Biomedical subjects
Publications and source records attributed to J Chiras.
The authors report their experience based upon 56 cases of CT in cerebral thrombophlebitis. Direct signs of occlusion of the veins are infrequent and interest lies in the abnormalities due to brain edema or venous infarct. It is fundamental to recognize these infarcts as their evolution is favorable under treatment. Angiography is necessary to confirm the diagnosis of thrombophlebitis which can be only suspected on CT findings.
Clinical, computed tomography and angiography investigations were conducted in 15 cases of venous angioma of brain. These rare malformations (70 cases reported) are often asymptomatic or are revealed by the onset of epileptic seizures. The scanner produced images suggestive of a vascular malformation in 80% of cases. However, the purely venous character of the angioma and its exact site require confirmation supplied by angiography only, the lesion provoking characteristic images from the latter examination.
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Extracranial vertebral arteriovenous fistulae of non traumatic origin are extremely rare. The authors report two cases of spontaneous vertebro-vertebral arteriovenous fistulae associated with fibromuscular dysplasia. They discuss the relation-ship between arteriovenous fistulae and fibro-muscular dysplasia, and the specific problems of treatment in these two cases.
C.T. scans of 19 patients with histologically proved primary lymphoma of the brain were reviewed and divided into three groups: solitary tumors (58%), multifocal tumors (31,5%), diffuse involvement of the brain (10,5%). The C.T. differential diagnosis are manifold, including meningioma, glioma, metastases, progressive multifocal leukoencephalopathy. Arteriography is not specific, but, correlation with C.T. results may suggest the correct diagnosis and encourage biopsy. The radiosensitivity of primary lymphoma of the brain emphasizes, the importance of an early diagnosis.
A 39-year-old woman experienced severe headache, epilepsy and rapidly progressive aphasia and hemianopia. Carotid angiograms displayed segmentary narrowing of intracranial arteries as previously described in benign cerebral vasculitis. Her superficial temporal artery was also involved, allowing a biopsy of the abnormal part of the vessel. Microscopical study of this artery was normal. A second carotid angiogram, 14 days later, showed normal intracranial arteries. These findings suggest arterial spasm rather than distal arteritis.
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A 58 year old man was admitted with a pseudo-coronary pain. Cardiological investigations (ECG, chest X-ray, enzymes) were normal. Pain however was exacerbated by movement, coughing and pressure over T4 to T10 vertebrae. On the 4th day, the patient developed a weakness of the right lower limb which worsened 15 days later. On examination there were in the right lower limb a combination of central (Babinski sign) and peripheral signs (diminished deep reflexes, loss of sensation to all modalities ipsilateral to the paralysis). Metrizamide myelography was within normal limits. Spinal angiography revealed a dural arteriovenous fistula draining into spinal veins, at the level of T5. Following the removal of the fistula, the pain disappeared and the other symptoms and signs improved.
From a group of 10 patients with arterio-venous meningeal fistulas of the dura-mater of the spinal cord, who where treated by embolization, the authors discuss and compare the results of this procedure to surgical management. This results, sometimes spectacular, are similar to surgical ones and sometimes better, essentially upon paresthesias and urinary troubles. They insist upon the interest of this management which appears often realizable in the same procedure than diagnostic angiography.
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In cerebral hemorrhage, it provides an easy and early diagnosis, by demonstrating hyperdensity indicative of the presence of coagulated blood in the cerebral tissue. During the course of the illness, this hyperdensity progressively lessens, to disappear within a varying interval of time. The sequelae are seen as a cavity, the density of which is close to that of the CSF. In cerebral infarctions, the scan remains normal for the first few hours, and its only value at this stage is to eliminate cerebral hemorrhage before anticoagulants are prescribed. It is only after 24 to 48 hours that the fundamental sign is seen, that is hypodensity of the ischemic territory. This hypodensity may be accompanied by a mass effect and, above all, the uptake of contrast, which may be of great diagnostic importance, and the significance of which has been widely discussed. The course takes the form of the progressive development of the sequelary cystic appearance.
The authors report a case of testing of the temporary occlusion of origin of the radiculo-medullar artery for the cervical enlargement by balloon occlusion and both testing by clinical evaluation and evaluation of somesthesic evoked potentials and F wave. This testing allowed the surgical removal of a malignant tumor of the cervical vertebra including the vertebral artery and the origin of the radiculo-medullar artery for the cervical enlargement. About this case, they discuss possibilities and the theorical value of these pre-operative tests.
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CT was performed on ten cases of dural intracranial arteriovenous fistulas. There were 3 fistulas of the transverse sinus draining directly into the homolateral jugular vein; 2 fistulas of the sinus with distal occlusion of the sinus and back flow into the cortical veins (one was on the transverse sinus, the other on the sagittal sinus); 2 fistulas of the middle fossa; 3 fistulas with direct venous drainage into the cortical veins, one of these forming a tumor process in the posterior fossa. Osseous abnormalities were seen in only one case. Cerebral CT abnormalities, such as patchy or vermicular enhancement, were seen in all the cases with fistulas draining into the cerebral veins. Cerebral CT was normal in cases of fistulas of the sinus without back flow into the cerebral veins.