[Recovery of saccular function after vestibular rehabilitation]. / Récupération de la fonction sacculaire après rééducation vestibulaire.

OBJECTIVE: The authors present a case of recovery of saccular function after vestibular rehabilitation. MATERIAL AND METHOD: Vestibular rehabilitation is proposed to a patient presenting a left lateral body deviation as well as postural disorders at the time of the vertical movements and in car, associated with an unilateral abolition of vestibular evoked myogenic potentials (VEMP). RESULTS: We observe a recovery of VEMP and a disappearance of symptomatology after vestibular rehabilitation. CONCLUSION: A loss of saccular function can involve a postural disorder in some circumstances. The best treatment is vestibular rehabilitation. We insist on the need for knowing otolithic semiology in order to propose suitable explorations and therapy.

[Siderosis of the brain and spinal cord. Report of two cases]. / Sidérose cérébrale et médullaire. A propos de deux observations.

Two cases of superficial siderosis of the brain and spinal cord with cochleovestibular and cerebellar symptoms are diagnosed on brain and spinal MRI scans. Low signal intensity lines are noted on the surface of the brainstem, cerebellum, spinal cord and within the interhemispheric and sylvian fissures. In one case, no brain or vascular malformation is identified; in the second case, two cavernous angiomas are noted on the MRI study. 3D CISS may visualize thickening of the cochleovestibular nerve.

[Reeducation of patients with vertigo]. / La rééducation des vertigineux.

The use of physical therapy in the treatment of vertigo is based on the plasticity and the restoration and adaptive qualities of the vestibular apparatus. Indications for physical therapy and the choice of techniques are based on the location of the lesions: exercises aimed at habituation in positional vertigo, with use of the rocking manoeuvre in the case of cupulolithiasis, and stimulation of spinal, labyrinth, visual or extraocular muscle proprioceptors in the case of unilateral lesions of the first neuron or in ototoxic destruction. These techniques give lasting effects and avoid prolonged treatment by anti-vertigo drugs which, by impairing the development of compensation, often lead to persisting functional disorders.

[Cerebellar cavernous angioma, cervical dystonia and crossed cortical diaschisis]. / Angiome caverneux cérébelleux, dystonie cervicale et diaschisis cortical croisé.

On four occasions since 1978, this 53 year-old woman presented with a right hemicorporal hypotonia, symptomatic of a hemispheric cerebellar syndrome. In 1981, she experienced the progressive development of a cervical dystonia. CT scan and RM scan showed a cavernous angioma in the right cerebellar hemisphere. The 18F-2-fluoro-2-deoxy-glucose PET scan revealed a right cerebellar and a contralateral cortical and striatal hypometabolism. This crossed cerebello-cortical diaschisis can be interpreted as a functional interruption of the cerebello-cerebral pathways. This case raises the question of the role played by a cerebellar lesion in the development of a focal dystonia.

[Contribution of MRI to the topography of oculomotor disorders in multiple sclerosis]. / Apport de l'I.R.M. au diagnostic topographique des troubles oculomoteurs dans la sclérose en plaques.

Magnetic resonance imaging (MRI) was performed in 20 patients with multiple sclerosis and abnormal electro-oculographic examination. All but 2 patients showed MRI abnormalities in the infratentorial region: hypersignal on T2-weighted sequences and/or images of atrophy. Usually, each patient had multiple abnormalities, which could prevent anatomico-oculographic correlations. With oculomotor disorders of cerebellar origin, correlations between clinical findings and MRI images were satisfactory, but with disorders due to brainstem lesions correlations were not so good, as shown by the results in 9 patients with internuclear ophthalmoplegia.

[Electro-oculographic study of reading in hemianopic patients]. / Etude électro-oculographique de la lecture chez les hémianopsiques.

Recordings of ocular movements during reading in hemianopic patients showed an increase in global reading time related mainly to the increase in number of movements of progression and regression in left hemianopsia and to the time to return to the line in right hemianopsia. Comparison of these changes with those noted in the same patients during recordings of elementary ocular movements and reading simulation suggests that they are not only of a linguistic and/or cognitive type but that they may also be related to altered sensorial data such as size of words or place of spaces between words.

[Equilibrium disorders, vertigo and nystagmus induced by maximal deviation of gaze. Role of extra-ocular proprioception]. / Troubles de l'équilibre, vertiges et nystagmus induits par l'excentration maxima du regard. Rôle de la proprioception extra-oculaire.

The behavior of 64 normal subjects was studied after they had been submitted to excentric lateral ocular fixation of gaze of more than 40 degrees for periods of one the three minutes. A significant proportion developed vertigo, slow segmental deviations and nystagmus. Nystagmus appearing during gaze fixation (physiological nystagmus of extreme lateral gaze) was distinguished from nystagmus in the opposite direction which appeared after cessation of fixation and was named "post-fixation nystagmus". The possible role of proprioceptive receptors in the extra-ocular muscles is discussed and a hypothesis proposed of an oculo-oculogyric reflex possibly through the vestibular nuclei and influencing the control mechanisms of posture and balance.

[Familial presenile dementia: Gerstmann-Sträussler-Scheinker's syndrome (author's transl)]. / Démence pré-sénile familiale: syndrome de Gerstmann-Sträussler-Scheinker.

A similar affection has developed in eight members from four generations of a family living in the Alsace. The disease is characterized by the onset of a pyramidal, pseudobulbar syndrome and dementia during the third or fourth decade of life. The outcome is fatal after a mean period of three years. Cerebral biopsies in three cases have demonstrated multicentric amyloid plaques differing from senile plaques. Clinical and pathological findings are similar to those currently reported in the literature as being typical of Gerstmann-Sträussler-Scheinker's syndrome. The affection appears as a separate entity: the multicentric plaques, clinical symptomatology, pyramidal or pseudobulbar, cerebellar syndromes, usually preceding dementia, age of onset, course, and familial character or the disorder distinguish it among presenile dementias. Its clinical profile and course are very similar to that of familial cases of Alzheimer's disease, some of which are probably cases of Gerstmann-Strässler-Scheinker's syndrome. Transmission to animals, though inconstant, places it within the group of transmissible dementias among kuru, Creutzfeldt-Jakob's, and familial forms of Alzheimer's disease. The familial nature of the affection and the variability of clinical and pathological features in the same family illustrate the complex relationships between hosts and pathogenic agents in the clinicopathological expression of a disease.

[Oculomotor disorders associated with Arnold-Chiari malformations (author's transl)]. / Les troubles oculomoteurs dans les malformations d'Arnold-Chiari.

Oculographic examinations were conducted in 24 cases of Arnold-Chiari malformation. Disorders in vertical eye movements with a spontaneous vertical nystagmus were frequently observed, together with disturbances in visual tracking. There was no case of paralysis of lateral eye movements, but an adduction internuclear ophthalmoplegia might be present. Though these anomalies are not specific, they differ for example from those usually observed in multiple sclerosis, which is often a differential diagnosis in such cases. Oculography therefore may be of particular value.