[Does general paralysis still exist in non-AIDS patients?]. / La paralysie générale existe-t-elle encore chez les non sidéens?

A 33 year-old man was twice admitted in psychiatry for a non typical depression. He was later hospitalized for a convulsive seizure. Then, the discovery of dementia, neurologic trouble, positivity of syphilitic reaction in blood and in cerebro-spinal fluid allowed to diagnose general paralysis. General paralysis is a late complication of syphilis and it has become exceptional because of efficacy of detection and treatment of early state of syphilis. Now, most of cases affects AIDS patients. Nevertheless, this case shows that realisation of syphilitic reaction is always justified by any dementia or any non typical depression.

[Extrapyramidal disorders induced by veralipride (Agreal). Apropos of 5 cases]. / Troubles extrapyramidaux induits par le véralipride (Agréal). A propos de cinq observations.

Veralipride is a substituted benzamide which is used for the treatment of menopausal hot flushes. We report five cases with extrapyramidal disorders associated to a treatment with this drug for which the neuroleptic activity resulting from an interaction with D2 receptors is not always known by prescribers. One case consisted of acute dyskinesias and four of parkinsonian syndromes, one of these being associated with tardive dyskinesia. In these four cases, dosing recommendations were not respected.

[Marchiafava-Bignami disease. Interhemispheric disconnection, favourable outcome, neurological aspect]. / Maladie de Marchiafava-Bignami: disconnexion interhémisphérique, évolution favorable. aspect neuroradiologique.

We report two cases of Marchiafava-Bignami disease studied by CT and MR imaging. Both had hemispheric disconnection syndrome and favorable outcome. The only residual signs were agraphia with the left hand in the two cases and mild dementia in one. In one case, a control CT scan performed 3 weeks after the first one was normal whereas T2-weighted MR images showed high intensity signal in the corpus callosum. We conclude that: 1. there are benign forms of MB disease; 2. neuroimaging has diagnostic and prognostic value; 3. vitamin B deficiency may play a role in the pathogenesis of the disease.

Marchiafava-Bignami disease, syndrome of interhemispheric disconnection, and right-handed agraphia in a left-hander.

We present an original case of Marchiafava-Bignami disease in a 47-year-old left-handed alcoholic man. Computed tomography and magnetic resonance imaging demonstrated the typical lesion, a necrosis of the middle portion of the corpus callosum. Diagnosis may thus be established in the living. In our case, the course was not fatal, which, to our knowledge, has only been described in four other cases in the literature. Clinically, our patient demonstrated an interhemispheric disconnection syndrome. The striking feature is that some of the symptoms were on the side opposite of the one that has previously been described in the literature, eg, right-handed agraphia, while others were on the usual side, eg, left-handed anomia. We discuss cerebral dominance for speech and handedness in left-handers and come to the conclusion that our patient's clinical features can only be explained by right hemispheric dominance for handedness and bilateral hemispheric representation of speech.

[Giant vertebro-basilar aneurysm. Frontal syndrome]. / Anévrisme géant vertebro-basilaire. Syndrome frontal.

A 72-year-old man presented with an apparent frontal syndrome. He also had bilateral trigeminal neuralgia, a pyramidal syndrome of all 4 limbs, balance disturbances, a horizontal nystagmus when looking to the left and a right velopalatine paralysis. CT scan with contrast showed a hyperdense rounded lesion in the left cerebello-pontine angle. Cerebral angiography showed this to be a large aneurysm of the end of the vertebral arteries. The patient died suddenly. Autopsy confirmed the site and presence of the aneurysm. Balance disturbances, the pyramidal syndrome and velopalatine paralysis could all be explained by brain stem compression and the bilateral nature of the trigeminal neuralgia by compression of the trigemino-thalamic tract. The apparent frontal syndrome, the authors suggest could have resulted from subacute raised intracranial pressure.

[Acute dyskinesia after the ingestion of antiemetics leading to emergency hospitalization]. / Dyskinésies aiguës après prise d'anti-émétiques à l'origine d'hospitalisations en urgence.

19 cases of acute dyskinetic reactions related to anti-emetic drugs have been retrospectively examined. In these cases, the diagnosis was not recognized and the patients were hospitalized. Metoclopramide was the most frequently involved drug (17 cases). In one case, domperidone was the drug responsible of the neurologic symptomatology. The doses used were not higher than recommended. In most of cases, the neurologic manifestations occurred within the first 24 hours and disappeared within a few hours after discontinuation of the treatment.

