Neonatal Seizures: Epidemiological, Diagnostic Aspects and Short-Term Outcome at Issaka Gazoby Maternity Hospital of Niamey, Niger

Introduction: Neonatal seizures are one of the most challenging situations for paediatricians. The objective of this work was to study the epidemiological and diagnostic aspects and short-term outcomes of neonatal seizures at Issaka Gazoby Maternity Hospital in Niamey. Patients and Methods: This was a prospective study from November 2020 to April 2021 in the neonatology department of Issaka Gazoby Maternity Hospital. All newborns aged 0 to 28 days hospitalized for seizures and/or having convulsions during hospitalization were included. Neonatal characteristics, diagnostic aspects, and their outcomes were studied. Data were analyzed using SPSS version 20 software. Results: Of the 3.068 newborns admitted, 69 cases of neonatal seizures were recorded (2.24%). The sex ratio was 1.22, and 94.2% of neonates were born at term. Generalized crises were found in 50.7%. The main etiologies were perinatal asphyxia (46.4%) and early-onset neonatal infection (40.6%). The death rate was 20.3%. Neonates died between one (1) and three (3) days of age in 42.9%. The main death causes were perinatal asphyxia (50%) and early-onset neonatal infection (21.4%). Conclusion: Neonatal seizures are uncommon frequent, with a semiology dominated by generalized seizures. Mortality is high. The reinforcement of preventive measures is necessary.

Effects of Ovariectomy and 17β-Estradiol Replacement on the Activity of Dopamine D2 Receptors in the Selection of Macronutrients Carbohydrates, Lipids and Proteins in Females Rats

17β-estradiol modulates the activity of D2 receptors in the regulation of food intake and body weight. The functional lack of 17β-estradiol in postmenopausal women could create a dietary imbalance and cause body weight gain. This study aimed to better understand the interferences that could exist between 17β-estradiol, D2 receptors and the selection of carbohydrate, fat and protein consumption, as well as their consequences on body weight gain by using an animal model of the menopause. Ovariectomy exacerbates the consumption of foods rich in lipids. Thus confirming an inhibitory action of 17β-estradiol (E2) on the consumption of these types of foods. This consumption stimulates body weight gain, which is promoted by the high caloric content of these foods and not by the amount consumed. Our results showed a direct involvement of D2 receptors in food choice. This choice would be made according to the two (2) isoforms of the D2 receptors. The D2/BR isoform directs towards a high carbohydrate consumption, without causing a gain in body weight. While D2/SUL, promotes high fat food consumption, causing an increase in body weight. In women, 17β-estradiol modulates the activity ratio between these two D2 receptor isoforms to ensure energy and homeostatic balance, stabilizing food intake and body weight.

Distal Sensory Polyneuropathy among HIV Patients in Libreville in Gabon

Distal sensory polyneuropathy (DSP) was more frequent among Human Immunodeficiency Virus (HIV) patients. The reliable tool for its diagnosis is not available everywhere in sub-Saharan Africa. We aimed to estimate the frequency of DSP among HIV patients in Libreville. We’ve conducted a cross-sectional study including all consecutives HIV-patients admitted to the HIV clinic in the University Teaching Hospital of Libreville (Gabon) between 1 May and 31 July 2014. All patients underwent a full neurological examination doing by two neurologists. The diagnosis of DSP was based on Brief Peripheral Neuropathy Screen (BPNS). We also collected the data concerning past medical history, the use of neurotoxic drug, history of disease and data of High Active Antiretroviral Therapy (HAART). The logistic regression was used to study the factors associated with DSP. They were 620 patients aged from 17 to 74 years with the mean age of 42.1 years ± 11.0 years and 570 (91.9%) were on HAART. The mean duration of disease was 57.6 ± 42.5 months. Among the 620 patients 170 fulfilled criteria for DSP, and the overall frequency of DSP was 27.4%. The associated factors in univariate analysis were the age, the occupation, the use of HAART, the HAART option, the stage of the disease, opportunistic disease, alcohol consumption, exposure to isoniazid, diabetes mellitus and the modes of contamination. But in multivariate analysis the associated factors were the stage of disease OR 2.7 [1.2 - 3.7], diabetes mellitus OR 2.4 [1.4 - 5.8] and the use of D4T in HAART OR 1.9 [1.1 - 4.9]. The main symptoms among the patients were burning feet (47.6%), the tingling (40.0%), numbness (27.6%), alteration of ankle reflex (87.6%) and alteration of vibration sensation (27.6%). The DSP was more frequent among HIV patients and could be explained by the duration of the disease, the association with metabolic disease and the use of D4T.

