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Biomedical subjects

J Jacquy

Publications and source records attributed to J Jacquy.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Lesions of ponto-cerebellar and olivo-cerebellar afferents demonstrated by neurophysiologic analysis].

We describe a 52-year-old woman presenting a 2-year history of limb clumsiness and gait difficulties, characterized by progressive worsening. Neurological examination revealed cerebellar intention tremor, cerebellar dysmetria of all 4 limbs and ataxic gait. However, brain MRI was normal. Analysis of fast wrist flexion movements demonstrated hypometric movements, with decreased intensities of agonist EMG activities and increased durations of antagonist EMG activities. Such EMG abnormalities have been demonstrated in patients presenting lesions of the middle cerebellar peduncle, affecting the crossed cerebellopontine projections. Moreover, adaptation motor learning during a pinch task (isometric force) showed a severe inability to adapt motor programming, indicating a disruption of cerebellolivary and cerebellopontine afferent systems. We suggest that our patient presented an exceptional brainstem syndrome involving the function of cerebellar inflow tracts. Such electrophysiological findings are not encountered in patients presenting a cerebellar cortical degeneration or cerebellovlivopontine atrophy, and might have important implications in the treatment of cerebellar ataxia in the future.

Afferent Pathways↗
PubMed1998

Subcutaneous sumatriptan compared with usual acute treatments for migraine: clinical and pharmacoeconomic evaluation.

Cost-effectiveness and cost per successful treatment has been evaluated in 186 outpatients randomised to treat moderate to severe migraine attacks either with subcutaneous sumatriptan 6 mg (n = 97) or with their current therapy (n = 89) during an open, multicentre study of 3 months. Within 2 hours, headache severity decreased to none/mild in 86% of all attacks in the sumatriptan group (STG) compared to 25% in the customary group (CTG). Migraine was alleviated earlier in the STG than in the CTG (median 3.78 vs. 13.39 hours, p < 0.0001). The direct and total cost of treatment was 133 and 2012 BF, respectively, in the CTG and 1400 and 2522 BF, respectively, in the STG. Measuring the effectiveness of earlier pain relief with sumatriptan, the incremental cost-effective ratios for direct and total cost were 132 and 53 BF per hour of relieved pain, respectively. For this price, significantly more sumatriptan patients improved their quality of life by more than 20% (61.6 vs. 20.6% patients, p < 0.001) and less sumatriptan patient consulted a medical professional (11.3 vs. 29.2% patients, p < 0.01), used less medication for adverse events (6.2 vs. 22.5%, p < 0.001) and suffered less from associated migraine symptoms. The median number of hours of diminished work-efficiency (3 vs. 7 hours, p < 0.01) or of suspension of non-professional activity (10 vs. 24 hours, p < 0.001) was also significantly lower in the STG. The total cost per successfully treated patient was lower in the STG. Sumatriptan is more effective, provides a better quality of life, reduces health care resource utilisation, and improves work productivity as compared to the CTG, thereby resulting in a favourable cost-effectiveness ratio.

Absenteeism↗
PubMed1997

Analysis of single-joint rapid movements in patients with sporadic olivopontocerebellar atrophy.

Patients with pure cerebellar cortical atrophy (CCA) present isolated cerebellar signs, whereas patients with sporadic olivopontocerebellar atrophy (sOPCA) present various combinations of cerebellar and extracerebellar signs. However, the differential diagnosis between these two forms of cerebellar degeneration is often a challenge for the clinician. Therefore, any test helping in this differential diagnosis might have a potential clinical interest. In this study, our goal was to investigate the adaptation to increased inertia in patients with sOPCA exhibiting combined cerebellar and pyramidal signs, during the performance of fast wrist flexions. We found that these patients exhibited a hypermetria which remained unchanged after addition of inertia, because they were unable to increase neither their agonist activity (launching force), nor their antagonist activity (braking force). This contrasts with our previous findings in patients with CCA. In these latter, the hypermetria worsened when the inertial load of the hand increased because those patients were able to increase their agonist activity, but not their antagonist activity. The adaptation to inertia might thus help to differentiate CCA and sOPCA.

