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Biomedical subjects

L Riffaud

Publications and source records attributed to L Riffaud.

At least 19 recordsLinked to original sources
PubMed2005

Intracranial epidural haematomas in elderly patients: observations in 14 patients.

BACKGROUND: Up to now, extra-dural haematomas (EDH) in elderly patients have been known for their poor prognosis and few studies have focused on the particularity of EDH in the elderly. Most clinical studies relating to EDH have generally focused on its occurrence in children and the middle-aged, grouping people of over 50 and 60 years together as the elderly. The purpose of this paper is to present a series of EDH cases in the elderly. METHOD: 500 EDH patients (of all ages) were admitted to our Department from January 1990 to December 2003 and this is a retrospective study of 14 of those patients who were aged 70 years and over. FINDINGS: The study consists of 8 women and 6 men with an average age of 74 years. A high incidence of disease predisposes elderly to falls, which are the most frequent cause of head trauma. The elderly are less likely to manifest signs or symptoms of increased intracranial pressure due to cerebral atrophy, and almost all haematomas occurred in the parietal area. Post-operative results were satisfactory and only one death was recorded. CONCLUSION: This study shows that the elderly, presenting EDH after a fall, have a better prognosis than is often feared.

Accidental Falls↗
PubMed2005

MR imaging features of spinal schwannomas and meningiomas.

Spinal schwannomas and meningiomas are mostly benign, intra-dural extramedullary tumours. We retrospectively reviewed the Magnetic Resonance Imaging (MRI) examinations of 52 spinal schwannomas and meningiomas operated on at our institution since 1998. The series included 28 schwannomas and 24 meningiomas. We compared MRI features of schwannomas and meningiomas and evaluated statistical features that would allow differentiation. Tumours with extraspinal extension were excluded. Concerning the cranio-caudal distribution, half of the cervical tumours were schwannomas, 72% of thoracic lesions were meningiomas and all lumbar tumours were schwannomas. Meningiomas were significantly located at the upper and mid thoracic levels and schwannomas in the lumbar area. On T1-weighted images, MRI signal intensity and heterogeneity were not statistically different between meningiomas and schwannomas. On T2-weighted images, the signal intensity appeared significantly hyperintense and heterogeneous for schwannomas. After Gd-DTPA, we observed a significant difference between meningiomas and schwannomas, the enhancement being intense and heterogeneous in cases of schwannomas, and moderate and homogeneous in cases of meningiomas. The last significant qualitative item was the "dural tail sign", a dural enhancement or thickening near the tumour. It was found in only 16 cases of meningiomas. A simple diagnostic test was built for schwannomas by processing a multiple agreement analysis with the 6 significant items: cranio-caudal location, T2 signal intensity, T2 signal heterogeneity, Gd-DTPA enhancement intensity and heterogeneity, and the "dural tail sign". This test allowed diagnosis of schwannomas with a sensitivity of 96.4%, a specificity of 83.3%, a positive predictive value of 87.1%, and a negative predictive value of 95.7%. In conclusion, we consider that a diagnosis of schwannoma should be made when a spinal intradural extramedullary tumour shows hyperintensity on T2W images or intense enhancement without dural tail sign; otherwise meningioma is more probable.

Adult↗
PubMed2004

Results of spinal meningioma surgery in patients with severe preoperative neurological deficits.

Spinal meningiomas are usually benign, slow-growing tumours and are commonly associated with good patient outcome following surgery. However, the existence of a severe preoperative neurological deficit has been considered to be a possible predictor of poor functional outcome after surgery. We retrospectively reviewed data from 33 patients with 35 spinal meningiomas treated in our institution over the past 17 years and exhibiting severe preoperative deficits before surgery. Among them, 20 suffered from paraparesis and 13 were paraplegic. The mean follow-up duration was 70.7 months (range 12-183 months). By the 1-year follow-up, all patients had improved in comparison with their preoperative neurological status, and 60% of them had totally recovered. It can be concluded from this study, that, in the vast majority of cases, patients harbouring spinal meningioma with severe preoperative deficits can expect a good outcome.

Adolescent↗
PubMed2003

Nervous system lymphoid infiltration in Waldenström's macroglobulinemia. A case report.

Neurological complications may occur in the course of Waldenström's macroglobulinemia (Wm). These complications affect both the central and peripheral nervous system. Pathogenesis is debated and several mechanisms have been suggested. Direct malignant lymphoid infiltration (MLI) is very rare and has only been reported in a few cases. Case report. A 67-year-old woman suffered from Wm for 10 years before she presented neurological complications of the disease. She did not receive any specific treatment for Wm owing to a lack of symptoms. The neurological complications consisted of peripheral demyelinating polyneuropathy and MLI of the nervous system. This infiltration was located in the lower perimedullary and cauda equina roots regions, with possible centromedullary involvement. Indirect demonstration of MLI was achieved through non-invasive tests including magnetic resonance imaging and detailed cerebrospinal fluid examination. General and intrathecal chemotherapy led to clinical, biological and radiological improvement over a four-year period.

