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1.
Julien Ognard Elsa Magro Jildaz Caroff Douraied Ben Salem Sebastien Andouard Michel Nonent Jean-Christophe Gentric 《Journal of neuroradiology. Journal de neuroradiologie》2018,45(3):177-185
Background and purpose
The Spetzler and Martin (SM) cerebral arteriovenous malformation (AVM) classification is a widely used 5-tier classification. This common language allows specialists to exchange about AVMs and must be reliably characterized by the imaging methods. We presented an agreement study on a new method of digital subtracted 3D rotational angiography resolved in time (four-dimensional DSA: 4D DSA) compared to the gold standard (two-dimensional DSA: 2D DSA) in AVM grading using the SM classification.Methods
Ten patients with AVMs were included during one year, they had an angiographic exploration with both 4D DSA and 2D DSA. Three readers assessed the SM classification. One reader conducted a second reading. The inter-, intra-observer and intermodality agreements were calculated by Kappas. Dose to patient was reported.Results
Considering the SM grade, the inter-observer agreement between 4D DSA and 2D DSA was equivalent (κ = 0.45 and 0.46), and calculated as substantial κ = 0.76 between the 2 methods. The agreement between 4D DSA and 2D DSA was calculated as moderate κ = 0.46 assessing the size of the nidus, slight κ = 0.18 analyzing the drainage and almost perfect κ = 0.95 depicting the localization. 4D DSA performed during a standard initial angiographic assessment of AVM represented approximately 6% of the total dose.Conclusion
The addition of this new technique 4D DSA could be performed regularly in addition to the 2D DSA if available, to assess SM grading, with an acceptable exposure to ionizing radiation. 相似文献2.
Laura Milanese Chiara Martini Carla Scaroni Francesca Dassie Filippo Ceccato Alessandro Della Puppa Luca Denaro Giulia Bommarito Valentina Citton Mario Ermani Pietro Maffei Renzo Manara 《Journal of neuroradiology. Journal de neuroradiologie》2018,45(5):323-328
Background
Radiation therapy (RT) effectiveness on hormonal reduction is proven in acromegaly; however, collateral long-term effects are still undetermined. This transversal neuroimaging study on a large cohort of acromegalic patients aimed to investigate the rate of parenchymal and vascular changes after RT.Materials and methods
Thirty-six acromegalic patients underwent RT (RT+) after unsuccessful surgery and were compared to RT? acromegalic patients matched for age, gender, adenoma features, clinical and surgical history. All patients underwent magnetic resonance angiography (MRA) to investigate intracranial artery abnormalities and FLAIR sequence to assess white matter changes according to the Wahlund scale.Results
RT+ acromegalic patients had a higher rate of controlled disease (29/36 vs. 12/36, P < 0.001). RT+ acromegalic patients had MRI/MRA evaluation 15.3 ± 9.6 years after RT. RT+ acromegalic patients had a significantly higher Wahlund score than RT? acromegalic patients (6.03 ± 6.41 vs. 2.53 ± 3.66, P = 0.006) due to increased white matter signal abnormalities at the level of the temporal lobes, the basal ganglia (insula) and the infratentorial regions, bilaterally. Among RT+ patients one died because of temporo-polar anaplastic astrocytoma, one suffered from a stroke due to right internal carotid artery occlusion, one presented with cystic degeneration of the temporal poles. Long-dated RT (> 10 years before MR evaluation) was associated with a higher rate of RT-related white matter changes (P = 0.0004).Conclusions
RT seems to have created a cohort of patients with brain parenchymal changes whose clinical and cognitive impact is still unknown. These patients might require a prolonged MRI and MRA follow-up to promptly detect delayed RT-related complications and minimize their clinical consequences. 相似文献3.
