Search PubMed⌕ Search

Biomedical subjects

M G Bousser

Publications and source records attributed to M G Bousser.

At least 325 records · Page 18Linked to original sources
PubMedDate not supplied

Spontaneous dissecting aneurysms of the internal carotid and vertebral arteries--two case reports.

Two patients had acute spontaneous dissection of both internal carotid arteries and of one or both vertebral arteries. One had angiographic signs suggestive of fibro-muscular dysplasia and both were on oral contraceptives. They were treated with high dose heparin and made a good clinical recovery. A digital intravenous angiography performed two to three months later showed a complete recanalization of arteries involved. These patients are similar to those reported as "idiopathic regressing arteriopathy" and "reversible angiopathy" which probably correspond to the same entity.

Acute Disease↗
PubMedDate not supplied

Cerebral venous thrombosis--a review of 38 cases.

A series of 38 patients with angiographically proven cerebral venous thrombosis (CVT) affecting dural sinuses is reported. This study shows that CVT is not rare, that the clinical diagnosis is extremely difficult because of the variable modes of onset and groupings of symptoms, that most CT findings are non specific and that angiography remains the best diagnostic tool. Only 4 patients died, which suggests a more benign outcome than classically described. None of the 23 heparin treated patients died, which indicates that anticoagulants were not harmful in this series.

Adult↗
PubMedDate not supplied

Effects of extra-intracranial arterial bypass on cerebral blood flow and oxygen metabolism in humans.

Twelve patients, eleven with a carotid obstruction and one with an occlusion of the middle cerebral artery, were studied before and after a successful unilateral extra-intracranial arterial by-pass, (EIAB) using PET and the 15-0 steady-state technique to measure regional cerebral blood flow (CBF), oxygen extraction fraction and oxygen metabolic rate (CMRO2). In the whole group of patients, both CBF and CMRO2 increased significantly on both cerebral hemispheres after EIAB, returning toward control levels defined in age-matched subjects. Mean oxygen extraction fraction, on the other hand, was not affected. Individually, three different effects of EIAB emerged: 1) Alleviation of a state of long standing unilateral "misery-perfusion", as reported earlier; 2) parallel increase of CBF and CMRO2 bilaterally, which appeared due to improvement of a hemodynamic depression of metabolism, the precise mechanism of which remains obscure; 3) Complex, unexpected changes in the CBF-CMRO2 couple again resulting in increases in CMRO2. This metabolic improvement afforded by EIAB in our patients has not been reported before; it suggests that long-standing hemodynamic failure may induce a metabolic depression that is still potentially reversible by surgical revascularization.

Adult↗
PubMedDate not supplied

Stroke, migraine and intracranial aneurysm: a case report.

A man had since childhood recurrent attacks typical of ophthalmic migraine. After an otherwise unremarkable attack, he was left with a permanent quadrantanopsia due to a right occipital infarct. The remarkable pattern of progression, which characterized the visual phenomenon of subsequent attacks, favours a primary neuronal phenomenon. The first angiography revealed an occlusion of the posterior cerebral artery (PCA) but the second one, performed two years later, disclosed a PCA aneurysm. Such a finding emphasizes the need of thorough and repeated evaluations of patients with so-called "migrainous infarcts."

Adult↗
PubMedDate not supplied

Duplex scanning of normal vertebral arteries.

Vertebral arteries were studied by Duplex scanning in 50 normal subjects. Pretransverse and C6-C5, C5-C4 intertransverse segments were visualized in all cases on both sides; segment C4-C3 was visualized in 100% of the cases on the right side and in 90% on the left; ostium was obtained in 94% of the cases on the right and in 60% on the left. The left vertebral artery was dominant in 48% of the cases while the right vertebral artery was dominant in 14%. Three vertebral arteries were hypoplasic. Duplex scanning was thus found to be an easily performed noninvasive method to study morphological and hemodynamic characteristics of vertebral arteries from their origin to the C4-C3 level.

Adolescent↗
PubMedDate not supplied

Extracranial vertebral artery dissections: a review of 13 cases.