Acute Disease↗
PubMed2003

Model of surgical procedures for multimodal image-guided neurosurgery.

OBJECTIVE: Improvement of the planning stage of image-guided surgery requires a better anticipation of the surgical procedure and its anatomical and functional environment. This anticipation should be provided by acquisition of multimodal medical images of the patient and by a better understanding of surgical procedures. In this paper, we propose improvements to the planning and performance of multimodal image-guided neurosurgery through the use of information models related to neurosurgical procedures. MATERIALS AND METHODS: A new generic model of surgical procedures is introduced in the context of multimodal image-guided craniotomies. The basic principle of the model is to break down the surgical procedure into a sequence of steps defining the surgical script. In the model, a step is defined by an action. The model assigns to each surgical step a list of image entities extracted from multimodal preoperative images (i.e., anatomical and/or functional images) which are relevant to the performance of that particular step. A semantic validation of the model was performed by instantiating the model entities for 29 surgical procedures. RESULTS: The resulting generic model is described by a UML class diagram and a textual description. The validation showed the relevance of the model, confirming the main underlying assumptions. It also provided some leads to improve the model. CONCLUSION: While further validation is needed, the initial benefits of this approach can already be outlined. It should add real value to the different levels of image-guided surgery, from preprocessing to planning, as well as during surgery. Models of surgical procedures can manage image data according to the surgical script, which should lead to better anticipation of surgery through the development of simulation tools. Furthermore, the models may improve the performance of surgery using microscope-based neuronavigation systems by making it possible to adapt both visualization and interaction features of multimodal preoperative images according to the model.

Humans↗
PubMed2003

[Sinus cavernous syndrome caused by isolated aspergillosis of the sphenoid sinus].

Isolated aspergillosis of the sphenoid sinus is a rare condition that is frequently diagnosed at a late stage because of its nonspecific and varying symptomatology. We report the case of a 75-year-old diabetic woman with a long history of retroorbital pain before she developed a subacute cavernous sinus syndrome. Neuroimaging including CT scan and MRI suggested a malignant tumor involving the sphenoid sinus but the diagnosis of aspergillosis was made intraoperatively and by histopathological examination. Soon after surgical drainage of the sphenoid sinus and systemic anti-fungal drug therapy, both retroorbital pain and cavernous sinus syndrome had completely resolved. This case emphasizes the fact that invasive isolated sphenoid sinus aspergillosis must be considered in the list of lesions causing sinus cavernous syndrome.

Aged↗
PubMed2003

[Post-traumatic exophthalmos caused by a subperiosteal hematoma of the orbit].

We report a case of a 27-year-old man who developed major exophthalmos associated with ophthalmoplegia occurring 48 hours after head trauma. CT scan showed an orbital roof fracture and a subperiosteal hematoma. Surgical evacuation of the hematoma and reconstruction of the orbital roof was performed via a frontal craniotomy. Two months later, the ophthalmologic examination was normal. We stress the importance of early diagnosis and prompt surgical treatment in such an unusual complication of head trauma.

Adult↗
PubMed2003

[Systemic sarcoidosis revealed by acute ataxic sensory polyradiculoneuropathy].

We present the case of a 35-year-old man who developed bilateral uveitis and acute ataxic sensorial polyradiculoneuropathy with sphincter dysfunction. The patient had multiple mediastinal adenopathies. Pathology examination led to the diagnosis of sarcoidosis. The patient improved partially spontaneously and totally after oral corticosteroid therapy. This case illustrates an unusual presentation of acute polyradiculoneuritis which is usually a predominantly motor disorder in sarcoidosis. Sensorial and ataxic neuropathy is uncommon. The course is more chronic and progressive.

Adult↗
PubMed2002

[Forestier disease presenting as dysphagia].

INTRODUCTION: Forestier's disease is characterized by hyperostosis of the anterolateral margin of the vertebral bodies. Cervical spine involvement rarely leads to dysphagia. OBSERVATION: A 76 year-old man suffered from progressive dysphagia, feeling of suffocation and left cervical pain. Clinical examination was unremarkable but cervical spine radiographies revealed large anterior osteophytes creating pharyngeal encroachment. Computed tomography showed a "double vertebral body" aspect notably in C2 and C3, compressing ahead structures. Surgical procedure consisted in resection of the anterior osteophytes. Postoperative course was uneventful and all the symptoms resolved within a few weeks. DISCUSSION: Anterior cervical spine hyperostosis in Forestier's disease can lead to dysphagia by direct pharyngeal or esophageal compression and, later on, by muscular fibrosis of the pharyngoesophageal wall in severe cases. Surgery must take the place of medical treatment in severe dysphagias with a good radioclinical correlation, to improve functional prognosis.

Aged↗
PubMed2001

Acute nontraumatic spinal subdural hematomas in three patients.

