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Cardioembolic strokes are serious and associated with high early and late mortality. The objectives of our study was to describe the demographic, clinical, etiological and CT characteristics of patients diagnosed as presumed cardio embolic stroke. Methods: This is a retrospective, descriptive study carried out in the neurology department of Befelatanana University Hospital for 18 months from January 2018 to June 2019. Results: One hundred and twenty cases were retained. The average age is 62.45 years with extremes ranging from 25 to 90 years and a predominance of men (sex ratio at 1.2). Arterial hypertension (hypertension) was found at 69.13% of cases. The admission mean NIHSS score was 10.90. Atrial fibrillation (AF) is the cause of cerebral infarction at 13.30 % of cases. The infarcts are located in multiple territories at 29.20% of cases and hemorrhagic transformation is observed at 47.50% of cases. The death rate was 5% and the etiologies remain undetermined in the majority of cases (78.30%). Mainly, the infarcts sit on the carotid territory (60%) and they are multi-territory in 29.20% of cases. Hemorrhagic transformation is observed in 47.50% of cases. Conclusion: The profile of cardioembolic cerebral infarctions is increasingly known in Madagascar by the data provided by our study. Its diagnosis remains difficult and requires an exhaustive etiological assessment. [ABSTRACT FROM AUTHOR]

Having brain CT (computed tomography) scan is limited by the financial means patients in Madagascar. Neurological examination becomes essential the management of stroke. Our goal was to establish the correlation between clinical criteria and brain CT scan result. Methods: we did a retrospective, descriptive and analytical study of patients admitted for stroke at the neurology department of the Joseph Raseta University Hospital in Befelatanana from October 2018 to September 2019. Results: Two hundred thirty seven cases were retained. The presence of higher functions problems’ is correlated with stroke of the superficial arteries and its absence with stroke of the perforating arteries. The Alternate syndrome predicted stroke of the brainstem and cerebellum. Conclusion: A well-conducted clinical examination helps manage stroke while waiting for a brain CT scan. The clinical criteria provide the topography of the artery affected during the stroke. [ABSTRACT FROM AUTHOR]

Context: Cardioembolic strokes are serious and associated with high early and late mortality. The objectives of our study was to describe the demographic, clinical, and etiological and CT characteristics of patients diagnosed as presumed cardio embolic stroke. Method: This is a retrospective, descriptive study carried out in the neurology department of Befelatanana University Hospital for 18 months from January 2018 to June 2019. Results: One hundred and twenty cases were retained. The average age is 62.45 years with extremes ranging from 25 to 90 years and a predominance of men (sex-ratio at 1.2). Arterial hypertension (hypertension) was found at 69.13 ٪ of cases. The admission mean NIHSS score was 10.90. Atrial fibrillation (AF) is the cause of cerebral infarction at 13.30 ٪ of cases. The infarcts are located in multiple territories at 29.20 ٪ of cases and hemorrhagic transformation is observed at 47.50% of cases. The death rate was 5 ٪ and the etiologies remain undetermined in the majority of cases (78.30%). Mainly, the infarcts sit on the carotid territory (60%) and they are multi-territory in 29.20% of cases. Hemorrhagic transformation is observed in 47.50 ٪ of cases. Conclusion: The profile of cardioembolic cerebral infarctions is increasingly known in Madagascar by the data provided by our study. Its diagnosis remains difficult and requires an exhaustive etiological assessment. [ABSTRACT FROM AUTHOR]

Résumé: La fibrillation auriculaire non rhumatismale représente l'étiologie la plus fréquente des infarctus cérébraux cardioemboliques. Elle est souvent asymptomatique ou peu symptomatique, ne gêne pas la vie quotidienne et est méconnue par la population générale, ce qui rend difficile sa découverte, souvent lors des stades de complications comme les infarctus cérébraux, alors qu'à ces stades, les conséquences sont graves et souvent handicapantes tout au long de la vie. Quant aux patients déjà victimes d'un AVC cardioembolique, le risque de récidive est important s'il est secondaire à une FA qui n'est pas dépistée. Dans la pratique quotidienne en unité de Neurologie du CHU Joseph Raseta Befelatanana, la recherche des FA au décours des infarctus cérébraux est systématique bien que toutes les investigations nécessaires pour le dépistage ne soient pas toujours toutes réalisées. Ainsi, la découverte et la connaissance sur les caractéristiques de ces FA à l'origine des infarctus cérébraux permettraient d'en améliorer la prévention secondaire. Non-rheumatic atrial fibrillation is the most frequent etiology of cardioembolic cerebral infarction. It is often asymptomatic or slightly symptomatic, does not interfere with daily life and is unknown to the general population, which makes it difficult to discover, often during the stages of complications such as cerebral infarction, whereas at these stages the consequences are severe and often disabling throughout life. As for patients who have already suffered a cardioembolic stroke, the risk of recurrence is high if it is secondary to AF that is not detected. In daily practice in the Neurology Unit of the CHU Joseph Raseta Befelatanana, the search for FA after cerebral infarction is systematic although all the investigations necessary for screening are not always all carried out. Thus, the discovery and knowledge of the characteristics of these AFs at the origin of cerebral infarctions would make it possible to improve their secondary prevention. [ABSTRACT FROM AUTHOR]

Patients with chronic kidney disease (CKD) have an increased risk of cognitive disorders, presenting as vascular dementia, compared with the general population. These cognitive disorders occur early during the course of the kidney disease and evolve in parallel with the decline in glomerular filtration rate. They affect 30 to 80 % of patients with stage 5 CKD. Kidney transplantation only partially improves cognitive impairment. In this narrative review, we summarize the epidemiology and recent clinical and experimental data on cognitive impairment in CKD and discuss the potential specific mechanisms. Among the factors associated with cognitive impairment, the accumulation of uremic toxins such as indoxyl sulfate appears to be a specific risk factor for cognitive decline. These toxins have an endothelial toxicity that can disrupt the cerebral endothelium. The rupture of the blood-brain barrier (BBB) is a mechanism implicated in several neurodegenerative pathologies and systemic diseases with cerebral tropism. Recent experimental findings in CKD indicate that disruption of the BBB appears to be an important mechanism behind cognitive impairment in CKD. In murine models of CKD, increased BBB permeability is linked to memory impairment and aryl hydrocarbon receptor activation following accumulation of circulating indoxyl sulfate. This disruption of the BBB could also have harmful consequences for stroke susceptibility and drug neurotoxicity in CKD patients.

