[Siderosis of the brain and spinal cord. Report of two cases]. / Sidérose cérébrale et médullaire. A propos de deux observations.

Two cases of superficial siderosis of the brain and spinal cord with cochleovestibular and cerebellar symptoms are diagnosed on brain and spinal MRI scans. Low signal intensity lines are noted on the surface of the brainstem, cerebellum, spinal cord and within the interhemispheric and sylvian fissures. In one case, no brain or vascular malformation is identified; in the second case, two cavernous angiomas are noted on the MRI study. 3D CISS may visualize thickening of the cochleovestibular nerve.

[Computer tomography changes in multiple sclerosis (author's transl)]. / Aspects tomodensitométriques évolutifs de la sclérose en plaques.

An attempt is made to evaluate the semiological data supplied by computer tomography, following its use on several occasions in 4 patients with multiple sclerosis. Three known signs in the encephalic forms are defined: cerebral atrophy, low density plates of sclerosis that do not take up the contrast medium, and those that do. These localized lesions are distinguished by their frequent multiplicity, often periventricular location, and absence of a mass effect. The semiological value of these signs involves discussion on the poor results of statistical evaluation, the significance of histology examination results, which are still being studied, and more particularly the variability, the best evidence of which seems to be the beginning and/or the changes occurring in contrast medium uptake. To this major diagnostic argument can be added the discovery of multilocular lesions which are sometimes present without clinical manifestations. Computer tomography is an essential procedure for establishing the differential diagnosis of multiple sclerosis, avoiding numerous valueless arteriographies, is a fundamental method for early positive diagnosis, and perhaps an element for establishing prognosis.

[Disseminated sclerosis: diagnostic value of neurophysiological investigations (author's transl)]. / Sclérose en plaques: valeur diagnostique des explorations neurophysiologiques.

Demyelinisation lesions of disseminated sclerosis actually present within the white matter are much more numerous than clinical manifestations would suggest that the majority of these lesions are clinically latent. Ophtalmologists were the first to seek a functional deficit reflecting the demyelinisation which so often affects the optic pathways. In practice, the recording of evoked visual potentials has proved to be the most reliable method. The brain stem is another region where demyelinisation lesions are frequent and quite often latent. Electronystagmography offers a highly sensitive means for the investigation of internuclear connections, whilst other authors use evoked auditory potentials. Similarly, evoked somaesthesic potentials make it possible to reveal lesions of the lemniscal tract.

[Use of cerebral computer tomography for the diagnosis of multiple sclerosis]. / Apport de la tomodensitométrie cérébrale au diagnostic de la sclérose en plaques.

The authors describe computer tomography findings in multiple sclerosis (MS)), and attempt an evaluation of the value of cerebral computer tomography for the diagnosis of this disease, especially those forms in which the clinical diagnosis is uncertain. A total of 33 patients, 15 men and 18 women, were studied. According to McAlpine's criteria, 21 patients had established MS, 2 were probably MS cases, and the other 10 were possible cases of the disease. The scanner used was an EMI 1010 apparatus giving 13 mm thick sections, with a matrix of 160 X 160. A contrast medium was injected systematically. Abnormal computer tomography results were noted in 28 of the 33 patients, including one or more low density areas in the white substance in 26 patients, taking up of the contrast medium after injection in 10 patients, and cerebral atrophy in 24 patients. Cases where only one of these anomalies was present are rare, and the various anomalies noted on computer tomography are usually associated in varying proportions. In most cases, the computer tomography findings were not related to any specific clinical picture. In cases of established MS, computer tomography can provide information on the extension and progression of the lesions at the time of examination. Out of the 12 cases in which clinical diagnosis was uncertain, 9 presented abnormal findings (low densities and/or taking up of contrast medium); the level of CSF gamma-globulins was normal in 4 of these 9 patients; visual evoked potentials were not altered in the 5 out of these 9 patients studied. In 3 patients with medullary signs, several low cerebral trunk and white substance of the cerebral hemispheres. When diagnosis is uncertain, cerebral computer tomography is the method of choice for demonstrating latent MS lesions of a certain type: it complements neurophysiological studies (visual, auditory, and somesthesic evoked potentials), used at the present time for the diagnosis of MS by exploration of the optic tracts and cerebral trunk.