Juvenile distal cerebral ischemia: angiographic features. A study of 55 cases.

This study of juvenile distal cerebral ischaemia is based on 55 patients aged from 18 to 30 years. The authors describe the circumstances of discovery, as well as the clinical features and the course of the disease which may be severe and lead to non-resolutive neurological accidents and sometimes dementia. Paraclinical evaluation includes capillaroscopy, finger and toe pads biopsy (which clearly shows a pathological process with fibrocellular promontories narrowing the lumen of arterioles), and above all angiography which displays two typical signs: arterial narrowness and bands of peripheral ischaemia. In advanced forms of the disease angiography reveals classical signs of ischaemic lesions, but charateritically these are very distal. Associated abnormalities of the carotid siphon can also be found. Finally, positive CT scans show an isolated widening of the sulci which is fairly suggestive of the disease.

[Cervical melanotic neurofibroma. Apropos of a case and a review of the literature]. / Neurofibrome mélanotique cervical. A propos d'un cas et revue de la littérature.

The authors report a case of cervical melanotic neurofibroma hour glass shaped, growing in the extra and intradural spaces. Melanotic aspect of spinal neurofibroma are rarely reported in the literature. Various etiopathologies have already been discussed.

Bilateral spontaneous dissection of extracranial vertebral arteries.

A previously healthy 35-year-old man suddenly developed vertebrobasilar ischaemia while playing tennis. Cerebral arteriography revealed a dissecting aneurysm of the cervical portion of both vertebral arteries. The neurological deficit and the angiographic features resolved with anticoagulant treatment alone. Only 15 patients with non-traumatic extracranial vertebral artery dissection have been previously reported. It is necessary to recognize the condition very quickly, because the authors consider that anticoagulation is required as an emergency.

Operative treatment of thoraco-lumbar metastases, using methylmetacrylate and Kempf's rods for vertebral replacement and stabilization. Report of 15 cases.

The authors report their experience in the treatment of 15 cases in thoracolumbar metastases with spinal cord compression. A decompressive laminectomy was routinely performed and followed by a transversoarthropediculectomy. Most part of the neoplastic tissue was removed from the epidural space, vertebral body and retroperitoneal or retro-pleural areas. Complete decompression of the nervous elements was always achieved. Stabilization was obtained by replacement of the neoplastic vertebral body with a methylmetacrylate prothesis and eventually by Kempf's compression instrumentation. The surgical treatment was completed in a single stage operation, by a classical posterolateral approach. Orthopaedic, neurologic and oncologic advantages of this treatment are discussed.

[Treatment of foraminal disk hernia by conservative hemi-transverso-arthro-pediculotomy]. / Traitement des hernies discales foraminales par hémi-transverso-arthro-pédiculotomie conservatrice.

The authors report a new approach of the intervertebral foramen using a conservative hemi-transverso-arthro-pediculotomy. It allows to remove one half of the posterior neural arch and to follow the nervous bundle from its origin to the extra-foraminal space. Removal of the foraminal disc herniation is easy and safe. The monobloc is replaced to prevent any instability.

[Juvenile distal cerebral ischemia: value of pulp biopsy]. / Ischémie cérébrale distale juvénile: intérêt de la biopsie pulpaire.

Juvenile distal cerebral ischemia has been attributed to small artery atherosclerosis (Arnold, Benoit, Merlen, Dobbelaere, Delandsheer, 1979), based on clinicopathologic findings in one male patient and results of big toe pulp biopsy in three other cases. Pathological findings were obstruction of small artery lumens by hypertrophic endothelium and loose fibrocellular bands, their origin being the result possibly of partial intimalization of media by elastic neogenesis. Appearances were similar to those described by Dahl in human cerebral atherosclerosis in 1976, and approached those of the initial stages of experimental atheroma (Ross, Glomset, 1976). Arterial exiguity was also present in the 4 cases. Results of biologic, metabolic, inflammatory and immunologic examinations were negative. The present study concerns 4 additional cases of juvenile distal encephalic ischemia. One case in a female patient not on oral contraceptives confirmed the hypothesis of intimalization of media of arterioles of big toe pulp. Elastic neogenesis was present in the tunica media in areas where there was a change of direction of myocytes, and was apparent at a distance from the internal elastic layer. The latter was fragmented, sometimes doubles and of variable color. In another case, a woman taking oral contraceptives, there was almost total obstruction of the pulp arteriolar lumens with a very thin tunica media. Elastic neogenesis encircled two very narrow lumens in the center of the vessel and there were also elastic changes common to both.(ABSTRACT TRUNCATED AT 250 WORDS)

[Isolated cervicothoracic spinal amyotrophy caused by hydromyelia. Stabilization by a ventricular shunt]. / Amyotrophie spinale cervico-thoracique pure par hydromyélie. Stabilisation par dérivation ventriculaire.

A 25-year-old man developed marked weakness of the upper limbs and shoulder girdle over a period of 6 months. On examination there was amyotrophy, fasciculations and areflexia of the upper limbs with increased lower limb reflexes. Sensation and CSF were normal. CT scan showed a thickened cord with a central medullary cavity of triangular shape with a ventral base. Myelobulbography showed a type I Arnold-Chiari malformation. Spinal angiography was normal. Isotopic studies showed early ventricular reflux. Although infusion tests gave negative results a ventriculoperitoneal shunt was performed and the condition stabilized. Follow-up examination 4 years later confirmed the absence of sensory disorders and nervous arthropathies. The mechanism of production of cervical cord lesions during hydromyelia may be related to hydrocephalus, with fluid absorption across the ependymal walls, or to venous stasis determined by the Arnold-Chiari malformation. The ventral extension of the central cord cavity accounted for the isolated atypical lesion of the anterior horns.

[Medullary compression due to vertebral angioma in pregnancy. A case treated by embolization]. / Compression médullaire par angiome vertébral au cours de la grossesse. Un cas traité par embolisation.

A previously healthy 24 year old woman presented a progressive paraplegia during the third trimester of her second pregnancy. Partial improvement occurred after caesarian. The neuroradiological study revealed spinal cord compression by an extensive corporeo-pedicular angioma of the T2 vertebrae. Almost total recovery occurred after selective embolization. The occurrence of neurological complications of vertebral angiomas during pregnancy is rarely reported in the literature. Mechanisms of the spinal cord compression and their relations with the pregnancy are discussed and difficulties for diagnosis and treatment are emphasized. When technically possible, the embolization appears to be the most adapted treatment, especially for these extensive types of vertebral angioma.

[Acutely developing glioma and negative CT scan. Apropos of 3 cases]. / Gliomes d'évolution aiguë et scanner négatif. A propos de trois observations.

Three adults presented convulsive fits for the first time in their lives, and examination with a CT scan showed no anomalies. Repetition of the CT scans a few weeks later revealed the presence of evolving lesions. Based on these 3 cases and 11 previously published cases, the problem of "normal" CT scans and rapidly developing glioblastomas is discussed.