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Biomedical subjects

F Regli

Publications and source records attributed to F Regli.

At least 181 records · Page 10Linked to original sources
PubMed1989

[Deafferentation pain following surgical intervention].

The authors describe five patients who presented with deafferentation pain after surgery. The physiopathology, general semeiological and therapeutic features are reviewed. The pain that occurs after nerve or spinal cord injury is due to chronic deafferentation characterized by a syndrome of ongoing pain and abnormal sensitivity. Surgical procedures for pain relief can be divided into two great categories: destructive procedures and neuro-stimulation. The first one which entails the surgical interruption of pain pathways is used in cancer. Peripheral or central stimulation are effective for many pain syndromes, principally the deafferentation pain.

Adult↗
PubMed1989

[Oligoclonal aspects of IgG of the cerebrospinal fluid. Methods of analysis and clinical correlations].

Intrathecal synthesis of immunoglobulins is analyzed by two methods: quantitatively by immunoglobulin titration (IgG index) in cerebrospinal fluid (CSF) and qualitatively by demonstration of oligoclonal distribution of gammaglobulins. The authors report the results of a comparative study evaluating the IgG index and agarose electrophoresis versus electrofocusing. Sensitivity of electrofocusing was higher than the IgG index of standard agarose electrophoresis. Electrofocusing is the best method of proving intrathecal synthesis of immunoglobulins. Although oligoclonal bands are a useful aid in the diagnosis of multiple sclerosis, they indicate an immunological response but are not diagnostic for a particular disease.

Central Nervous System Diseases↗
PubMed1989

Middle cerebral artery pial territory infarcts: a study of the Lausanne Stroke Registry.

Using a standard protocol (Doppler ultrasonography, electrocardiography, brain computed tomography, and in selected cases angiography, echocardiography, and Holter monitoring) we studied the clinical characteristics and etiological factors in 380 patients with first stroke who had a corresponding infarct limited to the territory of the pial branches of the middle cerebral artery (MCA) on computed tomography. The presumed cause of infarction was large-artery disease (greater than or equal to 50% carotid artery or MCA stenosis or occlusion) in one-third of the patients and cardioembolism in one-fourth of the patients. Half of 230 patients undergoing angiography showed evidence for distal occlusions suggesting artery-to-artery or cardiac emboli. Severe heart disease and potential cardiac sources of embolism were more common in patients with infarcts in the territory of the posterior (inferior) division of MCA than in patients with infarcts in the territory of the anterior (superior) division of MCA. Persisting functional disability on discharge was also more severe in patients with the former than in patients with the latter. The neurological picture was polymorphous and it could sometimes even be misleading, as in some patients with a classical lacunar syndrome or with aphasia and unexpected sparing of speech areas. However, a few clinical syndromes apparently specific for involvement of a single MCA branch could be delineated, and in some instances they were highly predictive of embolism from heart or proximal artery.

Aged↗
PubMed1989

Reversible emetine-induced myopathy with ECG abnormalities: a toxic myopathy.

A young anorexic woman is described with a history of progressive muscle weakness following chronic ingestion of syrup of ipecac that was used in an attempt at weight control. Electrocardiogram (ECG) showed T-wave inversion in all leads and prolongation of the Q-T interval. Electromyography was abnormal. Muscle biopsy revealed a randomized, generalized, predominantly type-2 fibre atrophy and structural alterations in oxidative enzyme stains, such as targetoid and moth-eaten fibres. A few necrotic cells were actively phagocytosed. Electron microscopy revealed severe sarcomeric abnormalities with Z-line streaming, myofibrillar disorganization and increased lysosomal activity. After discontinuation of ipecac syrup, the patient noted a gradual improvement in her condition. The ECG became normal. Emetine and related drug-induced myopathies are uncommon but are of experimental interest because of their effects on mitochondria and the light they shed on autophagic mechanisms in muscle.

Adult↗
PubMed1989

Encephalopathy, deafness and blindness in young women: a distinct retinocochleocerebral arteriolopathy?

Three young women (aged 18 years, 19 years and 19 years) who developed progressive neuropsychic and neurologic disturbances with hearing loss and multifocal retinal artery branch occlusions are reported. This retinocochleocerebral syndrome has been reported previously only in 12 young North American women. Its pathogenesis is unknown, but an atypical viral infection of the vessel walls has been suggested. Abnormalities of T lymphocytes subsets in blood in one of the patients suggested an immunological dysfunction, but all other tests, including immunological reactions on brain and skin biopsies, were negative or non-specific. Steroids and immunosuppressive agents have been advocated on an empirical basis, but the second patient showed a substantial recovery without any therapy and the third gradually deteriorated despite azathioprine, cyclophosphamide, prednisone and plasma exchanges. This retinocochleocerebral syndrome probably corresponds to an arteriolopathy of unknown nature.

