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H Loiseau

Publications and source records attributed to H Loiseau.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Chronic bilateral subdural hematomas].

BACKGROUND AND PURPOSE: Are chronic bilateral subdural hematomas different from unilateral forms in terms of delay of diagnosis, clinical presentation and post-operative recovery or recurrence? METHODS: Etiological, clinical, and radiological aspects and management outcome of bilateral chronic subdural hematomas consecutively managed from 1990 to 1995 were retrospectively analyzed and compared with unilateral forms managed in the same neurosurgical unit during the same period of time. RESULTS: There were 236 cases. Bilateral subdural hematomas occurred in 41 patients (17.4%). A good outcome was obtained in 97.5% of the cases and morbidity was 14.6%. The differences significantly observed between unilateral and bilateral subdural hematomas were duration of the prediagnostic period, pneumatoceles and recurrence rates (12%). Recurrences were all observed during the first postoperative month and treated with the same initial standardized procedure. The rate of infection or epileptic seizures was low. CONCLUSIONS: There are few limited differences between uni- and bilateral chronic subdural hematomas. In the latter, a possible correlation between the duration of prediagnostic period and an increased rate of recurrence could be explained by poorer cerebral reexpansion. The overall prognosis of bilateral hematomas is comparable with that observed in unilateral forms. A simple and routinely used burr hole procedure either under local or general anesthesia associated with closed drainage is a safe surgical procedure for either bilateral or unilateral forms and can be performed in all the cases including recurrences. Systematic antiepileptic drugs or antibiotherapy are unnecessary in the medical management of chronic subdural hematomas. One late delayed postoperative clinical control seems to be sufficient.

Aged↗
PubMed1997

[Isolated involvement of the trigeminal nerve of sarcoidosis origin].

Sarcoidosic neurological manifestations are uncommon. Isolated cranial nerve's injury is exceptional. The authors report the case of a 29 year-old woman with a trigeminal nerve tumor. Surgery and anatomopathology led to the diagnosis of sarcoidosic infiltration. No other neurological or extra-neurological localization was found. Cranial fifth nerve injury was observed in 14 cases of the literature. In all cases, trigeminal nerve injury was described as associated with another disease's localization (neurological and/or extra-neurological). This observation seems unusual due to isolated nature of the presentation and complete resolution after surgery. This case illustrated the diagnosis and nosologic difficulties raised by granulomatous lesions, symptomatic or not, in the absence of systemic localization.

Adult↗
PubMed1997

[Acute vertigo caused by ischemia of the postero-inferior cerebellar artery or PICA. Apropos of 2 cases].

Based on two cases and a review of the recent literature, we would like to draw attention to the fact that a cerebellar infarction, localised to the territory of the PICA, can present with just a single clinical feature-acute rotary vertigo. Cerebellar vascular accidents remain a little known cause of acute vertigo, often masquerading as a peripheral vestibular disturbance. The main differential diagnosis is vestibular neuronitis. The prognosis is usually good, but the risk of a late recurrence or of a further cerebro-vascular episode is difficult to predict. This uncommon aetiology should not be ignored because of the risk of progression towards a sort of pseudo-tumoral infarct, in which the risk of a fatal outcome remains ever present. In most cases, however, sequelae are few or absent.

Acute Disease↗
PubMed1996

Amyloid angiopathy-related cerebellar hemorrhage.

BACKGROUND: The posterior fossa localization of amyloid angiopathy-related hemorrhage is very unusual. Less than 10 cases have been previously reported. Surgical management of amyloid angiopathy-related hemorrhage is the subject of controversy. RESULTS: Typical aspects of amyloid angiopathy were found within the surgically removed biopsies of 71-year-old nonhypertensive, nondemented woman suffering cerebellar hemorrhage. CONCLUSIONS: Amyloid angiopathy-related hemorrhage could occur in the cerebellum, and diagnosis might be suspected when no past history of mental deterioration and/or arterial hypertension are present and when angiography rules out vascular malformation. Surgical management seems to have the same restricted indications as in other brain areas.

Aged↗
PubMed1996

Primary Langerhans' cell histiocytosis of the central nervous system with fatal outcome. Case report.

