FLAIR Vascular Hyperintensities as a Surrogate of Collaterals in Acute Stroke: DWI Matters.

BACKGROUND AND PURPOSE: FLAIR vascular hyperintensities are thought to represent leptomeningeal collaterals in acute ischemic stroke. However, whether all-FLAIR vascular hyperintensities or FLAIR vascular hyperintensities-DWI mismatch, ie, FLAIR vascular hyperintensities beyond the DWI lesion, best reflects collaterals remains debated. We aimed to compare the value of FLAIR vascular hyperintensities-DWI mismatch versus all-FLAIR vascular hyperintensities for collateral assessment using PWI-derived collateral flow maps as a reference. MATERIALS AND METHODS: We retrospectively reviewed the registries of 6 large stroke centers and included all patients with acute stroke with anterior circulation large-vessel occlusion who underwent MR imaging with PWI before thrombectomy. Collateral status was graded from 1 to 4 on PWI-derived collateral flow maps and dichotomized into good (grades 3-4) and poor (grades 1-2). The extent of all-FLAIR vascular hyperintensities and FLAIR vascular hyperintensities-DWI mismatch was assessed on the 7 cortical ASPECTS regions, ranging from 0 (absence) to 7 (extensive), and associations with good collaterals were compared using receiver operating characteristic curves. RESULTS: Of the 209 included patients, 133 (64%) and 76 (36%) had good and poor collaterals, respectively. All-FLAIR vascular hyperintensity extent was similar between collateral groups (P = .76). Conversely, FLAIR vascular hyperintensities-DWI mismatch extent was significantly higher in patients with good compared with poor collaterals (P < .001). The area under the curve was 0.80 (95% CI, 0.74-0.87) for FLAIR vascular hyperintensities-DWI mismatch and 0.52 (95% CI, 0.44-0.60) for all-FLAIR vascular hyperintensities (P < .001 for the comparison), to predict good collaterals. Variables independently associated with good collaterals were smaller DWI lesion volume (P < .001) and larger FLAIR vascular hyperintensities-DWI mismatch (P = .02). CONCLUSIONS: In acute ischemic stroke with large-vessel occlusion, the extent of FLAIR vascular hyperintensities does not reliably reflect collateral status unless one accounts for DWI.

[A perceptual analysis of dysarthria following cranial trauma]. / La dysarthrie chez les patients traumatisés crâniens: une analyse perceptive.

INTRODUCTION: Dysarthria is a frequent cause of handicap for patients with traumatic brain injury. Clinical assessment and quantification of the disorder is necessary before treatment. METHODS: We report a perceptual analysis of speech in a population of 18 patients with traumatic brain injury, in comparison with 18 control subjects. Evaluation was provided with a 33-item clinical scale. RESULTS: Interjuge reliability was good. Speech analysis distinguished controls from patients. Main perceptual deviances were impairment of naturalness, prosodic and phonetic disturbances.

Vigilance troubles in Parkinson's disease: a subjective and objective polysomnographic study.

BACKGROUND AND PURPOSE: To assess the prevalence of vigilance disorders in Parkinson's disease patients, relate the observed phenomena to potential causes and confirm these troubles with polysomnographic analysis. PATIENTS AND METHODS: A questionnaire was used to gather information on demographic data, previous and current treatments, disease characteristics, sleep and vigilance troubles. Somnolence was measured using the Epworth Sleepiness Scale (ESS). Nocturnal polysomnography (PSG) and multiple sleep latency tests (MSLT) were performed for a sample of parkinsonian patients. RESULTS: Two hundred twenty-two parkinsonian patients completed the questionnaire, and 36 patients had objective analyses. Of the patients, 43.2% had an ESS score >10, and 28.4% reported somnolence in the hour after taking dopaminergic drugs, whereas 6.8% reported unintended sleep episodes. In view of questionnaire data, these vigilance disorders may be partly explained not only by the impact of nocturnal sleep disorders (e.g. sleep apnea syndromes) but also by dopaminergic therapy (especially with dopaminergic agonists). With PSG and MSLT results, we have shown a significant correlation between mean sleep latency and ESS score. Patients with unintended sleep episodes have severe sleepiness in MSLT compared with others patients. CONCLUSIONS: Vigilance disorders are frequently observed in Parkinson's disease. We recommend informing patients of the risk of occurrence of such conditions, notably for patients with unintended sleep episodes and with sleepiness in the hour after taking dopaminergic drugs.

