Brain involvement in Dengue fever.

During the 1994-1995 outbreak of dengue fever in New Caledonia (1079 cases), two cases of encephalopathy were seen. Both patients suffered transient clinical (drowsiness, confusion) and electroencephalographic disturbances from which they fully recovered. Although this condition has been described in dengue infection a number of different pathological mechanisms are probably implicated.

[Eosinophilic meningitis due to Angiostrongylus cantonensis]. / La méningite à éosinophiles due à angiostrongylus cantonensis.

Angiostrongylus cantonensis is the most common etiological agent of eosinophilic meningitis. Adults are harbored in the pulmonary arteries of rats. Larvae develop within various natural (mollusks) and paratenic (snails...) hosts. After ingestion, larvae reach the human central nervous system where they cannot complete their life cycle. This zoonosis is usually seen in Southeast Asia and South Pacific islands. Nevertheless, a few imported cases have been reported in Western countries, possible because of the incubation delay. Mild meningeal irritation signs, paresthesia, cranial nerve abnormalities (i.e: II, III, VI, VII) are the most usual by encountered signs. Severe cases with brain involvement have been reported. In endemic areas, typical clinical signs associated with C.S.F. eosinophilic pleocytosis allow the diagnosis but Elisa test may be useful. Prognosis is always excellent even if headache and malaise may last a few weeks. No antihelminthic agent is efficient against Angiostrongylus cantonensis. Prophylaxia by public health counselling program is fruitful.

[Probable Miller Fisher syndrome during Dengue fever type 2]. / Probable syndrome de Miller Fisher au cours d'une dengue de type 2.

A 57 year-old-man developed a left ophthalmoplegia associated with ataxia and areflexia while he had fever (39 degrees C) for two days. Dengue fever (DF) was diagnosed by definite criteria, i.e.: IgM seroconversion, positive culture from serum and positive PCR both from serum and CSF. Within one week, he fully and spontaneously recovered. To our knowledge, this neurological picture has never been reported in DF. Considering the immune-mediated nature of this condition, its pathogenesis in DF is proposed in reviewing the literature.

[Recurrent Neisseria meningitidis meningitis associated with homozygote complement C7 fraction deficiency]. / Méningite récidivante à Neisseria meningitidis associée à un déficit homozygote en fraction C7 du complément.

A 20-year old man had three episodes of meningococcal meningitis. Complement assays showed a complete deficiency of the seventh component of the complement system. This case emphasizes the need to perform complement assays in young patients with recurrent bacterial meningitis.

[Myasthenia induced by tiopronin in the treatment of rheumatoid arthritis]. / Myasthénie induite par la tiopronine au cours du traitement de la polyarthrite rhumatoïde.

Myasthenia gravis (MG) is a well known side-effect of D-Penicillamine used in the treatment of rheumatoid polyarthritis. Tiopronin is another drug available in France, which can also induce MG. Drug-induced MG are characterized by frequent involvement of facial and oropharyngeal muscles. Moreover, the generalization is scarce and the outcome always quite good. No thymoma is present, anti-acetylcholine receptors antibodies are often highly positive. Furthermore, some HLA phenotypes are most frequently found among patients with drug-induced MG suggesting a genetic predisposition. This observation underlines the interest of careful management of patients treated by tiopronin.

[Potential value of hyperbaric oxygenation in the treatment of post-radiation myelopathies]. / Intérêt potentiel de l'oxygénothérapie hyperbare dans le traitement des myélopathies post-radiques.

We describe 9 patients with radiation myelopathy treated by hyperbaric oxygenation (HBO). In this retrospective study, six out of nine (66%) could have been stabilized or improved by HBO. Physiopathological mechanisms of radiation myelopathy remain controversial and incompletely known. We discuss the putative mechanisms of the beneficial action of HBO on radiation myelopathy. Controlled studies are required to clarify the interest of HBO in this disease.

