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H Desal

Publications and source records attributed to H Desal.

16 recordsLinked to original sources
PubMed2006

[Transarterial embolisation of intracranial dural arteriovenous malformations with ethylene vinyl alcohol copolymer (Onyx18)].

OBJECTIVE: To report our recent experience in transarterial embolisation of dural arteriovenous malformations (DAVM) using a new liquid embolic agent, Onyx18. PATIENTS AND METHODS: 6 patients were enrolled in this series. Clinical presentation was separated into 2 groups: aggressive (n=2), non aggressive (n=4). The DAVM was located at the superior sagittal sinus (n=1), at the transverse sinus (n=2), at the condylian canal (n=1), in the lesser sphenoid wing region (n=1), and in the tentorium region (n=1). The DAVM drained directly into a condylian or a cortical vein for three patients and into a venous sinus with cortical venous reflux for the three others. In this latter situation, the sinus was anatomically excluded from the normal brain venous drainage. RESULTS: A full brain angiogram including both internal carotid arteries, both external carotid arteries and ipsilateral vertebral artery, was performed before and after each treatment. The feeder chosen after a selective catheterisation for Onyx18 injection was always meningeal. Each treatment consisted of a single Onyx injection after one unique feeder catheterisation. Complete anatomical exclusion of the DAVM was achieved and demonstrated by the post treatment angiogram in all cases. There was no clinical complication after the treatment. CONCLUSION: Onyx18 used is a safe treatment for DAVMs. When its injection is performed in optimal conditions, it fills the total DAVM and its drainage vein or sinus after a single arterial feeder catheterisation.

Aged↗
PubMed2006

[Intracranial aneurysms presenting with ischemic stroke].

PURPOSE: To report four cases of patient with an acute ischemic event as a presenting symptom of a berry aneurysm. PATIENTS AND METHODS: One male and three female (aged range 38 to 65 years) patients were admitted for acute stroke. The neuroradiologic finding disclosed aneurysm thrombosis, inferior to twenty five millimetres in three cases. Lumbar puncture was done in one case and showed subarachnoid haemorrage. DISCUSSION: We will discuss the hypothesis leading to the mechanism of aneurysm thrombosis. Two theories will be presented: "hemodynamic" and "parietal" modifications. We will propose a management protocol for these patients with atypical presentation of intracranial aneurysms given the potential risk of rupture. CONCLUSION: The natural history of intracranial aneurysms is still not fully understood. Nevertheless, aneurym thrombosis may occur and lead to ischemic stroke.

Adult↗
PubMed2006

[Vertebrovertebral arteriovenous fistula diagnosis and treatment: report of 8 cases and review of the literature].

Vertebrovertebral Arteriovenous Fistula (V.V.A.V.F.) is a relatively rare entity. It may be an incidental finding or be detected in patients presenting with pulsatile tinnitus, cervical bruit, or vertebro-basilar insufficiency. It can be spontaneous but it most frequently is post-traumatic in etiology. The authors report 8 patients, 4 women and 4 men aged between 20 to 77 years, with 4 post-traumatic V.V.A.V.F. and 4 spontaneous V.V.A.V.F. that were seen over a 15 year period. Imaging work-up included Doppler US (n=4), MRI 9n=3) and angiography (n=8). Seven of 8 patients were treated successfully using an endovascular technique (5 with balloon occlusion, 1 with coil embolization and 1 using a mechanical maneuver), without complication or recurrence, except in one case. We compare our results with published reports from the literature and review the underlying pathology and management strategies of V.V.A.V.F.

Adult↗
PubMed2005

[The finding of incidental intracranial lesions with magnetic resonance imaging].

INTRODUCTION: Incidental findings on brain MRI are not rare since the development of MRI as a diagnostic and clinical research tool. STATE OF THE ART: Prevalence of cerebral incidental finding, based on research volunteers participating in studies, is estimated from 1.7 to 4 percent. The most frequently detected lesions are intracranial tumors (meningioma, arachnoid cysts, neuro-epithelial tumor) and vascular malformations. PERSPECTIVES: A better knowledge of the spontaneous outcome of incidental findings would allow adequate management of these patients. CONCLUSION: Clinicians should be aware of the outcome of incidental findings, to reassure patients or trigger a work-up if necessary.

Adult↗
PubMed2005

[MR-angiography of the head and neck vessels: technical considerations and clinical indications].

Magnetic resonance angiography (MRA) is a very valuable tool in the routine evaluation of patients with stroke syndrome. It provides powerful noninvasive imaging of the cervical and intracranial vessels allowing the detection and the diagnosis of vascular anomalies. MRA usefully supplements, during the same examination, the analysis by MRI of the cerebral parenchyma. We will describe the indications of the various techniques (MRA with and without injection of contrast media) and show the value, artifacts and limitations of MRA in atherosclerotic stenosis or occlusive disease and in arterial dissections. This noninvasive vascular assessment will depend on the initial therapeutic orientation. Within the framework of the hemorrhagic stroke, we will discuss the role and the interest of dynamic MR angiography in the tracking and control of intracranial aneurysms and also the contribution of this newer sequences with gadolinium injection in the detection of cerebral vascular malformations.

