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Biomedical subjects

C Brosset

Publications and source records attributed to C Brosset.

At least 19 recordsLinked to original sources
PubMed1998

[Cranial pachymeningitis or unknown origin].

Pachymeningitis of unknown origin is uncommon and is usually associated with headaches, cranial nerve lesions and cerebellar ataxia. Magnetic resonance imaging is particularly contributive to diagnosis. The default diagnosis must however be confirmed by brain biopsy. Treatment is not well defined. Basically, corticosteroid therapy, or immunosuppressive therapy in case of failure, is known to have little effect on the brain lesion. We report here a case characterized by headache associated with partial regression of the radiographic lesions.

Biopsy↗
PubMed1997

Human African trypanosomiasis: MRI.

We report a case of human African trypanosomiasis caused by Trypanosoma brucei rhodesiense. After the febrile period of parasite dissemination, the patient had meningeal involvement but normal CT. MRI showed the appearances of meningitis. After two periods of arsenical treatment, a severe encephalopathy occurred suggesting post-therapeutic reactive encephalitis (PTRE). Nevertheless, T2-weighted MRI showed no oedema, but focal bilateral high signal areas in the white matter. PTRE was excluded and a third course of treatment was undertaken. The lesions progressively disappeared.

Adult↗
PubMed1996

[Peripheral neuropathies caused by disulfiram].

Disulfirame is a rare cause of peripheral neuropathy in subjects with chronic alcoholism. We report here a case in a 42-year-old man and present the main clinical features and electrophysiological and pathology results. Disulfamine-induced peripheral neuropathy is dose-dependent and never occurs below 250 mg/d (1/2 tables of Espéral*). The pathogenesis is poorly understood.

Adult↗
PubMed1994

[Cerebral infarction in patients aged 16 to 35 years. Prospective study of 52 cases].

OBJECTIVES: Aetiologies of cerebral ischemic events in young adults are various and often contraversial: atherosclerosis plays a role after age 35 years, cardioembolism is often recognized as the major cause, and numerous new predisposing conditions have been described. To evaluate very premature cerebral infarction, we studied prospectively 52 consecutive patients (34 women and 18 men) aged 16-35 years (mean 28.6 +/- 5.6 years) admitted over a 6-year period for an arterial cerebral infarct identified on CT, on MRI or both. METHODS: All patients were investigated using a standard protocol including cerebral angiography, transthoracic echocardiography, 24-hour Holter ECG monitoring, coagulation inhibitors levels, lupus anticoagulant testing, HIV and syphilitic serologies. Additional investigations were performed in a majority of patients: transesophageal echocardiography in 33, contrast echocardiography in 50, and anticardiolipin antibodies levels in 38. RESULTS: The arterial distribution of infarction did not differ from that of overall stroke patients. Sixteen cases were classified as certain aetiologies, including cardiac diseases with high embolic risk (n = 9), spontaneous arterial dissection (n = 4), moya-moya disease (n = 1), atherosclerosis (n = 1), and inherited antithrombine III deficiency (n = 1). Eighteen cases were classified as possible aetiologies including cardiac diseases with low embolic risk (n = 11) such as mitral valve prolapse or atrial septal aneurysm, miscellaneaous arteriopathies (n = 3) such as arterial dysplasia, antiphospholipid antibodies syndrome (n = 1) and migrainous stroke (n = 3). The 18 last cases were classified as unknown aetiologies, despite all patients but one had at least one vascular risk factor: this group significantly differed from the formers in that the patients were more frequently women using oral contraceptive associated with tobacco consumption, hypercholesterolemia, or both. Two patients died acutely and the survivors were followed 31 +/- 18 months. Three patients experienced recurrent stroke. Functional outcome was assessed using the Rankin scale on admission and 6 to 12 months after the onset of stroke: patients evaluated < or = 2 (no to mild handicap) were 31% on admission and 82% after recovery. Twenty six p. cent remained unable to resume a work. CONCLUSION: Despite extensive evaluation, identification and classification of aetiologies of cerebral infarction in young adults should be cautious because the risk as well as the pathogenesis of many potential causes still need to be defined.

Adolescent↗
PubMed1994

[The sleep-wake cycle during Trypanosoma brucei rhodesiense human African trypanosomiasis in 2 French parachutists].

