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X Leclerc

Publications and source records attributed to X Leclerc.

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

[Moyamoya associated with Down syndrome].

We present a case of a six-year-old girl with Down Syndrom who developed recurrent ischemic strokes. Cerebral angiography demonstrated a supraclinoid stenosis of the right internal artery, an occlusion of the left supraclinoid internal cerebral artery and dilated collateral vessels, consistent with Moyamoya disease. We emphasize the increased frequency of Moyamoya in patients with Down Syndrome and also the most important pathophysiologic, clinical and radiological findings of this disease.

Child↗
PubMed1996

Preoperative percutaneous injection of methyl methacrylate and N-butyl cyanoacrylate in vertebral hemangiomas.

PURPOSE: To investigate the usefulness of preoperative percutaneous injections in vertebral hemangiomas. METHODS: Four patients presented with complicated vertebral hemangioma (spinal cord compression in three cases, intermittent spinal claudiction in one case). A three-part treatment was performed: initially, arterial embolization in three cases; 1 day later, percutaneous injections of methyl methacrylate into the vertebral body to strengthen it and of N-butyl cyanoacrylate into the posterior arch to optimize hemostasis during surgery; finally, the day after percutaneous injections, decompressive laminectomy and epidural hemangioma excision (when present). RESULTS: Laminectomy was performed with minimal blood loss. The epidural component present in three cases was excised without any difficulty. The follow-up (average, 20 months) showed no evidence of vertebral collapse. CONCLUSION: Percutaneous injections of methyl methacrylate and N-butyl cyanoacrylate might be useful before surgery for vertebral hemangiomas.

Aged↗
PubMed1995

Cerebellar border zone infarcts are often associated with presumed cardiac sources of ischaemic stroke.

It has been suggested that most border zone cerebellar infarcts are embolic infarcts or infarcts due to hypercoagulatble states. The aim of this study was to test this hypothesis. Risk factors for the presumed mechanism of stroke (TOAST criteria) were studied in 14 consecutive patients (nine men, five women; age range 29-84 years) with a total of 17 border zone cerebellar infarcts. The presumed cause of stroke was "cardioembolism" in nine patients. Three patients had a dissection of the vertebral artery. Two patients had a negative diagnostic investigation, and one had a cardiac arrest. These findings support the hypothesis that cardioembolism is a frequent mechanism of border zone cerebellar infarcts.

Adult↗
PubMed1995

Postpartum cerebral angiopathy possibly due to bromocriptine therapy.

BACKGROUND: Eight cases of benign angiopathy of the postpartum period have been reported previously, none of which involved the administration of bromocriptine. CASE DESCRIPTION: We describe a case of benign cerebral angiopathy in a 20-year-old woman in the postpartum period occurring after bromocriptine therapy prescribed to suppress lactation. CONCLUSIONS: Other adverse effects due to vasoconstriction have been reported during bromocriptine therapy, such as myocardial infarction and arterial hypertension. This case suggests that a similar mechanism may be possible in cerebral arteries, although the cause of vasoconstriction remains uncertain.

Adult↗
PubMed1995

Computed tomographic angiography for the evaluation of carotid artery stenosis.

BACKGROUND AND PURPOSE: No previous study has compared the reliability of carotid artery measurement provided by axial images, shaded surface display (SSD), and maximum intensity projection (MIP). METHODS: Helical CT and conventional angiography were performed prospectively in 20 patients with atherosclerotic stenosis of the internal carotid artery. Stenosis measurement was performed in a blinded fashion on angiography and CT by two independent examiners. Calcifications were segmented when they were located far enough from the vascular lumen. SSD and MIP were systematically performed for each carotid bifurcation. We measured stenosis using conventional angiography as standard and the different CT reconstructions (axial images, SSD, and MIP) by comparing the stenosis diameter at its narrowest point to the normal internal carotid artery. The degree of stenosis was classified into six groups: no stenosis, mild stenosis (< 30%), moderate stenosis (30% to 70%), severe stenosis (> 70%), near occlusion, and occlusion (100%). No measurement was made in cases of normal artery, near occlusion, and occlusion. RESULTS: Correlations between angiography and the three types of reconstruction were very good. Axial sections correctly classified the carotid arteries in 95% of cases. In 10 carotid arteries, stenosis was not assessable by SSD and MIP because of calcifications. In the remaining carotid arteries, MIP correctly classified the degree of stenosis in 96% of cases, whereas SSD misclassified 21% of cases. CONCLUSIONS: Our study showed that axial images provide a reliable evaluation of carotid artery stenosis. Calcifications are limiting factors in SSD or MIP. When atherosclerotic plaques are not calcified, MIP reconstructions provide a more reliable measurement of the vascular lumen than SSD.

