[Hypothalamic insufficiency following irradiation. Late, subacute and curable dementia]. / Insuffisance hypothalamique après irradiation. Démence tardive, subaiguë et curable.

A 31 year-old patient suffered from a subacute and major dementia, sixty months after whole brain irradiation with 54 grays for a pinealoma. Clinical features and biological investigations led to a diagnosis of hypothalamic insufficiency. A dramatic clinical recovery followed therapy with hydrocortisone and thyroxine. An hypothalamic radionecrosis and a vascular mechanism are presumed.

[Ineffectiveness of hyperbaric oxygen therapy in multiple sclerosis. A randomized placebo-controlled double-blind study]. / Inefficacité de l'oxygénothérapie hyperbare dans la sclérose en plaques. Essai randomisé contrôlé par placebo en double aveugle.

Seventeen patients with definite and progressive multiple sclerosis entered a double-blind randomized placebo-controlled therapeutic trial of hyperbaric oxygen (HBO). Exposure in monoplace chamber was 90 minutes long each time, 5 days a week, for 4 weeks. The treatment and placebo groups received 100% oxygen at 1.5 bar constant pressure or normal air at 0.1-0.2 bar, respectively. The clinical status of the patients in both groups were compared until one year after treatment. There was no benefit of HBO versus placebo according to the Kurtzke disability status scale. A lesser proportion of patients with deterioration of bowel/bladder function 12 months after therapy was the only benefit of HBO versus placebo according to Kurtzke functional systems scales. On the whole however, HBO is useless in the management of progressive forms of multiple sclerosis.

[Paralysis of downward gaze and chronic global amnesia as a result of a bilateral thalamo-subthalamic lesion]. / Paralysie de l'abaissement du regard et amnésie globale durables par lésion thalamo-sous-thalamique bilatérale.

A 47 year-old male was found in coma and upon awakening 36 hours later, he showed a selective paralysis of downward gaze and convergence associated to an intellectual impairment. He was euphoric, unconcerned, poorly attentive, and had a severe amnesia for both anterograde and retrograde material. CT scan and NMR demonstrated a bilateral lacunar lesion of thalamic and subthalamic paramedian region. Over the 5 years follow-up, behavioral, personality and amnestic changes remained. On the other hand, supranuclear gaze paralysis improved as documented by EOG recordings with persisting limitations in voluntary down movements amplitude and dramatic reduction of fast components velocity.