[Idiopathic and recurrent stupor: efficacy of flumazenil].
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Aged↗
Biomedical subjects
M Giroud
Publications and source records attributed to M Giroud.
Reduced brain N-acetyl-aspartate in frontal lobes suggests neuronal loss in patients with amyotrophic lateral sclerosis.
We performed proton magnetic resonance spectroscopy (1H-MRS) in three patients with amyotrophic lateral sclerosis (ALS) to evaluate the distribution and extent of cortical neuronal damage as demonstrated by decreased N-acetyl-aspartate (NAA) levels. We examined primary motor (precentral gyrus) and parietal neocortical (superior parietal gyrus) regions. ALS was defined with lower and upper motor neuron signs. Compared with matched healthy controls, ALS patients had a significant decrease in NAA levels in the primary motor cortex (p < 0.001) compared with parietal regions and homologous regions in healthy controls. Two clinical applications can be extracted: first, the upper motor neuron signs present in the ALS, come from a neuronal loss within the primary motor cortex and may explain the frontal syndrome associated with ALS. Second clinical applications of 1H-MRS could include identification of extent of upper motor neuron involvement, aiding diagnosis of syndromes presenting with an ALS-like syndrome.
Aged↗
Asymmetric metabolic profile in mesial temporal lobes: localized H-1 MR spectroscopy in healthy right-handed and non-right-handed subjects.
PURPOSE: To determine a possible asymmetric metabolic profile in right- handed and non-right-handed healthy subjects by comparing proton spectra from temporal lobes. MATERIALS AND METHODS: Twenty-eight healthy adults (17 right-handers, 11 non-right-handers) underwent magnetic resonance (MR) imaging and single-voxel MR spectroscopy. N-acetylaspartate (NAA), choline (Cho), and creatine (Cr) peak areas were measured. RESULTS: Volume of hippocampal formations was larger on the right in right-handers (right volume: 4.04 cm3 +/- 0.67 vs left volume: 3.84 cm3 +/- 0.62; P = .00004) and in non-right-handers (right volume: 4.22 cm3 +/- 0.78 vs left volume: 4.05 cm3 +/- 0.80; P = .004). NAA/Cho was significantly higher in the left temporal lobe of right-handers (right lobe: 1.53 +/- 0.18 vs left lobe: 1.89 +/- 0.18; P=.00004) as was NAA/Cr (right lobe: 1.79 +/- 0.36 vs left lobe: 2.45 +/- 0.45; P=.0001). No statistically significant difference was noted for these ratios in non-right-handers: NAA/Cho (right lobe: 1.49 +/- 0.18 vs left lobe: 1.61 +/- 0.35) and NAA/Cr (right lobe: 1.93 +/- 0.45 vs left lobe: 2.40 +/- 0.70). CONCLUSION: A clear metabolic asymmetry observed in right-handers is less clear-cut in non-right-handers. Both tendencies should be considered when assessing the brain metabolism of patients with uni- or bilateral disorders, such as temporal lobe epilepsy.
Adult↗
[Management of stroke. The value of the Dijon Stroke Registry].
Since 1985, the Stroke Registry of Dijon has performed a prospective, specific and exhaustive collection of stroke episodes occurring in patients living in the city of Dijon. The first aim of such a register is descriptive epidemiology to determine the natural history of strokes which would be impossible without this methodology. This procedure can also be used as a tool for research and evaluation. Therefore, over the past 9 years the Stroke Registry of Dijon has observed a 15% decrease of the incidence of cerebral haemorrhage, due to early diagnosis and treatment of arterial hypertension. Inversely, the incidence of cerebral infarct increased 8.5% during the same period due to the increased frequency of cardiac emboli. Mortality decreased in the same period from 22% to 15%, due to active treatments during the acute stage and to a decrease of the early severity of stroke at admission to hospital. The severity of the handicap decreased dramatically during the same period. Several case-control studies have shown the negative role of hyperglycaemia and cardiac arrhythmia on mortality in the acute stage of strokes. The role of dyslipidaemia has been evaluated in the aetiology of the different mechanisms of stroke, demonstrating the role of hypocholesterolaemia in the genesis of cerebral haemorrhage. Some interventions performed by the Registry in the population of the city of Dijon have shown that early diagnosis and treatment of transient ischemic attacks with anticoagulants may decrease the occurrence of cerebral infarction. Then, the evaluation of access to health care permitted to observe that the choice between public hospitals, private hospitals and home was dependent on age, troubles of consciousness, and severity of the neurological deficit. Therefore, the Stroke Registry of Dijon participates in improving our knowledge of the natural history of strokes, and to the evaluation of diagnostic and therapeutic strategies.
