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We found out the personality pattern of an incontinent population and proceeded to a correlation between the personality inventory and the ICIQ-UI-SF (International Consultation Incontinence Questionnaire Urinary Incontinence Short Form) to demonstrate reliability and sincerity of the answers and to establish that a personality disturbance may impact the physiopathology of micturition.We performed an observational prospective study. It included patient's answers to a computed questionnaire combining a double ICIQ-UI-SF questionnaire and the 71 questions of the Minimult questionnaire. Forty-seven patients were asked to participate.Over 37 patients included, Wilcoxon-Mann-Whitney non parametric test confirmed agreement of the two ICIQ-UI-SF questionnaires with P=0.1792. Twenty-three patients were validated to the Minimult inventory with F scale70. We analysed variability of the two global ICIQ-UI-SF score in regard with the validity scale using ROC analysis. We observed an AUC of 0.559 with sensitivity 78.6% and specificity 43.5%. No L score was above 70 demonstrating absence of lie. No personality disturbance was found in 9 cases. We observed six cases with a high hypochondric value, five with a high depressive value, and four with a high hysteric value. This neurotic triad was found in two cases. We noticed five cases with psychopathic deviance relative to antisocial behaviour while values of paranoia and hypomania were high in one case without any association of these personality aspects, which demonstrated absence of behavioural problem. Psychotic profile associating schizophrenia, paranoia, depression and hypomania was not found. We outlined in half of the valid population a significant high psycho-asthenic pattern.We conclude that a correlation between the personality inventory and the ICIQ-UI-SF is feasible. The comparative study demonstrate reliability of answers. Sincerity is established by the Minimult L scale. We confirm and precise literature information over clinical personality pattern of this population and observe relevant elements concerning the psycho-asthenic pattern which depicts an anxious personality with an important feeling of the problem. These elements permit to suspect that a personality disturbance may impact the physiopathology of the micturition.4.

Fifty victims of assaults and hold-ups underwent a medical and psychological examination in order to assess the semiological and psychometric features of post-traumatic stress disorder: 27 males and 23 females with a mean age of 41 years were examined 18 months after the traumatic event. The following semiology was observed: excitability, phobic avoidance, distrust, recurrent traumatic nightmares, difficulties in concentration, impaired memory, dysphoric mood, hyperfatigability, recurrent recollection of the traumatic event, headache, middle and terminal sleep disturbances and neurovegetative hyperreactivity. Testing demonstrated anxious and depressive troubles and moderate cognitive disturbances. Statistical study showed no correlation between type of aggression (psychological trauma with or without concomitant physical component) and cognitive and psycho-affective variables. Most of the cognitive disturbances were correlated with the severity of anxiety and depression. Post-traumatic stress disorder also perturbed the work capacity: only 8 patients resumed previous activities after a lapse of time of 1-54 months.

On the basis of a retrospective study concerning 63 cases of normal pressure hydrocephalus, the author examines the characteristics of patients with a traumatic aetiology who were not ameliorated by a ventricular derivation. Four of these patients suffering from a post-traumatic dementia are described. Reviewing the literature, several topics concerning post-traumatic dementia are considered: incidence, time delay before diagnosis, variation of pictures, aetiopathogenic explanations, medico-legal problems encountered with Alzheimer's of Pick's diseases. Finally the differential diagnostic characteristics between the curable and incurable forms of post-traumatic dementia syndromes are discussed.

Fetal alcoholic syndrome (F.A.S.) is a well-recognized entity for over 20 years; it associates mental retardation, delayed growth and anomalies of the cranium in children born from alcoholic mothers. The syndrome has been described primarily in young children. By contrast, its evolution is not well known. We report the case of a 15-year old youngster, who exhibited the characteristic features of F.A.S. We also review the data related to the clinical and pathophysiologic aspects of the syndrome.

Cette communication envisage les effets polymorphes d'un traumatisme crânien sur l'ensemble de la personnalité de la victime. Les angoisses centrées sur l'intégrité physique, intellectuelle et psychique peuvent glisser vers une crainte de perte d'objet qui ne fait que compliquer la situation initiale et modifier conséquemment l'image de soi. Si l'on peut parler d'un syndrome subjectif commun aux traumatismes du crâne, leurs modalités d'expression diffèrent considérablement. C'est cette différence que permet d'élucider le Rorschach en jetant une lueur sur la dynamique psychique et en évaluant sa régression affective. L'étude envisage également les capacités de réorganisation qui peuvent favoriser la "cicatrisation" de cette blessure narcissique provoquée par le trauma., de Mol J. Les modifications post-traumatiques de la représentation de soi au Test de Rorschach. In: Bulletin de la Société française du Rorschach et des méthodes projectives, n°34, 1990. La représentation de soi. pp. 77-84.

