Failure of omega-3 polyunsaturated fatty acids in prevention of migraine: a double-blind study versus placebo.

Omega-3 polyunsaturated fatty acids (OPFA) have beneficial effects on inflammatory reactions and production of cytokines. They decrease the release of 5HT by platelets and possess vasorelaxant activity. This led them to be tried in the prophylactic treatment of migraine. After 4 weeks of a single-blind placebo run-in period, patients were randomized and treated in double-blind condition by placebo or OPFA 6 g a day for 16 weeks, followed by a 4-week placebo run-out period. The intention to treat population included 196 patients. Those who received all four treatment periods included 96 patients taking OPFA and 87 taking placebo. The primary efficacy analysis was the number of migraine attacks during the last 4 weeks of treatment. During this period, the mean number of attacks was 1.20 +/- 1.40 in the OPFA group and 1.26 +/- 1.11 in the placebo group (NS). The total number of attacks during the 4-month period of the study was significantly different between groups: 7.05 in the placebo group, 5.95 in the OPFA group (P = 0.036). Mean intensity, mean duration of the attacks and rescue medication use, were not significantly different between the two groups. Except for a significant difference against OPFA for eructations, the tolerance was satisfying. Despite a run-in placebo period of 1 month, a very strong placebo effect was observed in this trial: 45% reduction of the attacks between run-in and 4-month treatment period (55% in the OPFA group, P = 0.058). Finally, this large study did not confirm two previous studies based on a small number of patients.

[Susac's syndrome: improvement with combined cyclophosphamide and intravenous immunoglobulin therapy]. / Syndrome de Susac: un cas d'évolution favorable sous cyclophosphamide et immunoglobulines intraveineuses.

We report a case of Susac's syndrome characterized by subacute encephalopathy, bilateral hearing loss and multiple bilateral branch retinal artery occlusions in a forty-year-old-white-woman. Brain Magnetic Resonance Imaging showed on T2-weighted images multiple, punctate areas of increased signal intensity in periventricular white matter, gray matter and brainstem most of them being enhanced by gadolinium. Cerebrospinal fluid was acellular but with an increased protein level (1.66 g/l). Treatment with cyclophosphamid and intravenous immmunoglobulin resulted in dramatic improvement of the clinical status over the following months and CSF normalization.

Microangiopathy of the inner ear, retina, and brain (Susac syndrome): report of a case.

Microangiopathy of the inner ear, retina, and brain was first described in 1979 by John O. Susac. Since then, approximately 60 cases have been reported. Otolaryngologists must be aware of this syndrome, in which cochleovestibular symptoms are an important part of the diagnosis. In this article, we report a new case of Susac syndrome and discuss the diagnosis, physiopathologic characteristics, and treatment of this disease.

Dysgenesis of the internal carotid artery associated with transsphenoidal encephalocele: a neural crest syndrome?

We describe two original cases of internal carotid artery dysgenesis associated with a malformative spectrum, which includes transsphenoidal encephalocele, optic nerve coloboma, hypopituitarism, and hypertelorism. Cephalic neural crest cells migrate to various regions in the head and neck where they contribute to the development of structures as diverse as the anterior skull base, the walls of the craniofacial arteries, the forebrain, and the face. Data suggest that the link between these rare malformations is abnormal neural crest development.

Facial diplegia complicating a bilateral internal carotid artery dissection.

BACKGROUND AND PURPOSE: We report a case of facial diplegia complicating a bilateral internal carotid artery dissection. CASE DESCRIPTION: A 49-year-old patient presented with unilateral headache and oculosympathetic paresis. Cerebral angiography revealed a bilateral internal carotid artery dissection. A few days later, the patient developed a facial diplegia that regressed after arterial recanalization. An arterial anatomic variation may explain this ischemic complication of carotid dissection. CONCLUSIONS: Double carotid dissection should be included among the causes of bilateral seventh nerve palsy.

[Intracranial hypotension]. / L'hypotension intracrânienne.

