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Biomedical subjects

G Rancurel

Publications and source records attributed to G Rancurel.

At least 55 records · Page 3Linked to original sources
PubMed1995

Direct transposition of the distal cervical vertebral artery into the internal carotid artery.

From January 1979 to December 1991, 92 revascularizations of the V3 segment of the vertebral artery were performed in 91 patients through a direct transposition of this artery into the internal carotid artery (ICA). These cases represented 15.1% of 610 vertebral revascularizations and 38.8% of 280 distal vertebral revascularizations performed during this period at our institution. The sex ratio of this population was 0.59, and the mean age was 59.4 +/- 13.2 years (range 14 to 82 years). Preoperative ischemic symptoms were vertebrobasilar in 87 (94.6%) cases, exclusively hemispheric in one (1.1%), and absent in the remaining four (4.3%). One of these four patients had asymptomatic severe multivessel occlusive disease and three others underwent resection of a spinal tumor involving the vertebral foraminal canal. In 31 (33.7%) cases significant carotid occlusive disease was also present. The distal V3 segment of the artery was directly transposed into the ICA in all cases in this series. In 24 (26.1%) cases the ICA was endarterectomized during the same operation. There were no deaths or strokes in this series but there were two (2.2%) transient ischemic attacks-one vertebrobasilar and the other hemispheric. However, eight (8.7%) transposed vertebral arteries were totally occluded at early follow-up. At 1 month, among the 87 patients with vertebrobasilar insufficiency, 44 (50.6%) were cured, 31 (35.6%) were improved, and 12 (13.8%) remained unchanged. Among the 12 who were unchanged, eight (66.7%) had occlusion or stenosis of the distal transposition at the time of discharge. At 5 years, the primary patency rate in the series was 89.1% +/- 7.2%. At the time of the last follow-up, among the 87 patients with vertebrobasilar insufficiency, 50 (57.5%) were cured, 25 (28.7%) were improved, two (2.3%) had remained unchanged since the operation, two (2.3%) suffered a relapse, and eight (9.2%) exhibited vertebrobasilar symptoms of varying severity and therefore could not be considered improved. Direct transposition of the V3 segment of the vertebral artery into the ICA is a simple, safe, and reliable technique for revascularization of the distal cervical vertebral artery.

Adolescent↗
PubMed1995

[Unilateral benign episodic mydriasis].

Ophthalmoplegic migraine is a rare phenomenon. In this setting, extrinsic as well as intrinsic fibers of the third nerve are involved. We report 2 cases of isolated, unilateral, remitting, mydriasis and describe 23 other cases already published. CT scan, MRI and angiogram were always normal when performed. The pathophysiology of this syndrome is probably related to a migrainous manifestation.

Adult↗
PubMed1995

[Bilateral occlusion of the internal carotid arteries. Analysis of a series of 19 patients].

The natural history of patients suffering from bilateral internal carotid occlusion is poorly known. We report a study of 19 patients presenting such a vascular condition as demonstrated by angiography. In all our cases, cardio-vascular risk factors were frequently found. Smoking was particularly frequent and present in 18 patients (95%). Presenting neurological episodes included either transient ischemic attack (8/19) or stroke (9/19). Associated arterial lesions were diffusely distributed on the other cerebral vessels, frequently involving the extra-cranial part of the vertebral arteries. Collateral circulation feeding the intracranial carotid system mainly, or exclusively, originated from the vertebro-basilar system. Ischemic strokes were frequently detected by cerebral CT scan. They were located in the middle cerebral territory or at the junctions between 2 major cerebral arteries. A radiological aspect of cortical atrophy was noted in 9 patients among 19. Regional cerebral blood flow assessed by Xe133 inhalation was usually normal at rest (16/19), but hyporeactivity to acetazolamide was found in 10 patients among 19. The latter was more frequent in patients suffering from arterial hypertension or diabetes mellitus. Our results confirm that the patients suffering atheromatous bilateral occlusion of the internal carotid arteries may survive with minimal neurological deficits. Collateral circulation is mainly provided by the vertebro-basilar system allowing to frequently maintain normal cerebral blood flow at rest.

Aged↗
PubMed1994

[Vertigo of vascular origin].

