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Biomedical subjects

F Regli

Publications and source records attributed to F Regli.

At least 271 records · Page 15Linked to original sources
PubMed1984

Thalamic hematomas: neuropsychological aspects. Report of 11 cases and review of literature.

We have recently observed 11 cases of thalamic hematomas. 5 of them (3 left and 2 right) were submitted to a detailed neuropsychological examination. All hematomas were mainly limited to the thalamus and the internal capsula without significant invasion or compression of surrounding structures. The level of consciousness was usually good. 4 of the 8 patients with left-sided hematomas showed dysphasia and the 3 patients submitted to a detailed neuropsychological examination suffered also severe and persistent mnesic disturbances (verbal and non-verbal). On the other hand, the two patients with right thalamic hematomas presented on neuropsychological testing non-verbal mnesic disturbances and features indistinguishable from right parietotemporal cortical lesions. Vital outcome was highly favourable since no patient died. Functional recovery was also rather satisfactory but formal neuropsychological testing of memory, language and right cortical functions showed significant persistent deficits at time of follow-up in most cases examined. Relevant literature is reviewed and possible pathogenetic mechanisms are discussed. Among various hypothesis concerning neuropsychological impairments, dysfunction of a specific alerting system appears the most seducing possibility but does not explain all observed deficits.

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PubMed1984

[Polyneuropathies and gammapathies: a form with antiglycoprotein MAG antibodies].

Two cases of polyneuropathy with IgM gammopathy are reported. Myelin associated glycoprotein is the antigen for the monoclonal antibody in both of these patients. The same antigenic specificity has now been identified in other patients having a paraproteinemia with a polyneuropathy. These findings suggest the existence of a new syndrome characterized by: a) a primary demyelinating neuropathy; b) a monoclonal IgM antibody to a specific glycoprotein component of myelin, referred to as myelin associated glycoprotein (MAG). As in other humorally mediated autoimmune diseases, it is suggested that demyelination is caused by circulating anti-MAG antibodies. The role of immunosuppressive drugs and plasmapheresis is discussed.

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PubMed1984

[Spontaneous dissecting aneurysms of the internal carotid artery. Prospective evaluation of the prognosis and arterial repermeation in 14 cases].

Fourteen patients with a spontaneous dissecting aneurysm of an internal carotid artery (ICA) have been admitted in our service since 1979 (incidence of 0,5 per 100,000 inhabitants per year). All these patients have been prospectively followed in order to determine their functional prognosis and a possible recanalization of the ICA. Three patients quickly died from an extensive middle cerebral artery infarct with brainstem compression. Among the 11 survivors, 7 completely recovered their functional ability or were left with very minor sequelae, and could go back to work. The 4 other patients remained with severe sequelae and could not work anymore. In the latter patients Doppler ultrasonographic study showed a persisting occlusion of the ICA, whereas a complete recanalization occurred in the former 7, usually as soon as the first month, on anticoagulant treatment. The presence on admission of a minor or moderate neurological deficit, a normal state of consciousness, an age above 45 years, and a patent collateral circulation allows to predict a favorable evolution (p less than 0.05). The same is true for the development of a partial or complete recanalization of the ICA on Doppler ultrasonography performed 2 to 4 weeks after admission. Sex, angiographic aspects of the dissection, and occurrence of headache or warning transient ischemic attacks had no prognostic significance in our study. Spontaneous dissecting aneurysms of the ICA can be a very serious disease, though nearly 50 p. 100 of the patients completely recover during the first months. Immediate anticoagulant therapy is still the treatment of choice and surgery is indicated only in those patients with recurrent episodes or a progressing stroke despite adequate anticoagulation.

Adult↗
PubMed1984

[Vertebrobasilar insufficiency and carotid artery occlusions: hemodynamic or embolic phenomenon?].

We compared 11 patients with an internal carotid artery (ICA) occlusion and vertebrobasilar insufficiency (VBI) with 52 patients with an ICA occlusion but without VBI. The patients with VBI significantly showed a weak collateral circulation and tight stenosis or occlusion of the contralateral ICA, suggesting that the mechanism responsible for the VBI was hemodynamic. Emboligenic factors ICA (stump, external carotid artery or common carotid artery ulcerated stenosis, ulcerated plaque on the contralateral ICA) dit not differ. Age, sex, vascular risk factors, vertebrobasilar or sub-clavian atheromatosis did not influence the development of VBI. We suggest that a hemodynamic phenomenon is the cause of VBI in our cases, probably from an intracranial steal from the vertebro-basilar circulation towards the carotid system.