Polysomnography was performed in two military personnel who contracted human African trypanosomiasis (HAT) in Rwanda. They were evacuated to France and gramined during the fourth, sixth and eleventh months of evolution. Patient A presented a meningoencephalitis with Trypanosoma brucei rhodesiense (T. b. r.) in the cerebrospinal fluid. Between the second and third treatments with melarsoprol, the patient presented an acute encephalitic attack with pyramidal and cerebellar symptoms, which were improved by corticotherapy and disappeared progressively in 6 months. Patient B presented a major inflammatory syndrome with T. b. r. in the blood and the medulla. Cerebrospinal fluid and serology remained normal. The patient received only one session of melarsoprol treatment. Polysomnography recordings were continuously taken on an ambulatory Oxford Medilog system during 48 hours. The different stages of vigilance were scored according to the classical Rechtschaffen and Kales criteria. During the fourth month, both subjects presented several long diurnal naps, with the presence of rapid-eye-movement sleep at the end of the sleep episodes. These abnormalities disappeared progressively during the following recordings. Electroencephalographic abnormalities were observed in patient A, particularly during the eleventh month. They consisted in transitory arousal phases concomitant with myoclonic jerks and with the persistence of slow waves during slow-wave sleep. The various anomalies noted in the two patients allow us to recommend the supervision of the evolution of HAT by polysomnographic recording in a sleep laboratory.

Adult↗
PubMed1994

[A study of 82 cerebral infarctions in the area of posterior cerebral arteries].

Of 598 consecutive non-selected cases of cerebral infarction included in a stroke registry, 82 cases (54 men and 28 women, mean age 66 +/- 14 years) of spontaneous and isolated posterior cerebral artery (PCA) territory infarction (right PCA in 36, left PCA in 35 and both in 11) were identified on the basis of CT combined with MRI in 51 cases. Infarction was superficial in 25 (group A), combined deep-superficial in 23 (group B) and deep in 34 (group C). Of 48 superficial lesions, 29 were massive while 19 were restricted to the territory of one branch. Of 57 deep lesions, 21 were located in the inferolateral thalamic territory, 10 in the paramedian thalamic territory, 12 in other midbrain or thalamic territories, and 14 in a combination of various midbrain and/or thalamic territories. Of 41 patients with unilateral superficial involvement, 39 had homonymous visual field defect. Unawareness of the visual defect and visual release hallucinations were observed with the same frequency in right and left lesions. Of 7 patients with bilateral superficial involvement, only 5 had bilateral visual field defect including incomplete cortical blindness in 3. The frequency of confusional state (n = 24) did not differ significantly in left versus right sided lesions while it was significantly higher in superficial or combined versus deep lesions (p = 0.05). Of 18 clinically evaluable patients with left PCA territory infarct, 14 had speech disorders including pure alexia in only one case. Of 15 patients with right territory infarction, 10 had spatial judgement disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Ganglioneuroma of the mediastinum. Apropos of a case].

The authors report a case of a large ganglioneurinoma located in the mediastinum. The clinical course of this rare benign neurogenic tumour of the posterior mediastinum includes a low risk of medullary compression. The treatment is surgical resection.

Adult↗
PubMed1994

[Ischemic cerebral vascular accidents in young subjects and livedo reticularis. Apropos of a case of Sneddon's syndrome or Divry-Van Bogaert's syndrome].

The authors report the case of a 28-year-old patient presenting with successive ischaemic cerebral vascular accidents, preceded by the appearance of a livedo reticulare, without any laboratory signs of an inflammatory syndrome. Since Sneddon, and before him Divry and Von Bogaert, patients with this dermatosis are known to have an increased frequency of ischaemic cerebral vascular accidents. This syndrome, considered for a long time to be minimally aggressive, appears to be a very serious disease, leading to a bedridden state and dementia. The prognosis for these patients, all young (30-40 years), therefore appears to be very poor. Any case of livedo reticulare requires the search for cerebral neurological lesions. After a complete neurological examination, imaging therefore has an important major in the assessment of cerebral lesions due to this corticomeningeal angiomatosis. CT scan and MRI are useful in this initial assessment and in the subsequent follow-up of patients. In cases with frank neurological lesions, cerebral arterial exploration is essential with demonstration of lesions of the midcerebral arteries and activation of collateral vascular anastomoses and their helicine vessels. The prognosis is based on the extent of these lesions. Cerebral biopsy may demonstrate a non-inflammatory endothelial cellular proliferation of midcerebral vessels.

Adult↗
PubMed1993

[Lateral thalamic infarction. 22 cases].

