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Biomedical subjects

B Guillon

Publications and source records attributed to B Guillon.

At least 19 recordsLinked to original sources
PubMed2003

Iatrogenic Creutzfeldt-Jakob disease subsequent to dural graft: persisting risk after 1987.

The first case of Creutzfeldt-Jakob disease (CJD) related to the use of a dura mater graft of cadaveric origin was identified in 1987 and this procedure is now considered as one of the main causes of iatrogenic CJD. Although the decontamination procedure for the preparation of graft material was modified, the product was withdrawn from the market in many countries a few years later and replaced by synthetic material. In this context, two patients treated in our institution developed CJD following a cadaveric dural graft performed after cerebral and lumbar trauma. Their clinical presentation, showing predominant cerebellar symptoms, late deterioration and myoclonic jerks, and a rapid disease course until death, was similar to that of previously reported cases involving the iatrogenic form. As the graft for one of the patients was performed in 1991 (several years after modification of the decontamination procedure), this fourth reported case suggests that the risk of iatrogenic CJD may have persisted in some patients treated after 1987, when grafts of cadaveric origin were totally abandoned.

Adult↗
PubMed2002

Migraine and the risk of cervical artery dissection: a case-control study.

The association between migraine and cervical artery dissection (CAD) was explored in a hospital-based case-control study. Migraine was present in 49.1% (23/47) of patients with CAD and in 21% (11/52) of patients hospitalized for a cerebral ischemic event not related to a CAD (adjusted odds ratio = 3.6; 1.5 to 8.6, p = 0.005). This result supports the hypothesis that an underlying arterial wall disease could be a predisposing condition for migraine.

Adult↗
PubMed2002

Decrease in heart ventricular ejection fraction during multiple sclerosis.

Recent studies have shown that mitoxantrone is effective in patients with active multiple sclerosis (MS) and that cardiac monitoring is usually required. However, right and left ventricular ejection fractions (VEFs) have never been studied in MS patients as compared with control subjects. Radionuclide angiocardiography (RA) was performed to assess right and left VEFs at rest in 40 consecutive patients with active definite MS [15 men and 25 women; mean age 33.9 +/- 10 years; mean disease duration 8 +/- 6.5 years; 18 had relapsing-remitting and 22 had secondary progressive forms of the disease; mean Expanded Disability Status Scale (EDSS) score 4.8 +/- 1.9]. The control group consisted of 40 subjects free of neurological or cardiovascular disease (17 men and 23 women; 44.6 +/- 13.4 years of age). The VEF values obtained in the control group defined the normal limits (right VEF 32-54%; left VEF 50-74%). A statistically significant decrease of right (P=0.02) and left (P < 0.0001) VEFs was found in MS patients as compared with control subjects. RA showed pathological results for right (7.5%), left (10%) and both (7.5%) VEFs in 25% of MS patients. No correlation was found between VEF and sex, age, disease duration, disease course, EDSS score or previous treatment. Autonomic impairment, which frequently occurs in MS patients, may have accounted for the decrease in VEFs. Further physiological studies are required to determine factor responsible for the decrease of VEFs in MS.

Adolescent↗
PubMed2002

[Epidemiology and pathophysiology of spontaneous cervical artery dissection].

Spontaneous cervical artery dissections are produced by the penetration of circulating blood into the vessel wall of one or more cervical arteries, without a preceding major trauma. Dissection is one of the most frequent etiologies of ischemic stroke in young patients. Its annual incidence is about 3 per 100,000. Pathophysiology of cervical artery dissection remains misunderstood. Triggering factors such as minor trauma and infection have been identified. However, they are too trivial to explain alone the occurrence of a mural hematoma. Several abnormalities suggesting an underlying arteriopathy related to an extracellular matrix defect which could predispose to dissection have been reported: arterial redundancies, intracranial aneurysms, aortic root dilatation, common carotid artery distensibility increase, fibromuscular dysplasia, inherited connective tissue disorders, ultrastructural dermal connective tissue abnormalities. Other factors associated with dissection, such as migraine, hyperhomocysteinemia and alpha-1 antitrypsin deficiency, suggest arterial wall fragility secondary to hyperactivity of some proteases. If an underlying arteriopathy is likely, its nature remains unidentified to date and does not seem to be unique.

Aortic Dissection↗
PubMed2001

[Stroke management in a general internal medicine department: results of a survey regarding practice].

