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Biomedical subjects

J M Blard

Publications and source records attributed to J M Blard.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Cerebrovascular complications and hereditary protein S deficiency: 2 cases].

Hereditary protein S deficiency (HSPD) is a predisposing factor to recurrent venous thrombosis but is not currently associated with stroke. We report two cases of HSPD revealed by stroke in young adults. The first one was a 36-year-old patient whith a pure motor hemiplegia, who gradually recovered without sequelae. Total and free protein S was decreased (55 and 10%). One of his brothers died from pulmonary embolism at 20 years and a sister had low protein S level without clinical signs. The second case was a 26-year-old patient who had a right hemiplegia with aphasia due to an infarction in middle cerebral artery area. He partially recovered, but the course of the illness was complicated by deep venous thrombosis of the lower limbs and pulmonary embolism. Total and free serum protein S level was severely decreased (25 and 0%). The patient's mother and one of his sisters also had low protein S but never had clinical complications. In both case, dupplex scanning, transcranial doppler, echocardiography, serum antithrombin III and protein C were normal. Cigarette smoking was the only risk factor for arterial disease. These two cases suggest that HSPD must be investigated in young patients with stroke, even in cases of lacunar stroke.

Adult↗
PubMed1994

[Benign multiple sclerosis with childhood onset].

We report a case of multiple sclerosis which began at the age of 12 years. Clinical symptoms at onset were acute, regressive cerebellovestibular ataxia and optic neuritis. Twenty-four years later vertigo, motor and sensory deficit of the right lower limb and grand mal seizures developed. CSF and MRI were suggestive of multiple sclerosis. The patient is now free of neurological symptoms with an 8 years' follow-up.

Child↗
PubMed1993

[Neurologic complications of cardiac myxomas].

Cardiac myxomas are rare tumours complicated by faintness or syncope usually occurring in upright position and due to obstruction of a cardiac valve orifice. Myxomas are also manifested by neurological deficits caused by myxomatous or fibrino-cruoric cerebral emboli. Intracranial aneurysms and metastases are exceptional. The simplest and most reliable diagnostic method is transthoracic two-dimensional cardiac echography. Treatment consists of surgical excision which has very low morbidity, mortality and recurrence rates.

Echocardiography↗
PubMed1993

[Normal pressure hydrocephalus and lumbar neurinoma].

A 76-year-old man presented with gait disturbances, mental deterioration and urinary incontinence. CT and MRI suggested a normal pressure hydrocephalus. Because of a raised protein content of CSF, a spinal MRI was performed and revealed a lumbar neurinoma. The patient improved after removal of the neurinoma and ventricular derivation.

Aged↗
PubMed1993

[Primary lymphoma of the central nervous system. Multiple remission with corticosteroid therapy].

A primary T-cell lymphoma of the central nervous system was diagnosed at autopsy in a 73-year-old woman. The course of the illness was made of multiple neurological episodes: hypersomnia, palsies of cranial nerves, aphasia, hemiparesis, epileptic fits during 4 years, with fast recoveries under corticosteroid therapy. CT scan and MRI abnormalities were also dramatically improved by the treatment.

Adrenal Cortex Hormones↗
PubMed1992

[Hemorrhage of the brain after therapeutic fibrinolysis. 11 cases].

Ten cases of cerebral hemorrhage and one of intraspinal subdural hematoma after thrombolytic therapy are reported. Six patients were treated with streptokinase, four with rt-PA and one with a combination of both drugs. The incidence was 0.5 to 2% and was higher in case of rt-PA therapy (3.7%). In all cases, CT scan showed primary hemorrhage rather than hemorrhagic infarction. Four patients died of stroke. Among the survivors, residual disability was severe in one and mild in five. Only one patient recovered completely. In patients treated with streptokinase, the hemorrhage was probably due to a more than 80% decrease in plasma fibrinogen. In those receiving rt-PA, either excessive dosage (2 cases in our series) or lysis of cerebral microthrombi are thought to be responsible for the hemorrhagic complications. Treatment consists of infection of aprotinin (an anti-fibrinolytic drug), cryoprecipitates with factors V and VIII and protamine sulfate.

Aged↗
PubMed1992

[Contribution of 99m Tc-HMPAO single-photon emission-computed tomography to the perioperative evaluation of subarachnoid hemorrhage caused by ruptured aneurysms].

Twenty one cases of proven subarachnoid hemorrhage (S.A.H.) have been analysed in a protocol especially including transcranial doppler (T.C.D.) and 88mTc-H.M.P.A.O. single photon emission tomography (H.M.P.A.O.-S.P.E.C.T.). Seventeen patients were intraoperatively studied. All data were compared with clinical grading, computerized tomography (C.T.) and angiography. S.P.E.C.T. is a quite recent method of measuring and three-dimensional imaging of brain perfusion. It provides important information for the diagnosis of ischemic syndromes in S.A.H. Sixty-two S.P.E.C.T.-scans were performed in twenty one patients. Fifty-eight were abnormal and showed significant abnormalities of brain perfusion varying in extent and severity. In this preliminary study, we set out to validate the clinical use of H.M.P.A.O.-S.P.E.C.T. for the diagnosis of "vapospasm" comparing S.P.E.C.T. data with classical criteria. We propose a classification which allowed us to quantify the ischemic risk in an attempt to adapt the global therapeutic management to hemodynamic data. This method appears to be very sensitive and reliable in this field. It will introduce, if these first results are confirmed, important criteria for the evaluation of patients presenting with S.A.H. as far as prognosis and treatment are concerned, especially in regard to timing of surgery and institution of medical hemodynamic therapy.

