[Rupture of an intracerebral dermoid cyst. Apropos of a case: x-ray computed tomographic aspects]. / Rupture d'un kyste dermoïde intra-cérébral. A propos d'une observation: aspect tomodensitométrique.

We report the C.T. findings of a dermoid cyst communicating with ventricular system and ruptured in the subarachnoid space. A fat-fluid level and calcifications were present on the plain skull X rays.

[Benign intracranial hypertension (17 cases) and cerebral venous thromboses (49 cases). Comparative study]. / Hypertension intracrânienne bénigne (17 cas) et thromboses veineuses cérébrales (49 cas). Etude comparative.

A series of 49 cases with cerebral venous thrombosis (CVT) and a series of 17 cases with benign intracranial hypertension (BIH) without CVT, both observed between 1973 and 1983, have been compared. Papilledema has been found in 100% of BIH and 28.5% of CVT, visual acuity loss in 52% of BIH and 6% of CVT, obnubilation in 0% of BIH and 65% of CVT. Cerebrospinal fluid, EEG, cerebral angiography and Scanner were normal in all cases of BIH, while in CVT the same investigations were abnormal in respectively 90%, 100%, 100% and 54% of cases. Prognosis was excellent in BIH with only one residual mild loss of visual acuity. Recurrences occurred in 18% of BIH. Among CVT 18% died, 23% developed neurological sequelae, 59% totally recovered. There was no recurrence. On the basis of this comparative study we emphasize the following points: 6% of CVT only follow a course of BIH from end to end, according to Johnston and Paterson's diagnostic criteria of BIH. These cases concern only thrombosis of lateral sinuses. Other cases of CVT rather deal with patients admitted in neurosurgical units on emergency. Diagnosis of CVT is a difficult one and prognosis is still serious in spite of the use of Heparin. 85% of BIH are irrelevant to CVT. BIH is a "quiet" intracranial hypertension without trouble of vigilance. Prognosis is really good if diagnosis is early made, in spite of possible multiple recurrences. Treatment consists of CSF subtraction, preferably through external lumbar drainage, and Acetazolamide prescription. Head injuries and hormonal imbalance in women are two common etiologies of BIH and CVT.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute benign cerebral angiopathy. 6 cases]. / Angiopathie cérébrale aiguë bénigne. Six observations.

The 6 cases reported here constitute, with 5 previously published cases, a special nosological entity tentatively called "acute benign cerebral angiopathy" by the authors. These 11 cases have in common certain radiological and clinical features. Arteriography shows segmental, multifocal and assymetrical stenoses involving the cerebral arteries between Willis' circle and the terminal arterioles and looking like "strings of sausages". The lesions disappear within one month and present the radiological characteristics of arteritis of medium caliber vessels. The clinical symptoms are suggestive of meningeal haemorrhage or acute cerebromeningeal oedema, with acute repetitive attacks of severe headache and agitation with obnubilation; epileptic seizures and transient neurological deficit may occur. True meningeal haemorrhage confirmed by lumbar puncture is seen in nearly one half of the cases; it seems to be due to alterations in the blood-brain barrier induced by the angiopathy. Intracerebral haematoma may develop, but the disease is usually benign and regresses spontaneously in a few days. None of the usual causes of cerebral arteritis (intra-cranial infection, collagen disease, allergic or toxic angitis) has been found. Pseudo-arteritis (notably spasm of ruptured arterial aneurysms) has been excluded. No aetiological factor common to the 11 cases reported has been elicited, although 6 of the patients had recently given birth and our 6 patients had benign virus infection before or during the clinical manifestations of the disease. In the authors' opinion, the most rewarding line of research would be the role of short acute attacks of arterial hypertension.

Fever and cerebral vasospasm in ruptured intracranial aneurysms.

