Effects of an ectodermal microceptor preparation on motor coordination in cerebellar mutant mice.

Lurcher mutant mice, characterized by degeneration of the olivocerebellar system, and dystonia musculorum (dt) mutant mice, characterized by degeneration of spinocerebellar fibers, were treated with an ectodermal microceptor preparation (EMP), a compound containing natural substances derived from embryonic bovine ectodermal tissue, or with placebo, and evaluated in motor coordination tests. EMP-treated lurchers, but not dt mutants, were quicker to initiate movement than placebo-treated controls in the inclined beam test. No group differences were found in terms of distance travelled on the beam or in motor coordination assessed in a more challenging coat-hanger test. These results indicate that ectodermal microceptors may improve movement initiation of cerebellar-related disorders in animals, but that these effects are test and disease-specific.

[Prevalence of patent foramen ovale in young patients with ischemic cerebral complications]. / Prévalence du foramen ovale perméable chez les patients jeunes atteints d'accident ischémique cérébral.

We compared the prevalence of patent foramen ovale (PFO), detected by two-dimensional contrast echocardiography, in a group of 60 adults aged under 55 who had experienced a cerebral ischaemic accident and had normal standard examination of the heart, and in a control group of 100 patients. The prevalence of PFO was significantly higher in neurological patients (40 p. 100) than in controls (10 p. 100; p less than 0.001). Within the neurological group, the prevalence of PFO determined blindly, i.e. without any knowledge of the aetiological diagnosis, increased with the uncertainty of diagnosis: 21 p. 100 when a cause could be determined (n = 19), 40 p. 100 when a facilitating factor of cerebral accident, such as mitral valve prolapse, migraine or consumption of oral contraceptives, could be identified (n = 15), and 54 p. 100 when neither cause nor facilitating factor could be found (n = 26; p less than 0.10). In view of the very high prevalence of clinically silent venous thrombosis, these results suggest that paradoxical embolism through a PFO might be responsible for cerebral ischaemic accidents more frequently than is generally believed.

[Cerebral vascular accidents in young subjects. A study of 133 patients 9 to 45 years of age]. / Accidents vasculaires cérébraux des sujets jeunes. Une étude de 133 patients âgés de 9 à 45 ans.

We report 133 cases of strokes in patients aged 9-45 (male: 68, female: 65), mean age: 33.5 years. There were 112 arterial infarcts (84%), 9 venous infarcts (7%), 12 hemorrhages (9%). Among the arterial infarcts, 23 (20.5%) were due to a dissecting aneurysm, 17 (15%) to atherosclerosis, 13 (12%) to cardiac embolism. Echocardiography with contrast was performed in 69 patients showing a patent foramen ovale in 15. Mitral valve prolapse was present in 8, among which 5 had in addition a patent foramen ovale. Among 16 migrainous patients there were 7 dissecting aneurysms and 3 patent foramen ovale. Twenty two of 65 women were taking oral contraceptives at the time of the stroke. Strokes in patients taking oral contraceptives or during the puerperium accounted for 43% of the strokes in women. Ten cases (9%) have had no explanation. Venous infarctions were mainly due to puerperium and oral contraceptives. Hemorrhages were mainly due to arterial hypertension. No cause was found in 4/12 cases. The most useful investigations were angiography and echocardiography with contrast. This study confirms that extensive and early investigations are necessary in strokes in the young and particularly in women taking oral contraceptives, migraine patients and patients with mitral valve prolapse.

[Dissecting aneurysm of the internal carotid artery and isolated Claude Bernard-Horner syndrome]. / Anévrysmes disséquants de l'artère carotide interne et syndrome de Claude Bernard-Horner isolé.

In 2 cases of dissecting aneurysm of the internal carotid artery the only clinical sign was a Claude Bernard-Horner's syndrome, with pain in the neck and face.

Prevalence of patent foramen ovale in patients with stroke.

The cause of ischemic stroke in younger adults is undefined in as many as 35 percent of patients. We studied the prevalence of patent foramen ovale as detected by contrast echocardiography in a population of 60 adults under 55 years old with ischemic stroke and a normal cardiac examination. We compared the results with those in a control group of 100 patients. The prevalence of patent foramen ovale was significantly higher in the patients with stroke (40 percent) than in the control group (10 percent, P less than 0.001). Among the patients with stroke, the prevalence of patent foramen ovale was 21 percent in 19 patients with an identifiable cause of their stroke, 40 percent in 15 patients with no identifiable cause but a risk factor for stroke, such as mitral valve prolapse, migraine, or use of contraceptive agents, and 54 percent in 26 patients with no identifiable cause (P less than 0.10). These results suggest that because of the high prevalence of clinically latent venous thrombosis, paradoxical embolism through a patent foramen ovale may be responsible for stroke more often than is usually suspected.

