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3. Trombosi venose cerebrali

Author

Alain Ameri, M G Bousser, D. Rougemont, and I Crassard

Subjects
media_common.quotation_subject, Art, Humanities, media_common
Abstract

Anche se piu rare delle trombosi arteriose, le trombosi venose cerebrali (TVC) sono una causa non trascurabile di accidenti vascolari cerebrali. Esse sono caratterizzate dall’estrema varieta della loro presentazione clinica e delle loro eziologie, cosi come dall’imprevedibilita della prognosi, che e, tuttavia, ben migliore di quella delle occlusioni arteriose. La risonanza magnetica associata all’angiografia per risonanza magnetica, facilmente realizzabile, non invasiva e che puo essere utilizzata per il follow-up, rimane attualmente l’esame di riferimento per la diagnosi di TVC. A lungo discusso, il beneficio della terapia eparinica e attualmente ben stabilito.

Published
2012
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5. Trombosis venosas cerebrales

Author

I Crassard, M G Bousser, and J Mawet

Abstract

Las trombosis venosas cerebrales representan una variedad rara de accidente cerebrovascular que puede afectar a personas de cualquier edad. Teniendo en cuenta la diversidad de sus etiologias, pueden observarse en todas las especialidades. Tienen asi mismo una presentacion clinica muy variada que en ocasiones dificulta su diagnostico, el cual se basa en la visualizacion de la trombosis venosa misma mediante la resonancia magnetica o a veces la tomografia computarizada o, en su defecto, mediante la demostracion de una oclusion venosa en las secuencias vasculares. El tratamiento, basado en anticoagulantes, permite por lo general que la evolucion sea favorable con una curacion sin secuelas en alrededor del 75% de los casos.

Published
2010
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6. Trombosi venose cerebrali

Author

M G Bousser, I Crassard, and J Mawet

Subjects
media_common.quotation_subject, Art, Humanities, media_common
Abstract

Le trombosi venose cerebrali rappresentano una rara varieta di accidente vascolare cerebrale che puo colpire persone di ogni eta. Tenuto conto della diversita delle loro eziologie, esse possono essere riscontrate in tutte le discipline. Hanno anche una presentazione clinica molto varia, che rende la loro diagnosi spesso difficile. La diagnosi si basa sulla visualizzazione della trombosi venosa stessa alla RM o a volte alla TC o, in mancanza di questa, sull’evidenziazione di un’occlusione venosa su sequenze vascolari. Il trattamento, basato sugli anticoagulanti, permette abitualmente un’evoluzione favorevole, con una guarigione senza postumi in tre quarti dei casi.

Published
2010
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7. Proposals for New Standardized General Diagnostic Criteria for the Secondary Headaches

Author

Peter J. Goadsby, H. Gobel, M. J. A. Lainez, R. B. Lipton, Jes Olesen, M. B. First, G. Nappi, H.-C. Diener, Jean Schoenen, T. Steiner, M.-G. Bousser, S. D. Silberstein, D. Dodick, and F. Sakai

Subjects
Nosology, medicine.medical_specialty, business.industry, MEDLINE, General Medicine, medicine.disease, Clinical Practice, Neurology, Migraine, Practice Guidelines as Topic, Headache Disorders, Secondary, Humans, Medicine, International Classification of Headache Disorders, Neurology (clinical), Medical emergency, Headaches, medicine.symptom, business, Psychiatry, Medication overuse, Construct (philosophy), Diagnosis-Related Groups
Abstract

Headache classification is a dynamic process through clinical testing and re-testing of current and proposed criteria. After publication of the second edition of the International Classification of Headache Disorders (ICHD-II), need arose for revisions in the classification of medication overuse headache and chronic migraine. These changes made apparent a further need for broader revisions to the standard formulation of diagnostic criteria for the secondary headaches. Currently, the fourth criterion makes impossible the definitive diagnosis of a secondary headache until the underlying cause has resolved or been cured or greatly ameliorated by therapy, at which time the headache may no longer be present. Given that the main purpose of diagnostic criteria is to enable a diagnosis at the onset of a disease in order to guide treatment, this is unhelpful in clinical practice. In the present paper we propose maintaining a standard approach to the secondary headaches using a set of four criteria A, B, C and D, but we construct these so that the requirement for resolution or successful treatment is removed. The proposal for general diagnostic criteria for the secondary headaches will be entered into the internet-based version of the appendix of ICHD-II. During 2009 the Classification Committee will apply the general criteria to all the specific types of secondary headaches. These, and other changes, will be included in a revision of the entire classification entitled ICHD-IIR, expected to be published in 2010. ICHD-IIR will be printed and posted on the website and will be the official classification of the International Headache Society. Unfortunately, it will be necessary to translate ICHD-IIR into the many languages of the world, but the good news is that no major changes to the headache classification are then foreseen for the next 10 years. Until the printing of ICHD-IIR, the printed ICHD-II criteria remain in place for all other purposes. We issue a plea to the headache community to use and study these proposed general criteria for the secondary headaches in order to provide more evidence for their utility—before their incorporation in the main body of the classification.

Published
2009
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8. Idiopathic intracranial hypertension: A comparison between French and North-American white patients

Author

Olivier Gout, Beau B. Bruce, Sarah Mrejen, Alain Vighetto, F. Audren, C. Vignal, Pisit Preechawat, M.-G. Bousser, Valérie Biousse, R. Gineys, Nancy J. Newman, and Alain Gaudric

Subjects
Adult, Male, medicine.medical_specialty, Pediatrics, Visual acuity, Adolescent, Anemia, Vision Disorders, Visual Acuity, Article, White People, Central nervous system disease, Young Adult, Cerebrospinal Fluid Pressure, Epidemiology, medicine, Humans, Risk factor, Retrospective Studies, business.industry, Vision Tests, Medical record, Body Weight, Sleep apnea, French, Middle Aged, medicine.disease, language.human_language, Socioeconomic Factors, Neurology, North America, language, Female, France, Neurology (clinical), Intracranial Hypertension, medicine.symptom, business
Abstract

To compare French and American white patients with idiopathic intracranial hypertension (IIH), and to determine prognostic factors associated with visual loss.Medical records of all consecutive white patients with definite IIH seen between 2001 and 2006 in three French tertiary care medical centers and one American tertiary medical center were reviewed. Demographics, associated clinical features, and visual function at presentation and follow-up were collected. French white patients were compared to American white patients.One hundred and thirty-four patients (66 French, 68 American) were included. American patients were 8.7 times more likely than French patients to have visual acuity 20/60 or worse or visual field constriction (95% CI: 2.1-36.1, p=0.0001). American patients were treated more aggressively than French patients. French patients were older (31 vs. 28 years, p=0.02) and more likely to have anemia (20 vs. 2%, p0.001). American patients had a longer duration of symptoms prior to diagnosis (12 vs. 4 weeks, p=0.01) and longer follow-up than French patients (26 vs. 11 months, p=0.001). Multivariable analysis found that nationality was an independent risk factor for visual loss. French and American patients did not differ regarding gender proportion, frequency of obesity, sleep apnea, endocrine diseases, or systemic hypertension. Cerebrospinal fluid (CSF) opening pressures were similar in both groups.American patients with IIH had worse visual outcomes than French patients despite more aggressive treatment. These differences are not explained by differences in previously known risk factors.

Published
2009
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9. Elicited repetitive daily blindness: A new phenotype associated with hemiplegic migraine and SCN1A mutations

Author

Alain Gaudric, K. Vahedi, D. Le Fort, M.-G. Bousser, Oriane Trouillard, M. A. Morris, Christel Depienne, P. Chaine, Florence Riant, E. Tournier-Lasserve, and Eric LeGuern

Subjects
Male, Proband, Adolescent, Migraine with Aura, Molecular Sequence Data, Mutation, Missense, Nerve Tissue Proteins, Amaurosis Fugax, medicine.disease_cause, Sodium Channels, Recurrence, ATP1A2, medicine, Humans, Missense mutation, Amino Acid Sequence, Familial hemiplegic migraine, Genetics, Mutation, Cerebellar ataxia, Genetic heterogeneity, medicine.disease, Phenotype, Circadian Rhythm, Pedigree, NAV1.1 Voltage-Gated Sodium Channel, Female, Neurology (clinical), medicine.symptom, Psychology, Sequence Alignment, Neuroscience
Abstract

Objective: Familial hemiplegic migraine (FHM) is a genetically heterogeneous disorder in which three genes, CACNA1A , ATP1A2 , and SCN1A , are currently known to be involved. FHM is occasionally associated with other neurologic symptoms such as cerebellar ataxia or epileptic seizures. A unique eye phenotype of elicited repetitive daily blindness (ERDB) has also been reported to be cosegregating with FHM in a single Swiss family. Methods: We report an additional family in whom the proband had, in addition to FHM, typical ERDB. In this family and the previously reported Swiss family, the whole coding region of the SCN1A gene was screened after exclusion of mutation in CACNA1A and ATP1A2 genes. Results: We identified two novel SCN1A mutations (c.4495T>C/p.Phe1499Leu and c.4467G>C/p.Gln1489His missense substitutions) in exons 24 and 23, respectively, segregating with the disease in all living affected members. Both mutations were absent from 180 healthy Caucasian controls and were located in an intracellular loop highly conserved throughout evolution. Conclusion: We report new clinical data supporting cosegregation of familial hemiplegic migraine and the new eye phenotype of elicited repetitive daily blindness and two novel SCN1A mutations as the underlying genetic defect in two unrelated families. SCN1A encodes the voltage-gated sodium channel Nav1.1 that is highly expressed in the CNS including the retina. This remarkably stereotyped new eye phenotype has clinical characteristics of abnormal propagation of the retinal electrical signal that may be a retinal spreading depression. These results suggest that SCN1A mutations, which alter neuronal brain excitability, may occasionally alter retinal cell excitability.