An unusual case of primary parenchymal Langerhans' cell histiocytosis of the central nervous system is reported. The definitive diagnosis was obtained by ultrastructural detection of Birbeck granules and by immunohistochemical evidence of CD1a expression. Despite complete surgical resection, there was an early recurrence with multiple central nervous system metastases leading to a fatal outcome.

Adult↗
PubMed1996

[Prognosis of gliomas].

In a given patient harbouring a glioma, prognosis is simply a question of survival duration rather than projecting the course of illness. The marked variability among glioma patients is due to prognosis factors. That are currently divided into four broad categories: characteristics of the host, characteristics of the tumor, factors related to the influence of the tumor on the host and factors related to treatment. For astrocytomas the three factors most closely related to duration of survival are age, functional status and histological grading. Age is fundamental because it underlies histological grade, functional status, accessibility for treatment and therapeutical responses Histological grading can now be evaluated with features actually correlated with duration of survival. Clinical examination should be recorded using functional scales that more precisely reflect the influence of the tumor on the host than simple clinical signs. Morphological data provided by neuroradiology, such as correct localization or existence of a mass effect provide supplementary prognosis factors. The identification, knowledge and quantification of prognostic factors and their influence are important and useful for understanding the natural history of the disease, to predict the expected survival for individual patient and to evaluate the beneficial effects of treatments. In spite of much work dealing with gliomas, several questions remain to be answered. The role of treatments in grade II astrocytomas is, for example, matter of debate. In malignant gliomas, surgical resection could improve the quality of survival, radiation therapy the duration of survival and chemotherapy the rate of survivors at one and two years. However, many questions are still unanswered. The utility of data from the literature is limited, partly due to flaws in the application of statistical methods, and partly to wide differences in histological and clinical selection criteria. Progress in the field of glioma prognosis is more likely to emerge from purely biological tumor research than from clinical studies.

Glioma↗
PubMed1995

Differential expression of inducible nitric oxide synthase mRNA in human brain tumours.

Messenger RNA encoding the inducible form of human nitric oxide synthase (iNOS) was quantified by reverse transcription and polymerase chain reaction (RT-PCR) in tissue samples from glioblastomas and meningiomas. iNOS mRNA expression was considerably higher in the glioblastoma than in the meningioma specimens (mean +/- s.e.m., 41.18 +/- 11.5, n = 25, vs 5.31 +/- 0.98, n = 21; p < 0.0001). Moreover, iNOS expression appeared as a polymorphic character among glioblastomas, as individual tumours expressed either high (n = 6), intermediate (n = 10) or low (n = 9) levels of iNOS mRNA.

Base Sequence↗
PubMed1995

Low-grade astrocytomas: prognosis factors and elements of management.

BACKGROUND: The literature provides information concerning prognosis of low-grade astrocytomas, but the series are quite heterogeneous in terms of clinical material, neuropathological evaluation, and statistical methods of analysis. Therapeutical indications are poorly defined. The last World Health Organization (WHO) histological classification provided a very precise definition of low-grade gliomas. METHODS: Taking into account a recent study of our own and literature data, management guidelines of these tumors were proposed. RESULTS: Grade I (pilocytic and subependymal giant cell astrocytomas) are surgically curable lesions. No adjuvant treatment is mandatory. Management of grade II astrocytomas is less clear-cut. Conservative management is probably possible in young patients without functional threat. The role of surgery on duration of survival has been properly established in very few series and was negative in many others. The role of radiotherapy has been demonstrated in a few subgroups of patients. In our study of ordinary astrocytomas, considering decades of age at diagnosis, survival curve analysis established three prognostic classes of age (before 50, between 50 and 60, and after 60 years of age). Based on our results and on recently published data, a branch decisional approach was proposed for management of grade II astrocytomas. Other grade II gliomas exhibit more favorable prognoses but could be managed in the same manner. CONCLUSIONS: Ordinary grade II astrocytomas constitute a paradigm of difficult differential management. Further pertinent information on these tumors could come from the field of tumor biology, or be provided by very large and homogeneous groups of patients.

