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F Proust

Publications and source records attributed to F Proust.

At least 37 records · Page 2Linked to original sources
PubMed1997

Tentorial edge traumatic aneurysm of the superior cerebellar artery. Case report.

The authors report an unusual case of a traumatic aneurysm of the right superior cerebellar artery (SCA). A 22-year-old woman presented with continuous headaches that appeared 15 days after she experienced closed head trauma as a result of a cycling accident. Computerized tomography scanning performed 3 months later showed a nodular lesion on the free edge of the tentorium, which mimicked a meningioma. The aneurysm was identified on magnetic resonance angiography, which showed the SCA as the parent vessel. The parent vessel was trapped, and the aneurysm sac was excised via right temporal craniotomy. Pathological examination of the sac revealed a false aneurysm. The patient's outcome was excellent. The pathophysiology of traumatic aneurysm at such a location suggests that surgery may be the treatment of choice.

Accidents, Traffic↗
PubMed1997

[Spontaneous thrombosis of cerebral arteriovenous malformation].

Complete disappearance of a cerebral arteriovenous malformation (AVM), 9 years after its discovery, is reported in a 45-year-old man. This unusual evolution was revealed by the onset of 3 seizures. CT scan and MR imaging eliminated any hemorrhage and carotid angiography showed the spontaneous thrombosis of the whole malformation. The evolution of the MRI signals demonstrates that seizures and the disappearance of the AVM were concomitant. It is suggested that the spontaneous thrombosis of the venous drainage caused the AVM disappearance with cerebral oedema responsible of seizures.

Epilepsy, Generalized↗
PubMed1997

[Intracranial meningioma in the elderly. Postoperative mortality, morbidity and quality of life in a series of 39 patients over 70 years of age].

UNLABELLED: The aim of this study was to assess the current morbidity and mortality in patients over 70 operated for intracranial meningioma. PATIENTS AND METHOD: We report a series of 39 consecutive patients (mean age: 73 y) operated for an intracranial meningioma over a period of 5 years (1990-1994). According to the Karnofski scale (KS), preoperative neurological status was inferior or equal to 70 in 21 patients (53.8%) and superior or equal to 80 in 18 (46.2%). All patients were followed up in order to precisely assess their post-operative condition and a computed tomographic scan (CT scan) was performed during the second semester of 1995 (mean follow-up 29 months). RESULTS: Operative mortality and permanent morbidity were respectively 7.6% and 10.3%. In 77% of this series, the KS score checked at the last follow up was 80 to 100 (good outcome). Poor outcome was defined by death or a postoperative (KS < or = 70, the principal cause being an hemorrhagic infarction. Three factors were predictors of poor outcome: poor preoperative neurological condition (KS < or = 70) (p = 0.07), location of the tumor on the base (p = 0.007), and the duration of surgery > 3 hours (p = 0.06). The logistical regression analysis showed that these three factors were independent. Tumor recurrence occurred in 5 (12.8%) of 39 patients. CONCLUSION: Preoperative KS is a prognosis factor, but a poor preoperative condition is not in itself a sufficient condition contraindicating surgery. The rates of operative mortality of 7.6%, and permanent operative morbidity of 10.3% can be given to patients and their families.

Aged↗
PubMed1996

Durable remission of a relapsing primary central nervous system lymphoma after autologous bone marrow transplantation.

A 30-year-old patient with a relapsing primary central nervous system lymphoma (PCNSL), was successfully treated with salvage chemotherapy and high-dose therapy including drugs that cross the blood-brain barrier followed by ABMT. Cerebrospinal irradiation was administered after hematological recovery. Six years after transplantation the patient is alive without evidence of recurrent disease with a good neuropsychological status. This result could justify further studies of aggressive management of PCNSL in relapse.

Adult↗
PubMed1996

[Lumbar interapophyseal septic arthritis. Apropos of 3 cases].

Septic arthritis of spinal apophyseal joint, seldom described, mainly concern the lumbar spine. We report three cases. Inflammatory lesions of the paravertebral soft tissues were associated in each case; an epidural abscess was present twice. Our three cases were due to Staphylococcus aureus. The initial clinical features were consistent with a spondylodiscitis. Imaging led to the correct diagnosis in all cases. According to our observations and several others of the literature: facet joint lesions are visible too late on plain films. Bone scintigraphy is sensitive, but not specific. CT scan and MRI are the most contributive investigations. A pathologic aspect of the paravertebral soft tissues is visible less than one week after the beginning of the symptoms on CT scan and MRI. Lesions of the facet joint are detectable as soon as the first week on MRI, and after 15 days of clinical course on CT scan. Epidural abscess, when present, is best shown by MRI as early as the first week. CT scan can guide percutaneous needle biopsies of the paravertebral abscesses or of the concerned facet joint.