Luca Saba Michele di Martino Paolo Siotto Michele Anzidei Giovanni Maria Argiolas Michele Porcu Jasjit S. Suri Max Wintermark 《Journal of neuroradiology. Journal de neuroradiologie》2018,45(2):136-141
Purpose
The purpose of this work was to compare the image quality and radiation dose delivered to patients during computed tomography (CT) angiography (CTA) of the supra-aortic arteries using two single-source (SS) and two dual-energy (DE) CT scanners.Material and methods
In this retrospective study, 120 patients who underwent CTA of supra-aortic arteries were studied using four different types of CT scanners: a sixteen and forty-detector-row SS and two DE CT scanners. Seventy milliters of contrast medium were injected at a flow rate of 4 mL/s using a power injector. For each patient the dose-length product (DLP), the volume computed tomography dose index (CDTIvol), the length of the scan and the effective dose (ED) were calculated. Qualitative and quantitative [image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR)] image quality assessment was performed.Results
A statistically significant lower value of the DE compared to the SS technology (P < 0.0001) for the CDTI, DLP and ED was found, whereas we did not find any statistically significant difference between the four scanners for the measurements of the image noise, SNR and CNR.Conclusion
DS CT scanners allow performing CTAs with a reduced dose compared to SS CT scanner with comparable image quality. 相似文献4.
A. Skalli E.H. Ait Ben Haddou R. El Jaoudi R. Razine G.A. Mpandzou H. Tibar E. El Fahime N. Bouslam A. Alami A. Benomar K. Hajjout M. Yahyaoui A. Bouhouche 《Revue neurologique》2018,174(3):150-156
Background
Growing evidence suggests that hypovitaminosis D contributes to the pathogenesis of multiple sclerosis (MS).Objective
This study aimed to evaluate whether vitamin D levels are associated with having MS and some of its characteristics in the Moroccan population.Methods
Using liquid chromatography-tandem mass spectrometry, the 25(OH)D3 metabolite was measured to quantify vitamin D serum levels (DSLs) in 113 patients with MS and 146 healthy controls matched for gender and age. DSLs were then compared between patients and controls, with correlations sought between DSLs and gender, age at onset, disease duration, MS type, degree of disability (EDSS score) and disease severity (MSSS) in patients.Results
Hypovitaminosis D (DSL < 30 ng/mL) was observed in 97.3% of MS patients and in 98.6% of controls. Although the mean DSL was slightly lower in patients (11.69 ± 6.97 ng/mL) than in controls (12.98 ± 6.58 ng/mL), there was no significant association between DSL and MS status (P = 0.131). Similarly, among patients, no apparent association was found between DSL and MS type (P = 0.214), EDSS score (P = 0.076) or MSSS (P = 0.772).Conclusion
Our study suggests that DSL is not associated with having MS nor with MS type, degree of disability or disease severity in the Moroccan population. On the other hand, DSL was lower in women and decreased with age. 相似文献5.
P. Koskas C. Pons-Peyneau N. Houenou-Quenum M. Romdhani M. Gasmi S. Galleron O. Drunat 《Revue neurologique》2018,174(1-2):36-43
Background
The few studies that have focused on Time between Onset of Signs and Symptoms and Referral (TOSR) for dementia to a memory center suggest a substantial delay of 1–3 years. This delay has a negative impact on both patients’ and their caregivers’ quality of life.Objective
This study aimed to evaluate this delay and the factors associated with it in a cohort of community-dwelling elderly people attending a memory clinic, as well as assess the impact of the Third French National Alzheimer Plan (2008–2012).Methods
All patients referred to the Bretonneau Memory Clinic for the first time between January 2006 (the clinic has maintained a specific database since then) and March 2016 were included in the study.Results
Of the 8543 patients attending our Memory Clinic during the study period, 3353 attending for the first time and with complete data were included. Briefly, their ages were 82 ± 7 years, and 67.2% were female; MMSE score was 21.2 ± 6.6, IADL was 4.06 ± 0.78 and the social-needs category of the Groupes Iso Ressources (GIR); Iso-Resource Group (IRG) scale was 4.04 ± 0.37. The TOSR was, on average, 35.4 ± 30.24 months, and increased after implementation of the Third French National Alzheimer Plan, from 26.68 ± 26.28 months before 2009 to 40.08 ± 31.2 months after 2009. Age and MMSE were associated with TOSR, but not the type of dementia, household composition and social characteristics. Also, there was a shorter TOSR for mild cognitive impairment than for dementia patients.Conclusion
Our results emphasize the need for more education and information among the general public about the early signs of cognitive impairment, especially in elderly people. 相似文献6.
