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Purpose The purpose of this study was to assess the accuracy of computed tomography angiography (CTA) for quantification of cerebral vasospasm following aneurysmal subarachnoid hemorrhage in proximal and middle segments of intracranial arteries. Materials and methods Twenty consecutive patients (7 men, 13 women; mean age, 47 ± 7 [SD] years; age range: 27–78 years) with aneurysmal subarachnoid hemorrhage who underwent CTA and digital subtracted angiography (DSA) with a 6-hour window at baseline and during vasospasm period were included. Twelve artery segments were analyzed in each patient. Vasospasm was blindly quantified on CTA and digital subtracted angiography (DSA) by two independent readers with discordance > 10% resolved by open data consensus. Inter-reader and inter-test correlations with DSA as reference, and causes of discordant readings were analyzed. The best sensitivity and specificity of CTA for determination of vasospasm ≥ 50% on DSA was determined using receiver operating curve analysis. Results Two-hundred-and-ten arterial segments were analyzed after exclusion of 30 segments with missing data or metallic artifacts. An inter-reader discordance >10% was observed in 82 segments (82/210; 39% [95% CI: 32–46]). Inter-test discordances >10% were observed respectively in 115 segments (115/210; 55% [95% CI: 49–62]) with the junior reader and in 73 segments (73/210; 35% [95% CI: 29–42]) with the senior reader. They were related to reader error in 55 (55/210; 26% [95% CI: 20–32]) with the junior reader and 13 (13/210; 6% [95% CI: 3–9]) with the senior reader, as well systematic biases in 8 (8/210; 4% [95% CI: 1–6]), and intrinsic limitation in 52 (52/210; 25% [95% CI: 19–31]). Best sensitivity and specificity of CTA were observed for a threshold value of 30% (sensitivity = 88% [95% CI: 78–97%]; specificity = 84% [95% CI: 77–90%]; area under curve = 0.92 [95% CI: 0.86–0.97]). On a patient basis, sensitivity was 100% (specificity = 60% [95% CI: 38–81%]; area under curve = 0.97 [95% CI: 89–100%] for this same threshold. Conclusion Our study shows a moderate accuracy of CTA for the quantification of cerebral vasospasm, mostly related to challenging interpretation and intrinsic limitations. CTA may rule-out angiographic vasospasm ≥ 50% when no segment has vasospasm over than 30%.

BACKGROUND AND PURPOSE: By studying the evolution of brain volume across the life span in male and female patients, we aimed to understand how sex, brain volume, and the epidermal growth factor repeat domain of the mutation, the 3 major determinants of disability in CADASIL, interact in driving disease evolution. MATERIALS AND METHODS: We used validated methods to model the evolution of normalized brain volume with age in male and female patients using nonparametric regression in a large, monocentric cohort with prospectively collected clinical and high-resolution MR imaging data. We used k-means clustering to test for the presence of different clinical course profiles. RESULTS: We included 229 patients (mean age, 53 [SD, 12] years; 130 women). Brain volume was larger in women (mean size, 1024 [SD, 62] cm(3) versus 979 [SD, 50] cm(3); P

Latex is considered a strategic material for the development of the country by the Ministry of Plantation of Sri Lanka. In response to the climate change, the country has adopted a policy focused on resilience and sustainable development. It is in this context that Ksapa initiated in 2022 the RIVER project which will develop a program to strengthen agricultural capacity in Sri Lanka through a digital suite, SUTTI. To carry out this project, the company commissioned YAPI Expertise to provide intercropping models based on rubber trees that are agronomically "performant" and economically interesting for producers to diversify their income. The RIVER project takes place in two districts in south-eastern Sri Lanka: Moneragala and Ampara. This study was based on literature searches which enabled to select crops that could be intercropped with rubber. In parallel, 80 interviews, prepared by YAPI Expertise, were conducted on the field by a local organisation, LOAM. The aim of these interviews was to identify rubber intercrops models already implemented in the study areas and to understand the reasons why farmers adopted these intercrop models. The interviews were analysed statistically by MCA and Chi². Combined with the literature review, the study established 5 models (Pineapple model, Cocoa model, Banana model, Passion fruit model, Soursop model) proposing several intercrops that could be planted with rubber. Finally, choice criteria have been established for each model, presenting their strong and weak points.

