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J Delavelle

Publications and source records attributed to J Delavelle.

At least 19 recordsLinked to original sources
PubMed2006

Speech arrest with stimulation may not reliably predict language deficit after epilepsy surgery.

The authors present a patient in whom electrical cortical stimulation of the posterior temporal cortex induced speech arrest, comprehension deficits, and other language-related impairments. This area was ultimately resected because of persistence of a severe seizure disorder. No postoperative aphasia was observed despite the cortical stimulation results, and the patient is since seizure free. These findings question the well-established principle that corticography directly reflects local cortical functions in all patients.

Adult↗
PubMed2006

Favourable outcome of progressive multifocal leucoencephalopathy in two patients with dermatomyositis.

Progressive multifocal leucoencephalopathy (PML), a demyelinating disease caused by the JC virus (JCV), occurs in immunosuppressed patients and carries a poor prognosis. A favourable outcome is reported in two patients with PML and dermatomyositis. Immunosuppressive drugs were stopped in patient 1 but could only be partially tapered in patient 2. The JCV-specific CD8+ T cell response was strong in patient 1 and weak in patient 2. Both were treated with cytosine-arabinoside, and patient 2 was also treated with mirtazapine, a 5HT2A receptor antagonist. Combination of these drugs might be helpful to treat HIV-negative patients with PML.

Adrenergic alpha-Antagonists↗
PubMed2005

White matter lesions in watershed territories studied with MRI and parenchymography: a comparative study.

Brain aging affects an increasing segment of the population and the role of chronic cerebrovascular disease is considered to be one of the main parameters involved. For this purpose we compared retrospectively MRI data with digitized subtraction angiography (DSA) data in a group of 50 patients focusing onto the watershed area of the carotid artery vascular territories. In order to evaluate the presence of white matter lesions (WML) in the hemispheric watershed areas, coronal fluid-attenuated inversion-recovery or axial T2 weighted MRI images of patients with symptomatic cerebrovascular insufficiency areas were compared with the capillary phase of DSA studies in anterior-posterior projection. Presence of cerebrovascular occlusive disease was evaluated on DSA using North American symptomatic carotid endarterectomy trial criteria and including evaluation of collateral vascular supply. Pathological MRI findings in the region of the watershed territories correlated overall in 66% of cases with a defect or delayed filling on DSA. In the case of asymmetrical MRI findings, there was a pathological finding of the capillary phase in the watershed area in 92% of DSA studies. Hypoperfusion in the capillary phase of the watershed area as seen on DSA correlated with the stenosis degree of the concerned carotid artery. Our findings suggest that asymmetrical findings of WML in the watershed areas as seen on MRI are caused by hemodynamic effect and a differentiation between small vessel disease and a consequence of distant stenosis may be possible under such conditions.

Aged↗
PubMed2005

Efficacy of TNF {alpha} blockade in cyclophosphamide resistant neuro-Behçet disease.

Behçet disease is a chronic relapsing inflammatory condition, predominantly affecting young adults, characterised by recurrent bipolar aphtae and systemic manifestations for which tumour necrosis factor (TNF) alpha blockade has recently emerged as an effective treatment. We report the case of a patient presenting with mucocutaneous and ocular manifestations who in the course of his disease developed CNS parenchymal involvement. While being treated with pulsed cyclophosphamide and corticosteroids, he suffered a relapse of his CNS involvement that was efficaciously controlled by infliximab. No disease activity was observed during a full year of TNF blockade, associated with azathioprine, colchicine, and corticosteroids. However, 7 months after the last administration of infliximab and still under immunosuppressant agents, CNS lesions recurred. Infliximab was successfully reintroduced and since continued with no side effects. The sequence of events observed in this patient suggests that TNF blockade is efficacious in suppressing neuro-Behçet disease and once introduced should be maintained for a prolonged period of time.

Adult↗
PubMed2004

ADC mapping of the aging frontal lobes in mild cognitive impairment.

