Cerebral vasculitis during FK 506 treatment in a liver transplant patient.

The immunosuppressive agent FK 506 is widely used in liver transplant patients. Neurotoxicity is a major complication of its use. We report progressive and irreversible neurologic complications occurring in a 39-year-old woman who underwent liver transplantation and was treated with FK 506. Neuropathologic examination revealed multiple vasculitic lesions. The possibility of an FK 506-mediated toxic effect on the cerebral vessels is suggested.

Acute embolic carotid occlusion after cardiac catheterization: effect of local intra-arterial urokinase thrombolysis.

A 64-year-old woman developed a severe embolic cerebral attack with total left hemiplegia approximately 30 hours after cardiac catheterization for mitral stenosis. She underwent intra-arterial thrombolysis of the right internal carotid artery four and one-half hours after the onset of neurologic deficit with subsequent recanalization of the occluded vessel and near complete neurologic recovery.

Empty sella syndrome associated with diabetes insipidus: case report and review of the literature.

Alteration of posterior pituitary function in the empty sella syndrome is rare. A case of central diabetes insipidus and clear-cut deficiency of gonadotropins associated with an empty sella is described. Although computed tomographic scan revealed a defect of the diaphragma sellae, other pathogenic mechanisms are considered. Previously documented cases of empty sella syndrome associated with diabetes insipidus are reviewed.

[An early case of hereditary spongious dystrophy (van Bogaert-Bertrand) (clinical aspects, radiology, anatomic pathology)]. / Cas précoce de dystrophie spongieuse héréditaire (van Bogaert-Bertrand) (clinique, radiologie, anatomo-pathologie).

A very early case of D.S.H. (Hereditary Spongy Degeneration of the central nervous system) is described: clinical examination, C.A.T.-Scan (computerized axial tomography), biopsy and autopsy. The case presented in a 3 weeks old girl as a "colic of early infancy". During the fourth week, sudden worsening took place with attacks of dyspnea, cyanosis and frothy sputum. Ultrasound showed an echogenic thalamus. Examination by C.A.T.-Scan showed pale areas in the mid-brain and the central nuclei on both sides suggesting cerebral lesions of circulatory origin. Despite a normal lumbar puncture, cerebral biopsy was performed to exclude a potentially treatable viral condition (herpetic encephalitis?). Death took place 24 hours later. No inflammatory or spongy degenerative changes compatible with D.S.H. were found at biopsy. At autopsy however, despite superimposed recent ischemic lesions, microscopy and electron microscopy were characteristic of Hereditary Spongy Degeneration of the C.N.S. Six previous cases of D.S.H. are reported in the literature (explored by C.A.T.-Scan and confirmed histologically), this being the first report of hypodensities in the brain stem and central nuclei. In conclusion, this case shows once more that C.A.T.-Scan can be a useful tool in this still little known condition.

[Spontaneous dissecting aneurysm of the internal carotid artery. General review of 205 published cases with 10 personal cases]. / L'hématome disséquant spontané de l'artère carotide interne. Revue générale de 205 cas publiés dont 10 personnels.

Spontaneous dissecting aneurysms of the internal carotid artery occur almost exclusively in the extracranial segment of the artery. The incidence is higher among males and the average age is relatively low (mean: 45 years). The existence of a lesion involving the wall of the carotid artery must be considered in the patient presenting with atypical facial neuralgia or incomplete but painful Horner's syndrome which may or may not be associated with a controlateral neurological deficit. Spontaneous dissecting aneurysms of the internal carotid artery cannot be diagnosed on the basis of a single angiogram. Definite diagnosis requires repeated ultrasonography and/or angiography. Spontaneous recanalization justifies the use of medical therapy (anticoagulant or antiplatelet aggregation therapy) in preference to surgical intervention.

[The diagnosis of subtentorial tumours by vertebral angiography (author's transl)]. / Die Diagnose der infratentoriellen Tumoren durch die Vertebrailisangiographie

The diagnosis of space-occupying lesions in the subtentorial space by vertebral angiography is based upon a good knowledge of arteries and veins and topographic points of this region. An imaginary line between the colliculo-central point and the chorioidal point divides the posterior fossa into two imaginary parts. In this way it is possible to localize displacements in the region of the posterior fossa. Of course, the displacement of the veins and arteries is very important in the verification of the tumours. Consequently, vertebral angiography is of vital importance in the investigation of space-occupying lesions in the posterior fossa.