[Simultaneous use of ultrasound and pulsed Doppler with spectrum analysis of frequency in diseases of the cervical and cerebral vessels. Initial results]. / Apport simultané de l'échotomographie et du Doppler pulsé avec analyse spectrale de fréquence dans la pathologie des vaisseaux cervicaux et cérébraux. Premiers résultats.

Preliminary results of the use of the ultrasound Duplex Scanner are reported and correlated with angiographic findings. The main interest of this examination resides in its application in cases of atheromatous obstruction of cervical vessels to the brain: definition of type of obstruction: occlusion or stenosis; assessment of hemodynamic alterations: modification of frequency spectrum, of pulsed Doppler signal to 5 degrees as defined by Strandness as a function of extent of narrowing of arterial lumen. Pre-occlusive lesions may be difficult to distinguish from an occlusion. In contrast, minor anomalies: plaque producing little or no stenosis, calcifications, appear to be simpler to detect than by angiography. In intracranial vascular malformations: arteriovenous fistulas and particularly intracranial angiomas of a certain size, this examination provides data on the increase in diameter and acceleration of flow in vessels supplying the malformation. In cases of brain death, the ultrasound Duplex Scanner demonstrates absence or marked reduction in internal carotid artery flow, whereas flow is normal in the external carotid arteries in the absence of collapse. Confirmation of reliability of this non-invasive exploratory procedure requires further evidence of correlations.

[Neurologic complications of essential thrombocythemia. 6 cases]. / Complications neurologiques de la thrombocytémie essentielle. Six cas.

Six cases of neurological complications of essential thrombocythemia are reported. Five were ischemic strokes and the clinical expression was heterogenous (transient ischemic attacks or completed strokes), in vertebro-basilar or carotid areas. There was no correlation between the nervous disorders and the severity of the thrombocythemia. In the last case, the patient presented with papillitis and peripheral neuropathy, and the relationship with thrombocythemia was not clear. It is suggested that thrombocythemia may directly induce an arterial or venous thrombosis or increase the severity of ischemic strokes of atheromatous origin.

[Alexia and agraphia caused by a lesion of the right hemisphere in a non-aphasic right-handed patient]. / Alexie et agraphie par lésion de l'hémisphère droit chez un droitier non aphasique.

Oral and written speech centers are commonly attributed to the dominant hemisphere, while body, spatial and facial recognition to the non-dominant. This paper examines the case of a 63 year old entirely right-handed male who presents alexia, agraphia, difficulties in spelling and word-finding together with left spatial and body agnosia, musical, letter and face agnosia, constructional apraxia and left hemianopsia. Computerized axial tomography confirms a right occipital tumor identified as an adeno-carcinoma probably of digestive origin. The role of right hemisphere as a spatial prerequisite to final elaborate speech is discussed.

[Long term survival after basilar artery occlusion. 4 cases]. / Survie prolongée après occlusion du tronc basilaire. 4 cas.

Four cases of basilar artery occlusion with a follow-up from 7 to 12 years are reported. The first patient, a 60 year old woman, had a proximal occlusion which was revealed by an acute brain stem ischemia. The second case was a 63 year old man with an aortic aneurysm who had a single episode of vertebro-basilar insufficiency. Cerebral angiography demonstrated a lower basilar artery occlusion. The third patient, a 60 year-old woman, had been operated from right carotid artery and left vertebral artery stenosis; 8 years later, without clinical manifestations, a left carotid artery stenosis and an occlusion of the lower part of the basilar artery were discovered. The evolution was eventless after a left carotid endarterectomy. The last case was a 60 year old man who had a lower basilar artery occlusion associated with a left internal carotid occlusion. There was a full recovery after a hemiplegic stroke. From our personal cases and the review of the literature, long term survival after basilar artery occlusion may occur in occlusions restricted to the lower or middle part of the basilar artery and with a good collateral supply from carotid and cerebellar arteries.

[Cerebellar teratoma in adults. Contribution of x-ray computed tomography and magnetic resonance imaging]. / Tératome cérébelleux de l'adulte. Apport du scanner X et de l'imagerie par résonance magnétique.