A CLINICAL DIAGNOSIS: Headache which appears in the upright position and subsides in the reclining position is suggestive of intracranial hypotension Brain magnetic resonance imaging can eliminate an intracranial tumoral process. In most cases, contrast images after gadolinium injection show a diffuse hypersignal of all the meninges including the falx cerebri and the tentorium cerebelli. SPONTANEOUS OR SECONDARY: This clinical presentation is sufficient for diagnosis. Occurring after a recent neurosurgical procedure, the intracranial hypotension is termed secondary. Inversely, is no known cause can be identified, the condition is termed spontaneous. CEREBROSPINAL FLUID: If the clinical manifestations are somewhat doubtful, a spinal tap can reveal the very low pressure of the cerebrospinal fluid (CSF) although it is advisable to avoid further loss of fluid. CSF LEAK: It is generally accepted that intracranial hypotension results from leakages of CSF through a breach in the dura mater caused by untreated trauma to a particularly fragile area due to a meningocele or an arachnoid cyst for example. Occasionally, the CSF leak can be evidenced with isotopic labeling used to visualize the breach and guide therapy. TREATMENT: By analogy with the spinal tap syndrome, a blood-patch with autologous blood is usually proposed as first line medical treatment. Prognosis is generally good.

[Multiple and recurrent paralysis of cranial nerves: primary Gougerot-Sjögren syndrome]. / Paralysies multiples et récidivantes des nerfs crâniens. Syndrome de Goujerot-Sjögren primitif.

Over a period of 10 years, a 49-year-old man had 3 episodes of recurrent cranial nerve palsy regressing within a few weeks. Each episode was accompanied with acute inaugural headache and diplopia and once with sensory impairment of the trigeminal nerf and once with tinnitus. The diagnosis of Goujerot-Sjögren's syndrome was retained after demonstration of hypergammaglobulinaemia, a positive Rose Bengale test and histological examination of biopsy specimens from the accessory salivary glands which revealed advanced typical lesions. Clinically, impaired secretion was not obvious.

[POEMS cured by radical treatment of plasmacytoma]. / POEMS guéri par le traitement radical d'un plasmocytome.

A 53-year-old man presented with POEMS syndrome characterized by a solitary plasmocytoma and an angiofollicular lymph node hyperplasia similar to that observed in Castelmann's disease. Two features were prominent: first, a severe hypertriglyceridemia, which could have been related to autoimmune suppression of lipoprotein lipase activity; second, a marked immunostaining of myelin sheaths with occasional widening of myelin lamellae. These data, added to the complete regression of the neuropathy immediately following surgical removal of the plasmocytoma (with subsequent irradiation) suggested that the paraprotein was responsible for the neuropathy.

[Polyradiculoneuritis in a developmental flare-up of Behçet's disease]. / Polyradiculonévrite au cours d'une poussée évolutive de maladie de Behçet.

A patient with Behçet's disease developed a polyradiculitis that was mainly motor. It was associated with an acute episode of mucocutaneous, articular and inflammatory symptoms and the neurological disorders regressed in a few months. A possible cause effect relationship is considered. Peripheral nerve lesions are rare in Behçet's disease. Only a few cases of polyneuritis radiculitis and mononeuritis multiplex have been reported.

[Oral contraception and cerebrovascular accidents]. / Contraception orale et accidents vasculaire cérébraux.

PIP: The authors had the opportunity to follow a case of fatal ischemic bilateral cerebral infarctus which occurred in a 28 year old female with a history of migraine (but without any anti-migrainous drug). She had been using a low dose (0.05 mg ethinyl estradiol) oral contraceptive (OC) for 2 years. The previous pathological data of subendothelial thickening and fibrosis with thrombosis were confirmed, but for the 1st time, a marked giant cell reaction was found in close contact with lesions of the internal elastic membrane. Thus, there was evidence of inflammatory thrombo-angeitis obliterans. Biological and immunological abnormalities such as a high rate of anti-ethinyl estradiol antibodies in the serum (polyclonal immunoglobulin IgC) and circulating blood immune complexes seem to be closely related to this inflammatory thrombo-angeitis. These biological and histological findings suggest that vascular accidents related to OCs may be induced by an immunological mechanism. (author's)^ieng

[Headache related to sexual intercourse (author's transl)]. / Les céphalées déclenchées par l'acte sexuel.

