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Biomedical subjects

F Regli

Publications and source records attributed to F Regli.

At least 55 records · Page 3Linked to original sources
PubMed1995

"Hyperneglect", a sequential hemispheric stroke syndrome.

We studied 8 patients with stroke and hemineglect, who presented with a transient active orientation and explorative behavior, turning head, eyes, and trunk in the opposite direction to any stimuli given in the neglected hemispace, as if repelled. This peculiar active behavior increased on repetitive stimulation, with the patient turning over by more than 180 degrees, with extreme rotation and opisthotonos-like extension of the axial muscles, as if looking for something behind him, his pillow or his bed. This behavior fluctuated during the day and vanished after a few days. We coined the term "hyperneglect" for this behavior, postulating a higher degree in the neglecting behavior or an additional field of hemineglect in the non neglected hemispace, or the release of repellent active behavior from parietal origin by the acute lesion. On CT, five patients showed two sequential uni- or bilateral hemispheric strokes of different ages on CT, while two patients had a large, unilateral infarct associated with hypertensive leukoencephalopathy and contralateral brain edema respectively. This behavioral syndrome seems to be associated with an acute stroke involving the frontal or parietal lobes and a previous lesion in the same or the opposite hemisphere.

Aged↗
PubMed1995

Klüver-Bucy syndrome after left anterior temporal resection.

A 70-year-old right-handed woman developed a complete Klüver-Bucy syndrome including psychic blindness, aberrant sexual behavior, hypermetamorphosis, aphasia and visual agnosia following left anterior temporal lobectomy for an anaplasic oligodendroglioma. MRI showed no argument for a contralateral ischemic infarct, tumoral growth or white matter damage. Thus the possibility that a unilateral anterior temporal lesion can cause the whole picture of Klüver-Bucy syndrome must therefore be considered.

Affect↗
PubMed1995

Infarction of the lower brainstem. Clinical, aetiological and MRI-topographical correlations.

Using a standard protocol including MRI and magnetic resonance angiography (MRA), we studied 28 consecutive patients, all with an acute infarct in the lower brainstem. MRI patterns above and below the inferior olivary nucleus enabled identification of six topographical types of infarct: small midlateral, dorsolateral, inferolateral, large inferodorsolateral, dorsal and paramedian infarcts. Small midlateral, dorsolateral, inferolateral and inferodorsolateral infarcts were the most common types and were associated with Wallenberg's syndrome, with specific clusters and severity of neurological features in each of the four groups. Dorsal infarcts were both anatomically and clinically overshadowed by a constant associated cerebellar infarct in the posterior inferior cerebellar artery (PICA) territory. Paramedian infarction led to crossed tongue and sensorimotor hemiplegia, while a patient with an almost complete hemimedullary infarct had unusual ipsilateral sensory and motor disturbance due to lesion extension toward the upper spinal cord. A coexisting cerebellar infarct was present in 36% of the cases, but was never found with midlateral or inferolateral infarct. Angiography showed an embolic occlusion of the PICA in five patients (18%), four of them having dorsal or dorsolateral infarct. Atheromatosis was by far the most frequent stroke aetiology (72%), with intracranial vertebral artery tight stenosis or occlusion in 28% of the cases and in 75% of the cases with large inferodorsolateral infarct. Vertebral artery dissection and cardioembolism accounted each for 14% of the cases, the latter being associated with dorsal infarct. Our study shows that differences in topographical patterns of infarction in the lower brainstem probably reflect differences in aetiopathogenic mechanisms.

Adult↗
PubMed1995

Idiopathic orbital inflammation (orbital inflammatory pseudotumour): an unusual cause of transient ischaemic attack.

A patient with idiopathic inflammation of the right orbit, established by biopsy, developed episodes of transient left sensorimotor hemiparesis. Neuroimaging showed intracranial extension of the disease with pronounced narrowing of the right internal carotid artery in its intracavernous portion. Oral cyclophosphamide induced gradual improvement. Transient ischaemic attack is rarely found in association with orbital disease and indicates possible intracranial extension.