Les m��galithes suscitent de nombreuses interrogations. Il est en effet difficile d���imaginer pr��cis��ment comment les populations du N��olithique ont pu extraire, d��placer et assembler des blocs de plusieurs tonnes dans des constructions parfois monumentales. La complexit�� de ces chantiers est encore plus difficile �� appr��hender lorsque ces monuments nous parviennent �� l�����tat de ruines, ne permettant pas toujours aux visiteurs de comprendre l���ampleur et la complexit�� de tels projets architecturaux. L���id��e du projet lanc�� en 2019 est de proposer une lecture renouvel��e et innovante des m��galithes �� travers la compr��hension des outils utilis��s au N��olithique pour abattre et pr��parer le bois d���oeuvre n��cessaire �� la manutention de m��galithes.

Les mégalithes suscitent de nombreuses interrogations. Il est en effet difficile d’imaginer précisément comment les populations du Néolithique ont pu extraire, déplacer et assembler des blocs de plusieurs tonnes dans des constructions parfois monumentales. La complexité de ces chantiers est encore plus difficile à appréhender lorsque ces monuments nous parviennent à l’état de ruines, ne permettant pas toujours aux visiteurs de comprendre l’ampleur et la complexité de tels projets architecturaux. L’idée du projet lancé en 2019 est de proposer une lecture renouvelée et innovante des mégalithes à travers la compréhension des outils utilisés au Néolithique pour abattre et préparer le bois d’oeuvre nécessaire à la manutention de mégalithes.

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We report a case of ischemic stroke characterized by unusual large thrombosis of the internal carotid, origin associated to pulmonary embolism in a patient without any prothrombotic factor except from mild signs of Covid-19 The high incidence of thrombotic phenomens observed among patients with coronavirus during the last months does not seem to systematically occur among patients with severe presentation of the infection, but seems associated to a worst functional prognosis © 2020, John Libbey All rights reserved

Objectives/hypothesis Because delayed post-contrast three-dimensional fluid-attenuated inversion recovery imaging sequences enable the distinction between the utricle and the saccule, we raised the hypothesis that patients with vestibular atelectasis (VA) could show unilateral collapse of the utricle and the ampullas on imaging. Study design Retrospective case series. Methods We retrospectively reviewed 200 patients who underwent 3 T magnetic resonance imaging (MRI) after intravenous administration of gadolinium. MRI scans were assessed for the presence of VA. The endolymphatic space was considered as collapsed when the utricle and at least two ampullas were not visible or were barely visible. Results We reported four patients with VA on MRI responsible for atypical clinical presentations of acute vestibular deficit. All patients presented a specific involvement of the pars superior sensory captors (utricle, ampullas), preserving the pars inferior sensory captors (cochlea and saccule). This was confirmed both clinically and on MRI. Conclusions Our study is the first to describe in vivo unilateral collapse of the pars superior on delayed postcontrast MRI in patients with a clinical unilateral vestibular loss. Level of evidence 4 Laryngoscope, 129:1689-1695, 2019.

Background “JUMP” is a multidisciplinary program based at the Pitie-Salpetriere Hospital Paris that transitions young adults with chronic neurological conditions from paediatric to adult healthcare. Transitional care programs have been shown to improve medical, educational and psychosocial outcomes for adolescent patients. Methods Demographic details and health-related variables of all patients referred to the JUMP program were collected. Satisfaction outcome measures were the 18-item On Your Own Feet Transfer Experience Scale (OYOF-TES) and a visual analogue scale, which assessed overall satisfaction with the transfer process. Scales were sent to JUMP patients attending the JUMP day hospital (n = 94) and their parents (n = 94). Results Since its inception, 111 patients have been seen in the JUMP program. Nine neurological clinical syndromes and four main underlying etiologies were identified. Approximately half of all questionnaires and scales (86/188) sent to patients and parents were returned. Eighty-nine percent of patients and 91% of parents were very satisfied with their transfer experience. There was a strong, positive correlation between patient and parent satisfaction [r = 0.910; p Conclusion The JUMP program which is rooted in a multidisciplinary and coordinated approach to transitional care encompasses a broad range of neuro-pathologies. Overall, satisfaction levels were high amongst patients within the program, and their parents. The key role played by the coordination nurse specialists throughout the transfer process is a likely key determinant in satisfaction levels.

