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J Bonnal

Publications and source records attributed to J Bonnal.

At least 19 recordsLinked to original sources
PubMed1998

[Heart rate variability and vagal syncope in the young adult].

Heart rate variability is a sign of sympathetic activity. The authors compared two study populations of young males aged 19 to 30 years: population T comprised 15 healthy volunteers who had two negative tilt tests, one under basal conditions and the other after a bolus of isoproterenol; population S comprised 12 patients without cardiac or other disease, who were followed up for malaise and in whom the basal tilt test was positive, confirming the vagal origin of syncope. Temporal and spectral (total power, low frequency 0.04-0.15 Hz, hight frequency 0.16-0.40 Hz) data was obtained concerning heart rate variability from 24 hour Holter monitoring. The main difference between the two study populations was in the temporal data over 24 hours especially with respect to the heart rate (T = 73.5 +/- 6.9; S = 65.4 +/- 6.2/min; p = 0.004) and the percentage of successive R-R intervals varying by more than 50 ms (PNN 50) (T = 20.2 +/- 8.3%; S = 30.7 +/- 10.2%; p = 0.024). At night, the lowest SDANN/5 (standard deviation of RR intervals over periods of 5 minutes) were observed in group S (67.2 +/- 16.7 ms vs 87.3 +/- 24.4 ms; p = 0.026). No statistically significant differences between the two groups was observed in the spectral data. The temporal data of heart rate variability on Holter ECG monitoring over 24 hours could therefore have a good predictive value of the vagal origin of syncope in young adults.

Adult↗
PubMed1988

Clinical and radiological aspects of dysplastic gangliocytoma (Lhermitte-Duclos disease): a report of two cases with review of the literature.

Two cases of Lhermitte-Duclos disease confirmed by biopsy are reported. Review of the 58 published cases shows that the disease can manifest itself only by signs of increased intracranial pressure. Cerebellar symptoms are not constant. Computed tomographic (CT) scans suggest the diagnosis by showing a posterior fossa lesion, iso- and hypodense, partially calcified, and not enhanced by contrast medium. Magnetic resonance imaging (MRI) seems to define limits of the lesion better than CT scanning and could improve the surgical approach. Surgical excision of the lesion is the only satisfactory treatment. The postoperative prognosis is usually favorable.

Adult↗
PubMed1987

Interobserver agreement in assessment of motor response and brain stem reflexes.

In 1982, we developed a new coma scale, the Glasgow-Liège scale, which combines the quantified analysis of five brain stem reflexes with the Glasgow methodology. The present study was undertaken to determine to what extent agreement exists among different raters assessing brain stem reflexes (Parameter R) and to compare the results with those observed from motor responses (Parameter M). We show the good agreement achieved by different examiners in the evaluation of brain stem reflexes. Brain stem reflexes offer a slightly higher agreement (kappa = 0.69) than that of the study of motor response (kappa = 0.65). Within Parameters M and R, we observed less agreement in the evaluation of flexion responses and in the interpretation of oculocephalic reactions. The reliability of the evaluation of M and R parameters justifies the use of the Glasgow-Liège scale as a means for evaluating disturbances of consciousness.

Blinking↗
PubMed1987

[Cervico-arthrotic myelopathies. Treatment and prognosis].

The authors present 50 cases of cervical spondylotic myelopathy treated by anterior or posterior approach. To assess the severity of the pre- and postoperative neurological symptoms, they define an original ten-point classification scale taking into account gait and urinary disturbance, ability to manipulate objects and pain. With C2-C7 laminectomy, 60% of the patients are improved, essentially for walk. A few cases only (14%) are upgraded for upper limbs function. The authors conclude that this surgical treatment should be applied only when there is a multi-level narrowed canal and predominant lower limbs deficits. The efficacy of the anterior approach depends on complete removal of osteophytes. In cases with complete osteophytectomy, this surgical treatment can improve both the upper and lower limbs function and 77.8% good results are obtained. In a few cases it may be necessary to use both approach successively. Discriminant analysis applied to 12 factors shows that pre-operative scores of upper and lower limbs and sagittal diameter of spinal canal are the most important factors for neurological prognosis.

Adult↗
PubMed1986

[Choroid plexus papilloma of the cerebellopontine angle. Presentation of a case and review of the literature].

Choroid plexus papillomas of the cerebellopontine angle are quite rare. Up to date, 19 cases surgically removed have been reported (table I). We describe the case of a 25 year old man with a choroid plexus papilloma (C.P.P.) who presented only two syncopes in the interval of 4 months. A computed tomographic scan revealed a calcified right extra-axial tumor occupying the cerebellopontine angle and a moderate degree of obstructive hydrocephalus. A vertebral angiogram showed that the tumor was avascular. A right suboccipital craniectomy was performed and the mass was excised in totality. The patient was discharged from hospital 2 weeks after surgery. 10 months later, neurological findings were normal. Histological examination exhibited a typical papilloma of the choroid plexus. The differential diagnosis of tumors in the C.P.P. angle is discussed. Total surgical excision in the treatment of choice. Radiation therapy could be used when the resection is incomplete.

Adult↗
PubMed1986

[Skull injury. Arteriovenous shunt. Limitations of cerebral x-ray computed tomography].

