[Precoce survey: a new self-assessment patient card for early detection and management of Parkinson disease fluctuations]. / Etude Précoce: évaluation d'un autoquestionnaire de dépistage et prise en charge précoces des fluctuations dans la maladie de Parkinson.

It has been known for more than 30 years that the efficiency of the dopaminergic treatments can wear off. Currently, motor fluctuations and especially non-motor fluctuations (dysautonomic, cognitive/psychiatric or sensory/pain) remain often underdiagnosed in the first years of treatment. The patient self-questionnaire used in this study has been developed and validated in the United States. Its French version has been tested in daily practice in a study with 938 Parkinson's patients followed-up by movement disorders specialists. Use of this self-assessment patient card has resulted in the detection of fluctuations in 49% of patients, considered nonfluctuating by neurologists after a clinical assessment. The impact of these fluctuations unknown at first is significant, since these motor and/or non motor symptoms are considered troublesome or perturbing for daily life activities by 70% of fluctuating patients. The investigators have recognized the usefulness of this self-assessment in order to detect fluctuations in 81% of fluctuating patients, which lead them to modify the treatment in 76% of them.

[Visuoverbal disconnection (optical aphasia) for objects, pictures, colors and faces with abstractive alexia]. / Disconnexion visuo-verbale (aphasie optique) pour les objets les images, les couleurs et les visages avec alexie "abstractive".

The case is reported of a patient who, after a left occipital infarction, presented a deficit in naming visually presented objects with neither aphasia, nor perturbation in the perceptive and associative processing of visual informations. This visuo-verbal disconnection was accompanied by disturbance of the semantic function when this was explored via the visual channel. In addition the patient showed an alexia which could be described as an abstraction defect. Finally, the patient showed a deficit in naming colors and faces, without evidence for agnosia. This observation argues in favor of maintaining a distinction between visual associative agnosia and optic aphasia. It also demonstrates that the naming deficit implies a deficit in extracting semantic values from visual informations such as objects or graphic symbols.

[Neurologic adverse effects of piperazine]. / Accidents neurologiques de la Pipérazine.

Piperazine has been used since the end of the nineteenth century as a urine alkalizing agent in gout and more widely in the past thirty years for its antihelmintic properties. It is known for being well tolerated and of low toxicity. However, there are cases, sometimes in particular circumstances, where piperazine causes severe and impressive neurological disorders, which can be totally reversed if the medication is discontinued. The disorders are accompanied by consistent, but similarly reversible, electroencephalographic changes. The etiopathogenesis of these accidents caused by piperazine is discussed.

[Spinal meningeal hemorrhage of tumor origin]. / Hémorragies méningées spinales d'origine tumorale.

Intraspinal tumors with subarachnoid hemorrhage are exceptional. They are most often localized at the cauda equina. Ependymoma is the most common tumor. Low back pain followed by headache (Fincher syndrome) should suggest hemorrhage originating from a low lesion.

[Involvement of oculomotor nerves. A little-known complication of Horton's disease]. / L'atteinte des nerfs oculo-moteurs. Complication peu connue de la maladie de Horton.

Third, fourth and sixth cranial nerve palsy is a less common complication of giant cell arteritis than ischemic optic neuritis. Nevertheless, it occurs in at least 10% of cases. A case of giant cell arteritis with third nerve palsy which resolved under corticosteroid therapy is reported. The incidence of ocular complications is assessed from a review of the cases previously seen in the department and of data from the medical literature. The authors believe that the index patient has ischemic neuritis rather than myositis. It is concluded that giant cell arteritis should be considered at an early reversible stage.