[Neurological features after consumption of a variety of neo-caledonian shellfish]. / Manifestations neurologiques consécutives à la consommation d'un coquillage du lagon calédonien.

A few days after a seafood meal a patient suffered ataxia and stupor. His examination revealed a confused patient with cerebellar signs and ocular disturbances (hypotropia). Blood results, cerebrospinal fluid and brain CT scan were unremarkable. The patient developed a septic shock and died 4 weeks after admission. No necropsy was performed. Questioning his family confirmed that he had eaten a shellfish meal a few hours before onset of the digestive signs. Trocas (Tectus pyramis) were definitely identified. The clinical picture strongly suggested a seafood poisoning, namely ciguatera. However, no toxicologic assay was performed. To our knowledge, this poisoning has never been reported with trocas. Nevertheless, the feeding habits of trocas would suggest similarity with ciguatera poisoning.

[Stabilized epilepsy in three adult cases of pachygyria]. / Epilepsie stabilisée dans trois cas adultes de pachygyrie.

In complex malformations of the neocortex due to neuronal migration disorders, epilepsy is usually intractable and is observed in childhood. The study of such malformations in adults is rare. Three adult cases are described with easily treated epilepsy controlled by one or two anti-epilectic drugs. A brain CAT-scan of these three patients showed pachygyria (macrogyria) sometimes associated with other malformations and disorders of neurone migration. These three 28, 40 and 53 year-old-patients (one woman and two men) were mentally disturbed with complex neurological disturbances and confined to a wheelchair. Their epilepsy had began in childhood and stabilised as these patients became adults. We raised the question as to whether this is in fact the long-term outcome for epileptic patients with pachygyria. The outcome of such epilepsy due to pachygyria could be better than initially supposed.

Treatment of hemifacial spasm with botulinum toxin. Value of preinjection electromyography abnormalities for predicting postinjection lower facial paresis.

Thirty-two patients with hemifacial spasm were treated with 61 botulinum toxin (BT) injections. Some patients had post-BT lower facial paresis (LFP+group) while others did not suffer this side effect (LFP-group). Abnormal electromyography (EMG) recordings were more frequent in the LFP+ group (6/11) than in the LFP- group (3/21; p < 0.05). This result suggests that an EMG performed before any BT injection could detect the patients with a higher risk for this side effect. The first dose of BT might be lowered in such cases.

Clinical aspects of ocular leptospirosis in New Caledonia (South Pacific).

PURPOSE: The incidence of leptospirosis is very high in New Caledonia (average annual incidence rate: 180/100 000 of the population). To investigate the role of pathogenic leptospires as an aetiological agent of ocular diseases, we report the results of a 5-year survey in New Caledonia. METHODS: We reviewed 13 patients (corresponding to 17 investigated pathologic eyes) retrospectively. The selection of patients was based on epidemiological data, initial clinical examination, biological confirmation of leptospirosis according to reference procedures and a specific polymerase chain reaction assay. The anatomic criteria of uveitis and the criteria describing the evolution of the disease were those recommended by the International Uveitis Study Group. RESULTS: Consequent rates of optic neuritis (65%), posterior uveitis (35%), secluded pupil (24%), interstitial keratitis (18%) and pars planitis (12%) were found. Our rates of recurrence (46%) and of ophthalmic complications (82%) were substantial; some symptoms indicated brain involvement.The final visual damage was severe in 35% of eyes. CONCLUSIONS: Microagglutination and polymerase chain reaction hybridization are complementary tests for the diagnosis of Leptospira-induced ophthalmic lesions. Before deciding on treatment, one must consider the ability of virulent leptospires to persist in immunologically privileged sites such as aqueous humor, cerebrospinal fluid and eukaryotic cells. Polymerase chain reaction is a useful tool for the diagnosis of Leptospira-induced ocular complications, which are probably misdiagnosed if based only on routine laboratory tests. It enables early diagnosis and early specific treatment that now consists of quinolone and cyclines.