[Indication of neuro-imaging for the initial management and the follow-up of acute community-acquired bacterial meningitis].

Lumbar puncture is the best way to prove bacterial meningitis. It should be performed without any delay if the diagnosis is suspected. Herniation is a rare complication of LP.

[Crossed anarthria and a dissociated lateralisation of language].

Introduction: Crossed anarthria cases are uncommon and rather old.

Observation: We report the case of a right-handed 55-year-old man who presented crossed pure anarthria due to a hemorrhage in the premotor cortex (feet of F1 and F2) and in the high part of Pierre-Marie's quadrangle.

Conclusion: The study of different tasks (articulation, verbal fluency, direct object word-generation from a verb) showed a dissociated lateralisation of his language.

A biased Valpha24+ T-cell repertoire leads to circulating NKT-cell defects in a multiple sclerosis patient at the onset of his disease.

As natural killer T (NKT) cells have been implicated in the regulation of multiple sclerosis (MS), we investigated expression of the Valpha24JalphaQ canonical rearrangement in MS patients during relapses. We observed major changes in the entire blood Valpha24(+) T-cell repertoire. Seven of the eight patients showed a marked decrease in Valpha24(+) transcript number and a decrease in the diversity of the Valpha24(+) T-cell repertoire, with the exception of a few expanded clones.

The same TCR (N)Dbeta(N)Jbeta junctional region is associated with several different vbeta13 subtypes in a multiple sclerosis patient at the onset of the disease.

In multiple sclerosis (MS), the T-cell receptors (TCRS) of autoreactive T lymphocytes recognize various myelin components or derivatives including peptides of the myelin basic protein (MBP). Using the exhaustive immunoscope approach we showed that the T-cell repertoires of MS patients differ from those of healthy controls, with expansion of Vbeta13 cell clones in cerebrospinal fluid (CSF) and in peripheral blood lymphocytes (PBLs). Sequencing of the beta13(+) chains of T cells recovered from the CSF revealed high interindividual diversity, and no particular Vbeta13(+) rearrangements were shown to be myelin-autoreactive.

[Psychological and neuropsychological problems in multiple sclerosis].

Neuropsychological investigations have demonstrated that cognitive disorders are common (about 60%) in patients with multiple sclerosis. 22 patients and 22 controls participated in the study with a review of literature. The cognitive dysfunction may be termed a subcortical white matter dementia.

Preferential survival of an MBP-specific T cell clone in an HLA-DR2 multiple sclerosis patient.

Anti-myelin basic protein (MBP) autoreactive T cells play a key role in the pathogenesis of multiple sclerosis. Thus, we applied the Immunoscope strategy to cerebrospinal fluid (CSF) and peripheral blood lymphocytes (PBLs) of an HLA-DR2 patient. Both compartments showed major expansion for the V(beta)13S5 chain, which was associated in peripheral blood with significant proliferation of PBLs in response to MBP and the 84-102 HLA-DR2-restricted peptide.

[Pulsating exophtalmos and contralateral carotid-cavernous fistula].

A rare case of spontaneous carotid-cavernous fistula with contralateral clinical signs (ocular discomfort, pulsating exophthalmos, chemosis, ptosis) is reported. It was associated with partial thrombosis of the ipsilateral cavernous sinus. It was cured with conservative treatment after six months.

[Acute polyradiculoneuropathy after Chlamydia pneumoniae infection].

A 36-year-old woman presented acute polyradiculoneuropathy following Chlamydia pneumoniae infection. Although electrophysiologic studies were normal, clinical features were typical of Guillain-Barré syndrome (GBS). Anti-ganglioside GM1 antibodies were positive.

[Radicular pain revealing Hodgkin's disease].

We report on a case of Hodgkin's disease, revealed in a 52 year-old woman by isolated neurological signs. Sciatica is an uncommon pattern of discovery that is particularly misleading. It may lead to a delayed diagnosis all the more prejudicial since it discloses an advanced stage of the disease.

