Neurological sequelae after cerebral anoxia.

PRIMARY OBJECTIVE: Cardiac arrest can cause neurological impairment. The aim of this study is to confirm the disability and the predominant part of executive and behavioural impairments after cardiac arrest. RESEARCH DESIGN: A retrospective study is proposed. METHODS AND PROCEDURES: All consecutive patients admitted to the Department of Rehabilitation for Neurological Impairments following cerebral anoxia after cardiac arrest between 1995-2007 were included. Clinical and neuropsychological assessment was proposed. MAIN OUTCOMES AND RESULTS: Thirty patients, 19 men, were examined. Ages ranged from 16-58 (mean = 39.5). Fourteen patients presented with severe disability and 16 patients presented with moderate disability. In the first group (severe disability) no patients were autonomous for daily life activities. They presented with dysexecutive syndrome and behavioural disorders associated with amnesia syndrome; 64% of them presented with motor disorders. In the second group, patients with moderate disability were autonomous in daily life but not for the complex activities or functioning. They had no motor impairment but suffered from executive and memory impairments. Behavioural changes were noted. Medical history or demographic data did not differ between the two groups. CONCLUSION: The study confirms the predominant part of executive, memory and behavioural impairments after cardiac arrest. This retrospective study cannot provide prognosis factors and further prognosis studies are needed.

[Perineal electrical stimulation and rehabilitation in urinary incontinence and other symptoms of non-neurologic origin]. / Electrostimulation et rééducation périnéale de l'incontinence urinaire et des troubles mictionnels non neurologiques.

A literature survey of 106 articles shows that standard electrostimulation is an effective treatment of urinary incontinence and urinary disorders with bladder instability. Bladder inhibition is obtained by applying an alternating current at a frequency of between 5 and 25Hz and with a pulse width of between 0.2 and 0.5ms. In 19 articles (including three randomized, placebo-controlled studies), good results were achieved in 60 to 90% of cases, depending on the exact method (i.e. chronic or acute stimulation). Standard electrostimulation is also efficient in stress urinary incontinence. Urethral closure is obtained by applying a 50Hz alternating current with, again, a pulse width of between 0.2 and 0.5ms. In 21 articles (including two randomized, placebo-controlled studies), good results were achieved in 47.5 to 77% of cases. Treatments combining perineal rehabilitation (behavioural education, muscle improvement and biofeed-back) and electrostimulation are reported by 10 authors, with good results in 70 to 80% of cases after 10 to 12 sessions. According to 14 studies, neuromodulation is also an efficient treatment for complex urinary disorders, urgency, pollakiuria and dysuria. The recommended stimulation parameters are a frequency of 10 to 15Hz and a pulse width of 210ms. Good results were found in 34 to 94% of cases (with between 60 and 75% in an international, multicenter study). The overall results different from one study to another because of the need to harmonize stimulation parameters, choice of the study population and treatment follow-up with self-training programs and therapeutic education.

[Fantastic confabulations or delusion?]. / Confabulations fantastiques ou délire ?

INTRODUCTION: Confabulations are inaccurate narratives purporting to convey information about the world or the self. Fantastic utterances from brain-injured patients are difficult to interpret as confabulation or delusion. METHODS: Starting from two clinical observations, we analyse the terms "spontaneous confabulations" and "delusion". RESULTS: Two brain-injured patients presented with fantastic utterances; the adhesion was complete for both patients. They also suffered from amnesic and executive disorders. Clinical interviews with neuropsychologist and psychopathologist could not distinct between spontaneaous confabulations and delusion. DISCUSSION: Neuropsychological interpretations of spontaneous confabulations are (1) the deficient strategic retrieval process arising from executive failures and (2) confusion of the temporal order of information within memory. These hypotheses cannot explain the fantastic utterances described. Are spontaneous fantastic confabulations a specific entity or did these patients present a morbid association of neurological and psychiatric disorders? Fantastic confabulations are very scarcely described and the association of neurological and psychiatric impairments enables us to better describe the clinical observations. Spontaneous confabulations reported after amnesic and executive disorders are indeed typically composed of the patient's past experiences and do not usually comprehend fantastic utterances. CONCLUSION: Neurological and psychological analyses of the fantastic utterances from two brain-injured patients do not respond to the definition of spontaneous confabulation. Fantastic confabulations are a rare entity and we propose another explanation consisting of the association of neurological and psychiatric disorders.

