Assessment of facial pain and headache before and after nasal polyposis surgery with the DyNaChron questionnaire.

OBJECTIVES: Facial pain/headache is reported in 16-67% of nasal polyposis (NP) patients. This wide range may be due to differences in assessment methods. The present prospective study assessed facial pain/headache and quality-of-life (QoL) impact before and after NP surgery. METHODS: Pain was assessed on the DyNaChron self-administered questionnaire in patients undergoing NP surgery, the day before the procedure (V0) and 6 weeks (V1) and 7 months (V2) after. All patients underwent the same nasalization procedure, sparing the middle turbinates when possible. The questionnaire extract comprised 1 item assessing pain, 13 assessing physical impact and 4 assessing psychosocial impact, with responses on visual analog scales (VAS) graded 0 (no discomfort) to 10 (unbearable discomfort). RESULTS: Sixty-three patients (mean age: 50.6±12.8 years; 32 male [50.8%], 31 female [49.2%]) were included. Thirty-seven patients (58.7%) had history of NP surgery. Fifty-two percent reported moderate to severe pain before surgery, 17.5% at 6 weeks, and 22.2% at 7 months. One-third reported no pain preoperatively, versus a half at 6 weeks and 7 months. Scores for the physical and psychosocial impact of pain were improved after surgery. CONCLUSION: Headache/facial pain is frequent in patients for whom NP surgery is indicated. Endoscopic surgery relieves the symptom and its physical and psychosocial impacts. However, one-fifth of patients reported residual postoperative pain.

Suprasellar arachnoid cyst after subdural haemorrhage in an infant. A case based update.

INTRODUCTION: Brain arachnoid cysts (AC) are congenital or acquired malformations. Their prevalence in children ranges between 0.2 and 2.3% of the studied populations. Few reported studies exist where AC appears after a subdural haemorrhage. METHODS: We present one case of a symptomatic suprasellar AC after post-traumatic subdural haemorrhage in an infant. RESULTS: After endoscopic ventriculocystostomy, the child quickly improved and the cyst reduced in size. The child was monitored for 22 months and his neurocognitive development remained normal. CONCLUSION: Our case led us to the hypothesis that the inflammatory process due to subdural haemorrhage may locally result in arachnoiditis, and thus to the creation of a neomembrane, and eventually to cyst formation. This is also the case with the development of post-traumatic spinal AC.

[Early somatosensory (SEP) and auditory (AEP) evoked potentials in anoxic coma: prognostic value]. / Les potentiels évoqués somesthésiques (PESp) et auditifs (PEAp) précoces dans les comas anoxiques: valeur pronostique.

Early somatosensory (SEP) and auditory (BAEP) evoked potentials, when recorded within the first seven days of the course of anoxic coma, appear to be reliable to evaluate anoxic ischemic cortical or under-cortical lesions. Prognosis depends especially on cortical SEP (N20-P25): the lack of SEP is a good outcome predictor of death (abnormal BAEP) or of vegetative status (normal BAEP); the presence of normal and bilateral cortical SEP (with normal BAEP) allows to predict awakening, without prejudging of neurologic sequelae, even if they are severe.

[Neurological manifestations in the vertebro-basilar system suggesting pregnancy toxemia]. / Manifestations neurologiques en territoire vertébro-basilaire révélatrices d'une toxémie gravidique.

Early CT scan showed a large hypodensity throughout midbrain. Brainstem auditory evoked potential showed initially an abolition of III and V pikes suggesting brainstem injury. Two days later neurologic examination and brain stem auditory evoked potential returned to normal. CT scan performed three weeks after the onset was normal. These finding suggest a vasospasm; in this case betasympathomimetic agents given two weeks before the onset of toxemia for preterm labor could lead to the vasospasm.

[Neurologic manifestations in the vertebro-basilar system revealing pregnancy toxemia]. / Manifestations neurologiques dans le territoire vertebro-basilaire révélatrices d'une toxémie gravidique.

We report a case with focal neurological deficits suggesting vertebro-basilar system ischemia, in the course of pre-eclampsia. An early CT scan showed a large hypodensity throughout the midbrain. Brainstem auditory evoked potentials initially showed an abolition of III and V pikes suggesting brainstem injury. Two days later both neurological examination and brain stem auditory evoked potentials returned to normal. A CT scan performed three weeks after the onset was normal. These findings suggest a vasospasm which may have been due to sympathomimetic agents given two weeks before the onset of toxemia for preterm labor.