The concept of vascular origin in vertigo and equilibrium disorders is only a pragmatic clinical tool used to initiate and direct complex, complementary clinical investigation to determine the location (peripheral, central or mixed), the pathophysiological mechanisms and the multiple etiologies of the vestibular disorder. The concept includes focal and systemic ischemic processes and haemorrhagic processes of the posterior fossa. If the vertigo is associated with central neurological signs, the method can lead to certain diagnosis. If such signs are not detected by neurological screening of all the intra-axial signs of the vertebrobasilar regions, the diagnosis is uncertain clinical. Screening associated CT scan and MRI is more reliable than neuro-otological quantification. The major diagnostic difficulty involves TIA. Vertebrobasilar appears to be more heterogeneous than carotid ischemia. Schematic distinction is possible to differentiate thrombo-embolic from hemodynamic TIA. It is based on methodic clinical analysis and complementary investigations that are of unequal value.

Brain Ischemia↗
PubMed1994

Dementia in two histologically confirmed cases of multiple sclerosis: one case with isolated dementia and one case associated with psychiatric symptoms.

During the past 10 years, considerable attention has been devoted to cognitive impairment in multiple sclerosis. Occasionally this impairment may be so severe that multiple sclerosis presents as a dementia associated with only minor neurological signs and symptoms. The cases of two women affected by multiple sclerosis who presented with a pure dementia are reported. In the first patient, a progressive apragmatic behavioural disturbance with reduced short term memory and learning abilities were the main clinical features. Neuropathological examination of the brain disclosed numerous plaques in the periventricular white matter, with severe atrophy of the corpus callosum. Plaques were also seen in the white matter of both hippocampus and in the columns of the fornix. The impairment of short term memory could be linked to these lesions. Behavioural changes were probably related to the bilateral lesions of the long associative bundles that disconnected the frontal lobes from other parts of the cerebral hemispheres. In the second patient, visual hallucinations were associated with cognitive dysfunction. MRI showed large plaques in the white matter of both left frontal and temporal lobes. Smaller plaques were also present in the periventricular white matter of the occipital lobes, the nature of which were confirmed by a stereotactic biopsy.

Adult↗
PubMed1994

Alphabetical paragraphia in a limited middle cerebral artery stroke.

A Yugoslavian perfectly bilingual for French and Serb had a limited left middle cerebral artery stroke. He developed a peculiar dysgraphia characterised by the use of Latin characters (French spelling) to transcribe Serb phonemes that would normally have been spelt in the Cyrillic alphabet. This dysgraphia was likely to be due to an impairment of the allographic procedure. It is concluded that allographs of the two alphabets are produced concomitantly in bialphabetical patients during the allographic procedure.

Agraphia↗
PubMed1994

The phenotype of "pure" autosomal dominant spastic paraplegia.

We studied 23 families with "pure" autosomal dominant spastic paraplegia. Examination of 142 at-risk individuals allowed identification of 70 patients, including 12 who were clinically affected but unaware of symptoms. The frequency of lower limb muscle weakness, decreased vibration sense, hyperreflexia in the upper limbs, and sphincter disturbances increased with the disease duration. The distribution of age at onset was unimodal, with a mean onset of 29 years (range, 1 to 68). The clinical manifestations of "early-onset" (< 29 years) and "late-onset" (> 29 years) patients were not significantly different. Age at onset varied as much within families as among families; anticipation and imprinting did not occur. No clinical criteria allowed differentiation among the families studied. Only linkage studies can provide accurate classification of this disease.

Adult↗
PubMed1994

[Intracerebral extension of cervical paraganglioma].

A large paraganglioma invaded the neck and skull, with extension into the right supratentorial cerebral hemisphere through the calvarium. Immunohistological markers were found useful for the diagnosis. The patient died rapidly. Despite no evidence of metastasis, the usually benign paraganglioma can have a malignant course.

Brain Neoplasms↗
PubMed1994

[Amnestic syndromes and confabulation in infarction of the posterior cerebral artery area].

The Posterior Cerebral Artery (PCA) supplies the greatest part of the limbic system. Several authors have reported amnestic syndromes in PCA infarcts. Amongst 76 patients with a CT proven PCA infarct, 21 suffered anterograde amnesia. Confabulations were associated in 5 cases. We studied CT scans according to previously reported templates in the 21 amnestic patients: all patients with confabulations had a paramedian or a tuberothalamic infarct associated with a cortical infarct within the superficial territory of the PCA. None of the 16 remainders had a thalamic lesion. These results emphasize the role of the thalamus especially of the dorsomedial nucleus in the pathogenesis of confabulation. The underlying mechanism could imply fronto-cingular deafferentation.

