Diagnostic différentiel d’un état de mal épileptique en réanimation : à propos d’un cas de Creutzfeldt-Jakob sporadique

A 78-year-old man was admitted in the intensive care unit for epilepsy seizure (tonic-clonic seizure). Since three months, his wife reports motor dysfunction (weakness) and since two weeks, rapidly progressive changes in cognition (apraxia, akinetic mutism). The diagnosis of probable sporadic Creutzfeldt-Jakob on the basis of clinical, EEG and MRI lesions was made. Refining diagnostic criteria is probably needed, including the usefulness of repeated MRI with FLAIR and diffusion-weighted imaging.     

Association d’une rééducation sous analgésie péri-nerveuse continue et d’une capsulo-distension de l’épaule dans le traitement du syndrome épaule-main rebelle

Objective

Evaluation of treatment of shoulder-hand syndromes resistant to conventional therapeutic. This approach consists of an intensive treatment based on arthrographic distension with rapid mobilization of the shoulder under general anaesthesia and on active rehabilitation under regional analgesia using infraclavicular brachial plexus catheter.

Material and methods

It was a retrospective study of twenty-five consecutive patients with severe shoulder-hand syndrome treated between 2007 and 2012. Besides their persistent pain, these patients presented a functional disability of their shoulder, wrist and hand. Treatment was initiated at least three months after diagnosis. All were assessed at the admission and six months later.

Results

After treatment, pain was reduced by at least three points at the NS in 64% of the patients. Twelve patients described a complete recovery of their shoulder function; eleven patients described a normal hand function recovery and six patients a partial recovery allowing regular life. Nineteen patients evaluated their functional improvement of more than 50%. Only two patients with more than one year of chronic pain reported no improvement after treatment.

Conclusion

After failure of the physiotherapy and analgesic treatment, there are no clear consensual procedures and guidelines remains discussed. The current study combined different approaches with a significant improvement of this complex regional pain syndrome called shoulder-hand syndromes.     

Lésions étagées contiguës du rachis cervical inférieur lors d’un traumatisme en flexion de diagnostic retardé : à propos d’un cas

The authors report a case of bilateral C4-C5 facet fracture dislocation associated with a severe sprain underlying C5-C6, which had occurred during an traffic accident. The diagnosis of severe sprain was raised on the 55th day. The injury mechanism is studied. Contiguous multilevel injuries of the lower cervical spine should be suspected in case of high-energy trauma. MRI can provide an exhaustif diagnosis of possible multilevel injuries. After fixation of the obvious lesion, intraoperative dynamic fluoroscopy must be performed to demonstrate any instability in another area.