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Biomedical subjects

S Bracard

Publications and source records attributed to S Bracard.

17 recordsLinked to original sources
PubMed1992

Aneurysms of the extracranial internal carotid artery due to fibromuscular dysplasia: results of surgical management.

Between January 1977 and December 1990, eight patients underwent surgical correction of aneurysms of the extracranial internal carotid artery due to fibromuscular dysplasia. Mean age of patients was 50 years (range 31 to 70 years). Five patients presented with neurologic hemispheric symptoms. Most aneurysms were saccular and occurred preferentially at the level of C2 or C3. All of these patients underwent operation through conventional cervicotomy. Resection-anastomosis was performed in three cases whereas resection-graft was performed in five. Histopathological examination of the eight specimens was consistent with fibromuscular dysplasia of the media. There was no central nervous system-related mortality and morbidity. Seven patients were alive and free of new neurological manifestations at mean follow-up of 156 months (18 to 180 months). One patient died of myocardial infarction at 96 months. All patients had postoperative duplex scanning or arteriograms. These revealed that carotid restorations were patent in seven whereas one patient had asymptomatic occlusion at 18 months.

Adult↗
PubMed1992

[Transluminal angioplasty in the treatment of vasospasm. Value of transcranial Doppler in the diagnosis and follow-up].

Vasospasm (V.S.) transluminal angiographic treatment (T.L.A.) is recommended in case of symptomatic V.S. before or after surgery. V.S. diagnosis and follow up after T.L.A. rely on clinical and transcranial doppler (T.C.D.) data. Before T.L.A. angiography (A degrees) demonstrates V.S. degree and location. T.L.A. technic is described. The authors report 14 cases of T.L.A. (7 before and 7 after surgery). Before surgery in 4 cases patients exhibited ischemic symptoms from V.S.: 2 died (one from reanimation problems the other from a new hemorrhage). After surgery of 7 patients one died from artery rupture, one from extra-neurologic complication. T.C.D. capacity to follow up V.S. is emphasized. As soon as T.L.A. is performed the mean cerebral blood flow (C.B.F.) decreases (< 100 cm/s) and does not increase anymore. At the level of non dilated arterial segments V.S. may increase after T.L.A.: it is then recommended to dilate all the spastic arteries, as far as it is possible. After T.L.A. C.B.F. may decrease in arteries far from the dilated ones probably because arterial supplies are no more necessary.

Angioplasty, Balloon↗
PubMed1992

[Neurinoma of the oculomotor nerves. Apropos of 2 cases].

The authors report two cases of neurinomas of the oculomotor nerves: one neurinoma of the oculomotor nerve and one of the abducens nerve. The study of 30 cases in the previous literature points out the major striking features of these tumors. Both headaches and oculo-motor palsies are the most regular clinical features. They are not typically suggestive. Therefore the diagnosis is difficult among all the tumors of cavernous sinus and surrounding structures. C.T. scan and M.R.I. with the clinical history should readily allow pre-operative diagnosis. These data are insufficient to distinguish the affected nerve. The surgical treatment is not always complete due to the tumor infiltration into the cavernous sinus.

Adult↗
PubMed1991

Persistent proatlantal artery associated with carotid artery stenosis treatment by percutaneous transluminal balloon angioplasty.

A 58-year-old man had an asymptomatic tight stenosis of the internal carotid artery associated with a persistent proatlantal artery. This as well as other compositional arterial anomalies of the basilar artery were discovered on arteriograms. The stenosis was successfully treated by percutaneous transluminal balloon angioplasty. Therapeutic choices are discussed in this setting because of the risk of carotid clamping in the presence of persistent carotid-basilar anastomoses.

Angioplasty, Balloon↗
PubMed1991

Cervical cord compression in scleroderma. One case.

The cervical spine is rarely involved in scleroderma. The lesions reported here consisted of osteolysis of the posterior arches disturbing vertebral statics, and exuberant calcifications responsible for spinal cord compression by stenosis of the vertebral canal.

Calcinosis↗
PubMed1991

[Papilledema and dural fistula].