A teratoma of the lower part of the posterior fossa was discovered in a 32-year-old woman who was suffering from vertigos and left deafness. The usefulness of CT scan and NMR imaging in the diagnosis of intracranial teratomas is emphasized.

[Primary lymphoma of the central nervous system. Multiple remission with corticosteroid therapy]. / Lymphome primitif du système nerveux central. Rémissions multiples sous corticoïdes.

A primary T-cell lymphoma of the central nervous system was diagnosed at autopsy in a 73-year-old woman. The course of the illness was made of multiple neurological episodes: hypersomnia, palsies of cranial nerves, aphasia, hemiparesis, epileptic fits during 4 years, with fast recoveries under corticosteroid therapy. CT scan and MRI abnormalities were also dramatically improved by the treatment.

[Vertebro-basilar aneurysms. 23 cases observed in a neurology department]. / Anévrysmes vertébro-basilaires. 23 cas observés en milieu neurologique.

Twenty-three cases of vertebro-basilar aneurysms observed in a neurology department are reported. Ten were located on the basilar artery (7 at the basilar bifurcation), 5 on the postero-inferior cerebellar arteries, 4 on the superior cerebellar arteries, 3 on the vertebro-basilar junction and 1 on the anteroinferior cerebellar artery. There were 6 fusiform and giant aneurysms, others were sacciform. In 5 cases, there was no clear relationship between the clinical data and the aneurysm, which was discovered by chance at angiography or MRI. One giant aneurysm of the basilar artery was mimicking a tumor of the posterior cerebral fossa. Two other cases were revealed by brain stem ischaemia. Aneurysmal rupture was present in 15 cases: there were signs of meningeal haemorrhage in all cases and clinical signs of posterior cerebral fossa involvement in 7 cases. CT scan, performed in 8 cases, showed in all of them a meningeal haemorrhage, with a brain stem haematoma in 3 cases. All the aneurysms were shown by angiography; 7 were associated with a vasospasm. Five patients were not operated upon; all died. In one case, clipping the aneurysm was impossible, but there was a good recovery with a 12 year follow-up. Nine patients were operated, 3 recovered completely, 2 had neurological sequelae, 1 a late worsening; 3 patients died of brain stem ischaemia.

[Infarction of the pons, neurosyphilis and HIV infection]. / Infarctus pontique, syphilis nerveuse et infection par le VIH.

A 31-year old patient presented a right hemiparesis related to a left basis pontis infarction. Laboratory investigations revealed both neurosyphilis and HIV infection. The patient was treated with two courses of penicillin and recovered from hemiparesis. The occurrence of strokes due to syphilitic arteritis in AIDS is emphasized.

[Thalamo-peduncular germinoma]. / Germinome thalamo-pédonculaire.

A 24 year-old patient presented with chronic intracranial hypertension, palsy of both abducens nerves and upward gaze, and right hypoesthesia. CT scan and MRI showed a left thalamic tumor infiltrating the left cerebral peduncle. A stereotactic biopsy revealed a germ cell tumor. Following radiotherapy the patient recovered except for ophthalmoplegia. The tumor totally disappeared on CT scan and MRI.

[Hemangioblastoma of the cerebellum, bulbo-spinal cord syringomyelia and bilateral pheochromocytoma]. / Hemangioblastome du cervelet, cavité bulbo-médullaire, phéochromocytome bilatéral.

A probable diagnosis of an incomplete form of von Hippel Lindau disease was made in a case of combined cerebellar hemangioblastoma, pontobulbar cavitation and bilateral pheochromocytoma. A survey of the literature review found only 3 similar cases among 64 patients reported as having combined lesions. A wide variety of lesions are in fact encountered.

[Extradural arachnoid cyst of the dorsal region with relapsing and recurrent development]. / Kyste arachnoïdien extradural de la région dorsale d'évolution régressive et à rechute.

An extradural arachnoid cyst of the thoracic spine was diagnosed and operated in a 39 year-old woman with a history of two regressive attacks of spastic paraplegia during a 19 year-period. The diagnosis was established by magnetic resonance imaging and myeloscan, which demonstrated the cyst and its consequences on the spinal cord and the spine. Theories of etiology and development of extradural arachnoid spinal cysts are reviewed.