Published
2009
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10. Dégénérescence maculaire liée à l’âge et risque d’accident vasculaire cérébral

Author

Alain Gaudric, M G Bousser, and Valérie Biousse

Subjects
medicine.medical_specialty, business.industry, Vascular risk, Macular degeneration, medicine.disease, eye diseases, Ophthalmology, Age related, Internal medicine, Epidemiology, medicine, Etiology, cardiovascular diseases, business, Stroke
Abstract

Age-related macular degeneration (ARMD) and stroke are common causes of disability in subjects over 40 years of age. The etiology of ARMD remains unknown and numerous epidemiological studies have suggested a relationship between vascular risk factors and ARMD. A direct relationship between stroke and ARMD has also been suggested. An update on the association between ARMD and stroke is discussed in this article.

Published
2008
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11. Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage

Author

Danni Zheng, Shoichiro Sato, Hisatomi Arima, Emma Heeley, Candice Delcourt, Yongjun Cao, John Chalmers, Craig S. Anderson, C.S. Anderson, J. Chalmers, H. Arima, S. Davis, E. Heeley, Y. Huang, P. Lavados, B. Neal, M.W. Parsons, R. Lindley, L. Morgenstern, T. Robinson, C. Stapf, C. Tzourio, J.G. Wang, S. Chen, X.Y. Chen, L. Cui, Z. Liu, C. Lu, J. Wang, S. Wu, E. Xu, Q. Yang, C. Zhang, J. Zhang, R. Beer, E. Schmutzhard, P. Redondo, M. Kaste, L. Soinne, T. Tatlisumak, K. Wartenberg, S. Ricci, K. Klijn, E. Azevedo, A. Chamorro, M. Arnold, U. Fischer, S. Kaul, J. Pandian, H. Boyini, S. Singh, A.A. Rabinstein, C. Estol, G. Silva, V.V. Olavarria, T.G. Robinson, R.J. Simes, M.-G. Bousser, G. Hankey, K. Jamrozik, S.C. Johnston, S. Li, K. Bailey, T. Cheung, C. Delcourt, S. Chintapatla, E. Ducasse, T. Erho, J. Hata, B. Holder, E. Knight, M. Leroux, T. Sassé, E. Odgers, R. Walsh, Z. Wolfowicz, G. Chen, S. Fuentes, B. Peng, H.-M. Schneble, M.-X. Wang, L. Billot, S. Heritier, Q. Li, M. Woodward, S. Abimbola, S. Anderson, E. Chan, G. Cheng, P. Chmielnik, S. Leighton, J.-Y. Liu, B. Rasmussen, A. Saxena, S. Tripathy, M. Armenis, M.A. Baig, B. Naidu, G. Starzec, S. Steley, A. Moles, A. Ruiz, M. Zimmermann, J. Marinho, S. Alves, R. Angelim, J. Araujo, L. Kawakami, C. Bustos, F. Gonzalez, P. Munoz Venturelli, X. Chen, R. Jia, N. Li, S. Qu, Y. Shu, A. Song, J. Sun, J. Xiao, Y. Zhao, Q. Huang, E. Vicaut, A. Chamam, M.-C. Viaud, C. Dert, U. Fiedler, V. Jovis, S. Kabla, S. Marchand, A. Pena, V. Rochaud, K. Mallikarjuna, N. Hasan, E. Berge, E.C. Sandset, A.S. Forårsveen, D. Richardson, T. Kumar, S. Lewin, N. Poulter, J. Field, A. Anjum, A. Wilson, H. Perelmuter, A.M. Agarie, A.G. Barboza, L.A. Recchia, I.F. Miranda, S.G. Rauek, R.J. Duplessis, H. Dewey, L. Walker, S. Petrolo, C. Bladin, J. Sturm, D. Crimmins, D. Griffiths, A. Schutz, V. Zenteno, F. Miteff, N. Spratt, E. Kerr, C.R. Levi, T.G. Phan, H. Ma, L. Sanders, C. Moran, K. Wong, S. Read, R. Henderson, A. Wong, R. Hull, G. Skinner, P. Hand, B. Yan, H. Tu, B. Campbell, D.J. Blacker, T. Wijeratne, M. Pathirage, M. Jasinararchchi, Z. Matkovic, S. Celestino, F. Gruber, M.R. Vosko, E. Diabl, S. Rathmaier, B. Pfausler, R. Helbok, F. Fazekas, R. Fischer, B. Poltrum, B. Zechner, U. Trummer, M.P. Rutgers, A. Peeters, A. Dusart, M.-C. Duray, C. Parmentier, S. Ferrao-Santos, R. Brouns, S. De Raedt, A. De Smedt, R.-J. VanHooff, J. De Keyser, S.C.O. Martins, A.G. de Almeida, R. Broudani, N.F. Titton, G.R. de Freitas, F.M. Cardoso, L.M. Giesel, N.A. Lima, A.C. Ferraz de Almeida, R.B. Gomes, T.S. Borges dos Santos, E.M. Veloso Soares, O.L.A. Neto, G.S. Silva, D.L. Gomes, F.A. de Carvalho, M. Miranda, A. Marques, V.F. Zétola, G. de Matia, M.C. Lange, J. Montes, A. Reccius, A. Soto, R. Rivas, C. Klapp, S. Illanes, C. Aguilera, A. Castro, C. Figueroa, J. Benavides, P. Salamanca, M.C. Concha, J. Pajarito, P. Araya, F. Guerra, Y. Li, G. Liu, B. Wang, Y. Chong, M. He, L. Wang, J. Liu, X. Zhang, C. Lai, H. Jiang, S. Cui, Q. Tao, Y. Zhang, S. Yao, M. Xu, H. Xiao, J. Hu, J. Tang, H. Ji, M. Jiang, F. Yu, X. Yang, X. Guo, Y. Wang, L. Wu, Y. Gao, D. Sun, X. Huang, L. Liu, P. Li, Y. Jiang, H. Li, H. Lu, J. Zhou, C. Yuan, X. Qi, F. Qiu, H. Qian, W. Wang, W. Sun, F. Li, R. Liu, Q. Peng, Z. Ren, C. Fan, H. Wang, T. Wang, F. Shi, C. Duan, Z. Chen, X. Tan, Z. Zhao, J. Chen, T. Han, L. Zhang, Q. Hu, Q. Hou, X. Zhao, G. Zeng, L. Ma, F. Wang, L. Zeng, Z. Guo, Y. Fu, Y. Song, L. Tai, X. Liu, X. Su, Y. Yang, R. Dong, Y. Xu, S. Tian, S. Cheng, L. Su, X. Xie, T. Xu, D. Geng, X. Yan, H. Fan, N. Zhao, S. Wang, J. Yang, M. Yan, L. Li, Z. Li, X. Xu, Y. Lian, H. Sun, D. Liu, N. Wang, Q. Tang, Z. Han, L. Feng, Y. Cui, J. Tian, H. Chang, X. Sun, C. Liu, Z. Wen, Q. Lin, L. Sun, B. Hu, M. Zou, Q. Bao, X. Lin, L. Zhao, X. Tian, X. Wang, X. Li, L. Hao, Y. Duan, R. Wang, Z. Wei, S. Ren, H. Ren, Y. Dong, Y. Cheng, W. Liu, J. Han, Z. Zhang, J. Zhu, J. Qian, Y. Sun, K. Liu, F. Long, X. Peng, Q. Zhang, Z. Yuan, C. Wang, M. Huang, P. He, Y. You, J. Xia, L. Zhou, Y. Hou, Y. Qi, L. Mei, R. Lu, L. Ping, S. Zhou, S. Zhang, R. Zou, J. Guo, M. Li, W. Wei, S. Curtze, M. Saarela, D. Strbian, F. Scheperjans, T. De Broucker, C. Henry, R. Cumurciuc, N. Ibos-Augé, A.-C. Zéghoudi, F. Pico, O. Dereeper, M.-C. Simian, C. Boisselier, A. Mahfoud, S. Timsit, F.M. Merrien, B. Guillon, M. Sevin, F. Herisson, C. Magne, A. Ameri, C. Cret, S. Stefanizzi, F. Klapzcynski, C. Denier, M. Sarov-Riviere, P. Reiner, J. Mawet, D. Hervé, F. Buffon, E. Touzé, V. Domigo, C. Lamy, D. Calvet, M. Pasquini, S. Alamowitch, P. Favrole, I.-P. Muresan, S. Crozier, C. Rosso, C. Pires, A. Leger, S. Deltour, C. Cordonnier, H. Henon, C. Rossi, M. Zuber, M. Bruandet, R. Tamazyan, C. Join-Lambert, E. Juettler, T. Krause, S. Maul, M. Endres, G.J. Jungehulsing, M. Hennerici, M. Griebe, T. Sauer, K. Knoll, R. Huber, K. Knauer, C. Knauer, S. Raubold, H. Schneider, H. Hentschel, C. Lautenschläger, E. Schimmel, I. Dzialowski, C. Foerch, M. Lorenz, O. Singer, I.M.R. Meyer dos Santos, A. Hartmann, A. Hamann, A. Schacht, B. Schrader, A. Teíchmann, K.E. Wartenberg, T.J. Mueller, S. Jander, M. Gliem, C. Boettcher, M. Rosenkranz, C. Beck, D. Otto, G. Thomalla, B. Cheng, K.S. Wong, T.W. Leung, Y.O.Y. Soo, S. Prabhakar, S.R. Kesavarapu, P.K. Gajjela, R.R. Chenna, K. Ummer, M. Basheer, A. Andipet, M.K.M. Jagarlapudi, A.U.R. Mohammed, V.G. Pawar, S.S.K. Eranki, Y. Singh, N. Akhtar, N.C. Borah, M. Ghose, N. Choudhury, N.R. Ichaporia, J. Shendge, S. Khese, V. Pamidimukkala, P. Inbamuthaiah, S.R. Nuthakki, N.M.R. Tagallamudi, A.K. Gutti, D. Khurana, P. Kesavarapu, V. Jogi, A. Garg, D. Samanta, G.R.K. Sarma, R. Nadig, T. Mathew, M.A. Anandan, E. Caterbi, A. Zini, M. Cavazzuti, F. Casoni, R. Pentore, F. Falzone, T. Mazzoli, L.M. Greco, C. Menichetti, F. Coppola, S. Cenciarelli, E. Gallinella, A. Mattioni, R. Condurso, I. Sicilia, M. Zampolini, F. Corea, M. Barbi, C. Proietti, D. Toni, A. Pieroni, A. Anzini, A. Falcou, M. Demichele, C.J.M. Klijn, A. Tveiten, E.T. Thortveit, S. Pettersen, N. Holand, B. Hitland, S.H. Johnsen, A. Eltoft, M. Wasay, A. Kamal, A. Iqrar, L. Ali, D. Begum, G. Gama, L. Fonseca, G. Moreira, L.M. Veloso, D. Pinheiro, L. Paredes, C. Rozeira, T. Gregorio, T. Segura Martin, O. Ayo, J. Garcia-Garcia, I. Feria Vilar, I. Gómez Fernández, S. Amaro, X. Urra, V. Obach, A. Cervera, Y. Silva, J. Serena, M. Castellanos, M. Terceno, C. Van Eendenburg, A. Weck, O. Findling, R. Lüdi, E.A. Warburton, D. Day, N. Butler, E. Bumanlag, S. Caine, A. Steele, M. Osborn, E. Dodd, P. Murphy, B. Esisi, E. Brown, R. Hayman, V.K.V. Baliga, M. Minphone, J. Kennedy, I. Reckless, G. Pope, R. Teal, K. Michael, D. Manawadu, L. Kalra, R. Lewis, B. Mistry, E. Cattermole, A. Hassan, L. Mandizvidza, J. Bamford, H. Brooks, C. Bedford, R. Whiting, P. Baines, M. Hussain, M. Harvey, K. Fotherby, S. McBride, P. Bourke, D. Morgan, K. Jennings-Preece, C. Price, S. Huntley, V.E. Riddell, G. Storey, R.L. Lakey, G. Subramanian, D. Jenkinson, J. Kwan, O. David, D. Tiwari, M. James, S. Keenan, H. Eastwood, L. Shaw, P. Kaye, D. Button, B. Madigan, D. Williamson, A. Dixit, J. Davis, M.O. Hossain, G.A. Ford, A. Parry-Jones, V. O'Loughlin, R. Jarapa, Z. Naing, C. Lovelock, J. O'Reilly, U. Khan, A. Bhalla, A. Rudd, J. Birns, D.J. Werring, R. Law, R. Perry, I. Jones, R. Erande, C. Roffe, I. Natarajan, N. Ahmad, K. Finney, J. Lucas, A. Mistri, D. Eveson, R. Marsh, V. Haunton, J.E. Fugate, S.W. Lepore, Neurologian yksikkö, Clinicum, Neurology, Clinical sciences, Neuroprotection & Neuromodulation, Supporting clinical sciences, UZB Other, Physical Medicine and Rehabilitation, and Vriendenkring VUB

