Listing 1 - 10 of 14 << page
of 2
>>
Sort by

Book
Infections intracrâniennes bactériennes chez l'enfant immunocompétent
Authors: --- --- ---
Year: 2013 Publisher: Bruxelles: UCL. Faculté de médecine et de médecine dentaire,

Loading...
Export citation

Choose an application

Bookmark

Abstract

Cette étude a pour objectif d'analyser les infections bactériennes intracrâniennes de l'enfant en insistant sur leurs présentations cliniques, les examens complémentaires utiles et pertinents pour le diagnostic, l'analyse des traitements et des séquelles.Méthodes : Ce travail concerne une étude rétrospective de 125 dossiers de patients âgés de 0 à 18 ans, pris en charge aux Cliniques universitaires St Luc entre 2004 et 2012. Les 125 patients sont immunocompétents. Après analyse des critères d'inclusion, nous avons conservé 98 dossiers dans l'étude. Résultats : 7 thrombophlébites, 11 abcès cérébraux, 8 empyèmes et 85 méningites ont été repertoriés. Les patients présentent parfois plusieurs pathologies successives. 61 % des patients sont âgés de moins de 2 ans dont 18 % âgés de moins de 1 mois. La vaccination a radicalement modifié l'épidémiologie. Les germes responsables de méningites les plus souvent retrouvés dans notre étude sont Streptococcus pneumoniae (27 % des cas), Neisseria meningitidis (14 % des cas) et Staphylococcus epidermidis (13 % des cas). Il y a 2 patients atteints de méningites à Haemophilus influenzae. Le diagnostic le plus précoce possible est essentiel. Les signes d'appels cliniques des méningites bactériennes sont majoritairement la fièvre (>38°C) 77 %, les nausées et vomissements 46 %, la raideur de nuque (ou un signe associé de Kernig ou de Brudzinski) 32 %, les convulsions 29 %, la somnolence 30 %, la fontanelle bombante 25 %, Je choc 19 % et les céphalées 14 %.Des signes biologiques infectieux sont retrouvés dans la majorité des cas de méningites . Les abcès et empyèmes présentent par contre peu de signes infectieux. L'analyse biologique dans les cas de méningite montre une réaction inflammatoire avec plus de 20 000 globules blancs sanguins/µl dans 20 % des cas et une CRP initiale supérieure à 2 mg/dl dans 75 % des cas. Cependant, 15 % des patients étaient en leucopénie (<4.103 globules blancs/µl) et 25 % des patients avaient une CRP inférieure à 1 mg/dl lors du diagnostic. Les hémocultures sont majoritairement positives pour les infections par Streptococcus pneumoniae, Neisseria meningitidis et Streptococcus agalactiae. Dans notre étude, nous montrons que ces données doivent être interprétées avec réserve.Dans le cas des méningites, le diagnostic définitif est posé par l'analyse du liquide céphalorachidien. L'analyse comporte une culture (culture positive dans plus de 75 % des cas), une numération de cellules (supérieur à 1 000 cellules/µl de LCR majoritairement neutrophiles dans 39 % des cas), 37 % de protéinorachie excessive (> 220 mg/dl), 50 % d'hypoglycorachie (< 34 mg/dl) et un dosage de l'acide lactique élevé (> 4,2 mrnol/l) dans 51 % des cas. L'intérêt de l'acide lactique est amplement discuté dans cette étude. Plusieurs facteurs de risques ont été étudiés dont les plus fréquents sont l'accouchement prématuré avant 37 semaines de grossesse (dans 23 % des cas), la présence d'un antécédent récent d'otite moyenne aiguë (dans 19 % des cas), le séjour en néonatalogie (dans 15 % des cas) et le poids de naissance inférieur à 2,500 kg (dans 6 % des cas). Les antécédents d'otite moyenne aigue sont étudiés plus en détails. Le cefotaxime est l'antibiotique le plus utilisé dans les cas de méningites. Pour les abcès,!'antibiothérapie comporte également une céphalosporine de 3° génération associée au métronidazole. L'évolution est favorable avec une guérison sans séquelles dans 60 % des cas. Cependant, des séquelles graves existent, parmi lesquelles 10 % de surdité, 12 % d 'hydrocéphalie nécessitant un drainage externe, 20 % de troubles moteurs et cognitifs et 14 % de troubles épileptiques. Le taux de mortalité est de 10 %. Conclusion : Les infections bactériennes intracrâniennes chez l'enfant sont une urgence thérapeutique avec des séquelles et une mortalité significative. Ces infections nécessitent donc un diagnostic précoce. Celui-ci est déterminé à partir de signes et symptômes cliniques atypiques et de