Pachyméningite associée à une probable maladie de Horton : étude d’une observation

Introduction

Horton's disease is the most common vasculitis of elder people. Several neurological complications are reported, but pachymeningitis is exceptional.

Observation

A 71-year-old patient who presented headache, hyperesthesia of the scalp, weight loss with a biological inflammatory syndrome and meningeal thickening on MRI. The diagnosis of pachymeningitis related to Horton's disease was retained. The patient was treated by corticosteroids with a good clinical, biological and radiological course after 22 months.

Conclusion

Horton's disease is a potential diagnosis in elderly persons with pachymeningitis and inflammatory syndrome.     

Hémorragie méningée focale et angiopathie amyloïde cérébrale : une association non fortuite

Introduction

Cerebral amyloid angiopathy is a degenerative angiopathy due to amyloid deposits in the walls of the meningeal and cortical vessels. It is considered as a major cause of cerebral hemorrhage to the elderly. It was recently demonstrated that the association of focal meningeal bleedings and cerebral hemorrhage is very suggestive of cerebral amyloid angiopathy. In contrast, the links between subarachnoid hemorrhage and amyloid angiopathy are less well-known.

Cases reports

We report nine cases of cerebral amyloid angiopathy. The clinical presentation was variable, but all had at least one inaugural meningeal bleeding. As cortico-meningeal biopsies were not performed the Boston criteria were used to establish the diagnosis.

Conclusion

Cerebral amyloid angiopathy is an underestimated cause of subarachnoid hemorrhage. Our observations show that this diagnosis should be evoked when focal meningeal bleeding occurs without head trauma or when focal subarachnoid hemorrhage is followed by a subcortical hematoma in an elderly subject.     

Syndrome de Bing-Neel révélateur d’une maladie de Waldenström : étude d’un cas et revue de la littérature

Introduction

The most frequent neurological complication of Waldenström's macroglobulinemia is IgM-mediated polyneuropathy. Direct tumor cell infiltration of the nervous system is very rare and better known as the “Bing and Neel syndrome”. This syndrome relates usually to a meningeal or meningo-myelo-cerebral tumor infiltration.

Observation

A 54-year-old man developed a terminal cauda equina syndrome over several years. MRI disclosed lumbar roots infiltration and lumbar puncture the presence of lymphocytic meningitis with intrathecal synthesis of monoclonal IgM identical to that found in the blood. The bone biopsy revealed a lymphoplasmocytic infiltration consistent with the diagnosis of Waldenström's macroglobulinemia. The final diagnosis was meningeal and lumbar roots infiltration revealing Waldenström's macroglobulinemia. Partial remission was obtained after polychemotherapy with CHOP, rituximab and methotrexate. At the end of the treatment, the patient improved his bladder's control and was able to walk with a stick.

Discussion

We reviewed the 35 cases of “Bing and Neel syndrome” we have identified by a PubMed research. The present case report is original by the initial neurological presentation of the disease three years before diagnosis and the successful use of rituximab in the polychemotherapy regimen.     

Soins psychiques et somatiques des sujets en grande précarité : une épreuve de corps

The clinical study of precariousness shows that the psyche and the somatic are no longer mediatized by the discourse of the Other. This absence of otherness projects the subjects that experience it in an unassimilable real. Unable to identify themselves with their body and their image, they cannot feel their physical degradation and their pathology. This leads to the assumption that a divided body is the object of a negation delirium. Nowadays, new medical technologies and mainly medical imaging divide the patient's body in separate units, blocking the access to the fantasized body. Through the socially excluded, this article poses the question of the impact of an increasing objectivization of the medical profession.     

Mémoire émotionnelle du soi

Emotion shapes autobiographical memory (AM) by tagging events that are relevant for the narrative self, which may be viewed as a hierarchical network of interconnected goals. Subsequent AM retrieval is a reconstruction process that grounds the self by providing coherent narratives organized to elicit a sense of identity across the time. The lateral and medial prefrontal cortices underlie reconstruction and self-referential processing, respectively, whereas the lateral and medial temporal cortices underlie semantic and episodic aspects, respectively. Additionally, the posterior cortical midline structures and the amygdala are involved in visual and emotional aspects, respectively. These regions have been found to display aberrant functioning in major depression. Accordingly, major depression is associated with impairments of AM retrieval combining mood-congruency, overgenerality, intrusive memories and third-person visual perspective.     

