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1. Être normal va-t-il de soi ?

Author

X. Ducrocq and Catherine Borella

Subjects
Issues, ethics and legal aspects, Health (social science), Health Policy, Philosophy, Humanities
Abstract

Resume Etre normal va-t-il de soi ? Reflexion ethique sur la notion de norme, analyse et enjeux. Une reflexion ethique sur la notion de norme suppose de se questionner sur sa definition et en particulier sur le lien avec son oppose, le pathologique, car l’interaction entre ces deux concepts determine toute notre pensee de la sante, de la maladie et du handicap. Avec Canguilhem et Ricœur, on voit qu’il existe fondamentalement deux manieres de distinguer le normal du pathologique : soit comme une difference quantitative, ce qui s’ecarte statistiquement d’une valeur de reference etant considere comme « anormal », soit comme difference qualitative, le pathologique etant une autre allure de vie possedant sa valeur propre. Le « normal » est donc relatif a plusieurs manieres d’etre, qu’on ne peut hierarchiser sans renoncer a les comprendre et a agir justement. On le voit avec le handicap de la surdite : la difference est radicale selon qu’il est apprehende dans l’un ou l’autre de ces paradigmes. Cette analyse n’est pas anodine puisque la notion de norme n’est jamais neutre, mais toujours liee a des actions de normalisation qui ont des consequences societales allant jusqu’a l’exclusion et au rejet actif, comme on le voit avec la trisomie 21. Il s’agit donc de comprendre comment on peut soigner sans normaliser, c’est-a-dire en respectant le sujet dans sa normativite propre, le role de la medecine etant de soutenir et developper infatigablement ce pouvoir sous peine de renoncer a soigner veritablement une personne. Redonner sa place au sujet, dans un monde ou l’exclusion ne fait que croitre, est donc a la fois un defi et une urgence.

Published
2014
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3. Contents Vol. 33, 2012

Author

Albert Y. Jin, Arne Lindgren, Qingwu Yang, Binghu Li, Ajay K. Wakhloo, Yeon Hyeon Choe, Johanna Svensson, Lili Zhang, Hua Su, Jaechun Hwang, Takashi Inoue, Druck Reinhardt Druck Basel, Espen J. Walker, P.C.M.I. Okubo, Ulf Persson, M. Toussaint-Hacquard, S. Richard, Henry Joseph Macaulay Barnett, X. Ducrocq, Thomas W. Leung, Chuanqin Fang, Christian Meisel, Eugene Lin, Zaal Kokaia, Francesco Arba, Eun Jung Choi, Lu Guo, Donatella Lippi, Yan Pi, Jae Hyun Park, Henrik Gensicke, Hendrik J. Harms, Sean W. Taylor, T. Lecompte, D.R. Domenis, Stefan T. Engelter, Jingcheng Li, Oh Young Bang, R. Fay, Nancy Futrell, Felix Fluri, Yoshiyuki Kanbara, William L. Young, J.C. Lacour, Leo H. Bonati, Vincent Mok, Bo Norrving, Majaz Moonis, Suk Jae Kim, Changyue Gao, Philippe Lyrer, Deepak Takhtani, Lena Ulm, Ola Ghatnekar, Margareth Amort, Sookyung Ryoo, Akira Ogawa, J.P. Mohr, Edward H.C. Wong, Yasutaka Kuzu, Nils Henninger, Ka-sing Lawrence Wong, S. Paul Oh, O.M. Takayanagui, Kuniaki Ogasawara, Fanxia Shen, Shunro Fujiwara, S.R.C. Fábio, Olle Lindvall, Shirin Jalini, Satz Mengensatzproduktion, Hideaki Nishimoto, Stephen P. Baker, José M. López-Novoa, Domenico Inzitari, Jing Xiang, Andreas Meisel, Hyun Jin Noh, Alexander Y.L. Lau, Adrian Wong, Florian Weisskopf, Jingzhou Wang, Helen M. Arthur, and Oliver Hartmann

Subjects
Neurology, Traditional medicine, business.industry, Medicine, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Published
2012
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4. AVC graves : pronostic, critères d’admission en réanimation et décisions de limitations et arrêt de traitements

Author

S. Crozier, P.-É. Bollaert, P. Aegerter, F. Santoli, X. Ducrocq, and Hervé Outin

Subjects
Palliative care, Neurology, Stroke etiology, Philosophy, Resuscitation Orders, Intensive care, Treatment withdrawal, Neurology (clinical), Humanities
Abstract

Resume Introduction La prise en charge en reanimation des malades victimes d’un accident vasculaire cerebral (AVC) et surtout la mise en œuvre d’une ventilation mecanique sont souvent considerees avec fatalisme. Les donnees de la litterature, variables et inhomogenes, meritent d’etre discutees notamment lors de decisions de limitations ou d’arret de traitements (LAT). Etat des connaissances Le pronostic souvent defavorable en cas de ventilation mecanique avec une lourde morbi-mortalite, continue de nourrir d’importantes controverses sur le benefice des techniques de reanimation a la phase aigue des AVC. Dans ce contexte, des LAT sont parfois discutees quand la survie peut ne pas etre souhaitee ou souhaitable. Les decisions de LAT ou les consignes de « non reanimation » (« DNR orders ») sont actuellement peu connues, mais seraient relativement frequentes puisque les « DNR orders » concerneraient environ 30 % des patients admis pour un AVC. Perspectives et conclusion Les decisions de LAT sont complexes car elles s’appuient sur une prediction de handicap et de qualite de vie par essence incertaine. Elles necessitent une reflexion ethique qui prend en compte l’incertitude pronostique, les souhaits et valeurs du patient et certaines contraintes organisationnelles. Les recommandations proposees par la SRLF s’inscrivent dans cette perspective.

Published
2011
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5. Ischaemic stroke and essential thrombocythemia: a series of 14 cases

Author

X Ducrocq, Sébastien Richard, J. C. Lacour, P. A. Baillot, and J. Perrin

Subjects
education.field_of_study, medicine.medical_specialty, medicine.diagnostic_test, Essential thrombocythemia, business.industry, Population, Complete blood count, Retrospective cohort study, medicine.disease, Thrombosis, Surgery, Neurology, Internal medicine, medicine, Platelet, Neurology (clinical), Thrombus, education, business, Stroke
Abstract

Background: Essential thrombocythemia (ET) is considered as a rare cause of stroke, partially because of difficulties to identify it when platelet count is not greatly elevated. However, early detection of ET is important because, without adapted treatment, recurrent thromboses are frequent. Method: We collected, retrospectively, data from 14 cases of stroke patients with ET. Clinical characteristics, ischaemic stroke, laboratory data (platelet and leucocyte count, haemoglobin, JAK2 V617F mutation, culture of haematopoietic progenitors) and treatment were reviewed. Every patient has been interviewed by phone to evaluate outcome. Results: The population consisted of nine women and five men with ages ranging from 40 to 87 years. Most of the patients (12) had atherosclerotic risk factors and two presented a thrombus in the internal carotid. ET was diagnosed early after the onset of stroke except in two patients. The platelet count was under 600*109/L for five patients. Mutation JAK2 V617F was found for eight patients. Thirteen patients were treated with an association between antiplatelet and cytoreductive treatment and did not present further thrombosis. Median follow-up is 2.8 years. Conclusion: These cases emphasize the problems of diagnosing ET at the onset of the stroke. Complete blood count has to be carefully read and ET can be suspected even if platelet count is not greatly increased. Diagnosis must be confirmed by haematologist to initiate appropriate treatment.

Published
2010
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6. Contents Vol. 23, 2007

Author

Rudolf Gesztelyi, Annabelle Y. Lao, V. Vidjak, Salim Yusuf, Sándor Kéki, Mariana Rovira, Sebastian Koch, Lukui Chen, Dragutin Januš, Miklós Zsuga, Attila Valikovics, Aleksandra Klimkowicz-Mrowiec, Yoko Kato, Dorota Wloch, M.J.E. van Zandvoort, F. Dubas, Adrià Arboix, Julien Bogousslavsky, Bradley P. Thomas, G. Marc, B.R. Chambers, Judit Zsuga, C.R. Levi, Ralph L. Sacco, A.L. Abbott, J.O. Fortrat, Diederik W.J. Dippel, I. Claeys, E. de Haan, G.A. Donnan, Jan Passchier, Peter J. Koudstaal, Wojciech Turaj, A. Pasco, Akiyo Sadato, G. Van Maele, Dániel Bereczki, Lisette Maasland, Hans-Christoph Diener, Dong-Wha Kang, Agnieszka Slowik, Sadayoshi Watanabe, Knut Stavem, Jan J. V. Busschbach, K. Daly, Marta Grau-Olivares, Gerard M. Ribbers, Vlatka Preden-Kereković, S. Sastry, Denise A. Figlewicz, J.L. Stork, E. Bernd Ringelstein, Didier Leys, J.M. de Bray, Anne-Sophie Darlington, Hirotoshi Sano, Rita Bhatia, Cem Calli, Carme Junqué, Minoru Yoneda, Jong Sung Kim, Jose C. Navarro, S. Cakmak, M. Michallet, Cecilia Targa, David Bartrés-Faz, C. Alecu, L. Derex, Mehmet Çelebisoy, Danijela Vrhovski-Hebrang, Neşe Çelebisoy, Werner Hacke, Zuhir Halloul, Sang-Beom Jeon, Paweł Szermer, Paweł Wołkow, Mária Tünde Magyar, Andrei V. Alexandrov, Maciej T. Malecki, Tetsuo Kanno, N. Nighoghossian, János Török, Tomasz Dziedzic, Sun Uck Kwon, P.L.M. de Kort, Markku Kaste, P. Lhoste, Ante Grga, H. Vespignani, Theodore C. Larson, Hugh S. Markus, G.M.S. Nys, Sonja Perkov, Dae Kyoon Lee, Romke van Balen, F. Vanhee, Peter Langhorne, Motoharu Hayakawa, Michael T. Wunderlich, Ole Morten Rønning, Georgios Tsivgoulis, Alejandro M. Forteza, Zlata Flegar-Meštrić, B. Vielle, László Csiba, L.J. Kappelle, Andrzej Szczudlik, T. Chengodu, Makoto Negoro, Andrija Hebrang, Joanna Pera, Grzegorz Kopeć, Martin Skalej, V. Pautot, Diler Hülya Canbaz, Emre Kumral, J. Dik F. Habbema, Vivek Sharma, J. De Reuck, Joan-Carles Soliva, Kostadin L. Karagiozov, Julia Schoof, J. Zyss, C. McCollum, B.P.W. Jansen, Keiko Irie, and X. Ducrocq

Subjects
Neurology, Traditional medicine, business.industry, Medicine, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Published
2007
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7. Determinants of arterial stiffness in an apparently healthy population over 60 years

Author

Paolo Salvi, Hervé Vespignani, X Ducrocq, C Alecu, R. Gueguen, C Perret-Guillaume, Athanase Benetos, and C. Aubry

Subjects
Male, medicine.medical_specialty, Mean arterial pressure, Population, Blood Pressure, Sex Factors, Diabetes mellitus, Internal medicine, Diabetes Mellitus, Internal Medicine, medicine, Humans, Pulse, education, Pulse wave velocity, Aged, Univariate analysis, education.field_of_study, business.industry, Age Factors, Middle Aged, medicine.disease, Femoral Artery, Carotid Arteries, medicine.anatomical_structure, Blood pressure, Hypertension, Vascular resistance, Physical therapy, Arterial stiffness, Cardiology, Female, Vascular Resistance, France, business, Blood Flow Velocity, Follow-Up Studies
Abstract

