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J P Neau

Publications and source records attributed to J P Neau.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Cerebral ischemic disorders in the young subject. Etiologic diagnostic approach to ischemic disorders].

EXHAUSTIVE WORK-UP: Initial explorations include standard laboratory tests, electrocardiogram, ultrasound exam of the cervical vessels, and transthoracic echocardiogram. If the initial work-up is normal, a transesophageal echocardiogram and/or an angiogram (arteriography, magnetic resonance angiography or spiral CT) can be helpful in addition to further immunology and hemostasis explorations. TRANSESOPHAGEAL ECHOCARDIOGRAM: This is a cardinal exam for the etiological work-up in young subjects having suffered a cerebral ischemic event. It can detect anomalies involving the left atrium and auricle, the interventricular septum or the aortic arch missed on standard echocardiography. CONVENTIONAL ARTERIOGRAPHY: There is a trend to replace conventional arteriography with less invasive techniques such as magnetic resonance angiography or spiral CT. When coupled with an ultrasound exploration of the cervical and intracranial vessels, the contribution of these new techniques is similar to that of conventional arteriography, particularly in patients with arterial disease.

Adult↗
PubMed1998

[Cerebral ischemic disorders in the young subject. The causes of ischemic disorders].

PROTEIN CAUSES: Although cardiogenic emboli, arterial dissection, and to a lesser extent, arteriosclerosis are the major underlying causes, clinicians should keep in mind the wide spectrum of possible etiologies. UNCOMMON CONDITIONS: Rigorous history taking (toxic risk, family history), systematic search for skin or skeletal anomalies, and an ophthalmologic examination can help orient the diagnosis and lead to the appropriate complementary explorations. DIAGNOSTIC STRATEGY: The need for a precise etiologic diagnosis is obvious as many vascular conditions are amenable to specific treatments or require particular monitoring or preventive measures. A family survey many be indicated.

Adult↗
PubMed1998

[Papillary fibroelastoma. A rare etiology of strokes in young patients].

BACKGROUND: The papillary fibroelastomas are cardiac lesions, which typically occur on the cardiac valves, but rarely on the endocardium. The incidence of these benign primitive tumors varies from 0.002 to 0.33% and increases with advancing age. METHODS: We report two cases of stroke, one in a 31-year-old man and the other in a 48-year-old woman, both admitted to the same stroke center. RESULTS: The diagnostic studies were normal in these two patients, except for the echocardiography. The first showed an echogenic mass on the mitral valve on transthoracic echocardiography (TTE), confirmed by the transesophageal echocardiography (TEE). The second demonstrated a mass on the sigmoid aortic valve on TEE, but the TTE was normal. For these two patients, a surgical excision was carried out and pathologic examination concluded to a papillary fibroelastoma. After surgery, no recurrence was observed. CONCLUSIONS: The papillary fibroelastomas are usually asymptomatic and easily detected by TEE. However, it can be revealed by stroke, myocardial infarction and lower limbs ischemia. These cardiac tumors should be surgically removed, since their complete excision remains the only means of avoiding a recurrence of embolism.

Adult↗
PubMed1997

Recurrent intracerebral hemorrhage.

Between 1984 and 1994, of the 375 patients admitted to our department for intracerebral hemorrhage (ICH), 24 (6.4%) had a recurrent ICH. There were 15 women and nine men and the mean age of the patients was 64.7 +/- 9.4 years (range 49-81) at the first bleeding episode and 68.7 +/- 7.5 years (range 57-83) at the second. The mean interval between the two bleeding episodes was 47.5 +/- 30.5 months (range 3 months to 14.8 years). Nine patients presented with more than one recurrence of ICH. Seventy-one percent of the patients were hypertensive. The site of the first hemorrhage was lobar in 17 patients, ganglionic (putamen, thalamus, or caudate nucleus) in six patients, and subdural in one. The recurrent hemorrhage occurred at a different location from the previous ICH. The most common pattern of recurrence was "lobar-lobar" (14 patients) and more rarely "ganglionic-ganglionic" (five patients), which was always observed in hypertensive patients. The outcome after the recurrent hemorrhage was usually poor, with severe cognitive impairment. By comparison with 81 patients followed up to 24 months (47.9 +/- 22.2 months) with isolated ICH without recurrence, only lobar hematoma and a younger age were risk factors for recurrences whereas sex and previous hypertension were not. The mechanisms of recurrence of ICH were multiple (hypertension, cerebral amyloid angiopathy). Control of blood pressure after the first hemorrhage may prevent ICH recurrences.

