Analyse et évolution des déficits cognitifs après rupture des anévrysmes de l'artère communicante antérieure [Analysis and course of cognitive deficits after rupture of aneurysms of the anterior communicating artery]

The aim of this study is to investigate general intellectual and memory performances at the secondary (3 weeks to 4.5 months) and late (10 to 16 months) stages following rupture of anterior communicating artery aneurysms (AACA). Twenty one patients presenting with selective lesion within frontal, or cingulate, callosal, caudate, basal forebrain areas were evaluated. At the secondary stage, the analysis of the general intellectual capacities revealed a drop of performance, prominent on performance IQ, which was more severe than the learning deficit. Specific cognitive evaluations revealed increase of the execution time, but performance was relatively preserved: in the Stroop test, focused attention disorder was moderate: the modified Wisconsin Card Sorting test was correctly performed in most cases; significant deficits of verbal short-term memory, long-term verbal and visuo-spatial learning, and access to semantic memory were observed. At the late stage, general intellectual performance improved, but did not reached the estimated prelesional level in most cases; specific cognitive disorders had most often disappeared. Most performances were best explained by the severity of lesions in the left cingulate cortex and corpus callosum area. These results show that the cognitive profile of AACA patients is different from classical descriptions of the "amnesic syndrome", and is also different at the secondary and late stages; this evolution has to be taken into account in studies describing cognitive deficits of such patients, or comparing them with others presenting with "annesic syndrome"

Dystonie et tremblement dans une lésion bilatérale du mésencéphale postérieur et du vermis [Dystonia and tremor in bilateral lesion of the posterior mesencephalon and the vermis]

The aim of this study is to report the association of diffuse dystonia and tremor in a bilateral and extended lesion of the posterior mesencephalon. After surgery on a meningioma of the upper part of the fourth ventricle, this patient presented with facial dystonia, predominating on orbicularis muscles and peribuccal area, and limb dystonia, with tonic extension of fingers and first toes. The tremor was associated with a rhythmic and most often alternate agonist-antagonist muscular activation, whose frequency varied from 3 to 7 Hz. These disorders were increased by the standing position, voluntary movement, somatosensory stimulations, stress or emotion. Pyramidal and somatosensory tracts were spared. Therapeutic trials showed that both the dystonia and tremor were improved by subcutaneous injection of apomorphine, the dystonia by trihexyphenidyle, and the tremor by carbamazepine and propranolol, but not by levodopa and benserazide. The cerebral blood flow study using HMPAO showed a relatively important activity on the cerebellum, which could play a role in the onset of these disorders

GDC 360° for the endovascular treatment of intracranial aneurysms: a matched-pair study analysing angiographic outcomes with GDC 3D Coils in 38 patients

International audienceThe purpose of this study was to determine whether coil embolisation with a new complex-shaped Guglielmi Detachable Coil (GDC 360°; Boston Scientific Neurovascular, Fremont, CA, USA) has any effect on the stability of aneurysm occlusion