Biomedical subjects
Publications and source records attributed to P Guillermain.
Spontaneous cerebellar hematomas account for 10 p. 100 of all spontaneous intra-cranial hemorrhages. In this series of 44 cases, 3 clinico-pathological groups are described on the basis of clinical and pathological data (small, middle and massive hematomas). The mortality rate was high (50 p. 100). Nevertheless, early and direct draining of the hematomas provides the best chances of survival.
During the same year (1984), we have seen 3 cases of meningiomas following radiation therapy of the brain for previously diagnosed tumors. A causal relationship between irradiation and meningioma has been postulated. Nevertheless, the coincidental occurrence in same patient of two different histological lesions is possible. The neoplasms developed after irradiation are of mesenchymal origin; they are fibrosarcomas, osteogenic sarcomas and meningiomas.
Our study is based on the analysis of traumatic I.C.H. 38 cases observed since we have had a C.T. Scan at our disposal (1975). Those cases (recorded in the departments of Paillas, Vigouroux, Sedan, Combalbert) represent 2,3% of the brain traumas, 6,5% of the traumatic intra-parenchymatous lesions and 9,5% of the traumatic intra-cranial hematomas. Most of the cases reported deal with male patients, with on average age of 46, who are often victims of traffic accidents. In half the cases of skull fractures, the hematoma is located in the opposite side of the fracture. In almost all cases, initial loss of consciousness is observed, followed by consciousness alterations, with few free intervals and with neurological focal signs depending on the site of the lesion. The C.T. Scan data of the those traumatic hematoma have been studied.
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In our Statistics, accidents in sports represent only 2,3% of the trauma cases hospitalized in the neurosurgical service of Marseille La Timone; of these cases 57% are cranio-cerebral injuries, 43% are vertebral or spinal cord injuries. The type and severity of trauma are of course directly related to the type of sport concerned. Cranio cerebral and spinal cord injuries occur with the same frequency in rugby. Horse back riding and foot-ball are responsible for severe cranio-cerebral injuries (respectively 90% and 92% of the total number of these accidents). Diving is the cause of spinal cord injuries in 79% of the cases. Close supervision of accident victims and systematic and technical analysis of accidents related with sports practice should improve the safety for both amateurs and professionals.
Traumatic thrombosis of the middle cerebral artery have been rarely reported and documented. Eight personal cases provide us an opportunity to stress the common features of this rare entity: onset of symptoms several hours after severe head-trauma, in young men; computerized tomography combined with carotid angiography are decisive for the diagnosis. Prognosis is poor-six deaths out of eight patients. Anticoagulantherapy is useless even dangerous. Extra-intra cranial anastomosis may appear a better solution in selected cases.
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