Clinical characteristics and brain PET findings in 3 cases of dissociative amnesia: disproportionate retrograde deficit and posterior middle temporal gyrus hypometabolism.

BACKGROUND: Precipitated by psychological stress, dissociative amnesia occurs in the absence of identifiable brain damage. Its clinical characteristics and functional neural basis are still a matter of controversy. METHODS: In the present paper, we report 3 cases of retrograde autobiographical amnesia, characterized by an acute onset concomitant with emotional/neurological precipitants. We present 2 cases of dissociative amnesia with fugue (cases 1 and 2), and one case of focal dissociative amnesia after a minor head trauma (case 3). The individual case histories and neuropsychological characteristics are reported, as well as the whole-brain voxel-based 18FDG-PET metabolic findings obtained at group-level in comparison to 15 healthy subjects. RESULTS: All patients suffered from autobiographical memory loss, in the absence of structural lesion. They had no significant impairment of anterograde memory or of executive function. Impairment of autobiographical memory was complete for two of the three patients, with loss of personal identity (cases 1 and 2). A clinical recovery was found for the two patients in whom follow-up was available (cases 2 and 3). Voxel-based group analysis highlighted a metabolic impairment of the right posterior middle temporal gyrus. 18FDG-PET was repeated in case 3, and showed a complete functional brain recovery. CONCLUSION: The situation of dissociative amnesia with disproportionate retrograde amnesia is clinically heterogeneous between individuals. Our findings may suggest that impairment of high-level integration of visual and/or emotional information processing involving dysfunction of the right posterior middle temporal gyrus could reduce triggering of multi-modal visual memory traces, thus impeding reactivation of aversive memories.

[Diagnosis contribution of biomarkers in Alzheimer disease: A case of frontotemporal dementia]. / Apport diagnostic des marqueurs biologiques de la maladie d'Alzheimer (MA) dans une observation de dégénérescence lobaire fronto-temporale (DLFT).

INTRODUCTION: Cerebrospinal fluid biomarkers are a fundamental contribution for the diagnosis of Alzheimer disease, in particular for young people. CASE REPORT: We report a case of Alzheimer disease of a 51-years old man whose clinical presentation corresponded to frontotemporal behavioural criteria. The clinical evaluation noticed some troubles in verbal memory. Only the CSF biomarkers confirmed the diagnosis. CONCLUSION: There are different phenotypes of presenile Alzheimer disease and among them we note frontotemporal dementia. It is very important to identify them to introduce a specific treatment.

[Atypical Lewy body disease revealed by burning mouth syndrome and a pseudo-psychiatric syndrome]. / Démence à corps de Lewy atypique révélée par une glossodynie et des troubles pseudo-psychiatriques.

INTRODUCTION: Among the degenerative diseases of the nervous system, Lewy body disease has the most psychiatric symptoms especially hallucinations, delusion and identification disorders. CASE REPORT: We report a case of Lewy body disease that started with a burning mouth syndrome for three year as the only symptom before the development of a pseudo-psychiatric syndrome (melancholy and Capgras). None of the usual cardinal criteria were present. MRI, cerebrospinal fluid, and DAT scan findings enabled the diagnosis. CONCLUSION: The dopaminergic hypothesis put forward in some cases of burning mouth syndrome might explain this symptom in Lewy body disease.

Diagnosis of pulmonary embolism in patients with proximal deep vein thrombosis: specificity of symptoms and perfusion defects at baseline and during anticoagulant therapy.

To determine the specificity of pulmonary embolism (PE) symptoms and lung scan perfusion defects in patients with deep vein thrombosis (DVT), we analyzed data on 400 patients with phlebography-proven proximal DVT included in a prospective trial. As the incidence of PE during anticoagulant therapy was the main outcome measure of the trial, all patients underwent lung scanning and/or pulmonary angiography within 48 h of inclusion, and then whenever PE was suspected. Angiography was recommended in patients with nondiagnostic lung scan. At baseline, the presence or absence of PE could be ascertained in 350 patients (87.5%), and 197 (56%) had PE. Sensitivity and specificity of symptoms for PE were 74 and 67%, respectively. Among 37 patients with symptoms and nondiagnostic lung scan, only 8 (22%) had PE at angiography. During anticoagulant therapy (3 mo), there were 29 events suspicious for PE, mostly (53%) within 2 wk of inclusion. Repeated perfusion studies with comparison to baseline tests excluded PE in 21 cases. Cumulated 3-mo risks of suspected and confirmed on-treatment PE were 6.8% (95% CI, 5.4- 8.2%) and 2.0% (95% CI, 0.6-3.4%) respectively. Even in patients with known proximal DVT, PE symptoms are unspecific and careful imaging studies are needed for diagnosis, both at baseline and during anticoagulant therapy.

Mismatch between radionuclide and contrast angiography in the assessment of the perfusion of a transplanted kidney.

When early complications occur after a kidney transplant, radionuclide angiography may be useful in determining a possible vascular origin. The authors describe the case of a patient with anuria continuing 24 hours after transplantation. Radionuclide angiography showed a defect at the site of the renal graft, suggestive of arterial or venous thrombosis. Contrast angiography was performed immediately but showed no vascular abnormality; neither did radionuclide angiography performed the next day. The authors concluded that a spasm at the site of the renal artery anastomosis, overcome by contrast angiography, could explain this phenomenon.

