A child with mutism after bilateral thalamic infarction.

The occurence of mutism after thalamic lesions has rarely been observed before adulthood. We report a 6.5-year-old girl who presented with sudden mutism with a decreased level of alertness. Her MRI revealed a T2-fluid attenuated inversion recovery hyperintensity in both thalami, which suggested bithalamic infarction in the territory of the thalamo-perforating arteries and, more specifically, the para-median territories. Mutism was followed by a deficit of speech initiation with slow and slurred speech. Her speech returned to normal at 3 months after the onset of symptoms. Thus mutism could be the equivalent of akinetic mutism limited to the speech sphere.

[Reduplication of an event after right caudate nucleus haemorrhage]. / Paramnésie De Réduplication D'évènement Après Hémorragie Du Noyau Caudé Droit.

BACKGROUND: Environmental reduplication which is characterized by reduplication of places has been reported in right hemispheric lesions, particularly but not only in the right frontal region. However, spatial delirium may follow right sub-cortical lesions. METHODS: We describe a 53 years-old man who had a reduplicative paramnesia for event alone after an intracerebral haematoma of the right caudate nucleus. RESULTS: MRI Scan showed also an extension of the right caudate nucleus haemorrhage into the ventricular system. Regional cerebral blood flow studied with 99Tcm-HMPAO showed a decrease of perfusion in the right dorso-lateral frontal cortex. To our knowledge, we reported the first case of reduplicative paramnesia of event associated with a right caudate nucleus injury. Similar right frontal deactivation was observed in two cases of reduplicative paramnesia for place, one of them after an infarction of the retro-lenticular portion of the right internal capsulae, the other after a right thalamo-capsular haemorrhage. CONCLUSION: We suggest that reduplicative paramnesia for event, like the previous cases reported of reduplicative paramnesia for place, may be linked to a subcortical lesion of the frontal lobe inducing a right functional frontal deactivation.

[Contribution of neuroradiology to the evaluation of peripheral nerves]. / Apport de l'imagerie dans l'évaluation des nerfs périphériques.

The evaluation of peripheral nerve impairment can use echography, MRI and CT. The alteration of the nerves in tunnel syndromes, especially if symptoms are not sufficiently contributive, is clearly visualized with MRI. Echography is very useful in the diagnosis of nerve tumors and neuromas. Plexus brachial palsies need to be evaluated using MRI. Progress in neuroimaging has improved clinical practice so that the most relevant treatment can be chosen for some pathologies such as infiltration performed under CT scanner guidance. The authors report which exam to use and the results to be expected for each pathology.

[High resolution MRI of carotid atherosclerosis: looking beyond the arterial lumen]. / IRM haute résolution de l'athérosclérose carotidienne: au-delà de la lumière artérielle.

Despite advances in diagnosis and treatment, atherosclerosis remains the second cause of death in the world. Due to technical advances, high resolution MRI (HR-MRI) allows depiction of the wall of cervical arteries, especially carotid atherosclerosis. HR-MRI allows visualization of the different components of atherosclerosis: necrotic lipid core, intraplaque hemorrhage, calcifications and fibrous cap. Global plaque volume as well as the volumes of individual plaque components can be calculated. Atherosclerotic plaque structure analysis, along with stenosis measurement, contribute to the stratification of the stroke risk. HR-MRI may also be used to assess treatment efficacy aimed at stabilizing or reducing plaque progression. Beyond the arterial lumen, direct evaluation of vessel wall should modify the management of atherosclerosis in the years to come.

[Solitary intracerebral langerhans cell histiocytosis: report of one case and literature review]. / Histiocytose langerhansienne encéphalique isolée à forme pseudotumorale: une observation et revue de la littérature.

INTRODUCTION: Langerhans cell histiocytosis is a multivisceral pathology. Neurological manifestations are rare. EXEGESIS: We report the case of a 31 year old man hospitalized for left partial motor seizure revealing a right frontal tumor with criteria for histiocytosis X. The histological and biological examination found criteria for Langerhans cell histiocytosis (CD1a and S100 reactivity). The check-up for extracerebral localisations of the disease was negative. The outcome was favourable after a total surgical resection. The review of the literature and a discussion on neurological manifestations of this disease were carried out. CONCLUSION: A neurological manifestation can be the first and only symptom of a Langerhans cell histiocytosis.