[Early somatosensory and auditory evoked potentials in anoxic coma. Role in evaluating and prognostic value]. / Les potentiels évoqués somesthésiques et auditifs précoces dans les comas anoxiques. Intérêt dans le bilan lésionnel et valeur pronostique.

Early somatosensory (ESEP) and auditory (EAEP) evoked potentials were recorded in 27 patients with severe coma (Glasgow score less than 5) following cardiorespiratory arrest, within the first 7 days of its course. Somatosensory responses were elicited by stimulation of the median nerve. ESEP were abolished in 17 patients due to a parietal thalamo-cortical lesion. Among these, 6 patients died within one month and 11 presented with a persistent vegetative state. In all patients EAEP were obtained, showing functional brainstem activity. Low-voltage EAEP, especially for peak V (inferior colliculus or upper part of the brainstem), was sometimes observed. One patient, in whom ESEP and EAEP were initially abolished, died rapidly. In 9 other patients scalp-recorded ESEP and EAEP were normal; all emerged from coma including 5 with good neurological recovery and 4 with neurological sequelae. Clinical, electroencephalographic and computerized tomographic data appeared to be devoid of predictive value at the same initial period. In view of their sensitivity to anoxia and to cerebral oedema, even with neurosedative drugs, ESEP seemed to be reliable in predicting outcomes and in evaluating central nervous system lesions at cortical and subcortical levels (basal ganglia and brainstem) after cardiorespiratory arrest.

[Evoked potentials in comatose children]. / Les potentiels évoqués chez les enfants comateux.

Auditory and somatosensory EPS obtained after median nerve stimulation are an interesting approach for the central nervous system investigation. However, there are some problems of interpretation during the first year of life, related to the maturation of the nervous system. We studied 20 severely comatose children aged 8 months to 15 years, admitted in an intensive care unit. Most of them were intubated, mechanically ventilated and received high doses of barbiturates. Coma was related to severe head injury, meningitis, encephalitis, Reye syndrome, malignant hyperthermia, cerebral lymphoma. Normal EP are correlated with a good recovery. Patients with abnormal EP may die or exhibit neurological sequelae. The absence of somatosensory EP is correlated with a bad outcome and is generally related to cerebral oedema. Appreciation of the prognosis in comatose children may be improved by repeated determination of auditory and somatosensory EP.

El electroencefalograma en el insuficient renal crónico tratado por hemodiális / EEG in the patient with insufficiency treated with hemodyalisis

Treinta enfermos en insuficiencia renal crónica han tenido un electroencefalograma sistemáticamente antes y después de la hemodiálisis. Hemos buscado las correlaciones entre los resultados electroencefalográficos y los datos biológicos, el aumento de peso corporal y otros factores clínicos asociados. Un examen tipo Scanner ha permitido eliminar las anomalías morfológicas en los sujetos que presentaban una asimetría en el EEG. No hemos tenido ningún caso de encefalopatía debida al aluminio, entre nuestros enfermos, pero un caso de hematoma subdural se presentó durante la hemodiálisis. El EEG representa un buen medio de control de la tolerancia de la hemodiálisis y permite prevenir las crisis comiciales y las complicaciones, ligadas ya sea a la depuración o a la enfermedad misma

El electroencefalograma en el insuficient renal crónico tratado por hemodiális / EEG in the patient with insufficiency treated with hemodyalisis

Treinta enfermos en insuficiencia renal crónica han tenido un electroencefalograma sistemáticamente antes y después de la hemodiálisis. Hemos buscado las correlaciones entre los resultados electroencefalográficos y los datos biológicos, el aumento de peso corporal y otros factores clínicos asociados. Un examen tipo Scanner ha permitido eliminar las anomalías morfológicas en los sujetos que presentaban una asimetría en el EEG. No hemos tenido ningún caso de encefalopatía debida al aluminio, entre nuestros enfermos, pero un caso de hematoma subdural se presentó durante la hemodiálisis. El EEG representa un buen medio de control de la tolerancia de la hemodiálisis y permite prevenir las crisis comiciales y las complicaciones, ligadas ya sea a la depuración o a la enfermedad misma (AU)

