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Biomedical subjects

P Castaigne

Publications and source records attributed to P Castaigne.

At least 19 recordsLinked to original sources

[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

[The treatment of organic pain of the peripheral nervous system using clomipramine. 30 cases (author's transl)].

Clomipramine used alone is an affective analgesic against organic pain due to a lesion of the peripheral nervous system, in particular post-herpetic pain. The quality of the result is related to the dose, and hence to tolerance. Fluohydrocortisone is the most powerful drug against orthostatic hypotension, the chief cause of limitation of treatment. No complications were seen, even in very elderly patients.

Adult

[Creutzfeldt-Jacob disease in continental France. Retrospective study from 1968 to 1977].

During the decade 1968-1977, 170 cases of Creutzfeldt-Jakob disease were found in France. The clinical features of 124 neuropathologically-verified cases are summarized and a multi-factor analysis performed to obtain the most frequent combinations of signs and symptoms. Certain exceptional features are discussed. The annual mortality rate during this period was 0.32 cases per million for the whole of France, and 0.69 cases per million for the Paris metropolitan area. Preliminary totals for 1978 suggest that these figures may possibly be doubled, with 30-40 new cases occurring annually. No temporal-spatial clustering of cases was observed, and no contact between patients could be established, except for familial cases (9% of the total). No risk factors were identified; in particular, iatrogenic surgical or neurosurgical transmission did not occur, nor was any relationship apparent between CJD in man, and scrapie in sheep or goats. These data furnish a base of comparison for prospective studies in France, with a view towards discovering the natural mode of transmission of the virus of CJD.

Adult

A study on sleep in amyotrophic lateral sclerosis.

A polygraphic study of sleep has been performed on 12 patients with ALS and 12 normal controls. Neither the total duration of sleep, nor the proportion of different stages of sleep differed significantly between the patient and control groups. A variety of morphologic peculiarities were observed in certain patients: frequent and repetitive blinking movements during the waking state (under quiet, dark conditions); persistence of EMG activity during both PS and SWS; and an early appearance of marked slow delta wave activity at the beginning of sleep. We observed in patients increased PS latency, and longer and more frequent awakenings. Certain patients also showed both qualitative and quantitative abnormalities of respiratory rhythm. A longitudinal study was performed on one patient. Results are discussed in relation to the existing literature.

Aged

[Monocular circumduction nystagmus (author's transl)].

Monocular circumduction nystagmus is a very rare ocular movement. A type of circumduction movement, it is caused by successive movements of all the ocular muscles within the framework of a pendular nystagmus. As a monocular movement, it raises the question of the physiopathological mechanism of such a movement which is so complex and is also limited to one eye. The existence of a monocular form of circumduction nystagmus makes it necessary to revise the mechanism of pendular nystagmus.

Adult

[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

[Multiple recurrent paralysis of the cranial nerves (author's transl)].

The authors describe three patients presenting several episodes of paralysis of the motor and sensory cranial nerves and discuss possible aetiological factors. The paralytic attacks were regressive and were repeated at irregular intervals over a period of several years. It was confirmed that no local or general cause for the symptoms existed and the conclusion was reached that they were part of an autonomous clinical syndrome of unknown aetiology. Other cases have been reported in the published literature in which a non-specific inflammatory mechanism is suggested but no biological or pathological basis exists to support this physiopathological hypothesis. The clinical syndrome follows a benign course, the paralysis being regressive and the affection remaining confined to the peripheral nervous system of mesencephalic origin.

Aged

[Supranuclear lateral gaze palsy of pontine origin. Report of 2 clinicopathologic cases with electrooculographic and electromyographic data].

Electro-oculographic, electromyographic and pathological findings in two cases of supranuclear lateral gaze palsy of pontine origin have allowed us to define the clinical and physiopathologic features of the Pontine Reticular Formation (PRF) syndrome, and to formulate hypothesis about the terminal portion of the Occipito-Pontine Tract (OPT) involved in horizontal pursuit eye movements. The unilateral PRF syndrome is characterized by abnormal eye movements in the direction of the lesion. In the ipsilateral hemifield of movement there is paralysis of all movements from midline to extreme ipsilateral side, except oculo-cephalic reflex which remains intact (dissociated palsy); in the contralateral hemifield all saccades from extreme contralateral side to midline are suppressed, and this constitutes a specific abnormality of the PRF syndrome: quick phase of optokinetic and vestibular nystagmus are absent, while voluntary gaze is preserved but remarkably slow. It is suggested that this last fact is due to simple disfacilitation arising from undamaged PRF. Electromyographic findings suggest that the division between excitatory and inhibitory fibers of descending supranuclear oculomotor tracts ending in the abducens nuclei probably occurs in the lower pans. Anatomopathologic findings in the two cases show that the OPT runs in front of the Medial Longitudinal Fasciculus or in the lateral tegmentum and that it decussates, at least once, below the upper pons.