Background Lateral sinus stenosis is a little-known cause for pulsatile tinnitus (PT). In several small series, stenting has been described as an effective treatment for disabling PT linked with this type of stenosis. Objectives To describe the clinical, radiological, and manometric characteristics of patients treated for disabling PT by lateral sinus stenosis. Assessment of the efficacy of stenting for this indication. Methods Retrospective study of patients treated for isolated PT by stenting of a lateral sinus stenosis in our institution, between 2009 and 2015. Results Fourteen patients were included in our study. All of them were women. The median age at the onset of symptoms was 39.0 (21.0) years. The median body mass index was 28.5 (7.0) kg/m 2 . Stenting of the lateral sinus led to the disappearance of PT without recurrence in 13 patients. In one patient, stenting did not modify the noise. In this case, another cause of PT was diagnosed after stent placement. Conclusion Lateral sinus stenosis is a curable cause of venous PT. Other causes of PT must be ruled out before an endovascular treatment is undertaken, due to the frequent asymptomatic nature of Pacchioni granulations in the lateral sinus. Treatment by stenting is effective in all cases, provided that stenosis underlies the PT.

This document provides a transversal analysis of the outcomes of the application of the TAP Common Framework (TAP CF) across the eight pilot countries of the CDAIS project (Angola, Bangladesh, Burkina Faso, Ethiopia, Guatemala, Honduras, Lao PDR and Rwanda): whether and how the TAP CF was used, and how usable and useful it proved to be. The analytical framework is grounded in the principles of realist evaluation, which recognizes that projects work differently in different contexts and through different change mechanisms. We compared "context-mechanismsoutcomes" configurations across the 34 innovation niche partnerships and the eight countries, using mixed-method approaches and the data collected through the CDAIS MEL (Monitoring, Evaluation, and Learning) system. The comparative analyses consisted in drawing impact pathways, merging common patterns and refining the initial rough Theory of Change of the CDAIS project. A first set of results gives empirical insights into agricultural innovation agendas and processes in these countries, the capacities needed to successfully achieve demand-driven innovation initiatives and the capacities needed to set up a well-functioning agricultural innovation system at the country level. A second set of results identify the hindering and catalyzing factors of the project's impact pathways in the countries, exploring contextual features (maturity of the AIS, diversity of innovation niche partnerships) and project implementation modalities (AIS-embedded and participatory architecture, demand-led approach, multi-level and process-led approach). The report ends with recommendations for upgrading the TAP CF across its theoretical and practical dimensions, and for designing interventions and future investments based on demand-led capacity development approaches for strengthening agricultural innovation systems. The report is intended for a specialist audience of development professionals and academia working on approaches to support agricultural innovation and to develop capacities for agricultural innovation systems.

Background: Over the past decade, stenting of lateral sinus stenosis has been used to treat idiopathic intracranial hypertension. Two types of stenoses have been identified: extrinsic and intrinsic. Objective: The aim of this study was to report the results of our use of this procedure to treat patients with extrinsic or intrinsic stenoses in idiopathic intracranial hypertension. Methods: We retrospectively studied clinical, radiological, and manometric data from patients with idiopathic intracranial hypertension who were treated at our institution between January 2009 and January 2015 by stenting of the lateral sinus. Results: Data were studied from 19 women and 2 men. Average body mass index was 29 kg/m 2 , and the median age at stenting was 33 years. Patients with extrinsic stenoses were younger than those with intrinsic stenoses. Transstenotic gradients measured with patients under general anesthesia were lower than those measured with patients under local anesthesia. In all cases, stenting was effective for papilledema and pulsatile tinnitus. Seventeen patients reporting headaches found that they disappeared completely after stenting. Two complications without long-term effects were reported. Conclusion: Irrespective of the type of stenosis, stenting of lateral sinus stenoses is an effective treatment for intracranial hypertension symptoms. At our institution, this treatment has replaced draining of cerebrospinal fluid when treatment with acetazolamide has proved to be ineffective.

Because delayed post-contrast three-dimensional fluid-attenuated inversion recovery imaging sequences enable the distinction between the utricle and the saccule, we raised the hypothesis that patients with vestibular atelectasis (VA) could show unilateral collapse of the utricle and the ampullas on imaging.Retrospective case series.We retrospectively reviewed 200 patients who underwent 3 T magnetic resonance imaging (MRI) after intravenous administration of gadolinium. MRI scans were assessed for the presence of VA. The endolymphatic space was considered as collapsed when the utricle and at least two ampullas were not visible or were barely visible.We reported four patients with VA on MRI responsible for atypical clinical presentations of acute vestibular deficit. All patients presented a specific involvement of the pars superior sensory captors (utricle, ampullas), preserving the pars inferior sensory captors (cochlea and saccule). This was confirmed both clinically and on MRI.Our study is the first to describe in vivo unilateral collapse of the pars superior on delayed postcontrast MRI in patients with a clinical unilateral vestibular loss.4 Laryngoscope, 129:1689-1695, 2019.