[Two-dimensional echocardiography in 100 cases of unexplained cerebral ischemic complications]. / Echocardiographie bidimensionnelle dans 100 cas d'accidents ischémiques cérébraux inexpliqués.

One-hundred patients with unexplained cerebral ischaemic events were explored by two-dimensional echocardiography. Thirty-nine patients showed abnormalities considered causative of embolic stroke. The most frequent cardiopathy found was mitral valve prolapse (38.5 per cent). This study suggests that unexplained cerebral ischaemic events should be evaluated by two-dimensional echocardiography and that the most frequent source of emboli to be expected is mitral valve prolapse.

[Focal motor crises: a transitory ischemic attack?]. / Crises motrices focales: un accident ischémique transitoire?

A 65-year-old man with hypertension and coronary artery disease presented with a history of 6 tonic fits of right upper limb and 2 clonic fits of the right side of the face with language suspension, each lasting for only 2 to 3 minutes. CT with contrast showed a right occipital low density area, a probable old infarct, and left carotid angiography showed an ulcerated cervical stenosis. Based on reported experimental data, it is suggested that these paroxysmal manifestations are related to transient ischemic attacks, are of epileptic nature and due to an ischemic mechanism.

[Blood concentrations of maprotiline in depressive patients]. / Etude des concentrations sanguines de maprotiline chez des patients déprimés.

Blood levels of Maprotiline were analysed and their relationship to the clinical response was examined in 89 depressed inpatients, according DSM III criteria for Major Depressive Episode, given the drug treatment for 3 weeks. Maprotiline produced marked decreases in mean MADRS and COVI scale scores by the end of treatment. On day 21, no correlation between blood levels of Maprotiline and MADRS or COVI scores were found when all patients were considered. Nevertheless, significant correlations were observed on day 14 (r = .22; p less than .05 for MADRS and r = .23; p less than .05 for COVI scale). In addition, a significant correlation between MADRS or COVI scale scores and Maprotiline blood levels were observed on days 14 and 21 in subgroups of young patients, severe depression (high scores to clinical global investigations), during of at least 3 months, treated without other drug than Maprotiline and good responders.

[Non-traumatic spinal epidural hematomas (2 cases): contribution of the CT scanner]. / Hématomes épiduraux rachidiens non traumatiques (2 cas): apports du scanner X.

Two cases of non-traumatic epidural hematoma are reported. The first case, a 76 year old woman receiving anticoagulant treatment, presented with paralysis of both lower limbs and right upper limb. Myelography and CT scan showed a widespread hematoma from C4 to T2. The second patient, a 63 year old hypertensive woman, developed flaccid paraparesis with urinary retention, myelography and CT scan showed an epidural hematoma extending from T12 to L2. In both cases, surgical evacuation was followed by a fair motor recovery. The 190 published cases of non-traumatic spinal epidural hematoma include 14 of precise etiology, 69 idiopathic and 107 associated with or 2 predisposing factors. Three mechanisms are proposed to explain the spontaneous cases: alteration of peridural veins; rupture of dural vascular clusters; minimal arterial injury. CT scan imaging shows a biconvex, hyperdense epidural image and is the investigation of choice for acute, hyperalgesic myelo-radicular compression syndromes.

[Predominantly crural hemiparesis and ipsilateral ataxia caused by meningioma of the falx cerebri]. / Hémiparésie à prédominance crurale et ataxie ipsilatérale par méningiome de la faux du cerveau.

In a 61 year-old woman with a right crural hemiparesis, and a history of progressive development of ipsilateral ataxia, CT scan showed a meningioma of falx cerebri confirmed by neurosurgery. Neurologic signs regressed within weeks. Compression of corticopontine and corticospinal tracts at their origin could account for the clinical disorders.

[Ocular bobbing. A new hypothesis]. / Bobbing oculaire. Une nouvelle hypothèse.