Subjects
CHRONIC KIDNEY-DISEASE, Male, systolic blood pressure, medicine.medical_treatment, Blood Pressure, 030204 cardiovascular system & hematology, GLOMERULAR-FILTRATION-RATE, 3124 Neurology and psychiatry, RESISTANT HYPERTENSION, 0302 clinical medicine, Modified Rankin Scale, cerebral hemorrhage, cerebrovascular disease, chronic kidney disease (CKD), dialysis, estimated glomerular filtration rate (EGFR), hemodialysis, intensive blood pressure lowering treatment, INTERACT2, intracerebral hemorrhage (ICH), Kidney function, stroke, Stroke, education.field_of_study, OUTCOMES, estimated glomerular filtration rate (eGFR), Antihypertensive Agents/pharmacology, ASSOCIATION, Urology & Nephrology, Middle Aged, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], 3. Good health, PREVALENCE, Nephrology, Acute Disease, Female, Cerebral Hemorrhage/drug therapy, WHITE-MATTER, Glomerular Filtration Rate, STROKE PATIENTS, medicine.medical_specialty, RENAL-FUNCTION, LONG-TERM, Population, Renal function, Blood Pressure/drug effects, 03 medical and health sciences, Internal medicine, medicine, Humans, education, Dialysis, Antihypertensive Agents, Aged, Cerebral Hemorrhage, Intracerebral hemorrhage, business.industry, 1103 Clinical Sciences, medicine.disease, Surgery, Blood pressure, business, 030217 neurology & neurosurgery, Kidney disease
Abstract

Markku Kaste ja Filip Scheperjans työryhmän jäsenenä. Background: The kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH) outcomes have yielded inconsistent findings. Although the second, main phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) suggests the effectiveness of early intensive blood pressure (BP) lowering in improving functional recovery after ICH, the balance of potential benefits and harms of this treatment in those with decreased kidney function remains uncertain. Study Design: Secondary analysis of INTERACT2, which randomly assigned patients with ICH with elevated systolic BP (SBP) to intensive (target SBP 90, 60-90, and Outcomes: The effect of admission eGFR on the primary outcome of death or major disability at 90 days (defined as modified Rankin Scale scores of 3-6) was analyzed using a multivariable logistic regression model. Potential effect modification of intensive BP lowering treatment by admission eGFR was assessed by interaction terms. Results: Of 2,623 included participants, 912 (35%) and 280 (11%) had mildly and moderately/severely decreased eGFRs, respectively. Patients with moderately/severely decreased eGFRs had the greatest risk for death or major disability at 90 days (adjusted OR, 1.82; 95% CI, 1.28-2.61). Effects of early intensive BP lowering were consistent across different eGFRs (P = 0.5 for homogeneity). Limitations: Generalizability issues arising from a clinical trial population. Conclusions: Decreased eGFR predicts poor outcome in acute ICH. Early intensive BP lowering provides similar treatment effects in patients with ICH with decreased eGFRs. Am J Kidney Dis. 68(1): 94-102. (C) 2016 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY-NC-ND license.

Published
2015

12. Cortical Neuronal Apoptosis in CADASIL

Author

Françoise Gray, Anand Viswanathan, Hugues Chabriat, M Baudrimont, and M G Bousser

Subjects
Adult, Male, Pathology, medicine.medical_specialty, Apoptosis, CADASIL, Central nervous system disease, Leukoencephalopathy, White matter, medicine, Humans, Cognitive decline, Vascular dementia, Receptor, Notch3, Aged, Cerebral Cortex, Neurons, Advanced and Specialized Nursing, Receptors, Notch, business.industry, Middle Aged, CADASIL Syndrome, medicine.disease, Magnetic Resonance Imaging, medicine.anatomical_structure, Cerebral cortex, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Abstract

Background and Purpose— Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is caused by mutations of the NOTCH3 gene and is a model of pure vascular dementia. Cortical atrophy has been reported to be associated with cognitive decline in the disease, although the underlying mechanism is unknown. We postulated that apoptosis may be involved in this process. Methods— We report the clinical history, magnetic resonance imaging findings, and pathologic examinations of 4 patients (2 of whom were demented) who died from complications of the disease. Apoptosis was evaluated in brain tissue using antibodies against activated caspase3 and in situ end labeling assays for DNA fragmentation. Results— Widespread neuronal apoptosis in the cerebral cortex (predominantly in layers 3 and 5) was observed in all patients. This was not seen in 3 non-CADASIL controls. Semiquantitative analysis suggested that apoptosis was more extensive in the presence of larger load of subcortical ischemic lesions and smaller brain volumes. Conclusions— Neuronal apoptosis may be involved in cortical atrophy in CADASIL and appears related to the burden of subcortical ischemic lesions. These findings may have important implications in other small vessel diseases and may provide a potential target for future therapeutic interventions.

