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Biomedical subjects

C Manelfe

Publications and source records attributed to C Manelfe.

At least 73 records · Page 4Linked to original sources
PubMed1996

Recurrent right hemiplegia associated with progressive ipsilateral carotid artery stenosis.

BACKGROUND: Ipsilateral sensory motor symptoms associated with carotid artery stenosis are rare, and few reports are available in the literature. CASE DESCRIPTION: We report the case of a 50-year-old man who presented with right hemiplegia that recurred 14 months later. A left hemisphere watershed infarction was detected. Repeated angiograms showed a left internal carotid occlusion and a right internal carotid stenosis that initially measured 50% and worsened to 80% after the second stroke. CONCLUSIONS: Repeated quantitative measurements of cerebrovascular reserve demonstrated the hemodynamic mechanism of the strokes and the role of a right internal carotid lesion in causing the recurrence of right hemiplegia.

Brain↗
PubMed1996

[Multiple cerebral telangiectasias. Apropos of an anatoma-radioclinical case].

UNLABELLED: Telangiectasias are vascular malformations corresponding to dilated capillary separated by nervous parenchyma. They are generally asymptomatic and discovered during autopsy. CASE REPORT: We describe the case of a 2-year-old girl who was admitted for drowsiness and vomitings with craniomegaly and right hemiparesis. The cerebral imaging demonstrated large amounts of calcium in the region of pons and left thalamus with a contrast enhancement throughout these calcifications. The thalamic lesion was cystic with obstruction of the third ventricle and hydrocephalus. There were multiple calcifications scattered throughout the basal ganglia and the white matter. The latter had a low density on CT and high signal intensity on MRI (T2). The cerebral angiographic study showed a blush in the pons and the thalamus. Clinical course was fluctuating or intermittently progressive. Finally, in spite of radiotherapy and oral corticosteroid treatment, the child became quadriparesic with oculomotor palsy. She suddenly died at age 4 years and 6 months from a hemorrhage of the pons. Neuropathological study showed two clusters of telangiectasias with calcifications in the pons and the thalamus. Other calcified vascular malformations were seen in the white matter and the basal ganglia. Near the lesions, astrocytar gliosis and edema were observed. The white matter was malacic with isolated calcifications. CONCLUSION: Cerebral telangiectasias may be multiple and may produce severe neurologic disorders, occurring in infancy with fluctuating clinical course. Arteriography may show these usually cryptic vascular malformations. This diagnostic should be kept in mind in view to the neuroradiological aspect we report here.

Basal Ganglia↗
PubMed1996

[Dissection of the intracranial arteries. Apropos of 10 cases].

Ten cases of spontaneous dissection of the cerebral arteries are reported. 3 males and 7 females aged 6 to 60 years (mean age 30 years) were investigated in the Department of Neuroradiology of Toulouse between 1989 and 1994 with CT, angiography and MRI. In 5 cases the dissection involved the carotid artery, in 5 cases the vertebro-basilar system. The clinical presentation was of two types: ischaemic stroke (7 cases) or subarachnoid haemorrhage (3 cases). Their evolution is never lethal, contrary to the classical descriptions of the literature. In all cases an initial angiography then follow up has been performed showing an irregular located arterial stenosis. The diagnosis of intracranial dissection is sometimes made in front of a dissequant aneurysm. In case of doubt, magnetic resonance (MR) imaging is helpful showing a linear hypersignal parallel to an arterial segmental stenosis, and angiography MR an irregular aspect and stenosis of the endoluminal artery.

Adolescent↗
PubMed1996

[The contribution of "time-of-flight" MRI-angiography in the study of neurovascular interactions (hemifacial spasm and trigeminal neuralgia)].

