Plasma and saliva levels of PGI2 and TXA2 in the headache-free period of classical migraine patients. The effects of nicardipine.

The levels of Prostacyclin (PGI2) and Thromboxane A2 (TXA2) were assayed simultaneously (RIA) in the plasma and saliva of 9 patients suffering from classical migraine attacks. The assays were done during an attack-free period. In relation to the control group we observed a significant decrease in the plasma levels of PGI2 together with a sharp increase in TXA2 in saliva. When the patients were treated with nicardipine, a calcium antagonist, the TXA2 increase in saliva did not occur. These results suggest both a systemic and local effect in the classical migraine attacks. We explain and discuss our results by referring to the PGI2: TXA2 equilibrium system. Nicardipine action might be related to its ability to reduce the calcium entry into the cell induced by thromboxane.

[Lumbosacral spinal cord infarction. Data from magnetic resonance imaging]. / Infarctus de la moelle lombosacrée. Données de l'imagerie par résonance magnétique.

A 77-year old woman and a 61-year old man with lumbosacral spinal cord ischaemic lesions and paraplegia presented with dissociated or partial forms of the lumbar enlargement artery (Adamkiewicz's artery) syndrom. Magnetic resonance imaging (MRI) was performed in both patient with an 0.15 Tesla resistive magnet. A hypersignal on T2-weighted images was present in both cases, which corresponded to the infarction affecting the lumbosacral part of the cord. MRI provided accurate delineation of the lesions and clinicoradiological correlations in both patients. The hypersignal occupied the lumbar cord in case 1 and the conus medullaris in case 2. The clinical signs and location of the lesions seemed to be determined by the different patterns of lumbosacral arterial supply. Since such images could be confused with tumoral images, surgical exploration was carried out in both patients; it failed to demonstrate any tumour or cyst and only showed a pale cord. Surgical cord biopsy in case 2 demonstrated ischaemic tissue. We conclude that ischaemia of the spinal cord can be demonstrated by MRI, but owing to the low specificity of this imaging method aedema cannot be distinguished from necrosis, gliosis or demyelination.

Neuronal antinuclear antibody (anti-Hu) in paraneoplastic encephalomyelitis simulating acute polyneuritis.

A patient with paraneoplastic encephalomyelitis (PEM) and small cell lung cancer had a clinical presentation of acute polyneuritis. The patient had an antibody (anti-Hu) restricted to nuclei of neurons identical to that reported in patients with subacute sensory neuronopathy and lung cancer. This finding further supports the hypothesis that PEM and subacute sensory neuronopathy are closely related disorders of autoimmune origin. PEM should be considered in patients with small cell lung cancer and clinical features limited to the peripheral nervous system.

The infrapiriformis foramen syndrome resulting from intragluteal injection.

The authors describe a syndrome resulting from a lesion at the level of the infrapiriform foramen due to intramuscular injection, with involvement of the sciatic nerve, the inferior gluteal nerve, the posterior femoral cutaneous nerve and the pudendal nerve. This appears to be the first case of a complete syndrome of the infrapiriform foramen to be reported. In a second case the pudendal nerve was not involved and a releasing neurolysis was performed with remarkable postoperative relief. All the reported cases with involvement of the inferior gluteal nerve are associated with a more or less complete injury of the sciatic nerve. Conversely, the cases of injection injury to the superior gluteal nerve are rarely associated with injury of the sciatic nerve. The anatomic reasons that might explain both kinds of lesion are given. Finally some aspects of 131 cases of sciatic paralysis resulting from injection are also examined.