Clinical and radiologic findings in 13 patients (11 women, 2 men) with extracranial vertebral artery dissection are reported. Dissection was spontaneous in 8 patients, occurred after neck manipulation in 2 and after a potential minor injury to the neck in 3. Six had a history of common migraine, 4 were using oral contraceptives at the time of dissection, and 3 had fibromuscular dysplasia. Dissection was bilateral in 8 patients and associated with carotid dissection in 3. It usually presented with neck or occipital pain preceding basilar ischemic symptoms by a few minutes to 1 month. In 3 patients, transient ischemic attacks were the only manifestation of basilar ischemia, and in 1 patient there was no symptom of basilar ischemia despite bilateral vertebral dissection. In 19 of the 21 dissected vertebral arteries, the angiographic appearance was that of an irregular stenosis, which was associated in 6 arteries with pseudoaneurysmal formation. In 2 patients, 1 vertebral artery was occluded but the contralateral artery showed the typical irregular stenosis. The dissection involved only the third segment in 33%, only the second segment in 24%, and 2 or more segments in 38%. Eleven patients were treated with anticoagulants and 2 with aspirin; 11 recovered without sequelae and 2 had residual deficit. No recurrence was observed (mean follow-up 34 months). At control angiography (n = 12) or ultrasonic study (n = 1), 63% of dissected vertebral arteries had returned to normal, 26% showed marked improvement, and 11% were occluded. Our patient characteristics are compared with those of previously published cases. The validity of the distinction between spontaneous dissection and dissection associated with minor trauma is discussed.

Adult↗
PubMedDate not supplied

[Anticoagulants and the prevention of deep venous thrombosis of the leg].

Because of its frequency, the risk of migration to the lungs, and the gravity of the sequelae, phlebitis requires prophylaxis even more than a curative treatment. The ideal prophylactic agent should have, on one hand, an efficacity equal or superior to that of existing therapeutic agents--heparin and antivitamin K--and, on the other hand, should be easy to administer, should not result in haemoragic complications, and should not necessitate complex laboratory tests, these last three conditions not being fulfilled by either heparin or by the antivitamins K. These disadvantages probably explain the present vogue for anti-aggregant substances. Nevertheless, the knowledge of the primordial role of stasis and the phenomena of coagulation, and not least the platelets, in the matter of venous thrombogenesis, and knowledge of the results of studies on experimental thrombosis and of the first clinical trials lead to the conclusion that it is dangerous, at least at the moment, to abandon therapy for the prevention of venous thrombosis the efficacity of which is certain (heparin), in favour of substances the efficacity of which only hypothetical(anti-aggregants).

Anticoagulants↗
PubMedDate not supplied

[2 rare neuro-ophthalmologic complications of long-term treatment with lithium salts].

We describe two patients with unusual neuro-ophthalmologic complications during long-term therapy with lithium carbonate given for bipolar affective disorder, "benign" intracranial hypertension in one, and downbeat nystagmus, with oscillopsia in the other. A review of the literature is proposed. Though rare, such neuro-ophthalmologic manifestations are worth being recognised since they usually disappear with cessation--when possible--of lithium therapy.

Adult↗
PubMedDate not supplied

Fate of the patient with chronic leg ischaemia. A review article.

Much has been published on the surgical treatment of leg ischaemia but relatively little is known about the incidence of claudication and the fate of the majority of patients presenting with chronic leg ischaemia who never come to surgery. A review of the available literature suggests the following conclusions: (1) about 1.5% of men under 49 and 5% of men over 50 will develop symptoms of intermittent claudication. The incidence of asymptomatic arterial disease is much higher; (2) the incidence of claudication in women is only slightly less, but the local disease follows a more benign course; (3) compared to the general population of comparable age the mortality of men presenting with chronic leg ischaemia is two to three times higher after 5 years; (4) about 50% of deaths will be due to myocardial ischaemia, 15% to stroke and 10% to vascular disease in the abdomen. In only 25% will the principal cause of death be unconnected with the circulation; (5) there is virtually no reliable information available at the moment on the incidence of non-fatal myocardial infarction or stroke in these patients.

