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Biomedical subjects

G Rodesch

Publications and source records attributed to G Rodesch.

At least 73 records · Page 4Linked to original sources
PubMed1990

Neuroradiologic findings in leptomeningeal carcinomatosis: the value interest of gadolinium-enhanced MRI.

Four patients with leptomeningeal metastases documented by neuroradiological examinations are reported. All had central nervous system or systemic neoplasms and showed clinical signs of carcinomatous meningitis. Gadolinium-enhanced MRI (Gd-MRI) disclosed for each patient pathological foci, allowing delineation of the extent of meningeal disease. Although non-specific, these findings, combined with the clinical context and CSF analysis, may lead to a rapid diagnosis and treatment of carcinomatous meningitis, even when malignant cells are not detected in the cerebrospinal fluid.

Adult↗
PubMed1990

Embolisation of the ophthalmic artery branches distal to its visual supply.

A study of the embryology and the anatomy of the ophthalmic artery shows that the branches to the important sensory structures arise proximal to the second intraorbital segment of the vessel. Damage to vision will be avoided if embolisation is restricted to vessels anterior to this "safety point", which is easily recognised on an angiogram. The ideal point of injection of emboli is even more distal and varies with the extent of the lesion and the material used. Three cases are described with vascular lesions supplied by the ophthalmic artery and embolised with Histoacryl.

Adult↗
PubMed1990

Revascularization of brain arteriovenous malformations after embolization with bucrylate.

Between 1984 and 1988, 52 brain arteriovenous malformations (AVMs) were embolized in the Radiology Department of the Toronto Western Hospital. 9 were localized in the occipital lobe. There was angiographic follow-up ranging from one to four years. Two embolized AVMs, both occipital, showed revascularisation at 6 months and two years respectively. In one case the embolization had resulted in a complete obliteration of the AVM. In the other, the nidus was reduced by 95%. It is suggested that the occipital lobe, because of its rich vascularity, is more prone than other parts of the brain to produce intense collateralization leading indirectly to resupply of embolized AVMs. Existence of these collaterals may also explain the rarity of visual defects in occipital AVMs. These cases confirm the need for post therapeutic angiographic controls to assess the stability of the results obtained.

Adult↗
PubMed1990

Argyrophilic breast carcinoma, single metastasis to the pituitary gland.

Five years ago, a 44 year-old woman presented with an apparently localized cancer of the right breast, initially treated by surgery, adjuvant chemotherapy and radiotherapy. After a 4 year disease-free interval, she developed bi-temporal hemianopsy, due to a suprasellar tumor causing compression of the optic chiasma. The tumor was resected by the transsphenoidal route and histological examination revealed neuroendocrine characteristics described as "argyrophilic breast carcinoma". The exceptional association of this peculiar histology for breast cancer with a rare pattern of recurrence (single pituitary metastasis) is worthwhile reporting.

Adult↗
PubMed1989

Nervous system manifestations and neuroradiologic findings in acquired immunodeficiency syndrome (AIDS).

We report a series of thirteen patients with nervous system complications out of a total of thirty AIDS patients admitted to our hospital over the last two years for which CT and/or MRI have been performed. Five were homosexual men and eight patients (5 men, 3 women) were of African origin (Zaïre and Rwanda) (n = 5) or had had sexual intercourse with the local African population (n = 3). The nervous system complications encountered included: toxoplasma gondii brain abscess (2 patients); cryptococcus neoformans meningitis + toxoplasmosis (1 patient); toxoplasmosis + lymphoma (2 patients); progressive multifocal leucoencephalopathy (1 patient); lymphocytic meningitis or encephalitis (3 patients); lymphoma (1 patient); polyradiculoneuritis (3 patients). Three of thirteen patients had multiple intracranial abnormalities: one had concomitant intraparenchymal toxoplasma abscess and cryptococcal meningitis; in one patient a lymphoma developed after the successful medical treatment of a toxoplasma abscess; conversely, one patient developed a toxoplasma abscess two years after mediastinal radiotherapy for a systemic non-Hodgkin lymphoma. In conclusion, in our experience, nervous system toxoplasmosis is the most frequent AIDS related CNS complication. Our series demonstrates the high frequency of a second neurological disease occurring either concomitantly or separately. In these cases, while CT may readily identify the intracranial abnormalities, it contributes little towards an etiological diagnosis. Finally, our series illustrates the importance of a central African endemic focus for AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Gd-DTPA-enhanced MR in thoracic disc herniations.