[Evaluation of surgical renal revascularization in renovascular arterial hypertension. Measurement by 99m Tc DTPA scintigraphy]. / Evaluation de la revascularisation rénale chirurgicale dans l'hypertension artérielle rénovasculaire. Appréciation par la scintigraphie au 99m Tc DTPA.

The effects of surgical renal revascularization on both hypertension and kidney function was assessed in 16 patients with renovascular hypertension (14 unilateral). We have taken a special interest to the split renal function studied with DTPA renogram. The function of the operated kidney was improved in 9 patients and not improved (worsened or unchanged) in 7. Hypertension was cured in 25% and improved in 56% of the patients, without correlation with split renal function outcome.

[Technics for the exploration of pulmonary arteriovenous shunts in liver cirrhosis. Apropos of 2 cases]. / Techniques d'exploration des shunts artério-veineux pulmonaires au cours des cirrhoses hépatiques. A propos de deux observations.

Pulmonary arterio-venous shunts represent a rare cause of hypoxia in cirrhosis. We present two cases, the first was an alcoholic cirrhotic with anthracosilicosis. This patient rapidly developed a picture of significant hypoxaemia with a raised alveolar-arterial oxygen gradient. The presence of this shunt was confirmed by a scintigraphic analysis. A porto-pulmonary localisation was excluded by a changing angiographic picture. Death supervened after refractory hypoxaemia. Post mortem microangiographic studies confirmed the pulmonary nature of the shunt and its pre-capillary localisation. The second patient was alcoholic, with a compensated cirrhosis and developed severe hypoxaemia which progressed to death in less than two months, when he was being treated effectively with corticosteroids for a diffuse interstitial pulmonary fibrosis confirmed histologically. The pulmonary localisation of the shunt was confirmed by an analysis of the angioscintigraphs. The different techniques for the investigation of intra-pulmonary shunt are discussed, as well as the patho-physiological mechanisms involved. The hormone levels measured (sex hormones, serotonin, prostaglandins, intestinal hormones) remained normal. The therapeutic trials tried out (oestrogen, CPD Choline, indomethacin) were ineffective.

Nycthemeral variations of 99Tcm-labelled heparin pharmacokinetic parameters.

Six healthy volunteers (5 males and one female) received four i.v. boluses of 160 U.I. of 99Tcm-heparin at 8.00, 14.00, 20.00 and 02.00 hours at seven-day intervals. Nine blood samples were taken covering a period of 2 h after administration. Simultaneously urine was collected and diuresis was noted. Plasma and urinary radioactivity were measured and standard pharmacokinetic parameters were calculated. Nycthemeral variations of these kinetic parameters were detected by means of distribution-free tests. Circadian rhythms (period = 24 h) were analysed by means of the cosinor method and the Gauss-Marquardt method. The mean raw value of the following parameters: apparent volume of distribution, plasmatic clearance and extra-renal metabolic clearance, increased significantly between 8.00 and 14.00 (p less than 0.01) and decreased between 14.00 and 20.00 (p less than 0.05). A circadian rhythm was found for the plasmatic clearance only (p less than 0.04). On the other hand the elimination half-lives and the renal clearance were unaffected by the time of the injections. These results obtained for low doses of 99Tcm-heparin suggest a circadian rhythm of the bio-availability of heparin in man. This fact should be taken into account for the use of 99Tcm-heparin in the diagnosis of deep-vein thrombosis and for the safe adjustment of the heparin dosages in the treatment of severe thromboembolism.

[Investigation of biliodigestive anastomosis with the help of radiopharmaceutical products]. / Exploration des anastomoses bilio-digestives à l'aide des produits radiopharmaceutiques.

Hepatobiliary investigation using 99mTc-diethyl-iminodiacetic acid (IDA) has permitted a new point of view about the morphological and functional investigation of the biliary-digestive anastomosis. Our clinical study concerning 31 patients (13 choledochoduodenostomies 10 hepaticojejunostomies, 6 choledochojejunostomies and 2 cholecystojejunostomies) helped to specify scintigraphic imaging (stasis in intrahepatic bile duct, reflux in stomach, strangulation phenomenon on the level of the mesocolon, incomplete or complete obstruction). The problems associated with current diagnostic procedures are discussed and we place the scintigraphic method amongst other radiologic methods (barium meal, endoscopic retrograde cholangiography and percutaneous transhepatic cholangiography). This non-invasive diagonostic procedure plays a leading part in the investigation of the biliary digestive anastomosis, and particularly in the hepatico-jejunostomies.

Plasma transport of 99mTc-p-butyl-IDA.

Plasma transport of 99mTc-p-butyl-IDA was measured by four in vitro methods: trichloroacetic acid precipitation, electrophoresis, HPLC, and Scatchard binding isotherm. The data are in accord with protein transport, the main carrier being albumin with two categories of sites. This work suggests that after IV injection of 99mTc-p-butyl-IDA in humans plasma protein binding is one of the limiting factors for the hepatic deposition of the radiopharmaceutical.