Adolescent↗
PubMed1989

Chiasmal apoplexy: haemorrhage from a cavernous malformation in the optic chiasm.

We present a patient who experienced sudden onset of orbital headache, visual loss and bitemporal visual field defect. MRI of the optic chiasm suggested a diagnosis of haemorrhage and hence a vascular malformation. Pterional craniotomy revealed an intrachiasmatic haematoma with a cavernous angioma. The malformation was totally excised and vision improved after surgery. The syndrome of chiasmal apoplexy is discussed.

Adult↗
PubMed1989

Postpartum cerebral angiopathy: reversible vasoconstriction assessed by transcranial Doppler ultrasounds.

Postpartum cerebral angiopathy is a distinct reversible clinicoradiological syndrome which develops shortly after a normal pregnancy. It may belong to the poorly defined group of acute benign cerebral angiopathy, in which multisegmental narrowings of cerebral arteries are also reversible. In a 22-year-old woman with postpartum cerebral angiopathy, sequential transcranial Doppler ultrasounds showed that the flow disturbances began to improve 4 days after onset, and normalized 4 weeks later. A vasoconstriction response to acute severe hypertension is likely to explain this reversible angiopathy.

Adult↗
PubMed1989

Infarcts in the territory of the deep perforators from the carotid system.

We studied risk factors and presumed causes of infarct in 100 consecutive patients with a first stroke, who had an appropriate CT-proven infarct in the territory of the deep perforators from the carotid system (ITDPCS). The infarct involved the territory of the lenticulostriate arteries in 65 cases, the anterior choroidal artery in 23 cases, watershed zones between these two territories in four cases, and another territory in eight cases. In 42% of the patients, we felt the cause of the infarct to be small-artery disease. In 36%, at least one source of embolism was present (in 27% from the internal carotid artery, in 17% from the heart), either with (25%) or without (10%) associated hypertension (HT) and diabetes mellitus (DM). Other possible less common etiologies included migraine, syphilitic angiitis, and systemic diseases. We have confirmed that HT or DM are the most common etiologic factors of ITDPCS. However, large-artery disease and cardioembolism may be more important than previously assumed.

Adult↗
PubMed1989

[Intrathecal immunity in multiple sclerosis: comparison of quantitative and qualitative methods of analysis].

The diagnosis of multiple sclerosis (MS) is difficult in the early cases, and the demonstration of oligoclonal IgG bands in cerebrospinal fluid (CSF) is the most frequent and undisputed laboratory abnormality observed. Intrathecal synthesis of immunoglobulins can be proved by three methods: quantitatively by the IgG index, and qualitatively by demonstration of oligoclonal bands in the CSF (electrophoresis and electrofocusing method). Electrofocusing method is a new technique to research oligoclonal IgG bands and has a higher resolution than electrophoresis. In 81 patients with clinically definite MS, 96.2% of CSF were abnormal with electrofocusing method instead of 60.4% of electrophoresis and 83.9% of IgG index. In our cases, electrofocusing was the best method to prove an immunoglobulin intrathecal synthesis in MS.

Adolescent↗
PubMed1988

[Isolated and recurrent peripheral facial paralysis in human infection with human immunodeficiency virus (HIV)].

Unilateral facial palsies were observed in three patients with positive serology for HIV. Two patients presented a second unilateral peripheral seventh nerve palsy after extraction of a tooth. Recovery was complete in each case. Peripheral neuropathies are present in 20% of cases with AIDS but cranial neuropathies are uncommon, affecting only 2 to 3% of patients. The seventh and the fifth are the most frequent cranial nerves involved. The reported isolation of HIV in the cerebrospinal fluid and from the nerve suggests a direct role of this agent. In this study an indirect mechanism such as a vascular spasm may also favour the occurrence of these facial palsies.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[Pathogenesis of carotid cerebrovascular accidents in an elderly cohort. Study of 62 patients more than 75 years old].

We have studied the cause of stroke in 62 patients aged over 75 years who suffered transient ischemic attacks (TIA) and minor stroke, compared to a control group of younger (age 45-74 years) patients with stroke of the same severity. Patients aged over 75 years had a higher incidence of events of undetermined origin, cardiac embolism, or multiple etiologies. This contrasted with a low prevalence of ischemic events secondary to stenosing carotid atheromatosis, and (to a lesser extent) hypertensive arteriolopathy, which predominated in the control group. The differences may be explained in part by a different distribution of risk factors in the older and younger patients, the latter being at higher risk for earlier vascular death.

Age Factors↗
PubMed1988

Subcortical neglect: neuropsychological, SPECT, and neuropathological correlations with anterior choroidal artery territory infarction.

