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Biomedical subjects

R Khalil

Publications and source records attributed to R Khalil.

At least 19 recordsLinked to original sources
PubMed1992

[Pure cerebellar infarction. Thirty cases].

Infarcts in the territory of cerebellar arteries, often involving both brainstem and cerebellum, have been well recognized in recent pathological and clinicoradiological studies. To evaluate the situation of pure cerebellar infarcts (PCI) we studied 30 consecutive cases of symptomatic PCI (22 men and 8 women, mean age 58 +/- 17 years) admitted over a 5-year period and selected on the basis of brain computed tomography completed by magnetic resonance in 20 cases and angiography in 15 cases. PCIs accounted for 53 percent of cerebellar infarcts, 10 percent of vertebrobasilar infarcts and 3.2 percent of all cerebral infarcts. The arterial territories involved were the superior cerebellar artery (SCA) in 13 cases (alone in 8 cases), the anterior inferior cerebellar artery in 2 cases, the posterior inferior cerebellar artery (PICA) in 17 cases (alone in 13 cases) and border areas in 5 cases (associated with SCA or PICA). The symptoms were the same in the arterial territories involved (SCA versus PICA), except for dysmetria and vestibular syndrome which were more frequent respectively in SCA territory infarction (P < 0.001) and in PICA territory infarction (P < 0.01). Certain or presumed causes were cardiogenic embolism (23 percent), atherosclerosis (43 percent) and other identified causes, such as oral contraceptives or temporal arteritis (10 percent). They remained undetermined in 24 percent of the cases. Although most patients were severely disabled in the acute stage (Barthel index < 60 in 21 cases), 90 percent recovered subsequently (Barthel index about 100 and 0-2 score on modified Rankin scale). Our findings indicate that symptomatic PCIs are rare; their main causes (cardioembolism and atherosclerosis) do not differ in frequency from those of all cerebral infarcts collected in stroke registries and their functional prognosis is good in almost all cases.

Adult↗
PubMed1992

Coordination between posture and movement in a bimanual load lifting task: putative role of a medial frontal region including the supplementary motor area.

The aim of the present experimental series was to investigate the role of the medial frontal region including the supplementary motor area in the coordination between posture and movement in a bimanual load lifting task. The seated subject was instructed to maintain in a horizontal position one forearm (postural arm) which was loaded with a 1 kg weight. The unloading was performed either by the experimenter (imposed unloading) or by a voluntary movement of the other arm (voluntary unloading). In normal individuals, with the voluntary unloading, the movement control was accompanied by an anticipatory adjustment of the postural forearm flexor activity, which resulted in the maintenance of the forearm position despite the unloading. The anticipatory postural adjustments were impaired in 4 out of 5 patients with unilateral lesion of the SMA region; the defect was observed mainly when the postural forearm was contralateral to the lesion. No change in the anticipatory postural adjustment was observed in one patient with complete callosal section. This finding indicates that the coordination between the posture and movement in this task is not organized through callosal fibers linking the cortices on both sides but rather at a subcortical level. The anticipatory postural adjustments were abolished in two patients with spastic hemiparesis when the postural forearm was the spastic arm. It is suggested that the SMA region contralateral to the postural forearm, together with other premotor or motor areas, may select the circuits responsible for the phasic postural adjustments which are necessary to ensure postural maintenance, whereas the motor cortex contralateral to the voluntary movement controls both the movement and, via collaterals, the preselected circuits responsible for the associated postural adjustments.

Adult↗
PubMed1992

Infarction in the territory of the anterior inferior cerebellar artery: report of five cases.

The clinical and MRI features were correlated in five cases of infarction in the territory of the anterior inferior cerebellar artery. The lateral portion of the pons area was affected in four cases, the middle cerebellar peduncle in two, and the cerebellar hemisphere in three. The lesion was restricted to the cerebellar hemisphere in one patient. In no case did the clinical features conform to the classical description.

Aged↗
PubMed1992

Preservation of urosexual functions after radical cystectomy.

Nerve-sparing radical cystectomy with ileocecal bladder substitute is highly recommended for male patients with schistosomal bladder carcinoma and for selected male patients with transitional cell carcinoma. Twenty-three patients underwent this procedure with preservation of the distal one third of prostatic capsule and inframontanal urethra, reinforcement of the ileocecal valve, and tightening of the two levator ani muscles over the cecourethral anastomosis. Urodynamic study revealed that the closed ileocecal segment is a highly compliant reservoir, and coupled with a reinforced ileocecal valve and distal urethral mechanism resulted in a low incidence of ureteral reflux (15%) and a high degree of urinary continence (100% by day and 40% by night). The procedure does not appear to undermine the principles of oncologic surgery, offers the psychologic and functional benefits of urethral micturition for all patients, and preserves erectile potency in half of them.

Cecum↗
PubMed1992

[Interhemispheric transfer in multiple sclerosis. Morphofunctional correlations].

