Microvascular retinal abnormalities in acute intracerebral haemorrhage and lacunar infarction.

BACKGROUND: Retinal microvascular changes have been previously associated with cerebral MRI markers of small vessel disease (SVD). Whether retinal changes differ between patient with intracerebral haemorrhage (ICH) and patients with lacunar infarction (LI) caused by small vessel disease has been poorly investigated. OBJECTIVE: The study aims to compare the frequency of retinal changes between patients with LI and patients with ICH at the acute stage of stroke-related SVD. METHODS: Microvascular wall signs (arteriolar occlusion, arteriovenous nicking, focal arterial narrowing) and retinopathy lesions (microanevrysms, cotton wool spots, retinal haemorrhages, hard exudates) were assessed by retinography up to three months after stroke onset. RESULTS: Forty-eight non-diabetic patients with acute stroke-related to SVD (26 LI, 22 ICH) were recruited prospectively in the study. Retinal wall signs (arteriovenous nicking, and focal arterial narrowing) were found in more than three quarters of subjects and most often bilaterally in both groups. Retinopathy lesions (cotton wool spots, retinal haemorrhages) were found more frequently in ICH patients than in LI patients (22.2% vs. 15.4%, 50% vs. 34% respectively, P>0.005). The frequency of bilateral cotton wool spots and of bilateral retinal haemorrhages was significantly higher in ICH patients than in LI patients (12.5% vs. 0%, P=0.012, 41.2% vs. 7.7%, P=0.029 respectively). CONCLUSION: These results confirm the high frequency of microvascular alterations in patients with hypertension-related SVD leading to LI or ICH and suggest that retinal tissue alterations are more frequent in ICH than in LI. Further investigations are needed to investigate the mechanisms underlying this difference.

Relationship between blood pressure, cognitive function and education level in elderly patients with diabetes: a preliminary study.

AIMS: This study aimed to assess the relationship between blood pressure and cognitive function in elderly patients with diabetes mellitus (DM). METHODS: A total of 32 patients with DM aged ≥ 65 years (seven women and 25 men; mean ± SD age: 74.3 ± 6.4 years) were included in this cross-sectional study. Relationships between blood pressure and neuropsychological tests were determined using Spearman's rank correlations (ρ) and multivariable linear regression models. RESULTS: Lower diastolic blood pressure was associated with lower scores on the Frontal Assessment Battery (ρ=0.32, P=0.02), longer times to complete the Trail Making Test Part B (ρ=0.51, P=0.003), lower scores for the Finger Tapping Test (ρ=0.36, P=0.046) and less verbal fluency (ρ=0.36, P=0.047). In multivariable models, these relationships were attenuated after adjusting for levels of education. CONCLUSION: There was an association between lower diastolic blood pressure and poorer executive function in this cohort of elderly DM patients. These results underline the importance of systematic cognitive evaluation in elderly patients with DM, and suggest that a too-low diastolic blood pressure may have deleterious effects on mental function. Larger studies in the future are required to confirm these preliminary results.

[The impact of early cranioplasty on cerebral blood flow and its correlation with neurological and cognitive outcome. Prospective multi-centre study on 24 patients]. / Impact de la cranioplastie sur l'hémodynamique cérébrale comme facteur pronostic de l'amélioration clinique chez les patients craniectomisés pour traumatisme crânien grave.