Acquired ocular motor apraxia due to bilateral frontoparietal infarcts.

A case of acquired ocular motor apraxia in a 78-year-old man is reported. Disordered saccades and pursuit movements in the horizontal and vertical planes were recorded electro-oculographically. Magnetic resonance imaging showed bilateral border-zone infarcts, involving the frontal lobes and the superior part of the inferior parietal lobules.

[Dolichoectatic intracranial arteries. Association with aneurysms of the abdominal aorta]. / Artères Cérébrales dolichoectasiques. Association aux anévrysmes de l'aorte abdominale.

Dolichoectatic intracranial arteries (DIA) have been given several names, e.g. fusiform aneurysms, dolichomega-arteries. It is not an uncommon condition and it raises interesting points: 1) symptoms and signs result from compression (cranial nerve palsies; hydrocephalus) from ischemic or hemorrhagic episodes; 2) the diagnosis is made easier with CT since the arterial wall is often calcified; 3) the pathophysiology has long been assumed to be atherosclerotic in nature, but controversial assumptions are discussed; 4) associated arterial abnormalities are common: one of our cases and approximately half of the post mortem reported DIA were associated with aneurysm of the abdominal aorta. Two cases are reported here: 1) A 56 y/o male presented with progressive gait disorder, deafness and ischemic episodes. CT showed DIA and hydrocephalus. DIA involved the basilar artery, both intracranial carotid arteries, the abdominal aorta and probably one renal artery. A ventriculo-atrial shunt was performed unsuccessfully. Post mortem findings are reported; 2) A 52 y/o male had suffered from trigeminal neuralgia for about one year and from trigeminal permanent pain for two weeks. He had developed left hemiparesis and dysarthria. DIA involved the basilar artery and the left intracranial internal carotid artery. The right internal carotid artery and the right vertebral artery were hypoplastic. Clinical, radiographical and pathophysiological features are reviewed.

Chronic localised encephalitis (Rasmussen's) in an adult with epilepsia partialis continua.

A 29 year old male presented with epileptic fits, progressive left sided focal seizures and epilepsia partialis continua, increasing left hemiparesis and mental slowing. Death occurred 2 years after the onset of the illness. Lesions were limited to the right cerebral hemisphere. Hypertrophic astrocytosis was diffuse throughout the gray and white matter but was more severe in the deep cortical layers and U fibres, where it was associated with vacuolar changes and capillary proliferation. Sparse perivascular lymphocytic cuffs, rod shaped microglia and microglial nodules were present. No inclusion bodies were found. These clinico-pathologic features were similar to the cases described by Rasmussen. Only five necropsy cases of this rare disease have been reported previously, all in children. The aetiology is unknown.

[Recurrent multiple paralysis of cranial nerves. Gougerot-Sjögren syndrome]. / Paralysies multiples et récidivantes des nerfs craniens. Syndrome de Gougerot-Sjögren.

A 53 year-old woman presented with 6 episodes of recurrent cranial nerve palsies over seven years, each episode lasting several weeks. She had three episodes of diplopia, one of difficulty with swallowing, a left facial paralysis and two episodes of trigeminal sensory neuropathy. Sjögren's syndrome was diagnosed when the patient developed dryness of the eyes and mouth, 7 years after the first episode. The diagnosis was proved by biopsy of the accessory salivary glands, the presence of a hypergammaglobulinaemia and anti-tissue antibodies.

[Spasm or dimpling of the hypothenar eminence]. / Le spasme ou fossette de l'éminence hypothénar.

Bilateral hypothenar muscular spasm ("dimpling") was discovered in a 62 year-old man. The spasms consisted of recurrent arrhythmic contractions of the palmaris brevis muscle. E.M.G. showed no signs of denervation but the contractions could be stopped by infiltration of the ulnar nerve by xylocaine. Apparently, this syndrome has previously been reported in only two cases. Its clinical and electromyographic characteristics are similar to hemifacial spasm. Compression of the ulnar nerve after its division at the wrist could be a cause.

A cerebrovascular accident with unusual features.

A 64 y/o man experienced during 2 weeks TIA's or TIA's like episodes, once or twice a day, with or without contralateral pain in the head. CT Scans showed peculiar enhanced areas appended to the superior sagittal sinus. Angiography was refused. Twenty-seven months later during mild exertion a left frontal hematoma developed. Among frontal symptoms and signs laconism, abulia and a striking whispering were prominent. Angiography showed a dural arteriovenous fistula draining into cortical veins on the inner aspect of the left hemisphere. The fistula was successfully operated.

[Cortical blindness from Horton's disease (author's transl)]. / Cécité corticale révélatrice d'une maladie de Horton.

A 66 years old woman presented with occipital blindness during the course of a giant-cell arteritis. A favorable course obtained under treatment with corticoïds.