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Biomedical subjects

P Toussaint

Publications and source records attributed to P Toussaint.

At least 19 recordsLinked to original sources
PubMed2006

[Terminovertebral aneurysm arising from basilar artery fenestration].

A case of ruptured middle saccular aneurysm arising from basilar artery fenestration is reported. Defects of the medial wall at the junctures of the fenestrated segments explain the association between vertebrobasilar aneurysms and basilar artery fenestration. A 47 year-old woman had a perimesencephalic subarachnoid hemorrhage. Immediate angiography revealed a ventral vertebrobasilar aneurysm and an endovascular coil occlusion was performed. Embryological development, pathogenesis and therapeutic difficulties are discussed.

Adult↗
PubMed2006

Lhermitte-Duclos disease and Cowden's syndrome. Report of two cases.

OBJECTIVE AND IMPORTANCE: Lhermitte-Duclos disease, or dysplastic cerebellar gangliocytoma is a rare entity characterized by a hamartomatous lesion in the posterior fossa. Cowden's syndrome, or hamartoma-neoplasia syndrome is a rare underdiagnosed autosomal dominant genodermatosis with high incidence of malignant tumors. Several recent reports suggest that Lhermitte-Duclos disease may be a component of Cowden's syndrome. CLINICAL PRESENTATION: We report two cases of Lhermitte-Duclos and Cowden disease occurring in adult patients. A 40-year-old woman had symptoms of raised intracranial pressure and macrocephaly. She displayed the stigmata of fibrocystic breast disease, thyroid goitre. Clinical examination showed mucocutaneous lesions. Her mother, brother and uncle had manifestations of Cowden's disease. An asymptomatic 38-year-old male had bilateral optic nerve drusen related to a cerebellar neoplasm. He exhibited manifestations of Cowden's syndrome and his familial history confirmed this hypothesis. INTERVENTION: The first patient was operated on for Lhermitte-Duclos disease. A conservative strategy was performed for the second patient and the clinical and imaging follow-ups were uneventful over 5 years. CONCLUSION: We stress the possibility that Lhermitte-Duclos and Cowden disease might be a peculiar form of phakomatosis. A conservative strategy can be chosen without neurological signs because of slow tumor growth. However, these patients should be carefully examined and followed up because of the risk of future malignancy.

Adult↗
PubMed2005

Melanocytic schwannomas. Report of three cases.

OBJECTIVE AND IMPORTANCE: Melanocytic tumors are rare. The literature reports less than 40 cases and suggests that they behave aggressively, can recur and progress to malignancy. CLINICAL PRESENTATION: We report three patients with melanocytic schwannomas located in the cervical spine, in the thoracic spine and in the lumbar spine. In the two first cases, these symptoms were a spinal cord compression whereas the last patient presented symptoms of cruralgy. IMAGING: MRI always showed an extramedullary intradural tumor arising from the root destroying the intervertebral foramen. INTERVENTION: The patients underwent laminectomy and the excision was complete. Immunohistochemical stains were positive to S100 and HMB45 antibodies. The evolution was unfavourable for two patients with local recurrence and leptomeningeal metastasis. CONCLUSION: These three cases demonstrate that melanocytic schwannomas have a guarded prognosis because of their metastatic potential, especially for young people.

Adult↗
PubMed2004

[Aneurysmal rupture during embolization with Guglielmi detachable coils].

OBJECTIVE: The purpose of this study is to determinate the frequency, causes, management and outcome of aneurysmal rupture occurring during embolization. We present our experience with this severe and feared complication. METHODS: We retrospectively reviewed 314 acute cerebral aneurysms that were treated with endovascular coiling. These patients were identified and the management and outcomes were recorded. The literature was reviewed. RESULTS: Six patients had an intraprocedural aneurysmal rupture. This complication occurred sporadically. Prevalence was 1.9%. Of these six, four were women and two were men. The mean age was 68 years (range: 43-74 years). Four aneurysms were located in the anterior circulation and two in the posterior circulation. Perforation occurred during microcatheterization of the aneurysm in one case and during coil deposition in five cases. In these five patients, aneurysmal rupture resulted from detachment of the first coil in three patients and detachment of the third and last coil in two patients. Hemodynamic changes were noted for one patient. The Glasgow Outcome Scale score at last follow-up examination was 1 in three patients and 3 in one patient (fair recovery). Mortality was 33% and morbidity was 16.7%. CONCLUSION: Aneurysmal perforation during embolization is a rare event (1.8 to 4.4%). When perforation is recognized, embolization can be completed immediately with further coil deposition and reversal of anticoagulation therapy.