Administration, Oral↗
PubMed1995

Acute hemiconcern: a right anterior parietotemporal syndrome.

Three patients developed a striking visual and motor behaviour in the acute phase of a stroke involving the territory of the right anterior parietal artery (postcentral gyrus, parts or upper and middle temporal gyri, anterior part of inferior parietal gyrus, and supramarginal gyrus). The patients concentrated on the left side of their bodies, looking at it for long periods and relentlessly rubbing, touching, pinching, pressing, lifting, and manipulating parts of the left arm, trunk, and leg with their right hand or foot. They all had severe loss of elementary sensation on the left (touch, pain, temperature, vibration, position). The behaviour was not associated with overinterest in the left hemispace apart from their own bodies. It lasted no more than a few days, disappearing when left sided sensation improved. The findings suggest an association between sensory dysfunction and this "acute hemiconcern". None of 13 patients with a mirror infarct in the left hemisphere and none of 38 patients with acute hemisensory loss due to thalamic capsular or brainstem stroke showed hemiconcern behaviour. This behaviour may result from a feeling of strangeness critically associated with hemisensory loss without hemispatial neglect, due to involvement of the right anterior parietotemporal region.

Aged↗
PubMed1995

Headache at stroke onset: the Lausanne Stroke Registry.

Within 12 hours of stroke onset 2506 patients with first ever stroke admitted to the Lausanne Stroke Registry were questioned about headache. Eighteen per cent of the patients reported headache, 14% with anterior circulation stroke and 29% with posterior circulation stroke (p < 0.001). Headache was reported by 16% of the patients with infarct and 36% of those with haemorrhage (p < 0.001). The prevalence of headache was 9% with lacunar infarct, 15% with middle cerebral artery territory infarct, 37% with infratentorial haemorrhage, and 36% with supratentorial haemorrhage. The most common topography of pain was frontal (41%), followed by diffuse headache (27%; p < 0.001). Diffuse (41%) or occipital (30%) headache was particularly frequent with posterior circulation stroke, whereas frontal headache was associated with anterior circulation stroke (51%; p < 0.001). Headache in stroke may be explained in part by involvement of blood vessels (acute distention or distortion) and mechanical (stretch of haemorrhage) stimulation of intracranial nociceptive afferents. Stroke due to dissection was strongly associated with headache (p < 0.001), whereas embolic (cardiac, artery to artery) stroke was more common without headache (p < 0.001), emphasising the role of extracranial v intracranial arteries in the genesis of headache at stroke onset. Moreover, dual trigeminal-vascular and cervical-vascular system involvement in causing headache may explain the lack of correspondence with the "rules of referral" in up to 38% of the cases.

Adolescent↗
PubMed1995

Parietal kinetic ataxia without proprioceptive deficit.

A patient with acute onset "classic" cerebellar ataxia of the right arm without clinically detectable deep sensory loss is reported, in relation to an acute posterior parietal infarct. Wild back and forth swaying of the arm, giving away, or worsening by suppression of vision were not seen. The lesion involved area 5, parts of area 7, the angular gyrus, the middle and posterior parieto-occipital gyri, and posterior parts of the superior and middle temporal gyri. The paracentral lobule, commonly thought to be responsible for parietal ataxia, was spared. Thus posterior parietal lesions can mimick cerebellar ataxia, possibly by severing specific projections to the ventrolateral thalamic nuclei. On the basis of previous studies in primates, the superior parietal gyrus may play a major part in the ataxia presented by this patient.

Ataxia↗
PubMed1995

Hyperkinetic motor behaviors contralateral to hemiplegia in acute stroke.

