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Transient global amnesia (TGA) is an acute and transient syndrome with a remarkably stereotypical set of signs and symptoms. It is characterized by the abrupt onset (no forewarning) of massive episodic memory impairment, both anterograde and retrograde. Ever since it was first described, TGA has fascinated neurologists and other memory experts, and in recent years, there has been a surge of neuroimaging studies seeking to pin down the brain dysfunction responsible for it. Several pathophysiological hypotheses have been put forward, including the short-lived suggestion of an epileptic mechanism. All the available data indicate that the brain modifications are reversible, and that the mechanism behind TGA is of a functional nature. However, while diffusion-weighted imaging studies have clearly identified the hippocampus and, more specifically, the CA1 area, as the locus of brain modifications associated with TGA, researchers have yet to determine whether the origin of the mechanism is vascular or neurochemical. Spectroscopy may provide a means of settling this issue once and for all., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: Cerebral metastases occur in 15 to 20% of cancers and their incidence is increasing. The majority occur at an advanced stage of the disease, but metastasis may be the inaugural sign of cancer. The aim of treatments, which are often palliative, is to preserve the neurological status of the patient with the best quality of life., State of Art: Corticosteroids are widely used for symptomatic palliation, requiring close monitoring and regular dose adaptation. Antiepileptic drugs should be given only for patients who have had a seizure. In case of multiple cerebral metastases occurring at an advanced stage of the disease, whole brain radiation is the most effective therapy for rapid symptom control. However, radiotherapy moderately improves overall survival, which often depends on the progression of disseminated systemic disease. On the contrary, surgery is indicated in case of a solitary metastasis, particularly when the patient is young (less than 65 years), with good general status (Karnofsky greater than 70), and when the systemic disease is under control. Radiosurgery offers an attractive alternative for these patients with good prognostic factors and a small number of cerebral metastases (< or = 4)., Perspectives: Chemotherapy, considered in the past as not effective, is taking on a more important place in patients with multiple nonthreatening metastases from chemosensitive cancers (breast, testes...). Radiosurgery and whole brain radiotherapy are complementary techniques. Their respective role in the management of multiple metastases (< 4) remains to be further investigated., Conclusions: Therapeutic options are increasingly effective to improve the functional prognosis of patients with cerebral metastases. Ideally, a multidisciplinary assessment offers the best choice of therapeutic modalities.

Unlabelled: MR-based diffusion- and perfusion-weighted imaging (DWI/PWI) has become the standard imaging technique to assess the individual brain pathophysiological status in acute ischemic stroke. The finding of a "mismatch" with larger PWI than DWI abnormality is thought to reflect the presence of tissue at-risk of infarction, i.e., penumbra. However, there has been no detailed study of the quantitative relationships between perfusion and diffusion changes in stroke patients. According to the experimental concept of penumbra, the ADC would be expected to remain unchanged despite decreasing perfusion until a critical threshold is reached. We have tested this hypothesis directly in man., Methods: DWI/PWI was performed in 7 patients with MCA territory stroke within 4-10 hrs from onset. Mismatch was defined on diffusion and rMTT maps, and circular ROIs were positioned within the ADC lesion (D), the mismatch area (M), and the normal appearing cortex (N); mirror ROIs were also obtained, and affected/unaffected ratios for ADC and rCBF were computed for each ROI., Results: The mean (+/-1 SD) ADC ratios were 0.60 +/- 0.09, 0.95 +/- 0.10 and 1.02 +/- 0.04 in L, M and N, respectively; the corresponding rCBF ratios were 0.32 +/- 0.12, 0.75 +/- 0.14 and 0.97 +/- 0.09, respectively. The relationship was non-linear, with the rCBF but not the ADC ratio for M being significantly lower (p < 0.01) than that for N. A threshold for decline in ADC was apparent around 0.50 rCBF ratio., Comment: These results directly document in man that the ADC declines only after hypoperfusion has reached a certain degree (about 50%), consistent with the concept of the ischaemic penumbra.