Adult↗
Late thalamic atrophy in infarction of the middle cerebral artery territory in neonates. A prospective clinical and radiological study in four children.
We report four cases of progressive thalamic atrophy following ipsilateral cerebral infarction in the territory of the middle cerebral artery in neonates, with prospective radiological and clinical follow-up. This type of atrophy appears within 6 months after the onset of cerebral infarction. In the short term, this atrophy has no action on sensory and memory function and/or on sensory evoked potentials. This atrophy is not the result of secondary ischemic neuronal damage. Judging from several other experimental studies, thalamic atrophy may primarily result from retrograde degeneration. It would be interesting to observe the consequences of this atrophy on sensory and memory function over a long period.
Cerebral Arteries↗
Cerebrovascular disease in children under 16 years of age in the city of Dijon, France: a study of incidence and clinical features from 1985 to 1993.
Our motivation for undertaking the present survey was to determine the incidence, the distribution, and the clinical features of ischemic and hemorrhagic strokes in children under 16 years old, in a well-defined population-based study. The survey was carried out on the population of the City of Dijon (150,000 inhibitants) from January 1, 1985 to December 31, 1993, collecting prospectively both in adulthood and in childhood (23,877 resident children). Diagnosis of stroke was established on the basis of clinical features and the mechanism was identified by CT scan from 1985 to 1987, and by CT scan and magnetic resonance imaging from 1987 to 1993. When a hemorrhagic stroke was identified, a cerebral arteriogram and an investigation of the coagulation factors were performed. When an ischemic stroke was identified, the following were performed: an ultrasound examination of the cervical arteries, a cerebral arteriogram, a lumbar puncture, an investigation of the coagulation factors and lipid status, a measurement of homocysteine in the plasma and the urine, an electrocardiogram (EKG), a Holter procedure, and a cardiac echography. During the 9 full calendar years of this study we observed 28 stroke patients from a population of 23,877 resident children. There were 17 cases of ischemic stroke, representing some 61% percent of the total, as well as 11 cases of hemorrhagic stroke, 39% percent of the total. The average annual incidence rate was 13.02/100,000 for all strokes, 7.91/100,000 for ischemic strokes, and 5.11/100,000 for hemorrhagic strokes.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Role of associated cortical lesions in motor partial seizures and lenticulostriate infarcts.
In a population-based study, we evaluated seizures occurring in the first 15 days after strokes among 1,640 consecutive patients who had ischemic (814 infarcts with atheroma and 126 with cardiogenic embolism, 273 lacunar infarcts, 259 transient ischemic attacks) or hemorrhagic stroke (129 supratentorial hematomas and 24 subarachnoïd hemorrhage) on computed tomography (CT) scan. Ninety patients had an epileptic seizure in the first 15 days after stroke onset. Thirteen of the 90 had a lenticulostriate infarct, diagnosed on CT scan, without an apparent ipsilateral cortical ischemic lesion. No lenticulostriate hematoma was observed with seizures. To determine the possible existence of an ipsilateral cortical lesion, magnetic resonance imaging (MRI) with gadolinium perfusion, and HMPAO single photon emission CT (SPECT) were performed in the 13 patients with seizures. MRI showed an associated ipsilateral posterofrontal or anterotemporal cortical ischemic lesion in 11 cases, and SPECT showed decreased blood flow in the ipsilateral frontal area in all cases (superficial sylvian territory). Overall, 56 patients had a lenticulostriate infarct and clinical, CT, and MRI data from the 13 with seizures was compared with those of the 43 without seizures. Two criteria differentiated the two groups: the size of the lenticulostriate infarct was larger (8.3 vs. 3.9 cm3) and ipsilateral cortical ischemic lesions were more frequent in the group with seizures (84 vs. 9%).
Aged↗
Clinical and topographical range of callosal infarction: a clinical and radiological correlation study.
