Neurologie et psychiatrie最新文献

The mean latency value of somatosensory evoked potentials (SEP) recorded at the Erb's point, spinal and cortical level, was assessed in 20 normal subjects by percutaneous stimulation of the peripheral nerves (median, ulnar, superficial radial, tibial and peroneal). At the Erb's point and spinal cervical level, we distinguished the classically described potentials (N9, N13, N14) and the cortical "far-field" potentials such as: P17, N20, P24, N35 and sometimes P45. The central conduction time was calculated by determination of the interpeak latency N9-N13 and N13-N20 (for the upper limb) and LP-P37 for the lower one. A study of 100 patients with peripheral nerve diseases: 30 polyneuropathies, 50 radiculopathies, 9 cases with carpal tunnel syndrome, 5 with brachial plexus injury, 6 with compressive or traumatic diseases of the peripheral nerves, demonstrates the value of the SEPs in the assessment of the nervous lesion site (central or peripheral). In polyneuropathies, a decrease in amplitude and delayed latency of the N9 potential as well as delayed latency of the early cortical potentials on stimulation of the median and tibial nerves occurred. Delayed N9 and low amplitude with delayed latency spinal potential (N13 and LP) were found in radiculopathies. In myelopathies, the central spinal conduction time (N9-N13) was delayed and there were also delayed latencies of the cortical SEPs on lower limb stimulation. The patients with brachial plexus injury had a change in the N9 to N13 amplitude ratio, with prognostic value. Cortical recordings of the SEPs are also of special prognostic value and may suggest the surgical exploration when the axonal functional continuity is lost in brachial plexus injury and compressive or traumatic lesions of the peripheral nerves.

Our study refers to the complex neuropathologic examination of 70 demented patients (40 males and 30 females) above 60 years of age. Proportion of different types of cerebral damage with vascular pathogeny showed that 78% of the vascular dementia cases had as morphological background various aspects of multi-infarct dementia; softenings of variable size and lacunae, associated or not with myelinic rarefactions and pallor specific to subcortical arteriosclerotic encephalopathy; the remaining cases pointed to single anoxic lesion and/or subcortical encephalopathy. Perfect clinico-morphological diagnostic concordance has not always been reached in our sample--as in literature cases--often due to the dementia subtypes overlapping, and to the fact that the same clinical syndrome may show in different cerebral lesions. Likewise, no correlation has been found between lesion type, site or size and clinical picture or dementia course, which was also reported by other authors. On a morphopathogenic basis, we support the view that necrotic lesions of ischemic origin--multi-infarct and lacunar dementias--should be distinguished from myelinic rarefactions and pallor in the white matter, whose pathogeny is still controversial. Due attention is paid to the importance of the venous factor in the development of subcortical encephalopathy.

The authors present a case of spontaneous intracerebral hematoma which developed after evacuation of chronic subdural hematoma. Possible mechanisms of the development of this rare complication are discussed.

The effect of hemodilution was studied in 106 acute ischaemic stroke patients (55 hemodiluted and 51 control subjects). The investigation did not show statistically significant differences between the two groups regarding the mortality rate and the degree of rehabilitation (modified Rankin Scale) but revealed a significant neurologic score (proposed by the Scandinavian Stroke Study Group) in the hemodiluted group. A correlation between the favourable score modification and the degree of hematocrit modification was also observed.

The study involved 75 patients with diencephalic pathology (58 females and 17 males, mean age 39 years). All patients underwent thorough somatic and neurological check up and examination of the autonomic nervous system as well. The etiology was considered to be infection in 60 patients (60%) and brain injury in the other 15 (20%). Paroxysmal disturbances were established in 23 patients, while in the other 52, the clinical manifestation had a permanent course. Changes in adenohypophyseal (TTH, GH, FSH, LH, ACTH and RRL) hormones were established and for mean basal plasma levels of FSH these changes were statistically significant (p less than 0.05). Catecholamine metabolism was impaired in the patients with diencephalic pathology, manifested by elevation of the urinary levels of dopamine, noradrenaline and adrenalin. The role of adenohypophyseal hormones and catecholamines for the pathogenesis of diencephalic dysfunctions is discussed.

Analysis of 41 cerebral hemorrhage cases associated or not with intraparenchymatous hematoma and ventricular rupture shows the role played by these associated phenomena in the evaluation and prognosis of these patients. The death rate was 56.25% in simple cerebral hemorrhage, 100% in hemorrhage associated with hematoma, 30.76% in hemorrhage associated with ventricular rupture and 80% in hemorrhage associated with hematoma and ventricular rupture. The authors point out that the mere presence of ventricular rupture is not a really aggravating factor. A particular severity resulting from association of hemorrhage with hematoma seems to be due to the extension of the cerebral lesion produced by the two conditions associated.

We studied in 300 stroke patients (100 carotid ischemic, 100 vertebrobasilar ischemic, and 100 hemorrhagic) the precipitating factors (PF) of stroke. Precipitating factors were observed in 63.7% of cases. Of the 407 PF found in the whole sample, 60% occurred 24 hours before stroke, and 40%-2-3 days before it. The most frequently met PF were: physical effort (32.3%), extreme temperature (29%), psychic trauma (23.3%), and head and body positions that may unfavourably influence cerebral circulation (23%). These PF were usually observed in associations. The differences regarding the PF incidence in the 3 stroke types were not statistically significant.

In a group of 111 students with depressive disorders, 70% presented a concurrent personality disorder and nearly 15% had prominent personality traits. The unstable, obsessive, hysteric and dysthymic types of personality disorders were relatively more frequent, the higher percent of cases (27.3%) being included in the mixed subgroup of these disorders. The patients with personality disorders had: an earlier age of affective illness onset, a more marked depression severity, a higher frequency of recurrent and nonreactive depression forms. Nonbipolar major depressive disorders were associated with the presence of unstable and dysthymic types of personality disorders, while minor depressive disorders were related with hysteric, asthenic and mixed ones.

Simultaneous ERG and VEP investigations were performed in 42 patients presenting reduced visual acuity and characteristic signs of retinopathy on direct ophthalmoscopic inspection: 1) primary retinal pigmentary degeneration - 15 cases; 2) secondary retinopathy - 11 cases; 3) infantile retinal degeneration - 16 cases. Reciprocal relations of ERG--VEP component latency/amplitude in the three types of retinal disorder are described.

The authors report the case of a 31-year-old female patient who 10 years earlier had displayed diabetes insipidus and hyperglycemia and for 4 years galactorrhea and amenorrhea. Since one year her visual acuity had gradually declined to blindness. CT-scan revealed the presence of a tumoural formation in the optic chiasma and hypothalamic region. The histological examination of the operative-removed tumour showed that it was a type B pinealoma. The postoperative course was good for 42 hrs after which the patient died suddenly. Necropsy disclosed the presence of a myocardial infarct. The authors distinguish three categories of ectopic pinealoma: 1. tumours of the pineal gland with an aberrant development at the level of the 3rd ventricle, 2. metastatic pinealoma, and 3. ectopic pinealomas with an independent development in patients with normal pineal gland. The case reported below is of the 3rd category which is also the most veridical.