Uvéo-méningo-encéphalite

Résumé On réunit sous le terme général d'uvéo-méningo-encéphalite la maladie de Harada et le syndrome de Vogt-Koyanagi. Ce tableu nosologique est actuellement bien défini et on distingue trois phases dans son évolution: une phase méningée, une phase ophatalmique et une phase de convalescence qui s'étend sur des mois. Au cours de cette dernière on assiste à la régression des lésions oculaires et à l'apparition (fréquente, mais non obligatoire) de lésions de la peau et des muqueuses.Les auteurs rapportent un cas d'uvéo-méningo-encéphalite survenu chez une jeune Espagnole de 27 ans. Ce cas a présenté une évolution tout-à-fait caractéristique, mais s'est signalé par des particularités biologiques inhabituelles: on a constaté en effet une hyperleucocytose sanguine très marquée (avec polynucléose) ainsi qu'une forte prédominence de polynucléaires dans les premières rachicentèses.L'évolution, suraigue à la phase initiale, s'est terminée à la convalescence par une régression notable des lésions oculaires et auditives.

---

Summary The term uveo-meningo-encephalitis associates two syndromes therefore considered different from each other: Harada's disease and Vogt-Koyanagi syndrome. As a clinical entity it is at the present time well defined and its evolution occurs in three phases; first meningeal involvement, later on ocular manifestations and finally a phase of recovery, which can extend over months. In the course of the last phase there is a regression of uveitis, and cutaneous and mucous lesions may often appear.In the present paper the authors report one case of uveo-meningo-encephalitis occurring in a 27 years old spanish woman. The evolution was typical but a biological peculiarity was represented by the very elevated white cells count with polymorphonuclear predominance, both in peripheral blood and cerebrospinal-fluid.Though the initial phase of meningitis was extremely dramatic, recovery was satisfactory and a marked regression of ear and eye lesions was observed.

---

Zusammenfassung Das Krankheitsbild der Uveo-Meningo-Encephalitis vereinigt den Morbus Harada und das Vogt-Koyanagi Syndrom; es ist zur Zeit klar definiert und umfaßt 3 Phasen: Eine meningeale Phase, eine ophthalmische Phase und das Stadium der Rekonvaleszenz, das sich über Monate erstrecken kann. In dieser letzten Phase bilden sich die Augenläsionen zurück, während häufig—jedoch nicht obligat—Haut- und Schleimhautläsionen auftreten.Die Autoren berichten über einen Fall von Uveo-Meningo-Encephalitis bei einer jungen, 27jährigen Spanierin. Der Krankheitsverlauf war charakteristisch, zeichnete sich jedoch durch einige biologische Besonderheiten aus: so bestand im weißen Blutbild eine ausgesprochene Leukocytose (mit vorwiegend Neutrophilen), in der Cerebrospinalflüssigkeit überwogen anfänglich die neutrophilen Leukocyten gegenüber den Lymphocyten.Trotz initial perakutem Verlauf bildeten sich während der Rekonvaleszenz die Seh- und Hörstörungen weitgehend zurück.

     

Ostéodystrophies par lésions du systéme neurovégétatif

Résumé Des lésions expérimentales du diencéphale ou des fibres sympathiques du nerf sciatique peuvent produire des ostéodystrophies des pattes chez le cobaye.Les examens radiographiques périodiques permettent de suivre l'évolution de ces lésions osseuses. D'abord à type d'arthropathies tabétiques ou syringomyéliques. ces lésions peuvent présenter des perturbations de la fixation du calcium qui se traduisent par des zones opaques et transparentes mêlées ainsi que par des phénomènes d'ostéogénèse hétérotopiques et des images en feu d'herbe correspondant au développement de spicules sur le périoste.Le Gallium 67 pouvant se substituer au calcium, on peut apprécier l'importance de cette ostéogénèse qui peut prendre des proportions considérables jusqu'à 550% par rapport au côté sain.On trouve assez fréquemment des nodules osseux ou cartilagineux développés dans le parenchyme pulmonaire et qui ont les caractères des tissus anormaux de la patte tumorale.Ces ostéodystrophies expérimentales obtenues par neuroirritation présentent des caractères de malignité, d'interprétation délicate. Associées à d'autres anomalies de développement des tissus, elles soulignent l'importance du rôle trophique du système neuro-végétatif.