certaines analyses biologiques qui nécessite un diagnostic différentiel le plus rapide possible afin d'instaurer le traitement immédiatement. Ce travail contribue également à l'analyse du lien entre les caractéristiques cliniques, biologiques et le pronostic (en particulier la mortalité) des patients atteints d'infections bactériennes intracrâniennes. The aim of this study is to analyze the bacterial intracranial infection (meningitis, brain abscesses, thrombophlebitis and empyema) of children emphasizing the clinical features, biological tests, treatment and outcomes.Methods: This is a retrospective study of 125 patient records 0-18 years old, admitted to the University Clinics St Luc between 2004 and 2012. Ali the patients were immunocompetent. After analyzing the inclusion criteria, 98 patient records have been retained in the study.Results: We found 7 thrombophlebitis, 11 brain abscesses, 8 empyema and 85 meningitis. Sorne patients have several successive pathologies. 61% of patient are younger than 2 years old, 18 % aged Jess than 1 month. Vaccination has dramatically changed the epidemiology. The causative agents of meningitis are most often found to be Streptococcus pneumoniae (27 % of cases), Neisseria meningitidis (14 % of cases) and Staphylococcus epidermidis ( 13 % of cases). There are 2 patients with meningitis caused by Haemophilus influenzae.The earliest diagnosis possible is essential. The most common onset clinical manifestations of bacterial meningitis were fever > 38°C (79 %), vomiting (46 %), symptoms of meningeal irritation such as neck stiffness, Kemig or Brundzinski signs (32 %), convulsions (29 %), somnolence (30 %), bulging fontanel (25 %), shock (19 %) and headache (14 %). However, 20% of patients show no pyrexia.Biological signs of infection are found in most cases of meningitis. However, abscesses and empyema shows fewer of these signs. In the cases of meningitis, biological tests show an inflammatory reaction with more than 20 000 white blood cells/µl in 20% of cases and an initial C-reactive protein (CRP) greater than 2 mg/dl in 75% of cases. However, 15% patients had leucopenia (<4.103 white blood cells/µl) and 25% of patients had CRP below 1 mg/dl at diagnosis. Blood cultures are mostly positive for Streptococcus pneumoniae, Neisseria meningitidis and Streptococcus agalactiae. In our study, we show that these data should be interpreted with caution.In the case of meningitis, the definitive diagnosis is made by the analysis of cerebrospinal fluid. This analysis includes a culture (positive in 75 % of cases), counting cells (greater than 1 000 cells/µl CSF in 39 % of cases), excessive protein level (> 220 mg/dl) in 37 % of cases, hypoglycorachia (< 34 mg/dl) in 50 % of cases, and deterrnination of high lactic acid (> 4,2 mmol/l) in 51 % of cases. The value of latic acid has been extensively discussed in the present study.Several risk factors have been studied, the most commons are premature birth before 37 weeks of amenorrhea (23 % of cases), the presence of a recent history of acute otitis media (19 % of cases), stay in neonatology (15 % of cases) and birth weight Jess than 2,5 kg (6 % of cases). The history of acute otitis media is discussed in more detail.Cefotaxime is the antibiotic used in the majority of cases of meningitis. For abscess, antibiotherapy also includes a 3rd generation cephalosporin associated with metronidazole. Evolution is in 60 % of cases favorable with healing without sequels. Nevertheless, serious sequels exist including 10 % of deafness, 12 % of hydrocephalus requiring extemal drainage, 20 % of motor and cognitive disorders and 14 % of epileptic disorders. The mortality rate is 10 %.Conclusion: Bacterial intracranial infections such as meningitis require emergent intervention and treatment due to significant mortality and morbidity. These infections require early diagnosis which is deterrnined from atypical clinical signs and symptoms and some laboratory tests that requires the most rapid differential diagnosis possible to initiate treatment immediately. This work also contributes to the analysis of the link between clinical, biological and therapeutic features and outcome prognosis (in particular mortality) of patients with bacterial intracranial infections.


