[Candida albicans cerebral granuloma in an immunocompetent patient. A case report]

We report a case of temporal lobe granuloma caused by Candida albicans in an immunocompetent patient. This 54-year-old patient had experienced headaches and some memory disorders for two to three months before his admission to the neurosurgical department. Cerebral-computer tomography and magnetic resonance imaging showed a single right-temporal lesion with a large peritumoral edema. We operated on the patient via a temporal approach using neuronavigation and resected the lesion. The anatomopathological result and the cultures of the granuloma showed C. albicans species. The patient received antifungal therapy for three months. No predisposing factors or immunosuppression was found. After seven months, he presented an ischemic cerebrovascular accident of the brain stem and then chronic meningitis complicated by hydrocephalus. The patient's condition progressively deteriorated and he died 18 months later in an other department. C. albicans can be found even in the immunocompetent patient, but is seldom observed. Surgery can provide an accurate diagnosis and therapeutic management in the initial phase, completed by antifungal therapy.

Papillary fibroelastoma of the ascending aorta presenting with cardiogenic shock

We describe an uncommon case of a 58-year-old woman who presented with cardiogenic shock. The echocardiography examination revealed a papillary fibroadenoma located in the ascending aorta which was subsequently surgically treated.

IRM de diffusion du système nerveux central : applications cliniques

Diffusion-weighted MR imaging is a technique in which image contrast is determined by the motion of water molecules within tissues. This motion is characterized by the apparent diffusion coefficient (ADC). This technique is particularly useful for the early detection of cerebral infarction but many other diseases of the central nervous system are associated with a change in water diffusion and may be assessed by diffusion-weighted MR imaging. This is an easy and fast pulse sequence providing useful data for early diagnosis and prognosis as well as information about underlying pathophysiology. After an overview of the basic concepts of diffusion imaging and the knowledge required for image interpretation, we will assess the potential value of this technique for the diagnosis of the main diseases of the central nervous system.

Relation quantitative des modifications de la diffusion et de la perfusion au sein du parenchyme cérébral au cours de l’accident ischémique aigu

MR-based diffusion- and perfusion-weighted imaging (DWI/PWI) has become the standard imaging technique to assess the individual brain pathophysiological status in acute ischemic stroke. The finding of a "mismatch" with larger PWI than DWI abnormality is thought to reflect the presence of tissue at-risk of infarction, i.e., penumbra. However, there has been no detailed study of the quantitative relationships between perfusion and diffusion changes in stroke patients. According to the experimental concept of penumbra, the ADC would be expected to remain unchanged despite decreasing perfusion until a critical threshold is reached. We have tested this hypothesis directly in man.

METHODS

DWI/PWI was performed in 7 patients with MCA territory stroke within 4-10 hrs from onset. Mismatch was defined on diffusion and rMTT maps, and circular ROIs were positioned within the ADC lesion (D), the mismatch area (M), and the normal appearing cortex (N); mirror ROIs were also obtained, and affected/unaffected ratios for ADC and rCBF were computed for each ROI.

RESULTS

The mean (+/-1 SD) ADC ratios were 0.60 +/- 0.09, 0.95 +/- 0.10 and 1.02 +/- 0.04 in L, M and N, respectively; the corresponding rCBF ratios were 0.32 +/- 0.12, 0.75 +/- 0.14 and 0.97 +/- 0.09, respectively. The relationship was non-linear, with the rCBF but not the ADC ratio for M being significantly lower (p < 0.01) than that for N. A threshold for decline in ADC was apparent around 0.50 rCBF ratio.

COMMENT

These results directly document in man that the ADC declines only after hypoperfusion has reached a certain degree (about 50%), consistent with the concept of the ischaemic penumbra.

Vitamin E protects against acetone-induced oxidative stress in rat red blood cells