Adult↗
PubMed2004

[Contribution of percutaneous acrylic vertebroplasty for tumor-related spinal cord compression].

We report two cases of spinal cord compression due to vertebral hemangioma in the first patient and myeloma in the other. Vertebroplasty was performed in both patients, combined with surgery for the first and radiotherapy for the second. Postprocedural pain decreased within 24 hours. Indications for percutaneous vertebroplasty are limited to aggressive vertebral hemangiomas, malignant spinal tumors including metastasis, multiple myeloma and solitary bone plasmocytoma. Vertebroplasty consolidates the vertebral body and reduces the risk of hemorrhage. It allows provides a rapid analgesic effect, radicullomedullary decompression associated with neurosurgery, spinal stabilization and can restrict progression of vascular malformations or tumors. Incidents and complications appear to be rare.

Aged↗
PubMed2004

[Atlantoaxial synovial cyst. A case report].

The case of a 62-year-old patient with an atlanto-axial synovial cyst is presented. The narrowing of the spinal canal was associated with anterior medullar compression and neurological deficit. A transoral approach with odontoid resection was performed. The diagnostic of synovial cyst was histologically confirmed. Secondary atlanto-axial instability required posterior fixation completed by C1-C2 transarticular screw fixation. The follow-up showed an improvement of the neurological deficit. Similar cases reported in the literature are reviewed and discussed.

Atlanto-Axial Joint↗
PubMed2004

[Sarcoidosis revealed by a spinal cord lesion].

Spinal neurosarcoidosis is rarely a presenting symptom. This case deals with a 45-year-old african woman who presented with a regressive spinal cord compression treated by parenteral corticosteroid. Different relapses allowed to diagnose multiple sclerosis. Spinal MRI scan showed diffuse enlargement of the cord with intense intramedullary enhancement from C3 to T1 and an aspect of large spinal cord from C7 to D1. Cranial MRI scan was normal. Radiographs and CT scan of the chest revealed an interstital syndrome without mediastinal lymphadenopathy (subgroup III). The serum angiotensin converting enzyme level was elevated in the blood as the cerebrospinal fluid. CSF fluid showed a lymphocytic meningitis. The bronchio-alveolar lavage found an hyperlymphocytosis with a high CD4/CD8 ratio. The neurological status and biological parameters were improved with oral corticotherapy treatment. This case report that a spinal cord involvement can reveal a sarcoidosis especially in the African race. Finally, in spite of lack of biopsy, the diagnosis is supported by clinical, biological and neuroradiological arguments.

Female↗
PubMed2003

The dural crossing of the vertebral artery.

The aim of this study was to present the anatomic and macroscopic aspects of the vertebral artery at the level of the dural crossing. Twenty vertebral arteries in 10 cadavers were dissected. The preparations were photographed and all the samples at the level of the dural crossing were submitted to a histologic study. Macroscopic results allow specification of the relationships between the dural crossing of the vertebral artery and the nervous elements (C1 and C2 nerves, mixed nerves), the vascular elements (postero-inferior cerebellar artery), the dural sheath and the first two dentate ligament tips. Microscopic results show the intricate relationship of the different layers of the vertebral artery with the dura at its crossing. Dural fibers reinforce the adventitial fibers not only by continuing them in their contact, much as the pages of a book, but also by being encrusted into the adventitia up to the tunica media, thus creating a very efficient mooring system. This work provides some information for an understanding of the symptoms induced by foramen magnum meningiomas and the onset of clinical signs after the surgical excision of these tumors. It also explains why dissections of the suboccipital segment of the vertebral artery stop at the level of the dural crossing, and never spread towards the intracranial segment.

Dura Mater↗
PubMed2003

[Lenticulostriate aneurysms. Radioclinical study].