Description. Bien que l'intégration communautaire (IC) constitue l'ultime but en réadaptation, elle s'actualise rarement en clinique. But. Le but de cette étude était de (a) synthétiser l'état des connaissances ergothérapiques liées à l'IC auprès de personnes atteintes d'un trouble neurologique et (b) dresser un portrait de l'opérationnalisation du concept d'IC au sein de ces écrits. Méthodologie. Un examen de la portée fut réalisé en double sélection pour ultimement retenir 47 écrits, touchant quatre populations sélectionnées. Les thématiques propres à l'ensemble des clientèles ont été dégagées par analyse de contenu et les constats touchant l'évolution des connaissances ont fait l'objet de synthèses itératives. Résultats. Les écrits retenus concernent le traumatisme craniocérébral (n = 21, 9 devis expérimentaux [EXP]), les blessures médullaires (n = 11, 4 EXP), l'accident vasculaire cérébral (n = 9, 4 EXP) et la sclérose en plaques (n = 4, 1 EXP). L'IC est employée de façon interchangeable avec la participation sociale: 51 % des écrits définissent l'IC uniquement à partir d'un outil de mesure et 10 % n'offrent aucune définition de l'IC. La dimension physique de l'IC est plus étudiée que les dimensions sociale et psychologique. Conséquences. Les pratiques innovantes doivent viser l'affiliation et l'exercice d'une pleine citoyenneté afin de soutenir une habilitation durable. [ABSTRACT FROM AUTHOR]

Résumé: Dans cette étude multicentrique prospective à visée descriptive sur 30 mois une sélection de dossiers a été effectuée devant la suspicion clinique d'un accident vasculaire cérébral en phase aigüe (moins de 24 h). Les patients ont tous été explorés avec un appareil d'IRM de 1,5 Tesla par des séquences « Flair » suivies des séquences de diffusion avec le calcul du coefficient apparent de diffusion (ADC). Parmi 232 dossiers retenus sur 1567, d'âge moyen 53,5 ans, les antécédents des patients étaient dominés par l'hypertension artérielle et le diabète respectivement dans 62,5 % et 56 % des cas. Les motifs de consultation étaient l'hémiplégie dans 69,5 % des cas suivie de l'aphasie dans 23,2 %. Dans 92 % des cas l'infarctus à la phase aiguë n'était pas visible sur les séquences Flair. L'ischémie cérébrale était révélée dans 100 % des cas chez tous les patients explorés par les séquences de diffusion avec calcul de l'ADC. La thrombolyse était le traitement pratiqué en urgence avec un taux de réussite à 91 % des cas. In this multicenter prospective study with descriptive aim over 30 months, a selection of the files was carried out in front of the clinical suspicion of an acute cerebral vascular accident (less than 24 hours). The patients were all explored with a 1.5 Tesla MRI by Flair sequences followed by diffusion sequences with apparent diffusion coefficient (ADC) calculation. Among 232 cases retained out of 1567, with a mean age of 53.5 years, patients' histories were dominated by hypertension and diabetes respectively in 62.5% and 56%. The reasons for consultation were hemiplegia in 69.5% followed by aphasia in 23.2%. In 92% of cases acute infarction was not visible on Flair sequences. Cerebral ischemia was revealed in 100% of cases in all patients investigated by ADC-based diffusion sequences. Thrombolysis was the emergency treatment with a success rate of 91% of cases. [ABSTRACT FROM AUTHOR]

Abstract: The reversible cerebral vasoconstriction syndrome (RCVS) is an under-estimated transient acute cerebrovascular disorder. It has long been mistaken as central nervous system vasculitis whereas it is now believed to result from an acute but prolonged vasospasm of cerebral arteries. This disorder can be precipitated by postpartum or vasoactive drug. However, it occurs spontaneously in a significant number of cases. The characteristic clinico-radiological presentation and disease course of the RCVS has been delineated only recently. Mean age at onset is 40–45years, with a female predominance. A provocative factor can be identified in 12–60% out of the patients. Clinical presentation is predominantly marked by recurrent thunderclap headaches, but can be complicated with focal neurological deficit or seizures. Brain imaging is normal in most cases, but can reveal hemorrhagic or ischemic complications. Cortical subarachnoid hemorrhage is a suggestive finding. A posterior reversible encephalopathy syndrome (PRES) can be seen occasionally. Cerebral angiography reveals multifocal arterial narrowing with string and bead appearance. Cerebrospinal fluid reveals no or mild abnormalities. The disease resumes spontaneously within several days to weeks, whereas vasoconstriction reverses within 1 to 3months. This clinico-radiological presentation should be promptly recognized in order to avoid unnecessary investigations and aggressive treatment, and lead to search for a triggering factor. Further studies are required in order to clarify the precipitating role of several drugs, and clinical trials are needed to reduce the occurrence of strokes. [Copyright &y& Elsevier]

Summary: Transfusion programs are sometimes necessary to take care of severe sickle-cell patients. Treatment of cerebrovascular disease in sickle-cell disease is the most common indication. Periodic automated red blood cell exchange (erythrocytapheresis) is an alternative treatment. Sixteen patients less than 20 years old have been treated with chronic erythrocytapheresis since 2004 in the pediatric hematology and oncology department of the University Hospital of Rouen, 10 patients for cerebrovascular disease (1 was on secondary prevention and 9 were on primary prevention), 5 patients for pain crisis recurrence, and the last one for mild psychocognitive deficit disorder. This treatment was unsuccessful for 4 patients, 3 on primary prevention and 1 treated for pain crisis recurrence. These failures were caused by alloimmunization for 2 patients and venous access problems for 2 patients. For the other 12 patients, 5 of the 6 patients on primary prevention showed clear improvement (normalization of transcranial Doppler ultrasound or improvement on magnetic resonance angiography), the patient on secondary prevention had stability on cerebral MRI after 2 years of treatment, the 5 patients with pain crisis recurrence had good improvement, and psychocognitive abilities improved for the last patient. One hundred and ninety-nine erythroexchange sessions were performed for the 9 patients treated over a period of 10 to 30 months. Erythrocytapheresis sessions ran on average less than 1.5h. Three patients showed high ferritin levels at the beginning of erythroexchange, which normalized 2 to 10 months later. All patients reported better quality of life. Periodic erythroexchanges are an effective treatment for complicated sickle-cell anemia and iron overload. It requires human, material, and financial support, but not as much as simple transfusion or manual erythroexchange. Practical experience shows problems of venous access because of coagulation when sampling. [ABSTRACT FROM AUTHOR]

