elderly BPA patients presented a higher functional class (mean O: 3,16 versus Y: 2,73; P=0,001), with similar hemodynamics parameters compared with the younger patients. Indication for BPA in the elderly was the presence of comorbidities contraindicating surgery in 33% of cases vs. 9,3% in the younger group (P=0,005). Response to treatment was comparable in both groups with significant reductions of mPAP, PVR and improvement of functional class. Complications rate was alike between groups for hemoptysis, reperfusion lesions or mortality, with the exception of a higher incidence of contrast-induced nephropathy, without need for dialysis, in the elderly group (O: 8,4% versus 2,6%; P=0,010). Elderly PEA patients were more often male (O: 76,5% versus Y: 50,1%; P=0,034) and with a lower creatinine clearance (O: 57,6±13,4 versus Y: 72,2±21,2mL/min/m2; P=0,004). Functional class, hemodynamics, surgical times and in-hospital stay was similar between groups. There is a non-significant trend towards higher in-hospital mortality in the elderly group, CONCLUSIONS: In our experience, treatment of CPC PE in elderly patients, either by PEA or BPA is effective with acceptable complication rates.
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Angioplastia com Balão , Endarterectomia , Hipertensão Pulmonar/cirurgia , Embolia Pulmonar/cirurgia , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Hipertensão Pulmonar/complicações , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicaçõesRESUMO
The authors report their experience of endovascular treatment of coronary fistulae in 25 patients aged 2 to 77 years (median 29 years) who underwent 30 interventional catheterisation procedures. The origin of the fistulae was variable: left coronary (14 cases), right coronary (6 cases) and bilateral (5 cases) as were the sites of drainage: right atrium (5 cases), right ventricle (8 cases) pulmonary artery (7 cases) and bronchial artery (5 cases). Different materials were used: releasable balloons (9 cases), coils (17 cases), microparticles (5 cases) and Amplatzer occluder and plug (2 cases). The result, judged by occlusion or sub-occlusion of the given pedicle, was a success in 92% of cases. Total or sub-total occlusion of the fistula was obtained in 22 patients (88%); 2 patients had residual fistulae due to non-embolisation of the pedicle; in one patient, it was not possible to embolise the pedicle despite two attempts. A single serious complication, ventricular fibrillation during the catheterisation, was observed but without a sequel. Follow-up ranged from 6 to 176 months; 4 patients died of other causes, 3 were lost to follow-up; one coronaro-pulmonary fistula recurred but no other recurrence was observed in the other patients. The authors conclude that embolisation is the treatment of choice for coronary fistulae providing the cases are managed by teams trained in the use of different materials. The choice of material of embolisation should be adapted to the anatomical conditions which determine the success rate and the absence of complications.
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Anomalias dos Vasos Coronários/terapia , Embolização Terapêutica/métodos , Adolescente , Adulto , Idoso , Fístula Artério-Arterial/terapia , Oclusão com Balão/instrumentação , Artérias Brônquicas/anormalidades , Cateterismo Cardíaco/efeitos adversos , Criança , Pré-Escolar , Embolização Terapêutica/instrumentação , Feminino , Seguimentos , Átrios do Coração/anormalidades , Ventrículos do Coração/anormalidades , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/anormalidades , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Fibrilação Ventricular/etiologiaRESUMO
Emergency bedside veno-arterious ECMO implantation can be the only saving gesture in the suspicion of acute massive pulmonary embolism leading to haemodynamic failure, even before CT-scan imaging. Once the massive pulmonary embolism is confirmed it is possible to undergo surgical or percutaneous pulmonary thrombectomy, when thrombolytic therapy is contraindicated.