In 2 patients with infarction in the territory of the right anterior choroidal artery, hemiparesis, hemihypesthesia (in 1), and hemianopia or superior quadrantanopia were associated with severe multimodal hemineglect, without anosognosia, disorientation, or asomatognosia. Single-photon emission tomography showed that marked hypoperfusion was not limited to the right posterior capsular region, but also involved the overlying parietal cortex, and to a lesser extent the frontal cortex. At autopsy in 1 patient, the infarct was nearly limited to the deep white matter of the temporal isthmus and the retrolenticular part of the internal capsule; only minute lesions were present in the globus pallidus, body of caudate, and amygdala. These findings are consistent with a disconnection phenomenon as the basis for subcortical neglect with ipsilateral deactivation of the parietofrontal cortex.

Aged↗
PubMed1988

Acute transcortical mixed aphasia. A carotid occlusion syndrome with pial and watershed infarcts.

Four of 1,200 consecutive patients with their first stroke showed acute transcortical mixed aphasia (TMA) characterized by nonfluent speech with impaired naming, semantic paraphasias, echolalia, impaired comprehension, good repetition, reading, and writing on dictation. All 4 had left internal carotid artery (ICA) occlusion with ipsilateral anterior pial territory infarction (precentral-central sulcus artery territory) and watershed infarction between the middle and posterior cerebral artery territories, which spared and 'isolated' the perisylvian speech areas. Although rare, acute TMA is highly suggestive of infarction due to ICA occlusion, in that it is probably related to simultaneous embolism (anterior pial infarction) and haemodynamic insufficiency (posterior watershed infarction).

Acute Disease↗
PubMed1988

Manic delirium and frontal-like syndrome with paramedian infarction of the right thalamus.

A disinhibition syndrome affecting speech (with logorrhoea, delirium, jokes, laughs, inappropriate comments, extraordinary confabulations), was the main manifestation of a right-sided thalamic infarct involving the dorsomedian nucleus, intralaminar nuclei and medial part of the ventral lateral nucleus. Resolution of conflicting tasks was severely impaired, suggesting frontal lobe dysfunction. These abnormalities correlated with the finding on SPECT of a marked hypoperfusion in the overlying hemisphere predominating in the frontal region. We suggest that this behavioural syndrome was produced by disconnecting the dorsomedian nucleus from the frontal lobe and limbic system.

Afferent Pathways↗
PubMed1988

Transient global amnesia and stroke.

Four patients who experienced isolated transient global amnesia had computed tomographic evidence for a cerebral infarct (3 cases) or hemorrhage (1 case). The medial part of the temporal lobe was involved in 2 patients (left in 1, right in 1), the left lentiform nucleus in 1 patient, and the left thalamus in 1 left-handed patient. These findings suggest that transient global amnesia may be associated with stroke in some cases, but it has no localizing value within the temporodiencephalic structures. No cerebrovascular events occurred over a 1-to 5-year follow-up, suggesting that transient global amnesia with infarction or hemorrhage is not a strong predictor of further stroke.

Aged↗
PubMed1988

Prognosis of high-risk patients with nonoperated symptomatic extracranial carotid tight stenosis.

Forty-five patients with symptomatic (20 with transient ischemic attack, 25 with minor stroke) greater than or equal to 75% stenosis of the cervical internal carotid artery had no endarterectomy and received only medical therapy because the surgical risks (severe cardiac disease, chronic obstructive pulmonary disease, hypertension or diabetes with systemic complications, aortic aneurysm) were believed to be unacceptable. During follow-up (mean 48 months), occlusion of the internal carotid artery developed without symptoms in two patients and with symptoms in three patients. The cumulative stroke and/or death rate was 24% at 2 years and 50% at 6 years. The ipsilateral infarct rate was 10% after the first year, but decreased markedly thereafter (2.4% per year), and one third of these infarcts were probably lacunes due to hypertensive small vessel disease. Overall, stroke related to previously symptomatic internal carotid artery stenosis was not the major problem during follow-up but was largely overcome by other strokes and cardiac death.

Aged↗
PubMed1988

The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke.

We present epidemiologic, etiologic, and clinical data for 1,000 consecutive patients with a first stroke (cerebral infarction or hemorrhage) admitted to the Centre Hospitalier Universitaire Vaudois since 1982. The patients were evaluated using a standard protocol of tests (computed tomography, Doppler ultrasonography, and electrocardiography in all patients, as well as angiography and specific cardiac investigations in selected patients). Each case was coded prospectively into a computerized registry. We believe that the Lausanne Stroke Registry is the first registry with complete computed tomography and Doppler ultrasonography data on all patients, which allows correlation between clinical findings, presumed etiology, and stroke location. Although the Lausanne Stroke Registry is not population-based, it gives a good estimate of the stroke-related problems in patients admitted to a primary-care center since our hospital is the sole acute-care facility for stroke in the Lausanne area.

Adult↗