[Improvement in swallowing difficulties treated by subcutaneous apomorphine infusion after deep brain stimulation in Parkinson's disease]. / Amélioration des troubles de la déglutition par l'apomorphine en perfusion sous cutanée au décours de la mise en place d'électrodes de stimulation cérébrale profonde, dans la maladie de Parkinson.

In Parkinson's patients, swallowing difficulties may result in inhalation pneumonia, with a potentially serious prognosis. They may be revealed by withdrawal of L-dopa, especially after deep brain stimulation surgery. The following two cases illustrate the usefulness of apomorphine.

[Internal carotid artery dissection after Heimlich maneuver]. / Dissection de l'artère carotide interne extracrânienne au décours d'une manoeuvre d'Heimlich.

We report a case of cervical artery dissection following a Heimlich maneuver. Cervical artery dissections are at the present time well known and are sometimes associated with trivial traumas. However, to our knowledge, this complication of such maneuver was never reported in the literature. Pathophysiological mechanisms are discussed.

[Low-dose chest CT with millimetric thin slices: myth or reality?]. / Scanner thoracique basse dose en coupes millimétriques: mythe ou réalité?

PURPOSE: To evaluate the diagnostic accuracy of millimetric thin slices low dose chest CT. MATERIALS AND METHODS: Forty one patients underwent a chest CT thin slices (1 mm every 10 mm) exploration using both a 170 milliamperage and a low dose acquisition using 80 mA. The examination were read by 2 senior radiologists specialized in chest imaging without knowledge of acquisition parameters and in a random order. A statistical analysis of interobserver agreement was performed using Kappa analysis. Doses of both acquisition were estimated by compagning the dose length product calculated by the CT software and be using a simulation software. RESULTS: Excellent interobserver and intermodalities agreements were found. A 53% decrease in dose was estimated with the low dose modality compare to the normal dose. CONCLUSION: Low dose thin slice chest CT using 80 mA has a similar diagnosis accuracy as standard dose thin slice chest CT and delivers half dose of irradiation.

[Homonymous lateral hemianopsia revealing cerebral thrombophlebitis. Role of a deficiency of protein S induced by l-asparaginase]. / Hémianopsie latérale homonyme révélant une thrombophlébite cérébrale. Rôle d'un déficit en protéine S induit par la l-asparaginase.

BACKGROUND: Cerebral thrombosis associated with protein S deficiency is very rare and is mainly related to hereditary form of protein S deficiency. CASE REPORT: A 19-year-old girl with acute lymphoblastic leukemia presented hemianopsy within a few days after the first administration of L-asparaginase. Magnetic resonance of the brain showed a cortical infarct. A marked decrease of the level of protein S was documented. Few days later, the patient was free of symptoms and protein S level was restored to the normal suggesting that the cerebral thrombosis was caused by transient protein S deficiency induced by L-asparaginase administration. DISCUSSION: Patients with neurological complication caused by L-asparaginase should be tested for protein S and other anticoagulant deficiencies.

Primary intracerebral malignant lymphoma: report of 248 cases.

