[Acute myelitis after immunization against hepatitis B with recombinant vaccine].
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Biomedical subjects
Publications and source records attributed to C Belin.
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We report the assessment by MRI of a case of radiculomyelitis after vaccination against tetanus-poliomyelitis. In the acute stage the appearance was an isolated myelitis of the conus medullaris with contrast enhancement. The upper thoracic cord presented central areas of high signal intensity on T2 weighted images. Rapid clinical recovery was correlated with resolution of abnormal enhancement. Follow-up MR at 5 months showed persistence of slight T2 prolongation in the conus medullaris and syringohydromyela of the thoracic cord. A single lesion of the spinal cord is a rare presentation of acute disseminated encephalomyelitis, the course of such lesions, to date not previously displayed by MR, is unknown. Proper diagnosis should help prevent administration of further vaccine doses.
Three cases of visual illusion of obliquity were observed. This rare disorder is due to impaired of panorama/vertical orientation. When present, special care must be given during visual correction to spatial orientation of the perceived image in the vertical axis.
Reading associates a perceptive time, a motor time and a cognitive time, all three phenomena being extremely interdependent. After a review of the physiological mechanisms of reading, the authors discuss, on the basis of experimentation in the normal subject, the results of a study involving electro-oculographic recording of reading.
Single photon emission computed tomography (SPECT) using 99mTc-bicisate and N-isopropyl-p-[123I]iodoamphetamine ([123I]IMP) was compared in 25 patients suffering cerebral ischemia during the subacute phase (7-14 days) of stroke. Patients were classified as cortical strokes (15) and subcortical strokes (10) according to clinical and CT data. Images were analyzed by five independent blinded observers. Then, using a cross-matching method between normal and abnormal brain areas, we evaluated the sensitivity and specificity for 99mTc-bicisate and [123I]IMP and inter- and intraobserver reproducibility. A semiquantitative analysis was performed to compare abnormal hypoactive areas versus the corresponding contralateral areas for 99mTc-bicisate and [123I]IMP in the two patient groups. There was no significant difference for sensitivity and specificity between 99mTc-bicisate and [123I]IMP. Matching was approximately 90% in the two groups. The kappa-concordance index was satisfactory and slightly better for 99mTc-bicisate (0.485) than for [123I]IMP (0.435). Level of hypoactivity in the abnormal areas was significantly higher for 99mTc-bicisate (p < 0.03, n = 25) than for [123I]IMP, especially for cortical strokes. This comparative study demonstrates that 99mTc-bicisate is a very useful tracer for the detection of focal cerebral ischemia by SPECT during the subacute phase of stroke.
Visual perseveration and palinopsia are defined as the persistence or the reappearance of the visual image. These infrequent symptoms are thought to be linked to the right hemisphere posterior areas. We report a case of this syndrome in which the initial fixation was foveal. The palinoptic image was sometimes moving. This suggests that palinopsia is due to a dysfunction of the visual memory, rather than of the visual system: this dysfunction may be related to hyperactivity of the visual buffer.
Gerstmann-Sträussler-Scheinker's disease is a familial spongiform encephalopathy whose pathological hallmark is the existence--especially in the cerebellum--of numerous amyloid plaques. We report here the third clinicopathological case in a French family. Brain tissue from one of its members--initially described as familial Creutzfeldt-Jakob's disease--has been reported as successfully inoculated to monkeys. We present the currently accumulating data favouring the hypothesis of a common etiology for familial Creutzfeldt-Jakob's disease and Gerstmann-Sträussler-Scheinker's disease. The familial characteristics, resulting in different durations of incubation and evolution, could lead to different clinical and histological expressions.
Tachistoscopy is an experimental method used to study processes involved in hemispheric specialisation and the lateralisation of cerebral functions. The authors review the various findings emerging from this technique and briefly assess its methodological constraints.
The authors study the tachistoscopic recognition of Arabic words in Arabic speakers. This study shows that Arabic words are read by Arabic speakers in the same way as French words by French speaking readers. Under such circumstances, the direction of reading appears to be less important than hemispheric specialisation.
Three cases of patients with lateral gaze palsy due to brainstem lesion were studied. They underwent a non-verbal dichotic listening test which evidenced a significant decrease of performance in the ear located on the same side as the lesion. This result can be interpreted as an inter-hemispheric imbalance linked to the pathological gaze deviation.
A right-handed woman who became blind at 25 was a good braille reader. After a right parieto-occipital brain damage, she developed a braille reading disorder which contrasted with a completely normal language. This reading disability cannot be analysed in terms of left hemineglect syndrome; rather, it is explained in the broader context of the patient's haptic disorders in many others fields. This hypothesis is connected to others works which suggest a right hemispheric specialization for tactile information processing.
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In 15 patients with a recent ischaemic cerebral vascular accident computerized tomography (CT) of the brain was normal whereas scintigraphy, performed at the same time, clearly showed the ischaemic area. These discordant findings may be interpreted as false-negative CT results. Factors such as the time elapsed between the cerebral accident and the CT examination, and the use or non-use of an intravenous contrast injection are discussed. It seems that the key factor is the proximity of the ischaemic lesion to the surface of the brain: cortical necrosis is undetectable at CT but distinctly visible at scintigraphy.
Periodic alternating ping pong gaze (PAPPG) represent a particular entity among abnormal ocular movements sometimes observed during coma. They usually result from a widespread bilateral hemispheric ischemia. A case of PAPPG is reported that presents a twofold particularity: the lesion responsible for the abnormal movement, although eventually bilateral, was initially unilateral, and the PAPPG were intermittent and associated with a Cheyne-Stokes respiration. This latter finding requires reconsideration of the nature of the stimulus responsible for this curious abnormal ocular movement.
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PK 11195, an antagonist of the peripheral type benzodiazepine receptor, does not affect either the duration of the action potential or the tension of the guinea pig papillary muscle. However, it antagonized the effects of the calcium channel blockers, nitrendipine, verapamil, diltiazem, and of BAY K8644, a calcium channel agonist in this heart preparation. On the other hand, PK 11195 does not change the increase in the action potential duration provoked by the potassium channel blocker tetraethylammonium. RO5-4864, an agonist of the peripheral type benzodiazepine receptor, decreased the tension of the guinea pig papillary muscle. The effect was reversed by increasing extracellular Ca2+ concentrations up to 4 mM. These results suggest that in the heart the peripheral type benzodiazepine receptors are coupled to calcium channels.
RO5-4864 decreased in a dose-dependent manner the duration of intra cellular action potential and the contractility in the guinea pig papillary muscle. Diazepam was less active and clonazepam inactive. The effects of RO5-4864 were blocked by PK 11195 but not by RO15-1788. These results indicate that peripheral type benzodiazepine binding sites are pharmacological receptors. PK 11195 antagonized the increase and the decrease in the duration of intracellular action potential induced by BAY K-8644 and calcium channel blockers (nitrendipine, diltiazem, verapamil) respectively but not the increase induced by tetraethylammonium which blocks potassium channel. Moreover the decrease in contractility provoked by RO5-4864 was antagonized by 4 mM Ca2+. Thus peripheral type BZ receptors are coupled with Ca2+ channels in the heart.