Intracerebral Hemorrhage in Pointe a Pitre Hospital

Background: In caribbean space stroke incidence is 50% higher than in Europe. This study aims to describe characteristics of intracerebral hemorrhage in Guadeloupe. Methods: This was a retrospective study of hospitalized patients with a no-traumatic intracerebral hemorrhage during one year from 2013 to 2014. Survivors were contacted by telephone at the end of the study and;if accept, vital status and Rankin scale were assessed. Results: In one year, 1418 patients were hospitalized for an acute stroke. 112 had no-traumatic intracerebral hemorrhage (7.9%). The sex ratio F/H was 0.72. Mean age of the population was at 63.0 ± 14.7 years. Hypertension and diabetes were the leading risk factors notice with respectively 62 and 25 patients. Intracerebral hemorrhage distribution was: deep 48.2%, lobar 30.4%, sub-tentorial 17.9%, meningeal 3.5%. Severity signs distribution were mass effect 79%, ventricular contamination 43% and cerebral herniation 37%. Mean during of in-hospital stay was 10.6 ± 10.3 days and in-hospital mortality was 22 patients (19.6%). A year and a half after emergency 5 additional death (4.5%) between 35 patients survivors was noticed with median Rankin scale 1.5. Conclusion: Intracerebral hemorrhage is less frequent in African American as compared to Caucasian;the epidemiological excess of strokes in this population is related to ischemic strokes.

Psychological Experience of Children and Adolescents with Homozygous Sickle Cell Disease in Brazzaville

Introduction: Sickle cell disease, the most frequent hemoglobinopathy, is one of many causes of psychological repercussions. Objectives: To determine the prevalence of psychological disorders in children/adolescents living with sickle cell disease and to identify the associated factors. Patients and Method: An analytical cross-sectional study was conducted from June to September 2019 at the national sickle cell center and at the mother-child consultation of the University Hospital of Brazzaville. Children/adolescents aged six to 19 years old followed for sickle cell disease were included. Psychological disorders were assessed using the Diagnostic and Statistical Manual of Mental Disorders “DSM-5” which assesses depression and anxiety disorders, the Rosenberg Self-Esteem Scale, and the Brief Illness Perception Questionnaire which assesses representations of chronic diseases. SPSS 20.0 software was used for statistical analysis. Results: Out of 201 children/adolescents included, a drop in self-esteem was noted: 76.1%, anxiety 29.9%, depression 5.5% and a negative impact on daily life in all cases. These were significant negative consequences 39.3%. Advanced age, duration of illness, delay in school and puberty, use of upper-level analgesics, number of complications and hospitalizations, and occurrence of complications were associated with psychological disorders. Conclusion: The frequency of psychological disorders during the experience of the child/adolescent living with sickle cell anemia, requires that education, behaviour change communication be strengthened in order to improve the quality of care.

Unilateral Femoral Neck Fracture after Epileptic Seizure in Young Patient: A Case Report

Femoral neck fracture occurring after an epileptic seizure is a rare and under-diagnosed injury. The majority of the reported cases in literature are old patients with osteoporosis. Younger patients present several risk factors of osteopenia and the treatment remains controversial. We present an outcome of a 23 years old patient with unilateral femoral neck fracture occurring during an epileptic seizure and we discuss the associated multiple risk factors of osteopenia and osteonecrosis of the hip. The patient was brought to the emergency department of Teaching Hospital of Kamenge (CHUK) complaining of pain in his left hip that had been progressing for one month after an epileptic seizure. There is a history of HIV infection since birth and epileptic seizures with ongoing treatments for both diseases. Despite the high risk of avascular necrosis, the treatment choice has been influenced by the patient’s age and a conservative surgery by internal fixation with Dynamic Hip Screw has been made. Unfortunately, this treatment early resulted in osteonecrosis of the hip since HIV infection itself and the highly active anti-retroviral therapy increase its risk.

