[Acute disseminated encephalomyelitis associated with mycoplasma pneumoniae infection]. / Encéphalomyélite aiguë disséminée associée au Mycoplasma pneumoniae.

A 20-year old man was hospitalized for acute urinary retention, headaches and mild fever. Neurological examination revealed a meningeal syndrome and a bilateral pyramidal syndrome of lower extremities with a C7 sensory level. The level of antibodies against Mycoplasma pneumoniae (Igm and IgG) suggested a recent unrecognized infection. Cerebral and medullar MRI showed T2-hyperintense lesions in the right thalamus and at the level of C1-C2 and C6. Evoked potentials were normal but EEG showed some bilateral theta waves. The cerebrospinal fluid analysis demonstrated 170 white cells/mm3 with 66% lymphocytes and proteins at 73 mg/dl. A few weeks after treatment with intravenous immunoglobulins at 0.4 g/kg/day for 5 days, the patient showed complete clinical recovery. MRI and urinary flowrate normalized after nine weeks. The authors are discussing the probable diagnosis of acute disseminated encephalomyelitis occurring after a mycoplasma unrecognized infection.

[Long-latency auditory evoked responses in Parkinson disease and in parkinsonism induced by neuroleptics]. / Potentiels évoqués auditifs de longue latence (AEP) dans la maladie de Parkinson et le parkinsonisme induit par neuroleptiques.

The amplitude and latency of the N100 wave (auditory evoked potentials) were studied in 28 normals, 85 parkinsonians, 24 extrapyramidal syndromes induced by neuroleptics and 12 neurological control patients. The latency decreases as an inverse function of the intensity of stimulation in normals, controls, treated parkinsonians and in extrapyramidal syndrome induced by neuroleptics. Untreated parkinsonians do not show an evident relation between the latency and the stimulation level. The amplitude of the N100 decreases when neuroleptic induced parkinsonism improves.

Unusual complication after pelvic surgery: unilateral lower limb crush syndrome and bilateral common peroneal nerve paralysis.

We present a patient who developed a right anterior leg compartment syndrome and bilateral common peroneal nerve paralysis following radical hysterectomy in the lithotomy position. We describe the physiopathology of the syndrome, its various etiologies, the treatment, and prevention of this complication.

[Acute maternal anterior poliomyelitis in a non-endemic zone]. / Poliomyélite antérieure aiguë maternelle en zone non endémique.

The authors report the case of a 26 year old woman with acute anterior poliomyelitis contracted during the vaccination of her baby. Despite having been herself vaccinated in infancy she was not protected against the poliovirus. The clinical interest of this uncommon case is a severe paralytic state with definitive paraplegia. The authors suggest serologic testing of patients born before 1967 especially if they are at risk of encountering the virus.

Further observations showing the impact of the probenecid test in movement disorders.

Two patients with movement disorders are described and neurochemically studied. The first subject concerns a central anticholinergic syndrome in a 83 years old man treated with l-dopa and amantadine for red nucleus tremor. The second one is an association of parkinsonism and chorea in a 76 years old woman presenting with FAHR's syndrome. In both cases, CSF HVA levels were measured before and after oral probenecid load. The observations confirm the usefulness of this neurochemical strategy in order to classify aging patients with parkinsonism into dopasensitive and doparesistant groups.

[Value of the probenecid test in the diagnosis and treatment of parkinson disease]. / Apport du test au probenecid dans le diagnostic et le traitement de la maladie de Parkinson.

Forty-five patients presenting a parkinsonian syndrome, accompanied in some cases by depressive and/or confusional signs, were subjected to neurological and neurobiochemical investigation involving a probenecid test (estimate of central turnover of dopamine by determination of homovanillic acid in cerebrospinal fluid before and after an oral dose of probenecid). Patients were classified in two groups on the basis of the benefit procured by dopa therapy as estimated at least one year after treatment. The probenecid test revealed a sharp drop in turnover of dopamine in the dopasensitive group. Furthermore, in this group the dopamine turnover was not related to sex, age, duration of the parkinsonian syndrome or clinical severity. In contrast, there seemed to be a correlation between dopamine turnover and optimum dosage of l-DOPA. Lastly, the study showed that, beyond the diagnosis of dopasensitivity, the test was useful for patient follow-up. The test profile in cases of excess dopatherapy is described.

