PubMed Health⌕ Search

Biomedical subjects

J M Blard

Publications and source records attributed to J M Blard.

At least 19 recordsLinked to original sources
PubMed2005

[Lateral bulbar infarction due to intracranial dissection and subarachnoid haemorrhage].

INTRODUCTION: Intracranial vertebral artery dissecting aneurysms are a recognized cause of subarachnoid hemorrhage and the hemorrhagic recurrence risk after a first rupture of the dissecting aneurysm is high and of poor prognosis. However, when the dissection is discovered in a patient with vertebrobasilar territory ischemia, little is known about the risk of hemorrhagic rupture risk and there is no consensus on management. OBSERVATION: We report the case of a 49-year-old man who developed subarachnoid hemorrhage 48 hours after the occurrence of a latero-bulbar syndrome caused by a spontaneous dissection with occlusion of the right vertebral artery. The subsequent angiography showed a V4 dissecting aneurysm of the right vertebral artery which was treated by stenting and coiling without any complications. CONCLUSION: This case underlines the hemorrhagic risk of an intradural vertebral artery dissection and its possible progression to aneurysm. Subsequent angiographic imaging must be carefully examined to search for aneurysms which may require early specific treatment because of the high risk of recurrent bleeding.

Brain Infarction↗
PubMed2004

[Ataxic sensory neuropathy and Lyme disease].

INTRODUCTION: The clinical spectrum of peripheral neuropathies in Lyme disease is very wide. We report a case which was revealed by an ataxic sensory neuropathy. OBSERVATION: A 77-year-old patient presented with a subacute ataxic sensory neuropathy which occurred 2 weeks after a skin lesion involving the right lower limb. He fully recovered after specific antibiotic treatment. EMG was suggestive of a predominantly axonal neuropathy. Diagnosis of Lyme disease was assessed by progressive elevation of serum antibodies, demonstration of a lymphocytic meningitis and intrathecal synthesis of antibodies. CONCLUSION: Lyme disease may be added to the list of diseases which may induce subacute sensory neuropathies.

Aged↗
PubMed2004

[Intracranial haemorrhage associated with phaeochromocytoma].

INTRODUCTION: Pheochromocytoma is rarely disclosed by intracranial hemorrhage. We report two cases. OBSERVATION: The first 26-year-old patient developed subarachnoid hemorrhage due to a ruptured aneurysm of the middle cerebral artery. The second patient, aged 44 years, had a temporal hematoma. Diagnosis was suggested in both patients by hypertension and elevated urinary catecholamines and confirmed by imaging and MIBG scintigraphy. Adrenal gland tumors, on both glands in the first patient and on the right gland in the second were successfully removed; cranial hypertension totally regressed. Von Hippel Lindau disease was diagnosed by molecular genetics in the first patient. Paroxysmal hypertension could explain the brain hemorrhage in the first patient and may have favored aneurysmal rupture in the second. CONCLUSION: The relationships between pheochromocytoma and cerebral aneurysm are discussed.

Adrenal Gland Neoplasms↗
PubMed2004

[Facial palsy and central nervous system infection with varicella virus following adult chickenpox].

INTRODUCTION: VZV virus-related peripheral neuropathies usually occur after shingles in adults and more rarely after chickenpox in childhood. CASE REPORT: A 54-year-old patient presented with a right VIIth nerve palsy following a chickenpox rash and recovered after antiviral treatment. CSF analysis revealed lymphocytic meningitis and the virus was identified by PCR. CONCLUSIONS: Although previous chickenpox was not found in the patient's past history, the probability of reinfection is likely. The virus can be assumed to affect the nervous system directly; the axonal or demyelinating mechanism of the neuropathy may be discussed.

Acyclovir↗
PubMed2003

[Hypertensive encephalopathy as revealing symptom of Takayasu's arteritis].

A 29-year-old patient presented with Takayasu's arteritis which was revealed by heart failure, epilepsy, right hemiparesis and fever. Transient abnormalities of MRI and CSF (raised protein and cell content) were initially observed. The hypothesis of a hypertensive encephalopathy is suggested.

Acyclovir↗
PubMed2002

[Cerebral hemorrhage due to a ruptured mycotic aneurysm. Two cases].

INTRODUCTION: Cerebral hemorrhages due to rupture of mycotic aneurysms are rare but severe complications of infective endocarditis. We report two cases with a good outcome. EXEGESIS: The first patient presented with a parieto-occipital hematoma which occurred in the course of a relapsing infective endocarditis due to Streptococcus mitis. She fully recovered after neurosurgical treatment. In the second case, a right frontal hematoma revealed two mycotic aneurysms and an infective endocarditis due to Streptococcus gordonii. Motor weakness partially recovered after antibiotic therapy and angiography demonstrated complete resolution of aneurysms. CONCLUSION: Ruptured mycotic aneurysms are poor prognosis factors in infective endocarditis. Adapted antibiotic therapy is the first-intent treatment. Neurosurgery is indicated when hematomas are poorly tolerated and in cases requiring anticoagulant therapy.

