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Biomedical subjects

M Hermier

Publications and source records attributed to M Hermier.

At least 55 records · Page 3Linked to original sources
PubMed2001

MRI of acute post-ischemic cerebral hemorrhage in stroke patients: diagnosis with T2*-weighted gradient-echo sequences.

The use of T2*-weighted sequences has been advocated for early differentiation between hematoma and ischemia in patients with acute stroke. Early hemorrhagic transformation of ischemic stroke is an adverse event which may occur under treatment and may impair the prognosis: our aim is to evaluate the ability of T2*-weighted gradient-echo sequence (T2* GRE) to detect post-ischemic cerebral hemorrhage. The imaging procedure included: (1) baseline CT scan at admission. (2) MRI performed within 24 h of therapy onset including: (a) dual fast spin echo T2 sequence, (b) axial isotropic echoplanar diffusion-weighted imaging sequence, (c) conventional T2* GRE, and (d) 3D TOF turbo MRA. Post-ischemic cerebral hemorrhage was diagnosed if T2* GRE detected a focal intraparenchymal area of signal loss. The diameter of this lesion had to be more than 5 mm in order to eliminate past microbleeds. (3) Patients who showed an early suspicion of bleeding on MRI promptly had a second CT scan, and, if this one was negative for bleeding, another CT scan was performed 1 day later. All the other patients had a control CT scan during the first week. Forty-five consecutive patients have been included. T2* GRE showed intracranial bleeding in seven. The diagnosis of post-ischemic cerebral bleeding was confirmed by CT in all patients. Control CT scans did not reveal any post-ischemic cerebral hemorrhage in patients with negative MRI. In one case, hemorrhage was seen earlier on MRI than on CT scan. In conclusion, T2* GRE appeared to be at least as efficient as CT scan in the detection of early post-ischemic cerebral hemorrhage.

Acute Disease↗
PubMed2001

Early diagnosis of hemorrhagic transformation: diffusion/perfusion-weighted MRI versus CT scan.

UNLABELLED: Standard magnetic resonance imaging (MRI) techniques failed to image adequately acute hemorrhagic transformation (HT). Therefore, computed tomography (CT) is still needed to exclude intracerebral hemorrhage. New MRI techniques such as diffusion- and perfusion-weighted imaging (DWI and PWI) may improve the early detection of HT. The utility of this approach requires a direct comparison of the sensitivity of CT with these MRI techniques. METHODS: Nine patients experienced an acute carotid artery territory ischemic stroke diagnosed on a first CT performed 3.8 +/- 2 h after the onset of stroke. They underwent a second CT 12 +/- 4 h after the onset of stroke, followed 35 +/- 10 min later by an MRI protocol including: (1) an axial isotropic DWI SE echo-planar imaging (EPI) sequence; (2) time of flight MR angiography (TOF MRA); (3) PWI with an axial T(2)*-weighted gradient echo EPI sequence using 20 ml gadolinium contrast agent (Gd-DTPA); HT was characterized on DWI SE EPI as a heterogeneous area of signal loss within the ischemic area; (4) at day 7, CT was also performed in all patients who had an early suspicion of bleeding according to MRI. RESULTS: An HT was detected exclusively with CT in 1 out of 9 patients, while an MRI pattern of HT was found in 6 out of 9 patients. In 5 of these 6 patients, the CT scan did not show an obvious pattern of HT. Day 7 CT confirmed HT in all patients who had early suspicion of bleeding according to DWI criteria. CONCLUSION: This study suggests that new MRI techniques may allow an early detection of HT, thus improving the management of stroke.

Adult↗
PubMed2001

[Helical CT and diagnostic evaluation of cranio-facial fibrous dysplasia].

PURPOSE: To evaluate the role of helical CT in the evaluation of skull abnormalities seen in fibrous dysplasia. MATERIALS AND METHODS: Prospective study on 6 cases with cranio-facial fibrous dysplasia (3 males and 3 females) aged 8 to 59 years old, evaluated with plain radiographs, helical CT and, in 1 case, MRI. Helical CT was performed in 3 cases on a CT Twin scan (Elscint), in 3 cases on a Somatom Plus scan (Siemens). Multiplanar reconstructions and 3D reconstructions were done in all cases. 4 cases had a histopathological confirmation of fibrous dysplasia lesions by bone-biopsy (3 cases) or surgical biopsy (1 case). RESULTS: The 6 cases included sclerotic form in 3 cases, cystic variety in 1 case, polyostotic variety in 1 case, mixed form in 1 case. Topographic localizations of fibrous dysplasia were skull base involvement in 1 case, multizonal skull involvement in 4 cases, maxillo-mandibulary involvement (cherubism) in 1 case. CONCLUSION: Helical CT is an optimal method to evaluate the skull lesions of fibrous dysplasia. The review of source images must always be done. 3-dimensional bone reconstructions are better to visualize the anterior cranial vault and skull base dysmorphy. Helical acquisition is a compromise in case by case between the dose of irradiation and the quality of source images.