A prospective clinical and radiological correlation study was performed to determine the frequency, and the clinical and radiological features of callosal infarction. From 1 January 1993 to the end of December 1993 282 cases of cerebral infarction seen in the Neurology service of the University Hospital of Dijon were studied prospectively. Eight cases with callosal ischaemic lesions were identified by CT and MRI. A callosal disconnection syndrome occurred in only five of eight patients, related to a single, large infarct or several infarctions in the anterior part of the corpus callosum. Clinical features were characterised by left ideomotor apraxia, construction apraxia, and left agraphia in all five cases. Alien hand was noted in only two cases. There were gait disorders in three cases with MRI features of multiple lacunes in a large part of the corpus callosum, and also the subcortical areas of both hemispheres. It is emphasised that callosal infarctions are not rare and that they contribute to the clinical features of strokes. As well as the classic incomplete callosal disconnection syndrome, these callosal ischaemic lesions may induce non-specific gait disorders.
Aged↗
Risk factors for primary cerebral hemorrhage: a population-based study--the Stroke Registry of Dijon.
Risk factors for primary cerebral hemorrhage remain uncertain. The population-based Stroke Registry of Dijon provides data on the risk factors. Among residents of Dijon (France), 130 cases of primary cerebral hemorrhage hospitalized from 1985 to 1992 were matched with 130 controls by age and sex. The following data were collected: history of hypertension, alcohol consumption, tobacco consumption, history of coagulation disorder, diabetes mellitus, dyslipidemia, and infectious disease in the 7 days before admission. The following parameters were measured on admission: blood pressure, blood glucose, cholesterol, triglycerides, hematocrit, fibrinogen, prothrombin levels, platelet counts, prothrombin time, bilirubin, transaminases, gamma-glutamyltransferase, and alkaline phosphatase. Electrocardiogram and Doppler ultrasound examination of cervical arteries were performed. Statistical analysis was performed by means of relative risk ratio for paired samples when dealing with proportions, and Student's t test for quantitative variables. A stepwise discriminant analysis was carried out to establish the relative weight of the different risk factors and their discriminant values. Among the qualitative data, the significant factors were history of hypertension, alcohol consumption, cardiac arrhythmia, atherosclerosis of carotid arteries and a previous infectious disease in the 7 days before admission. Among the quantitative data, the significant factors were early hypertension, high blood glucose levels, high hematocrit, and low cholesterol levels, in the acute stage of the stroke. After multifactorial analysis, only two factors were significant: hypertension and low cholesterol levels. Our population-based case-control study showed that hypertension and low cholesterol levels are the two discriminant risk factors for both lobar and basal ganglia primary cerebral hemorrhage. Therefore, treatment of hypercholesterolemia may increase risk of cerebral hemorrhage.
Adult↗
[Value of gadolinium magnetic resonance imaging of the lumbosacral roots in acute polyradiculoneuritis].
Four patients with acute inflammatory polyradiculoneuropathy were evaluated with MRI. In 3 of 4 cases, gadolinium enhancement was observed in the nerve roots of cauda equina, on frontal and horizontal slices. This enhancement was correlated with the severity of the clinical picture and the cerebrospinal-fluid inflammatory protein concentration and supports the inflammatory nature of this forms of acute polyradiculoneuropathy.
Acute Disease↗
[Cortico-basal degeneration: a new entity].
Cortico-basal degeneration is a progressive disease comprisong characteristic features concerning both cortical and basal ganglionic dysfunction. Manifestations include akineto-rigid syndrome and apraxia strictly limited at disease onset to one hemibody, especially the left. Myoclonus, chorea a alien limb syndrome can begin within the clinicalcome. Functional exploration of the brain shows an asymmetric hypometabolism affecting both cortical and basal structures. Neuropathologic studies show pathological features including neuronal loss, gliosis and neuronal achromasia affecting the cortex (frontal and parietal), basal ganglia and locus niger. Further evaluation of this disease is needed to understand its links with the other neurological degenerative diseases especially progressive aphasia and Pick's disease.
Atrophy↗
[Effect of smoking in cerebral vascular accidents].
Until recently, the effect of smoking as a risk factor in cerebral vascular events had not been analyzed carefully and no causal relationship had been identified. This could appear paradoxical since it has been well established that smoking plays a role in the pathogenesis of ischaemic cardiopathies and peripheral angiopathies. Indeed, several population studies have demonstrated that smoking plays a role in meningeal haemorrhage, but in other types of cerebral vascular events, biases related to the heterogeneous character of the involved mechanisms could explain the lack of any identifiable relationship. The most recent hospital series both in Europe and in North America based on case-control studies have however demonstrated that tobacco smoking is a vascular risk factor for most types of cerebral vascular events. Increased risk has been estimated between 1.7 and 5.7. While smoking habits in Western countries have declined, these findings emphasize the importance of the tendency towards an increased rate of cigarette smoking in third-world countries. In addition, from a public health standpoint, smoking is an extremely interesting aetiological factor since it is theoretically controllable.
