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Trigeminal trophic syndrome (TTS) can occur after any injury on the fifth cranial nerve. The etiology is dominated by iatrogenic causes, especially after gasserian ganglion ablation. Middle-aged women are mostly involved and the differential diagnosis is vast.A 88-year old woman presented with TTS and destruction of the right nasal ala 25 years after retrogasserian alcohol injection for trigeminal neuralgia. Facing iterative failure of medical treatment, topics and neurostimulation, we performed lipofilling for the lesion. In the third month, we found a 50 % decrease in size of the lesion, as well as a complete disappearance of pruritus, thus allowing to consider reconstructive surgery.Our literature review reports 28 cases of TTS subsequent to alcohol injection of the gasserian ganglion. Age of presentation ranges from 49 to 88 years, with a time of onset between trigeminal injury and TTS ranging from 2 weeks to 17 years. Recurrences are frequent. The management varies a lot according to the authors (topics, antibiotics, flaps), however the efficiency of lipofilling has not been reported yet.The pathophysiology of TTS remains unknown, nevertheless the therapeutical care has to be multidisciplinary. Even though not described yet, lipofilling seems to be an interesting treatment of TTS following alcohol injection in the trigeminal ganglion.

Chronic alcohol intoxication is able to modify the lipid structure and fluidity of synaptosomal membranes and influence hereby the activity of some membraneous enzymes and receptors. These changes could play a key role in the development of alcohol tolerance and dependence. This "membraneous hypothesis" allows to explain, at least in part, the influence of nutritional factors as well as of differences in genetic or individual susceptibility on alcohol dependence. It suggests furthermore the possibility of prevention of alcohol dependence through dietary and pharmacological means.

A resolving form of Marchiafava-Bignami disease is reported. This patient with a history of chronic alcoholism was hospitalised for a recent demential syndrome. Clinical examination did not show any signs of interhemispheric disconnection LP and EEG were normal. CT examination showed a low density area in the corpus callosum without any other anomaly. MRI examination confirmed the cystic area of the corpus callosum. The Marchiafava-Bignami disease was easily suggested on the basis imaging and clinical signs. Interhemispheric disconnection is not always found so MRI and CT examinations seem to be very useful tools for early diagnosis of Marchiafava-Bignami in the same way as neuropsychological tests.

Acute ethylic intoxication (AEI) or alcoholic drunkenness is not only a youth-specific disorder. It also occurs at advanced ages of life. Diagnosis is not easy, at times made in excess, but more often underestimated, then leading to the negligence of a risk situation and suffering. AEI represents about 3% of all hospitalizations. In 2005, 973 alcohol tests taken at the hospital of Mâcon (France) were positive. The rates ranged from 0.10 g/L to 6.26 g/L (m = 2.06 +/- 1,18). 41 subjects were aged over 75 (5%). The alcohol rates found were lower after 75 years (1.34 +/- 1.1 g/L) than before 75 years (2.11 +/- 2,1; p<0,001). Subjects were referred to the Emergency unit for a fall in 61% of the cases, and dizziness in 34%. Among the aged subjects, 30% received external care and 70% were hospitalized. According to the DSM-IV, misuse of alcohol was found in 87% of subjects (abuse in 67%, addiction in 20%) and temperance in 13%. Drinking alcohol is not a pathology in itself. However, if it causes suffering or has negative consequences on health or lifestyle, care is required. Aging doesn't change anything to this reality. AEI, in truth, requires even more specific care and attention, in the elders.

Central pontine and extra-pontine myelinolysis (CPM/EPM) is a rare neurological disorder, well documented for more than 50 years but whose pathogenesis remains obscure. The existence of predisposing factors occurs in the most cases; chronic alcohol abuse is one of the most commonly encountered, among many others. Alcohol withdrawal represents an additional vulnerability factor, being responsible for electrolyte imbalances which are not always demonstrable but are certainly involved in the development of CPM and/or EPM. CPM/EPM may be responsible for severe morbidity and is potentially life-threatening. The diagnosis of CPM/ EPM remains mostly clinical and is confirmed by magnetic resonance imaging of the brain. It should be considered in the setting of any unexplained neurological symptoms during the course of alcohol withdrawal or for any patient with chronic alcohol abuse, as promptly as possible, given the potentially fatal outcome.

