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Biomedical subjects

L Milandre

Publications and source records attributed to L Milandre.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Chronic subdural hematoma and transient neurologic deficits].

Three cases of chronic subdural hematoma (CSDH) revealed by transient neurological accidents are reported. Although well-known this condition is rare: 1 to 9 p. 100 of CSDHs. Questioning may bring out a history of cranial injury and headache, even minor ones, which are unusual in transient ischemic accidents (TIA). Transient phenomena, such as motor aphasia or speech interruption, point to the diagnosis, especially in male patients over 60 years of age. The finding at electroencephalography of a delta activity more than 48 hours after a TND should exclude the diagnosis of TIA until a CT scan is performed. Since the causes of neurological deficits regressing within less than 24 hours may be ischemia as well a hemorrhage or tumour, the term of transient neurological accident (TNA) should preferably be used, and an emergency CT scan should be performed for diagnostic and therapeutic purposes. Owing to the possibility of another concomitant cause of TNA, the finding of a subdural haematoma should not deter from pursuing cardiovascular examinations. The mechanism of TNA probably involves a vascular factor, as suggested by I-123 IMP cerebral SPECT which shows an intercritical decrease in cerebral blood flow and/or an epileptic factor.

Aged↗
PubMed1989

Spontaneous dissection of both extracranial internal carotid arteries.

Neurological examination and Doppler sonography of a 50-year-old patient were suggestive of a spontaneous dissection of the left internal carotid artery (left-sided headaches, amaurosis fugax, Horner's syndrome and hemispheric stroke). Four-vessel angiogram performed several days after the onset of the symptoms showed dissection of both extracranial carotid arteries, more pronounced on right side where the dissection was clinically asymptomatic. Angiogram follow-up demonstrated a recanalization of both carotid arteries. A review of 15 other documented reports indicates that bilateral internal carotid dissection is usually associated with fibromuscular dysplasia. A large majority of cases does not clinically differ from unilateral carotid artery dissection.

Carotid Artery Diseases↗
PubMed1989

Capsular ataxic hemiparesis. Early diagnosis with MRI.

The Authors report a case of ataxic hemiparesis caused by a lacunar infarct involving the posterior limb of the right internal capsule, in a 64-year-old hypertensive man who completely recovered in about two weeks. The lesion was detected by MRI four days after the onset of illness, when the CT scan was normal. In patients presenting with ataxic hemiparesis, MRI is the most accurate tool in locating very small causative infarcts of the brainstem or the subcortical white matter.

Ataxia↗
PubMed1989

[Cerebral venous thrombosis in adults. Diagnostic and therapeutic aspects in 20 cases].

The authors have reported on 20 cases of cerebral venous thrombosis and reviewed the literature. In most of these 20 cases, CT scan findings were non-specific. Digital subtraction angiography was used for diagnosis in 6 cases. In 7 cases, no etiology was found. 12 patients received anticoagulant treatment despite CT scan showed hemorrhagic infarct in 4 of them. No neurological complication was reported after anticoagulation. Venous thrombosis was fatal in 3 non-anticoagulated patients. 4 others showed mild or severe sequellae after discharge.

Adult↗
PubMed1988

[The role of edema in cerebral ischemia. From physiopathology to therapeutics].

Brain ischemia induces an original form of edema associating a "cytotoxic" component and a "vasogenic" component which is more inconstant. The authors set out a synthesis of fundamental research concerning the different factors of ischemic brain edema. Although anti-edematous drugs (steroids, barbiturates, diuretics) are widely used, there is no serious evidence of their efficacity. New therapies are based on a specific approach of the different disturbances of cerebral ischemia. However, controlled studies are necessary to evaluate the effects of these new drugs.

Blood-Brain Barrier↗
PubMed1988

[Value and limits of antiplatelet agents in cerebral ischemic pathology].

The authors have reviewed the role of platelets in thromboembolic strokes, the effects of usual antiplatelet drugs on haemostasis and the new approaches to the prevention of thrombosis. Critical analysis of controlled clinical trials indicates only aspirin use showed evidence of effectiveness in prevention of transient ischemic attacks or minor strokes related to atherosclerosis.

Aspirin↗
PubMed1987

Non-hereditary multiple telangiectasias of the central nervous system. Report of two clinicopathological cases.

