The potential and limitations of transcranial Doppler in clinical practice

The aim of this review is to bring the clinical relevance of transcranial Doppler (TCD) to light with all of its possibilities and limitations. Indeed TCD, a non-invasive ultrasound technique, allows instantaneous evaluation of the cerebral blood flow: adding physiological information to the anatomical images. Although TCD is frequently used in some places, in other regions TCD remains relatively unknown. However TCD can help the neurologist not only in the management of cerebrovascular disease, but also in a wide variety of central nervous system disorders. TCD monitoring with multichannel and multigate probes can assess vascular reactivity by following various parameters, such as CO2 or arterial blood pressure. Despite the need for more work, emboli detection seems to offer great potential in the future diagnosis, treatment and prevention of stroke

Early ischemic lesions following subarachnoid hemorrhage : common cold remedy as precipitating factor?

A 46-year-old woman presented with tetraplegia contrasting with a relatively preserved consciousness following aneurysmal subarachnoid hemorrhage (SAH). Multiple ischemic lesions were detected by magnetic resonance imaging (MRI), in the absence of vasospasm or signs of increased intracranial pressure. During the weeks before SAH, the patient had repeatedly used a nasal decongestant containing phenylephrine. After coiling of the aneurysm harboured by the right posterior cerebral artery, symptomatic vasospasm developed in the territory of the right middle cerebral artery and required aggressive therapy by intra-arterial infusion of milrinone followed by continuous intravenous administration. Follow-up MRI did not reveal new ischemic lesions. Echocardiography had demonstrated the presence of a patent foramen ovale. At 3 months follow-up, a major motor deficit persisted with akinetic mutism. The mechanisms of multiple early infarction following aneurysmal SAH are still debated, as vasospasm is usually not seen on the first imaging. Among precipitating factors of microvascular vasospasm, vasoactive substances like phenylephrine, may play a significant role

Acute ischaemic pontine stroke revealing lyme neuroborreliosis in a young adult.

We report the case of a 23-year-old male patient who suddenly developed right hemiparesis, cerebellar ataxia, dysarthria, and bilateral dysmetria. Brain magnetic resonance (MR) examination demonstrated hyperacute ischaemic lesions within the pons. CSF analysis revealed a high protein content, lymphocytic pleocytosis, and oligoclonal IgG bands not present in the serum. Elevated IgM and IgG anti-Borrelia burgdorferi antibodies were shown in both serum and CSF samples, associated with an intrathecal synthesis of these antibodies. Ischaemic CNS lesions have been rarely observed as the first manifestation of Lyme neuroborreliosis. The putative mechanism for parenchymal ischaemia is the local extension of inflammatory changes from meninges to the wall of penetrating arterioles

Possible overlap between reversible cerebral vasoconstriction syndrome and symptomatic vasospasm after aneurysmal subarachnoid hemorrhage.

A 34-year-old woman with a previous history of severe headache ("thunderclap") was admitted with a diagnosis of aneurysmal subarachnoid hemorrhage (SAH). The patient developed symptomatic vasospasm on day 5 that resolved rapidly after having increased arterial blood pressure. She experienced also short-lasting excruciating headache. On day 12, while velocities had normalised, as revealed by transcranial Doppler (TCD), for more than 48 h, she developed aphasia and right hemiplegia associated with diffuse segmental vasospasm on the left middle cerebral artery. Intra-arterial infusion of vasodilatory agents was required. Recurrence of symptomatic vasospasm was noted on day 25, with a great number of territories involved as shown in the cerebral angiogram. A second intra-arterial treatment was needed. The patient complained of multiple episodes of extremely severe headache ("thunderclap"), with also transient dysarthria and hemiparesia on day 30. She was discharged on day 38 after full recovery. The clinical and TCD/radiological findings were consistent with a reversible cerebral vasoconstriction syndrome overlapping SAH related symptomatic vasospasm

Wernickes Encephalopathy and Central Pontine Myelinolysis Induced By Hyperemesis Gravidarum

A 21-year-old woman developed hyperemesis gravidarum, complicated by Wernicke's encephalopathy and central pontine myelinolysis. For the latter, time course of the lesions on magnetic resonance imaging suggests a pathogenetic role for hypophosphatemia rather than for hyponatremia

Pregnancy-specific beta 1 glycoprotein (SP1) in the cerebrospinal fluid.

Pregnancy-specific beta 1 glycoprotein (SP1) was assayed by Particle Counting Assay in the cerebrospinal fluid (CSF) from 26 non-neurological patients, from 190 patients with various neurological disorders and from 84 patients with malignant hemopathies. With a sensitivity limit of 0.5 microgram/l, SP1 was undetectable in normal CSF. High levels were observed in CSF from one pregnant woman with herpetic encephalitis and from another woman with post-puerperal thrombophlebitis as a result of high serum concentrations and leakage of the blood-brain barrier. SP1 was detected at low levels in the CSF from 1 patient out of 5 with Creutzfeldt-Jakob disease and from a patient with Behçet's disease. Seven patients out of 84 with malignant hemopathies presented cerebral involvement; 3 of them had detectable SP1. However, SP1 was also detected in the CSF of 2 patients in apparently complete remission. The determination of SP1 in CSF appears to be of limited value in the diagnosis of neurological disorders and in the early detection of a cerebral localization of malignant hemopathies

[Acute Osteomyelitis Following a Closed Vertebral Fracture - Report of a Case and Review of the Literature]

We report a new case of haematogenous infection at the site of a spinal fracture. The patient developped a severe bronchopneumonial infection. After the trauma three weeks later he developped a severe but incomplete cord lesion due to acute vertebral osteomyelitis. The patient was treated with antibiotics. He made a slow, but uneventful and complete neurological recovery. 28 instances of osteomyelitis after fracture of which seven involved vertebral bones have been previously reported. The spontaneous appearance of haematogenous osteomyelitis in a fractured bone is a rare but not exceptional event

Infection par voie hématogène d'une fracture vertébrale fermée: A propos d'un cas et revue de la littérature.

We report a new case of haematogenous infection at the site of a spinal fracture. The patient developed a severe bronchopneumonial infection. After the trauma three weeks later he developed a severe but incomplete cord lesion due to acute vertebral osteomyelitis. The patient was treated with antibiotics. He made a slow, but uneventful and complete neurological recovery. 28 instances of osteomyelitis after fracture of which seven involved vertebral bones have been previously reported. The spontaneous appearance of haematogenous osteomyelitis in a fractured bone is a rare but not exceptional event