[Speech therapy for the dysarthria of Parkinson's disease]. / La rééducation orthophonique de la dysarthrie parkinsonienne.

INTRODUCTION: Dysarthria is frequent in Parkinson's disease and impairs communication. STATE OF THE ART: Use of levodopa or surgical procedures does not significantly improve speech. Traditional speech therapy can lead to improvement of dysarthria, and intensive programs have recently showed substantial beneficial effects on parkinsonian dysarthria. PERSPECTIVES: More work is needed to evaluate speech treatment efficacy. CONCLUSION: Earlier and more frequent speech therapy in parkinsonian dysarthria patients may contribute to better quality of life.

Effects of bilateral subthalamic stimulation on sleep in Parkinson's disease.

OBJECTIVE: Sleep disturbances are frequently observed in Parkinson's disease (PD). Bilateral chronic subthalamic nucleus (STN) stimulation is an alternative treatment for advanced PD. Improvements in motor disturbances after STN stimulation are well documented and seem to be associated with better sleep quality, even though the objective effect on sleep structure remains unclear. We have therefore studied the sleep/wakefulness cycle before and after surgical treatment in 10 consecutive parkinsonian patients. METHODS: Subjective sleep quality and sleep recordings were evaluated one month before and three months after initiation of STN stimulation. After surgery, the recordings were performed under two conditions: with stimulation (the "on" condition) and-if patients had given their consent-in the absence of stimulation (the "off" condition). RESULTS: With STN stimulation, subjective and objective sleep qualities were improved. Total sleep time, sleep efficiency and the durations of deep slow wave sleep and paradoxical sleep increased significantly. When stimulation was absent, sleep disturbances were similar to those observed before surgery. CONCLUSION: Chronic STN stimulation is associated with a sleep improvement, which can be explained in part by the concomitant decrease in motor disturbances but also by the reduction in dosages of antiparkinsonian medication. However, we can not exclude a direct effect of STN stimulation on sleep regulatory centres.

[Cortico-basal degeneration]. / La dégénérescence corticobasale.

Cortico-basal degeneration (CBD) has recently emerged as a distinctive entity of the Parkinson-plus syndromes but presents with great clinical and anatomopathological heterogeneity. The purpose of this review is to increase awareness of the syndrome and facilitate its recognition in both typical and unusual cases. We will herein review the 398 cases found in the English and French literature with their clinical, laboratory and pathological features.

[Perceptual analysis of dysarthria: presentation and validation of a clinical scale. Preliminary study]. / Evaluation perceptive de la dysarthrie: présentation et validation d'une grille clinique.

Perceptual analysis is widely used in clinical practice to assess motor speech disorders such as dysarthria. Unfortunately, there is no standardised tool available in French. The purpose of this study was first to develop a perceptual rating system modelled after systems currently used in the English literature and second to determine its reliability. We evaluated 33 dimensions using a 5-point scale. The production of 10 dysarthric patients were rated by 9 clinicians during both spontaneous speech and a reading task. Intra judge reliability (at 1-point) was about 90 percent, while inter judge reliability was about 80 percent. Ratings were comparable for the spontaneous speech and the reading task. Perceptual analysis of dysarthria is an easy and reproducible approach that can be used for the initial evaluation and for the follow up of dysarthric patients.

[Naming impairment for man-made objects in a case of herpes encephalitis]. / Trouble de la dénomination pour les objets manufacturés dans un cas d'encéphalite herpétique.

We report the naming performances of a 25 year-old woman with a left internal and inferior temporal lesion caused by herpes encephalitis who showed a preferential impairment for naming man-made objects. Evidence for category-specific effect was provided by a stepwise logistic regression using 171 pictures characterized by several parameters (words frequency, diversity of responses, length, name agreement, majoritary response, familiarity, visual complexity and canonicity). Analyses were realized over a 5 month period. Methodological considerations, anatomic correlations and arguments suggesting lexical access or semantic storage disturbance are discussed.

[EEG recordings during episodes of palinacousis and palinopsia]. / Enregistrements EEG contemporains d'épisodes de palinacousie et de palinopsie.

Palinopsia (visual perseveration) and palinacousis (auditory perseveration) are reported in a 51-year-old woman with a left temporo parietal astrocytoma. EEG showed a left temporal delta-focus with sharp waves. EEG was not modified during neither palinacousis nor palinopsia. The relationship between the two hallucinatory phenomena and epilepsy is discussed.