We describe 2 clinicopathological cases of non-hereditary multiple telangiectasias of the nervous system. In the first case, the general course of the disease was characterized by spells over a period of 7 years and the major lesions successively involved cranial nerves, spinal cord and brain. Neuropathological examination showed both ischemic and hemorrhagic changes. Systematized degenerative changes were found and were similar to those observed in spinocerebellar heredodegenerations (Friedreich's ataxia). In the second case, the 3 years of evolution were characterized by spells of the encephalitic type only. A review of the literature indicates the rarity of this kind of disease, the usual localization of capillary malformations and the clinical polymorphism (epilepsy, strokes, multifocal syndromes masquerading as multiple sclerosis). The pathogenesis of pathological changes is discussed.

Aged↗
PubMed1984

[Late post-poliomyelitic muscular atrophy. Apropos of 14 cases].

The authors report 14 cases of late post-poliomyelitis muscular atrophies. The atrophy appears many years after the acute episode of anterior poliomyelitis. Several types of disorders were observed: extension of weakness and wasting; chronic spinal amyotrophy; amyotrophic lateral sclerosis without bulbar atrophy, coincidental muscular dystrophy. These cases have been interpreted in different ways. Further studies are necessary.

Adult↗
PubMedDate not supplied

[Cerebral arterial ischemic complications in young adults. Etiology and prognosis].

The authors investigated 100 patients (55 males and 45 females) aged 16 to 45 years who experienced cerebral ischemic attack, excluding venous thrombosis. Transient ischemic attacks accounted for 12% only. Attacks were related to usual causes of brain ischemia in 49 cases (premature atherosclerosis in 26, cardiopathy in 20 and lacunar stroke in 3). Thirty-eight events were attributed to most uncommon etiologies. Nonatherosclerotic arteriopathies (10 cases) such as spontaneous dissection, dysplasia or megadolichoarteries were easily diagnosed by angiography. Oral contraceptives (14 cases) and migraine (2 cases) were diagnosis of exclusion. Hematological disorders were a possible cause in 10 patients. Etiology remained undetermined in 13 cases. Four patients died acutely. Follow-up data were obtained in 93 survivors with a mean duration of 26 months (range, 6 to 60 months). Four subjects died during follow-up and 6 experienced recurrent stroke (annual recurrence rate: 3%). In activities of daily living, 64% of patients had complete autonomy while 13% had mild residual disability and 23% had severe handicap.

Adolescent↗
PubMedDate not supplied

[Prevention of deep venous thrombosis of the leg by a very low molecular weight heparin fraction (CY 222) in patients with hemiplegia following cerebral infarction: a randomized pilot study (30 patients)].

The effectiveness and safety of a very low molecular weight heparin fraction were evaluated in the prevention of deep-vein thrombosis in patients confined to bed due to hemiplegia consecutive to a recent cerebral infarction. CY 222 was administered within 48 hours of the stroke by one single daily subcutaneous injection of 0.6 ml (= 15,000 U AXa IC) during 14 days. This randomized pilot study involved 30 patients. The effects of CY 222 were assessed in a group of 15 patients compared with a control group of 15 untreated patients. No deep-vein thrombosis was detected by the labelled fibrinogen test in the treated group, as against 12 patients in the control group. Six patients (3 in each group) died during the study. One case of lethal pulmonary embolism was observed and confirmed at autopsy in the control group. In the remaining 5 patients, no systematic autopsy which would have asserted the absence of pulmonary embolism or drug-induced haemorrhage was performed. Numerous standard laboratory tests confirmed that CY 222 was well tolerated.

Aged↗
PubMedDate not supplied

[Hypoglycemic hemiplegia. Apropos of a case].

An insulin-dependent 26-year-old woman was complaining of nocturnal attacks of transient right hemiplegia. Hypoglycemia was found to be present at the time of each attack, and further investigations showed that these neurological disorders were related to an overdose of insulin. The authors discuss the effects of hypoglycemia on the brain and the pathogenetic theory of "hypoglycemic hemiplegia", involving selective neuronal vulnerability, regional blood flow disturbances or underlying ischaemic disease.

Adult↗
PubMedDate not supplied

[Stuporous state in an epileptic treated with sodium valproate. Diagnostic problems].

The authors report a case of stupor secondary to valproic acid, in a patient treated with this drug and phenobarbital for a complex partial form of epilepsy. The pathogeny of this rare complication is discussed. In this patient, a paradoxical epileptic reactivation is excluded, and the authors favor a metabolic mechanism: either hyperammoniemia or a perturbation in cerebral neuro-transmitter systems are proposed.

Adult↗
PubMedDate not supplied

[Bilateral carotid artery occlusion. Analysis of 9 cases].

The authors report on a series of 9 cases of bilateral internal carotid artery occlusion with long-term follow-up. Risk factors, clinical presentation and outcome have been reviewed. On basis of angiographic and CT scan features, the role of collateral circulation is discussed.

Aged↗