Arterial stiffness assessed by the pulse wave velocity (PWV), a non-invasive and reproducible method, predicts cardiovascular morbidity and mortality. The main determinants of arterial stiffness are well established in younger and middle-aged populations, but much less in the elderly. The aim of this study was to describe the determinants of arterial stiffness in elderly apparently healthy subjects. The study included 221 voluntary subjects born before 1944 (mean age 67.4+/-5.0 years), who had a standard health check-up at the 'Centre de Medecine Preventive' of Nancy. Arterial stiffness was evaluated by measuring the carotid-femoral PWV with the PulsePen automatic device. Clinical and biological parameters were evaluated at the same day. Measurements were valid and analysed in 207 subjects (94 women). Mean PWV was 9.39+/-2.64 m/s. Men showed higher PWV values than women (9.99+/-2.56 vs 8.66+/-2.56, P

Published
2006
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8. Prospective study of symptomatic atherothrombotic intracranial stenoses: The GESICA Study

Author

Serge Bracard, X Ducrocq, Mikael Mazighi, F Woimant, R Tanasescu, Eric Vicaut, and Emmanuel Houdart

Subjects
Adult, medicine.medical_specialty, Adolescent, Vertebral artery, medicine.medical_treatment, Brain Ischemia, Recurrence, Risk Factors, medicine.artery, Angioplasty, medicine, Basilar artery, Humans, Carotid Stenosis, Prospective Studies, Stroke, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Intracranial Artery, Middle Aged, Intracranial Arteriosclerosis, medicine.disease, Thrombosis, Surgery, Stenosis, Ischemic Attack, Transient, Cerebral Arterial Diseases, Neurology (clinical), Internal carotid artery, Tomography, X-Ray Computed, business, Magnetic Resonance Angiography, Follow-Up Studies
Abstract

Background: Symptomatic intracranial atherothrombotic stenoses (ICAS) are associated with high rates of cerebrovascular ischemic events. Objective: To conduct a prospective multicenter study to evaluate the natural history of ICAS and, in those patients refractory to medical treatment, the outcomes associated with intracranial angioplasty. Methods: Patients aged 18 to 80 were enrolled with symptoms attributed to a single ICAS of ≥50%. Optimal medical therapy of vascular risk factors and preventive antithrombotic therapy were at the discretion of the local investigator. Patients were eligible for intracranial angioplasty after experiencing recurrent stroke despite medical therapy. Neurologic and ultrasonographic examinations were performed at study inclusion, 3 months after enrollment, and every 6 months of follow-up thereafter, for 36 months. Results: One hundred two patients were included, with a mean age of 63.3 ± 10.4 years. Intracranial artery stenoses involved the vertebral artery in 22.5%, the basilar artery in 25.5%, the middle cerebral artery in 26.5%, and the internal carotid artery in 25.5%. In 27.4% of the patients, the stenoses had clinical hemodynamic characteristics. During a mean follow-up of 23.4 months, 38.2% of the patients had a cerebrovascular event: ischemic stroke in 13.7% and TIA in 24.5%. Among patients with a hemodynamically significant stenosis, 60.7% had a recurrent stroke or TIA in the territory of the stenotic artery; this association was significant in univariate analysis. Twenty-eight patients underwent an endovascular procedure with a neurologic periprocedural complication rate of 14.2%. The overall vascular death rate was 8.8%. Conclusions: Despite medical treatment, the 2-year recurrence rate of ischemic events in the territory of the stenotic artery was 38.2%. Cardiovascular events occurred in 18.6% of patients. Clinically significant hemodynamic stenoses were associated with stroke recurrence and may help identify a high risk subset of patients.

Published
2006
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9. Bronchial blocker compared to double-lumen tube for one-lung ventilation during thoracoscopy

Author

C. Winter, X. Ducrocq, J. P. Dupeyron, J. G. Hentz, Christian Bauer, and Annick Steib

Subjects
Artificial ventilation, medicine.medical_specialty, Bronchus, Lung, medicine.diagnostic_test, business.industry, medicine.medical_treatment, General Medicine, Bronchial blocker, Surgery, Collapsed Lung, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Anesthesia, medicine, Thoracoscopy, Intubation, Prospective cohort study, business
Abstract

Background: Video-assisted thoracoscopic surgery (VATS) requires one-lung ventilation with a properly collapsed lung. This study compared the Broncho-Cath double-lumen endotracheal tube with the Wiruthan bronchial blocker to determine the advantages of one device over the other during anaesthesia with one-lung ventilation for thoracoscopy. Methods: Thirty-five patients undergoing VATS were randomly assigned to one of two groups. Sixteen patients received a left-sided double-lumen tube (DLT) and nineteen a Wiruthan bronchial blocker (BB). The BB group was subdivided in two: BB in the right mainstem bronchus (BBR) for right-sided VATS (9 patients), BB in the left mainstem bronchus (BBL) for left-sided VATS (10 patients). The position of the devices was checked using a fibreoptic bronchoscope. The following variables were measured: 1) number of unsuccessful placement attempts; 2) number of malpositions of the devices; 3) time required to place the device in the correct position; 4) number of secondary dislodgements of the devices after turning the patient into the lateral decubitus position. The quality of lung deflation was evaluated by the surgeons who were blinded to the type of tube being used. Results: The number of unsuccessful placement attempts was one in the DLT group (1/16), three in the BBL group (3/10) and none in the BBR group (0/9). The number of malpositions was significantly greater in the BBL group (10/10) compared to the DLT group (2/16) and to the BBR group (1/9) (P

Published
2001
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10. Surgical correction of lumbar scoliosis: a comparison of different techniques. Results

Author

X. Ducrocq, J. Bogorin, J. P. Steib, and C. Averous

Subjects
musculoskeletal diseases, Orthodontics, Cobb angle, business.industry, Torsion (mechanics), Scoliosis, Anatomy, Surgical correction, medicine.disease, body regions, Lumbar, Vertebral rotation, Medicine, Orthopedics and Sports Medicine, Surgery, Lumbar scoliosis, Lumbar spine, business
Abstract

Vertebral rotation is at the basis of structural scoliosis. Its measurement gives the possibility to evaluate the surgical correction. Three groups of five lumbar scolioses (means angle 45°) were treated with rotation of the convex rod (group 1), bending in situ (group 2) and bending associated with rotation of the convex screws (group 3). Cobb angle improvement was the same with the three techniques. The Vertebral Rotational Angle (VRA) and the most suitable Intervertebral Rotational Angle (IRA) were used for this study. IRA (difference of rotation between two consecutive vertebrae) stays the same whatever the reference axis and VRA depends on conditions of measurement. IRA is improved of 15% in group 1, 35% in group 2 and 54% in group 3.In situ bending associated with the rotation of the convex screws is a good method for correcting the torsion of the scoliotic lumbar spine.

Published
1999
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11. Quels malades admettre en réanimation? Quels malades ventiler? Quels malades ne pas ventiler?

Author

P.E. Bollaert and X. Ducrocq

Subjects
Artificial ventilation, Mechanical ventilation, medicine.medical_specialty, business.industry, Vascular disease, medicine.medical_treatment, Ischemia, Critical Care and Intensive Care Medicine, medicine.disease, Central nervous system disease, Informed consent, Intensive care, Emergency medicine, medicine, business, Stroke
Published
1999
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12. Contents Vol. 9, 1999

Author

J.C. Lacour, Martin Dennis, J.C. Froment, Aurélia Mussi, I. Mourand, Elspeth J. Freeman, Geoffrey A. Donnan, Jose Antonio Egido, L. Derex, Dirk W. Droste, J. Honnorat, Joanna M. Wardlaw, Richard A L Macdonell, V. Oliveira, R. Anxionnat, X. Ducrocq, Martin Stangel, Enio Buffolo, L. Taillandier, Vendel Kemény, Pinchas Fainshtein Fainstein, Günter Breithardt, J.M. Ferro, Amos D. Korczyn, F. Turjman, P. Lucain, María L. Cuadrado, Antonio C. Carvalho, Peter Marx, John J McNeil, Alberto A. Gabbai, Paulo Batista, Catherine M. Sharples, Darwin Federico, M. Weber, Christian Stapf, Ayrton Roberto Massaro, Carlos A. Teles, F. Artru, David Signorini, Suzana M. F. Malheiros, E. Bernd Ringelstein, J L González-Gutiérrez, Valdir A. Moises, Amanda G. Thrift, Graeme J. Hankey, Natan M. Bornstein, Gerold Mönnig, Y. Berthezene, N. Nighoghossian, Peter Sandercock, Eduardo Varela-de-Seijas, Charles Warlow, Martin A. Ritter, Helen M Dewey, Alexander Y. Gur, and P. Trouillas

Subjects
Neurology, Traditional medicine, business.industry, Medicine, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Published
1999
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13. Syncope Update 1999: Syncope and Orthostatic Intolerance

Author

Amos D. Korczyn, J.C. Froment, Elspeth J. Freeman, P. Trouillas, Eduardo Varela-de-Seijas, Martin Dennis, Aurélia Mussi, Günter Breithardt, R. Anxionnat, Charles Warlow, Valdir A. Moises, Helen M Dewey, Alexander Y. Gur, M. Weber, N. Nighoghossian, Peter Sandercock, J. Honnorat, Carlos A. Teles, Martin Stangel, Amanda G. Thrift, X. Ducrocq, F. Turjman, P. Lucain, María L. Cuadrado, Antonio C. Carvalho, L. Derex, Jose Antonio Egido, Alberto A. Gabbai, Catherine M. Sharples, Martin A. Ritter, Dirk W. Droste, J.C. Lacour, Richard A L Macdonell, Vendel Kemény, V. Oliveira, Darwin Federico, Joanna M. Wardlaw, Paulo Batista, E. Bernd Ringelstein, J L González-Gutiérrez, Gerold Mönnig, David Signorini, Suzana M. F. Malheiros, J.M. Ferro, John J McNeil, Christian Stapf, I. Mourand, Ayrton Roberto Massaro, Graeme J. Hankey, Natan M. Bornstein, Pinchas Fainshtein Fainstein, Geoffrey A. Donnan, Enio Buffolo, Peter Marx, F. Artru, L. Taillandier, and Y. Berthezene

Subjects
medicine.medical_specialty, biology, business.industry, Syncope (genus), Orthostatic intolerance, biology.organism_classification, medicine.disease, Neurology, Anesthesia, Internal medicine, Cardiology, medicine, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Published
1999
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14. Les indications urgentes de l'EEG face à un malaise, une perte de connaissance brève, une crise épileptique généralisée chez l'adulte

Author

Hervé Vespignani, JL Schaff, and X Ducrocq

Subjects
Neurology, Electrodiagnosis, medicine.diagnostic_test, Physiology (medical), Philosophy, medicine, Neurology (clinical), General Medicine, Humanities
Abstract

Resume L'EEG apporte des informations essentielles a la prise en charge du malade suspect d'avoir presente une premiere crise epileptique. Meme dans les situations cliniques les plus evocatrices, la decouverte d'anomalies conforte le clinicien dans son diagnostic. Les anomalies EEG ont plus de chances d'etre detectees sur un trace realise precocement apres l'episode et repete par la suite, chez un malade non traite par des benzodiazepines. Les indications d'urgence face a un malaise ou une perte de connaissance breve concernent: (i) les malaises dont le profil evolutif et la semeiologie sont compatibles avec une crise epileptique focale ; (ii) les pertes de connaissance breves evoquant une crise partielle complexe (automatismes oro-alimentaires, gestuels ou deambulatoires) ; (iii) les malades suspects d'avoir presente une crise generalisee tonicoclonique, c'est-a-dire en cas de perte de connaissance prolongee au-dela de la duree d'une syncope, suivie d'un stertor ou d'une confusion, accompagnee de clonies ou de spasmes, compliquee d'une morsure de langue, responsable d'une chute avec traumatisme cranien ou precedee d'un signe/symptome evocateur. En revanche, la pratique systematique d'un EEG en urgence ne se justifie absolument pas devant un malaise ou une perte de connaissance mal etiquetes sur le plan clinique.