Heart involvement is frequent in systemic sclerosis. Cardiomyopathy is the main localization but its diagnosis is often late. Cardiac echography or radionuclide imaging show early involvement of the myocardium while showing alterations of diastolic function of the left ventricle or perfusion defects. The pathogenesis of this cardiomyopathy is supposed to be related to myocardial ischemia in relation with vasospasm, or with organic lesions of small arteries or coronary microcirculation. Pericarditis rarely is of clinical significance. Pulmonary hypertension concerns patients with proximal and advanced systemic sclerosis or limited forms such as CREST. It can be efficiently diagnosed by doppler echography but its therapy is difficult and its prognosis is poor. Epoprostenol in continuous venous infusion seems to be efficient but the accessibility to this therapy is difficult. While the involvement of middle-sized arteries of the hands is common, systemic sclerosis seems to be associated to an increased frequency of large-sized arteries disease.

Numerous studies have shown alterations of some structures and/or cerebral functions in patients with schizophrenia. However, the nature of the neurobiological process which could be at the origin of schizophrenic symptoms is still unknown. Magnetic resonance spectroscopy (MRS) is a unique technique which allows us to estimate the concentrations of endogenous substances which contain natural paramagnetic nuclei such as phosphorus (31P) and hydrogen (proton or 1H). The non invasive character of this technique, the absence of side effects, and the possibility of repetitive evaluations allowing for longitudinal studies, make possible MRS studies on the in vivo cerebral metabolism in schizophrenia. The prefrontal cortex, the hippocampus and the basal ganglia have all been implicated in the pathophysiology of schizophrenia. Therefore these brain regions have been frequently studied using MRS. Both proton and phosphorus spectroscopy have been used to study schizophrenia. Compounds that are detectable by 1H-MRS include N-acetyl aspartate (NAA), choline (Cho), creatine (Cr) and myo-inositol (ml). A deficit in NAA has been consistently shown in both the frontal and temporal lobes suggesting neuronal loss in these areas. Compounds detectable by 31P-MRS include phosphomonoesters (PMEs) and phosphodiesters (PDEs), which largely represent metabolites generated by lipid turnover. 31P-MRS can also detect certain energy-containing phosphorus metabolites such as phosphocreatine (PCr) and nucleotide triphosphates. Decreased levels of PMEs and increased levels of PDEs have been consistently described in the prefrontal lobes suggesting an alteration of phospholipid metabolism. The purpose of this review is to summarize the research on schizophrenia using MRS, to show the utility of this technique in understanding schizophrenia.

In order to evaluate the efficacy of interferon alpha (IFNa) in mixed cryoglobulinemia (MC), a prospective multicenter clinical trial was conduced in April 1992. It consisted of treating 20 clinically symptomatic MC patients with IFNa for 26 weeks. Hepatitis C virus (HCV) infection was detected in 16 patients. A complete or partial clinical remission was obtained in 12 patients (60%). Eleven of these 12 responders (91.6%) experienced a clinical relapse less than 12 months after the end of therapy. Side effects were noted in 10 patients (50%). It was concluded that subcutaneously administered IFNa does not provide long-term remission.

The therapeutic problems raised by recurrences are different from those which apply to the initial malignant glioma. Firstly, the histological diagnosis is known (by excision or biopsy) and secondly the clinical period which has elapsed before the recurrence represents a factor in the assessment of progression and/or malignancy. The management of treatment must take into account various parameters of an anatomical and clinical nature, but although those relating the various forms of treatment used already. Although the methods used are the same: surgery, radiotherapy, chemotherapy, the strategy will differ according to indications of final recourse or reoperation will be discussed after initial surgery followed by radiotherapy, irradiation in those cases in which radiotherapy has not already been used and chemotherapy, Corticosteroids are also widely employed. Whilst such palliative treatment has the merit of ensuring prolongation of survival, the principal aims must be concerned with the quality and conditions of this survival.

