[Abnormalities of the interatrial septum associated with cerebral ischemia in young adults: Contribution of trans-oesophageal echocardiography]

About 40% of the mechanism of ischaemic stroke in young adults remains unclear. A paradoxical embolism associated with persistence of a patent foramen ovale and/or the presence of an atrial septal aneurysm are significantly more frequent in patients examined for ischaemic stroke of unknown cause than in control subjects. Was to evaluate the contribution of trans-oesophageal echocardiography to the diagnosis of abnormalities of the interatrial septum and to identify the role played by this condition in unexplained ischemic stroke. In 30 consecutive patients, trans-oesophageal echocardiography recording were made during a saline contrast study. Abnormalities of the interatrial septum was diagnosed in 23.3% cases. The proportion of patent foramen ovale was 10% [3 patients]; atrial septal aneurysm was detected in 6.6%[2 patients]. The prevalence of patent foramen ovale associated with atrial septal aneurysm was 6.6% [2 patients]. Transesophageal echocardiography with contrast appears to be an effective exam in diagnosis of abnormalities of the interatrial septum and our study was suggestive of their embolic nature

Encephalopathie posterieure reversible

Posterior reversible encephalopathy [PRE] is a recent syndrome characterized by headache, vomiting, seizures, visual loss, altered mental status with or without motor or sensitive deficit. Neuroimaging demonstrates symmetrical posterior cortical and subcortical lesions. The aetiology remains uncertain but vascular hypotheses is the most retained. We report a case of a 21 year old man with posterior cerebral encephalopathy; the toxic hypothesis remains the most probable

Neurofibromatose de type 1 et epilepsie

Epilepsy has been rarely reported with type 1 neurofibromatosis [Reckling Hausen disease]. It may occur in 3 to 6% of cases. We report in this study three cases of patients with type I neurofibromatosis associated with epilepsy. The patients were respectively 23, 30 and 35 years old. Epilepsy was focal and complex in one patient, generalized in one case and simply focal in another one. Cerebral MRI showed sphenoidal dysplasia and temporal lobe ectopy compressing orbital structures in one patient and normal in the other cases. We discuss through these three cases the relationship between Reckling Hausen disease and epilepsy

Accidents vasculaires cerebraux ischemiques du sujet jeune

Objectives The purpose of this study was to determine etiologies and outcome of strokes in young adults. Patients and methods We studied retrospectively 48 cases of patients with transient ischemic attack or arterial ischemic stroke aged between 15 and 48 years admitted in the Neurology and Cardiology Departments of the University Hospital of Monastir from 1987 to 1996. The study variables included the full clinical spectrum, spanning historical, laboratory, radiological and outcome parameters. Results Thirty four were female and 14 male, the mean age was 33 +/- 8,8 years, with a peak in the 4th decade. Our series is caracterised by the higher incidence of cardioembolic dominated by prosthetic valve. 62,5% of patients had common vascular risk factors. Non-atherosclerotic arteriopathies were observed in six cases uncommun etiologies of ischemic stroke [Moya-Moya disease, Tokayasu's disease] Etiology remain indeterminated in four cases. Mortality rate was 8,5%. Reccurrences were observed in 12,5%. 29% of patients have recovered a complete autonomy while 26% have conserved severe handicap. Conclusion We found a higher incidence of cardioembolic diseases dominated by prosthetic valve