Search PubMed⌕ Search

Biomedical subjects

S Bracard

Publications and source records attributed to S Bracard.

At least 73 records · Page 4Linked to original sources
PubMed1996

Arteriovenous malformations of the corpus callosum--radioanatomic study and effectiveness of intranidus embolization.

Forty-three patients with arteriovenous malformations (AVMs) of the corpus callosum treated by embolization were reviewed. The following clinical and radioanatomic characteristics were found: 84% (36 patients) presented with intracranial hemorrhage, 43% (20 nidi) of the lesions were located in the posterior half of the corpus callosum, multiple nidi were more frequent (21%) than expected, 27 nidi (59%) were fed by branches of both the anterior and posterior cerebral arteries, AVMs mainly drained into the internal cerebral vein and/or interhemispheric superficial veins, and 19 (41%) had both draining pathways, 10 patients (23%) had impaired drainage through the straight sinus due to dysplasia. Staged embolization was performed in 245 feeders. Curative occlusion (more than 95%) was obtained in 17 patients (40%) and considerable occlusion (more than 75%) in 33 patients (77%). Large and giant, diffuse-type, and multifocal AVMs were difficult to completely embolize. Complications associated with embolization occurred in six patients, mostly during the first 5 years. Only two patients had a permanent deficit related to a complication. Overall morbidity and mortality were 7% and 2%, respectively. Nine patients were referred for stereotactic radiosurgery, three of whom were completely cured and five patients have not been assessed. Most AVMs in the corpus callosum are supplied by multi-axial feeders, so multi-target intranidus embolization is very important to prevent the development of other feeders secondary to the hemodynamic shift. Combined therapy using maximum embolization and subsequent radiosurgery may be the most effective method to treat AVMs in the corpus callosum.

Adolescent↗
PubMed1995

Autosomal dominant migraine with MRI white-matter abnormalities mapping to the CADASIL locus.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an autosomal dominant cerebral arteriopathy mapped to chromosome 19 and characterized mainly by recurrent subcortical ischemic strokes and extensive white-matter signal abnormalities (WMAs) on magnetic resonance imaging. Other clinical features include migraine attacks and progressive subcortical dementia. Herein, we describe several members of the same family who suffered migraine attacks, mostly with aura, associated with WMAs, segregating with an autosomal dominant pattern of inheritance. One individual had a progressive subcortical dementia with similar WMAs. Although ischemic stroke, one of the hallmarks of CADASIL, was not present in this family, we hypothesized that the present disorder resulted from an alteration of the CADASIL gene. Genetic linkage analysis, using four chromosome 19 markers spanning the CADASIL locus, supports this hypothesis.

Adult↗
PubMed1995

[A rare cause of neurologic bladder: arteriovenous dural fistula with venous epidural drainage].

Spinal dural arteriovenous fistula (DAVF) with epidural drainage is infrequent: 22 cases of the 194 reported DAVF. In the case reviewed, DAVF is associated with a complete urinary retention and its somatic neurologic features are moderate. Such spinal arteriovenous fistula clinical picture is rare and occurs in only 4 to 5% cases. Urological diagnosis approach is interesting because of a patient presenting with a benign prostatic hypertrophy.

Aged↗
PubMed1994

Venous territories of the brain.

The venous return of the cerebral hemispheres is ensured by two systems. The first, superficial system, reaches the peripheral dural sinuses, i.e. the superior sagittal sinus, the lateral sinus and the cavernous sinus. The second, deep system, corresponds to Galen's vein. Anatomical and angiographic data from the literature enable the usual drainage territory to be defined for each of these collecting vessels. However, the variability of the superficial sylvian vein and the importance of cortical anastomotic vessels make impossible to delimit precisely the territory of each peripheral sinus. The functional role played by numerous centro-peripheral anastomoses is more difficult to assert in each individual. It is therefore probable that in the cerebral hemispheres there is a deep territory balancing the superficial territories.

Cavernous Sinus↗
PubMed1994

Present status of computerized tomography and angiography in the diagnosis of cerebral thrombophlebitis cavernous sinus thrombosis excluded.

