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Biomedical subjects

J Bonnal

Publications and source records attributed to J Bonnal.

At least 73 records · Page 4Linked to original sources
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[Neurological complications of anticoagulants (author's transl)].

During a course of therapy by anticoagulants, 16 intracranial haemorrhages and 10 cerebral infarctions, were observed over a period of seven years. The intracranial haemorrhages include 11 subdural haematomas (four acute, seven chronic) and ive intracerebral haemorrhages, one of which resulted from the rupture of an arterial aneurysm. The anticoagulant therapy lasted in 12 cases for more than two years, and in four cases between twenty-four hours and two months. Monocoumarinics are most often the cause of the haemorrhages. The subdural haematomas are unpredictable and a traumatism was only observed in four cases. Three out of four patients with acute haematomas died, as well as two out of seven patients with chronic haematomas. Three out of four intracerebral haemorrhages occurred after ischemic cerebral accidents. The existence of a cerebral infarction counter-indicates the use of anticoagulants. The cerebral infarctions occurred five times during the anticoagulation therapy, and five times after stopping the treatment (from within a few days to a few weeks). Anticoagulation therapy, apart from infarction, is in general well supported and well supervised during the first weeks. Used for a long time, it may lead to very serious and often fatal complication, and must therefore be weighed against the advantages of the treatment.

Adult↗
PubMedDate not supplied

[Unrecognized aneurysms of the circle of Willis].

The authors present, among 200 intracranial arterial aneurysms, 13 cases where the angiographic diagnosis of the aneurysm had been difficult. Among them, there were ten mistakes through default, and four mistakes through excess. Angiographic studies were done early, about the third day following subarachnoidal hemorrhage, so that conscious patients may have rapid surgery. The main diagnosis defaults were observed in aneurysms of the anterior communicating artery (cases 1, 2, 3, 4, 6), where the flexurae and arterial anomalies explain the diagnostic mistakes; double anterior cerebral artery, median anterior cerebral artery of Lazorthes, early origin of the frontopolar artery or of the callosomarginal artery. The aneurysms of the posterior wall of the carotid bifurcation, were hidden by this artery in the A.P. view and by the middle cerebral artery in the profile view (cases 5 and 7). Oblique views are necessary for the two localizations of these aneurysms. The middle cerebral aneurysms (case 8) may be hidden by a bony superposition. The Ziedses des Plantes subtraction method obviates this diagnostic default. Aneurysms of the peripheral branches of cerebral arteries (case 9) are filled later and slightly. Aneurysms of an artery less than 3 mm wide (posterior communicating artery, lenticular artery) are difficult to discriminate from their enlarged infundibulum (case 10). The small size of the aneurysm is not the only explanation of the difficult diagnosis. Indeed, few aneurysms are not evidenced by the first angiography, done at an early stage, even if any spasms exist. Only repeated angiographies could show the aneurysm particularly in young people. We repeat the angiography 15 to 20 days after the first one, and even some months later. In two young patients, angiographic studies were repeated a few times in three years and were normal; but after four years in one case and five years in the other, a new subarachnoidal hemorrhage occurred, and only then was the aneurysm shown by a new angiography (cases 4 and 5). In our series, the angiographic spasm could not afford an explanation for the diagnostic default. This, soon after the subarachnoidal hemorrhage, might be explained by the hemostatic clot which compresses or plugs the aneurysm. Further, the clot's lysis occurs, and the aneurysm can be evident. A double conlcusion must be drawn: --first, the angiography must be repeated if the image is dubious; the angiographic technique must be perfect and varied (oblique view, subtraction method, enlargement technique). Mistakes through excess, leading to useless operations, are as dangerous as mistakes through default; --secondly, great care should be exerted when reading and interpreting the X-ray films in the post-operative period in order to evaluate the surgical results, as well as in the preoperative period.

Adult↗
PubMedDate not supplied

[Initial clinical signs and results of surgical removal of cerebral arteriovenous malformations].

On the basis of 90 cerebral AVMs, the authors study clinical signs which show the AVM, before a dramatic bleeding. Such clinical signs are: benign subarachnoid hemorrhage or intracranial hypertension and, only for lobar AVMs, migraine, epileptic seizures, progressive neurological deficit. In such cases a misdiagnosis is avoided by CT Scan with contrast. In the second part, the authors show that the AVMs surgical removal gives better results than AVMs natural history studied over a 20 years period. Ten AVMs observed in deep coma died. Two surgical deaths are only observed out of 73 AVMs surgical removals. Out of 44 lobar AVMs totally removed, 37 show good results and seven disabilities. Out of 19 deep AVMs, 13 were totally removed and six partially. Such deep AVMs, especially AVMs of the corpus callosum or of lateral and third ventricles choroid plexus give excellent surgical results. The authors conclude that surgical removal is the safer treatment for the majority of AVMs (Acta neurol. belg., 1985, 85, 65-81).

Adult↗
PubMedDate not supplied

[Analysis of the results of nine-year experience in the surgical treatment of intracranial arterial aneurysm (author's transl)].

Two series of cerebral aneurysms are compared. The first was composed of 86 cases. The second, 73 cases, benefited from modern techniques, such as microscope, arterial hypotension, Yasargil's clips, bipolar coagulation, as well as from greater experience on the part of the surgical and anesthetic team. To avoid the risk of recurrent subarachnoidal hemorrhage, the surgical procedure has been done during the first week when consciousness is good or when corotid angiography shows a large cerebral hematoma. The surgical procedure is postponed if the patient shows a low state of consciousness or a cerebral vasospasm. In these cases, controlled external ventricular drainage improves patients' conditions and often allows for surgical intervention after three to five days. The Botterrel classification is used to evaluate the surgical results: good results were obtained in 71% of the entire series, as well as in 94% of grades 1 and 2 patients. The overall mortality rate was 15%. That for grades 1 and 2 was 2.7% and that for grades 1, 2 and 3 was 7.5%. The preoperative, operative and postoperative factors affecting results are discussed with particular attention to cerebral vasospasm and hydrocephalus.

Humans↗