Published
1997
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15. Fourth meeting of the European Neurological Society 25–29 June 1994 Barcelona, Spain

Author

H. Hattig, C. Delli Pizzi, M. C. Addonizio, Michelle Davis, A. R. Giovagnoli, L. Florensa, M. Roth, J. de Kruijk, Francisco Lacruz, Ph. Dewailly, A. Toygar, C. Avendano, P.P. De Deyn, J. F. Hurtevent, F. Lomeila, T. W. Wong, Gordon T. Plant, M. Bud, H. J. Willison, DH Miller, D. W. Langdon, R. Cioni, J. Servan, A. Kaygisiz, E. Racadot, D. B. Schens, E. Picciola, L. Falip, C. Bouchard, J. Jotova, A. Jorge-Santamaria, P. Misra, A. Dufour, C. P. Panagopoulos, A. Venneri, B. Sredni, B. Angelard, M. Janelidze, M. Carreno, J. Obenberger, J. Pouget, H. W. Moser, R. Kaufmann, J. A. Molina, D. Linden, A. Martin Urda, E. Uvestad, A. Krone, J. P. Cochin, J. Mallecourt, A. Cambon-Thomsen, K. Violleau, P. Osschmann, A. M. Durocher, E. Bussaglia, D. M. Danielle, H. Efendi, C. Van Broeckhoven, K. G. Jordan, W. Rautenberg, C. Iniguez, J. M. Delgado, Graham Watson, M. Lawden, Gareth J. Barker, K. Stiasny, James T. Becker, G. Campanella, E. Peghi, A. Poli, A. Haddad, T. Yamawaki, Giacomo P. Comi, S. Sotgiu, B. Ersmark, A. Pomes, M. Ziegler, P. Ferrante, P. Ruppi, H. KuÇukoglu, R. Bouton, U. K. Rinne, P. Vieregge, M. Dary, P. Giunti, Peter J. Goadsby, S. Jung, E. Secor, A. Steinberg, N. Vila, M. A. Hernandez, M. Cursi, A. Enqelhardt, A. Engelhardt, J. Veitch, F. Di Silverio, F. Arnaud, B. Neundörfer, R. Brucher, Dominique Caparros-Lefebvre, B. Meyer, Marianne Dieterich, M. H. Snidaro, R. Gomez, R. Cerbo, M. Ragno, J. M. Vance, S. Nemni, A. Caliskan, F. Barros, I. Velcheva, D. Ceballos-Baumann, V. Barak, A. Avila, N. Antonova, F. Resche, S. Pappata, L. Varela, S. R. Silveira Santos, A. Cammarota, L. Naccache, Y. Nara, E. Tournier-Lasserves, R. Mobner, T. Chase, A. Ensenyat, J. Ulrich, G. Giegerich, M. Rother, M. Revilla, N. Nitschke, K. Honczarenko, E. Basart Tarrats, J. Blin, B. Jacob, J. Santamaria, S. Knezevic, J. L. Castillo, M. Antem, J. Colomer, O. Busse, Didier Hannequin, S. Carrier, J. B. Ruidavets, C. Rozman, J. Bogoussslavsky, J. Pascual Calvet, E. Monros, J. M. Polo, M. Zucconl, Javier Muruzabal, R. R. Allen, R. Rivolta, K. Haugaard, A. Nespolo, K. Hoang-Xuang, G. Bussone, T. Avramidis, E. Corsini, Christiana Franke, T. Vinogradova, H. Boot, K. Vestergaard, G. H. Jansen, N. Argentino, M. Raltzig, W. Linssen, Mark B. Pepys, P. Roblot, L. Lauritzen, E. Fainardi, D. Morin, T. X. Arbizu Urdiain, J. Wollenhaupt, S. Bostantjopoulou, G. Pavesi, A. D. Forman, Giovanni Fabbrini, D. Jean, J. J. Archelos, M. I. Blanchs, M. Del Gobbo, Anna Carla Turconi, Ch. Derouesné, Elio Scarpini, A. Visbeck, P. Castejon, J. P. Renou, F. Mounier-Vehier, G. Potagas, Ch. Duyckaerts, A. Filla, R. Schneider, G. Ronen, K. Nagata, J. P. Vedel, A. Henneberg, G. van Melle, C. Baratti, H. Knott, M. C. Prevett, A. Bes, B. Metin, Jos V. Reempts, L. Martorell, Mefkure Eraksoy, H. O. Handwerker, D. S. Younger, O. Oktem, D. Frongillo, C. Soriano-Soriano, L. Niehaus, F. Zipp, A. Tartaro, S Newman, R. H. Browne, P. Davous, R. Sanchez, M. Muros, M. E. Kornhuber, A. Lavarone, M. Mohr, M. R. 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Masana, A. Goossens, B. Heye, K. Lauer, Heinz Gregor Wieser, Stephen R. Williams, B. Garavaglia, A. P. Sempere, F. Grigoletto, P. Poindron, R. Lopez-Pajares, I. Leite, T. A. McNell, C. Caucheteur, J. M. Giron, A. D. Collins, P. Freger, J. Sanhez Del Rio, D. A. Harn, K. Lindner, S. S. Scherer, G. Serve, M. Juncadella, X. Estivill, R. Binkhorst, M. Anderson, B. Tekinsoy, C. Sagan, T. Anastopoulos, G. Japaridze, S. Guillou, F. Erminio, Jon Sussman, P. G. Oomes, D. S. Rust, S. Mascheroni, O. Berger, M. Peresson, K. V. Toyka, T. W. Polder, M. Huberman, B. Arpaci, H. Ramtami, I. Martinez, Ph. Violon, P. P. Gazzaniga Pozzill, R. Ruda, P. Auzou, J. Parker, S. P. Morrissey, Jiahong Zhu, F. Rotondi, P. Baron, W. Schmid, P. Doneda, M. Spadaro, M. C. Nargeot, I. Banchs, J.S.P. van den Berg, R. Ferrai, M. Robotti, M. Fredj, Pedro M. Rodríguez Cruz, B. Erne, D. G. Piepgras, M. C. Arne-Bes, J. Escudero, C. Goetz, A. R. Naylor, M. Hallett, O. Abramsky, E. Bonifacio, L. E. Larsson, R. Pellikka, P. Valalentino, D. Guidetti, B. Buchwald, C. H. Lücking, D. Gauvreau, F. Pfaff, A. Ben Younes-Chennoufi, R. Kiefer, R. Massot, K. A. Hossmann, L. Werdelin, P. J. Baxter, U. Ziflo, S. Allaria, C. D. Marsden, M. Cabaret, S. P. Mueller, E. Calabrese, R. Colao, S. I. Bekkelund, M. Yilmaz, O. Oktem-Tanor, R. Gine, M. E. Scheulen, J. Beuuer, A. Melo, Z. Gulay, M. D. Have, C. Frith, D. Liberati, J. Gozlan, P. Rondot, Ch. Brunholzl, M. Pocchiari, J. Pena, L. Moiola, C. Salvadori, A. Cabello, T. Catarci, S. Webb, C. Dettmers, N. A. Gregson, Alexandra Durr, F. Iglesias, U. Knorr, L. Ferrini-Strambi, F. Kruggel, P. Allard, A. Coquerel, P. Genet, F. Vinuels, C. Oberwittler, A. Torbicki, P. Leffers, B. Renault, B. Fauser, C. Ciano, G. Uziel, J. M. Gibson, F. Anaya, C. Derouesné, C. N. Anagnostou, M. Kaido, W. Eickhoff, G. Talerico, M. L. Berthier, A. Capdevila, M. Alons, D. Rezek, E. Wondrusch, U. Kauerz, D. Mateo, M. A. Chornet, Holon, N. Pinsard, I. Doganer, E. Paoino, H. Strenge, C. Diaz, J. R. Brasic, W. Heide, I. Santilli, W. M. Korn, D. Selcuki, M. J. Barrett, D. Krieger, T. Leon, T. Houallah, M. Tournilhac, C. Nos, D. Chavot, F. Barbieri, F. J. Jimenez-Jimenez, J. Muruzabal, K. Poeck, A. Sennlaub, L. M. Iriarte, L. G. Lazzarino, C. Sanz, P. A. Fischer, S. D. Shorvon, R. Hoermann, F. Delecluse, M. Krams, O. Corabianu, F. H. Hochberg, Christopher J. Mathias, B. Debachy, C. M. Poser, L. Delodovici, A. Jimenez-Escrig, F. Baruzzi, F. Godenberg, D. Cucinotta, P. J. Garcia Ruiz, K. Maier-Hauff, P. R. Bar, R. Mezt, R. Jochens, S. Karakaneva, C. Roberti, E. Caballero, Joseph E. Parisi, M. Zamboni, T. Lacasa, B. Baklan, J. C. Gautier, J. A. Martinez-Matos, W. Pollmann, G. Thomas, L. Verze, E. Chleide, R. Alvarez Sala, I. Noel, E. Albuisson, O. Kastrup, S. I. Rapoport, H. J. Braune, H. Lörler, M. Le Merrer, A. Biraben, S. Soler, S. J. Taagholt, U. Meyding-Lamadé, K. Bleasdale-Barr, Isabella Moroni, Y. Campos, J. Matias-Guiu, G. Edan, M. G. Bousser, John B. Clark, J. Garcia de Yebenes, N. K. Olsen, P. Hitzenberger, S. Einius, Aj Thompson, Ch. J. Vecht, T. Crepin-Leblond, Klaus L. Leenders, A. Di Muzio, L. Georgieva, René Spiegel, K. Sabey, D. Ménégalli, J. Meulstee, U. Liszka, P. Giral, C. Sunol, J. M. Espadaler, A. D. Crockar, K. Varli, G. Giraud, P. J. Hülser, A. Benazzouz, A. Reggio, M. Salvatore, K. Genc, M. Kushnir, S. Barbieri, J. Ph. Azulay, M. Gianelli, N. Bathien, A. AlMemar, F. Hentati, I. Ragueneau, F. Chiarotti, R. C. F. Smits, A. K. Asbury, F. Lacruz, B. Muller, Alan J. Thompson, Gordon Smith, K. Schmidt, C. Daems Monpeun, Juergen Weber, A. Arboix, G. R. Fink, A. M. Cobo, M. Ait Kaci Ahmed, E. Gencheva, Israel-Biet, G. Schlaug, P. De Jonghe, Philip Scheltens, K. Toyka, P. Gonzalez-Porque, A. Cila, J. M. Fernandez, P. Augustin, J. Siclia, S. Medaglini, D. E. Ziogas, A. Feve, L. Kater, G. J. E. Rinkel, D. Leppert, Rüdiger J. Seitz, S. Ried, C. Turc-Carel, G. Smeyers, F. Godinho, M. Czygan, M. Rijntjes, E. Aversa, M. Frigo, Leif Østergaard, J. L. Munoz Blanco, A. Cruz-Matinez, J. De Reuck, C. Theillet, T. Barroso, V. Oikonen, Florence Lebert, M. Kilinc, C. Cordon-Cardon, G. Stoll, E. Thiery, F. Pulcinelli, J. Solski, M. Schmiegelow, L. J. Polman, P. Fernandez-Calle, C. Wikkelso, M. Ben Hamida, M. Laska, E. Kott, W. Sulkowski, C. Lucas, N. M. Bornstein, D. Schmitz, M. W. Lammers, A. de Louw, R. J. S. Wise, P. A. van Darn, C. Antozzi, P. Villanueva, P. H. E. Hilkens, C. Constantin, W. Ricart, A. Wolf, M. Gamba, P. Maguire, Alessandro Padovani, B. M. Patten, Marie Sarazin, H. Ackermann, L. Durelli, S. Timsit, Sebastian Jander, B. W. Scheithauer, G. Demir, J. P. Neau, P. Barbanti, A. Brand, N. AraÇ, V. Fischer-Gagnepain, R. Marchioli, G. Serratrice, C. Maugard-Louboutin, G. T. Spencer, D. Lücke, G. Mainardi, K. Harmant Van Rijckevorsel, G. B. Creel, R. Manzanares, Francesco Fortunato, A. May, J. Workman, K. Johkura, E. Fernandez, Carlo Colosimo, L. Calliauw, L. Bet, Félix F. Cruz-Sánchez, M. Dhib, H. Meinardi, F. Carrara, J. Kuehnen, C. Peiro, H. Lassmann, K. Skovgaard Olsen, A. McDonald, L. Sciulli, A. Cobo, A. Monticelli, B. Conrad, J. Bagunya, J. Benitez, V. Desnizza, B. Dupont, O. Delrieu, D. Moraes, J. J. Heimans, F. Garcia Rio, M. Matsumto, A. Fernandez, R. Nermni, R. Chalmers, M. J. Marchau, F. Aguado, P. Velupillai, P. J. Martin, P. Tassan, V. Demarin, A. Engelien, T. Gerriets, Comar, J. L. Carrasco, J. P. Pruvo, A. Lopez de Munain, D. Pavitt, J. Alarcon, Chris H. Polman, B. Guldin, N. Yeni, Hartmut Brückmann, N. Wilczak, H. Szwed, R. Causaran, G. Kyriazis, M. E. Westarp, M. Gasparini, N. Pecora, J. M. Roda, E. Lang, V. Scaioli, David R. Fish, D. Caputo, O. Gratzl, R. Mercelis, A. Perretti, G. Steimetz, I. Link, C. Rigoletto, A. Catafau, G. Lucotte, M. Buti, G. Fagiolari, A. Piqueras, C. Godinot, J. C. Meurice, Erodriguez J. Dominigo, F. Lionnet, H. Grzelec, David J. Brooks, P. M. G. Munro, F. X. Weilbach, M. Maiwald, W. Split, B. Widjaja-Cramer, V. Ozturk, J. Colas, E. Brizioli, J. Calleja, L. Publio, M. Desi, R. Soffietti, P. Cortinovis-Tourniaire, E. F. Gonano, G. Cavaletti, S. Uselli, K. Westerlind, H. Betuel, C. O. Dhiver, H. Guggenheim, M. Hamon, R. Fazio, P. Lehikoinen, A. Esser, B. Sadzot, G. Fink, Angelo Antonini, D. Bendahan, V. Di Carlo, G. Galardi, A. F. Boller, M. Aksenova, Del Fiore, V. de la Sayette, H. Chabriat, A. Nicoletti, A. Dilouya, M. L. Harpin, E. Rouillet, J. Stam, A. Wolters, M. R. Delgado, Eduardo Tolosa, G. Said, A. J. Lees, L. Rinaldi, A. Schulze-Bonhage, MA Ron, C. Lefebvre, E. W. Radü, R. Alvarez, M. L. Bots, P. Reganati, S. Palazzi, A. Poggi, N. J. Scolding, V. Sazdovitch, T. Moreau, E. Maes, M. A. Estelies, P. Petkova, Jose-Felix Marti-Masso, G De La Meilleure, N. Mullatti, M. Rodegher, N. C. Notermans, T. A. T. Warner, S. Aktan, J. P. Louboutin, L. Volpe, C. Scheidt, W. Aust, C. M. Wiles, U. Schneider, S. K. Braekken, W. R. Willems, K. Usuku, Peter M. Rothwell, C. Talamon, M. L. Sacchetti, A. Codina, M. H. Marion, A. Santoro, J. Roda, A. Bordoni, D. J. Taylor, S. Ertas, H. H. Emmen, J. Vichez, V. BesanÇon, R. E. Passingham, M. L. Malosio, A. Vérier, M. Bamberg, A. W. Hansen, E. Mostacero, G. Gaudriault, Marie Vidailhet, B. Birebent, K. Strijckmans, F. Giannini, T. Kammer, I. Araujo, J. Nowicki, E. Nikolov, A. Hutzelmann, R. Gherardi, J. Verroust, L. Austoni, A. Scheller, A. Vazquez, S. Matheron, H. Holthausen, J. M. Gerard, M. Bataillard, S. Dethy, V. H. Patterson, V. Ivanez, N. P. Hirsch, F. Ozer, M. Sutter, C. Jacomet, M. Mora, Bruno Colombo, A. Sarropoulos, T. H. Papapetropoulos, M. Schwarz, D. S. Dinner, N. Acarin, B. Iandolo, J. O. Riis, P. R. J. Barnes, F. Taroni, J. Kazenwadel, L. Torre, A. Lugaresi, I. L. Henriques, S. Pauli, S. Alfonso, Pedro Quesada, A. S. T. Planting, J. M. Castilla, Thomas Gasser, M. Van der Linden, A. Alfaro, E. Nobile-Orazio, G. Popova, W. Vaalburg, F. G. A. van der Mech, L. Williams, F. Medina, J. P. Vernant, J. Yaouanq, B. Storch-Hagenlocher, A. Potemkowski, R. Riva, M. H. Mahagne, M. Ozturk, Ve. Drory, N. Konic, C. Jungreis, A. Pou Serradell, J. L. Gauvrit, G. J. Chelune, S. Hermandez, T. Dingus, L. Hewer, Ch. Koch, M. N. Metz-Lutz, G. Parlato, M. Sinaki, Charles Pierrot-Deseilligny, H. C. Diener, J. Broeckx, J. Weill-Fulazza, M. L. Villar, M. Rizzo, O. Ganslandt, C. Duran, N. A. Fletcher, G. Di Giovacchino, Susan T. Iannaccone, C. Kolig, N. Fabre, H. A. Crockard, Rita Bella, M. Tazir, E. Papagiannuli, K. Overgaard, Emma Ciafaloni, I. Lorenzetti, F. Viader, P. A. H. Millac, I. Montiel, L. H. Visser, M. Palomar, P. L. Murgia, H. Pedersen, Rafael Blesa, S. Seddigh, W. O. Renier, I. Lemahieu, H. M. L. Jansen, L. Rosin, J. Galofre, K. Mattos, M. Pondal, G. M. Hadjigeorgiou, D. Francis, L. Cantin, D. Stegeman, M. Rango, A. B. M. F. Karim, S. Schraff, B. Castellotti, I. Iriarte, E. Laborde, T. J. Tjan, R. Mutani, D. Toni, B. Bergaasco, J. G. Young, C. Klotzsch, A. Zincone, X. Ducrocq, M. Uchuya, O. J. Kolar, A. Quattrone, T. Bauermann, Nereo Bresolin, J. Vallée, B. C. Jacobs, A. Campos, Werner Poewe, J. A. Villanueva, A. W. Kornhuber, A. Malafosse, E. Diez-Tejedor, G. Jungreia, M. J. A. Puchner, A. Komiyama, O. Saribas, V. Volpini, L. Geremia, S. Bressi, A. Nibbio, Timothy E. Bates, T. z. Tzonev, E. Ideman, G. A. Damlacik, G. Martino, G. Crepaldi, T. Martino, Kjell Någren, E. Idiman, D. Samuel, J. M. Perez Trullen, Y. van der Graaf, J. O. Thorell, M. J. M. Dupuis, E. Sieber, R. D'Alessandro, C. Cazzaniga, J. Faiss, A. Tanguy, A. Schick, I. Hoksergen, A. Cardozo, R. Shakarishvili, G. K. Wennlng, J. L. Marti-Vilalta, J. Weissenbach, I. L. Simone, Amalia C. Bruni, Darius J. Adams, C. Weiller, A. Pietrangeli, F. Croria, C. Vigo-Pelfrey, Patricia Limousin, A. Ducros, G. Conti, O. Lindvall, E. Richter, M. Zuffi, A. Nappo, T. Riise, J. Wijdenes, M. J. Fernandez, J. Rosell, P. Vermersh, S. Servidei, M. S. C. Verdugo, F. Gouttiere, W. Solbach, M. Malbezin, I. S. Watanabe, A. Tumac, W. I. McDonald, D. A. Butterfield, P. P. Costa, F. deRino, F. Bamonti, J. M. Cesar, C. H. Lahoz, I. Mosely, M. Starck, M. H. Lemaitre, K. M. Stephan, S. Tex, R. Bokonjic, I. Mollee, L. Pastena, M. Gutierrez, F. Boiler, M. C. Martinez-Para, M. Velicogna, O. Obuz, A. Grinspan, M. Guarino, L. M. Cartier, E. Ruiz, D. Gambi, S. Messina, M. Villa, Michael G. Hanna, J. Valk, Leone Pascual, M. Clanet, Z. Argov, B. Ryniewicz, E. Magni, B. Berlanga, K. S. Wong, C. Gellera, C. Prevost, F. Gonzalez-Huix, R. Petraroli, J. E. G. Benedikz, I. Kojder, C. Bommelaer, L. Perusse, M. R. Bangioanni, Guy M. McKhann, A. Molina, C. Fresquet, E. Sindern, Florence Pasquier, M. J. Rosas, M. Altieri, O. Simoncini, M. Koutroumanidis, C. A. F. Tulleken, M. Dary-Auriol, S. Oueslati, H. Kruyer, I. Nishisho, C. R. Horning, A. Vital, G. V. Czettritz, J. Ph. Neau, B. Mihout, A. Ameri, M. Francis, S. Quasthoff, D. Taussig, S. Blunt, P. Valentin, C. Y. Gao, O. Heinzlef, H. d'Allens, C. Coudero, M. Erfas, G. Borghero, P. J. Modrego Pardo, M. C. Patrosso, N. L. Gershfeld, P. A. J. M. Boon, O. Sabouraud, M. Lara, J. Svennevig, G. L. Lenzi, A. Barrio, H. Villaroya, JosÇ M. Manubens, O. Boespflug-Tanguy, M. Carreras, D. A. Costiga, J. P. Breux, S. Lynn, C. Oliveras Ley, A. G. Herbaut, J. Nos, C. Tornali, Y. A. Hekster, J. L. Chopard, J. M. Manubens, P. Chemouilli, A. Jovicic, F. Dworzak, S. Smirne, S. E. Soudain, B. Gallano, D. Lubach, G. Masullo, G. Izquierdo, A. Pascual Leone Pascual, A. Sessa, V. Freitas, O. Crambes, L. Ouss, G. W. Van Dijk, P. Marchettini, P. Confalonieri, M. Donaghy, A. Munnich, M. Corbo, and M. E. L. van der Burg

