Facial reflex myoclonus induced by language: a neuropsychological and neurophysiological study.

We studied a 53 year old right-handed patient who presented isolated myoclonus of right facial muscles induced exclusively by language. Twitching significantly hindered speaking and reading performance. MRI and CT-scan revealed no brain lesion. Conventional EEG showed a few spike-waves predominantly in the left hemisphere. Spike-waves increased during drowsiness. An EEG-EMG polygraphic study was performed during stimulation tests which included linguistic tasks and non-verbal/non-linguistic tests. Myoclonus was triggered by speaking and writing but not by non-linguistic tasks. The severity of myoclonus was dependent on the complexity of the language task. Back-averaging of right facial EMG bursts failed to show a reliable EEG-EMG correlation. However, the facial reflex myoclonus might have originated from the left rolandicopercular cortex, as it was triggered by complex language activities. Findings in this case are compared with those reported for other forms of reflex seizure and myoclonus.

[A case of transient amnesia caused by cerebral thrombophlebitis: contribution of neuroimaging to physiopathogenesis of transient amnesia]. / Un cas d'amnésie transitoire par thrombophlébite cérébrale: apport de la neuro-imagerie a la physiopathogénie des amnésies transitoires.

We report a case of transient global amnesia (TGA), in a right-handed woman, which was due to a cerebral venous thrombosis. In our knowledge it is the first case reported. MRI and SPECT revealed the existence of a dysfunction in the right internal temporal region. Such a localization leads us to discuss the specialisation of each hippocampus.

[Marchiafava-Bignami disease: interhemispheric disconnection, Balint syndrome, spontaneously favourable outcome]. / Maladie de Marchiafava-Bignami: disconnexion interhémisphérique, syndrome de Balint, évolution spontanément favorable.

We report a new case of Marchiafava-Bignami disease with favourable outcome. This case is particular on several scores. The interhemispheric disconnection syndrome was associated with Balint's syndrome, and this had apparently never been reported in this context previously. Despite the intensity and diffusion of white matter lesions in both hemispheres, and in the absence of vitamin treatment, the clinical and neuroradiological (CT, MRI) improvement occurred early and rapidly. This course, similar to that of toxic drug withdrawal, suggested that this was not a process of vitamin deficiency. Data from the literature indicate that a wide extension of corpus callosum lesions to the semi-ovale centre has a poor vital and functional prognosis. Our case shows that this is not always correct and that the appearance of intralesional necrosis and cavitation is not the rule. We consider that the most reliable factor of poor prognosis seems to be an initial coma.

[Development of antibiotic consumption at the Regional University Hospital Center of Toulouse from 1980 to 1989]. / Evolution de la consommation des antibiotiques au CHRU de Toulouse de 1980 à 1989.

Eighties were characterized by the development of new antibiotic drugs and the introduction of systemic fluoroquinolones. The consumption of antibiotics at the Toulouse University Hospital was evaluated during the ten last years. Total consumption remained stable around 350,000 days of treatment. From 1980 to 1989, consumption of penicillins rose (from 36.6 to 43.7% due to the introduction of gram negative acting drugs). The increase in cephalosporin use (from 5.4 to 9.9%) is explained by the development of third-generation products. In contrast, we observed a decrease in the use of aminoglycosides (from 12.2 to 5.4%) tetracyclines and chloramphenicol (from 13.4 to 1.7%) as well as urinary quinolones (from 6.8 to 3.5%) without any variation of macrolides and drugs used in the chemotherapy of tuberculosis. In 1989, consumption of systemic quinolones raised 10% out of antibiotic drugs.

[The significance of quantified EEG in Alzheimer's disease. Changes induced by piracetam]. / Intérêt de l'EEG quantifié dans la maladie d'Alzheimer. Modifications induites par le piracétam.

One study was performed in 12 patients with presenile Alzheimer's disease (group I), the other one in 16 patients with mild senile dementia of Alzheimer type (group II). In each study, patients were divided into two randomized parallel groups, one receiving placebo, the other piracetam (9 g daily in group I piracetam and 2.4 g daily in group II piracetam) during three months, piracetam induced a decrease in EEG power on the 2-6 Hz range (group I piracetam), 3-5 Hz and 7 Hz (group II piracetam) and an increase of EEG power in the 9-11 Hz range (group I piracetam) and in the 10 Hz and 13 Hz frequencies (group II piracetam). There was also a significant improvement in the Trail Making Test part A in group II piracetam. Correlations between decreased EEG low frequency components and improvement in some psychometric tests were found significant in the two groups. It seems that the main effect of piracetam was to induce increased alertness. The same results were found in both studies; the good reproducibility suggests that EEG spectral analysis is a reliable tool in the assessment of psychotropic drug effects.

[Neonatal death following injuries in utero, in the absence of maternal lesions]. / Mort néonatale dans les suites d'un traumatisme in utéro, en l'absence de lésions maternelles.

The authors report a case of neonatal death at 24 hours following maternal trauma during a traffic accident. The abdominal trauma did not result in any maternal injury. Caesarean delivery was justified by fetal rhythm disorders. A wide variety of fetal injuries, in the absence of maternal injuries, are reported in the literature. Some benefit from an early diagnosis, improving therefore the fetal prognosis.

[Phyllodes breast tumors]. / Les tumeurs phyllodes du sein.

Phyllodes tumors represent a particular class in breast pathology. They are defined as bi-tissue, fibro-epithelial tumors, similar to fibro-adenomas, but their connective tissue component is greatly predominant. They are infrequent as they represent only 3% of breast tumors. They mainly occur during the premenopausal period, since alteration of the hormonal balance may play a role. The authors feel that they represent only a type of the evolution of the fibroadenomas with a relationship, in time, following the sequence: fibroadenomaphyllodes tumor-sarcoma. The diagnosis is exclusively made by histology and there is no pathognomonic sign, whether it is clinical or mammographic. The course is essentially characterized by the possibility of local recurrences, sometimes numerous, and by the occurrence of metastases in case of malignant phyllodes tumor. These two possibilities are correlated with the histological stage of the tumor. The treatment is definitely surgical, possibly mastectomy in case of large or aggressively active tumor.

[Recurrent intracerebral lobar hematoma in cerebral amyloid angiopathy. A clinicopathologic case]. / Hématomes intracérébraux lobaires récidivants au cours de l'angiopathie amyloïde cérébrale. Un cas clinico-pathologique.

The clinico-pathological case of a 71 year-old woman who presented 5 lobar intracerebral hematomas in 27 months is reported. There were no familial factor nor arterial hypertension. Amyloid deposits in cortical and meningeal arteries were present at post-mortem examination. There were no lesions of the Alzheimer type.