Abducens Nerve

Sleep respiratory arrhythmias in control subjects, narcoleptics and non-cataplectic hypersomniacs.

Normal subjects may present central-type apneas or periodic respiration during sleep (stages I and II and paradoxical sleep). The importance of these respiratory disorders increases with age. Hypersomniac patients can manifest either similar or more significant sleep respiratory disorders than normal subjects. The presence of cataplexy or obesity does not permit the prediction of the existence of respiratory arrhythmias or of their type. Sleep respiratory arrhythmias of central type are not likely to cause hypersomnia; however, an aggravating role may be played by obstructive apneas.

Adult

[Change in recurrent inhibition when standing in normal subjects and spastics (author's transl)].

In normal subjects and patients with diseases of the upper motor neurone, recurrent inhibition directed to soleus motoneurones was studied in three different postures: sitting (control situation), standing when leaning backward on a wall, standing independently without the support of a wall. In normal subjects, this recurrent inhibition was not modified when standing with the support of a wall, while it was enhanced when standing without such a support.

H-Reflex

[Epidemiology of Creutzfeldt-Jakob disease in the Paris area].

The area studied includes the city of Paris and the neighboring departments of Val-d'Oise, Seine-Saint-Denis, Hauts-de-Seine, Yvelines, Essonne, Val-de-Marne, and Seine-et-Marne. Case finding methods and diagnostic criteria are defined. The temporal and spatial distribution of cases is described, and the absence of case clustering is noted. Incidence per million people (per year) was found to be 1,09 in the city, 0,55 in the adjacent departments, and 0,25 in the peripheral departments. These results are discussed.

Age Factors

[Peripheral and central factors controlling reciprocal Ia inhibition in man].

Variations of the soleus H reflex were studied during voluntary contractions of the tibialis anterior in man. At the onset of contraction there was a weak inhibition of the soleus H-reflex which was not related to the force of the tibialis anterior contraction. 110 msec after the onset of the EMG activity the inhibition became secondarily more marked and was then related to the force of the contraction. This secondary potentation of the H-reflex inhibition is brought about by group I fibres activity, since it was markedly reduced during ischemia of the leg. It is concluded that the early inhibition is only due to suprasegmental activity whereas during the secondary part of the inhibition, there is a supplementary inhibitory action likely brought about by Ia fibres tibialis anterior. The secondary potentiation of the inhibition is therefore likely to be produced via the gamma loop.

Central Nervous System

[Tomographic study in humans of blood flow and oxygen consumption of the brain by continuous inhalation of oxygen 15. Preliminary findings in cerebral ischemic accidents].

Transverse axial tomographic imaging of regional cerebral blood flow (rCBF) and regional oxygen extraction fraction (rOEF) were obtained in 13 patients hospitalizedfor ischemic strokes (eleven middle cerebral artery territory infarcts, one capsular or pontine lacune, one transient hemispheric attack) by continuous inhalation of 15O2 and C15O2 to equilibrium and exclusive detection of the gamma rays emitted in coincidence by means of a tomograph for positron emitting agents. In the transient ischemic attack and in the case of lacune the rCBF and the rOEF images were found to be normal, and they were abnormal in all cases of middle cerebral artery territory infarcts. In recent infarcts, rOEF was always strikingly decreased in the clinically suspected area, whilst the rCBF was either decreased, normal or increased. In infarcts older than 30 days rCBF was always clearly decreased over the clinically suspected area whilst rOEF was in most cases normal or only slightly decreased. These results are briefly discussed. Some practical and theoretical limitations of this method are mentioned. The potential of the present technique appears great however, since it is possible to simultaneously visualize in tomographic fashion the blood flow and the oxygen metabolism in areas of the brain that are of small volume, and however deep they are. A quantification of these parameters is presently under investigation, as well as the verification of the theoretical model on which such method is based. The non-invasiveness of the present method, the feasibility of repeating it at regular intervals of time, and the possibility of measuring the immediate effects of a given therapeutic mode on the regional metabolism of brain all constitute further advantages whose action apply preeminently in the field of the cerebral ischemic diseases.

Aged

[Frequency and symptomatology of disorders of micturition during cerebrovascular accidents. Interest of complementary examinations (author's transl)].

A total of 228 patients with cerebrovascular accidents have been studied since 1975. Micturition disorders were present in 124 cases (54 p. 100), including total incontinence in 45 p. 100, imperative micturition in 37 p. 100, and complete retention in 18 p. 100 of the patients. They are associated in a significant manner with severe psycho-intellectual disorders, an extensive hemiplegia, bilateral pyramidal signs, and ruological abnormalities. Useful complementary examinations and some therapeutic modalities are briefly reviewed.

Cerebrovascular Disorders