A primary T-cell lymphoma of the central nervous system was diagnosed at autopsy in a 73-year-old woman. The course of the illness was made of multiple neurological episodes: hypersomnia, palsies of cranial nerves, aphasia, hemiparesis, epileptic fits during 4 years, with fast recoveries under corticosteroid therapy. CT scan and MRI abnormalities were also dramatically improved by the treatment.

Cardiac myxomas are rare tumours complicated by faintness or syncope usually occurring in upright position and due to obstruction of a cardiac valve orifice. Myxomas are also manifested by neurological deficits caused by myxomatous or fibrino-cruoric cerebral emboli. Intracranial aneurysms and metastases are exceptional. The simplest and most reliable diagnostic method is transthoracic two-dimensional cardiac echography. Treatment consists of surgical excision which has very low morbidity, mortality and recurrence rates.

Familial hemiplegic migraine is defined by three criteria, i.e., occurrence of migraine attacks with concomitant hemiplegia, genetic transmission (usually on an autosomal dominant basis), and absence of other causes of hemiplegia. Considered infrequent, this condition is probably underdiagnosed. Four new affected families are reported herein.

A 76-year-old man presented with gait disturbances, mental deterioration and urinary incontinence. CT and MRI suggested a normal pressure hydrocephalus. Because of a raised protein content of CSF, a spinal MRI was performed and revealed a lumbar neurinoma. The patient improved after removal of the neurinoma and ventricular derivation.

A primary T-cell lymphoma of the central nervous system was diagnosed at autopsy in a 73-year-old woman. The course of the illness was made of multiple neurological episodes : hypersomnia, palsies of cranial nerves, aphasia, hemiparesis, epileptic fits during 4 years, with fast recoveries under corticosteroid therapy. CT scan and MRI abnormalities were also dramatically improved by the treatment.

A case of aneurysm of the basilar artery bifurcation identified only ten years after the first clinical manifestations is reported. Initially, several successive angiographic studies showed only evidence of transient occlusion of the basilar artery. The mechanism of this transient occlusion is discussed.

Ten cases of cerebral hemorrhage and one of intraspinal subdural hematoma after thrombolytic therapy are reported. Six patients were treated with streptokinase, four with rt-PA and one with a combination of both drugs. The incidence was 0.5 to 2 % and was higher in case of rt-PA therapy (3.7 %). In all cases, CT scan showed primary hemorrhage rather than hemorrhagic infarction. Four patients died of stroke. Among the survivors, residual disability was severe in one and mild in five. Only one patient recovered completely.In patients treated with streptokinase, the hemorrhage was probably due to a more than 80 % decrease in plasma fibrinogen. In those receiving rt-PA, either excessive dosage (2 cases in our series) or lysis of cerebral microthrombi are thought to be responsible for the hemorrhagic complications. Treatment consists of infection of aprotinine (an anti-fibrinolytic drug), cryoprecipitates with factors V and VIII and protamine sulfate.

Three cases of neurobrucellosis are reported. Clinical manifestations in the first case were suggestive of cerebral ischemia, with transient ischemic attacks followed by sudden, stroke (after intradermal testing with melitin, suggesting an immunoallergic mechanism) in the vertebrobasilar territory. The second patient developed cauda equina syndrome with progressive hydrocephalus which responded to intrathecal corticosteroid therapy. Clinical findings in the third patient were consistent with acute meningoencephalitis with positive cerebrospinal fluid cultures for Brucella melitensis. These case-reports suggest that neurobrucellosis is still a current problem in southern France and can be responsible for a very broad spectrum of clinical patterns.

Eleven cases of cardiac myxoma with neurologic manifestations were reviewed retrospectively. In nine cases, neurologic symptoms occurred as the first manifestation of the tumor. Dizziness or syncope was a symptom in five cases. A neurologic deficit occurred in six patients and resolved in four. All eleven patients had surgery no postoperative complications, tumor recurrences or recurrent cerebrovascular accidents were recorded.

