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Biomedical subjects

F Regli

Publications and source records attributed to F Regli.

At least 217 records · Page 12Linked to original sources
PubMed1987

Spontaneous carotid dissection with acute stroke.

Thirty (2.5%) of 1200 consecutive patients with a first stroke had a spontaneous dissection with occlusion of the cervical internal carotid artery (ICA). A suggestive picture with ipsilateral headache and oculosympathetic paresis was uncommon (17%), so that diagnosis was uncertain before angiography. Seven patients died within one week. During follow-up (mean, 3.2 years) with sequential Doppler ultrasonographic testing, 12 survivors had a good recovery and early reopening of the occluded ICA, and 11 had a poor recovery usually without reopening of the ICA. Recurrence of a dissection occurred in only one patient. Large infarcts causing death or a severe disability were associated with an ICA thrombus and distal emboli; the organization of this intraluminal thrombosis may explain the absence of reopening in these cases while resorption of the intramural hematoma developed. Early heparin sodium therapy may help prevent intraluminal clotting without carrying an important risk of extending the dissection, but its clinical benefit remains unproven. Contrary to current opinions, ICA dissection with occlusion causing cerebral infarction may often carry a severe prognosis.

Adult↗
PubMed1987

Ischemic stroke in adults younger than 30 years of age. Cause and prognosis.

Because the cause and prognosis of ischemic stroke in adults younger than 30 years of age are not known, we observed 41 such patients (26 females and 15 males) using a standard protocol of investigations, including cerebral angiography and echocardiography. Mitral valve prolapse and arterial dissection accounted for 51% of infarcts, migrainous infarction was the likely cause in 15% of infarcts, and uncommon causes accounted for 34% of infarcts. Atherosclerosis played a role in only two patients. Two thirds of the women were taking oral contraceptives, which may have been the primary cause of stroke in one woman who had recurrent venous thromboses followed by thrombosis of the aortic arch. Three patients (7.3%) died of acute causes. During follow-up (mean, 46 months), the annual incidence of death (0.7%) and recurrent stroke (0.7%) was low. Eighty-one percent of the survivors could return to work. We conclude that cerebral angiography and echocardiography are indicated in all adults younger than 30 years of age. After the acute phase of stroke, prognosis is reasonable.

Adolescent↗
PubMed1987

Lingual and fusiform gyri in visual processing: a clinico-pathologic study of superior altitudinal hemianopia.

A macular-sparing superior altitudinal hemianopia with no visuo-psychic disturbance, except impaired visual learning, was associated with bilateral ischaemic necrosis of the lingual gyrus and only partial involvement of the fusiform gyrus on the left side. It is suggested that bilateral destruction of the lingual gyrus alone is not sufficient to affect complex visual processing. The fusiform gyrus probably has a critical role in colour integration, visuo-spatial processing, facial recognition and corresponding visual imagery. Involvement of the occipitotemporal projection system deep to the lingual gyri probably explained visual memory dysfunction, by a visuo-limbic disconnection. Impaired verbal memory may have been due to posterior involvement of the parahippocampal gyrus and underlying white matter, which may have disconnected the intact speech areas from the left medial temporal structures.

Aged↗
PubMed1987

Optico-cerebral syndrome: simultaneous hemodynamic infarction of optic nerve and brain.

Three (0.5%) of 612 patients with an acute ischemic stroke in the carotid territory also had ipsilateral optic nerve infarction. They had unilateral or bilateral internal carotid artery occlusion and reversed flow in the ophthalmic artery. Hemodynamic infarction was suggested by triggering by a drop in blood pressure, decreased ophthalmic artery flow and perfusion pressure, and cerebral infarction in a watershed area. The "optico-cerebral syndrome" suggests internal carotid artery occlusion with hemodynamic disturbances. In carotid disease, monocular blindness may be due to an optic nerve lesion sparing the retina.

Arterial Occlusive Diseases↗
PubMed1987

[Benign encephalitis of the brain stem].

Seven cases of an encephalitic brainstem syndrome are reported. All had an initial flu-like phase, with a febrile state. Then, all had eye movements disturbances and ataxia. Six had a variable dysfunction of other cranial nerves, five had dysmetria of limbs and three had pyramidal signs. In all, the topographic diagnosis was based on clinical, neurophysiological (electromyography, evoked potentials) and neuroradiological (swelled brainstem on CT scan) findings. Analysis of cerebro-spinal fluid revealed pleocytosis (mean; 165 cells/ml), without profile indicative of multiple sclerosis. Serologic tests for Adenovirus or Echovirus were positive in three cases. All recovered spontaneously. With a mean follow-up of three years there was no relapse and the clinical examination remained normal. These seven cases had, after exclusion of other brainstem syndromes, a Bickerstaff's encephalitis. Previous reports are discussed and a post-infectious origin is proposed to this benign syndrome.