The Gd-DTPA-enhanced magnetic resonance findings in two patients with herniated thoracic intervertebral discs are reported. The first patient was a 56-year-old woman with a small subligamentous T6-7 disc herniation, slightly lateralized to the right. The second patient was a 51-year-old man with a central and right posterolateral disc herniation, including a large calcified fragment, at the T8-9 level. The nonenhanced MR examination revealed the presence of an extradural mass lesion in both patients, impinging upon the dural sac and compressing and displacing the spinal cord posteriorly. The lesion was slightly hypointense on both T1- and T2-weighted spin echo sequences. Following intravenous injection of Gd-DTPA in a dosage of 0.1 mmol/kg body weight, enhancement of the posterior longitudinal ligament was noted and triangular areas of contrast uptake were seen to occur in the epidural space above and below the herniated disc. At surgery, they were found to correspond to dilated and congested epidural veins.

Contrast Media↗
PubMed1989

Vein of Galen aneurysmal malformations. Report of 36 cases managed between 1982 and 1988.

The authors report a series of 36 vein of Galen aneurysmal malformations (VGM) diagnosed in the paediatric (78%) and adult (22%) populations that were referred to them for therapeutic management between 1982 and 1988. The clinical signs leading to the diagnosis were variable: 36% of systemic manifestations, 22% of neurological symptoms, 17% of hydrocephaly and 11% of intracranial haemorrhage. 30 angioarchitectural analyses could be obtained and allowed to classify these VGMs into 5 different types: 44% parenchymatous AVMs, 20% mural AVFs, 30% choroidal arteriovenous fistulas, 3% dural AVFs, 7% vein of Galen varices. This series demonstrates that the paediatric population is most sensitive to shunt effect whatever its type. Systemic manifestations and hydrocephaly are the most common signs encountered in the newborn and infants; whereas neurological signs and symptoms and haemorrhage belong mostly to the adult symptomatology. Because of the poor outcome of VGMs, all authors believe that these malformations have to be treated aggressively. However, we found contra-indications to be represented by pretherapeutic demonstration of cerebral tissue damage, or uncontrollable systemic failure, thus treatment is indicated to compensate for cardiac failure previously responding (even partially) to medical treatment. Secondly, appearance of sub-cortical calcifications, resistance to medication or clinical deterioration will also lead to urgent treatment. The endovascular method represents at present the best treatment with an overall low mortality (13%) and a 0% technical morbidity in children compared to the surgical one of (91% mortality in newborns and 38% in infants). The results achieved by embolization in this series were as follows: 27% satisfactory results with complete or almost complete occlusion of AV Shunt, 53% significant clinical improvement, 7% of patients were unchanged. The authors believe fundamentally that these patients (specially those belonging to the paediatric population) have to be treated in a centre where a paediatric intensive care unit, neurological, neurosurgical and surgical neuro-angiographic departments coexist, in order to assure the best possible management of these children.

Adolescent↗
PubMed1989

The trans-cerebral veins: normal and non-pathologic angiographic aspects.

The trans-cerebral v. have long been described, but there is little or no knowledge of their function and dysfunction. They are the site of fundamental interchange across the blood-brain barrier, a unique process within the organism. Two systems can be structurally distinguished: the venous system draining the white matter and the trans-cerebral anastomotic system. The former seems to be associated with the nutrition and drainage of the parenchyma, and is rendered visible at angiography by anatomic variations based on developmental venous anomalies. The anastomotic trans-cerebral ventriculo-cortical system seems concerned with the regulation of reabsorption of the cerebrospinal fluid. It is visualized only in exceptional situations where an increased flow (arteriovenous shunt) is combined with obstruction of the normal routes of venous drainage and collateral circulation. It usually functions in the ventriculo-cortical direction. No specific dysfunction of this system is currently recognized.

Cerebral Angiography↗
PubMed1989

Global aphasia without hemiparesis following prerolandic infarction.

Acute global aphasia without hemiparesis (GAWH) is said to result from the association of 2 separate lesions in the anterior and posterior left hemisphere language areas. We present 2 unusual cases of GAWH whose CTs revealed only a single lesion of the posterior part of F2 and F3. There was good recovery of verbal communicative abilities. Functional disconnection of posterior language areas seems responsible for this syndrome in such cases.

Aged↗
PubMed1989

Gd-DTPA-enhanced MR imaging of spinal tumors.

Forty-eight Gd-DTPA-enhanced MR examinations of the spine were performed in 40 patients referred for MR because of clinically suspected spinal tumor or for further evaluation of an expanded cord. The study group consisted of 32 patients with spinal tumors (seven ependymomas; seven astrocytomas; four hemangioblastomas; two arteriovenous malformations; two unidentified intramedullary neoplasms; four meningiomas; and single cases of metastatic breast carcinoma, cavernous hemangioma with associated hematomyelia, neurinoma, angiolipoma, drop metastasis from medulloblastoma, and epidermoid with diastematomyelia). In the remaining eight patients, other diagnoses were established: thoracic disk herniation (two patients), lumbosacral meningocele (one), syringomyelia secondary to arachnoiditis (four), and expanded cord secondary to gliotic tissue (one). All but two diagnoses were proved histologically by biopsy, surgery, or autopsy; in the two patients with arteriovenous malformations, the definitive diagnosis was made by spinal angiography. Contrast enhancement occurred in 30 of the 32 spinal tumors, and Gd-DTPA-enhanced T1-weighted images proved helpful in defining and outlining intra- and extramedullary spinal neoplasms. All ependymomas and astrocytomas (including low-grade astrocytomas) enhanced. In meningiomas, an immediate and uniform contrast uptake was demonstrated. Additional advantages of Gd-DTPA MR include the differentiation of solid tumor components vs syrinx or cyst or pseudotumoral areas of cord expansion, and the differentiation of residual or recurrent tumor from scar tissue in postoperative patients. Our results suggest that IV-injected Gd-DTPA improves MR sensitivity and specificity in the evaluation of spinal lesions.