The purpose of this study was to investigate capabilities of Magnetic Resonance Angiography (MRA) in delineating neurovascular compression which has emerged as the most frequent etiology in cases of Hemi-Facial Spasm and Trigeminal Neuralgia. MR investigations were carried out at 1.5 t unit (Magnetom Vision, Siemens). The examination consisted of 3D time-of-flight MRA (3d TOF) protocol, with a FISP sequence (Fast Imaging Steady Precession) and magnetization transfer. Imaging parameters were; TR 39 ms, TE 7 ms; MX 256-512; FOV 210-210 mm. Time acquisition is 10 mm 30 s. The axially acquired angiographic slices were reformatted with a multiplanar reconstruction program (MPR) along and across the plane of facial and trigeminal nerves. Then millimetric raw data images were postprocessed with a maximum intensity projection (MIP) technique. 58 patients presented either with hemifacial spasm (36 cases, 16 women, 20 men, mean age: 58.5 y) or trigeminal neuralgia (22 cases, 13 women, 8 men, mean age: 51 y) were compared with 17 patients (9 women, 8 men, mean age: 57.5 y) as references. MRA with MIP and MPR techniques reliably demonstrates neurovascular compression at the root entry zone (REZ), and allows recognition of the implicated vascular loop in 34 the cases of hemifacial spasm investigated. Raw data were post-processed in an axially oblique plane parallel to the acoustico-facial bundle and secondarily reconstructed in coronally obliques views. These reconstructed images clearly delineate the cross-compression of the emerging facial nerve. The neurovascular conflict was related to an arterial loop from the postero-inferior cerebellar artery (PICA, 21 cases, 61%) and the antero-inferior cerebellar artery (AICA, 8 cases, 23%). Vertebral artery is implicated in conflicts in 5 cases. In 2 cases MRA exploration was negative. In HFS group distance between Vth nerve emergency and neuro vascular contact was measured and compared with control group; there is a significative difference (p < 0.01). In case of trigeminal neuralgia, MRA demonstrates neurovascular compression at the root entry zone of the Vth nerve of 16 patients. In theses cases, oblique and coronally reconstructed images are crucial in demonstrating neurovascular contacts. The vessel implicated in conflict is always the superior cerebellar artery (SCA). A supero-medial loop of the superior cerebellar artery was depicted in these 16 cases. Although 3 patients had negative MRA and MR studies, a case of compression of the origin of the Vth nerve by a enlarged draining vein in a case of brainstem arterio-venous malformation, a petrous apex meningioma was incidentally discovered and thoroughly investigated with gadolinium T1 weighted sequences and 1 demyelinating plaques located along the intraaxial course of the Vth nerve were noticed. In control group on 34 explanations only there are only 4 contacts between Vth nerve and SCA. MRA with a 3D-TOF FISP sequence allows recognition of neurovascular conflicts in case of hemifacial spasm and trigeminal neuralgia while MIP helps to characterize the implicated vessel. Sources images need to be carefully assessed in order to depict unsuspected pathology.

Adolescent↗
PubMed1995

Activation of association auditory cortex demonstrated with functional MRI.

Activations in the temporal lobes previously observed using positron emission tomography and auditory stimuli were partially reproduced with functional MRI and echo-planar imaging at 1.5 T in six volunteers performing tone and phoneme monitoring tasks. Verbal processing compared to a tone recognition task significantly activated a cortical area located in the left anterior temporal region (P < 0.02).

Adult↗
PubMed1995

[Cerebral lesions in AIDS: what can be expected from scintigraphy? Cerebral tomographic scintigraphy using thallium-201: a contribution to the differential diagnosis of lymphomas and infectious lesions].

CT and MRI are not consistently able to differentiate central nervous system (CNS) lymphoma from focal cerebral infection such as toxoplasmosis in the human immunodeficiency virus (HIV) involvement. In this study thallium 201 (and/or technetium-MIBI) SPECT was performed in 6 patients suffering from AIDS and CNS lesions. An index based on the ratio of thallium uptake in the lesion vs the contralateral scalp was calculated. In 4 out of 5 patients with lymphoma (3 confirmed by biopsy, 2 highly suspected on CT and resistance to antitoxoplasmosis treatment) focal lesions showed high uptake of thallium. On the other hand one markedly necrotic lymphoma and all infectious lesions did not take up thallium. This suggests a role for thallium 201 brain SPECT in the workup of focal CNS lesions in AIDS.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Results of magnetic resonance imaging in the acute phase of cerebral infarction].

Brain ischemia is now possible to trace through the multiple facets of MRI, morphological as well as functional. Experimental studies have been conducted for many years and clinical feasibility is reached. Although the initial decrease in blood flow does not influence morphological imaging, this early phase is shown with functional MRI, either with diffusion imaging or with cerebral blood volume imaging. The later is achieved either with the calculation of the integral of the first passage of a bolus of a diffusible paramagnetic agent or with the circulation of positive or negative blood pool contrast agents. This may serve to confirm an early diagnosis before inclusion in therapeutic trials. Immediate metabolic changes are reflected on phosphorus and proton spectroscopy achievable during the same session as imaging. This type of information may at this stage serve as a reference. It allows observation of the turnover of lactate over time in the lesion and the neuronal loss shown by decreased N-acetyl-aspartate. Edema, as a reaction to ischemia, builds up over time and has already been described for long as it modifies T1- and T2- weighted sequences. Similarly the breakdown of the blood-brain barrier is well known on conventional sequences because it produces contrast enhancement.

