[Postpartum cerebral angiopathy of iatrogenic origin]. / Angiopathie cérébrale du post-partum d'origine iatrogène.

A 30 year old women, beginning her 19th day postpartum, was admitted for lowering of alertness. The day before she complained of cephalalagia. Neurologic examination showed pyramidal tract signs on the right part of the body, a bilateral Babinski sign, and central oculomotor palsy. She started a treatment by nasal pulverization of phenylephrine, a sympathomimetic vasoconstrictor, one week before, and took bromocriptine (5 mg per day) from childbirth to second week postpartum. CT scan was normal. Lumbar puncture showed a high level of proteins, from transsudative origin. Cerebral angiography showed a beading aspect of arterial branches, especially in the left middle cerebral artery territory. Two days after drug withdrawal, the patient recovered. This angiographic pattern has already been described in cases of cerebral angiopathy due to sympathomimetic drug abuse, and in cases of postpartum cerebral angiopathy. The chronology, in our case, makes the responsibility of the phenylephrine very likely. Nonetheless, ergot derivatives (i.e. ergonovine, bromocriptine) have also been accused of giving cerebral postpartum angiopathy. In our case, we think that bromocriptine may have triggered the cerebral angiopathy due to phenylephrine.

[Contribution of the electromyogram in the diagnosis of infantile spinal muscular atrophy in the neonatal period]. / Apport de l'électromyogramme au diagnostic d'amyotrophie spinale infantile en période néonatale.

BACKGROUND: The acute form of Werdnig-Hoffman disease, infantile spinal muscular atrophy type I (SMA I), is characterized by severe paralytic hypotonia with neurogenic electromyographic (EMG) pattern and specific histologic features. PATIENTS: Four cases of very severe SMA I suffering from generalized muscle weakness at birth were included in the study. RESULTS: The neurogenic EMG pattern was observed at the first exam performed between D2 and D46. The muscular biopsy performed between D18 and D45 showed only a mild decrease of the muscle fiber size without grouping of fiber types. CONCLUSION: In those forms of SMA I with a neonatal clinical onset, the diagnosis is assessed by clinical and EMG findings while early muscular biopsy can be misleading. EMG is the relevant diagnostic test which confirms the anterior horn cell disease and can justify the DNA study.

[Pseudo-eventration: unusual complication of vertebral osteoporotic compression]. / Une pseudo-éventration: complication inhabituelle d'un tassement vertébral ostéoporotique.

A new case of neurological complication of an osteoporotic vertebral fracture is reported. Authors emphasize electromyography which explained the clinical presentation of pseudo-evisceration by showing an injury of the 12th spinal nerve. To their knowledge, this kind of complication was never reported before, but they think that the development of electromyographic practice would allow to find many others cases. Authors emphasize MRI which gives strong argument for osteoporotic nature of a vertebral fracture and could avoid having recourse to vertebral biopsy.

Prevalence of neurological disorders in Haute-Vienne department (Limousin region-France).

The Limousin region had at present one of the largest elderly populations in France and in Europe. To determine the frequency of certain neurological disorders in the elderly, a neuroepidemiological survey was conducted in 1986-1987 on a representative sample of the population in Haute-Vienne (the most population-dense department in the Limousin region). This study used a WHO protocol which was first introduced at the beginning of the 1980s. It had been previously tested in France on a pilot population in 1984. The prevalences of the principal neurological disorders encountered per 100,000 inhabitants were as follows: nonmigraine headache 5,059, migraine 4,270, epilepsy 788, completed stroke 1,445, transient ischemic attacks 657, neuropathy 1,642, Parkinson's disease 328, and dementia 197.