The authors report four cases of aneurysm of the lenticulostriate arteries, three idiopathic and one with underlying MoyaMoya disease. This unusual pathology, which often affects young patients, is revealed by a meningeal syndrome and sometimes focal neurological signs. The bleeding is highlighted by a CT scan without contrast injection, even by MRI, these examinations making it possible to evaluate its repercussion. Arteriography or MRA show the aneurysm and eliminate vascular malformation. According to literature (15 cases published) and our experience, considering the difficulty of a surgical or endovascular approach, morbidity and the frequency of spontaneous thromboses, it seems that a conservative management is justified after a negative etiologic check-up and under radio-clinical monitoring.

Adult↗
PubMed2003

[Combined transfacial and neurosurgical approach for the treatment of ethmoid cancers].

OBJECTIVES: The purpose of this work was to examine the indications for the combined transfacial and neurosurgical approach to ethmoid cancers. PATIENTS AND METHODS: Fifteen patients with ethmoid cancers underwent surgery via the combined approach between 1990 and 2000 at the Amiens University Hospital. The transfacial approach alone was reserved for elderly patients. RESULTS: The histological diagnosis was adenocarcinoma in 10 patients. There was one postoperative death. Mean follow-up was 45 months (range 3 - 129). Six patients died from local or metastatic recurrence. At last follow-up eight patients were disease free, two had local or metastatic recurrence. CONCLUSION: We compared systematic use of the combined approach for curative surgery with surgical strategies adopted by other teams. The combined approach is indicated for T3 or T4 tumors and for all other tumors with a posterior or superior extension. Anterior and unilateral tumors may be treated with the transfacial access alone. Limited tumors without extension to the orbit or cribiform plate may be managed endoscopically. The role of histological diagnosis and the choice of the surgical approach remain to be evaluated.

Adenocarcinoma↗
PubMed2003

[Transarticular atlanto-axial screw fixation for treatment of C1-C2 instability].

Posterior transarticular screw fixation of the C1-C2 complex has become an accepted method of arthrodesis for patients requiring posterior C1-C2 fusion. Since 2000, four patients (2 males and 2 females) were treated with this surgical approach for management of atlantoaxial instability, including odontoid fracture with unilateral C1-C2 luxation, odontoid pseudarthrosis, complex congenital malformation of the craniovertebral junction and rheumatoid arthritis. All patients underwent stabilization with 2 transarticular C1-C2 screws, without any posterior interspinous graft. Patients were maintained in a rigid cervical orthesis 3 months postoperatively. Results were good, without any complication, after a short mean follow-up (8 months). Technical aspects of the technique are reported, The risk of screw malpositioning and vertebral artery or neural injury is minimal and can be lowered by using preoperative CT scan and MRI, and by using intraoperative fluoroscopy. Transarticular C1-C2 screw fixation proves to be a major surgical approach for treatment of atlantoaxial instability.

Aged↗
PubMed2002

Architectural decisions with respect to the introduction of PACS.

In this paper we report on a study on the possible scenarios for the introduction of PACS that was conducted at the LUMC in 2002 by a workgroup. The results of this study should facilitate the decision on PACS to be taken by the management of the LUMC at a later stage. In this paper our main research question is to what extent the decisions to be made at the introduction of PACS can be derived from an information system architecture in place, and vice versa: how can these decisions help to refine an information system architecture that is still immature.

Computer Systems↗
PubMed2001

Pediatric cerebral aneurysms.

OBJECT: The exceptional pediatric aneurysm can be distinguished from its adult counterpart by its location and size; however, patient outcomes remain difficult to evaluate based on the published literature. METHODS: Twenty-two children, all consecutively treated in three neurosurgery departments, were included in this study. Each patient's preoperative status was determined according to the Hunt and Hess classification. Routine computerized tomography scanning and angiography were performed in all children on the 10th postoperative day. Each patient's clinical status was evaluated 2 to 10 years postoperatively by applying the Glasgow Outcome Scale (GOS). Twenty-one children presented with a subarachnoid hemorrhage (SAH) and one child harbored an asymptomatic giant aneurysm. Thirteen patients were in good preoperative grade (Hunt and Hess Grades I to III) and eight in poor preoperative grade (Hunt and Hess Grade IV or V). The symptomatic aneurysms were located on the internal carotid artery bifurcation (36.4%); middle cerebral artery (36.4%), half of which were found on the distal portion; anterior communicating artery (18.2%); and within the vertebrobasilar system (9.1%). A giant aneurysm was observed in 14% of patients. Overall outcome was favorable (GOS Score 5) in 14 children (63.6%) and death occurred in five (22.7%). Causes of unfavorable outcome included the initial SAH in four children, a complication in procedure in three children, and edema in one child. CONCLUSIONS: Pediatric aneurysms have a specific distribution unlike that of aneurysms in the adult population. The incidence of giant aneurysms and outcomes were similar to those in the adult population. The major cause of poor outcome was the initial SAH, in particular, the high proportion of rebleeding possibly due to a delay in diagnosis.

