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Objective: Jugular bulb abnormalities can induce tinnitus, hearing loss, or vertigo. Vertigo can be very disabling and may need surgical treatments with risk of hearing loss, major bleeding or facial palsy. Hence, we have developed a new treatment for vertigo caused by jugular bulb anomalies, using an endovascular technique., Patients: Three patients presented with severe vertigos mostly induced by high venous pressure. One patient showed downbeat vertical nystagmus during the Valsalva maneuver. The temporal-bone computed tomography scan showed a high rising jugular bulb or a jugular bulb diverticulum with dehiscence and compression of the vestibular aqueduct in all cases., Intervention: We plugged the upper part of the bulb with coils, and we used a stent to maintain the coils and preserving the venous permeability., Results: After 12- to 24-month follow-up, those patients experienced no more vertigo, allowing return to work. The 3-month arteriographs showed good permeability of the sigmoid sinus and jugular bulb through the stent, with complete obstruction of the upper part of the bulb in all cases., Conclusion: Disabling vertigo induced by jugular bulb abnormalities can be effectively treated by an endovascular technique. This technique is minimally invasive with a probable greater benefit/risk ratio compare with surgery., (© The Author(s) 2013.)

Magnetic resonance imaging (MRI) applied to the hippocampus is challenging in studies of the neurophysiology of memory and the physiopathology of numerous diseases such as epilepsy, Alzheimer's disease, ischemia, and depression. The hippocampus is a well-delineated cerebral structure with a multi-layered organization. Imaging of hippocampus layers is limited to a few studies and requires high magnetic field and gradient strength. We performed one conventional MRI sequence on a 7T MRI in order to visualize and to delineate the multi-layered hippocampal structure ex vivo in rat brains. We optimized a volumic three-dimensional T2 Rapid Acquisition Relaxation Enhancement (RARE) sequence and quantified the volume of the hippocampus and one of its thinnest layers, the stratum granulare of the dentate gyrus. Additionally, we tested passive staining by gadolinium with the aim of decreasing the acquisition time and increasing image contrast. Using appropriated settings, six discrete layers were differentiated within the hippocampus in rats. In the hippocampus proper or Ammon's Horn (AH): the stratum oriens, the stratum pyramidale of, the stratum radiatum, and the stratum lacunosum moleculare of the CA1 were differentiated. In the dentate gyrus: the stratum moleculare and the stratum granulare layer were seen distinctly. Passive staining of one brain with gadolinium decreased the acquisition time by four and improved the differentiation between the layers. A conventional sequence optimized on a 7T MRI with a standard receiver surface coil will allow us to study structural layers (signal and volume) of hippocampus in various rat models of neuropathology (anxiety, epilepsia, neurodegeneration).

This study investigates the efficacy of chemonucleolysis using RGE in the treatment of cervical disk hernias in a small sample of patients who had cervical diskogenic or radicular pain secondary to disk herniations. Results were satisfactory in 89.5% patients, with no adverse events recorded during the procedure or after. The use of RGE shows promising results and might be a feasible and safe alternative in the treatment of cervical disk hernias.

Introduction: Blunt injury to the carotid and vertebral arteries is uncommon and potentially devastating. Neurofibromatosis type 1, or von Recklinghausen's disease is an autosomal dominant disorder affecting one in 3000 individuals. This genetic disease may affect many organs, including vessels., Case Presentation: This report describes a very unusual case of multiple traumatic arterial injuries in a 44-year-old Caucasian neurofibromatosis type 1 patient, with delayed diagnosis. The vascular abnormalities observed in neurofibromatosis type 1, probably enhanced the arterial lesions. Medical treatment with antiplatelet therapy combined with endovascular stent-assisted angioplasty allowed a good evolution for the patient., Conclusion: Patients with medical history of neurofibromatosis type I are at risk to develop blunt cervical vascular injury. This association has to be known by emergency and intensivist physicians to optimize screening of cerebrovascular injuries and treat early such devastating lesions.

