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Biomedical subjects

F Lhermitte

Publications and source records attributed to F Lhermitte.

At least 109 records · Page 6Linked to original sources
PubMed1981

[Necrotic aspects of multiple sclerosis and Schilder's disease (author's transl)].

Two anatomo-clinical cases of a necrotic form of demyelinating disease are reported. The disease occurred in two women, had a late onset (patient were about 50 years old) and had a relapsing-remitting course during more than 10 years. The CSF displayed a high protein level over 125 mg/100 ml whereas the gamma-globulin level was normal. The anatomical study found symmetrical cavitations involving both hemispheres and optic tracts with clear-cut limits. Axons and myelin were both destroyed, only the vascular network being partially spared. At the lesion's border-line mononuclear cell infiltrates as well as some phagocytes with sudanophilic inclusions were found. The scarcity of the compound granular corpuscules suggest an old pathological process. A narrow zone of myelin-axonal dissociation was also observed. Astrocytic proliferations was unimportant. Blood vessels were normal. In one case plaques of multiple sclerosis were found in the spinal cord. Those two cases are unusual forms of a diffuse disseminated sclerosis: multiple sclerosis and Schilder's disease are considered as two anatomo-clinical variants of the same pathological process. The observed necrotic lesions are different from the acute necrotic forms of multiple sclerosis as the latter have rapidly developed. The long lasting course of the disease, over 10 years, allowed a complete resolution of the lesions explaining the cavitations. The late onset of the disease and the CSF high protein level are pointed out. The significant of the high protein level and normal gammaglobulin level in the CSF is discussed.

Brain↗
PubMed1981

[Asymptomatic multiple sclerosis - 3 cases (author's transl)].

Multiple Sclerosis (MS) cases found at autopsy in patients who had died from other diseases and in whom no sign or symptom could be related to MS are called "asymptomatic". Three cases are reported. The first patient was a 62 year old man who presented with a slowly progressive disturbance of gait, incontinence and deterioration of intellectual function. A falx meningioma was surgically removed. The patient died 3 years later with an acute respiratory illness. Examination of the brain disclosed evidence of the operation and numerous old plaques disseminated through the cerebral hemispheres (centrum semi-ovale, periventricular regions, internal thalamus and junction between cortex and white matter) and in the brain stem. The second case, a 77 year old woman with diabetes mellitus and hypertension, presented with cortical blindness and disturbances of memory of acute onset. She died one year later. Examination of the brain showed multiple infarcts involving the territories of both posterior cerebral arteries and the left middle cerebral artery. Numerous old plaques were seen in the periventricular regions, in the corpus callosum and in the left middle cerebellar peduncle. The third case, a 60 year old woman with mitral and aortic stenosis, presented with cortical deafness and transient right hemiparesis. She died 5 years later. Brain examination showed infarcts involving both middle cerebral artery territories. There was also many old plaques in the periventricular areas, thalamus, internal capsule, centrum semi-ovale, brain stem and right nucleus dentatus. In the 3 cases, the optic tracts were normal. The spinal cord, examined only in the first case, was also normal. The asymptomatic character of these MS cases can be explained first by the location of the plaques and the lack of spinal cord and optic tract involvement. It could also be due to the small size of the plaques and to axonal preservation. Such features are rare since our 3 observations have been selected from a pathological collection of 125 MS cases and 9,300 general neuropathological records. Six other cases have been previously reported by other authors.

Aged↗
PubMed1981

[Associative visual agnosia: role of the left hemisphere in visual perception (author's transl)].

