[The delusion of place: contribution of the measurement of cerebral deficit]. / Le délire des lieux: apport de la débitmétrie cérébrale.

The authors report the observation of a 61-year-old female patient who, following a right frontal-temporal ischemia, presented disorientation with respect to her surroundings. She was convinced during her hospital stay that her house had been transformed into a hospital. There was no evidence of intellectual confusion or deterioration, and the neuropsychological examination revealed visuo-spatial disturbances only. A low basal cerebral blood flow was found in the right anterior hemisphere which further decreased when the patient was asked where he was. It is hypothesized that confabulatory responses corresponded to a disinhibition of the left hemisphere from the control of the hemisphere dominant in dealing with visuo-spatial data.

[Skeletal and velar myoclonus with vision disorders. Efficacy of carbamazepine]. / Myoclonies squelettiques et du voile avec troubles visuels. Efficacité de la carbamazépine.

The authors report the case of a 71 year-old woman presenting right velopharyngo-laryngeal and skeletal rhythmic myoclonus, associated with visual and phasic disorders. They appeared four months after an infarct in the region of the left posterior cerebral artery. The ischemia was of temporo-occipital location, very probably extending to the region of the left red nucleus, thereby interrupting the dento-olivary pathway. Several drugs which are usually active in the treatment of myoclonus proved ineffective. But carbamazepine at a dose of 600 mg per day was effective from the third day and remained so after seven months. It would seem to act by inhibiting the occurrence of paroxystic discharges of an epileptic type in the olivary body disinhibited by the underlying lesion.

[Cortical and subcortical dementia. The value of long auditory evoked potentials]. / Démences corticales et sous-corticales. Intérêt des potentiels évoqués auditifs tardifs.

Long latency auditory evoked potentials were studied in 27 normal subjects, 19 patients with Alzheimer's Disease (A.D.) and 70 patients with Parkinson's Disease (P.D.). 17 patients with P.D. showed cognitive impairment measured by the "test rapide d'évaluation des fonctions cognitives - E.R.F.C.". The N2 and P3 peak latencies were prolonged in the demented group of P.D. compared to the non demented group P.D.. Between the electrophysiological parameters only the N1 latency prolongation distinguished the demented parkinsonian patients from the patients with A.D..

[Disconnection and recognition of faces. A case with lesions of the left visual cortex and the splenium]. / Disconnexion et reconnaissance des visages. Un cas avec lésions du cortex visuel gauche et du splenium.

We report the clinical findings in a case of alexia without agraphia, due to a left posterior cerebral artery infarction, in which C.T. showed occipital and splenial lesions. There were in addition a right homonymous hemianopsia and agnosia for colors, objects and pictures, with both associative and disconnective aspects. The hypothesis of an occipito-occipital disconnection, depriving the left visual associative areas of inputs, could explain this agnosia. The most striking findings in this case was, besides an anomia for faces, a peculiar difficulty to recognize her own face. The patient seemed to recognize herself. The patient spoke about herself in the third person, giving genuine autobiographical details, without being able to say: "it is me". This phenomenon is discussed in terms of disconnection: the right hemisphere sending information from the semantic field evoked by her own face, through the anterior part of the corpus callosum, to the left hemisphere. We discuss the hemispheric contribution within cognitive experience, and the role of language concerning the conscious experience in man.

[Motor impersistance of the eyelids. Study of 93 cases and a discussion of pathogenic mechanisms]. / L'impersistance motrice palpébrale. Etude de 93 cas et discussion des mécanismes pathogéniques.

In a prospective study, 252 subjects were investigated for motor impersistence of the eyelids (MIE) by means of a protocol that evaluated its intensity and detected associated signs, notably other phenomena of motor impersistence. MIE was frequent, being found in 93 subjects. It was usually observed in diffuse brain lesions, then in lesions of the right hemisphere, particularly in the posterior and deep cortex. In right hemisphere lesions, MIE was significantly associated with constructional apraxia, visual neglect and Anton-Babinski syndrome. In diffuse cerebral lesions, MIE was accompanied by other phenomena of motor impersistence on a background of dementia. In these cases the P 300 wave latency was significantly prolonged. Three main mechanisms may be regarded as responsible for the occurrence of MIE: apraxia, disturbance of the interhemispheric balance (notably in lesions of the right hemisphere) and disorders of attention (predominant in diffuse lesions). Actually, in every case MIE should be inserted in a continuum the extremities of which are represented by the above mentioned mechanisms.

