Isabelle Hansen

Brain function in the vegetative state.

Positron emission tomography (PET) techniques represent a useful tool to better understand the residual brain function in vegetative state patients. It has been shown that overall cerebral metabolic rates for glucose are massively reduced in this condition. However, the recovery of consciousness from vegetative state is not always associated with substantial changes in global metabolism. This finding led us to hypothesize that some vegetative patients are unconscious not just because of a global loss of neuronal function, but rather due to an altered activity in some critical brain regions and to the abolished functional connections between them. We used voxel-based Statistical Parametric Mapping (SPM) approaches to characterize the functional neuroanatomy of the vegetative state. The most dysfunctional brain regions were bilateral frontal and parieto-temporal associative cortices. Despite the metabolic impairment, external stimulation still induced a significant neuronal activation (i.e., change in blood flow) in vegetative patients as shown by both auditory click stimuli and noxious somatosensory stimuli. However, this activation was limited to primary cortices and dissociated from higher-order associative cortices, thought to be necessary for conscious perception. Finally, we demonstrated that vegetative patients have impaired functional connections between distant cortical areas and between the thalami and the cortex and, more importantly, that recovery of consciousness is paralleled by a restoration of this cortico-thalamo-cortical interaction.

Natalizumab induces a rapid improvement of disability status and ambulation after failure of previous therapy in relapsing-remitting multiple sclerosis.

Background:  Natalizumab (Tysabri) is a monoclonal antibody that was recently approved for the treatment of relapsing‐remitting multiple sclerosis (RRMS). Our primary objective was to analyse the efficacy of natalizumab on disability status and ambulation after switching patients with RRMS from other disease‐modifying treatments (DMTs).

Comparison of the Timed 25-Foot and the 100-Meter Walk as Performance Measures in Multiple Sclerosis

Background. Ambulation impairment is a major component of physical disability in multiple sclerosis (MS) and a major target of rehabilitation programs. Outcome measures commonly used to evaluate walking capacities suffer from several limitations. Objectives. To define and validate a new test that would overcome the limitations of current gait evaluations in MS and ultimately better correlate with the maximum walking distance (MWD). Methods. The authors developed the Timed 100-Meter Walk Test (T100MW), which was compared with the Timed 25-Foot Walk Test (T25FW). For the T100MW, the subject is invited to walk 100 m as fast as he/she can. In MS patients and healthy control volunteers, the authors measured the test–retest and interrater intraclass correlation coefficient. Spearman rank correlations were obtained between the T25FW, the T100MW, the Expanded Disability Status Scale (EDSS), and the MWD. The coefficient of variation, Bland–Altman plots, the coefficient of determination, and the area under the receiver operator characteristic curve were measured. The mean walking speed (MWS) was compared between the 2 tests. Results. A total of 141 MS patients and 104 healthy control volunteers were assessed. Minor differences favoring the T100MW over the T25FW were observed. Interestingly, the authors demonstrated a paradoxically higher MWS on a long (T100MW) rather than on a short distance walk test (T25FW). Conclusion. The T25FW and T100MW displayed subtle differences of reproducibility, variability, and correlation with MWD favoring the T100MW. The maximum walking speed of MS patients may be poorly estimated by the T25FW since MS patients were shown to walk faster over a longer distance.

Neutrophilic Eccrine Hidradenitis. A Case Report

Neutrophilic eccrine hidradenitis (NEH) is a rare neutrophilic dermatosis occurring most frequently during induction chemotherapy for a variety of malignancies. We report a case of NEH in a 41-year-old woman with acute myeloblastic leukemia under daunorubicin, cytarabine and etoposide chemotherapy. She developed red, tender and painful nodules on a shoulder. The lesions resolved spontaneously. Histological examination is mandatory as the clinical presentation of this dermatosis is highly polymorphic. Leukemia cutis, sepsis, deep fungal infection and Sweets syndrome must be excluded as these implicate different therapies.

Primary Systemic Amyloidosis - A report of 2 cases

We report 2 cases of primary systemic amyloidosis. A monoclonal gammopathy was confirmed at the postmortem examination of the first patient. An extensive search for evidence of chronic infection, inflammation, neoplasms and paraproteinemia was conclusively negative in the other patient. The recognition of cutaneous signs of primary systemic amyloidosis is crucial to insure a rapid management aimed at postponing the fatal issue of the disease.

NMOSD with anti-MOG antibodies following anti-TNFα therapy: A case report

Tumor necrosis factor α (TNFα) inhibitors are highly effective and a therapeutic choice for several inflammatory diseases. Their broad and long-term use is associated with a growing number of paradoxical autoimmune events including demyelinating lesions of the central nervous system (CNS). We report and discuss a case of neuromyelitis optica spectrum disorder (NMOSD) with positive myelin oligodendrocyte glycoprotein antibodies (MOG-IgG1) following anti-TNFα therapy for a pustular psoriasis.

Pathologie inflammatoire de ľhypophyse et grossesse

Adenomateuse, inflammatoire, infectieuse ou tumorale, la pathologie hypophysaire s’observe chez la femme a n’importe quel moment de ľexistence. Cependant, certaines affections hypophysaires, qu’elles soient ou non de nature dysimmune, surviennent de maniere preferentielle chez la femme enceinte.