[Cerebral trunk abscess due to Neisseria meningitidis in a 28-year-old immunocompetent patient]. / Abcès du tronc cérébral àNeisseria meningitidis chez une patiente de 28ans, immunocompétente.

Meningococcal disease can manifest in very different clinical situations. Meningococcal meningitis and fulminant meningococcemia (or purpura fulminans) are the most common forms of these infections, but many other manifestations can be seen including septic arthritis, pericarditis, pleurisy and conjunctivitis. Brain abscesses have also been described; they are a rare complication of meningococcal disease. We report the case of a 28-year-old immunocompetent patient who developed meningococcal infection associated with brain abscesses and oligo-arthritis.

[Saccadic latencies and unilateral spatial neglect caused by parietal lesions]. / Latences saccadiques et négligence spatiale unilatérale par lésion pariétale.

Latencies of lateral visually guided saccades were studied in 12 right handed patients who had unilateral ischaemic lesions involving the parietal lobe. The patients were divided into two groups according to the right or left side of the lesions. The severity of unilateral spatial neglect was assessed. In right parietal lesions, the asymmetry of latencies was related to the presence of unilateral spatial neglect and correlated with ist severity. According to the stimulus condition used, we suggest that the asymmetry of latency is explained in terms of an inability to disengage.

[Palinacousis with hemianacusia caused by left temporal lesion]. / Palinacousie avec hémianacousie par lésion temporale gauche.

Palinacousis (auditory perseveration) is reported in a 78-year-old patient with a left temporo parietal astrocytoma. The patient complained of "echoing voice" in his right ear. Palinacousis was associated with sensitive partial seizures. Neuropsychological investigations revealed hemianacusia with normal performance for phonological discrimination and verbal repetition. We suggest that these preserved abilities allowed emergence of palinacousis.

[Intermittent sea-saw nystagmus successfully treated with clonazepam]. / Abolition par le clonazépam d'un nystagmus en bascule intermittent.

See-saw nystagmus is a pendular nystagmus with two distinct components: a conjugate torsional component and a disjonctive vertical component. The acquired form of nystagmus is usually seen with parasellar mass and less frequently in head injury or brainstem infarction. Almost all patients with parasellar mass or head injury have associated bitemporal hemianopia. We report the case of a 27-year-old man who developed intermittent daily oscillopsia five years after a severe head injury. On neurological examination, the patient showed a congenital left eye divergence with left eye convergence paresis, an anosmia, a right optic atrophy and a bitemporal hemianopia. Visual acuity was 7/10 and 3/10 for the right and left eyes. The rest of the neurological examination was unremarkable. Electroencephalogram during oscillopsia was normal. MRI revealed bilateral orbito-frontal low signal intensity on T1 weighted images. The brainstem, the diencephalon and the ventricular system appeared to be intact. Eye movement recordings exhibited intermittent see-saw nystagmus. Clonazepam treatment resolved the see-saw nystagmus. Slowly withdrawal of clonazepam was done without return of the see-saw nystagmus.

[Continuous partial epilepsy disclosing diabetes mellitus]. / Epilepsie partielle continue révélatrice d'un diabète sucré.

Continuous partial epilepsy (CPE) is characterized by isolated, subintrant clonus focalized to a limited territory with critical focal electroencephalography in a concordant territory. CPE is observed in various cortical lesions but also in disorders of metabolism and notably decompensated diabetes mellitus. We report a case of CPE without focal lesion at MRI which revealed hyperglycaemia without ketosis. The 54-year old female patient was hospitalised for C.P.E.. Early CT and later MRI gave normal results. Biochemistry showed hyperglycaemia without kenoturia, acidosis or hyperosmolality. Insulin therapy rapidly brought glycaemia down to its normal level and the clonsism disappeared. Five months later, the patient had no other seizure and the EEG was normal. Epileptic seizures are frequent in hyperglycaemia without ketosis (25% of the cases) where they are mainly partial and motor (75 to 86% of the cases), rarely associated with a focal lesion (15% of the cases with CT scan). They are rare in patients with ketoacidosis. This apparent protective effect of ketoacidosis may be attributed to an increase of GABA bioavailability consecutive to acidosis. CPE is resistant to antiepileptic treatments. In CPE induced by hyperglycaemia without ketosis normalization of blood glucose level with insulin therapy is concomitant with a rapid cure of epilepsy. Thus glycaemia should be measured in all patients presenting with CPE, the aim being to diagnose hyperglycaemia without ketosis rapidly to avoid hyperosmolality and to prescribe an adequate treatment based exclusively on insulin and rehydration.