Arteriosclerosis↗
Decrease in cerebellar blood flow in patients with Friedreich's ataxia: A TC-HMPAO SPECT study of three cases.
Three cases of Friedreich's ataxia were submitted to diverse neuroradiological procedures in order to determine the extent of atrophic processes in the central nervous system. All patients underwent computerized-tomography scan, Magnetic Resonance Imaging, and HMPA-single Photon emission computerized tomography studies, focusing in cerebellar lobes. A slight atrophy was observed in the vermis and the cerebellar lobes with CT scan and MRI. In contrast a significant decrease in cerebellar blood flow was shown by TC-HMPAE SPECT study. The significance of these findings in understanding physiopathological mechanisms in Friedreich's ataxia is discussed.
Adult↗
Preliminary observations of metabolic characterization of bilateral temporal epileptic focus, using proton magnetic resonance spectroscopy. Three cases.
The authors report the case of 3 patients with bilateral temporal lobe epilepsy demonstrated by EEG and sphenoïdal electrodes. Two out of the 3 patients presented with childhood febrile convulsions. Their neurological and mental examination was normal. EEG showed spikes within the anterior part of the 2 temporal lobes. CT scan and MRI showed no atrophic lesion within the 2 temporal lobes. Proton magnetic resonance spectroscopy, performed within a cube of 8 cube-centimetres localized in the anterior part of the 2 temporal lobes showed a significant decrease of N-acetyl-aspartate in the 2 temporal lobes of the 3 cases, compared with controls matched with age, sex and laterality. Because N-acetyl-aspartate is a marker of the neuronal cells, the decreased level of NAA in the temporal area with spikes, may be related to a decreased number of neuronal cells, developing an abnormal tendency to seizures.
Adolescent↗
Incidence of internal carotid artery dissection in the community of Dijon.
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Adult↗
Homolateral ataxia and crural paresis: a crossed cerebral-cerebellar diaschisis.
A patient developed weakness of the right leg and homolateral ataxia of the arm, caused by a subcortical infarct in the area supplied by the anterior cerebral artery in the left paracentral region, demonstrated by CT and MRI. Cerebral blood flow studied by technetium-labelled hexamethyl-propylene-amine oxime using single photon emission computed tomography showed decreased blood flow in the left lateral frontal cortex and in the right cerebellar hemisphere ("crossed cerebral-cerebellar diaschisis"). The homolateral ataxia of the arm may be caused by decreased function of the right cerebellar hemisphere, because of a lesion of the corticopontine-cerebellar tracts, whereas crural hemiparesis is caused by a lesion of the upper part of the corona radiata.
Aged↗
[Prevalence and prognostic value of transient ischemic complication preceding cerebral infarction].
To evaluate the prevalence, the aetiological profile and the neurological consequences at day 15 of a transient ischaemic attack (TIA) before a cerebral infarction, we undertook survey from 1985 to 1991, on 1,149 cases with cerebral infarction observed on the population of Dijon. On 1,149 cases, 275 (24%) were preceded by a TIA. Fifty seven cases were lacunar infarcts (20.7%) and 218 were cortical infarcts (79.3%). On the aetiological point of view, the group with 275 infarctions preceded by a TIA was statistically different from the group of 874 infarctions without any TIA, with higher blood pressure, cardiac arrhythmia, tobacco abuse and ischaemic cardiac disease history. Only 65 out of 275 infarctions preceded by one TIA (23.6%) had a perfect territorial relationship between the 2 attacks, and 210 out of 275 (76.4%) had no territorial relationship. While the Barthel score at day 15 was similar within the 2 groups, inversely, pseudo-bulbar syndrome was significantly more frequent in the first group. Former TIA does not increase the general handicap resulting from a cerebral infarct, nevertheless it gives rise to a pseudo-bulbar syndrome.
Aged↗
[Primary meningeal gliomatosis].
A 44 year old woman presented with chronic meningitis. Magnetic resonance imagery showed a diffuse contrast enhancement of the leptomeninges. Cerebrospinal fluid studies showed a high hyperproteinorachia and light pleiocytosis. A left temporal tumor appeared four months later. Histological studies revealed an anaplastic oligosatrocytoma leading to the diagnosis of primary leptomeningeal gliomatosis.
Adult↗