Background
In spite of their extensive use, the ecological relevance of tasks dedicated to assessing real-world decision-making in a laboratory setting remains unclear.Objectives
Our study aimed to evaluate the relationship between decision-making and behavioral competency and awareness of limitations.Methods
A total of 20 patients with Alzheimer's disease (AD), 20 with amnestic mild cognitive impairment (aMCI) and 20 healthy controls (HC) were assessed for decision-making using the Iowa Gambling Task (IGT). Behavioral competency was evaluated by the Patient Competency Rating Scale (PCRS), which requires each participant and a relative to answer the same 30 questions on participant's competency and to rate each item, while awareness of limitations was evaluated by subtracting the self-rated score from the relative-rated score.Results
Using the median-split approach, the proportion of disadvantageous decision-makers was higher in both the MCI and AD groups than in HC (P = 0.02 and P = 0.03, respectively), with no differences between clinical groups. The percentage of participants with poorer behavioral competency was also higher in the MCI and AD than in the HC (self-rated: P = 0.025 and P = 0.01, respectively; relative-rated: P = 0.008 and P = 0.008, respectively), again with no differences between MCI and AD. All groups were comparable in awareness. For all participants, disadvantageous decision-making was associated with both reduced behavioral competency and poor awareness of limitations (OR: 3.47, P = 0.03 and OR: 5.4, P = 0.004, respectively).Conclusion
Our findings support the ecological relevance of the IGT. Behavioral competency integrity and awareness of limitations are both associated with advantageous decision-making profiles. 相似文献7.
I. López-de-Uralde-Villanueva A. Gil-Martínez P. Candelas-Fernández J. de Andrés-Ares H. Beltrán-Alacreu R. La Touche 《Neurología (Barcelona, Spain)》2018,33(8):505-514
Introduction
The self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) scale is a tool designed to identify patients with pain with neuropathic features.Objective
To assess the validity and reliability of the Spanish-language version of the S-LANSS scale.Methods
Our study included a total of 182 patients with chronic pain to assess the convergent and discriminant validity of the S-LANSS; the sample was increased to 321 patients to evaluate construct validity and reliability. The validated Spanish-language version of the ID-Pain questionnaire was used as the criterion variable. All participants completed the ID-Pain, the S-LANSS, and the Numerical Rating Scale for pain. Discriminant validity was evaluated by analysing sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). Construct validity was assessed with factor analysis and by comparing the odds ratio of each S-LANSS item to the total score. Convergent validity and reliability were evaluated with Pearson's r and Cronbach's alpha, respectively.Results
The optimal cut-off point for S-LANSS was ≥ 12 points (AUC = .89; sensitivity = 88.7; specificity = 76.6). Factor analysis yielded one factor; furthermore, all items contributed significantly to the positive total score on the S-LANSS (P < .05). The S-LANSS showed a significant correlation with ID-Pain (r = .734, α = .71).Conclusion
The Spanish-language version of the S-LANSS is valid and reliable for identifying patients with chronic pain with neuropathic features. 相似文献8.
Marta Skowronska Anna Piorkowska Anna Czlonkowska 《Neurologia i neurochirurgia polska》2018,52(2):162-167
Objectives
There is little data about sex differences in carotid atherosclerosis in the early phase after an ischemic event. The aim of this study was to examine the carotid artery atherosclerosis differences between men and women in early phase after TIA or stroke.Methods
Consecutive patients with recent ischemic event, admitted during the first week after symptom onset were examined with ultrasound. Sex differences in degree of stenosis, number of plaques and plaque morphology were compared. Plaque morphology was assessed by gray-scale median (GSM), according to which lower values were associated with hemorrhagic/necrotic core indicating plaque instability.Results
Of the 316 patients with ischemic events, 196 (50.5% male) entered the study. Men had more often moderate as well as severe ipsilateral carotid stenosis (12.1% vs 7.2% for moderate and 12.1% vs 2.1% for severe; p = 0.024). Men had more often the largest plaque hypoechogenic contralateral (62.6% vs 37.1%, p = 0.0008), but not ipsilateral. Men had 3 or more hypoechogenic plaques (24.2% vs 4.1%, p = 0.0001; 17.2% vs 4.1%, p < 0.0001) both ipsi and contralateral respectively. Male sex was a risk factor for having 3 or more ipsilateral hypoechogenic plaques (p = 0.002, OR = 20 CI 95% [5.5–75].Conclusions
Men had more often carotid stenosis and higher number of hypoechogenic plaques. 相似文献9.
