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Biomedical subjects

A Verier

Publications and source records attributed to A Verier.

27 records · Page 2Linked to original sources

Cervical neurological complications of rheumatoid arthritis. Surgical treatment techniques and indications.

A critical study of 11 cases with neurological complications resulting from damage to the cervical spine during rheumatoid arthritis prompts the authors to reconsider their therapeutic strategy. After recalling the various neurological complications and their mechanisms, they propose an extension of the range of indications for surgical treatment. The limits of this extension are defined according to neurological and radiological criteria and the risks inherent in each method.

Adult↗

[Diagnostic and prognostic value of diaphragmatic electromyography and somatosensory evoked potentials in cervical spine and spinal cord injuries].

SEP contribution to diagnosis is interesting but limited to hardly examined complete syndromes in an emergency care unit. The predictive value of SEP is high if electrophysiological data are correlated the 10th. day with the clinical status. A good prognostic value is shown when the clinical posterior column and pyramidal tract dysfunctions are equal in intensity and distribution, i.e. in complete syndromes or central spinal cord syndromes or Brown-Sequard's ones. However, not any correlation exists in cases of anterior spinal cord syndromes. Dg.EMG. is an easy, atraumatic useful tool for the clinician. It must be a systematic approach of the brain stem and cervical spinal cord phrenic centers vitality that may be involved by the trauma. When a respiratory deficiency occurs, it allows the diagnosis of a "peripheral" or "neurological" etiology. Its high prognostic value for m tor diaphragmatic function (increase or decrease) must be discussed before any therapeutic decision.

Adolescent↗

[Post-radiotherapy stenosis of the supraclinoid internal carotid artery. Moyamoya network].

A 36 year-old caucasian woman was operated and then irradiated for a pituitary adenoma. Two years later, a left anterior temporal lobectomy for a grade I astrocytoma was performed. Four years later, she experienced right hemiparesis and aphasia. CT scan showed a left temporo-occipital low density area. A left carotid angiogram showed a narrowing of the left carotid artery beginning in the lower part of the siphon and progressing to a complete supraclinoid occlusion. There was a collateral circulation of the Moyamoya type. Radiation-induced narrowing or occlusion of the intracranial internal carotid artery is an infrequent finding. Most cases appear in young subjects, several years after a high dose of radiation therapy (30 to 60 grays). Some cases may show a network of the Moyamoya type. Usually, the absence of vascular abnormalities prior to radiation cannot be demonstrated. In our case, as in 3 other cases of the literature, the intracranial vessels were of normal appearance before irradiation. The vascular lesions can thus be considered as acquired and secondary to radiation therapy.

Adult↗

[Clinical and prognostic evaluation of post-traumatic coma according to the level of brain stem injury].

On the grounds of studies carried out in the last ten years, the authors criticize the usual classification of comas and question the Glasgow scale (opening of eyes, verbal answer, motor response). Their description of brain stem injury by axial herniation and explanation of the role of diffuse encephalic lesions causing intracranial hypertension is based upon anatomo-clinical findings and results of investigations in comatose patients with head injury. For prognostic purposes, a simple and fairly reliable classification of post-traumatic comas is proposed. Comas are divided into five stages of rostro-caudal destructuration (cortico-sub-cortical, diencephalic, meso-diencephalic, mesencephalic and pontic) by studying the response to pain (unadapted, adapted, absent) and four brain stem reflexes (fronto-orbicular, vertical and horizontal oculocephalic, light reflexes).

Brain Injuries↗

[Post-traumatic cerebral edema. Physiopathology and treatment].

Severe head injury often produces complex intracranial displacements of the brain, resulting in widespread, often microscopic lesions. These are responsible for two types of edema: vasogenic edema, with outflow of molecules and fluid into the extracellular spaces by rupture of the blood-brain barrier and vasoplegia, and cytotoxic edema, with swelling of astrocytes due to membrane lesions. The connexions between these two types of edema are still obscure. Alterations in membrane phospholipids may impede function of Na-K pump enzymes, causing accumulation of water in the cell. Cerebral edema is responsible for intracranial hypertension and tentorial herniation, which in turn increase edema through venous compression, ischemia, and hypoxia. The least controversial anti-edema therapeutic measures include relative fluid and salt restriction, mannitol if called for, neuroplegia, in particular with diazepam and Gamma-OH, and assisted ventilation.

Alfaxalone Alfadolone Mixture↗