Complex hyperkinesias ipsilateral to right frontoparietal cortical infarction.
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Biomedical subjects
Publications and source records attributed to P Dobbelaere.
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A case of basal encephalocele protruding through a defect in the greater wing of the sphenoid bone is presented. The transalar type of encephalocele is uncommon and unclassified. This case, documented by computed tomography and magnetic resonance imaging, is unique in that it presented with trigeminal neuralgia and was associated with an angioma of the soft palate.
Basal encephaloceles are uncommon congenital malformations occurring with an estimated frequency of one case in 35,000 births. They are frequently occult since they protrude into the orbit, nasal cavity, nasopharynx or paranasal sinuses. Basal encephaloceles are divided into five anatomical types. We report a case of transsphenoidal encephalocele which differed from the classical type in that it protruded through a congenital defect in the greater wing of the sphenoid bone. This case had an unusual clinical presentation, being responsible for trigeminal neuralgia and associated with an angioma of the soft palate.
A new case of sub-occipital Pott's disease is reported: a 26 year old, coloured male patient from Senegal was admitted for: cervical pain of 6 month duration, neck stiffness, dysphagia, left XII paralysis and left hemiparesis. The radiological study found an anterior atlanto-axial subluxation, basilar impression, and increased thickness of the retropharyngeal soft tissue, lysis of the left occipital condyle and the left lateral mass. CT scan study revealed a retropharyngeal mass and an epidural contrast-enhanced lesion at the C2 C3 C4 levels. Chest-X ray showed one tuberculous lesion at the right apex. The research of Acid Fast Bacilli in gastric secretion samples and the results of the retropharyngeal mass puncture were positive. An antituberculous trichemotherapy was started. After early reduction by skull tongs traction, an occipito-cervical arthrodesis by Roy Camille plates was performed, followed by the wearing of a minerva plaster jacket and then a plastic collar. Each one for a 5 month period. One year later, there remained only a left XII paralysis, but the bony reconstruction was not yet obvious on tomography. A survey of the literature of 70 cases of sub-occipital Pott's disease has pointed out these findings: cervical pain (98%), neck stiffness (82%), Atlantoaxial subluxation (68%), thickened prevertebral soft tissue shadow (77%), lateral mass lysis (48%) other tuberculous focus (29%). The main therapeutic trends are: early and long-lasting antituberculous poly-chemotherapy, early reduction of subluxations, prolonged contention for slight osteolytic lesions and for major: lytic lesions, a posterior surgical procedure either by bone graft combined with wires or preferably fusion by means of occipito-cervical plates. The removal of abscess is discussed.
There has been remarkable progress in the therapy of maxillofacial disorders, mainly as a result of the development of Djinjian and Merland's techniques for the exploration and selective embolization of the region supplied by the external carotid artery. These methods facilitate management of bone and skin angiomas and help to resolve problems of therapeutic arteriography for orofacial tumors. Two particularly hypervascular types of tumor: nasopharyngeal angiofibroma and carotid glomus tumor, as well as the hemorrhagic complications of facial epitheliomas, are conditions in which extremely useful data is obtained. Post-traumatic arteriovenous fistula can be treated by introducing inflatable balloons that are releasable or linked to a catheter. Acute severe epistaxis following injury responds to emergency embolization of the external carotid artery branches.
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The clinical diagnosis of acoustic neuroma was suggested by the cochleovestibular symptomatology in a young woman who, was found indeed to have a neurinoma of the foramen laceratum. Such masquerading symptoms and signs are frequently reported (in one quarter of the cases) in these tumors, and probably partly explain their rarity, only 59 cases having been described. Tomography of the base of the skull appears as the main investigation leading to a correct diagnosis.
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A man of 19 years of age was found to have a diffuse livedo, a quadruple asphyxic acrosyndrome, and dementia. Angiography confirmed the presence of distal ischemia with multiple circulatory blocks and a reduced distal network. The patient died at the age of 25 years and histopathological examinations of the vessels demonstrated obstructive atheromatous lesions in the medium sized and small arteries of the brain and viscera. By comparing these findings with those observed in three other cases, in which biopsy of the pulp of the toe was also performed, the hypothesis can be advanced that these juvenile encephalic ischemic accidents are caused by atheroma, which can be detected, at an early stage, by studying the distal arteries in the finger or toe pulp.
The authors analysed in particular the venous drainage of 370 arteriovenous aneurysms operated during 20 years in neurosurgery at Lille's Hospital. If in many cases the study in details of the different arterious pedicles take an important place in the discussion of the indications and operative technics; in other cases a bad estimate of the interest of careful study of veins can be at the beginning of great disappointments. Also the authors insist on the necessary study of the venous system in totality by seeing after agenesia of some passages, the respective drainage of the angioma and the brain, the existence of a saturation venous phenomenon. The analysis in details of the anatomical and functional distribution of the venous drainage in these malformations can be taken into consideration in the operative decision. The analysis of results in ten preference observations suggest that it is an important element in the arteriovenous aneurisms' evolution and in the final prognostic.
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A report of the case of a 68 year old patient with a 9,5 cm long ectasia of the cisternal portion of the left internal carotid. On the basis of this case, the authors review the pathology due to such dolichomega-arteries and the aetiology of arteriectasia which are partly dysplasic in origin.