Normal aging, leukoaraiosis (LA) and vascular disease particularly involve the human frontal lobes. We decided to investigate a population of elderly patients referred for neuroimaging because of progressive minor cognitive deficits but no dementia. They underwent conventional Magnetic resonance imaging (MRI) using axial T1 and T2-weighted imaging as well as coronal FLAIR sequences in addition to the axial diffusion-weighted MRI. MRI allowed us to differentiate patients with leukoaraïosis (LA+) from those without it (LA-) and mapping of the apparent diffusion coefficient (ADC) to investigate local tissular water motion. We observed an increase in the ADC in all investigated patients with increasing age (r=0.326, p=0.002). This increase was observed in both patients groups (LA+ and LA-). In addition, the LA+ group had significant higher ADC values than the LA- group after controlling for age (p<0.0001).

Adult↗
PubMed2004

Diffusion-weighted MRI in cortical ischaemia.

We carried out MRI on 16 male and three female comatose patients, aged 2 days to 79 years, with suspected cortical ischaemia referred from our intensive care units. Using a head coil, and following standard imaging, including coronal fluid-attenuated inversion-recovery images, we performed diffusion-weighted imaging (DWI) using a whole-brain multislice single-shot echo-planar sequence with b 0 and 1000 s/mm2: 5-mm slices covering the whole brain, TR 7000 TE 106 ms, 128 x 128 pixels, field of view 250 mm, one excitation. Maps of apparent diffusion coefficients (ADC) were generated automatically. DWI showed cortical, basal ganglia and watershed-area high signal in all cases, associated with a decrease in ADC to 60- 80% of normal. DWI showed lesions not seen (40%) or underestimated (40%) on conventional T2-weighted imaging. Within 24 h of the onset of symptoms, DWI showed changes not readily detectable on T2-weighted images. The cortical high signal on DWI and the ADC changes, suggesting severe ischaemia rather than oedema, was found in areas known to be affected by cortical laminar necrosis. Extension to the brain stem and white matter was associated with a higher likelihood of death.

Adolescent↗
PubMed2004

Bilateral occipital condylar fracture. Case report about successful treatment with SOMI brace.

Treatment guidelines for occipital condyle fractures (OCFs) are not established. Options for unilateral OCF have been discussed in the literature, but not for bilateral cases. We describe a bilateral OCF type II (according to the Anderson/Montesano classification) in a 30-year-old patient, where immobilisation in a SOMI brace (sternal occipital mandibular immobilisation) was successfully used.

Adult↗
PubMed2004

Patients with extratemporal lobe epilepsy do not differ from healthy subjects with respect to subcortical volumes.

BACKGROUND: Evidence from previous volumetric magnetic resonance studies has revealed that patients with chronic temporal lobe epilepsy show atrophy of distinct subcortical nuclei, predominantly ipsilateral to the focus side. We were interested to find out if there is also selective subcortical atrophy in patients suffering from long standing extratemporal lobe epilepsy. METHODS: Thirty one patients in whom pre-surgical evaluation unambiguously localised an extratemporal focus were included in this study. Using high resolution magnetic resonance imaging, the volumes of the caudate nuclei, putamen, pallidum, and thalamus were measured bilaterally in both hemispheres and compared with measurements obtained in 15 healthy volunteers. RESULTS: No significant difference in volumes was found between the two subject groups, or in any subgroup of extratemporal lobe epilepsy patients, nor was there any relation to clinical variables such as age of onset, overall seizure frequency, or disease duration. However, patients who had no or only rare generalised tonic-clonic seizures seemed to differ from the other patients and controls in that they had smaller putamen volumes bilaterally (p<0.001). CONCLUSION: We concluded that extratemporal lobe epilepsy in general is not associated with diminished volumes in the studied subcortical structures, which contrasts with findings in temporal lobe epilepsy patients. Thus, both entities differ both cortically and subcortically. However, we found that small putamen volume was bilaterally associated with absent or rare generalised tonic-clonic seizures, implicating the putamen in the control of the most disabling seizure type, independent of the site of neocortical focus.

Adult↗
PubMed2003

Dysplastic dens of the axis: case report.

In a patient injured in a bicycle accident, radiological evaluation of the cervical spine revealed an oblique orientation of a dysplastic dens of the axis, which, to our knowledge, has not been reported in the literature. There were no other bony or soft tissue anomalies and no associated instability. This case should draw attention to congenital anomalies of the cranio-cervical junction in trauma patients.