Frequency of Distal Sensory Polyneuropathy among Diabetics in Parakou in 2012

Background: The distal sensory polyneuropathy (DSP) was more frequent among diabetics, although its determinant was not well known among diabetics in Benin. Objective: We aimed to assess the frequency of DSP and its determinants among diabetics at Parakou. Methods: It was a cross-sectional study carried out from 1 March to 31 August 2012 and included 336 diabetics followed at the diabetes unit of Parakou hospital. The diagnosis of DSP was based on DNS (Diabetic Neuropathy Score) criteria and other criteria. All data concerning the diabetes mellitus were recorded. We used Epi-Info and SPSS 16.0 software to perform analysis. Results: They were 187 females (56.0%) with the mean age of 54.9 ± 10.9 years. 298 patients fulfilled criteria for DSP;the overall prevalence of DSP was 88.7%. The main associated factors in multivariate analysis were treatment duration of diabetes more than 4 years: OR = 36.7 [4.0 - 336.9];the elevated glycaemia: OR = 3.1 [1.4 - 7.1];the activity with high income: OR = 0.2 [0.0 - 0.8];the ethnicity: nagots/fon: OR: 3.7 [1.4 - 12.5]. Conclusion: Those results suggested the high frequency of DSP among diabetics at Parakou.

Identifying sex-specific differences in the carotid revascularisation literature:findings from a scoping review

Objective No systematic review of the literature has dedicated itself to looking at the management of symptomatic carotid stenosis in female patients.In this scoping review,we aimed to identify all randomised controlled trials(RCTs)that reported sex-specific outcomes for patients who underwent carotid revascularisation,and determine whether sufficient information is reported within these studies to assess short-term and long-term outcomes in female patients.Design,setting and participants We systematically searched Medline,Embase,Pubmed and Cochrane libraries for RCTs published between 1991 and 2020 that included female patients and compared either endarterectomy with stenting,or any revascularisation(endarterectomy or stenting)with medical therapy in patients with symptomatic high-grade(>50%)carotid stenosis.Results From 1537 references examined,27 eligible studies were identified.Sex-specific outcomes were reported in 13 studies.Baseline patient characteristics of enrolled female patients were reported in 2 of those 13 studies.Common outcomes reported included stroke and death,however,there was significant heterogeneity in the reporting of both periprocedural and long-term outcomes.Sex-specific differences relating to the degree of stenosis and time from index event to treatment are largely limited to studies comparing endarterectomy to medical therapy.Adverse events were not reported by sex.Conclusions Only half of the previously published RCTs and systematic reviews report sex-specific outcomes.Detailed analyses on the results of carotid artery intervention for female patients with symptomatic stenosis are limited.

