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Biomedical subjects

B Laurent

Publications and source records attributed to B Laurent.

At least 73 records · Page 4Linked to original sources
PubMed1996

Slowly progressive anarthria with late anterior opercular syndrome: a variant form of frontal cortical atrophy syndromes.

We describe eight patients with slowly progressive speech production deficit combining speech apraxia, dysarthria, dysprosody and orofacial apraxia, and initially no other deficit in other language and non-language neuropsychological domains. Long-term follow-up (6-10 years) in 4 cases showed an evolution to muteness, bilateral suprabulbar paresis with automatic-voluntary dissociation and frontal lobe cognitive slowing without generalised intellectual deterioration. Most disabled patients presented with an anterior opercular syndrome (Foix-Chavany-Marie syndrome), and pyramidal or extrapyramidal signs. CT and MRI findings disclosed asymmetric (left > right) progressive cortical atrophy of the frontal lobes predominating in the posterior inferior frontal region, notably the operculum. SPECT and PET revealed a decreased cerebral blood flow and metabolism, prominent in the left posterior-inferior frontal gyrus and premotor cortex, extending bilaterally in the most advanced cases. Pathological study of two cases showed non-specific neuronal loss, gliosis, and spongiosis of superficial cortical layers, mainly confined to the frontal lobes, with no significant abnormalities in the basal ganglia, thalamus, cerebellum, brain stem (except severe neuronal loss in the substantia nigra in one case), and spinal cord. We propose to call this peculiar syndrome Slowly Progressive Anarthria (SPA), based on its specific clinical presentation, and its metabolic and pathological correlates. SPA represents another clinical expression of focal cortical degeneration syndromes, that may overlap with other similar syndromes, specially primary progressive aphasia and the various frontal lobe dementias.

Aged↗
PubMed1996

Glomerular disease during HCV infection in renal transplantation.

In general nephrology, HCV infection has been associated with type I membranoproliferative glomerulonephritis (MPGN type I) associated with cryoglobulinaemia. In a cohort of 399 renal transplantation (RT) recipients, 117 of whom (29%) were HCV-positive, we selected all patients diagnosed as having membranous GN or type I MPGN by graft biopsy. The prevalence of MGN was 16/399 (4%) with three recurrences, and 13 de novo cases. Only 5/16 (31%) were HCV+, not different from the general RT population. Five patients had an outcome of graft failure after 43 months. Conversely, there were 15 cases of type I MPGN (two recurrences, 13 de novo) but with eight HCV+ recipients (53%, P = 0.02). Considering only the French patients, prevalence was 44% vs 12% in the French RT population (P = 0.006). Eight patients had graft rejection after 59 months (five HCV+). In this type I MPGN subgroup, there were two positive cryoglobulins, two rheumatoid factors and four hypocomplementaemias. In conclusion, there is a clear association between HCV infection and the occurrence of type I MPGN in the allograft in renal transplantation, with terminal renal failure as an outcome.

Adolescent↗
PubMed1996

Chronic inflammatory demyelinating polyneuropathy associated with carcinoma.

The association of chronic inflammatory demyelinating polyneuropathy (CIDP) and carcinoma has rarely been reported and its relevance is debated. Thirty three consecutive patients with probable or definite CIDP (idiopathic or associated with M protein) were investigated. Three patients with definite CIDP had a concomitant carcinoma. One had an IgM paraprotein. Steroids and intravenous immunoglobulins were effective.

Aged↗
PubMed1996

[Preservation of procedural memory in 18 patients operated for aneurysm of the anterior communicating artery].

Organic amnesia is typically associated with lesions in either the diencephalic or medial temporal regions of the brain. However, amnesia can result from other kinds of lesions, in particular those resulting from an aneurysm of the anterior communicating artery (ACoA). In the present study, 7 patients who became amnesic following a ruptured and operated ACoA aneurysm were comparated neuropsychologically with 11 patients with ruptures but no cognitive complaints and 18 normal control subjects. They were submitted to explicit and implicit memory tests and to tests claimed to be sensitive to frontal lobe dysfunction. The performance of the 11 ACoa patients without cognitive complaints revealed evidence for a functional frontal dysfunction (test of Stroop) and a partial deficit of explicit memory (free recall and long-term recall). The performance of the 7 ACoa amnesics revealed evidence for a functional frontal dysfunction and a deficit of explicit memory (safe in recognition). Anosognosia was also observed. The performance of all patients revealed the preservation of implicit memory in procedural tasks (serial reaction time and mirror reading) as diencephalic and temporal amnesia. The functionnal nature of the syndrome is discussed.

Adult↗
PubMed1995

[Specialized memory consultation and management of dementia syndrome].

