Detection of vertebrobasilar intracranial stenoses: transcranial Doppler sonography versus angiography.

Vertebrobasilar intracranial stenoses seem to carry a higher risk of brain stem ischemia than proximal vertebral artery stenoses. Our aim was to assess the value of transcranial Doppler sonography versus angiography in detecting and quantifying these intracranial stenoses. All consecutive patients who underwent transcranial Doppler sonography prior to angiography from 1989 to 1994 and whose sonograms showed a stenosis of greater than 50% of one vertebral artery (21 cases) or of the basilar artery (eight cases) were included in the study. These patients were compared with 60 other consecutive stroke patients studied via transcranial Doppler sonography prior to normal vertebrobasilar angiography The transcranial Doppler sonographic criteria for stenosis were a peak systolic frequency shift greater than 2 KHz. A tight stenosis was identified by this pattern combined with direct and reverse low frequencies of high spectrum energy. The sensitivity of transcranial Doppler sonography using a peak systolic frequency shift in diagnosing stenoses reached 80% and its specificity was 97% if only atheromatous stenoses were considered. The main diagnostic failures concerned bilateral stenoses or contralateral occlusion, tandem lesions, and upper basilar artery stenosis. Transcranial Doppler sonography underestimated the degree of stenosis compared to angiography in 55% of the cases. We conclude that transcranial Doppler sonography is accurate in recognizing a stenosed vessel in the intracranial vertebrobasilar circulation, but if this finding will alter therapy, the examination must be complemented by magnetic resonance angiography.

[Visual illusions of obliquity]. / L'illusion visuelle d'obliquité.

Three cases of visual illusion of obliquity were observed. This rare disorder is due to impaired of panorama/vertical orientation. When present, special care must be given during visual correction to spatial orientation of the perceived image in the vertical axis.

[Doppler transcranial ultrasonography in carotid and vertebral dissections: 36 cases involving angiography]. / Le Doppler transcranien dans les dissections carotidiennes et vertébrales: étude de 36 cas artériographies.

The aim of this prospective study was to investigate the additional information provided by transcranial pulsed Doppler for the determination of the upper part of dissections of the carotid and vertebral arteries and following-up. Earlier results concerning the role of ultrasound investigations for this indication have been presented elsewhere. Twenty-nine patients were examined (17 females, 12 males; mean age 43 years). All had arterial dissections confirmed by arteriography. There were 24 carotid dissections and 12 vertebral dissections. Investigations were performed during the acute phase and 2 months later. Most of the severe endocranial stenoses were identified by transcranial Doppler: 5 out of 6 severe stenoses of the carotid siphon and 6 out of 7 vertebral stenoses. The haemodynamic effect as measured by sylvian flow was significantly greater (p < 0.01) after a permanent ischaemic event than after temporary events and improved significantly with time (p < 0.008). There was no significant variation in the pulsatility transmission index (PTI), but this index requires a reference artery and is not particularly adapted in cases with bilateral dissection. Collateral perfusion, observed during the acute phase in all cases of occlusion and in 6 of the 8 carotid stenosis, was insufficient in half of the cases. Transcranial pulsed Doppler can be used to guide arteriography and helps determine the length of the dissection. It provides an easy way to assess the haemodynamic consequences of the dissection and is quite useful during follow-up.

[The interest of CSF examinations in the etiological diagnosis of intracranial hypertension (author's transl)]. / Intérêt de l'examen cytologique du LCR dans le diagnostic étiologique de l'hypertension intra-crânienne.

The authors discuss the case of a 15-year-old girl suffering from intra-cranial hypertension. Neuroradiological examinations do not reveal any obstruction in the cerebral spinal fluid circulation. The CSF cylologic examination was the first to give etiological indications, showing the existence of malignant cells which the cerebral biopsy later enabled us to classify as glioblastoma. This case affords an opportunity to recall the three stages of the diagnosis: first, intra-cranial hypertension; secondly, chronic meningitis; thirdly, cytological difficulties in the examination of CSF in patients having undergone neuro-radiological examinations.

[Familial anomaly of the seventh cervical vertebra. Radio-clinic comparison in a fourteen member family]. / Atteinte familiale de C7. Confrontation radio-clinique de 14 patients.

We report a fourteen member family presenting with an anomaly of the seventh cervical vertebra. The symptoms associate pain and paresthesias, a C8-D1 syndrome or arterial manifestations. The radiologic lesions noticed are bilateral in twelve cases, either cervical ribs or apophysomegaly of the seventh vertebra's transverse process. There is no correlation between the severity of the clinical impairment and the importance of the radiologic image. We insist on the familial character rarely reported in the literature of an anomaly noticed in radiologic practice.

[Problems in the treatment of a patient with longstanding epilepsy (author's transl)]. / Problèmes thérapeutiques chez une épileptique ancienne.

The case of a female patient with longstanding epilepsy is reported. Many problems in achieving a satisfactory therapeutic regimen were encountered. They originated in storage of phenobarbital, which had been prescribed since childhood, interference between phenobarbital, dipropylacetic acid, and phenylhydantoins. Some pharmacokinetic principles are reviewed in the light of this clinical experience.

[A familial case of thoracic outlet syndrome. Clinical, radiological study with treatment (author's transl)]. / Un cas familial de côte cervicale. Etude clinique, radiologique et thérapeutique.

The authors report the clinical and radiological study and the treatment of a fifteen members family (the two parents and their thirteen children) affected with a thoracic outlet syndrome secondary to a cervical rib and or an apophysomegaly of the seventh cervical vertebra. On the fifteen people considered, the father being deceased has not been examined but has an evocative clinical history. The mother has a clinical impairment with a late beginning and no radiological sign. Twelve children have clinical and radiological signs, one has radiological without clinical signs. Three children underwent a surgical treatment, the others only medical treatment. There is no satisfactory correlation between the clinical features and electrical investigations (electromyography, nerve conduction studies) and radiological examinations. The semiology is vascular, neurologic or mixt. Roos test seems more reliable than that of Adson, Calb and Roth, and Saunders. Eight grand-children out of fourty have been examined. Five have clinical and radiological signs, three have casual radiological signs. The radiological impairment of this family contrasts with the normal frequency of cervical anomalies in the population which is 0,12 to 1%. The family impairment of the thoracic outlet syndrome is rarely reported.