动脉粥样硬化血栓形成门诊患者1年内心血管事件的发生率

背景：目前，有关社区中动脉粥样硬化血栓形成稳定患者心血管（cardiovascular，CV）事件发生率的资料比较少，既往也无国际性队列研究对冠状动脉病（coronary artery disease，CAD）、脑血管病（cerebrovascular disease，CVD）、外周动脉病（peripheral arterial disease，PAD）确诊患者以及此类疾病高危患者不同事件的发生率进行评估。 目的：在患有动脉疾病的门诊患者或存在多个动脉粥样硬化血栓形成危险因素的门诊患者中确定当今世界1年内CV事件的发生率。 设计、地点及参试者：“减少动脉粥样硬化血栓形成维系健康（Reduction of Artherotllrombosis for Continued Health，REACH）”注册研究是一项国际前瞻性队列研究。研究人员于2003—2004年从44个国家、5587名医生入选68236例已确诊的动脉粥样硬化性血管病患者（CAD、PAD、CVD；n=55814）以及至少存在3个动脉粥样硬化血栓形成危险因素的患者（n=12422）。 主要观测指标：CV死亡、心肌梗死（myocardial infarction，MI）及卒中的发生率。结果：截至2006年7月，共有95．22％的患者（n=64977）提供了1年内的结局。心血管死亡、MI及卒中的总体发生率为4．24％；动脉粥样硬化性血管病患者为4．69％，仅存在多个危险因素的患者为2．15％。CAD、CVD及PAD患者CV死亡、MI及卒中的总体发生率分别为4．52％、6．47％和5．35％。CAD、CVD及PAD患者发生终点事件（即CV死亡、MI、卒中）以及因动脉粥样硬化血栓形成事件入院的几率分别为15．20％、14．53％和21．14％。上述事件发生率随症状性动脉疾病病变部位数量的增加而增加，仅存在危险因素的患者为5．31％，有1处症状性动脉疾病的患者为12．58％，有2处症状性动脉疾病的患者为21．14％，有3处症状性动脉疾病的患者为26．27％（趋势P〈0．001）。 结论：在这项当代大型国际研究中，患有动脉粥样硬化性血管病的门诊患者以及有动脉粥样硬化血栓形成危险的门诊患者CV事件的年发生率相对较高。存在多部位病变者CV事件的1年发生率升高。

中脑动脉梗死后沿丘脑纵向扩散的变化

Background: Cerebral infarcts are responsible for functional alterations and microscopic tissue damage at distance from the ischaemic area. Such remote effects have been involved in stroke recovery. Thalamic hypometabolism is related to motor recovery in middle cerebral artery (MCA) infarcts but little is known concerning the tissue changes underlying these metabolic changes. Diffusion tensor imaging (DTI) is highly sensitive to microstructural tissue alterations and can be used to quantify in vivo the longitudinal microscopic tissue changes occurring in the thalamus after MCA infarcts in humans. Methods: Nine patients underwent DTI after an isolated MCA infarct. Mean diffusivity (MD), fractional anisotropy (FA), and thalamic region volume were measured from the first week to the sixth month after stroke onset in these patients and in 10 age matched controls. Results: MD significantly increased in the ipsilateral thalamus between the first and the sixth month (0.766× 10- 3mm2/s first month; 0.792× 10- 3 mm2/s third month; 0.806× 10- 3 mm2/s sixth month). No significant modification of FA was detected. In six patients, the ipsilateral/contralateral index of MD was higher than the upper limit of the 95% CI calculated in 10 age matched controls. An early decrease of MD preceded the increase of ipsilateral thalamic diffusion in one patient at the first week and in two other patients at the first month. Conclusion: After MCA infarcts, an increase in diffusion is observed with DTI in the ipsilateral thalamus later than 1 month after the stroke onset. This is presumably because of the progressive loss of neurons and/or glial cells. In some patients, this increase is preceded by a transient decrease in diffusion possibly related to an early swelling of these cells or to microglial activation. Further studies in larger series are needed to assess the clinical correlates of these findings.

α-Synuclein-carrying astrocytic extracellular vesicles in Parkinson pathogenesis and diagnosis

Background The accumulation ofα-synuclein(α-syn),an essential step in PD development and progression,is observed not only in neurons but also in glia,including astrocytes.The mechanisms regulating astrocyticα-syn level and aggregation remain unclear.More recently,it has been demonstrated that a part ofα-syn spreading occurs through extracellular vesicles(EVs),although it is unknown whether this process is involved in astrocytes of PD.It is known,however,that EVs derived from the central nervous system exist in the blood and are extensively explored as biomarkers for PD and other neurodegenerative disorders.Methods Primary astrocytes were transfected with A53Tα-syn plasmid or exposed toα-syn aggregates.The level of astrocyte-derived EVs(AEVs)was assessed by nanoparticle tracking analysis and immunofluorescence.The lysosomal function was evaluated by Cathepsin assays,immunofluorescence for levels of Lamp1 and Lamp2,and LysoTracker Red staining.The Apogee assays were optimized to measure the GLT-1+AEVs in clinical cohorts of 106 PD,47 multiple system atrophy(MSA),and 103 healthy control(HC)to test the potential of plasma AEVs as a biomarker to differentiate PD from other forms of parkinsonism.Results The number of AEVs significantly increased in primary astrocytes withα-syn deposition.The mechanism of increased AEVs was partially attributed to lysosomal dysfunction.The number ofα-syn-carrying AEVs was significantly higher in patients with PD than in HC and MSA.The integrative model combining AEVs with total and aggregatedα-syn exhibited efficient diagnostic power in differentiating PD from HC with an AUC of 0.915,and from MSA with an AUC of 0.877.Conclusions Pathologicalα-syn deposition could increase the astrocytic secretion of EVs,possibly throughα-syninduced lysosomal dysfunction.Theα-syn-containing AEVs in the peripheral blood may be an effective biomarker for clinical diagnosis or differential diagnosis of PD.

