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M Goulon

Publications and source records attributed to M Goulon.

At least 37 records · Page 2Linked to original sources
PubMed1988

The clinical spectrum of alcoholic pellagra encephalopathy. A retrospective analysis of 22 cases studied pathologically.

A retrospective clinical study of 22 heavy alcohol drinkers is reported in which postmortem study showed diffuse chromatolysis of neurons identical to that found in neurological pellagra, associated in 13 cases with Marchiafava-Bignami disease and/or Wernicke-Korsakoff disease. The clinical features included confusion and/or clouding of consciousness, marked oppositional hypertonus ('gegenhalten') and myoclonus. Because of the frequent coexistence of other alcoholic encephalopathies in the same patient, alcoholic pellagra was often unrecognized. Fifteen patients received thiamine and pyridoxine therapy without niacin. It appeared to aggravate the neurological state or to trigger the development of alcoholic pellagra encephalopathy in 9 cases. The relationship between pellagra occurring during thiamine and pyridoxine therapy and 'nicotinic acid deficiency' is discussed. Multiple vitamin therapy should be given in the treatment of undiagnosed encephalopathies in alcoholic patients.

Adult↗
PubMed1988

[Anoxic encephalopathy after cardiocirculatory insufficiency. Neuropathological study apropos of 16 cases].

Sixteen cases of anoxic encephalopathy in adult patients admitted to the intensive Care Department of Raymond Poincaré Hospital (Garches) have been selected on the following criteria: resuscitation by external cardiac massage for cardio-respiratory failure, without any previous history of anoxia and with detailed data on the subsequent evolution of neurological signs and symptoms. Main clinical features were compared to the results of the neuropathological examination. The pattern and the distribution of changes are detailed. The cerebral cortex was always involved by diffuse ischemic cell changes or by laminar necrosis. The Sommer's sector of Ammon's horn was affected in 15 cases, the basal ganglia in 14, the cerebellum in 11, the brain stem in 6. The very rarely mentionned necrotic brain stem changes, which involved inferior colliculi, periaqueductal gray matter and substantia nigra were sometimes associated with lesions of the floor of the IVth Ventricle and of the mamillary bodies. They were different from Wernicke's encephalopathy with could be dismissed on clinical and pathological grounds. No clinical signs or symptoms specific for this distribution of changes could be found by the retrospective study of the clinical files.

Adolescent↗
PubMed1988

[Neuropathologic study of 15 cases of multinucleated giant cell encephalitis in acquired immunodeficiency syndrome (AIDS)].

The central nervous system (CNS) of 40 patients who died of acquired immune deficiency syndrome (AIDS) between August 1982 and August 1987 was examined. In 15 cases, multinucleated giant cells (MGC) characteristic of Human Immunodeficiency Virus (HIV) infection were observed. In 3 cases ultrastructural examination disclosed HIV-like viral particles in the cytoplasm of some MGC. All cases with MGC showed, in addition, predominant white matter lesion: diffuse myelin pallor, multiple small, usually subcortical, necrotic foci, vacuolar myelopathy, proliferation of rod-shade microglia and microglial nodules, reactive astrocytosis, mineralization of the vessel walls. These changes, typical of HIV encephalitis, were isolated in 3 cases. In the other cases, they were associated with other AIDS-related CNS lesions, i.e., cerebral toxoplasmosis (9 cases), cytomegalovirus infection (5 cases), progressive multifocal leukoencephalitis (1 case), cryptococcosis (1 case) and cerebral lymphoma (1 case). The involvement of MGC with these lesions was remarkable.

Acquired Immunodeficiency Syndrome↗
PubMed1986

[Surgically treated syphilitic gumma of the brain. Computerized tomography findings].

Syphilitic gumma is now exceptional. Symptomatology is non-specific and frequently, as in the case reported here, the onset is marked by a localized or generalized convulsion. A space-occupying lesion is recognized by angiography and CT. The precise diagnosis is suggested by evidence of arteritis or of a hypodense mass outlined by contrast or slight calcifications and confirmed by positive serology in a patient with a suspected cerebral tumor. In some cases a positive diagnosis can be made only by pathological examination after surgical ablation of the gumma. An area of central necrosis is surrounded by a granulomatous layer rich in plasmocytes (the polyclonal nature of the secretion is shown by immunocytochemistry) and a peripheral fibroblastic zone. The arteries are ensheathed by a dense inflammatory infiltrate constituted almost entirely by plasmocytes and their lumens are either stenosed or filled with endarteritic debris. Surgical treatment should be combined with penicillin administration. For a patient in good general condition with a suspected gumma, medical treatment can be given initially, with follow-up by CT, neurosurgery being indicated only in case of failure of medical therapy. The rarity of gummata in relation to other tertiary syphilitic lesions remains unexplained. The patient reported here had multiple infections including one due to cytomegalovirus after ablation of the gumma, highly suggesting an immunity disorder.

Adult↗
PubMed1986

[The Landry-Guillain-Barré syndrome. Study of prognostic factors in 223 cases].

