[Research of Lyme's disease in facial paralysis. A French multicenter study]. / Recherche de maladie de Lyme dans les paralysies faciales. Une étude multicentrique Française.

OBJECTIVES: Apparent a frigore facial palsy could possibly mask manifestations of unrecognized Lyme's disease. Since commonly used corticosteroid treatment could be deleterious if Borrelia burgdorferi infection was indeed the cause, we conducted a prospective study to search for possible infections in cases of recently diagnosed a frigore facial palsy. METHODS: For 3 years, 1990-1992, 49 French centres diagnosed a facial palsy in 346 patients (310 adults, 36 children under 15 years of age; mean age 38; range 16 months to 83 years). The patients were divided into three groups: a) facial palsy alone, b) zoster origin recognized due to outer ear eruption and c) cases with meningoradiculitis or joint signs or cases with facial diplegia. A questionnaire was used to evaluate exposure to risk of tick bits. A control group was established with 246 serum samples from subjects matched with the patients for age, geographical origin and exposure to risk of tick bits. Laboratory tests (indirect immunofluorescence and Western blot) were performed to search for anti-Borrelia burgdorferi antibodies in serum samples, and cerebral spinal fluid when possible, collected at presentation, on day 30 and on day 90. RESULTS: Sixty percent of the patients were urban dwellers, 15% lived in rural and 25% in semi-rural areas. There were 294 patients with facial palsy alone and their serum results were compared with those of the matched controls. There was no significant difference in the positivity for Borrelia burgdorferi antibodies between these two groups. CONCLUSION: These findings indicate that, unless there are clinical signs suggestive of borreliosis, it would not be necessary to test for Lyme's disease in patients with apparent a frigore facial palsy.

[Multiple complications of monoclonal IgM]. / Multiples complications d'une IgM monoclonale.

A 64 year old woman with monoclonal IgM Kappa cryoglobulinemia had developed neurologic, vascular and bone involvements. If each features were previously reported, their association appears to be rare. The polyneuropathy was consistent with an IgM anti MAG neuropathy rather than a cryoglobulinemic neuropathy. The vascular occlusion is well known in dysglobulinemia. The diffuse osteosclerosis without medullary fibrosis or myeloproliferative disorder was as like as a Schnitzler's syndrome (chronic urticaria, osteosclerosis, monoclonal IgM Kappa gammopathy.

[Polymyalgia induced by topical minoxidil]. / Etats polyalgiques induits par le minoxidil topique.

Topical minoxidil, used in the treatment of baldness, has been commercially available since 1987. Its systemic side effects are rare. We observed an as yet unreported "polymyalgia syndrome" in four otherwise healthy males whose sole medication was topically applied minoxidil. They experienced fatigue, weight loss and severe pain in the shoulders and pelvic girdle, suggesting connective tissue disease. Three patients had a transient rise in liver enzymes, while other laboratory analyses remained normal. Tritanomaly was detected in two patients who underwent systematic color vision testing. All symptoms disappeared after withdrawal of minoxidil. Rechallenge was positive once in one patient and twice in another. The mechanism of this side effect remains to be determined.

[Resistance in cerebrospinal fluid flow in normal pressure hydrocephalus]. / La résistance à l'écoulement du liquide céphalo-rachidien dans l'hydrocéphalie à pression normale

C.S.F. resistance to flow (Rf) was measured in 24 patients by the mean of a constant infusion manometric test, and the results were compared with those of pneumo-encephalography and isotope cisternography. It is concluded that Rf is constantly elevated in patients with normal pressure hydrocephalus, is at least as reliable as the two other tests and therefore provides a really valuable aid to the identification of the patients to be shunted.