Dementia in a 58-year-old woman.
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AIDS-Related Opportunistic Infections↗
Biomedical subjects
F Sellal
Publications and source records attributed to F Sellal.
Vertebral haemangiomas with spinal cord compression: the place of preoperative percutaneous vertebroplasty with methyl methacrylate.
We report on cervical and two thoracic vertebral haemangiomas with neurological disturbance successfully treated by percutaneous vertebroplasty followed by decompression surgery. Vertebroplasty consolidates the vertebral body and reduces the risk of haemorrhage. Subsequent surgery may be limited to decompressive laminectomy and resection of the epidural extension of the haemangioma. embolisation was also carried out in one case. Complete neuroimaging workup, including CT, myelo-CT and MRI, is necessary prior to treatment.
Bone Cements↗
[Subcortical dementia].
Subcortical dementia, a concept introduced 20 years ago, is a clinical entity characterized by memory disorders, an impaired ability to manipulate acquired knowledge, important changes of personality (apathy, inertia or depression), slowed thought processes (or bradyphrenia). It is also marked by overwhelming signs of frontal dysfunction. Cognitive and behavioural disturbances are frequently combined to movement disorders (tremor, chorea, dystonia etc). Anatomical, clinical and scintigraphic data suggest that the frontal signs result from a disconnection of the frontal cortex from the basal ganglia. Therefore it is probably more accurate to use the term subcortico-frontal dementia. This pattern of dementia, clearly different from a cortical dementia as dementia of Alzheimer's disease, may be described in a wide range of diseases which mainly involve the subcortical areas: some cases of Parkinson's disease, Progressive Supranuclear Palsy, Huntington's disease, Wilson's disease, the état lacunaire, multiple sclerosis and so on. The concept of subcortical dementia has allowed a better understanding of the role of the basal ganglia and their cortical connections in cognition and behavior. Its neurochemical substrate remains poorly characterized, although the ascending dopaminergic and cholinergic pathways seem to be good candidates, at least in Parkinson's disease.
Brain Diseases↗
To be or not to be at home? A neuropsychological approach to delusion for place.
A woman, LB, while in recovery from a viral encephalitis, exhibited a delusion for place, which led her to insist that she was at home, in spite of compelling evidence to the contrary. Later, she developed a Capgras syndrome, that is, another misidentification syndrome. The patient was given a detailed neuropsychological evaluation to shed light on the mechanisms underlying her delusional misbelief. Two main deficits were in evidence: (1) a severe visual-spatial impairment, giving the patient a distorted perception of her surroundings; and (2) frontal lobe dysfunction, which played a critical role in her impulsive responses and lack of self-awareness. The pathogenesis of delusion for place and persons if discussed in light of these observations.
Awareness↗
[The man with 6 arms. An analysis of supernumerary phantom limbs after right hemisphere stroke].
Consequently an infarct in the territory of the right middle cerebral artery, a 77-year old man had a complete left sensory motor hemiplegia, with left neglect. For several weeks, he described the existence of one and more supernumerary phantom limbs. The patient's adamant and delusional conviction of their reality caused him considerable distress. Without being anosognosic he was not completely aware of his disorder, and had slight difficulties in judging what was plausible. The mechanisms underlying this delusion concerning specific parts of the body probably involve multifactorial disorders: first, a sensory deafferentation source of a distorsion of the perceived body schema; second, a resulting discrepancy between the perception of the body schema and its innate representation; third abnormalities of self-awareness and of self-judgement, leading the patient to argue forcellully in favor of incongruous rationalizations.
Aged↗
Nocturnal paroxysmal dystonia: a clinical form of focal epilepsy.
Different paroxysmal movements occur during sleep. They correspond either to epileptic seizures of sleep, or to parasomnia. Recently, other nocturnal motor phenomena have been described in the literature as nocturnal or hypnogenic paroxysmal dystonia (NPD), paroxysmal arousal, episodic nocturnal wanderings, etc. The NPD are involuntary nocturnal movements characterized by the association of dystonic postures, tonic movements of the four limbs and the body axis, automatisms, affective mimicry, and vocalization. In certain patients, the EEG records show abnormalities characteristic of epilepsy; in others, the EEG appears normal. A large proportion of the patients present epileptic seizures as antecedents. Typical generalized tonic-clonic seizures can follow an NPD. The NPD are improved with anti-epileptics. The considerable similarity of the clinical and paraclinical signs and of the effects of anti-epileptic treatments do not seem to justify the individualization of different subgroups as a function of the EEG patterns: the NPD are always the result of focal epilepsy, and never of a pathology of movement or of parasomnia. Numerous arguments based on the symptoms and the EEG suggest that these seizures involve the mesial frontal regions.
Adult↗
[Encephalopathy and Hashimoto thyroiditis].
A generalized epileptic seizure revealed a subactute encephalopathy which was attributed to Hashimoto's thyroiditis. Primary biliary cirrhosis was also discovered. The encephalopathy rapidly followed a favourable course under corticosteroid therapy, which confirms that it was an immune disease.
Adult↗
[Memory and benzodiazepines].
Benzodiazepines (BZs) affect acquisition of new information, while retrieval of already learned information is unimpaired. The variability of this effect is important and depends on the nature of the BZ, its dose, the route of administration and the susceptibility of the subject taking the drug. This last factor depends itself on the anxiety level, the age, and a less known idiosyncratic susceptibility of the patient. Finally, there is probably a partial tolerance for the amnestic action of BZs, which explains the fact that the most dramatic amnesias have been described after administration of a single dose of BZ, taken by a patient unaccustomed to BZs. The value of pharmacocinetic and pharmacodynamic characteristics in predicting cognitive impairment remains misunderstood, even though in clinical practice the greatest amnestic effects have been described with short-acting BZs. The interest of studying BZs induced amnesia rely upon several arguments: first, it can be an harmful side-effect, which could be avoided or at least predicted by a better knowledge of BZs and the synthesis of new and more specific drugs; secondly it is an interesting model of organic amnesia, which could allow a better understanding of normal memory.
