Xavier Ducrocq

Brain death and transcranial Doppler: Experience in 130 cases of brain dead patients

BACKGROUND AND PURPOSE Diagnosis of brain death requires confirmation of the clinical diagnosis by appropriate tests, generally electroencephalography (EEG) and angiography. The diagnostic limitations or logistical problems inherent to these tests indicate the need to develop other more appropriate methods. The results obtained with transcranial Doppler (TCD) led us to conduct this prospective study of TCD recordings in brain dead patients. METHODS 130 patients, aged 2-88 years were diagnosed as brain dead between July 1987 and June 1993. Clinical criteria were confirmed in all cases by EEG (n=88) and or angiography (n=64). Intracranial anterior circulation was insonated via temporal windows or, when impossible, via a transorbital approach. The posterior circulation was studied only in more recent patients. Examinations were made as soon as possible after brain death diagnosis and repeated for about 30 min. Vital parameters and treatments were taken into account. RESULTS There was only one false negative result, in a patient with an extended skull defect, who retained TCD and angiographic intracranial circulation despite confirmed irreversible brain death. All other patients displayed typical ultrasonic patterns of cerebral circulation arrest: an oscillating signal (n= 190, 73%), a systolic spike (n=62, 24%) or a unilateral absence of signal (n=5). Despite a total correlation for positive diagnosis, TCD and angiography may differ as to the level of circulation arrest. TCD is useful for patients under sedative drugs. No false positive result was encountered but we were unable to insonate any intracranial artery in 5 patients. CONCLUSION Data from previous studies and the results of this study indicate that TCD is a very sensitive and safe method for diagnosing cerebral circulatory arrest. TCD may be used as a confirmatory test alongside EEG and angiography. TCD is more widely applicable than EEG and may be earlier and safer than angiography.

Paralysie vélopalatine isolée aiguë réversible de l’enfant

Resume Introduction La paralysie velopalatine unilaterale de l’enfant est une situation rare qui pose principalement le probleme de son diagnostic etiologique et donc de l’extension du bilan pour y parvenir. Observation Nous rapportons les cas des deux enfants âges respectivement de 10 et 11 ans, jusque-la en bonne sante, presentant une paralysie velopalatine transitoire unilaterale, associee dans un cas a une paralysie de l’hemipharynx homolateral. Resultats La confrontation des donnees de ces deux observations a celles de la litterature suggere le diagnostic d’une neuropathie peripherique idiopathique. Conclusion Compte tenu de la rarete de ce tableau clinique, il parait necessaire de colliger d’autres cas similaires afin d’affirmer le caractere benin de l’affection, et d’eviter la multiplication d’examens complementaires invasifs.

Encéphalite herpétique du sujet âgé: 13 observations

Herpes simplex encephalitis can rarely occured in the elderly. Clinical and paraclinical manifestations are the same as in young people. Prognosis depends on early diagnosis and treatment with aciclovir. Geriatric cases due to reinfection or endogen virus reactivation than to primo-infection.

Éducation thérapeutique et information

Resume Les auteurs montrent que l’education therapeutique du malade presentant des crises epileptiques et de son entourage est necessaire, mais non encore organisee en particulier en cas d’epilepsie pharmaco-resistante. Les objectifs de cette education therapeutique sont detailles a partir des constats existants et des besoins. Les auteurs precisent l’exigence d’un abord global subjectif autant qu’organique integrant des dimensions psychosociales et le vecu du patient. La necessite d’une formation specifique des medecins et autres professionnels de sante est soulignee dans l’attente d’un statut de l’education therapeutique. Les auteurs proposent un projet d’education therapeutique d’un malade atteint d’une epilepsie pharmaco-resistante.

Anticoagulants circulants de type antiprothrombinase : étude rétrospective de 61 cas

We recense 61 positive cases of circulating antibodies with antiprothrombinase activity from february 1989 to may 1991 at the transfusion centers of Nancy. Anti-phospholipid antibodies were present in the serum of 40 patients. We make the retrospective analysis of these cases.

Hydrocéphalie secondaire à un mégadolichotronc basilaire. À propos de 2 observations

The authors reports two cases of anevrysmal malformation of the vertebral basilar arteries causing hydrocephalus. Others clinical aspects of intracranial diffuse arterectasis are cranial nerve palsies, ischemic of hemorrhagic complications.