Abstract: Nutrition is an important factor to take into account in the management of stroke. Within the framework of primary and secondary prevention, different risk factors are now well known and designed as target, among them numerous nutritional factors like overweight or obesity, diabetes, dyslipidemia. At the opposite, stroke favours troubles of the glycoregulation and is a risk factor of malnutrition. Malnutrition has to be detected and treated because of its negative effects on morbidity and mortality. Dysphagia is one of the main causes of malnutrition, in particular if it do not regress rapidly. In this case, enteral nutrition is indicated and a gastrostomy is preferred if enteral nutrition has to be prolonged. In order to reduce morbidity and mortality, different nutritional interventions are yet to be evaluated. [Copyright &y& Elsevier]

Abstract: Objective: Readmission is an important indicator for the quality of healthcare services. The authors examined the reasons for 30-day readmission among urban stroke patients, and their clinical consequences. Methods: Consecutive patients admitted to a JCAHO certified primary stroke center with ischemic stroke or transient ischemic attacks (TIA) were included. Demographics, TOAST mechanism, risk factors, treatments administered and discharge destination were collected. Charts were reviewed for readmissions up to 30days from discharge. Reasons for readmission and outcomes in terms of disability and discharge destination were determined. Results: Two hundred sixty-five patients (50.9% male; 79.6%African American; mean age 60.9years) were included. There were 205(77.4%) strokes and 60(22.6%) TIAs. Thirteen (5%) patients died during their first admission. Of the remaining 252 patients, 25 (9.9%) were readmitted within 30days. The reason for readmission was neurological in 8/25 patients (32%; 3 ischemic strokes, 1 hemorrhagic stroke and 4 TIAs); and non-neurological in 17/25 patients (68%). The frequent non-neurological reasons were infections (6/25), electrolyte disturbances (3/25) and trauma related to falls (2/25). Patients with coronary artery disease were more likely to be readmitted (45.5% vs. 14.7%; p=0.001) An NIH stroke scale ≥10 predicted readmission (50.0% vs. 25.4% for NIHSS <10; p value 0.02). Patients discharged home or to acute rehabilitation units were less likely to be readmitted than those discharged to subacute rehabilitation units or nursing homes (8.2% vs. 23.8%; p value=0.01). Interpretation: Disabling strokes are more likely to be readmitted. The reason is often non-neurological, and sometimes preventable. Physicians should review cases that return within 30days and determine best practices that prevent readmission. [Copyright &y& Elsevier]

Résumé: La prise en charge médicale des patients victimes d’un accident vasculaire cérébral est bien codifiée. Concernant les troubles sexuels, des efforts sont à faire en matière d’information et d’explications. Car si 80 % des patients parviennent à marcher à l’issue de l’accident, plus de la moitié des patients gardent des difficultés dans l’accomplissement de leur sexualité. Malgré des réticences d’ordre morales ou privées, nous avons tenté d’explorer la sémiologie des troubles sexuels rencontrés par cette population et d’en inventorier les causes possibles. Méthodologie: En 2008–2009, 16 patients (11 H et 5 F, de moyenne d’âge 48 ans) sur 42 contactés ont accepté de revenir en entretien après leur sortie d’un centre de rééducation et de remplir, avec le médecin, trois questionnaires. L’autonomie des patients (indice de Barthel), leur état thymique (score de Beck) et la qualité de leur sexualité (questionnaire de Hudson) ont été successivement évalué. Résultats: Près de 40 % des sujets (16) ont répondu à nos questionnaires. Onze hommes et cinq femmes. Parmi les patients dont la sexualité est qualifiée de médiocre, il n’a pas été retrouvé de corrélation avec la prise d’un traitement médicamenteux lourd. Par ailleurs, l’échantillon a été jugé trop faible pour retrouver une corrélation entre la qualité de la sexualité et l’indice d’indépendance. Nous n’avons pas non plus retrouvé de corrélation entre état dépressif, latéralité de la lésion cérébrale et qualité de la sexualité. Discussion: L’étiologie des troubles sexuels rencontrés après un accident vasculaire cérébral est multiple et polymorphe. L’importance de la lésion cérébrale, de l’atteinte sensitivomotrice ou génitosphinctérienne sont des facteurs importants mais il ne faut pas négliger la responsabilité de l’état psychologique secondaire à l’accident vasculaire, de l’incidence des traitements ou de la modification de l’image corporelle et du poids des représentations de la sexualité de la personne handicapée dans la genèse de ces troubles. Conclusion: L’incidence du traitement médicamenteux, d’un syndrome dépressif ou l’existence d’une atteinte corticale droite ne semble pas être corrélée à la survenue de troubles sexuels. En revanche, le degré d’indépendance fonctionnelle semble être un facteur déterminant dans l’apparition d’un dysfonctionnement sexuel. [Copyright &y& Elsevier]