Acute Disease↗
PubMed1994

Histiocytosis X of the petrous bone in the adult: MRI.

Two cases of histiocytosis X in young adults with involvement of only the petrous bone are reported. In the first symptoms and signs consisted of a seventh nerve palsy of gradual onset over 3 years, and in the second, of pulsatile tinnitus associated with otorrhoea of clear fluid and impaired vestibular function. CT revealed large lytic lesions of the petrous bone. T1-weighted MRI before and after gadolinium confirmed the presence of a mixed tumour of the petrous bone with marked uptake of contrast medium. Spin echo images demonstrated the absence of extradural extension, and the patency of the arterial and venous network, therefore enabling differential diagnosis from extensive glomus jugulare tumours.

Adolescent↗
PubMed1994

Randomised double blind trial of the safety and efficacy of two gadolinium complexes (Gd-DTPA and Gd-DOTA).

The main difference between macrocyclic Gd-DOTA and linear Gd-DTPA complexes is the greater stability of the former which theoretically might reduce biological interactions in man. To evaluate the clinical relevance of this property, 300 unselected neurological patients were included in a randomised double-blind comparison involving five European centres, focused mainly on the tolerance of these two contrast media. Clinical tolerance was assessed immediately after the procedure and 24 h later. Adverse events were found with a similar frequency in the two groups (17.3% for Gd-DOTA and 19.3% for Gd-DTPA). Minor neurological symptoms were the most frequent (48.6%) headache being the most common (29.2% of adverse events). No difference in efficacy was found.

Adult↗
PubMed1994

[Complications of the intravascular treatment of intracranial aneurysms using metal microcoils. Embolization using coils in intracranial aneurysms].

Embolization of intracranial aneurysms with coils. The authors present the results and complications of microcoils embolization of intracranial aneurysms in 28 patients. Fibers platinum microcoils were used (Target Therapeutic) 28 patients (males: 6, females: 22; mean age: 51 years) were treated, 27 suffered from sub-arachnoid hemorrhage (SAH) and one presented with a pseudotumoral syndrome (giant aneurysm). All patients were evaluated on the day of treatment, according to the World Federation of Neuro-Surgeon classification (W.F.N.S.) of SAH and after 4 months of follow-up. At a mean follow-up period of 4 months, according to Glasgow Outcome Scale (G.O.S.) there were 13 cases of good results, 5 cases of "moderate disability", 2 cases of "severe disability", 2 cases of "vegetative state" and 6 deaths. Complications were observed in 11/28 cases. Coils migration and malposition in the parent artery were linked to the procedure (mechanical detachable coil) and resulted in severe deficit (one case), transient disability (one case) or went unnoticed (4 cases). Primary or secondary complete occlusion was achieved in 8/28 patients (32%). A majority of cases (11 cases) ended with stable residual aneurysmal sac lumen while rebleeding occurred in 3 patients and was responsible for 2 deaths. In the third case a favourable outcome was obtained after balloon occlusion of the parent artery.

Adult↗
PubMed1993

[Transmission of neurosurgical medical records through computers. Simple reality, considerable progress].

Tests on the transmission of view data processing images were undertaken for 5 months from two experimental micro-processing sites specialized in medical imagery and linked to the R.N.I.S. network. The aim of the research was to validate the equipment and the software, and to find a way of working with regard problems related to long-distance diagnosis. Using an everyday equipment like Apple Macintosh II fx, 75 files were transferred corresponding in 375 images (1% conventional X-ray, 5% digital angiography, 31% scanner and 63% M.R.I.). It has been found that the transfer of medical data is reliable (the images do not deteriorate), easy (less than 3 hours to be familiar with the program) and above all fast (actual transfer time: 8.72 Ko per second). Neurosurgeon and neuroradiologist writers talk about their experience in this field.

Computer Communication Networks↗
PubMed1993

[Percutaneous treatment of lumber disk herniation. Radiological criteria of therapeutic decision].

Invasive diagnostic imaging methods such as discography, discomanometry, C.T.-discography are generally not required to accurately depict herniated lumbar disks. On the contrary they should be implemented in specific clinical situations in order to confirm the choice of a percutaneous treatment: nucleolysis or nucleotomy. The major role is devoted to discography. Discomanometry and C.T.-discography are second order methods that will help in difficult cases in choosing therapeutic strategy.

Adult↗
PubMed1993

[Foraminal and latero-foraminal hernia. Mid-term results of percutaneous techniques nucleolysis-nucleotomy].

