Biomedical subjects
Publications and source records attributed to A Jeanneau.
A traumatic injury of the anterior part of the corpus callosum led to a peculiar symptomatology associating motor conflicting behavior (diagnostic dyspraxia or voluntary ambivalence) and conflicting thoughts (emotional ambivalence) inducing a distressing feeling.
Brain imaging showed extra-hippocampal temporal lesions in two patients with major disturbances of memory for academic knowledge including complete loss of professional knowledge and school learning especially regarding history, but sparing recent episodic memory in both cases and remote episodic memory in one of them. The antero-inferior and/or lateral regions of the temporal lobe could contain critical structures required to evoke and maintain memory of academic knowledge.
While clinical experience has long since shown that there are different types of depression, in particular anxious and hostile depressions, the psychopathological analysis of the various forms remains of current interest. At least four psychopathological models are currently available. The first raises the question of the continuity between reactions to separation, particularly studied in children, and the clinical expression of certain forms of depression in adults. In many aspects, the latter suggest the sequence: protest-despair-detachment. The second model raises the question of the relationship between the depressive disorder and the organization of certain personalities. The considerable comorbidity between the borderline personality and affective disorders suggest that these two different disorders share a common dimension. The third-cultural-model hypothesizes a relationship between the sociocultural prohibition of aggressive responses and the incidence of depression. The fourth model is based on the existence of a specific biological constraint related to abnormalities of serotonin metabolism, to which dysregulation of anxious and aggressive-impulsive behavior patterns during depression are considered related. In conclusion, it may be considered that several models, in particular that of reaction to separation, may, at least in part, account for "positive-expression" depression, but that at least two questions have still to be answered: that regarding the relationships between depression and personality, and that concerning the relationships between the psychopathological constraints related to serotonin metabolism dysfunction and the "positive" expressions.
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For historical reasons, Pick's disease is sometimes misunderstood in the medical literature. However, clinical signs are quite typical, and different from those of Alzheimer's disease. The disease is characterized by a circumscribed fronto-temporal atrophy, without senile lesions. Neuronal loss and ballooned neurons are present in the atrophic cortex. In about 30 p. 100 of cases, Pick's bodies are present, with various shapes, perhaps depending upon the duration of the disease process. Other lesions are described. The symptomatology is characterized by personality changes of the frontal type, associated with verbal and behavioural stereotypies, and bulimia. There is a striking normality of the EEG, and CT scan shows the fronto-temporal cortical atrophy and atrophy of the caudate nucleus. In most cases, memory for recent events is quite normal, but sometimes an amnestic syndrome is closely related with an unusually severe atrophy of the hippocampus. The consequences of atrophy of the caudate nucleus are debated, since extrapyramidal symptoms appear to be mild and late.
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Clinical and anatomical report of a post traumatic amnestic syndrome (Korsakoff's syndrome), associating anterograde amnesia persisting for fifteen years, with temporal disorientation, false recognitions, initially intense transitory confabulation and secondarily bursts of confabulation, intact remote memory and persistence of old learnings. Death after twelve years from mesenteric infarction. Anatomically, post-traumatic sequellae are limited to both cingulate gyri in their anterior part. This cingula involvement is easy to understand if one knows that post-traumatic Korsakoff's syndrome appears after severe cranial traumatisms, with at least three days of coma, and develops constantly, even if transitory, after long duration comas with 20 to 30 days of loss of consciousness. Anatomical explanation depends on the fact that Korsakoff's syndromes from various etiologies need, to be produced, a bilateral damage of the limbic circuit and that severe head traumatisms, when dying early in the evolution without possibility of a neuro-psychological investigation, have always a destruction of corpus callosum or cingulate gyri or both, resulting from crushing of these structures by the edge of the faulx cerebri. Consistent with these constatations, it is logical that a Korsakoff's syndrome develops after severe head traumas with bilateral lesions of the limbic circuit and especially of the cingulate gyri. But anatomical evidence remains rare, because early fatal evolution does not permit psychological evaluation and, reversely, long survivals who may die from another pathology would not have brain examination. We prefer the name of "Korsakoff's syndrome" rather than that of "amnesic syndrome" to denominate the anterograd amnesia (amnésie des faits récents) encountered in nutritional disorders due to B1 deficiency in true Korsakoff's disease, but also with other etiologies such as cerebral tumours, vascular cerebral disorders, post-commital anoxia, herpetic encephalopathy, head traumas, all of them developing amnesia for recent events, formerly classified under the title of "korsakowian syndrome" or "mental syndrome of Korsakoff" and more recently under the denomination of "amnesic syndrome". But whatever is the etiology of the memory disorder, the amnesic syndrome remains identical and the advanced small differences, such as euphoria in alcoholics or mood depression in tumours, are often fallacious, so that the only way of differentiation deals with accessory symptoms such as intracranial hypertension in tumours, sudden onset in vascular etiologies or polyneuritis in B1 deficiency. Post-traumatic Korsakoff's syndrome joins with this scheme, for its clinical aspect is so similar to that of nutritional disorders that it might be difficult to reach the exact diagnosis when an alcohol addict develops, after a head trauma, an amnesia which could be the consequence of the trauma but also of a nutritional disorder developed after the accident with inadequate parenteral treatment. Our case, which is the first well documented observation of this disease reported with long clinical survey and final pathological examination, was presented in 1981 at a joint meeting of the French and Dutch neurological societies. It gives the proof of the importance, in limbic circuit, of the cingulate gyri. A comparison is made with four other clinical cases of post traumatic amnestic syndrome with MNR procedures which show, for two of them, cingula lesions explaining the clinical features, for one of them a bilateral lesion of Ammon's homs and for the last one extra-limbic lesions, with destruction of the inferior part of both frontal lobes, associated with a possible deafferentation of the right cingula cortex.
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Diffuse Lewy body disease has not been yet described in France, although some authors, essentially Japanese ones reported cases of this disease. A man began at age 56 to be very apathetic with memory disturbances. Later, he developed aphasia, stereotypies, and mild parkinsonian rigidity. He died in cachexia, three years after the onset of the disease. Post-mortem examination showed diffuse senile plaques and tangles in the cortex. But there was also a striking widening of Lewy bodies, in the pons and in the frontal, temporal and cingular cortex. These Lewy bodies were located in the 5th cortical layer, and their immature and irregular shape made them difficult to identify. The authors discuss the role of each lesions on the clinical disturbances, in regard to other described cases.
This review of the literature shows that Parkinson's disease can be considered as an indication of sismotherapy. The therapeutic effects of ECT on the extra-pyramidal syndrome are reviewed whether it is associated with a depression or not. The various biological mechanisms of the antiparkinsonian effect of ECT are discussed ie the increase of the permeability of the brain blood barrier, the action on the dopamin metabolism and the dopamin receptors and the action on the opioid receptors and melatonin. The role of maintenance ECT in the treatment of Parkinson's disease is cleared up. In conclusion, it appears that sismotherapy can be considered as an adjuvant therapy in Parkinson's disease especially when there is a resistance to dopatherapy.
A sample of 38 adolescents hospitalized for a major depressive episode melancholic type or a manic episode during the course of a bipolar disorder (according to the DSM III-R Criteria) was examined with particular emphasis on precipating life events and family relationships. Psychosocial stressors in the year preceding onset of the affective disorder were found in a very high proportion of cases (about 80%). Stressors are most often severe. All of these stressors have to do with loss or threat of loss, particularly the most frequent one: the sentimental failure. Analyzing results of a familial dynamic questionnaire, we showed in the MDD sample the prevalence of two psychopathological index: maternal rejection, parental dysharmony.