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Biomedical subjects

F Lhermitte

Publications and source records attributed to F Lhermitte.

At least 91 records · Page 5Linked to original sources
PubMed1982

Confusion, dementia and anticholinergics in Parkinson's disease.

Among a population of 75 hospitalised Parkinsonian subjects, confusional states were observed in 46% of demented patients not receiving anticholinergic drugs and in 93% of demented patients under anticholinergic therapy. The sensitivity of demented Parkinsonians to anticholinergic drugs can be attributed to a cholinergic deficiency which has been detected in the cortex and hippocampus of Parkinsonian patients post-mortem. The observations suggest that anticholinergic medication should be avoided in Parkinsonians with intellectual impairment.

Cognition Disorders↗
PubMed1982

[Effect of a synthetic analog of enkephalin on the choreic syndrome].

A cross-over, double-blind intravenous administration of a single dose of FK 33-824, a rigid analog of enkephalin, was performed in 12 choreic patients (0,5 mg in 6 patients, 2 mg in 6 patients). The number of abnormal involuntary movements per minute and their amplitude was not altered after FK 33-824 when compared to placebo administration. This result however does not exclude the possibility of a functional interaction between Met-enkephalinergic and dopaminergic systems in the human brain.

Adult↗
PubMed1982

[The pontine reticular formation syndrome. Physiopathologic data on voluntary eye movement abnormalities].

A new clinical case of Pontine Reticular Formation (P.R.F.) syndrome is reported and analysed using electro-oculograms. The CAT scan showed a probably metastatic tumour, clearly limited and located in the ventral part of the left tegmentum in the lower pons. The oculomotor disorders were typical of the P.R.F. syndrome and similar to those previously reported in pathological studies. The left P.R.F. damage was clinically evidenced by the loss of all leftward saccades (voluntary saccades and quick phases of nystagmus), including also those situated in the right hemifield of movement. It was noticed that the voluntary return movement driving both eyes from the right lateral position to the midline was remarkably slow and twice slower for the left eye (10 degrees/s) than for the right one (20 degrees/s). The loss of pursuit movements in the left hemifield of movement suggested that the lower part of the left P.R.F. was affected by the lesion. The preservation of normal leftward oculocephalic movements for the right eye indicated that the left abducens nucleus was spared. Lastly, the complete abductive paralysis of the left eye including the oculocephalic movement implied that the left abducens motoneurons passing through the lower part of the P.R.F. were damaged. All these functional and structural correlates are consistent with the location of the lesion given by the CAT scan. They are reviewed in the light of recent experimental and clinico-pathological data. A detailed physiopathological interpretation accounting for the slow voluntary movements, observed in place of the leftward return saccades in the right hemifield of movement, is proposed. The slowness of the movements of both eyes results from lack of phasic excitation of the motoneurons of the agonist muscles and from lack of phasic inhibition of the motoneurons of the antagonist muscles, both mechanisms being suppressed by the lesion which damages the excitatory burst neurons of the left P.R.F. As the tonic cells of the left P.R.F. are also out of action, these slow movements could mainly be controlled by the tonic cells of the right P.R.F. For the left eye, as the root fibres of the left abducens nucleus are damaged, no excitation can occur on the agonist muscle (left lateral rectus) and there is only a voluntary tonic disfacilitation of the motoneurons of the antagonist muscle (left medial rectus). For the right eye, the same mechanism involving the antagonist muscle (right lateral rectus) would be combined with some tonic excitation of the motoneurons of the agonist muscle (right medial rectus), thus accounting for the twice faster velocity of this eye. This tonic excitation reaching the right medial rectus could be mediated either by one of the other afferent neurons of the left abducens nucleus encoding eye position--namely those arising from the vestibular nuclei or from both prepositus hypoglossi nuclei--or by the right ascending tract of Deiters projecting to the right medial rectus motoneurons.

Abducens Nerve↗
PubMed1982

[Parinaud's syndrome and tonic vertical gaze deviation. 3 anatomo-clinical observations].

Two anatomo-clinical cases of downward gaze palsy and one case of upward gaze palsy are reported. A tonic and intermittent downward gaze deviation is described. The supranuclear palsies of the downward gaze were related to paramedian lesions of the rostral mesencephalon; the lesions involved the rostral interstitial nucleus of the medial longitudinal fasciculus, the nucleus interstitial of Cajal, and/or their afferent and/or efferent pathways. The supranuclear palsy of the upward gaze was related to lesions of the posterior commissure. Tonic and intermittent downward deviation of gaze and ocular bobbing have opposed features. The former could be related to disinhibited reticular mesencephalic neurones activated by vestibular inputs. Tonic upward deviation of gaze is also related to a vestibulo-ocular reflex. In this case, partial or total damage of the nucleus of Cajal, and/or its input and/or its output fibers appears to have a critical role.

Aged↗
PubMed1981

[Clinical symptoms and anatomical locations in primary haemorrhages of the basal ganglia. A neuropathological study of 64 cases (author's transl)].

The signs, symptoms and courses of 64 cases of "primary" haematoma of the basal ganglia have been retrospectively studied, and the main clinical data have been analyzed in relation to the location and extent of the bleeding. Onset with hemiplegia, accompanied or not by impaired consciousness, was more frequent with intermediate and lateral haematomas than with medial haematomas (p less than 0.001). Among patients with initial hemiplegia, impaired consciousness was more frequent with intermediate and medial haematomas than with lateral haematomas (p less than 0.005). At a later stage, patients with intermediate and lateral haematomas more often went into deep coma than those with medial haematomas (p less than 0.01). There were no statistically significant differences between the three anatomical groups with regard to frequency of other signs and symptoms or duration of the disease before death occurred.

