Biomedical subjects
Publications and source records attributed to P Brunet.
Five patients presented with the painful legs and moving toes syndrome as defined by Spillane et al. (1971). A peripheral nervous disorder was present in 4 of these cases while the fifth patient showed evidence of a central lesion. Results of clinical and electrophysiologic investigations in the 4 peripheral cases, are compared with data from the literature.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
CT analysis in 26 patients with well-identified muscle diseases, and 4 normal controls was performed to evaluate its diagnostic interest. Scans were obtained through pelvis, thigh and calves at comparable levels in all subjects. Results showed that elementary changes were devoid of specificity and density measurements did not significantly increase the diagnostic significance of images. A good correlation was found between the degrees of CT changes and clinical evaluation of the muscles. However, CT allowed a more precise study of abnormalities in muscles difficult to assess clinically and, in all pathological cases, led to a clear analysis of the topography and the selectivity of the pathological process. If safety criteria are fulfilled, CT would allow a precise follow-up study of muscle atrophies.
Twenty-seven cases of panarteritis nodosa (PAN) with peripheral neuropathy are reported. Diagnosis was based on pathological criteria of necrotizing vasculitis in 20 patients (group I) and on clinical, biological and sometimes arteriographic data in 7 (group II). The 27 patients (18 women and 9 men), aged between 30 and 78 years (mean: 53.4 years), presented either a mono- or multineuropathy (8 cases), a polyneuropathy (17 cases), or sensory symptoms (2 cases). A neuropathy was the initial feature of the PAN in 15 cases. The CSF, examined in 16 cases, was always normal, and results of electrophysiological investigations constantly suggested the presence of an axonal neuropathy with normal motor nerve conduction rates. Other signs of PAN included fever (81 p. 100 cases) and loss of weight (74 p. 100). The ESR was increased in 70 p. 100 cases and hypereosinophilia was present in 33 p. 100. Quantitative pathology in 13 cases from group I revealed typical findings, and associated microvasculitis in 4 cases. The outcome was fatal in 13 cases while 12 recovered and have been followed up for from 1 to 14 years.
Eight cases of spontaneously regressive cranial nerve paralysis related to the meningo-radiculitis reported by F. Rohmer et al. in 1974 are described. The epidemiological, clinical features, and the CSF changes which should allow early diagnosis are detailed, but this can only be confirmed by the spontaneous regression of the condition. The problems in determining the etiology are emphasised.
A patient developed polyneuropathy during carbimazole treatment for thyrotoxicosis. Electrophysiological data and a neuromuscular biopsy suggested a combined axonal and demyelinative lesion together with microvasculitis. Physiopathological hypotheses are discussed.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Twenty-three clinical cases are reported, illustrating the difficulties of diagnosing migrainous focal cerebrovascular accidents. Cases of constituted cerebral infarcts and transient cerebral ischemia occurring during the cephalalgic phase, without headache and in patients with no previous history of typical migrainous attacks are described. Migraine may be considered to be the cause on convincing clinical criteria, but the diagnosis can only be established after negative results of investigations to exclude other causes of focal cerebral ischemia.
Explore the source record for details and available documents.
(1) The concentrations of various anticonvulsants (PB, PHT, CBZ, VPA) were measured in brain specimens from 7 patients who had undergone neurosurgery for a therapy resistant epilepsy of tumoral origin (astrocytoma) in 6 cases, glioblastoma in 1 case). (2) Great interindividual variability of the mean brain/plasma concentration ratios was observed for PB in 5 patients (range: 0.4-1.0). A mean brain/plasma ratio of 1.0 was recorded for PHT and CBZ (one patient each). (3) In the different tissue specimens (7-14) from the same patient AED concentrations varied greatly, even in neighboring areas. (4) Intraindividual variations were more marked in the present group of patients than in previously studied non-tumoral epileptics. (5) No correlation was found between the localization of the lesions and the variations in AED concentrations. (6) Brain AED concentration appeared to be higher in the few samples of non-tumoral tissue and lower in the 'epileptogenic' areas as defined by stereo-EEG seconding. (7) On the basis of these data, the hypothesis can be formulated that the therapy resistance of these patients may be at least partly explained by the presence of low AED concentration (even in presence of 'therapeutic' AED plasma levels) in the epileptogenic areas.
The authors report three cases of complete urinary retention of sudden onset during a herpes genitalis infection secondary to traumatic sexual relations. In practice, the diagnosis was made in the absence of any urological cause, the presence of local signs indicative of herpetic infection of the genital organs and lumbar puncture. Mictional disturbances disappeared in 2 to 3 weeks without leaving any sequelae. The possibility of nervous system complications in genital herpes infections has been know since 1904. By contrast, disturbances in micturition have been reported much more recently, in 1953. Complete urinary retention of sudden onset is not rare: 17 cases out of a series of 486 cases of genital infection. This may be the only clinical sign of nervous system involvement. Urinary retention develops between a few days and 3 weeks after the onset of genital herpes. Neurological examination of the lower limbs is normal. There may be transient impotence in the male and loss of the bulbo-cavernosus reflexes and impaired sensation in an S2-S3 distribution. Bladder tone is spontaneously hypoactive and increases following the injection of Urecholine. The herpes virus (HSV) is found only during the acute phase of the genital infection but almost never a few days later, when urinary retention develops.
We report four cases of femoral palsy due to compressive fibrosis, after pelvic radiation therapy. Three patients had Hodgkin's disease, and one testicular seminoma. Prominent clinical features include major groin induration and underlying swelling. Unlike what is usually seen in tumor relapse, little or no pain is associated with these neuropathies. The femoral post-radiation palsy develops earlier and faster than brachial plexus palsy of same aetiology. In one case, progressive aggravation led to surgical neurolysis which resulted in dramatic and long lasting improvement. The principal preventive and therapeutic managements are discussed: since compressive fibrosis is related to the use of isolated and massive electron beam therapy, various association of cobalt and electron beam therapy are designed to best prevent the side effects of each of these methods. The early treatment of developing fibrosis by D. penicillamine is discussed.