The temperature curves of 262 patients affected by subarachnoid hemorrhage, including 107 arterial aneurysms, 26 arteriovenous malformations, 42 idiopathic subarachnoid hemorrhages, and 87 cerebral hemorrhages, were observed and classified into three types: Type I: absence of fever; Type II: fever oscillating between 37 degrees and 38 degrees C; and Type III: fever with a plateau between 38 degrees and 39 degrees C beginning on the fifth day at the latest and lasting an average of nine days, with a decline over the next three days. Type III was observed in 3.8% of the patients with arteriovenous malformations, 7% of those with cerebral hemorrhages, and 88.3% of those who had arterial aneurysms with severe angiographic vasospasm associated with delayed ischemic signs. We suggest that the delayed fever is not a simple sign of meningeal syndrome but a sign related to cerebral vasospasm.

[Pre-operative non-shaving for neurosurgical operations (author's transl)]. / Le non rasage pré-opératoire en neurochirurgie.

The authors report their pre-operative technique for scalp attendance according to which they operated on more than 1000 cranial neurosurgical patients in three years without the classical complete hair shave. Major psychological advantages are obvious. Principle technical details are: as complete cleaning of scalp-grease as possible by repeated shampoos; in the operating room: shaving only a thin pathway along the skin incision drawn by the surgeon himself, and disinfection with tincture of iodine exclusively. During the same time, they observed a fall to 0,6% of surgical infections needing bone flap removal because of osteitis. Secondary but always transitory partial alopecia has been observed in three patients.

[The narrow lumbar canal: 53 operated cases (author's transl)]. / Canal lombaire étroit: à propos de 53 cas opérés.

These 53 operated patients were divided into 2 groups: 29 had an intermittent claudication as Verbiest first described it soon as 1949, whereas 24 had permanent radicular pain in legs as Epstein emphasized it. We think emulsified Duroliopaque myelography to be the best investigation to make sure the diagnosis and to forecast the operative tactics: we gave up Dimer X myelography which occasioned serious complications in 2 cases and gas myelography which seems to us inadequate to this radicular pathology. Total-Body Scanner is rather an elegant method but a discontinuous one. The radiographic and operative findings have shown the stenosis of the lumbar canal to be congenital in 5 cases, development in 20 cases, degenerative in 27 cases (with 15 pseudo-spondylolisthesis) and tabetic in one case. A disc herniation was found in 25 cases over 53. The extent of the bone resection has been in relation with clinical picture, myelography and mainly operative findings, aiming at a "cut-to-measure costum". In every case the initial laminectomy was made easier by trenching the thickened laminae on each side of the spinal process prior to remove it. Only soft disc hernations were removed; the dura was never opened; no vertebral fusion was performed; for 2 years we have tried to avoid the "laminectomy membrane" by interposing an autogenous fat and aponevrotic graft between the dura and the overlying paraspinal muscles. The operative results are satisfactory with 75% of excellent and good; they are much better in patients with intermittent claudication than in those with permanent radicular pain. It is a question of functional surgery in one case, of pain surgery in the other. The major trick seems to us to be that of the associated disc hernation with the risk of missing the narrow canal.

[Inter thalamo-trigonal approach to the third ventricle (author's transl)]. / Accès au troisième ventricule par voie inter-thalamo-triagonale.

The exploration and surgical treatment of the lesions of the 3rd ventricle may be carried out without sectioning the anterior columns of the trigonum. The body of the trigonum and the choroid tissue are lifted sometimes at the cost only of the sectioning of the thalamostriated vein. The absence of mnesic trouble particularly in benign tumours of the third ventricle is the essential advantage of same. Access is very much wider particularly for the posterior part of third ventricle.

[Intracrânial venous sinus thrombosis (22 cases) (author's transl)]. / Thrombose des sinus veineux intra-craniens (à propos de 22 cas).