Subjects
Neurology, business.industry, Media studies, Library science, Medicine, Neurology (clinical), business
Published
1994
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16. Méningoencéphalite herpétique du sujet âgé. À propos de 13 observations

Author

H. Vespignani, Pierre Jouanny, J.B. Dureux, M. Weber, A. Gerard, X. Ducrocq, C Jeandel, Ph. Canton, G. Cuny, and F. Penin

Subjects
Gynecology, medicine.medical_specialty, business.industry, Gastroenterology, Internal Medicine, medicine, medicine.disease, business, Encephalitis
Abstract

Resume L'analyse retrospective d'une serie de 13 observations geriatriques d'encephalite herpetique (dix femmes, trois hommes, âge moyen : 67,2 ± 6,4 ans) montre que cette infection est le plus souvent due a Herpes simplex virus de type I chez le sujet âge. Facile a la phase d'etat, le diagnostic doit etre evoque a la phase initiale devant toute confusion (neuf cas sur 13), a fortiori febrile (11 cas sur 13), associee a des signes neurologiques (dix cas sur 13), notamment epileptiques (cinq cas sur 13) et imposer la ponction lombaire qui ramene un liquide clair et lymphocytaire. Cette meningoencephalite curable est une urgence therapeutique dont depend le pronostic, et qui impose la mise en route du traitement par aciclovir devant toute presomption diagnostique. L'EEG est utile quand il inscrit une activite periodique (dix cas sur 13). L'imagerie (TDM, IRM) n'apporte que des arguments presomptifs, souvent tardifs. La biologie apporte la confirmation diagnostique a posteriori , surtout grâce aux progres des methodes Elisa. L'amplification genique (PCR) permet un diagnostic precoce. Ces formes du sujet âge sont plus dues a une reinfection ou a une reactivation d'un virus anciennement contracte qu'a une primo-infection.