Three of 4 patients with ocular bobbing were typical cases while in the last case the ocular disorder was asymmetric. A neuropathologic study was conducted in 2 cases. In both use, findings included variable degrees of pontine destruction without lesion of the medulla, with extension of the lesion into the mesencephalon in 1 case. The various physiopathogenic hypotheses put forward are reviewed but none appears satisfactory. A new hypothesis is proposed, based on available clinico-pathologic data (35 published and 2 personal cases) and recent experimental studies. Two centers, one mesencephalic, the other in the medulla, could exist that would generate saccadic movements downwards, and in the pons a center would provoke inhibition of saccadic movements. Destruction of the latter could activate spontaneous saccadic movements downwards (the only possible ones remaining) with the condition that the mesencephalic generating center and its pathways are intact.

[Ophthalmoplegia, ataxia and areflexia in frontal and pontine metastases simulating Fisher's syndrome]. / Ophtalmoplégie, ataxie et aréflexie au cours de métastases frontale et pontine simulant un syndrome de Fisher.

A patient presented with facial diplegia, occulomotor paresis, ataxia, areflexia and albuminocytologic dissociation. Such clinical features mimicked Fisher's syndrome. In fact, these signs were due to two metastases, one in the pons, the other in the right frontal lobe.

[Neuropathy and cerebellar syndrome induced by amiodarone]. / Neuropathie et syndrome cérébelleux à l'amiodarone.

A 62 year old man developed a neuropathy after several months of treatment with amiodarone. The clinical picture was atypical in that it associated a polyradiculoneuritis with cell-protein dissociation and an axial and peripheral cerebellar syndrome. Pathology of muscle and nerve showed dense inclusions in Schwann cell cytoplasm and in pericytes, highly suggestive of fat inclusions. Discontinuation of amiodarone therapy resulted in a slow regression of disorders. Diabetes mellitus developed. Several pathogenic hypotheses are proposed.

[Benign intracranial hypertension (pseudotumor cerebri). 12 cases]. / Hypertension intracrânienne bénigne (pseudo tumor cerebri). Douze cas.

Twelve cases of benign intracranial hypertension (BIH) are reported, there being a higher proportion of women patients and a greater frequency of those in the 3rd decade of life. Symptoms were principally headache (11 patients) and/or transient or permanent visual disorders (10 patients). Bilateral papillary edema was often associated with diminished visual acuity (5 cases) and/or amputation of the visual field (5 cases). Cerebral venous occlusion was detected in 3 patients and an infective focus in 7 cases. Three patients were receiving some treatment but none of the women was taking oral contraceptives. Two were pregnant. The CSF was abnormal in 5 of the 7 patients (mixed cell reaction and red blood cells: 1 case; pleiocytosis: 3 cases; raised protein levels: 1 case), and CT scans were normal except for reduced ventricular system size in 9 patients. Follow-up for a mean of 1 year showed total disappearance of symptoms and signs in 4 cases. Papillary edema had not totally regressed at the last ophthalmological examinations performed on 5 patients, and visual sequelae (visual acuity and/or visual field anomalies) were present in 5 cases. Two patients relapsed. The conventional acceptance of the benign nature of BIH must be tempered by the possible onset of possible serious visual disorders. Two factors appear to be determinant: the presence of severe visual disorders initially and/or the existence of arterial hypertension. Various physiopathogenic hypotheses have been evoked to explain BIH. The essential mechanism appears to be an anomaly of absorption of CSF, either from increased pressure in the dural venous sinuses or lesions of the arachnoid villi, but the role of cerebral edema and/or increased cerebral blood volume cannot be excluded. Incomplete understanding of physiopathogenic mechanisms account for the numerous treatments proposed and for some confusion in their indications.

[Acute neurologic complications of rubella]. / Complications neurologiques aiguës de la rubéole.

Two cases of rubella with neurological complications are reported. In one case an extensive atypical polyradiculoneuritis was associated with a late albumino-cytologic dissociation. The other presented as a transverse myelitis with meningitis and radiculitis. In neither case was an history of contagion or recent vaccination elicited, and no eruption appeared in either patient. Clinical onset was sudden, with an acute meningitis followed several days later by neurological deficits. The course was marked by successive phases of early rapid deterioration, stabilization and slow regression over several months. Sequelae were minimal. Diagnosis was based on a sharp fall in the ratio of serum/CSF levels of specific antibodies to the rubeola virus. This was sure evidence of the presence of intrathecal synthesis of specific antibodies.