[Hyperbaric oxygen therapy and inert gases in cerebral ischemia and traumatic brain injury]. / Oxygénothérapie hyperbare et gaz inertes dans l'ischémie cérébrale et le traumatisme crânien.

Cerebral ischemia is a common thread of acute cerebral lesions, whether vascular or traumatic origin. Hyperbaric oxygen (HBO) improves tissue oxygenation and may prevent impairment of reversible lesions. In experimental models of cerebral ischemia or traumatic brain injury, HBO has neuroprotective effects which are related to various mechanisms such as modulation of oxidative stress, neuro-inflammation or cerebral and mitochondrial metabolism. However, results of clinical trials failed to prove any neuroprotective effects for cerebral ischemia and remained to be confirmed for traumatic brain injury despite preliminary encouraging results. The addition of inert gases to HBO sessions, especially argon or xenon which show neuroprotective experimental effects, may provide an additional improvement of cerebral lesions. Further multicentric studies with a strict methodology and a better targeted definition are required before drawing definitive conclusions about the efficiency of combined therapy with HBO and inert gases in acute cerebral lesions.

[Long-term cerebral effects of perinatal inflammation]. / Conséquences cérébrales à long terme de l'inflammation périnatale.

Perinatal inflammation can lead to fetal/neonatal inflammatory syndrome, a risk factor for brain lesions, especially in the white matter. Perinatal inflammation is associated with increased incidence of cerebral palsy in humans and animal models and there is a strong relationship with increased incidence of autism and schizophrenia in humans. Perinatal inflammation causes acute microglial and astroglial activation, blood-brain barrier dysfunction, and disrupts oligodendrocyte maturation leading to hypomyelination. Inflammation also sensitizes the brain to additional perinatal insults, including hypoxia-ischemia. Furthermore, long after the primary cause of inflammation has resolved, gliosis may also persist and predispose to neurodegenerative diseases including Alzheimer's and Parkinson's disease, but this relation is still hypothetical. Finding of acute and chronic changes in brain structure and function due to perinatal inflammation highlights the need for treatments. As gliosis appears to be involved in the acute and chronic effects of perinatal inflammation, modulating the glial phenotype may be an effective strategy to prevent damage to the brain.

[Anaesthesia and Parkinson's disease]. / Anesthésie et maladie de Parkinson.

OBJECTIVE: The purpose of this review is to draw up a statement on current knowledge available on perioperative management of Parkinson's disease patients. STUDY DESIGN: Review. DATA SYNTHESIS: In France, approximately 150,000 persons suffer from Parkinson's disease, a neurodegenerative disorder of central nervous system. Parkinson's disease results in selective and irreversible loss of dopaminergic neurons in the substantia nigra pars compacta. Medications based on dopaminergic drugs are used to control motor symptoms and improve motor function. Development of surgical approach, especially deep brain stimulation, has revolutionized the medical management of many patients with Parkinson's disease. Anesthesia of these patients remains a challenge for the clinician. The aim of this review is to describe anaesthetic considerations of patients with Parkinson's disease and to discuss management of antiparkinsonians medications during the perioperative period.

[Acute meningoencephalitis after influenza vaccination]. / Méningoencéphalite après vaccination antigrippale.

We report a case of meningoencephalitis following influenza vaccine revealed by status epilepticus. The patient, an 82-year-old man who had been vaccinated against influenza two days before, had a favourable outcome after intensive care admission including mechanical ventilation. Neurologic side effects have been previously described after influenza vaccination. Although confirmation's exams do not exist, diagnosis is based on imputability criteria, with a complete aetiologic check-up in particular microbiologic check-up. This case, illustrated by modern techniques of biology and imaging, completes the rare and old cases already described in the literature.