---

Summary Diencephalic experimental lesions or lesions of sympathethic fibers of sciatic nerve may cause osteodystrophies to legs of guinea pig.Periodical X-ray examinations enable to follow the development of such bone lesions. From initial types of tabetic or syringomyelic arthropathies the lesions may later present alterations of calcium fixation that are shown by mixed up opaque and transparent zones and heterotopic phenomena of osteogenesis and grass fire images corresponding to spicles development on periostium.67 Gallium may be substituted to Calcium, therefore one may appreciate the importance of this osteogenesis, that may assume considerable proportion, until 550% in comparison to healthy side.Frequently osseous or cartilagineous nodulations are found, developed in pulmonary parenchyma and have abnormal tumor-like tissues characters.Such experimental osteodystrophies obtained by neuro-irritation have malignant characters of difficult interpretation. With other abnormalities of tissue development, they stress the importance of trophic role of neurovegetative system.

---

Zusammenfassung Experimentelle Läsionen des Diencephalon oder der sympathischen Fasern des N. ischiadicus können Osteodystrophien an den Pfoten von Meerschweinchen hervorrufen.Die periodischen radiographischen Untersuchungen erlauben, diese Knochen schädigungen zu verfolgen. Neben dem Typ der tabischen oder syringomyelieartigen Arthropathie können diese Läsionen Störungen in der Kalkablagerung aufweisen, die durch Mischungen von opaken und transparenten Zonen sowie durch heterotope Osteogenese und grasbüschelartige Bilder entsprechend der Entstehung von periostalen Spiculae charakterisiert sind.Durch substituiertes Gallium 67 kann man die Wichtigkeit dieser Osteogenese schätzen, die ein bemerkenswertes Verhältnis von 550% gegenüber der gesunden Seite erreichen kann.Man findet ziemlich häufig Knochen- und Knorpelknötchen im Lungenparenchym als Charakteristikum des abnormen Tumorgewebes in der Pfote.Diese experimentellen Osteodystrophien durch Neuroirritation besitzen malignen Charakter und lassen sich schwer erklären. Mit anderen Anomalien der Gewebsentwicklung vergesellschaftet, unterstreichen sie die Wichtigkeit der trophischen Rolle des neurovegetativen Systems.

---

Riassunto Lesioni sperimentali del diencefalo o delle fibre simpatiche del nervo sciatico possono produrre osteodistrofie agli arti della cavia.Gli esami radiografici periodici permettono di seguire l'evoluzione di tali lesioni ossee. Partendo da forme di artropatie a tipo tabetico o siringomielico, queste lesioni possono presentare turbe della fissazione del calcio che si traducono in zone opache commiste a zone trasparenti oltrechè in fenomeni di osteogenesi eterotopica e di immagini a ciuffo d'erba corrispondenti a osteofiti periostali.Poichè il Gallium 67 può sostituirsi al calcio, si può apprezzare l'importanza di questa osteogenesi che può assumere considerevoli proporzioni, sino al 550% rispetto alla parte sana.Si trovano di frequente noduli ossei o cartilaginei sviluppati nel parenchima polmonare con carattere di tessuti abnormi a tipo tumorale.Queste osteodistrofie sperimentali ottenute con neuroirritazione presentano caratteri maligni di difficile interpretazione. Associate ad altre anomalie dello sviluppo dei tessuti esse sottolineano l'importanza dell'azione trofica del sistema neurovegetativo.

---

---

Avec 9 Figures     

La découverte des propriétés antidépressives de la kétamine

Background

Depression is a frequent disease with a significant medico-economic impact. Conventional antidepressants have a delayed action and are ineffective in one third of cases. Discovery of ketamine's antidepressant effects these last years opens new perspectives for treatment-resistant depression.

Hémiplégie cérébrale infantile : épidémiologie,aspects étiologiques et développements thérapeutiques récents

IntroductionHemiplegic (or spastic unilateral) cerebral palsy accounts for about 30% of all cases of cerebral palsy. With a population prevalence of 0.6 per 1000 live births, it is the most common type of cerebral palsy among term-born children and the second most common type after diplegia among preterm infants.State of the artMany types of prenatal and perinatal brain injury can lead to congenital hemiplegia and brain MRI is the most useful tool to classify them with accuracy and to provide early prognostic information. Perinatal arterial ischemic stroke thus appears as the leading cause in term infants, whereas encephalopathy of prematurity is the most common cause in premature babies. Other causes include brain malformations, neonatal sinovenous thrombosis, parenchymal hemorrhage (for example due to coagulopathy or alloimmune thrombocytopenia) and the more recently described familial forms of porencephaly associated with mutations in the COL4A1 gene.PerspectivesIn adjunction with pharmacologic treatment (botulinium neurotoxin injection), new evidence-based rehabilitational interventions, such as constraint-induced movement therapy and mirror therapy, are increasingly being used.     