Published
2006
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14. Traitement médicamenteux de fond de la migraine

Author

H. Massiou and M.-G. Bousser

Subjects
Drug, Topiramate, Aspirin, business.industry, media_common.quotation_subject, Methysergide, medicine.disease, chemistry.chemical_compound, Neurology, chemistry, Migraine, Anesthesia, medicine, Amitriptyline, Neurology (clinical), Oxetorone, business, Flunarizine, medicine.drug, media_common
Abstract

Prophylactic treatment is mainly intended to reduce the frequency of migraine attacks. Based on the results of published controlled trials, the main prophylactic drugs are some beta-blockers, methysergide, pizotifene, oxetorone, flunarizine, amitriptyline, NSAIDs, sodium valproate and topiramate. With these drugs, the frequency of attacks can be reduced by half in 50 percent of patients. Some less evaluated substances such as aspirin, DHE, indoramine, and angiotensin II inhibitors may be useful. The decision to treat with drugs and the choice of a prophylactic drug are made together with the patient. The superiority of one major drug over another has never been demonstrated in a comparative trial, thus the choice of the drug to start with depends on the possible side effects and contraindications, the characteristics of the migraine attacks, and the associated morbidities and possible interactions with abortive medications. Doses should be increased gradually, in order to reach the recommended daily dose, only if tolerance permits. Treatment efficacy has to be assessed after 2 or 3 months, and in case of failure or poor tolerance, another treatment should be started. If the treatment is successful, it should be continued for 6 to 12 months, and then tapered off. The moderate efficacy and the frequency of the side effects observed with prophylactic drugs explain the high rate of withdrawals. Some patients nevertheless dramatically improve, warranting trying several drugs successively in order to find the most appropriate one.

Published
2005
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15. The International Classification of Headache Disorders, 2nd Edition (ICHD-II)—-Revision of Criteria for 8.2 Medication-Overuse Headache

Author

J. W. Lance, David W. Dodick, M. J.A. Lainez, Jean Schoenen, Peter J. Goadsby, Richard B. Lipton, G. Nappi, Stephen D. Silberstein, M. First, Jes Olesen, H. Göbel, F. Sakai, M. G. Bousser, T. J. Steiner, and H. C. Diener

Subjects
Analgesics, book.periodical, medicine.medical_specialty, business.industry, Headache, General Medicine, Substance Withdrawal Syndrome, 03 medical and health sciences, 0302 clinical medicine, Cephalalgia, medicine, Physical therapy, Humans, International Classification of Headache Disorders, 030212 general & internal medicine, Neurology (clinical), Headache Disorders, Medication overuse, Psychiatry, business, book, 030217 neurology & neurosurgery
Abstract

Silberstein SD, Olesen J, Bousser M-G, Diener H-C, Dodick D, First M, Goadsby PJ, Gobel H, Lainez MJA, Lance JW, Lipton RB, Nappi G, Sakai F, Schoenen J & Steiner TJ on behalf of the International Headache Society. The International Classification of Headache Disorders, 2nd Edition (ICHD-II)—revision of criteria for 8.2 Medication-overuse headache . Cephalalgia 2005; 25:460–465. London. ISSN 0333-1024

Published
2005
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16. Hypotension spontanée du liquide cérébrospinal

Author

S. Berroir and M.-G. Bousser

Subjects
Gynecology, Epidural blood patch, medicine.medical_specialty, Neurology, business.industry, medicine, Neurology (clinical), medicine.disease, Intracranial Hypotension, business, Orthostatic headache
Abstract

Resume L'hypotension intracrânienne spontanee est une cause rare de cephalee secondaire due a une hypovolemie du liquide cerebrospinal, survenant en l'absence de breche durale connue. L'association d'une presentation clinique simple, d'une cephalee orthostatique et d'une imagerie par resonance magnetique caracteristique a permis ces dernieres annees d'en faire plus facilement et beaucoup plus frequemment le diagnostic. La semiologie jusqu'alors rigoureusement stereotypee s'enrichit d'annee en annee de formes atypiques trompeuses. En revanche l'attitude therapeutique, qui repose sur l'emploi du « blood-patch » epidural, commence a etre mieux codifiee.

Published
2004
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17. Nouvelle classification internationale des céphalées

Author

H. Massiou and M.-G. Bousser

Subjects
Neurology, business.industry, Medicine, Neurology (clinical), business, Humanities
Abstract

Resume La deuxieme classification internationale des cephalees vient d'etre publiee (2004) sous l'egide de l'International Headache Society. La premiere classification (1988) avait constitue une avancee majeure dans le domaine des cephalees, permettant a tous d'utiliser des criteres diagnostiques communs, base indispensable a toute recherche scientifique. Cet article resume et commente la structure et les principes communs aux deux classifications, ainsi que les principales modifications effectuees dans la seconde edition.

Published
2004
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18. Reversible leukoencephalopathy in cerebral amyloid angiopathy presenting as subacute dementia

Author

Pierre Amarenco, D. Dimitri, J. Mikol, M. G. Bousser, M. Sarazin, and G. Lot

Subjects
Pathology, medicine.medical_specialty, Hypertensive encephalopathy, Biopsy, Leukoencephalopathy, Nerve Fibers, medicine, Humans, Dementia, Antihypertensive Agents, Aged, medicine.diagnostic_test, business.industry, Brain biopsy, Brain, Magnetic resonance imaging, medicine.disease, Magnetic Resonance Imaging, Cerebral Amyloid Angiopathy, medicine.anatomical_structure, Neurology, Cerebral cortex, Hypertension, Anticonvulsants, Female, Neurology (clinical), Cerebral amyloid angiopathy, business
Abstract

This report concerns a 71-year-old woman who had rapid progressive dementia along with myocloni and increased blood pressure. Cranial computed tomography and magnetic resonance imaging scans showed bilateral widespread white matter changes with mass effect. A brain biopsy revealed an amyloid angiopathy in leptomeningeal as well as cerebral cortex arteries. After 2 months of antihypertensive treatment, a dramatic improvement of cognitive functions and a spectacular regression of leukoencephalopathy were observed. We suggest that hypertensive encephalopathy may worsen or reveal cerebral amyloid angiopathy.

Published
2002
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19. Association between migraine and endothelin type A receptor (ETA -231 A/G) gene polymorphism

Author

Christophe Tzourio, M.-G. Bousser, V. Nicaud, M. El Amrani, Annick Alpérovitch, and Odette Poirier

Subjects
Male, medicine.medical_specialty, Genotype, Migraine Disorders, DNA Mutational Analysis, Population, Nitric Oxide, Sex Factors, Risk Factors, Polymorphism (computer science), Internal medicine, Prevalence, medicine, Humans, Longitudinal Studies, education, Alleles, Aged, education.field_of_study, Polymorphism, Genetic, Endothelin-1, Receptors, Endothelin, business.industry, Age Factors, Odds ratio, Receptor, Endothelin A, medicine.disease, Endothelin 1, Endocrinology, Migraine, Vasoconstriction, Cerebrovascular Circulation, Female, Neurology (clinical), Headaches, medicine.symptom, business, Endothelin receptor
Abstract

Background: Previous studies have described an association between migraine and endothelin, a potent vasoconstrictor. Objective: To test the association between migraine and gene polymorphisms of the endothelin system. Methods: A population-based study of elderly individuals (n = 1,188) in Nantes (western France) was conducted. Lifetime migraine was defined according to the International Headache Society criteria, after an interview with a headache specialist. Five polymorphisms in genes encoding endothelin 1, endothelin type A (ET A ), and type B receptors were determined in more than 90% of the sample. Results Migraine was diagnosed in 140 participants (11.9%). The ETA (−231 A/G) polymorphism was the only polymorphism significantly associated with migraine. There was a trend of decreasing prevalence of migraine with number of copies of the G allele (AA genotype: 15.7% of participants with migraine, AG: 9.7%, GG: 2.9%; p G allele was associated with a sex- and age-adjusted odds ratio of 0.50 (95% CI, 0.34 to 0.74). The association was observed in both sexes and was stronger in participants with a family history of severe headaches than in those without. Conclusions: A variant of the ET A receptor gene modulates the risk for migraine. These results offer new insights into the pathophysiology of the vascular component of migraine.