Motor behaviors on the 'good side' of the body, i.e. ipsilateral to the hemispheric lesion, have not been studied systematically. We assessed motor behaviors in 20 consecutive patients during the acute phase (first 1-2 weeks) of a hemispheric stroke with hemiparesis. The behaviors were essentially rotations of the head, neck, eyes and trunk, orofaciopharyngeal or limb stereotypes, compulsive manipulation of the surroundings, or passive mobilization of the paralyzed arm or leg. These behaviors were found only with large infarcts in the territory of the internal carotid artery, middle cerebral artery and/or the anterior cerebral artery (ACA). All but two ACA infarcts involved the internal capsule and basal ganglia. The severity of the motor deficit and the presence of aphasia, neglect, or sensory loss were significantly correlated with the motor behaviors. Although the understanding of these behaviors remains unclear, we suggest that they may represent the clinical expression of early plastic changes of brain maps and circuits after an acute lesion; this is probably an active process induced by disinhibition, in order to establish new compensatory pathways.

Acute Disease↗
PubMed1995

Chronic relapsing neuropathy associated with Castleman's disease (angiofollicular lymph node hyperplasia).

We report a 17-year-old patient who presented a chronic relapsing sensorimotor demyelinating neuropathy with 6 relapses over a 7-year period, preceding by 4 years the diagnosis of a multicentric angiofollicular lymph node hyperplasia. A role for Epstein-Barr virus (EBV) as a trigger of the neuropathy may be suggested by the presence of EBV DNA in the biopsied abdominal abdominal adenopathies. This unusual reported association seems to have a better prognosis than the known chronic progressive form of neuropathy associated with Castleman's disease and the Crow-Fukase syndrome.

Adolescent↗
PubMed1995

[Eosinophil meningoradiculitis caused by Angiostrongylus cantonensis].

The authors report the case of a 46-year-old woman who presented with an eosinophilic meningoradiculits after a trip to Tahiti. Because of the type of presentation of the symptomatology, the CSF findings, and the spontaneously favourable outcome, it was related to an infection by Angiostrongylus cantonensis. The authors review the neurological manifestations of this parasite and emphasize the different clinical aspects of infection by Gnathostoma spinigerum, which causes myeloencephalitis in the South-East of Asia.

Angiostrongylus cantonensis↗
PubMed1995

[Minor cranio-cervical injuries, cerebral malformations and chronic headaches].

We have presented two cases of chronic disabling exertional headaches following a minor head trauma. MRI studies of the cranio-cervical junction showed Chiari Type I malformation, without bony occipito-cervical dysplasia. Headaches after a mild trauma are a common finding. The exertional character of the headache can lead the clinician to his diagnosis in cases involving long-term complaints.

Adult↗
PubMed1995

[Recurrent Miller Fisher syndrome. Significance of anti-GQ1B antibodies].

In the present report, an unusual case of recurrent Miller Fisher syndrome is described. The patient presented within ten years three similar episodes of ophthalmoplegia, ataxia and areflexia associated with oropharyngeal weakness and signs of mild distal sensory neuropathy. An elevated titer of anti-GQ1b ganglioside antibodies correlated well with the clinical symptoms and signs. The pathogenic role of these antibodies in Miller Fisher syndrome is discussed.

Autoantibodies↗
PubMed1995

Considerations in the prophylactic treatment of transient ischemic attack or ischemic stroke in the carotid artery territory.

This non-randomized study surveys the prophylactic treatment of 154 patients after transient ischemic attack or ischemic stroke in the carotid artery territory. Clinical presentation and etiologies were compared on the basis of the proposed prophylactic treatment. A surgical intervention or a long-lasting anticoagulation was restricted to only 30 patients (20%) due especially to the gravity of the ischemic cerebral lesions, general deterioration, and the advanced age of most of the patients. The purpose is to emphasize the "down-to-earth" situation in current medical care of non-selected patients as distinguished from the strictly selected patients of randomized studies. More importance should be done to open studies which better reflect the daily medical reality.

Adult↗
PubMed1995

[Neuritis of multiple cranial nerves in idiopathic focal pachymeningitis].