Covered stents have been successfully used in the treatment of fusiform aneurysms and post dissection aneurysms in peripheral arteries as well as in post-traumatic arteriovenous fistulas. We report a case where a pseudoaneurysm of the cervical vertebral artery was excluded by placement of two covered stents, preserving patency of the parent artery, in a 15-year-old patient.

Objectives: To characterise clinically a large French family affected with cerebral cavernomas and to check for linkage of this condition to chromosome 7., Methods: A family, originating from Normandy and in which five members had undergone surgery for cavernomas, was extended. All members older than 18 were studied clinically and by neuroimaging. Genetic linkage analysis was conducted using 11 polymorphic microsatellite markers located between D7S502 and D7S479., Results: The family included three generations. Among the 25 members investigated, 11 had an abnormal cerebral MRI, eight of them being symptomatic, and 12 were asymptomatic with a normal MRI. The status of the two remaining members could not be established on the basis of clinical and MRI data. The family reported shares some striking features with other previously linked families--namely, a high clinical penetrance and the presence of multiple lesions within most of the affected members. A lod score of 4.04 was obtained with marker D7S657 with no recombinant. Significant lod scores were also obtained with D7S524 (Zmax=3.32 at 0=0.00) and D7S630 (Zmax=3.44 at 0=0.00). These results establish linkage of the condition found in this family to chromosome 7. Haplotype analysis strongly suggests that the gene is telomeric to D7S802 and centromeric to D7S479., Conclusions: These data confirm linkage of cerebral cavernous malformations to chromosome 7 in a non-Hispanic family.

Objective: The localization of insulinomas is a central problem, because none of the imaging techniques has proved sufficiently reliable for the diagnosis of tumors smaller than 2 cms., Patients and Methods: Calcium stimulation test was performed during selective pancreatic angiogram with calcium gluconate injection in the pancreatic arteries, e.g. gastroduodenal, superior mesenteric and splenic. A simultaneous catheterization of hepatic veins through the femoral vein allowed measurement of insulin level increment after calcium stimulation., Results: In our experience, this test allowed a positive location of an insulinoma in three consecutive patients presenting with organic hypoglycemia, and was useful for surgeons while non-invasive imaging techniques failed to locate the tumor in any of the three patients., Discussion: The calcium stimulation test is a reliable preoperative procedure, particularly when other imaging techniques fail to locate the tumor. However it remains invasive, and our data are still too preliminary to clearly define its place within imaging techniques.

Purpose: To evaluate endovascular treatment of saccular intracranial aneurysms with mechanical detachable spiral coils., Materials and Methods: Fifty-three patients with 56 saccular aneurysms underwent endovascular treatment with spiral coils. All but five had symptomatic subarachnoid hemorrhage staged according to the Hunt and Hess classification as follows: stage IV or V (n = 20), stage III (n = 10), stage I or II (n = 20), and stage 0 (asymptomatic [n = 6])., Results: Forty-seven aneurysms were occluded (100% occlusion) on follow-up angiograms with the following time distribution: 24 months for six aneurysms (six patients), 12 months for 14 aneurysms (11 patients), 6 months for 13 aneurysms (13 patients), 4 months for four aneurysms (four patients), and only immediate postprocedure study for 16 aneurysms (16 patients) (excludes two deaths and one failure)., Conclusion: In this relatively small group, endovascular treatment with mechanical detachable spiral coils had a success rate of 90%, and it appears to be a rapid, reliable, and relatively safe technique in the treatment of life-threatening subarachnoid hemorrhage.