[Ramsay-Hunt's syndrome: a case report with pathological examination (author's transl)]. / Syndrome de Ramsay-Hunt. Etude anatomique d'un cas.

A patient developed dyssynergia cerebellaris myoclonica, following an epileptic attack at the age of 19 years, with the progressive onset of involuntary movements and a cerebellar syndrome. He was second of a family of six children in which the same affection was present in the older sister while the four others were not affected. The involuntary movements corresponded to krebs type III intentino myoclonus, to massive myoclonic movements, and Krebs type I fibrillary myoclonia. The E.E.G. changes were typical, particularly the constant reinforcement of epileptic potential by photic stimulation. Completely disabled at 35 years, the patient was hospitalized at age 51 and kept under observation for 18 months. The per os administration of 5-hydroxytryptophane (5-H.T.P.), 150 mg daily, without a decarboxylase inhibitor, resulted in a spectacular reduction of the myoclonic movements and a marked improvement in autonomy. The patient died at 53 years of age from deglutition disorders related to oropharyngeal myoclonus. Pathological examination revealed no abnormalities in the brain, particularly in the dentate nuclei and the superior cerebellar penduncles. The only lesions observed were in the spinal cord: atrophy and demyelinization of Goll's columns and of the posterior lumbar and dorsal roots, and slight atrophy of the lateral funiculi. This case raises the problem of the relationship between myoclonus and lesions of the dentate nucleus, observed in 13 out of 16 cases of anatomically confirmed D.C.M., and lesions of its efferent pathways, present in 8 cases out of 16. The case reported here is the only one with an isolated spinal cord lesion, apart from that of Bradshaw in which no lesion was found but the cord had not been examined. The improvement obtained with the precursor of serotonin, 5-H.T.P. in the Lance and Adams syndrome (in which the intention myoclonus is semiologically very close to that of D.C.M., whatever their respective lesions), suggests that pathogenic studies should be carried out along biochemical lines. Though all authors do not agree, many accept a disturbance in serotoninergic pathways in the genesis of intentional myoclonus. The improvement in clinical signs and symptoms obtained in the present case with low doses of 5-H.T.P. brings additional evidence in favor of this hypothesis.

[Hemiballism caused by metastasis to Luys' body]. / Hémiballisme par métastase du corps de Luys.

A 66 year-old man suddenly developed a left-sided hemiballism. CT scan revealed 3 metastases, one of them in the area of the right subthalamic nucleus (corpus Luysii). A primary lung tumor was suspected. Haloperidol and tiapride were unsuccessful to control the hemiballism. The patient died 5 months later. Pathological examination confirmed the diagnosis. The pathophysiology of this case is discussed with regard to the pathological findings. Hemiballism secondary to a metastasis is rare, 9 cases have been reported during the past 65 years. Vascular lesions are the usual cause (75 per cent); on rare occasions degenerative disorders (14 per cent), destructive (tumors: 10 per cent or surgical lesions: 0,3-9 per cent) can also result in hemiballism.

[The gaze and functional hemispheric activation in normal subjects]. / Regard et activation fonctionnelle hémisphérique chez le sujet normal.