Adult↗
PubMed2002

[Recurrent acute polyneuropathy and cutaneous vasculitis].

A patient with relapsing cutaneous vasculitis presented 3 times in 10 years with an acute extensive neuropathy and respiratory failure which fully recovered. The relationships between Guillain-Barré syndrome and vasculitis are discussed.

Adult↗
PubMed2001

Transcranial Doppler detection of cerebral microemboli during left heart catheterization.

The role of transcranial Doppler ultrasonography (TCD) in individual risk assessment of embolic complications and the development of prevention strategies during coronary angiography remains to be determined. The purpose of this study was to assess the prevalence, time of occurrence and potential significance of microembolic signals (MES) detected with TCD during femoral left heart catheterization. TCD monitoring of the right and left middle cerebral artery was performed in 51 consecutive patients (36 men, 15 women) who were referred for coronary angiography. Percutaneous coronary angioplasty was performed during the same procedure in 16 patients. MES were counted manually during and after (off-line analysis) the procedure. Two patients were excluded from analysis because of the absence of an adequate acoustic temporal window. No neurological event occurred within 24 h in the 49 included patients. MES were detected in all except 2 patients (mean number 17.1 +/- 12.8 per patient), mainly during left ventriculography (38%) and contrast media injection into the coronary arteries (55%), suggesting their gaseous origin. There was no statistically significant association between the number of MES and patient age, cardiovascular history and risk factors, or catheterization results. The presence of coronary artery disease was inversely related to the number of MES (15.8 +/- 0.3 compared to 21.8 +/- 0.2 per patient when a normal angiogram was present; p < 0.05). In conclusion, although asymptomatic microemboli commonly occur during left heart catheterization, the majority of them are probably of gaseous origin, since they occurred predominantly during contrast media injection in this study, and were not related to cardiovascular history or to atheroma risk factors. Because air embolism has been reported to be harmful, attempts to reduce its occurrence during catheter-based procedures could be pertinent.

Aged↗
PubMed2001

[Neurological manifestation of infectious endocarditis: 14 cases].

Fourteen cases of infective endocarditis revealed by neurological manifestations are reported: 8 strokes (one transient ischemic attack, one regressing and 6 completed strokes), 2 intracranial hematomas (one due to ruptured mycotic aneurysm), 2 toxic encephalopathies, one grand mal seizure, one suppurative meningitis. Most of them were native valve endocarditis, and streptococcus was the most frequently responsible bacteria. The outcome was characterized by a high mortality (6 cases) and morbidity (4 cases). This emphasizes the usefulness of preventing antibiotherapy in patients with known predisposing factors and the necessity for these patients to be admitted in neurological intensive care units.

Adult↗
PubMed2001

[Benign acute ataxia in an adult with VZV infection].

In adults, neurological complications of VZV virus usually occur after herpes zoster infection in patients with AIDS. We report a case of acute and benign cerebellar ataxia after chickenpox in a patient without immunodeficiency.

Acyclovir↗
PubMed2001

[Arterial thrombolysis and angioplasty in atheromatous basilar artery occlusion].

Basilar occlusions treated with conventional therapy (anticoagulants or antiplatelets) have a poor outcome (80p. cent mortality). This unfavorable outcome may require a treatment within 6 hours by intra-arterial thrombolysis, sometimes followed by percutaneous transluminal angioplasty (PTA) in case of atherothrombotic occlusion due to a tight atherosclerotic stenosis. A 48 year-old patient, presented with left hemiparesis, left multimodal hypoesthesia, paralytic dysarthria. CT-scan showed a spontaneous hyperdensity of the basilar artery and arterial occclusion was confirmed by angiography, which showed an atherothrombotic occlusion involving the proximal part of the vessel. Intra-arterial thrombolysis began five hours after the onset with 0,25mg/kg of Rt-Pa (Actilyse((R))), given by bolus followed by 4 others bolus of 10mg. After a total dose of 60mg, arterial recanalization was obtained showing a tight atherosclerotic stenosis involving the proximal part of the basilar artery. PTA was performed 18 hours later with a ballon inflation at 6 atmospheres during 20 seconds. It allowed to decrease the stenosis from 80p. cent to 60p. cent. The patient recovered and MRI at D20 showed a small right lateral infarct involving the pons. Our study confirms the usefulness of intra-arterial thrombolysis in basilar artery occlusion. Consecutive PTA may be proposed in case of associated atherosclerotic stenosis, and the interest of PTA is further discussed.

Angioplasty, Balloon↗
PubMed2001

[Acute onset syringomyelia: two cases].

Two cases of acute presentation of cervical syringomyelia associated with Chiari malformation are reported. In the first case, dysphagia was the main symptom; the second patient had symptoms suggesting acute brain stem ischemia. The mechanism of this acute onset of the illness is discussed.

