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Biomedical subjects

M G Bousser

Publications and source records attributed to M G Bousser.

At least 181 records · Page 10Linked to original sources
PubMed1992

[Pathology of cranial nerves: diagnostic orientation and aphorisms].

Despite the remarkable progress of Neuroradiology, the etiologic diagnosis of cranial nerve disorders remains, because of the numerous potential causes, one of the most difficult clinical problems in Neurology. It requires a perfect collaboration between neurologists, ophthalmologists, and ENT specialists, and also between clinicians and radiologists. First of all however, it is based on a rigorous clinical analysis in order to determine the site of the lesion and to guide complementary investigations. The purpose of this short paper is to provide a brief outline of this clinical approach and to recall some aphorisms which are essential to keep in mind when dealing with this pathology.

Cranial Nerve Diseases↗
PubMed1992

[Management of migraine].

When considering treatment for migraine patient, the physician should bear in mind how little is known about this remarkably complex and diverse condition with no miracle cure or single uniform method of treatment. Experience suggests that adherence to a number of principles based on a combination of common sense, modesty, and open-mindedness is essential to effective management of migraine. The patient needs to be both reassured and taken seriously, and should be told that the cause of migraine is unknown and that performing multiple investigations would be unhelpful. The difference between acute treatments and maintenance prophylactic treatments should be clearly explained. The patient should participate in therapeutic decisions such as whether or not to use prophylaxis and whether pharmacologic or nonpharmacologic treatment is most appropriate. Finally, and most importantly, both the physician and patient must be aware that much patience is needed but that this patience will usually be rewarded, not by complete resolution of the disease, but by an often dramatic improvement in the migraine patient's quality of life.

Adolescent↗
PubMed1992

[Beta-blockers and migraine].

Five beta-blocking agents are effective as long-term prophylactic treatment of migraine: propranolol, metoprolol, timolol, atenolol and nadolol. Propranolol has been most extensively studied and proved effective in 19 of 21 controlled trials. The optimal dose should be determined on a case-by-case basis, by increasing the daily dosage gradually. Among the properties of beta-blockers, the only one which appears to be correlated--albeit negatively--with effectiveness on migraine is intrinsic sympathomimetic activity (ISA): drugs without ISA are effective against migraine whereas partial agonists are not. The mode of action of beta-blockers in migraine is still poorly understood; one of the most cogent current hypotheses involves reduction of brain catecholaminergic hyperactivity.

Adrenergic beta-Antagonists↗
PubMed1992

[Methodology of clinical trials in migraine: a rating system].

Several problems confront trials of drugs for migraine: no clinical or biological markers for objective diagnosis are available, severity of the attack cannot be readily evaluated, the placebo effect is significant, and both compliance with therapy and patient follow-up may be difficult to ensure. No statistical method is capable of solving these problems and it is the clinicians' role to minimize them by consistent efforts at establishing good communication with their patients during the trial. Because of these significant intrinsic difficulties, trials of drugs for migraine require especially stringent data collection and analysis protocols in order to minimize the risk of errors which exist in any drug trial. The protocol used have not always been satisfactory with this respect. A rating system for helping non-specialists to evaluate the reliability of migraine drug trials is proposed.

Clinical Trials as Topic↗
PubMed1992

Cerebral venous thrombosis.

Neuroimagining facilities allow early recognition of cerebral venous thrombosis (CVT), which now appears far more common than previously assumed. The diagnosis remains difficult because of a wide spectrum of clinical presentation and a highly variable mode of onset. Numerous conditions (presently mostly noninfectious) can cause or predispose to CVT, which therefore requires an extensive etiologic work-up. The functional and vital prognosis is much better than classically thought with, in noninfectious CVT, a fatality rate of less than 10% and a complete recovery in over 70%. Although spontaneous recovery is possible, the efficacy of heparin is now well established.

Anticoagulants↗
PubMed1991

Paravermal infarct and isolated cerebellar dysarthria.

A patient with isolated cerebellar dysarthria is reported. Computed tomography showed a small infarct in the left paravermal zone of the rostal cerebellum (lobulus simplex and semilunaris superior) in the territory of the medial branch of the superior cerebellar artery. This patient demonstrates the important role of this area of cerebellum in the control of voice.

Aged↗
PubMed1991

Effectiveness of oral diclofenac in the acute treatment of common migraine attacks: a double-blind study versus placebo.

In a multicentre double-blind cross-over trial, oral diclofenac at a dose of 50 mg to 100 mg was compared to placebo in the acute treatment of migraine attacks. A hundred and seven patients suffering from migraine without aura were included, and 91 were analysed for efficacy; they had to treat four successive attacks--two with diclofenac and two with placebo. Diclofenac was significantly more effective than placebo (p less than 0.05) on the main judgement parameter, which was the number of attacks aborted within 2 h of drug intake, as well as on the following secondary parameters: the necessity for an escape medication and the evaluation of global efficacy. Diclofenac was well tolerated. This trial demonstrates the efficacy of diclofenac in the acute treatment of migraine attacks. It confirms the good clinical relevance of the main judgement parameter chosen, which is the one recommended by the International Headache Society, but appears to be a severe one in terms of successes.

Administration, Oral↗
PubMed1991

Autosomal dominant syndrome with strokelike episodes and leukoencephalopathy.

