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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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Cerebrovascular diseases (CVD) claim 1.5 million lives each year in industrialized countries; in developing countries, estimates suggest the same distressing trends. CVD rank as the third leading cause of death after ischaemic heart disease and cancer. Surviving patients are left disabled and paralysed, dependent on their families and on society. Lifestyle, an issue of concern both for the individual and the community, can play an important role in the primary prevention of CVD when combined with dietary adjustments and appropriate drug therapy; it can prevent and slow down the development of atheroma, help to regulate blood pressure and contribute to the prevention of heart diseases likely to cause embolic strokes. The preventive treatment and management of other conditions, such as rheumatic heart disease, coronary artery disease with myocardial infarction and cardiac arrhythmias (embolic strokes), combined with healthy eating habits that tend to reduce the intake of saturated fats (atherosclerosis) and salt (high blood pressure) and the avoidance of smoking and alcohol (ischaemic and haemorrhagic strokes) will help to lower the incidence of mortality and morbidity due to CVD.

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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.

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A teratoma of the lower part of the posterior fossa was discovered in a 32-year-old woman who was suffering from vertigos and left deafness. The usefulness of CT scan and NMR imaging in the diagnosis of intracranial teratomas is emphasized.

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Four cases of basilar artery occlusion with a follow-up from 7 to 12 years are reported. The first patient, a 60 year old woman, had a proximal occlusion which was revealed by an acute brain stem ischemia. The second case was a 63 year old man with an aortic aneurysm who had a single episode of vertebro-basilar insufficiency. Cerebral angiography demonstrated a lower basilar artery occlusion. The third patient, a 60 year-old woman, had been operated from right carotid artery and left vertebral artery stenosis; 8 years later, without clinical manifestations, a left carotid artery stenosis and an occlusion of the lower part of the basilar artery were discovered. The evolution was eventless after a left carotid endarterectomy. The last case was a 60 year old man who had a lower basilar artery occlusion associated with a left internal carotid occlusion. There was a full recovery after a hemiplegic stroke. From our personal cases and the review of the literature, long term survival after basilar artery occlusion may occur in occlusions restricted to the lower or middle part of the basilar artery and with a good collateral supply from carotid and cerebellar arteries.

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An extradural arachnoid cyst of the thoracic spine was diagnosed and operated in a 39 year-old woman with a history of two regressive attacks of spastic paraplegia during a 19 year-period. The diagnosis was established by magnetic resonance imaging and myeloscan, which demonstrated the cyst and its consequences on the spinal cord and the spine. Theories of etiology and development of extradural arachnoid spinal cysts are reviewed.

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An acute polyradiculoneuritis with tetraplegia and respiratory failure was observed in a 27 year-old heroin addict 3 hours after an intravenous injection of heroin. Full recovery was obtained after respiratory assistance and plasma exchanges. The biological and morphological changes (sural nerve biopsy) suggested an immune mediated mechanism. Three years after the recovery, the patient was tested for HIV antibody and was seropositive. The role of HIV infection and of the injection of heroin are discussed.

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A 61-year-old patient had complained of sciatica in the left lower limb for three years. The pain was located in the posterior area of the thigh and leg and radiated to the first toe. Examination showed a tumor of the middle part of the thigh. A sciatic nerve tumor was confirmed at operation. Pathological examination revealed a neurofibrosarcoma. The patient died from pulmonary metastasis 17 months later.

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A right facial paralysis led to the discovery of a tumor on the left side of the medulla oblongata. A neurinoma was suspected on MRI and confirmed by surgery and pathological examination. Ultrasonic aspiration was on interest in this case. The mechanism of the facial paralysis is uncertain: ischemia, compression and pure coincidence may be considered.

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