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Biomedical subjects

A Guillard

Publications and source records attributed to A Guillard.

At least 19 recordsLinked to original sources

Detection of HIV-1 RNA in two consecutive blood donations screened negative for HIV antibodies.

BACKGROUND AND OBJECTIVES: An unusual serological pattern of HIV-1 seroconversion in a blood donor is described. The seroconversion panel was used to investigate the sensitivity of existing screening assays. MATERIALS AND METHODS: A volunteer blood donor who had given blood 79 times was diagnosed anti-HIV-1-antibody-positive. The heteroduplex mobility assay identified a subtype B HIV-1 strain. The frozen plasmas from the last four blood donations had been kept at -30 degrees C. They were thawed and aliquoted for subsequent testing. RESULTS: The last two blood donations contained HIV-1 RNA, 2,800 copies/ml (October 26) and 170 copies/ml (November 23). Weak anti-p24 antibodies were detected by Western blot in the October 26 sample, and a clear p24 reactivity along with a faint gp160 reactivity was observed on November 23. HIV p24 antigen was undetectable in both samples. Out of 13 screening assays, only 6 gave positive results on the November sample and 7 negative results which were obtained by 1 competitive enzyme immunoassay (EIA) and 6 of the 9 sandwich EIAs. CONCLUSION: Most sandwich EIAs gave prolonged false-negative results in the present case. p24 antigen testing was negative and would not have reduced the risk of HIV transmission.

Adult↗

[Contribution of position emission tomography in a case of Marchiafava Bignami disease: Morel's laminar sclerosis?].

We report the case of a 26-year old alcoholic woman who abruptly presented with confusion associated with a major hypertonia. She evolved into a chronically vegetative state. Magnetic resonance imaging (MRI) was consistent with the diagnosis of Marchiafava Bignami disease. The corpus callosum first presented an oedematous aspect, then a central atrophy with an axial band. The clinical presentation and the functional imaging strongly suggest an association between the Marchiafava Bignami disease and diffuse cortical lesions, such as the laminar sclerosis of Morel.

Acute Disease↗

Parkinsonism and dilatation of the perivascular spaces (état criblé) of the striatum: a clinical, magnetic resonance imaging, and pathological study.

Two men, 89 and 83 years of age, presented with predominantly axial parkinsonian signs. In both cases, magnetic resonance imaging of the brain showed numerous small foci, delineating the striatum. The lesions had the same signal as cerebral spinal fluid in both T1 and T2 sequences. Postmortem examination of the brain showed numerous lacunes due to dilatation of the perivascular spaces, frequently associated with alterations of the surrounding brain parenchyma. Typical changes of Parkinson's disease were associated in one case. Such vascular changes may produce, or modify, a parkinsonian syndrome.

Aged↗

[Hypoxic cerebral lesions. X-ray computed tomography and MRI aspects. Apropos of 20 cases. Selective vulnerability of the striatopallidum].

Brain lesions following hypoxic-ischaemic injuries are known from autopsy studies, but their appearance in live patients has been only occasionally described, and only sporadic reports have been published on their CT and MRI images. Over a 2-year period (1991-93) we studied the clinical, MRI and CT features in 20 patients shortly after a severe hypoxia. Clinical examination showed motor extrapyramidal signs in 13 cases and coma in 7 cases. MR with inversion recovery (IR) and T2-weighted spin echo (SE) sequences was performed in 17 patients and CT in 15. Bilateral lesions were found in 11 cases, but in 13 of them CT was normal. Radiological lesions were always symmetrical and bilateral, located in the pallidum in 10 cases, the striatum in 4 cases and the thalamus in 2 cases. Additional white matter lesions were present in only 4 MRI examinations. No relationship was found between the mechanism of hypoxia and the severity of clinical signs. The course of the clinical signs was correlated with the presence of radiological lesions. In comatous patients there was a relation between parkinsonism and abnormalities of basal ganglia. None of the patients who had perinatal asphyxia had radiological lesions. The presence of pallidal or striatal confirmed the hypoxic origin of neurological symptoms, especially in patients with parkinsonism. MRI, particularly in IR sequences, makes it possible to detect small lesions in basal ganglia after hypoxic injuries.

Adult↗

[Multiple and recurrent paralysis of cranial nerves: primary Gougerot-Sjögren syndrome].

Over a period of 10 years, a 49-year-old man had 3 episodes of recurrent cranial nerve palsy regressing within a few weeks. Each episode was accompanied with acute inaugural headache and diplopia and once with sensory impairment of the trigeminal nerf and once with tinnitus. The diagnosis of Goujerot-Sjögren's syndrome was retained after demonstration of hypergammaglobulinaemia, a positive Rose Bengale test and histological examination of biopsy specimens from the accessory salivary glands which revealed advanced typical lesions. Clinically, impaired secretion was not obvious.