The authors report 22 cases of intracranial venous sinus thrombosis and study what is new about that old pathology. Sagittal superior sinus is still the most touched one, followed by the lateral sinuses. Half of the cases are traumatic: their clinical picture consists either of benign intracranial hypertension, either of intracranial hypertension and neurological signs. Puerperal thrombosis of the sinuses have quite disappeared and have been replaced by thrombosis in women taking oestro-progestional agents, whose clinical picture is absolutely the same. Infectious thrombophlebitis are quite less frequent than intracranial abcesses, whose diagnosis must be made first. About diagnosis, the certitude is still given by bilateral carotid arteriography which demonstrates the thrombosed sinus, whereas cerebral scintigraphy shows whether their is an adjacent infarction of venous origin or not. Treatment is a medical one. It consists rather of methods to reduce cerebral volum, aiming at maximal use of collateral varices. Heparin should be used only if there is no cerebral infarction of venous origin. Total mortality is 27% and among survivals there are few sequels. Prognosis depends on the thrombosed sinus, on the rapidity for clinical signs to appear and especially on the anastomotic venous collateral ability demonstrated by carotid angiography.

[4 cases of traumatic cerebral aneurysms are reported (author's transl)]. / Anévrysmes artériels traumatiques de la convexité cérébrale. (a propos de 4 cas).

Among them: one aneurysm of the meningeal artery and 2 cases of aneurysm of cortical arteries. The delay between trauma--mild or severe--is variable: eight days to 3 weeks. Cerebral angiography is the only diagnostic procedure which can identify these traumatic aneurysms. Surgical treatment is discussed.

[Thrombosis of the intracranial venous sinuses after ingestion of estroprogestative agents. 4 cases]. / Thrombose des sinus veineux intra-crâniens après prise d'estro-progestatifs. 4 cas.

The authors report 4 cases of thrombosis of the superior longitudinal sinus (SLS) in women taking oestroprogestational agents. This complication is very rare, only 25 cases existing in the literature. The clinical picture consists of premonitory headaches associated with neurological signs suggesting lesions affecting both hemispheres in alternation. In the absence of treatment, sudden deterioration on about the tenth day is to be feared. This picture is similar to that of puerperal thrombosis of the SLS. The diagnosis should be confirmed by carotid arteriography, which demonstrates the presence of collateral varices and the thrombosed sinus giving a "negative" image on the AP view. Cerebral scintigraphy shows one or more areas of uptake in the form of adjacent rounded shapes, corresponding to cerebral infarctions of venous origin. As far as the responsibility of oestro-progenstational agents is concerned, the role is suggested by the analogy with puerperal thromboses and also by the absence of cases in men (with the exception of head injury, infections of the face and haematological malignancies). The prognosis is grave (19 deaths out of 29 cases), but surviving patients are completely cured. This prognosis would seem to be essentially dependent upon the possibilities of venous callateral circulation, which are variable in each individual patient. Anticoagulants and thrombolytic risk, in effective doses, to transform the venous thrombosis into a cerebral haemorrhage. Treatment consists rather of methods to reduce cerebral volume, aimed at maximal use of collateral varices and assisting the patient to overcome to acute phase of the first 2 weeks. Headache would seem to be the principal presenting symptom. In our opinion, no biological test gives a reliable indication as to those women most at risk and contraindictions are in fact of a clinical character.

PIP: 4 cases of thrombosis of the intracranial venous sinuses (TIVS) which occurred in patients 22-38 years of age who used oral contraceptives are discussed. Of the 29 reported cases of this type, 19 of the patients died. There are 3 stages in the evloution of TIVS: headache, hemispheric focus symptoms (e.g., Bravis-Jacksonian crises), and a phase of dramatic aggravation (e.g., severe headache, coma). Arteriography of the carotid artery and cerebral scintigraphy are the methods used to diagnose TIVS. Besides such predisposing factors as diabetes, obesity, migraines, etc., the use of oral contraceptives containing estrogen seem to be a factor in the development of TIVS, particularly within the 1st year of estrogen use. The reduction of cerebral volume seems to be the best treatment for TIVS: anticoagulants and thrombolytic compounds can cause fatal hemorrhaging

[Triple contrast ventriculography using air-lipiodol-dimer]. / La ventriculographie au triple contraste air-lipiodol-dimer.

A mixture of three contrast media - air, Lipiodol and Dimer - was used in ventriculography in order to combine the advantages of each of them. Air is used for topographical localisation, Dimer shows the overall shape of the ventricular system and Lipiodol outlines blocks. This simple and rapid technique provides easily interpretable films, whatever the indication for the ventriculography.