Adult↗
PubMed1993

[Verbal fluency and EEG coherence in Alzheimer's disease].

EEG coherence of 16 derivations and a verbal fluency test were evaluated on 25 ambulatory patients suffering from Alzheimer's disease (age: 74 +/- 5.7). The aim of the study was to analyze coherence rate variations from different cortical areas in relation to the performance in the test. Coherence rates of each derivation with the other ones were calculated for four frequency bands from 0.5 to 13.5 Hz. Arithmetic averages of these rates were then calculated to obtain scalp averaged coherence rates. The patients were submitted to a verbal fluency test and divided into two groups according to their test score as compared to normative data: impaired (n = 10) and not impaired (n = 15). Results showed that averaged coherence rates of theta and alpha 1 frequency bands were significantly depressed in the impaired group in comparison with those of the not impaired group. Two cortical areas were concerned with this difference, the left temporo-occipital and frontal zones, in an independent way for the same subject. Moreover, we observed that the patients who where impaired in the verbal fluency test, also presented a significantly greater ancientness of the clinical symptoms as compared to the not impaired patients.

Aged↗
PubMed1993

Aneurysm of the interventricular membranous septum with thrombo-embolism--an indication for surgical repair?

A 40-year-old woman with a significant neurological history presented with right hemiparesia, paraesthesia of the right upper member and of the hemiface. Computer tomography scanning revealed hypodensity along the right lateral ventricle which corresponded to the left hemiplegia which had developed when she was 20 years old. Arteriography of the four cervical axes was normal. Echocardiography visualized an aneurysm of the membraneous septum free of thrombosis without ventricular septal defect. The embolism was thought to be of cardiac origin and a decision was taken to correct it by surgery. Ten years after surgical repair no other neurological event has occurred.

Adult↗
PubMed1992

Fatal familial insomnia: clinical and pathologic study of five new cases.

In 1986, we reported two anatomoclinical observations of a familial condition that we called "fatal familial insomnia" (FFI). We now present the pedigree as well as the clinical and neuropathologic findings in five new subjects. The pedigree includes 288 members from six generations. Men and women are affected in a pattern consistent with an autosomal dominant inheritance. The age of onset of the disease varies between 37 and 61 years; the course averages 13 months with a range of 7 to 25 months. Progressive insomnia (polygraphically proven in two cases); autonomic disturbances including hyperhidrosis, hyperthermia, tachycardia, and hypertension; and motor abnormalities including ataxia, myoclonus, and pyramidal dysfunction, were present in every case, but with variable severity and time of presentation. Sleep and autonomic disorders were the earliest signs in two subjects, motor abnormalities were dominant in one, and others had intermediate clinical patterns. Pathologically, all the cases had severe atrophy of the anterior ventral and mediodorsal thalamic nuclei. Other thalamic nuclei were less severely and inconsistently affected. In addition, most of the cases had gliosis of the cerebral cortex, a moderate degree of cerebellar atrophy with "torpedoes," and severe atrophy of the inferior olivary nuclei. One case also showed spongy degeneration of the cerebral cortex. We conclude that all the lesions were primary, and that FFI is a multisystem disease in which the different structures are primarily affected with different severity. The insomnia appears to correlate best with the major thalamic pathology. The possibility that FFI belongs to the group identified as prion diseases or diseases transmitted by unconventional agents is examined.

Adult↗
PubMed1991

Absence of aluminium in Alzheimer's disease brain tissue: electron microprobe and ion microprobe studies.

Brain tissue from the frontal cortex and hippocampal formation, taken at autopsy or biopsy from 7 patients with Alzheimer's disease, was studied by two methods of microanalysis. One case of Down's syndrome was also studied. Electron probe microanalysis of the frontal cortex and Ammon's horn of the hippocampus showed no aluminium in the various cell organelles, especially in the lysosomes, although some aluminium was found in a few contaminating dusts. Ion microscopy, a method of extremely high sensitivity, also showed the absence of an aluminium signal.

Adult↗