Acute Disease↗
PubMed2000

Dural puncture and corticotherapy as risks factors for cerebral venous sinus thrombosis.

Dural puncture with corticosteroid could be a predisposing factor for cerebral venous thrombosis (CVT). A 35-year-old woman using oral contraception was treated with corticosteroid epidural infiltration for L5 radiculalgia. The following day a postural headache developed and accidental dural puncture was suspected. Four days later, she presented with fever and consciousness impairment requiring mechanical ventilation. Magnetic resonance angiography (MRA) confirmed thrombosis of the superior sagittal sinus. Recanalization was observed three weeks later and the patient fully recovered. Blood tests for thrombophilia showed a moderate decrease in the C protein level (chronometric activity 44%, N = 65-130). CVT has been reported after spinal anaesthesia or peridural anaesthesia with accidental puncture. After dural puncture the decrease of cerebrospinal fluid pressure induces a rostrocaudal sagging effect with traumatic damage to the fragile venous endothelial wall, and may trigger a venous vasodilatation with resultant stasis. CVT has also been described in patients after lumbar puncture and oral corticoid treatment for multiple sclerosis and after corticosteroid intrathecal infiltration. Therefore, corticosteroids can be considered as a potential additional procoagulant stimuli.

Adrenal Cortex Hormones↗
PubMed2000

[POEMS syndrome disclosed by ophthalmological manifestation].

POEMS syndrome is characterized by Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and Skin changes. Papilledema is a common finding but ophthalmological complaints are rare. We report a case of POEMS syndrome in a 42-year old man which was revealed by oscillopsia and blurred vision. An osteosclerotic myeloma of the fifth lef rib was found, but there was no improvement after removal of the rib. The patient died two months later from pulmonary embolism.

Adult↗
PubMed1999

[Postural balance following stroke: towards a disadvantage of the right brain-damaged hemisphere].

In the light of studies published in the last ten years, we have suspected a differential influence of the sides of hemispheric cerebral lesions on posture and balance. A study was aimed at verifying this hypothesis, the method of which being original because many possible confounding factors such as age, sex as well as topography and size of the brain lesion have been taken into account in the statistical analysis. Inclusion criteria were: right-handed patients, first stroke, no previous disease which might have affected balance. Their postural abilities (ranging from 0 to 36) were assessed 90 +/- 3 days after stroke onset on a clinical scale. This clinical assessment was used here because it could be easily performed in all patients, irrespective of the severity of their impairment. Lesion locations were determined using the Atlas by Talairach and Tournoux and the number of cerebral areas altered gave an estimation of the lesion size. The first fifty patients consecutively admitted to rehabilitation and responding to the inclusion criteria were thus examined (25 with a right and 25 with a left hemispheric lesion; 14 women and 36 men; mean age 57.2 = yrs). The main result was lower postural performances in right brain-damaged patients than in left brain damaged patients (21.5 vs 29.4; p = 0.01). Postural abilities were also inversely related to age (r = -0.28; p = 0.04), lesion size (r = -0.41; p = 0.003) and were lower in women than in men (22.1 vs 28.8; p = 0.02). This study therefore confirms the existence of a right hemispheric dominance for postural control. The existence of inverse correlation between postural abilities and the number of omitted targets in cancellation task on one hand (r = -0.63, p < 0.001), the ipsilesional bias in line bissection on the other hand (r = -0.36; p = 0.01), argued for a relationship between the main result of this study and the well known cerebral organization of spatial information processing, based on a right hemisphere dominance for spatial attention and/or representation. The 'postural neglect' concept is discussed.

Aged↗
PubMed1997

[Symptomatic aneurysms of the postero-inferior cerebellar artery. A multicenter retrospective study of 29 cases].

A multicenter retrospective study of 29 cases of posterior inferior cerebellar artery is reported. Over a period of 21 years, the frequency of posterior inferior cerebellar artery aneurysm among all intracranial aneurysm was estimated to 1.38 p. 100 of cases of aneurysms followed by 3 University Hospitals. Frequency of rupture appeared to be very high (93 p. 100) in this series probably because of the type of selection. Average grade of presentation according to Hunt and Hess classification being < III in 3 fourth of the cases. Neither clinical presentation nor suspicious etiological factors were specific of this localization. Only two cases were of pseudotumoral appearance. Positive diagnosis of subarachnoid hemorrhage was made by CT scan. Angiograms gave diagnosis of localization of the malformation and its type. Intraventricular hemorrhage was found in 62 p. 100 of our cases: all had hemorrhage of the fourth ventricle. Hydrocephaly was more frequent as compared to supratentorial localizations, Vasospasm was less frequent as in supratentorial localizations. Nimodipin seems to be efficient. Therapeutic possibilities are primary dominated by surgery with good results when it is possible. Endovascular treatment is under evaluation.

Adult↗