Acetone may induce oxidative stress leading to disturbance of the biochemical and physiological functions of red blood cells (RBCs) thereby affecting membrane integrity. Vitamin E (vit E) is believed to function as an antioxidant in vivo protecting membranes from lipid peroxidation. The aim of the present study was the evaluation of possible protective effects of vit E treatment against acetone-induced oxidative stress in rat RBCs. Thirty healthy male Wistar albino rats, weighing 200-230 g and averaging 12 weeks old were randomly allotted into one of three experimental groups: Control (A), acetone-treated (B) and acetone + vit E-treated groups (C), each containing ten animals. Group A received only drinking water. Acetone, 5% (v/v), was given with drinking water to B and C groups. In addition, C group received vit E dose of 200 mg/kg/day i.m. The experiment continued for 10 days. At the end of the 10th day, the blood samples were obtained for biochemical and morphological investigation. Acetone treatment resulted in RBC membrane destruction and hemolysis, increased thiobarbituric acid reactive substance (TBARS) levels in plasma and RBC, and decreased RBC vit E levels. Vit E treatment decreased elevated TBARS levels in plasma and RBC and also increased reduced RBC vit E levels, and prevented RBC membrane destruction and hemolysis. In conclusion, vit E treatment appears to be beneficial in preventing acetone-induced oxidative RBC damage, and therefore, it can improve RBC rheology.

"Protected" wallstenting of atheromatous stenoses at the carotid bifurcation

SUMMARY

Atheromatous stenoses at the carotid bifurcation were treated by angioplasty and Wallstenting with cerebral protection obtained in most cases by temporary occlusion of the internal carotid artery. 287 carotid stenoses were treated in 233 patients. The stenosis was symptomatic in 79% of cases. All patients presented either a stenosis of >70% with significant impairment of the cerebral circulation (281 cases) or a symptomatic ulcerated plaque (six cases). A self-mounted protection system was used in 177 cases, the Percusurge Guardwire protection device in 98 cases an EPI filter in 12 cases. There was a contralateral internal carotid occlusion in 13% of cases. A combined stenting (vertebral, siphon, subclavian) was performed in 14% of cases. A Rolling membrane Wallstent was used in 84 patients, a first generation Easy Wallstent in 38 cases, a "Carotid" Easy Wallstent 35 in 55 cases and monorail 14 in 110 cases. Full opening of the stenosis was obtained in 98% of patients with correction of the arterial curve and improvement of the cerebral vascular supply. There were 0.7% cases with transient symptomatic neurological complications and 2% with permanent sequelae mainly related to avoidable inadequacy in flushing or to the insufficient radial force of the first generation Easy Wallstent. There were no per and one post-procedural cardiac complication (0.6%) in the s165 cases performed with the "Carotid" Easy Wallstent. Follow-up angiograms showed 0.7% of restenoses. Still in evolution, endovascular treatment of atheromatous stenoses at the carotid bifurcation with cerebral protection and stenting is a promising alternative technique to surgery. The association of Carotid Easy Wallstent 14 monorail and Percusurge Guardwire appears to be currently satisfactory.

Magnetic resonance imaging of patients with cervicogenic headache

Cervicogenic headache (CH) is a syndrome which is postulated to originate from nociceptive structures in the neck or head. The anatomical neck or head structures that are responsible for the pain in CH have not been clearly identified, but the pain in these patients probably originates from the structures of the cervical spine. In this study, cervical MRI were studied in 22 patients with cervicogenic headache and 20 control patients who did not have any disease which may effect the bone and muscle structures of cervical region. MRI imaging of cervical vertebra showed a disc bulging in 10 (45.4%) out of 22 patients with CH and in 9 (45.0%) of 20 controls (P > 0.05). The distribution of pathological lesions in patients and controls were not significantly different (P > 0.05). As a result, MRI may not be an adequate method to detect pathological findings underlying the aetiology of CH such as nerve roots, intervertebral joints and periosteum.

[Otogenic cavernous sinus thrombophlebitis. A case report]

OBJECTIVES

Acquire knowledge concerning the diagnosis and treatment of otogenic cavernous sinus thrombophlebitis.

PATIENT AND METHODS

We report a case of otogenic cavernous sinus thrombophlebitis (CST) in a 6-year-old boy.

RESULTS

CST diagnosis was based on clinical signs (septic illness, ocular nerve palsy and chemosis), and neuro-imaging confirmed the diagnosis. Contrast-enhanced CT scan demonstrates different signs: (i) filling defect or heterogeneous enhancement of cavernous sinus, (ii) cavernous sinus enlargement with bulging of the lateral wall, (iii) intensive enhancement of lateral wall corresponding to enhancement of a collateral network replacing the thrombosed cavernous veins, (iiii) and sometimes indirect orbital signs (exophthalmus, densification of the retro-orbital fat, superior ophthalmic dilatation with partial or no enhancement in case of thrombosis extension). The bacteria most frequently found are Streptococci, Streptococcus pneumoniae, Staphylococcus aureus, Gram-negative rods and anaerobes combined. The therapeutic management of CST consists of intravenous administration of appropriate antibiotics combined radical mastoidectomy if medical therapy has failed. Anticoagulant therapy is controversial.

