After studying 85 patients with severe traumatic coma and reviewing the published literature, the authors propose a simple clinical procedure for the diagnostic of such cases. This classification is based on signs without any ambiguity, easily recognized by different physicians, and of pathognomonic significance. These include reaction to pain, testing four reflexes integrated at different levels in the brain stem, pupil morphology, and spontaneous ocular movements. The clinical features corresponding to different levels of dysfunction in the brain are described and their characteristics outlined. The importance of motor reactivity to pain associated to the brain stem reflexes (fronto-orbicular, photomotor, horizontal and vertical oculo-encephalic) is stressed.

Brain Stem↗

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[EEG and clinical study of 107 patients with acute severe traumatic comas (author's transl)].

The authors describe the EEG recordings of 107 patients with acute severe cranial trauma and signs of axial lesions. The initial EEG included: sleep patterns, alternating tracings, alpha band tracings which were either nonreactive pseudo-alpha or modulated alpha often reactive, and diffuse slow wave tracings. They found no particular tracing corresponding to a precise level of rostrocaudal destructuration, but some associations were seen more frequently. EEG sleep patterns and alternating tracings were never observed in brain stem lesions, the activity recorded being of low voltage, rigid, and non-reactive. The presence of spontaneous fluctuations (with sleep rhythms in some cases) and reactivity in other levels (mesodiencephalic junction, diencephalic and cortical-subcortical) are good prognostic signs. Focalised EEG signs are seen especially in the more rostral levels.

Brain Injuries↗

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[Recurring intracranial meningioma with metastase to the lung. A clinicopathological report with electron microscopic study and review of literature (author's transl)].

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Adult↗

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[Intracranial arachnoid cysts in children. Apropos of 8 cases].

Eight cases of intracranial arachnoid cysts are reported. They are benign congenital lesions who result from an abnormal development of the earliest arachnoid. A subsequent development is possible. The macrocephaly is the first sign and other symptoms give evidence to the localization. Thanks to the C.T. scan one can make the diagnosis, appraise the repercussion and put the therapeutic indications. The surgical treatment is reserved to symptomatic forms. The peritoneal shunt takes the ablation's place. This method is easier and less liable to complications. The results depend on the localization, the pattern of operation and the precocity of the diagnosis.

Adolescent↗

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