[Study on the intraspinal cord regeneration of sensory fibers sectioned in the posterior root of the cat]. / Recherches sur la repousse intra-cordonale de fibres sensitives sectionnées dans la racine postérieure chez le chat

In order to assess the potential ability for posterior column fibers to repair, cat sensory root fibers where their repair is known to be possible. Progress of the outgrowth of fibers into the spinal cord (posterior columns) was tested by observation of the animals, histological investigation of the roots, examination of the posterior columns on cross-section at various levels, and by electrological investigation of conduction from root to spinal cord. The results obtained indicate that repair of root fibers may continue into the spinal cord, both segmentally and all along the posterior columns. These results are discussed and compared with failure of repair of posterior column fibers after spinal cord section.

[Recurrent polyneuropathy with a 19-year course, associated with a benign IgG monoclonal gammapathy]. / Pol-neuropathie a rechutes, évoluant depuis 19 ans, associée à une gammapathie monoclonale IgG bénigne. Effet favorable de la corticothérapie

A case of recurrent polyradiculoneuritis in a 54-year-old man is described. It is exceptional because of its lengthy development over a period of 19 years and by its association with a paraprotein of the IgE type without anyother anomal. Corticotherapy had a favourable effect on the clinical symptoms but did not affect the amount of monoclonal immunoglobulin in the serum. The nosological position of this neuropathy and the type of gammapathy are discussed. An immune mechanism seems likely, but no proof of a link between the neuropathy and the gammapathy could be found.

[Wallenberg's syndrome due to a dissecting aneurysm of the vertebral artery]. / Syndrome de Wallenberg par hémodissection (anévrysme dissequant) de l'artère vertébrale.

A 54 year old man without pathologic past history but mild hypertension, obesity and gastric ulcer, presented with a syndrome of Wallenberg. He had complained for five days of progressive and diffuse headache. The neurological condition improved initially, but the patient died suddenly two weeks later. Pathological examination showed no significant alteration except for left ventricular enlargement and mild arteriosclerosis. There was a hemodissection (dissecting aneurysm) of the left vertebral artery next to the inferior oliva. It induced a lateral infarct and a limited dorsal infarct at the middle third level of medulla oblongata. Although the location of the arterial changes is usual, their nature is exceptional. The cause of the arterial hemodissection could not be ascertained: fibrous arterial dysplasia, atherosclerosis or congenital abnormalities of internal elastic layer may be discussed. But no definite conclusion can be reached.

[Oculomotor forms of myasthenia]. / Les formes oculo-motrices de la myasthénie.

The diagnostic difficulty in purely oculo-motor forms of myasthenia can be due to the lack of fluctuation in symptoms, the occurrence of complete spontaneous remissions, lasting several months or years, the absence of a decremental response in muscle potentials as evidenced by classical repetitive stimulation of the motor nerve, and negative responses to pharmacological testing. Thus, several investigative procedures have been developed to aid in the diagnosis of questionable cases. These include electromyography of proximal muscles and single fiber recordings, the dosage of acetylcholine receptors antibodies (specificity of nearly 100 %), and histological examination of neuro-muscular junction (invariably finding specific lesions of motor end plates). In spite of the diffuse pathological process and the possible overlapping with other types of myasthenia, many oculo-motor forms remain strictly localized throughout their course. Furthermore the prognosis of oculo-motor myasthenia is far better than other forms. Several hypotheses exist to explain the peculiarities of ocular myasthenia. Among these explanations are the theories that there are structural factors specific to oculo-motor muscles and that there exist a heterogeneity of acetylcholine receptor antibodies. On the therapeutic grounds, the frequent failure of anticholinesterase agents has been established. Corticosteroids are often very efficacious, but require high maintenance doses. The adverse side effects of such therapy have led some authors to suggest thymectomy as an alternative therapeutic modality.

[Cerebral cavernoma: a rare vascular malformation]. / Les cavernomes cérébraux: une malformation vasculaire rare.

The authors have observed 7 cases of intracranial cavernous haemangioma. A review of the literature shows that the diagnosis is suggested by the occurrence of epileptic seizures, signs of expansive process or meningeal haemorrhage. Computerized tomography displays an area of hyperdensity enhanced by injections of a contrast medium. Surgical excision is mandatory. The post-operative mortality varies with the site of the malformation.

[Polyneuropathy complicating Horton's disease (author's transl)]. / Polyneuropathie compliquant l'évolution d'une maladie de Horton.

A patient diagnosed as having Horton's disease presented a complex neurological picture dominated by sensory-motor neuropathies of all four limbs, one year after the appearance of signs of temporal arteritis. No other etiological factor, apart from the Horton's disease, was discovered, and the causal relationship between this disease and the neuropathy is discussed. The possibility of dysimmunity factors being involved in Horton's disease is raised and the resulting therapeutic implications discussed.

