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Spasms of skeletal muscles occur in healthy individuals or in the course of functional disorders of the peripheral motor neuron or its axons. Like fasciculations, they are a motor manifestation, but a painful one. Cramps evoke the notion of ephapsis and of immature terminal axons. There are, however, also other responsible regulatory systems, mostly the sensible and spinal ones. Three personal observations are used to illustrate the various triggering mechanisms. A review of the literature on this subject is added. Symptomatic treatment has not changed over past decades: Quinidine remains the treatment of choice. Other stabilizers of cell membranes are actually available, whose usefulness varies as a function of the cause of cramps.

The authors describe the clinical picture, etiology and evolution of 64 patients admitted because of an acute confusional state to the Department of Neurology of the University Hospital in Lausanne (CHUV) during two years (1991 to 1992). The difficulty of clinical diagnosis, particularly in vascular and epileptic cases, the high percentage of focal neurological causes, the role of (underlying) dementia, drugs, systemic disturbances (fever, infections, dehydration, etc.) and the importance of etiology for prognosis are particularly stressed.

Tremor can present a diagnostic problem in family practise. Systematic analysis of this symptom allows rapid classification of the problem without use of rigid definitions. Unilateral or very asymmetric tremor that disappears at the onset of a movement is for example a typical sign for parkinsonism without analysis and differentiation between tremor at rest or position-dependent tremor. Also one may assume, that a symmetric tremor that aggravates during standing or movement in most cases is essential and not of cerebellar origin. Different forms of tremor and their therapies and main tremor types are presented graphically.

In this paper we studied the neurological polymorbidity in a group of 467 hospitalized patients of more than 70 years of age. A disorder of the central nervous system (CNS) was of the principal mainly diagnosis in 393 cases, the peripheral nervous system (PNS) in 71 cases and in 3 cases a myopathy. In 77.9%, the various neurological disorders were within the CNS, including mainly cerebrovascular events (226 cases, 48%). Among 156 patients, there was an accompanying disorder of the PNS.

There are very few observations on the occurrence of stroke after general surgery; the incidence lies between 0.2 and 0.7%. On the other hand, cerebrovascular accidents are mainly seen after cardiac and carotid surgery, where the incidence is high (5%). Strokes are also an important cause of morbidity and mortality following orthotopic transplantations, particularly heart, heart/lung and liver transplantations.

Acute or chronic spinal cord syndromes with or without evidence of cord compression are a common diagnostic problem in neurology. Magnetic resonance imaging (MRI) was performed on 127 patients to assess the sensitivity of this examination in detecting local spinal cord lesions. The most common location noticed in this study were the cervico-thoracic (40.9%) and cervical regions (33.8%). A total spine examination accounted for 14.9% of the examinations performed, and the lumbar spine was evaluated in 10.2%. An increased signal corresponding to plaques of multiple sclerosis was the most frequent diagnosis (25 cases), followed by cervical narrowing of the spinal canal and cervical disk diseases (23 cases), neoplasms (15 cases), spinal cord infarctions (12 cases), spinal infections (6 cases) and spinal cord injuries (3 cases). A myelopathy of undetermined etiology was diagnosed in 19 cases. MRI is very sensitive in multiple sclerosis, but it is not possible to diagnose the disease from abnormal scan only, other supportive laboratory results, such as oligoclonal bands, are necessary. MRI is very useful in evaluating intraspinal cord parenchymal lesions, such as neoplasms or congenital abnormalities.

The effects of alcohol on the central nervous system can be subdivided into three main categories: the effects of acute intoxication (drunkenness, acute encephalopathy, stroke), the effects of tolerance and ethanol withdrawal (delirium tremens, seizures) and the delayed manifestations of chronic alcohol consumption (cerebellar degeneration, Wernicke's encephalopathy, dementia).

This article will review age-related changes in the neurological examination. The involutional process is a diffuse one, affecting all levels of the neuraxis simultaneously. Most of the numerous little manifestations distinguishing them so sharply from the youthful are really features of the neurology of the elderly. Some signs are characteristic: attitude of general flexion, general poverty of movement, gait, minor extrapyramidal signs, primitive reflexes. However, these features may also be caused by neurological diseases common in the elderly, such as dementia or cervical myelopathy, which is very common after 75 years.

