R. Gil

Neuropsychological disturbances in cerebellar infarcts.

Background– Recent clinical and research reports suggest that the cerebellum may contribute to the modulation of higher cognitive functions. Material and methods– We included 15 consecutive patients with isolated cerebellar infarcts (4 superior cerebellar artery territory infarcts, 1 anterior inferior cerebellar artery territory infarct and 10 posterior inferior cerebellar artery territory infarcts), all confirmed by magnetic resonance imaging. These subjects plus 15 controls matched for age, sex, and educational level underwent a neuropsychological test battery including vocabulary, similarities and block design subtests of the Wechsler Adult Intelligence Scale Revised (WAIS‐R); verbal fluency tests (categorial, phonemic, and alternate categorial fluency tests); Reys 15 auditory word learning list; the paced auditory serial addition task; the Stroop test and the Zerssen Rating Scale. One year after the cerebellar infarct, each subject with cerebellar infarct was asked to undergo a second neuropsychological examination with the same test battery. Results– Patients with cerebellar infarcts exhibited significantly lower neuropsychological performances compared to those of the control group without any obvious difference between the different vascular cerebellar territories. After 1 year of follow‐up, this neuro‐psychological impairment tended to improve. Conclusions– The pattern of deficits observed in isolated cerebellar infarcts highlights the non‐motor functions of the cerebellum and functional relationship between the cerebral cortex and the cerebellum.

Intracranial Hemorrhage and Oral Anticoagulant Treatment

Objective: To detect risk factors for intracranial hemorrhage (ICH) in patients with long-term oral anticoagulant and to identify clinical or radiological data specific of anticoagulant-related ICH. Methods and Patients: Three groups of patients were included. Group 1 represents patients who were admitted because of anticoagulant-related ICH between January 1984 and February 1996. All patients underwent CT scan. Clinical data, anticoagulation parameters, location and volume of the ICH, treatment and the 30-days in-hospital mortality were analyzed. Group 2 consisted of patients selected at random among all patients with spontaneous ICH admitted to our department during the same period of time. Patients without ICH, but regularly taking oral anticoagulants constituted group 3. Results: Seventy-nine patients with anticoagulant-related ICH were compared to 127 patients with spontaneous ICH. The volume of supratentorial ICH was greater in group 1 of patients and was correlated with a worse prognosis. Comparison of group 1 with group 3 (212 controls) demonstrated that length of anticoagulation, prothrombin time or excessive anticoagulation, prior cerebral infarct and use of acénocoumarol, but not age or indication of anticoagulant, were significant risk factors for ICH in multivariate analysis. Conclusions: The results emphasize that anticoagulant-related ICH are not clinically different from spontaneous ICH except for volume of bleeding, and that frequent and careful coagulation monitoring is needed, especially during the first year in order to decrease the risk of ICH.

Le zona et ses complications neurologiques

Resume Introduction Le zona est une pathologie secondaire a une reactivation du varicella-zoster virus (VZV), frequent dans la population generale. Etat des connaissances Le zona est susceptible d’entrainer de nombreuses complications, parmi lesquelles des manifestations neurologiques peripheriques ou centrales de gravite variable. Dans tous les cas, et particulierement concernant les complications neurologiques, un traitement associant un antiviral ainsi que des mesures locales et antalgiques doit etre debute le plus precocement possible. Une corticotherapie peut etre proposee, en particulier en cas de syndrome de Ramsay-Hunt ou de complications neurologiques centrales dont le pronostic fonctionnel et vital reste reserve. Conclusion Le zona est une pathologie virale banale, mais potentiellement grave dans certaines situations. La detection et la precocite du traitement sont gages d’une diminution de la severite des complications neurologiques.

Les paralysies diaphragmatiques révélées par une insuffisance respiratoire aiguë: A propos d'une observation de sclérose latérale amyotrophique et revue de la littérature

A case of acute respiratory failure revealing amyotrophic lateral sclerosis is reported. The other neurological diseases with diaphragmatic paralysis are recalled.

Statines et prévention des accidents vasculaires cérébraux

Resume Les statines sont devenues un des premiers postes budgetaires en France tant leur champ de prescription s’est elargi depuis ces cinq dernieres annees sous l’impulsion d’etudes prospectives multicentriques. Ainsi, outre leur vertu preventive dans les affections coronariennes, il semble actuellement demontre qu’elles protegent egalement de la survenue d’accidents vasculaires cerebraux (AVC) chez les sujets coronariens (etudes CARE et LIPID) comme chez les sujets a risque (etudes HPS et ASCOT-LLA), et ce, quel que soit le taux plasmatique de cholesterol avec une diminution de 30 p. 100 environ du risque relatif d’AVC par rapport au placebo. Cette vertu preventive s’exerce a priori par d’autres voies que la diminution du cholesterol et/ou du LDL-cholesterol, probablement par un effet direct sur l’inflammation, la coagulation et la modulation de certains processus atherogenes et de la fonction endotheliale. Neanmoins, il reste a l’heure actuelle, de nombreuses zones d’incertitudes quant au role exact des statines sur la prevention secondaire des AVC (etude SPARCL), a leur utilite reelle chez le sujet âge (etude PROSPER) et a la superiorite eventuelle d’une statine par rapport a l’autre.