Adult↗
Electroclinical signs of benign neonatal familial convulsions.
Benign neonatal familial convulsions comprise a distinct epileptic syndrome with an autosomal mode of transmission. The electroclinical signs of seizures in this syndrome are not yet well defined. In 3 children from two families presenting with benign neonatal familial convulsions, 14 seizures were recorded during electroencephalographic (EEG)-video sessions. All seizures occurred during sleep, after a short arousal reaction. Seizures started with bilateral, symmetrical flattening of the EEG for 5 to 19 seconds; simultaneously there was apnea and tonic motor activity. The EEG flattening was followed by a long (1-2-minute) bilateral discharge of spikes and sharp waves; simultaneously, there were vocalizations, chewing, and focal or generalized clonic activity. The prominence of EEG and motor abnormalities varied between the left and the right from one seizure to the next in any given child. The seizures stopped without EEG or clinical postictal depression. These electroclinical observations suggest that the convulsions of benign neonatal familial convulsions are a form of generalized tonic-clonic seizure whose expression may be asymmetrical, probably because of the immaturity of the corpus callosum or other structures ensuring seizure synchronization.
Adult↗
Nocturnal paroxysmal dystonia.
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Athetosis↗
A case of symptomatic hemidystonia improved by ventroposterolateral thalamic electrostimulation.
A 16-year-old boy presented with a left anterothalamic lesion secondary to an extradural hematoma. A few months later, a right hemidystonia developed. The dystonic posture, which predominated in the right hand, was not associated with any motor deficit or sensory loss. Superficial sensory stimulation of the right palm and forearm and proprioceptive stimuli induced by passive movements of the right thumb decreased the dystonic posture. Electrical stimulation of the left ventroposterolateral nucleus of the thalamus induced a dramatic improvement in the dystonic postures and movement of the upper right limb. This finding suggests that the role of tactile and proprioceptive stimulation should be analyzed in patients presenting with a symptomatic hemidystonia. When such sensory stimulation is effective, thalamic stimulation may be tried in patients whose condition is incapacitating.
Adolescent↗
'Pinocchio syndrome': a peculiar form of reflex epilepsy?
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Deception↗
[Tick-borne encephalitis in Alsace].
Central European tick-borne encephalitis is mainly found in Central European countries and Austria where hundreds of cases are reported each year. Apart from 2 cases diagnosed in Alsace in 1968 and 1970 respectively, this disease was hitherto unknown in France. We report 8 new cases observed in Alsace between 1985 and 1990. Clinical presentation in these 10 patients was a pure meningitis syndrome in 4 cases and meningo-encephalitis in 6 cases, very severe in 3 of them. All patients recovered rapidly, and only 3 have slight sequelae. In a seroprevalence survey conducted in 1989 among 619 professional foresters of Eastern France, 8% were found to be seropositive, which suggests that the disease is often unrecognized. A study of the large series published in Austria and in other Central European countries has shown that the prognosis of tick-borne encephalitis is not always as favourable as it was in the Alsatian cases: severe sequelae or death occur in 1 to 2% of the patients. The need for a better detection of the disease and for vaccination of the subjects at risk must be emphasized.
Adolescent↗
Antineuronal antibodies and subacute paraneoplastic neuropathy.
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Antibodies, Antinuclear↗
Differential effects of diazepam and lorazepam on repetition priming in healthy volunteers.
The effects of two benzodiazepines, diazepam (15 or 20 mg orally) and lorazepam (1.75 or 2.5 mg orally), and a placebo on explicit memory, lexical priming and perceptual priming were assessed using a free-recall, a word-completion and a picture-completion test. The picture-completion test included two different study conditions intended to manipulate the magnitude of the priming effect. Sixty healthy volunteers took part in this double-blind study. Free-recall performances were altered by both drugs. Lorazepam impaired word-completion and picture-completion performance, whereas diazepam only exhibited a deleterious effect on the more sensitive of the two measures of the picture-completion test. These results indicate that the two benzodiazepines have differential amnestic effects. It is suggested that these differential effects could be accounted for by a different cortical distribution of the two benzodiazepines.
Adult↗
Contralateral disappearance of parkinsonian signs after subthalamic hematoma.
A man with Parkinson's disease (PD) suddenly developed a left hemiballismus, and the CT showed a hematoma of the right subthalamic nucleus. After the ballistic movements had disappeared, akinesia and the other parkinsonian signs did not reappear on the left. This clinical case confirms the involvement of the subthalamic nucleus in the akinesia of PD, as suggested by recent experimental data.
Aged↗
[Paroxysmal neurological manifestations disclosing panic attacks].
Thirty-seven patients presented with paroxysmal neurological manifestations attributed to anxiety attacks. The manifestations included loss of consciousness, focal sensorimotor deficits, diffuse dysesthaesiae, visual disorders and tremor. They lasted 10 to 45 minutes and occurred once per day to once per week. Organic pathology was dismissed on the basis of normal examinations and atypical course. In all patients questioning revealed symptoms that were those of acute anxiety. The fact that these attacks took place in suggestive (circumstances e.g. in crowds and car driving), and that they could be induced by challenge tests hyperpnoea, infusion of lactate) suggested that these disorders were consecutive to panic attacks.
Adult↗