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Biomedical subjects

P Garde

Publications and source records attributed to P Garde.

6 recordsLinked to original sources

[Clinical and electroencephalographic manifestations during the Wada test using intracarotid injection of methohexital (Brietal)].

In this retrospective study we report our 12 years' experience of the Wada test (intra-carotid injection of short half-life barbiturates) using Methohexital. The clinical manifestations induced by Methohexital were similar to those observed with Amobarbital. The inocuity of the test is attested by the finding that no incident or accident has been reported in 126 injections, the risk being the same as for arteriography. The two main advantages of Methohexital over Amobarbital are: 1) short hemispheric narcosis, which makes it possible to explore the two carotid arteries territories during the same session and limits the risk of drug diffusion to the two hemispheres; 2) the rare occurrence of vigilance troubles such as drowsiness or falling-asleep, which are frequently observed during Amytal Wada test. Intracarotid Methohexital injections are effective to determine the hemispheric lateralization of language and useful to evaluate the role of each hemisphere in memory, especially before the surgical treatment of drug-resistant focal epilepsies.

Brain Diseases↗

[Early somatosensory (SEP) and auditory (AEP) evoked potentials in anoxic coma: prognostic value].

Early somatosensory (SEP) and auditory (BAEP) evoked potentials, when recorded within the first seven days of the course of anoxic coma, appear to be reliable to evaluate anoxic ischemic cortical or under-cortical lesions. Prognosis depends especially on cortical SEP (N20-P25): the lack of SEP is a good outcome predictor of death (abnormal BAEP) or of vegetative status (normal BAEP); the presence of normal and bilateral cortical SEP (with normal BAEP) allows to predict awakening, without prejudging of neurologic sequelae, even if they are severe.

Acoustic Stimulation↗

[Nocturnus terrors--somnambulism].

Among disorders of sleep in children, pavor nocturnus ("night terrors") is common and considered harmless. Yet the clinical picture, the child's personality and the polygraphic electroencephalographic recordings suggest that it should be treated sooner and more often than is usually done. Somnambulism ("sleep walking") also is very frequent. It has no consequences in most cases, but it may be the cause of serious events such as falling out of a window which is rare but may result in death or disablement. Some children have repeated attack of somnambulism, and these constitute a true pathology of sleep requiring a specific treatment that will cure or improve. All this must be known to the practitioner who will inform the parents.

Adolescent↗

[Prolonged absence states in aged patients without epileptic antecedents].

Eight cases of [absence status] are reported, occurring in old patients (7 females, 1 male), mean age 75 years, without any known history of epilepsy. The main clinical feature was a fluctuating state of consciousness, during which the EEG showed diffuse spikes and polyspikes with a frontal predominance. These abnormalities disappeared after intravenous benzodiazepine administration, resulting in most cases in a spectacular clinical improvement. Five of our patients had a depressive history and were taking antidepressive or psychotropic drugs. Hyponatremia or hypokalemia probably secondary to diuretic medications, was present in 4 cases. No recurrence occurred with or without long-term anti-epileptic medication.

Aged↗

[Spatial delusion: sign of lesions of the non-dominant hemisphere].

Two cases with respectively an ischemic and a tumoral lesion of the right hemisphere showing a striking and isolated delusional belief to be relocated elsewhere are reported. Delusion had the remarkable intrinsic coherence of a paranoid delirium but was limited to the localization in space. In contrast these patients had no mental clouding or hallucinations and were well orientated for time and persons. Associated findings were a misrepresentation of space in drawing in the first case, and a left hemiparesis, a left sensory extinction, a left hemianopsia, a left visual neglect, a constructional apraxia and a misrepresentation of space in the second case. Such a spatial delirium has been described after severe head injury but rarely after unilateral cerebral lesions. The latter involve constantly the right hemisphere, either in the frontal, temporo-parietal or thalamic region. Usual neurobehavioral correlates in these cases were a disorder of visual memory, a topographical disorientation, a lack of representation and use of visuospatial data, and an anosognosia. The putative role of a 'release' of the left hemisphere is discussed.

Aged↗