MémoireConscience et compréhension du consentement dans la maladie d’AlzheimerAwareness and understanding of consent in Alzheimer's disease

Before a patient can take part in a clinical research, French legislation requires his/her free, express and informed consent. In the same way, the information must be given in a clear, fair and appropriate manner. However, in the context of Alzheimers disease, one might wonder about the patients capacity to consent. The goal of our research was to study the capacity to provide informed consent in a group of patients with mild Alzheimers disease and in a control group, using two specialized clinical vignettes inspired by Marsons studies. The aim of the study was to assess discernment in capacity to consent to a treatment and to determinate the possible links between impaired capacities to consent and cognitive and behavioral impairments involved in Alzheimers disease. The data collected confirm that the capacity to make and maintain a choice is preserved while the capacities to appreciate the consequences of choosing a treatment, to reason and to understand the treatment situation are already impaired in mild Alzheimers disease. The impairment of these capacities can be linked to dysexecutive syndrome, apathy and impaired self-awareness. Caregivers and family should take into account the risk of weakened capacities of discernment as soon as possible.

Conscience et compréhension du consentement dans la maladie d’Alzheimer

Before a patient can take part in a clinical research, French legislation requires his/her free, express and informed consent. In the same way, the information must be given in a clear, fair and appropriate manner. However, in the context of Alzheimers disease, one might wonder about the patients capacity to consent. The goal of our research was to study the capacity to provide informed consent in a group of patients with mild Alzheimers disease and in a control group, using two specialized clinical vignettes inspired by Marsons studies. The aim of the study was to assess discernment in capacity to consent to a treatment and to determinate the possible links between impaired capacities to consent and cognitive and behavioral impairments involved in Alzheimers disease. The data collected confirm that the capacity to make and maintain a choice is preserved while the capacities to appreciate the consequences of choosing a treatment, to reason and to understand the treatment situation are already impaired in mild Alzheimers disease. The impairment of these capacities can be linked to dysexecutive syndrome, apathy and impaired self-awareness. Caregivers and family should take into account the risk of weakened capacities of discernment as soon as possible.

Réactivation automatique en mémoire sémantique de connaissances didactiques au cours du vieillissement normal et dans la maladie d’Alzheimer

Resume Introduction Ce travail a eu pour but d’etudier les aspects les plus consolides de la memoire semantique chez des sujets normaux et des patients ayant une maladie d’Alzheimer (MA). Patients et methode . Une premiere epreuve basee sur la reactivation automatique de connaissances didactiques a ete elaboree. Constituee de 250 expressions verbales automatiques explorant la culture generale, elle a ete validee en fonction de l’âge et du niveau culturel chez 219 sujets temoins (20-90 ans). Une epreuve simplifiee appelee EVA, incluant 50 des 250 items initialement choisis, a ensuite ete construite. Les scores obtenus a l’EVA par la population normale en fonction de l’âge et du niveau culturel ont ete classes en centilages. Les scores obtenus par 20 patients MA a l’EVA, au MMSE et au « Pyramids and Palm Trees Test » (evaluation « classique » de la memoire semantique), ont ensuite ete compares. Resultats . Les resultats montrent que l’augmentation des scores obtenus a l’epreuve initiale par les sujets temoins de meme niveau culturel est significativement correlee a l’accroissement de l’âge. Les resultats obtenus a l’EVA par les temoins montrent que la valeur de la mediane, pour une meme tranche d’âge, est d’autant plus elevee que le niveau culturel est plus eleve. Les scores des patients MA a l’EVA et au MMSE sont significativement correles (resultats d’autant plus faibles que la demence est plus severe) ; il en est de meme pour les scores a l’EVA et au « Pyramids and Palm Trees Test ». Parmi dix patients presentant une demence legere (MMS > 20), 7 obtiennent au « Pyramids and Palm Trees Test » des scores pathologiques. Conclusion . Notre etude confirme donc le fait que les changements lies au vieillissement normal n’affectent pas tous les aspects de la cognition. Les elements les plus consolides de la memoire semantique tels qu’ils sont explores par l’EVA resistent a la deterioration aux stades initiaux de la MA, mais subissent ensuite le meme declin que celui observe pour d’autres aspects de la memoire semantique. L’etude montre aussi que la normalite des performances a une epreuve de ce type n’elimine pas pour autant l’existence d’un trouble de la memoire semantique aux stades initiaux de la MA. Nous proposons donc ici une epreuve qui permet d’explorer certains aspects du stock semantique sans necessairement faire intervenir de processus actif de recuperation. Cette epreuve ne permet pas un diagnostic precoce de la MA. Elle peut, en revanche, contribuer a evaluer la gravite de la maladie au fur et a mesure de l’evolution des troubles.

Recurrent hemorrhage in cerebral amyloid angiopathy

Reply from the Authors: We thank Drs. McCarron and Nicoll for their helpful comments. Their recent study4 …

Author Index for the Abstracts of the Fourth European Stroke Conference

Abreu,F. Ill Aebischer, N. 38, 84 Aichner.F. 28,54, 178,242 Aichner, F.T. 134 Aktan.S. 82,226 Alb, K. 92 Albucher,J.F. 87,156,157 Aldrey.J.M. 130 Alexandrov, A. V. 13,163,164 Allot, E. 204 Amaducci, L. 238 Amarenco,P. 230 Anderson, R.E. 106 AngeU, S. 263 Ansquer, O. 240 Anxionnat, R. 131 Arboix,A. 188,255 Ardron,M.E. 174 Argentino, C. 5,86,103,118 Arnaboldi, M. 52 Arpaci, B. 70 Arwert,F. 67 Ay.H. 244,245,246 Aykut-Bingol, C. 82,226 Azzimondi, G. 102