Signs of cerebral disconnection, especially left ear suppression to dichotically presented verbal stimuli, have been reported in multiple sclerosis patients and found to be correlated to morphological atrophy of the corpus callosum on magnetic resonance imaging. To reinvestigate this issue, 26 patients satisfying criteria for definite multiple sclerosis were proposed 3 tasks aimed at evaluating interhemispheric function: a dichotic listening task, a motor finger-tapping task and a sensory transfer task. Performance at these tasks suggested impaired callosal function in MS patients, compared to normal controls. Callosal morphology was assessed on midsagittal MRI sections using a digitalised method of partition of the callosal area into 6 subregions and automatized surface measurements. Results of correlations between task performance and callosal areas showed a significant correlation between total callosal atrophy and severity of interhemispheric impairment on each functional task. Moreover, impaired motor transfer was specifically related to atrophy of the anterior callosal regions. These results suggest that MS patients may constitute a suitable population to studying interhemispheric transfer of information through the callosal commissure and that this approach may be useful in the clinical management of MS patients.

Adolescent↗
PubMed1992

[Epileptic crisis during and after cerebrovascular diseases. A clinical analysis of 78 cases].

Seventy-eight patients with post-stroke seizures were studied retrospectively to determine the clinical, EEG and CT features of these seizures and their prognosis. There were 57 cerebral infarctions and 21 hemorrhages. Twenty-eight (36%) initial seizures occurred within one month after the stroke (0-24 hours in 19 cases) and were classified as early-onset seizures. Fifty (64%) initial seizures occurred more than 3 months after the stroke (3-12 months in 33 cases) and were classified as late-onset seizures. Compared with a population of 1938 strokes admitted during the same period, the proportion of patients with alcohol abuse, infarction in the anterior cerebral artery territory, watershed infarcts and lobar haemorrhages was significantly greater in our series. The proportion did not vary with the nature of the stroke (infarction or hemorrhage), except for early onset seizures in which the proportion of hemorrhages was significantly greater. Nor did it vary with the cause of hemispheric infarctions (cardioembolism or atherothrombosis or others). Ninety-five percent of the lesions affected the cerebral cortex or the subcortical white matter or both. Of all 78 initial seizures, 64% were partial motor (simple or secondarily generalized); 32% were primarily generalized, and 4% were partial not motor; status epilepticus was seen in 14% of the cases. An initial EEG, performed in 76 patients was normal in 7. Among the remaining 69 patients EEG showed focal or diffuse slowing down in 63% and epileptic features in 37% (including 10 cases of PLEDs). Early post-seizure EEG and repeated recordings significantly increased the specificity of EEG.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1992

[Segmental dystonia and mitochondrial encephalomyopathy].

A 55 year-old male experienced a dystonia of the right upper limb followed by a ptosis with complete ophthalmoplegia and cataract. He developed a sensory neuropathy and personality changes. Ragged-red fibers were found on muscle biopsy. There was a major defect in complex III and IV activity.

Blepharoptosis↗
PubMed1992

Anti-inflammatory effect of natural steroid sapogenins on oral aphthous ulcers.

The search in plants for sapogenins has been stimulated by the need for readily accessible sources of sapogenins which can be converted in the laboratory to animal sterols of therapeutic importance. The present study represents a clinical trial for the investigation of the antiinflammatory effect of natural steroidal sapogenins on oral aphthous ulcers.

Adolescent↗
PubMed1992

[Systematized cavernous angiomatosis with multiple cerebral and cutaneous localizations].

A 45 year-old woman with no history of familial disease presented with multiple cutaneous and cerebral cavernous angiomas. The diagnosis rested on biopsy for cutaneous angiomas and on MRI for cerebral angiomas. The clinical manifestations of cerebral angiomas were headaches and a cerebellar syndrome, the latter most probably due to progressive growth of cerebellar angiomas. Systematized cavernous angiomatosis is characterized by multiple angiomas of the brain and other viscera and is considered to be a phacomatosis.

Angiomatosis↗
PubMed1992

[Cerebral phlebitis and Crohn disease].

A 17 year-old man with a one-year history of Crohn's disease presented with superior sagittal sinus thrombosis in spite of an apparent remission of the inflammatory bowel disease. Under treatment, the neurological disorders rapidly improved. Hematological studies showed mild thrombocytosis, spontaneous platelet aggregation, and an increase of the fibrinogen level, plasmatic viscosity and red blood cells aggregability. Mild hypofibrinolysis and antiphospholipid antibodies were also noted. Nine fully documented cases of cerebral venous thrombosis associated with an inflammatory bowel disease are reviewed. The possible prothrombotic role of thrombocytosis and other hematological disorders is discussed.

Adolescent↗
PubMed1992

[Paralysis of the common oculomotor nerve and contralateral cerebellar syndrome (Claude's syndrome). 2 cases caused by mesencephalic infarction].

Two cases of Claude's syndrome due to a mesencephalic infarction in the territory of the interpedoncular fossa arteries are reported. The first case had pupillary sparing while ptosis was lacking in the second case. Partial impairment of the oculomotor nerve suggests an intra-axial fascicular organization. However, the precise intra-axial pattern of the nerve is unknown in humans.

