The G79A polymorphism of protein Z gene is an independent risk factor for cerebral venous thrombosis.

BACKGROUND AND PURPOSE: Protein Z (PZ), a vitamin Kdependent protein, plays a role in inhibiting coagulation. Its plasma level or PZ gene polymorphisms have been discussed as risk factors for stroke with conflicting results reported between various studies. Only one of these polymorphisms was studied in a cohort of patients suffering from cerebral venous thrombosis (CVT). METHODS: We performed a retrospective genetic study comparing 100 healthy controls to 54 patients referred to our hemostasis unit after CVT occurrence. We compared the distribution of three PZ gene polymorphisms that may influence PZ plasma levels: A-13G in the promoter and G79A in intron F were tested using previously described techniques, and we developed a technique to evaluate the G-103A in intron A. RESULTS: The G79A polymorphism was significantly more frequent in patients than in controls (p = 0.012): the presence of at least one A allele led to an odds ratio of 2.57 with a 95 % confidence interval of 1.23-5.34. The A-13G polymorphism also showed a nonsignificant trend towards a higher prevalence in patients. CONCLUSION: The G79A polymorphism of the PZ gene was shown to be a new independent risk factor for cerebral venous thrombosis. Nevertheless, these results have to be confirmed by a prospective study including plasma PZ evaluation.

Migraine aura lasting 1-24 h in children: a sequence of EEG slow-wave abnormalities vs. vascular events.

The aim of this study was to describe the abnormalities associated with migraine aura lasting 1-24 h in children as shown by EEG, trancranial Doppler (TCD) and single photon emission computed tomography (SPECT). In this retrospective study, 11 patients each underwent EEG, TCD and brain SPECT on the day of admission and the day thereafter. On the day of admission, the migrainous hemisphere of all patients showed that the mean velocities were decreased in the middle cerebral artery by TCD, slow-wave abnormalities were recorded after several hours of aura by EEG and the SPECT showed hypoperfusion. On the day after, in the same hemisphere, slow waves were recorded only in the occipital area by EEG, and SPECT showed slight hyperperfusion. In these patients, there was a clear sequence of EEG, TCD and SPECT abnormalities.

[Progressive BK virus associated multifocal leukoencephalopathy in an immunocompromised patient treated with corticosteroids]. / Leucoencéphalopathie multifocale progressive à BK virus chez un patient immunodéprimé par une corticothérapie.

INTRODUCTION: BK virus has been described previously in renal transplant patients, but has also been reported in cases of progressive multifocal leukoencephalopathy. METHOD: A case of progressive BK virus multifocal leukoencephalopathy induced by long-term corticosteroid therapy is reported. RESULTS: In our case, BK virus was detected in cerebrospinal fluid by polymerase chain reaction (PCR). A detailed review of similar cases in the literature showed most of them occurred in AIDS patients, but four involved immunocompetent patients. CONCLUSION: Though BK virus infection usually leads to urinary tract symptoms in immunologically suppressed patients, it is important to be aware of its neurological manifestations and to recognize BK infections that can occur in immunocompetent patients.

[Anti-Ri paraneoplastic syndrome associated with ophtalmoplegia, blepharospasm and palilalia]. / Ophtalmoplégie, blépharospasme et palilalie associés à des anticorps anti-Ri.

INTRODUCTION: Anti-Hu and anti-Yo are the most well-known anti-neuronal antibodies. The anti-Ri antibodies, which are less common, are generally found in subjects with opsoclonus-myoclonus, often associated with breast cancer. CASE REPORT: A 54-year-old woman presented anti-Ri antibodies associated with a paraneoplastic syndrome and unusual symptoms of ophthalmoplegia, blepharospasm, palilalia and ataxia. Adenocarcinoma of the breast was also found. After chemotherapy, radiotherapy, and several immunoglobulin infusions, the patient did not improve ten months after tumor surgery. CONCLUSION: Anti-Ri antibodies associated with paraneoplastic syndrome can be observed in patients who develop a rapidly progressive brainstem tumor. Breast or lung cancer and conduct to search a breast or pulmonary cancer.

[Chronic ergotism: spinal lesion and neuropathy]. / Ergotisme chronique: atteinte médullaire et mononeuropathie.