Published
1994
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17. Ischaemic stroke and essential thrombocythemia: a series of 14 cases

Author

S, Richard, J, Perrin, P-A, Baillot, J-C, Lacour, and X, Ducrocq

Subjects
Adult, Aged, 80 and over, Male, Stroke, Platelet Count, Humans, Female, Middle Aged, Aged, Brain Ischemia, Retrospective Studies, Thrombocythemia, Essential
Abstract

Essential thrombocythemia (ET) is considered as a rare cause of stroke, partially because of difficulties to identify it when platelet count is not greatly elevated. However, early detection of ET is important because, without adapted treatment, recurrent thromboses are frequent.We collected, retrospectively, data from 14 cases of stroke patients with ET. Clinical characteristics, ischaemic stroke, laboratory data (platelet and leucocyte count, haemoglobin, JAK2 V617F mutation, culture of haematopoietic progenitors) and treatment were reviewed. Every patient has been interviewed by phone to evaluate outcome.The population consisted of nine women and five men with ages ranging from 40 to 87 years. Most of the patients (12) had atherosclerotic risk factors and two presented a thrombus in the internal carotid. ET was diagnosed early after the onset of stroke except in two patients. The platelet count was under 600*10(9) /L for five patients. Mutation JAK2 V617F was found for eight patients. Thirteen patients were treated with an association between antiplatelet and cytoreductive treatment and did not present further thrombosis. Median follow-up is 2.8 years.These cases emphasize the problems of diagnosing ET at the onset of the stroke. Complete blood count has to be carefully read and ET can be suspected even if platelet count is not greatly increased. Diagnosis must be confirmed by haematologist to initiate appropriate treatment.

Published
2010

18. Neurological complications and pleural lavage with a fibrinolytic agent. A two-case report

Author

R. Lion, X. Ducrocq, C. Kummerlen, J. D. Tempé, and Francis Schneider

Subjects
Adult, Male, medicine.medical_specialty, Pleural effusion, Streptokinase, Critical Care and Intensive Care Medicine, Bronchoalveolar Lavage, Air embolism, Pleural disease, Fibrinolytic Agents, medicine, Embolism, Air, Humans, business.industry, Respiratory disease, Middle Aged, medicine.disease, Surgery, Embolism, Anesthesia, Nervous System Diseases, business, Complication, Fibrinolytic agent, medicine.drug
Abstract

We report on an unusual, albeit potentially severe, complication of the performance of a pleural lavage with streptokinase in two patients demonstrating parapneumonic pleural effusion. During the time they underwent repeated pleural lavages with saline and streptokinase, they suddenly demonstrated focal neurological signs. As a result of early diagnosis and emergency hyperbaric oxygenation, both patients recovered without delayed sequelae. Air embolism is a potentially severe complication which can occur during pleural lavage. Whether streptokinase increases the risk of opening a latent vascular breach cannot be definitely established, but clinicians should be aware of this risk. In this context, the onset of acute focal neurological signs should suggest the possibility of air embolism and lead to the transfer of the patient close to a hyperbaric facility within a few hours.

Published
2000
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19. Cerebral venous thrombosis caused by spontaneous intracranial hypotension: two cases

Author

P. Boyer, H. Vespignani, J. C. Lacour, Stéphane Kremer, Sébastien Richard, and X Ducrocq

Subjects
Adult, Male, Venous Thrombosis, medicine.medical_specialty, business.industry, Intracranial Hypotension, Middle Aged, Cortical Vein, medicine.disease, Venous thrombosis, Neurology, Anesthesia, Internal medicine, medicine, Cardiology, Spontaneous Intracranial Hypotension, Humans, Female, Neurology (clinical), Risk factor, Intracranial Thrombosis, business, Thrombotic complication
Abstract

The association of spontaneous intracranial hypotension (SIH) with cerebral venous thrombosis (CVT) is rare. We are reporting two new cases. In one case, CVT is extensive concerning three sinuses and bilateral parietal cortical veins and, in the other case, only a cortical vein is involved. Both the patients presented had no thrombosis risk factors. There is certainly a link between these two pathologies. SIH should be considered as a risk factor of CVT. Modification of symptoms of SIH leading to CVT must be known to start early treatment.

Published
2007

21. Duplex scanning diagnosis of internal carotid artery dissections. A case control study

Author

C, Alecu, J O, Fortrat, X, Ducrocq, H, Vespignani, and J M, de Bray

Subjects
Adult, Male, Ultrasonography, Doppler, Duplex, Reproducibility of Results, Carotid Artery, Internal, Dissection, Middle Aged, Sensitivity and Specificity, Stroke, Ophthalmic Artery, Logistic Models, Databases as Topic, Predictive Value of Tests, Case-Control Studies, Laser-Doppler Flowmetry, Humans, Female, France, Ultrasonography, Doppler, Color, Blood Flow Velocity, Carotid Artery, Internal, Retrospective Studies
Abstract

The reliability of duplex scanning (DS) for the diagnosis of internal carotid artery dissections (ICAD) is not clear.Nine DS signs known to be suggestive for the diagnosis of ICAD were compared between 70 patients with ICAD and 70 matched patients without dissection.Visible internal tapering occlusion, regular eccentric narrowing channel, ectasia beyond the carotid bulb, resistive index asymmetry, blood flow slowdown, ophthalmic artery blood flow inversion, and biphasic flow are more frequent in cases than in controls (p0.001). Atheroma plaques were absent in 80% of ICAD. When DS direct signs and hemodynamic signs were studied, sensitivity was 90% and specificity 60%.Diagnosis of ICAD by DS could be improved if direct signs were combined with hemodynamic signs, giving a high sensitivity and a rather good specificity.

Published
2006

22. [Acute, isolated and reversible paralysis of the soft palate in childhood]

Author

A, Jary, L, Maillard, E, Raffo, X, Ducrocq, M, Braun, and H, Vespignani

Subjects
Accessory Nerve Diseases, Acute Disease, Humans, Paralysis, Female, Palate, Soft, Child
Abstract

Unilateral spinal and accessory palsy is uncommon in children. The main problem is the extensive exploration undertaken to achieve etiological diagnosis.We report two cases of transitory, unilateral, spinal and accessory palsy, associated in one case with homolateral hemi-pharyngeal palsy, that occurred in two previously healthy children.Few reports have been published in the literature to date. From those two cases and data of the literature, we suggest that the clinical presentation results from idiopathic peripheral nerve palsy.Further case reports would be useful to confirm the benign nature of this syndrome so that complementary investigations may be limited in future cases with a similar presentation.

Published
2004

23. [Thrombus of the left lateral sinus spreading to the internal jugular vein]

Author

J-C, Lacour, X, Ducrocq, C, Moret, R, Anxionnat, S, Richard, S, Bracard, and G, Barroche

Subjects
Central Nervous System Vascular Malformations, Sinus Thrombosis, Intracranial, Tinnitus, Heparin, Anticoagulants, Humans, Female, Thrombolytic Therapy, Epilepsies, Partial, Jugular Veins, Middle Aged, Magnetic Resonance Imaging, Contraceptives, Oral, Hormonal
Abstract

Cerebral venous thrombosis is an uncommon event which presents a wide spectrum of sometimes extraneurological signs different from the classical clinical presentation. We report the cases of two middle-aged women who developed thrombosis of the left lateral sinus spread-ing to the internal jugular vein from the sigmoid sinus. The time course of the symptoms suggested that intracranial thrombosis occurred first. No infectious or neoplastic local disease could be found but both women were taking oral contraceptives. Medical treatment led to good reperfusion of the intracranial sinuses but occlusion of the jugular vein persisted despite prolonged oral anticoagulants. Long-term outcome was favorable with residual benign epilepsy in one patient, and occurrence of an arteriovenous fistula in the other.

Published
2003

24. [Thrombosis of deep cerebral veins in form adults: clinical features and diagnostic approach]

Author

J C, Lacour, X, Ducrocq, R, Anxionnat, L, Taillandier, J, Auque, and M, Weber

Subjects
Adult, Venous Thrombosis, Brain, Humans, Female, Middle Aged, Tomography, X-Ray Computed, Cerebral Veins, Magnetic Resonance Imaging
Abstract

Thrombosis of deep cerebral veins is a rare condition, and is associated with a poor prognosis. We report four new cases observed between 1994 and 1997. All four cases were women, aged less than 45 years. Initial symptoms associated alteration of consciousness, change in mental status, progressive headache and vomiting. We observed also uni or bilateral signs of long tract injury. In three cases, diagnosis initially suspected by CT scan was confirmed with encephalic MRI. For the last patient, conventional angiography was needed. Thrombosis affected straight sinus, vein of Galien and internal cerebral veins in all patients. Basilar veins were also affected in one patient, without dural sinuses extension. Lateral sinus was involved in two others cases, and superior sagittal in the last patient. Etiology remains undetermined in one patient, associated with post-partum, use of oral contraceptive pill, and familial protein S deficiency, one case each. Outcome was favorable in all four cases with anticoagulation therapy. Precocity of diagnosis is determinant and MRI is usefull in this issue. These observations show that evolution of deep veins thrombosis can be favorable, without needing fibrinolytic therapy.

Published
2000

25. [Ethical approach to informed consent for participation in clinical studies in acute cerebral infarct]

Author

X, Ducrocq, L, Taillandier, R, Anxionnat, J C, Lacour, M, Debouverie, L, Lanotte, H, Vespignani, and M, Weber

Subjects
Adult, Aged, 80 and over, Male, Informed Consent, Cerebral Infarction, Middle Aged, Survival Rate, Legal Guardians, Double-Blind Method, Acute Disease, Humans, Ethics, Medical, Female, Mental Competency, France, Aged, Randomized Controlled Trials as Topic
Abstract

We sought to evaluate the application of the French law for the protection of persons participating in research studies in biology and medicine. Specifically, we examined comprehension and consequences of informed consent procedures in the field of stroke, characterized by an emergency setting, cognitive impairment and poor prognosis.Patients (or proxies) included in recent years in clinical studies conducted in our Neurology Department for evaluating treatment of acute phase cerebral ischemia were interviewed to determine their knowledge of the disease, its treatment, the study protocol and the legal regulations, and the affective and psychological consequences of the informed consent procedure.Among 72 patients included in 7 studies ([fibrinolytic agent: 3 (n = 43), anticoagulant agent: 1 (n = 4), neuroprotective drugs (n = 25)], [7 randomized studies, 6 double-blind versus placebo, 5 with a 6-hour inclusion time interval]), 15 died during the acute phase, 5 were lost to follow-up, 4 refused to participate and 7 gave very partial answers. Consent was signed by the patient in 15% of cases, the spouse in 50%, a descendant in 23%. These persons were aware of the spontaneous risk of death (85%) or definitive functional impairment (95%). Half of them thought a specific treatment existed, 11% had some idea of the mechanism of action of the proposed treatment while 67% learned about this mechanism from the information provided. Although they had received information, only 25% of the patients had knowledge of placebo and 7% of therapeutic risk. 37% expected complete recovery from the treatment, 44% partial recovery, and 13% were very disappointed by the outcome. 81% felt they were free to make their own decision. Although 86% did not know there was a law protecting them, 82% were in agreement with the requirement for their consent while 17% would have preferred to delay consent. Most wished to be given the opportunity to discuss the study again, after the acute phase, and to receive the results of the study.This study shows that most French stroke victims and their closest relatives are unaware of the law protecting persons in biomedical research and have poor knowledge of medical data after being given appropriate information. Even so, the quality of information increases the quality of the patient-physician relationship. Patients want to be free to make their own decision to consent to biomedical research, but their desire was more for good information than for the power to make their decision alone. Being asked to give informed consent in order to participate in a clinical study accentuates the affective and psychological consequences of stroke, a factor which should be taken into consideration during follow-up.