Abstract: Objectives: Pulse pressure variations are used to assess fluid responsiveness in mechanically ventilated patients. The accuracy of this index in open chest conditions remained unclear. The aim of the study was to evaluate the effect of open chest conditions on pulse pressure variations. Study design: Non-interventional prospective study. Methods and patients: Twenty-eight mechanically ventilated patients scheduled for open-heart surgery were included. Pulse pressure variations, peak aortic velocity, and stroke volume were measured before and after thoracotomy with pericardotomy. Measurements were made at each step and compared. Results: Neither pulse pressure variation nor peak aortic velocity and nor stroke volume variation were modified by open chest conditions (median=5% [interquartile range=6] vs 4% [6], p =NS), (20% [11] vs 17% [12], p =NS and 11% [7] vs 10% [3], p =NS) respectively. Pulse pressure variations were correlated to stroke volume before thoracotomy (r’=−0.432; p =0.02) and after thorocatomy (r’=−0.433, p =0.02). Conclusion: In these studied patients, preload dependancy indices were not modified by open chest conditions. Pulse pressure variations remained correlated to stroke volume even after thoracotomy. [Copyright &y& Elsevier]

Abstract: There are more and more data suggesting efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depressions in older patients. Thus, the authors found useful to realize an up-to-date review of studies which examined the efficacy and safety of rTMS to treat depressive disorders in aged. Several parameters might be associated with greater antidepressant efficacy: higher intensity pulses of rTMS of the left dorso latéral préfrontal cortex (DLPFC), 90 to 110% of motor threshold; higher total number of stimulations (more than 1000); higher number of total rTMS sessions (10 to 20). Poorer responsiveness to rTMS may be related to several patients’ factors, including older age and lesions of the central nervous system. Literature data globally confirm that rTMS is safe and does not produce cognitive deficits, even among highly vulnerable patients with clinical evidence of cerebrovascular disease. [ABSTRACT FROM AUTHOR]

Abstract: It has long been believed that cerebral lesions were irreversible in the adult human brain. However, the spontaneous improvement in functional outcome observed in the following weeks after cerebral ischemia suggests plasticity phenomenons involving postischemic neuronal network reorganization. Regarding the large prevalence of stroke in industrialized countries, and the few available treatments, the understanding of cerebral plasticity has become an important issue but also a potential source of new therapeutic approaches in stroke. Thus, “constraint induced therapy” and repetitive transcranial magnetic stimulation (rTMS) are based on the concept of local but also remote consequences of the ischemic focal lesion. Cell-therapy is based on the capacity of stem cells to respond to hypoxic signals and adapt their phenotype to the host organ, but above all to release cytokines locally and boost endogeneous repair mechanisms. We could consider to perform in the future a sequential treatment with fibrinolysis, stem cell therapy, repetitive transcranial magnetic stimulation and constraint-induced therapy in the same patient. [Copyright &y& Elsevier]

Summary: Background: In the management of stroke disease, evidences from the literature demonstrate that the introduction of stroke units, hospital wards with dedicated beds providing intensive care within 48hours of symptoms’ onset, produced a real improvement in the outcome, reducing in-hospital fatality cases and increasing the proportion of patients independently living in long term follow-up. Discussion: The article focuses on stroke disease-management, suggesting a stroke integrated approach for the admission of patients on dedicated beds, in order to extend the “stroke care” approach outcomes to as many hospitals as possible in Italy. This approach implies the set up of a stroke network for an effective patients’ stratification according to the severity of the illness at debut; the set up of an integrated team of specialists in hospital management of the acute phase (first 48hours) and a timely rehabilitation treatment. Ultimately the hospital should be organized according to department's semi-intensive areas in order to assure to the patients, in the early stage of the disease, a timely high intensity care aimed to improve the long term outcome. [Copyright &y& Elsevier]

Abstract: Introduction: Patients with moderate traumatic brain injury (TBI) (Glasgow Coma Scale, GCS, 9–13) or minor TBI (GCS 14–15) are at risk for subsequent neurological deterioration. Serum protein S-100 is believed to reflect brain damage following TBI. In patients with normal or minor CT scan abnormalities on admission, we tested whether the determination of serum protein S-100 beta could predict secondary neurological deterioration. Methods: Sixty-seven patients with moderate or minor TBI were prospectively studied. Serum samples were collected on admission within 12hours postinjury to measure serum protein S-100 levels. Neurological outcome was assessed up to seven days after trauma. Secondary neurological deterioration was defined as two points or more decrease from the initial GCS, or any treatment for neurological deterioration. Results: Nine patients had a secondary neurological deterioration after trauma. No differences in serum levels of protein S-100 were found between these patients and those without neurological aggravation (n =58patients): 0.93μg/l (0.14–4.85) vs 0.39μg/l (0.04–6.40), respectively. The proportion of patients with abnormal levels of serum protein S-100 at admission according to two admitted cut-off levels (>0.1 and >0.5μg/l) was comparable between the two groups of patients. Elevated serum levels of protein S-100 were found in patients with Injury Severity Score (ISS) of more than 16 (n =23patients): 1.26μg/l (0.14–6.40) vs 0.22μg/l (0.04–6.20) in patients with ISS less than 16 (n =44patients). Discussion: The dosage of serum protein S-100 on admission failed to predict patients at risk for neurological deterioration after minor or moderate TBI. Extracranial injuries can increase serum protein S-100 levels, then limiting the usefulness of this dosage in this clinical setting. [Copyright &y& Elsevier]

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of IRBM is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Introduction: Celiac disease is a common condition with a prevalence of about 1%. Clinical extradigestive presentations are various and stroke can be one of the neurological manifestations. Exegesis: Two cases of stroke occurring in young adults are described, leading to the diagnosis of celiac disease. Hyperhomocysteinemia or cerebral arterial vasculopathy in one case and antiphospholipid syndrome in the other case are thought to be involved in the pathogenesis of stroke during celiac disease. Conclusion: The possible presence of celiac disease should be discussed in unexplained young adult stroke. [Copyright &y& Elsevier]