The specialized memory consultation is based on two successive examinations: one by a neurologist, the other by a psychologist, using standardized batteries of tests. In 200 consecutive subjects with 63.8 years mean age, the authors observe dementia syndromes (39%), age related disorders of memory (6.5%), psychiatric disorders (28.5%), disorders after brain injury or neurosurgery (18.5%) and medical neurological pathologies (5.5%). Patients are addressed by practician in 34.5%. In the group of 78 patients with dementia syndrome were studied the delay before consultation, familial story, memory complaints of patients and family and diagnosis. In subjects with memory complaints a psychometric evaluation performed by a team of specialists seems to be a mean of refining the diagnosis and to improve a personalized management.

Aging↗
PubMed1995

Electrical stimulation of precentral cortical area in the treatment of central pain: electrophysiological and PET study.

The clinical, electrophysiological and haemodynamic effects of precentral gyrus stimulation (PGS) as a treatment of refractory post-stroke pain were studied in 2 patients. The first patient had a right hemibody pain secondary to a left parietal infarct sparing the thalamus, while the second patient had left lower limb pain developed after a right mesencephalic infarct. In both cases, spontaneous pain was associated with hyperpathia, allodynia and hypoaesthesia in the painful territory involving both lemniscal and extra-lemniscal sensory modalities in patient 1, extra-lemniscal sensory modality only in patient 2. Both patients were treated with electrical PGS by means of a 4-pole electrode, the central sulcus being per-operatively located using the phase-reversal of the N20 wave of somatosensory evoked potentials. No sensory side effect, abnormal movement or epileptic seizure were observed during PGS. The analgesic effects were somatotopically distributed according to the localization of electrode on motor cortex. A satisfactory long-lasting pain control (60-70% on visual analog scale) as well as attenuation of nociceptive reflexes were obtained during PGS in the first patient. Pain relief was less marked and only transient (2 months) in patient 2, in spite of a similar operative procedure. In this patient, in whom PGS eventually evoked painful dysethesiae, no attenuation of nociceptive RIII reflex could be evidenced during PGS. Cerebral blood flow (CBF) was studied using emission tomography (PET) with O-labeled water. The sites of CBF increase during PGS were the same in both patients, namely the thalamus ipsilateral to PGS, cingulate gyrus, orbito-frontal cortex and brainstem. CBF increase in brainstem structures was greater and lasted longer in patient 1 while patient 2 showed a greater CBF increase in orbito-frontal and cingular regions. Our results suggest that PGS-induced analgesia is somatotopically mediated and does not require the integrity of somatosensory cortex and lemniscal system. PGS analgesic efficacy may be mainly related to increased synaptic activity in the thalamus and brainstem while changes in cingulate gyrus and orbito-frontal cortex may be rather related to attentional and/or emotional processes. The inhibitory control on pain would involve thalamic and/or brainstem relays on descending pathways down to the spinal cord segments, leading to a depression of nociceptive reflexes. Painful dysesthesiae during stimulation have to be distinguished from other innocuous sensory side effects, since they may compromise PGS efficacy.

Aged↗
PubMed1995

Adult first generalized seizure: etiology, biological tests, EEG, CT scan, in an ED.

The purpose of this study was to evaluate adult first seizures in an emergency department by analyzing etiologic and epidemiological data and studying the usefulness of biological screening, electroencephalogram (EEG), and cerebral computed tomography (CT) scan. This was a retrospective study of a 3-year period during which 247 patients were admitted to an emergency department for a first generalized seizure. A CT scan had been performed in 247 patients and an EEG in 209. Etiologies were found to be (1) unknown, (2) alcohol abuse, (3) stroke, and (4) tumor. Early recurrence rate was 18.5%. EEG was of low interest in emergency. The rate of cerebral focal lesions on CT scan was significantly lower when both examination results and EEG were normal. The rate of metabolic abnormalities was 4.9%. It was concluded that (1) a short hospitalization is advisable because of recurrences, (2) recurrence rate does not increase significantly in patients with focal cerebral lesion, (3) metabolic screening is necessary, and (4) CT scan will be an outpatient procedure for most patients.

Adolescent↗
PubMed1995

[The principle of Colson's flap applied to facial reconstruction].

Reconstruction of facial skin defects after cancer surgery or trauma with conventional flaps can give a poor cosmetic result when a thick flap is used to replace thin skin. The thickness of the flap can be a disadvantage to replacing a thin skin. Defatting the flap can resolve these situations, using the principle of Colson's flap. This operative procedure is safe, and improves the cosmetic results. The authors report a series of 21 full-thickness skin defects located at the junction of two or three regional units. The defects were repaired with total or partial undermining flap (frontal, nasoiabial, cheek flaps). The viability of these reconstructions was perfect and the cosmetic results fairly esthetic in comparison with conventional flaps.

