Pergolide in the treatment of Parkinson's disease.

Pergolide, a long-acting central dopamine agonist, was used as monotherapy in 16 parkinsonian patients. A mean daily dose of 6.3 mg resulted in 73% improvement of parkinsonian disability. Clinical improvement after acute administration of one dose of pergolide was similar to that observed after levodopa plus a peripheral decarboxylase inhibitor but at a dose 100 times lower (2.2 mg and 200 mg, respectively). The effect lasted twice as long (5 1/2 hours and 2 1/4 hours, respectively).

Rupture of the arterial wall in two cases of recent cerebral embolism: morphological expression of cerebral vasospasm?

Previously undescribed morphological changes are reported in two cases of recent, non-septic cerebral embolism. These consisted of an arterial rupture involving the whole thickness of the wall. A direct tear by a sharp embolus seems unlikely but, as proposed by Villaret et al. in 1937, the arterial spasm may have occurred at the time of cerebral embolism. The embolic occlusion would prevent narrowing of the vascular lumen, so that focal spasm would rupture the arterial wall even at the level of a healthy and relatively thick media.

Effect of gamma-vinyl GABA in Friedreich's ataxia.

Gamma-Vinyl GABA, an irreversible inhibitor of GABA-transaminase, was administered orally in two daily doses of 250 mg to 10 patients with cerebellar ataxia (9 with Friedreich's ataxia, one with olivo-ponto-cerebellar atrophy) for at least one month in an open study. No significant difference occurred in the disability scores of cerebellar symptomatology for the group as a whole, but seven patients showed some improvement in scores with treatment and two patients claimed marked subjective amelioration. Tolerance to Gamma-Vinyl-GABA treatment was excellent. These preliminary results suggest that further studies with well-tolerated agents which enhance CNS GABA-ergic function are warranted in patients with cerebellar ataxia.

[Non-ischemic borderline brachial paralysis]. / Paralysie brachiale frontière d'origine non ischémique.

Non ischemic anterior borderzone brachial paralysis. Anterior borderzone brachial paralysis (ABBP) is a hemodynamic ischemic syndrome of the watershed zone between the anterior and middle cerebral arteries. Two cases of non ischemic reversible ABBP are reported. The first suffered from multiple sclerosis; a CT-scan showed a lesion of the corona radiata, at the level of the anterior hemispheric borderzone. The second suffered from lung adenocarcinoma. A CT-scan showed multiple metastases, one being surrounded with oedema at the level of the anterior borderzone. According to its reversibility, the ABBP was reported to the inflammatory-oedematous reaction and not to a demyelinating or metastatic lesion itself. As ABBP may occur unilaterally, the name "one-armed man syndrome" should be used instead of "man-in-the-barrel syndrome" (which always implies a bilateral paralysis).

[Bilateral infarction of the lateral area of the medulla. Semeiologic and pathologic aspects of a rare anatomo-clinical case occurrence]. / L'infarctus bilatéral du territoire latéral du bulbe. Aspects sémiologiques et pathologiques d'un fait anatomo-clinique rare.

The specific characteristics of bilateral infarction of the lateral medullary region, a rare anatomo-clinical event, are defined on the basis of a case known to the authors and five other cases taken from the literature. Certain semiological points specific to the lateral medullary syndrome are also discussed.

[Ataxic hemiparesis due to a cerebellar lacuna]. / Hémiparésie ataxique par lacune cérébelleuse.

The authors report a case of ataxic hemiparesis (dysarthria-clumsy hand syndrome plus crural hemiparesis with homolateral ataxia), secondary to a single cerebellar lacuna (CT scan), in a left rostral para-vermian position in the vicinity of the peduncle and secondary to arterial hypertension. They discuss the nosological aspects of this recently established entity and the origin of particularly severe and persistent dysphagia in their case (cerebellar dysphagia?)

[The thalamic syndrome of Déjérine-Roussy. Prolegomenon]. / Le syndrome thalamique de Déjérine-Roussy. Prolégomènes.