Abstract: Primary stroke can be due to embolism or an obstructive process of the vascular wall. Embolism may come from a parietal lesion of a large artery in the neck (traumatic dissections), from a cryptic cardiopathy, from a venous thrombosis associated with a right-left shunt. Among pathologies of endocranial arteries, the most frequent is the acute, postviral arteriopathy of the sus-clinoïd carotid, which evolves toward stabilisation or regression. Insidious obstructive arteriopathies of the Willis circle, including development of a transparenchymal suppletive circulation (Moya-Moya disease), cumulate chronic circulatory insufficiency and repetitive strokes. Inflammatory multifocal cerebral arteriopathies mainly involve mean and small arteries. Most of them are secondary to a multisystemic disease, but some are primary. The basic investigation is anatomical and begins with MRI. Emergency conventional cerebral angiography is discussed when heparinotherapy is difficult to decide (evolutive thrombosis), or when an endovascular intervention appears possible (anoeuvrism). Secondarily, conventional angiography is indicated in any chronic situation where a precise anatomical follow-up is necessary. Investigations of the cardiovascular system, of the thrombophilic risk, of a dysimmune process are discussed according to the clinico-anatomical diagnosis. [Copyright &y& Elsevier]

Abstract: Background: The relationship between diabetes mellitus and risk of stroke is well established. This risk is more elevated for hypertensive diabetics men. Objective: To determine the incidence and the risk factors of stroke among hypertensive diabetics. Methods: This prospective study has considered baseline demographic, behavioural and biological parameters collected in 2002 among black Congolese hypertensive diabetics from Kinshasa till the onset of stroke or not in 2006. Results: Out of 492 followed-up patients (279 women, 213 men, 57±10 years), 41.9% were old of age ≥ 60 years, and 16.5% experienced acute stroke. In univariate analysis, a significant association between age ≥ 60 years, cigarette smoking, excessive alcohol intake, diabetes duration ≥ 2 years, pulse pressure ≥ 60mmHg, acute bacterian pneumonia, left ventricule hypertrophy, hypertensive retinopathy, diabetic retinopathy, diabetic foot, diabetic neuropathy, congestive heart failure, chronic renal failure, lack of diabetic treatment compliance and the occurance of acute stroke. However, multivariate analysis identified only acute bacterian pneumonia, diabetic retinopathy, diabetic neuropathy, chronic renal failure and pulse pressure ≥ 60mmHg as the independent risk factors of stroke onset among these black congolese hypertensive diabetics with the following and respective values of relative risk (hazard ratio): 6,2 (IC 95%: 3.2 to 11.9; P <0.0001), 2,2 (IC 95%: 1.2 to 4.1; P <0.01), 3.6 (IC 95%: 1.9 to 6.8; P <0.0001), 6.4 (IC 95%: 2.9 to 14.1; P <0.01) and 4.1 (IC 95%: 1.6 to 10.3; P <0.0001). Conclusion: The rate of stroke onset is high among these hypertensive diabetics. This is the consequence of independent and respective action of infection, diabetic retinopathy, diabetic neuropathy, chronic renal failure and arterial stiffness. [Copyright &y& Elsevier]

Abstract: Delayed neurological deficit occurs among 30% of patients after aneurysmal subarachnoid haemorrhage, mainly related to cerebral vasospasm. The early detection of cerebral ischemia remains problematic. Conventional cerebral monitoring (as intracranial pressure and cerebral perfusion pressure) appears to be insufficient, because cerebral ischemia may occur without elevated intracranial pressure. Global cerebral monitoring as venous jugular oxygen saturation are useful for regional monitoring. Local monitoring as oxygen tissue partial pressure (PtiO2) and microdialysis are sensible for brain ischemia detection, but may also ignore episodes occurring in non-monitored brain area. For the detection of most episodes of brain ischemia, several monitoring system should be use performing a multimodal intracerebral monitoring. Brain microdialysis and oxygen tissue partial pressure are promising monitoring system. [Copyright &y& Elsevier]

Abstract: Introduction: The cerebral salt wasting syndrome (CSWS) is characterized by hyponatraemia secondary to excessive natriuesis with osmotic duiresis. This syndrome, frequently, occurs after subarachnoid haemorrhage (SAH), but may occur after any acute cerebral aggression. Objectives: The aim of the study was to assess the frequency of the CSWS in animal models with, SAH, cerebral ischemia (CI), and cranial trauma (CT), and its correlation with the secretion of brain natriuretic peptide (BNP). Method: Four groups of rats were selected: group SAH (n =7) consisted of SAH induced by perforation of the carotid artery in its intracerebral part; group CI (n =7) consisted of CI induced by ligature of the carotid artery; group CT (n =7) consisted of induced CT; and a control group Sham (n =7). Weight, serum sodium, BNP, and urinary sodium, were measured at baseline and 24 hours after. Results: Rats with SAH had significant natriuresis and diuresis with negative sodium balance (–95.9±447.4 μmol) with a significant difference (P <0.05) compared to the rats of the CI and the Sham groups. There was no difference in the 24 hours level of BNP between the four different groups. Conclusion: We conclude that SAH, in animal models, induced high diuresis with negative sodium balance in the first 24 hours. These findings were absents in the others groups. This was independent of the BNP secretion and may correspond to the early occurrence of a CSWS. [Copyright &y& Elsevier]

Over the last decade, functional magnetic resonance imaging (fMRI) has become a useful, complementary tool in the presurgical evaluation of numerous brain diseases. In clinical practice, fMRI is commonly used to map eloquent sensorimotor and speech-related areas before surgical resection of brain tumours. fMRI also provides insights into brain perfusion and oxygenation changes in response to vasomotor agents. An evaluation of cerebrovascular reactivity is in progress. [ABSTRACT FROM AUTHOR]

Abstract: A 36-year-old patient was admitted to our hospital with ischaemic stroke. The initial assessment allowed the diagnosis of an antiphospholipid syndrome (APS) and an intracardiac mass suggestive of a heart tumour. The patient was treated with unfractionated heparin. Type II heparin-induced thrombopenia (HIT) was diagnosed on the 18th day of therapy. Given the risk of stroke recurrence it was decided to remove the cardiac tumour surgically. Cardiopulmonary bypass (CPB) was performed using danaparoid in a state of deep hypothermia, in accordance with the well-established protocol in use in our department. As the CPB and surgical procedure came to an end a massive thrombus began forming in the circuit, requiring immediate displacement of the CPB cannulae. The anti-Xa activity level obtained had been considered effective at an estimated 1.20 IU/ml, although, the level recommended by Magnani is between 1.50 and 2.0 IU/ml. There was no clinical consequence and postoperative recovery was uneventful. The discrepancy between the satisfactory level of anti-Xa activity and the thrombus formation in the CPB circuit raises the issue of the diversity of published anticoagulation protocols, the difficulty to extrapolate within a surgical team, the need for intensive laboratory monitoring within a narrow therapeutic range, as well as the patient profiles variability with concurrent disorders complicating their clinical management. [Copyright &y& Elsevier]

