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Biomedical subjects

A Tourbah

Publications and source records attributed to A Tourbah.

At least 19 recordsLinked to original sources
PubMed2005

Hepatitis B vaccination and central nervous system demyelination: an immunological approach.

Demyelination events or multiple sclerosis following hepatitis B virus (HBV) vaccination have been reported. We therefore compared the T-cell response to HBsAg in patients with CNS demyelination following HBV vaccination and in HBV-vaccinated healthy individuals. Our data showed no differences in terms of T-cell proliferation or cytokine production between these groups and may help to allay concerns that HBV vaccination might trigger a deleterious immune response.

Adult↗
PubMed2005

[Contribution of proton magnetic resonance spectroscopy to the diagnosis of Balo's concentric sclerosis].

INTRODUCTION: Balo's concentric sclerosis is a neuropathological type of multiple sclerosis characterized by alternating rings of spared myelin and demyelination. Diagnosis is based on MRI, but very few data are available concerning the lesion features using serial proton magnetic resonance spectroscopy (1H-MRS). METHODS: We report 1H-MRS initial findings and disease course in one case of Balo's concentric sclerosis. RESULTS: The first 1H-MRS study of 2 concentric ring-enhanced lesions showed a decreased N-acetyl-aspartate (NAA) peak, an increased choline peak, 2 broad lactate peaks and the presence of a lipid peak at 0.9 ppm. Six months later, 1H-MRS showed a decrease of choline peak, whereas the lactate peak had disappeared. The NAA peak was still at a low level. CONCLUSION: These findings are similar to those reported in demyelinating disorders, such as multiple sclerosis. Thus, in Balo's concentric sclerosis, 1H-MRS may provide neurochemical arguments for inflammation and demyelination, and indicate the severity of axonal damage and recovery.

Adult↗
PubMed2005

[Isolated ptosis in a 58-year-old woman].

A 60-year-old woman who had experienced isolated ptosis for two years was seen when it had been fixed for one year. She had a personal and familial history of stromal corneal dystrophy. The diagnosis of mitochondrial cytopathy was made on the basis of clinical, electrophysiological, biological and histological findings. Surgical repair of the ptosis allowed visual recovery. The relationship between ptosis, corneal dystrophy and mitochondrial cytopathy is discussed.

Blepharoptosis↗
PubMed2005

[Adult onset hereditary leukoencephalopathies].

In clinical practice, the term "genetic leukoencephalopathy" refers to a group of genetic diseases whose common point is to give an aspect of diffuse leukoencephalopathy on MRI. With progress in diagnostic techniques including radiology, biochemistry or genetics, a large number of hereditary diseases causing leukoencephalopathy have been identified. Although generally beginning in childhood, these diseases often have more insidious clinical forms which can begin in adulthood. These forms remain poorly known. Some are accessible to treatment so their diagnosis appears essential. The diagnostic steps must be guided by clinical examination (neurological, ophthalmological and systemic), electromyography and MRI. The purpose of this review is to propose a classification of the genetic leukoencephalopathies and to give a progress report applicable in neurological practice.

Age of Onset↗
PubMed2005

Acute demyelination: an insight into the effect of mitoxantrone on CNS lesions.

We report the cases of 2 severely disabled patients with large inflammatory lesions suggestive of demyelination treated with mitoxantrone. Clinical condition was improved and brain lesions volume was reduced. On serial MR spectroscopy, there were variations in peaks between 0.9 and 1.4 ppm, suggestive of free lipids and amino acids. These variations may represent neurochemical markers of clinical recovery of large inflammatory lesions in multiple sclerosis.

Acute Disease↗
PubMed2002

[Acute optic neuritis: clinical and MRI prognostic factors. Study of fifty patients].

The objective of this study was to evaluate the risk of visual outcome after acute optic neuritis (ON) in relation to clinical and MRI findings. Fifty cases of acute ON within one month were retrospectively studied. MRI with Short Tau Inversion Recovery (STIR) sequence of the optic nerve were obtained with a median time onset of 9 days after ON. Mean age of patients was 32.8 years, mean initial visual acuity was 3/10 and orbital pain was present in 86 percent100 of patients. The STIR sequence revealed lesion in 88 percent 100 of acutely symptomatic optic nerves. An initial low visual acuity (less than 2/10), the absence of orbital pain and involvement of the intracanalicular portion of the optic nerve on STIR sequence were statistically correlated with a poorer visual outcome (respectively p=0.0041, p=0.035 and p=0.011).

Acute Disease↗
PubMed2002

[Inflammatory optic neuropathy and multiple sclerosis].

The diagnosis of inflammatory optic neuritis remains essentially clinical, and may be improved by complementary investigations. The prognosis is related to the evolution of visual acuity and the risk of development of multiple sclerosis. The treatment of acute episodes is better precised but remains a matter of debate. Long term treatment has benefited from the results of recent MRI studies.