A 19-year-old man presented with a 1.5-month history of hypokinetic dysarthria, slight hypokinesia, and micrographia. Brain MRI showed fluid-attenuated inversion recovery (FLAIR) (figure 1) and T2 (figure 2) hyperintensities in the medulla oblongata and the mesencephalon. Copper tests reported high 24-hour urinary copper excretion, low serum copper, low ceruloplasmin, and high exchangeable copper. Kayser-Fleischer rings were present. ATP7B genetic analysis confirmed the diagnosis of Wilson disease (WD) with the presence of 2 mutations.

Susceptibility-weighted magnetic resonance imaging (MRI) sequences may demonstrate various signal intensities of draining veins in cases of high-flow vascular malformation (HFVM), including arteriovenous malformation (AVM) and dural arteriovenous fistula (dAVF). Our objective was to evaluate susceptibility-weighted angiography (SWAN) for the detection of HFVM. Fifty-eight consecutive patients with a suspected intracranial vascular malformation were explored with SWAN and post-contrast MRI sequences at 3 T. The diagnosis of slow-flow vascular malformation (SFVM), including developmental venous anomaly (DVA) or brain capillary telangiectasia (BCT), was based on MRI. Patients with suspected HFVM underwent digital subtraction angiography (DSA). SWAN images were analysed by three blinded readers according to a three-point scale of the venous signal. Thirty-one patients presented 35 SFVM (26 DVA and 9 BCT) that systematically appeared hypointense on SWAN images. In patients with atypical MRI findings, DSA revealed one patient with an atypical DVA and 26 patients with HFVM (22 AVM and 4 dAVF). SWAN revealed at least one venous hyperintensity in all patients with HFVM. Agreement between readers was excellent. SWAN appears reliable for characterising blood flow dynamics in brain veins. In clinical practice, SWAN can routinely rule out HFVM in patients with atypical brain veins. • Susceptibility-weighted angiography (SWAN) offers new perspectives for detecting intracranial vascular malformations. • SWAN sequence provides non-invasive characterisation of blood flow dynamics. • SWAN can differentiate between high and slow flowing venous blood. • SWAN can routinely rule out high-flow vascular malformations.

Isolation is a moment every human being goes through at least once in their life time. That situation becomes harmful for the development and the blooming of men when it lasts. Multi-handicapped children also are concerned by this phenomenon. Despite the importance of their dependency which mobilizes the professional’s entire attention, isolation may persist and therefore disturb any therapeutic approach. Psychomotricity does not directly deal with isolation but its use shows non negligible effects on the latter. Through psychomotor therapy, this report suggests a study on the phenomenon of isolation regarding young multi-handicapped children. Based on the follow-up of two kids, it puts forward the origins of the issue, the solutions and the risks of its rupture., L’isolement est une situation que tout être humain traverse au moins une fois dans sa vie. Cette situation devient nocive pour le développement et l’épanouissement de l’homme quand elle s’éternise. Les enfants polyhandicapés n’échappent pas à ce phénomène. Malgré l’importance de leur dépendance qui mobilise toute l’attention du professionnel, l’isolement peut s’imposer et venir perturber toute démarche thérapeutique. La psychomotricité n’agit pas directement sur l’isolement mais son utilisation présente des effets non négligeables sur ce dernier. À travers la thérapie psychomotrice, ce mémoire propose une étude du phénomène d’isolement chez les jeunes enfants polyhandicapés. En s’appuyant sur le suivi de deux enfants, il explique l’origine de ce problème, les solutions et les risques à sa rupture.