PURPOSE: The incidence of strokes in the general population and the insufficient numbers of centers specialized in their management has led to the increased hospitalization of patients in general, internal medicine departments. The prognosis for patients is related to the relevance of the initial diagnostic and therapeutic measures. To optimize management of stroke patients outside of specialized units, a survey concerning practice was conducted in internal medicine departments in western France, and a meeting was held to define guidelines. METHODS: Data sheets were mailed to practitioners in internal medicine departments prior to the survey. The following data were recorded for each patient hospitalized during the two-week study: age, sex, clinical characteristics of stroke, risk factors, investigations performed, and initial and subsequent medical management. On the basis of the results, management guidelines were considered and defined. RESULTS: Patients hospitalized for a stroke in internal medicine departments have a similar profile to those hospitalized in neurology departments. CT-scan and EKG recordings were performed in most patients whereas other investigations (cervical ultrasound, echocardiography, MRI) were used less frequently. The use of rehabilitation and therapeutic strategies for secondary stroke prevention were not always performed according to current guidelines. CONCLUSION: Internal medicine departments are frequently involved in the care of stroke patients. The present study of clinical practice may help to improve stroke management in these non-specialized departments.

Adult↗
PubMed2001

[Recurrent syncope and Chiari malformation].

Downward herniation of the cerebellar tonsils through the foramen magnum (Chiari I malformation) is usually revealed by head and neck pain, often associated with brain-stem or spinal cord disturbances. Syncopes are rarely reported and may be difficult to link to their cause when they occur alone. We report two cases with brief and repetitive syncopes revealing a Chiari I malformation. These manifestations may be attributed to transient compression of brain stem or vascular structures at the craniocervical junction, triggered by intracranial pressure increase, as they disappear after posterior fossa decompression.

Budd-Chiari Syndrome↗
PubMed2000

Arterial wall properties in carotid artery dissection: an ultrasound study.

BACKGROUND: Cervical artery dissection is often attributed to an underlying arteriopathy related to a generalized extracellular matrix defect. OBJECTIVE: The authors compared the hemodynamic and morphologic properties of the carotid artery, as assessed noninvasively by ultrasonography, in patients with spontaneous internal carotid artery dissection (ICAD) and control subjects. METHOD: Twenty-six patients who experienced ICAD more than 6 months before evaluation were compared with 26 controls matched for age, sex, and height. Cases and controls had ultrasound measurement of common carotid artery diameter and diameter change during the cardiac cycle, bulbar and suprabulbar internal carotid artery diameters, and common carotid artery intima-media thickness. The unaffected carotid artery in cases was compared with the carotid artery of the same side in controls. RESULTS: Common carotid artery relative diameter change was significantly higher in cases than controls, whereas other measurements were not significantly different between the groups. In multivariate analyses, the highest tertile of common carotid artery relative diameter change was associated with the risk of ICAD (OR, 10.0; 95% CI, 1.8 to 54.2; p = 0.002) CONCLUSION: An underlying arteriopathy, presumably related to an extracellular matrix defect, may be present in patients with spontaneous ICAD.

Adult↗
PubMed2000

MR angiography for the long-term follow-up of dissecting aneurysms of the extracranial internal carotid artery.

OBJECTIVE: We used MR angiography to examine and follow up the changes of dissecting aneurysms of the extracranial internal carotid artery (ICA). MATERIALS AND METHODS: We retrospectively reviewed the records of 101 consecutive patients with dissecting aneurysms of the extracranial ICA. Twenty patients with 26 spontaneous dissecting aneurysms were followed up with MR angiography every 1-2 years (men, 16; women, four; age range, 28-67 years; mean age, 51 years). RESULTS: The mean duration of follow-up was 41 months (range, 10-93 months). At MR angiography follow-up, 20 aneurysms did not change, four decreased from their original size by 33-53% (mean, 43%), and two resolved. One patient had an asymptomatic recurrent dissecting aneurysm of the extracranial ICA. Clinically, no patient had a thromboembolic stroke or transient ischemic attack during the follow-up period. CONCLUSION: MR angiography revealed that dissecting aneurysms of the extracranial ICA remain stable, decrease in size, or resolve--but they do not increase in size.

Adult↗
PubMed2000

[Late cerebrovascular complications of cardiac transplantation].

The occurrence of stroke after the post-operative period of cardiac transplantation is a rare event, and the role of the cardiac transplant in these patients, who often have various vascular risk factors, is unclear. We reviewed the clinical records of 303 consecutive patients with orthotopic cardiac transplantation performed from March 1985 to December 1996 and selected those who developed a stroke over the first 2 months postoperatively, in order to evaluate the frequency and the mechanisms of late cerebrovascular complications. Four patients had presented cerebral infarct and two intracranial hemorrhage. The overall risk of late cerebrovascular complications was 2.6p.100 at 5 years. Ischemic stroke was related to cardiac embolus in one patient, lacunar infarction in another, and was of undetermined etiology in two cases. In addition to vascular risk factors prior to transplantation and the development of intracardiac thrombus, immunosuppressive therapy, the surgical procedure and cardiac rejection may play a role in the occurrence of stroke in such patients.