Arteriosclerosis↗
PubMedDate not supplied

[Holter monitoring in patients with focal cerebral ischaemic attacks (author's transl)].

One hundred patients with focal cerebral ischaemic attacks of suspected embolic origin were investigated by Holter monitoring to determine whether paroxysmal arrhythmia may have been responsible for the episodes. There were 57 men and 43 women aged from 16 to 79 years (mean 50 years). Ninety-seven had residual focal neurological deficits and 3 had transient ischaemic attacks. The neurological lesions were verified by cerebral angiography in 68. Twenty-one had arterial hypertension and 9 had old myocardial infarction or angina. Nine had a history of palpitations. None had cardiac valve disease. All patients were in sinus rhythm, 4 had ventricular extrasystoles on routine ECG, and 4 had supraventricular extrasystoles. None of the patients were receiving anti-arrythmic drugs at the time of investigation. Holter monitoring was performed for 18 hours in 91 cases and for 24-54 hours in the remaining ones. The interval between the cerebral ischaemic attack and the monitoring was less than one month (mean 20 days) for 50 patients and longer for the others. Cardiac arrythmias were found in 36 patients. Sixteen had more than 10 supraventricular extrasystoles per hour, 13 had runs of 3 to 8 beats of supraventricular tachycardia, 1 had an episode of atrial fibrillation. Eighteen subjects had more than 5 ventricular extrasystoles per hour, 1 had accelerated ventricular rhythm, 2 had runs of 4 to 7 beats of ventricular tachycardia. Two patients had second degree A.V. block. None had palpitations during monitoring. Arrythmias were increasingly frequent with age. Our findings are similar to those obtained with monitoring in ambulatory asympatomatic subjects of the same age without apparent heart diseases reported by other authors. On the other hand, the frequency of arrythmia was unrelated to the time elapsed between the ischaemic attack and Holter monitoring. In conclusion, Holter monitoring performed several weeks after suspected cerebral embolism failed to reveal arrythmias likely to be responsible for a focal cerebral ischaemic attack.

Adolescent↗
PubMedDate not supplied

Comparison study of CT and positron emission tomographic data in recent cerebral infarction.

To better understand the pathophysiologic correlates of the computed tomographic (CT) scan changes seen in recent cerebral infarction, 17 patients (20 studies) underwent both x-ray transmission and positron emission CT investigations within 18 days after clinical onset of complicated ischemic stroke in the internal carotid artery territory. The density changes before and after contrast study measured within the CT lesion were correlated to the local cerebral blood flow (CBF), oxygen utilization (CMRO2), and oxygen extraction fraction (OEF) measured with the oxygen-15 steady-state positron technique. Statistically significant linear correlations were found between hypodensity and CBF, hypodensity and CMRO2, and contrast enhancement and CBF, such that the more CBF and CMRO2 were depressed, the more marked was the hypodensity; and the more CBF was elevated, the more marked was the contrast enhancement. Although marked contrast enhancement was associated with decreased OEF (luxury perfusion), it was only rarely associated with increased CBF. Various hypotheses are discussed to explain these findings.

Brain↗
PubMedDate not supplied

[Should asymptomatic carotid stenosis be operated on?].

Should asymptomatic carotid stenosis be operated on? The aim of the present editorial is to stress that there is no simple answer to this question. The only undisputed point is that mild non hemodynamic stenosis carry such a low risk of ipsilateral brain infarct that surgery is unjustified. For tight asymptomatic stenosis ( > or = 75% at angiography according to the European method of measurement, > or = 60% according to the American method), the indication of surgery should be discussed on a case by case basis. Four main factors should be taken into account: the spontaneous risk of ipsilateral brain infarct (2% per year for stenosis > or = 75%) the risk of surgery (which should be less than 3%); the patient's life expectancy, and his own will as regards a surgical operation. It is thus possible to evaluate for each patient, the pertinence of preventive surgery and the benefit/risk ratio of the operation in order to optimize the surgical decision.

Brain Ischemia↗