[Transient ischemic attacks in the elderly: new definition and diagnostic difficulties].

Transient ischemic attacks (TIA) are very frequent in the elderly. Their frequency increases beyond 65 years. However, no epidemiologic study was specifically dedicated to elderly patients.

[Asomatognosia and oral drive: a psychoanalytical perspective].

Objective: The psychoanalytic concept of specular image refers to the complex construction that associates the body image with the language coordinates of the individual, thus making him/her a human subject. The acquisition of this specular image implies the loss of corporeal exchanges between mother and child, i.e.

DWI prediction of symptomatic hemorrhagic transformation in acute MCA infarct.

Purpose: Symptomatic hemorrhagic transformation is a severe complication of acute ischemic stroke which occurs at a higher frequency after thrombolysis. The present study was designed to analyze whether early DWI can be used for predicting the risk of hemorrhagic transformation with clinical worsening in MCA stroke patients.

Materials And Methods: Of 28 patients with a middle cerebral artery (MCA) infarct and proven MCA or carotid T occlusion on DWI and MR angiography performed within 14 hours after onset (mean 6.

Unusual origin of the artery of Adamkiewicz from the fourth lumbar artery.

The main arterial supply of the dorso-lumbar spinal cord is usually derived from a single anterior radiculo-medullary artery called the artery of Adamkiewicz and referred to as having a middle or low location. In some cases, the artery origin is higher, and a vessel which arises in the lower part of the region supplements the supply of the anterior spinal artery. In the literature, those arteries have been described as arising from L3 upwards, and have never been previously described angiographically, to our knowledge, below this level, although Suh and Alexander and Gililan have mentioned this eventuality.

[Endoluminal dilatations and stenosis of symptomatic vertebral arteries].

Surgical treatment of symptomatic atherosclerotic stenosis of vertebral arteries has been proposed for many years but this technique remains quite confidential due to technical difficulties and relatively high risks. Transluminal angioplasty has been proposed and we developed a simplified technique using coronary stent placement. The aim of this study was to evaluate the feasibility and efficacy of transluminal angiography with primary stenting for proximal stenosis for vertebral arteries.

Incidence and predictive factors of cerebrovascular events in 8,846 elderly treated hypertensive patients during a 3-year follow-up: the PRESAGE study.

This epidemiological study was carried out as a 3-year follow-up project to assess the incidence of transient ischemic attacks (TIAs) and strokes; 8,846 treated hypertensive patients (mean BP, 149/84 mm Hg) aged 65 years or over (mean age, 73.7 +/- 6.3 years), devoid of symptoms of dementia and with documented vascular risk factors were recruited from January 1994 to August 1995, by 1,598 general practitioners in connection with 36 referral university neurology units throughout metropolitan France.

Diffusion-weighted imaging patterns of brain damage associated with cerebral venous thrombosis.

Background And Purpose: Apart from cases studies, little is known regarding diffusion-weighted imaging of brain lesions associated with human cerebral venous thrombosis (CVT). Our aim was to describe the initial diffusion-weighted imaging patterns observed in brain areas with MR signal changes associated with CVT and to compare them with those of follow-up imaging.

Methods: The cases of nine patients with brain lesions associated with CVT who underwent CT and diffusion-weighted imaging 3 hours to 4 days after sudden neurologic onset were retrospectively reviewed.

False-negative diffusion-weighted MR findings in acute ischemic stroke.

Background And Purpose: Lesions associated with acute stroke are often missed by diffusion-weighted imaging (DWI), suggesting that the sensitivity of this technique for detecting acute ischemic stroke may not be as high as initially thought. Our aim was to estimate the rate of false-negative DWI studies in patients with persistent neurologic deficit due to an ischemic stroke and to identify which stroke lesions are most likely to be missed by DWI.

Methods: We reviewed MR images obtained within 48 hours after stroke onset in 139 patients admitted for symptoms consistent with ischemic stroke in whom the deficit lasted more than 24 hours.

Diagnosis of acute ischaemic stroke with fluid-attenuated inversion recovery and diffusion-weighted sequences.

We evaluated the feasibility and use of diffusion-weighted and fluid-attenuated inversion-recovery pulse sequences performed as an emergency for patients with acute ischaemic stroke. A 5-min MRI session was designed as an emergency diagnostic procedure for patients admitted with suspected acute ischaemic stroke. We reviewed routine clinical implementation of the procedure, and its sensitivity and specificity for acute ischaemic stroke over the first 8 months.

Prediction of malignant middle cerebral artery infarction by diffusion-weighted imaging.

Background And Purpose: This study was designed to analyze whether early diffusion-weighted imaging (DWI) provides reliable quantitative information for the prediction of stroke patients at risk of malignant brain infarct.

Methods: We selected 28 patients with a middle cerebral artery (MCA) infarct and proven MCA or carotid T occlusion on DWI and MRI angiography performed within 14 hours after onset (mean 6.5+/-3.

Percutaneous transluminal angioplasty and stenting of the proximal vertebral artery for symptomatic stenosis.

Background And Purpose: Percutaneous transluminal angioplasty (PTA) for significant stenosis involving the origin of the vertebral artery is now a well established treatment for selected patients when posterior cerebral arterial circulation is compromised. Arterial spasm, dissection, and restenosis may occur in some instances, with subsequent hemodynamic compromise. To prevent these potential complications, we combined PTA of the vertebral artery with primary stenting, using coronary stents, in seven patients.