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Testes Imediatos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/terapia , Trombectomia , Terapia Trombolítica , Tomografia Computadorizada por Raios X , Emergências , Humanos , Embolia Pulmonar/diagnóstico , Índice de Gravidade de Doença , Trombectomia/métodos , Terapia Trombolítica/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Filtros de Veia CavaRESUMO
OBJECTIVE: The 2 main causes of death after thromboendarterectomy for chronic pulmonary thromboembolism are incomplete repermeabilization responsible for persistent pulmonary hypertension and acute high-permeability pulmonary edema. We wish to establish an experimental model of chronic pulmonary thromboembolism to replicate the conditions encountered during and after pulmonary thromboendarterectomy. METHODS: Multiple-curled coils and tissue adhesive were embolized in 6 piglets to induce complete obstruction of the left pulmonary artery, documented by angiography. After 5 weeks, the main pulmonary artery was repermeabilized by thromboendarterectomy during circulatory arrest. The left lung was reperfused ex vivo with autologous blood at constant flow, and patency of the pulmonary artery was evaluated on a barium angiogram. The endarterectomy-reperfusion procedure was also done in 6 nonembolized piglets that served as the controls. The severity of lung injury induced by 60 minutes of reperfusion was assessed on the basis of measurements of the lung filtration coefficient and of lung myeloperoxidase activity. RESULTS: Marked hypertrophy of the bronchial circulation was seen in the chronic pulmonary thromboembolism group. Thromboendarterectomy removed the organized obstructing thrombus that was incorporated into the arterial wall and restored patency of the pulmonary artery. Acute lung inflammation and high-permeability edema occurred after reperfusion, as indicated by a 1.5-fold increases in both lung filtration coefficient and lung myeloperoxidase values in the chronic pulmonary thromboembolism group; these 2 variables being correlated. CONCLUSIONS: Our model replicated the perioperative conditions of pulmonary thromboendarterectomy, suggesting that it may prove useful for improving the repermeabilization technique and for investigating the mechanisms and prevention of reperfusion injury.
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Endarterectomia , Embolia Pulmonar/cirurgia , Animais , Doença Crônica , Hipertensão Pulmonar/etiologia , Pulmão/irrigação sanguínea , Edema Pulmonar/etiologia , Embolia Pulmonar/complicações , Distribuição Aleatória , Traumatismo por Reperfusão/prevenção & controle , Síndrome do Desconforto Respiratório/etiologia , Suínos , Grau de Desobstrução VascularRESUMO
Left ventricular (LV) function was studied in 30 patients using digital subtraction angiography by the intravenous approach. Each ventriculogram was processed with a specific videodensitometric analysis to determine LV ejection fraction. The program was verified in an experimental set-up consisting of nine latex balloons filled with contrast medium. Its validation has been established by comparing videodensitometric results with classical results supplied by geometric methods. A good correlation was obtained (r = 0.9449) and, furthermore, with experimental models, videodensitometric analysis seemed to be more accurate than geometric analysis. Digital videodensitometry appears to be a valuable and accurate method for quantifying LV function, and a promising technique for determination of the real volumes.
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Volume Sistólico , Técnica de Subtração , Gravação em Vídeo , Adolescente , Adulto , Idoso , Angiografia/métodos , Densitometria , Feminino , Humanos , Masculino , Matemática , Pessoa de Meia-Idade , Intensificação de Imagem Radiográfica , Gravação em Vídeo/métodosRESUMO
After experiencing problems of catheterisation during coronary angioplasty, the authors tried using a 3.2 F ultraflexible catheter with a 2.2 F tapered tip. In 2 patients, initial attempts at coronary catheterisation were failures but when this new catheter was used, angioplasty could be performed without any difficulty. This catheter was then used in 4 other patients and in all cases the Tracker enabled the operators to catheterise the coronary arteries and to perform angioplasty in 3 of the 4 cases. Therefore, this new ultraflexible catheter would seem to be a valuable alternative for catheterising particularly sinuous coronary arteries in which angioplasty is often technically difficult.