Numerous factors remain unknown as far as the mechanism of induction of cerebral metastases is concerned. Where as of cancer give metastases more readily than others, especially cerebral metastases, the neoplastic embolus can be either eliminated or remain in place in a state of quiescence. What is the role played by the blood brain barrier from a pathophysiological point of view? Is there a mechanism which prevents central nervous system metastases? What is the importance of individual variation? We attempted to induce cerebral metastases in VX2 carcinoma carrying rabbits to look for an approach to these problems and to create an experimental model of cerebral metastase. The VX2 carcinoma is easily transplantable and its biological characteristics are well known. The VX2 tumor is implanted in the thigh of the rabbits and is used in the experimentation starting two weeks following the take of the graft; the tumor is surgically resected and a solution containing approximatively 50,000 tumor cells for 0,1 ml is prepared. This solution is inoculated via the carotid artery to the same rabbit or to another rabbit of the same breed either or intrathecal way into the brain. Death occurred 6 to 20 days later and was followed by a complete pathological survey. The results were the following: --The inoculation via the carotid artery, even with very highly concentrated solution was never followed by any recognizable brain metastasis. --The inoculation intrathecaly produced only extraparenchymatous metastases where as the direct intracerebral inoculation was followed by the occurence of intracerebral metastases.

The authors have been using routinely since February 1983 a french 80W. CO2 Laser unit. They discuss the advantages and limits of this technic in the light of the first 26 intracranial and intraspinal operations carried on with it. The main and wellknown qualities of CO2 Laser are: the easiness of the hemostasis of the tumor and of the surgical cavity; and the absence of traction on the same tissue. The coupling of CO2 Laser with the operating microscope appeared very useful and made safer deep tumor excision, particularly that of the posterior fossa such as neurinomas and meningiomas. It was also quite efficient for intra-orbital tumors. The maniability of the hand piece was increased by the use of oblique mirror (45 degrees and 60 degrees) fixed at its extremity. The incision of skin, subcutaneous and muscular layers was not simplified by CO2 Laser; indeed this apparatus increased the operatory duration and was responsible of a healing time extension.

The authors have been using real time echography in neurosurgical procedures since 1981: either for detection of a small sub-cortical tumor during a surgical operation, either for biopsy-guidance, or for puncturing a cavity (abscess, cyst or hematoma). The imaging is performed with a CGR SONEL 100 apparatus and two different frequency transducer elements: 3.5 MHz and 5 MHz. 56 patients underwent this technique; 22 times the lesion was hypoechoic: abscess give homogeneous, round hypoechoic image, often surrounded by a fine hyperechoic line; intracerebral hematoma produces an hypoechoic image after a 10 to 15 days evolution: compared to an abscess it then has a more hyperechoic irregular wave-like limit; tumoral-cyst echogenicity is very low; it can even be anechoic. If a stereotaxic structure exists, indication of real time echography must be limited to such stereotaxy contraindications: threatening intracranial hypertension, suppurated lesion, fragile patient. The technique has its limit: that is the small volume of the target-lesion (inferior to 10 mm); advantages must be emphasized: light procedure, satisfying confidence when considering the probe progression, sometimes better information than that of a CT-Scan examination especially for tumoral and cystic lesions.

Fronto ethmoidal osteoma are rare slow growth benign tumors. Exceptional ophthalmological and neurological complications can occur. The authors report a case of 32 years old man with eye compression by a giant frontal sinus osteoma. This lesion was responsible for a vertical diplopia and moderate proptosis. Plain skull X-Ray show a well defined opacity filling the whole left frontal sinus and C.T. scan delimited precisely orbital extension. Neurosurgical exposure enabled a complete extraction of the tumor and satisfying recovery. The authors have compared this case to those described in literature and insist on the importance of the pre-operative C.T. scan.