[Postvaccinal encephalitis in adult. A case with anatomo-clinical report (author's transl)]. / Encéphalite post-vaccinale de l'adulte, Etude anatomo-clinique d'une observation.

While post-vaccinal encephalitis in children is unfortunately well known, its occurrence in adults is rather exceptional. The calendar of a poly vaccination situated so close to each other, most probably account for such an evolution. The case reported concerns a man of 27 years who presented 10 days after a polyvaccination (7 vaccines in 2 months) altered consciousness, epileptic fits, right hemiplegia, vegetative dysfunctions and meningeal status. Evolutionary clinical course led to death in 21 days. Neuropathological findings showed lymphocytic infiltrates in the cortex and basal ganglia, congestive aspect with petechial areas in the white matter and inflammatory meningeal infiltrates. All viral investigations both in the blood, brain and cerebrospinal fluid remained negative. Post-vaccinal encephalitis is reviewed. Vaccination cannot be condemned, but in case of polyvaccination lapse of time in between vaccines should be longer so as to prevent such exceptional evolution and fatal course.

[Intracranial hypertension and ependymoma of the end of the spinal cord]. / Hypertension intracrânienne et épendymome de la terminaison de la moelle épinière.

A 42 year-old woman was admitted with a subacute intracranial hypertension which improved under medical treatment. Angiographic data and CT scan showed enlarged ventricles. CSF showed 1.95 g/l of proteins. Five months later, a relapsing acute intracranial hypertension led to a ventricular derivation. CT scans, angiographies and ventriculography showed progressively enlarged ventricles but failed to disclose any intracranial tumor. A thoraco-lumbar tumor of the spinal cord was incidentally discovered and removed. Histopathology concluded to an ependymoma. No sign of recurrence has occurred after an eighteen month follow up. The pathogenesis of intracranial hypertension occurring in spinal cord tumors is discussed.

[Cleido-cranial dysostosis with malformation of the cervico-occipital junction]. / Maladie de Pierre Marie et Sainton avec malformation de la charnière cervico-occipitale.

A 66 years old man with cleido-cranial dysostosis suffered from a progressive ataxic gait for 45 years. Physical examination discovered cerebellar and pyramidal signs and altered deep sensibility in lower limbs. Roentgenograms showed skeletal dysostosis and a severe malformation of the cervico-occipital junction. The disease was transmitted with a dominant autosomic inheritance. The patient died from cardiac and respiratory distress. Post mortem examination confirmed radiologic anomalies: basilar invagination with a low-situated brain stem. The paucity of neurological complications of cleido-cranial dysostosis is emphasized. This is apparently the first reported case with clinical signs of cervico-occipital malformation.

[Haemorrhagic necrosis of a pituitary adenoma in a case of multiple endocrine neoplasia (author's transl)]. / Nécrose hémorragique d'un adénome hypophysaire. Polyoncose endocrinienne.

A case of pituitary adenoma in a 55 years old man was revealed by sudden pituitary apoplexy due to haemorragic necrosis of the tumor. Neurological signs were intracranial hypertension, epistaxis and evolutive bilateral ophtalmoplegia. Case history revealed a multiple endocrine neoplasia including a pancreatic insuloma and a parathyroïd adenoma. Biological data were hypercalcemia, hypophosphoremia and elevated serum levels of prolactine and parathormone. The characteristic features of pituitary haemorragic necrosis and multiple endocrine neoplasia are reviewed.

[Emergency disobliteration of the carotid prepolygonal segment. Personal experience of 76 cases]. / La désobstruction d'urgence de l'axe carotidien dans son segment pré-polygonal. Expérience personnelle à partir de 76 observations.