The aim of this work was to determine whether the study of lateral and vertical conjugated eye movement could serve as an indicator of the functional hemispheric activation. Questions of vocabulary, calculation, logic (V.C.L.) and visuo-spatial instructions, as well as music-listening (V.S.M.), were proposed to 60 control subjects (21 men, 39 women). They were divided in 4 groups of 15 according to their laterality (complete right handed, incomplete right handed, ambidextrous, left handed). Eye movements were recorded using a video system. Deviations of the eyes towards the right and left, upwards and downwards, as well as episodes of staring were noted. Concerning V.C.L. questions, there was a significant correlation between conjugated lateral eye movements and the contralateral hemisphere activation. The study of vertical eye movements revealed a correlation only in complete right-handed and left-handed subjects: deviation upwards during the left hemisphere activation, and downwards during the right hemisphere activation. This pattern of response was no longer found during V.S.M. questions which, in the 4 groups, evoked staring episodes in 56 to 72 per cent of the cases. The negative emotional stimuli (emotional words, non verbal stimuli, stressful situations) evoked preferentially, but independently of laterality, deviations towards the left and downwards in favor of the right hemisphere activation. This method of observation of eye movements seems therefore of significant interest in Neuropsychology, provided that methodologic rules are rigorously respected.

[Visual evoked potentials and face recognition. Influence of celebrity and emotional expression]. / Potentiels évoqués visuels et reconnaissance des visages: influence de la célébrité et de l'expression émotionnelle.

Visual evoked potentials (VEP) were recorded in the right and left parietal and occipital regions of 40 right-handed controls in a facial recognition task. VEP were studied first according to the renown of the faces, then according to their emotional expression. Asymmetry was noted between the hemispheres: P100 was of greater amplitude and longer latency in the left occipital region. Later components (P400 and P600) were of greater amplitude and longer latency in the right parietal region in all situations. P100 latency on the left side was shorter for renowned faces than for non-renowned faces (P = 0.05). P600 latency was shorter on the right (P < 0.03) and left (P < 0.05) sides for smiling than for non-smiling faces. When the subjects were asked to look for emotional expression of the face (smiling or non-smiling) P400 was very ample and P600 of little amplitude. When the subjects were asked to recognize the face (renowned or not renowned) P600 was very ample and P400 of little amplitude. Thus, there seems to be a differential treatment of information: automatic and rapid to detect emotion (P400), controlled, tardy (P600) and involving memory in the search for renown.

[Late auditory evoked potentials in subcortical cognitive deterioration]. / Potentiels évoqués auditifs tardifs dans les détériorations cognitives sous-corticales.

Late auditory evoked potentials (AEPs) were recorded by the odd-ball method in 55 non-deteriorated parkinsonians (NP) and in 27 parkinsonians with cognitive deterioration (CDP), compared with 20 controls (C) and 24 patients with Alzheimer-type senile dementia (ATSD). The latency of P 300 was prolonged in the CDP and ATSD groups (410.72 +/- 24.45 and 433.62 +/- 38.30 respectively; P less than 0.001. The latency of N 100 was prolonged only in the CDP group (106.6 +/- 4.82; P less than 0.001). Late AEPs were also studied in 63 subjects with possible or confirmed disseminated sclerosis (DS) compared with 33 controls of similar mean age. The ERFC test divided these patients into 38 with non-deteriorated DS (NDS) and 25 with deteriorated DS (DDS). The latency of P 300 was prolonged in both groups: NDS 331.14 +/- 25.89; DDS 376.64 +/- 29.51 (P less than 0.001). The latency of N 100 was prolonged in the NDS group (100.25 +/- 9.20) and the DDS group (104.43 +/- 9.01). Following a study of correlations between the degree of mental deterioration and the electrophysiological parameters in these populations, the significance of the N 100 latency as electrophysiological marker of subcortical dementia is discussed.

[Association of cerebral cysticercosis and multifocal glioma. Discussion of interactions]. / Association d'une cysticercose cérébrale et d'un gliome multifocal. Discussion des interactions.

Diagnosis in a case of cerebral parenchyma cysticercosis was based on conventional arguments described in the literature. The patient died after progression of the disease over 6 months, despite two courses of Praziquantel. Results of neuropathologic examination confirmed diagnosis of cysticercosis and the discovery of a multifocal astrocytic tumor involving mainly the periventricular regions. Possible interactions between parasitic infection and glioma are discussed but it is difficult to determine the precise role played by the parasitosis in the evolution of the tumor, the hypothesis of a simple coincidence being most likely. Periventricular images of an inflammatory nature observed after PZQ treatment should not be accepted unreservedly, and when an unfavorable course is apparent the periventricular histopathologic lesions should be compared with results of CT scan imaging qualified as periventricular in origin.