[Mechanisms of aphasia recovery and brain imaging].

Aphasia recovery may depend on right hemisphere or non-lesioned left hemisphere structures, pre-morbid brain language organization, and de novo learning of language. Here we review the brain imaging evidence supporting these different hypotheses. CT-scan studies have investigated the prognosis value of size and site of left hemisphere lesions.

[Fronto-temporal degenerative dementia. A modern neuropathologic approach].

The classification of degenerative dementias with fronto-temporal atrophy has been debated since the description of Pick's disease. The study of a clinico-pathological series of 10 cases using immunohistochemistry lead to the following conclusions: reserving the name of Pick's disease to those cases with argyrophilic inclusions, the most recognisable and characteristic marker at neuropathological examination, allows an easy and reliable diagnosis; keeping on with the splitting of these disorders into various clinico-pathologic entities seems today more useful than grouping them into a single syndrome until new data, based for example on genetic analysis, show that different phenotypes correspond to the same disease.

A 24-month, double-blind, placebo-controlled multicentre pilot study of the efficacy and safety of nicergoline 60 mg per day in elderly hypertensive patients with leukoaraiosis.

In this pilot study, 72 non-demented and non-depressive elderly hypertensive patients with evidence of leukoaraiosis on cerebral computed tomography scan (Rezek score: > 16) were randomly assigned to receive either nicergoline 30 mg b.i.d.

Somatosensory cortical activations are suppressed in patients with tactile extinction: a PET study.

Objective: To investigate whether tactile extinction alters the cortical somatosensory activations induced by hand vibration.

Background: Tactile extinction occurs mainly after right-brain lesions and consists of the inability to perceive a contralesional cutaneous stimulation when a similar stimulus is applied to the mirror region of the ipsilesional hemibody. The pathophysiology of tactile extinction is poorly understood, but it is considered to be a deficit of selective attention of somatosensory stimuli.

Cerebellar dysfunctions of temporal processing in the seconds range in humans.

The roles of the basal ganglia and cerebellum in timing remain subject to debate. It has been suggested that temporal range may dissociate them, since cerebellar research has focused on intervals of < 1 s, compared with many seconds used in much basal ganglia research. Here we show increased but scalar variability of time estimates in patients with focal lesions of the lateral cerebellar cortex and nuclei when trained to remember durations in the seconds range, compared with patients with lesions of the mesial cerebellum and vermis.

Diffusion-weighted magnetic resonance imaging in a case of cerebral venous thrombosis.

Background: Diffusion-weighted imaging (DWI) is the most sensitive MR sequence in acute arterial ischemic stroke but has not yet been evaluated in venous cerebral ischemia. We describe a patient with DWI performed at the acute phase of a venous ischemic stroke.

Case Description: A rapid cerebral MRI including DWI and fast fluid-attenuated inversion recovery (FLAIR) sequences was performed at the acute phase of a venous stroke confirmed by conventional angiography.

Frontal dysfunction in neurologically normal chronic alcoholic subjects: metabolic and neuropsychological findings.

Background: Neuropsychological and imaging studies suggest that frontal dysfunction may occur in apparently normal chronic alcoholic subjects.

Methods: To investigate this issue further, we performed neuropsychological and fluorodeoxy-glucose-PET studies in 17 chronic alcoholics without patent neurological and psychiatric complications.

Results: Metabolic abnormalities were found in the mediofrontal and in the left dorsolateral prefrontal cortex, but not in the orbitofrontal cortex.

[Visual hallucinosis and hyperhedonism in pontine and thalamic infarction].

The syndrome of peduncular hallucinosis in characterized by transient visual hallucinations which often consist in animated and mobile characters or animals, and which are often associated with disordered sleep. Although vivid and life) like, these hallucinations are generally not mistaken for reality. In view of the associated neurological symptoms, this syndrome was first believed to occur only with lesions of the mesencephalon.

Clinicometabolic dissociation of cognitive functions and social behavior in frontal lobe lesions.

Objective/background: Case studies suggest a dissociation between cognitive functions that have been impaired after damage to the dorsolateral prefrontal cortex and social skills disturbed when the ventromedial prefrontal areas are affected. Because this dissociation had not been confirmed in a clinical setting, clinicometabolic correlations were sought in 13 patients with various lesions of the prefrontal cortex.

Design/methods: The clinical assessment included extensive testing of executive functions and evaluation of behavioral abnormalities based on an informant questionnaire.

Effects of anterior cingulate cortex lesions on ocular saccades in humans.

Cerebral blood flow studies in humans suggest that the anterior cingulate cortex (ACC) could be involved in eye movement control. In two patients with a small infarction affecting the posterior part of this area (on the right side) and in ten control subjects, we studied several paradigms of saccadic eye movements: gap task, overlap task, antisaccades (using either a 5 degrees or 25 degrees lateral target), memory-guided saccades with a short (1 s) or long (7 s) delay, and sequences of memory-guided saccades. Compared with controls, patients had normal latency in the gap task but increased latency in the other tasks.

Evolving isolated hand palsy: a parietal lobe syndrome associated with carotid artery disease.

Six patients with cerebral ischaemia who presented evolving isolated hand palsy were studied, five prospectively and one retrospectively. The motor deficit involved only the hand and the wrist in some cases. In almost all cases the motor deficit was pseudo-ulnar.