Humans↗
PubMed2001

Clinical and spectroscopic improvement in HIV-associated cognitive impairment.

To assess the impact of highly active antiretroviral therapy (HAART) on AIDS-associated cognitive impairment, 22 patients with AIDS with (n = 11) and without (n = 11) cognitive deficit were evaluated clinically and by MRS every 3 months for 9 months. Nineteen patients were on HAART at study entry, 21 after 2 months. Cognitively impaired patients presented with a subcorticofrontal deficit and decreased N-acetyl-aspartate in frontal white matter. These clinical and metabolic abnormalities reversed partially on HAART, whereas they remained within normal limits in cognitively unimpaired patients.

AIDS Dementia Complex↗
PubMed2001

Correlating multiple MRI parameters with clinical features: an attempt to define a new strategy in multiple sclerosis.

MRI is the most powerful imaging technique in managing patients with suspected or confirmed multiple sclerosis (MS). However, conventional MRI variables show nonspecific abnormalities weakly correlated with clinical progression of the disease. New techniques, now routinely available, offer better characterisation of the pathophysiology. We combined conventional MRI, including lesion load, contrast enhancement and "black holes" with magnetisation transfer and diffusion-weighted imaging and localised proton MR spectroscopy (MRS) to study their relationship with disability, course and duration of MS. The variables that were the most significantly linked to the course of the disease (relapsing remitting versus secondary progressive) were lesion load, mean overall magnetisation transfer ratio and apparent diffusion coefficient (MGADC), the percentage of ADC in (PADCIMD), and out of (PAD-COMD) modal distribution, and the ratio N-acetylaspartate and creatine-containing compounds on MRS of the centrum semiovale. MGADC and PADCIMD were the independent factors most related to disability and duration of disease. Combining MRI techniques is clinically relevant and feasible for studies of MS and may be applied to other diseases of the central nervous system.

Adult↗
PubMed2001

Focal neurological signs in hepatic encephalopathy in cirrhotic patients: an underestimated entity?

OBJECTIVES: Focal neurological signs have been poorly documented in the course of hepatic encephalopathy in cirrhotic patients because they are not mentioned in any textbooks of liver diseases. Having the opportunity to observe such cases, we underwent a prospective study to determine incidence, characteristics, associated factors, prognostic significance, and outcome of this rare form of hepatic encephalopathy. METHODS: Over a 12-month period, all cirrhotic patients hospitalized in the intensive care unit of our department for hepatic encephalopathy were prospectively studied. Patients with clinical and electroencephalogram evidences of hepatic encephalopathy were examined by a senior physician and, in cases of focal neurological signs, underwent examination by a neurologist, CT scan, lumbar punction, and cerebral magnetic resonance imaging and echo Doppler examination of neck and head vessels. Clinical and biological parameters were compared in patients during episodes with and without focal neurological signs, and outcome was noted. RESULTS: Thirty-four cirrhotic patients were hospitalized for 48 episodes of hepatic encephalopathy; two of these patients with cerebral hematoma were excluded. Twenty-four patients exhibited 38 hepatic encephalopathy episodes without focal neurological signs (82.6%), and eight patients exhibited eight hepatic encephalopathy episodes with focal neurological signs (17.4%) that were hemiplegia and hemiparesia in six patients (75%). In all patients, cerebral CT scan and cerebrospinal fluid examination disclosed no abnormalities, as neither did cerebral magnetic resonance imaging (n = 5) and echo Doppler examination of neck and head vessels (n = 5). Except for female sex, which was more often encountered in patients with focal neurological signs (p < 0.05), there were no differences between episodes with and without focal neurological signs for any of the parameters studied. In surviving patients who recovered from hepatic encephalopathy (7/8), focal neurological signs disappeared without recurrences after follow up of 6 months (3-12). CONCLUSIONS: Hepatic encephalopathy with focal neurological signs when carefully searched is not uncommon. It could be more frequent in cirrhotic females, is reversible, and has no prognostic significance.

Case-Control Studies↗
PubMed2001

[Study with localized proton magnetic resonance spectroscopy of 31 multiple sclerosis lesions: correlations with clinical and MRI features].