Dissertation
MR perfusion imaging in cerebral ischemia
Authors: ---
ISBN: 9039318204 Year: 1999 Publisher: Utrecht Elinkwijk

Loading...
Export citation

Choose an application

Bookmark

Abstract


Dissertation
Concerning CADASIL from NOTCH3 mutation to stroke, dementia and migraine
Authors: ---
ISBN: 9090170456 Year: 2003 Publisher: Leiden Grafische producties

Loading...
Export citation

Choose an application

Bookmark

Abstract


Book
Intracranial atherosclerosis
Authors: --- ---
ISBN: 9781405178228 1405178221 Year: 2008 Publisher: Chichester ; Hoboken, NJ : Wiley-Blackwell,


Book
Moyamoya disease update
Authors: ---
ISBN: 4431546499 4431997024 9786612829048 4431997032 1282829041 Year: 2010 Publisher: Tokyo : Springer,

Loading...
Export citation

Choose an application

Bookmark

Abstract

Moyamoya disease (MMD) was first reported as a new entity among vascular disorders in 1957. Named for the abnormal vascular networks found around the occluded distal internal carotid artery, it is the most common pediatric cerebrovascular disease in East Asia. In recent years large amounts of data on MMD have been collected and important investigations have been carried out in Japan and Korea, even as the pathophysiology of the disease remains to be discovered. This monograph covers a diversity of topics and presents a systematic compilation of the data and current status of MMD in clinical practice and basic research. With contributions by more than 70 authors, the book includes sections on genetics, computational analysis of hemodynamic shear stress, new imaging techniques, and endovascular treatment of MMD, along with practical applications and future directions for gene and stem cell therapies. For neurosurgeons as well as neurologists and pediatricians, this volume will help lead to more efficient and informed management of MMD.


Book
Neurovascular Imaging
Authors: ---
ISBN: 9781848821347 9781848821330 Year: 2010 Publisher: London Springer London

Loading...
Export citation

Choose an application

Bookmark

Abstract

The comparison of MR images and cadaver microangiograms of the basal perforating arteries is crucial for understanding the courses and supply areas of these vessels and in turn, for diagnosing pathologies in this region. Divided into three sections- normal anatomy of brain vessels; neurovascular imaging in pathology; and anatomy and imaging of spinal vessels- Neurovascular Imaging contains a rich collection of images to teach the reader how to interpret MR images of the brain vessels and spinal vessels, and how to identify pathologies. Written and edited by a group of highly acclaimed experts in the field, Neurovascular Imaging is an authoritative account of the interpretation of MR images of the brain vessels and spinal vessels, and is a valuable addition to the library of the diagnostic radiologist.


Periodical
Journal of vascular surgery cases and innovative techniques.
Author:
ISSN: 24684287 Year: 2016 Publisher: New York : Elsevier Inc.,

Vascular dementia : cerebrovascular mechanisms and clinical management
Author:
ISBN: 9781588293664 1588293661 9781592598243 9786610359844 1280359846 1592598242 Year: 2005 Publisher: Totowa, N.J. : Humana Press,

Loading...
Export citation

Choose an application

Bookmark

Abstract

With an aging population suffering from a high level of cardiac and cerebrovascular disease, it has become increasingly clear that the time may be ripe for a deeper understanding of vascular disease (VaD). In Vascular Dementia: Cerebrovascular Mechanisms and Clinical Management, a panel of multidisciplinary experts summarizes our current understanding of the biological and clinical aspects of the condition. The authors describe the basic mechanisms associated with aging and cerebrovascular disease that may play an important role in the development of VaD, and identify its impact on cognitive status, psychiatric health, and the ability of patients to complete the tasks of daily living. Additional chapters address the pharmacological management of vascular dementia and the use of neuroimaging methods to investigate it, with particular attention devoted to both functional and structural imaging techniques. The complex relationship between VaD and Alzheimer's disease (AD) is fully explored, with chapters on how these processes may interact and how one disease may lower the threshold for clinical expression of the other. The authors also consider the impact of VaD on the perceived quality of life of patients and caregivers, two issues rarely discussed in the scientific community. Comprehensive and thoroughly up-to-date, Vascular Dementia: Cerebrovascular Mechanisms and Clinical Management offers both clinicians and basic scientists a wide ranging account of this rapidly developing field, explores the direction of future VaD studies, and authoritatively describes today's optimal therapeutic approaches.


Book
Carotid artery disease
Authors: --- ---
ISBN: 1607951371 9781607951377 9781607950523 1607950529 Year: 2010 Publisher: [Place of publication not identified] People's Medical Pub House USA