The author describes the place of the neuropsychological investigation in the clinical evaluation of patients suspected of mental deterioration and criticizes classic psychometry as inadequate in its quantitative and non specific approach to dementia, to examine the operative behavior of demented patients. More specifically, the author points out the careful attention which must be paid in utilizing the usual intelligence scales, the mental deterioration index and organic impairment scoring systems, often unsuitable for the diagnosis. On the other hand, the author preferes the use of a mental investigation more specifically based on fundamental cognitive functions (language, gnosis, praxis) and illustrates this point of view by some mental deterioration batteries currently used in some countries. Finally, the neuropsychological assessment appears indispensable for diagnosis, prognosis and therapy. Problems raised with early diagnosis, differential diagnosis between reversible and non reversible dementia, between dementia and pseudodementia are discussed with the specific contribution of neuropsychology. The necessity of further investigations in this field is emphasized. A proposition is outlined which would lead to improved neuropsychological tests of greater sensibility and accuracy.

Starting with 8 neuropsychological detailed observations, the author has studied mental deterioration resulting from normal pressure hydrocephaly and the short term evolution of mental troubles after apinal fluid derivation. The presurgical mental troubles are characterized essentially by short term memory troubles, by behavioural troubles relating to the two poles of the frontal syndrome and by distrubances in writing and calculus. The modification of the state of consciousness, the visual constructive troubles, attention and concentration troubles, verbal language troubles and psychomotor retardation are also frequent. Aphasia and alexia are rare. Generally, postsurgical evolution is immediate and global; the troubles of consciousness, mental deterioration and behaviour disorders are parallely reduced. Globaly, three out of four troubles disappear. Memory troubles and difficulties in concentrating, although improving, are still maintained six month after ventricular drainage.

The authors report a case of hysterical paraplegia occurring two days after a craniovertebral trauma. They describe the patient's evolution on psychological, neurological and physical therapy grounds. They also discuss the concept of traumatic neurosis with regard to definition, characteristics, classification and its boundaries in relation to the subjective central post-traumatic syndrome. They also study the definition, frequency, limits and course of conversion hysteria with special emphasis on hysterical paralysis and its characteristics.

After reviewing the literature on psychic disturbance in normal pressure hydrocephalus, the author reports on 26 cases of CSF drainage. Impairment of memory and concentration were always present in normal pressure hydrocephalus; behaviour disorders were very frequent and characterized by both types of frontal behaviour; the mental picture also comprised difficulties of calculation, writing, visuoconstructive praxis and, less frequently, impaired speech and reading ability. CSF drainage brought clinical improvement in 73% of the cases. Disorders of consciousness, mental function and behaviour regressed generally progressively as soon as the operation had been performed. Two major factors affecting therapeutic efficacity appear to be the patient's age and the length of time between onset of the symptoms and start of therapy.

A 54-year-old female patient presented acute hallucinatory psychotic episodes with irritative EEG for seven years before an initial state of complex partial mal. A single convulsive episode occurred 14 years after the beginning of the psychiatric symptoms. The intercritical EEG showed independent temporal lobe foci predominating on the right. It varied little during delirious phases but these occurred three times during weaning from antiepileptic drugs. The delirium improved when the treatment was restored, whereas neuroleptics proved ineffective. Psychiatric signs frequently described in epilepsy and particularly temporal epilepsy are reviewed. Usually, these symptoms are not concomitant. The literature mentions only a very few cases where psychosis appears to be ictal as in the reported case.

After reviewing the literature on post-concussional syndrome in head injured patients and some studies which have contributed to objectify post-traumatic personality characteristics, the authors were particularly interested in studying depressive signs complained of by such patients without any psychopathological history. The analysis of a group of 47 head injured patients shows that one in two patients openly revealed such depressive tendencies. These patients, who were observed on average less than one year after the trauma, do not differ from the others, whether by age, sex, the severity of the head injury, the existence of a neurosurgical operation. However, they showed many symptoms which were different from those of the other patients in the group and different from those of the whole group. This "depressive" syndrome appears in a more specifically anxious form. The study of the Rorschach's test, on the other hand, does not show any change in the basic personality, especially inhibited in the two groups. For the patients who do not complain openly of depressive signs, the hypothesis of a masked depression was raised. This perspective is compared with the literature's data and allowed to point out several forms of post-traumatic depression.

