Immune complexes in cerebrospinal fluid and serum of neurological patients. Possible intrathecal formation in bacterial meningitis and herpetic encephalitis.

We assayed immune complexes (IC) by Particle Counting ImmunoAssay in the serum and cerebrospinal fluid (CSF) of patients with various neurological disorders. In pyogenic meningitis, the levels of IC sharply increased 4-8 days after onset with a fall before the 10th day of the disease. In herpetic encephalitis the IC and antibody levels started to increase about 12 days after onset. The IC persisted at high values for 3-4 weeks, whereas the high antibody titers persisted for several months during the follow-up. In these 2 groups of patients IC were probably locally produced as indicated by the lack of correlation with the IC levels in the serum. We did not detect any significant increase of IC in the serum and CSF of patients with multiple sclerosis (N = 48) or with acute idiopathic polyradiculoneuritis (N = 11). Using another technique based on the determination of IgG and C4 in polyethylene glycol precipitates we also failed to detect any significant increase of IC in multiple sclerosis sera.

C-reactive protein in serum and cerebrospinal fluid in various neurological disorders. Apparent local consumption during bacterial meningitis.

The level of C-reactive protein (CRP) was determined in the cerebrospinal fluid (CSF) by particle counting immunoassay. In non-neurological patients (N = 24), CRP was detectable only in 10 samples at concentrations ranging from 1.5 to 37 micrograms/l. The multiple sclerosis group did not differ from the controls. The highest CRP levels were found in viral and bacterial, including tuberculous, infections of the nervous system, with overlapping results for the various types of infections. However, in serum, the levels of CRP were much higher in pyogenic than in viral meningitis. We compared the CSF CRP/serum CRP ratio to the same ratio for albumin and found a significant correlation between the two ratios in viral, but not in bacterial, infections. These results suggest a local consumption of CRP during bacterial meningitis.

The concentration of IgM in the cerebrospinal fluid of neurological patients.

The level of IgM was determined by Particle Counting Immunoassay in the cerebrospinal fluid. In non-neurological patients (N = 20) the mean was 97.5 micrograms/l with the upper reference limit at 380 micrograms/l. The mean IgM index was 0.021 with the upper reference limit at 0.071. Of 21 patients with stroke, 5 had an IgM index exceeding the reference limit. High levels and indices of IgM were observed in most patients (N = 27) with infectious meningo-encephalitis. In this group, the IgM index was abnormal in about 30% of cases with a normal total protein content, and was more often increased than the IgG index. In multiple sclerosis patients (N = 80), the IgM index was increased in 32%. In this disease very high values of IgM index (greater than 0.13) were never associated with very high values of IgG index (greater than 1.8). A significantly higher proportion of males was found in the group of patients with very high values of IgM index (N = 11). No significant influence of the age of onset, the interval between onset and sampling and clinical state was observed. However, of 10 patients with a multiple sclerosis history exceeding 15 years none had an IgM index exceeding the upper reference limit. Four patients with multiple sclerosis had a high IgM index without either an increase of the IgG index or the presence of oligoclonal bands.

Neurological complications of intravenous immunoglobulin (IVIg) therapy: an illustrative case of acute encephalopathy following IVIg therapy and a review of the literature.

We report the case of a 73-year-old man who developed an acute encephalopathy during IVIg therapy for AIDP. The signs and symptoms of the encephalopathy completely resolved after discontinuation of the treatment. We also reviewed the literature over the major neurological complications of IVIg therapy, including aseptic meningitis, cerebral infarction, and acute encephalopathy. About 30 cases of aseptic meningitis are reported. They are probably related to an immunoallergic reaction, caused by the entry of the exogenous IgG into the CSF compartment. CSF examinations usually show a neutrophilic or a mixed pleocytosis. Three cases of cerebral infarction and 2 patients with acute encephalopathy, following IVIg therapy, were also reported in the literature. Cerebral vasospasm, cerebral vasculitis, and/or serum hyperviscosity may be implicated in the pathogenesis of these neurological complications. There is a clinical similarity between these IVIg-related encephalopathy and the "reversible posterior leukoencephalopathy syndrome", described by Hinchey et al., 1996.

Delayed-onset hemidystonia and chorea following contralateral infarction of the posterolateral thalamus. A case report.

