Bilateral loss of vision in bright light.
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Biomedical subjects
Publications and source records attributed to M Giroud.
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The authors have evaluated the indications, method and results of utilising sphenoidal electrodes in epilepsy. This method makes it possible to study the hippocampal area which cannot be studied by extra-cranial electrodes. It also localizes in the temporal lobe complex seizures without investigation by an electroencephalogram, or with a non-specific electroencephalographic picture. Thus, sphenoidal electrodes enable temporal seizures to be identified and localized, leading to more specific neuroradiological exploration, and therefore to the selection of patients for specific surgery.
In an investigation of 15 patients with Duchenne muscular dystrophy, the authors found mental retardation in all cases. In addition, CT scan showed a cortical atrophy after the age of 10 years. This finding suggests that a cerebral degenerative process is present in cases of Duchenne muscular dystrophy.
We report 33 cases of intracerebral hemorrhage (ICH) in patients aged from to 9/44 years (male: 20, female: 13, mean age: 32.5 years). ICH was due to vascular malformations in 39 p. 100 of cases, to arterial hypertension in 30% and to various causes in 18% no cause could be found in 13% of the cases. ICH was lobar in 64%, deep in 33% and infratentorial in 3% of the cases. The diagnosis was assessed by arteriography in 9 patients. The vascular malformations were arterial angiomas, saccular aneurysms and cavernous angiomas. Death rate was 24%. There was a fast ICH handicap in 40% of cases. Only 36% of the patients were not disabled.
We describe a new case in which cocaine use was related to stroke and review the literature. Cocaine is increasingly used by drug addicts. The neurological complications are unpredictable. They include generalized or partial epileptic seizures, ischaemic or haemorrhagic cerebral vascular accident. In this case, stroke after intravenous drug injection is associated with rupture of an intra-cranial aneurysm. We put the accent on the difficulties to diagnose the cerebral stroke in cocaine abusers.
The authors report 10 cases of newborns with neonatal hypoxic encephalopathy and presence of spikes in the vertex area on EEG. Evolution was characterized by the onset of a spastic paraparesy with frontal atrophy on CT scan examination and disappearance of the spikes after 2 months of age. This graphic pattern is usually absent in neonatal anoxic encephalopathy. Vertex spikes thus appear to have a prognostic value in neonates with brain anoxia.
Since 1985, cases of acute vascular cerebral diseases observed among the inhabitants of the city of Dijon have been systematically recorded: 88 cerebral haemorrhages were reported from 1985 to 1988. Twenty-five variables have been defined from antecedents, clinical and para-clinical data. Seven variables, were statistically associated with death at the end of the first month: age, severity of neurological palsy, meningeal syndrome, coma or comatose state, hyperglycemia and mass effect on CAT-scan. Using a step-down variable selection procedure, two prognostic factors were found: loss of consciousness and advanced age.
In a consecutive series of 984 first-ever strokes (from 1985 to 1989) in a population based study, 165 (16.7%) had lacunar infarction confirmed by CT-scan or M.R.I. The annual incidence was 35.6/100,000 in women, and 47.8/100,000 in men. Survival rates were 90% at 1 month, and 78% at 2 years. The rate of recurrent strokes was 11% at 2 years. The natural history of lacunar infarction could be drawn in this study which was population-based; 29% of lacunar infarctions are indeed not managed in hospitals. Lacunar infarctions should be identified as such in therapeutic trials since their course is clearly different from other types of strokes.
Three cases of multiple sclerosis, characterized by disorders of superior functions such as memory loss, either isolated (1 case) or as part of a frontal syndrome (2 cases) are reported. The importance of these disorders, often presenting as the main symptoms, their good prognosis and their rarity in adulthood are underlined. From a pathophysiologic point of view, the authors discuss the role of the frontal, near the limbic area, localization of the plaques.
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The authors have evaluated the indications, methods and results of sphenoidal electrodes in epilepsy. This method makes it possible to study the hippocampal area which cannot be studied by extracranial electrodes. It also localizes in a temporal lobe complex seizures without electrical events, or complex seizures giving bilateral temporal spikes or a fronto-temporal focus of spikes. It may even show evidence of temporal focus in cases with bilateral and synchronous spikes. Thus, sphenoidal electrodes enable temporal seizures to be identified and localized, leading to more specific neuroradiological explorations and therefore helping in the selection of patients for specific surgery.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The authors report a patient with Miller-Fisher syndrome in whom MRI of the brain stem showed increased signal density on T2 sequence anterior to the fourth ventricle, on the right and the left. The authors discuss the relation between these MRI abnormalities and some clinical features of the syndrome. The authors believe that the cardinal features of Miller-Fisher syndrome are due to peripheral nervous system dysfunction, but that this does not preclude a possible central nervous system involvement.
The authors report a case of a 15-month-old infant who presented a left hemiballismus associated with left Marcus-Gunn pupil, and retrobulbar optic neuritis, which disappeared spontaneously in 7 days. Six weeks later, the infant experienced a mild paraparesis with a palsy of the left sixth cranial nerve, which disappeared following steroid therapy. Evoked visual potentials elicited abnormal latencies; cerebrospinal fluid (CSF) showed a rise in white cells and oligoclonal bands. According to the usual classification, this case corresponds to definite multiple sclerosis. The fact that hemiballismus was the initial clinical feature in an infant makes this observation very interesting. In the literature, eight cases of hemiballismus in patients with multiple sclerosis are reported; however, only two cases of multiple sclerosis in infancy have been published, making our case report of particular interest.
EEG features in acute necrotizing encephalitis show periodic activity, localized in the temporal area with a slow background activity. Nevertheless, this periodic activity is transient and may lack. Sphenoidal electrodes study of the internal face of the temporal lobe could record such activity in herpes encephalitis. Sphenoidal electrodes were inserted in 4 patients known to have herpes encephalitis. In 2 cases, periodic discharges were observed both on the surface and sphenoidal electrodes, while in 2 cases, periodic discharge was observed under only sphenoidal electrodes. Faced with uncertain diagnosis of herpes encephalitis, it may be useful to insert sphenoidal electrodes to record deep periodic discharges, not seen on surface electrodes, in order to confirm the diagnosis.
We report 3 cases of epilepsy with bilateral occipital calcifications followed up for several years. These cases were compared with 21 published cases and were found to differ from the classical Sturge-Weber syndrome on several points: 1) the disease appeared around the age of 5 years and consisted of focal epilepsy without neurological or mental disorders; 2) the epilepsy was easy to control during 2 to 5 years. This was followed by a diffuse encephalopathy with severe, treatment-resistant epilepsy, Gerstmann's syndrome, optic ataxia, cerebellar syndrome and slow activity at EEG. It appears from these 3 cases that: 1) occipital calcifications may be unilateral at the onset of the disease; 2) visual evoked potentials are affected at a late stage, and 3) CT scans are of considerable value in the prognosis of benign epilepsy in childhood.
Five cases of infarction in the territory of the middle cerebral artery (MCA) are reported. The main feature common to these 5 cases was the presence at CT without contrast injection, in the first 24 hours, of a spontaneous hyperdensity of the ipsilateral MCA. In one case, angiography demonstrated that this hyperdensity was associated with occlusion. In 2 other cases, doppler examination showed occlusion of the internal carotid artery. The transient character of these radiological findings is underlined. In the acute phase of an infarction, hyperdensity of the MCA at an early CT scan without contrast injection suggests an occlusive mechanism and massive infarction with poor clinical outcome.