Aneurysm, Ruptured↗
PubMed1991

[Thalamo-peduncular germinoma].

A 24 year-old patient presented with chronic intracranial hypertension, palsy of both abducens nerves and upward gaze, and right hypoesthesia. CT scan and MRI showed a left thalamic tumor infiltrating the left cerebral peduncle. A stereotactic biopsy revealed a germ cell tumor. Following radiotherapy the patient recovered except for ophthalmoplegia. The tumor totally disappeared on CT scan and MRI.

Adult↗
PubMed1991

[Infarction of the pons, neurosyphilis and HIV infection].

A 31-year old patient presented a right hemiparesis related to a left basis pontis infarction. Laboratory investigations revealed both neurosyphilis and HIV infection. The patient was treated with two courses of penicillin and recovered from hemiparesis. The occurrence of strokes due to syphilitic arteritis in AIDS is emphasized.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Vertebro-basilar aneurysms. 23 cases observed in a neurology department].

Twenty-three cases of vertebro-basilar aneurysms observed in a neurology department are reported. Ten were located on the basilar artery (7 at the basilar bifurcation), 5 on the postero-inferior cerebellar arteries, 4 on the superior cerebellar arteries, 3 on the vertebro-basilar junction and 1 on the anteroinferior cerebellar artery. There were 6 fusiform and giant aneurysms, others were sacciform. In 5 cases, there was no clear relationship between the clinical data and the aneurysm, which was discovered by chance at angiography or MRI. One giant aneurysm of the basilar artery was mimicking a tumor of the posterior cerebral fossa. Two other cases were revealed by brain stem ischaemia. Aneurysmal rupture was present in 15 cases: there were signs of meningeal haemorrhage in all cases and clinical signs of posterior cerebral fossa involvement in 7 cases. CT scan, performed in 8 cases, showed in all of them a meningeal haemorrhage, with a brain stem haematoma in 3 cases. All the aneurysms were shown by angiography; 7 were associated with a vasospasm. Five patients were not operated upon; all died. In one case, clipping the aneurysm was impossible, but there was a good recovery with a 12 year follow-up. Nine patients were operated, 3 recovered completely, 2 had neurological sequelae, 1 a late worsening; 3 patients died of brain stem ischaemia.

Adolescent↗
PubMed1991

[Recurrent peripheral neuropathy caused by thallium poisoning].

A 28-years old woman, working as a secretary, developed a rapidly progressive paraplegia with burning pain in the lower limbs. She recovered within 4 months but relapsed shortly after she was discharged. There was flaccid tetraplegia, associated with hyperalgesia of the limbs, diffuse muscle atrophy, blindness and alopecia. The patient needed respiratory assistance for 2 months. Bilateral optic neuropathy and paraparesis persisted after a 17 months follow-up. The clinical picture suggested thallium poisoning, which was confirmed by high thallium concentration in plasma and urine. The most likely cause was accidental poisoning with rodenticides.

Adult↗
PubMed1989

[Long term survival after basilar artery occlusion. 4 cases].

Four cases of basilar artery occlusion with a follow-up from 7 to 12 years are reported. The first patient, a 60 year old woman, had a proximal occlusion which was revealed by an acute brain stem ischemia. The second case was a 63 year old man with an aortic aneurysm who had a single episode of vertebro-basilar insufficiency. Cerebral angiography demonstrated a lower basilar artery occlusion. The third patient, a 60 year-old woman, had been operated from right carotid artery and left vertebral artery stenosis; 8 years later, without clinical manifestations, a left carotid artery stenosis and an occlusion of the lower part of the basilar artery were discovered. The evolution was eventless after a left carotid endarterectomy. The last case was a 60 year old man who had a lower basilar artery occlusion associated with a left internal carotid occlusion. There was a full recovery after a hemiplegic stroke. From our personal cases and the review of the literature, long term survival after basilar artery occlusion may occur in occlusions restricted to the lower or middle part of the basilar artery and with a good collateral supply from carotid and cerebellar arteries.

Arterial Occlusive Diseases↗
PubMed1989

[Acute polyradiculoneuritis after intravenous injection of heroin, HIV seropositivity disclosed 3 years later].

An acute polyradiculoneuritis with tetraplegia and respiratory failure was observed in a 27 year-old heroin addict 3 hours after an intravenous injection of heroin. Full recovery was obtained after respiratory assistance and plasma exchanges. The biological and morphological changes (sural nerve biopsy) suggested an immune mediated mechanism. Three years after the recovery, the patient was tested for HIV antibody and was seropositive. The role of HIV infection and of the injection of heroin are discussed.

Acute Disease↗