Astrocytoma↗
PubMed1995

Surgical treatment of an early epileptic encephalopathy with suppression-bursts and focal cortical dysplasia.

A case of early epileptic encephalopathy (EIEE) with suppression-bursts or Ohtahara's syndrome, associated with focal cortical dysplasia is reported. Infantile spasms and brief tonic unilateral seizures began on the fifth day of life. Interictal EEG demonstrated an asymmetrical "suppression-burst" pattern with no wake or sleep cycling. Seizures were refractory to all antiepileptic drug (AED) and steroid therapy. Magnetic resonance imaging (MRI) showed right frontotemporal cortical thickening. After three weeks of an ineffective medical treatment a preoperative evaluation with single photon emission computed tomography (SPECT) and electrocorticography (ECoG) was performed to characterize epileptogenic focus. Surgical resection of the precentral area was performed at age 1 month. Neuropathologic examinations confirmed diagnosis of focal cortical dysplasia by identifying cytoarchitectural disarray and ectopic neurons located deep in subcortical white matter. During follow-up, 1-year postoperative the child had a single febrile seizure. Neurologic examination showed minor developmental delay and slight left-sided weakness.

Age Factors↗
PubMed1995

Lymphoplasmacyte-rich meningioma in a child. Case report.

A rare case of lymphoplasmacyte-rich meningioma observed in a young girl is reported. The first clinical manifestations of the disease were seizures. Neuroradiological images favored the existence of a meningioma. Abnormalities in the patient's blood chemistry, principally including hypergammaglobulinemia and inflammatory syndrome, were associated with the disease. The tumor was histologically confirmed as meningioma with massive infiltrates of type B lymphocytes. The pathophysiology of the conspicuous lymphoplasmacyte infiltrates, responsible for peripheral blood abnormalities, has remained poorly understood. Alternative diagnostic hypotheses of masses that mimic this type of meningioma are discussed.

Brain Neoplasms↗
PubMed1995

[Supra-tentorial low-grade astrocytomas in adults. Prognostic factors and therapeutic indications. Apropos of a series of 141 patients].

An abundant literature provides informations upon the prognosis of supratentorial low grade (grade II) astrocytomas, but the series are quite heterogeneous in terms of clinical material, neuropathological evaluation and statistical methods of analysis. So, outcome, prognostic factors and therapeutical indications are poorly defined. A retrospective study of 141 adults patients suffering ordinary low grade astrocytoma diagnosed in our unit between 1978 and 1988 was conducted. A follow up of 5 years or more, since neuropathological diagnosis, was mandatory for inclusion. Endpoint of statistical analysis was duration of survival. Results were expressed after uni and multivariates analysis. Clinical and morphological features of our series were comparable to those previously reported in the literature. Median survival time was 52 months. Considering age at diagnosis, survival curve analysis showed highly significant differences (p < 0.0001) and established three prognostic classes of age (before 50, between 50 and 60, and after 60 years of age). Comparisons of survival curves showed significant statistical differences (p < 0.0001) according to pretreatment functional status. Analysis of a clinical condition using a functional scale is more powerful, from a statistical point of view, than an individual analysis of each constituting parameters. In this series a good correlation was found between functional status and age at diagnosis. Neurological deficit was more correlated to age than to tumor location. Multivariate analysis, using the Cox model, defined some parameters acting independently on duration of survival: fronto-parietal location (p < 0.0001), pretherapeutical functional status (p < 0.001), age at diagnosis (p = 0.001), deepseated or multicentric tumor, mass effect (p < 0.01), frontal location (p < 0.02), total surgical removal (p < 0.05). Non significant parameters were: radiotherapy, time before diagnosis, age of onset, sex, contrast enhancement on CT scan. Our results are in agreement with previously reported data confirmed literature data concerning prognostic factors characteristics of the host (age), characteristics of the tumor (location) and expressing the influence of the tumor on the host (functional status). Our series documented prognostic clinical forms of these tumors (function of age, of performance status, and of tumor location). Our results confirm the relative inefficacy of therapeutic weapons, considering the population as a whole, on duration of survival. Based on our results and on recently published data, a decision tree analysis was proposed for management of grade II astrocytomas.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1995

[Pseudo-tumoral lesions of multiple sclerosis].