Objective: The object of the present study was to identify metabolic differences between low-grade astrocytomas and oligodendrogliomas and to improve their diagnosis and noninvasive assessment, because both types of tumors look very similar from the point of view of clinical and radiological data (as assessed by computed tomography and magnetic resonance imaging)., Methods: Before any aggressive treatment, 22 patients with primary low-grade gliomas (astrocytomas in 12 patients and oligodendrogliomas in 10) were investigated with positron emission tomography for both glucose metabolism (18F-fluorodeoxyglucose) and amino acid uptake (11C-L-methylmethionine). An original software that allows a full metabolic analysis of the tumor region of interest (defined from the T1-weighted magnetic resonance image) and compares tumor tissue uptake tracer concentrations with average healthy tissue values has been implemented for data processing. Heterogeneity of each individual tumor has been taken into account and was expressed in histograms, which provided data about the mean and also extreme and intermediate values of tracer concentrations and the way these values are distributed among the full tumor mass., Results: It has been shown that both tumor types exhibit a glucose hypometabolism (slightly more pronounced with astrocytomas), whereas they strongly differ in methionine uptake, which is high in all oligodendrogliomas and either decreased, normal, or moderately increased in astrocytomas. This latter metabolic difference between both tumor populations may be partially explained by their different cell densities., Conclusion: This study suggests that despite similar radiological and clinical presentations, these two kinds of low-grade gliomas are metabolically different and could therefore have specific responses to different therapies. Moreover, their in vivo metabolic follow-up with positron emission tomography should rely on different parameters, depending on their histological type; methionine uptake may be more relevant than glucose metabolism in the follow-up of oligodendrogliomas.

Purpose: Our purpose was to show how difficult it is to diagnose a dural fistula of the cavernous sinus, which is an anomalous arteriovenous shunt within the dura mater extending from meningeal arteries to the cavernous sinus., Case Report: A dural fistula was suspected in four female patients aged between 61 and 80, presenting with a red eye, dilated episcleral veins, exophthalmos and elevated intraocular pressure. A cerebral hyperselective angiography was performed in all cases., Results: The cerebral angiography confirmed the diagnosis of a dural fistula in all cases, showing the early filling of the cavernous sinus followed by the draining vessel (posterior in case n. 4, anterior in cases n degrees 1, 2, 3). Case n degrees 2 was unilateral and cases n. 1, 3, 3 were bilateral. The blood flow was low in all cases. A successful embolization was performed in all patients with resolution of all symptoms., Conclusion: The diagnosis of dural fistulas is often difficult because of misleading clinical signs. It is documented by a cerebral angiography showing the feeding vessels and helping to choose either venous or arterial embolization which is the most suitable treatment.

The authors report 4 cases of symptomatic dural fistula of the carotid cavernous sinus treated by transvenous coils. The objectives of dural fistula treatment are now clearly established and several methods are available. Abstention is the rule for asymptomatic forms, whereas symptomatic forms with ophthalmological complications may respond to manual compression of the jugular vein and the carotid artery, arterial embolization, radiotherapy or venous embolization. Arterial embolization results in complete cure in 72% to 78% of the cases, but it is limited by the meningeal supply of the internal carotid artery, with the microcatheter the transvenous route make it possible to treat the meningeal supply from the internal and external carotids without affecting the arterial system, but this technique is restricted by the anatomy of each patient.

The authors report their experience with management of venous erectile insufficiency. The patients were classified according to radiologic criteria. 46 patients with venous insufficiency of the Santorini plexus were treated by detachable balloons and coils with 57% of satisfactory clinical results.

The authors report 25 cases of pre-operative embolisation of tumours of bone or muscle. The aim of this technique is to improve surgical safety by diminishing hemorrhage at operation and to preserve vessels in the region of the tumour especially if secondary intra-arterial chemotherapy is required.

A study of 130 patients having presented either a transient ischemic attack or a completed stroke, or admitted for an asymptomatic carotid stenosis, allowed the following investigations: CT-scan, doppler, angiography, measurement of the regional cerebral blood flow (rCBF) by the study of 133Xe clearance (Novocerebrograph (R)), and measurement of the regional cerebral blood volume (rCBV) made by gamma emission tomography after autotransfusion of 99m Tc-labeled erythrocytes with an Elscint Apex 415 ECT (R) camera. Our aim was to look in which case a rCBF and/or a rCBV interhemispheric asymmetry was observed, by comparing the previous hemodynamic parameters with clinical, CT-scan and angiographic data. Although a rCBF and/or a rCBV asymmetry appeared more often among patients presenting with infarction than among those of the asymptomatic category, this does not seem specific for any clinical grade. The same statement applies to the comparison between hemodynamic parameters and CT data. The arterial lesions were classified in 4 groups: no stenosis (12 cases), uni or bilateral moderate carotid stenosis (40 cases), unilateral severe carotid stenosis or occlusion (65 cases), bilateral carotid severe stenosis or occlusion (13 cases). We observed a rCBF asymmetry among some patients in the 4 groups, although this was more frequent among the two latter groups. Nevertheless no case of a rCBV asymmetry was observed in the 2 first groups. Such an asymmetry was present in 31 percent of the patients belonging to the two latter groups. In patients of the third group the asymmetry was always due to a relative increase of rCBV beyond the carotid lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