Adult↗
PubMed1995

[Cerebral venous thromboses: study of the course].

The management of patients with presumed cerebral venous thrombosis has been recently modified by magnetic resonance imaging and evidence that heparin decreases mortality and morbidity. No large consecutive series of patients with cerebral venous thrombosis has been reported since then. The aim of our study was to determine the prognosis factors of patients with cerebral venous thrombosis. Demographic, clinical and radiological characteristics were recorded in a homogeneous series of 18 consecutive patients with cerebral venous thrombosis collected over a 31-month period. All patients were treated by heparin at the acute stage. We found no difference in demographic, clinical and radiological characteristics of the patients according to the 1-month and 6-month outcome. We only found a tendency towards a better 1-month outcome in younger patients (p = 0.06) and in patients with an isolated intracranial hypertension (2p = 0.06). A long therapeutic delay might be a factor of poor prognosis which might be hidden by a better spontaneous outcome in patients with isolated intracranial hypertension in whom the diagnostic delay is longer. A multicentric study allowing a multivariate analysis may therefore be useful to identify prognosis factors in patients with cerebral venous thrombosis.

Adolescent↗
PubMed1994

Pituitary microadenomas: experience with Gd-DOTA-enhanced MR imaging at 0.5 Telsa.

PURPOSE: We report our experience with magnetic resonance imaging at 0.5 Tesla in the radiological diagnosis of pituitary adenomas. METHODS: Over 2 years we performed a prospective study in 38 patients with pituitary microadenomas to assess the potential additional benefit of gadolinium in the detection of small intrasellar lesions. The protocol included three coronal T1-weighted sequences: precontrast, early postcontrast (obtained less than 2 min after injection) and late postcontrast (obtained 5 min after injection). For each sequence lesions were classified according to their visibility into three categories: definite lesion, probable lesion or absent lesion. RESULTS: Lesions were classified as well-defined in 55% of patients on the precontrast study, 89.5% on the early postcontrast study and 60.5% on the late postcontrast study. Of nine microadenomas not detected on the precontrast scans, all were clearly seen on the early post contrast scans; only four were well-defined on the late postcontrast study. Only one lesion was not seen on the early postcontrast study but was well-defined on precontrast study as a spontaneous high-intensity focal area: it was a hemorrhagic microadenoma. CONCLUSION: Our results suggest that the early postcontrast study is the most useful sequence for the detection of microadenomas. Precontrast image is necessary to detect hemorrhagic lesions; the late postcontrast sequence has a low additional diagnostic yield and seems unnecessary unless the other sequences are inconclusive.

Adenoma↗
PubMed1994

[Unilateral paralysis of the glossopharyngeal, vagus and hypoglossal nerves].

A 32-year-old woman complained of swallowing difficulty after a general seizure. Neurological examination revealed unilateral palsies of the 9th, 10th, and 12th cranial nerves. CT, MRI and internal carotid artery angiogram were normal. Selective catheterization of the external carotid artery and ascending pharyngeal system suggested a cranial nerve ischaemic arterial syndrome. The apparent sparing of the eleventh nerve may be explained by the double vascularization of this nerve. This may also be related to the double innervation of the trapezius and sterno-cleido-mastoid muscles by the 11th nerve and cervical spinal nerves.