Adult↗
PubMed1997

Dissociation in the neural control of single-joint and multi-joint movements in the thalamic ataxia syndrome.

We report a patient presenting with a right thalamic ataxia syndrome following a hemorrhage located in the left lateral and posterior thalamus. We investigated the fast goal-directed movements of the wrists (single-joint movements) and the fast pointing movements in the upper limbs (multi-joint movements). On the right side, single-joint movements were markedly hypermetric and characterized by an asymmetry in kinematics, an abnormality of ballistic movements which is considered to be a fundamental cerebellar disorder. By contrast, rapid multi-joint movements were only very slightly impaired. These results suggest that ballistic movements of the wrist are under the strong influence of the cerebello-thalamo-cortical pathway, while rapid pointing multi-joint movements in upper limb are mostly influenced by another pathway emerging from the lateral cerebellum, possibly the dentato-rubral or the dentato-reticular projections in the brainstem. The roles of these neuroanatomical pathways in the control of fast single-joint and multi-joint movements are discussed.

Ataxia↗
PubMed1997

[Anatomo-clinical conference: bronchiolo-alveolar cancer and confusion].

A 67 year old man is admitted with mental confusion. He has been treated 10 months before the present complication for a diffuse bronchiolo-alveolar carcinoma with a good response to chemotherapy. Brain imaging shows symmetrical lesions in the periventricular areas and in the semi-oval centers. A test will allow to obtain the diagnosis.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1996

Cerebellar hypermetria associated with a selective decrease in the rate of rise of antagonist activity.

Classically, cerebellar hypermetria observed during fast and accurate movements is ascribed to a delayed onset of the electromyographic activity of the antagonist muscle. We describe here 3 patients presenting a late-onset cerebellar degeneration and exhibiting a hypermetria during their fast and accurate movements in spite of a normal onset latency of the antagonist activity. Hypermetria was found to be due to a slower rate of rise of the antagonist activity.

Adult↗
PubMed1996

Subacute pancerebellar syndrome associated with systemic lupus erythematosus.

A pancerebellar syndrome of subacute progression associated with cerebellar atrophy is highly suggestive of a paraneoplastic cerebellar degeneration (PCD). We describe a 27-year-old woman with systemic lupus erythematosus (SLE) that presented with a subacute pancerebellar syndrome. Serum and CSF anti-Yo, anti-Hu and anti-Ri antibodies were not found neither in blood, nor in CSF. Brain MRI showed a cerebellar atrophy. The cerebellar ataxia improved markedly following corticosteroids administration. This case probably demonstrates that an antineuronal antibody negative subacute cerebellar disease may not only be a manifestation of paraneoplastic disease, but that it can also be associated with SLE.

Adult↗
PubMed1996

Analysis of cerebellar dysmetria associated with lithium intoxication.

By contrast to the permanent cerebellar sequelae developing over the weeks following a lithium intoxication, the cerebellar dysfunction occurring in the acute phase is poorly documented. In this study, we analysed the fast and accurate wrist flexion movements and the associated electromyographic activities in 6 patients as soon as possible after a lithium intoxication and three months later. Movements were recorded before and after increasing the inertial load of the moving hand. During the acute phase of the disease, three patients performed dysmetric movements, which became hypermetric when the inertia was increased. In the three other patients, the overshooting of the target which was already observed in the basal condition (no load), was even larger when masses were added. In all the patients, addition of loads increased the onset latency of the antagonist activity during the acute stage of the intoxication. Three of the six patients who presented fever, renal failure and did not undergo hemodialysis developed permanent cerebellar deficits. The three others who presented no fever, no renal failure and underwent hemodialysis recovered completely.

Acute Disease↗
PubMed1996

[Carotid dissection during childbirth].