Min Soo Kim Sung Ho Park Eun Suk Park Jun Bum Park Soon Chan Kwon In Uk Lyo Hong Bo Sim 《Journal of neuroradiology. Journal de neuroradiologie》2018,45(5):310-315
Purpose
The purpose of this study was to verify changes in diffusion tensor imaging (DTI) factors in patients with brain metastases treated with stereotactic radiotherapy (SRT). We also investigated the impact of SRT on peritumoral volumes though the use of DTI.Methods
A total of 28 patients with brain metastases who had undergone SRT between March 2014 and December 2015 were enrolled. Magnetic resonance imaging with DTI factors, such as fractional anisotropy (FA) and apparent diffusion tensor (ADC) value, was performed 1 day before the procedure and 3 months after the procedure. DTI data from tumor lesions, edema volumes, and the volumes that received 12 Gy were measured.Results
Tumor volume (P = 0.001) and ADC values in the volumes that received 12 Gy (P = 0.018) and the edema volumes (P = 0.003) significantly decreased after the procedure. Decreases in tumor volume were only correlated with decreases in edema volumes (P < 0.001). Decreases in edema volumes were correlated with increases in FA values and decreases in ADC values of the volumes that received 12 Gy [P = 0.019 (FA)/0.002 (ADC)] and the edema volumes [P = 0.011 (FA)/0.002 (ADC)].Conclusions
It was possible to quantify changes in peritumoral volumes in patients with brain metastases after SRT by using DTI. ADC values of peritumoral volumes decreased significantly after SRT. Therefore, it was confirmed through DTI that performing SRT on tumor lesions has a positive effect on the structure and function of peritumoral volumes. 相似文献10.
A. Kachouchi M. Sebbani S. Salim I. Adali F. Manoudi M. Amine F. Asri 《L'Encéphale》2018,44(5):409-414
Background
Persons with schizophrenia are thought to be at increased risk of committing violent crime – 4 to 6 times the level of general population individuals without this disorder. The relationship between schizophrenia and homicide is complex and cannot be reduced to a simple causal link.Objectives
The objectives of this study were to describe the characteristics of homicide in Moroccan patients suffering from schizophrenia and to determine the correlated sociodemographic, clinical and toxic variables.Methods
The study included two groups of patients with a DSM IV diagnosis of schizophrenia who attended the “Ibn Nafis” university psychiatric hospital of Marrakech in Morocco. The first group was composed of 30 patients hospitalized for homicide in the forensic unit between 1 January 2005 and 31 August 2015. The second group included 90 patients without any criminal record. These two groups have been matched according to age and gender. Demographic, clinical and therapeutic variables were analyzed and compared between the two groups.Results
Data analysis has objectified the following results: the mean of age in the first group was 37.03 (± 9.09) and in the second group was 31.4 (± 8.76). No significant differences were found between the two groups regarding the different sociodemographic variables and the age of onset of disease. Significant differences were found between the two groups regarding: personal antecedents of attempt of homicide (P = 0.003), personal antecedents of attempt of suicide (P < 0.001), a history of previous violence (P = 0.005), untreated psychosis before the act (P < 0.001), poor medication compliance and a low familial support (P < 0.001), antisocial behavior (P < 0.001) and addictive behavior (P = 0.005).Discussion
Several studies identified some possible predictor factors for violent behavior: poor compliance, lack of insight impulsivity and paranoid–hallucinatory symptoms, systematized delusions and addictive behavior seem to considerably increase the risk of turning to violence. Demographic variables as suggested by other studies are less valuable predictors of homicide in patients with schizophrenia.Conclusion
Awareness of these factors will allow us to provide improved prevention of violence within schizophrenic subjects. Interventions for reducing such behavior should focus on clinical variables and integrate an early diagnosis of the disease and an improvement of medication compliance. 相似文献11.