[Asymmetry of visual perceptive activity of faces and emotional facial expressions]. / Asymétrie dans l'activité perceptive visuelle des visages et des expressions faciales emotionnelles.

Eye movements were studied in 40 right-handed subjects during perception of symmetrical chimerical faces. These movements were recorded using an original system based on a differential optical method for the detection of corneal reflection and of the pupil made shiny. Under basal conditions, the first fixation was usually located in the left visual hemifield. The subjects spent more time gazing at the right hemiface (P less than 0.04). This visuo-spatial asymmetry in favour of the left hemispace was increased when the subject was requested to determine the emotional expressions of a new series of faces (P less than 0.002). Compared with basal conditions, the increase in the percentage of time spent in the left area was significant (P less than 0.035). An analysis performed on the first 3 seconds confirmed and amplified the differences observed. These results can partly be explained by reading habits and exploratory activity for symmetrical shapes. However, activation of the right hemisphere, specialized in the perception of faces and facial expressions, probably influenced visual exploration by drawing attention to the left area and favouring the left visual hemifield.

[Unconjugated pteridines and neuromeningeal infections]. / Ptéridines non conjuguées et infections neuro-méningées.

Concentrations of unconjugated pteridines (neopterin, monapterin, biopterin, pterin) were measured in the cerebrospinal fluid (CSF) of 310 patients, using a high performance liquid chromatography (HPCL) method. Our cohort included 209 controls (C), 15 patients with meningism (M), 22 with viral meningitis (VM), 17 with bacterial meningitis (BM), 9 with herpetic meningoencephalitis (HME), 2 with tuberculous meningoencephalitis (TME) and 36 with peripheral systemic infections (PI). These measurements, expressed as nmol/litre, showed a gradation of neopterin concentrations according to the type of infection: 20.1 + 6.5 in group C; 46.9 +/- 29.9 in group PI; 274.3 +/- 231.7 in group VM; 699.2 +/- 711.2 in group BM, 1,101.9 +/- 1,107.9 in group HME and 1,169 +/- 1,171.9 in group TME. There was no such gradation with biopterin. Comparisons of means showed that total concentrations in the pathology groups were very different from those observed in controls and in the neuromeningeal infections of the PI group. There was no correlation between the number of lymphocytes and the concentrations of neopterin or biopterin in the CSF. It is concluded that the concentration of neopterin in the CSF is a sensitive but little specific marker of infection, independent of CSF cellular reaction. Measuring this concentration makes it possible: 1) to evaluate the status of immune defences; 2) to predict that a meningitis will become chronic, and 3) to detect a possible parenchymal participation in a meningeal infection.

[Correlations between delayed auditory evoked potentials and clinical evaluation of schizophrenic symptoms]. / Corrélations entre les potentiels évoqués auditifs tardifs et l'évaluation clinique des symptômes de schizophrénie.

Late auditory evoked potentials (AEPs) were recorded by the "odd-ball" method in 20 schizophrenic patients according to DSM III R diagnosis criteria compared with 30 control subjects matched for sex and age. Patients were on antipsychotic medications; mean duration of illness was 3, 55 years. We have also proceeded to a clinical quantitative assessment of negative and positive symptoms of schizophrenia with Andreasen's rating scales. In the group of patients, we have observed a significant lengthening of the latency of N 1, N 2, P 3, N 3 and a decreased amplitude of N 1 and P 3. These results are in favour of an impairment of cerebral information processing probably localized in the subcortical level. Statistically significant correlations have been noticed between the anomalies of the last stages of information processing (P 3, N 3) and negative symptoms, more particularly affective flattening and attentional impairment. The disturbances of the first stages of information processing (P 2) and of automatic information processing (N 2) were related to positive symptoms, hallucinations and delusions especially. The anomalies of N 2 were also related to the sum of the global scores: an attentional impairment could be a main factor in the determinism of schizophrenia.