A series comprising 12 patients who had intraarterial local fibrinolysis in the carotid territory is reported. A classification is proposed that divides the different types of occlusions into three groups on the basis of angiographic location. Group 1 (two cases) comprises occlusion of the extra- and/or intracranial carotid artery with patency of the circle of Willis and the lenticulostriate arteries. In this group, there is no brain infarction, the CT findings are normal, and the clinical signs are mainly hemodynamic and intermittent. Fibrinolysis may be performed late and rather safely and completed by surgery or angioplasty of the neck vessel stenosis responsible for the occlusion. Group 2 (five cases) comprises occlusions of the cortical arteries without involvement of the lenticulostriate arteries. The mechanism of the occlusion can be hemodynamic or embolic. Group 3 (five cases) comprises occlusions of intracerebral arteries involving the lenticulostriate arteries. In groups 2 and 3 with brain infarction, fibrinolysis will only be able to restore viability of the area of cerebral tissue surrounding the infarction (penumbra). The time factor is particularly critical in group 3 because lenticulostriate arteries are terminal vessels whose revascularization may induce hemorrhages with increasing frequency as the occlusion time is prolonged. The time factor is less critical in group 2 because collaterals make the ischemia less severe in the infarcted area and the vital and functional consequences of hemorrhage are not as serious as in group 3 because of the location. In this series, all the symptomatic complications of hemorrhage (two cases) occurred in group 3, in patients treated later than 6 hr after clinical onset. Given the time delay inherent in performing CT and angiography and in making the medical decision, it is considered dangerous to undertake fibrinolytic therapy in group 3, unless it can be started before 4 or 5 hr after clinical onset.

The authors reported a case of cervical paraganglioma. Patient had a coma suggesting secretary activity of the lesion or cerebral venous thrombosis. Angiography showed an hypervascular lesion characterized by venous reflux into the contro-lateral sinus. After neurological stabilization by tumor embolization, the tumor was surgically removed.

A 2 year-old child admitted for Haemophilus meningitis was immediately treated by adequate antibiotic treatment. Three days later multiple hypertonic strokes and periodic respiration occurred; a resuscitation was necessary. CAT scan showed an acute hydrocephalus with non visible 4th ventricle and low-density areas in both cerebellar hemispheres allowing the diagnosis of cerebellar infarction. External drainage of CSF was rapidly performed and maintained for 11 days with success. The child was secondarily discharged with temporary cortical blindness and persistent moderate static cerebellar signs. The etiology of the cerebellar infarction was likely to be an arterial thrombosis in the vertebro-basilar area, probably secondary to cerebral arteritis related to Haemophilus.

The authors report a case of rupture of the free wall of the right ventricle, diagnosed by two dimensional echocardiography. This examination revealed an intrapericardial clot associated with a fissure of the diaphragmatic wall of the right ventricle. This case emphasises the value of two dimensional echocardiography in the acute phase of myocardial infarction for the diagnosis of complications which require urgent surgical treatment.

Forty-six patients with defective erection of venous origin were treated by embolization of deep dorsal vein at the Santorini plexus level. Embolization was by insertion of disposable balloons after surgical approach to deep dorsal vein of penis. Follow up showed that 57% of patients had recovered satisfactory, normal sexual activity and 15% a fairly satisfactory sexual activity.