[Sensory syndrome and aphasia after left insular infarct]. / L'insula, une île oubliée? Troubles sensitifs et troubles du langage après infarctus insulaire gauche.

INTRODUCTION: Sensorial impairment without hemiplegia is usually caused by a thalamic lesion. CASE REPORT: A 28-year-old woman presented with hemianesthesia associated with aphasia following a left insular lesion, subsequent to subarachnoid hemorrhage. Brain MRI Flair sequence revealed a high intensity signal in the left insular and frontal subcortical regions. Insular infarct was diagnosed, associated with hemorrhagic sequelae. DISCUSSION/CONCLUSION: Study of the normal and pathologic insular cortex suggest several implications of the region in somatosensory and language functions. However, the insular cortex has been mainly associated with central pain. Lasting objective hypoesthesia has been very rarely documented. The left insular cortex has also been implicated in speech apraxia but our patient presented with fluent aphasia mostly affecting the rhythm of speech, as it has been observed in thalamic aphasia.

Intrathecal baclofen for treatment of spasticity of multiple sclerosis patients.

We conducted a retrospective study of the case files of 64 multiple sclerosis (MS) patients presenting severe spasticity, who had received intrathecal (IT) baclofen test injections between 1992 and 2004 in a rehabilitation unit. In almost all cases of our series, IT baclofen was proposed to patients who were no longer able to walk. IT baclofen is a safe and effective treatment to reduce spasticity in MS patients. Despite an advanced stage of the disease at the time of pump placement, the complication rate was low and the efficacy of this treatment was maintained over time.

[Multiresistant bacteria colonisation in rehabilitation units]. / Colonisation à bactéries multirésistantes en service de médecine physique et réadaptation.

The objective of this study was to evaluate the management of multiresistant bacteria infection in French rehabilitation units. We e-mailed a questionnaire to French rehabilitation practitioners asking them what they did and what they knew about multiresistant bacteria colonisation. Their answers are described and analysed. We received 60 answers representing most of the country's rehabilitation centers. Routine screening was rare, but multiresistant bacteria were often looked for when certain risk factors were present. Methicillin-resistant Staphylococcus aureus and multiresistant enterobacteria were the usual target germs. In general, respondents asked for evidence-based recommendations that are also applicable without too great a prejudice (for the rehabilitation as well as for the psychological state) for a patient hospitalised in a rehabilitation unit. The legal risks and the costs involved are also to be tested. Many questions lay unanswered, although the literature is rich in descriptions of this area. The opposition between the medical advice of isolation and the readaptation objectives of a rehabilitation unit are strong. This study aims to highlight the most important uncertainties so as to promote prospective studies and enlighten the legal authorities.

Aseptic meningitis after intrathecal baclofen injection.

STUDY DESIGN: Two case reports of aseptic meningitis after intrathecal baclofen injection. OBJECTIVES: To report an unusual complication of intrathecal baclofen injection during test injections. SETTING: Department of Neurological Rehabilitation, R Poincaré Hôpital (Paris-Ile de France-Ouest University). CASE REPORTS: We present two cases of chemical meningitis after intrathecal baclofen injections by lumbar puncture. These cases presented with febrile meningeal syndromes during the 24 h following intrathecal baclofen injection. Direct cerebrospinal fluid (CSF) examination and CSF cultures were negative. An intense cellular reaction was observed with a marked predominance of neutrophils. Meningitis resolved spontaneously over 3-4 days. CONCLUSIONS: Chemical meningitis is a rare complication of intrathecal baclofen injections that must be recognized. It is a diagnosis of exclusion and its pathophysiological mechanism remains unclear.