Adult↗
PubMed1994

[Value of vertebroplasty combined with surgical decompression in the treatment of aggressive spinal angioma. Apropos of 3 cases].

Vertebral hemangiomas can cause difficult-to-treat neurological complications. We report our experience with three such cases. Patients no. 1 and 2 were females aged 64 and 71 years, respectively; patient no. 1 had a two-year history of weakness in the lower limbs and patient no. 2 had a five-month history of back pain. Both these patients had a pyramidal syndrome in the lower limbs. Patient no. 3 was a 61 year old male with a one-year history of left sciatica. Roentgenograms were suggestive of a hemangioma occupying the entire T8 (cases 1 and 2) or L5 (case 3) vertebra. Computed tomography and magnetic resonance imaging confirmed this diagnosis and showed that patients 1 and 2 had an anterior epidural hemangioma opposite T8 impinging on the spinal cord. In patients 1 and 2, treatment consisted in embolization of T8 followed by transpedicular injection of 6 cc of methylmethacrylate into the body of T8. One cubic centimeter of histoacryl was also injected in each lamina. The third patient had a similar vertebroplasty procedure without prior embolization since he had no epidural hemangioma. One patient (no. 1) developed intercostal neuralgia of several hours duration after the procedure. All three patients subsequently underwent laminectomy (T7-T8 with removal of the epidural hemangioma in cases 1 and 2, L5 in case 3). The pyramidal syndrome resolved within 15 days in patients 1 and 2; the nerve root pain resolved within 48 hours in patient 3.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Pure sensory stroke revealing a complex malformation of extra- and intracranial cerebral arteries.

Pure sensory strokes (PSS) are usually due to thalamic lacunar infarcts. We report a case of PSS in a 34-year-old female suffering from migraine who complained of sudden isolated left-sided paresthesia involving face, upper and lower limbs. We found a complex vascular abnormality associating internal carotid artery occlusion, posterior cerebral artery agenesia, aneurysm at the posterior face of the carotid siphon and angiomatous rete at the top of the basilar artery. The acquired origin of the carotid artery occlusion by possible neonatal dissection is probable since this patient has a permeable carotid canal on CT scan.

Adult↗
PubMed1993

[Searching for prolactin microadenoma: scanner or MRI?].

Thirty three hyperprolactinemic women, aged 16-46 years, have been investigated by pituitary CT and MRI scans, searching for a microadenoma. The MRI scan with Gadolinium injection (MRI G+) appeared more efficient than the CT scan to detect a picture highly suggestive of a microprolactinoma (30/33 positive scans vs 21/33, respectively, p = 0.06). However, when the CT scan was performed optimaly (i.e. thin cuts, sequential imaging after iode injection, no artefact), its diagnostic potenty was close to the one of MRI G+, missing only 17.6% of lesions. All these were less than 5 mm in diameter. The indirect signs of microadenoma (focal convexity of the superior surface of pituitary, tilting of pituitary stalk, focal sella floor erosion or destruction) had a minimal value. Their sensitivity was 66.6% and 63.3 for convexity, and 63.3 and 46.6% for tilting of pituitary stalk, by MRI and CT scans, respectively. Therefore, they did not afford any help in our experience. Considering the cost and the limited accessibility of MRI, at least in our country, we advise to use CT scan as the primary morphologic means to detect a microadenoma.

Adolescent↗
PubMed1992

Prevalence and significance of hyperdense middle cerebral artery in acute stroke.