A histological study of lymphocytic infiltration has been undertaken following removal at operation of one hundred human gliomas. This study has been completed with eight cases of tumour recurrence, six attempted autologous grafts, twenty one post-mortems and fourteen explorations of delayed hypersensitivity reactions. About half of the glioma specimens showed lymphocytic infiltration and no reaction was present in the other. Within this series of glioblastomas a correlation existed between the presence of infiltrating lymphocytes and the duration both of pre and post operative tumour evolution. The rejection of autologous grafts seemed to depend directly on the presence of lymphocytic infiltrations associated with the primary tumour. The retarded hypersensitivity reactions obtained after intradermic inoculations of cellular lyophilizates did not seem to be directly related either to the phenomenon of autologous graft rejection or to the presence of lymphocytic infiltrations. The results suggest that there is a complex system represented by two antigenic groups of transplantation type and sensitization type.

One case of trigeminal neuralgia and operative giant basilar aneurism is reported. This feature is quite rare, this case however emphasizes the importance of further investigations before surgery, especially if a direct approach is considered.

Concentrated irradiation (two series of 1,800 rads in 2 sessions and 3 days) separated by a rest period of 3 to 4 weeks has been used to treat 214 adult patients with brain tumors between 1965 and 1972. These included 108 glioblastomas, 18 astrocytomas and 88 brain metastases from different origins. Early side effects are moderate or inexistent provided synthetic ACTH or corticoid steroids have been given several days before irradiation. Survival is related, at least, in the first 2 groups of primary tumor to local failure. For brain metastases, death could be related to others reasons. In spite of the fact that comparison is made with a previous series of 121 cases it seems that this type of irradiation gives the same survival rates. Moreover it has specific advantages as reducing duration of hospitalization and the number of treatment sessions.

One hundred and fifty patients admitted consecutively to the same neurosurgical service in Paris were reviewed retrospectively. There is no definite difference between intracranial tumors in mental patients and those encountered in a normal population in terms of: frequency, anatomic localisation and histological distribution. All the patients had been referred previously to psychiatric hospitals for: confusional states, disturbed behaviour or pseudo-depression in 60% of the cases. Neurological localizing signs were present in 83% of the cases; EEG was abnormal in 96% of the patients recorded during their stay in psychiatric wards. Diagnosis of brain tumors in mental patients appears feasible if not always simple; it is based upon elementary neurological examination and routine investigations. In a near future, isotopic scan and CT scan should become a great help to reduce excessive diagnostic delays in order to improve the prognosis which remains poor.

Three cell lines derived in our laboratory from human malignant gliomas (SA 130, SA 132, SA 134) were injected subcutaneously into pathogen-free nude thymus less mice. These three cell lines gave origine to malignant tumors which, as original tumors, were positive for the glial fibrillary acidic protein (GFAP) revealed by immunoperoxidase method.

A case of familial deficiency in alpha-1-antitrypsin connected with Pi-0Z gene led to the finding of a new Gcler variant partly deficient, the electrofocusing pattern of which, located between that of G and I variants, was modified after neuraminidase digestion. A study of three generations shows that Gcler variant is transmitter according to an autosomally codominant mode. Moreover serum trypsin inhibitory capacity and concentration of ten proteins have been measured in this family. Except the known relation between serum alpha-1-antitrypsin level and trypsin inhibitory, capacity, only serum IgA showed a significant correlation with serum alpha-1-antitrypsin in the deficient group with Pi-Z allele.