Comportement et activités extra-scolaires : une étude en vie quotidienne de l’échec et de la réussite scolaire

Objectives

In light of its high prevalence and important consequences for future opportunities, academic failure is a major preoccupation of the French educational system. Difficulties at school are associated with later social and professional exclusion and may have an important psychological impact on students, notably concerning self-esteem. However, while the majority of research concerning academic difficulties has been conducted at school or within educational contexts, there is a growing literature demonstrating its association with extracurricular activities. The study of daily life activities poses several problems for the researcher in that students may not accurately recall specific behaviors or correctly report their frequency when assessed retrospectively over long time delays. In order to understand the daily life experiences of students outside of school, this investigation therefore used the Experience Sampling Method in order to collect information at several times throughout the day concerning the environments, activities and routines of students.

Materials and methods

All students and their parents provided written informed consent to participate. Students were selected from ten junior high schools in Southwest France, including five traditional schools and five ‘education priority’ schools based on low academic performance in the school district. Within each type of school, 65 students were selected for being in academic difficulty (defined as having scores below 50% on national evaluations of both French and Math) and 66 were selected for being in academic success (defined as having scores above 80% in these same subjects). Following recruitment into these groups, students were trained in how to complete electronic interviews for a 1-week period using a personal digital assistant (PDA). This device was then programmed to provide three signals a day after school between 6 pm and 9 pm, and five signals a day on the weekend between 10 am and 9 pm. At each signal, the PDA administered an electronic interview asking the students to describe at that given moment their geographic location, social environment, and specific activities. At the end of the 1-week period, the PDAs were returned and data were analyzed using multilevel modeling using a Bonferroni correction for multiple comparisons.

Results

Students in the academic difficulty and success group did not differ by sex, maternal language, country of birth, or by type of school. However, students in the academic success group more often had fathers with higher career or professional status. Concerning daily life experiences, students in academic difficulty were more likely to be spending time in academic or commercial locations, more likely to be with domestic animals or with persons other than family and friends. These students were also more likely to be ‘doing nothing’, and less likely to be performing sustenance or leisure activities. However, students in the academic difficulty group were more likely be doing school work, and several differences were also observed in the structure of these daily life routines across days.

Conclusions

Using an ambulatory monitoring protocol, daily life activities and environments were recorded in real-time and in natural contexts among students experiencing either difficulty or success. The findings demonstrating greater passivity, fewer leisure activities, and fewer moments spent with family for students in academic difficulty may indicate that less structured or unsupervised time schedules should be examined for its potential role in academic difficulty. While students in difficulty were also more often in academic settings and likely to being doing school work, these seemingly paradoxical findings are likely to reflect the academic tutoring or other intentional strategies to cope with such difficulties. Future research should consider extracurricular activities and contexts when investigating risk and protective factors associated with academic performance.     

Trouble de l’identité et de l’intégrité corporelle : interrogations pathogéniques et enjeux éthiques autour d’une pathologie émergente

A forty-year-old, socially well-adapted mother with no medical background comes to the emergency room after willingly exposing her leg to severe burns. She clearly and quietly explains that she wants to have both her legs amputated. She has never felt like those legs actually belonged to her physical integrity even though she clearly perceives their being attached to her body. This feeling appeared back when she was six years old; the desire to become an amputee aroused later, when she was around 12. She has already repeatedly consulted surgeons and submitted to various psychiatric and psychological evaluations that did not discern any clear psychiatric pathology. The paradox here is that of an apparently psychically normal woman asking surgeons to perform an abnormal procedure consisting in removing a healthy part of her body. To grant such a demand is mostly unorthodox nowadays even though some surgeons do publicly comply. Scientific publications on the subject are still scarce since the phenomenon itself is rather recent. However, a community of patients acknowledging the same challenge - which consists in not accepting a healthy part of their body - and making the same demand - which is to have such part of their body removed - has developed through the modern medium of the Internet. Outside of the medical and academic field, a rather elaborate discourse on the subject has thus appeared. A new and precise vocabulary was created so as to distinguish between various clinical situations, involving patients diagnosed with a pathology now known as “Body Identity Integrity Disorder”. The specific case of the aforementioned patient resembles other Internet compiled cases and raises pathogenic, therapeutic, medico-legal and ethical issues. From the pathogenic point of view, and after positively ruling out any psychotic pathologies, these clinical cases could be compared to the case of transsexuals since they both involve acknowledging one's anatomical reality while failing to identify with it. In such cases, despite the lack of clear medical explanations of such confusion, therapeutic procedures have been established, eventually allowing surgical, therefore mutilating, rectifications. From the therapeutic point of view, it may all be about choosing the lesser of two evils: rather an operation by a competent surgeon than death from self-inflicted injury. On the other hand, nothing proves that amputation is the best answer and care; thus it seems important to offer a necessarily long psychological undertaking previous to any surgical decision. From the medico-legal point of view, the law states that one's body integrity can only be impaired in case of medical necessity, which leads to ponder on the definition of such “necessity”, since its limits seem to vary according to place, time and cultural values. At that point, the ethical debate finally rises. It exceeds the simple issue of freedom and the right of any mentally healthy person to dispose of one's body; it also involves a debate between practitioners, psychiatrists and surgeons on the enigma of an up-to-now unheard-of symptom requiring enlightened therapeutic answers.     