A 68 year-old man developed progressive hemidystonia and chorea 8 months after a contralateral thalamic stroke. The neurological examination also showed a right pyramidal syndrome without hemiparesis, a right horizontal sectoranopia, and a right hemihypesthesia for all sensory modalities. The MRI revealed infarctions in the left medial temporo-occipital lobes and left posterolateral thalamus, corresponding to the vascular territories of both the thalamo-geniculate and posterolateral choroidal arterial pedicles. The thalamic lesion involved the pulvinar, the lateral geniculate body, and the ventro-postero-lateral, dorso-lateral, posterolateral, and dorso-medial nuclei, but apparently did not extent to the ventrolateral thalamic nucleus, and the subthalamic and midbrain regions. Thalamic and striatopallidal dystonia have not a common pathophysiological mechanism. The involvement of the pulvinar nucleus and of the strategic crossing of proprioceptive, cerebellar, pyramidal, and subthalamic pathways may play a role in the genesis of the posterolateral thalamic dystonia.

[Folic acid deficiency with leukoencephalopathy and chronic axonal neuropathy of sensory predominance]. / Carence en acide folique avec leucoencéphalopathie et neuropathie axonale chronique à prédominance sensitive.

A 44-year-old, alcoholic, woman developed a prolonged folate deficiency with a chronic predominantly axonal sensory polyneuropathy. The cerebral CT and MRI revealed a diffuse, clinically asymptomatic, leukoencephalopathy. A partial improvement of the neurological symptoms was observed after two months of oral administration of folate. Neurological complications of folate deficiency are rare and similar to those observed in cobalamin deficiency. Both cobalamin and folate deficiencies may interfere with the synthesis of the central myelin. This case report illustrates the possibility to observe a leukoencephalopathy due to folate deficiency, in association with the classical polyneuropathies and/or subacute combined degenerations of the spinal cord.

[Borrelia burgdorferi encephalomyelitis]. / Formes encéphalomyélitiques de l'infection a Borrelia burgdorferi.

We report two patients with chronic encephalomyelitis due to Borrelia burgdorferi in whom the definite diagnosis was delayed because of atypical clinical features. The first patient presented with chronic spastic paraparesis, slight ataxia and nystagmus of several years' duration. A tentative diagnosis of multiple sclerosis was made in spite of important abnormalities of the CSF biological characteristics. The second patient presented with an acute aphasia and a bilateral Babinski's sign. He was thought to suffer from benign herpetic meningoencephalitis. Several months later, as the patient experienced relapses with cerebellar and spinal cord involvement, falsely positive tests for syphilis were found and an antibiotic treatment was given. High protein content, low glucose levels, pleocytosis and oligoclonal bands were observed in all CSF samples, but the definite diagnosis was based on the detection of serum and CSF antibodies against B. burgdorferi.

[Motor neuropathy, putamen necrosis and optic nerve atrophy after acute methanol poisoning]. / Neuropathie motrice, nécrose putaminale et atrophie optique après intoxication aiguë au méthanol.

Optic neuropathy and putaminal necrosis are the most common sequellae of methanol poisoning. We report a case in a patient with a chronic motor neuro(no)pathy in addition to these neurological complications. Peripheral nerve and spinal cord disorders, related to methanol poisoning, are uncommon and probably underestimated.

[Cerebral cysticercosis treated by albendazole: development of cerebral magnetic resonance imaging]. / Cysticercose cérébrale traitée par albendazole: évolution de l'imagerie par résonance magnétique cérébrale.

A 36-year-old Indian man presented with a generalized tonic-clonic seizure. The diagnosis of neurocysticercosis was suspected by the presence of multiple cystic and nodular cerebral lesions on MRI, and was confirmed by serological studies (ELISA). He was treated with albendazole during one week at the daily dose of 15 mg/kg. This case illustrates the advantage of MRI over CT for the detection and the therapeutical follow-up of neurocysticercosis. Moreover, the MRI findings can be correlated to the anatomical stage of neurocysticercosis, proposed by Escobar (1983); four stages are described: I = vesicular stage (living larvae), II = vesicular colloidal stage (degenerating larvae), III and IV, granular nodular and nodular calcified inactive stages respectively.

[Agenesis of the corpus callosum, heterotopia of the gray cortex and interhemispheric cyst. Late radiologic diagnosis in an asymptomatic adult]. / Agénésie calleuse, hétérotopie de substance grise et kyste interhémisphérique. Diagnostic radiologique tardif chez un adulte asymptomatique.