BACKGROUND AND PURPOSE: Early noncontrast computed tomographic scans may visualize a hyperdense middle cerebral artery before the infarct becomes visible. This sign disappears within a few days, corresponds to the clot itself, and might be associated with a poor prognosis. The aim of the study was to determine its prevalence, diagnostic value, relationship to demographic data, ability to separate embolic from nonembolic causes, short-term prognostic value, evolution over time, and relationship to arterial occlusion on angiography. METHODS: We performed this study using computed tomographic scans performed within 12 hours after onset in 272 consecutive unselected patients with a first acute cerebrovascular event. RESULTS: Seventy-three subjects had the hyperdense middle cerebral artery sign, leading to a prevalence of 26.8% in the whole group and 41.2% in patients with a middle cerebral artery infarct. Specificity was 100%, but sensitivity was only 30%. This sign was not dependent on cerebrovascular risk factors, but was more likely to occur in cortical and in large, deep, middle cerebral artery infarcts (p less than 0.01). It provided only a 3.5% gain in predicting death, and one fifth of patients with the sign recovered within 2 weeks; this sign was not an independent variable of poor outcome on multiple linear regression. It spontaneously disappeared within a few days and was always related to an occlusion of the middle cerebral artery in patients who underwent early angiography. CONCLUSIONS: The hyperdense middle cerebral artery sign is useful in the diagnosis of middle cerebral artery occlusion but does not always predict a poor prognosis.

Acute Disease↗
PubMed1991

Early hypopituitarism following cavernous sinus thrombosis: total recovery within 1 year.

Hypopituitarism related to cavernous sinus thrombosis is a very rare event which usually occurs at least 1 year after the acute stage. We report a case which distinguished itself from the previously reported cases through (i) its occurrence during the acute stage and (ii) its total recovery within 1 year. Early anterior hypopituitarism is probably more frequent than expected on the basis of reported cases and it may contribute to the high rate of mortality in cavernous sinus thrombosis. This underscores the need to consider hypopituitarism in every patient with cavernous sinus thrombosis.

Adult↗
PubMed1991

Monosporium apiospermum meningoencephalitis: a clinico-pathological case.

Twenty nine cases of central nervous system infection due to Monosporium apiospermum have been reported. Six of them occurred after an aspiration pneumonia following a near drowning. The case of a 53 year old man is reported: M apiospermum was isolated from cerebrospinal fluid, sputum, urine and from the mud of the ditch where the patient had fallen. Though the treatment used recommended doses of intravenous, intrathecal and intraventricular amphotericin B, it was ineffective and the patient died 97 days after the near drowning. Necropsy showed that the ventricular infectious process was more prominent distant from the antifungal ventricular source.

Brain↗
PubMed1989

MRI in the diagnosis of so-called pituitary apoplexy: seven cases.

The authors describe seven cases of pituitary adenoma with acute neurological symptoms (the so-called pituitary apoplexy), which were examined by magnetic resonance imaging (MRI). Four patients underwent surgery and the diagnosis of pituitary adenoma was histologically confirmed. In 3 patients, conservative treatment was decided and serial MRI examinations showed progressive decrease in size of the tumour, leading in one case to an empty sella. Computerized tomography (CT) was positive in all 7 cases, but less contributive than T1-weighted MRI images both for tumoral volume determination and detection of intratumoral haemorrhage. Although theoretical problems may arise concerning the diagnosis of acute intratumoral bleeding at an early stage, the authors emphasize the value of MRI in showing the extension of the tumor into the retroclival cistern and the cavernous sinus, especially when surgery is not performed in the acute period.

Acute Disease↗
PubMedDate not supplied

Cerebral venous infarction following thrombosis of the draining vein of a venous angioma (developmental abnormality).

We report two cases of cerebral venous angioma presenting as venous infarction, one in the left parietal lobe, the other in the left frontal lobe. Cerebral imaging demonstrated thrombotic occlusion of the draining vein of the venous angioma associated in the latter case with thrombosis of the anterior part of the superior longitudinal sinus. Both patients were free of coagulopathy. They were treated with anticoagulant therapy. One completely recovered, while the other was left with slight residual disability. Thrombosis of the draining vein has been reported in only 6 previous cases, of whom only 2 received anticoagulant therapy. Discovery of a venous angioma in the diagnostic workup of a patient with recent neurological disorders should raise the question of a possible occlusion of the draining vein and lead to an appropriate therapy.

Adult↗