Published
2001
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20. Sphenoid and optic nerve sheath meningioma revealed by recurrent brain infarctions

Author

M.-G. Bousser, A. Mourad, Katayoun Vahedi, C. Vignal, and Jean-Pierre Guichard

Subjects
Adult, Carotid Artery Diseases, Male, Microsurgery, Recurrence, medicine.artery, Sphenoid Bone, Aphasia, otorhinolaryngologic diseases, medicine, Anterior cerebral artery, Humans, cardiovascular diseases, neoplasms, Optic canal, business.industry, Optic Nerve Neoplasms, Carotid Artery Thrombosis, Cerebral Infarction, Anatomy, Cerebral Arteries, Decompression, Surgical, medicine.disease, nervous system diseases, Optic nerve sheath meningioma, Carotid Arteries, medicine.anatomical_structure, Neurology, Middle cerebral artery, Cavernous sinus, cardiovascular system, Optic nerve, Neurology (clinical), Internal carotid artery, Meningioma, Tomography, X-Ray Computed, business, Orbit
Abstract

Meningioma, though benign, may invade adjacent structures such as bone, soft tissues, dural sinuses and arteries. However brain infarctions secondary to meningioma involving the cavernous sinus and encasing and narrowing the intracranial carotid artery are rare. We report the case of a young man with recurrent left carotid artery infarctions due to a left sphenoid meningioma infiltrating the posterior optic nerve sheath through the optic canal and circumscribing the intracranial carotid artery. The patient had a gradually progressive occlusion of the middle cerebral artery, the distal internal carotid artery and finally the anterior cerebral artery ipsilateral to the sphenoid meningioma.

Published
2009
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22. Acute Ischemic Stroke and Heparin Treatments

Author

P C Desnoyers, M G Bousser, J. Conard, and M.M. Samama

Subjects
medicine.medical_specialty, medicine.drug_class, business.industry, Vascular disease, Cerebral infarction, medicine.medical_treatment, Ischemia, Low molecular weight heparin, Hematology, Heparin, medicine.disease, Surgery, Clinical trial, Fibrinolysis, medicine, Platelet activation, business, Intensive care medicine, medicine.drug
Abstract

Several case-control studies have reported enhanced platelet activity, hypercoagulation and/or reduced fibrinolytic activity in patients with acute ischemic stroke. However, results of these studies are conflicting and do not allow to make recommendations regarding heparin treatment. The aim of heparin treatment in stroke patients is to prevent venous thromboembolic complications, to improve patient neurologic outcome, to reduce mortality and to prevent early recurrence. Unfortunately, only the first objective has been confirmed. As far as neurologic outcome and mortality are concerned, only trials performed since the CT era should be taken into account because the former ones did not rule out cerebral haemorrhages. The most recent clinical trials using LMWHs gave better results than the previous trials with UFH, but data are still conflicting and firm recommendations cannot be made until the results of ongoing megatriasl (such as IST) become available. As regards prevention of early recurrence, most authors agree that heparin is indicated in cardioembolic stroke.

Published
1997
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23. Céphalées de l’hypotension spontanée du liquide cérébro-spinal

Author

M.-G. Bousser

Subjects
Epidural blood patch, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Vascular disease, Lumbar puncture, medicine.disease, Surgery, Central nervous system disease, Lumbar, Cerebrospinal fluid, Neurology, medicine, Neurology (clinical), business, Intracranial Hypotension, Orthostatic headache
Abstract

Cerebrospinal fluid hypotension is a rare, incapacitating syndrome characterized by cerebrospinal fluid hypovolemia occurring in the absence of known dural tear. Severe orthostatic headache is the main symptom and clinical examination is usually normal. Magnetic resonance imaging shows the characteristic association of three signs: diffuse pachymeningeal gadolinium enhancement, sagging brain and bilateral subdural collections. Lumbar puncture is contraindicated. The single most effective treatment is lumbar epidural blood patch which cures over 50 percent of the patients and can be repeated in case of recurrence. The search for a dural tear is rarely necessary and surgical treatment is exceptionally required.

Published
2005
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24. Céphalées au cours des thromboses veineuses cérébrales

Author

M.-G. Bousser and I. Crassard

Subjects
Pediatrics, medicine.medical_specialty, Headache diagnosis, Vascular disease, business.industry, Disorders of consciousness, Neurological disorder, medicine.disease, Central nervous system disease, Venous thrombosis, Neurology, Migraine, medicine, Neurology (clinical), Venous disease, business
Abstract

Headache is the most frequent symptom of cerebral venous thrombosis. They do not have particular characteristics and can mimic other numerous varieties of headache. Frequently associated with other neurological symptoms, such as intracranial hypertension, seizures, focal deficits or disorders of consciousness, they are sometimes isolated, which stresses the need for investigations in all recent and unusual headache.

Published
2005
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25. Carotid artery dissection with renal infarcts. Two cases

Author

Pierre Amarenco, Ariel Cohen, Marie-Laure Seux-Levieil, Pierre-Jean Touboul, M G Bousser, and C. Levy

Subjects
Carotid Artery Diseases, Male, medicine.medical_specialty, Horner Syndrome, Cerebral arteries, Blood Sedimentation, Fibromuscular dysplasia, Kidney, Carotid artery dissection, Renal Artery, medicine.artery, Ascending aorta, Fibromuscular Dysplasia, Humans, Medicine, Fatigue, Advanced and Specialized Nursing, Aortic dissection, medicine.diagnostic_test, business.industry, Middle Aged, medicine.disease, Abdominal Pain, Aortic Dissection, Infarction, cardiovascular system, Female, Neurology (clinical), Radiology, Internal carotid artery, Cardiology and Cardiovascular Medicine, business, Renal Infarct, Carotid Artery, Internal, Cerebral angiography
Abstract

Clinical features of carotid artery dissection include ipsilateral local signs, contralateral ischemic stroke, or both. We observed two patients in whom these features were associated with renal infarcts. A 57-year-old woman had painful Horner's syndrome caused by a right internal carotid artery dissection. On days 3 and 4 she had acute abdominal pain, first on the right side and later on the left. The computed tomographic (CT) scan showed a left renal infarct. No aortic dissection or cardiac source of embolism was found. Transesophageal echocardiography showed a mild dystrophy of the ascending aorta and of the mitral valve. Cerebral angiography showed irregularities of the V3 segment of the left vertebral artery compatible with fibromuscular dysplasia. Erythrocyte sedimentation rate was 100 mm/h, and she complained of intense fatigue. She fully recovered within 3 months. A 53-year-old man had sudden severe abdominal pain followed by headache and difficulty in swallowing. He had 9th, 10th, 11th, and 12th cranial nerve involvement on both sides due to bilateral internal carotid artery dissections and pseudoaneurysms. CT scan showed a left renal infarct. Angiography showed extensive signs of fibromuscular dysplasia involving carotid, vertebral, renal, iliac, and mesenteric arteries as well as a dissection of the left renal artery. Erythrocyte sedimentation rate was 65 mm/h, and he complained of severe fatigue. His neurological signs returned to normal in 6 months. Renal infarct due to renal artery dissection may occur together with cerebral artery dissection. Acute abdominal pain, increased erythrocyte sedimentation rate, and intense fatigue are the warning symptoms.

Published
1994
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26. Fourth meeting of the European Neurological Society 25–29 June 1994 Barcelona, Spain

