[Sea horse, silkworm, ram, hippopotamus, dolphin: the hippocampus or Ammon's horn bestiary].
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Biomedical subjects
Publications and source records attributed to Y De Smet.
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A female patient treated by mechanical ventilation with high doses of pancuronium and methylprednisolone for status asthmaticus presented with acute total areflexic and severe amyotrophic tetraplegia; she died after multiple organ failure. Muscle biopsy confirmed the clinical diagnosis of "acute corticosteroid myopathy", precipitated by a corticosteroid "disuse hypersensitivity" after pancuronium. The electromyogram showed a critical illness polyneuropathy, secondary to multiple organ failure. Nerve biopsy was normal. The respective parts played by corticosteroids, curare-like derivatives and intensive care in the genesis of unexplained difficulty in weaning from the ventilator are discussed.
Non ischemic anterior borderzone brachial paralysis. Anterior borderzone brachial paralysis (ABBP) is a hemodynamic ischemic syndrome of the watershed zone between the anterior and middle cerebral arteries. Two cases of non ischemic reversible ABBP are reported. The first suffered from multiple sclerosis; a CT-scan showed a lesion of the corona radiata, at the level of the anterior hemispheric borderzone. The second suffered from lung adenocarcinoma. A CT-scan showed multiple metastases, one being surrounded with oedema at the level of the anterior borderzone. According to its reversibility, the ABBP was reported to the inflammatory-oedematous reaction and not to a demyelinating or metastatic lesion itself. As ABBP may occur unilaterally, the name "one-armed man syndrome" should be used instead of "man-in-the-barrel syndrome" (which always implies a bilateral paralysis).
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A patient, treated by mechanical ventilation with pancuronium or atracurium and with intravenously administered corticosteroid for status asthmaticus, presented with rhabdomyolysis (severe amyotrophy and marked of creatine kinase activity) and acute flacid and areflexic quadriplegia, involving the proximal and distal muscles but sparing the cephalic musculature. After review of the investigations (biochemistry, electromyogram, muscle biopsy), the diagnostic of acute corticosteroid myopathy following status asthmaticus was suggested, and a pancuronium neuromuscular complication or a critically ill polyneuropathy excluded. The non-inflammatory rhabdomyolysis concerned all the fiber types. Predominantly distal weakness resolved six months after the insult, in spite of the laboratory recurrence of the rhabdomyolysis at the time of a new status asthmaticus briefly treated with corticosteroid.
A rare case of avoiding phenomenon presenting as transient ischemic attacks is reported. The distal anterior parietal artery was probably occluded.
A patient with capsulo-lenticular cavernous angioma presented with transient hemiparetic attacks. A diagnosis of transient ischemic attacks has been accepted and a platelet thrombo-embolic mechanism is suggested.