Aortic Dissection↗
PubMed2004

[Value of epidural blood-patches for the treatment of spontaneous intracranial hypotension].

OBJECTIVE: Spontaneous intracranial hypotension (SIH) is a rare syndrome. It is due most often to a spinal meningeal leak. Symptoms due to SIH are often difficult to treat and epidural blood-patch (BP) has been proposed. The aim was to evaluate the effects and the problems associated with lumbar blood-patch to treat SIH. STUDY DESIGN: Case series. PATIENTS AND METHODS: The diagnosis of SIH was made in six consecutive patients on clinical signs and radiological findings (CT-scan and MRI). A lumbar BP (L1-L2 level) was performed as soon as possible after diagnosis. A maximum of three procedures was allowed in case of failure of the initial BP. RESULTS: BP was effective and well tolerated for five patients (3 immediately after BP, 2 others patients needed 2 and 3 BP). In one patient, an incomplete response was observed and was related to a large CFS leak diagnosed by CT-myelogram. CONCLUSION: When the diagnosis of spontaneous intracranial hypotension is confirmed, a repeated blood patch lumbar procedure can be efficient to treat these patients.

Adolescent↗
PubMed2004

[Dural arteriovenous fistula. A rare cause of treatable dementia].

Dural fistulas are acquired arteriovenous shunts, accounting for 10-15p.cent of cerebrovascular malformations. Symptoms are commonly tinnitus or intracranial hemorrhage. Rarely, patients with dural fistulas can present with rapid cognitive impairment. We report two women with rapidly evolving dementia. Cerebral angiography revealed dural arteriovenous fistula, with retrograde drainage into cortical veins, related to thrombosis of both transverse sinuses. Intra-arterial and intra-venous endovascular approaches failed to cure the fistula. Venous embolization via a transcranial approach was required to occlude the fistula, leading to resolution of the symptoms. Dural arteriovenous fistulas may lead to dementia with diffuse white matter changes related to venous ischemia, and must be considered as a reversible cause of vascular dementia. A transcranial approach for venous embolization is sometimes required.

Central Nervous System Vascular Malformations↗
PubMed2004

[Diffusion, perfusion and activation functional MRI studies of brain arteriovenous malformations].

The management of Brain Arteriovenous Malformations continues to be challenged by a lack of understanding and control of pathophysiological processes implied in the clinical symptoms. New data from functional MRI with diffusion-weighted, perfusion-weighted and neuronal activation highlight abnormal brain areas near or remote to the AVM nidus. Moreover, these techniques are able to show hemodynamic and neuronal adaptative phenomena involved in brain plasticity. They reflect the instantaneous hemodynamic brain conditions that may help to correlate the clinical symptoms with the anatomical and functional substratum and to influence any invasive therapy.

Brain↗
PubMed2001

Aldosterone synthase (CYP11B2) gene polymorphism and cerebral white matter hyperintensities.

The association between aldosterone synthase (CYP11B2) gene polymorphism and white matter hyperintensities seen on cerebral MRI was studied in a population-based sample of 829 individuals aged 63 to 75 years. The T allele was associated with the risk of severe white matter hyperintensities. Compared with the CC genotype, the adjusted OR for severe white matter hyperintensities was 4.61 (95% CI, 1.46 to 14.55) for the TT genotype and 2.45 (95% CI, 0.81 to 7.46) for the TC genotype in men. This association was independent of hypertension.

Aged↗
PubMed2001

[Recurrent syncope and Chiari malformation].

Downward herniation of the cerebellar tonsils through the foramen magnum (Chiari I malformation) is usually revealed by head and neck pain, often associated with brain-stem or spinal cord disturbances. Syncopes are rarely reported and may be difficult to link to their cause when they occur alone. We report two cases with brief and repetitive syncopes revealing a Chiari I malformation. These manifestations may be attributed to transient compression of brain stem or vascular structures at the craniocervical junction, triggered by intracranial pressure increase, as they disappear after posterior fossa decompression.

Budd-Chiari Syndrome↗
PubMed2001

[Moyamoya disease: importance of the MRI-MRA combination and difficulties in management and follow-up in 7 cases].