Author

H. Hattig, C. Delli Pizzi, M. C. Addonizio, Michelle Davis, A. R. Giovagnoli, L. Florensa, M. Roth, J. de Kruijk, Francisco Lacruz, Ph. Dewailly, A. Toygar, C. Avendano, P.P. De Deyn, J. F. Hurtevent, F. Lomeila, T. W. Wong, Gordon T. Plant, M. Bud, H. J. Willison, DH Miller, D. W. Langdon, R. Cioni, J. Servan, A. Kaygisiz, E. Racadot, D. B. Schens, E. Picciola, L. Falip, C. Bouchard, J. Jotova, A. Jorge-Santamaria, P. Misra, A. Dufour, C. P. Panagopoulos, A. Venneri, B. Sredni, B. Angelard, M. Janelidze, M. Carreno, J. Obenberger, J. Pouget, H. W. Moser, R. Kaufmann, J. A. Molina, D. Linden, A. Martin Urda, E. Uvestad, A. Krone, J. P. Cochin, J. Mallecourt, A. Cambon-Thomsen, K. Violleau, P. Osschmann, A. M. Durocher, E. Bussaglia, D. M. Danielle, H. Efendi, C. Van Broeckhoven, K. G. Jordan, W. Rautenberg, C. Iniguez, J. M. Delgado, Graham Watson, M. Lawden, Gareth J. Barker, K. Stiasny, James T. Becker, G. Campanella, E. Peghi, A. Poli, A. Haddad, T. Yamawaki, Giacomo P. Comi, S. Sotgiu, B. Ersmark, A. Pomes, M. Ziegler, P. Ferrante, P. Ruppi, H. KuÇukoglu, R. Bouton, U. K. Rinne, P. Vieregge, M. Dary, P. Giunti, Peter J. Goadsby, S. Jung, E. Secor, A. Steinberg, N. Vila, M. A. Hernandez, M. Cursi, A. Enqelhardt, A. Engelhardt, J. Veitch, F. Di Silverio, F. Arnaud, B. Neundörfer, R. Brucher, Dominique Caparros-Lefebvre, B. Meyer, Marianne Dieterich, M. H. Snidaro, R. Gomez, R. Cerbo, M. Ragno, J. M. Vance, S. Nemni, A. Caliskan, F. Barros, I. Velcheva, D. Ceballos-Baumann, V. Barak, A. Avila, N. Antonova, F. Resche, S. Pappata, L. Varela, S. R. Silveira Santos, A. Cammarota, L. Naccache, Y. Nara, E. Tournier-Lasserves, R. Mobner, T. Chase, A. Ensenyat, J. Ulrich, G. Giegerich, M. Rother, M. Revilla, N. Nitschke, K. Honczarenko, E. Basart Tarrats, J. Blin, B. Jacob, J. Santamaria, S. Knezevic, J. L. Castillo, M. Antem, J. Colomer, O. Busse, Didier Hannequin, S. Carrier, J. B. Ruidavets, C. Rozman, J. Bogoussslavsky, J. Pascual Calvet, E. Monros, J. M. Polo, M. Zucconl, Javier Muruzabal, R. R. Allen, R. Rivolta, K. Haugaard, A. Nespolo, K. Hoang-Xuang, G. Bussone, T. Avramidis, E. Corsini, Christiana Franke, T. Vinogradova, H. Boot, K. Vestergaard, G. H. Jansen, N. Argentino, M. Raltzig, W. Linssen, Mark B. Pepys, P. Roblot, L. Lauritzen, E. Fainardi, D. Morin, T. X. Arbizu Urdiain, J. Wollenhaupt, S. Bostantjopoulou, G. Pavesi, A. D. Forman, Giovanni Fabbrini, D. Jean, J. J. Archelos, M. I. Blanchs, M. Del Gobbo, Anna Carla Turconi, Ch. Derouesné, Elio Scarpini, A. Visbeck, P. Castejon, J. P. Renou, F. Mounier-Vehier, G. Potagas, Ch. Duyckaerts, A. Filla, R. Schneider, G. Ronen, K. Nagata, J. P. Vedel, A. Henneberg, G. van Melle, C. Baratti, H. Knott, M. C. Prevett, A. Bes, B. Metin, Jos V. Reempts, L. Martorell, Mefkure Eraksoy, H. O. Handwerker, D. S. Younger, O. Oktem, D. Frongillo, C. Soriano-Soriano, L. Niehaus, F. Zipp, A. Tartaro, S Newman, R. H. Browne, P. Davous, R. Sanchez, M. Muros, M. E. Kornhuber, A. Lavarone, M. Mohr, M. R. Garcia, S. Russell, H. Kellar-Wood, M. R. Tola, B. Ostermeyer, Ch. Tzekov, K. Sartor, E. B. Ringelstein, P. P. Gazzaniga, Paul Krack, H. Fidaner, H. Rico, T. Dbaiss, F. Alameda, E. Torchiana, L. Rumbach, I. Charques, J. M. Bogaard, C. D. Frith, L. J. Rappelle, R. Brenner, A. Joutel, K. Fuxe, G. HÄcker, M. J. Blaser, J. Valls-SolÇ, G. Ulm, M. Alberdi, A. Bock, F. W. Bertelsmann, U. Wieshmann, J. Visa, J. R. Lupski, D. D'Amico, L. M. P. Ramos, A. A. Vanderbark, R. Horn, M. Warmuth, Dietmar Kühne, Mark S. Palmer, C. Ehrenheim, E. Canga, S. Viola, O. Scarpino, P. Naldi, R. Almeida, A. A. Raymond, J. Gamez, Stephan Arnold, A. DiGiovanni, J. Dalmau, C. C. Chari, H. F. Beer, J. C. Koetsier, J. Iriarte, E. Yunis, J. Casadevall, E. Le Guern, E. Stenager, S. R. Benbadis, J. M. Warter, F. Burklin, I. Theodorou, L. Johannesen, G. A. Graveland, X. Leclerc, I. Vecchio, L. Ozelius, G. Nicoletti, R. K. Gherardi, E. Esperet, M. L. Delodovici, F. Cattin, F. Paiau, Giorgio Sacilotto, C. A. J. Broere, D. Chavdarov, J. P. Willmer, C. H. Hawkes, Th. Naegele, E. Ellie, E. Dartigues, M. J. Guardiola, S. Hesse, Z. Levic, Marco Rovaris, P. Saugeir-Veber, B. A. Yaqub, H. F. Durwen, R. Larumbe, J. Ballabrina, M. Sendtner, J. Röther, M. Horstink, C. Kluglein, M.P. Montesi, H. Apaydin, J. Montoya, E. Waubant, Ch. Verellen-Dunoulin, A. Nicolai, J. Lopez-Delval, R. Lemon, G. Cantinho, E. Granieri, A. Zeviani, Wolfgang H. Oertel, U. Ficola, V. Di Piero, V. Fragola, K. Sabev, M. V. Guitera, I. Turki, F. Bolgert, P. Ingrand, J. M. Gobernado, L. M. E. Grimaldi, S. Baybas, B. Eymard, Y. Rolland, Y. Robitaille, Ta. Pampols, P. J. Koehler, A. Carroacedo, J. Vilchez, S. Di Vittorio, I. R. Rise, T. Nagy, M. Kuffner, E. Palazzini, A. Ott, J. Pruim, T. X. Arbizu, E. Manetti, C. Cervera, S. Felber, G. Gursoy, J. Scholz, G. A. Buscaino, M. S. Chen, A. Pascual, J. Hazan, J. U. Gajda, J. G. Cea, G. Bottini, G. Damalik, F. Le Doze, G. Bonaldi, J. M. Hew, C. Messina, A. M. Kennedy, J. M. Carney, N. M. F. Murray, M. Parent, M. Koepp, V. Dimova, D. De Leo, K. Jellinger, G. Salemi, S. Mientus, M. L. Hansen, F. Mazzucchelli, J. Vieth, M. Mauri, E. Bartels, L. Johannsen, C. Humphreys, J. Emile, D. N. Landon, E. Kansu, R. Sanchez-Pernaute, Rsj Frackowiak, M. Gonzalez Torres, L. Oller, C. Machedo, J. Kother, M. Billiard, H. Durak, T. Schindler, A. Frank, A. Uncini, A. Sbriccoli, C. Farinas, D. W. Paty, N. Fast, A. T. Zangaladze, A. Kerkhofs, J. M. Pino Garcia, I. De la Fuente, B. Marini, L. Gomez, I. Rubio, Alessandra Bardoni, C. Brodie, P. Acin, U. Sliwka, S. A. Hawkins, S. Tardieu, F. Vitullo, J. M. Pereira Monteino, R. Gagliardi, T. Jezewski, A. Cano, T. Lempert, F. Abad Alegria, G. Rotondo, D. Ince, C. Martinez Parra, Y. Huang, H. Luders, Y. Steinvil, F. G. A. Van Der Meche, R. Bianchi, A. Sanchez, T. Sevilla, J. M. Ketelslegers, A. Domzal-Stryga, M. Pandolfo, M. O. Josse, K. W. Neff, I. Blanco, G. W. Bruyn, O. W. Witte, J. L. Thibault, G. Andersen, J. Pariset, A. Marcone, R. J. M. Lane, A. Hofman, M. Verin, T. Matilla, P. Bedoucha, J. Roche, M. Lai, M. Collard, A. Ugarte, F. Gallecho, D. Silbersweig, C. Kennard, J. P. Azulay, T. W. Ho, P. L. I. Dellemijn, R. Girardello, F. Baas, B. Voss, F. Rozenberg, E. M. Brocker, V. Stanev, A. A. J. Soeterboek, A. Marra, A. Rey, E. Ertem, M. Sawradewicz-Rybak, J. De Keyser, P. Cavallari, F. Proust, Y. Chevalier, H. C. Hansen, D. Leys, C. A. Davie, K. Hoang-Xuan, C. Bairati, H. van Crevel, Thomas T. Warner, B. Bompais, A. Dobbeleir, T Campbell, C. Macko, C. J. M. Klijn, M. Dussallant, T. P. Berlit, W. Rozenbaum, M. J. van den Bent, W. A. Rocca, M. Muller, H. Hundemer, U. Zifko, M. Campera, F. Drislane, D. Ranoux, T. M. Kloss, Anil Kumar, I. Ruolt, C. Bargnani, B. Marescau, N. A. Losseff, S. Notermans, B. Kint, E. T. Burke, C. Aykut, J. Matias Guiu, P. Maquet, T. Drogendijk, M. Leone, K. von Ammon, M. Pepeliarska, C. Prados, L. DiGiamberardino, T. Logtenberg, G. Lenoir, I. Castaldo, Damhaut, M. Radionova, G. Sirabian, R. Navon, Giovanni Antonini, K. Al Moutaery, E. Chamas, R. Schönhuber, M. Giannini, B. Debilly, I. Labatut, H. Henon, J. A. Egido, M. Baudrimont, J. N. Lorenzo, J. E. C. Bromberg, R. Antonacci, J. J. Vilchez, T. Moulin, B. Rautenstrauss, Giovanni Meola, J. Noth, S Mammi, P. Laforet, F. Lopez, C. Gehring, S. Bort, G. Rancurel, D. Decamps, S. Kostadinova, Y. Shapira, B. Neundoerfer, D. Chavrot, M. Solimena, J. P. Salier, W. Deberdt, R. Hoff-Jörgensen, A. Messina, S. Meairs, G. Rosoklija, E. Nelis, I. Bertran, C. Ertekin, J. Lohmeyer, Mitermayer Galvao dos Reis, L. Calo, E. Maccagnano, A. P. Hays, J. Verlooy, M. G. Forno, T. Blanco, L. Bail, Gabriella Silvestri, J. Montero, F. Bertrand, R. T. Ghnassia, C. Besses, T. Sereghy, F. Shalit, G. Bogliun, S. Braghi, St. Baykouchev, C. Franke, A. Lasa, L. C. Archard, J. Kriebel, S. Shaunak, M. Nocito, Alexander Tsiskaridze, E. Manfredini, T. Seigal, David G. Gadian, M. Barlas, J. D. Degos, C. Seeber, J. Caemert, J. L. Mas, R. B. Pepinsky, M. G. 