Neurologie et psychiatrie最新文献

The authors analysed CT-scan with intravenous contrast infusion in 18 patients with recurrent pain after lumbar discectomy. CT showed in these patients the cause of recurrency with 100% accuracy, confirmed by reoperation. Contrast enhancement permitted differentiation of postoperative cicatrix from other causes of lumbar spinal canal stenosis. The authors point out that decision about reoperation should be based upon computed tomography examination.

Somatosensory evoked potentials (SEPs) were studied in 115 patients with spinal cord diseases (multiple sclerosis, amyotrophic lateral sclerosis, cervical myelopathy, subacute combined degeneration, myelitis, spinal cord injury, tumours). The SEPs were recorded at three levels: parietal, spinal (cervical or lumbar), and at the Erb point. The central conduction time was also estimated (N9-N13 and lumbar potential (LP): LP-P37). The most sensitive test (95% abnormalities) was represented by the cortical recording of the SEPs when the tibial nerve was stimulated. The interval LP-P37 was increased, the SEPs being delayed or unrecordable and desynchronized (in cases of polyneuropathies only the latency was increased whereas the waveform was normal). In 50 patients with definite form of multiple sclerosis (MS) abnormalities of the cervical potential N13 were obtained in 96% of cases. The cortical SEPs to the median nerve stimulation were abnormal in 64% of cases only (32 patients). Of 10 patients with amyotrophic lateral sclerosis (ALS), cortical SEPs to the lower limb stimulation were abnormal in 6 patients (20%) and only 2 patients had also abnormal N13 and N20. Of 15 patients with cervical myelopathy, SEPs to the tibial nerve stimulation were abnormal and N9-N13 delayed in all but 2 patients. All the 5 patients with subacute combined degeneration had abnormal SEPs to the tibial nerve stimulation. In all the 15 patients with inflammatory spinal cord diseases, the SEPs were abnormal and the central conduction time was delayed. In 5 cases with spinal cord injury the SEPs were absent above the lesion. In 15 patients with tumoral compression SEPs to the stimulation of the nerve dependent on the sensitive root compressed as well as the lower limb SEPs were abnormal.

The authors describe the case of a 37-year-old patient, who, after a minor craniocerebral trauma suffered in 1970, was admitted to hospital because of progressive headache, unsteady gait and balance disturbances, deglutition disorders and diplopia. Computed tomography (CT) scan showed a large median hyperdense tumour of posterior fossa with the fourth ventricle involvement. Operation under microscope was performed to remove a considerably large cystic tumour, occupying the fourth ventricle and cisterna magna, displacing the cerebellar lobes and pushing the vermis upward. The tumour was waxy and grey, whereas the cystic liquid had the colour and consistency of oily fluid. The capsule was occluded with the CO2 laser. Postoperative course was good.

It was observed that treatment of mother guinea pigs with myelin basic protein (MBP) in encephalitogenic form during pregnancy (1) (5) and in nonencephalitogenic form during pregnancy and/or lactation (3) resulted in a temporary resistance to experimental allergic encephalomyelitis (EAE) in their offspring. The nature of the factor(s) transferred from the mother to the progeny and responsible for induction of the unresponsiveness to an EAE-provoking challenge at maturity, is not known. These might be antibodies, cells or tolerogenic fragments of the MBP molecule. The aim of the present study was to prove the possibility for active induction of resistance to EAE in newborn guinea pigs by their immunization with MBP or spinal cord homogenate (SCH) in nonencephalitogenic form. The stability of thus induced resistance was tested by cyclophosphamide (CY) and host versus graft reaction (HVGR).

The author presents a study of Doppler cerebrovascular ultrasonography carried out in 38 aphasie patients (forms ranging from transient speech disturbances to severe, persistent disturbances of motor, sensory or mixed aphasia) after ischemic or hemorrhagic stroke. In these cases, the clinical symptoms were dominated by speech impairment and neurological deficits (mainly pyramidal), of low intensity or transient. The angiographic study revealed stenotic or occlusive disturbances at various levels of the cerebral arterial trunks. The prevalence of some clinical aspects of aphasia correlated with Doppler velocimetric images is discussed and the use of transcranial Doppler method in idiopathic aphasia, possible consequence of a transient ischemic attack, is suggested.

An autopsy case of haemangioblastoma of the medulla oblongata is presented. The clinical course was atypical and suggested a.l.s., demyelinization process of the CNS, or systemic disease. Two years before, paresis of IX, X, XII cranial nerves, left-side paresis and positive extensor plantar responses had been found. Pathological EEG recordings from both temporal regions with more pronounced changes on the left side had been observed too. In this case, we have not found any other tumours apart from that in the medulla oblongata.

Out of 397 patients presenting hypomagnesaemia there were selected for this study only 107 cases with neurotic and neuromuscular clinical picture (sometimes with short and simple loss of consciousness) without any sign of organic cerebral lesion. The dosing of the seric and erythrocytic magnesium was performed by means of a colorimetric method of Mann and Yoe, modified by the authors. In all the cases, the EEG and EMG changes were studied by simultaneous recording of the EEG and EMG before, during and after hyperpnoea. In these 107 selected cases (divided into three groups: children, adolescents and adults) the computerized electroencephalographic maps (CEM) were carried out by an original method, transcribing the primary data of Hjorth's NSD parameters (Amplitudes and Frequencies) into a Romanian M-118 microcomputer, by a technique with analog-digital conversion. The CEM (in white-black and in colour cartography) were performed for various epochs, including the sequential ones (second by second, all along the EEG discharges during and after hyperpnoea). By these methods, we analyzed the dynamic fluctuation and temporo-spatial cortical distribution of the sinusoidal slow waves generated by the reticulate neuronal hypersynchrony. The CEM showed some differences in the three groups of hypomagnesemic syndromes selected.

Personality traits of 46 psychotic depressive patients (PD) were compared with those of two matched control groups of nonpsychotic endogenous (NPED) and nonpsychotic nonendogenous (NPNED) depressive patients. Discriminant analyses using personality variables point to more marked differences between PD and NPNED patients than between PD and NPED ones. PD and NPNED groups had opposite traits on the bipolar personality scales of obsessionality vs. hysteria and self-sufficiency vs. group dependence; anxiety, present in both groups, was more pronounced in the NPNED patients. The dependence, introversion and prominent obsessional traits were the distinctive attributes of PD patients when compared with NPED patients. The results are discussed in terms of the two alternative hypotheses concerning psychotic depression: one considering delusions as a function of depression severity and the other as a distinct pathological trait. Our data do not support the exclusive validity of either of these two models.

The authors carried out 8 hours of continuous night polysomnographic recordings in 40 selected cases with various forms of absences. In all these patients, the computerized electroencephalographic mappings were performed according to several methods achieved by the authors. The nocturnal electrographic abnormalities, the morphological patterns of the epileptic discharges during different sleep stages and the cortical computerized cartography were comparatively analysed in the five groups of patients: 1) genuine (pure, classical or simple) petit mal (PM) absences: 8 cases; 2) myoclonic PM absences: 10 cases; 3) amyotonic-akinetic PM absences: 6 cases; 4) "false" temporal epileptic absences: 10 cases; 5) "hybrid" (or "bastard") PM absences in 6 cases with Lennox-Gastaut disease.