[Femoral neuropathy with deafferentation pain. Complications of a hematoma during anticoagulant treatment]. / Neuropathie crurale avec douleurs de déafférentation. Complication d'un hématome au cours d'un traitement anticoagulant.

A case of femoral palsy associated with chronic pain sensible to Carbamazepine, secondary to iliacus haematoma during anticoagulant therapy is reported. Late femoral nerve decompression followed by transcutaneous neurostimulation permit the normalization of the sensory nerve conduction and a complete clinical recovery. The localizations of hemorrhage and nervous compression are discussed. The necessity of a nerve decompression when features of nervous conduction persist is emphasized. Clinical symptomatology, Carbamazepine and transcutaneous neurostimulation efficacity, electrophysiological features are correlated with a central deafferentation state caused by an incomplete and heterogeneous lesion of the sensory nerve conduction pathways.

[Multiple cerebral hemorrhage and amyloid angiopathy of the white matter in a case of Alzheimer's disease]. / Hémorragies cérébrales multiples et angiopathie amyloïde de la substance blanche dans un cas de maladie d'Alzheimer.

Amyloid angiopathy is a common pathological finding in Alzheimer's disease. It usually involves leptomeningeal and cortical vessels but spares the white matter. It may cause lobar cerebral hemorrhages at a late stage of the disease. We report a case of Alzheimer's disease at an early stage with diffuse lesions of amyloid angiopathy including some within the white matter, apparently responsible for 2 deep and 1 superficial cerebral hemorrhages.

[Juvenile distal cerebral ischemia: value of pulp biopsy]. / Ischémie cérébrale distale juvénile: intérêt de la biopsie pulpaire.

Juvenile distal cerebral ischemia has been attributed to small artery atherosclerosis (Arnold, Benoit, Merlen, Dobbelaere, Delandsheer, 1979), based on clinicopathologic findings in one male patient and results of big toe pulp biopsy in three other cases. Pathological findings were obstruction of small artery lumens by hypertrophic endothelium and loose fibrocellular bands, their origin being the result possibly of partial intimalization of media by elastic neogenesis. Appearances were similar to those described by Dahl in human cerebral atherosclerosis in 1976, and approached those of the initial stages of experimental atheroma (Ross, Glomset, 1976). Arterial exiguity was also present in the 4 cases. Results of biologic, metabolic, inflammatory and immunologic examinations were negative. The present study concerns 4 additional cases of juvenile distal encephalic ischemia. One case in a female patient not on oral contraceptives confirmed the hypothesis of intimalization of media of arterioles of big toe pulp. Elastic neogenesis was present in the tunica media in areas where there was a change of direction of myocytes, and was apparent at a distance from the internal elastic layer. The latter was fragmented, sometimes doubles and of variable color. In another case, a woman taking oral contraceptives, there was almost total obstruction of the pulp arteriolar lumens with a very thin tunica media. Elastic neogenesis encircled two very narrow lumens in the center of the vessel and there were also elastic changes common to both.(ABSTRACT TRUNCATED AT 250 WORDS)

[Successive encephalic ischemic accidents in a young patient: Buerger's disease, buergerian syndrome, or juvenile atheroma? A report in clinical, angiographic, and anatomical findings in one case, compared to three other ones, in which a biopsy of the pulp of the toes was also performed (author's transl)]. / Accidents ischémiques encéphaliques successifs chez un sujet jeune: maladie de Buerger, syndrome buergerien ou athérome juvénile? A propos d'une observation clinique, angiographique et anatomique, comparée à trois autres avec étude de biopsie de pulpe d'orteil.

A man of 19 years of age was found to have a diffuse livedo, a quadruple asphyxic acrosyndrome, and dementia. Angiography confirmed the presence of distal ischemia with multiple circulatory blocks and a reduced distal network. The patient died at the age of 25 years and histopathological examinations of the vessels demonstrated obstructive atheromatous lesions in the medium sized and small arteries of the brain and viscera. By comparing these findings with those observed in three other cases, in which biopsy of the pulp of the toe was also performed, the hypothesis can be advanced that these juvenile encephalic ischemic accidents are caused by atheroma, which can be detected, at an early stage, by studying the distal arteries in the finger or toe pulp.

[Total right hemispherectomy: neurophysiological study after twenty-six years]. / Hémisphérectomie droite totale. Etude neurophysiologique après vingt-six ans.