Isolated lateral thalamic infarcts (LThl) are rare. They often produce lacunar syndromes, and their main cause is thought to be an hypertensive arteriolopathy. To verify these data, we reviewed 639 cerebral infarcts demonstrated by CT and/or MRI and included in a hospital stroke registry over a 4-year period. We identified 22 cases (3.5 p. 100) of isolated LThl (right LThl: 15; left LThl: 7). Nineteen had MRI study. There were 13 men and 9 women of mean age 65 years. None had the complete Dejerine-Roussy syndrome: sensory disturbances 21 cases, hemiparesis 7, hemiataxia 5, involuntary movements 4. They were divided in group 1 (14 cases) with prominent sensory symptomatology and group 2 (8 cases) with prominent motor symptomatology. The pulvinar and the ventral posterior thalamic nucleus were affected in both groups while adjacent nuclei such as ventral lateral or lateral posterior were more often affected in group 2. All patients but one had good recovery but 13 developed thalamic pain severely interfering with social activities in 5 cases. Several findings suggested that rather an arteriolopathy than large vessels disease or cardiogenic embolism had been a major cause in this series: 1) all patients but one (including 2 with a potential cardiac source of embolism) were hypertensive or diabetic, 2) lesions were small infarcts in the territory of perforators, 3) patients did not experience premonitory as well as subsequent cerebral events suggestive of vertebrobasilar atherosclerosis while 2 experienced deep cerebral hypertensive hemorrhage, and 4) neuro-imaging found additional asymptomatic lacunes in numerous patients. However, in the absence of angiography in most patients, these results do not preclude a potential role of artery-to-artery microembolism.

Adult↗
PubMed1993

[Marchiafava-Bignami's disease with a favourable course. Apropos of a case].

A resolving form of Marchiafava-Bignami disease is reported. This patient with a history of chronic alcoholism was hospitalised for a recent demential syndrome. Clinical examination did not show any signs of interhemispheric disconnection LP and EEG were normal. CT examination showed a low density area in the corpus callosum without any other anomaly. MRI examination confirmed the cystic area of the corpus callosum. The Marchiafava-Bignami disease was easily suggested on the basis imaging and clinical signs. Interhemispheric disconnection is not always found so MRI and CT examinations seem to be very useful tools for early diagnosis of Marchiafava-Bignami in the same way as neuropsychological tests.

Adult↗
PubMed1993

[Transient involuntary movement disorders and thalamic infarction].

Stroke-related nonepileptic transient dyskinesias are rare, and the site of ischemia remains often undetermined. Five cases out of 47 consecutive thalamic infarcts (10.6 per cent) are reported. Patients presented with monochorea (1 case), hemiballism-hemichorea (2 cases), choreoathetosis (1 case with subsequent arm painful dystonia and hand tremor), and asterixis (1 case). Magnetic resonance imaging demonstrated that the subthalamic nucleus was spared in all cases. Transient dyskinesias occurred at any time in the course of infarction (as a warning sign in 1 case, as an associated symptom in 3 cases, or during recovery in 1 case). Moreover, this study suggests that: 1) transient dyskinesias are mainly related to thalamic ischemic injury, and 2) small vessels disease is the main etiology.

Aged↗
PubMed1992

[Pure cerebellar infarction. Thirty cases].

Infarcts in the territory of cerebellar arteries, often involving both brainstem and cerebellum, have been well recognized in recent pathological and clinicoradiological studies. To evaluate the situation of pure cerebellar infarcts (PCI) we studied 30 consecutive cases of symptomatic PCI (22 men and 8 women, mean age 58 +/- 17 years) admitted over a 5-year period and selected on the basis of brain computed tomography completed by magnetic resonance in 20 cases and angiography in 15 cases. PCIs accounted for 53 percent of cerebellar infarcts, 10 percent of vertebrobasilar infarcts and 3.2 percent of all cerebral infarcts. The arterial territories involved were the superior cerebellar artery (SCA) in 13 cases (alone in 8 cases), the anterior inferior cerebellar artery in 2 cases, the posterior inferior cerebellar artery (PICA) in 17 cases (alone in 13 cases) and border areas in 5 cases (associated with SCA or PICA). The symptoms were the same in the arterial territories involved (SCA versus PICA), except for dysmetria and vestibular syndrome which were more frequent respectively in SCA territory infarction (P < 0.001) and in PICA territory infarction (P < 0.01). Certain or presumed causes were cardiogenic embolism (23 percent), atherosclerosis (43 percent) and other identified causes, such as oral contraceptives or temporal arteritis (10 percent). They remained undetermined in 24 percent of the cases. Although most patients were severely disabled in the acute stage (Barthel index < 60 in 21 cases), 90 percent recovered subsequently (Barthel index about 100 and 0-2 score on modified Rankin scale). Our findings indicate that symptomatic PCIs are rare; their main causes (cardioembolism and atherosclerosis) do not differ in frequency from those of all cerebral infarcts collected in stroke registries and their functional prognosis is good in almost all cases.

Adult↗
PubMed1991

[Ataxic hemiparesis and simultaneous supra- and subtentorial hematomas].

In a chronically hypertensive woman with a rapidly developing right ataxic hemiparesis syndrome, computed tomography and magnetic resonance imaging (MRI) revealed two small unrelated hemorrhages: one in the posterior limb of the left internal capsule, the other in the right cerebellar hemisphere. In this patient, the ataxic hemiparesis syndrome might have resulted either from the association of the two lesions or from the capsular hemorrhage alone. The rarity of simultaneous hypertensive hematomas and the value of MRI in the diagnosis are underlined.

Aged↗