[BAC 40 battery: a tool of cognitive evaluation for the diagnosis of Alzheimer's disease at the specialist office]. / La batterie BAC 40: un outil d'évaluation cognitive pour le diagnostic de la maladie d'Alzheimer au cabinet du spécialiste.

BAC 40 is a "composite" battery of psychometric tests useful for the diagnosis of Alzheimer's dementia. It was elaborated using the modified Mini-Mental Status (MMS). The advantage is to establish a diagnosis in less than 20 minutes, exploring all the sectors of cognitive life. This tool was validated in a control population of 103 aged normal subjects and in 97 patients living at home or in institution and attending a neurology outpatient clinic for a memory complain. The scores obtained with "BAC 40" and the "ADAS-COG SCALE" were compared in all patients. The statistical analysis demonstrated a good correlation between the two scales, with a Spearman coefficient of -0.72 for the controls, and -0.90 for the patients. Cutoff values were determined below which a pathologic dementia process can be highly suspected. Score variations according to different parameters, and particularly in function of age, are given.

A double-blind, placebo-controlled, enriched population study of tacrine in patients with Alzheimer's disease.

The efficacy of tacrine in the treatment of patients with probable Alzheimer's disease (AD) was evaluated in a double-blind, placebo-controlled, enriched population multicenter study in France. A total of 280 patients entered the dose titration phase of the study. The assessment of potential benefit of tacrine ("best dose") was based on demonstrating improvement on the Alzheimer's Disease Assessment Scale (ADAS) total score versus a blinded placebo. One hundred and thirty of 242 (54%) patients achieved a "best dose" and were eligible for the double-blind, parallel group (pivotal) phase. Primary efficacy measures were ADAS-Cognitive and Clinical Global Impression of Change; secondary efficacy measures of cognition and activities of daily living were also included. Results indicated that tacrine-treated patients showed improved functioning based on the ADAS-Cognitive in comparison to placebo-treated patients. Transaminase elevations above the upper limit of normal occurred in 32% of patients, were more frequent in women than in men, demonstrated a delayed onset, and returned to normal limits for all patients following discontinuation of treatment The results from this study are supportive of the efficacy of tacrine in the treatment of AD as demonstrated in a study of similar design conducted in the US and studies using different designs.

[Changes in erythrocyte deformability in Alzheimer's disease]. / Modification de la déformabilité érythrocytaire dans la maladie d'Alzheimer.

In a previous work we showed an alteration of erythrocyte filtration ability in patients with Alzheimer's disease according to their age and illness duration. This study has for aim to find a criteria of deformability that would be constant in all Alzheimer patients and would show a modification of red cell membranes. The erythrocyte filterability was studied in this present paper, in accord to Reid and Dormandy method using two values of depression (5 and 0 cm of water). These depressions correspond to the physiological values of blood pressure at the level of precapillary and capillary systems. The ratio between the result obtained at 5 cm and the result at 0 cm is constant in normal patient without organic disease and it is independent of age. At the opposite, this ratio increase very significantly in all Alzheimer patients, and this is not correlated to the initial value of filtrability. This ratio could be an index of the alteration of red cell membranes.

[Multiple sclerosis associated with biological symptoms of systemic lupus erythematosus. A case with anatomical study]. / Sclérose en plaques associée à une symptomatologie biologique évocatrice d'un lupus érythémateux disséminé. Une observation avec étude anatomique.

A clinical history typical of multisclerosis began in a 20-year old man with transient, then permanent manifestations involving the optic tract and the pyramidal, extrapyramidal and cerebellar systems. The patient died at the age of 62, at the end-stage of a complex clinical situation which included paraplegia, bilateral cerebellar syndrome, optic nerve atrophy, epileptic seizures and dementia. When the patient was 54 years old, laboratory findings suggestive of systemic lupus erythematosus (SLE) were discovered, namely: antinuclear, native anti-DNA, anti-Sm antibodies, circulating anticoagulant, cryoglobulinaemia and low complement level. These abnormalities persisted up to the patient's death, 8 years later, without any non-neurological sign of SLE. Post-mortem examination showed lesions of focal demyelination characteristic of multiple sclerosis, but no evidence of cerebral or extracerebral SLE. This case raises the problem of borderlines or associations between systemic lupus erythematosus and multiple sclerosis. In our case, as in other cases of "lupoid sclerosis" reported in the literature, there was a frank and isolated elevation of serum IgM levels.

[Cardio-respiratory anomalies in disseminated sclerosis]. / Anomalies cardio-respiratoires dans la sclérose en plaques.

A case of acute pulmonary edema without cardiac failure, infectious or toxic cause, revealing a Multiple Sclerosis (M.S.), one case of bradycardia during a bout in a known M.S. and one case of orthostatic hypotension without change of cardiac frequency, during a bout of a known M.S. are reported. The common point of these 3 cases is that during their autonomic failure, there were disorders pointing to the medulla oblongata: swallowing difficulties, rotatory nystagmus, vestibulo-cerebellar syndrome, sensory and motor defect of upper limbs. A plaque of M.S. in the medulla oblongata, particularly near the tractus solitarius could explain these cardio-pulmonary abnormalities unusual in M.S.