Abstract: Haemorrhagic stroke is frequent and associated with a high mortality and morbidity. Less than 30% of patients are still alive five years after onset and few patients regain functional independence. The worsening effect of anticoagulation has been demonstrated and the failure to rapidly normalize coagulation further increases haematoma expansion. In a recent phase II trial, recombinant activated factor VII given within 4 hours of stroke onset, reduced haematoma growth, mortality and disability. An aggressive blood pressure and intracranial pressure control early after the haemorrhage seems beneficial. A large prospective randomized study (the STICH trial) did not demonstrate any beneficial effect of surgery. [Copyright &y& Elsevier]

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Abstract: The ischemic threshold is reached when the availability of oxygen in the cerebral tissue does not cover oxygen requirement. For a patient sedated, with constant PaO2 and haemoglobin, the cerebral blood flow (CBF) global and local is the essential factor to maintain such a balance. At a cellular level, ischemia occurs when the CBF is below 20–25 ml/min. However, this threshold probably varies with the patient and also within the normal or perilesional tissue. A cerebral perfusion pressure (CPP) of 60 mmHg, recommended for a cerebral perfusion allowing a sufficient CBF for normal brain, does not prevent ischemia. Monitoring aimed to control parameters of the aerobic metabolism (PtiO2, SjO2 and microdialysis) and to detect the ischemic threshold allows to adapt the CPP to each patient and continuously. [Copyright &y& Elsevier]

Abstract: Jugular venous oxygen saturation (SvjO2) monitoring has been developed in order to detect cerebral ischaemia. The interpretation of SvjO2 values remains nevertheless complex, and should be associated with cerebral haemodynamic multimonitoring with ICP and transcranial Doppler. With the hypothesis of a constant cerebral oxygen consummation, and also with a constant haematocrit, SvjO2 variations correlates with cerebral blood flow variations. After a brain trauma, an SvjO2 <50% or>75% is associated with a bad prognosis. To maintain SvjO2 >50% constitutes a reasonable therapeutic objective, but the benefice associated with such a strategy has not been validated. Oxygen partial pressure (PtiO2) in the brain parenchyma may be monitored in the non-lesioned area (usually frontal) in order to detect a global cerebral ischaemia, or in the penumbra of a cerebral lesion in order to detect a local ischaemia. The values associated with an ischemic risk are not fully defined and may be under 10–15 mmHg. A concomitant metabolic monitoring by cerebral microdialysis is of importance to fully address the real cerebral local ischaemic burden. Scientific studies are mainly focused on patients with a brain traumatism. Nor SvjO2, nor PtiO2 monitoring have at present been demonstrated to be associated with a clinical benefit, and their use should be restricted to scientific research. [Copyright &y& Elsevier]

Abstract: Purpose. – Neurological symptoms of B12 vitamin deficiency are polymorph. Causes are dominated by Biermer''s disease and B12 vitamin non dissociation that is frequent in the elderly. Methods. – We realized a retrospective study during 11 years. Patients with neurological symptoms associated to megaloblastosis were included. Treatment with B12 vitamin lead to haematological manifestation regression. Results. – 26 cases were analyzed. Mean age was 50±14.5 years and there were 11 women and 15 men. Neurological signs included combined medullar sclerosis (N =10), peripheral neuropathy (N =10), isolated paresthesia (N =5) and inferior limb pyramidal syndrome (N =1). Neurological signs revealed vitamin B12 deficiency in 4 cases. Mean haemoglobin rate was 6.2±2.6 g/dl, mean MCV was 109±56 fl. Eight patients had macrocytic anaemia, nine bicytopenia and eight deep pancytopenia. Electromyography (N =8) confirmed neuropathy and medullar MRI (N =2) showed antero-posterior cordonal demyelisation of cervico-dorsal medulla. Causes of B12 vitamin deficiency were Biermer''s disease (N =11), non dissociation of B12 vitamin''s syndrome (N =8) and partial gastrectomy (N =1). In 6 patients, no aetiology was found. Treatment with parenteral vitamin B12 induced neurological symptoms regression in 14 cases. Patient with neurological disorder had significantly higher platelet count and haemoglobin level as compared with patients without neurological disorder. Reticulocyte crisis was more precocious in patients with neurological disorders. Conclusion. – Neurological symptoms in vitamin B12 deficiency are frequent. We insist on isolated forms, inaugural forms and on the interest of medullar MRI for early diagnosis. [Copyright &y& Elsevier]

Abstract: Concerning any socioprofessional category, some addictive drugs like cocaine are responsible for many complications. The authors relate two case reports of young patients who suffered from cardiovascular accidents due to this drug. The first one was diagnosed with an ischemic stroke caused by carotid artery dissection and a leg distal vascular obliteration, the second one with a myocardial infarction with transient left ventricular dysfunction. Through these two case reports, the authors take stock of the pathophysiological and therapeutic knowledge of cardiovascular accidents after cocaine intake. [Copyright &y& Elsevier]