Objectives: To establish the prevalence of intracranial atherosclerosis (ICAD) and symptomatic stenoses by MRangiography in a registry of patients hospitalized for ischemic stroke. To study its association with cardiovascular risk factors and other atherosclerotic locations. Materials and methods: Contrast-enhanced and TOF MRA sequences of 427 patients hospitalized for TIA or cerebral infarction were analyzed, blind from clinical datas and brain MRI. Stenoses were rated according to their severity (50-69%, 70-99%, occlusion), location, and number. Symptomatic nature of the lesions was established secondarily. These data were analyzed in relation to cardiovascular risk factors and extracranial locations of atherosclerotic disease. Results: The prevalence of ICAD was 27.4%, and half of the stenoocclusive lesions (13.6%) were symptomatic. ICAD prevalence increased significantly with age, blood pressure and atherogenic dyslipidemia regardless of the symptomatic character of stenosis. There was no association with diabetes mellitus. We found a strong association between ICAD and ischemic stroke (p=0.023), and between ICAD and CAD (p=0.023). Conclusion: ICAD is present in a quarter of our patients and is responsible for 13% of ischemic strokes. ICAD is strongly associated with coronary artery disease, and should not be ignored from radiologists during etiological assessment of ischemic stroke.; Objectifs : Établir la prévalence de l'athérosclérose intracrânienne (ICAD) et des sténoses symptomatiques en ARM au sein d’un registre de patients hospitalisés pour un accident ischémique cérébral. Étudier son association aux facteurs de risque cardiovasculaire et aux autres sites d'athérosclérose. Matériels et méthodes : Les ARM sans et avec injection de 427 patients hospitalisés pour AIT ou infarctus cérébral ont été analysées en aveugle de la clinique et de l'IRM encéphalique. Les sténoses étaient cotées selon leur sévérité (50-69%, 70-99%, occlusion), localisation, et nombre. Le caractère symptomatique des lésions était établi secondairement. Ces données ont été analysées par rapport aux facteurs de risque cardiovasculaire et aux localisations extracrâniennes d'athérosclérose. Résultats : La prévalence de l'ICAD était de 27,4%, et la moitié des lésions (13,6%) étaient symptomatiques. Le risque d’ICAD augmentait significativement avec l’âge, la pression artérielle et la dyslipidémie athérogène indépendamment du caractère symptomatique de la sténose, et sans association au diabète. On retrouvait une forte association entre ICAD et constitution d’un accident ischémique (p=0,023), et d’autre part entre ICAD et coronaropathie (p=0,023). Conclusion : L'ICAD est présente chez un quart de nos patients et responsable de 13% des AVC ischémiques. L’ICAD est fortement associée à la coronaropathie et ne doit pas être méconnue des radiologues lors du bilan étiologique d’un infarctus cérébral.

Introduction Le traitement d’un anevrisme intracrânien (AIC), non rompu ou deja embolise, ainsi que la modalite therapeutique (traitement endovasculaire – TEV – versus chirurgie) est generalement discutee dans le cadre d’une approche multidisciplinaire. L’experience de l’equipe chirurgicale, propre a chaque centre, est un des criteres qui intervient dans la decision. Celle-ci est evaluee par l’analyse des resultats cliniques et radiologiques des patients traites pour un AIC. Patients et methode Il s’agit d’une serie prospective de 44 patients chez qui 48 AIC ont ete traites chirurgicalement entre decembre 2007 et aout 2014. Ont ete retenus les AIC non rompus (embolises ou non) et les AIC rompus, « recanalises » apres un ou plusieurs TEV. L’evaluation clinique s’est basee sur le mRS (Modified Rankin Score). La qualite de l’exclusion, le respect des arteres et des veines ont ete evalues par un examen angiographique (angioscanner et/ou angiographie cerebrale) pre- et postoperatoire et le parenchyme cerebral par un scanner et/ou une IRM pre- et postoperatoire. Resultats Quarante-huit anevrismes ont ete operes chez 44 patients. Aucun anevrysme vertebro-basilaire n’a ete opere. Onze patients (25 %) avaient deja ete traites, dix d’entre eux par TEV. Les lesions radiologiques rapportees, tous degres confondus, sont : 8 ischemies (16 %), 9 œdemes (19 %) et 4 hemorragies (8 %). Deux lesions ischemiques (4,5 %) ont ete responsables d’une degradation du mRS a 3 mois (mRS a 1 pour chacun d’eux). Les autres lesions, resorbees secondairement, n’ont pas eu de retentissement. Les facteurs associes aux ischemies sont la proximite d’arteres perforantes. L’etude des veines, en l’absence d’interruption de veine sylvienne superficielle, n’a pas permis d’expliquer certaines lesions œdemateuses transitoires. Conclusion Malgre une technique microchirurgicale visant a respecter les vaisseaux (arteres et veines) et le parenchyme (peu de retraction), malgre l’utilisation de techniques recentes (doppler et fluorescence), des lesions radiologiques, mises en evidence par un bilan rigoureux, ont concerne 5 patients (11 %). Parmi ces patients, 2 ont ete symptomatiques (4,5 %).