We have analyzed with localized proton magnetic resonance spectroscopy (MRS) 31 lesions in 28 patients with multiple sclerosis (MS). The course of the disease was either relapsing remitting, secondary progressive, or primary progressive. Four patients had an isolated neurological syndrome suggestive of MS. The decrease in the NAA/Cre ratio and the raise of the Cho/Cre ratio were more pronounced in patients with an acute isolated neurological syndrome, suggesting the predominance of an inflammatory process, and the presence of an axonal dysfunction in the initial course of the lesion. The NAA/Cre ratio was negatively correlated with clinical disability and thus could be used as an index of disease activity. Patients with a secondary progressive course exhibited a significant increase in the Myo/Cre ratio compared to those with a relapsing remitting course. Thus, there may be an association between the evolution towards a progressive disease and axonal loss or the development of gliosis. The isointense lesions to the cerebrospinal fluid on MRI T1 weighted sequences were characterized by a sharp raise in the Cho/Cre ratio suggesting demyelination and/or intense inflammation. Gadolinium enhanced lesions were not characterized by a specific neurochemical profile.

Adolescent↗
PubMed2001

[Idiopathic orbital myositis].

Orbital myositis is a rare disorder considered as a subgroup of inflammatory orbital pseudotumors. The pathophysiology is still unknown. Patients typically present with orbital pain exacerbated by eye movement and diplopia. Response to steroids is dramatic. We report a case of idiopathic myositis of the right inferior muscle, which recovered after steroid therapy.

Adult↗
PubMed2001

[The role of MRI in the diagnosis and the natural course of multiple sclerosis].

Magnetic resonance imaging (MRI) is very sensitive in depicting multiple sclerosis (MS) lesions, but its specificity is poor. New sequences such as fast spin echo and FLAIR (fluid attenuated inversion recovery) improve the detection of lesions. The exploration of the whole central nervous system, brain, optic nerves and spinal cord improves sensitivity and specificity. The existence of lesions at different ages responds to temporal dissemination. MRI has also allowed to better understand the natural history of MS, showing 5 to 10 times more radiological than clinical activity. In case of isolated demyelinating syndrome, MRI is the best predictor of the occurrence of definite MS and of the severity of disability in the subsequent 10 years. However, the diagnosis of MS remains clinical, and systematic control MRI are not useful in clinical practice.

Brain↗
PubMed2001

[Value of MRI in patients with multiple sclerosis].

Diagnosis criteria of multiple sclerosis (MS) have been recently reconsidered, introducing the possibility to validate temporal dissemination with the use of MRI. In fact, MRI parameters may be considered as reflecting the biological activity of MS. MRI is used to monitor treatment in clinical trials. However, and except for particular circumstances, its use in routine follow-up of patients with MS is not recommended, because of weak correlations with clinical disability and technical difficulties of such follow-up.

Brain↗
PubMed2000

[Magnetic resonance imaging in multiple sclerosis].

The contribution of magnetic resonance imaging techniques to the clinical prognosis of multiple sclerosis. Magnetic resonance imaging (MRI) is a diagnostic technique with a high sensitivity for the detection of lesions, but with a poor pathological specificity. In the case of multiple sclerosis (MS), the improvement of diagnostic efficacy depends on a careful analysis of the clinical presentation and the use of increasingly stringent MRI criteria aimed at improving the specificity of the conventional MRI T2 sequences. New sequences such as fast spin-echo (also called turbo spin-echo) and FLAIR (fluid attenuated inversion recovery, a method derived from inversion recovery) have improved the visualization of lesions. MRI can under certain conditions be used to monitor the evolution of MS. Acute-phase monitoring is focused on observed changes in disease activity such as the appearance, recurrence or extension of lesions after i.v. injection of contrast medium, i.e., gadolinium (Gd)-enhanced MRI. In the chronic phase, the lesions is the aspect used as the monitoring criterion. However, MRI is still only a secondary criterion in phase III therapeutic trials due to its insufficient correlation with the disability. In neurological daily practice, conventional MRI is only of limited interest at the individual level in patient follow-up, as its prognostic value is poor. Moreover, the difficulty in determining the lesion load can only be excluded in the context of clinical trials, in which certain methodological precautions are taken. This is why techniques other than MRI are being investigated to obtain a better correlation with the clinical course of the disease, for instance the quantification of 'black holes' on T1 weighted images, and the measurement of cerebral and spinal atrophy. Adapted MRI techniques allow a weighted signal to be obtained via the movement (diffusion imaging), by the complexity of the molecular structure (magnetization transfer imaging), by chemical shift (spectroscopic imaging), or by local oxygenation (functional MRI). These new MRI techniques allow a more precise assessment of the pathological mechanisms involved in MS, such as edema, blood brain barrier break-down, demyelinisation, gliosis, cellular infiltration and axonal loss; they provide a better means of establishing the correlation between clinical impact and the destructive nature of the MS lesion. The importance of axonal loss has recently been confirmed in MS by analyzing MRI spectroscopic and neuropathological findings. In addition to magnetization transfer imaging, MR diffusion imaging and functional MRI are being intensively studied in order to assess their contribution to the study of reversibility of the degenerative process.

Brain↗