Adult↗
PubMed1987

[Infarct of the territory of the left anterior cerebral artery. I. Clinico-computerized tomographic correlations].

Clinico-topographic correlations were made in 10 consecutive patients with an isolated infarct in the territory of the left anterior cerebral artery, with sagittal reconstruction of the lesions. Our results suggest that the classical syndromes reported in autopsied patients with large lesions often associated with other infarcts are uncommon. The classical crural hemiparesis was often replaced by a facio-brachio-crural or brachio-facial hemiparesis, when the lesion was anterior to the pre-central region and extended deeply toward the anterior part of the internal capsule. Hemisensory disturbances were related to involvement of the post-central region, were always associated with a hemiparesis and involved mainly the elementary modes of sensation. A grasp reflex occurred only when the contralateral lesion was limited to the orbito-frontal region, in the absence of a severe hemiparesis. Prolonged urinary incontinence, generalized hypokinesia and opposition hypertonia (Gegenhalten) were rare and were related to the size of the lesion. These findings suggest that partial infarcts in the territory of the anterior cerebral artery may be difficult to differentiate clinically from middle cerebral artery territory infarcts.

Adult↗
PubMed1987

[Infarct in the area of the left anterior cerebral artery. II. Language disorders].

Language disturbances and other neuropsychological dysfunctions were evaluated in 10 right-handed patients with left anterior cerebral artery (ACA) infarcts with CT correlation. Transcortical motor aphasia was present in 4 cases, related to involvement of the supplementary motor area (SMA) or the underlying and immediately anterior white matter. In 4 patients with sparing of the SMA but with involvement of the cingulate region, only alterations of verbal memory were found. Sensory or mixed transcortical aphasia was not observed, in any of the patients, including those in whom the supplementary sensory area (SSA) or the underlying white matter were involved, casting doubt upon the presumed receptive role in language function attributed to the SSA by some authors. Buccolingual-facial apraxia was related to subcortical lesions. A callosal disconnection syndrome was uncommon (2 patients) and no hemi-neglect was encountered, even in those cases with cingulate involvement.

Aphasia↗
PubMed1986

[Neurologic manifestations of Borrelia burgdorferi infections].

Lyme disease, first recognized in 1975, typically begins in summer with erythema chronicum migrans (ECM) followed some months later by neurological symptoms (meningoencephalitis, cranial neuropathy), associated with carditis and arthritis. Bannwarth's syndrome is characterized by an ECM followed by radicular pain and radicular sensory and motor disturbances, accompanied by aseptic meningitis. In both cases the cerebrospinal fluid typically shows marked lymphocytic pleocytosis accompanied by an oligoclonal reaction. Despite differences in the clinical symptoms, a borrelia isolated from ticks has been implicated as the etiologic agent of both diseases, and specific antibody titers usually reach a peak between the third and sixth week after onset of the disease. Investigations in 5 patients who developed neurologic symptoms after tick-borne borrelia infection revealed specific antibodies (IgM, IgG) against Borrelia burgdorferi in all sera, and all the patients recovered, one of them without treatment and the others under penicillin or tetracyclines. None developed major complications (carditis, arthritis).

Adult↗
PubMed1986

[Cerebellar infarct. Clinical presentation and x-ray computed tomography of the brain].

A series of 12 patients with cerebellar infarcts diagnosed by computerized tomography are reviewed. The clinical features of cerebellar infarctions cover a wide spectrum, mimicking symptoms and signs from an acute labyrinthitis to a rapidly expanding posterior fossa mass lesion with brain stem and cerebral dysfunction. Two patients were asymptomatic and three showed signs of cerebellar dysfunction only. Three patients had evidence of brain stem dysfunction with cranial nerve palsies accompanying the cerebellar deficit. Two presented a pseudovestibular form with sudden onset of nausea, vomiting, rotary dizziness and ataxia. A pseudotumoral form with intracranial hypertension was found in two cases, in which softening tissue acts as a rapidly expanding posterior foss mass lesion. It is difficult to identify the exact artery involved in a cerebellar infarct because of the collateral circulation and connections between the three major arteries. Atherosclerosis and general decrease in blood flow can be regarded as the most likely factors precipitating focal cerebellar infarction. Surveillance is necessary during the first days with anti-edematous therapy. Rapid deterioration of consciousness should be considered a sign of increasing intracranial pressure progressing with the development of hydrocephalus. If necessary, surgical decompression by external drainage or by direct access to the posterior fossa can be carried out.