INTRODUCTION: Cranioplasty after decompressive craniectomy in patients suffering from severe head injury often leads to a functional improvement although, to date, the pathophysiology of this phenomenon remains unclear. A few hypotheses have been proposed. The impact of cranioplasty on cerebral perfusion could be one explanation. We have evaluated the impact of cranioplasty on the functional status of patients undergoing decompressive craniectomy for severe head injury with its influence on cerebral perfusion. MATERIALS AND METHODS: Twenty-four patients undergoing craniectomy for severe head injury were included in this multi-centric and prospective study. All of them had a cranioplasty within 12 weeks following decompressive craniectomy. A clinical and radiological evaluation was performed prior to and after cranioplasty. Neurological and cognitive evaluation was performed with the Glasgow Outcome Score (GOS), the Frontal Assessment Battery (FAB) and the Mini Mental State Examination (MMSE). Radiological evaluation was performed by perfusion CT scan and transcranial Doppler. RESULTS: A statistically significant neurological and cognitive improvement was observed in 92% of patients at 6 months follow-up (F-U). Brain perfusion was improved at 6 weeks F-U, predominantly in the affected hemisphere. Systolic and diastolic blood velocity flow were improved in both middle cerebral arteries. CONCLUSION: Cranioplasty after decompressive craniectomy for patients suffering from severe head injury probably improves the functional outcome of these patients, thanks to a global improvement of cerebral perfusion.

Unilateral carotid granulomatous arteritis and Crohn's disease.

Chronic idiopathic granulomatous arteritis of the large vessels - and, specifically, "Takayasu's arteritis" and "giant cell arteritis" - is an unusual condition that rarely leads to stroke and is only occasionally associated with Crohn's disease. We report here on a unique case of a 56-year-old man with a 25-year history of Crohn's disease who also had a 4-year history of recurrent right-sided ischaemic strokes and partial seizures, and a unilateral progressive retrograde occlusion of the right internal and common carotid arteries. Biopsies of the temporal and carotid arteries showed large-vessel granulomatous arteritis, with features of both giant cell and Takayasu's arteritis.

Calculi and memory.

We describe a case of transient global amnesia related to symptomatic renal stones. Transient global amnesia has been related to intense emotional or painful experiences, such as sexual intercourse, cold water bathing and trigeminal stimulation. Renal stones may be at the origin of a painful experience and thus may induce transient global amnesia.

[The problem of contraception in young psychotics treated in a day care hospital]. / Observations sur le problème de la contraception chez des jeunes psychotiques traitès dans un hôpital de jour

PIP: This presentation about lack of communication on contraception between staff and patients in an outpatient mental hospital consists of 7 parts: 1) an exposition of the authors' hypothesis; 2) the subject matter and method of this study, i.e., analysis of recorded staff interviews; 3) a description of the transcripts on a textual level; 4) an inventory of staff opinions classified by the key words: "contraception, abortion, mental patient, relatives, psychiatrist and responsibility;" 5) an "analysis of structures" implied by these themes; 6) "incarnations of contraception," i.e., 12 typical histories of mental patients given or denied contraception or abortion; and 7) a conclusion. The hypothesis is that contraception speaks precisely to therapists in the repetitive relationship implied constantly by the psychotic course, in terms of desire, identity, bodily organization and structure of speech. This study is based on 10 recorded conversations between a female intern and individual hospital staff members, prompted by a newspaper article about a young psychotic given oral contraceptives without her knowledge. The transcripts revealed denial of the issue, depersonalization, projection and delegation of responsibility to others. When grouped into the 6 key words, the opinions uncovered a vast somatic field, confusion couched in metonymic figures of speech, such as using the term "woman" for "mental patient," moral, genital and sexual connotations. Mental patients were depersonalized; parental roles were confused in speaking of contraception for the patients; physicians were considered judges; responsibility was denied for the patients and avoided generally. The authors' structural analysis took the form of a diagram with responsibility in the center, always preceded or followed by contraception and abortion, and by the triangle psychiatrist-relatives-patient (or mother, young person or woman). Maternity or relationships were always excluded. The 12 anecdotes included hysteria, schizophrenia, hypochondria, obsession, drug abuse, latent homosexuality, repeated pregnancies, self-induced abortions, sterilization, abortion, pills, injections and castration without the patients' consent, or with their ambivalince toward these procedures. Thus, contraception resulted in structural reversals in both patients and staff, involving the fundamental access to genitality for patients and defensive constructions by staff, which is not surprising in a cultural milieu which confuses sexuality and procreation.^ieng