Burcu Polat Ozlem Saatci Nesrin Helvaci Yilmaz Ozge Arici Duz 《Neurologia i neurochirurgia polska》2018,52(3):347-351
Background
It is known that complementary and integrative medicine (CIM) methods are especially used by patients with chronic headaches. The aim of our study is to increase the knowledge on this topic, to provide objective data about use in Turkish headache patients.Methods
This study included 425 patients with headache. The survey form prepared was filled in under the supervision of a health professional. The questionnaire included 2 items, about CIM methods and finance.Results
Among the patients evaluated, 316 were female, and 109 were male. All of 52% answered yes to the question “did you ever use any CIM treatment method for headaches during your life?”. The most frequently used methods were combined (herbal + one or more other method) (29.6%), herbal (9.4%) and cupping therapy (4.2%). Among the patients that used combined methods, 26.9% had spent 30–100 TL (5–25 euro), 20.6% had spent 100–300 TL (25–70 euro), 26.9% had spent 300–500 TL (70–120 euro) and the last two groups that formed 12.6% had spent 500–1000 (120–250 euro) and >1000 TL (>250 euro).Conclusion
Half of the patients that applied to outpatient clinic with headaches use one or more of these methods and make budgets in accordance with their income levels. Physicians should have sufficient knowledge and clinical opinions about the CIM methods used by headache patients. 相似文献12.
Paweł Daszkiewicz Paweł Kowalczyk Marcin Roszkowski 《Neurologia i neurochirurgia polska》2018,52(1):2-8
Background
Neuronal-glial tumors (ganglioglioma and dysembryoplastic neuroepithelial tumor) are a frequent cause of focal, drug-resistant and epilepsy in children and young adults, that is amenable for surgical treatment.Aim of paper
Assessment of late outcome of surgical treatment and degree of seizure control, as well as prognostic significance of selected clinical factors.Material and method
52 Pediatric patients presenting with epilepsy, lesion of mesio-basal temporal lobe and histologically verified neuronal-glial tumor treated at our facility since 2000–2011.Results
After the mean follow-up of 2.94 years, satisfactory treatment outcome (Engel classes I and II) was obtained in 92% of the patients (n = 48). Poor outcome (Engel class III) was seen in 8% of patients (n = 4). New neurological deficits appeared in 28% of the patients (n = 20) but in most of them resolved over time.Conclusions
In patients with drug-resistant epilepsy and a lesion of mesial-basal part of temporal lobe suggestive of a glial-neuronal tumor, surgical treatment is strongly recommended, aiming at excision of tumor and elimination of seizures. Histological verification of the lesion is a pre-requisite for optimal treatment planning. In most patients, both treatment goals may be reached. Short duration of epilepsy prior to surgery and young age are favorable prognostic factors. Histological diagnosis of GG, co-existence of cortical dysplasia and location of tumor extending beyond mesial-basal temporal structures are associated with a higher risk of postoperative complications. These may out-weight expected benefits of surgery. 相似文献13.
Jin Wook Choi Miran Han Ji Man Hong Jin Soo Lee Sun Yong Kim Sam Soo Kim 《Journal of neuroradiology. Journal de neuroradiologie》2018,45(3):186-191
Background and purpose
This study was to evaluate the diagnostic value of improved motion-sensitized driven-equilibrium (iMSDE)-prepared 3D T1-weighted magnetic resonance imaging (MRI) (iMSDE-3DMRI) in intracranial vertebrobasilary dissection (VBD) and to compare iMSDE-3DMRI images with those obtained using 2D high-resolution (HR) MRI with respect to their diagnostic performance in VBD.Materials and methods
We retrospectively reviewed 105 lesions from 102 patients who underwent multimodal imaging and contrast-enhanced iMSDE-3DMRI (CE-iMSDE-3DMRI). The 2D-HRMRI protocol comprised four axial HR images. The CE-iMSDE-3DMRI images were reformatted in the axial, coronal, and sagittal planes. The 2D-HRMRI-based diagnosis was compared with the final diagnosis. The 2D-HRMRI and CE-iMSDE-3DMRI images were examined independently for the diagnosis performance of dissection.Results
VBD was confirmed in 66 lesions in 63 patients; 17 patients had confirmed atherosclerosis, and 22 had no lesions in the vertebrobasilar artery. Diagnostic performances of 2D-HRMRI (AUC, 0.839 ± 0.04; sensitivity, 94.0; specificity, 79.5; diagnostic accuracy, 88.6) CE-iMSDE-3DMRI (AUC, 0.847 ± 0.04; sensitivity, 84.8; specificity, 84.6; diagnostic accuracy, 84.7) and 2D-HRMRI + CE-iMSDE-3DMRI (AUC, 0.893 ± 0.03; sensitivity, 97.0; specificity, 85.0; diagnostic accuracy, 92.5) were good. Comparisons of the diagnostic performance of 2D-HRMRI andCE-iMSDE-3DMRI showed that combined interpretation of 2D-HRMRI and iMSDE-3DMRI yields a significantly higher diagnostic performance than that of 2D-HRMRI (P = 0.042).Conclusions
CE-iMSDE-3DMRI showed good diagnostic performance for the diagnosis of intracranial VBD. These results suggest that CE-iMSDE-3DMRI can be used in combination with 2D-HRMRI for the diagnosis of intracranial VBD. 相似文献14.
