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Biomedical subjects

M Rivierez

Publications and source records attributed to M Rivierez.

31 records · Page 2Linked to original sources
PubMed1984

Prediction of cerebral vasospasm value of fibrinogen degradation products (FDP) in the cerebro-spinal fluid (CSF) for prediction of vasospasm following subarachnoid haemorrhage due to a ruptured aneurysm.

In a new treatment regimen with antifibrinolytic drugs in patients with aneurysmal subarachnoid haemorrhages, we have systematically controlled the level of fibrinogen degradation products (FDP) in the cerebrospinal fluid (CSF). The frequency of severe vasospasm with clinical ischaemia has been compared with the patient's initial level of FDP. Fifty patients have been included in this study. (All in Hunt and Hess's grades I or II on their arrival.) Patients with a secondary deterioration unrelated to vasospasm were excluded. The FDP levels were measured in the first three days following the bleeding and we were informed of them at the end of the study. The diagnosis of severe vasospasm was confirmed by arteriography and computed tomography (CT) and it was named "severe" when accompanied with signs of clinical ischaemia. Twenty patients developed a severe vasospasm with clinical ischaemia. In these patients, the mean value of the initial FDP level was between 80 and 320 mcg/ml compared with 20 to 80 mcg/ml for those who had not developed clinical ischaemia (p = 0.0009). Furthermore, two different groups may be discriminated by their initial FDP level: FDP greater than 80 mcg/ml; n = 23, 65% severe vasospasm; FDP less than 80 mcg/ml; n = 27.8% no severe vasospasm (p less than 0.001). These results do not imply a direct role of FDP in pathophysiological mechanisms of vasospasm, but they suggest a relationship between the clot lysis and the appearance of vasospasm with clinical ischaemia. To our knowledge this is the first time that such a predictive role can be attributed to the initial FDP level in the prognosis of vasospasm.

Female↗
PubMed1984

[Contribution of the electroencephalogram to the diagnosis of vasospasm after rupture of intracranial aneurysms].

This study concerns 74 patients with subarachnoid haemorrhage from ruptured supratentorial aneurysm--Serial electroencephalographic recordings (EEG) have been made with precise chronology. The first EEG (Day 1 or 2) had a prognostic value, good if it was normal, alarming if axial bursts or comatose patterns were recorded. Associated with CT scan and dosage of Fibrin degradation products in C.S.F. (F.D.P.), initial EEG gave a strong probability in predicting the occurrence of secondary ischemia. The second EEG, between Day 4 and Day 7, had a diagnostic value. When a vasospasm occurred, confirmed by further angiography, focal or unilateralized slow waves were recorded in more than 85% or these EEG. Further EEG gave the opportunity of controlling the evolution of ischemic electrical patterns.

Electroencephalography↗
PubMed1983

[Cerebellar hemorrhage. Clinico-topographic correlations and therapeutic indications].

Spontaneous cerebellar hemorrhages are more easily recognized since the large use of CT scanner. In this series of 28 cases, they represent 9% of all spontaneous intra-cranial hemorrhages. Three main categories may be described. Small hematomas (less than 3 cm) are located in the postero-medial part of the cerebellum (9 cases): they are difficult to recognize, due to their limited clinical signs; their evolution is spontaneously favorable. Larger hematomas (more than 3 cm) represent two thirds of our clinical cases. When situated near the midline (7 cases) stupor or coma are quite constant, as neurovegetative signs; differentiating this type of case from brain-stem hemorrhages is difficult; prognosis is severe as even with surgery; there is a high mortality rate. When located more laterally (12 cases), their evolution is less acute: consciousness disturbances do not generally occur at the onset, whereas cerebellar disfunction is quite obvious; contrary to midline cases, these, when operated upon at an early stage, show a high success rate. If operation is delayed, the prognosis is much more serious due to the mass effect of this lesion in the posterior fossa. This is clearly demonstrated by CT scan which consistently shows displacement of the 4th ventricle with hydrocephalus of the lateral ventricles.

