[Description and scanographic study of Leborgne's brain. Broca's discovery].
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Biomedical subjects
Publications and source records attributed to J L Signoret.
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Kinesthetic aphasia, as described by Luria, was evoked in a case of aphasia associated with a "pseudothalamic syndrome" of partial superficial Sylvian infarction. A neurolinguistic study of oral utterances enabled qualitative and quantitative analysis of the errors: the disorder is characterized by the high incidence of articulation substitutions. A comparative study differentiated such disorders of oral expression from other aphasic disorders of expression (arthric disorders and phonemic jargon). Kinesthetic aphasia is distinguished by this clinical specificity and by the site of the lesion in the anterior parietal region of the dominant hemisphere.
Various studies have demonstrated that the ability to draw may be unaffected in motor aphasia, and even in some cases of sensory aphasia when there is no associated constructive apraxia. An artist, who was both a satirist and a caricaturist, was followed up for three years during re-educational therapy following the onset of an overall aphasia, and this raises the problem of the possible effects of drawing on recuperation of language, and the role of the right hemisphere in this recuperation. The question arises as to whether drawing should be restricted to certain particular cases during re-education or be employed in a more general manner?
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.
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.
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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.
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.
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The four cases of dyskinesia at the "beginning and end of dose" caused by L-Dopa presented in this series were characterized by four essential features: 1) their onset at the beginning and end of the period of effectiveness of a dose of L-Dopa + IDC (benserazide); 2) their ballic and dystonic appearance associated with a reinforcement of Parkinsonian signs; 3) the possibility of their reduction by an increase and fractionning of the daily dose of L-Dopa; 4) the particular nature of the underlying Parkinsonian problem in which they were seen, i.e. the young age at onset of the disease, the severity of akinesia, and the quality of the clinical response to L-Dopa. Thus on the basis of the circumstances of their development, their appearance, and their treatment, such forms of dyskinesia at the "beginning and end of dose" appear to be different from classical "mid-dose" dyskinesia. In addition, they pose a new physiolopathological problem.
Herpetic encephalitis in a 16 year old adolescent of average intelligence up to then and having had no psychiatric disorders. 3 years later, the subacte hypomanic excitation like behaviour disorder, distrubed alimentary and sexual behaviour rendered maintenance in the family environment and professional activity difficult; and this in spite of the absence of membory disorders, and the preservation of verbal and pragmatagnosic possibilities. Use of lithium led to the progressive sedation of the behaviour disorders and enabled return to work of the patient in a protected environment. This favorable action of lithium in a state of excitation of organic origin seems to be situated in the present stream of research which is attempting to enlarge the indications for it beyond manic depressive psychosis.
The authors report five new cases of myoclonic encephalopathy caused by bismuth salts with a characteristic and constant clinical picture. The signs regressed when treatment was stopped.
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