Agenesis of the corpus callosum may occur as an isolated finding; most often, it is present in association with other cerebral malformations such as cortical heterotopias. Computerized tomography and magnetic resonance imaging are methods of choice to detect these cerebral prenatal abnormalities, especially asymptomatic forms. We report the case of an asymptomatic young adult with complete callosal agenesis, cortical heterotopia and interhemispheric cyst, on CT and MR imaging.

[Acute encephalomyopathy and persistent cerebellar syndrome after lithium salt and haloperidol poisoning]. / Encéphalomyopathie aiguë et syndrome cérébelleux persistant après intoxication par sel de lithium et halopéridol.

A 44-year-old maniacodepressive woman developed acute encephalopathy due to the association of lithium carbonate and haloperidol. She was treated with lithium salts for many years and the serum level of lithium was within the therapeutic range. The encephalopathy was worsened by hyperthermia, dehydration, and reintroduction of haloperidol, 5 days after the first discontinuation of the neuroleptic. The clinical features were characterized by a persistent cerebellar syndrome, more than one year after the interruption of these medications.

[Central pontine myelinolysis with cerebellar ataxia and dystonia]. / Myélinolyse centropontine avec ataxie cérébelleuse et dystonie.

A 46-year-old alcoholic woman presented with dementia, chronic cerebellar ataxia and diffuse dystonia. Neurological examination also demonstrated emotional lability and a pyramidal signs on the four limbs. CT showed mild cerebellar and frontal atrophy. The diagnosis of central pontine myelinolysis was confirmed by MRI. The centropontine lesion gave an hyposignal on T1-weighted sequences and a hypersignal on T2-weighted sequences. It was shaped as a trident and symmetrical, sparing the tegmentum and the ventro-lateral regions of the pons. Cerebellar ataxia was related to cerebellar atrophy and extension of myelinolysis to the middle cerebellar peduncles. Dystonia, rarely reported in central pontine myelinolysis, was not associated with striatal lesions on MRI. The pathophysiology of these movement disorders in central pontine myelinolysis remains unclear. This case shows that central pontine myelinolysis is a rare cause of dystonia and can be diagnosed by MRI.

OFSETH: smart medical textile for continuous monitoring of respiratory motions under magnetic resonance imaging.

The potential impact of optical fiber sensors embedded into medical textiles for the continuous monitoring of the patient during Magnetic Resonance Imaging is presented. We report on two pure optical sensing technologies for respiratory movements monitoring - a macro bending sensor and a Bragg grating sensor, designed to measure the elongation due to abdominal and thoracic motions during breathing. We demonstrate that the two sensors can successfully sense textile elongation between, 0% and 3%, while maintaining the stretching properties of the textile substrates for a good comfort of the patient.

Optical fibre sensors embedded into technical textile for a continuous monitoring of patients under Magnetic Resonance Imaging.

The potential impact of optical fiber sensors embedded into medical textiles for the continuous monitoring of the patient during Magnetic Resonance Imaging (MRI) is presented. In that way, we report on several pure optical sensing technologies for pulse oximetry and respiratory movements monitoring. The technique for pulse oximetry measurement is known as NIRS (Near Infra-Red Spectroscopy) in a reflectance mode. On the other hand, we tested two different optical based designs for the respiratory motions measurements--a macro bending sensor and a Bragg grating sensor, designed to measure the elongation of thoracic and abdominal circumferences during breathing.

Neurotrophic ulcer following Wallenberg's syndrome.

A 61-year-old man consulted for two long-standing ulcerations on the scalp and one on the nose, following an acute vascular disorder of the brain stem (Wallenberg's syndrome). The aetiology and pathogenesis of neurotrophic ulcers are briefly discussed.

Lymphocytic meningoradiculitis and encephalomyelitis due to Borrelia burgdorferi: a clinical and serological study of 18 cases.

Clinical features of 18 patients with either lymphocytic meningoradiculitis (n = 17) or chronic encephalomyelitis (n = 1) due to Borrelia burgdorferi are reported. Arthropod bites were recorded in only seven patients. High titres of anti B burgdorferi antibodies were detected in sera from all patients and in CSF from 12 out of 17 patients tested. All patients had CSF abnormalities especially pleocytosis and oligoclonal bands. A falsely positive syphilitic serology was observed in the CSF from the patient with encephalomyelitis.