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Meinardi, F. Carrara, J. Kuehnen, C. Peiro, H. Lassmann, K. Skovgaard Olsen, A. McDonald, L. Sciulli, A. Cobo, A. Monticelli, B. Conrad, J. Bagunya, J. Benitez, V. Desnizza, B. Dupont, O. Delrieu, D. Moraes, J. J. Heimans, F. Garcia Rio, M. Matsumto, A. Fernandez, R. Nermni, R. Chalmers, M. J. Marchau, F. Aguado, P. Velupillai, P. J. Martin, P. Tassan, V. Demarin, A. Engelien, T. Gerriets, Comar, J. L. Carrasco, J. P. Pruvo, A. Lopez de Munain, D. Pavitt, J. Alarcon, Chris H. Polman, B. Guldin, N. Yeni, Hartmut Brückmann, N. Wilczak, H. Szwed, R. Causaran, G. Kyriazis, M. E. Westarp, M. Gasparini, N. Pecora, J. M. Roda, E. Lang, V. Scaioli, David R. Fish, D. Caputo, O. Gratzl, R. Mercelis, A. Perretti, G. Steimetz, I. Link, C. Rigoletto, A. Catafau, G. Lucotte, M. Buti, G. Fagiolari, A. Piqueras, C. Godinot, J. C. Meurice, Erodriguez J. Dominigo, F. Lionnet, H. Grzelec, David J. Brooks, P. M. G. Munro, F. X. Weilbach, M. Maiwald, W. Split, B. Widjaja-Cramer, V. Ozturk, J. Colas, E. Brizioli, J. Calleja, L. Publio, M. Desi, R. Soffietti, P. Cortinovis-Tourniaire, E. F. Gonano, G. Cavaletti, S. Uselli, K. Westerlind, H. Betuel, C. O. Dhiver, H. Guggenheim, M. Hamon, R. Fazio, P. Lehikoinen, A. Esser, B. Sadzot, G. Fink, Angelo Antonini, D. Bendahan, V. Di Carlo, G. Galardi, A. F. Boller, M. Aksenova, Del Fiore, V. de la Sayette, H. Chabriat, A. Nicoletti, A. Dilouya, M. L. Harpin, E. Rouillet, J. Stam, A. Wolters, M. R. Delgado, Eduardo Tolosa, G. Said, A. J. Lees, L. Rinaldi, A. Schulze-Bonhage, MA Ron, C. Lefebvre, E. W. Radü, R. Alvarez, M. L. Bots, P. Reganati, S. Palazzi, A. Poggi, N. J. Scolding, V. Sazdovitch, T. Moreau, E. Maes, M. A. Estelies, P. Petkova, Jose-Felix Marti-Masso, G De La Meilleure, N. Mullatti, M. Rodegher, N. C. Notermans, T. A. T. Warner, S. Aktan, J. P. Louboutin, L. Volpe, C. Scheidt, W. Aust, C. M. Wiles, U. Schneider, S. K. Braekken, W. R. Willems, K. Usuku, Peter M. Rothwell, C. Talamon, M. L. Sacchetti, A. Codina, M. H. Marion, A. Santoro, J. Roda, A. Bordoni, D. J. Taylor, S. Ertas, H. H. Emmen, J. Vichez, V. BesanÇon, R. E. Passingham, M. L. Malosio, A. Vérier, M. Bamberg, A. W. Hansen, E. Mostacero, G. Gaudriault, Marie Vidailhet, B. Birebent, K. Strijckmans, F. Giannini, T. Kammer, I. Araujo, J. Nowicki, E. Nikolov, A. Hutzelmann, R. Gherardi, J. Verroust, L. Austoni, A. Scheller, A. Vazquez, S. Matheron, H. Holthausen, J. M. Gerard, M. Bataillard, S. Dethy, V. H. Patterson, V. Ivanez, N. P. Hirsch, F. Ozer, M. Sutter, C. Jacomet, M. Mora, Bruno Colombo, A. Sarropoulos, T. H. Papapetropoulos, M. Schwarz, D. S. Dinner, N. Acarin, B. Iandolo, J. O. Riis, P. R. J. Barnes, F. Taroni, J. Kazenwadel, L. Torre, A. Lugaresi, I. L. Henriques, S. Pauli, S. Alfonso, Pedro Quesada, A. S. T. Planting, J. M. Castilla, Thomas Gasser, M. Van der Linden, A. Alfaro, E. Nobile-Orazio, G. Popova, W. Vaalburg, F. G. A. van der Mech, L. Williams, F. Medina, J. P. Vernant, J. Yaouanq, B. Storch-Hagenlocher, A. Potemkowski, R. Riva, M. H. Mahagne, M. Ozturk, Ve. Drory, N. Konic, C. Jungreis, A. Pou Serradell, J. L. Gauvrit, G. J. Chelune, S. Hermandez, T. Dingus, L. Hewer, Ch. Koch, M. N. Metz-Lutz, G. Parlato, M. Sinaki, Charles Pierrot-Deseilligny, H. C. Diener, J. Broeckx, J. Weill-Fulazza, M. L. Villar, M. Rizzo, O. Ganslandt, C. Duran, N. A. Fletcher, G. Di Giovacchino, Susan T. Iannaccone, C. Kolig, N. Fabre, H. A. Crockard, Rita Bella, M. Tazir, E. Papagiannuli, K. Overgaard, Emma Ciafaloni, I. Lorenzetti, F. Viader, P. A. H. Millac, I. Montiel, L. H. Visser, M. Palomar, P. L. Murgia, H. Pedersen, Rafael Blesa, S. Seddigh, W. O. Renier, I. Lemahieu, H. M. L. Jansen, L. Rosin, J. Galofre, K. Mattos, M. Pondal, G. M. Hadjigeorgiou, D. Francis, L. Cantin, D. Stegeman, M. Rango, A. B. M. F. Karim, S. Schraff, B. Castellotti, I. Iriarte, E. Laborde, T. J. Tjan, R. Mutani, D. Toni, B. Bergaasco, J. G. Young, C. Klotzsch, A. Zincone, X. Ducrocq, M. Uchuya, O. J. Kolar, A. Quattrone, T. Bauermann, Nereo Bresolin, J. Vallée, B. C. Jacobs, A. Campos, Werner Poewe, J. A. Villanueva, A. W. Kornhuber, A. Malafosse, E. Diez-Tejedor, G. Jungreia, M. J. A. Puchner, A. Komiyama, O. Saribas, V. Volpini, L. Geremia, S. Bressi, A. Nibbio, Timothy E. Bates, T. z. Tzonev, E. Ideman, G. A. Damlacik, G. Martino, G. Crepaldi, T. Martino, Kjell Någren, E. Idiman, D. Samuel, J. M. Perez Trullen, Y. van der Graaf, J. O. Thorell, M. J. M. Dupuis, E. Sieber, R. D'Alessandro, C. Cazzaniga, J. Faiss, A. Tanguy, A. Schick, I. Hoksergen, A. Cardozo, R. Shakarishvili, G. K. Wennlng, J. L. Marti-Vilalta, J. Weissenbach, I. L. Simone, Amalia C. Bruni, Darius J. Adams, C. Weiller, A. Pietrangeli, F. Croria, C. Vigo-Pelfrey, Patricia Limousin, A. Ducros, G. Conti, O. Lindvall, E. Richter, M. Zuffi, A. Nappo, T. Riise, J. Wijdenes, M. J. Fernandez, J. Rosell, P. Vermersh, S. Servidei, M. S. C. Verdugo, F. Gouttiere, W. Solbach, M. Malbezin, I. S. Watanabe, A. Tumac, W. I. McDonald, D. A. Butterfield, P. P. Costa, F. deRino, F. Bamonti, J. M. Cesar, C. H. Lahoz, I. Mosely, M. Starck, M. H. Lemaitre, K. M. Stephan, S. Tex, R. Bokonjic, I. Mollee, L. Pastena, M. Gutierrez, F. Boiler, M. C. Martinez-Para, M. Velicogna, O. Obuz, A. Grinspan, M. Guarino, L. M. Cartier, E. Ruiz, D. Gambi, S. Messina, M. Villa, Michael G. Hanna, J. Valk, Leone Pascual, M. Clanet, Z. Argov, B. Ryniewicz, E. Magni, B. Berlanga, K. S. Wong, C. Gellera, C. Prevost, F. Gonzalez-Huix, R. Petraroli, J. E. G. Benedikz, I. Kojder, C. Bommelaer, L. Perusse, M. R. Bangioanni, Guy M. McKhann, A. Molina, C. Fresquet, E. Sindern, Florence Pasquier, M. J. Rosas, M. Altieri, O. Simoncini, M. Koutroumanidis, C. A. F. Tulleken, M. Dary-Auriol, S. Oueslati, H. Kruyer, I. Nishisho, C. R. Horning, A. Vital, G. V. Czettritz, J. Ph. Neau, B. Mihout, A. Ameri, M. Francis, S. Quasthoff, D. Taussig, S. Blunt, P. Valentin, C. Y. Gao, O. Heinzlef, H. d'Allens, C. Coudero, M. Erfas, G. Borghero, P. J. Modrego Pardo, M. C. Patrosso, N. L. Gershfeld, P. A. J. M. Boon, O. Sabouraud, M. Lara, J. Svennevig, G. L. Lenzi, A. Barrio, H. Villaroya, JosÇ M. Manubens, O. Boespflug-Tanguy, M. Carreras, D. A. Costiga, J. P. Breux, S. Lynn, C. Oliveras Ley, A. G. Herbaut, J. Nos, C. Tornali, Y. A. Hekster, J. L. Chopard, J. M. Manubens, P. Chemouilli, A. Jovicic, F. Dworzak, S. Smirne, S. E. Soudain, B. Gallano, D. Lubach, G. Masullo, G. Izquierdo, A. Pascual Leone Pascual, A. Sessa, V. Freitas, O. Crambes, L. Ouss, G. W. Van Dijk, P. Marchettini, P. Confalonieri, M. Donaghy, A. Munnich, M. Corbo, and M. E. L. van der Burg