After a review of current concepts about post-traumatic mutism, the authors describe five patients with this unusual symptom. The study extends on a long follow-up period. Differential diagnosis and possible neurological and psychopathological factors are discussed. Analysis of their personal observations leads the authors to think that there is a relationship between the length of coma and the duration of mutism. Frontal and/or bilateral lesions seem to be more likely to produce post-traumatic mutism, as does the existence of emotional disturbances or depressive symptoms in past history.

The neuropsychological observations of 63 patients undergoing surgery for "normal pressure hydrocephalus" (NPH) have been analyzed retrospectively. To make a semiological picture of mental disturbances in NPH, the level of consciousness, behaviour and cognitive functions were studied. A neuropsychological investigation of the main cognitive functions (language, gnosis, praxis, calculation, memory) enables us to specify the characteristics of dementia shown by these patients. A mental picture of the most frequent neuropsychological signs is described. The mental syndrome which characterized NPH reveals an alteration of alertness and concentration, a deficiency in memory, a disorganization of graphism (writing and drawing), a dyscalculia and behaviour problems (bradypsychy, apathy, indifference). Such a syndrome points out a bilateral frontal lesion. On the other hand, the less frequent signs are largely verbal and show different stages of aphasia. These signs can usually be found in patients who don't improve after ventricular drainage and are more suggestive of a degenerative disease of the Alzheimer type. The results are compared with the psychometric and neuropsychological data of the literature. More specific attention is accorded to differential diagnosis.

The authors report ten cases of progressive dementia. Nine are associated with gait disturbances and seven with urinary incontinence. Despite the severity of dementia and Ct Scan signs of cortical atrophy, magnitude of neuroradiological ventricular dilatation and ventricular reflux at isotopic cisternography lead to shunt therapy. After ventricular shunting of CSF, a follow-up at short and long terms shows different clinical evolutions: two transitory improvements, three cases without change and five worsening. Retrospective clinical study of these cases in which diagnosis leads to a degenerative process of the Alzheimer type shows atypical premorbid neuropsychological characteristics by a normal-pressure hydrocephalus. In fact, in the ten cases preoperative neuropsychological investigation shows, at various levels, aphasic, alexic and agraphic signs. Their occurrence in the clinical picture represents an essential contribution to differential diagnosis.

The authors describe one case of bismuth encephalopathy, insisting particularly on neuropsychological and neurolinguistic troubles. They analyze, the related literature in reference to the clinical picture in its prodromic phase, state phase, differential diagnosis, course and potential neuropsychological complications.

de Mol J. Valeur pronostique du test de Rorschach dans le syndrome subjectif des traumatisés du crâne. In: Bulletin de la Société française du Rorschach et des méthodes projectives, n°31, 1978. Les méthodes projectives en médecine psychosomatique. pp. 53-62.

In view of the unpredictable percentage of NPH patients who benefit from surgery and the risk of postoperative complications, the study of predictive parameters appears essential. The literature shows many conflicting results in studies which focus on predictive values. The present study is based on a series of 63 patients, all of whom underwent surgery for NPH. Fifty one historical, clinical, paraclinical and neuropsychological parameters were submitted to statistical analysis on the basis of the postoperative results. Nine of these parameters were correlated with the postoperative evolution: aetiology, chronic alcoholism and seven neuropsychological signs, in particular verbal signs. A statistical analysis by logistical regression allows us to describe an optimum predictive model. The most significant results are discussed.

The clinical observation of 47 patients, undergoing surgery for "normotensive hydrocephalus" during the period January 1975 to January 1981 have been analysed retrospectively. The condition of half the patients improved following insertion of a cerebrospinal fluid bypass. Complications of varying degrees of severity were noted in 21 percent of cases. The correlation between the post-operative results and the clinical data was subjected to statistical analysis. Some factors appeared to have an important predictive value. These were the age, the absence of cortical atrophy on C.T. scan and the prolonged ventricular filling on cisternography. Other factors, although without statistical significance, seem to predict a better result: the existence of prior etiological data, presence of a frontal syndrome and evidence of periventricular hypodensity on C.T. scan. Finally, some other factors in our series appeared to have no influence on the prognosis. These were: duration of the preoperative evolution of the disorder, the degree of mental disturbance and difficulties of gait, the presence of urinary incontinence, the value of the ventricular cranial ratio. None of the recognized significant criteria was sufficiently reliable to predict the quality of surgical result, when studied in isolation. The association between the different significant criteria, such as have been described above notably, improves the chances of a favorable post-operative outcome but it is insufficient to predict it with great certitude. The continuous monitoring of the intracranial pressure during periods of 24 to 48 hours appears to be the most reliable factor on which to make a decision to operate in the light of the findings described in recent literature.