Abstract: Background and Purpose. – Several prognostic factors have been identified for outcome after stroke. We conducted a study to determine early predictive factors of functional outcome one year after stroke and to evaluate which factors are independent predictors, with an aim of specifying the role of age, aphasia, unilateral neglect, cognitive impairment and family social support. Methods. – Observational cohort study of 156 patients. All patients admitted to the university hospital for initial unilateral hemispheric stroke were included. The study duration was two years (inclusion, one year, and follow-up, one year) .The initial evaluation of stroke was conducted at day 2 and day 15 and included the Motricity Index and Trunk Control Test, New Functional Ambulation Classification, Frenchay arm test, Mini-Mental State Examination, Boston Diagnostic Aphasia Examination, unilateral neglect evaluation, and depression. Data on functional recovery (Barthel Index) were collected at day 360. Results. – The average age of patients was 72 years. Age was correlated to social situation (P <0.01) and previous neurological impairment (P <0.01). A multiple regression analysis, including 14 initial clinical factors correlated with the Barthel Index score at day 360, revealed 4 independent early predictive factors of outcome: initial score of Barthel Index at day 2 and its progression from day 2 to day 15, disorders of the executive functions and previous neurological impairment. Conclusion. – In our cohort, in accordance with previous studies, age, cognitive impairment, unilateral neglect, aphasia, depression and social situation are not independent factors of poor outcome after stroke as evaluated by the Barthel Index. [Copyright &y& Elsevier]

Abstract: Introduction. – Although more rare than arterial thrombosis, cerebral venous thrombosis are a non-negligible cause of stroke. Characterised by the large diversity of clinical presentations and etiologies, they have a much better prognosis than arterial stroke. The evolution remains unforeseeable, with a non-negligible proportion of worsening at the acute phase and diagnosis must be early to begin as soon as possible the treatment, which is at present based on heparin therapeutics. Current knowledge and key points. – Neuroimaging examinations are essential for diagnosis of CVT. MR Imaging with MR venography is the key procedure. New sequences are on evaluation in CVT bringing some physiopathogical arguments (Diffusion weighted imaging) or help for diagnosis (with T2* MRI sequence). If D-dimers dosage is helpful for diagnosis of deep venous thrombosis, its interest remains to be determined during CVT. Conclusion. – CVT diagnosis is a challenge for the clinician. Because of the multiple causes and favorising factors, CVT are at the convergence of many specialties and could thus benefit of each one contribution for better understanding the physiopathology, improving earlier diagnosis or identifying the severe forms that could require right away more aggressive treatments than heparin. The interest of local thrombolysis or thrombectomy remains to be determined in an international randomised study. [Copyright &y& Elsevier]

Abstract: Objective. – To review the current data on clinical bedside use of cerebral microdialysis. Data source. – Search through Medline® database of articles in French and English (keywords: microdialysis, cerebral ischaemia, head trauma, subarachnoid haemorrhage, clinical study). Study selection. – All clinical articles published between 1995 and 2005, including original papers and some case reports. Data synthesis. – Microdialysis after occlusive stroke has shown elevated levels of glutamate and lactate. When space-occupying oedema develops, biochemistry abnormalities occur first, before ICP increases. Bedside microdialysis appears to be a sensitive and earlier indicator of space occupying oedema. Most Accurate markers to monitor ischaemia induced by vasospasm are glutamate and lactate/pyruvate ratio. These markers are earlier than clinical abnormalities or pressure measurements (sensibility 82%, specificity 89%). In the field of head trauma, the same compounds were utilised. The level of these compounds correlates with outcome in a different manner whether the area studied is close to a concussion or not. Most of biochemical events are linked to global cerebral ischaemia. We can observe some abnormalities limited to the pericontusional area, which are not detected by the global monitoring. Microdialysis appears a useful tool to investigate disease mechanisms but cannot be recommended for a widespread use after head trauma. Conclusion. – Bedside cerebral microdialysis allows clinical decisions in the setting of subarachnoid haemorrhage and ischaemic stroke. It represents a valuable tool to investigate head trauma pathophysiology. [Copyright &y& Elsevier]

Abstract: Aim. – To determine whether very old age, older than 80 years, after a stroke is a significant predictor of mortality, orientation to a specific care pathway after the acute phase and functional status at 6 months after the stroke. Patients. – A sample of 112 consecutive patients admitted to the emergency department because of a first stroke, with hemiplegia and/or aphasia over 6 months, who satisfied strict inclusion/exclusion criteria. Forty-seven patients were older than 80. Method. – After initial diagnosis and enrolment in the study, follow-up assessments were conducted at 48 hours, 15 days and 6 months. Demographic, medical, and radiographic data were collected, and patients were evaluated on the NIHSS, MMSE, Barthel Index, FIMTM and FAM scales. Descriptive statistics were generated, as were uni- and multivariate between group comparisons. Results. – Our study shows that after a first stroke, old age is significantly associated with a high rate of death, a low rate of orientation to a physical medicine and rehabilitation unit and return to home but not poorer functional outcome. Conclusion. – Old age is therefore a determinant of post stroke management. Further studies are needed to evaluate whether in patient rehabilitation would result in significant functional benefit, considering the high cost of care, high risk of recurrent stroke, and high rate of death. [Copyright &y& Elsevier]

Abstract: Ischemic strokes represent a rare condition in childhood, mostly revealed by a motor deficit. In the pediatric age, strokes are different than in adulthood where atherosclerosis is the major cause. The etiologies of stroke in childhood are rather multiple and each of them is rare. In nearly half of the pediatric cases no cause can be found and usually no recurrence occurs. The aim of this presentation is to propose a diagnosis strategy for ischemic strokes in children. An extensive search should be performed in every children presenting a stroke episode even if the initial outcome appears favorable. Such investigations could improve our understanding and therapeutic strategies of stroke in childhood, a condition where the cognitive and functional prognosis can be severely compromised. [Copyright &y& Elsevier]

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Abstract: Objectives. – To identify and describe the most useful functional disability scales for assessing post-stroke hemiplegic patients and those used largely in clinical trials. Methods. – A literature review of Medline about the functional parameters for balance, gait and mobility, upper extremity functional abilities, and activities of daily living. The metrologic properties of the scales were specified as were their clinical use. Results. – Thirty-three scales were evaluated and classified into five categories: balance (6 scales), gait and mobility (4), upper limb function (11), global motricity scales (5) and independance in activities of daily living (7). Discussion and conclusion. – Many functional scales are useful for assessing post-stroke hemiplegic patients. To assess balance, the Postural Assessment Stroke Scale and Berg Balance Scale are the most interesting. The Functional Ambulation Classification and the Timed Up and Go Test are the most relevant to assess gait and mobility. The Action Research Arm Test is largely used to assess upper limb functional abilities. The Functional Independence Measure and the Barthel Index are largely used to assess independence in activities of daily living. [Copyright &y& Elsevier]