Accidents, Traffic↗
PubMed2003

Diffusion weighted MR imaging on a low-field open magnet. Comparison with findings at 1.5T in 18 patients with cerebral ischemia.

Diffusion-weighted MR imaging (DWI) is particularly sensitive for the detection of acute stoke. Until recently, DWI was performed with EPI technology. We compared 18 patients with clinical suspicion of acute stroke on a standard 1.5T unit and an open low-field MR scanner. Eighteen patients with 20 lesions of acute stroke were studied retrospectively with DWI and ADC mapping on both systems. The technique used was a rotating fast-spin echo T2 at low-field and an EPI sequence at 1.5T. Both examinations were performed within 24 hours and analyzed by two neuroradiologists. We obtained the same results on DWI sequences on both systems, regarding high intensity lesions on DWI. Interpretation of the ADC maps proved to be difficult on low-field MR near the lateral ventricles (3/18). We experienced the same difficulty of interpretation at low and high field in the cerebellum, in the temporal fossa and in cortex situated near bone, due to susceptibility artifacts. Chronic lesions were better visualized at low than at high field. In our opinion, DWI on a low-field open MR scanner is a good technique to evaluate subacute stroke and was as reliable as when performed on a 1.5T MR system.

Adult↗
PubMed2003

Therapeutic decision and management of aneurysmal subarachnoid haemorrhage based on computed tomographic angiography.

The purpose of this study was to evaluate the potential of high quality computed tomographic angiography (CTA) to replace digital subtraction angiography (DSA) in cases of ruptured saccular aneurysms and perform early surgical clipping or coiling on the basis of CTA alone. In a prospective study, 100 patients with aneurysmal subarachnoid haemorrhage (SAH) diagnosed by computed tomography underwent CTA. CTA revealed a total of 118 aneurysms including all ruptured aneurysms. A decision of direct surgical clipping, endovascular coiling or therapeutic abstention was made in 89 cases (89%) on the basis of CTA alone. Sixty-one direct surgical procedures were performed after CTA. Twenty-six cases underwent DSA for immediate endovascular treatment of the ruptured aneurysm. In 11 cases (11%), a DSA was performed prior to the therapeutic decision because of unclear aneurysm. Four cases were not treated because of initial poor clinical grade. The surgical findings were compared with CTA data and were considered accurate in all but one case. All patients underwent postoperative DSA within 10 days after SAH. The sensitivity and the specificity of CTA for the detection of all aneurysms, as compared with postoperative DSA, were 95.1 and 100%, respectively. A total of six unruptured aneurysms were missed initially, but were visible retrospectively on CTA in all but one case and were found in patients with multiple aneurysms in whom the ruptured aneurysm was detected by CTA. Current quality CTA allows reliable pretreatment planning for the majority of cases of aneurysmal subarachnoid haemorrhage and diminishes the pretreatment evaluation time critically. Complementary pretreatment DSA is required in situations where CTA characteristics of the ruptured aneurysm is unsatisfactory.

Aneurysm, Ruptured↗
PubMed2002

Is the rupture of cerebral berry aneurysms influenced by the perianeurysmal environment?

