Biomedical subjects
Publications and source records attributed to J Boudouresques.
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A confusional state due to hypercalcemia led to the discovery of multiple myeloma in a 73 year old man. The recurrence of a confusional state, related to plasma cell meningitis called for hospitalization. Serum, urine and cerebrospinal fluid immunoelectrophoresis revealed monoclonal immunoglobulines of lambda light chains. The pathologic study showed an invasion of the subarachnoid space by abnormal plasma cells. The dura mater and brain substance were not invaded. The leptomeningeal invasion by multiple myeloma plasma cells in a rare occurrence. We have found only three such cases published before. The analysis of our case and the three other leads to some comment. The clinical features are those of chronic meningitis revealed by a confusional study or epilepsy. The existence of abnormal plasma cells in the cerebrospinal fluid and their absence in the blood stream seems to suggest a local production of these cells. The histopathological study confirmed, in our case as in the others published, the massive invasion of the subarachnoid space by plasma cells while the dura mater is not invaded.
The authors report a case of tuberculous meningitis in which multiple bacteriological samples were negative during the eleven months of the clinical course. There were no other visceral localizations. The fatal outcome was due to vascular lesions (multiple cerebral infarcts), and to CSF flow disorders. The findings of cranial computerized axial tomography and of the pathological examination are reported.
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We report the clinical and pathological study of a patient with vascular leucoencephalopathy almost restricted to the left posterior hemisphere. A 65 year--old right handed hypertensive woman has presented with a neuropsychological symptomatology of transcortical sensorial aphasia. We discuss the following points: 1) the patient's disease must be considered as Binswanger's subcortical encephalopathy despite the asymetric topography of the lesions ; 2) particular hemodynamic cerebral factors has possibly determined the asymetric nature of the disease ; 3) a lesion of the left temporo-parieto-occipital area that was strictly sub-cortical, with complete destruction of the posterior part of the arcuate fasciculus has presented with the clinical picture of a transcortical sensorial aphasia.
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The authors describe a case of post-traumatic aphasia in a 39-year-old man. The linguistic disturbances were marked by the unusual association of oral expression consisting mainly of neologisms, normal comprehension and almost normal written expression. A physiological interpretation based on disturbance of treatment of the sensory afferent nerves from the bucco-phonator organs is suggested to account for the neologisms in this particular form of aphasia.
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Anatomo-clinical findings are reported in a case of central nervous system degeneration which began at age 47 and progressed over a three year period. Information obtained prior to the patient's death suggested probable spinocerebellar degeneration with amyotrophies. Postmortem anatomical examination confirmed this diagnosis but also revealed the existence of unsuspected lesions. These clinically non-manifested lesions involved severe pallido-luysian degeneration as well as numerous and diffuse senile plaques. The nosological implications of this case are discussed.
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