A retrospective analysis of three cases of papilledema was made, initially attributed to idiopathic raised intracranial pressure on the basis of the following data: symptoms and signs of raised intracranial pressure, no other neurological signs, normal electroencephalogram, normal computerised tomography, and normal cerebrospinal fluid. The discovery of a dural arteriovenous malformation was made only after a period over six months, by cerebral angiography. After a survey of medical data concerning the incidence of papilledema in dural fistulae, a description of the supposed pathogenic mechanisms of papilledema formation in this disease is proposed. Venous hypertension was found to be the main factor leading to papilledema. It could be in relation with obstruction of the involved venous sinus, and with the high level of blood flow of the dural arteriovenous malformation. It appeared that drainage with involvement of subarachnoid veins was the main characteristic for arteriovenous malformations to be directly responsible for papilledema. The possible lack or delay of suggestive signs such as intracranial bruit and the potential seriousness of the vital and visual prognosis led us to routinely carry out angiologic investigations comprising first doppler ultra-sound of the cervical vessels and secondly cerebral angiography, before diagnosing benign raised intracranial pressure.

Adult↗
PubMed1990

Role of angioplasty in the treatment of symptomatic vascular spasm occurring in the post-operative course of intracranial ruptured aneurysms.

Angioplasty of vascular spasm (VS), related to subarachnoid hemorrhage (SAH) has been recently introduced to the medical field. The authors report 5 cases treated by this mean in the postoperative period. These patients were all symptomatic from their VS inspite of early surgery and of the preventive treatment by Nimodipine. In all cases, obtained increase in the caliber of the spastic vessels was followed by a rapid clinical improvement coupled with a significant decline of the flow rates as confirmed by transcranial Doppler (TCD). No recurrence of VS has been observed. This technique appears quite effective provided that it is performed as early as the clinical symptoms come out in correlation with important acceleration of flow rates on TCD.

Adult↗
PubMed1990

Long term hemodialysis spondylarthropathy: an atlanto-occipital location.

A 41 years old patient on hemodialysis for 17 years with a clinical and radiological picture of osteoarticular beta 2 microglobulin amyloidosis, is presented. The patient had skeletal involvements, included cystic lesions of the left hip and both humeral heads and a C5/C6 spondylarthropathy. She had also associated carpal tunnel syndrome. Radiological exploration of the atlanto-occipital articulation demonstrated destructive changes. Histology documented osseous and periarticular deposition of beta 2 microglobulin derived amyloid. This is an unusual location of destructive spondylarthropathy in a patient on chronic hemodialysis.

Adult↗
PubMed1990

Mucoceles of the sphenoidal sinus. Report of six cases and review of the literature.

Six personal cases of mucocele of the sphenoidal sinus are reported, and 124 cases from the literature are reviewed. Sphenoidal sinus mucocele is a benign and rare lesion which has long been unrecognized. Clinical features include fronto-orbital pain, oculomotor palsies, loss of visual acuity, exophthalmos and anosmia. Our series is of particular interest since four of our six patients presented with endocrine disorders. Recent advances in neuroradiological methods should rapidly lead to the correct diagnosis. Treatment consists of aspiration and drainage of the mucocele via a trans-sphenoidal approach. The results are good, and ophthalmoplegia usually subsides. In our experience, endocrine disorders do not always respond to treatment. The prognosis of sphenoidal sinus mucocele depends on the preoperative duration of the loss of visual acuity.

Adult↗
PubMed1990

Dural fistulae of the tentorium cerebelli. Radioanatomical, clinical and therapeutic considerations.

Among the 84 intracranial dural fistulae treated in the Neuroradiology department of the University Hospital Centre of Nancy between August 1983 and April 1990, 10 (11.9%) were located on the tentorium cerebelli. The patients were 7 men and 3 women aged from 41 to 61 years at the time of diagnosis. All tentorial dural fistulae showed an exclusively cortical drainage, and only one of them was associated with probable thrombosis of a major sinus. Nine patients presented with at least one episode of neurological deficit (including 2 with progressive ascending myelopathy) associated with a cerebro-meningeal haemorrhage in 6 cases. In all patients the initial treatment was an endovascular one, subsequently reinforced by surgery in 2 patients. In every case the clinical condition was improved or stabilized and no recurrent haemorrhage was observed, but radioanatomical cure was obtained in only 3 patients: 1 treated by the endovascular route and 2 by embolization combined with surgery. The anatomical, physiopathological and clinical aspects of these particular fistulae and the different possible therapeutic approaches are discussed.