Personality changes and behavioral disturbances have been studied in nineteen adult head-injured patients who did not present the usual features of the "post-traumatic syndrome". The characteristics of this group of patients are described: sex, age, severity of the injury, brain damage localization and associated neuropsychological symptoms. The premorbid personality and psychopathologic antecedents are analyzed. After comparing the results of this study with those reported in the literature, the author comes to the conclusion that behavioral disorders and personality changes in head-injured patients do not show any clear correlation with the severity of the injury but are more likely to occur after temporal lobe damage and especially in patients with a previous history of neurotic or psychopathic symptoms.

The authors have studied the influence of Pervincamine on the postconcussional syndrome in a group of 30 patients with cranial trauma examined for at least six months after their accident. The double blind testing was utilised and the patients were followed at regular intervals spanning three weeks. Each patient was evaluated by semi-directed interviews and tests of "double barrage" of Zazzo and the 15 words test of Rey. In addition, an EEG was performed at the beginning and the end of the study. Statistical analysis of the evolution of symptoms and the results obtained by psychological testing has revealed the positive action of Pervincamine on the postconcussional syndrome and on mental as well as motor functioning in general. Furthermore, the secondary effects of this product are negligible.

After reviewing the literature on personality and Parkinsonism and recalling the two concepts which conflict on the etiology of their personality, the author has examined Rorschach charts of 20 Parkinsonians. This was done through formal analysis and content analysis in order to show the various dynamic aspects of personality, the psychic mechanisms preferentially used and the possible relations between psyche and soma. The results reveal a modification of personality in the direction of global narrowing, on ideas and affect, a reduction of relational investments, a narcissitic and hypochondriac retrieval and an important reduction of affects. Two different types of personality appear out of this common branch. The first is characterized by rigidity and stereotipy, the second characterized by some smoothness and a wider opening toward the external world. The psychodynamic study reveals that personality reorganization takes place through libidinal retrieval, through defensive and narcissisic move. After the completion of the study, the somatopsychic hypothesis remains most produce; however the premorbid personality and in particular the aggressive problem can integrate with the behavioral modifications due to Parkinson's disease in order to finally bring a original psycho-affective picture.

The authors study the characteristics of a group of 23 patients for whom an initial tentative diagnosis of Hakim-Adams syndrome (H-A syndrome) was eventually rejected. On account of several factors distinguishing these patients from the true H-A group, the authors propose using the term "pseudo Hakim-Adams syndrome". The distinguishing factors include: the grounds for admission, i.e. mental or mnesic deterioration, associated with radiological images of ventricular dilatation; a clinical picture dominated by mental disorders with only rare disorders of gait and sphincter control (several neurological defects were direct consequences of previous cerebral disease); no antecedents of spontaneous meningeal hemorrhage or meningitis in the case history; neuropsychological examination showing fewer disorders of concentration and less dyscalculia and constructive dyspraxia than in true HA, and far more atypical signs of the aphasic and anxio-depressive type. The authors think that various pathological processes may be responsible for this pseudo H-A syndrome in which a predominant mental picture is associated with ventricular dilatation.

The authors describe 6 cases of post-traumatic schizophrenia and make a critical review of the literature concerning this unusual post-traumatic personality disturbance. Various schizophrenic manifestations are observed: they principally consist of delusion, hallucination, paranoid and mystical ideas, autism, psychomotor instability, fugues. Post-traumatic schizophrenia occurs mostly in young men, before thirty years. The severity of traumatic brain injury appears irrelevant in its genesis. Temporal lobes are more often involved (one third of the cases). Pre-traumatic personality disturbances are the main factor as demonstrated by the anamnesis and by the results of Rorschach test.

The authors report a case of loss of mental imagery in a 35 year old male patient who was operated on for an intraventricular meningioma in the region of the left trigonum collaterale. The symptomatology and its evolution are described. Discussion of the pathophysiologic hypotheses is focused on the possible role of a selective memory disturbance, of a functional disconnection between language- and visual representation-areas of the brain, and of visual agnosia. In the reported case, the underlying pathophysiologic mechanism seems to be very close to the one responsible for visual agnosia, and could be explained as a partial dissolution of visual memories. Analysis of 35 cases of loss of mental imagery reported in the literature shows that the investigation of this peculiar disturbance is in many cases incomplete. It nevertheless reveals that visual agnosia, or a particular form of visual agnosia, is present in all cases of unilateral posterior lesion of the dominant hemisphere.