Adult↗
PubMed1983

[Prognostic value of cerebrospinal fluid fibrinolytic activity in meningeal hemorrhages as a result of aneurysm rupture].

26 patients with subarachnoid hemorrhage from ruptured cerebral aneurysms have been reviewed. Fibrinolytic activity of the C.S.F. has been evaluated by the dosage of Fibrin/Fibrinogen degradation products (F.D.P.). When patients have developed clinical signs of ischemia, F.D.P. levels were significantly higher than in those without neurological deficit. Even, if the detection of F.D.P. seems directly correlated to the presence of blood in the C.S.F., there is no direct relation between their level and the importance of S.A.H. as shown by C.T. scan. However when F.D.P. levels are greater than 80 mcg/ml, there is a high risk of vasospasm with clinical signs.

Adult↗
PubMed1980

[Involvement of the large vessels supplying the brain in sickle cell disease: a possible cause of Moya-moya (author's transl)].

In two children (1 girl and 1 boy aged 6 years) with an SS haemoglobinopathy, a neurological deficit affecting one half of the body led to arteriograms being performed. These revealed stenoses of the major vessels (above all anterior and middle cerebral with development of a collateral circulation giving an appearance suggestive of Moya-moya syndrome). Various aetiologies have been suggested for this syndrome: congenital disease, oral contraceptives, atheroma. Sickle cell disease is a new cause. The mechanism would appear to be fibrosis proliferating secondary to sub-endothelial anoxia caused by sludging in the vasa vasorum.

Anemia, Sickle Cell↗
PubMed1980

[Gasserian differential thermocoagulation in trigeminal neuralgia: a medium-term follow up (author's transl)].

The results of thermo-coagulation have been evaluated in a series of 50 patients followed up from two to six years (average three years). Neuralgia disappeared in nearly 80 p. 100 of the cases (however this was obtained with a second operation in nine cases). The frequency of recurrences increase with time: 20 p. 100 during the first two years reaching 40 p. 100 after three years. They were more likely to occur if the post-operative sensory deficit is moderate. Complications directly related to the surgical technique were rare: some faded away relatively quickly (oculo-motor palsies less than 1 p. 100, masseter weakness 20 p. 100 in the first weeks). The only residual problems were related to sensory deficits: in general they were limited to a small cutaneous area and total anesthesia was never been observed. Although paresthesias were noted in 12 p. 100 of the cases, these usually were not really troublesome. Our conclusion, therefore, is that differential thermocoagulation appears to be the best surgical treatment for trigeminal neuralgia.

Aged↗
PubMedDate not supplied

Dural arteriovenous fistulas of the posterior fossa draining into subarachnoid veins.

PURPOSE: To describe the clinical presentation, angioarchitecture, and risks and problems of therapy in patients with dural arteriovenous malformations of the posterior fossa draining into subarachnoid veins. PATIENTS AND METHODS: Twelve patients with dural arteriovenous malformations of the posterior fossa draining into subarachnoid veins were studied. RESULTS: These fistulas often presented with intracranial hemorrhage (eight cases) and myelopathy (two cases). They were located in the tentorium (six cases) or at the skull base (six cases). The arterial supply was provided by branches of the external carotid artery (nine cases), by the posterior meningeal branch of the vertebral artery (nine cases), and by the meningohypophyseal trunk (three cases). The fistulas drained directly into a cortical vein (six cases) or into a venous lake (six cases). In two cases, perimedullary draining veins were observed. The treatment modalities were endovascular embolization alone (two cases), surgery alone (five cases), and embolization followed by surgery (three cases). Despite the treatment, four patients died; in two cases, intracranial hemorrhage recurred. CONCLUSIONS: Subtotal occlusion of a fistula by surgery or embolization alone is not protective against further complications, especially hemorrhage. The goal of treatment is to achieve a rapid and complete anatomical cure; combined endovascular and neurosurgical treatment seems to be the therapeutic choice.

Adult↗