[Cisterno-medullary anomalies. Diagnostic problems, surgical treatment (author's transl)]. / Les anomalies de la région bulbo-cisternale. Leurs problèmes diagnostiques, leur traitement chirurgical.

Under the term cisterno-medullary anomalies are included several disorders: bony and nervous malformations, arachnoiditis of the posterior fossa. As they are frequently associated, a thorough investigation, both anatomical and dynamic, is a prerequisite to any therapeutic attempt. Along with causing damage to the neuraxis, these anomalies interfere with the dynamics of the CSF and may lead to the development of a communicating syringomyelia, whatever the theory proposed. The presenting symptoms are varied, and diagnosis should be accordingly suspected. Of fundamental importance are instrumental investigations. A complete evaluation is in most of the cases obtainable with: bone X-rays, air-myelography (or "bulle"), intrathecal ou ventricular radio-isotope scan. Surgery is the only treatment. The aim is both decompression of the neural structures and restoration of a normal CSF dynamic flow. Opening of the posterior fossa is successful in the case of developmental abnormalities, But it seems to prove a failure when the chief anomaly is arachnoiditis. In such cases, ventricular drainage alone may be followed by improvement. It appears from this that the problem is twofold: the technical problem of the drainage, and the pre-operatory diagnosis of a posterior fossa arachnoiditis.

[Incomplete regressive obstruction of the internal carotid artery in a female patient with fibromuscular dysplasia]. / Obstruction incomplète de la carotide interne d'évolution régressive chez une malade atteinte de dysplasie fibro-musculaire.

The authors report on the case of a 48-year-old woman, with no history of cardiovascular disease, presenting with a progressive right cerebral deficiency syndrome predominating in the parietal region. X-ray, arteriography and CT scan findings led to the diagnosis of right middle cerebral artery ischemic stroke, in the proximal territory, due to a practically complete occlusion of the right internal carotid artery. The patient recovered and a right carotid arteriography performed 8 months after the initial one showed repermeation of the carotid artery, as well as evidence of fibromuscular dysplasia (FMD). The authors then reviewed the literature dealing with cervico-cephalic FMD and concluded that FMD only exceptionally leads to arterial occlusion, whether by arterial dissection, intimal hyperplasia or thrombosis. This case is remarkable by its favorable outcome: the thrombus, which was unquestionably responsible for the clinical picture, dissolved spontaneously.

[Long term administration of oral prednisone or prednisolone in treatment of myasthenia gravis. Report of five cases (author's transl)]. / Traitement de la myasthénie par la prednisone ou prednisolone administrrée par voie orale au long cours. A propos de cinq observations.

Five patients, four of them with severe or severe generalized myasthenia gravis, were treated by long term orally administrated prednisolone, with following results: one complete remission and two almost complete remissions (in three aged fernale patients), two substantial improvements (one in a male patient, one in a young adult female patient, both thymectomized). The least favourable result was observed in the male patient. Positive results of such treatment were similarly reported by several authors (with an average of 70% complete or almost complete remission, 20% substantial improvement, 7% moderate improvement). These results appear qualitatively superior to those obtained with ACTH, and may be long-lasting. Treatment with prednisolone may be applied to any form of myasthenia gravis, particularly those which do not react to anticholinesterasic agents in moderate dosages. At onset of treatment, patients should be under care of a reanimation unit. Dosage is initially high (60--100 mg daily, secondarily on alternate days), and should be reduced very slowly, once a definite improvement is achieved. The duration of this treatment depends upon the results obtained: it should not last under one year. Associated treatment with anticholinesterasic agents remains disputable, whereas associated thymectomy seems to provide best results.

[Plexus lesions following radiation therapy. Report of nineteen cases (author's transl)]. / Les atteintes plexiques post-radiothérapiques. A propos de dix-neuf cas.

Nineteen patients with plexus lesions following radiation therapy were investigated: fifteen with brachial plexus, 4 with lumbar or sacral plexus involvement. Symptoms at onset are usually sensory. Motor disturbances occur either simultaneously or after some delay, their course is generally gradual and unfavourable. Areflexia appears early and was present in every case. Important cutaneous lesions (radiodermitis) and considerable induration of soft tissues were observed in every patient. Diagnosis is a relapse of the mitotic process. Severity of prognosis makes imperative a definite technique of radiation therapy. In all the patients included in this study, dosage had exceded 1,600 rets. Patients were tentatively treated with D-penicillamine, an inhibitor of collagen synthesis.