Cerebellar Diseases↗
PubMed1992

[Lacunar syndromes due to intracerebral hemorrhage].

Nine cases (seven men and two women, mean age 64.5 years) of classical lacunar syndromes due to intracerebral hemorrhage are reported. Three patients presented with pure motor hemiparesis (two putaminal hematomas with proportional weakness and one cortical hemorrhage with brachio-crural hemiparesis). Four patients presented with sensorimotor stroke due to thalamo-capsular hemorrhage. The last two patients had thalamic hemorrhage causing ataxic hemiparesis or dysarthria-clumsy hand syndrome. Four subjects had arterial hypertension, one was diabetic, and two were treated with anti-vitamin K. Abrupt onset was noted in all instances. Only one patient experienced moderate inaugural headaches. Good recovery occurred in all cases. Lacunar syndromes are a very uncommon presentation of intracerebral bleeding. Hemorrhages are yet the second etiology of such syndromes. Distinguishing hemorrhage from infarction is not clinically possible and needs early unenhanced CT scan.

Aged↗
PubMed1991

Effects of handedness and sex on the morphology of the corpus callosum: a study with brain magnetic resonance imaging.

In view of conflicting data in the existing literature, we examined 53 normal subjects using a handedness questionnaire and callosal area measurements obtained from midsagittal MRI images. The callosum was found to be significantly larger in nonconsistent right-handers (NCRH), especially in its anterior half and especially for males. A significant hand x sex interaction, favoring consistent right-handed (CRH) females, was also found for the posterior midbody, a region known to house interhemispheric fibers connecting the right and left posterior association cortices. These results (1) confirm Witelson's (1985) first findings on postmortem specimens; (2) validate a dichotomy between CRH and NCRH rather than simply considering the writing hand, as was the case in most other similar studies; and (3) suggest that at least two different sex-related--probably hormonal--factors may be acting during the callosal development, one explaining the larger anterior half in NCRH males and the other the larger posterior midbody in CRH females.

Adolescent↗
PubMed1991

[Vertebrobasilar arterial dolichoectasia. Complications and prognosis].

Symptomatic dolichoectasia of the vertebrobasilar system was found in 23 patients (16 males and 7 females, mean age: 62 years) during a 13-year period. Arterial hypertension was noted in 20 cases and associated aortic ectasia in 4. The malformation was identified in all patients on CT completed by angiography in 19, MRI in 7. Autopsy was performed in 5 cases. Fourteen subjects (group 1) presented with a vascular event (ischemic in 13) affecting the brainstem and/or cerebellum. Nine other patients (group 2) had a chronic symptomatology resulting from compression of the cranial nerves, central nervous system and/or CSF pathway. Two patients died of stroke within the first month (rupture of the ectasia in one and occlusion in the other one). The 21 survivors were followed for a mean period of 45.3 months. Eight patients had a stroke, with a significantly higher incidence in group 1 than in group 2 (p less than 0.05). Ten patients (5 in each group) developed progressive dementia possibly resulting from multiple cerebral infarction, hypertensive leucoencephalopathy, and/or hydrocephalus. Twelve patients died during the follow-up (4 of stroke, 6 of profound mental and motor deterioration, one from ruptured ectatic aorta, and the last one of unrecognized cause). The actuarial survival rate was 60% after 3 years of follow-up. Except for the incidence of stroke, inaugural manifestations (stroke vs nervous compression) did not seem to influence the long-term prognosis.

Actuarial Analysis↗
PubMed1991

[Changes in personality and hypertension. The "athymhormic" syndrome].

In 3 hypertensive patients, aged 57 to 66, profound behavioral and personality changes occurred rather abruptly, characterized by total loss of spontaneous activity and initiative, apathetic behavior, passivity, lack of drive and motivation, loss of interest for any of previous occupations and hobbies, and total flatness of affect. Neurological examination was normal or only showed mild extra-pyramidal signs. Neuropsychological evaluation was only remarkable for mild intellectual impairment suggestive of frontal lobe dysfunction. None of the 3 patients fulfilled criteria for dementia or severe depression. This neurobehavioral syndrome has been coined "athymhormic syndrome" (Habib & Poncet, 1988), a term emphasizing the specific defect in drive ("horme") and affect ("thumos"). Electrical and clinical heart examination was unremarkable. Blood pressure was always found within normal limits during hospitalization, including 24-hour monitoring in one case. However, all patients were known as hypertensive in the past, with repeated bouts of high blood pressure (up to 270 mmHg systolic in one case). X-ray CT-scan was usually normal or showed non-specific white matter changes (so-called "leukoaraiosis"). In all 3 cases, a brain MRI scan showed multiple small infarcts mainly involving deep subcortical structures (caudate nuclei and/or adjacent periventricular white matter) of both hemispheres, consistent with the definition of lacunes.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