In order to evaluate the contribution of computerized tomography (CT) to the diagnosis of cerebral thrombophlebitis, a series of 28 cases was reviewed and compared with data from the literature. In an examination carried out 4 to 5 days of its constitution the thrombus may be directly visualized as a spontaneous hyperdensity. This early but very transient sign, called "cord sign", can easily be overlooked, which explains why it was found in only 5 of our 28 cases and in 2% of the largest series of the literature. The thrombus thereafter becomes hypodense and can be intensified by peripheral contrast enhancement which produces the classical "delta sign". This sign is more frequent: 13/28 in our series and 16 to 30% in published cases. It is usually found in the superior sagittal sinus and must be distinguished from anatomical variations which are common at that level. These two direct signs acquire a greater value when associated with such indirect signs as diffuse or localized cerebral oedema (12 to 52%) and venous ischaemia (22 to 59%). Venous ischaemia is characterized by its strong bleeding potential (more than 50% of the cases) and by its usually favourable course; these two elements and its site differentiate it from arterial ischaemia. Finally, venous stasis is responsible, in 5 to 19% of the cases, for intense enhancement of the tentorium cerebelli; this sign is not specific but easy to evidence and of great value when associated with a direct sign. Dilatation of cortical veins, found in 4 of our 28 cases, also seems to be an interesting sign which, to our knowledge, has not yet been mentioned in the literature. Since in 3.6 to 26% of the cerebral thrombophlebitis the CT scan is normal, a negative CT examination does not rule out this disease, and in many cases the exploration must be rapidly completed by angiography or MRI. Because it is non-invasive and very sensitive to flows, MRI has become the key examination to assert the diagnosis. Angiography is now restricted to those cases where cases where MRI cannot be performed promptly or to certain, purely cortical thrombophlebitis which might pass unnoticed at MRI. When carried out and interpreted cautiously, angiography always shows the venous thrombosis, its exact size and its suppletive network. The results of this study show that MRI alone can diagnose cerebral thrombophlebitis in most patients, that CT well done and interpreted often provides useful but seldom sufficient indices, and that angiography should be reserved for difficult cases.

Cavernous Sinus↗
PubMed1994

[Is surgery of a carotid lesion possible without arteriography?].

Cerebro-vascular angiography has been for a long time the standard for operative decision. It has been ten years since the development of duplex scanning has allowed a non invasive approach of the diagnosis. Several authors have reported series of endarterectomy, some of them without preoperative arteriography. The authors remind us of the different arteriography procedures, their advantages and their risks and compare them to the results of duplex scanning: they admit that it is possible to do a carotid endarterectomy without preoperative arteriography. They define their indications but they are persuaded that arteriography is an excellent procedure and the rate of neurologic complications due to the technique is lower than 0.5%.

Cerebral Angiography↗
PubMed1994

Dissection of intracranial vertebral arteries revealed by subarachnoidal haemorrhage. Report of seven cases.

Between April 1986 and April 1991, seven cases of meningeal haemorrhage consecutive to dissection of the 4th segment of a vertebral artery were observed at the Neuroradiology Department of the Nancy University Hospital. Four of the 7 patients were men, and 3 were women; mean age varied from 45 to 61 years. The clinical presentation was not suggestive, except in one case where the haemorrhagic episode was associated with Wallenberg's syndrome, pointing to the aetiological diagnosis. The outcome was variable. Two patients died of early complications of the haemorrhage which occurred before treatment could be given. In 2 others patients treated with antiplatelet agents the outcome was favourable; however, at angiography the lesions regressed in one of these two patients, but they progressed in the other with formation of a false aneurysm. The remaining 3 patients were treated by endovascular occlusion of the lesion-bearing vessel: one died of complications of a haemorrhage-induced vasospasm; the other two are symptomless after a 2 to 6 months follow-up.

Aortic Dissection↗
PubMed1994

[Pericranial sinus].

This study concerns four cases of sinus pericranii observed at the Neurological Department of Nancy. Sinus pericranii is a direct communication between the outer surface of the skull and the intracranial venous sinuses. It may be congenital, acquired or traumatic. This abnormality, usually located in the midline and often in the frontal region, is usually symptomless, but some patients complain of headache, nausea and vertigo. Sinus pericranii shows as a fluctuating non pulsatile mass of reddish or bluish colour, expanding when the patient bends his head down. Radiography usually shows one or several bone defects opposite the lesion found at CT bone window. On soft tissue window the mass is not calcified and usually enhanced by contrast injection. It is sometimes possible to visualize the vascular communication between the extracranial region and the underlying dural sinus. When visualization is blurred, or CT shows intracerebral abnormalities, MRI examination is required. Angiography with subtraction in venous phase (40 to 60 seconds after the injection), sometimes aided by films taken in head down position. It is of interest only in cases where CT and MRI have shown associated vascular abnormalities. Otherwise, direct injection of contrast medium into the malformation makes it possible to assert the diagnosis of sinus pericranii and to determine the flow rate within the malformation, which to some extent commands the the therapeutic technique. In patients with small and asymptomatic sinus pericranii absention is the rule. When the sinus is of moderate size, and the flow rate not rapid and when there is no significant communication with the cerebral veins, endovascular sclerosis may be advocated. In all other cases, surgical removal is recommended and is usually easy.

Angiography, Digital Subtraction↗
PubMed1992

Aneurysms of the extracranial internal carotid artery due to fibromuscular dysplasia: results of surgical management.

Between January 1977 and December 1990, eight patients underwent surgical correction of aneurysms of the extracranial internal carotid artery due to fibromuscular dysplasia. Mean age of patients was 50 years (range 31 to 70 years). Five patients presented with neurologic hemispheric symptoms. Most aneurysms were saccular and occurred preferentially at the level of C2 or C3. All of these patients underwent operation through conventional cervicotomy. Resection-anastomosis was performed in three cases whereas resection-graft was performed in five. Histopathological examination of the eight specimens was consistent with fibromuscular dysplasia of the media. There was no central nervous system-related mortality and morbidity. Seven patients were alive and free of new neurological manifestations at mean follow-up of 156 months (18 to 180 months). One patient died of myocardial infarction at 96 months. All patients had postoperative duplex scanning or arteriograms. These revealed that carotid restorations were patent in seven whereas one patient had asymptomatic occlusion at 18 months.