Assuntos
Angioplastia Coronária com Balão/instrumentação , Cateterismo Cardíaco/instrumentação , Doença das Coronárias/terapia , Adulto , Idoso , Cateterismo Cardíaco/métodos , Angiografia Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Digitised intravenous angiography (Diva), initially applied to the study of the aorta and great vessels, has benefited from technical advances, especially the possibility of recording 25 frames per second, which now allows studies of the heart itself. 22 subjects underwent angiography with digitised subtraction after injection of 50 ml of sodium diatrizoate and meglumine in the right atrium and selective left ventriculography in the same catheter session. The end diastolic and systolic indices and global ejection fractions were measured independently for each technique by Chapman's method by two observers. The model of digitised angiography used was a CGR Divas prototype functioning in the pulsed graphic mode at 25 images per second. The results showed that the Diva method gave reproducible values of the end diastolic index (101 +/- 29.8 and 104.5 +/- 30.7: r = 0.98), of the end systolic index (43.2 +/- 32.9 and 44.6 +/- 32.5; r = 0.98), and of the ejection fraction (62.5 +/- 17.16 p. 100 and 62.17 +/- 15.7 p. 100; r = 0.96). There was a close correlation between the results of Diva and selective ventriculography (end diastolic index: 97.8 +/- 21.1 and 101.6 +/- 10.3; r = 0.87; end systolic index: 38.82 +/- 24.8 and 43.9 +/- 21.17; r = 0.95; ejection fraction: 62.12 +/- 16.27 and 57.29 +/- 15.53; r = 0.95). There was a significant underestimation of the end systolic index using Diva (0.01 less than p less than 0.02). The originality of the pulsed graphic method is the totally digitised character of the data.(ABSTRACT TRUNCATED AT 250 WORDS)
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Angiografia Coronária , Coração/fisiologia , Adulto , Idoso , Angiografia/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Técnica de SubtraçãoRESUMO
The investigation of isthmic coarctation of the aorta comprises radiological opacification usually by a retrograde arterial approach. Digitised intravenous angiography (DIVA) is a new way of carrying out this task by a relatively simple and non-invasive technique. We investigated 32 patients with this method and now present our results: the investigation was performed for suspected coarctation in 22 cases and for postoperative assessment in 10 cases. The equipment used was characterised by a variable rate of acquisition from 1 to 3 images per second with a 512 X 512 matrix. The investigation consisted in an intravenous injection of 50 to 100 ml of contrast, usually via a peripheral vein (87.5 p. 100). Overall, DIVA demonstrated the coarctation or the appearances of the site of operation in 97 p. 100 of cases. This high success rate was related to the study population: young cooperative patients capable of maintaining apnoea and remaining still during the procedure. In the 21 patients referred for suspected coarctation (excluding the only failure of the series), the diagnosis was confirmed and the site of coarctation accurately located. The degree of stenosis was assessed subjectively: appearances of the site of coarctation, importance of the collateral circulation. In addition, a videodensitometric study, i.e. a study of the variations of the patterns of grey with respect to time, was carried out in 4 patients; in severe coarctation, a delay of about 4 seconds in the opacification of the zone distal to the stenosis was observed. This analysis is still at the experimental stage, but it may eventually allow reliable quantification of the degree of stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Coartação Aórtica/diagnóstico por imagem , Técnica de Subtração , Adolescente , Adulto , Angiografia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Coartação Aórtica/cirurgia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Fatores de TempoRESUMO
The clinical and electrophysiological features and the natural history of median intra-His block with a normal resting electrocardiogram were studied: 11 patients had a fixed split H1-H2 potential with a spontaneous or induced block between H1 and H2. The patients (5 men and 6 women) were aged 17 to 70 years (average 53 years). Associated pathology included 2 cases of aortic stenosis (1 severe), 1 case of ischaemic heart disease (effort angina), 1 case of mitral valve prolapse and 2 cases of hypertension. The presenting symptoms were syncope (4 cases), dizziness (2 cases), effort angina (1 case) and tiredness (3 cases); 1 patient was asymptomatic. Holter monitoring (24 hours) was performed in 8 patients and s-owed paroxysmal conduction defects in 6 cases; 4 Mobitz II 2nd degree AV block, 1 3rd degree AV block with narrow QRS complexes and 1 case of blocked atrial extrasystoles at coupling intervals longer than 480 ms and sinus cycle lengths of over 800 ms. Exercise testing by bicycle ergometry (4 patients) was normal in 1 case and revealed Mobitz II 2nd degree AV block in 3 cases. Baseline electrophysiological studies showed an A-H1 interval ranging from 60 to 100 ms (average 78 ms), a H1-H2 interval of 20 to 40 ms (average 31 ms) and a H2-V interval of 30 to 50 ms (average 32 ms). Block between H1 and H2 was observed: "spontaneously" during electrophysiological investigation in 6 cases, after IV atropine in 1 case, during overdrive atrial pacing at rates slower than 150/min in 7 cases, after atrial extrastimulus with a functional intra-His refractory period of over 420 ms in 7 cases, after ajmaline in 3 of the 4 cases in which this test was performed. A cardiac pacemaker was implanted in 10 patients in whom the initial symptoms have all regressed; the remaining patient considered to be "epileptic" had another syncopal attack under therapy and was finally paced. This series demonstrates that the diagnosis of median intra-His block depends on precise electrophysiological criteria and should be looked for even when the presenting symptoms are atypical; some of our patients complained only of tiredness. The value of Holter monitoring and careful endocavitary investigation is emphasised. Median intra-His block should be distinguished from longitudinal and functional His bundle dissociation.