A retrospective study of 223 patients (111 men, 112 women, mean age 40.6 years) with the Landry-Guillain-Barre syndrome investigated vital or functional prognostic factors. Patients were first seen between 1963 and 1981, when 192 were noted to have cranial nerve disorders. Assisted ventilation was required in 152 cases, and 23 patients died, including 5 from cardiocirculatory dysautonomy. Plasma exchange was not used. Patients were divided into 3 groups as a function of the degree of maximum paralysis: group 1 (n = 63) patients had incomplete quadriplegia without assisted ventilation, group 2 (n = 93) incomplete quadriplegia with assisted ventilation, group 3 (n = 62) quadriplegia with or without assisted ventilation. Vital prognosis was related to the severity of neurologic disorders. Frequency of intercurrent complications, dysautonomic disorders and mortality increased with maximal severity of motor deficit. The 3 groups did not differ as a function of previous history, mode of onset of polyradiculoneuritis, duration of extension phase of paralysis, or CSF protein content at the first examination during the extension phase of the paralyses. It is therefore impossible at an early stage of the disease to predict future motor deficit. The cumulative percentage of patients who recovered a normal muscular force in limbs and cranial territories was 48 p. 100 after one year and 60 p. 100 after two years (actuarial values). The functional prognosis depends upon the degree of motor deficit at maximum paralysis and duration of the plateau phase. Probability of full muscular strength recovery was lower in group 3 and in those patients with a plateau phase duration longer than 2 weeks. Independently of groups, motility recovery rate was markedly higher in patients with a plateau phase duration of less than one week. Motility recuperation was independent of age, sex, duration of extension phase, CSF protein levels during the acute phase, and presence of autonomic nervous system disorders.

Adolescent↗
PubMed1986

Postmortem studies on posthypoxic and post-methyl bromide intoxication: case reports.

In two cases of action myoclonus following hypoxic or shock encephalopathy, neuropathological examination disclosed mild or moderate scattered changes involving thalamus, griseum centrale mesencephali, and nucleus centralis superior. Other areas were affected only in one of these cases (striatum, nucleus subthalamicus or hippocampus, nuclei pontis, and cerebellar cortex). In another case (an alcoholic patient), the changes, which involved only corpus mamillare and thalamus, were those of Wernicke-Korsakoff encephalopathy. In one case of oscillatory myoclonus following septic shock, there were marked cerebellar changes involving deep nuclei and mild abnormalities in the thalamus and inferior olive. The last case of action myoclonus following acute methyl bromide intoxication was characterized by marked changes in the inferior colliculi and moderate or mild abnormalities of thalamus, griseum centrale mesencephali, nucleus centralis superior, nucleus reticularis tegmenti pontis, nuclei pontis, and dentatus. The findings are compared with the data of seven previously reported neuropathological examinations in action myoclonus following hypoxic encephalopathy.

Adult↗
PubMed1985

[Status epilepticus in the adult. Epidemiologic and clinical study in an intensive care unit].

The present study, conducted between January 1975 and June 1983, includes 282 adult patients admitted for status epilepticus (SE) in 2 intensive care units (3.5% of all admissions). In their great majority, i.e., 201, patients had no previous history of epilepsy, and initiated the SE during the course of recent affections such as brain or systemic diseases. In 81 patients with previous seizure, epilepsy was idiopathic in 20, and symptomatic in 61, the 3 main causes being cranial traumatism, cerebrovascular accident and chronic alcoholism. SE was of various causes. The most frequent were cerebro-vascular disease, post-anoxic encephalopathy, intoxication, bacterial or viral meningo-encephalitis. In some patients, SE was preceded by manifestations such as convulsions, behavorial disturbances or conscience impairment. One should be aware of these facts and undertake or increase an anticonvulsivant medication at their onset. Duration of SE, when clearly established, was highly variable but had no apparent correlation to sequelae or death occurrences. SE itself was directly related to death in only 2 cases; in all other instances death was the consequence of the primary disease. These results are consistent with previous reports: presently SE occurs more frequently in the course of other affections than in prior epileptic patients. The better vital prognosis of SE is due to the simultaneous conjunction of new anticonvulsivant medication and supportive care associated with the cure of the causative disease.

Adolescent↗
PubMed1985

[Treatment of status epilepticus in the adult. Retrospective analysis of 192 cases treated in intensive care units].

The results of therapy have been analyzed in a series of 192 patients admitted for status epilepticus over 7 years in two intensive care units. Most (142 cases without any prior epilepsy) corresponded to secondary forms. In 2/3 of the cases, the patients were admitted because of failure of benzodiazepines and/or phenobarbitone. Sodium thiopentone achieved control of seizures in 75%; short-acting barbiturates should be especially prescribed in grand mal status with impending brain anoxia. Diphenylhydantoin would appear suitable in non-life-threatening conditions such as serial seizures or partial status. Chlormethiazole often succeeds in controlling convulsive status which has proved refractory to other treatment. Supportive management is mandatory: 52% of patients required respiratory assistance. Fatalities (36%) exclusively correspond to the underlying cerebral conditions and systemic disorders.

Adult↗