Adolescent↗
PubMed2001

[Diagnostic problems in brain abscess: 45 cases].

BACKGROUND AND PURPOSE: We analysed the difficulties encountered in the differential diagnosis between brain abscess and brain tumor and their influence on treatment and outcome. METHODS: - Forty-five adults with brain abscess operated on between 1993 and 1999 were retrospectively reviewed. We studied preoperative diagnosis, clinical, radiological, bacteriological findings, surgical procedure, primary sources of infection and outcome. RESULTS: Preoperative diagnosis was right in 55.6% (25/45), wrong in 22.2% (10/45) and doubtful in 22.2% (10/45). Diffusion-weighted MR imaging was successfully used in 4 doubtful cases to make the differential diagnosis between abscess and tumor. When the preoperative diagnosis was right, the surgical procedure was a burr-hole aspiration in 73.3% (22/25) whereas when it was wrong, an excision was performed in 60% (6/10) of the cases. Aspiration was the last diagnostic investigation in 80% (8/10) of doubtful cases. Microbacterial organisms were identified in 75.5% (34/45) of the cases and primary cause of infection in 62.2% (28/45). The outcome depended on clinical status on admission, preoperative diagnosis and surgical procedure. In four cases, diffusion-weighted MRI allowed differential diagnosis between brain abscess and tumor through calculation of the Apparent Diffusion Coefficient which is low in abscess and high in cystic tumor. CONCLUSION: The diagnosis of brain abscess remains difficult in certain patients. Correct preoperative diagnosis influences the decision on the appropriate surgical procedure and helps improve outcome.

Adult↗
PubMed2000

[POEMS syndrome revealed by a scleroderma-like skin thickening].

BACKGROUND: POEMS syndrome is a rare form of plasma-cell dyscrasia characterized by the various association of Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal component and Skin changes. The most frequent skin changes such as hyperpigmentation, hypertrichosis, scleroderma-like skin thickening and angiomas are not pathognomonic but nearly constant. However, they are rarely isolated. CASE REPORT: A 57-year-old Caucasian woman presented with a 6 month history of skin thickening on both hands and feet, Raynaud's phenomenon and facial telangiectasias. Physical examination on presentation revealed hepatomegaly, signs of a sensorimotor peripheral neuropathy which was demyelinating in type on electrophysiological assessment, and ankle edemas. Initial laboratory investigations revealed a platelet count of 900 000/mm(3), a monoclonal IgG lambda gammapathy. Plasma-cells were slightly increased (10 p. 100 of marrow elements) and full skeletal radiographs showed no focal osteosclerotic or lytic lesion. A diagnosis of POEMS syndrome was made. The patient was treated with tamoxifen, methylprednisolone and plasmapheresis without improvement in polyneuropathy or in skin changes. DISCUSSION: Our patient satisfied the criteria for POEMS syndrome. The most typical feature here was the scleroderma-like skin change, which has been recognized by other authors. But, in the present case, Raynaud's phenomenon, skin thickening and facial telangiectasias were present 6 months before the diagnosis, and initially suggestive of systemic scleroderma, confirmed histologically. The pathogenesis of POEMS syndrome might be regarded as the result of a marked activation of the proinflammatory cytokine network, but an increase in serum Vascular Endothelial Growth Factor (VEGF) levels could well account for other manifestations such as skin thickening.

Anti-Inflammatory Agents↗
PubMed2000

[Temporo-spheno-orbital meningioma. An unusual cause of exophthalmos. Report of one case].

We report the case of a 48-year-old woman with no prior medical history who developed headache and unilateral exophthalmos for 6 months. Clinical and radiographic findings detailed the intracranial extension of a temporo-spheno-orbital meningioma. Histological diagnosis was established after curative neurosurgery. This case recalls the characteristic features of temporo-spheno-orbital meningiomas.

Exophthalmos↗