Adult↗
PubMed1989

[Embolization of vertebral hemangioma. Technic-indications-results].

A series of 19 cases of vertebral hemangiomas treated by hyperselective embolization is reported. Localization is thoracic in 12 cases and lumbar in 7. Patients were referred for back pain in 10 cases, neurological signs of spinal cord compression in 5 and of radicular compression in 4. The first step is a precise analysis of the vascular pattern of each case with identification of the feeders of the spinal cord. Embolization as the only treatment, was proposed in 12 cases with painful manifestations. In 5 cases with symptoms of spinal cord compression, it was associated with surgery. The last 2 cases were not treated because of the close proximity of an Adamkiewicz artery. Results on painful symptoms were excellent in 9 cases and good in 3. There was no complications in this series. Therefore, we consider embolization to be a safe tool in the treatment of vertebral hemangiomas, with good efficiency on painful symptom and pre-operatively in case of spinal cord compression.

Adolescent↗
PubMed1989

[Intracerebral cavernous angioma].

Thirty four cases (18 operated, 16 non-operated), of cavernous angioma are reported. The presenting symptoms and signs were epilepsy in 22 cases, neurologic deficit in 9 and cerebromeningeal hemorrhage without vigilance disorders in 3. In the operated group 15 angiomas were supratentorial, 3 were subtentorial. In the non-operated group symptoms and signs were epilepsy in 11 cases and a neurologic deficit related to a brain stem lesion in 4/5 cases. Follow-up of 2 to 39 years after the first fit episode and of 1 to 7 years after initial diagnosis suggested that the risk of hemorrhage is low. Indications for neurosurgery are discussed as a function of the site of the angiomas and of the operative hemorrhagic risk.

Adolescent↗
PubMed1988

[Immediate and severe epistaxis caused by traumatic rupture of the carotid siphon. Apropos of a case treated by intravascular approach].

The authors report a recent case of massive and immediate epistaxis resulting from a rupture of the internal intracavernous carotid artery caused by closed head injury. The point out the unusualness and the extreme severity of such lesions. The pathogenesis of these epistaxis can be explained by an immediate arterial rupture proceeding from a sphenoidal fracture. The emergency bilateral carotid angiography states precisely the diagnosis and the level of the rupture, allowing in the same time the intravascular treatment by detachable balloon.

Carotid Artery Injuries↗
PubMed1988

[Neurological manifestations of alveolar echinococcosis].

Among 78 cases of alveolar echinococcosis reported in Lorraine, France, 5 had neurologic complications which in 3 cases revealed the disease. Results of parasitic tests are discussed and emphasis is placed on differences between this disease and hydatidosis. Encephalic localizations (3 cases) were multiple making neurosurgery impossible. The outcome was fatal in 2 cases: 1 month after the initial neurologic signs in the absence of treatment (case 1) and 4 months after treatment with flubendazole (case 2). This drug was however effective in the 3rd case (hepatic, pulmonary and cerebral form) with follow-up now at 4 years. Epidemiologic, histopathologic, clinical, diagnostic characteristics and course of these encephalic localizations are reviewed. Spinal localizations (2 cases) presented with a picture of spinal cord compression. After laminectomy and flubendazole, the course was marked by relapse with death in one case and a satisfactory neurologic course with a 4 year follow-up in the other one.

Aged↗
PubMed1987

Microvascularization of the intracranial dura mater.

The authors have studied the microvascularization of the intracranial dura mater by microradiographic and histologic examination of 73 injected anatomic specimens. There exists a very abundant superficial arterial plexus which also serves to supply the inner table of the cranial vault. This plexus is continuous, even at the walls of the venous sinuses and the dural septa. The arteries are for the most part tortuous. The veins may be satellites of the arteries or, on the contrary, from a plexiform network passing through crevices in the interior of the dural layer. The walls of these veins consist only of an endothelium to be seen within the fibrous layer of the dura. Often, the arteries compress the venous lumen; this dangerous situation probably explains the frequent occurrence of arteriovenous fistulae of the dura mater, known by the name of dural fistulae.

Adult↗