Cerebellar Ataxia↗
PubMed1986

Borderzone infarctions distal to internal carotid artery occlusion: prognostic implications.

Bilateral watershed (WS) infarction at the borderzone of the middle cerebral artery territory are typically related to severe hypotensive events. Unilateral WS infarctions have sometimes been reported in occlusion of the ipsilateral internal carotid artery (ICA), but their pathogenesis and prognostic implications are poorly known. Twenty-six of 154 (17%) consecutive patients with ICA occlusion had a computed tomography-proved ipsilateral WS infarct. Severe active heart disease with hypotension and syncope (p less than 0.0001), severe contralateral ICA disease (p less than 0.001), and elevated venous hematocrit values (p less than 0.001) related to heavy smoking were more frequent in the patients with WS infarction than in other patients. Delayed infarctions in the territory of the main branches of the middle cerebral artery distal to the ICA occlusion correlated with a visible stump or emboligenic changes (ulcerated or irregular stenosis) on the collateral channels, but this was not true for delayed WS infarctions. These findings suggest that most of the WS infarctions were hemodynamic. The patients with WS infarct had a higher death rate (9.9% per year) than did the patients without WS infarct (2.3% per year), suggesting that heart disease should be particularly closely managed in patients with WS infarctions. As WS infarctions were the most frequent type of infarction distal to an occluded ICA, appropriate treatment of all potential causes of systemic hemodynamic disturbances may be crucial in the long-term management of patients with ICA occlusion.

Adult↗
PubMed1986

Palpebral asymmetry and hyperthyroidism. Two cases in connection with Graves' disease.

The causes of eyelid retraction or ptosis are numerous. Eye changes associated with thyroid dysfunctions are frequent, and diagnosis is not difficult in patients who are thyrotoxic. In euthyroid patients more difficulty may be encountered, especially if the disorder is asymmetric. The cases are described of two patients with ptosis and eyelid retraction on the other side, who suffered from thyroid disorder.

Blepharoptosis↗
PubMed1986

Search for antibodies to skeletal muscle proteins in amyotrophic lateral sclerosis.

We have investigated serum from 16 patients with amyotrophic lateral sclerosis (ALS) and 15 patients with other neurological diseases (OND) for antibodies which react with skeletal muscle derived antigens. Two different preparations of skeletal muscle antigens were used: i) proteins released from rat diaphragm in organ culture and ii) proteins obtained from a muscle homogenate. We also compared antigen preparations from denervated and non-denervated muscles. A rabbit anti-serum reacted strongly with three proteins in both types of protein preparation, but none of these proteins were specific to denervated muscle. None of the 16 ALS sera could be shown to react with protein antigens from any of the muscle preparations. One of the ALS patients had an IgG lambda monoclonal protein in the setting of a multiple myeloma. This monoclonal protein did not react with protein antigen from rat muscle, human grey or white matter.

Adult↗
PubMed1986

Unilateral left paramedian infarction of thalamus and midbrain: a clinico-pathological study.

In a patient with a unilateral embolic infarct in the left posterior thalamo-subthalamic paramedian artery territory, neuropathological studies showed involvement of the intralaminar, dorsomedial, and internal part of the ventral posterior nuclei of the thalamus, of the rostral part of the mesencephalic reticular formation, and of the posterior commissure. The patient showed upgaze palsy for voluntary saccades, smooth pursuit and vestibulo-ocular movements, sustained downgaze, right-sided motor hemineglect and facio-brachial hypaesthesia, motor transcortical aphasia and anterograde amnesia. This case confirms that unilateral destruction of the posterior commissure, rostral interstitial nucleus of the MLF and interstitial nucleus of Cajal produces a non-dissociated upgaze palsy. Involvement of the nucleus of Cajal probably produced the sustained downward deviation of the eye, by causing predominance of downward vestibulo-ocular inputs. This case also shows that thalamic aphasia and anterograde amnesia may be related to a paramedian lesion of the thalamus, with special reference to involvement of the dorsomedial nucleus, in the absence of lesion of the pulvinar and mamillo-thalamic tract and of conspicuous involvement of the ventral lateral nucleus. Selective hemineglect for motor tasks may occur in infarction of the dominant thalamus, involving the intralaminar nuclei.

Aged↗