15.
Objective
The aim of this pilot study was to adapt the intensive mothering ideology concept in a French sample and to get an assessment tool.Method
First, the Intensive Parenting Attitudes Questionnaire (IPAQ), a U.S. scale comprising 25 items, was translated and submitted online to French mothers and mothers-to-be (n = 250). Structural validity was tested through confirmatory factor analysis with poor results. Secondly, to increase the cultural validity of a new tool, new items were derived from French women speech. French mothers and mothers-to-be (n = 22) were asked about their views regarding motherhood and childcare (semi-structured interviews). A thematic content analysis was performed with good inter-judge agreement (0.53–0.86) and 27 items were created. Finally, the total set of 52 items was submitted online to French mothers and mothers-to-be (n = 474). The structure was tested through exploratory factor analysis.Results
A new tool called the Measure of Intensive Mothering Ideology (MIMI) was obtained. This 21 items scale with 6 dimensions (Essentialism, Consuming Fulfillment, Child-centrism, Challenge, Sacrifice and Stimulation) explains 59.75% of variance. Internal consistencies were satisfactory (0.61–0.83) and most dimensions were positively and moderately correlated (0.17?0.38).Conclusion
The MIMI is the first French-language scale assessing IMI and offers interesting research avenues notably regarding perinatal parental adaptation. 相似文献16.
Joanna Wzorek Marek Karpiński Ewa Wypasek Michał Michalski Andrzej Szczudlik Krzysztof Piotr Malinowski Anetta Undas 《Neurologia i neurochirurgia polska》2018,52(3):352-358
Objective
Genetic background of cryptogenic ischemic stroke (IS) and transient ischemic attack (TIA) remains uncertain. Alpha-2-antiplasmin (α2AP) Arg407Lys polymorphism has been shown to be less common in patients with abdominal aortic aneurysm (AAA) compared with healthy controls. We investigated associations of α2AP Arg407Lys polymorphism with cryptogenic IS and TIA.Methods
We studied 165 consecutive Caucasian patients who experienced cryptogenic IS (n = 123) or TIA (n = 42). Neurological outcomes were assessed using the modified Rankin Scale (mRS) in the acute phase of cerebral ischemia and 8 (6–12) months after the index episode. Patients were genotyped for α2AP Arg407Lys polymorphism (rs1057335) using real time PCR technique.Results
The allele frequency of Arg407Lys polymorphism was: 0.82/0.18. The 407Lys allele was more frequent in TIA patients compared to the IS group (0.29 vs. 0.14, p = 0.003). In the whole group, as well as in IS and TIA patients analyzed separately, possession of the 407Lys allele was associated with excellent outcome (mRS 0–1) during follow-up (p < 0.05) but not in the acute phase of ischemic events both in thrombolyzed and nonthrombolyzed IS patients.The multivariate logistic regression model showed that the excellent outcome (mRS 0–1) assessed after 8 (6–12) months since the index cerebral ischemia was predicted by the occurrence of Lys407 allele (OR 6.18, 95% CI, 2.01–18.98, p = 0.001).Conclusion
The presence of 407Lys allele is associated with better prognosis in cryptogenic cerebrovascular events. Our findings suggest that the α2AP Arg407Lys polymorphism could be involved in the pathogenesis of cerebral ischemia and its outcomes. 相似文献17.