Adolescent↗
PubMed2000

Intravenous tPA in acute ischemic stroke related to internal carotid artery dissection.

The authors describe the outcomes in 11 patients who had acute ischemic stroke related to internal carotid artery (ICA) dissection and were treated with IV tissue plasminogen activator (tPA). One symptomatic intracerebral hemorrhage occurred 36 hours after tPA was given. The mean day 90 modified Rankin Scale (m-RS) score was 2.4 (+/-1.6). No death was observed at 3 months. Four patients of 11 (36.4%) made an excellent recovery (day 90 m-RS score: 0 to 1). This study demonstrates the feasibility of IV thrombolysis with tPA (0.8 mg/kg) in ischemic stroke related to ICA dissection within the first 7 hours.

Adult↗
PubMed2000

Radiologic anatomy of the spinal dorsal horn at the cervical level (anatomic-MRI correlations).

The spinal dorsal horn is known for its important functional role in the field of transmission and modulation of sensory afferents. Because of this, the dorsal horn represents a target for numerous analgesic and antispastic procedures. Thus, it would be interesting to develop imaging dedicated to this spinal structure. The purpose of this study was to investigate the radiologic anatomy of the cervical dorsal horn by magnetic resonance imaging (MRI) (1.5T). The first step consisted in the validation of the anatomic information provided by MRI on 5 human cadavers. A spin-echo sequence (T2, 2000/45) enabled the demonstration of good correlations between histologic sections and axial MRI slices performed at the corresponding cervical levels. The second step was the < > exploration of 20 subjects, aiming at the development of a gradient echo sequence (T2*) with a conventional MRI unit, compatible with a routine clinical examination. The dorsal horn was clearly identified in 77% of the axial slices performed (n = 300). The angle between the dorsal horn axis and the sagittal plane was measured as from 25.5 degrees at C2 to 40 degrees at C8 segments. The results of this anatomico-radiologic study of the cervical dorsal horn suggest that preoperative MRI could be useful to design the surgical approach to this structure, as performed during cervical microsurgical drezotomy (DREZ = dorsal root entry zone) for the treatment of selected cases of chronic pain or disabling spasticity in the upper limbs.

Aged↗
PubMed2000

The first case of new variant Creutzfeldt-Jakob disease in France: clinical data and neuropathological findings.

Clinical data and autopsy findings in a case of new variant Creutzfeldt-Jakob disease (vCJD) are reported. This case, the first histologically confirmed case described outside the United Kingdom, very much resembles the cases described by Will et al. [(1996) Lancet 347:921-925] and Zeidler et al. [(1997) Lancet 350:903-908, 908-910]. Neuropathological studies failed to reveal any conspicuous clues that could be relevant for understanding the pathophysiology of the disease. For epidemiological surveillance, neuropathologists should scrutinize suspected cases keeping in mind the possibility of vCJD.

Adult↗
PubMed2000

Membranous nephropathy and orbital malignant tumor.

A 7-year-old girl with membranous nephropathy is reported who suffered 16 months later from an orbital rhabdomyosarcoma. Proteinuria disappeared at the time of the remission of the tumor. Membranous nephropathy as paraneoplastic syndrome is exceptional in children, since only two other cases associated with a solid tumor have been reported in the literature.

Child↗
PubMed2000

[Spiral CT evaluation of the craniosynostoses].

Craniosynostoses are defined as the premature closure of one or more sutures of the cranial bones. The resulting craniofacial deformities may be associated with neurologic complications owing to the disproportion between the growing brain and the limited content of the intracranial cavity. Plain skull radiographs are often contributive to the diagnosis. However, they may not be sufficient to detect early cases and to properly evaluate the more complex cases. Computed tomography has been proved to be more efficient in the pretherapeutic evaluation. The authors present here their results in the spiral computed tomographic evaluation of primary and syndromic craniosynostosis, based on a prospective series of 26 patients. The radiologic findings are presented. They have been found here to be similar to those previously described on sequential acquisitions. Spiral computed tomography was found to provide better information than did plain radiographs in 5 cases. The value of the helical acquisition as well as tridimensional reconstructions are discussed.

Child, Preschool↗
PubMed1999

Chronic intestinal pseudoobstruction syndrome: clinical analysis, outcome, and prognosis in 105 children. French-Speaking Group of Pediatric Gastroenterology.