Transient global amnesia associated with hydrocephalus. Report of two cases.

The cases are reported of two men, aged 20 and 47 years, who suffered an episode of transient global amnesia. Both were subsequently found to have hydrocephalus.

[Ischemic cerebrovascular accident and sport activity. 6 cases]. / Accident vasculaire cérébral ischémique et activité sportive. 6 observations.

Six cases of ischaemic stroke which occurred during sporting activities are reported. The authors insist on the unusual features of the ischaemic events which had the same characteristics as other ischaemic strokes in young subjects: frequent involvement of the main cerebral arteries, good vital and functional prognosis in short--and mid-term. They consider that three factors might have concurred in precipitating the ischaemic accident, viz.: fibromuscular dysplasia (observed in 3 patients), warm summer weather encouraging haemoconcentration and poor physical training in 5 out of 6 cases.

[Crossed alexia-agraphia in a right-handed patient]. / Alexie-agraphie croisée chez un droitier.

A right-handed man, born of a right-handed family, presented an infarct in the territory of the right middle cerebral artery, with a left hemiplegia, a left lateral homonymous hemianopsia and an expression aphasia. The oral trouble disappeared in some weeks, but later a permanent linguistic deficit persisted, affecting mainly the written language and realizing a clinical picture of alexia-agraphia with Gerstmann's syndrome. The neurolinguistic study showed a preferential alteration of the phonologic system in the written language, and at a lesser degree in the oral modality. The extent of the lesion and the relative integrity of oral expression and comprehension, suggested that these functions were localized in the left hemisphere, whereas lecture, writing, calculation, body-parts notion, laterality notion, had been simultaneously implanted during the ontogenesis in the right hemisphere. The latter was probably also responsible for phonological aspects of written and spoken language, according to a scheme opposite to that of usual right-handers.

[Elevation of gamma-glutamyltransferase levels in treated epileptic patients]. / Elévation des taux de gamma-glutamyl-transférase chez les épileptiques traités.

Plasma levels of gamma-glutamyl transpeptidase were measured prospectively in 75 epileptic patients treated with one of the following drugs: phenobarbitone (n = 20), phenytoin (n = 23), carbamazepine (n = 18) or sodium valproate (n = 14). A significant increase in gamma-glutamyl transpeptidase levels was observed from the 7th day of treatment onward. The increase was particularly pronounced in the phenytoin group, with mean and maximum values of 104.10 and 215 mU/ml respectively, followed by the phenobarbitone group (mean 68.15, max. 124 mU/ml), the carbamazepine group (mean 49.83, max. 100 mU/ml) and the sodium valproate group (mean 35.42, max. 70 mU/ml). This was due to enzyme induction being highest with phenytoin and phenobarbitone which are strongly liposoluble and have prolonged half-life. Any epileptic patient with plasma gamma-glutamyl transpeptidase levels higher than those found in this study may be suspected of having viral or alcoholic hepatitis.

[Migraine and somnambulism. A survey of 122 migraine patients]. / Migraine et somnambulisme. Une enquête portant sur 122 migraineux.

A retrospective study looking for an history of somnambulism in childhood, in a population of 122 patients with migraine, and 110 patients with non-migraine headache has been performed. A very high frequency of somnambulism in patients with migraine was found whereas frequency of somnambulism in patients with non-migraine headache was similar to that of the general population. The probability that a sleepwalking child acquires a migraine is greater when she is a girl. Migraine is then often of the ophthalmic type. Somnambulism and migraine appear at different ages, the former in the late infancy, the latter in childhood and both could be due to a disorder of serotonin metabolism. The authors suggest that somnambulism be considered as an accessory criterion for the diagnosis of migrainous disease.

[Thalamic dementia after a unilateral hemorrhagic lesion of the right pulvinar]. / Démence thalamique après lésion hémorragique unilatérale du pulvinar droit.

A 68 year-old man with a history of right thalamic hemorrhage demonstrated radiologically in the pulvinar and posterior portion of the dorsomedian nucleus developed a clinical picture of severe physical sequelae associated with major affective, behavioral and psychic disorders. Affective manifestations were a permanent anxiety-depression state contrasting with indifference to his surroundings. Behavioral changes included marked apathy, inertness and hypersomnia, together with occasional clastic agitated episodes and verbal and gestural stereotypies and soliloquies. Psychic sequelae were psychotic in nature: depersonalization crises, delusions of persecution, multisensorial hallucinations and absurd acts.

Effects of vasopressin and desmopressin on memory. A double-blind study in 40 healthy volunteers.

In a study involving 40 healthy student volunteers, 10 subjects were given lysine vasopressin at a dose of 0.4 ml (23 IU) per day in 3 divided doses for 15 days by the nasal route. Ten subjects were given desmopressin at a dose of 0.2 ml (20 micrograms) per day in a single dose for 15 days by the nasal route. Twenty subjects were given placebo by the nasal route. Memory tests were conducted under the same conditions before and after treatment (verbal span, verbal retention, visual retention, visual learning, verbal learning). Only the contents of the tests were varied, so as to avoid familiarity. Statistical analysis did not show any significant change in the scores between the first and the second series of tests, between the two treated groups, or between them studied separately and the control subjects.

