Asterixis in focal brain lesions.

Asterixis was observed in 20 cases of focal brain lesions. Metabolic or toxic factors were excluded. An electromyogram study of asterixis was carried out in nine cases to establish the diagnosis. The site of the focal lesion was either parietal or mesencephalic and was always contralateral to the asterixis. "Focal asterixis" could result from a dysfunction of the sensorimotor integration in the parietal lobe and the midbrain.

Motor consequences of motor area ablations in man.

Motor disorders reported in the present paper do not result from cortical ablations stricto sensu since some white matter was excised in every patient. However they appear to suggest that, as suggested by Walshe (1935), the central region and premotor area are a functional entity, i.e. they work as a whole. The extensive lesions of the premotor area, leaving untouched the motor region, have the same motor and tonic consequences as lesions limited to the central region. This point which appears specific for man does not imply that the premotor region subserves activities similar to those subserved by the central region. Rather it may suggest a deafferentiation of the central region, the consequences of which would be more important than is generally assumed. Extensive central or premotor lesions determine various tonic disorders: a well known spasticity, with exaggeration of the stretch reflex, associated with an increase in passive swinging of segments of limbs and in extensibility of joints. These two latter phenomena are usually defined as hypotonia. With premotor and precentral lesions the hypotonia disappears and a hemiplegic posture is observed. This hemiplegic posture is a dystonia which apparently does not result directly from the exaggeration of the stretch reflex. Anatomically it appears to result from lesions of both central and premotor regions. This is in agreement with Denny-Brown's (1966) contention that an extrapyramidal region lies rostral to the prerolandic sulcus. As suggested by Evarts (1973) motor regions appear to control automatic as well as voluntary movements. They probably play a role in the trophic function of muscle, since, despite rehabilitation, amyotrophy was present in every case reported in the present paper.

[Computed tomography in multiple sclerosis]. / La tomodensitométrie dans la sclérose en plaques.

Sixty patients with multiple sclerosis were examined by computed tomography using an Acute 200 Pfizer apparatus (matrix: 256 X 256; sections: 8 mm thick). In 48 cases iodine contrast medium was injected prior to examination, and in 6 cases the examination was repeated after several months. Abnormal C.T. readings were found in three quarters of the patients; increased image density in 10 patients, reduced density in 10 other cases; isolated cerebral atrophy in 26 patients, associated in 10 other cases with increased or reduced density of the image. Increased densities were seen mainly during acute episodes, then tended to isodensities or low densities. Though these different images are not specific, their association, the absence of mass effect and the absence of correlation between their location and the clinical signs, are elements in favor of the diagnosis of multiple sclerosis. Regions of increased density probably represent active foci of demyelinization and their investigation could be of value during long-term follow-up of these patients.

[Sleep disorders in Steele-Richardson disease. Polygraphic study of 3 cases]. / Troubles du sommeil dans la maladie de Steele-Richardson. Etude polygraphique de 3 cas

24 recordings of night-time sleep in three patients suffering from progressive supranuclear paralysis were carried out. There was observed: a tendency to insomnia, disappearance of spindles, an invasion of slow sleep immediately it appeared by the muscular and ocular criteria of paradoxical sleep, a considerable reduction in paradoxical sleep in the strict sense of the term, the latency of which in making its appearance was, however, maintained; progressive invasion of the paradoxical phases by slow waves. These abnormalities differ from those found in Parkinson's disease.

[Disturbances of wakefulness, sleep and respiratory function in Steinert's disease]. / Troubles de la vigilance, du sommeil et de la fonction respiratoire dans la maladie de Steinert.

36 night sleep recordings were carried out on 15 patients suffering from myotonia dystrophica. 9 of these patients complained of diurnal hypersomnia. 10 patients had a disturbance of night sleep with a reduction of REM sleep sometimes associated with interruption of the recording with an increase in the light stages of sleep or alternatively with an increase of REM sleep with a reduction in the latency period of the first paradoxical sleep or with narcoleptic elements. 13 patients had abnormally early abolition of chin EMG activity, almost on falling asleep. 11 cases had pathological apnoeic episodes during sleep and in 9 of the 10 patients who underwent respiratory function studies there was a restrictive airways defect. In addition 9 had frank hypoxia without hypercapnia and 4 a right to left shunt. 3 clinically unaffected patients but with affected relatives were also investigated, 2 were found to have sleep disturbances 1 of which was associated with early abolition of tone.