[Infarction of the anterior choroidal territory. Clinical and tomodensitometric study of 11 cases]. / L'infarto nel territorio di irrorazione dell'arteria corioidea anteriore. Studio clinico e tomodensitometrico di 11 casi.

Clinical features of anterior choroidal artery (ACA) territory infarct are hemiplegia, hemi-anaesthesia and homonymous hemianopia. However this syndrome in its complete form is of rare occurrence, since one or more signs or symptoms may be lacking. The Authors describe 11 patients with CT-documented infarctions in the (ACA) territory in order to establish clinical-CT correlations and possible risk factors. Among the investigated risk factors arterial hypertension is the most frequent in these patients. This finding, and the small size of the ischemic lesions make the ACA territory infarctions similar to Lacunar Infarcts. The Authors, emphasize that, as in lacunar infarcts, a thromboembolic mechanism cannot always be ruled out in ACA infarctions. Therefore a cause other than arterial hypertension should be considered in each patient for a better management of this type of infarcts.

Acute transient cerebral intoxication induced by low doses of baclofen.

We report a case of acute transient encephalopathy with confusion, drowsiness, myoclonic jerks, periodic triphasic sharp wave EEG patterns induced by low doses of baclofen. We discuss the pathogenesis and the differential diagnosis from the subacute spongiform encephalopathy of sudden onset.

Aphonia due to paramedian thalamo-subthalamic infarction. Remarks on two cases.

We describe two patients in whom CT brain scans imaged paramedian thalamo-subthalamic infarcts in the territory of the thalamo-mesencephalic arteries. Such infarcts give rise to a complex syndrome marked by disturbances of consciousness and of eye movement and neuropsychological disorders, including attentional, memory and, more rarely, language deficits. A loss of voice volume may accompany aphasic disturbances but is exceedingly rare in isolation. In the cases described the aphonia, total but transient, was the only language disorder. The physiopathological mechanisms involved in aphonia are complex and controversial.

Quadriceps myopathy: report of a late onset sporadic case.

The Authors describe the case of a 44 year-old man whose familial and personal histories were negative for muscular diseases. The patient complained slowly progressive wasting and weakness localized to the quadriceps muscles. The bioptic study of the gastrocnemius and the quadriceps showed dystrophic changes, confirming that muscular dystrophy closely localized to quadriceps is of rare occurrence. Muscles other than quadriceps can often be involved by the same pathology even if the clinical signs continue to be localized to the quadriceps muscles for many years.

Language disturbances from mesencephalo-thalamic infarcts. Identification of thalamic nuclei by CT-reconstructions.

The authors report the cases of two patients with CT-documented paramedian mesencephalo-thalamic infarcts, showing language disturbances. The first patient showed a non fluent, transcortical motor-like aphasia, the other had a fluent but severely paraphasic language disorder. The CT study disclosed that it was the dorso-median thalamic nucleus that was mostly involved in both cases. These findings agree with a few previous pathological studies suggesting that the paramedian thalamic nuclei, particularly the dorso-median nucleus may play some role in language disturbances. However the anatomical basis for thalamic aphasia remains speculative, taking into account the importance of cortical connections in the origin of subcortical neuropsychological disturbances.

[Leucoaraiosis: correlation of arterial hypertension and lacunar infarct (study of 80 patients)]. / Leucoaraiose: corrélations entre hypertension artérielle et infarctus lacunaires (étude de 80 sujets).

We studied 80 patients with lacunar strokes in the attempt to find a relation between lacunar strokes, arterial hypertension and leucoaraiosis. Leucoaraiosis was found in 47 patients (58,75%) on CT-scan. Our findings emphasize that arterial hypertension is the most important risk factor of leucoaraiosis (p less than 0.003); but we did not find a relation between the admission value of systolic or diastolic blood pressure and leucoaraiosis. Our data do not confirm the hypothesis that leucoaraiosis may be the result of a confluence of several lacunar infarcts, although we found that a rarefaction of cerebral white matter was associated with arterial hypertension.

Risk factors in lacunar strokes. A retrospective study of 52 patients.

A retrospective analysis was carried out on 52 patients with CT-identified lacunar infarcts in order to identify possible risk factors. It was found that arterial hypertension, cardiac emboli and/or emboli from epiaortic vessels play a significant role in the genesis of lacunar infarcts. No preferential relationship was found between "small" lacunes and arterial hypertension or between "large" lacunes and embolic disease.

Subacute subdural hematoma presenting as reversible ischemic attacks.

We describe the case of a right-handed, 83 year-old woman with CT-documented left frontal subacute subdural hematoma showing reversible right-sided hemiparesis and aphasia. We discuss possible pathogenetic mechanism for this unusual condition and emphasize that the clinical evaluation cannot always distinguish ischemic causes for certain. Therefore CT-scan is an essential investigative tool before initiating therapy in patients suspected of having cerebrovascular diseases.

Peripheral neuropathy associated with allergic granulomatous angiitis (Churg-Strauss syndrome): clinical features and histological findings.

We describe the case of a patient with a history of resistant asthma who presented with subacute neuropathy, hypereosiniphilia and central nervous system involvement; these findings were consistent with allergic granulomatous angiitis (Churg-Strauss syndrome). Although cutaneous biopsy prompted the diagnosis, the cases reported suggests that clinical, biological and histological data are all essential for the diagnosis. We emphasize that an early recognition of this syndrome may be important, since appropriate therapy may lead to recovery or influence favorably at least long term survival.

[Value of visually evoked potentials in lesions of the optic nerve caused by a mucocele]. / Intérêt des potentiels évoqués visuels dans les lésions du nerf optique par mucocèle.

Mucoceles originating in accessory paranasal sinuses with orbit involvement are quite rare. The authors describe two cases of mucoceles, revealed by CT-Scan, the first in the ethmoid-sphenoidal-maxillary sinuses and the other in the ethmoid-frontal sinuses respectively. In both cases Visual Evoked Potentials were most important for assessing optic nerve involvement. They were also useful to check post surgical recovery. These case reports emphasize that early diagnosis of mucoceles involving the optic nerve is very important because prompt surgical treatment may lead to recovery of visual disturbances.