[Reversible cardiac valve abnormalities with pergolide treatment]. / Valvulopathie réversible et traitement par pergolide.

We report the case of a parkinsonian patient treated by pergolide who developed aortic and mitral regurgitations and pulmonary hypertension. When she stopped the medication, the cardiac symptoms disappeared. Retroperitoneal and pleural fibrosis have been described with pergolide but never valvulopathy until 3 cases reported in December 2002.

[Bilateral ageusia after left insular and opercular ischemic stroke]. / Agueusie bilatérale après accident vasculaire cérébral ischémique insulaire et operculaire gauche.

Gustatory disorders after ischemic stroke is an uncommon event, generally occurring unilaterally, ipsilateral or contralateral to the stroke depending on the site of the lesion. We report a patient who developed bilateral agueusia after a unilateral insular stroke. This 70-year-old right-handed man developed a sudden onset left opercular syndrome in March 1999 with right hemiphyosethesia. Magnetic resonance imaging revealed a left insular and opercular stroke. Anarthria, swallowing and sensorial disorders regressed in a few weeks, but taste disturbances led to a 6 kg weight loss. After six months, the symptoms disappeared. To our knowledge, 32 cases of taste disorders after stroke have been reported. For most of the cases, the agueusia was unilateral. Our case illustrated the predominance of the left cortical hemisphere for taste perception in the right-handed subject.

Leptomeningeal myelomatosis mimicking a subdural haematoma.

We report a rare appearance at presentation of meningeal myelomatosis without bone involvement, in the form of an extraaxial mass of mixed density, resembling a chronic subdural haematoma.

Facial diplegia after hymenoptera sting.

Two cases of bilateral facial palsy after hymenoptera sting are presented. In both cases, the neurological examination is otherwise normal, a lymphoplasmocytic reaction is present in the CSF, no other etiology is found, and the recovery is complete. The neurological complications of hymenoptera sting and the differential diagnosis of bilateral facial palsy are discussed.

[Neuritis of the serratus anterior muscle associated with Borrelia burgdorferi infection]. / Névrite du grand dentelé associée à une infection par Borrelia burgdorferi.

A long thoracic nerve palsy developed in two patients with Borrelia burgdorferi infection. In both cases, pain in the shoulder preceded a scapula detachment suggesting first a diagnosis of neuralgic shoulder amyotrophia. In the first case, there was a context of typical meningoradiculitis, while the second patient had an isolated right shoulder amyotrophia without any other neurologic signs and with normal CSF analysis. A detailed anamnesis, the serology profile, and the good response to an adequate antibiotic treatment allowed us to attribute these two long thoracic nerve palsies to B. burgdorferi. This infection is important to consider as a possible etiology in cases of peripheral neuritis without other obvious causes.

[Oculomotor disorders caused by thalamo-peduncular infarction after vertebral artery dissection]. / Troubles oculomoteurs dus à un infarctus thalamo-pédonculaire par dissection de l'artère vertébrale.

A case of left vertebral artery dissection after neck manipulation associated with an ipsilateral thalamo-peduncular infarct by distal embolism is reported. The oculomotor signs observed are explained for the left eye by an intra-axial third nerve lesion, and for the right eye by a limitation of the horizontal gaze to the right and an upgaze palsy of supranuclear origin. The association of infra and supranuclear lesions without nuclear lesion in thalamo-peduncular infarcts is considered.

Secretion of active truncated CD4 into Escherichia coli periplasm.

A truncated molecule containing the first 183 amino acid residues of the HIV-1 receptor, CD4, was made by periplasmic secretion in Escherichia coli. The signal sequence from the E. coli proteins OmpA, PhoA, or OmpF was fused to the truncated CD4, under the control of either the trp or the lac promoter. The processed material secreted into the periplasm reacted with monoclonal antibodies and exhibited binding activity to the HIV-1 envelope protein gp120. Not all of the processed product was recovered in the periplasm by osmotic shock, suggesting that either the material aggregated in the periplasm or, during secretion, the molecule assumed some transient conformation that interfered with its translocation across the inner membrane. A mutation in prlA (a gene involved in secretion) increased the level of processing, suggesting that secretion of a heterologous protein in E. coli can be optimized by manipulating the host secretion apparatus.

Homolateral disappearance of essential tremor after cerebellar stroke.

The case of a patient with essential tremor in whom tremor disappeared on the right side after a homolateral cerebellar infarct is reported. The pathophysiology of essential tremor remains unknown. Vascular and surgical lesions of dentorubrothalamic pathway have been reported to improve various kinds of tremor including essential tremor. In this patient, a lesion of this pathway related to the cerebellar infarct probably explains the homolateral cessation of essential tremor.

[Multiple neurologic manifestations of Borrelia burgdorferi infection]. / Les multiples manifestations neurologiques des infections à Borrelia burgdorferi.

The neurological spectrum of Borrelia burgdorferi infections is still enlarging. We review epidemiological, pathological and serological data of Lyme disease. The course of the disease is divided in three stages: stage 1 during the first month is characterised by erythema chronicum migrans and associated manifestations; stage 2 includes not only the classical European meningoradiculitis but also less specific neurological symptoms: isolated lymphocytic meningitis with an acute or even relapsing course, apparently idiopathic facial palsy, neuritis of other cranial nerves, polyneuritis cranialis, Argyll-Robertson sign, peripheral nerve involvement, acute transverse myelitis, severe encephalitis, myositis. During stage 3, three to five months or longer after the onset of the disease, chronic arthritis, acrodermatitis chronica atrophicans and various neurological symptoms can be observed: chronic neuropathy with mainly sensory or motor signs, recurrent strokes due to cerebral angiopathy and progressive encephalomyelitis; this third stage the central nervous system involvement is characterised by slowly progressive or fluctuating course during months or years, ataxic or spastic gait disorder, bladder disturbances, cranial nerve dysfunction including optic atrophy and hypoacusia, dysarthria, focal and diffuse encephalopathy. This chronic central nervous system disease can mimic multiple sclerosis, anorexia nervosa, psychic disorders or subacute presenile dementia. It is often associated with pleiocytosis, abnormal EEG and evoked potentials, sometimes multifocal and mainly periventricular white matter lesions visualised by CT or MRI, and as a rule high antibody titers against Borrelia burgdorferi. High doses of penicillin can halt the disease, sometimes induce spectacular regression of symptoms or sometimes be inefficient; ceftriaxone could be a more powerful therapy. Similarities between syphilis and Borreliosis are multiple: both of these spirochetes contain plasmids, can be transmitted through the placenta and progress for many years through successive stages, with multiorgan symptoms, including parenchymatous and vascular lesions of the central nervous system. Borrelia burgdorferi is the new great imitator.