Astrocytoma↗
PubMed1989

Treatment of vein of Galen aneurysmal malformation.

The authors report the case of a vein of Galen aneurysmal malformation in a 1-year-old baby presenting with an enlarging head. The lesion was a direct arteriovenous fistula in a dilated vein of Galen and was treated by complete embolization in one session. Four months after occlusion of the shunt, the ectatic vein of Galen and torcular were normal, and the head circumference had stabilized. This case serves as an opportunity to emphasize the quality of results that can be obtained with endovascular techniques. Proper analysis of the vein of Galen angioarchitecture allows planning for appropriate treatment with the lowest possible risk of morbidity and mortality.

Cerebral Angiography↗
PubMed1989

[Benign pulsatile cranial bruit in children. Apropos of 6 cases].

The authors report a series of 6 patients aged 8-25 months, without any intracranial vascular pathology, presenting with an objective intracranial bruit associated with visible veins in the naso-orbital region. These bruits, frequent in children between 4 months and 5 years, become rare when patients grow older and disappear in adulthood. Naso-orbital veins are frequently normally detected until the age of 3 years. An intracranial bruit and visible facial veins may be clinical signs indicative of an underlying intracranial vascular malformation (IVM). Enhanced CT scanning should be performed when these two symptoms are associated. If the scan is abnormal, a selective angiography should be performed.

Brain↗
PubMed1989

[True and false cerebral venous malformations. Venous pseudo-angiomas and cavernous hemangiomas].

The authors report their classification of venous anomalies and abnormalities within the central nervous system. The so-called venous angiomas are developmental venous anomalies (D.V.A.). The different forms encountered express the extreme variations in the transcerebral venous system. Their symptomatic character depends on the aging changes that the cerebral venous system undergoes or the frequent association of D.V.A. with cavernomas of the central nervous system. The cavernous hemangiomas are true tumors that present a proliferative character. They are localized in the dura or in the extradural space intracranially or at the spinal level. They must be considered as tumors and can be seen at angiography as they present a fine parenchymatous stain. The cavernomas of the central nervous system are true vascular malformations of the venous type; they are locally multiple, but can also be disseminated within the intracranial space. Some familial forms have been reported. They are often associated with D.V.A. They have a high bleeding potential, which does not carry a high morbidity or mortality incidence. However, the natural history of this lesion is poorly known at present. The spinal cord posterior fossa and paraventricular localizations present probably the least favorable localizations. Only the cavernomas deserve to belong to the vascular malformation group. The same comments and observations apply to spinal cord venous lesions.

Brain Neoplasms↗
PubMed1988

[Intracranial arteriovenous vascular lesions in children. Role of endovascular technics apropos of 44 cases].

The clinical and radiological files of 44 children with intracranial arteriovenous malformations (AVM (20 AVMs with ectasia of the vein of Galen, 21 parenchymatous or choroid AVMs without ectasia of the vein of Galen and 3 congenital dural AV fistulas) were reviewed. Clinical symptoms, architecture and the used therapy are analyzed. The only specific features of the pediatric population are the clinical systemic manifestations. In comparison to the adult population, a higher percentage of multiple lesions (20%), mostly direct AV fistulas were observed and conversely less associated arterial ectasias. Because of the high mortality associated to the natural history of these lesions in children, one must look for a complete and stable disappearance of the lesion. Among the therapeutic modalities available, embolization has proven a precise and efficient treatment. As the sole treatment, anatomic cure was obtained in 16.6% of patients; significant clinical improvement was obtained in an additional 50% of patients. The morbidity of the technique is low: 3.1% of neurologic complications (all being transitory). Embolizations associated to surgery achieved 3 more anatomic cure. The use of all these combinations allowed us to reach 79.2% of very good results (30.4% of anatomic cure). 3 cases of vein of Galen aneurysms died in our series (newborn during open surgery, one child 24 hours after thrombosis of the vein of Galen by endovascular means, a third one (newborn) one week after partial embolization as a defavorable outcome of major cardiac and hepatic insufficiency.

Adolescent↗