INTRODUCTION: Neuropathologic manifestations due to chronic ergotism are rare. OBSERVATION: We report the case of a 40-year-old patient who presented clinical signs and symptoms of a spinal lesion and also the symptoms of neuropathy involving the right sciatic nerve, more precisely the internal and external popliteal nerves, following ingestion of methysergide. Complete recovery was achieved with calcium blocker treatment. CONCLUSION: Ergotism should be considered in patients treated by ergot alkaloids presenting an atypical clinical manifestations.

[The treatment of migraine by pharmacists: a French multicenter study]. / La migraine en pharmacie d'officine: une étude multi-centrique française.

Migraine remains an under-diagnosed disease. Many migraine sufferers are not currently treated within the healthcare system and most of them take self-medication. A prospective national study was conducted in France with 770 pharmacies. Data on symptoms, drug dispensing, patient management, and satisfaction of 7 264 subjects complaining of headache at the pharmacy were collected. Two-third of the subjects were migraine sufferers according to the IHS criteria. 32 p. cent of them came to the pharmacy during a pain attack. 63 p. cent had a medical prescription (46 p. cent in the non-migraine group) with triptans being most often prescribed drug (in almost half of the cases). Nearly one-third of the migraine sufferers without medical prescription were referred to a doctor by the pharmacist. This first study on migraine and headaches and pharmacies highlights the important role that pharmacists can play in improving the management of migraine and headache through advice and proper orientation towards medical practitioners.

Antiphospholipid antibodies in the acute phase of cerebral ischaemia in young adults: a descriptive study of 139 patients.

A total of 139 young stroke patients were consecutively examined and tested for antiphospholipid antibodies (APLA) to evaluate the role of these antibodies in cerebral ischaemia before the age of 45. APLA were found in 28.8% of patients. Two factors, hypertriglyceridaemia and alcohol abuse, were significantly more frequent in patients with a positive APLA test. The demographic characteristics, other risk factors, history of prior thrombotic events and distribution of aetiopathogenic types of cerebral ischaemia were not different in patients with or without APLA. Laboratory assays for APLA were highly positive for only two patients, who both had autoimmune diseases. These results suggest that with the exception of a clinical context of antiphospholipid syndrome or other autoimmune diseases, the usefulness of this diagnostic tool in the management of cerebral ischaemia remains limited.

[Therapeutic efficacy during active phases of multiple sclerosis: gait analysis and comparison with the EDSS score]. / Mesure de l'efficacité thérapeutique au cours d'une poussée de sclérose en plaques par l'analyse de la marche: comparaison avec le score EDSS.

Fifteen patients experiencing a flare-up of multiple sclerosis were given 1 g methylprednosolone per day for 5 days. The EDSS score and gait analysis using spatio-temporal variables were recorded for these patients on days 0, 5 and 45. Both methods evidenced significant improvement but the significance was observed between day 0 and day 5 for the EDSS and between day 5 and 45 for gait speed and between day 0 and 45 for step rate. Gait speed was correlated with the pyramidal scale but not with the other functional scales of the EDSS. These results suggest that EDSS and spatio-temporal gait analysis are different tools for the assessment of therapeutic effect. Gait analysis can provide a precise quantitative assessment of the locomotor handicap as a function of the proposed treatment.

[Musical hallucinosis following infarction of the right middle cerebral artery]. / Hallucinose musicale au décours d'un infarctus sylvien droit.

A 44-year-old woman demonstrated a musical hallucinosis four months after a massive infarction in the territory of the right middle cerebral artery. This musical hallucinosis consisting of familiar tunes, was continuous and perceived by both ears. Magnetic Resonance Imaging, middle and late auditory evoked potentials suggested that right Heschl's gyrus and associative areas were imparied. Audiometry demonstrated a low right transmission deafness. The hallucinosis was persistent for seven months and stopped just after hemorrhage of the right ear. This case gives the opportunity to review the different mechanisms responsible for musical hallucinosis.

Comparison of naratriptan and sumatriptan in recurrence-prone migraine patients. Naratriptan International Recurrence Study Group.