Loading...
Export citation

Choose an application

Bookmark

Abstract

Keywords

Carotid artery --- Investigative Techniques --- Analytical, Diagnostic and Therapeutic Techniques and Equipment --- Cerebrovascular Disorders --- Publication Formats --- Cardiovascular Surgical Procedures --- Brain Diseases --- Vascular Diseases --- Publication Characteristics --- Surgical Procedures, Operative --- Cardiovascular Diseases --- Central Nervous System Diseases --- Diseases --- Nervous System Diseases --- Methods --- Vascular Surgical Procedures --- Carotid Artery Diseases --- Diagnosis --- Congresses --- Medicine --- Health & Biological Sciences --- Cardiovascular Surgical Procedure --- Procedure, Cardiovascular Surgical --- Procedures, Cardiovascular Surgical --- Surgical Procedure, Cardiovascular --- Surgical Procedures, Cardiovascular --- Cardiovascular System --- Thoracic Surgery --- Cerebrovascular Diseases --- Cerebrovascular Insufficiency --- Cerebrovascular Occlusion --- Brain Vascular Disorders --- Intracranial Vascular Disorders --- Vascular Diseases, Intracranial --- Brain Vascular Disorder --- Cerebrovascular Disease --- Cerebrovascular Disorder --- Cerebrovascular Insufficiencies --- Cerebrovascular Occlusions --- Disease, Cerebrovascular --- Diseases, Cerebrovascular --- Insufficiencies, Cerebrovascular --- Insufficiency, Cerebrovascular --- Intracranial Vascular Disease --- Intracranial Vascular Diseases --- Intracranial Vascular Disorder --- Occlusion, Cerebrovascular --- Occlusions, Cerebrovascular --- Vascular Disease, Intracranial --- Vascular Disorder, Brain --- Vascular Disorder, Intracranial --- Vascular Disorders, Brain --- Vascular Disorders, Intracranial --- Investigative Technics --- Investigative Technic --- Investigative Technique --- Technic, Investigative --- Technics, Investigative --- Technique, Investigative --- Techniques, Investigative --- Antemortem Diagnosis --- Diagnoses and Examinations --- Examinations and Diagnoses --- Postmortem Diagnosis --- Diagnose --- Antemortem Diagnoses --- Diagnoses --- Diagnoses, Antemortem --- Diagnoses, Postmortem --- Diagnosis, Antemortem --- Diagnosis, Postmortem --- Postmortem Diagnoses --- Disease --- Arterial Diseases, Carotid --- Arterial Diseases, Common Carotid --- Arterial Diseases, External Carotid --- Arterial Diseases, Internal Carotid --- Atherosclerotic Disease, Carotid --- Carotid Artery Disorders --- Carotid Atherosclerotic Disease --- Common Carotid Artery Diseases --- External Carotid Artery Diseases --- Internal Carotid Artery Diseases --- Carotid Atherosclerosis --- Arterial Disease, Carotid --- Artery Disease, Carotid --- Artery Diseases, Carotid --- Artery Disorder, Carotid --- Artery Disorders, Carotid --- Atherosclerotic Diseases, Carotid --- Carotid Arterial Disease --- Carotid Arterial Diseases --- Carotid Artery Disease --- Carotid Artery Disorder --- Carotid Atheroscleroses --- Carotid Atherosclerotic Diseases --- Disorders, Carotid Artery --- Plaque, Atherosclerotic --- Procedure, Vascular Surgical --- Procedures, Vascular Surgical --- Surgical Procedure, Vascular --- Surgical Procedures, Vascular --- Vascular Surgical Procedure --- Blood Vessels --- Methodological Studies --- Methodological Study --- Procedures --- Studies, Methodological --- Study, Methodological --- Method --- Procedure --- Nervous System Disorders --- Neurological Disorders --- Neurologic Disorders --- Disease, Nervous System --- Diseases, Nervous System --- Disorder, Nervous System --- Disorder, Neurologic --- Disorder, Neurological --- Disorders, Nervous System --- Disorders, Neurologic --- Disorders, Neurological --- Nervous System Disease --- Nervous System Disorder --- Neurologic Disorder --- Neurological Disorder --- Neurology --- CNS Diseases --- Central Nervous System Disorders --- CNS Disease --- Central Nervous System Disease --- Central Nervous System Disorder --- Cardiovascular Disease --- Disease, Cardiovascular --- Diseases, Cardiovascular --- Cardiology --- Ghost Surgery --- Operative Procedures --- Operative Surgical Procedure --- Operative Surgical Procedures --- Procedure, Operative Surgical --- Procedures, Operative Surgical --- Surgery, Ghost --- Surgical Procedure, Operative --- Surgical Procedures --- Operative Procedure --- Procedure, Operative --- Procedure, Surgical --- Procedures, Operative --- Procedures, Surgical --- Surgical Procedure --- General Surgery --- Disease, Vascular --- Diseases, Vascular --- Vascular Disease --- Brain Disorders --- CNS Disorders, Intracranial --- Central Nervous System Disorders, Intracranial --- Central Nervous System Intracranial Disorders --- Encephalon Diseases --- Encephalopathy --- Intracranial CNS Disorders --- Intracranial Central Nervous System Disorders --- Brain Disease --- Brain Disorder --- CNS Disorder, Intracranial --- Encephalon Disease --- Encephalopathies --- Intracranial CNS Disorder --- surgery --- diagnosis --- surgery. --- diagnosis. --- methods.

Listing 1 - 10 of 14 << page
of 2
>>
Sort by