Published
2000

26. [Isolated dissection of the basilar artery]

Author

J C, Lacour, X, Ducrocq, R, Anxionnat, S, Auliac, S, Bracard, and M, Weber

Subjects
Adult, Male, Aortic Dissection, Hematoma, Basilar Artery, Vertebrobasilar Insufficiency, Humans, Intracranial Aneurysm, Magnetic Resonance Imaging, Brain Ischemia, Cerebral Angiography
Abstract

Two cases of isolated dissection of the basilar artery responsible for ischemic stroke are reported. This rare condition is still associated with a poor outcome. Most patients were male and the clinical presentation consisted of ischemic symptoms or subarachnoid hemorrhage in posterior circulation. Angiography and Magnetic Resonance Imaging are usefull for the diagnostic, showing parietal hematoma, or as for our first case, double lumens. Optimal therapeutic is unknown.

Published
2000

27. [Painless abducens palsy disclosed by spontaneous dissection of the intracavernous internal carotid artery]

Author

X, Ducrocq, J, Lacour, R, Anxionnat, C, Marchal, S, Bracard, and H, Vespignani

Subjects
Male, Ophthalmoplegia, Image Processing, Computer-Assisted, Humans, Cavernous Sinus, Carotid Artery, Internal, Dissection, Middle Aged, Magnetic Resonance Imaging, Carotid Artery, Internal, Abducens Nerve Diseases, Cerebral Angiography
Abstract

A 63-year-old man presented suddenly and spontaneously an isolated painless oculomotor palsy of the nerve abducens. As no etiology could be suspected a head MRI was performed. It showed a T1 hypersignal of the intracavernous segment of the internal carotid artery with a double-lumen pattern typical of dissection. The patient was treated with aspirin and recovered from clinical symptoms in 10 weeks. A control MRI was performed 3 months after the onset of symptoms and showed the regression of the images of dissection. There was no ischemic lesion of the brain. This case underlines the diversity of the symptoms of spontaneous dissections of cervicocephalic arteries, especially absence of pain, palsies of cranial nerve that are not always limited to lower cranial nerve, and existence of dissections limited to the intracranial segment of the carotid artery. It suggests the interest of MRI in the diagnosis of isolated oculomotor nerve palsies.

Published
2000

28. [Diffusion imaging in asymptomatic focal vasospasm. Apropos of a case]

Author

S, Bracard, S, Auliac, R, Anxionnat, J C, Lacour, X, Ducrocq, M, Braun, C, Moret, and L, Picard

Subjects
Adult, Male, Middle Cerebral Artery, Intracranial Aneurysm, Aneurysm, Ruptured, Subarachnoid Hemorrhage, Image Enhancement, Magnetic Resonance Imaging, Temporal Lobe, Brain Ischemia, Diffusion, Risk Factors, Cerebrovascular Circulation, Humans, Vasospasm, Intracranial, Forecasting
Abstract

We report a case of an asymptomatic vasospasm with a focal, reversible apparent diffusion coefficient (ADC) decrease after a middle cerebral artery aneurysm rupture. This isolated decrease of ADC has not yet been reported in this pathological situation. It could be interesting to predict the risk of ischemic delayed complications of vasospasm.

Published
2000

29. [Cerebral ischemic accidents in young subjects. A prospective study of 296 patients aged 16 to 45 years]

Author

X, Ducrocq, J C, Lacour, M, Debouverie, S, Bracard, F, Girard, and M, Weber

Subjects
Adult, Male, Cerebrovascular Disorders, Sex Factors, Adolescent, Risk Factors, Humans, Female, Prospective Studies, Middle Aged, Lipids, Brain Ischemia
Abstract

From 1990 to 1997, June, 296 patients (156 males and 140 females), aged 16 to 45 years, admitted in the Neurology Department of the University Hospital of Nancy (F) for ischemic stroke, were prospectively evaluated according to a standardized analysis of anamnestic and clinical data, angiography (90 p. 100 of cases), TEE (78 p. 100), hemostasis. Women were younger (mean age = 34.82 y) than men (36.87 y; p = 0.003), with a peak in the 4th decade. Clinical event was a TIA in 14.2 p. 100, a stroke in 51.7 p. 100; it concerned the anterior circulation in 64.5 p. 100, posterior circulation in 25 p. 100, multiple territories in 10.5 p. 100. History of TIA, cervical-cranial pain or Horner syndrome suggestive of dissection, pregnancy or post-partum were found respectively in 60 (20.3 p. 100), 34 (11.1 p. 100) and 13 (9.3 p. 100) cases. Risk factors concerned 87.2 p. 100 of patients, mainly smoking (55.1 p. 100), oral contraceptive (53 p. 100), hyperlipemia (35 p. 100), and were more frequent in case of atheroma and lacunar stroke (p0.0000). Etiology, according to TOAST classification, was: atheroma (8.4 p. 100), cardioembolism (8.7 p. 100), small-artery disease (7.1 p. 100), dissection (15.5 p. 100), other determined causes (11.1 p. 100), multiple causes (5.7 p. 100), undetermined cause (34.8 p. 100). Septal pathology was found 34 times. Patients whose stroke remained unexplained were younger (33.7 y vs 37.7, p = 0.002), had less risk factors (p0.0000), had more TIA (p = 0.005), more often in the carotid territory (p = 0.008), had a better prognosis (p = 0.01), and showed more often emboli at angiography (p = 0.001). During a mean follow-up of 33 months (median = 19), 21 recurrent strokes occurred and 6 patients died. 134 (46 p. 100) patients had no sequelae, 101 (34.7 p. 100) minor disability, 42 (14.4 p. 100) major sequelae. These results, compared to the main studies of the literature, suggest the interest of common definition criteria and classification of etiologies. In practice, hierarchisation of investigations may be proposed, and vascular risk factors should be tracked in young patients. In patients whose stroke remains unexplained, further studies, as atrial vulnerability, are needed.

Published
1999

30. [Paraneoplastic opsoclonus-myoclonus syndrome revealing T-cell lymphoma]

Author

X, Ducrocq, J, Petit, L, Taillandier, V, Dorvaux, R, Anxionnat, F, Plénat, and H, Vespignani

Subjects
Myoclonus, Neuroblastoma, Ocular Motility Disorders, Paraneoplastic Syndromes, Humans, Female, Lymphoma, T-Cell, Magnetic Resonance Imaging, Mediastinal Neoplasms, Aged
Abstract

Nonrhythmic involuntary ocular oscillations and axial and segmentary myoclonia are associated in the opsoclonus-myoclonus syndrome. In adults, a paraneoplastic origin is generally found. We report the first of opsoclonus-myoclonus associated with non-Hodgkin's lymphoma.A 66-year-old woman rapidly developed a typical opsoclonus-myoclonus syndrome within a few hours, presenting vertigo, cerebellous ataxia, multidirectional involuntary ocular movements and non-rhythmic axial and segmentary myoclonia. Brain computed tomography and magnetic resonance imaging demonstrated discrete diffuse anomalies of the white substance predominating in the pons. The cerebrospinal fluid showed discrete lymphocytosis. Antineuron antibodies were negative. No cause could be identified until the development 11 months later of pleomorphic T-cell mediastino-cervical lymphoma. The patient responded moderately to a CHOP regimen which had no effect on the opsoclonus-myoclonus syndrome. Death occurred after a 16-month course due to pulmonary complications.Neuroblastoma and infectious causes predominate in opsoclonus-myoclonus syndromes observed in children; in adults, the predominant cause is cancer. Antineuron, anti-Ri and anti-Hu antibodies can be evidenced in some cases, arguing in favor of a paraneoplastic mechanism. Recent reports have evidenced MRI anomalies in the pons and the cerebellum, anatomically well correlated with the opsoclonus-myoclonus syndrome. Besides small-cell bronchogenic anaplastic cancer, the possibility of cancer of the breast and uterus, and both non-Hodgkin and Hodgkin lymphoma should be explored, knowing the cancer develops several month after the opsoclonus-myoclonus syndrome.

Published
1999

33. Subject Index Vol. 23, 2007

Author

J.M. de Bray, Rudolf Gesztelyi, E. de Haan, J. Zyss, L. Derex, C. McCollum, Julia Schoof, Andrzej Szczudlik, V. Vidjak, Maciej T. Malecki, Carme Junqué, B.P.W. Jansen, Keiko Irie, Gerard M. Ribbers, Agnieszka Slowik, Dragutin Januš, Mariana Rovira, Werner Hacke, X. Ducrocq, Joanna Pera, Grzegorz Kopeć, N. Nighoghossian, Dániel Bereczki, V. Pautot, M.J.E. van Zandvoort, Ralph L. Sacco, Sándor Kéki, Yoko Kato, Paweł Szermer, Andrei V. Alexandrov, Diederik W.J. Dippel, Theodore C. Larson, A.L. Abbott, S. Sastry, Hans-Christoph Diener, Tomasz Dziedzic, Hugh S. Markus, Denise A. Figlewicz, F. Dubas, Hirotoshi Sano, B.R. Chambers, Tetsuo Kanno, Marta Grau-Olivares, J.L. Stork, Rita Bhatia, Sun Uck Kwon, E. Bernd Ringelstein, J.O. Fortrat, Julien Bogousslavsky, Bradley P. Thomas, M. Michallet, P.L.M. de Kort, Markku Kaste, G.A. Donnan, Romke van Balen, F. Vanhee, Peter Langhorne, G.M.S. Nys, Zuhir Halloul, Sebastian Koch, Lisette Maasland, C. Alecu, Danijela Vrhovski-Hebrang, S. Cakmak, Aleksandra Klimkowicz-Mrowiec, Dong-Wha Kang, Paweł Wołkow, Wojciech Turaj, A. Pasco, J. De Reuck, Joan-Carles Soliva, Akiyo Sadato, Didier Leys, C.R. Levi, G. Van Maele, Cecilia Targa, Mária Tünde Magyar, Vlatka Preden-Kereković, Sadayoshi Watanabe, Knut Stavem, János Török, Neşe Çelebisoy, P. Lhoste, Anne-Sophie Darlington, I. Claeys, David Bartrés-Faz, Cem Calli, Dorota Wloch, Adrià Arboix, Ante Grga, Mehmet Çelebisoy, Minoru Yoneda, K. Daly, B. Vielle, J. Dik F. Habbema, Attila Valikovics, Kostadin L. Karagiozov, H. Vespignani, Judit Zsuga, Motoharu Hayakawa, Michael T. Wunderlich, Ole Morten Rønning, Alejandro M. Forteza, Zlata Flegar-Meštrić, Jong Sung Kim, Jose C. Navarro, Sang-Beom Jeon, Jan Passchier, Martin Skalej, Peter J. Koudstaal, Emre Kumral, Sonja Perkov, Dae Kyoon Lee, Annabelle Y. Lao, László Csiba, L.J. Kappelle, Miklós Zsuga, G. Marc, Andrija Hebrang, Diler Hülya Canbaz, Georgios Tsivgoulis, T. Chengodu, Makoto Negoro, Vivek Sharma, Salim Yusuf, Lukui Chen, and Jan J. V. Busschbach

Subjects
Index (economics), Neurology, business.industry, Statistics, Medicine, Subject (documents), Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Published
2007
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34. Consensus opinion on diagnosis of cerebral circulatory arrest using Doppler-sonography: Task Force Group on cerebral death of the Neurosonology Research Group of the World Federation of Neurology

Author

X, Ducrocq, W, Hassler, K, Moritake, D W, Newell, G M, von Reutern, T, Shiogai, and R R, Smith

Subjects
Brain Death, Cerebrovascular Disorders, Ultrasonography, Doppler, Transcranial, Humans, Blood Flow Velocity
Abstract

Oscillating flow or systolic spikes are typical Doppler-sonographic flow signals found in the presence of cerebral circulatory arrest, which if irreversible, results in brain death. The Neurosonology Research Group (NSRG) of the World Federation of Neurology (WFN) created a Task Force Group in order to evaluate the role of Doppler-sonography as a confirmatory test for determining brain death.The available evidence from the literature has been reviewed and discussed by a group of experts, the members of the Task Force Group on cerebral death of the NSRG.Extra- and intracranial Doppler-sonography is a useful confirmatory test to establish irreversibility of cerebral circulatory arrest as optional part of a brain death protocol. Doppler-sonography is of special value when the therapeutic use of sedative drugs renders electroencephalography unreliable. Doppler-sonographic criteria are defined and guidelines for the use of Doppler-sonography in this setting are presented.

