Biomedical subjects
P Cellerier
Publications and source records attributed to P Cellerier.
[Benign paralysis of the last 4 cranial nerves. Arguments in favor of an ischemic mechanism].
The last four cranial nerves are fed by the ascending pharyngeal artery, a branch of the external carotid artery. The fact that paralysis of these nerves may occur immediately after arteriography of the external carotid artery demonstrates that ischaemic truncular neuropathies do exist. The deficit is sudden and usually regressive. Ischaemia may account for regressive paralysis of these nerves reported in diabetes, herpes zoster and after some traumas. Apparently idiopathic and benign paralysis might be due to the same mechanism. All 4 nerves may be affected, or only the IXth, Xth and XIth nerves, or the XIth nerve may be spared, being fed by two arteries. Apart from the obvious case of arteriographic accident, the diagnosis of paralysis of ischaemic origin can only be made after other causes, notably compression, have been excluded, since direct evidence of arterial obstruction is exceptionally obtainable; regression at follow-up is a major argument in favour of ischaemia.
[Acute parasellar compression syndrome disclosing hypophyseal adenoma. 3 cases].
Three cases of acute necrosis of a hypophyseal adenoma are reported with a review of the medical literature. The clinical presentation as an acute parasellar compression syndrome was the result of aseptic meningitis in 2 cases and of cavernous sinus thrombosis in the other; the usual symptoms of headaches, oculomotor paralysis and impairment of consciousness were observed. The diagnosis was suspected on clinical grounds, by the radiological changes of the pituitary fossa and confirmed by computerised axial tomography. All three patients had a favourable outcome. Surgery was only required in one case with threatening visual complications. Dissociated anterior pituitary deficiency persisted in all cases; two patients also had diabetes insipidus. In one case, the pituitary necrosis stabilised an acromegaly for a two year period.
Computed tomography in primary lymphoma of the brain.
C.T. scans of 19 patients with histologically proved primary lymphoma of the brain were reviewed and divided into three groups: solitary tumors (58%), multifocal tumors (31,5%), diffuse involvement of the brain (10,5%). The C.T. differential diagnosis are manifold, including meningioma, glioma, metastases, progressive multifocal leukoencephalopathy. Arteriography is not specific, but, correlation with C.T. results may suggest the correct diagnosis and encourage biopsy. The radiosensitivity of primary lymphoma of the brain emphasizes, the importance of an early diagnosis.
[Dissection of the vertebral arteries after manipulation of the cervical spine. Apropos of a case].
Dissecting aneurysm of the vertebral arteries following chiropractic manipulation of the spine. A thirty-five years old man had a Wallenberg Syndrome following chiropractic manipulation of the spine. Plain films and hypocycloidal tomography showed a foramen arcuale on both side. Arteriography lead to the diagnosis of dissecting aneurysm of the vertebral arteries. The favourable course point to the value of the posterior communicating arteries and the spinal artery as collateral pathways of the vertebro-basilar circulation.
[Computed tomography in the diagnosis and surveillance of cerebrovascular accidents].
In cerebral hemorrhage, it provides an easy and early diagnosis, by demonstrating hyperdensity indicative of the presence of coagulated blood in the cerebral tissue. During the course of the illness, this hyperdensity progressively lessens, to disappear within a varying interval of time. The sequelae are seen as a cavity, the density of which is close to that of the CSF. In cerebral infarctions, the scan remains normal for the first few hours, and its only value at this stage is to eliminate cerebral hemorrhage before anticoagulants are prescribed. It is only after 24 to 48 hours that the fundamental sign is seen, that is hypodensity of the ischemic territory. This hypodensity may be accompanied by a mass effect and, above all, the uptake of contrast, which may be of great diagnostic importance, and the significance of which has been widely discussed. The course takes the form of the progressive development of the sequelary cystic appearance.
Results of computerized metrizamide cisternography. 37 cases of fracture of the anterior and/or middle fossae of the base of the cranium.
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Cerebrospinal fluid rhinorrhea: evaluation with metrizamide cisternography.
Metrizamide computed tomographic cisternography was used to examine 27 patients (19 males and eight females, 14-59 years old) clinically suspected of having cerebrospinal fluid fistulae with rhinorrhea. Twenty-one fistulae were traumatic and six were spontaneous. Five to 6 ml of metrizamide (or lopamidol, two cases) were injected by lumbar puncture at a concentration of 185-200 mg I/ml for direct coronal and axial computed tomographic sections of the skull base. Cerebrospinal fluid rhinorrhea was present at the time of examination in 12 of 27 cases. Results were evaluated according to three criteria: (1) metrizamide passage through the bony and dural defect; (2) demonstrable site of the fracture and/or bony defect; and (3) metrizamide visualized within a paranasal sinus, nasal cavity, or cotton pledget. The examination was considered positive when criterion 1 alone was present and when 2 and 3 were associated. In 15 of 27 cases, cisternography was positive, with the exact site of cerebrospinal fluid leakage demonstrated in 10 patients. In six cases, the results were not definitive; only one of the criteria (2 or 3) was fulfilled. In six cases, cisternography was normal. Seventeen patients underwent surgery. The site of cerebrospinal fistulae was ethmoidal in nine cases, frontoethmoidal in seven, sphenoidal in two, and sphenoethmoidal in one. The relative value of metrizamide computed tomographic cisternography compared with other diagnostic studies, polytomography, positive or negative contrast studies, and radionuclides, is discussed. Diagnostic pitfalls include artifacts and partial volume effect.
Metrizamide CT cisternography and perioptic subarachnoid space imaging.
Opacification of the perioptic subarachnoid space (PSAS) is a normal occurrence. Opacification depends on the anatomy of the meningeal layers surrounding the optic nerves. To determine the reliability and the most efficacious technique for opacifying the PSAS, a retrospective study of 200 computed tomographic cisternography studies with water soluble contrast medium (metrizamide or iopamidol) was undertaken. Of these patients, 32.5% had opacification of the PSAS. Opacification was facilitated by examining the patients in the prone position. Demonstration of the PSAS was frequently noted in patients with empty sella and rhinorrhea.