脊髓多发性硬化斑块周围组织的重塑

关于多发性硬化(multiple sclerosis,MS)斑块的病理以及MS患者灰白质的弥散性改变,目前已有相当多的深入研究报道。但对于脱髓鞘斑块周围组织的改变,尤其对是脊髓MS斑块周围组织的病理研究,目前几乎没有报道。本研究即对进展性脊髓MS患者的脊髓脱髓鞘病灶周围组织(periplaque demyelinated lesions,PDLs)进行分子免疫病理方面的研究。纳入初发或复发进展型脊髓MS患者21例,尸检得到其颈髓组织,对其PDLs的神经病理特征进行分析。结果显示,PDLs存在大面积的不完全性脱髓鞘现象,而且存在促炎症和抗炎症的叠加分子反应。巨噬细胞和小胶质细胞聚集在PDLs,但对脱髓鞘碎片的吞噬作用很弱。下调PDLs的少突胶质细胞基因,胶质细胞相关的分子标志物,如水通道蛋白(aquaporin)-4、缝隙连接蛋白(connexin)-43及谷氨酸转运子(glutamate transporter)EAAT1的mRNA及蛋白表达水平均明显下调。本研究还显示,在进展型脊髓MS患者的脊髓组织中,伴随脱髓鞘斑块的形成,PDLs内的组织重塑早已开始并一直伴随着斑块的形成。笔者推测脊髓病灶PDLs内,组织重塑的过程一定伴随着星形胶质细胞功能的改变、较轻的炎症反应,共同促进了脱髓鞘的发生和进展。

破伤风疫苗接种所致四肢软瘫(法国)

Introduction. Anti- tetanus vaccination is considered to bevery safe. However complications such as mononevritis,multinevritis or even polyradiculonevritis can be encountered.Observation. An 85- year- old man was admitted to our unit after a traffic accident caused by stroke. Seventy- two hours later thepatient developed tetraplegia within a few hours, caused by neuropathy secondary to anti- tetanus vaccination. Discussion.In this elderly patient, the rapid onset and severe presentation of the tetraplegia as well as the past history of normal vaccination and the axonal form of the neuropathy could have led to a misdiagnosis of neuropathy after booster- anti- tetanus vaccination. We first ruled out other possible diagnoses and then reviewed the possible mechanisms of neurological complications of vaccinations. These complications are probably underestimated in elderly hospitalized patients who receive a booster shot in the emergency department. Conclusion. This report illustrates the importance of reconsidering the benefit/risk relationship of anti- tetanos vaccination.

成人发生水痘后的面神经麻痹和中枢神经系统水痘带状疱疹病毒感染(法国)

Introduction. VZV virus- related peripheral neuropathies usually occur after shingles in adults and more rarely after chickenpox in childhood. Case report. A 54- year- old patient presented with a right VIIth nerve palsy following a chickenpox rash and recovered after antiviral treatment CSF analysis revealed lymphocytic meningitis and the virus was identified by PCK. Conclusions. Although previous chickenpox was not found in the patient’ s past history, the probability of reinfection is likely. The virus can be assumed to affect the nervous system directly; the axonal or demyelinating mechanism of the neuropathy may be discussed.