Carotid Artery Thrombosis↗
PubMed1984

[Hemiparesis with lingual involvement. Hematoma of the genu of the internal capsule].

A 62 year-old hypertensive patient with a small left lenticulo-capsular hematoma presented with a right facio-brachial hemiparesis, dysarthria, and a right lingual paresis. The hematoma was limited to the genu and the anterior part of the posterior limb of the internal capsule. The occurrence of this incomplete pseudo-opercular syndrome in relation to a capsular lesion provides evidence for a cortico-hypoglossal projection with predominantly crossed fibers. The situation of the pyramidal tract in the internal capsule is considered.

Cerebral Hemorrhage↗
PubMed1984

[Isolated axial latero-pulsion in flocculo-nodular cerebellar infarction].

Usual clinical syndromes in cerebellar infarcts include the pseudotumoral and the pseudovestibular forms. Less often, cerebellar infarcts may produce cerebellar disturbances or remain asymptomatic. The authors report a case with a right juxta-pontobulbar cerebellar infarct involving the flocculo-nodular lobe. No vertigo, cerebellar or oculomotor symptoms were present, but the patient showed an isolated axial latero-pulsion towards the affected side. The nature and mechanisms of this previously unreported syndrome are discussed.

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PubMed1984

[Obstruction of the internal carotid artery and cerebral malacias. Tomodensitometric factors of the prognosis in 150 cases].

We studied clinical, CT, angiographic and prognostic parameters in 60 cases with an occlusion, 48 with a tight stenosis, and 42 with a moderate stenosis of an internal carotid artery (ICA). The volume of infarction ranged from 0 to more than 600 cm3. It was significantly related to the degree of ICA obstruction, the number of risk factors, but not to age or sex. The quality of the collateral supply did not significantly influence the size or localization of infarctions, although it was better in the patients with occlusion than in those with tight stenosis. Deep infarcts were associated with diabetes and hypertension. The volume of infarction and early/late neurological disability were closely related to each other. Early death was associated with large infarctions (greater than or equal to 250 cm3). Thus, massive sylvian infarction corresponded to a poor prognosis (life and neurological function), whereas no visible infarction on CT corresponded to a good prognosis. Superficial infarctions had a variable prognosis, and evolution of deep infarctions was size-dependent. Late death or delayed stroke were not predictable from CT parameters. The quality of collateral supply did not markedly influence the functional prognosis. The development of a unilateral ipsilateral ventricular dilation and cortical atrophy was related to the degree of obstruction and to the weakness of the collateral circulation. In occlusion patients, the occurrence of ventricular dilation was related to the volume of infarction; cortical atrophy developed later and was associated with superficial infarctions. In ICA occlusion or stenosis, the study of CT parameters may help delineate prognostic features and may thus ameliorate the therapeutic follow-up.

Carotid Artery Diseases↗
PubMed1984

[Staged or bilateral malacias in the area of the middle cerebral or posterior cerebral arteries. Comparative study of the risk of multifocal stroke in 120 patients].

We studied and compared 120 cases with an infarction in the superficial area of the middle cerebral artery (MCA) or the posterior cerebral artery (PCA). Among the patients with an infarction of the MCA area, 8% had a capsular involvement and 3% a delayed contralateral sylvian infarction. Among the patients with an infarction of the PCA area, 35% had a thalamo-mesencephalic involvement and 23% a delayed contralateral occipital infarction. Thus, multifocal infarction was significantly more frequent in the PCA area than in the MCA area. No particular vascular risk factor could explain this difference, which may be related to general constitutional factors, such as the type of collateral supply or the vascular anatomy itself. In the PCA area only, we found a significant association between the severity of risk factors and occurrence of multifocal infarction.

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PubMed1984

[Intra-axial involvement of the common oculomotor nerve in mesencephalic infarctions].