Aged↗
PubMed2000

[Progressive multifocal leukoencephalopathy and pulmonary sarcoidosis].

An association of progressive multifocal leukoencephalopathy (PML) and sarcoidosis in a 47 year-old-woman is reported. This is the third case in which PML has been diagnosed by PCR. Clinical, biological and radiological features were in agreement with previous findings in immunologically suppressed patients. JC virus should be systematically detected by PCR in blood and cerebrospinal fluid (CSF) in patients with sarcoidosis presenting neurological and radiological PML manifestations.

Anti-Inflammatory Agents↗
PubMed1999

Long-term follow-up of aneurysms developed during extracranial internal carotid artery dissection.

OBJECTIVE: To evaluate the clinical course of aneurysms developed during extracranial internal carotid artery (ICA) dissection. BACKGROUND: Aneurysms developed during extracranial ICA dissection are detected angiographically in 5 to 40% of cervical artery dissections. The clinical and radiologic course of these aneurysms is not known, and it is not known how they should be treated. METHODS: Fifty-eight consecutive patients with extracranial ICA dissection were reviewed, and those with radiographically detectable dissecting aneurysm at the acute stage or during early follow-up were included in this study. All patients had regular clinical and MR angiography examinations. Sixteen patients (27.5%) with a total of 20 ICA dissecting aneurysms were followed for a mean period of 36.9+/-21 months (range, 10 to 93 months). RESULTS: No clinical symptoms suggestive of aneurysmal rupture or embolization from the aneurysm were identified. Extracranial ICA aneurysms remained unchanged in 65% of patients, were resolved in 5% of patients, and decreased in size in 30% of patients. CONCLUSIONS: The clinical course of dissecting aneurysms was benign, although spontaneous radiologic resolution occurred rarely. Medical management with antiplatelet therapy alone (after early anticoagulation) is generally sufficient, and surgical management was seldom required.

Adult↗
PubMed1999

[Cervical artery dissection: recent data physiopathologic hypotheses].

INTRODUCTION: Cervicocranial arterial dissection is a major cause of cerebral infarction in young subjects. Traumatic and infectious factors are frequently suspected to be at the origin of cervicocranial artery dissection. However, they are usually too minor or too common to explain the vessel wall split-off. Underlying arteriopathy predisposing to dissections is therefore often suspected. CURRENT KNOWLEDGE AND KEY POINTS: The hypothesis of an underlying arteriopathy is based in certain cases on either the discovery of hereditary connective tissue disorders (or secondary signs of these diseases) or their frequent association with vascular and cardiac morphological abnormalities, thus suggesting extracellular matrix abnormalities. Current histological and biochemical data do not suggest the existence of a unique form of the disease but rather indicate the presence of various matrix abnormalities that could involve one of the fibrillar components or its enzymatic regulation. FUTURE PROSPECTS AND PROJECTS: Classification of dissections according to the various vascular wall alterations would therefore permit to better define recurrence and familial risks and to improve overall management of the patients.

Aortic Dissection↗
PubMed1998

Internal carotid artery dissection: an update.

Carotid artery dissection is a major cause of cerebral infarction in the young. The extracranial portion of the internal carotid artery is much more frequently involved than the intracranial portion. In up to 20% of cases it is bilateral or associated with vertebral artery dissection. It is mainly characterised by local signs such as headache or facial pain, Horner's syndrome, lower cranial nerve palsies and pulsatile tinnitus, followed a few hours or days later by signs of cerebral or retinal ischemia. Ultrasound investigations show signs of distal stenosis or occlusion, highly suggestive of dissection, but the best diagnostic tool is presently the association of magnetic resonance imaging (MRI) and MR angiography which tend to replace intra-arterial angiography. The prognosis is highly variable: excellent in cases limited to local signs, but very poor leading to death or major sequelae in about 15% of cases. Various treatments have been suggested but no controlled trial has ever been performed in this condition. Heparin in the acute stage followed by warfarin or aspirin for 3 to 6 months is most commonly used.

Animals↗
PubMed1998

Orbital pain as an isolated sign of internal carotid artery dissection. A diagnostic pitfall.

Head pain is one of the main presenting symptoms of internal carotid artery (ICA) dissection, usually in association with ischemic and/or local signs such as Horner's syndrome, lower cranial nerve palsies, or tinnitus. In rare cases, head pain remains isolated and mimics other conditions. We report a patient who suffered isolated prolonged orbital pain as the only sign of intrapetrous ICA dissection. Early recognition of such unusual facial pain may be crucial in decreasing the risk of secondary cerebral or retinal ischemia.

Aortic Dissection↗