Visual agnosia following ischaemic accidents of the left posterior cerebral artery is often associated with intellectual deficiencies, memory disorders, elementary perceptive disturbances and elements of visuoverbal disconnection, with the result that some authors reject the notion of visual agnosia. By using a relatively simple examination procedure it is, however, possible to clearly differentiate the various disturbances, as shown by the case of a right-handed 66-year-old man in whom this type of vascular accident occurred. Neither the reduced intellectual capacities nor the memory disorders can explain the differences observed in the treatment of visual stimuli, which was very disturbed, and the normal treatment of other types of stimulus. Elementary difficulties are not sufficient to prevent correct discrimination, as all tests of matching object, images, colours, and graphic signs were successfully accomplished. Identification was disturbed however: the patient could not show the use of objects presented visually, and this disorder is related to the visual characteristics of the stimuli, which excludes a simple visuogestural disconnection; results of tests of classifying types of object images, colours, and graphic signs were markedly abnormal. Naming of these stimuli was also affected, even when they were correctly identified; this results from the visuoverbal disconnection associated with the agnosia, but it is insufficient to account for it, as the patient could correctly use objects that had been wrongly named, but could not use those that had been poorly identified. This case, therefore, has enabled a visual identification disorder to be isolated independently from a discrimination problem, and visuoverbal or visuogestural disconnections. It is the significance of ths stimulus that is disturbed. In contrast, functional or categorical classification is respected in right temporo-occipital lesions. It is the individuality of a stimulus within a physical category which is disturbed.

Aged↗
PubMed1980

[Kinesthetic aphasia associated with a pseudothalamic syndrome (author's transl)].

Kinesthetic aphasia, as described by Luria, was evoked in a case of aphasia associated with a "pseudothalamic syndrome" of partial superficial Sylvian infarction. A neurolinguistic study of oral utterances enabled qualitative and quantitative analysis of the errors: the disorder is characterized by the high incidence of articulation substitutions. A comparative study differentiated such disorders of oral expression from other aphasic disorders of expression (arthric disorders and phonemic jargon). Kinesthetic aphasia is distinguished by this clinical specificity and by the site of the lesion in the anterior parietal region of the dominant hemisphere.

Aged↗
PubMed1980

[Possible effects of drawing on the language and re-education of an aphasic patient (author's transl)].

Various studies have demonstrated that the ability to draw may be unaffected in motor aphasia, and even in some cases of sensory aphasia when there is no associated constructive apraxia. An artist, who was both a satirist and a caricaturist, was followed up for three years during re-educational therapy following the onset of an overall aphasia, and this raises the problem of the possible effects of drawing on recuperation of language, and the role of the right hemisphere in this recuperation. The question arises as to whether drawing should be restricted to certain particular cases during re-education or be employed in a more general manner?

Adult↗
PubMed1980

[Neuropathological study of adult intracranial hemorrhage. III. Analysis of 107 meningeal hemorrhages due to rupture of arterial aneurysms].

The findings in 107 pathological studies of meningeal hemorrhages due to rupture of arterial saccular aneurysms are reported. There were 62 women (58 p. 100) and 45 men (42 p. 100). Mean age was 56, lower in men (53) than in women (58). 45 aneurysms of the Anterior Communicating Artery, 26 of the Middle Cerebral Artery, 15 of the Internal Carotid Artery, 10 of the Anterior Cerebral Artery, 1 of the Anterior Choroidal Artery and 10 of the Posterior System were studied. These ruptured aneurysms were compared to 31 non ruptured ones. Mean size of the ruptured aneurysms was 10, 62 mm, not statistically different from that of non ruptured aneurysms (9, 05 mm). Multiple aneurysms represent 10 p. 100 of the whole ruptured aneurysms population. They affected mostly the Middle Cerebral Artery. High blood pressure had been present in 56/107 cases of ruptured aneurysms (52 p. 100). The prevalence of high blood pressure in patients with ruptured aneurysms (men: 60 p. 100 between 35 and 49, 63 p. 100 between 50 and 64; women: 31 p. 100 between 35 and 49, 54 p. 100 between 50 and 64) was statistically higher than in the same age and sex ranges of the general French population. The other causes of bleeding were rare: 4 liver cirrhosis (2 of the patients were also hypertensive) and 5 anticoagulant therapies (2 of which were also associated with high blood pressure). Intracerebral hematomas were found in 43 cases (40 p. 100): 39 lobar, more frequent in the frontal (26) than in the temporal (13) lobes, due mainly to Anterior Communicating Artery and Anterior Cerebral Artery aneurysms; very few were in the basal ganglia (3) or brainstem (I). Intraventricular hemorrhage was found in 39 cases (36 p. 100). Forty (37 p. 100) cerebral infarcts had occurred. They were located in the territory of the same artery in 20 cases (19 p. 100), in a different territory in 11 cases (10 p. 100), in both in 9 cases (8. p. 100).