Abscess↗
PubMed1995

Vasospasm diagnosis: theoretical and real transcranial Doppler sensitivity.

In 40 patients middle cerebral artery trunk (M1) flow velocity was recorded just before 54 carotid angiography in 54 cases exhibiting vasospasm after aneurysm rupture. Angiographic vasospasm distribution was studied; cases of symptomatic vasospasm were noted and were compared with transcranial Doppler data. Angiographic vasospasm was present in M1 in 41/54 carotid angiograms. Postulating that all the cases of M1 angiographic vasospasm should be identified by transcranial Doppler, the theoretical sensitivity of TCD was 76%. In this series however the real sensitivity of TCD in vasospasm diagnosis was only 70%: besides 13 cases where vasospasm was not present in M1 (mainly after ACoA Aneurysm rupture), TCD failed to identify 3 cases of M1 angiographic vasospasm. Vasospasm may not be located in M1 even when severe and symptomatic (4 cases in this series). Transcranial Doppler remains a mediocre tool for identifying vasospasm after anterior communicating artery aneurysm rupture (sensitivity: 55%). Its reliability is better after internal carotid aneurysm rupture (sensitivity: 72%) and excellent after middle cerebral artery aneurysm rupture (sensitivity: 93%). In order to test the drugs or methods used to prevent or combat vasospasm, angiography has to be considered when during the vasospasm risk period TCD does not demonstrate vasospasm in M1, either in patients in whom clinical deterioration is occurring without other obvious explanation, or in all patients.

Aneurysm, Ruptured↗
PubMed1995

Causes of morbidity and mortality after ruptured aneurysm surgery in a series of 230 patients. The importance of control angiography.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the causes of morbidity and mortality after surgery for ruptured aneurysms. METHODS: Two hundred thirty consecutive patients were studied. Initial hemorrhage volume and vasospasm were evaluated preoperatively with CT, transcranial Doppler ultrasonography, and angiography. Nimodipine infusion was started before surgery. Preoperative clinical status was evaluated according to Hunt and Hess grading criteria. Surgery was performed early in 186 patients (81%). Control angiography, transcranial Doppler ultrasonography, and CT were performed routinely after surgery. Hypodense areas revealed by control CT were related to intracerebral initial hematoma, vasospasm, postoperative thrombosis, or spatula hyperpressure. RESULTS: Clinical outcome was excellent or good (Glasgow Outcome Scale [GOS] scores of 1 or 2) in 176 patients (77%), 17 (7%) were disabled (GOS score of 3), and 37 (16%) were vegetative or dead. In patients in good condition (grades I to III) preoperatively (n = 200), 38 had an unfavorable outcome (GOS score of 2, 3, 4, or 5). The major cause of complication was postoperative thrombosis (42%). In patients in poor condition (grade IV or V) (n = 30), 27 had an unfavorable outcome. The major cause of complication was initial bleeding (66%). Vasospasm was responsible for delayed ischemic deficit in 9 patients (3.9% of the total population). CONCLUSIONS: Systematic angiography remains by far the best means for determining the cause of a poor postoperative course.

Adolescent↗
PubMed1995

[Stress-induced pituitary apoplexy in 2 phases].

A case of pituitary apoplexy occurring in the context of physical effort is reported. A 47-year-old man presented headache after a foot-race. Secondary visual deficit developed. On admission, bilateral cavernous sinus syndrome with bitemporal hemianopia was observed. The CT scan showed an enlarged sella eroded by an intrasellar soft tissue mass. Magnetic resonance imaging (MRI) confirmed the presence of the mass with peripheral enhancement following gadolinium injection. Decompression was carried out by transsphenoidal surgery. The microscopic study demonstrated infarction of the anterior hypophysis with peripheral tissular scarring. The post-operative outcome was characterized by visual recovery and anterior hypophyseal insufficiency. The possible pathophysiological mechanisms are discussed.

Endoscopy↗
PubMed1995

[Vasospasm after rupture of aneurysms of the anterior communicating artery. Sensitivity and specificity of transcranial Doppler].