Biogenic amine disturbances in cerebrospinal fluid in parkinsonism and unipolar depression: use of the probenecid method.

Probenecid was administered to 7 unipolar depressed patients, 7 parkinsonians and 7 extrapyramidal patients with senile dementia matched for age and sex. Before and after the administration of probenecid, the levels of 5-hydroxindoleacetic acid (5HIAA) and homovanillic acid (HVA) were determined in the cerebrospinal fluid (CSF) of all patients in order to study the central turnover rate of serotonin and dopamine. Unipolar depressed patients showed a significantly lower increase in CSF 5HIAA levels after probenecid than parkinsonians. Patients with parkinsonism had a reduced increment of CSF HVA levels following probenecid administration when compared to unipolar depressed and extrapyramidal patients with senile dementia. The authors conclude that the biochemical study of CSF biogenic amines using the probenecid method can be used as a highly sensitive biological screening test for diagnosing Parkinson and depressive syndromes among an aging population of retarded, tremoring, rigid and hypokinetic patients.

Serotonin and dopamine disturbances in patients with unipolar depression and Parkinsonism.

Probenecid was administered to 7 unipolar depressed patients, 7 parkinsonians and 7 extrapyramidal patients with senile dementia matched for age and sex. Before and after the administration of probenecid, the levels of 5 hydroxyindoleacetic acid (5HIAA) and homovanillic acid (HVA) were determined in the cerebrospinal fluid (CSF) of all patients in order to study the central turnover rate of serotonin and dopamine. Unipolar depressed patients showed a significantly lower increase in CSF 5HIAA levels after probenecid than parkinsonians. Patients with Parkinsonism had a reduced increment of CSF HVA levels following probenecid administration when compared to unipolar depressed and extrapyramidal patients with senile dementia.

[A case of post-hepatitic Guillain-Barré-Strohl syndrome with extension to all pairs of cranial nerves and late papilledema. Review of recent literature (author's transl)]. / A propos d'un cas de syndrome de Guillain-Barré-Strohl posthépatitique avec extension à toutes les paires crâniennes et oedème papillaire tardif. Revue de la littérature récente.

The authors report the case of a 17 year-old female patient who presented acute ascending polyneuritis of the Landry-Guillain-Barré type extending to all cranial nerve pairs during the abatement of hepatitis of unspecified etiology. The patient remained in a state of coma vigil for five days prior to gradual but full recovery over a six-month period. The patient was given respiratory assistance for 55 days, together with corticosteroid therapy and above all plasmapheresis. After five weeks of treatment a transient late papilledema was noted for about six weeks. The authors discuss the diagnostic criteria of the Guillain-Barré-Strohl syndrome, its etiology, the possibility of central nerve involvement and late papilledema. Treatment with corticosteroids and plasmapheresis is also discussed.

[Use of the probenecid test for the diagnosis and treatment of Parkinsonism. Review of the literature and personal experience (author's transl)]. / Apports du test au probénécide au diagnostic et à la thérapeutique des parkinsoniens. Revue de la littérature et études personnelles.

After describing the clinical picture of Parkinsonism, other Parkinson and depressive syndromes, the authors clarify ascending dopaminergic and serotoninergic pathways in the central nervous system as well as current knowledge on the nigro-striatal pathway. They also underline the interest of the probenecid test in the diagnosis of Parkinsonsism with or without depression. Neurochemical criteria of dopa-sensititivy and dopa-resistance are proposed as well as criteria aimed at serotoninergic therapy. Finally, the use of this neurochemical test in treatment and follow up is illustrated by a clinical case report.