PURPOSE: To evaluate contact between cerebral berry aneurysms and the perianeurysmal environment and to study the influence this contact has on aneurysm rupture. MATERIALS AND METHODS: In a series of 76 consecutive patients, pre- and post-contrast CT images of 87 aneurysms were evaluated. Aneurysm locations were identified and aneurysms were divided into two different groups depending on whether they had ruptured or not. Contact between aneurysms and the perianeurysmal environment was studied when present, and considered to be balanced or unbalanced according to symmetry of contact and type of contact interface, i.e. with bone, dura, etc. RESULTS: Rupture occurred in 47 aneurysms at an average maximum dome size of 7.4 mm. There was contact with elements of the perianeurysmal environment in 38 (81%) of ruptured cases and no evidence of contact in 7 (15%). The nature of contact was unclear in 2 (4%) ruptured aneurysms. In the aneurysms with contact, the nature of contact was unbalanced in 34 (72%) and balanced in 4 (9%). Unbalanced aneurysms ruptured at significantly smaller sizes (average: 7.7 mm) than balanced aneurysms (average: 11.4 mm). Seven aneurysms of small size (3.3-6.9 mm, average: 4.8 mm) were found to have ruptured, despite the fact that they were too small to exhibit contact with the perianeurysmal environment. In 40 unruptured aneurysms (average size: 6.3 mm), contact with the perianeurysmal environment was found in 15 aneurysms, for which balanced contact was found in 11 (27.5%) and unbalanced contact in 4 (10%), and no contact in 25 (62.5%). The average size of the aneurysms without contact (3.7 mm) was significantly smaller than that with balanced contact (10.3 mm) or with unbalanced contact (11.3 mm). CONCLUSION: Aneurysms exhibit contact with their perianeurysmal environment as soon as they reach a size that exceeds their allowance given by the local subarachnoid space. The contact with the environment was found to be an additional determinant parameter in the evolution of cerebral berry aneurysms and their risk to rupture.

Adult↗
PubMed2001

Volumetric measurements of subcortical nuclei in patients with temporal lobe epilepsy.

OBJECTIVE: To determine the volumes of subcortical nuclei in patients with chronic epilepsy. BACKGROUND: Animal and human data suggest a crucial role for subcortical structures in the modulation of seizure activity, mostly as seizure-suppressing relays. Although cortical epileptogenic foci can vary in localization and extent, it nevertheless appears that these structures subsequently influence seizure propagation in a universal fashion. There is, however, little knowledge about the size of implicated subcortical structures in patients with epilepsy. METHOD: Using high-resolution MRI, the volumes of selected subcortical nuclei, such as the thalamus, caudate nucleus, putamen, and pallidum, were measured in both hemispheres of 27 patients with temporal lobe epilepsy. Fourteen healthy volunteers served as controls. Statistical analysis was done for both normalized volumes (by total brain volume) and unnormalized volumes. RESULTS: Overall, the patient group had smaller thalamic and striatal volumes in both hemispheres, mostly ipsilateral to the epileptic focus. No significant correlations were noted between volume measurements and age, age at onset, duration of epilepsy, or total seizure frequency, including frequency of generalized seizures. The putamen and thalamus seemed to be affected predominantly in patients with a history of febrile convulsions, whereas patients without febrile convulsions had smaller caudate nuclei bilaterally. CONCLUSIONS: Volumetric measurements of subcortical nuclei reveal atrophy of distinct subcortical nuclei in the patient group, predominantly ipsilateral to the focus. This finding probably reflects persistent abnormalities and not secondary change. In addition, the structural differences between patients with and patients without previous febrile convulsions suggest that these conditions may have different causes.

Adult↗
PubMed2001

Subarachnoid hemorrhage: a rare presentation of cerebral venous thrombosis.

Because of its large spectrum of clinical manifestations, diagnosis of cerebral venous thrombosis may be very difficult. Since appropriate treatment influences prognosis, early recognition of this condition is extremely important. We report a subarachnoid hemorrhage as a rare initial manifestation of cerebral venous thrombosis. A 58-year-old woman was admitted with severe headache of sudden onset, neck stiffness, dysarthria, and ataxia. Computed tomography scan showed a subarachnoid hemorrhage in the right posterior fossa. Magnetic resonance imaging coupled with magnetic resonance angiography revealed right transverse/sigmoid sinus thrombosis with hemorrhagic infarction of the right cerebellar hemisphere leading to a pseudotumoral appearance and displacing the fourth ventricle. Anticoagulant treatment resulted in rapid clinical recovery and in resolution of the radiological signs of infarction and of the subarachnoid and subdural hemorrhages.

Cerebral Veins↗
PubMed2000

MRI, (1)H-MRS, and functional MRI during and after prolonged nonconvulsive seizure activity.

