[Non-traumatic coma. Diagnostic orientation].
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Biomedical subjects
Publications and source records attributed to C Saint-Val.
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Five patients developed neurologic symptoms a few hours to 2 months after being stung by a non-hooking arthropod with immediate cutaneous reaction. The patients had no clinical or serologic evidence for Lyme borreliosis and rickettsial disease. Clinical and electrophysiologic findings were consistent with a mixed axonal and demyelinating mononeuropathy, a monomelic multiple mononeuropathy, a mononeuropathy multiplex, a radiculoneuritis, and a distal symmetric polyneuropathy. Muscle and nerve biopsies showed lymphoplasmacytic small-vessel vasculitis in all patients, and wallerian degeneration in three. These patients, and 17 others from the literature, indicate a spectrum of peripheral neuropathies occurring after insect and spider stings.
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We report the case of an 80 year-old woman who developed an unilateral brainstem infarction with a lesion of the intraparenchymatous fibres of the IIIrd cranial nerve. Intraaxial lesions of this nerve are usually part of the alternate paralysis syndrome. Our case might be the second since the report of Achard and Levi in 1901. Infarction limited to the fascicular fibres of the oculomotor nerve sparing the oculomotor nuclei results in characteristic clinical manifestations. This in turn results from the highly selective distribution of the terminal arterial territories in the midbrain.