Twenty-six years after a total right hemispherectomy for tumor when thirteen years old, a right-handed patient presented with disturbances of equilibrium, urinary incontinence, and a marked reduction in motor impulses, in spite of a subnormal intelligence quotient (0.85). Computed tomography examinations suggested the presence of a normal pressure hydrocephalus. However intracranial pressure monitoring and isotopic and cerebrospinal fluid perfusion tests showed the absence of any cerebral obstruction, and free communication between the cerebral and spinal spaces, though intracranial volume capacity accommodation was greatly reduced. Clinical examination demonstrated good quality sensory appreciation by the left half of the body, the possibility of detecting an object in the visual hemifield supposedly blind, and perfect location of a sound source. Somesthetic evoked potentials were studied by stimulating the median nerve in the left and right wrist regions. Left hemisphere evoked potentials from a contralateral stimulus, were of normal latency, amplitude and morphology, the response to an ipsilateral stimulus also presenting an early potential component (N 26 starting at N 21). This exceptional finding in a hemispherectomized patient could be related to activity of the spinoreticulothalamic tracts in the lemniscal or extralemniscal systems. Auditory function tests demonstrated perfect stereoaudiometry and the quality of perception during dichotic listening tests. Auditory evoked potentials in the brain stem included only minor functional-type anomalies, with slightly increased latencies in the pons on the left, and the mesencephalon and pons on the right. The presence of a bilateral wave VI was related to activity of the median geniculate pathway. Visual function tests showed good quality left photomotor reflexes and positive object detection in the anopsic hemifield. Results of these tests were reproducible during the same examination and after an interval of several months. The relevant literature is reviewed.

Juvenile distal cerebral ischemia: angiographic features. A study of 55 cases.

This study of juvenile distal cerebral ischaemia is based on 55 patients aged from 18 to 30 years. The authors describe the circumstances of discovery, as well as the clinical features and the course of the disease which may be severe and lead to non-resolutive neurological accidents and sometimes dementia. Paraclinical evaluation includes capillaroscopy, finger and toe pads biopsy (which clearly shows a pathological process with fibrocellular promontories narrowing the lumen of arterioles), and above all angiography which displays two typical signs: arterial narrowness and bands of peripheral ischaemia. In advanced forms of the disease angiography reveals classical signs of ischaemic lesions, but charateritically these are very distal. Associated abnormalities of the carotid siphon can also be found. Finally, positive CT scans show an isolated widening of the sulci which is fairly suggestive of the disease.

[Diagnostic and prognostic value of diaphragmatic electromyography and somatosensory evoked potentials in cervical spine and spinal cord injuries]. / Intérêt diagnostique et pronostique de l'électromyographie diaphragmatique et des potentiels evoqués somesthésiques dans les traumatismes vertébro-médullaires cervicaux.

SEP contribution to diagnosis is interesting but limited to hardly examined complete syndromes in an emergency care unit. The predictive value of SEP is high if electrophysiological data are correlated the 10th. day with the clinical status. A good prognostic value is shown when the clinical posterior column and pyramidal tract dysfunctions are equal in intensity and distribution, i.e. in complete syndromes or central spinal cord syndromes or Brown-Sequard's ones. However, not any correlation exists in cases of anterior spinal cord syndromes. Dg.EMG. is an easy, atraumatic useful tool for the clinician. It must be a systematic approach of the brain stem and cervical spinal cord phrenic centers vitality that may be involved by the trauma. When a respiratory deficiency occurs, it allows the diagnosis of a "peripheral" or "neurological" etiology. Its high prognostic value for m tor diaphragmatic function (increase or decrease) must be discussed before any therapeutic decision.

[Leão's spreading depression in the study of the relationship of central structures]. / Utilisation de la dépression envahissante de Leão pour l'etude de relations entre structures centrales.

The use of Leão's spreading depression for studying the action of connections between central structures is examined. Extracellular recordings of cortical and striatal spreading depressions with single microelectrodes are presented using both a DC channel and spike recordings systems. Striatal spreading depression was produced by peristaltic perfusion of a KC1 solution via a push-pull cannula system. The characteristics of cortical and striatal spreading depressions were studied and their effects on antidromically provoked cellular spikes. Using double microelectrode recordings modifications of spontaneous activity provoked by cortical spreading depression were examined in n. ventralis posterior (VP) and centralis lateralis (CL) of the thalamus. In both nuclei a silence corresponding to the block of spontaneous activity of a localised cortical area was observed. The controls originated from different cortical regions for each nucleus. The discharge preceeding the onset of the spreading depression slow wave is reflected by a similar discharge in VP but not in CL. The differences in the frequency following of CL and VP was examined in order to explain this discrepancy. The results just summarized can be explained if we accept that a tonic facilitatory control exists between localised cortical areas and the two thalamic nuclei studied. Similar experiments were performed to study the controls exerted by cortical areas on dorsal column nuclei. Only phasic transitory effects were observed which were either an increase or a decrease in activity. These facilitatory or depressive effects were attributed to the initial excitation signalling the propagation of a cortical spreading depression. No tonic effects were observed. Striatal spreading depression was not accompanied by a cortical effect but on the contrary the activity of cells in substantia nigra was significantly altered. In pars reticulata two populations could be distinguished. The first presented a phasic increase followed by a long period of decreased activity, they are proposed to be under the control of striatum via an excitatory pathway. The second was initially depressed then presented a long period of increased activity. This probably reflects the block of an inhibitory striato-nigral pathway. Both striato nigral effects were tonic in nature. The possibility of separating the effects due to cortical excitation or cortical block are discussed as well as the problems of interpretation of long distance changes in cellular activity.