Médiation interculturelle : une mutuelle interprétation

Whichever approach one prefers – consultation in the native language and culture, transcultural consultation, mediation, information about cultures, translating – the idea of mediation is central to every intercultural approach in psychiatry. Mediators not only reintroduce ways of doing and ways of interpreting, which are unique to particular cultures, they provide support for the indispensable work of articulation within the social or familial environment of patients. The conditions of their intervention rest on both their ability to translate these usages and to position themselves in the delicate work of psychosocial interfacing. They are conversant both with cultures that are generally ignored by caretakers and with the living societies to which these cultures are connected. They represent at the same time the institutions that contract them and the interests of patients. Their intervention calls upon them to exercise their art of translating according to a rigorous ethic in support of lives that are always unique. This art is able to join itself at will to therapeutic processes when these processes are in harmony with teams that know how to utilize their approach to interpretation, an approach which clears the way for a multiplicity of meanings and appropriations, not one which is based on an univocal and closed translation. Contrary to relativism or to assimilationism, such an art is disposed to encounter and dialogue.     

Fragilité de l’environnement et événement psychique chez l’adolescent placé en institution : une étude clinique

This clinical study addresses fragility of environment, construction of psychic event and its update in emotional development of the youth placed in institutions for protection. It is made from a device practitioner Social Children's House, which involves in the field of Child Protection. Through a case study structured around three analyzers: process development, environmental quality and occurrence of the event, we show the complexity of a chaotic life actualized in institutions and outlining professionals to participate in the repetition of the traumatic history of the adolescent.     

La connotation dans les paroles de patients atteints de la maladie d’Alzheimer : une méthode d’écoute

The change of the semantic memory in the Alzheimer's disease makes complex the understanding speech of patients. The very important lexical reduction in this disease does not allow to understand the sense of speech. These patients keep an intact phonological capacity. It will be separated of what is pronounced of the whole verbal exchange. The said is often qualified as semantic no sense. The questions of nurses and families to clarify the requests fail. The patient is only repeating his request. For example, the patients ask to see a dead person (her mother) or a requirement (take a taxi). The explicit, literal sense (denotation), does not any more allow to understand this phonological production. It is impossible to act for these pressing requests. For us, these words are full of sense but condensed. The concept of connotation (say it) allows to seize the wide sense of the intention. From clinical examples, we propose answers according to the connotation of what is pronounced. So, we determine a first method of care to understand the requests of these persons.     

Anévrismes intracrâniens et sclérose tubéreuse de Bourneville : une association rare

Introduction

Tuberous sclerosis is an autosomal dominant inherited phakomatosis. It is associated with a wide variety of central nervous system abnormalities, but intracranial aneurysms are rare.

Case report

We report a 34-year-old patient fulfilling the diagnostic criteria of tuberous sclerosis in association with intracranial aneurysm.

Discussion

This association has been reported in only 17 other cases of tuberous sclerosis. We discuss the etiopathogenic mechanisms, preferential localizations and the various therapeutic propositions.     

Normalisation d’une batterie d’évaluation de l’imagerie mentale visuelle et de la perception visuelle

Introduction

The relationship between visual perception and visual mental imagery are at the center of a lively theoretical debate between those postulating common neurocognitive processes between perception and imagery and those who emphasize the differences between these two entities. Neuropsychology can make an important contribution to this debate, by assessing associations and dissociations between perceptual and imaginal deficits in patients with brain damage. However, currently there is no standardized test battery available for such assessments.

Material and methods

Here we present a battery of paper-and-pencil tests assessing different domains of visual mental imagery and visual perception abilities: object form and color, animals, orthographic material, numbers, faces, and space. We also explored the effects of age, educational level and gender on performance on a group of 103 participants free of neurological damage.

Results

The battery includes two parts: one composed of 14 tests assessing mental imagery and the second part composed of eight tests assessing the abilities of visual perception. We calculated the correlations between the tests, and found that, with the exception of orthographic material, there were generally poor correlations between imagery and perceptual tests.

Conclusion

This result seems inconsistent with hypotheses postulating a strict correspondence between perceptual and imagery abilities.