The use and tolerance of cyclosporine A (Cy A) and azathioprine (AZA) are compared as long-term immunosuppression treatment for multiple sclerosis. 38 patients with multiple sclerosis were randomized and received either Cy A (5 mg/kg/d) or AZA (2 mg/kg/d) during 24 months. These patients were assessed clinically and with different biological parameters. The Cy A blood level was controlled, and Cy A was well tolerated without side effects forcing to stop the treatment. However, its benefits were limited when the different clinical scores are compared.

Hemiplegia is the most frequent form of paralysis in humans and involves face, arm and leg on one side of the body. Diseases localized in the cortex, the cerebral white matter (corona radiata) and the internal capsule usually manifest themselves by weakness or paralysis of the face, the arm and the leg on the opposite side. In the causation of hemiplegia, vascular diseases of cerebrum and brainstem exceed all others in frequency. Trauma ranks second, and other important causes are brain tumor, encephalitis or abscess and demyelinating diseases.

Toxic myopathies are an uncommon manifestation of chemotherapeutic agents. Most myopathies are characterized by a weakness affecting proximal limb-muscles more than distal ones. Steroids, chloroquine and ipecac syrup are the most common drugs inducing myopathies. Toxic myositis is rare and reported with D-penicillamine abuse. Myotoxicity of local agents injection such as anesthetics, steroids or antibiotics is also known. Congenital myopathies such as malignant hyperthermia, hypokalemic periodic paralysis or paroxysmal myoglobinuria may also be induced by drugs but are very rare.

A number of therapeutic options are available to clinicians caring for patients with ischemic cerebrovascular diseases. The efficacy of some strategies that aim at mitigating the effects of cerebral infarction are presented. The optimal role of carotid surgery, platelet-antiaggregant drugs and anticoagulation in the prevention of stroke are analysed.

The authors describe five patients who presented with deafferentation pain after surgery. The physiopathology, general semeiological and therapeutic features are reviewed. The pain that occurs after nerve or spinal cord injury is due to chronic deafferentation characterized by a syndrome of ongoing pain and abnormal sensitivity. Surgical procedures for pain relief can be divided into two great categories: destructive procedures and neuro-stimulation. The first one which entails the surgical interruption of pain pathways is used in cancer. Peripheral or central stimulation are effective for many pain syndromes, principally the deafferentation pain.

Peripheral neuropathy is a common manifestation of chemotherapeutic agents. Most drugs produce a distal axonal degeneration and long axons are predominantly affected, giving a clinical picture characterized by a symmetrical sensory neuropathy. The toxicity of therapeutic agents to the peripheral nervous system particularly includes those used in cancer-chemotherapy (cisplatin, vinca alkaloids), but antimicrobial agents such as isoniazide or nitrofurantoin and vitamin abuse (pyridoxine) are also discussed.

The various clinical pictures of lower limb's mononeuropathies are described. An essential step in the diagnosis of pressure and entrapment neuropathies is to obtain an accurate description of the patient's symptoms and to ascertain whether the sensory and motor symptoms and signs correspond to the distribution of a single peripheral nerve. EMG is a useful adjunct to the physical examination and nerve conduction studies. Computer tomogram scanning may reveal bone, joint or soft tissues abnormalities responsible for the neuropathy. The attitude and the prognosis depend on the physical and functional state of damaged nerve trunks, mainly based on the classification of neuropraxia, axonotmesis and neurotmesis.

Many drugs may cause cerebral infarction or hemorrhage. The authors describe the epidemiology and the physiopathological aspects of stroke in patients using anticoagulant therapy, oral contraception or ergot alkaloids. Cerebrovascular complications are also noticed in abusers of cocaine or other stimulants of the central nervous system: amphetamine, phenylpropanolamine, xanthines.

Practically all drugs administered in large amounts can give rise to neurologic symptoms such as drowsiness, insomnia, confusion, seizures or coma and extrapyramidal disorders. In this study, five classes of agents are reviewed: antipsychotic drugs, drugs for Parkinson's disease, antiepileptic drugs, calcium antagonists and salts of bismuth.