BACKGROUND AND PURPOSE: We conducted a prospective survey of a family presenting a new syndrome characterized mainly by recurrent strokelike episodes and neuroimaging evidence of leukoencephalopathy. SUMMARY OF REPORT: Forty-five members of a single family were studied clinically and with magnetic resonance imaging. Nine had strokelike episodes, including transient ischemic attacks, and minor or major strokes starting between the fourth and sixth decades, with neuroimaging evidence of small, deep infarcts and a widespread white matter disorder. Other symptoms included migraine (three), dementia (two), epilepsy (one), and hearing loss (one). In some patients, we found various immunologic anomalies and muscular lipidosis without ragged-red fibers. Eight other family members were clinically normal, but had identical neuroimaging signs of leukoencephalopathy. No abnormality was detected in the 28 other members of the family examined. Extensive investigations failed to reveal any known cause of cerebral ischemia. CONCLUSIONS: There appears to be a new syndrome in this family that is characterized by recurrent subcortical strokelike episodes, leukoencephalopathy, immunologic anomalies, muscular lipidosis, and an autosomal dominant pattern of transmission.

Adult↗
PubMed1991

Infarction in the anterior rostral cerebellum (the territory of the lateral branch of the superior cerebellar artery).

We report 9 patients with an isolated infarct of the anterior part of the rostral cerebellum, ie, the territory of the lateral branch of the superior cerebellar artery. Clinicoanatomic correlations are based on CT, MRI, or both in 8 patients and on pathologic data in the ninth. The main clinical features were ipsilateral dysmetria and axial lateropulsion, dysarthria, and unsteadiness. In 1 patient, the clinical presentation mimicked a lacunar stroke (dysarthria and clumsy hand syndrome). There were no edematous cerebellar infarcts with signs of brainstem compression, and all patients spontaneously improved without significant sequellae. Angiography in 2 patients and pathologic examination of arteries in 1 patient disclosed no occlusion in the vertebrobasilar system. Six patients had a cardiac source of emboli. In conclusion, infarcts of the anterior part of the rostral cerebellum can be regarded as a benign condition in which there is, frequently, a cardiac source of emboli.

Adult↗
PubMed1991

[Neurosarcoidosis].

Explore the source record for details and available documents.

Central Nervous System Diseases↗
PubMed1991

[Cerebral venous thrombosis. Report of 76 cases].

Progress in neuroimaging has led to a considerable change in our knowledge of cerebral venous thrombosis (CVT). Together with a series of 76 cases, a review of literature is presented. CVT is a far from negligible variety of stroke. It may occur at any age and despite numerous causes (nowadays mostly non infective), the proportion of cases of unknown aetiology remains around 25%. Superior sagittal sinus and lateral sinus are the most frequently involved, often associated with cortical vein thrombosis. Cavernous sinus thrombosis remains the most common form of septic thrombosis. Thrombosis of the galenic system and of cerebellar veins are uncommon. The clinical picture is extremely variable with a mixture of focal signs (deficits or seizures) and symptoms of raised intracranial pressure. The mode of onset is also variable, over hours, days, weeks or months. The presentation can thus be very misleading, simulating an arterial stroke or an abscess, an encephalitis, a tumor or a pseudo-tumor cerebri. CT scan is crucial to rule out other conditions and angiography to confirm the diagnosis of cerebral venous thrombosis. MRI is very performing since it visualizes the thrombus itself and allows a non invasive follow up. Most cases have a benign course but mortality is still around 30% in infective cases and 10% in non infective ones. Although it has long been debated, the benefit of anticoagulant (heparin) is now well established.

Cerebral Veins↗
PubMed1990

[Dissection of the extracranial internal carotid artery. 62 cases].

The results of a study of 62 patients with 69 dissections of the extracranial internal carotid artery are presented. Mean age at the time of diagnosis was 43 years, with a preponderance of men over women. The patients were followed up for a mean period of 41 months. In 6 cases regarded as being "traumatic" in origin, the outcome was similar to that of "spontaneous" dissection. The most significant associated factors seemed to be migraine (34 per cent), on-going treatment with oestrogens and progestogens (48 per cent of women) and fibromuscular dysplasia (21 per cent). The clinical features consisted of local signs (isolated in 8 cases), signs of ischaemia (isolated in 9 cases) or both together. There were 35 established cerebral vascular accidents and 2 cases of ischaemic optic neuritis with blindness, responsible for invalidating sequelae in 31 per cent of the patients. The most frequent local signs were suggestive hemicrania, cervical pain, Horner syndrome and tinnitus. The initial angiography showed occlusion in one quarter of the cases and stenosis in 70 per cent. Stenosis was usually located in the second infrapetrosal half of the artery and had the most favourable angiographic prognosis.

Adolescent↗
PubMed1990

[What is new in the treatment of migraine?].

No miracle treatment has occurred which would cure the migraineur, but treatments able to improve him are more numerous and better defined. Conditions are now achieved for significant progress in the field of migraine treatment: better knowledge of the pathophysiology progress in the field of migraine treatment: better knowledge of the pathophysiology of the attack, definition of diagnostic criteria unanimously accepted and of rigorous and specific methodologic rules for therapeutic trials in migraine, discovery of new drugs such as more and more specific agonists or antagonists of serotonin-receptors subtypes.

Administration, Cutaneous↗