The authors report the case of a patient suffering from a head trauma after dizziness followed by a loss of consciousness. In the hours following the admission, he developed drowsiness and a left hemiparesis. CT scanner showed an intracerebral haematoma. Due to the dizziness a carotid angiography has been realized and has demonstrated an intracerebral avascular mass, an arteriovenous shunt and an epidural haematoma at the vertex. Two aspects of the case seem to be important: the first one is the limit of CT scanner; the second one is the relationship between the three lesions.

Adult↗
PubMed1985

Relative prognostic value of best motor response and brain stem reflexes in patients with severe head injury.

The object of this study was to determine whether the addition of information on brain stem reflexes improves the prognostic precision of the Glasgow coma scale for patients with severe head trauma. The study is based on 109 patients with a Glasgow coma score of 7 or less during the first 24 hours after injury. The average age was 23 years. The patients were classified into three groups according to their actual outcome after 6 months: dead, 44 patients; persistent vegetative state and severe disability, 13 patients; moderate disability and good recovery, 52 patients. We then compared, by means of multiple group logistic regression, the prognostic ability of motor responses alone using the Glasgow criteria and of brain stem reflexes via an original approach. We showed that the predictive capabilities of brain stem reflexes were greater than those of motor responses. Although closely related (r = 0.68), the use of these two parameters in a single scale, the Glasgow-Liege scale, improves the precision of prognosis, especially for those head trauma patients with initial and complete loss of consciousness. Age was also revealed to be an important factor for outcome prediction.

Adolescent↗
PubMed1985

One-stage excision of high-flow arteriovenous malformations.

The authors describe two cases of high-flow arteriovenous malformations which illustrate a new technique to reduce the risk of brain swelling and diffuse hemorrhage during or after operation. This technique, used in the latter of the two cases, includes occlusion of the shunt, followed by the progressive tightening of a Selverstone clamp placed on the cervical internal carotid artery, lowering of the systemic arterial pressure, and the use of barbiturate anesthesia. Clamping and anesthesia are maintained for a 24-hour period after surgery.

Cerebrovascular Circulation↗
PubMed1984

[Classifications and therapeutic indications in spontaneous intracerebral hematomas in the absence of any vascular malformation. Preliminary study apropos of 65 cases].

CT Scan and I.C.P. monitoring help us in management of spontaneous intracerebral haemorrhage to decide if surgical evacuation is necessary or not. The various opinions expressed in literature seem to depend on the lack of correlations between clinical state, CT Scan and I.C.P. monitoring. Three groups of patients were studied: Group I: patients with ingravescent coma during the first three days. Their natural history is death. Group 2: patients with disturbances of consciousness which appear, persist or increase during the first week. Group 3: awake patients with spontaneous improvement. In group I: Patients in cortico-subcortical or diencephalic stage (according to Plum and Posner) or with clinical signs of uncus hernia have been operated on: three deaths out of eleven cases. But patients in mesodiencephalic stage or worse all died (14 cases). In group 2: Three reasons indicated surgery: first, patients with clinical deterioration; second, patients with increasing of the Shift of Septum Lucidum on CT Scan; third, patients with I.C.P. increasing. In group 3: No operation was necessary. CT Scan allowed to separate three sites of the hematoma: Deep or in basal ganglia, superficial or lobar, and a middle class of hematoma who can also be called a middle hemispheric hematoma. It allowed to separate its size, big: more than 3 cm of biggest diameter, and little. In case of middle or labor hematomas, surgical management is very simple. We performed a little craniotomy (3 X 4 cm) with holl drill, short cortical incision, and clots were sucked carefully without damaging the walls of the cavity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Correlation between the Liège scale and a biomechanical marker of the cerebral lesion].

Brain type creatine kinase isoenzyme (CK.-1) was measured in the ventricular cerebrospinal fluid in a series of 42 patients within 7 +/- 3,4 hours following severe head injury (GCS less than or equal to 7, LCS less than or equal to 12). The presence of the CK.-1 isoenzyme correlated with the degree of head injury as indexed by the Glasgow coma scale and the Liege coma scale. There was a significant logarithmic correlation between CK.-1 activity in the C.S.F. and the coma scores. However, the correlation with the Liege coma scale score (r = -0,84) is significantly better (Z = 1,97; p less than 0,05) than with the Glasgow coma scale score (r = -0,65). Thus, the Liege coma scale is a better index of neurological trauma.

Adolescent↗
PubMed1984

[Intracranial pressure in severe brain injuries. 2nd Part: Therapeutic interests and prognosis].

Sixty-seven patients with severe head injury underwent intracranial pressure (ICP) monitoring (10 extradural and 57 intraventricular). All patients had Liege coma scale (LCS) score of 12 or less. Ventriculitis (E. Coli) occurred in one patient (1,8%). The intraventricular method allows C.S.F. drainage with lowering of I.C.P. even with slit ventricles. After 8 days, if an intracranial hypertension persists, we perform a ventriculo-atrial drainage. Pressure recording is a useful way of following the patient's evolution and a guide for prognosis of survival. If I.C.P. is constantly below 5 torr, then the probability of a bad outcome is great. The study also confirms the high mortality rate (93%) if I.C.P. is greater than 40 torr.

Adolescent↗