CONCLUSION

Knowledge of early diagnosis of otogenic cavernous sinus is important because prior to the antibiotic era, CST was almost always fatal. Currently, therapeutic outcome is not always favorable due to high morbidity after aggressive treatment.

Electronic equalization for enabling communications at OC-192 rates using OC-48 components

We propose using electronic equalization technology to allow components typically used in 2.5Gb/s systems to be used at 10Gb/s. We simulate the performance of links exploiting this concept and study the effect of receiver bandwidth on equalized systems in general. Links utilizing transmitters designed for 2.5Gb/s rates are experimentally demonstrated. Experiments also show that photo-receivers with 2.5 GHz bandwidths add minimal penalty when post-detection electronic equalization is employed.

Distal muscular dystrophy of the Miyoshi type

OBJECTIVE

Miyoshi myopathy is an autosomal recessive muscular dystrophy. It is characterized by distal muscle involvement, especially the gastrocnemius and soleus. The disease starts with weakness and atrophy of the calves.

MATERIAL AND METHODS

Here we report on 2 patients, brother and sister, from a Turkish family. Onset of the disease was at the age of 20 and 26 years of age, respectively. In both siblings, there was an early and predominant involvement of the distal muscles of the lower limbs. Creatine kinase activity was elevated 50- to 100-fold above normal values.

RESULTS

Electromyography revealed a myopathic pattern. Histology of the biceps muscles indicated some myopathic changes consistent with muscular dystrophy. Occurrence in only these 2 siblings with no other family members was indicative of an autosomal recessive inheritance.

CONCLUSIONS

We describe the distinctive clinical features in 2 siblings of a Turkish family with MM as differential diagnosis and histological change.

[Rotational vertebro-basilar insufficiency secondary to a fibrous band of the longus colli muscle: value of CT spiral angiography diagnosis]

A CASE REPORT

The authors report a case of rotational vertebro-basilar insufficiency causing "drop-attacks". To our knowledge, it is the first case of extraluminal vertebral artery compression caused by a fibrous band of the longus colli muscle, demonstrated by spiral computed tomographic angiography with volume rendering reformation.

The 'dry-needle technique': intramuscular stimulation in tension-type headache

The 'dry-needle technique', an intramuscular stimulation technique carried out by using a fine solid, 1-inch long, 30-gauge needle, was investigated in the treatment of tension-type headache (TTH) in a randomized, placebo-controlled trial. Fifteen patients with TTH received intramuscular needle insertions into six designated trigger points, while 15 controls received subcutaneous insertions. Headache indices, muscle tenderness and neck ROMs were evaluated before and after treatment. Mean headache indices improved significantly after treatment, both in the treatment group and in the placebo group, but the difference between the two groups was insignificant. In the treatment group the tenderness score and the neck ROM limitation score were significantly improved after treatment, while there was no significant improvement in the placebo group. We conclude that more and larger controlled, comparative trials are needed to show whether the dry-needle technique is an effective non-pharmacological alternative for the treatment of TTH.

Cervical automated discectomy. Report of 150 cases and evolution in the management of failure cases

SUMMARY

The lumbar automated discectomy system described by Onik has been used in the treatment of cervical disk herniations whose symptomatology resisted medical treatment. Experience on 150 patients is reported showing a 74.5% success rate. This series performed in most cases on an outpatient basis had no complications. Up to 1992 failure cases were treated by intradiscal injections of triamcinolone with 62 % of success. This complementary technique was abandonned after the description of epidural calcifications secondary to this type of injections in the lumbar area. Since 1992, failure cases have been managed differently with injections of steroids in the cervical joints, especially when a hypertrophy of the ligamentum ftavum supposedly a sign of an inflammatory posterior component of the pain was demonstrated on the CT. Nine patients received intradiscal injections of microdoses (600IU) of chymopapaine with excellent results. No patient has had open surgery since 1992. It is concluded that percutaneous automated discectomy is a very promising and safe technique which can be used as a first choice technique for most cervical disk herniations resisting medical treatment.

Carotid-cavernous fistulas: diagnosis with spiral CT angiography

Four cases in which the diagnosis of carotid-cavernous fistula was made by using CT angiography are illustrated. The diagnosis was confirmed by digital subtraction angiography in all four instances. To our knowledge, this is the first report of the CT angiographic appearance of carotid-cavernous fistulas.