Basal Ganglia↗
PubMed1981

Paramedian thalamic and midbrain infarct: clinical and neuropathological study.

The clinical and neuropathological findings in 28 cases of paramedian thalamic and midbrain infarcts are reported. The 4 instances of unilateral paramedian thalamic infarct were characterized by mood and behavioral changes, limitation of the infarct to the center of the anatomical paramedian territory, and symmetrical configuration of the paramedian thalamic arteries. Basilar artery occlusion was found in 1 patient. The 5 cases of bilateral paramedian thalamic infarcts were characterized by disturbances of consciousness and behavior, extension of the infarct (to the mammillothalamic tracts in 4 cases, the red nuclei in 3, and the hypothalamus in 2), and a variable paramedian thalamic arterial pattern. The arterial pattern was symmetrical in 2 cases, asymmetrical in 1, and unilateral in 1. The basilar artery was occluded in 1 case, the basilar communicating and posterior cerebral arteries in 1, and a third patient had occlusion involving an aneurysm of the basilar artery. The 19 patients with paramedian thalamopeduncular infarcts had marked disturbances of consciousness (hypersomnia, deep coma, akinetic mutism) associated with ocular motility changes. Later, abnormal movements--always delayed--and memory disturbances were observed in some. Thalamic changes were restricted to beh paramedian territory in only 3 cases. The arterial pattern was symmetrical in 5. The basilar and posterior cerebral arteries were occluded in 4 patients each. Paramedian infarcts were rarely found as isolated lesions and were always bilateral when there was only one arterial pedicle. The paramedian thalamic pedicle can supply the polar thalamic territory.

Aged↗
PubMed1981

Bromocriptine in Parkinson's disease: a study of cardiovascular effects.

Blood pressure and pulse rate were studied in 20 Parkinsonian patients on no treatment, and during treatment with bromocriptine (mean dosage 148 mg/day) as the sole anti-Parkinsonian therapy. The drug was shown to reduce erect systolic and diastolic and supine systolic blood pressure and to increase erect pulse rate, in a predictable dose-dependent manner. The occurrence of episodes of significant postural hypotension was less predictable and was a transitory phenomenon in all patients. Peripheral dopamine receptor blockade with domperidone did not alter the findings, suggesting that the principal mechanism for these cardiovascular effects is a central dopaminergic one.

Benzimidazoles↗
PubMed1981

Bromocriptine and domperidone in the treatment of Parkinson disease.

In a single-blind trial of therapy in 20 patients with idiopathic Parkinson disease, domperidone prevented nausea and vomiting induced by bromocriptine without diminishing beneficial central effects. Combination of the two drugs permitted rapid increase in bromocriptine dosage from 22.5 mg per day to 148 mg per day, with 71% mean clinical improvement over baseline score; continuing efficacy of the regimen was evident for a mean follow-up of 2 months.

Benzimidazoles↗
PubMed1981

Transient global amnesia and migraine.

Twelve patients with transient global amnesia (TGA) had prior migraines (six classical and six common). In three patients, classic migrainous phenomena accompanied TGA, and in nine patients severe headache accompanied the amnestic attack. Migrainous vascular dysfunction in the dominant posterior cerebral artery territory could explain TGA: (1) The pathophysiology and transient nature of TGA have led many to postulate posterior circulation vascular disease; migraine is a vascular disorder with a posterior circulation bias. (2) TGA and migraine share common precipitants. (3) Migraine differs from arteriosclerotic ischemia; the repetitive queries of TGA are absent in amnestic stroke. (4) TGA and migraine are usually benign.

Adult↗
PubMed1981

[Memory disturbances, eyelid conditioning, startle and orienting reactions (author's transl)].

Patients with memory disturbances were submitted to eyelid classical conditioning procedure in which a sound was reinforced at a 50 p. 100 rate by an air puff. They were compared to normal subjects and to patients with unilateral forebrain lesions. Six patients with mesodiencephalic lesions (mamillary bodies, fornix, cingulum) didn't have any conditioning while 2 patients with bilateral temporal lesions had normal conditioning. Startle and orienting reactions were very weak too in patients with mesodiencephalic lesions and normal in patients with bilateral temporal lesions. The startle and orienting reaction impairment can be related to attention disturbances leading to the lack of conditioning.

Amnesia↗
PubMed1981

[Necrotic aspects of multiple sclerosis and Schilder's disease (author's transl)].

Two anatomo-clinical cases of a necrotic form of demyelinating disease are reported. The disease occurred in two women, had a late onset (patient were about 50 years old) and had a relapsing-remitting course during more than 10 years. The CSF displayed a high protein level over 125 mg/100 ml whereas the gamma-globulin level was normal. The anatomical study found symmetrical cavitations involving both hemispheres and optic tracts with clear-cut limits. Axons and myelin were both destroyed, only the vascular network being partially spared. At the lesion's border-line mononuclear cell infiltrates as well as some phagocytes with sudanophilic inclusions were found. The scarcity of the compound granular corpuscules suggest an old pathological process. A narrow zone of myelin-axonal dissociation was also observed. Astrocytic proliferations was unimportant. Blood vessels were normal. In one case plaques of multiple sclerosis were found in the spinal cord. Those two cases are unusual forms of a diffuse disseminated sclerosis: multiple sclerosis and Schilder's disease are considered as two anatomo-clinical variants of the same pathological process. The observed necrotic lesions are different from the acute necrotic forms of multiple sclerosis as the latter have rapidly developed. The long lasting course of the disease, over 10 years, allowed a complete resolution of the lesions explaining the cavitations. The late onset of the disease and the CSF high protein level are pointed out. The significant of the high protein level and normal gammaglobulin level in the CSF is discussed.

Brain↗