Aged↗
PubMed1997

[Amyotrophic lateral sclerosis and cognition disorders. Neuropsychological study of a population of 26 patients].

Typical amyotrophic lateral sclerosis (ALS) is described as a motoneuron disease which spared cognitive functions. Recent studies reported cognitive impairement associated with classical ALS. Gallasi and al. (1985) detect subtle cognitive impairement sparing memory in a population of 22 patients affected with sporadic motoneuron disease. Iwasaki and al. (1990) finds lower scores, including memory tests. Our study evaluated 26 patients compared with 26 control subjects with neurospychological tests (rapid evaluation of cognitive function fluency, Weschler adult intelligence scale, Wisconsin cards, Rey scheme, memory tests - Luria -, trail making, visual retentional test of Benton Violon Seyll test). All the neuropsychological tests were significantly lower for the patients group. The cognitive impairement is global: memory and frontal functions were not spared and this impairement is also subtle. It may easily go undetected without tests. We cannot isolate a cortical or subcortical profile of the deterioration.

Aged↗
PubMed1997

Long-term evolution of daytime somnolence in patients with sleep apnea/hypopnea syndrome treated by continuous positive airway pressure.

We demonstrated in a previous study that excessive daytime sleepiness (EDS) in patients who have sleep apnea/hypopnea syndrome (SAHS) and are undergoing continuous positive airway pressure (CPAP) treatment improved differently in two groups of patients: in group I, multiple sleep latency tests (MSLT) were normalized after 50 days of treatment (individual value > 10 minutes), whereas they remained low (individual value < 10 minutes) in group II, with a significant difference between groups. To evaluate the long-term evolution of daytime somnolence under nasal CPAP treatment, five patients from group I and seven patients from group II underwent a new polysomnography and MSLT 4 years after the previous study. Clinical, polysomnographic and MSLT results obtained at baseline before treatment (T1), after the initial 50-day period of CPAP treatment (T2), and after 4 years (T3) were compared. The significant difference in mean MSLT value between the two groups previously observed at T1 and T2 disappeared at T3 (group I: 12.4+/-5.9 minutes; group II: 9.7+/-5.9 minutes). We found that this long-term improvement in excessive daytime somnolence was independent of the initial MSLT value, the severity of SAHS, and the initial MSLT changes under nasal CPAP. Long-term MSLT evolution was significantly correlated to CPAP compliance. These results demonstrate that even in the absence of a significant increase in MSLT at the beginning of CPAP treatment, further improvement is still possible several years later, which may encourage the regular, long-term use of nasal CPAP by patients.

Aged↗
PubMed1996

The syndrome of posterior choroidal artery territory infarction.

Posterior choroidal artery (PChA) territory infarcts remain the least well-known type of thalamic infarcts. Our study of 10 personal cases, selected from 2,925 stroke patients admitted consecutively to a community-based primary care center, and 10 published cases of unilateral PChA territory infarct suggests that they can often be differentiated clinically from other thalamic infarcts. Patients with PChA territory infarct associated with superficial posterior cerebral artery territory infarct or with another infarct were excluded. Damage was characteristically limited to the lateral geniculate body, pulvinar, posterior thalamus, hippocampus, and parahippocampal gyros, without involvement of the upper midbrain and the anterior nucleus of thalamus. In lateral PChA territory infarct, the most common clinical manifestations included homonymous quadrantanopsia, with or without hemisensory loss and neuropsychological dysfunction (transcortical aphasia, memory disturbances). A homonymous horizontal sectoranopsia is exceptional but particularly suggestive of the involvement of the lateral geniculate body in this territory. Media] PChA territory infarct was less frequent. Its neurologic picture was dominated by eye movement disorders not particularly suggestive of thalamic involvement. Late disability was usually absent or slight, being related to pain and delayed abnormal movements. The most common stroke etiology was presumed small-vessel occlusive disease.

Adult↗
PubMed1995

Event-related auditory evoked potentials and amyotrophic lateral sclerosis.

