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Biomedical subjects

P Convers

Publications and source records attributed to P Convers.

33 records · Page 2Linked to original sources
PubMed1994

[Aneurysms of the intra-atrial septum complicated by cerebral ischemia in young subjects. 4 cases].

Transoesophageal echocardiography has improved the detection of potential sources of cerebral embolism. We report our experience with a group of 38 patients under 45 years of age who were examined after an arterial ischaemic cerebral event. We observed 4 patients (2 males, 2 females; age 17, 24, 38 and 40 years) with an atrial septal aneurysm. Cerebral ischaemia was permanent in 3 patients and temporary in 1 and a cerebral embolism was the most probable cause based on angiographic findings. The atrial septal aneurysm was only diagnosed by transoesophageal echocardiography (type IA in case 3, IB in the others). A patent foramen ovale was observed in 3 and this abnormality, which is known to have a high prevalence in the general population, could at most be an aggravating factor. In our series, we can assume a causal association between atrial septal aneurysm and stroke in young patients (10.5% among 38 young stroke patients vs 3% of 30 patients referred for other reasons). The treatment is still under discussion although the consensus would favour surgery if another heart malformation is associated, if a visible thrombus is identified or if repeated cerebrovascular events occur despite adequate anticoagulation. Studies conducted in large series of patients should provide more adequate therapeutic schemas.

4-Hydroxycoumarins↗
PubMed1993

[Post-traumatic syringomyelobulbia and inferior vertical nystagmus].

A case of post-traumatic cervico-thoracic syringomyelia was complicated, 3 years after the injury, by a bulbar extension manifested by a downbeat vertical nystagmus which became a source of disabling oscillopsia. The syringobulbia was visualized at MRI. The usefulness of syringostomy in such a case is discussed.

Adult↗
PubMed1992

[Unilateral scapulohumeral amyotrophy. Contribution of imaging].

A case of right scapulohumeral muscular atrophy stable after a 6 month progressive course is reported. Cervical metrizamide CT and MRI showed a flattened right cervical spinal cord regarded as a segmental atrophy. The case could belong to the Kaeser type of sporadic chronic spinal amyotrophy, or perhaps corresponds to a benign focal amyotrophy.

Adult↗
PubMed1991

Pathology of roots, spinal cord and brainstem in syringomyelia-like syndrome of Tangier disease.

We report here a post-mortem examination of a 46-year-old patient who died after a 23-year-long syringomyelia-like syndrome of Tangier disease. The L5 dorsal root and the superficial peroneal nerve showed fiber loss and lipid vacuole accumulation in Schwann cell cytoplasm. The L5 ventral root had moderate fiber loss without lipid vacuoles. In the cervical roots, fiber loss was intense and there were no foamy Schwann cells. Motor neuron loss was severe in the cervical spinal cord and the facial nerve nucleus and slight at the lumbar level. Under electron microscopy, some neurons of the lower spinal cord showed atypical inclusions. These data suggest that an unknown metabolic defect is responsible for a primary neuronopathy. Lipid accumulation in Schwann cells, resulting from fiber degeneration is probably transient, accounting for the absence of foamy cells in regions with longstanding involvement.

Autopsy↗
PubMed1991

Unusual amyloid polyneuropathy with predominant lumbosacral nerve roots and plexus involvement.

We report a 25-year-old patient with a progressive asymmetric peripheral neuropathy of the distal lower limbs. Imaging studies showed enlargement of lumbosacral roots, plexus, and proximal sciatic nerve. Sacral plexus biopsy revealed amyloidosis associated with endoneurial edema. Immunohistochemistry with anti-prealbumin, serum amyloid A, and immunoglobulin light chain antisera failed to label the amyloid.

Adult↗
PubMed1990

[Contribution of magnetic resonance imaging in 100 cases of refractory partial epilepsy with normal CT scans].

One hundred epileptic patients were included in this study according to the following criteria: intractable partial epilepsy, normal CT scan and focal EEG abnormalities. Eighty-nine patients were suffering from complex partial seizures of temporal or frontal origin, 55 and 34 cases respectively. Eleven patients presented with only simple partial seizures. MRI was abnormal in 31 patients. The abnormalities were: focal T2 increased signal intensity (13 cases) most often temporal (10 cases), cryptic arteriovenous malformation (4 cases), focal T1 and T2 signal abnormality (4 cases), focal atrophy (2 cases) and multiple abnormal T2 signals scattered in the white matter (8 cases). The site of MRI abnormalities was consistent with electroclinical data in 22 patients, of whom 20 had a temporal lobe epilepsy. Thus MRI proved to be more often abnormal in temporal than in frontal lobe epilepsy (36 p. 100 and 5.9 p. 100 respectively) when the CT scan is normal. However MRI data, particularly focal T2 hypersignals should be confronted to electroclinical and metabolic findings whenever functional surgery is considered.

Adolescent↗
PubMed1990

[Cortical pain. Clinical, electrophysiologic and topographic study of 12 cases].

Vascular lesions of the cerebral cortex sparing the thalamus (MRI or CT with reconstructions) may be accompanied by burning or constrictive pain which suggests thalamic pain as it affects one half of the body and is associated with induced pain. Summation hyperpathia is rare; allodynia is more common and sometimes isolated (2 cases). Cortical pain may be paroxysmal, and in 3 of our patients it progressed like a jacksonian seizure. The territory of pain is also the site of global or spinothalamic hypoaesthesia (5 cases). Early SEPs are abolished or of low amplitude (8 cases). The lesion is located in area SI or extends to the thalamo-parietal radiations; in 11 out of 12 patients it was located in the minor hemisphere. Two physiopathological theories are discussed: hyperactivity of the intralaminar thalamus relieved from cortical inhibition, or denervation hyperactivity related to the cortical or subcortical lesion.