Forty cases of foraminal (28) and lateroforaminal (12) herniated discs treated either by nucleolysis (N.L.) or percutaneous automated nucleotomy (P.A.N.) were investigated over a period of 12 months or more. The group of patients treated with P.A.N. (15 males, 5 females) with a mean age of 41.8 years, had severe radicular pain in 25% of cases, caused by foraminal (15 cases) and lateroforaminal (5 cases) herniated discs which were predominantly located at the L4-L5 level (12 cases). The group of patients treated with N.L. (13 M, 7 F) with a mean age of 50.3 years complained of severe radicular pain in 65% of cases, caused by foraminal (13 cases) and lateroforaminal (7 cases) disc herniations evenly distributed over the last three mobile segments. The overall results obtained with N.L and P.A.N. showed a 67.5% success rate. The best results were obtained in cases of cruralgia with severe radicular pain caused by foraminal herniated disc at the L3-L4 or L4-L5 levels. A significantly better result was obtained in the group of patients treated by N.L. (80% success rate) than in the group of patients treated by P.A.N. (p < 0.04).

Adult↗
PubMed1993

[Histiocytosis X of the petrous pyramid in adults. X-ray computed tomographic and MRI aspects].

Two cases are reported of histiocytosis X in young adults, both confined to the petrous bone. In one case the clinical signs were those of a progressive facial palsy, developing over 3 years; the other case had pulsatile tinnitus with clear otorrhoea and symptoms of vestibular deficiency. Computed tomography showed extensive bone destruction by a soft-tissue density process which enhanced strongly after iodinated contrast injection. Magnetic resonance imaging (T1 weighted sequences before and after intravenous gadolinium injection) confirmed the presence of a mass lesion in the petrous bone with contrast medium uptake which showed cystic areas within it: it also showed the absence of extension through the dura mater by the intracranial component which remained extradural. It confirmed the patency of arteries and veins, so enabling a differentiation to be made between histiocytosis X and advanced glomus tumours.

Adolescent↗
PubMed1993

Magnetic resonance imaging evaluation of lower limb muscles during bed rest--a microgravity simulation model.

Head-down (-6 degrees) bed rest, a microgravity simulation model in humans, leads to muscular atrophy of the lower limbs. Magnetic Resonance Imaging (MRI) at 0.5 tesla was performed at 1 year intervals on the same six volunteers (except one) before and after 1 month bed rest. Three of the six subjects were daily exposed in a lying position to LBNP (lower body negative pressure), a countermeasure to cardiovascular deconditioning (LBNP group). The groups were exchanged the second year. After bed rest, the quadriceps of the thigh lost uniformly 11% of its cross section area (CSA) and the triceps of the leg 10.5%, with 12.8% lost from the deeper soleus versus 8.5% from the gastrocnemius (p < 0.05). LBNP produced no effect on these changes. The MRI signal intensity of muscles exhibited a trend toward higher values after bed rest although without statistical significance. MRI allowing for noninvasive and reliable quantification of muscle fibers of the lower limbs is an excellent procedure for the assessment of muscle disuse and countermeasures.

Adult↗
PubMed1992

Experimental focal cerebral ischaemia assessed with IVIM*-MRI in the acute phase at 0.5 tesla.

Intravoxel incoherent motion (IVIM*)-MRI has been performed on a clinical system at 0.5 tesla with a b gradient factor of 100 s/mm2, in a feline focal model of cerebral ischaemia. Images were obtained in 26 cats from less than 1 hour and up to 7-12 hours after stroke. The apparent diffusion coefficient (ADC) was decreased at the site of injury when compared to the contralateral normal side, by 30% in the first, 33% in 1-2 h and 27% in 2-4 h; it increased at 7-12 h, when vasogenic oedema occurred. IVIM*-MRI demonstrated early changes, due to cytotoxic oedema, during the acute phase of cerebral ischaemia to which conventional T2-weighted spin-echo imaging was not sensitive.

Animals↗
PubMed1992

[Neuro-imaging studies in migraine].

Neuroimaging studies in migraine patients are useful for three important reasons. 1) Brain imaging techniques and primarily CT-scan should be used in every patient with atypical or complicated migraine to rule out a vascular malformation or brain tumor; 2) angiography, which was extensively used in the 1960's and 1970's, discloses a number of arterial anomalies including spasm or occlusion, of unclear pathogenic significance; 3) T2-weighted magnetic resonance images in migraine often show increased signals generated by the white matter; this finding is as yet poorly understood but is undoubtedly related to factors very different from those seen in elderly patients or patients with vascular risk factors.

Adult↗