[A multi-factorial approach in the vital prognosis of spontaneous intracerebral hematoma]. / Approache multi-factorielle du pronostic vital des hématomes intra-cérébraux spontanés.

The prognostic assessment of a patient with intra-cerebral hemorrhage (IH) requires simultaneous appraisal of several parameters. We have attempted this with a multivariate method: discriminant analysis. We studied retrospectively 142 patients with non-operated IH, not due to vascular malformation, distributed two months after the initial event in two groups: 92 living patients and 50 dead. Discriminant analysis of 21 parameters from the initial examination and CT scan, selected five factors which best separate the two groups, since 89% of the patients were well classified. These five parameters (age, consciousness impairment, temperature, volume of the hematoma and ventricular hemorrhage) combined, give a prognostic score which gives for each patient his probability of survival or death. The validity of the proposed model was controlled on a test-sample of 66 patients from another department. The possibility of giving a trustworthy spontaneous prognosis on the first day can enable the evaluation of the possible benefit from surgery, which we illustrated with a group of 23 operated patients.

[Clinical and evolutive aspects of cerebellar infarction]. / Aspects cliniques et évolutifs des infarctus du cervelet.

This study included 125 cases of cerebellar infarction followed during an average period of 4.3 years. The diagnosis was made by CT or MRI. Infarctions localized to the territory of the superior cerebellar artery (SCA) and the territory of the posterior inferior cerebellar artery (PICA) occurred with the same frequency. Transient ischemic attacks preceded infarction in 26% of cases. Symptoms and signs were usual with sudden association of headache, dizziness, unsteadiness and vomiting. Vestibular signs were more important in infarctions of the PICA territory; cerebellar signs and dysarthria were more frequent in infarction of the SCA territory. A decreased level of consciousness developed in only 21% of cases. Surgical operation was required in 9 cases. Investigations have showed the large responsibility of cardiac embolisms and atherosclerosis. Short term outcome was more often favourable: 116 patients were alive at the end of the first month; 80% of survivors were independent one year later. At 5 years, 73% of patients were alive. After the acute period, mortality was mainly due to cerebro-vascular and cardiac events.

[Acute polyradiculoneuritis after intravenous injection of heroin, HIV seropositivity disclosed 3 years later]. / Polyradiculonévrite aiguë après injection intra-veineuse d'héroine, séropositivite HIV constatée trois ans plus tard.

An acute polyradiculoneuritis with tetraplegia and respiratory failure was observed in a 27 year-old heroin addict 3 hours after an intravenous injection of heroin. Full recovery was obtained after respiratory assistance and plasma exchanges. The biological and morphological changes (sural nerve biopsy) suggested an immune mediated mechanism. Three years after the recovery, the patient was tested for HIV antibody and was seropositive. The role of HIV infection and of the injection of heroin are discussed.

[Chronic ergotism: spinal lesion and neuropathy]. / Ergotisme chronique: atteinte médullaire et mononeuropathie.

INTRODUCTION: Neuropathologic manifestations due to chronic ergotism are rare. OBSERVATION: We report the case of a 40-year-old patient who presented clinical signs and symptoms of a spinal lesion and also the symptoms of neuropathy involving the right sciatic nerve, more precisely the internal and external popliteal nerves, following ingestion of methysergide. Complete recovery was achieved with calcium blocker treatment. CONCLUSION: Ergotism should be considered in patients treated by ergot alkaloids presenting an atypical clinical manifestations.

[Spontaneous intracranial hypotension syndrome. A case]. / Syndrome d'hypotension intracrânienne spontanée. Un cas.

We report a 49-year-old woman with spontaneous intra-cranial hypotension. this characteristic syndrome associates postural headache and a low cerebro-spinal fluid pressure. It was confirmed by lumbar puncture and magnetic resonance imagery. We describe the clinical and the cerebro-spinal fluid features, the radiological appearances, and the clinical and radiological course. The interests of this diagnosis are, first, its spontaneous benign course and, second, to avoid unnecessary invasive investigations.

[Brachial diplegia caused by cervical spinal cord ischemia. A case]. / Diplégie brachiale par ischémie médullaire cervicale. Un cas.

We report one case of acute cervical spinal cord infarction characterized by motor impairment of the upper limbs with respect of the lower limbs. It occurs infrequently. The purpose of this paper is to discuss the clinical, neurophysiological and magnetic resonance imaging findings, and to review the presumed mechanisms of spinal cord infarction.

Antiphospholipid antibodies in the acute phase of cerebral ischaemia in young adults: a descriptive study of 139 patients.

A total of 139 young stroke patients were consecutively examined and tested for antiphospholipid antibodies (APLA) to evaluate the role of these antibodies in cerebral ischaemia before the age of 45. APLA were found in 28.8% of patients. Two factors, hypertriglyceridaemia and alcohol abuse, were significantly more frequent in patients with a positive APLA test. The demographic characteristics, other risk factors, history of prior thrombotic events and distribution of aetiopathogenic types of cerebral ischaemia were not different in patients with or without APLA. Laboratory assays for APLA were highly positive for only two patients, who both had autoimmune diseases. These results suggest that with the exception of a clinical context of antiphospholipid syndrome or other autoimmune diseases, the usefulness of this diagnostic tool in the management of cerebral ischaemia remains limited.