[Superficial siderosis of the central nervous system].

We report five cases of superficial siderosis of the central nervous system. All patients developed progressive deafness and cerebellar ataxia associated with pyramidal tract signs or mental deterioration. The cerebrospinal fluid examinations usually revealed an elevated protein level, without other abnormalities.

[Isaacs syndrome: long-term improvement with intravenous polyvalent immunoglobulins].

A 35 year-old man developed a syndrome with muscle cramp, myokimia, generalized, fasciculations, excessive sweating, sleep disorders and severe impairment. It was a syndrome of continuous muscle fiber activity--or Isaacs syndrome--with central disorders (this may be called "Maladie de Morvan"). Previous reports have suggested that Isaac's syndrome might be an autoimmune disorder.

Expansion of a recurrent V beta 5.3+ T-cell population in newly diagnosed and untreated HLA-DR2 multiple sclerosis patients.

We have used a PCR-based technology to study the V beta 5 and V beta 17 repertoire of T-cell populations in HLA-DR2 multiple sclerosis (MS) patients. We have found that the five MS DR2 patients studied present, at the moment of diagnosis and prior to any treatment, a marked expansion of a CD4+ T-cell population bearing V beta 5-J beta 1.4 beta chains.

The pattern of production of cytokine mRNAs is markedly altered at the onset of multiple sclerosis.

Using two independent PCR-based quantification techniques, we have determined the levels of IL1 beta, IL2, IL4, IL6, IL10, IFN gamma and TNF alpha mRNA in multiple sclerosis patients at the moment of diagnosis of the disease and prior to any immunosuppressive treatment. These patients exhibit markedly reduced IL2 and IL10 mRNA expression accompanied by decreased levels of TNF alpha mRNA. Our results add to the evidence that IL10 plays a role in multiple sclerosis and suggest that decreased production of this interleukin allows the proliferation of autoreactive T cells at the onset of the disease.

[Cadasil--a new model for subcortical dementia].

We report 3 cases of Cadasil with dementia. In the 3 cases, the dementia had a subcortical and frontal presentation. It associated behavioural symptoms, amnesia, executive functions disturbances, bradyphrenia, slowing of information processing and frontal symptoms, without aphasia, apraxia or agnosia.

[Aluminum, hypothetic cause of Alzheimer disease].

A great deal of research has focused on aluminium as a putative causative factor in Alzheimer's disease. We measured by atomic absorption spectrophotometry aluminium levels in blood, urine and cerebrospinal fluid from 15 patients with Alzheimer's disease, compared with 20 control individuals. There were no statistically significant differences between the two groups.

[Cysticercosis: a frequent and redoubtable parasitic disease].

Cysticercosis is due to development of the larval form of Taenia solium, Cysticercus cellulosae in human tissue. It is widespread in developing countries especially in rural areas where it is endemic. Larval invasion of the central nervous system constitutes a dreadful complication.

A patient with one limb interstitial myositis with localised lipoatrophy presenting with severe cramps and fasciculations.

A case of interstitial myositis associated with a localised lipoatrophy is reported. The patient is a 24 year old man who presented with severe painful cramps and fasciculations localised to one limb. The rarity of both disorders, and their likely common autoimmune mechanism, suggest that this is not a chance association.

[Subacute leukoencephalopathy of the rhombencephalon after pituitary radiotherapy].

Two patients had early delayed leucoencephalopathy mainly confined to the brainstem after radiotherapy for pituitary tumours. To our knowledge, we report the first MRI description. The patients had somatotroph cell adenomas (associated with prolactin secretion, patient 2).

[Acute myelitis after vaccination against hepatitis B].

A 56-year old man was hospitalized for spasmodic paraparesis with sphincter disorders. After exclusion of spinal cord compression and all other inflammatory, infectious or neoplastic causes, the possibility of a connexion with an hepatitis B vaccination performed with a recumbent vaccine three weeks before the neurological disorders appeared was considered. The pathogenesis of such a myelitis remains uncertain.