Adult↗
PubMed1980

[Paralysis of digestive tract with lesions of myenteric plexuses. A new paraneoplastic syndrome (author's transl)].

A 67 years old man was admitted on July 1979 for nausea, dysphagia and rectal pain. At age 64 he had undergone radiotherapy on the lower lip for an epidermoid carcinoma. He remained then healthy. His medical history was negative with the exception of chronic bronchitis. He had never been exposed to toxic agents or drugs and had never left Europe. A few days after admission he suffered acute intestinal obstruction but at laparostomy no etiology was found. At the same time the patient complained of pain in all four limbs and he was found to have diffuse wasting of muscles, areflexia and distal sensory loss. No sign of dysautonomia was present. Physical examination was negative with the exception of a cervical lymphadenopathy. The lymph node biopsy showed an undifferentiated metastatic carcinoma. Negative investigations included: blood cells count; serum ionogram and immunoelectrophoresis; thyroid function tests; serological test for Chagas' disease. The following abnormalities were found: ESR: 55-105; CSF protein: 145 mg/100 ml and 1 cell mm3; whole blood folic acid: 1,7 mg/ml; Hbs antigen was present in blood; EMG showed evidence of denervation but motor conduction velocities were normal. By September the patient's weakness had increased and complete intestinal obstruction persisted. At oesophageal, gastric and duodenal fibroscopy no contraction was visible, and biopsies were negative. The patient died of peritonitis on October 5th, 1979. At necropsy peritonitis secondary to multiple perforation of the large bowel was found. No recurrence of the lip carcinoma or metastase or evidence of a primary carcinoma was found. Light microscopy showed no evidence of amyloidosis or scleroderma. Examination of the alimentary tract showed abnormalities restricted to the myenteric plexuses which varied from one level to another. In the small bowel there was hyperplasia of the smooth muscle and the myenteric plexuses were enlarged by marked proliferation of Schwann cells. Severe neuronal loss and nodules of Nageotte were also noted. Schwann cells proliferation was less marked in the stomach and large bowel. Lympho-histiocytic infiltration strictly confined to the region of the myenteric plexuses was present in oesophagus, stomach, large bowel and rectum. Mild chronic inflammatory lesions were also found in anterior and posterior spinal roots and semi-lunar ganglia. The striking feature of this case is the association of an undifferentiated carcinoma and a polyradiculoneuritis with a complete alimentary tract palsy of rapid onset, secondary to lesions restricted to the myenteric plexuses. The low folate level was insufficient to explain the neuropathy. Investigations showed no evidence of the usual causes of intestinal pseudo-obstruction: muscular, dysautonomic, toxic, plexic (idiopathic, familial, inflammatory), Chagas' disease). The clinical course, the pathological pictures of the alimentary tract and spinal roots and the association with a carcinoma suggest that our case may represent a paraneoplastic syndrome...

Aged↗
PubMed1980

Analysis of visual evoked responses in multiple sclerosis.

In Multiple Sclerosis (MS) the modification of the latency of visual evoked responses (VER's) shows sequels of the involvement of anterior optic tracts manifested by a retro-bulbar optic neuritis (RBON). This study was made on 102 patients with MS. The stimulus used the pattern reversal of a checkboard. The influence of the size and squares 8' and 20' chosen as stimulus has been first studied in patients with antecedents of RBON. Using the 8' squares, all eyes with a history of RBON had pathological VER's. When there is no clinical antecedent of RBON, this means of stimulation enabled us to detect sequels of RBON. In "definitive" and "probable" MS, 100% of patients had pathological VER's either for both eyes of a single eyes. In "possible" MS a sequel of RBON was demonstrated in 57% of this population without clinical antecedent of RBON. A correlation between VER's result and the ophthalmological examination (visual acuity, fundoscopic examination and acquired dyschromatopsie) was made. Although VER's are an excellent method for detecting the sequels of RBON in MS. VER's abnormalities have no etiological significance, they are observed in other neurological involvements of anterior optic tracts. These different points are discussed and a physiological interpretation of VER's abnormalities is proposed.