Published
1998

35. [MNGIE syndrome in 2 siblings]

Author

M, Debouverie, M, Wagner, X, Ducrocq, Y, Grignon, B, Mousson, and M, Weber

Subjects
Adult, Male, Mitochondrial Encephalomyopathies, Intestinal Pseudo-Obstruction, Humans, Peripheral Nervous System Diseases, Female, Syndrome, Pedigree
Abstract

Two siblings (one man, one woman), presenting with diarrhea, severe weight loss peripheral neuropathy, ophthalmoparesis, asymptomatic leukoencephalopathy were diagnosed as a new cases of Mitochondrial Neuro Gastro Intestinal Encephalomyopathy syndrome (MNGIE). Hirano (1994) defined four criteria for the diagnostic: peripheral neuropathy, ophthalmoparesis, gastro intestinal dysmotility, muscle biopsy with histologic features of mitochondrial myopathy (ragged-red fibers, muscle fibers with increased succinate deshydrogenase stain or ultra structurally abnormal mitochondria). In a review of the literature, we found 31 cases with MNGIE. With our two cases, we study this group of 33 patients. First symptoms begin about 13.5 years with a median of 10 years and extremes for 1 to 32 years. The first signs are gastro intestinal symptoms (recurrent nausea, vomiting or diarrhea with intestinal dysmotility) in 22 cases, an ophthalmoparesia in 4 cases, intestinal and ocular signs in 1 case, gait ataxia or peripheral neuropathy in 3 cases, hearing loss in 1 case, gait ataxia or peripheral neuropathy in 3 cases, hearing loss in 1 case. During the evolution, besides the cardinal signs, the following features have been observed with a variable frequency: hearing loss, short stature, facial palsy, dysphonia, dysarthria, sweating, orthostatic hypotension, bladder dysfunction, hepatomegalia, The laboratory features are: abnormal Nerve Condition Studies/EMG compatible with a sensory motor neuropathy, lactic acidosis, mitochondrial respiratory chain defect (essentially complex IV deficiency, complex I deficiency or multiple complex defect), MRI leukodystrophy, elevated CSF protein, heart block, ragged-red fibers or increased SDH stain. The prognosis is poor, due to a severe weight loss bordering on cachexia 13 patients died with a mean age of 28.5 years (median 24 years, extreme 3 years to 51 years). The prognosis seems to be worsened by a young age of onset. The 33 patients belong to 19 families with 7 cases of consanguinity. 25 patients had a brother, a sister or a cousin affected. The study of these families is compatible with an autosomic recessive transmission, suggesting a pathology of the nuclear genomi, probably impliying the control of the mitochondrial DNA replication. In fact, in 13 cases, a study of the mt DNA was realized: multiple deletions were founded in 6 cases, multiples mutations in one case, unique mutation in 1 case. In 5 cases ther was no evidence of abnormality. These precise etiology and pathophysiologic significance of the mt DNA deletions, and the heterogeneity of the modifications of the mt DNA remain unknown. However, the possibility of various phenotypes for a same genotype or inversely is known in mitochondriopathies.

Published
1998

36. Event-related potentials in the segmental exclusion syndrome of the upper limb

Author

J M, Beis, J M, André, A, Vielh, and X, Ducrocq

Subjects
Adult, Male, Adolescent, Arm, Humans, Peripheral Nervous System Diseases, Female, Middle Aged, Event-Related Potentials, P300
Abstract

Upper limb segmental exclusion syndromes are frequent after traumatic or infectious affections. They can be defined as an insufficient utilization of a limb segment--fingers or hand--reversible on verbal exhortation and arising in subjects with no other neurologic or psychiatric disorder. Our hypothesis was that the segmental exclusion syndrome could be likened to a neglect behavior. To verify the validity of this hypothesis, we measured digital nerve short-latency SEP and SEP-P300 waves in response to odd-ball task target stimuli in healthy volunteers (n = 11) and patients with digit exclusion syndromes (n = 19). For N20 latency, there was no significant difference (Wilcoxon's test: p = 0.52) between normal and excluded digits. Stimulation of the excluded vs normal digit resulted in a significant lengthening in SEP-P300 latency (p = 0.0003). The implication of these results and means of extending our knowledge of the pathophysiology of exclusion syndromes are discussed.

Published
1998

37. [Indications for emergency EEG in disease, a brief loss of consciousness in generalized epileptic seizures in the adult]

Author

H, Vespignani, X, Ducrocq, and J L, Schaff

Subjects
Adult, Emergency Medical Services, Humans, Electroencephalography, Epilepsy, Generalized
Abstract

EEG provides essential information for the management of patients in whom a first epileptic seizure is suspected because of transient alteration of consciousness. Postictal or interictal EEG abnormalities are useful to the clinician even when the diagnosis of epileptic seizure appears clinically evident. EEG is especially useful when recordings are performed immediately after the episode, in the absence of benzodiazepine therapy, and repeated later. After a transient loss or alteration of consciousness, the EEG should be considered as part of the emergency management, and thus rapidly obtained, whenever the evolution and/or the clinical signs of the episode are consistent with a focal epileptic seizure, especially if gestual or oro-facial automatisms, or bizarre deambulatory behavior have preceded the episode. EEG should also be considered as an emergency examination when a tonic-clonic seizure is suspected clinically, eg, when loss of consciousness is prolonged and inconsistent with a syncopal attack; when it is accompanied by clonic movements or spasms and followed by postictal confusion or stertor; when it entails a head injury or a tongue biting, or when it is preceded by premonitory signs or symptoms consistent with epilepsy. In the absence of such clinical suspicion, an EEG is not justified.

Published
1998

39. [Endovascular treatment of vasospasm]

Author

S, Bracard, R, Anxionnat, X, Ducrocq, E, Da Costa, G, Audibert, J, Auqué, J C, Marchal, and L, Picard

Subjects
Ischemic Attack, Transient, Papaverine, Vasodilator Agents, Humans, Infusions, Intra-Arterial, Radiology, Interventional, Combined Modality Therapy, Angioplasty, Balloon
Abstract

Various therapeutic strategies have been recently proposed to prevent the vasospasm after subarachnoid haemorrhage, and to avoid its clinical consequences. Despite these progresses, mortality and morbidity of delayed ischaemic consequences of vasospasm remain important. Two endovascular treatments have been proposed. The successful use of transluminal angioplasty for vasospasm was first reported by Zubkov in 1984. Transluminal angioplasty is very effective with clinical improvement when the treatment is undertaken without delay after the onset of symptoms. Limitations of this technique are the inaccessibility of distal arteries and the risks (vascular rupture or occlusion). More recently, to overcome these limitations, a selective intraarterial infusion of papaverine has been proposed. These infusions are less risky and can be employed in distal vasospasm. However, clinical results seem to be less favourable and often transient. These two techniques are still used with slightly different indications. According to our experience, it seems reasonable to reserve transluminal angioplasty for symptomatic vasospasm, associated with papaverine or not, and to use papaverine alone in all other cases.

Published
1996

40. [Do pericardial strips (Peri-Strip) facilitate the follow-up after pulmonary surgery in emphysematous patients?]

Author

G, Massard, G, Grosdidier, X, Ducrocq, P, Barsotti, M, Beaufigeau, J G, Hentz, G, Morand, and J M, Wihlm

Subjects
Adult, Male, Lung Neoplasms, Length of Stay, Middle Aged, Respiratory Function Tests, Pulmonary Emphysema, Surgical Stapling, Humans, Pleura, Female, Pneumonectomy, Pericardium, Aged, Follow-Up Studies
Abstract

The aim of this study was to evaluate the contribution of bovine pericardial strips (Peri-Strip) to achieve aerostasis within emphysematous lungs. A preliminary evaluation included 15 patients (13 men and 2 women, mean age 57 years) with severe emphysema (mean FEV-1: 28.6 +/- 10.2% of predicted, mean RV: 18.4 +/- 41.3% of predicted). Two patients were on ventilator owing to acute respiratory failure. Indication for surgery was elective surgery for emphysema in 9 patients, emergency surgery for emphysema in 2, and resection for bronchogenic cancer in 4 patients. The various procedures included single aerostasis in 1, unilateral bullectomy in 6, bilateral volume reduction in 4, thoracoscopic wedge resection for peripheral cancer in 1 and lobectomy for cancer in 3 (2 of which underwent simultaneous bullectomy) Peri-Strip were used to buttress the staple lines at the base of bullae, on parenchymatous transsection lines, and on the borders of fissures. One patient who underwent emergency thoracotomy for single aerostasis died 8 days post-operatively due to multiple organ failure. Another patient developed pneumonia which resolved under treatment. Mean duration of air leaks was 5.6 days (0-21, median 8). Two patients required tube thoracotomy for residual effusions. Mean hospital stay was 17 days (6-53; median 16). We conclude that use of Peri-Strip offered a real benefit to 12 patients; no evidence of benefit was noted in 3 patients.

Published
1996

41. [Atrial electrophysiological study of unexplained ischemic cerebrovascular disorders]

Author

T, Reeb, C, de Chillou, N, Sadoul, J C, Lacour, X, Ducrocq, M, Debouverie, M, Weber, and E, Aliot

Subjects
Adult, Male, Flecainide, Cardiac Pacing, Artificial, Middle Aged, Sensitivity and Specificity, Cerebrovascular Disorders, Atrial Flutter, Heart Conduction System, Predictive Value of Tests, Atrial Fibrillation, Electrocardiography, Ambulatory, Humans, Female, Heart Atria, Anti-Arrhythmia Agents, Follow-Up Studies
Abstract

The aim of this study was to search for the presence of atrial vulnerability by programmed atrial stimulation in patients with unexplained ischaemic cerebrovascular strokes and to evaluate the effects of intravenous flecainide acetate on the electrophysiological parameters and on the induction of atrial arrhythmias. Thirty-eight patients (20 men, 18 women) with a mean age of 38.4 +/- 11 years were investigated. Programmed atrial pacing triggered a sustained (1 min) atrial arrhythmia with 1 or 2 extrastimuli in 23 of the 38 patients (61%), in these patients, there was a significant shortening of the effective refractory periods (ERP: 193 +/- 23 vs 218 +/- 30 ms; p0.02) and of the functional refractory periods (FRP: 228 +/- 25 vs 253 +/- 27 ms; p0.01) with lengthening of the A2 auriculogramme (99.7 +/- 22 vs 76.1 +/- 16 ms; p0.05). A combined study of the refractory periods and conduction defects provides a means of calculating an index of latent vulnerability which is greatly shortened when an atrial arrhythmia is induced (2 +/- 0.5 cm vs 3 +/- 0.6 cm; p0.001). Atrial arrhythmias could not be initiated after intravenous 3 mg/kg of flecainide acetate in 4 subjects (17%) with initially positive atrial stimulation tests. This study confirms the high frequency of atrial vulnerability in patients with unexplained ischaemic cerebrovascular strokes. In their population, the authors observed a low efficacy of flecainide acetate in the prevention of reinduction of atrial arrhythmias. The indication of long-term antiarrhythmic drugs in these patients are questionnable and should be assessed by a prospective long-term multicentre trial.