OBJECT: The authors present a retrospective analysis of 248 immunocompetent patients with primary intracerebral lymphoma treated at 19 French and Belgian medical centers between January 1980 and December 1995. METHODS: This study involved 127 female and 121 male patients with a median age of 61 years (range 2-88 years). All tumors available for review were classic diffuse non-Hodgkin's lymphoma, for which the phenotype was determined in 220 patients: 212 (96.4%) were B-cell and eight (3.6%) were T-cell type tumors. According to the Revised European-American classification of lymphoid neoplasms, most lesions were diffuse large cell tumors (62%). A total of 196 tumors were reviewed in 127 patients for whom preoperative computerized tomography and magnetic resonance studies were available. There was a single lesion in 66% of the cases, with a supratentorial location in 87%. Tumor location in the basal ganglia, corpus callosum, or fornix, infiltration of the periventricular ependyma, or a mirror pattern, were strongly suggestive of a lesion of lymphomatous origin. The histological diagnosis was obtained after surgical resection in 116 patients, with the remainder undergoing biopsy sampling only. Of the 248 patients studied, 129 (52%) received chemotherapy plus radiation therapy, 60 (24%) received radiation therapy alone, 35 (14%) received chemotherapy alone, and 24 (10%) received no postsurgical treatment. CONCLUSIONS: Using univariate analysis, the authors determined prognostic factors that were significantly associated with a favorable impact on survival including age younger than 60 years, radiation therapy (without evidence of a dose-response relationship), radiation therapy combined with chemotherapy, and chemotherapy consisting of anthracycline. Partial surgical resection was an unfavorable prognostic factor. Multivariate analysis was used to confirm the independent prognostic value of radiation therapy, age, chemotherapy consisting of anthracyclines or methotrexate, and partial surgical resection. This European survey provides a reasonable basis for the treatment of primary intracerebral lymphoma with the following sequence: stereotactic biopsy sampling, chemotherapy with a methotrexate- and anthracycline-based regimen, followed by cranial irradiation.

[Cauda equina tumors in adults]. / Tumeurs de la queue de cheval chez l'adulte.

Large series of cauda equina tumors in adults are seldom reported. This study was based on the 231 cases collected in the French neurosurgery units for the congress of the Société Française de Neurochirurgie in October 1996. Schwannomas were the most frequent benign tumor in this series, followed by ependymomas. Very few malignant tumors were recorded, usually malignant neurinomas nearly always arising in patients with neurofibromatosis. Some other rare tumors were also observed including paragangliomas. This series confirms the contribution of pre-therapeutic neurological status to functional prognosis. All schwannomas can be cured while ependymomas and paragangliomas may recur after a very long delay. Surgery must be as complete as possible since adjuvant therapies have proven to have little efficacy. This type of tumor requires a very long follow-up. Prognosis is good for hemangioblastoma. When present, abnormal sphincter function is an argument for poor prognosis. It may appear after primary surgery or more often after treatment of recurrence.

[Importance of MRI in the diagnosis of meniscal ossicle. Apropos of 2 cases]. / Intérêt de l'IRM dans le diagnostic d'ossicule méniscal. A propos de 2 cas.

PURPOSE OF THE STUDY: To determine the contribution of magnetic resonance (MR) imaging in the diagnosis of meniscal ossicle. MATERIALS AND METHODS: Two cases of meniscal ossicle were evaluated by plain radiography and MR imaging. Sagittal and coronal T1-weighted (400/15), proton density and T2-weighted (2,000/20,80) sequences were performed with 0.5 T magnet. RESULTS: Plain radiography revealed a triangular ossified body in the postero-medial aspect of the knee joint. MR images demonstrated that these ossicles were located within the posterior horn of the medial meniscus. The signal of these ossicles was isointense with that of bone marrow in all sequences. CONCLUSION: MR findings allow the diagnosis of meniscal ossicle and help to differentiate it from osteochondral loose body.

[Epidural air after closed thoracic trauma]. / Air épidural apres traumatisme fermé du thorax.

We report a rare case of spontaneous pneumorachis (epidural air in the spinal canal) after benign chest trauma without rib fracture or pneumothorax.

Recurrent intracerebral hemorrhage.

Between 1984 and 1994, of the 375 patients admitted to our department for intracerebral hemorrhage (ICH), 24 (6.4%) had a recurrent ICH. There were 15 women and nine men and the mean age of the patients was 64.7 +/- 9.4 years (range 49-81) at the first bleeding episode and 68.7 +/- 7.5 years (range 57-83) at the second. The mean interval between the two bleeding episodes was 47.5 +/- 30.5 months (range 3 months to 14.8 years). Nine patients presented with more than one recurrence of ICH. Seventy-one percent of the patients were hypertensive. The site of the first hemorrhage was lobar in 17 patients, ganglionic (putamen, thalamus, or caudate nucleus) in six patients, and subdural in one. The recurrent hemorrhage occurred at a different location from the previous ICH. The most common pattern of recurrence was "lobar-lobar" (14 patients) and more rarely "ganglionic-ganglionic" (five patients), which was always observed in hypertensive patients. The outcome after the recurrent hemorrhage was usually poor, with severe cognitive impairment. By comparison with 81 patients followed up to 24 months (47.9 +/- 22.2 months) with isolated ICH without recurrence, only lobar hematoma and a younger age were risk factors for recurrences whereas sex and previous hypertension were not. The mechanisms of recurrence of ICH were multiple (hypertension, cerebral amyloid angiopathy). Control of blood pressure after the first hemorrhage may prevent ICH recurrences.