Coïtal cephalalgic (CC) is rare (1/360 headaches); it occurs more frequently among men. Out of 16 unpublished cases, in 4 cases, CC was the inaugural symptom of vascular attack. In the 12 other cases, CC was isolated or primary. According to the time of onset of headache during coït one may distinguish three types: 1) early CC usually moderate and short lasting; 2) orgasmic CC, abrupt, severe, lasting 15 to 20 minutes; 3) late CC of long duration (hours, days) follows sometimes orgasmic CC. Isolated CC is usually repetitive but capricious, episodical, not periodical. Prognosis is good. Mechanism is mainly vascular and muscular. The role of high blood pressure, migraine, and psychological factors is discussed.

[Involvement of the central nervous system in Behçet's syndrome. Report of two cases (author's transl)]. / L'atteinte du système nerveux central au cours de la maladie de Behçet. A propos de deux observations.

After presenting two personal observations, the authors underline the fact that the neurological manifestations of Behçet's disease are more frequent than they were supposed to be. Their symptoms are overly manifold but have in common constant abnormality in the cerebrospinal fluid when an attack occurs. The affection is a very serious one demanding an early and well established diagnosis only to be obtained thanks to a clinical examination. Corticosteroïd therapy (1 mg/kg per day) either alone or associated with immuno-suppressive therapy may check the attack. Preventing relapses implies a non-stop treatment. Immuno-suppressive therapy seems to be the most efficient one.

[Iatrogenic arthritis after intestinal by-pass as a treatment for obesity (author's transl)]. / Les polyarthralgies en rapport avec les dérivations intestinales.

The authors report three observations of patients having suffered from arthralgias as an aftermath of intestinal by-pass for treatment of refractory obesity. They remind the main troubles cropping up after such surgical treatment and refer to the data already existing in the literature dealing with articular manifestations. They think this pathology is in keeping with arthritis already reported in inflammatory colitis and they suggest a similar pathogeny.

[Giant cell thromboangiitis in a patient taking an oral contraceptive (author's transl)]. / Thromboangéite à cellules géantes au cours d'une contraception orale. Etude anatomo-clinique et immunologique.

Pathological examination in a patient who developed an ischemic cerebrovascular accident while taking an oral contraceptive demonstrated widespread lesions in the right and left carotid regions. Histological examination revealed the presence of an obliterating thromboangiitis in the arterial walls, with subendothelial fibrosis of the intima, arterial thrombosis, and a marked giant cell reaction where the lesions were in contact with the internal elastic layer. Immunological and biological anomalies confirmed the inflammatory nature of the lesion with the presence of anti-ethinyl estradiol antibodies in the serum and circulating blood immune complexes. These biological and histological results suggest the immunological nature of the mechanism of origin of the cerebrovascular accident in this case.

PIP: The article presents the case of a 28-year-old patient, on oral contraception for 2 years, who suddenly developed massive right hemiplagia. Pathological observations revealed widespread lesions in the right and left carotid regions, while histological observations revealed the presence of obliterating in the arterial walls, causing arterial thrombosis and giat cell reaction where the lesions were in contact with the internal elastic layer. Antiethinyl estradiol antibodies were found in the serum, together with immune circulating complexes. Such results suggest the immunological nature of the case presented.

[Syphilitic meningo-encephalitis with probable associated arteritis (author's transl)]. / Méningo-encéphalite syphilitique avec participation artéritique probable.

A 21-year-old woman was referred for consultation because of sensory and motor disorders of sudden onset but on lung duration. Neurological examination was normal. Lumbar puncture confirmed the presence of a clear liquid meningitis. Arteriography demonstrated segmental arteritis of the anterior cerebral vessels. Systematic serological tests were positive for syphilis. The authors discuss the relation between arteritis and syphilitic meningitis in this young woman taking oral contraceptives.