A 33-year-old woman presented transient ischemic attach (hemiparesis of the left arm and right amaurosis), 14 days after childbirth, due to dissection of the right carotid that occurred probably during delivery as suggested by right earache at that time. Carotid dissection during pregnancy or after childbirth is rare an exceptional during delivery. Neurological symptoms and arterial lesions were followed by duplex ultrasound.

Adult↗
PubMed1996

Analysis of ballistic movements in ataxic hemiparesis following a pontine stroke.

Although cerebellar-like ataxia is a well known component of the ataxic hemiparesis (AH), the mechanism of hypermetria in AH has not been established. We describe a patient presenting a left AH following a right pontine infarction. We investigated the ballistic flexion movements of both wrists and the associated agonist and antagonist electromyographic (EMG) activities, before and after addition of inertial loads. At the time of motion analysis, neurological examination showed cerebellar-like dysmetria of the left side but the patient had recovered a normal strength. In the basal state (without addition of loads), movements of the left wrist were hypermetric. The duration of the agonist EMG activity was prolonged and the onset latency of the antagonist EMG activity was not delayed. Moreover, when a mass was added, the hypermetria was unchanged because the patient was unable to adapt appropriately neither the agonist, nor the antagonist EMG activity. We suggest that the hypermetria was due to an imbalance between the duration of the agonist EMG activity (the launching force) and the duration of the antagonist EMG activity (the braking force).

Aged↗
PubMed1996

[Mechanism of hypometria caused by pontocerebellar infarction].

By contrast to cerebellar hypermetria, the pathophysiology of cerebellar hypometria associated with a focal lesion is poorly understood. We describe a patient presenting an ischemic stroke involving the left lateral pons and middle cerebellar peduncle and exhibiting severely hypometric ballistic movements of the left wrist. Hypometria was associated with two distinct abnormalities of the triphasic electromyographic (EMG) pattern: a prolongation of the duration of the antagonist EMG activity and a reduced intensity of the agonist EMG activity. The first mechanism has been described previously in patients with a cerebellar disease and exhibiting hypometria, but not the second. The concomitant presence of these two elementary mechanisms contributed to the severity of hypometria in our patient. Moreover, this case illustrates that the integrity of the crossed pontocerebellar fibers passing through the middle cerebellar peduncle is necessary to generate an adequate agonist EMG activity.

Cerebellopontine Angle↗
PubMed1995

Detection of silent cerebellar lesions by increasing the inertial load of the moving hand.

In a previous study, we analyzed the hypermetria of wrist flexion movements in patients with a cerebellar syndrome. We found that hypermetria augmented when the inertial load of the moving hand was artificially increased. In the present study, we applied the same protocol to patients with an apparently normal neurological examination, in spite of a cerebellar lesion documented by magnetic resonance imaging. In all of these patients, the addition of a mass to the moving hand caused the appearance of a hypermetria. This lack of adaptation of fast and accurate movements to an increased inertia thus appears as a new diagnostic tool enabling the detection of silent cerebellar lesions.

Adaptation, Physiological↗
PubMed1995

Recovery of hypermetria after a cerebellar stroke occurs as a multistage process.

In a prospective study, we repeatedly recorded fast goal-directed wrist movements of 8 patients who had experienced an acute cerebellar hypermetria due to a stroke and who had subsequently recovered clinically. Movements and the associated agonist and antagonist electromyographic (EMG) activities were recorded before and after addition of inertial loads. Four stages characterized the recovery process. At stage 1, hypermetria was present in the basal state and was not modified by the addition of inerital loads. At stage 2, hypermetria, which was present in the basal state, was enlarged by mass addition. At stage 3, hypermetria was absent in the basal state, but was revealed by an inertial load increase. At stage 4, as in healthy subjects, there was no hypermetria without or with addition of inertial loads. At stage 1, the patients presented several defects. (1) Facing an increased inertia, they could not increase their agonist EMG activity. (2) The onset latency of their antagonist EMG activity was delayed. (3) Facing an increased inertia, they could not increase their antagonist EMG activity. Among these three defects, the first disappeared at stage 2, the second at stage 3, and the third at stage 4.

Adult↗