BACKGROUND: Various structural and functional changes, such as focal edema, blood flow, and metabolism, occur in the cerebral cortex after focal status epilepticus. These changes can be assessed noninvasively by means of MRI techniques, such as fluid-attenuated inversion recovery (FLAIR), EEG-triggered functional MRI (EEG-fMRI), and proton MR spectroscopy (MRS). METHODS: The authors report on a 40-year-old patient with nonlesional partial epilepsy in the left posterior quadrant in whom these MRI techniques were applied in an active seizure focus and repeated during a follow-up of 1 year. RESULTS: FLAIR imaging taken at the time of status epilepticus showed a signal hyperintensity in the occipital region. (1)H-MRS of this cortical region showed elevated lactate, decreased N:-acetylaspartate (NAA), and elevated choline (Cho). In the same region, EEG-fMRI revealed an area of signal enhancement. After seizure control, recovery of lactate and Cho was observed, whereas the NAA level remained reduced. The structural abnormality demonstrated on FLAIR disappeared within 3 months. CONCLUSIONS: Repetitive MRI with sensitive sequences during clinically critical periods may disclose the structural correlate in a previously nonlesional epilepsy case. Corresponding to the clinical evolution, reversible and irreversible focally abnormal metabolism can be determined with (1)H-MRS, reflecting both increased neuronal activity and neuronal damage.

Adult↗
PubMed2000

EEG-triggered functional MRI in patients with pharmacoresistant epilepsy.

Functional magnetic resonance imaging (fMRI) triggered by scalp electroencephalography (EEG) recordings has become a promising new tool for noninvasive epileptic focus localization. Studies to date have shown that it can be used safely and that highly localized information can be obtained. So far, no reports using comprehensive clinical information and/or long-term follow-up after epilepsy surgery in a larger patient group have been given that would allow a valuable judgment of the utility of this technique. Here, the results of 11 patients with EEG-triggered fMRI exams who also underwent presurgical evaluation of their epilepsy are given. In most patients we were able to record good quality EEG inside the magnet, allowing us to trigger fMRI acquisition by interictal discharges. The fMRI consisted of echoplanar multislice acquisition permitting a large anatomical coverage of the patient's brain. In 8 of the 11 patients the exam confirmed clinical diagnosis, either by the presence (n = 7) or absence (n = 1) of focal signal enhancement. In six patients, intracranial recordings were carried out, and in five of them, the epileptogenic zone as determined by fMRI was confirmed. Limitations were encountered a) when the focus was too close to air cavities; b) if an active epileptogenic focus was absent; and c) if only reduced cooperation with respect to body movements was provided by the patient. We conclude that EEG-triggered fMRI is a safe and powerful noninvasive tool that improves the diagnostic value of MRI by localizing the epileptic focus precisely.

Adolescent↗
PubMed2000

Magnetic resonance imaging and proton spectroscopic alterations correlate with parkinsonian signs in patients with cirrhosis.

BACKGROUND & AIMS: The relationship between abnormalities found by magnetic resonance imaging (MRI) and proton spectroscopy (MRS) and the clinical signs of hepatic encephalopathy is not well characterized. Motor disturbances have been described, suggesting that basal ganglia (BG) are altered. METHODS: We evaluated 19 unselected consecutive patients with biopsy-proven cirrhosis evaluated for liver transplantation for the presence of parkinsonian signs using the Unified Parkinson's Disease Rating Scale (UPDRS) and Purdue Pegboard test, and correlated these neurologic abnormalities with MRI and MRS studies. Brain MRI intensities were expressed as signal-to-noise ratios. MRS findings obtained from one voxel in the BG and one in the occipital white matter (WM) were expressed as metabolite ratios. Six healthy subjects had normal values. RESULTS: Compared with healthy subjects, patients with subclinical or grade 1 hepatic encephalopathy had hyperintensity in occipital WM and all BG tissues except thalamus and reduced Ino/Cr and Cho/Cr ratios in both voxels. In the BG, MRI intensity was correlated with the UPDRS (P < 0.05, r = 0.56). The Cho/Cr ratio also correlated with both UPDRS (P < 0.02, r = -0.59) and Pegboard scores (P < 0.02, r = 0.61). CONCLUSIONS: In cirrhosis, parkinsonian signs correlate with BG alterations detected by MRI and MRS.

Adult↗