伴有短暂性神经功能缺损和脑脊液淋巴细胞增多的假性偏头痛(法)

Introduction. Pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis is a rare syndrome resolving within less than 3 months. Case report. A young 17- year-old woman without previous medical history was admitted to the hospital because of right motor weakness and language disturbances. The symptoms resolved in a few hours and were followed by severe left headaches with important vegetative signs. Several similar episodes were noted in the previous 10 days. Cranial MRI was normal. EEGshowed important slowing of the cerebral electrogenesis. More than 250 lymphocytic cells were found at CSF analysis. Outcome was spontaneously favorable, without similar symptoms after 6- month follow-up. Conclusion. Pseudomigraine with lymphocytic pleocytosis seems to be a particular syndrome of unknown origin. This is an elimination diagnosis, generally with a benign course.

丘脑梗死的3个变异分型:前内侧型、中央型和后外侧型

Background and Purpose - Thalamic infarcts have traditionally been classified into 4 territories: anterior, paramedian, inferolateral, and posterior. The purpose of this study was to review this classical versus variant distribution in patients with thalamic stroke. Methods - We reviewed all patients with a first clinical stroke included in the Lausanne Stroke Registry between 1990 and 2002. Among 71 patients with an acute stroke isolated to the thalamus confirmed by MRI, we selected all patients with lesions outside the classical territories and studied their clinical, etiological, and radiological features. Results - A total of 21 patients (30% of all thalamic stroke patients) showed infarction outside the classical territories, allowing us to delineate 3 variant distributions: (1) Anteromedian territory (9 patients [13% Abstract:) involving anterior and paramedian territories, with predominantly cognitive impairment, including executive dysfunction, anterograde amnesia, and aphasia in left- sided or bilateral lesions. The most frequent stroke mechanism was cardiac embolism. (2) Central territory (4 patients [6% Abstract:), with lesions on the central part of the thalamus, resulting in a variety of neurological and neuropsychological signs, reflecting the involvement of several adjacent structures. Microangiopathy was the most frequent etiology. (3) Posterolateral territory (8 patients [11% Abstract:), involving inferolateral and posterior territories, with hemihypesthesia as the most frequent manifestation, followed by hemiataxia, executive dysfunction, and aphasia in left- sided lesions. Artery- to- artery embolism and microangiopathy were the main stroke mechanisms. Conclusions - We describe 3 variant topographic patterns of thalamic infarction with distinct manifestations and etiologies. We postulate that these infarcts are the result of a variation in thalamic arterial supply or reflect borderzone ischemia.

对卒中急性期护士护理的评估(法国)

Introduction. We report the results of a one-day survey of nursing care loa d in University Hospitals (UH), General Hospitals (GH) and Stroke Units (SU) reg arding the acute stage of stroke. Methods. The type of care and the time devoted to care were compared by type of stroke (transient ischemic attack, ischemic st roke, hemorrhagic stroke, cerebral thrombophlebitis, sub-arachnoid hemorrhage) , and degree of handicap (Barthel score). Results. Twenty-two hospitals (13 UH and 9 GH) participated in the study and provided care for 328 stroke victims (3 0 transient ischemic attacks, 247 ischemic strokes, 36 hemorrhagic strokes, 3 ce rebral thrombophlebitis events and 11 strokes of unknown mechanism). Care was gi ven in UHs for 63 percent of the patients and in GHs for 37 percent; in SUs for 40 percent (132 patients) and general neurology units for 60 percent (196 patien ts). Care involved physiotherapy for 70 percent, speech therapy for 42 percent, and care for cognitive decline for 36 percent. Mean time spent by nurses and nur sing assistants peaked in the morning with a significant time not devoted to car e. More than 3 hours of nurse care per day of care was significantly more freque nt in SUs (p < 0.001) and in GHs (p = 0.02) for patients with Barthel score < 40 or hemorrhagic stroke, irrespective of age. Patients older than 80 years, with a Barthel score < 40, with hemorrhagic stroke, and who were admitted more than 1 5 days before the survey required more than two hours per day of nursing assista nt care significantly more often. The probability of more than three hours per d ay of nurse care for stroke increased 2.8-fold for hemorrhagic stroke, 6.0-f old for Barthel Score < 40, and 2.0-fold for care in a GH. The probability of more than two hours per day of nurse assistant care for stroke increased 3.0- fold for hemorrhagic stroke, 6.1-fold for Barthel score < 40, 2.0-fold for patient s older than 70 years, and 1.5-fold for stroke onset more than 14 days before the survey. Conclusion. This survey enabled calculating the number of care giver s required for 10 patients: 6 nurses and 5 nursing assistants, a level in line w ith recommended practices. These results emphasize the important role of nursing care for stroke victims, and points out that the type of hospital, the type of stroke, and the patient’s age and degree of handicap have an effect on nursing load. This one-day survey enabled calculation of the number of nurses and nur sing assistants needed for a 10-patient unit.