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Fascículo Atrioventricular , Eletrocardiografia , Bloqueio Cardíaco/fisiopatologia , Sistema de Condução Cardíaco , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Bloqueio Cardíaco/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Esforço Físico , Descanso , Fatores de TempoRESUMO
Digitalisation enables angiocardiography to be performed by a peripheral intravenous injection. Computer-assisted analysis of the date widens the possibilities of quantification. The authors have developed a videodensitometric method of studying the left ventricular ejection fraction. The research was performed on an experimental model and the technique validated in a series of 10 patients. The experimental model consisted of a series of balloons which, when inflated with contrast medium assumed an allipsoid shape resembling a left ventricle. The balloons were blown up in two stages with an automatic injector to simulate systole and diastole. The images were recorded in the same way as during ventriculography. Videodensitometric measurements showed 3 to 5% variations from the true values. The method was then applied to the calculation of the left ventricular ejection fraction in 10 patients: left ventricular function was also quantified by geometrical methods (Dodge) from the same angiogrammes and the 2 sets of results were then compared. The correlation coefficient between the two methods was 0.97, so validating the new technique. Videodensitometry opens up new perspectives in the study of left ventricular function. On the other hand it can be used to monitor the ejection fraction in severely ill or recently operated patients, and, on the other hand the principle of videodensitometry eliminates the geometrical approximations inherent in the classical methods of angiographic analysis and would therefore seem to be more suitable for the study of pathological left ventricules (aneurysm...). Finally, the technique of videodensitometry represents a new step towards the measurement of true volumes and flow rates.
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Angiocardiografia/métodos , Volume Sistólico , Absorciometria de Fóton/métodos , Adulto , Idoso , Computadores , Diatrizoato , Feminino , Humanos , Masculino , Matemática , Meglumina , Pessoa de Meia-Idade , TelevisãoRESUMO
Between June 1992 and January 1996, 27 patients aged 3.9 to 74 years with an ostium secundum (22 patients) or patent foramen ovale with right-to-left shunts (5 patients) underwent percutaneous closure of their atrial septal defects with the Sideris occluder. After a thromboembolic complication, transesophageal echocardiography was performed routinely after the procedure in 15 patients between 1 month and 2 years, and in 6 patients on the 15th day. Two patients died, on the 2nd day and 21st month, of non-related causes. After an average follow-up of 33 months, 59% of patients had complete occlusion of the atrial septal defects or only a minimal residual shunt. Displacement of the prosthesis was defects or only a minimal residual shunt. Displacement of the prosthesis was observed in 7 cases with no relationship to size: 4 parallel to the septum with reappearance or increase in shunt, 3 with tilting of the prosthesis. All of these patients had a large residual defect compared with 20% with a normally positioned prosthesis (p < 0.05). Tilting of the occluder was associated with left atrial thrombosis (present in 40% of these patients), complicated by systemic embolism in one case: there were no cases of left atrial thrombus in the 9 with complete occlusion and the 5 patients with an isolated residual defect (p < 0.05). Occlusion of atrial septal defect with the Sideris device is effective and a safe method in the majority of cases. However, a badly positioned prosthesis with a residual shunt should be extracted as seen as possible or within three weeks if displacement is observed at control echocardiography.
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Cateterismo Cardíaco , Cateterismo/efeitos adversos , Comunicação Interatrial/terapia , Análise Atuarial , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Ecocardiografia Transesofagiana , Falha de Equipamento , Feminino , Seguimentos , Migração de Corpo Estranho/etiologia , Átrios do Coração/cirurgia , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Radiologia Intervencionista , Tromboembolia/etiologia , Tromboembolia/terapia , Resultado do TratamentoRESUMO
Carotid artery bifurcations were studied in 18 patients with arteritis, by Doppler ultrasound imaging and intravenous computed angiography. Both techniques are reliable examinations for detection of stenosed carotid artery lesions. Combining the two is increasingly used as a reliable means of exploration of stenosis of the carotid artery bifurcations. They therefore reduce the need for the more invasive conventional arteriography.