Predicted by Dejerine and Long in 1898 and formally described by Dejerine and Roussy in 1906, the "thalamic syndrome" corrected the wrong hypothesis of a capsular "sensory cross roads" suggested by Charcot after 1873 and supported in France during 25 years. Both established the "persistent frank organic hemianesthesia" (sensory-sensitive for Charcot, pure sensitive for Dejerine), namely that a sensory deficit, still severe after regression of the early hemiplegia, could be due to focal brain damage. At that time such a clinical concept was hardly acceptable because it opposed the classic greek philosophical idea that sensation and movement should not be separated. Moreover, intelligence was at that time looked as a four-stage process including sensation, imagination, intellect and memory. The very first step began with the "sensus communis", an anteroom-like where all the sensations simultaneously perceived were coordinated to ensure mind unity. This "sensus communis" was given many subcortical seats during the following centuries, such as the trigone (Herophilus), the ventricles (Founders of the Church, Soemmering), the pineal body (Descartes), the striate bodies (Willis) and, finally, the thalamus (Todd and Carpenter's "English theory"). The description by Meynert in 1871 of a transcapsular direct "sensory bundle" and the cases reported by Türck in 1859 of a sensory-sensitive hemianesthesia after a posterior capsular lesion (in fact, thalamo-capsulostriate) led Charcot to develop his theory after 1873. Owing to the new staining methods of Weigert and Marchi introduced around 1885, Dejerine showed in 1895 the route of the medial lemniscus and his arrival in the thalamus, which led him to postulate in 1898 a "thalamic syndrome" and later to demonstrate it.

[Status asthmaticus. Acute myopathy induced by cortisone and neuropathy during resuscitation]. / Etat de mal asthmatique. Myopathie aiguë cortisonique et neuropathie de réanimation.

A female patient treated by mechanical ventilation with high doses of pancuronium and methylprednisolone for status asthmaticus presented with acute total areflexic and severe amyotrophic tetraplegia; she died after multiple organ failure. Muscle biopsy confirmed the clinical diagnosis of "acute corticosteroid myopathy", precipitated by a corticosteroid "disuse hypersensitivity" after pancuronium. The electromyogram showed a critical illness polyneuropathy, secondary to multiple organ failure. Nerve biopsy was normal. The respective parts played by corticosteroids, curare-like derivatives and intensive care in the genesis of unexplained difficulty in weaning from the ventilator are discussed.

[Persistence of a conjugate eye and head deviation of hemispheric origin]. / Persistance d'une déviation conjuguée des yeux et de la tête d'origine hémisphérique.

The conjugate eye and head deviation (CD) after acute hemispheric stroke normally resolves into poor days, but delayed recovery may occurs after previous contralateral frontal lobe damage or after acute right parietal lesion. This is a report of a ten months persistent CD at rest, without visual or auditory stimuli. CT showed a bilateral capsular infarct of the genu and a recent right frontal posterior infarct. The persistence of the deviation may thus be explained by such a combination of bilateral anterior lesions.

[Avoidance phenomenon caused by transient ischemic attacks]. / Phénomène d'évitement provoqué par des accidents ischémiques transitoires.

A rare case of avoiding phenomenon presenting as transient ischemic attacks is reported. The distal anterior parietal artery was probably occluded.

[Intracerebral cavernous angioma and transient ischemic complications]. / Angiome caverneux intracérébral et accidents ischémiques transitoires.

A patient with capsulo-lenticular cavernous angioma presented with transient hemiparetic attacks. A diagnosis of transient ischemic attacks has been accepted and a platelet thrombo-embolic mechanism is suggested.

[Bilateral, symmetrical and simultaneous putamino-capsulo-caudal infarction]. / Infarctus putamino-capsulo-caudés bilatéraux, symétriques et simultanés.

The first case, to our knowledge, of bilateral, symmetric and simultaneous infarction in the basal territory of the middle cerebral arteries is reported. The patient presented with a pseudo-rostral brainstem syndrome, including loss of oculo-vestibular reflexes, severe tetraparesia and akinetic mutism-like disturbance of consciousness. The lesions were due to embolism, caused by atrial fibrillation, occluding the ostium of the lenticulostriate arteries. It involved only the putamino-capsulo-caudal regions, concerning the whole anterior and posterior dorsal capsules. The term tetraparetic mutism is proposed to describe this new clinico-pathological syndrome, which is the sum of a capsular tetraparesia, due to the lesion of the geniculate and cortico-spinal fibres at the level of the genu and posterior limbs, and of a capsular akinetic mutism, due to the lesion of the reticular thalamo-cortical tracts at the level of the anterior limbs. These total capsular infarcts moreover involved all the oculomotor cortico-reticular tracts, which could explain the absence of oculo-vestibular reflexes.