Stiffness of the jaw was noted in the first descriptions of temporal arteritis. It was only in 1944 that Horton used the term intermittent claudication and related this sign to effort ischemia due to thrombosis of facial arteries. The introduction of ultrasound techniques has enabled the permeability of facial arteries to be confirmed in spite of induration and absence of pulsatility clinically. Anatomical studies have defined the preponderant role of the internal maxillary artery in the vascular supply of the masseter muscles and have enabled the localization of an appropriate and reliable site for ultrasound study: the pterygo-maxillary fossa. The velocimetric data thus collected confirm that the internal maxillary artery is affected and define the etiopathogenesis of intermittent jaw claudication during temporal arteritis. This sign is observed on average in one patient in three suffering from temporal arteritis. While several cases of intermittent jaw claudication have been described in severe atheromatous stenosis of the common carotid or external carotid arteries, or in relation to other causes (rheumatological, neoplastic, psychological ...), the observation of this syndrome in a suspicious clinical and paraclinical context constitutes an excellent orientation sign in favor of temporal arteritis.

The authors are reporting their experience about percutaneous transluminal angioplasty in atheromatous stenosis of proximal supra-aortic arteries. In this series of 12 patients, with an 6 months follow-up, vertigo was the main clinical symptom (6 cases), and it must be pointed out that 5 of these 6 patients also underwent a proximal angioplasty of one or the two of their vertebral arteries at the same time. Two subclavian steal syndromes, one arterial insufficiency of an upper limb, one transient cerebral ischaemia, and two asymptomatic cases were also treated by the same procedure. For diagnosis as well as for follow-up, the authors are emphasizing the value of hemodynamic results of Doppler recording. As for the technics itself, it mainly derives from the PTA of the lower limbs arteries. The results in this series appear to be good from an hemodynamic point of view, with neither morbidity, nor mortality.

Selective embolization of the distal branches of the internal maxillary artery was performed to treat severe essential epistaxis in 11 patients. Elective indications for this technique are elderly patients with profuse epistaxis.

Percutaneous transluminal angioplasty of the carotid artery was performed in four patients with recurrent stenosis following endarterectomy. Balloon catheter dilatation was successful in 3 of the 4 lesions. Post dilatation angiography demonstrated an increase in luminal diameter: there were no neurological complications with the procedure. PTA appears to be an effective method of treating recurrent stenosis following carotid endarterectomy.

Eight cases of isolated, mature and active arteriovenous malformations of scalp were explored and treated with embolization, alone or combined with surgery. A programme of exploration and the therapeutic approach as a function of angiographic findings are discussed, the latter being the basis for pathologic and hemodynamic features allowing classification of these malformations into two distinct groups.

In 1932, Horton, Magath and Brown reported two cases of a "new form of arteritis affecting the temporal vessels ... which probably represents a new clinical syndrome". In reality, several publications, devoted to the same pathology already preceded this article. The most ancient is that of an ophthalmologist from Baghdad, Ali Ibn Isa (940 to 1010). In his memories, translated and published in english in 1936, the author states that "he undertook excision and cauterisation of arteries to treat patients who were suffering from heat and inflammation of their temporal muscles and which sometimes ended in loss of vision ...". In 1890, J. Hutchinson, an English surgeon, reported a case "... of inflammed and swollen temporal arteries ...". This article was only brought to light in 1946. In 1930, M. Schmidt, published a probable case of temporal arteritis, subsequently reported in 1947. In 1934 and 1936, Horton published new cases of temporal arteritis and defined the clinical characteristics of the disease and its histology. In 1938, Jennings made a particular contribution in reporting the first case of blindness. From this time on, cases of temporal arteritis became increasingly common in the literature. The first French case was described by J. Paviot et al. in 1934, but remained largely unrecognized until 1942. In 1936, J. Chavany was the first to describe the pillow sign, but more particularly in 1948, he prescribed the first treatment with steroids, with spectacular results. It was only in 1950 that R.M. Shick et al. published the effects of steroid therapy in temporal arteritis.(ABSTRACT TRUNCATED AT 250 WORDS)

A case report concerning a left primary maxillary meningioma is presented. Clinical, conventional radiographic and CT signs are presented. The diagnosis was made after histologic examination of the specimen. The pathogenesis is discussed.