Mesencephalic infarcts are rarely limited to the midbrain, and usually extend rostrally to the thalamus. This fact explains why an elective palsy of the oculomotor nerve is exceedingly uncommon in brainstem infarcts. We studied 4 cases with a unilateral infarct apparently restricted to the middle mesencephalon, with intra-axial involvement of the oculomotor nerve. In 2 cases with a fascicular lesion, there was a contralateral hemiparesis or hemi-ataxia, so that it is possible to term them Weber's syndrome and Claude's syndrome. In the 2 other cases, we suggest that a nuclear syndrome of the oculomotor nerve was present, because of bilateral involvement of the rectus superior in both cases, of the levator palpebrae in one case, and of the parasympathetic pupillary fibres in the other, although the infarct was unilateral. There are several clinical variants of the intra-axial syndrome of the oculomotor nerve which can be differentiated according to the uni or bilaterality of the oculomotor palsy, the pupillary disturbances, and the type of associated neurological dysfunction. The nuclear syndrome corresponds to an infarction of the median arterial area, which is directly supplied by the most distal part of the basilar artery. The fascicular syndromes correspond to infarction of the paramedian and intermediolateral areas supplied by the first part of the posterior cerebral artery (basilar communicating or mesencephalic artery). As the paramedian thalamic arteries also originate from the basilar communicating artery, most infarcts also involve the upper midbrain and the thalamus, producing supranuclear oculomotor disturbances.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1983

[Cerebrovascular complications of thrombocytosis].

Cerebrovascular complications of thrombocytosis may be the presenting symptoms of the disease (thrombocythemia or secondary thrombocytosis). In the light of 3 recently studied cases, the clinical, pathogenic and therapeutic aspects are emphasized. Early diagnosis is fundamental if the occurrence of permanent neurologic dysfunction is to be avoided.

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PubMed1983

Internuclear ophthalmoplegia, prenuclear paresis of contralateral superior rectus, and bilateral ptosis.

A patient with infarction of the paramedian part of the lower midbrain on the right side is described, in whom internuclear ophthalmoplegia and bilateral ptosis were associated with limitation of elevation of the contralateral eye from paresis of the superior rectus. Supranuclear paresis was suggested by partial dissociation between phasic and tonic components of upward gaze. It is suggested that the right-sided lesion involved the rostral median longitudinal fasciculus before it reached the oculomotor nucleus, the central caudal nucleus medially situated in the lower end of the oculomotor nucleus, and the prenuclear fibres from the posterior commissure to the ipsilateral nucleus of the contralateral superior rectus. A supranuclear lesion may be suspected when there is a complex association of dysconjugate palsy of oculomotor muscles.

Blepharoptosis↗
PubMed1983

Unilateral occipital infarction: evaluation of the risks of developing bilateral loss of vision.

Fifty-eight patients with a unilateral infarction in the superficial area supplied by a posterior cerebral artery were followed (mean: 39.6 months). Thirteen (22.4%) developed cortical blindness associated with a delayed contralateral occipital infarction. Advanced age, general vascular risk, a history of strokes, Sylvian border-zone extension of the initial infarct, and an absence of improvement of initial visual field defects were strongly associated with spread to the other side. The lack of visual field improvement most accurately predicted a high risk of cortical blindness. A careful follow-up and controlled medical therapy is particularly indicated in these patients.

Adult↗
PubMed1983

Encephalopathy, peripheral neuropathy, dysautonomia, myasthenia gravis, malignant thymoma, and antiacetylcholine receptor antibodies in the CSF.

A 54-year-old man suffered from multiple neurologic disturbances (polyneuropathy, encephalopathy, dysautonomia) associated with myasthenia gravis and malignant thymoma. No morphological signs of inflammation were present in the brain and peripheral nerves. Antiacetylcholine receptor antibodies were present in the brain and peripheral nerves. Antiacetylcholine receptor antibodies were present in serum and in cerebrospinal fluid. The association of thymoma, myasthenia gravis, multiple neurologic syndromes, and antiacetylcholine receptor antibodies in serum and cerebrospinal fluid has not been reported as yet. We suggest that this clinical picture is related to a generalized cholinergic dysfunction.

Atrophy↗