[Non-traumatic rhinorrhea from a latero-sellar fistula of the temporal fossa adjacent to an empty sella turcica. Computed tomography aspects; surgical treatment]. / Rhinorrhée non traumatique par fistule latérosellaire de la fosse temporale au voisinage d'une selle turcique vide. Aspects tomodensitométriques; guérison chirurgicale.

The authors report a case of non traumatic rhinorrhea due to an osteo-dural fistula communicating between the latero-sellar part of the left middle cranial fossa and the sphenoidal sinus. This fistula, probably congenital, was adjacent to an intrasellar arachnoidocele ("empty" sella turcica), but was not responsible for it. This lesion was demonstrated by CT scan associated with the injection of Metrizamide. The surgical treatment (trans-sphenoidal approach) allowed complete cure of the fistula and its associated symptoms.

[Orthostatic arterial hypotension and giant aneurysm of the basilar trunk]. / Hypotension artérielle orthostatique et anévrysme géant du tronc basilaire.

The authors report two observations of giant aneurysm of basilar artery, where the first neurological signs were preceded or escorted by a postural hypotension. They emphasize the place of rhombencephon in the control of blood pressure and they bring together their cases with those reporting a postural hypotension revealing a lesion of medulla. They insist upon the necessity to look a peripheric and central neurological lesion in front of a postural hypotension.

[Evaluation of changes in gamma-glutamyltransferase in chronic treatment with antiepileptic agents]. / Evaluation des variations de la gamma-glutamyl-transférase lors des traitements chroniques par les antiépileptiques.

To know the intensity of liver enzyme induction during a treatment with anticonvulsant, the authors have measured gamma GT before and at the 7th, 30th, 60th days after a treatment by one of the 4 major anticonvulsant as phenobarbital, diphenylhydantoin, carbamazepine and sodium valproate. All alcoholic patients, and all the patients having a liver disease have been eliminated. The results show that diphenylhydantoin is the most important inductor of gamma GT with an elevation that can reach 312% of basal level, followed by phenobarbital, when sodium valproate and carbamazepine are the weakest inductors. More, induction by carbamazepine in women is more weak than in man. Age takes a place in intensity of induction with a major induction observed between 30 and 50 years old for phenobarbital, and above 50 years old for sodium valproate. These effects are not dependent of an hepatitis. The knowledge of the upper levels of gamma GT induction by anticonvulsant appear to us usefull for several reasons: carbamazepine and sodium valproate being the weakest inductors, they must be chosen in priority in women under contraceptive treatment. Any abnormal elevation of gamma GT need to look of an alcoholic intoxication, an hepatitis or a liver cancer.

[Interhemispheric disconnection syndrome in glioma of the posterior part of the corpus callosum]. / Le syndrome de disconnexion interhémisphérique au cours des gliomes de la partie postérieure du corps calleux.

The syndrome of interhemispheric disconnexion has been systematically researched in 10 cases of medial and posterior callosal tumours. The cases have been documented with CT Scann and two of them were anatomically verified. Two had a complete disconnexion syndrome; another, whose lesion was situated on the forceps major, had no sign of disconnexion. In the others, the semiology was proportional to the extent of the tumour, sometimes minimal and in this case, only corresponding to an extinction of the left ear in the dichotic test, which therefore appeared in our series as the most constant sign of a transfer-trouble. Among the other signs, left tactile anomia was found in two patients, left ideomotor apraxia in three, left visual anomia in five. Seven patients had a right constructional apraxia, which was bilateral in five of them. Left agraphia was noted in five patients, among which three had also a right hand dysgraphia, whose physiopathology is discussed. Tactile alexia was noted in three patients, two had a trouble of somesthesic information's transfer, one had a pure alexia (left occipital lesion plus splenium). Signs of hemispheric independence were uncommon: one patient presented a "foreign-hand sign".

[Value of a neurologic assessment when faced with the discovery of a cervical lesion using the Doppler method]. / Intérêt d'un bilan neurologique devant la découverte d'une lésion cervicale au Doppler.

Four situations are envisaged for which a Doppler "unravelling" examination in a patient with arteritis, conducted on a routine basis, led to the detection of stenotic or occlusive lesions of neck vessels. The first case concerns a patient with a recent or long-standing permanent neurological disorder related to an established cerebral lesion. Once the latter has been confirmed as being due to the cervical lesion then angiography is not always essential, since treatment of an established vascular accident is usually ineffective. The second case involves asymptomatic patients with a history indicative of one or more transient episodes suggestive of carotid or vertebro-basilar insufficiency. This situation is the one where most benefit can be obtained from future investigations. The case of a patient with "cerebral circulatory insufficiency" is discussed ant the different clinical pictures produced outlined, while emphasizing that this term should not be used too easily for all presenile intellectual deterioration states. Finally, the last situation is that of an asymptomatic patient (rarely referred to the neurologist for an opinion): various topoghraphic, clinical and paraclinical factors must then be assessed before deciding to continue or not with investigations.