Three patients underwent a cerebral biopsy for clinical and radiological features suggesting a brain tumor. In all cases, the lesion contained large pleomorphic astrocytes that might have led to the erroneous diagnosis of grade II astrocytoma. However, the presence of foamy macrophages, demyelination and the relative preservation of axons led to the definitive diagnosis of multiple sclerosis which was confirmed by the subsequent clinical course.

Adult↗
PubMed1995

[Significance of polyglucosan bodies in neuropathology. Clinico-pathologic study of seven cases].

Seven observations, having in common an accumulation of polyglucosan bodies in the nervous system, are reported. In 2 cases of adult polyglucosan body disease, characteristic polyglucosan bodies were found on the peripheral nerve biopsies, and also on the cerebral biopsy in one of these patients who was demented. The 5 other cases presented medically intractable temporal lobe epilepsy. Recovery was obtained by a temporal lobectomy in which a massive accumulation of polyglucosan bodies was discovered. These personal observations are discussed with regard to other conditions characterized by accumulation of polyglucosan bodies in the nervous system. The non specificity of these formations is emphasized.

Adult↗
PubMed1994

Glial and neuronoglial malformative lesions associated with medically intractable epilepsy.

In a large series of 116 cortical resections for treatment of medically intractable epilepsy, 10 glial hamartomas and 11 neuronoglial malformative lesions were found. Glial hamartomas were astrocytic in 3 cases, oligodendrocytic in 6 and mixed oligoastrocytic in 1. Neuronoglial lesions corresponded to "focal cortical dysplasia" in 6 patients and to "microdysgenesis" in 5 others. This study focuses on the various neuropathological presentations of these malformative epileptogenic lesions, and on correlations with neuro-imaging data.

Adolescent↗
PubMed1994

[Histopathology of 110 cortical resections for drug-resistant epilepsy].

Histopathologic findings in 110 cortical resections performed for medically intractable epilepsy are reported. The abnormalities observed in our series fell into seven categories: vascular lesions, tumors, non-vascular malformative lesions, focal accumulation of polyglucosan bodies, non infectious inflammatory lesions, hippocampal sclerosis, and mild non-specific lesions. There was no microscopic abnormality in 14 cases. Several patients presented a double pathology, most often an hippocampal sclerosis as one part of the dual pathology.

Anticonvulsants↗
PubMed1993

[Polysaccharide bodies: an unusual finding in a case of temporal epilepsy. Review of the literature].

Massive occurrence of polyglucosan bodies (PB) was found in the surgically removed temporal lobe of a 34 year-old woman presenting with complex partial seizures. The term of PB was proposed in order to group Lafora bodies (LB), corpora amylacea (CA) and Bielschowsky bodies (BB) on the basis of their biochemical similitude. A rigorous histochemical differentiation between these anomalies appears to be impossible at present. LB, BB and CA are mainly made up of glucose polymers i.e. polyglocusans. The pathway(s) leading from glycogen accumulation to PB formation is still unknown. PB are a hallmark of two diseases: Lafora disease and adult polyglucosan body disease. PB have occasionally been reported in rare cases of a variety of other neurological diseases. In all cases they were located within the neurons. This site characterizes Lafora bodies. BB are intraneuronal inclusions but restricted to neurons of the external pallidum. CA occur predominantly in the astroglia during the course of ageing. The significance of these structures depends on their regional distribution. The resemblance does not imply a common etiology for all conditions in which such bodies occur; it is probably due to the sharing of the final path in their causative pathway. Our case does not correspond to any of the classical diseases in which PB have been found. In our opinion, the patient exhibited a localized form of glycogen storage disease.

Adult↗
PubMed1992

Occurrence of polyglucosan bodies in temporal lobe epilepsy.

Massive occurrence of polyglucosan bodies (PBs) was found within the surgically removed temporal lobe of a 34 year old woman with complex partial seizures. This peculiar feature is very unusual in neuropathological examinations of epileptogenic foci. This patient could not be included in any of the classic diseases in which PBs are found. She exhibited a localised form of glycogen storage disease.

Adult↗