ABSTRACT
Five cases are reported of patients with so-called primary progressive apraxia, defined as a slowly worsening disturbance of gestural abilities, without other major cognitive changes during a long period, in relation to degenerative cortical atrophy. All five cases, as other cases in the literature, share the following common features: 1) asymmetrical onset of upper limb clumsiness, more often involving the left side, later involving the contralateral side and lower limbs; 2) after a variable delay, the occurrence of symptoms suggesting subcortical involvement (akinesia, limb stiffness, various kinds of movement disorders, dystonia, paresis of vertical gaze); 3) diffuse cortical atrophy typically more pronounced in the superior parietal cortex opposite to the first side affected. The unusual nature of apraxia in all these cases is pointed out and referred to as Luria's "kinesthaesic apraxia", ascribed to a loss of "selectivity" of distal elementary movements. This pattern of symptoms and their specific outcome could represent a distinct entity.
Subject(s)
Apraxias/complications , Cerebral Cortex/pathology , Gestures , Aged , Apraxias/classification , Apraxias/diagnosis , Atrophy/diagnostic imaging , Cerebral Cortex/diagnostic imaging , Female , Humans , Male , Middle Aged , RadiographyABSTRACT
A 45 year-old woman with no history of familial disease presented with multiple cutaneous and cerebral cavernous angiomas. The diagnosis rested on biopsy for cutaneous angiomas and on MRI for cerebral angiomas. The clinical manifestations of cerebral angiomas were headaches and a cerebellar syndrome, the latter most probably due to progressive growth of cerebellar angiomas. Systematized cavernous angiomatosis is characterized by multiple angiomas of the brain and other viscera and is considered to be a phacomatosis.
Subject(s)
Angiomatosis/diagnosis , Brain Neoplasms/diagnosis , Cerebellar Neoplasms/diagnosis , Skin Neoplasms/diagnosis , Angiomatosis/complications , Brain Neoplasms/complications , Cerebellar Ataxia/etiology , Cerebellar Neoplasms/complications , Female , Humans , Middle AgedABSTRACT
The authors report on a series of 100 patients, who underwent an ischemic cerebrovascular accident (CVA) (8 transient attacks, 15 minor CVAs and 77 completed strokes) which revealed internal carotid artery occlusion (unilateral in 93 cases and bilateral in 7), proven by ultrasonography and/or angiography. The computerized tomography scan was normal in 8 cases. The middle cerebral artery territory was involved in 84 patients (isolated or associated (25 patients) with another site), whereas an isolated watershed infarction was the only lesion in the other 8 patients. Twenty-two patients died during the acute phase. Among the 68 survivors followed for a long time, 28 were severely incapacitated. The occlusions were not atherosclerotic in 18 cases (8 spontaneous dissections, 5 cardiogenic emboli, 3 radiation-induced arteries, 2 multiple causes). Eighty-two patients had atherosclerotic thromboses (67 men and 15 women, mean age 63.1 +/- 12.7 years). Among them, 24 had previously experienced minor ischemic strokes. In this group, the two year survival rate was 63 p. 100. Patients with non-fatal atherosclerotic thromboses were followed for an average of 22.2 months, during which time 28.2 p. 100 experienced another stroke.
Subject(s)
Brain Ischemia/etiology , Carotid Artery Thrombosis/complications , Actuarial Analysis , Adult , Aged , Aged, 80 and over , Aortic Dissection/complications , Arteriosclerosis/complications , Brain Ischemia/diagnostic imaging , Carotid Artery Thrombosis/diagnosis , Carotid Artery Thrombosis/etiology , Carotid Artery, Internal , Cerebral Angiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Risk Factors , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Cortical language areas were identified by CT scan or NMR imaging, using planes of horizontal sections parallel to the orbitomeatal plane and therefore indirectly to the bicommissural plane. Sections 45 and 50 mm above the bicommissural plane pass electively through temporal structures i.e. the posterior part of T1 and T2, while sections at 60 and 70 mm pass through the angular gyrus and supramarginal gyrus.
Subject(s)
Brain Mapping , Cerebral Cortex/anatomy & histology , Language , Brain Mapping/methods , Cerebral Cortex/diagnostic imaging , Frontal Lobe/anatomy & histology , Humans , Magnetic Resonance Imaging , Temporal Lobe/anatomy & histology , Tomography, X-Ray ComputedABSTRACT
The authors report a case of neuro-endocrine sarcoidosis, associating panhypopituitarism , diabetes insipidus, and involvement of the optic chiasma with behavioural changes, chronic meningitis and a diffuse pyramidal syndrome. The diagnosis was suggested by the presence of mediastinal lymphadenopathy and confirmed during a surgical procedure to conserve the optic nerves. The clinical course on corticosteroids was unfavourable because of iatrogenic cushing' syndrome and steroid dependence . It was not possible to withdraw steroids, even with the use of immunosuppressors (Methotrexate).
Subject(s)
Central Nervous System Diseases/etiology , Hypopituitarism/etiology , Optic Nerve Diseases/etiology , Sarcoidosis/complications , Adrenal Cortex Hormones/therapeutic use , Adult , Follow-Up Studies , Humans , Hypopituitarism/diagnosis , Hypopituitarism/therapy , Male , Optic Chiasm/pathology , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/surgery , Pituitary Hormones/blood , Prognosis , Sarcoidosis/therapyABSTRACT
The authors study the arterial vascularisation of the retro chiasmatic optic tracts in man by means of total or selective arterial injections on 200 brain specimens. They underline the important vascularisation of the optic tracts, the lateral geniculate body and the first part of the optic radiations contrasting with the precarious vascularization of the latero-ventricular part of the optic radiations. The importance of the Sylvian contribution is noted at the origin of the optic radiations and on the occipital cortex level.