OBJECTIVE: This randomized, double-blind, crossover study was undertaken to compare the incidence of headache recurrence after treatment with naratriptan or sumatriptan in migraine patients with a history of frequent headache recurrence (recurrence in > or =50% of successfully treated attacks). BACKGROUND: Although the selective 5-hydroxytryptamine, (5-HT1) agonist sumatriptan is effective and well tolerated for acute treatment of migraine in most patients, headache recurrence within 24 hours of initial successful treatment with sumatriptan and other medications has been reported in approximately 35% of patients. The novel 5-HT1 agonist naratriptan possesses pharmacologic and pharmacokinetic characteristics that may address the issue of headache recurrence. METHODS: Men and women aged 18 to 65 years with a > or =1-year history of migraine with or without aura were randomly assigned to treat 1 moderate or severe migraine attack in a nonclinical setting with one 2.5-mg naratriptan tablet and 1 attack with one 100-mg sumatriptan tablet. A pain-free interval of > or =24 hours was required between attacks. At 4 hours, patients not using rescue medication and experiencing headache recurrence could take a second, identical dose of study medication to treat recurrence. No more than 2 tablets of study medication were permitted in any 24-hour period. RESULTS: A total of 253 patients treated > or =1 migrane attack and were included in the safety analysis; the 225 patients who treated both attacks were included in the efficacy analysis. Of the 164 naratriptan-treated and 181 sumatriptan-treated patients experiencing headache relief after > or =1 attack, headache recurrence 4 to 24 hours after treatment was reported by 74 naratriptan-treated patients (45%) and 101 sumatriptan-treated patients (57%; not statistically significant). (One naratriptan- and 3 sumatriptan-treated patients who experienced headache relief did not record recurrence status and were not included in the denominator for the percentage calculation.) In a subset of patients experiencing headache relief after 2 attacks, headache recurrence 4 to 24 hours after initial dosing was reported by 55 naratriptan- and 77 sumatriptan-treated patients (41% and 57%, respectively; P = 0.005). The overall incidence of adverse events was 22% after treatment with naratriptan and 33% after treatment with sumatriptan. This incidence did not increase after use of a second dose of naratriptan (20%) or sumatriptan (31%). CONCLUSION: These data suggest that naratriptan is a long-acting and well-tolerated addition to currently available medications for the treatment of acute migraine.

[Acute headaches]. / Céphalées aiguës.

Etiologic diagnosis of acute headache is made by accurate history of the pain and systematic examination in search of associated signs: the aim of this reasoning procedure is identification of secondary (organic) headache disorders which are infrequent but are needing urgent evaluation and care from primary headaches whose various methods of treatment are specific.

[Spontaneous intracranial hypotension syndrome. A case]. / Syndrome d'hypotension intracrânienne spontanée. Un cas.

We report a 49-year-old woman with spontaneous intra-cranial hypotension. this characteristic syndrome associates postural headache and a low cerebro-spinal fluid pressure. It was confirmed by lumbar puncture and magnetic resonance imagery. We describe the clinical and the cerebro-spinal fluid features, the radiological appearances, and the clinical and radiological course. The interests of this diagnosis are, first, its spontaneous benign course and, second, to avoid unnecessary invasive investigations.

[Brachial diplegia caused by cervical spinal cord ischemia. A case]. / Diplégie brachiale par ischémie médullaire cervicale. Un cas.

We report one case of acute cervical spinal cord infarction characterized by motor impairment of the upper limbs with respect of the lower limbs. It occurs infrequently. The purpose of this paper is to discuss the clinical, neurophysiological and magnetic resonance imaging findings, and to review the presumed mechanisms of spinal cord infarction.

[Pseudothromboangiitis obliterans and qualitative protein C deficiency: report of a case]. / Pseudothrombo-angéite oblitérante et déficit qualitatif en protéine C: a propos d'un cas.

Thromboangiitis obliterans is a segmental obliterating inflammatory arteritis, usually found in young (below 40) smoking males. Its diagnosis relies on patient history, clinical features, arterial angiography, and more rarely on pathological findings, though none of these is specific of the disease, and on the absence of other diseases such as early atheroma, thromboembolic processes, vascular malformation, trauma, collagen or blood disorders. Raynaud's phenomenon, digital arteritis, superficial and often migrating venous thromboses are further arguments for the disease. However, such associations can also occur during other diseases, especially congenital or acquired deficits in coagulation factors (antiphospholipid syndrome, S protein deficiency...). In our patient with suspected thromboangiitis obliterans, the occurrence of superior longitudinal and right lateral sinus thrombosis led to the discovery of a qualitative C protein defect. This observation stresses the need for careful elimination of a coagulation disorder before confirming the diagnosis of thromboangiitis obliterans.