Pure ipsilateral central facial palsy and contralateral hemiparesis secondary to ventro-medial medullary stroke.

Medullary infarcts are occasionally associated with facial palsy of the central type (C-FP). This finding can be explained by the course of the facial corticobulbar (F-CB) fibers. It is believed that fibers that project to the upper facial muscles decussate at the level of the facial nucleus, whereas those destined to the lower facial muscles decussate more caudally, at the level of the mid or upper medulla. It has been proposed that the lower F-CB fibers descend ventromedially near the corticospinal tract to the upper medulla where they cross midline and ascend dorsolaterally. Accordingly, ventromedial medullary infarcts are expected to result in contralateral facial and limb weakness. We report a patient with a medial medullary infarct restricted to the right pyramid and associated with ipsilateral C-FP and contralateral hemiparesis. The neurological findings are discussed in light of the hypothetical course of the F-CB fibers in the medulla.

[Myocarditis versus myocardial infarction in diabetic patients: a new role for non invasive imaging]. / Myocardite ou infarctus chez le diabétique: un nouveau rôle pour l'imagerie non invasive.

A young diabetic patient was referred to our institution for clinical symptoms of myopericarditis. Cardiac MRI and MDCT of the coronary arteries were performed successively. They demonstrated an acute myocardial infarction related to a left circumflex coronary artery occlusion which was treated by stent angioplasty. This case suggests that cardiac MR and possibly cardiac MDCT could be proposed in patients with a suspected myopericarditis, especially if diabetes mellitus is associated.

[Management of abdominal trauma in children]. / La prise en charge des traumatismes abdominaux de l'enfant.

Management of abdominal trauma in children has considerably changed over the last fifteen years. This is mainly due to advances in imaging techniques combined with a more conservative approach. Non-surgical management is frequently preferred with close clinical and biological surveillance, in addition to comprehensive imaging evaluation. The imaging work up must be adapted to this conservative approach. The increasing availability of helical CT technology and Doppler US imaging can be used to advantage in the evaluation of these patients. Euratom Directive 97-43 identifies children as a particular subgroup of patients with regards to exposure to ionizing radiation thus requiring us to reconsider the routine use of CT in this patient subpopulation and promoting the use of alternate imaging techniques. Based on a review of the literature as well as our own experience, where we currently favor US with selective use of CT, the advantages and pitfalls of each imaging technique will be reviewed. Ultimately, the imaging protocol for each patient should be based on availability, expertise, and individual clinical setting.