Unlabelled: During the period January 1975-October 1987, we performed stereotactic ventriculocisternostomy (V.C.S.) on 23 patients (13 M., 10 F.; age: 11-73 years, m: 33). Sometimes used as an isolated therapeutic procedure, V.C.S. may also follow stereotactic biopsies using Talairach's methodology. Serial stereotactic biopsies were performed in 15 out of 23 patients showing 11 tumoral lesion, two arachnoïdal cysts and two cryptic vascular malformations. Eight patients presented with an isolated aqueductal stenosis. Among the 12 non tumoral patients, seven had very large triventricular hydrocephalus (6 with a retroclival dilatation of the third ventricle) and 5 showed significant dilatation. Of the 11 tumoral patients, 7 had significant ventricular dilatation (1 with a protrusion of the floor of the third ventricle) and 4 with modest dilation. V.C.S. is done by creating an opening (diameter: 5-6 mm) in the floor of third ventricle with a fine forceps introduced through a tubular guide (diameter: 2.45 mm). The percutaneous double oblique transfrontal trajectory (drill-hole: 2.5 mm of diameter) passing through the foramina of Monro, avoids superficial and deep vessels visualised on the previous Stereoscopic Tele-Angiographic and Ventriculographic study. A systematic verification of the V.C.S. patency is made intraoperatively by injection of iodine contrast medium into the third ventricle., Results: (non tumoral patients: 12) (m follow-up: 4 years): two patients needed a ventricular shunt after 3 and 1 months respectively, the first one because of an associated communicant hydrocephalus, the second because of a post-operative meningeal infection. Long-term clinical and CT-Scan follow-up showed that complete resolution (7 cases) or partial (2 cases) improvement of symptoms and signs was not accompanied by normalization of ventricular size, even though the dilatation was significantly reduced in 8 cases and to a lesser extent in 2., Results: (tumoral patients: 11) (m follow-up: 3 years). Hydrocephalus was reduced in 6 cases and remained unchanged in 5. Two patients needed a ventricular shunt 2 years after the V.C.S.: 1 patient, because of a tumoral recurrence involving the region of the fenestration, the second patient because of adhesive arachnoiditis following reoperation for suspicion of recurrence, though this was found to be granulomatous inflammation. Two patients died as a result of their tumors at 2 and 6 years., Conclusion: Stereotactic V.C.S. is the treatment of choice for triventricular obstructive hydrocephalus even when there is no retroclival dilatation of the floor of the third ventricle.

On the basis of studies utilizing antibody to GFAP (glial fibrillary acidic protein) in the indirect immunofluorescent and immunoperoxydase methods we report the presence of GFAP in 5 astrocytomas, 1 ependymoma and 1 medulloblastoma. The GFAP was evidenced on cryostat sections of frozen material and in short-term tissue culture. Five others tumors including 1 oligodendrocytoma, 1 choroid-plexus papilloma, 1 meningioma and 2 secondary sarcomas were negative. Possible applications of antibodies to GFAP for localization and therapy of brains tumors were considered.

The effects of six chemotherapeutic drugs currently used in human gliomas treatment were tested with an in vitro cytotoxicity test. Out of six, VM 26 proved to be the most potent against tumor cells along with a moderate cytotoxicity against normal brain or embryonnic human cells. This specificity did not seem to be related to differences in cellular growth rates.

Serum uric acid levels were determined in 229 individuals of Rodome and 127 individuals of Camurace, in the french Pyrénées. The difference of average levels between these two populations was found to be due very likely to different way of life. Intra-familial correlations suggest a greater importance of environmental than genetic factors on serum uric acid levels.

The particular thermal properties of CO2 laser make it an useful instrument for neurological surgery. Necrosis and carbonization zones, as well as its thermal diffusion in the nervous tissue are dramatically less important with a CO2-laser unit than with other lasers (Nd-Yag or Argon) and moreover with the electrical mono--or bipolar coagulator. That is why the authors chosed this instrumentation for achieving a good hemostasis. It was particularly useful during removal of intracranial tumors situated close to the functional structures of the basis of the brain and the brainstem. The authors present their experience with the french CO2-laser unit Ercelas 80 (Robert et Carrière Biomedical) that they have been using routinely since 1983 in 60 neurosurgical procedures. They present the technical standards necessary to perform such an hemostasis either with the hand-piece or using the micromanipulator. In all cases the output power must be much lower for hemostasis than for tumoral cutting or vaporization. Depending on the type of tumor, radiation power should vary from 2 to 10 watts if a linear emission is used, and from 10 to 30 watts in case of pulsed emission. On the other hand, CO2-laser beam must be unfocussed so as to avoid cutting the vessels less than 0.5 mm in diameter before coagulating them properly.