Color Perception↗
PubMed1979

[Diagnosis of cerebral hemorrhages. A report of 247 anatomo-pathological cases (author's transl)].

A series of 247 cases with simple and apparently primitive cerebral hemorrhages selected from the pathological records of Charles Foix laboratory from 1962 to 1977 is reviewed with regard to the accuracy of the premortem diagnosis as a function of the size, the location and the age of the bleeding, the patient's age, the practices of angiography or lumbar puncture and the considered period of death. The clinical diagnosis of cerebral vascular disease was made in 75% of the cases from that serie but the hemorrhagic mechanism was identified only in 50,6% of cases. The diagnosis accuracy was enhanced in large and recent hemorrhages occuring in patients under 70 years old. It seemed better in cerebellar and intermediate locations. It was enhanced in more recent observations (collected since 1974). The practice of cerebral angiography and lumbar puncture rose up (in a somewhat equivalent way) the proportion of accurate diagnoses. The lumbar puncture practice was not associated with a higher rate of cerebral herniae.

Adult↗
PubMed1979

Bromocriptine associated with a peripheral dopamine blocking agent in treatment of Parkinson's disease.

A peripheral dopaminergic blocking agent, domperidone (60 mg daily), or placebo was given, double-blind, to 17 parkinsonian patients who also received increasing doses of bromocriptine. Combined treatment with domperidone reduced total disability by 76% in 8 patients receiving a mean dose of 148 mg of bromocriptine daily. There was no vomiting and involuntary movements and psychic disturbances were similar to those in patients on levodopa and a peripheral decarboxylase inhibitor. In 9 patients taking placebo instead of domperidone, the average daily dose of bromocriptine could not be raised beyond 92 mg. The mean total disability score in this group was reduced by only 48%. Thus, peripheral blockade of dopamine receptors is a promising means of limiting the adverse side-effects of the treatment of parkinsonism with central dopaminergic receptor stimulating agents such as bromocriptine.

Adult↗
PubMed1979

[Crossed aphasia with jargon aphasia in two right-handed patients (author's transl)].

Two cases of crossed aphasia in right-handed patients are reported. The oral language of these two patients was characterized by a reduction in its lexical and grammatical content. Their written language, however, was a veritable jargon with anosognosia. The jargon aphasia of the first patient consisted mainly of neologisms. The written language of the second patient was slightly less disorganized and corresponded to an asemantic jargon. The existence of this jargon aphasia gives these two observations an exceptional character in relation to other cases of crossed aphasia in right-handed patients. It supplies new information which can be the basis for discussion on the relations between cerebral laterlization of language functions and manual preference.

Aged↗
PubMed1979

[Neuropathological study of adult intracranial hemorrhage. General data in 500 cases].

The systematic pathological study of 500 patients with intracranial hemorrhages (ICH) [341 (68 P. 100) CEREBRAL HEMORRHAGES (C.H.); 119 (24 p. 100) meningeal hemorrhages (M.H.); 39 (7,8 p. 100) subdural hematomas (S.H.) and, at last, one extradural hematoma] has been practiced. Those cases were issued primarily from neurological and, at a lesser degree, from neurosurgical departments. Etiological data, complications, associated findings and causes of death have been analysed. High blood pressure is the main etiological factor in C.H. This is confirmed by the statistical comparison between the incidence of this factor in our material and in the whole French population. However, nearly 50 p. 100 of ICH occuring in normotensive patients are C.H. The incidence of cirrhosis is much higher in our study than in other reports from the literature. The frequently associated high blood pressure does not seem to enhance the incidence of CH in patients with liver cirrhosis. Although this last factor can be found alone, its real etiological importance in CH cannot be assessed on account of the lack of data concerning the incidence of liver cirrhosis in the French population. The incidence of anticoagulant therapy is high in S.H. On the contrary, this factor does not seem to enhance the risk of high blood pressure induced C.H. The traumatic etiology of S.H. is significantly higher than the anticoagulant therapy etiology which, however, is very high in our study.

Adult↗