A patient with a left parieto-occipital tumor presented generalized convulsions, and aphasia with alexia and agraphia. Diagnosis was confirmed by CT scan. Partial excision only was possible and was followed by radiotherapy. Histology showed the tumor to be composed of moderate and large sized cells with a granular PAS+ cytoplasm. Protoplasmic astrocytes were numerous at the periphery. Electron microscopy demonstrated typical features of Abrikossof's granular cell tumor: heterogeneous granulations constituted mainly of secondary lysosomes, autophagic vacuoles, multivesicular bodies, and rare angular bodies. The granular cells were interspersed with astrocytes, the feet of which were implanted on the capillary basal membrane. Immunoperoxidases assay of gliofibrillary protein acid demonstrated high levels in the intercellular prolongations, considered here to be astrocytic, but weak concentrations in the granular cells. This suggests uptake by the latter cells of adjacent astrocytic gliofibrillary protein acid, especially as the action of an anti-albumin serum on the tumor demonstrated that the granular cells can take up extracellular proteins by a passive mechanism. These findings stand against an astrocytic origin of the tumor. Comparison with other granular cell tumors, particularly pituicytomas, provides evidence of morphological unity, but cerebral granular cell tumors are rich in astrocytes, whereas these are absent in pituicytomas. The oncogenic unity of these tumors has not been established.

Phenol injected transcutaneously into the lumbar sympathetic chain appears to be effective in ischemic arterial disease of the lower limbs. Among the other procedures, such as angioplasty, belonging to the field of therapeutic radiology, this technique seems to have it's specific indications. A preliminary study in fifty patients is reported.

A patient presented with visual and tactile agnosia due to a spontaneous left occipito-temporal hematoma. Major memory and spatial orientation disorders were also noted, but language, gestures, auditory and olfactory perception, and interior visual imagerie were unaffected. A review of the literature since 1970 found 6 cases of an association of this type among 17 patients with visual agnosia. There appears to be no relationship between the presence of tactile agnosia and the global or partial character of the visual agnosia, the severity of memory disturbances, the presence of visuoverbal disconnection or visual imagery disorders. In contrast, these cases differed in that the lesions were more extensive and extended beyond the internal occipital regions: they were widespread in 3 cases and in the left internal occipital and parietal region in 1 case. In the patient reported in this paper there was a wide lesion of the posterior white matter of the left hemisphere.

Twenty-one patients with hepatic metastases were treated by chemoembolization over a 2-year period, the technique consisting of selective injection of a mixture of Spongel powder and Adriamycin plus 5-FU into the hepatic artery. Indications and results are discussed as a function of clinical, biologic and radiologic criteria.

A case of bilateral spontaneous carotid-cavernous fistula with increased intra-ocular pressure is reported. Two new methods have been performed with success on this patient during successive interventions realised by two teams (maxillo-facial surgeons and neuroradiologists). Coils and sclerotic liquid are introduced by the distal superior ophthalmic vein.

The authors report 2 cases of acute hepatic failure secondary to a pulmonary embolism, the [atypical] symptomatology of which considerably interfered with diagnosis. A review of the literature confirms the rarity of embolic pathology as causing acute cardiac liver. The authors emphasize the importance of echotomography (cardiac and abdominal) in seeking dilatation of the right heart cavities, as well as of the inferior vena cava and hepatic veins.

The authors review a radiological classification of venous impotence and report their therapeutic approach. 13 patients with a venous insufficiency of Santorini's plexus were treated by detachable balloons and coils. This technic was convenient in 11 of the 13 cases. 5 patients with a superficial venous insufficiency were treated by embolization by coils. The results in this group appear to be good in 4 cases.

An anatomical and neuroradiologic study was conducted to define arterial irrigation of the nasal fossae, the topography of the different vascular territories, particularly that supplied by territories, particularly that supplied by the internal maxillary artery which is by far the most important, and the anastomoses of the different endo- and extra-nasal internal and external carotid systems.

A case of bilateral spontaneous carotid-cavernous fistulas producing increased intraocular pressure is reported. The fistulas lay between the meningeal branches of the internal carotid artery (ICA) and the cavernous sinus, but the ICA itself was not involved. Successful treatment was accomplished by the introduction of steel coils and a sclerotic liquid into the cavernous sinus via the distal superior ophthalmic vein.