Ten cases of cerebral hemorrhage and one of intraspinal subdural hematoma after thrombolytic therapy are reported. Six patients were treated with streptokinase, four with rt-PA and one with a combination of both drugs. The incidence was 0.5 to 2% and was higher in case of rt-PA therapy (3.7%). In all cases, CT scan showed primary hemorrhage rather than hemorrhagic infarction. Four patients died of stroke. Among the survivors, residual disability was severe in one and mild in five. Only one patient recovered completely. In patients treated with streptokinase, the hemorrhage was probably due to a more than 80% decrease in plasma fibrinogen. In those receiving rt-PA, either excessive dosage (2 cases in our series) or lysis of cerebral microthrombi are thought to be responsible for the hemorrhagic complications. Treatment consists of infection of aprotinin (an anti-fibrinolytic drug), cryoprecipitates with factors V and VIII and protamine sulfate.

A 24 year-old patient presented with chronic intracranial hypertension, palsy of both abducens nerves and upward gaze, and right hypoesthesia. CT scan and MRI showed a left thalamic tumor infiltrating the left cerebral peduncle. A stereotactic biopsy revealed a germ cell tumor. Following radiotherapy the patient recovered except for ophthalmoplegia. The tumor totally disappeared on CT scan and MRI.

A 31-year old patient presented a right hemiparesis related to a left basis pontis infarction. Laboratory investigations revealed both neurosyphilis and HIV infection. The patient was treated with two courses of penicillin and recovered from hemiparesis. The occurrence of strokes due to syphilitic arteritis in AIDS is emphasized.

A 24 year-old patient presented with chronic intracranial hypertension, palsy of both abducens nerves and upward gaze, and right hypoesthesia. CT scan and MRI showed a left thalamic tumor infiltrating the left cerebral peduncle. A stereotactic biopsy revealed a germ cell tumor. Following radiotherapy the patient recovered except for ophthalmoplegia. The tumor totally disappeared on CT scan and MRI.

Six cases of neurological complications of essential thrombocythemia are reported. Five were ischemic strokes and the clinical expression was heterogenous (transient ischemic attacks or completed strokes), in vertebro-basilar or carotid areas. There was no correlation between the nervous disorders and the severity of the thrombocythemia. In the last case, the patient presented with papillitis and peripheral neuropathy, and the relationship with thrombocythemia was not clear. It is suggested that thrombocythemia may directly induce an arterial or venous thrombosis or increase the severity of ischemic strokes of atheromatous origin.

Twenty-three cases of vertebro-basilar aneurysms observed in a neurology department are reported. Ten were located on the basilar artery (7 at the basilar bifurcation), 5 on the postero-inferior cerebellar arteries, 4 on the superior cerebellar arteries, 3 on the vertebro-basilar junction and 1 on the anteroinferior cerebellar artery. There were 6 fusiform and giant aneurysms, others were sacciform. In 5 cases, there was no clear relationship between the clinical data and the aneurysm, which was discovered by chance at angiography or MRI. One giant aneurysm of the basilar artery was mimicking a tumor of the posterior cerebral fossa. Two other cases were revealed by brain stem ischaemia. Aneurysmal rupture was present in 15 cases: there were signs of meningeal haemorrhage in all cases and clinical signs of posterior cerebral fossa involvement in 7 cases. CT scan, performed in 8 cases, showed in all of them a meningeal haemorrhage, with a brain stem haematoma in 3 cases. All the aneurysms were shown by angiography; 7 were associated with a vasospasm. Five patients were not operated upon; all died. In one case, clipping the aneurysm was impossible, but there was a good recovery with a 12 year follow-up. Nine patients were operated, 3 recovered completely, 2 had neurological sequelae, 1 a late worsening; 3 patients died of brain stem ischaemia.

A 28-years old woman, working as a secretary, developed a rapidly progressive paraplegia with burning pain in the lower limbs. She recovered within 4 months but relapsed shortly after she was discharged. There was flaccid tetraplegia, associated with hyperalgesia of the limbs, diffuse muscle atrophy, blindness and alopecia. The patient needed respiratory assistance for 2 months. Bilateral optic neuropathy and paraparesis persisted after a 17 months follow-up.The clinical picture suggested thallium poisoning, which was confirmed by high thallium concentration in plasma and urine. The most likely cause was accidental poisoning with rodenticides.