STUDY DESIGN: The clinical data, magnetic resonance imaging, intraoperative findings, and functional outcome were reviewed for three patients under anticoagulant therapy who experienced acute nontraumatic spinal subdural hematoma. OBJECTIVES: To draw attention to this rare complication of anticoagulant therapy and to assess the magnetic resonance findings and clinical outcome of patients with spinal subdural hematoma after surgical evacuation. SUMMARY OF BACKGROUND DATA: Among intraspinal hematomas, spinal subdural hematomas are by far the least common. Magnetic resonance findings have been demonstrated in only a few cases of spinal subdural hematomas. The timing of the operation and the anatomic location of the hematoma essentially determine the functional outcome. METHODS: Three case reports of spinal subdural hematomas in patients receiving anticoagulant therapy are presented. Particular interest was given to the clinical and magnetic resonance data, the intraoperative findings, and the functional outcome. RESULTS: The three patients each had a complete preoperative neurologic deficit. Sagittal T1- and T2-weighted magnetic resonance images of the spine proved to have high sensitivity for defining the type of bleeding and delineating the craniocaudal extension of the hematoma. Surgical evacuation was performed within 26 hours after the onset of symptoms. Intraoperative findings showed the hematoma to be confined between the dura and the arachnoid in two patients, and to be associated with rupture into the subarachnoid space in one patient. Postoperative recovery was incomplete in two patients, and did not improve in the remaining patient. CONCLUSIONS: Spinal subdural hematoma must be considered in patients under anticoagulant therapy with spontaneous signs of acute spinal cord or cauda equina compression. Magnetic resonance imaging with sagittal T1- and T2-weighted images were adequate and reliable for diagnosis of spinal subdural hematoma. On the basis of previous studies and the authors' intraoperative findings, spinal subdural hematomas could be viewed as spinal dural border hematomas. The level of preoperative neurologic deficit seemed to be critical for recovery despite prompt surgical evacuation.

Acute Disease↗
PubMed2001

Primary isolated lymphoma of the fourth ventricle: case report.

The authors present the case of a 33-year-old woman presenting with a 4-week history of vertigo and headaches. Physical examination revealed an isolated static cerebellar syndrome. Magnetic resonance imaging showed a homogeneously enhancing tumor located in the fourth ventricle. Complete surgical removal was performed and microscopic examination revealed a high-grade B-cell lymphoma. Postoperative investigations confirmed it to be primary. Only one case of primary isolated lymphoma of the fourth ventricle has been briefly reported in the medical literature. The authors suggest that primary lymphoma must be considered in the list of fourth ventricle tumors.

Adult↗
PubMed2001

Supratentorial ependymoma in children.

The clinical and pathological characteristics of supratentorial ependymomas (STE) in children are not well identified in the literature, because most series deal with ependymomas regardless of their location or the age of the patient. As a result, the pathological description of the disorder is still debated. We therefore reviewed our cases of children operated for STE and compared them with cases of infratentorial ependymomas (ITE) to provide a better characterization of STE and suggest guidelines for treatment. From 1985 to 1999, we operated 18 children for STE, almost half of which developed with no connection to the ventricular system. Intraoperative bleeding and infiltration of the basal ganglia prevented total removal in 4 cases and were the main causes of operative mortality and morbidity. The 5-year overall survival and recurrence-free survival rates were 54 and 37%, respectively, and were highly affected by the extent of resection, but not by histological grade. Because of the high recurrence rate, we recommend systematic postoperative irradiation limited to the tumor site for all high-grade tumors in older children, and reoperation after subtotal removal and for recurrences.

Adolescent↗
PubMed2001

Intracerebral hemorrhage complicating cervical "hourglass" schwannoma removal. Case report.

The authors report a case of infra- and supratentorial intracerebral hemorrhage complicating the postoperative course of a patient who had undergone surgical removal of a cervical schwannoma with an hourglass configuration. To their knowledge, this is the first case in which this neurosurgical procedure was followed by such a complication. Possible mechanisms are discussed; however, pathological events leading to this complication are unclear. The development of new neurological deficits not attributable to the surgical procedure should suggest this possibility.

Adult↗
PubMed2001

[Extraosseous Ewing's sarcoma of the spinal epidural space].

Ewing's sarcoma is found exceptionally as a primary epidural tumor of the spine. Four cases of extraosseous Ewing's sarcoma of the spinal epidural space are presented. Another 17 cases were found in the pertinent literature and are discussed. There were 15 males and 6 females with mean age of 16 years (range, 4 to 30). Symptoms included back pain and/or radicular pain, paresis of one or more limbs, sensory disturbances, and bladder and bowel dysfunction. The mean diagnostic delay was 4,7 months. Each patient underwent surgery but complete resection of the tumor was obtained in only half of the cases. Most patients received radiation therapy and chemotherapy. Twelve patients died, 1 to 54 months (mean, 18) after diagnosis. Even though the number of patients was too small in this series for statistical analysis, partially resected tumors do appear to be associated with a higher mortality.

Adolescent↗