Septic arthritis of lumbar facet joints. A review of six cases.

Hematogenous infection of the facet joints by pyogenic organisms is exceedingly rare. We report six cases of lumbar facet joint septic arthritis due to hematogenous spread of a pyogenic organism. A review of the literature identified ten anecdotal reports of similar cases. An analysis of these 16 cases showed that the diagnosis was based mainly on imaging study findings and that clinical data failed to discriminate between facet joint septic arthritis and infectious discitis. Increased uptake on the radionuclide bone scan was an early finding and the pattern of uptake was different from that seen in discitis. Computed tomography was the investigation that best delineated the facet joint lesions. Magnetic resonance imaging of the lumbar spine was superior over computed tomography in demonstrating spread of the infection to the epidural space and/or soft tissues and in some instances demonstrated enhancement of the infected facet joint on T1 images after gadolinium injection. Aspiration of the facet joint under fluoroscopic guidance was required only when blood cultures were negative or when the diagnosis of the septic nature of the arthritis was in doubt. Blood cultures yielded a Staphylococcus aureus in the six cases in our series. Appropriate antimicrobial therapy was successful in most cases. In our series, four of the six patients had posterior epiduritis, pyomyositis, or an abscess in the paraspinal muscles or psoas muscle, suggesting that some epidural infections or psoas muscle abscesses believed heretofore to be primary may in fact be complications of facet joint septic arthritis. Facet joint septic arthritis is a new aspect of pyogenic spinal infections that deserves to be considered in patients with febrile spinal syndromes not explained by discitis.

[Imaging aspects of primary cerebral lymphoma]. / Aspects par imagerie des lymphomes cérébraux primitifs.

Th CT and MRI appearance of 196 lymphomatous histologically proved lesions were rewied in 127 patients. A post contrast study was performed in all patients studied with CT; 118 lesions were also assessed before an iodine contrast injection. 40 lesions were both studied with CT and MRI, and 12 only with MRI. There is a single lesion in 86% of the cases with a supratentorial location in 87%. The lesion size is over 1 cm in 90% and 87% of the lesions appear with regular and sharp demarcation. A mild edema is associated in 86%. Most of the lesions display an infiltrative pattern with a soft mass effect on the surrounding cerebral parenchyma. The basal ganglion, corpus callosum and trigone location, or an infiltration of the periventricular ependyma, or a mirror pattern, appear strongly suggestive for a lesion of lymphomatous origin. The CT post contrast enhancement of the lesion is present in 99% and homogeneous in 82%.

Posterior rounded high-intensity zone on magnetic resonance images as a sign of painful disk. Report of a case.

In 1992, Aprill and Bogduk reported that a rounded high-intensity zone was seen in the posterior part of the annulus fibrosus on T2-weighted images of at least one of the last intervertebral disks in 29% of 500 patients with low back pain. This image was correlated with Dallas stage 4 disk disease and with reproduction of the spontaneous pain during discography coupled with computed tomography. We report a case and discuss the value of this image.

[Evolutive morphology of the olfactory bulb in man and certain non-human mammals]. / Morphologie évolutive du lobe olfactif chez l'Homme et quelques Mammifères non humains.

Human and comparative anatomy of the olfactory lobe and the anterior floor was studied in 241 patients and 27 specimens (2 human fetuses, 4 specimens from adult humans, 11 non human primates and 10 carnivorous mammals). Macroscopic morphology and imaging data (CT-scan, 3D) reconstruction and magnetic resonance imaging) were obtained at the same time. The results obtained provide radiographic knowledge of the olfactory bulb ontogenesis and a basis for recognizing inborn or acquired pathology of the olfactory bulb. Evidence was also obtained for distinguishing between macrosmatic and microsmatic criteria in mammals.