An uncommon electrocardiographic change in subarachnoid hemorrhage: increase in the Sokolow's Index.

In this paper we are reporting a case of electrical left ventricular hypertrophy with increased Sokolow's index following subarachnoid hemorrhage. Two-dimensional echocardiography ruled out anatomical left ventricular hypertrophy, and the Sokolow's index eventually reverted to normal. This electrocardiographic abnormality has rarely been associated with subarachnoid hemorrhage and does not appear to be related to the neurologic grade of the patient because he presented with headaches only and was conscious throughout (Hunt and Hess grade I). The possibility that such electrocardiographic changes should reflect anatomical changes in the heart should always be ruled out by proper investigations (i.e., echocardiography and coronarography), as the presence of cardiac disorders would greatly influence medical and surgical management. In terms of electrocardiography, this observation suggests that the Sokolow's index is a poor indicator of left ventricular hypertrophy, and tends to reflect a more comprehensive catecholaminergic process.

[Mitochondrial diabetes complicated by or associated with "MELAS" syndrome?]. / Diabète mitochondrial compliqué ou associé à un syndrome MELAS?

We report the case of fifty-two year-old mentally deficient female who presented with diabetes mellitus, deafness, stroke-like episodes, cardiomyopathy, and macular pattern dystrophy of the retina. Her brain exhibited calcification within basal ganglia, lactacidaemia was not increased. Although her skeletal muscles had never been clinically impaired, a quadriceps biopsy led to the diagnosis of mitochondrial disease because it exhibited ragged red fibers and heteroplasmic point-mutation at position 3243 of the mitochondrial DNA, although not any detectable respiratory chain complex deficiency was found. The mutant percentage in muscle was 70 p.100 and 5 to 10 p.100 in leukocytes. The question of whether a diabetic microangiopathy may be responsible stroke-like episodes is discussed. We suggest it was rather a complicated form of diabetes-deafness than a incomplete MELAS syndrome associated with mitochondrial diabetes.

Assessment of chronic childhood dysphonia.

Chronic childhood dysphonia is a common condition in the school-age period. Perceived functional disorder is subjective and the alert is usually given by a person not belonging to the child's immediate environment. History-taking often suggests a malformation or acquired lesion. Functional assessment helps measure and diagnose the vocal impairment. Physical and endoscopic assessment in consultation is the key examination: it is only rarely impossible in children and can often found diagnosis. Additional examinations are sometimes necessary.