OBJECTIVE: To study event-related potentials and particularly the P300 wave in a group of patients with amyotrophic lateral sclerosis (ALS), as changes in the P300 wave have been observed in many cases of brain damage-inducing cognitive impairment. DESIGN: Case series. SETTING: University hospital. PATIENTS: Twenty patients with ALS were compared with 20 healthy control subjects, with no significant age range and no significant difference in their education level. MAIN OUTCOME MEASURES: Amplitudes and latencies of long-latency auditory evoked potentials for the N100, P200, N200, and P300 waves were measured in the "odd-ball paradigm." Mental status was assessed by the Similarities subtest of the Wechsler Adult Intelligence Scale and by the Rapid Evaluation of Cognitive Function that allows for a mini-neuropsychological testing. The degree of disability was scored on the ALS Severity Scale, which rates bulbar and spinal functions. RESULTS: The latencies of the N100 and P200 waves did not appear to differ between normal and affected subjects; in contrast, the N200 and P300 latencies were significantly longer in the group with ALS. Sixty percent of the patients had a P300 latency more than 2 SDs above the theoretical norm that was established by the linear curve for control subjects. The N100, P200, N200, and P300 amplitudes showed no significant difference between the control subjects and the group of patients with ALS. There was no significant correlation between the N200 and P300 latencies and the disease duration or between the N200 and P300 latencies and the degree of motor impairment. The scores from the Rapid Evaluation of Cognitive Function were significantly lower in the group of patients with ALS than in the group of control subjects. CONCLUSIONS: A subtle cortical cognitive dysfunction is frequently observed in patients with ALS. These findings point also in the same direction as did previous neuropsychological, histological, and positron emission tomographic studies of ALS. Limb motor deficits and speech difficulties make it difficult to study the time course of changes in intellectual function in patients with ALS by using psychometric methods; thus, in the future, cognitive evoked potentials should constitute a fruitful method of testing cognitive function in patients with ALS to follow up their development over time.

Aged↗
PubMed1995

Habitual snoring as a risk factor for brain infarction.

The association of habitual snoring with cerebral ischaemia was studied, in a case control-study, in 133 patients aged 45-75 years (103 men and 30 women) and 133 controls matched for sex and age. Ischaemic stroke was confirmed by brain computed tomography or magnetic resonance imaging. History of risk factors, especially of snoring and sleeping habits was recorded with structured questionnaire during interview. Prevalence of habitual snoring significantly differs between patients with stroke and controls: 31/133 (23.3%) vs 11/133 (8.3%) (Odds ratio 3.4, 95% confidence interval 1.5 to 7.6, p < 0.001). Even after adjusting for matching variables and confounding risk factors (arterial hypertension, cardiac arrhythmia, and obesity), habitual snoring carries a significant risk factor for stroke (odds ratio: 2.9, 95% confidence interval 1.3 to 6.8 (p = 0.01)). The risk of ischaemic stroke was higher among older male patients with arterial hypertension who always snored. Habitual snoring was not significantly linked with sleep-related stroke nor with the pathophysiology of strokes. Inquiring about habitual snoring should become a routine practice, especially among older male patients with arterial hypertension, and specific preventive measures should be instituted at an earlier stage.

Adult↗
PubMed1995

[Differences in efficiency of continuous positive pressure respiration on the diurnal somnolence of patients with sleep apnea/hypoapnea syndrome].

Diurnal hypersomnia was studied in sixteen patients suffering from the sleep apnoea/hypopnoea syndrome (SHAS) Group I, and seventeen snorers Group II. The groups were studied in their basal state then after 51 +/- 14 days of continuous positive pressure (CPP) in Group I with the aid of clinical scores and of multiple latency tests of sleeping episodes (TLME). The patients in Group I presented with increased and pathological diurnal somnolence (TLME = 3.9 +/- 2.45 min) associated with disturbances of oxygen saturation during the course of sleep (a significant reduction of the mean SaO2) and of the pattern of sleep (significant reduction in light slow sleep at the expense of deep slow sleep, with a significant increase in the index of brief arousals). We have found a positive correlation between the initial TLME and the mean SaO2 during the course of sleep (p < 0.05; R = 0.51) without any correlation with other polysomnographic parameters. At the time of the final assessment, the improvement in TLME in the patients of Group I was significant (p < 0.001). However, in a sub-group of patients (BR: n = 7) the TLME were returned to normal using CPP (16.4 +/- 2.21 min) while those in patients in the second sub-group (MR: n = 9) the TLME remained below ten minutes on CPP (6.18 +/- 1.88 min). In the BR subgroup which presented with the most elevated mean initial TLME levels the amplitude of the rise of TLME between the two groups was significantly larger. No initial polysomnographic difference existed between the two sub-groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Arousal↗
PubMed1995

[Anosognosic graphomimia: an uncommon variety of hypergraphia in right sylvian infarction].

