[Hydrocephalic and/or degenerative dementia]. / Démence hydrocéphalique et/ou dégénérative.

The authors report ten cases of progressive dementia. Nine are associated with gait disturbances and seven with urinary incontinence. Despite the severity of dementia and Ct Scan signs of cortical atrophy, magnitude of neuroradiological ventricular dilatation and ventricular reflux at isotopic cisternography lead to shunt therapy. After ventricular shunting of CSF, a follow-up at short and long terms shows different clinical evolutions: two transitory improvements, three cases without change and five worsening. Retrospective clinical study of these cases in which diagnosis leads to a degenerative process of the Alzheimer type shows atypical premorbid neuropsychological characteristics by a normal-pressure hydrocephalus. In fact, in the ten cases preoperative neuropsychological investigation shows, at various levels, aphasic, alexic and agraphic signs. Their occurrence in the clinical picture represents an essential contribution to differential diagnosis.

Late occurrence of additional ocular and intracranial pathologies in the linear naevus sebaceous (Feuerstein-Mims) syndrome.

The linear naevus sebaceous syndrome of Feuerstein-Mims belongs to the phacomatoses and classically is composed of a linear cutaneous lesion associated with mental retardation and epilepsy, sometimes also with ocular dystrophies. During an unusually long follow-up of 32 years of such a case, which is reported here, the late occurrence of additional ocular and intracranial pathology are demonstrated: conjunctival and bulbar tumours with progressive deterioration of visual acuity, bilateral intracranial arachnoidal cysts, dilatation and tortuosity of the middle cerebral artery. As a consequence of these observations the prognosis in cases with this syndrome has to be given with special caution.

Management and surgical outcome of suprasellar meningiomas.

The authors analyse 22 cases of suprasellar meningiomas, drawing attention to factors influencing on the surgical outcome. In all but one case, symptomatology began with progressive visual failure in one eye. Bilateral anosmia was noted in 4 patients with large tumour. Mental disorders were conspicuous in 5 cases and 3 patients suffered from epilepsy. Headache was severe in 5 cases. Endrocrinological disorders were observed in 3 patients. The sella turcica was of normal shape in all cases. Marked hyperostosis of the planum or tuberculum existed in 7 cases. The tumour was heavy-calcified in 2 cases. CT scanning showed everytime a marked enhancement of the tumour and in 4 cases, a large hypodense area surrounded the tumour. The patients were operated on through a bifrontal approach or a unilateral frontal flap. A partial anterior frontal lobectomy was regularly performed on one side. While the tumour is piecemeal exacavated, the dural attachment at the base is reached as quickly as possible. Complications consisted in rhinorrhea of CSF in 2 cases, once in a transitory diabetes insipidus and in a secondary hydrocephalus. Post-operative mortality remains high. Among the eleven cases of large tumours, a direct postoperative death occurred, due to a severe arterial bleeding. Two other patients died 4 and 6 weeks respectively after operation. An other patient died 8 years after operation, from meningitis. Among the 5 cases of medium-sized tumours, one post-operative death occurred in a young female, 30 of age, following urinary infection by Klebsiella, complicated by toxicemia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Epidural metastases at the spinal level. Clinical study of 82 cases]. / Les métastases épidurales au niveau du rachis. Etude clinique de 82 cas.

This is a retrospective review of 82 cases of spinal epidural metastasis. A warning vertebral or radicular pain was present in 85% of the cases. In 33% of the patients, who complained only of pain without any neurological deficit, a complete myelographic block was already present. It is thus of prime importance not to neglect a vertebro-radicular pain in cancer patients, and even in patients without known cancer since the epidural metastasis was the first manifestation of the neoplasm in 30% of our cases. The indications for myelography are defined. The functional result (i.e. ability to walk) after treatment depends on the neurological state before treatment. In our series, total paraplegia was always irreversible. Early diagnosis and treatment are thus very important. The surgical treatment alone is judged insufficient. We were not able to prove the superiority of one of the following therapeutic modalities: laminectomy followed by radiotherapy or radiotherapy alone. Radiotherapy is indicated in all cases, often as the sole treatment. The indications for surgery are defined; they are based on our own experience and the literature. High dose steroids are indicated as adjuvant therapy.

[Normotensive hydrocephalus. Retrospective clinical study of 47 cases]. / Hydrocéphalie dite "normotensive". Etude clinique rétrospective de 47 cas.

