Mild encephalopathy with reversible splenial lesion: Description of nine cases and review of the literature.

Mild encephalopathy/encephalitis with reversible splenial lesion (MERS) is a transient clinico-radiological syndrome characterized by non-specific encephalopathy and specific magnetic resonance imaging (MRI) pattern. MRI shows an ovoid lesion in the mid-splenium of the corpus callosum (SCC), with signal-intensity anomaly similar to stroke but vanishing within few weeks. Although there are a lot of child MERS cases descriptions, there are just a few adult-onset reported. Our goal is to provide a better clinical and radiological description of this entity. We reported nine adult-onset cases of MERS managed in our stroke unit between 2017 and 2019. The study of our adult series suggests that epilepsy and the context of an infection are very common in MERS. Adult cases show frequent focal neurological deficits and few encephalopathies compared to children. The measurement of very low ADC values in SCC lesion is a new radiological feature of MERS that should be systematically assessed in suspected cases to differentiate this complex syndrome from SCC strokes.

Management of a Mobile Floating Carotid Plaque Responsible for Calcified Cerebral Emboli: A Double Sword of Damocles.

INTRODUCTION: The management of a rare case of calcified cerebral emboli associated with a mobile carotid plaque (MCP) is reported and discussed. REPORT: A 76 year old patient presented with sudden weakness of the left lower limb one month ago, which resolved spontaneously. A cerebral magnetic resonance imaging showed recent multiple infarcts in the right middle cerebral artery (MCA) territory. Computed tomography cerebral angiogram (CTA) revealed calcified cerebral emboli (CCE) in the right MCA territory and an isolated calcified embolus in the M3 segment of the right MCA. No calcification was observed in the aorta. The echocardiogram findings were normal. Trans-oesophageal echocardiography did not show aortic or mitral valve calcifications. A cervical duplex ultrasound (DUS) was performed and demonstrated a highly mobile carotid plaque located in the right carotid bifurcation, contrasting with static CTA imaging showing a common calcified plaque, probably because the plaque appeared against the carotid wall during image acquisition. Antiplatelet and anticoagulation therapy were initiated, and carotid endarterectomy was performed on day two to prevent further embolisation. One month follow up including carotid DUS was satisfactory. DISCUSSION: A case of mobile carotid plaque responsible for CCE which was diagnosed with DUS dynamic imaging is described, emphasizing the importance of multimodal imaging in such settings. Though the treatment of MCP remains controversial because of the paucity of published cases, carotid endarterectomy was considered to be the safest option to prevent recurrent stroke. Additional clinical data including large series and controlled trials are required to determine the best management of mobile carotid plaques with less than 50% diameter carotid stenosis.

[Non-motor symptoms of Parkinson disease and their management]. / Les troubles non moteurs de la maladie de Parkinson et leur prise en charge.

Non-motor symptoms of parkinson's disease and their management. Non-motor symptoms of Parkinson's disease are often the first manifestations of the disease before diagnosis is made. These symptoms are diverse: psychic manifestations such as anxiety, depression or behavioral disorders, dysautonomia, pain, alteration of smell or vision, and sleep disturbances. These symptoms can be dramatic and confounding such as those seen in nonmotor fluctuations. Altogether, non-motor symptoms contribute to the impairment of the quality of life of the patients. Therefore, they must be systematically analyzed, and, when possible corrected.

Les troubles non moteurs de la maladie de parkinson et leur prise en charge. Les signes non moteurs de la maladie de Parkinson sont souvent les premiers à se manifester, avant même que le diagnostic soit porté. Ils sont très divers : troubles psychiques comme les symptômes anxio-dépressifs ou comportementaux, dysautonomie, douleurs, troubles de l'olfaction, de la vision ou du sommeil. Ils sont parfois être spectaculaires et déconcertants comme c'est le cas des fluctuations non motrices. Dans tous les cas, ils contribuent à l'altération de la qualité de vie des malades. Ils doivent donc être recherchés systématiquement en consultation spécialisée et corrigés quand cela est possible.