This study was undertaken to determine the sensitivity and specificity of the transcranial Doppler (TCD) for diagnosis of vasospasm after rupture of anterior communicating artery (CoA) aneurysm. Results provided by 164 carotid angiograms and TCD measures were compared in 40 patients with CoA ruptured aneurysm. Twelve patients demonstrated a vasospasm on 22 angiographies. The distribution of angiographic vasospasm was 95.5% anterior cerebral artery (A1), 77.3% pericallosal artery (A2) and 59.1% middle cerebral artery (M1). A TCD velocity value equal or superior to 120 cm/sec was the criterion for TCD vasospasm on M1. The sensitivity of TCD on M1 for diagnosing vasospasm on M1 with high specificity (96.4%) was only 66.7%. A TCD velocity value equal or superior to 80 cm/sec, or superior to the homolateral TCD value on M1, was the criterion for TCD vasospasm on A1. The association of TCD criteria on A1 and M1 increased sensitivity to 83.3%, but specificity decreased to 75%. These results demonstrate that TCD is not yet efficient enough to diagnose vasospasm accurately when it is limited to A1. Moreover, the fact that vasospasm limited to A1-A2 was symptomatic in three patients suggests that angiography is still necessary to diagnose VS after CoA ruptured aneurysm.

Adult↗
PubMed1994

Vasospasm diagnosis: theoretical sensitivity of transcranial Doppler evaluated using 135 angiograms demonstrating vasospasm. Practical consequences.

The authors inspected 135 angiograms (A zero) demonstrating vasospasm (VS) after aneurysm (An) rupture. There were 54 anterior communicating artery (ACoA), 38 internal carotid artery (ICA) and 43 middle cerebral artery (MCA) ruptured aneurysms. VS was searched for on each A zero in distal branches of MCA (M2) proximal MCA (M1), ICA, anterior cerebral artery (A1) and pericallosal artery (A2). In each An group (ACoA - ICA - MCA) the theoretical sensitivity of transcranial doppler (TCD) was calculated postulating that when present (M1) or (M1 + ICA) or (M1 + ICA + A1) angiographic VS would be constantly and reliably recorded by TCD. If only M1 is insonated TCD sensitivity would be 54% after ACoA, 82% after ICA and 88% after MCA An rupture. If M1 and ICA are insonated TCD sensitivity would be 61% after ACoA, 95% after ICA and 88% after MCA An rupture. TCD sensitivity would be almost perfect with a reliable and constant A1 insonation but that hypothesis is today purely speculative. An additional A zero appears to be necessary to establish VS diagnosis, mainly after ACoA An rupture when a discrepancy is observed between normal TCD data and delayed clinical worsening.

Aneurysm, Ruptured↗
PubMed1994

[Multiple cerebral aneurysms disclosed by subarachnoid hemorrhage. Apropos of 60 cases].

In a series of 60 consecutive patients, 137 multiple aneurysms (An) were discovered after subarachnoid hemorrhage. Multiple An were mostly double (83 % of the patients). The incidence of middle cerebral artery An was 42 %, internal carotid artery An 25.5 %, anterior communicating artery An 15 %. Both angiography (A degree) and CT scan could identify the ruptured An in 56 cases or at least the side of the ruptured An in the remaining 4 cases. Among the routine A degree criteria used to determine which one of the An had bled the most reliable ones appears to be: the existence of vasospasm of the parent artery, the bigger size of the sac, the irregular wall of the sac. The incidence of rupture is the highest in anterior communicating artery An (16/21). When an An located on the polygon of Willis is associated to a distal An, the former ruptures in 17 cases/18. All ruptured An were treated during the first operative session. In 47 patients (78.3%) all the An, ruptured and asymptomatic, were treated during the first procedure or in one or two additional surgical sessions. In 13 patients (22.7%) for several reasons only ruptured An and asymptomatic An that could be reached via the same craniotomy were treated. There was no morbidity or mortality related to the surgical treatment of asymptomatic An.

Aneurysm, Ruptured↗
PubMed1992

[Diagnosis of vasospasm: comparison between arteriography and transcranial Doppler. A series of 112 comparative tests].

56 consecutive patients with ruptured aneurysm (An) were studied. The An localisation were: anterior communicating artery (ACoA) 26 cases, internal carotid artery (I.C.A.) 13 cases, Middle cerebral artery (M.C.A.) 11 cases, Pericallosal artery (P.C.A.) 4 cases, anterior cerebral artery (A.C.A.) 2 cases. Nimodipine infusion was started as soon as the diagnostic was established. Transcranial Doppler (T.C.D.) and angiography (A degrees) were performed at the arrival and 10 to 12 days after surgery. Surgery was performed in the 72 first hours after S.A.H. in 79% of the cases. 112 comparisons A degrees-T.C.D. were available. An A degrees vasospasm (V.S.) was assessed if the reduction of calibre was 25% or more, on T.C.D. V.S. was assessed if mean cerebral flow (M.C.F.) was equal to or more than 130 cm/sec. There were 15 cases of A degrees V.S. in 14 patients: 2 cases before surgery, 1 case before and after surgery in the same patient and 11 cases after surgery. D.T.C. exhibited 11 cases of V.S. at the level of M.C.A.; there were 11 true positive, 0 false positive, 97 true negative and 4 false negative. The diagnosis of V.S. was always correct with T.C.D. when A degrees V.S. was present at the level of M.C.A., it was not made when A degrees V.S. was restricted to the initial part of A.C.A. (A1) uni or bilaterally: 3/6 cases of ACoA. An rupture or to I.C.A.: 1/4 case of I.C.A. An. rupture.(ABSTRACT TRUNCATED AT 250 WORDS)