Adult↗
PubMed1989

[Anomalies in early somatosensory evoked potentials in brain stem lesions (study of 64 cases)].

Short latency somatosensory evoked potentials (SEPs) have been recorded in 64 patients with brainstem lesions documented by neuroimaging techniques. Patients were classified in four groups according to the lesion topography: cervico-medullary junction and medulla (16 cases), pons (19 cases), mesencephalon (8 cases), extensive (21 cases). SEPs were abnormal in 57.8% of cases either bilaterally (17.2%), or unilaterally (40.6%). The different components were affected as follows, P14: 34.4%; N20: 56.9%; P22 and N30: 54.7%, peripheral and spinal responses were always spared: N18 and P14 abnormalities were highly correlated. In cervico-medullary lesions P14 and N20 were constantly abnormal, P14 was normal in strictly mesencephalic lesions but could be abnormal in cases of subthalamic lesions with mesencephalic extension; in pontic lesions, P14 could be normal or not, and N20 was always very reduced. These results confirm that P14 has a supra-spinal origin and may have two generators. SEPs detected a subclinical dysfunction of the lemniscal pathways in 18% of patients with normal somatosensory performances and, as BAEPs (abnormal in 54% of the 54 recordings performed in this series) deserve to be recorded for the routine investigation of brainstem function.

Adolescent↗
PubMed1989

Magnetic resonance imaging in refractory focal epilepsy with normal CT scans.

One hundred patients suffering from focal epilepsy with complex partial seizures refractory to medical treatment and showing no abnormality at CT were explored by MRI with an 0.5 Tesla magnet. MRI detected an abnormality in 25 patients with, in 17 of them, good correlation between MRI and clinical as well as electroencephalographic findings. Abnormal morphology and signal was found in 5 patients, with positive CT results on reexamination of previous CT images or on new CT scans in 4 of them. There was a diffuse temporal lobe high-intensity signal in 3 cases and a localized high-intensity signal in 9 cases (temporal lobe 4, occipital lobe 3, frontal lobe 1, fronto-parietal and parietal lobes 1). Thus, in 13% of the cases MRI demonstrated a lesion that had not been detected at CT, and the location of the lesion was concordant with clinical and electroencephalographic data.

Adolescent↗
PubMed1988

[Dissecting aneurysm of the intracranial vertebral artery. An anatomo-clinical case].

A 64 year old patient with a cardiac prosthesis and receiving antivitamin K therapy presented with a right bulbar syndrome. Based on absence of meningeal signs and hemorrhage on CT scan heparin therapy was instituted. Fatal coma developed two and a half days later. Autopsy findings included a right lateral bulbar infarct and meningeal hemorrhage, predominant around a fusiform dilatation of the end of the right vertebral artery. Serial sections showed a large dissecting aneurysm between media and adventitia communicating with an intimal tear. Among intracranial dissecting aneurysms those of vertebrobasilar localization have the peculiarity of being subadventitial in some cases, with a subsequent enhanced risk of hemorrhagic complications. The use of anticoagulants appears contraindicated in these cases, even if their clinical expression is suggestive of an infarct. Their etiology is often unknown.

Aortic Dissection↗
PubMed1986

[Dural arteriovenous fistulas of the posterior cerebral fossa and thrombosis of the lateral sinus. Discussion of their relations and treatment apropos of 2 cases].

Two cases of a posterior fossa dural arteriovenous malformation associated with a lateral sinus thrombosis are reported. In the first case, a right tentorial meningioma develops at the end of the superior sagittal sinus and on the transverse sinus which are occluded. A cranial bruit, heard by the patient four months after the surgical removal of the tumour, brings up a dural fistula supplied by the occipital, middle meningeal and pharyngeal arteries and drained away by cervical and cortical veins. Many attempts of extirpation and radiological embolization stop the bruit. In the second case, an increased intracranial pressure mixes up with an aphasia. A continuous emission doppler examination and a CT scan make likely a dural fistula. The malformation, which is associated to a left sigmoid sinus thrombosis, is fed by the occipital and middle meningeal arteries and drained by cortical veins to the cavernous sinus. The occipital artery ligation and a by-pass between the lateral sinus and the internal jugular vein cure the patient with a very good patency of the venous graft that holds up two years after. A few cases of the literature show the succession of the two vascular lesions and prove the primitive occurrence, either of the sinus occlusion, or of the dural fistula. A venous thrombosis might cause a fistula by the opening of physiological shunts of the dura-mater which consequently deviates the blood into the cortical veins, brings down the increased intracranial pressure and stops the thrombosis to spread.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Thrombotic thrombocytopenic purpura: MR findings.

Neurologic manifestations occur in over 90% of patients with thrombotic thrombocytopenic purpura. Neuropathologically, thrombi produce occlusion of terminal arterioles and capillaries resulting in diffuse small infarcts. In the great majority of surviving patients, brain CT does not disclose any abnormalities. The authors report a case of thrombotic thrombocytopenic purpura in which brain MR examination showed multiple punctate lesions in the white matter.

Adult↗