Los potenciales evocados somestésicos en la insuficiencia renal crónica tratada por hemodiálisis / The somatosensory evoked potentials in chronic kidney failure treated with hemodialysis

La actividad de las vías lemniscales en respuesta a la estimulación del nervio mediano en el puño puede ser registrada a distancia por medio de electrodos localizados sobre el scalp. Estos potenciales evocados somestésicos precoces (PESp) tienen una polaridad positiva y sus latencias están comprendidas entre los 9 y 15 mseg. Le siguen los PES de latencia intermedia, de origen parietal N20 y N25. En el adulto se recogen cuatro potenciales evocados somestésicos precoces (PESp) sobre el scalp (P9, P11, P13 y P14), dos de ellos constantes, P9 y P14. Se registraron los PES en 20 enfermos en hemodiálisis crónica. Las latencias de culminación se mostraron alargadas, evidenciando la polineuropatía de estos enfermos. Por otra parte, el tiempo de conducción central (TCC) calculado entre N13-N20 no mostró diferencias estadísticamente significativas, en relación con el grupo testigo. En algunos enfermos los PESp mostraron una amplitud reducida, traduciendo la neuropatía axonal. Por el contrario, en los enfermos con más de siete años de tratamiento de hemodiálisis se encontró una amplitud aumentada del potencial cortical P25, calculado entre el pico máximo del potencial negativo N20 y el pico del potencial positivo P25. Quizás la insuficiencia renal crónica y su tratamiento por hemodiálisis periódicas podrían modificar no sólo las latencias de los PES, sino también la amplitud, al tocar los niveles de excitabilidad corticales y subcorticales implicados en la génesis de los PES

Los potenciales evocados somestésicos en la insuficiencia renal crónica tratada por hemodiálisis / The somatosensory evoked potentials in chronic kidney failure treated with hemodialysis

La actividad de las vías lemniscales en respuesta a la estimulación del nervio mediano en el puño puede ser registrada a distancia por medio de electrodos localizados sobre el scalp. Estos potenciales evocados somestésicos precoces (PESp) tienen una polaridad positiva y sus latencias están comprendidas entre los 9 y 15 mseg. Le siguen los PES de latencia intermedia, de origen parietal N20 y N25. En el adulto se recogen cuatro potenciales evocados somestésicos precoces (PESp) sobre el scalp (P9, P11, P13 y P14), dos de ellos constantes, P9 y P14. Se registraron los PES en 20 enfermos en hemodiálisis crónica. Las latencias de culminación se mostraron alargadas, evidenciando la polineuropatía de estos enfermos. Por otra parte, el tiempo de conducción central (TCC) calculado entre N13-N20 no mostró diferencias estadísticamente significativas, en relación con el grupo testigo. En algunos enfermos los PESp mostraron una amplitud reducida, traduciendo la neuropatía axonal. Por el contrario, en los enfermos con más de siete años de tratamiento de hemodiálisis se encontró una amplitud aumentada del potencial cortical P25, calculado entre el pico máximo del potencial negativo N20 y el pico del potencial positivo P25. Quizás la insuficiencia renal crónica y su tratamiento por hemodiálisis periódicas podrían modificar no sólo las latencias de los PES, sino también la amplitud, al tocar los niveles de excitabilidad corticales y subcorticales implicados en la génesis de los PES (AU)

[Neurophysiologic study of 2 cases of hemianesthesia as a result of subcortical lesions. Results of recording far-field somatosensory evoked potentials]. / Etude neurophysiologique de deux observations d'hémianesthésie par lésion sous-corticale.

The volume-conducted responses of the lemniscal pathways to median nerve stimulation at wrist may be recorded on the scalp (far-field potentials). These positive far-field SEPs components are widely distributed on the scalp and their peaking latencies vary between 9 and 15 milliseconds. In normal adults a maximum of 4 far-field potentials (P9, P11, P13 and P14) may be individualized; two of them (P9 and P14) are constant. These SEPs were studied in two patients with lateralized somatosensory loss; one with a cervico-medullary traumatic lesion, the other with a thalamic infarct. These observations allow the following conclusions 1) the P9 component takes origin in the proximal part of the brachial plexus roots; 2) the P14 potential has a brainstem origin; 3) the contralateral N20 potential is generated in (or close to) the primary somato-sensory cortex (SI). Thus it is possible with a single channel to record the activity of the somatosensory pathways from dorsal roots up the parietal cortex.