构音障碍的感知分析在皮质基底节变性和帕金森病鉴别诊断中的作用

Objective: To characterize the dysarthria in patients with corticobasal degeneration (CBD) and determine if analysis of speech in isolation helps to distinguish CBD patients from patients with Parkinson’s disease (PD). Methods: 60 subjects were assessed by means of perceptual analysis of speech: 15 patients with CBD, 15 patients with PD and 30 control subjects. A detailed profile was furnished with the help of 33 perceptual items. A global perceptual approach was used to classify patients by judges blind to the medical diagnosis. Rating scales were adapted to quantify the degree of spasticity and hypokinesia in the speech of each patient. Results: Dysarthria was frequent in CBD even though it remained mild for a long period of time. Group analysis revealed the importance of temporal errors of speech control in CBD patients while voice disturbances were most frequent in PD patients. However, attempts to classify patients according to global perceptual analysis remained below a reasonable level of clinical acceptability. Finally, even though the widespread neuropathological changes suggest that deviant speech dimensions of several types of dysarthria might be found in CBD, evidence for a mixed dysarthria with presence of spastic elements could not be established. Conclusion: The findings support the view that even though perceptual analysis is mandatory in the management of dysarthric patients, it does not help in the clinical differential diagnosis of CBD.

HIV感染出现双侧视神经病变

We report the case of a 57-year-old man who presented bilateral subacute and painless optic neuropathy after meningopolyradiculitis revealing a primary human immunodeficiency virus infection. Both antiretroviral and steroid treatments were ineffective. Clinical symptoms and evolutive pattern were consistent with a mechanism of microvascular ischaemia of the optic nerve head. Optic neuropathies related to HIV infection are rare compared to those resulting from opportunistic infections. There are several pathophysiological mechanisms involved.

腔隙性梗死的形状和体积:一项对伴有皮质下梗死和脑白质病的常染色体显性遗传性脑动脉病的3DMRI研究

Background and Purpose -The shape and exact size of lacunar infarcts have been investigated only postmortem. Recent imaging techniques based on triangulation and connectivity can now be used for 3D segmentation of cerebral lesions. The shape and size of lacunar infarcts was investigated using these techniques in 10 cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) patients. Methods -We segmented 102 lacunar infarcts on T1-weighted images. The surface of the corresponding set of voxels was computed as a mesh of triangles. Thereafter, the shape of each lesion in 3D was visually analyzed by 2 investigators. Results -The volume of lesions ranged from 10.5 to 1146 mm, with 93%of them having a volume < 500 mm; 83%lacunar infarcts had a spheroid or ovoid shape, but 17%presented as sticks, slabs, or with a complex shape. Lesions with multiple components appeared larger than the others, and a tail extension was noticed in 13 of 102 lesions. Conclusions -These results sugges t the following: (1) most lacunar infarcts in CADASIL have a volume far below one third of that of a sphere of 15 mm in diameter, the upper limit currently used for their identification on 2D imaging; (2) a significant proportion of lacunar infarcts have a shape distinct from the spheroid-ovoid morphology; and (3) les ions with a complex shape may result from the involvement of the largest small a rteries, confluence of ischemic lesions, or secondary tissue degeneration. The s egmentation of lacunar infarcts appears promising to better understand the patho physiology of tissue lesions secondary to small vessel diseases.