Fernanda C. Rueda-Lopes Fernanda M.C. Pessôa Gustavo Tukamoto Fabíola Rachid Malfetano Simone Batista Scherpenhuijzen Soniza Alves-Leon Emerson L. Gasparetto 《Journal of neuroradiology. Journal de neuroradiologie》2018,45(4):256-260
Objective
The aim of our study was to detect functional changes in default-mode network of neuromyelitis optica (NMO) patients using resting-state functional magnetic resonance images and the evaluation of subcortical gray-matter structures volumes.Materials and methods
NMO patients (n = 28) and controls patients (n = 19) were enrolled. We used the integrated registration and segmentation tool, part of FMRIB's Software Library (FSL) to segment subcortical structures including the thalamus, caudate nucleus, putamen, hippocampus and amygdalae. Resting-state functional magnetic resonance images were post-processed using the Multivariate Exploratory Linear Optimized Decomposition into Independent Components, also part of FSL. Average Z-values extracted from the default-mode network were compared between patients and controls using t-tests (P values <0.05 were considered statistically significant).Results
There were areas of increased synchronization in the default-mode network of patients compared to controls, notably in the precuneus and right hippocampus (corrected P < 0.01). The frontal area had decreased synchronization in patients compared to controls (corrected P < 0.01). There were no observed differences between patients and controls in subcortical volumes or average Z-values values for default-mode network.Conclusion
The hyperactivity of certain default-mode network areas may reflect cortical compensation for subtle structural damage in NMO patients. 相似文献18.
P. Sahuc-Rodrigues E. Sagui D. Wybrecht J.-B. Veyrières S. Gazzola A. Dagain J. Valance P. Alla A. Faivre 《Revue neurologique》2018,174(3):125-136
Introduction
Intravenous thrombolysis with rt-PA is the key treatment for acute ischemic stroke (IS), and has largely been developed at the Military Teaching Hospital in Toulon since 2003. This report is of the results of our practices compared with those in the literature, as well as our attempts to identify factors predictive of a favorable outcome after thrombolysis.Methods
All patients treated with rt-PA for IS in the carotid territory between 2003 and 2014 were prospectively included. Disability was assessed at 3 months by modified Rankin Scale (m-RS) scores; outcome was considered unfavorable if the m-RS score was >2. Multivariate analyses were also performed to identify parameters correlating with poor and favorable outcomes.Results
Of the 289 patients prospectively enrolled in the study [mean initial National Institutes of Health Stroke Scale (NIHSS) score: 14.3], 52.5% had an m-RS score >2 at 3 months of follow-up. Three independent predictive factors for poor functional outcomes at the 3-month follow-up were identified: NIHSS score > 12 on admission (P = 0.048); NIHSS score > 8 at discharge (P < 0.001); and early neurological worsening within the first 24 h (P = 0.015). Early neurological improvement within 24 h of rt-PA infusion was significantly associated with recanalization of the stroke-related occluded cerebral artery (P < 0.001, r = 0.37).Conclusion
After 12 years of practice, our stroke unit has produced results similar to those of the major clinical studies in terms of safety and efficacy. High NIHSS scores on admission and a lack of neurological improvement during the first 24 h of thrombolysis due to failure of early recanalization were identified as independent predictive factors of poor functional outcomes. 相似文献19.
Matthias Barral Louis Lassalle Cyril Dargazanli Mikael Mazighi Hocine Redjem Raphael Blanc Georges Rodesch Bertrand Lapergue Michel Piotin 《Journal of neuroradiology. Journal de neuroradiologie》2018,45(4):211-216
Introduction
Mechanical thrombectomy for anterior circulation large vessel occlusion (LVO) improves functional outcome at three months. This therapeutic approach is the new gold standard, with a benefit being also observed in elderly patients. However, data are limited in this heterogeneous and fragile population. The objectives of this study were, first, to describe outcome after mechanical thrombectomy in a representative group of patients over 80. Second, to evaluate factors associated with a favorable functional outcome after thrombectomy for anterior circulation LVO in elderly patients (aged ≥ 80 years).Methods
A total of 169 patients with anterior circulation LVO referred for an endovascular treatment were included. Primary outcome evaluated functional outcome at three months. Multivariable analysis was performed to identify prognostic factors in elderly patients with pre-stroke mRS ≤ 3.Results
Overall, 25.34% of patients (43/169) were functionally independent at three months (mRS ≤ 2) and 16.57% (28/169) had a moderate functional disability (mRS = 3). Mortality rate was 33.14% (56/169). At 24 h, 7.1% of patients (12/169) had symptomatic hemorrhage. Male gender (P = 0.033), low initial NIHSS (P = 0.037), higher DWI-ASPECTS (P = 0.022) and use of intravenous thrombolysis (IVT) (P = 0.0193) were associated with a better functional outcome.Conclusions
There is no reason to withhold mechanical thrombectomy on the basis of age alone. Small infarct core, low NIHSS, male gender and use of IVT are associated with a better functional outcome. 相似文献20.