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Arterite/complicações , Doenças das Artérias Carótidas/diagnóstico , Perna (Membro)/irrigação sanguínea , Ultrassonografia , Adulto , Idoso , Angiografia/métodos , Arterite/diagnóstico , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Constrição Patológica/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Fistulisation of an atheromatous aneurysm of the aorta into the inferior vena cava is a rare type of rupture. Emergency surgery is required following its diagnosis. A case of this type is reported where a diagnosis was obtained without delaying surgery using a new radiological technique: numerical angiography via a venous approach. By virtue of its simplicity, reliability and safety, this technique is of great value in the emergency investigation of rupture of an atheromatous aneurysm of the aorta.
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Doenças da Aorta/diagnóstico por imagem , Fístula Arteriovenosa/diagnóstico por imagem , Veia Cava Inferior , Angiografia/métodos , Aorta Abdominal , Aneurisma Aórtico/complicações , Arteriosclerose/complicações , Fístula Arteriovenosa/etiologia , Humanos , Pessoa de Meia-Idade , Ruptura EspontâneaRESUMO
Forty-six patients who had undergone neck vessel surgery were investigated postoperatively by intravenous digitalised angiography. In 30 patients an endarterectomy had been performed and in one case the examination did not provide satisfactory opacification of the carotid vessels. In 29 cases the result was of satisfactory quality: the appearance of the operative site was normal in 21 patients, dilated in 3, irregular in 7 and stenosed in 1. Twenty patients had undergone a bypass. There was one failure and 19 results suitable for analysis. The bypass was normal in appearance and permeable in 14 cases, irregular in 1, dilated in 2 and obstructed in 2. Overall, intravenous digitalised angiography provided satisfactory assessment of the operative result in 96% of patients.
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Artérias Carótidas/diagnóstico por imagem , Pescoço/irrigação sanguínea , Adulto , Idoso , Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/cirurgia , Endarterectomia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Pescoço/cirurgia , Período Pós-Operatório , Radiografia , Técnica de SubtraçãoRESUMO
A study was carried out of 32 patients suffering from multiple sclerosis the diagnois of which was quite definite according to Mac Alpine's criteria and which had developed over more than two years. Comparison was made with patient suffering from optic neuritis of a different aetiology and with normal subjects. The method of investigation was dynamic electroretinoencephalography : the visual evoked potentials were investigated after stimulation by white and coloured light before and after adapatation to darkness. The specificity of the results was tested by, firstly, electro-retinogram recording for control of the visual system, and secondly, by the recording of auditory evoked potentials for control cerebral function. Abnormalities in visual evoked potentials were found in 77 percent of the cases. In particular, there was delayed latency, that is, a slowing of retino-cortical conduction. The significance of these abnormalities is discussed, by analyzing the electroclinical correlationships according to whether there was obvious or subclinical optic neuritis, and the dissemination, activity or duration of the disease. The incidence of visual evoked potential abnormalities was considerably greater than that in optic neuritis (35 percent). The links between abnormalities in nervous conduction and demyelinisation are emphasized. The role and specificity of electrophysiological investigation in diagnosis of multiple sclerosis are discussed.
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Potenciais Evocados , Esclerose Múltipla/fisiopatologia , Percepção Visual , Adulto , Percepção de Cores , Eletroencefalografia , Feminino , Humanos , Masculino , Condução Nervosa , Atrofia Óptica/fisiopatologia , Neurite Óptica/fisiopatologia , Tempo de ReaçãoRESUMO
We report a case of Jakob-Creutzfeldt's disease (amaurotic form of Heidenmain's disease) showing typical clinical, anatomical, microscopic and electrophysiologic (E.E.G, polygraph sleep recordings, Evoked Potential) signs. Changes in visual Evoked Potentials were quite specific whereas Auditory and Somesthesic E.P'. were not modified. Early elements (O, I, II, and III having a latency of less than 100 ms) were strongly developed, while later elements of the associative type were absent. The precociousness and specificity of the E.P. abnormalities are stressed in the differential diagnosis of J.-C's disease from other insanities, or from cortical blindness of other aetiology. The physiopathologic implications of electrophysiological data is discussed to illustrate the possibility of using Evoked Potentials to help resolve the problems of functional cerebral stratigraphy in man.