The clinical observation of 47 patients, undergoing surgery for "normotensive hydrocephalus" during the period January 1975 to January 1981 have been analysed retrospectively. The condition of half the patients improved following insertion of a cerebrospinal fluid bypass. Complications of varying degrees of severity were noted in 21 percent of cases. The correlation between the post-operative results and the clinical data was subjected to statistical analysis. Some factors appeared to have an important predictive value. These were the age, the absence of cortical atrophy on C.T. scan and the prolonged ventricular filling on cisternography. Other factors, although without statistical significance, seem to predict a better result: the existence of prior etiological data, presence of a frontal syndrome and evidence of periventricular hypodensity on C.T. scan. Finally, some other factors in our series appeared to have no influence on the prognosis. These were: duration of the preoperative evolution of the disorder, the degree of mental disturbance and difficulties of gait, the presence of urinary incontinence, the value of the ventricular cranial ratio. None of the recognized significant criteria was sufficiently reliable to predict the quality of surgical result, when studied in isolation. The association between the different significant criteria, such as have been described above notably, improves the chances of a favorable post-operative outcome but it is insufficient to predict it with great certitude. The continuous monitoring of the intracranial pressure during periods of 24 to 48 hours appears to be the most reliable factor on which to make a decision to operate in the light of the findings described in recent literature.

[Pseudo-Hakim-Adams syndrome. Neuropsychological study of 23 cases of misdiagnosed Hakim-Adams syndrome]. / Pseudo-syndrome de Hakim et Adams. Etude neuropsychologique de 23 cas de faux diagnostic de syndrome de Hakim et Adams.

The authors study the characteristics of a group of 23 patients for whom an initial tentative diagnosis of Hakim-Adams syndrome (H-A syndrome) was eventually rejected. On account of several factors distinguishing these patients from the true H-A group, the authors propose using the term "pseudo Hakim-Adams syndrome". The distinguishing factors include: the grounds for admission, i.e. mental or mnesic deterioration, associated with radiological images of ventricular dilatation; a clinical picture dominated by mental disorders with only rare disorders of gait and sphincter control (several neurological defects were direct consequences of previous cerebral disease); no antecedents of spontaneous meningeal hemorrhage or meningitis in the case history; neuropsychological examination showing fewer disorders of concentration and less dyscalculia and constructive dyspraxia than in true HA, and far more atypical signs of the aphasic and anxio-depressive type. The authors think that various pathological processes may be responsible for this pseudo H-A syndrome in which a predominant mental picture is associated with ventricular dilatation.

[Post traumatic schizophrenic bouts: with regard to 6 cases of traumatic schizophrenia (author's transl)]. / Les décompensations schizophréniques post-traumatiques. A propos de 6 cas de schizophrénie traumatique.

The authors describe 6 cases of post-traumatic schizophrenia and make a critical review of the literature concerning this unusual post-traumatic personality disturbance. Various schizophrenic manifestations are observed: they principally consist of delusion, hallucination, paranoid and mystical ideas, autism, psychomotor instability, fugues. Post-traumatic schizophrenia occurs mostly in young men, before thirty years. The severity of traumatic brain injury appears irrelevant in its genesis. Temporal lobes are more often involved (one third of the cases). Pre-traumatic personality disturbances are the main factor as demonstrated by the anamnesis and by the results of Rorschach test.

Post neurosurgery Gram-negative bacillary meningitis.

The findings of a retrospective analysis of 20 patients who developed Gram-negative bacillary meningitis (GNBM) following neurosurgery are reported. The predisposing causes included surgery for skull fracture or cerebral contusion (9 patients), neoplasm (6) and vascular disease (2). Nine of the patients (45 per cent) had a cerebrospinal fluid (CSF) leak from a fistula. The organisms isolated, which included Pseudomonas aeruginosa (6), Klebsiella spp. (5) and Escherichia coli (4), had, in 75 per cent of cases, been isolated from other sites prior to the onset of GNBM. Initial diagnosis was achieved by Gram-stain of CSF in 15 of 19 cases (78 per cent). Culture of lumbar CSF was positive in 19 of the patients (95 per cent) and concommittant ventriculitis was confirmed by positive culture of ventricular CSF in 10 of 11 cases (91 per cent) from whom it was obtained. The overall mortality was 80 per cent, 11 patients dying of causes directly related to GNBM. Eradication of the infecting organism from CSF was achieved in 79 per cent of patients receiving intraventricular aminoglycoside therapy, but in only 40 per cent of those receiving intralumbar therapy. Deaths in the latter group were associated with ventriculitis whereas those in patients receiving intraventricular therapy resulted from intracranial abscess formation. These findings, plus the observation of chloramphenicol resistance in 80 per cent of the isolates, suggest that systemic and intraventricular aminoglycoside administration is indicated in patients with post-neurosurgical GNBM.