Published
1995

42. Clinical spectrum of CADASIL: a study of 7 families. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

Author

H, Chabriat, K, Vahedi, M T, Iba-Zizen, A, Joutel, A, Nibbio, T G, Nagy, M O, Krebs, J, Julien, B, Dubois, and X, Ducrocq

Subjects
Adult, Male, Genetic Linkage, Mood Disorders, Migraine Disorders, Diffuse Cerebral Sclerosis of Schilder, Cerebral Infarction, Syndrome, Middle Aged, Magnetic Resonance Imaging, Brain Ischemia, Pedigree, Cerebrovascular Disorders, Humans, Dementia, Female, Age of Onset, Aged
Abstract

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited arterial disease of the brain recently mapped to chromosome 19. We studied 148 subjects belonging to seven families by magnetic resonance imaging and genetic linkage analysis. 45 family members (23 males and 22 females) were clinically affected. Frequent signs were recurrent subcortical ischaemic events (84%), progressive or stepwise subcortical dementia with pseudobulbar palsy (31%), migraine with aura (22%), and mood disorders with severe depressive episodes (20%). All symptomatic subjects had prominent signal abnormalities on MRI with hyperintense lesions on T2-weighted images in the subcortical white-matter and basal ganglia which were also present in 19 asymptomatic subjects. The age at onset of symptoms was mean 45 (SD [10-6]) years, with attacks of migraine with aura occurring earlier in life (38.1 [8.03] years) than ischaemic events (49.3 [10.7] years). The mean age at death was 64.5 (10.6) years. On the basis of MRI data, the penetrance of the disease appears complete between 30 and 40 years of age. Genetic analysis showed strong linkage to the CADASIL locus for all seven families, suggesting genetic homogeneity. CADASIL is a hereditary cause of stroke, migraine with aura, mood disorders and dementia. The diagnosis should be considered not only in patients with recurrent small subcortical infarcts leading to dementia, but also in patients with transient ischaemic attacks, migraine with aura or severe mood disturbances, whenever MRI reveals prominent signal abnormalities in the subcortical white-matter and basal ganglia. Clinical and MRI investigations of family members are then crucial for the diagnosis which can be confirmed by genetic linkage analysis. The disease is probably largely undiagnosed.

Published
1995

43. [Venous angiography: importance in the diagnosis of brain death. 125 cases]

Author

L, Picard, M, Braun, R, Anxionnat, B, Claise, X, Ducrocq, B, Pincemaille, and H, Hepner

Subjects
Radiography, Brain Death, Humans, Electroencephalography, Cerebral Veins, Retrospective Studies
Abstract

According to many ethical and humanitarian arguments, the diagnosis of "brain death" is more and more an emergency. The forensic criteria include abolition of consciousness, abolition of brain stem reflexes, abolition of spontaneous breathing joined to electrocerebral silence. However using EEG criteria of electrical silence may be unreliable because of technical artefacts or depressed electrical activity due to drug intoxication and hypothermia. Venous angiography was used in 125 cases: our experience proves reliability and efficiency of angiographic criteria for diagnosis of brain death. For organ transplant, it is better to be as fast as possible: transplanted organ will be better and it reduces the cost of a long useless intensive care. When it is necessary, we suggest to allow the choice between EEG and angiography.

Published
1995

44. Dissection of intracranial vertebral arteries revealed by subarachnoidal haemorrhage. Report of seven cases

Author

R, Anxionnat, D, Roy, S, Bracard, J C, Marchal, J, Auque, X, Ducrocq, J, Roland, and L, Picard

Subjects
Diagnosis, Differential, Male, Radiography, Aortic Dissection, Fatal Outcome, Vasoconstriction, Humans, Female, Middle Aged, Subarachnoid Hemorrhage, Vertebral Artery
Abstract

Between April 1986 and April 1991, seven cases of meningeal haemorrhage consecutive to dissection of the 4th segment of a vertebral artery were observed at the Neuroradiology Department of the Nancy University Hospital. Four of the 7 patients were men, and 3 were women; mean age varied from 45 to 61 years. The clinical presentation was not suggestive, except in one case where the haemorrhagic episode was associated with Wallenberg's syndrome, pointing to the aetiological diagnosis. The outcome was variable. Two patients died of early complications of the haemorrhage which occurred before treatment could be given. In 2 others patients treated with antiplatelet agents the outcome was favourable; however, at angiography the lesions regressed in one of these two patients, but they progressed in the other with formation of a false aneurysm. The remaining 3 patients were treated by endovascular occlusion of the lesion-bearing vessel: one died of complications of a haemorrhage-induced vasospasm; the other two are symptomless after a 2 to 6 months follow-up.

Published
1994

45. [Herpetic meningoencephalitis in the elderly. Apropos of 13 cases]

Author

P, Jouanny, H, Vespignani, A, Gérard, C, Jeandel, X, Ducrocq, F, Penin, M, Weber, J B, Dureux, G, Cuny, and P, Canton

Subjects
Male, Electroencephalography, Herpes Simplex, Middle Aged, Prognosis, Antiviral Agents, Magnetic Resonance Imaging, Meningoencephalitis, Humans, Female, Emergencies, Tomography, X-Ray Computed, Aged, Retrospective Studies
Abstract

In a retrospective analysis of 13 cases of Herpes simplex encephalitis (mean age: 67.2 +/- 6.4 years; ten women, three men), the authors conclude that this infection is more often due to Herpes simplex virus 1 in the elderly. Diagnosis is difficult at an early stage, and must be suspected in case of confusion (9/13), especially feverish (11/13), associated with neurological signs (10/13), and particularly epilepsy (5/13). It requires a lumbar puncture which collect a clear and lymphocytic fluid. Prognosis of this encephalitis depends on early diagnosis and an presumptive therapy with acyclovir. EEG is helpful showing periodic activity (10/13). CT scan and MRI can show unspecific abnormalities, but often too late. Laboratory findings will secondarily confirm the diagnosis quite frequently, using new Elisa methods. Polymerase chain reaction allows earlier diagnosis. Geriatric cases seem more often due to reinfection or to endogen virus reactivation rather than to primary infection.

Published
1994

46. [Transluminal angioplasty in the treatment of vasospasm. Value of transcranial Doppler in the diagnosis and follow-up]

Author

S, Bracard, X, Ducrocq, L, Picard, J C, Marchal, and J, Auque

Subjects
Ischemic Attack, Transient, Cerebrovascular Circulation, Humans, Postoperative Period, Echoencephalography, Angioplasty, Balloon, Follow-Up Studies
Abstract

Vasospasm (V.S.) transluminal angiographic treatment (T.L.A.) is recommended in case of symptomatic V.S. before or after surgery. V.S. diagnosis and follow up after T.L.A. rely on clinical and transcranial doppler (T.C.D.) data. Before T.L.A. angiography (A degrees) demonstrates V.S. degree and location. T.L.A. technic is described. The authors report 14 cases of T.L.A. (7 before and 7 after surgery). Before surgery in 4 cases patients exhibited ischemic symptoms from V.S.: 2 died (one from reanimation problems the other from a new hemorrhage). After surgery of 7 patients one died from artery rupture, one from extra-neurologic complication. T.C.D. capacity to follow up V.S. is emphasized. As soon as T.L.A. is performed the mean cerebral blood flow (C.B.F.) decreases (100 cm/s) and does not increase anymore. At the level of non dilated arterial segments V.S. may increase after T.L.A.: it is then recommended to dilate all the spastic arteries, as far as it is possible. After T.L.A. C.B.F. may decrease in arteries far from the dilated ones probably because arterial supplies are no more necessary.

Published
1992

47. [Value of transcranial Doppler ultrasonography in patients with suspected brain death]

Author

X, Ducrocq, B, Pincemaille, M, Braun, M, Hummer, H, Vespignani, and H, Hepner

Subjects
Adult, Aged, 80 and over, Male, Brain Death, Adolescent, Electroencephalography, Middle Aged, Echoencephalography, Cerebral Angiography, Cerebrovascular Circulation, Child, Preschool, Humans, Female, Child, Blood Flow Velocity, Aged
Abstract

Transcranial Doppler ultrasonography (TCD) is a non invasive technique which assesses blood flow velocitics in basal cerebral arteries. Specific patterns have been observed in brain death. In a continuous series of 72 patients, the TCD recordings from the intracranial internal carotid and middle cerebral arteries were compared with the results from the usual investigations for brain death, such as electroencephalogramme (EEG), and arteriography. All the patients were clinically brain dead: Glasgow score of 3, apnoea, bilateral mydriasis, loss of cortical function and cerebral reflexes. This clinical diagnosis was confirmed by and isoelectric EEG with or without angiographic circulatory arrest. Two characteristic patterns were identified: an oscillating to and fro signal, with a positive sharp systolic peak and a negative diastolic reflux; and a systolic peak without any diastolic component. The absence of signal on both sides did not allow any conclusion, except when this pattern occurred during follow-up. The oscillating pattern was seen on both sides in 60 patients (83%), and, in 3 other patients, only on one side, always combined with a contralateral systolic peak pattern, in 3 other patients. A bilateral systolic peak pattern was identified in 7 patients (10%). The TCD results were compared with angiography in 37 cases. TCD circulatory arrest preceded angiographic arrest by six hours in three cases. Hypotension was the main limitation to this technique. n the other hand, TCD may be used in patients treated with sedative drugs. The non invasive character of TCD, its low cost, the possibility of repeating it at the patient's bedside make TCD a very interesting diagnostic tool.(ABSTRACT TRUNCATED AT 250 WORDS)

Published
1992

48. Role of angioplasty in the treatment of symptomatic vascular spasm occurring in the post-operative course of intracranial ruptured aneurysms

Author

S, Bracard, L, Picard, J C, Marchal, X, Ducrocq, A, Per, A, Czorny, C, Islak, D, Roy, J, Roland, and J, Lepoire

Subjects
Adult, Male, Rupture, Spontaneous, Angiography, Intracranial Aneurysm, Middle Aged, Subarachnoid Hemorrhage, Postoperative Complications, Ischemic Attack, Transient, Circle of Willis, Humans, Female, Nimodipine, Angioplasty, Balloon, Ultrasonography
Abstract

Angioplasty of vascular spasm (VS), related to subarachnoid hemorrhage (SAH) has been recently introduced to the medical field. The authors report 5 cases treated by this mean in the postoperative period. These patients were all symptomatic from their VS inspite of early surgery and of the preventive treatment by Nimodipine. In all cases, obtained increase in the caliber of the spastic vessels was followed by a rapid clinical improvement coupled with a significant decline of the flow rates as confirmed by transcranial Doppler (TCD). No recurrence of VS has been observed. This technique appears quite effective provided that it is performed as early as the clinical symptoms come out in correlation with important acceleration of flow rates on TCD.

Published
1990

49. Hyperplasie hématopoïétique focale de la côte

Author

Marie-Pierre Chenard, B. Gasser, C. Laurent, Benoit Lhermitte, S. Croce, X. Ducrocq, and J. Franques

Subjects
Pathology and Forensic Medicine
Abstract

Introduction Les tumeurs primitives de la cote representent environ 5 % des tumeurs osseuses. Nous rapportons un cas exceptionnel de pseudotumeur costale par hyperplasie hematopoietique focale (HHF). Observation Une femme de 36 ans consulte pour des dysesthesies de l’hemicorps gauche, spontanement resolutives en cours de bilan. Une radiographie de thorax systematique revele une lesion de l’arc anterieur de la 3e cote gauche, soufflant l’os. Au scanner, elle est de densite osseuse, avec amincissement cortical, sans reaction periostee. Macroscopiquement, la masse osseuse de 10x7x7 cm est constituee d’un tissu brun hemorragique. A l’histologie, des travees osseuses greles et irregulieres entourent une moelle hematopoietique tres hyperplasique, voisinant avec des zones de moelle adipeuse. L’hyperplasie hematopoietique est harmonieuse, touchant les 3 lignees, sans troubles de la maturation ou anomalies morphologiques. Le bilan hematologique est normal. Discussion Depuis sa 1re description en 1984, 4 cas d’HHF de la cote ont ete rapportes chez des patients âges de 24 a 71 ans, sur l’arc anterieur ou posterieur des 3e, 6e et 10e cotes. Toutes etaient asymptomatiques et de decouverte fortuite. L’etiopathogenie de cette pseudo-tumeur hematopoietique, jamais decrite en dehors de la cote, reste indeterminee. Les diagnostics differentiels radiologiques sont la dysplasie fibreuse, le kyste anevrysmal, le chondrosarcome et le plasmocytome. Conclusion. L’HHF est une lesion costale solitaire pseudotumorale rarissime, asymptomatique, ressemblant histologiquement a une « grosse moelle », sans maladie hematologique associee.

Published
2004
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