A 76 years old patient suffering from insulin dependent diabetes presents a multiple, bilateral and asymmetric cranial neuropathy involving on the left side the cranial nerves VIII, IX with a participation of the efferent autonomic fibers of the nerves VII and IX (xerostomia) and the nerve XII, and involving on both sides the nerves VII and X. Like it is known from literature the nerve XI was spared, probably because of the more caudal emergence from the brainstem. The disease was preceded by a violent otalgia on the left side which was initially interpretated as a malignant external otitis. This affection was associated with an inflammatory syndrome that was easily monitored by the blood sedimentation rate. The course was favorable but marked by fluctuations of the neurological deficits. The MRI shows a pachymeningitis localised at the beginning in the medial fossa and on the cerebellar tentorium, later on the left parieto-occipital convexity. The diagnosis of a focal idiopathic pachymeningitis was confirmed by excluding different other affections like inflammatory, tumoral and infectious diseases, by using MRI examinations, CSF analysis and especially meningeal biopsy. It is a rare inflammatory disease of unknown origin with potentially persistent neurological deficits. We discuss the differential diagnosis and the therapeutical possibilities, which consist in a long term immunosuppression with corticosteroids and azathioprine.

Adrenal Cortex Hormones↗
PubMed1994

[Range of neuromuscular involvement in 47 patients infected with the human immunodeficiency virus].

Over a 30 month period, 47 out of 749 patients infected with the human immunodeficiency virus had various neuromuscular symptoms. Based on clinical and electrophysiological data, 47% had distal symmetric polyneuropathy, 11% chronic inflammatory demyelinating polyneuropathy (CIDP), 8.5% toxic neuropathy related to 2-3-dideoxyinosine (DDI), 8.5% cranial neuropathy, 8.5% mononeuropathy multiplex or isolated focal neuropathy, 8.5% progressive lumbosacral polyradiculopathy, and 8.5% myopathy. Half of the patients exhibited previous or concomitant signs of central nervous system involvement and 18 patients died during the study period. CIDP and cranial neuropathies usually appeared early in the course of the disease and consequently showed neurological improvement. Nerve conduction studies of DDI related toxic neuropathies showed distal axono-myelinic sensitivo-motor neuropathy, differing from CIDP by the absence of a conduction block. Distal symmetric polyneuropathies, frequent in the advanced systemic illness, do not systematically require an extended workup, but more unusual peripheral neuropathies which might be treatable necessitate further investigations (electromyography, radiology, serological blood tests; protein chemistry and routine workup of the cerebrospinal fluid). For example, progressive lumbosacral polyradiculopathies responded to early treatment, with a better outcome in one case of herpetic origin than in another case due to cytomegalovirus infection. Our observations suggest that myopathies in HIV infected patients should first be tackled by temporary interruption of virostatic medication, followed by muscle biopsy if the symptoms persist.

AIDS Dementia Complex↗
PubMed1994

[Muscle cramps: mechanism , etiology and current treatment].

Spasms of skeletal muscles occur in healthy individuals or in the course of functional disorders of the peripheral motor neuron or its axons. Like fasciculations, they are a motor manifestation, but a painful one. Cramps evoke the notion of ephapsis and of immature terminal axons. There are, however, also other responsible regulatory systems, mostly the sensible and spinal ones. Three personal observations are used to illustrate the various triggering mechanisms. A review of the literature on this subject is added. Symptomatic treatment has not changed over past decades: Quinidine remains the treatment of choice. Other stabilizers of cell membranes are actually available, whose usefulness varies as a function of the cause of cramps.

Adult↗
PubMed1994

[Acute confusional states. Analysis of 60 cases observed in a neurological department].

The authors describe the clinical picture, etiology and evolution of 64 patients admitted because of an acute confusional state to the Department of Neurology of the University Hospital in Lausanne (CHUV) during two years (1991 to 1992). The difficulty of clinical diagnosis, particularly in vascular and epileptic cases, the high percentage of focal neurological causes, the role of (underlying) dementia, drugs, systemic disturbances (fever, infections, dehydration, etc.) and the importance of etiology for prognosis are particularly stressed.

Acute Disease↗