PURPOSE: To point out the importance of both MRI and MR angiography for the diagnosis and follow-up of moyamoya disease. MATERIALS AND METHODS: We report seven cases. MRI was performed in the initial phase in three cases. MR angiography without conventional angiography led to the diagnosis in one case. Conventional angiography was performed in six cases. Follow-up MRI and MR angiography were obtained in two. RESULTS: The initial MRI revealed ischemic lesions in the sylvian territory in two cases, and a cerebral malformation in one, after-effect lesions in two, and cerebral atrophy and ventricular dilatation in one. Conventional angiography provided the diagnosis of moyamoya disease in all cases, associated with cerebral arteriovenous malformation in two. CONCLUSION: MRI and MRA should be performed for the diagnosis and follow-up of moyamoya disease.

Adult↗
PubMed2000

[Late cerebrovascular complications of cardiac transplantation].

The occurrence of stroke after the post-operative period of cardiac transplantation is a rare event, and the role of the cardiac transplant in these patients, who often have various vascular risk factors, is unclear. We reviewed the clinical records of 303 consecutive patients with orthotopic cardiac transplantation performed from March 1985 to December 1996 and selected those who developed a stroke over the first 2 months postoperatively, in order to evaluate the frequency and the mechanisms of late cerebrovascular complications. Four patients had presented cerebral infarct and two intracranial hemorrhage. The overall risk of late cerebrovascular complications was 2.6p.100 at 5 years. Ischemic stroke was related to cardiac embolus in one patient, lacunar infarction in another, and was of undetermined etiology in two cases. In addition to vascular risk factors prior to transplantation and the development of intracardiac thrombus, immunosuppressive therapy, the surgical procedure and cardiac rejection may play a role in the occurrence of stroke in such patients.

Aged↗
PubMed1999

[Symptomatic venous angioma. Report of a case].

We report a case of venous angioma revealed by seizure after a non hemorrhagic venous infarct. The initial neuroradiological work-up with CT scan, angiography and brain MRI evidenced the venous infarction with abnormal contrast uptake. The control MRI 3 months later showed clear involution of the venous infarct. Non-hemorrhagic venous infarction on venous angiomas are exceptional. Only 2 cases have been reported in the literature. Impaired venous drainage could be implicated.

Cerebral Veins↗
PubMed1997

Super-acute aseptic spondylitis as the first manifestation of round calcifying nucleopathy in a 77-year-old man. A case report.

STUDY DESIGN: This is a report of an unusual case of very late onset, symptomatic, round calcifying nucleopathy. OBJECTIVE: To describe this unusual case of calcifying nucleopathy in a 77-year-old man who had no previous back problems, but had a history of diffuse skeletal hyperostosis. SUMMARY OF BACKGROUND DATA: The resorption of calcifying nucleopathy associated with reactional spondylitis is a classic occurrence in children but is rare in adults. METHODS AND RESULTS: Spondylitis was diagnosed on the basis of pain, a transient Babinski's sign, and systemic inflammation. Radiographs, a bone scan, and magnetic resonance imaging revealed a large calcified nucleopathy of the T12-L1 disc associated with spondylitis of T12. The calcification disappeared within 3 weeks, and recovery was clinically and biologically complete after treatment consisting of only rest and analgesics. CONCLUSION: A diagnosis of resorption of a round calcifying nucleopathy is not to be excluded in the elderly patient. This event can mimic an infectious spondylitis clinically and biologically.

Aged↗
PubMed1997

[Direct carotid-cavernous fistula. Clinical, radiologic and therapeutic studies. Apropos of 49 cases].

MATERIALS AND METHODS: From 1977 to 1996, 49 direct carotido-cavernous fistulae were studied among the sixty some cases diagnosed over these 20 years. Five were caused by spontaneous rupture of an intracavernous aneurysm and the others were caused by trauma. RESULTS: The clinical presentation in 37 patients was exophthalmia with pulsating conjunctival hyperhemia and vascular murmur. Some cases had a neurological syndrome suggesting cavernous involvement. A bilateral presentation was observed in 2 cases. One patient had no ophthalmologic syndrome but had a vascular murmur. Prior to 1982, all patients were treated and cured by occlusion of the internal carotid after direct access via the neck using a 3 F Fogarty catheter. Since 1982, patients have been treated with the detachable balloon technique. The carotid was preserved in 16 cases. In one case, secondary thrombosis occurred due to major dissection. In one case, the size of the breach was too small for the balloon so a coil was used. In one other case, insertion of the guide wire and catheter was sufficient to occlude the fistula. There was one death during treatment due to fistula rupture and one partially regressive right hemiplegia which could not be explained. This patient also developed left hemiplegia two years later, again with no explaining cause. Cure was achieved in the other patients without sequellae. DISCUSSION: Direct carotido-cavernous fistulae due to rupture of an aneurysm or trauma are uncommon. When flow through the breach is minimal, vascular treatment may not be necessary unless clinical signs appear since this type of fistula heals spontaneously. In other cases, an endovascular balloon procedure is indicated. There are few complications. Embolization with coils or other devices should only be used in selected cases when the breach is too small for the balloon.

Adolescent↗