[Infarction of the olivary area of the medulla oblongata]. / L'infarctus du territoire olivaire du bulbe.

The two first cases of an infarct involving the arterial olivary territory of the medulla oblongata are reported. In the first one, an old infarct of the medial territory and a recent infarct involving the whole inferior olivary nucleus at its middle third level were associated. Rostrally this infarct was reduced to the medial reticular formation and internal half of the olive. Caudally it was reduced to its external half. In the second case the infarct involved only the external half of the right olive, but involved also the external half of the left olive with the lateral territory. From these two cases and from the anatomic, pathologic and clinical data reviewed in the literature, the authors propose as "total" olivary territory a triangular area including all the inferior olivary nucleus, the dorsal accessory olivary nucleus and partly the medial reticular formation, and as "minimum" olivary territory the external half of the olive. The many important medial, lateral and cranio-caudal arteries which supply the olivary territory account for these "total" and "minimum" territories, as well as for some cases in the literature. They account also for the pyramid-like cranio-caudal extension of the olivary territory infarction. The olivary territory is likely to be supplied by two short circumferential arterial groups, i.e. inferior bulbar and superior medullo-pontine. Nevertheless, the cause of the olivary territory infarction is an occlusion of the vertebral artery.

[Acute corticosteroid myopathy in patient with asthma]. / Myopathie aiguë cortisonique de l'asthmatique.

A patient, treated by mechanical ventilation with pancuronium or atracurium and with intravenously administered corticosteroid for status asthmaticus, presented with rhabdomyolysis (severe amyotrophy and marked of creatine kinase activity) and acute flacid and areflexic quadriplegia, involving the proximal and distal muscles but sparing the cephalic musculature. After review of the investigations (biochemistry, electromyogram, muscle biopsy), the diagnostic of acute corticosteroid myopathy following status asthmaticus was suggested, and a pancuronium neuromuscular complication or a critically ill polyneuropathy excluded. The non-inflammatory rhabdomyolysis concerned all the fiber types. Predominantly distal weakness resolved six months after the insult, in spite of the laboratory recurrence of the rhabdomyolysis at the time of a new status asthmaticus briefly treated with corticosteroid.

[Indications for new antidepressants with reference to ICD-10: a waggish question or the future of psychiatry?]. / Indications des nouveaux antidépresseurs à la lecture de la CIM-10: question farfelue ou avenir de la psychiatrie?

The biological psychiatry's postulate is that depression is related to a lack of balance between the dopaminergic, noradrenergic and serotonergic monoaminergic neurotransmitters systems. These systems are related to cortico-striatal-thalamo-cortical circuits, involving the association and limbic prefrontal cortex and the basal ganglia (caudate nucleus, putamen, nucleus accumbens, globus pallidus). The pharmacology of depression recently grows rich from "new" antidepressive agents, having selective monoaminergic activity: Selective Serotonin presynaptic Reuptake Inhibition ("SSRIs"), selective Reversible Inhibition of the Monoamine oxidase A ("RIMAs"), selective dopaminergic or noradrenergic agents. The last International Classification of mental and behavioural Disorders proposed by the World Health Organisation: the ICD-10, proposes a "new" classification of the depressive disorders based on atheoric "practical" diagnostic criteria. These criteria are unrelated to neurobiochemical, neuroanatomical or neurophysiological data. Reviewing the diagnostic criteria of depressive disorders proposed by the ICD-10 in relation to the neuroanatomic structures subtending the monoaminergic theory of the depressions, the author attempts to answer to the question: is the "new" pharmacology of the depressions that constitute the "new" antidepressants blind or correlable to the "new" nosology of the depressive disorders proposed by the ICD-10? Finally, indications in first intention of the "new" antidepressive agents for each depressive disorder defined by the ICD-10 are proposed.