Cranial Nerve Diseases↗

[Specialized memory consultation. Value and evaluation after 2 years of functioning].

Disorders of memory are a frequent cause of consultation and are observed in dementias, in some depressive syndromes and in normal ageing. The specialized memory consultation is based on two successive examinations: one by a neurologist, the other by a psychologist, using standardized batteries of tests. In 100 consecutive subjects, 3 main groups of about 20 to 30 individuals each could be identified: dementia syndromes, psychiatric disorders and age-related disorders of memory. The remaining subjects had various diseases. In subjects with memory complaints a psychometric evaluation performed by a team of specialists seems to be the only means of refining the diagnosis enough for a personalized management. In addition, the specialized consultation team acquires the knowledge that will help it, in the future, to lay down the bases of medical prevention of pathological cerebral ageing.

Aging↗

Postneuroleptic laryngeal dyskinesias: a cause of upper airway obstructive syndrome improved by local injections of botulinum toxin.

We report a case of laryngeal dyskinesia resulting in severe rest and exercise dyspnea. A 51-year-old man treated for 2 years with flupentixol, an incisive neuroleptic, developed severe dyspnea due to intermittent, rhythmic, and dystonic movements of the vocal cords and upper airway. Local injections of botulinum toxin resulted in spectacular regression of laryngeal spasms and major improvement in breathing. This case emphasizes the risk of upper respiratory dyskinesias associated with neuroleptic treatment and shows the feasibility of a new local treatment in this life-threatening disorder.

Airway Obstruction↗

Axial motor disturbances after hypoxic lesions of the globus pallidus.

Four subjects aged between 29 and 60 years were examined because of axial motor impairment after hypoxic brain injury. Magnetic resonance imaging revealed circumscribed lesions of the globus pallidus in every case. The association of freezing of the gait, speech disorders, axial bradykinesia, and postural disturbances, with no rigidity or tremor and little or no distal akinesia, suggests a role of the globus pallidus in controlling axial motion.

Adult↗

[Musical hallucinations: 7 cases].

Musical hallucinations (MH) occurred in 7 patients (5 women and 2 men, age 58-90 yrs) with mild to severe unilateral or bilateral deafness. The hallucinations usually consisted of musical memories (childhood songs, past "hits"). They started abruptly and were identified, sometimes after a period of doubt, as hallucinations. They became "louder" in the silence and, when iterative, could be distressing. By concentrating, 3 patients could change the ongoing tune for another. Elementary (1 case) or verbal (3 cases) auditory hallucinations could be associated and, in one case, vivid visual hallucinations occurred which were not criticized. One patient suffered depression and the MH faded after antidepressive treatment. In the other cases, no psychiatric disorder was identified. Neurological examination, EEGs and brain MRI (in 5 cases) were normal in all but one case, in which MH followed seizures secondary to a left parietal metastasis. Such MH may be termed hallucinosis according to Ey's description. They share some characteristics with other hallucinatory phenomena associated with sensory deprivation, such as the Charles Bonnet syndrome and "pain memories" in phantom limbs. However, the role of deafness, the underlying central mechanisms and psychological factors are poorly understood.

Aged↗

[Abnormal movements of the larynx. Diagnostic approach and therapeutic perspectives].

Laryngeal movement disorders of neurological cause are actually misunderstood. In the course of chorea, or tardive post neuroleptic dyskinesia, vocal, swallowing for threatening breathing troubles could occur. Ten patients with generalized dyskinesias were studied by endoscopy with flexible laryngoscope and laryngeal electromyogram. Four of them were choreic and six had tardive dyskinesia (one had a severe breathing disorder). Nine patients had abnormal movement disorders (MD) involving intrinsic laryngeal musculature. MD were spontaneous or were triggered by vocalization. These facts suggest that dyskinesia as they involved the upper airway tract could be life threatening. Laryngeal electromyography is a useful method for diagnosis and treatment of these dyskinesia. As in spasmodic dysphonia, botulinum toxin could be helpful in this local treatment.

Adult↗

[Progressive paraparesis, complication of acquired pagetic synostosis of the cervical vertebrae. 2 cases].

Two cases of pagetic cervical intervertebral synostosis with spinal cord compression are reported. Computed tomography and magnetic resonance imaging enabled detailed analysis of pagetic bone structure and relationships between the fused spinal segment and spinal cord. Few similar cases have been reported and most authors have advocated conservative therapy with calcitonin and/or diphosphonates, with surgery only in cases unresponsive to pharmacotherapy.

Aged↗