The authors report 76 cases of carotid obstruction, mainly localized at the origin of the carotid artery, that have been operated upon in emergency. Two types of lesions are considered: occlusion and very tight stenosis. The principle of early surgery in cases of acute occlusion is very controverse. According to the facts reported (38 cases) results are rewarding when operative decision is taken under precise conditions judged as favorable: short lapse of time since occlusive onset, absence of intracranial hypertension, absence of comatose state and no sign of brain oedema. Some patients under go surgery in the priviledged condition of being already in a medico-surgical unit (post operative, post angiographic, embolic occlusions). Majority present the most common hemiplegic attack. However difficulty resides in the inefficient mode of transport to hospital and lack of highly specialized units on admission. A very tight stenosis (at extreme a pseudo-occlusive stenosis) with clinical recurrent deficit, modified Loppler's recording and hemodynamic repercussion at angiography is an operative emergency. When results of early surgery on 38 cases of stenosis are compared to those of late operation in 14 similar cases early decision becomes compulsory once tight stenosis of the carotid artery is identified and operative criteria respected. In the light of this report that "wait and see attitude" needs be somewhat revised when confronted to the dramatic ictal hemiplegia.

[Sciatica. Neurofibrosarcoma of the thigh]. / Sciatique tronculaire. Neurofibrosarcome de la cuisse.

A 61-year-old patient had complained of sciatica in the left lower limb for three years. The pain was located in the posterior area of the thigh and leg and radiated to the first toe. Examination showed a tumor of the middle part of the thigh. A sciatic nerve tumor was confirmed at operation. Pathological examination revealed a neurofibrosarcoma. The patient died from pulmonary metastasis 17 months later.

[Acute polyradiculoneuritis after intravenous injection of heroin, HIV seropositivity disclosed 3 years later]. / Polyradiculonévrite aiguë après injection intra-veineuse d'héroine, séropositivite HIV constatée trois ans plus tard.

An acute polyradiculoneuritis with tetraplegia and respiratory failure was observed in a 27 year-old heroin addict 3 hours after an intravenous injection of heroin. Full recovery was obtained after respiratory assistance and plasma exchanges. The biological and morphological changes (sural nerve biopsy) suggested an immune mediated mechanism. Three years after the recovery, the patient was tested for HIV antibody and was seropositive. The role of HIV infection and of the injection of heroin are discussed.

[Recurrent peripheral neuropathy caused by thallium poisoning]. / Neuropathie périphérique récidivante par intoxication au thallium.

A 28-years old woman, working as a secretary, developed a rapidly progressive paraplegia with burning pain in the lower limbs. She recovered within 4 months but relapsed shortly after she was discharged. There was flaccid tetraplegia, associated with hyperalgesia of the limbs, diffuse muscle atrophy, blindness and alopecia. The patient needed respiratory assistance for 2 months. Bilateral optic neuropathy and paraparesis persisted after a 17 months follow-up. The clinical picture suggested thallium poisoning, which was confirmed by high thallium concentration in plasma and urine. The most likely cause was accidental poisoning with rodenticides.

[Occlusion of the vertebral artery (100 personal cases)]. / Occlusion de l'artère vertébrale (100 cas personnels).

Occlusion of the vertebral artery is usually due to atherosclerosis. According to the site and extension of the arterial lesions 3 clinico-pathologico-angiographic situations can be encountered: segmental occlusion (proximal: V1 or distal: V3, V4), multisegmental (mainly V1-V2, sometimes V1-V2-V3) or extensive (V1 or V4). Subsequent infarctions are localized in ipsilateral cerebellar lobes and ipsilateral lateral part of the medulla oblongata; supra-medullary involvement is rare and indicates a propagation of the vertebral thrombus into the basilar artery. Cerebellar, vestibular or cerebello-vestibular strokes and Wallenberg's syndrome are the more frequent clinical disorders. They are often preceded by occipito-cervical headache. Contrary to a common belief, the vital risk in vertebral artery occlusion is not negligible. Among 160 cases, 100 of which are personal, mortality was 25%. In fact benign segmental and proximal occlusion adequately compensated, specially when isolated, must be opposed to segmental distal occlusion and extensive occlusion. Angiography and Döppler examinations localize arterial lesions and subsequent hemodynamic disorders. The treatment is often symptomatic only. Surgery of the proximal vertebral artery may in some cases be the only hope of preventing occlusion.