[The presentation of small-cell lung cancer with metastatic carcinomatous encephalitis in a non-Hodgkin's lymphoma patient]. / Encéphalite carcinomateuse métastatique révélatrice d'un cancer pulmonaire à petites cellules associé à un lymphome non hodgkinien.

BACKGROUND: Carcinomatous encephalitis or milary cerebral metastases characterized by signs of diffuse encephalopathy is a rare form of brain metastases. Tiny tumor nodules are seen throughout the cortical and subcortical gray matter. OBSERVATION: We report the case of a patient with a history of non-Hodgkin lymphoma who developed carcinomatous encephalitis probably secondary to small-cell lung cancer. This case is discussed in light of findings of 16 cases of carcinomatous encephalitis reported in the literature. We discuss clinical, radiological, histological, pathophysiological characteristics and the survival of this form. CONCLUSION: The frequency of carcinomatous encephalitis is underestimated because clinical expression is non specific. Brain magnetic resonance imaging must be performed in all patients presenting encephalopathy without an obvious cause.

[Evaluation of motor speech function in the diagnosis of various forms of dysarthria]. / Intérêt de l'évaluation motrice des organes de la parole dans le diagnostic des dysarthries.

Perceptual analysis is not sufficient enough to identify specific dysarthria types. In order to improve the discrimination between dysarthria types, we developed a standardized evaluation of different functions controlling speech motor performances. This was applied to 90 patients suffering from hypokinetic, spastic or ataxic dysarthria and 15 control subjects. A discriminate analysis showed that 71.4 p. 100 of the cases were correctly classified. This model was validated within a new group of 21 patients and showed that the less severe dysarthric parkinsonian patients were difficult to distinguish from control subjects. The discriminate analysis was then used for 20 patients with atypical parkinsonism. Seven patients with progressive supranuclear palsy were considered to have hypokinetic dysarthria. The 6 patients with multisystem atrophy and 7 with corticobasal degeneration were classified among the 3 dysarthric types. We suggest that motor speech evaluation may contribute to differential diagnosis within groups of patients suffering from atypical parkinsonism.

[Clinical assessment of dysarthria: presentation and validation of a method]. / Evaluation clinique de la dysarthrie: présentation et validation d'une méthode.

We adapted in French the Frenchay Dysarthria Assessment (FDA) developed by P. Enderby in 1983. This tool quantitatively evaluates the organs involved in speech and provides a measurement of intelligibility. Productions of normal subjects were analyzed. Reproductibility of data (correlation and interobserver concordance) was high in 18 dysarthric patients. A study performed in 100 dysarthric patients corresponding to 4 types of dysarthria (spastic, ataxic, hypokinetic and mixte) showed that dysarthria resulted from a global impairment of organs implied in speech, rather than one specific organ. The reduction in the intelligibility score was related to organ impairment.

[Myasthenic syndrome induced by lithium]. / Syndrome myasthénique induit par le lithium.

BACKGROUND: Lithium salts can induce a dysfunction of the neuromuscular junction. CASE REPORT: A patient given lithium for bipolar psychosis developed a state of major fatigue revealing a myasthenia syndrome which resolved progressively after lithium withdrawal. DISCUSSION: In the literature, we found 4 cases of neuromuscular junction disorders in patients treated with lithium. A myasthenia syndrome was induced by lithium in 3 cases and underlying myasthenia was disclosed by lithium in the last one. The long-term course in our patient was in favor of an induced syndrome rather than underlying myasthenia. We discuss the pathophysiological mechanisms. Lithium is a commonly prescribed drug. Clinicians should be aware of the possibility of neuromuscular junction disorder in patients taking lithium who develop muscle fatigue.

[Isolated truncular paralysis of the musculocutaneous nerve of the upper limb]. / Paralysies tronculaires isolées du nerf musculocutané au membre supérieur.

Isolated palsy of the musculocutaneous nerve, terminal branch of the lateral cord of the brachial plexus, is rare. It is responsible for sensory loss of the distal forearm and weakness of elbow flexion. It occurs after shoulder or clavicle surgery, trauma (fracture, dislocation, blows on the shoulder), violent exercice or extension of the forearm, prolonged positioning of the shoulder in extension-abduction-external rotation and phlebotomy. Different mechanisms such as stretching, compression or direct nerve injury are encountered. We report 5 cases with isolated musculocutaneous nerve palsy, including bilateral palsy caused by violent forearm extension. In other cases, mechanisms were an extensive stretching during surgery and compression caused by prolonged supine position. Different injury locations and causes described in literature are reviewed.