Adult↗
PubMed1992

[Transluminal angioplasty in the treatment of vasospasm. Value of transcranial Doppler in the diagnosis and follow-up].

Vasospasm (V.S.) transluminal angiographic treatment (T.L.A.) is recommended in case of symptomatic V.S. before or after surgery. V.S. diagnosis and follow up after T.L.A. rely on clinical and transcranial doppler (T.C.D.) data. Before T.L.A. angiography (A degrees) demonstrates V.S. degree and location. T.L.A. technic is described. The authors report 14 cases of T.L.A. (7 before and 7 after surgery). Before surgery in 4 cases patients exhibited ischemic symptoms from V.S.: 2 died (one from reanimation problems the other from a new hemorrhage). After surgery of 7 patients one died from artery rupture, one from extra-neurologic complication. T.C.D. capacity to follow up V.S. is emphasized. As soon as T.L.A. is performed the mean cerebral blood flow (C.B.F.) decreases (< 100 cm/s) and does not increase anymore. At the level of non dilated arterial segments V.S. may increase after T.L.A.: it is then recommended to dilate all the spastic arteries, as far as it is possible. After T.L.A. C.B.F. may decrease in arteries far from the dilated ones probably because arterial supplies are no more necessary.

Angioplasty, Balloon↗
PubMed1992

[Neurinoma of the oculomotor nerves. Apropos of 2 cases].

The authors report two cases of neurinomas of the oculomotor nerves: one neurinoma of the oculomotor nerve and one of the abducens nerve. The study of 30 cases in the previous literature points out the major striking features of these tumors. Both headaches and oculo-motor palsies are the most regular clinical features. They are not typically suggestive. Therefore the diagnosis is difficult among all the tumors of cavernous sinus and surrounding structures. C.T. scan and M.R.I. with the clinical history should readily allow pre-operative diagnosis. These data are insufficient to distinguish the affected nerve. The surgical treatment is not always complete due to the tumor infiltration into the cavernous sinus.

Adult↗
PubMed1991

Persistent proatlantal artery associated with carotid artery stenosis treatment by percutaneous transluminal balloon angioplasty.

A 58-year-old man had an asymptomatic tight stenosis of the internal carotid artery associated with a persistent proatlantal artery. This as well as other compositional arterial anomalies of the basilar artery were discovered on arteriograms. The stenosis was successfully treated by percutaneous transluminal balloon angioplasty. Therapeutic choices are discussed in this setting because of the risk of carotid clamping in the presence of persistent carotid-basilar anastomoses.

Angioplasty, Balloon↗
PubMed1991

Cervical cord compression in scleroderma. One case.

The cervical spine is rarely involved in scleroderma. The lesions reported here consisted of osteolysis of the posterior arches disturbing vertebral statics, and exuberant calcifications responsible for spinal cord compression by stenosis of the vertebral canal.

Calcinosis↗
PubMed1991

[Papilledema and dural fistula].

A retrospective analysis of three cases of papilledema was made, initially attributed to idiopathic raised intracranial pressure on the basis of the following data: symptoms and signs of raised intracranial pressure, no other neurological signs, normal electroencephalogram, normal computerised tomography, and normal cerebrospinal fluid. The discovery of a dural arteriovenous malformation was made only after a period over six months, by cerebral angiography. After a survey of medical data concerning the incidence of papilledema in dural fistulae, a description of the supposed pathogenic mechanisms of papilledema formation in this disease is proposed. Venous hypertension was found to be the main factor leading to papilledema. It could be in relation with obstruction of the involved venous sinus, and with the high level of blood flow of the dural arteriovenous malformation. It appeared that drainage with involvement of subarachnoid veins was the main characteristic for arteriovenous malformations to be directly responsible for papilledema. The possible lack or delay of suggestive signs such as intracranial bruit and the potential seriousness of the vital and visual prognosis led us to routinely carry out angiologic investigations comprising first doppler ultra-sound of the cervical vessels and secondly cerebral angiography, before diagnosing benign raised intracranial pressure.

Adult↗
PubMed1990

Role of angioplasty in the treatment of symptomatic vascular spasm occurring in the post-operative course of intracranial ruptured aneurysms.

Angioplasty of vascular spasm (VS), related to subarachnoid hemorrhage (SAH) has been recently introduced to the medical field. The authors report 5 cases treated by this mean in the postoperative period. These patients were all symptomatic from their VS inspite of early surgery and of the preventive treatment by Nimodipine. In all cases, obtained increase in the caliber of the spastic vessels was followed by a rapid clinical improvement coupled with a significant decline of the flow rates as confirmed by transcranial Doppler (TCD). No recurrence of VS has been observed. This technique appears quite effective provided that it is performed as early as the clinical symptoms come out in correlation with important acceleration of flow rates on TCD.

Adult↗