The trigeminal neuralgia or "painful tic" of the face is an invalidating affection, which affects the quality of life of the patient. The odontologist must be able to diagnose it and take part in his good therapeutic assumption of responsibility. The diagnosis is sometimes difficult, being able to involve unsuited therapeutic methods prejudicial for the patient. The objective of our study was to analyse the clinical and therapeutic aspects of the trigeminal neuralgia. It was a transverse and descriptive study which 27 files of patients suffering of trigeminal neuralgia and treated in the odontology service of the General hospital of Grand-Yoff in Dakar between July 2002 and July 2008. We exploited the following parameters: the age, the sex, the oral state, duration of the symptoms, characteristics of the pain, the type of treatment. 22 patients of the 27 cases were female. The time of consultation was often late, the patients generally preferring begin with the traditional treatments. The neuralgia of V2 dominated the clinical picture, followed that neuralgia of V3. The pain was strictly unilateral, it was started by movement, speaking, eating or touching the trigger zone. The prescription of carbamazepine (Tegretol) was systematic, and constituted a true test diagnosis, it made possible to obtain an immediate sedation of the pains. In front of the medicamentous treatment failure, the alcoholization of the trigeminal branch has given good performances, indeed it made possible to obtain, a clear lull of more than 12 months for 9 patients out of the 10 who profited from it. The alcoholization of the trigeminal nerve remains an effective cure and constitutes an accessible alternative under our work conditions in Africa.

Neuroimaging, particularly MR imaging, plays a major role for the diagnosis of many acute toxic encephalopathies. Toxic disorders are related to drugs (immunosuppressive agents, chemotherapeutic agents, anti-epileptic drugs, heroin...), to metals (lead, manganese, mercury...), and to industrial and environmental chemicals (solvent, carbon monoxide...). MR imaging with diffusion and perfusion imaging provides information regarding brain lesions induced by the toxic agents (vasogenic edema, cytotoxic edema, infarction, hemorrhage, demyelination...).

Disulfiram is commonly used in the treatment of alcohol dependence. It induces aversive symptoms after alcohol ingestion: the "acetaldehyde syndrome". Most often "acetaldehyde syndrome" is moderate but severe life-threatening symptoms may occur in specific circumstances. We report the case of a serious "acetaldehyde syndrome" with shock compounded by the initial administration of dopamine. Discussion clarifies the pathophysiology and develops the therapeutic management.

Ethanol blood levels are the result of alcohol absorption and the process of its distribution, metabolism and excretion. Kinetics are complex and not yet well known. They can be influenced by acquired factors (type of alcohol ingested, association with fasting or eating, induction or inhibition of ethanol metabolism) or by genetically determined differences in the activity of alcohol and of acetaldehyde dehydrogenase. The presence of ethanol in the organism leads to various consequences. On the one hand, hydropic changes on membranes modify their function and thus that of membrane proteins (particularly receptors); on the other, ethanol can affect neurotransmitter metabolism. Such modification of the major neurotransmitter systems (cholinergic, aminergic and GABA) in some cerebral regions explains the pharmacologic consequences of acute alcohol ingestion. In chronic alcohol dependence, adaptation phenomena occur, in both the membranes (increased rigidity) and the neurotransmitter systems. They are reflected by the hyperexcitability (catecholaminergic hyperactivity and GABA hypoactivity) observed after disappearance of the tranquilizing effect of ethanol and are clinically expressed by the withdrawal syndrome.

A concerted study of the clinical and electrophysiologic effects of tianeptine was conducted in alcoholic patients hospitalized for 5 weeks for alcohol withdrawal cures and subsequent depression. Because of the well known manifestations of infraclinical cognition impairment, sleep disorders and greater susceptibility to undesirable effects of psychotropic drugs, which hinder health care in this type of patient, the authors investigated changes in cognitive functions and the effect of tianeptine on sleep organization and daytime vigilance. Results after 4 weeks treatment (3 times 12.5 mg/day) included: besides its antidepressant effect, tianeptine reduces the manifestations of anxiety, without sedation effects, either clinical or electrophysiologic; tianeptine has no deleterious effect on cognitive functions, on the contrary, it appears to favour recovery when they are impaired; tianeptine does not modify sleep structure, notably in paradoxal sleep; tianeptine is an antidepressant which has a good acceptability, even for a population at "risk".