Aneurysm, Ruptured↗
PubMed1992

[Vasospasm, early surgery and nimodipine. A series of 120 consecutive cases of surgically treated ruptured aneurysm].

A total of 120 consecutive ruptured aneurysms (An) were managed according to a radio clinical investigation protocol. Preoperative evaluation included clinical grading (Hunt & Hess classification) (3 patients were Gr. I, 62 Gr. II, 27 Gr. III, 13 Gr. IV, 15 Gr. V) angiography (A degree) and C.T.Scan grading. Nimodipine infusion was started before surgery (1 mg/Kg/h). Surgery was performed from Day 0 to Day 3--Control A degrees and C.T.Scan were performed 10 to 12 days after surgery. Post operative C.T.Scan hypodensities were evaluated according to preoperative C.T.scan anc control A degrees. The outcome was evaluated according to the Glasgow Outcome Score (G.O.S.) and the causes of sequelae and decreases were listed according to vasospasm (V.S.), initial hemorrhage and post operative thrombosis (T.H.R.). The outcome was good or excellent in 95.4% of 65 Gr. I.II cases, in 85.9% of 92 Gr. I.II.III cases. Among the causes of disability or death only one case of diffuse severe V.S. was noted; besides that and according to our experience V.S. incidence was lower in this series (25%) than in our previous experience. It is stated that nowadays with Nimodipine treatment and early surgery V.S. is no more a problem.

Adolescent↗
PubMed1991

[A model for intracranial vasospasm in subarachnoid hemorrhage].

Cerebral vasospasm (V.S.P.) is a major complication of subarachnoid hemorrhage. In order to investigate this cerebral vasospasm, an intracisternal injection of autologous blood and topical application around the internal carotid artery was performed in the dog model. Thirty dogs were divided into five groups and a cerebral angiography was performed on D0, D2, D5, D7 and D9. In comparison with the control group (group 1), the angiography in group 2 (12 dogs) systematically exhibited severe V.S.P. In group 3 (intracisternal injection of venous blood: 5 dogs), the angiography exhibited no vasospasm at all. In group 4, a left frontoparietal flap was opened, allowing us to deposit blood around the carotid bifurcation. In these cases, a severe narrowing of cortical arteries was demonstrated. In group 5 (intracisternal injection of heparinated blood), no vasospasm was observed. These findings suggest that the vasospasm involves the circle of Willis' as well as the cortical arteries.

Animals↗
PubMed1989

[First transplantation of embryonic serotonergic neurons in primate spinal cord].

Three adult monkeys (Macaca fascicularis) underwent a total section of the spinal cord at thoracic level (T6). 1 week later, two of them received at T8 level an injection of a cellular suspension prepared from the raphe region of a foetal macaque 39 days old. The third animal received one injection of buffer solution. 1 month later, the animals were sacrificed, and their spinal cord was processed for the immunocytochemical detection of serotonin with light and electron microscopy. Serotonergic neurons had survived after transplantation, and had grown axons and dendrites. Afferent and efferent synapses to serotonergic neurons were readily identified.

Animals↗
PubMed1988

[Rupture of the rotator cuff. Quantification of indirect signs in standard radiology and the Leclercq maneuver].

The roentgenograms and the "Leclercq's manoeuvre" of 105 patients who had a shoulder arthrography were reviewed. We differentiated two groups: One with a rotator cuff tear. The other without a rotator cuff tear. The space between the acromion and the head of the humerus was measured on rotation zero degree and external rotational roentgenograms. When the acromio-humeral space was less than 8 mm, it was always correlated with a rotator cuff tear (specificity = 1). If at least tow of the following signs were present, there was in most cases a rotator cuff tear (specificity = 0.96): Sclerosed acromion. Spur of the acromion. Cystic changes around the greater tuberosity. Rounded tuberosities. Inferior gleno-humeral spur. The "Leclercq's manoeuvre" was considered positive either when there was an acromio-humeral space narrowing compared with the other side, or when there was an upward subluxation of the head of the humerus. When positive there was always a rotator cuff tear (sensibility = 0.7; specificity = 1).

Arthrography↗