Abstract: Transcranial Doppler and, if possible, measurement of intracranial pressure (ICP) allow preoperative diagnosis of acute intracranial hypertension (ICH) after brain trauma. The main goal of the anaesthesiologist is to prevent the occurrence of secondary brain injuries and to avoid cerebral ischaemia. Treatment of high ICP is mainly achieved with osmotherapy. High-dose mannitol administration (1.4 to 2 g/kg given in bolus doses) may be considered a better option than conventional doses, especially before emergency evacuation of a cerebral mass lesion. Hypertonic saline seems as effective as mannitol without rebound effect and without diuresis increase. Haemostasis should be normalized before neurosurgery and invasive blood pressure monitoring is mandatory. For anaesthesia induction, thiopental or etomidate may be used. In case of ICH, halogenated and nitrous oxide should be avoided. Until the dura is open, mean arterial pressure should be maintained around 90 mmHg (or cerebral perfusion pressure around 70 mmHg). If a long-lasting (several hours) extracranial surgery is necessary, ICP should be monitored and treatment of ICH should have been instituted before. [Copyright &y& Elsevier]

Abstract: Introduction. – Postural control aims to build up and align the body orientation (posture) and stabilize body segments. The existence of two separate mechanisms, one for the control of body orientation with respect to gravity and one for its stabilisation, is an emerging concept that allows a better understanding of postural disorders, including pushing, after stroke. Objectives. – Literature review concerning pushing, one of the most puzzling postural behaviours after stroke. Methods. – Critical review of papers indexed in Medline and book chapters dealing with pushing. Results. – There is no agreement about the definition of pushing: some authors consider that pushers push himself toward the paretic side using the healthy arm or leg; others consider that pushers lean (list) toward the side opposite the lesion and resist any attempt to become more upright. Surprisingly, the push itself has never been measured. Some ordinal scales have been recently proposed, but their psychometric properties have not been analysed. These methodological insufficiencies explain in part the disagreements about frequency (from 5% to 50% of patients with stroke) and cause(s) of pushing. Conclusion. – Pushing may be the most dramatic clinical manifestations of an extreme bias in the construction of the biological vertical. We argue for a better assessment of vertical perception/representation after stroke involving the three modalities of the biological (subjective) vertical: the visual vertical, the haptic or tactile vertical, and especially the postural vertical. [Copyright &y& Elsevier]

Abstract: Acute hepatic porphyrias are genetic diseases, characterized by acute neurological symptoms, sometimes fatal, triggered by different factors, in particular by many anaesthetic drugs, and also by pregnancy. We report here the experience of three porphyric patients''deliveries, allowing us to consider a proposition of management in this context. After discussion between anaesthesiologist, obstetrician and porphyria specialist, two types of management of such patients can be foresee. Asymptomatic patients, or in long remission, can benefit from locoregional anesthesia techniques with bupivacaine for both labour analgesia and Caesarean section. Spinal anaesthesia is then the technique of choice, allowing using smaller quantity of local anaesthetic than epidural anaesthesia. For symptomatic patients, or in crisis, we have rather choose intravenous narcotics for labour analgesia, and general anaesthesia for Caesarean section. The hypnotic agent of choice for both induction and maintenance of such anaesthesia is then propofol. [Copyright &y& Elsevier]

Abstract: Objectives. – To describe the incidence, circumstances, and consequences of falls in patients admitted in a rehabilitation ward after a stroke. Methods. – Prospective monitoring of falls over four years in a neurological rehabilitation unit. Use of fall registry. Inclusion criteria: age&#60;75 years, admission&#60;45 days after stroke onset, single stroke of 1 cerebral hemisphere (nonlacunar) or of the brain stem. Only falls due to loss of balance were considered; falls caused by a seizure or syncope were not considered. Results. – Of 217 consecutive patients with the inclusion criteria, 34 had fallen at least once (15.7%) and 10 twice (4.1%). Fall incidence, defined as the number of falls per patient per day was 2.2 per thousand. Half of the patients fell the first three weeks after admission. Most falls involved getting to or from the wheelchair or the bed; 1 patient had recovered minimal postural abilities at the gym but was not independent. Traumatic lesions were noted in 13 patients: they were minor in nine and severe in four, including three fractures. Conclusion. – Falls due to loss of balance are a major problem in patients undergoing rehabilitation after a stroke. Getting to and from wheelchairs in the bedroom and bathroom by patients who are not allowed to do so play a key role in many falls. Prevention programs should consider this information. [Copyright &y& Elsevier]

Abstract: Approximately 770,000 persons in France suffer from dementia. Alzheimer’s disease is the most frequent cause of dementia, followed by the vascular and mixed forms of dementia. In mixed dementia, the vascular lesions contribute to the severity of the cognitive impairment linked to neurodegenerative lesions. In fact, although the prevalence of cerebrovascular disease and Alzheimer’s disease are both high, some data suggest that their association is not fortuitous. Some vascular risk factors, that also represent risk factors for the development of dementia, are liable to be modified, and especially by nutrition. The question is to what extent nutritional factors may de implicated in the risk of developing dementia, and thus to estimate the possibility of modulating this risk by environmental measures. Cognitively impaired patients lose weight and present many nutritional deficiencies, but transversal studies do not allow to establish a causal link between nutrition and the risk of developing dementia. Longitudinal and cohort studies show an association between diabetes, hyperhomocysteinemia, hypercholesterolemia, low intake in n-3 fatty acids and oxidative stress and the risk of dementia. These nutritional factors contribute to the process of atherosclerosis, but also seem implicated in the physiopathology of neurodegenerative lesions by complex mechanisms. On the whole, few interventional studies have been conducted. Only these studies will help propose specific nutritional recommendations for the prevention of the risk of dementia, and/or to develop a new therapeutic approach. Meanwhile, the priority seems to prevent vascular risk factors, in accordance with the objectives of the Programme National Nutrition et Santé. [Copyright &y& Elsevier]

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