Our aim was to collect a large number of cases to characterize clinical presentation, outcome, and prognosis of chronic intestinal pseusoobstruction in children. We conducted a retrospective multicenter study that included children treated for chronic intestinal pseusoobstruction defined as recurrent episodes of intestinal obstruction with no mechanical obstruction, excluding Hirschsprung's disease. In all, 105 children, 57 boys and 48 girls, were studied, including five familial forms. Prenatal diagnosis was made in 18 patients. Eighty patients were less than 12 months old at onset; the disease began at birth for 37 patients. The most frequent signs were abdominal distension, vomiting, and constipation. Megacystis was noted in myopathies (7 cases), neuropathies (10 cases) and unclassified forms (13 cases). For all but three cases (two patients with CMV infection, one with Munchhausen-by-proxy syndrome), the associated diseases and disorders could not account for chronic intestinal pseusoobstruction as a secondary disorder. At least one full-thickness biopsy from the digestive tract was studied for 99 patients. The diagnosis recorded was visceral neuropathy in 58 cases, visceral myopathy in 17 cases, and uncertain or normal biopsy results in 24 cases. Seventy-eight children were fed intravenously, and only 18 were able to be fed orally throughout their illness. Seventy-one patients underwent surgery during their illness, and 217 surgical procedures, a mean of 3 per patient, were performed. Ostomy was the most performed procedure. Follow-up continued in 89 patients for 3 months to 16 years (mean 85 months). Forty-two patients were still fed by parenteral (39 patients) or enteral nutrition (3 patients) at the time of the study. Eleven patients died between the age of 1 month and 14 years 7 months.

Age of Onset↗
PubMed1999

[Fetal anophthalmos. Problem of the prenatal diagnosis: a case report].

We report a case of anophthalmia discovered after birth and discuss the need to resolve diagnostic difficulties and determine prognosis. This is an exceptional malformation which is particularly difficult to manage. It often occurs in the context of a complex malformation syndrome. Recent imaging techniques including magnetic resonance imaging help determine the degree of malformation and provide useful information for giving genetic advice to parents.

Abortion, Induced↗
PubMed1997

[Hypersensitivity to 5-aminosalicylic acid. Value of desensitization by oral route].

BACKGROUND: Treatment with sulphasalazine of patients with mild and moderate forms of Crohn's disease may result in side effects in some of them. CASE REPORT: An 11-year-old girl with Crohn's disease was given 40 mg/kd/day of sulphasalazine after achieving remission with prednisone. She developed urticaria and eosionophilia 8 days later, then extended skin edema during a second course of sulphasalazine requiring methyl prednisolone therapy. Mesalazine administration (25 mg/kg/day), one month later, resulted to watery stools, vomiting, and fever, a side effect observed again after two further mesalazine challenges of one-month interval. Eosionophilia was present and the lymphocyte stimulation test with mesalazine was positive. Successful desensitization to sulphasalazine could be obtained 9 months later permitting further safe administration of this drug up to 18 months. CONCLUSION: Hypersensitivity to sulphasalazine may be successfully overcame by oral desensitization, especially in those patients with low-grade activity of Crohn's disease.

Administration, Oral↗
PubMed1997

Auditory cortex activation in deaf subjects during cochlear electrical stimulation. Evaluation by functional magnetic resonance imaging.

RATIONALE AND OBJECTIVES: The authors detect activation in the auditory cortex during cochlear electrical stimulation in deaf patients using functional magnetic resonance (MR) imaging. METHODS: Stimulating electrode was inserted gently under local anesthesia close to the round window membrane of the cochlea in seven cochlear implant candidates. These patients suffered from postlingual-acquired deafness. Four patients were stimulated above the electrical perception threshold and three below the electrical discomfort threshold. Functional scans (fast low-angle shot 91 mseconds/60 mseconds) were acquired in an oblique axial plane running parallel to the sylvian fissure. Four consecutive series of six images were obtained in 6 minutes. The acquisition time of each image was 15 seconds. RESULTS: During electrical cochlear stimulation below the discomfort threshold, the three patients described "auditory" sensations with activation of the superior temporal regions. In two patients with electrical stimulation of the left ear, the maximum signal intensity increased by 8.42% in the right auditory cortex and 5.69% in the left. In one patient with a right electrical stimulation only the left cortex was activated. Electrical cochlear stimulation above the perception threshold induces no significant activation in the auditory cortex. CONCLUSION: Functioning MR imaging can detect activation in the auditory cortex during cochlear electrical stimulation in deaf patients using a conventional 1.5-tesla system in a routine hospital environment. Further studies are needed to investigate its usefulness in clinical practice.

Adult↗
PubMed1997

[MRI in the study of multiple sclerosis].

Magnetic resonance imaging (MRI) has provided considerable insight into the pathological process and disease activity and progression in multiple sclerosis. MRI has become an important tool for the diagnosis of multiple sclerosis, and increasingly for monitoring treatment trial. The growing use of MRI calls for careful consideration in applications so that the technology is not misused. Here we propose a summary of the literature on MRI in application in clinical neurology.

Humans↗