[A new form of arbitrary commitment].
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Biomedical subjects
Publications and source records attributed to F Lhermitte.
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A series of 247 cases with simple and apparently primitive cerebral hemorrhages selected from the pathological records of Charles Foix laboratory from 1962 to 1977 is reviewed with regard to the accuracy of the premortem diagnosis as a function of the size, the location and the age of the bleeding, the patient's age, the practices of angiography or lumbar puncture and the considered period of death. The clinical diagnosis of cerebral vascular disease was made in 75% of the cases from that serie but the hemorrhagic mechanism was identified only in 50,6% of cases. The diagnosis accuracy was enhanced in large and recent hemorrhages occuring in patients under 70 years old. It seemed better in cerebellar and intermediate locations. It was enhanced in more recent observations (collected since 1974). The practice of cerebral angiography and lumbar puncture rose up (in a somewhat equivalent way) the proportion of accurate diagnoses. The lumbar puncture practice was not associated with a higher rate of cerebral herniae.
A peripheral dopaminergic blocking agent, domperidone (60 mg daily), or placebo was given, double-blind, to 17 parkinsonian patients who also received increasing doses of bromocriptine. Combined treatment with domperidone reduced total disability by 76% in 8 patients receiving a mean dose of 148 mg of bromocriptine daily. There was no vomiting and involuntary movements and psychic disturbances were similar to those in patients on levodopa and a peripheral decarboxylase inhibitor. In 9 patients taking placebo instead of domperidone, the average daily dose of bromocriptine could not be raised beyond 92 mg. The mean total disability score in this group was reduced by only 48%. Thus, peripheral blockade of dopamine receptors is a promising means of limiting the adverse side-effects of the treatment of parkinsonism with central dopaminergic receptor stimulating agents such as bromocriptine.
In this article, the clinical actions of the principal dopamine receptor stimulating agents (apomorphine and its derivatives; piribedil, rye-ergot derivatives) are discussed on the basis of their biochemical and pharmacological properties.
Two cases of crossed aphasia in right-handed patients are reported. The oral language of these two patients was characterized by a reduction in its lexical and grammatical content. Their written language, however, was a veritable jargon with anosognosia. The jargon aphasia of the first patient consisted mainly of neologisms. The written language of the second patient was slightly less disorganized and corresponded to an asemantic jargon. The existence of this jargon aphasia gives these two observations an exceptional character in relation to other cases of crossed aphasia in right-handed patients. It supplies new information which can be the basis for discussion on the relations between cerebral laterlization of language functions and manual preference.
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The systematic pathological study of 500 patients with intracranial hemorrhages (ICH) [341 (68 P. 100) CEREBRAL HEMORRHAGES (C.H.); 119 (24 p. 100) meningeal hemorrhages (M.H.); 39 (7,8 p. 100) subdural hematomas (S.H.) and, at last, one extradural hematoma] has been practiced. Those cases were issued primarily from neurological and, at a lesser degree, from neurosurgical departments. Etiological data, complications, associated findings and causes of death have been analysed. High blood pressure is the main etiological factor in C.H. This is confirmed by the statistical comparison between the incidence of this factor in our material and in the whole French population. However, nearly 50 p. 100 of ICH occuring in normotensive patients are C.H. The incidence of cirrhosis is much higher in our study than in other reports from the literature. The frequently associated high blood pressure does not seem to enhance the incidence of CH in patients with liver cirrhosis. Although this last factor can be found alone, its real etiological importance in CH cannot be assessed on account of the lack of data concerning the incidence of liver cirrhosis in the French population. The incidence of anticoagulant therapy is high in S.H. On the contrary, this factor does not seem to enhance the risk of high blood pressure induced C.H. The traumatic etiology of S.H. is significantly higher than the anticoagulant therapy etiology which, however, is very high in our study.
Eight patients with Alzheimer's disease presenting whith memory difficulties and no significant intellectual deterioration were treated with 9 grams daily. Choline base orally for 3 weeks. Quantitative testing, which evaluate memory capabilities such as learning and recall after delays of 1 hour and 24 hours, were used before and after the administration of Choline. The results of a global statistical analysis did not show any significant difference in the performances obtained before and after choline. However, in two patients, recall performance improvement was confirmed clinically. Most likely, these two patients were suffering from an mild foorm of Alzheimer's disease.
Intensive antilymphocyte serum treatment was given to 50 patients with severe, progressive multiple sclerosis for a period of 6 weeks. Conclusions were favourable as regards the possibility of using this treatment and its immunodepressive effect. Therapeutic efficacy is difficult to evaluate, but a favourable impression was obtained from the fact there was improvement and transitory stabilization in some of the patients. These results suggest that the study should be continued, using longer treatment, on more recent cases, and with a randomized control group.
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Ballistic and dystonic involuntary movements occurring at the beginning and end of the period of levodopa efficacy are described in nine patients exhibiting dyskinesis during long-term levodopa therapy. In contrast to classical abnormal interdose movements, these biphasic dyskinesias were reduced by increasing and fractionating the daily doses of levodopa.
Bilateral tactile aphasia was exhibited by a patient who was operated upon for a left parieto-occipital haematoma. Neuropsychological investigation established the following points: (1) the patient, in whom no expressive or receptive dysphasia could be found, misnamed objects when they were presented to him tactually, whereas he almost always gave the correct name when they were presented visually or auditorily; (2) the naming disturbance was identical when the object was presented to the left hand or to the right hand; (3) not only did the patient have no sensory deficit, but he could give unquestionable proof of correct tactile identification by using the objects presented to him tactually; (4) the defect appeared in the verbo-tactile as well as in the tacto-verbal direction; (5) it was not restricted to the name of the object since the patient was unable to describe, without making dysphasic errors, the morphology or usage of objects presented to him tactually; (6) the tacto-verbal dysfunction did not result from a tacto-visual impairment. Computerized tomography scans showed that: (1) there was no evidence suggesting a lesion of the right hemisphere, nor of the corpus callosum; (2) the left lesion involved the angular gyrus, the posterior part of the second temporal convolution, the inferior longitudinal fasciculus, the geniculostriate fibres and some fibres of the tapetum.
The area studied includes the city of Paris and the neighboring departments of Val-d'Oise, Seine-Saint-Denis, Hauts-de-Seine, Yvelines, Essonne, Val-de-Marne, and Seine-et-Marne. Case finding methods and diagnostic criteria are defined. The temporal and spatial distribution of cases is described, and the absence of case clustering is noted. Incidence per million people (per year) was found to be 1,09 in the city, 0,55 in the adjacent departments, and 0,25 in the peripheral departments. These results are discussed.
The authors report on four patients with vascular lesions of the thalamus, three on the left side and one on the right, two of which were due to haemorrhage and two to infarcts. Language difficulties were observed in those cases with left thalamic lesions only. Speech was either slower or faster than normal, and there were verbal perseveration, semantic paraphasia, and more especially, reduction in verbal fluency with loss of control of logic, causing a true jargon in some tests in certain cases. Articulation, and phonemic programming were unaffected, as were comprehension, reading and writing. A comparison is made between these findings and those reported in the literature. Among the hypo-theses suggested, the authors subscribe to that which accepts the predominant role played by the interruption of the activating system of the left hemisphere by the thalamic lesion. The relative inactivation resulting from this could produce modifications in language dynamics and disturbances in attention in relation to language. The semantic paraphasia could be related to the intrusion of the right hemisphere apparatus into language, because of the lack of balance between the activation of each of the two hemispheres. The fact that thalamic lesions are characterized by language disorders would tend to show that sub-cortical dynamic factors constantly regulate the activation of the hemispheres.