[Long-term treatment of Alzheimer's disease: followup of a cohort of 255 patients treated with lacrine for four years]. / Traitement de la maladie d'Alzheimer au long cours: à propos d'une cohorte de 255 patients traités quatre ans par tacrine.

We describe the follow-up of a cohort of 255 Alzheimer's disease (AD) patients (81 males, 174 females) treated by tacrine during 4 years. We performed the survey of hepatic, cholinergic and general tolérance. Drug efficacy was measured by MMS examination on weeks 0, 18, 30, 52, 104, 156 and 208. A total of 190 patients (74.5 percent) were dropped out of this study, 75 (29 percent) for adverse events. We found 85 hepatic (33 percent), 79 cholinergic (31 percent), 31 (12 percent) neuropsychiatric and 72 general (28 percent) side effects. In term of drug efficacy we observed a global decline of 2.5 MMS points during the first year and 2 MMS points between W52 and W156. Tacrine's symptomatic efficacy, defined as the number of patients improved or stabilized at W30, was present in 50 patients (46 percent) among the 109 patients reaching W30. The intensity of symptomatic efficacy was expressed by a 2.7 MMS points increase in 37 patients improved on W30. The long term effects of Tacrine, measured by the MMS score at one year, showed a positive impact as the MMS was 2.5 points above the expected score in non treated AD patients. This study raises the practical problem of optimal cholinesterase inhibitors use in AD and the theoretical question of long term action of cholinesterase inhibitors on cerebral lesions of AD.

[Cerebral venous thrombosis in adults. Diagnostic and therapeutic aspects in 20 cases]. / Les thromboses veineuses cérébrales de l'adulte. Aspects diagnostiques et thérapeutiques a propos de 20 observations.

The authors have reported on 20 cases of cerebral venous thrombosis and reviewed the literature. In most of these 20 cases, CT scan findings were non-specific. Digital subtraction angiography was used for diagnosis in 6 cases. In 7 cases, no etiology was found. 12 patients received anticoagulant treatment despite CT scan showed hemorrhagic infarct in 4 of them. No neurological complication was reported after anticoagulation. Venous thrombosis was fatal in 3 non-anticoagulated patients. 4 others showed mild or severe sequellae after discharge.

[Hypoglycemic hemiplegia. Apropos of a case]. / L'hémiplégie hypoglycémique. A propos d'une observation.

An insulin-dependent 26-year-old woman was complaining of nocturnal attacks of transient right hemiplegia. Hypoglycemia was found to be present at the time of each attack, and further investigations showed that these neurological disorders were related to an overdose of insulin. The authors discuss the effects of hypoglycemia on the brain and the pathogenetic theory of "hypoglycemic hemiplegia", involving selective neuronal vulnerability, regional blood flow disturbances or underlying ischaemic disease.

[Bilateral carotid artery occlusion. Analysis of 9 cases]. / Occlusion bilatérale des artères carotides. Analyse de neuf observations.

The authors report on a series of 9 cases of bilateral internal carotid artery occlusion with long-term follow-up. Risk factors, clinical presentation and outcome have been reviewed. On basis of angiographic and CT scan features, the role of collateral circulation is discussed.

[The role of edema in cerebral ischemia. From physiopathology to therapeutics]. / Place de l'oedème dans l'ischémie cérébrale. De la physiopathologie à la thérapeutique.

Brain ischemia induces an original form of edema associating a "cytotoxic" component and a "vasogenic" component which is more inconstant. The authors set out a synthesis of fundamental research concerning the different factors of ischemic brain edema. Although anti-edematous drugs (steroids, barbiturates, diuretics) are widely used, there is no serious evidence of their efficacity. New therapies are based on a specific approach of the different disturbances of cerebral ischemia. However, controlled studies are necessary to evaluate the effects of these new drugs.