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P Salvaing

Publications and source records attributed to P Salvaing.

18 recordsLinked to original sources

[Occlusion of the vertebral artery (100 personal cases)].

Occlusion of the vertebral artery is usually due to atherosclerosis. According to the site and extension of the arterial lesions 3 clinico-pathologico-angiographic situations can be encountered: segmental occlusion (proximal: V1 or distal: V3, V4), multisegmental (mainly V1-V2, sometimes V1-V2-V3) or extensive (V1 or V4). Subsequent infarctions are localized in ipsilateral cerebellar lobes and ipsilateral lateral part of the medulla oblongata; supra-medullary involvement is rare and indicates a propagation of the vertebral thrombus into the basilar artery. Cerebellar, vestibular or cerebello-vestibular strokes and Wallenberg's syndrome are the more frequent clinical disorders. They are often preceded by occipito-cervical headache. Contrary to a common belief, the vital risk in vertebral artery occlusion is not negligible. Among 160 cases, 100 of which are personal, mortality was 25%. In fact benign segmental and proximal occlusion adequately compensated, specially when isolated, must be opposed to segmental distal occlusion and extensive occlusion. Angiography and Döppler examinations localize arterial lesions and subsequent hemodynamic disorders. The treatment is often symptomatic only. Surgery of the proximal vertebral artery may in some cases be the only hope of preventing occlusion.

Adult

[Intracranial hypertension and ependymoma of the end of the spinal cord].

A 42 year-old woman was admitted with a subacute intracranial hypertension which improved under medical treatment. Angiographic data and CT scan showed enlarged ventricles. CSF showed 1.95 g/l of proteins. Five months later, a relapsing acute intracranial hypertension led to a ventricular derivation. CT scans, angiographies and ventriculography showed progressively enlarged ventricles but failed to disclose any intracranial tumor. A thoraco-lumbar tumor of the spinal cord was incidentally discovered and removed. Histopathology concluded to an ependymoma. No sign of recurrence has occurred after an eighteen month follow up. The pathogenesis of intracranial hypertension occurring in spinal cord tumors is discussed.

Adult

[Spontaneous hematomas of the cerebellum. 28 personal cases].

Cerebellar hematomas constitute an emergency as emphasized by a study of 28 personal and 189 published cases. Accounting for 10 per cent of the total of cerebral hemorrhages, they occur mainly in patients after 40 years of age essentially as a complication of hypertension. An evocative stereotyped triad characterizes their sudden onset: severe headache, repeated vomiting, vertigo and imbalance. In their subacute and acute forms, a rapid impairment of consciousness occurs. Death is constant in such cases. Computerized axial tomography is the essential mean of accurate diagnosis and shows the subsequent consequences on other brain structures. Surgical evacuation of hematomas preceded or not by ventricular drainage is the useful procedure in most cases. Results depend on a timely decision and on the conscious level. In other cases, the spontaneous course is more favorable. Brain herniation is however possible and the presence of a vascular posterior fossa malformation must be kept in mind.

Adult

[Occlusion of the basilar artery. A review with 17 personal cases (author's transl)].

Occlusion of the basilar artery is mainly of atherosclerotic origin; embolic occlusion, dissecting aneurysm, trauma and arteritis are less frequent. Pathologic and angiographic findings allow to classify basilar artery occlusions in three types: segmental (superior, medial or inferior), plurisegmental and extensive. The infarcted areas involve brain stem, especially pons and cerebellum, also diencephalon and cerebral hemispheres, in various combinations. Clinically, there is typically a prodromic stage, with transient ischemic attacks (vertigo, headaches, visual disturbances, motor deficit). Few weeks later, a decreased level of consciousness and motor anomalies are the most important signs. A fatal outcome is noted in 85,98 p. 100. Among laboratory examinations, only angiography proves the occlusion: it also shows the arterial supply (carotido-basilar reflux; inter-cerebellar anastomosis). Computed tomography usually eliminates an expanding mass of the posterior fossa. Management is only of general type. Surgical management of carotid arteries stenosis may ameliorate the anastomotic flow.

Arterial Occlusive Diseases