Following a massive infarction in the territory of the right sylvian artery, a right-handed patient with a left hemiplegia and anosognosia, developed a peculiar hypergraphia. It consisted of an inappropriate and permanent writing behaviour, disappearing only during sleep. Space-constructional components of writing were severely disturbed. Graphemes were poorly formed. The graphic disturbances were different from hypergraphia previously described in stroke patients who produced linguistically correct but semantically loose writing. They were also different from graphomania reported in a case of fronto-callosal glioma. Our case of anosognosic hypergraphia suggests a sudden loss of inhibition of writing activity of the left hemisphere. The term graphomimia is proposed to distinguish this writing behaviour from the cases of hypergraphia previously reported and from graphomania.

Aged↗
PubMed1994

Auditory brain-stem responses (ABRs) in sleep respiratory disorders.

Neurophysiological repercussions of sleep respiratory disorders (SRDs) are still unclear. It has been shown that SRDs induce disturbance on auditory event-related potentials with a delayed latency of the cognitive P300 potentials. Since the Auditory Brainstem Responses (ABRs) explore the auditory brainstem structures and are independent on cognition, we evaluated the neurological impact of SDRs on central nervous system by ABRs in these patients. Four groups of patients were studied: snorers (S, 17 subjects), sleep apnoea syndrome (SAS, 48 subjects), apnoeic patients with respiratory insufficiency (SAI, 17 patients) and patients with respiratory insufficiency alone (RI, 12 subjects). A standard polysomnographic study was done in each patient with further quantitative analysis of sleep, respiratory events, and oxygen arterial saturation. ABRs were recorded before the study night and interpeak latencies (IPLs) between waves I, III and V were measured. Results were expressed as the mean of each group for all the different parameters. ABR IPL latencies (IPLI-III, IPLIII-V, IPLI-V) of the four groups were within the normal range. However, comparing groups between themselves, there were significant differences (ANOVA) between groups. Longer IPLIII-V and IPLI-V (which explored the central conduction time) were observed in group SAI compared to group SAS. No evidence on the origin of this elongation was found; the level of hypoxia, in particular, was not related to IPL values. These results show that SAS alone do not affect lower brainstem auditory function, in contrast to the association of SAS and RI.

Adult↗
PubMed1994

Predictive factors of long-term compliance with nasal continuous positive airway pressure treatment in sleep apnea syndrome.

The long-term acceptability of treatment with nasal continuous positive airway pressure (CPAP) was studied prospectively in 44 patients with obstructive sleep apnea syndrome. At 14 months on the average after starting treatment with CPAP, 30 patients (68 percent) were found to be compliant (characterized by use of the apparatus every night throughout the night, for more than 5 h per night). The daily use of nasal CPAP was significantly correlated to the initial apnea/hypopnea index (p = 0.013; r = 0.37), as well as to the percentage of light sleep (p = 0.045; r = 0.30) and slow-wave sleep (p = 0.037; r = -0.31) during the initial polygraphic recording. We found a strong correlation between the daily use of nasal CPAP and the difference in the apnea/hypopnea index (p = 0.025; r = -0.34), the difference in mean oxygen saturation during sleep (p = 0.013; r = 0.38), and the difference in hypersomnia scores (p = 0.006; r = -0.40) obtained before and after treatment by nasal CPAP. Thus, patients used CPAP much more if they had an initial significant clinical handicap and if they were aware of the beneficial effects of CPAP. Under these conditions, patients tended to use the apparatus for the optimal length of time, regardless of the side effects linked to the treatment. This ensured efficacy and the maintenance of good compliance. This study confirms the importance of supervision of the time counter, as well as regular encouragement of patients to use the treatment as long as possible each night, in order to extract a maximum benefit from treatment by nasal CPAP.

Adult↗