Les infarcissements hémorragiques de l'écorce cérébrale

Sans résuméAvec 11 figures     

Sur quelques phénomènes de régénération au niveau du système neuro-végétatif périphérique

Sans résuméAvec 3 figures     

Dépression et accidents vasculaires cérébraux

Poststroke depression is a frequent and specific entity that impairs the rehabilitation and the functional recovery of hemiplegic patients. It is a common disorder, affecting 30 % to 50 % of hemiplegic patients within 1 year of their cerebral infarction. It is associated with increased morbidity and mortality. The diagnosis of poststroke depression is difficult, based, when possible, on the Diagnostic and Statistical Manuel of Mental Disorders criteria for mood disorders due to a general medical condition. Antidepressive medication is frequently administered to depressed stroke patients. Selective serotonin re-uptake inhibitors are generally preferred because they induce fewer side effects than tricyclics for example. Effective treatment for such depression is believed to contribute to the recovery of stroke-induced deficits. A specialized psychological follow-up is often needed although the best approach remains to be defined. Support from care givers and a dynamic rehabilitation program are certainly key elements providing relief.     

Malformation vasculaire cérébrale découverte dans le bilan pré-thrombolyse d’un infarctus cérébral. Impact sur la décision thérapeutique

Intravenous recombinant tissue plasminogen activator for acute ischemic stroke is contraindicated in patients harboring an asymptomatic intracranial vascular malformation, whether it is incidentally discovered at the time of the initial cerebral imaging or previously known. Because thrombolysis is associated with a risk of serious intracerebral hemorrhage, it is theoretically possible that this treatment increases the risk of bleeding or rupture of these malformations. However, this risk seems very low in clinical practice. We report two cases, one with a probable brainstem cavernous malformation treated with alteplase for a supratentorial ischemic stroke who developed just after treatment a fatal brainstem hemorrhage, and another one with asymptomatic dural arteriovenous fistula, treated by endovascular thrombectomy solely. This approach was safe and effective, and the patient had an endovascular embolization of the fistula one month later as it became symptomatic. Based on the literature, we discuss the bleeding risk of asymptomatic intracranial vascular malformations in acute ischemic stroke patients treated with alteplase, depending on the type of malformation (intracranial aneurysm, arteriovenous and cavernous malformation or fistula), and the alternative therapeutic options.     

Collaboration entre médecins généralistes et psychologues en libéral

Psychologists and general practitioners (GPs) are the stakeholders most consulted by patients with psychological difficulties. They each have their own professional identity, their own working framework, references, and language. In France, interactions between them seem limited in private practice. The importance of developing collaboration between GPs and psychologists is supported by data from collaborative mental health practices developed in various countries. Such practices have shown significant improvement in health care, and benefits for patients’ health, as well as for GPs’ and psychologists’practices, and for the community. In 2018, the French National Authority for Health published an overview of the situation and recommendations to improve the coordination between GPs and other healthcare actors concerning adult patients with mental health disorders. The review invites healthcare actors to work with better conviction, involvement, and shared culture, as well as to recognize each other's roles and competences. The professionals interviewed in this article, three psychologists and three GPs, outline the current state of collaboration between psychologists and GPs in France and in Belgium, reviewing professional identities, barriers to interactions and organizations. Interprofessional collaboration in mental health involving these actors is formalized and developed in several countries, unlike in France where work and experimentation are rare. The role of each is not well known, and few opportunities are offered for interprofessional practice and education. The authors report on their experience in the field, and on initiatives that have been implemented in a Southern France region. Several actions are reported: joint professional training evenings, “public cross-consultations” and “joint case studies” (with patients’ agreement), working group between faculties leading to a joint Study Day, programming paired cross-consultations in the practice of each, as well as exchanging medical and psychology students. This experience allowed for constructive meetings, exchanges within “professional couples” on common patients, and opportunities to expose medical and psychological views. It also enabled the authors to observe their different professional language and tools used, to break the isolation of mental health care actors, to accelerate the understanding of patients’ situations, and to mutually enrich professional knowledge and practices. This feedback from field experience, which is not representative or generalizable, shows that it is possible to take advantage of interprofessionality in the field. When the actors know each other, working together in the interest of the professionals and of the patients shows better results. Finally, the authors question what desirable directions should be adopted–particularly concerning the institutional frameworks recently implemented in France, and the need for shared professional training–and interrogate the definition of “collaboration” itself.