Basal Cell Carcinoma↗
PubMed1995

[Cervicofacial involvement of primary cutaneous neuroendocrine carcinomas or Merkel cell tumors: therapeutic considerations].

Seven cases of primary skin neuroendocrine carcinoma or Merkel cell tumours with cervico-facial localization are reported. The poor prognosis of these tumours is essentially due to the potential for local recurrence and the frequency of locoregional and visceral metastasis. Surgical treatment is required but rarely sufficient to control the disease. Complementary radiotherapy, when performed early, can reduce the rate of locoregional recurrence. Lymph node resection is important to determine prognosis but has not been proven to improve outcome. In addition, parotid metastasis appears to result from blood stream dissemination and has a very poor prognosis. Exclusive radiotherapy may be discussed in such cases.

Adult↗
PubMed1994

[Aneurysms of the intra-atrial septum complicated by cerebral ischemia in young subjects. 4 cases].

Transoesophageal echocardiography has improved the detection of potential sources of cerebral embolism. We report our experience with a group of 38 patients under 45 years of age who were examined after an arterial ischaemic cerebral event. We observed 4 patients (2 males, 2 females; age 17, 24, 38 and 40 years) with an atrial septal aneurysm. Cerebral ischaemia was permanent in 3 patients and temporary in 1 and a cerebral embolism was the most probable cause based on angiographic findings. The atrial septal aneurysm was only diagnosed by transoesophageal echocardiography (type IA in case 3, IB in the others). A patent foramen ovale was observed in 3 and this abnormality, which is known to have a high prevalence in the general population, could at most be an aggravating factor. In our series, we can assume a causal association between atrial septal aneurysm and stroke in young patients (10.5% among 38 young stroke patients vs 3% of 30 patients referred for other reasons). The treatment is still under discussion although the consensus would favour surgery if another heart malformation is associated, if a visible thrombus is identified or if repeated cerebrovascular events occur despite adequate anticoagulation. Studies conducted in large series of patients should provide more adequate therapeutic schemas.

4-Hydroxycoumarins↗
PubMed1994

[Aging and procedural memory. Study of a series of tests on microcomputers].

The authors have assessed perceptual motor tasks involving the learning of the mouse control by locking at a Macinthosh computer screen during three consecutive sessions. Tests were performed by 102 control subjects aged between 16 and 85 years. Concerning age, there was a significant time difference (ANOVA) but improvement was the same for all subjects. Educational level and IQP results didn't influence procedural performance. Men were faster in three tasks. We can argue that implicit learning abilities appear before explicit memory and within the adult life span there appears to be little significant deterioration in implicit memory abilitie.

Adolescent↗
PubMed1994

[Spelling impairments. Neuropsychological study in two adolescents with developmental dysgraphia].

Two adolescents 14 and 16 years of age presented with isolated developmental agraphia. The spelling errors were correlated with the degree of orthographic ambiguity and with the word frequency as in acquired agraphia. Patients used to simplify the words spelling and to follow the phoneme-grapheme conversion. The deficit is interpreted as a failure of a selective visual memory for irregular words, representing a developmental graphemic logogene impairment. The better performance of reading is interpreted in relation to phonological system integrity which could better supply the grapheme phoneme conversion of reading even for irregular words. The ambiguous and irregular words recognition during reading appeared easier than their spelling during writing. Short term and working memory for irregular words appeared normal; the deficit occurred only for the long term recall after 20 minutes. Learning of 20 irregular words was made possible in one case by selective reminding of the errors. In spite of normal MRI, a developmental disorder involving the angular gyrus is proposed as for acquired lexical agraphia in adults.

Adolescent↗
PubMed1993

[Neurologic emergencies in acute alcoholic intoxication].

Neurologic complications of acute alcohol intake are less well known to the general practitioner than those punctuating the course of chronic alcohol dependency. The state of ebriety is a poor incentive to precise neurologic analysis and follow-up. Nevertheless, only such surveillance in acute intoxication can distinguish a specific neurological complication, a complication following a fall or prolonged immobilisation, or rapid decompensation of alcoholic encephalopathy. Among the specific complications, myopathies and strokes are described here because of their rarity compared to the more common epilepsy and withdrawal syndromes. The neurologic semiology of ebriety is reviewed, including recent pathophysiological acquisitions specifying the mechanism of functional disorders in regions susceptible to alcohol such as the cerebellum and the reticular formation.

Alcoholic Intoxication↗