Subjects
Neurology, business.industry, Media studies, Library science, Medicine, Neurology (clinical), business
Published
1994
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28. Head Pain in Non-Traumatic Carotid Artery Dissection: A Series of 65 Patients

Author

M.-G. Bousser, Valérie Biousse, Jacques D’Anglejan-Chatillon, and H Massiou

Subjects
Adult, Carotid Artery Diseases, Male, medicine.medical_specialty, Horner Syndrome, Adolescent, Migraine Disorders, Pain, Brain Ischemia, Diagnosis, Differential, Carotid artery dissection, Tinnitus, Aneurysm, Facial Pain, Ischemia, medicine.artery, medicine, Fibromuscular Dysplasia, Humans, Vertebral Artery, Aged, Internal carotid artery dissection, medicine.diagnostic_test, business.industry, Headache, Retinal Vessels, Nausea, General Medicine, Middle Aged, medicine.disease, Cerebral Angiography, Surgery, Aortic Dissection, Dissection, Migraine, Hypertension, Female, Neurology (clinical), Radiology, Internal carotid artery, Presentation (obstetrics), business, Carotid Artery, Internal, Neck, Contraceptives, Oral, Cerebral angiography
Abstract

In order to assess the prevalence and characteristics of cephalic pain in internal carotid artery (ICA) dissection, and to compare clinical and angiographic features of patients with painful and non-painful dissections, we observed 65 patients with angiographically diagnosed extracranial ICA dissection from 1972 to 1990. Forty-eight patients (74%) complained of a cephalic pain which was inaugural in 38 (58.5%). It was homolateral to the dissection in 79% of cases and lasted from 1 h to 30 days, with a median of 5 days. Signs of cerebral or retinal ischemia were observed in 79% of patients, often delayed and occurring up to 29 days after the onset of pain. A painful Horner's syndrome was present in 31% of patients, and was the only manifestation of dissection in 16%. The clinical presentation of the dissections and angiographic findings were similar in patients with and without pain except for a past history of migraine which was more frequent in patients with painful dissections. Cephalic pain is frequent and often inaugural in carotid dissection. Its recognition is important for early diagnosis and treatment.

Published
1994
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29. Causes and mechanisms of territorial and nonterritorial cerebellar infarcts in 115 consecutive patients

Author

E Roullet, Pierre-Jean Touboul, Pierre Amarenco, Ariel Cohen, C. Levy, and M G Bousser

Subjects
Male, medicine.medical_specialty, Occlusive disease, Arterial Occlusive Diseases, Central nervous system disease, Cerebellar Diseases, Risk Factors, Internal medicine, medicine, Humans, Prospective Studies, Risk factor, Advanced and Specialized Nursing, medicine.diagnostic_test, business.industry, Vascular disease, Coronary Thrombosis, Magnetic resonance imaging, Cerebral Infarction, Blood Coagulation Disorders, Cerebral Arteries, Middle Aged, medicine.disease, Surgery, medicine.anatomical_structure, Embolism, Angiography, cardiovascular system, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Cerebellar artery
Abstract

Territorial cerebellar infarcts have mainly a thromboembolic mechanism. Cerebellar infarcts less than 2 cm in diameter have recently been reported as nonterritorial infarcts, but it is not clear whether they are low-flow or embolic infarcts. The aim of the present study was to compare the characteristics and causes of territorial and nonterritorial infarcts in a prospective series of 115 patients. We collected data from 115 consecutive patients with cerebellar infarcts (79 territorial and 36 nonterritorial [ie, less than 2 cm]), using magnetic resonance imaging (88 patients) and computed tomography. Patients with territorial infarcts and those with nonterritorial infarcts had similar vascular risk factors and clinical presentations and an equal frequency of cardiac source of embolism (32% versus 42%; P = NS) and of large artery occlusive disease (23% versus 19%; P = NS). Occlusive lesions of large arteries at angiography occurred at the level of one cerebellar artery (5% versus 0%; P = NS) and proximal to the ostia of the cerebellar arteries (18% versus 19%; P = NS). Infarcts distal to occlusive lesions were subdivided into unilateral vertebral artery occlusive disease (presumed artery-to-artery embolic mechanism; 18% versus 5%; P = NS) and low-flow state distal to bilateral vertebral or basilar artery occlusion (presumed hemodynamic mechanism; 0% versus 14%; P = .004). Patients with nonterritorial infarcts had more frequent hypercoagulable state (17% versus 1.25%; odds ratio, 15.6 [95% confidence interval, 1.8 to 135]). For the remaining patients, the mechanism of the infarct was unknown (34% versus 22%; P = NS). Cerebellar infarcts less than 2 cm in diameter (ie, nonterritorial) have the same high rate of embolic mechanism as territorial infarcts (47% versus 49%; P = NS), have more frequent hypercoagulable state, and sometimes have a hemodynamic mechanism.

Published
1994
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30. Efficacy of subcutaneous sumatriptan in the acute treatment of early-morning migraine: a placebo-controlled trial

Author

M G Bousser, H D'Allens, and A Richard

Subjects
business.industry, Placebo-controlled study, Placebo, medicine.disease, Crossover study, law.invention, Sumatriptan, Randomized controlled trial, Migraine, law, Anesthesia, Severity of illness, Internal Medicine, medicine, business, Adverse effect, medicine.drug
Abstract

Objectives. To evaluate the efficacy of self-administered subcutaneous sumatriptan in the acute treatment of early-morning migraine attacks. Design. A double-blind, randomized, placebo-controlled, cross-over study. Setting. Thirteen neurology centres in France. Subjects. Patients of either sex, 18–65 years old, with two to six attacks of migraine (according to the International Headache Society (IHS) criteria, with or without aura) per month, of which at least two had to be early-morning migraine attacks. One-hundred-and-one patients were included, 96 being evaluable for the first attack and 81 for the cross-over design. Interventions. Two migraine attacks (grade 2/3) were treated with sumatriptan (6 mg) or placebo, with an optional second injection 1–24 h later. Main outcome measures. The primary end-point was headache relief: reduction in headache severity from grade 2/3 (moderate/severe) to grade 1/0 (mild/none) 2 h after treatment. Results. Sumatriptan was superior to placebo for headache relief (32 [78%] vs. 11 [28%] at the first attack; 29 [73%] vs. 8 [20%] at the second; P < 0.001). Because of a significant carry-over effect for some of the secondary end-points, a parallel-group analysis of the first attack was performed, which confirmed a significantly higher efficacy of sumatriptan for all end-points: pain-free rate (22 [46%] vs. 7 [15%]; P = 0.001) and use of a second injection (26 [53%] vs. 38 [81%]; P = 0.004). Sumatriptan was preferred by 74% of patients vs. 17% for placebo, and 9% expressed no preference (P < 0.0001). After complete relief, headache reappeared in 8/23 (35%) patients with sumatriptan and 3/7 (43%) with placebo. Adverse events were significantly more frequent with sumatriptan but they were minor and transient. Conclusion. Subcutaneous sumatriptan auto-injection is an effective and well-tolerated acute treatment of early-morning migraine attacks allowing earlier return to normal activity.

Published
1993
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31. Migraine and risk of ischaemic stroke: a case-control study

Author

Valérie Biousse, Christophe Tzourio, J B Hubert, F. Woimant, J M Visy, M.-G. Bousser, S Iglesias, Alain Djacoba Tehindrazanarivelo, and Annick Alpérovitch

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Vascular disease, General Engineering, Case-control study, Magnetic resonance imaging, General Medicine, Odds ratio, medicine.disease, Confidence interval, Migraine, Internal medicine, medicine, Physical therapy, General Earth and Planetary Sciences, Risk factor, business, Stroke, Research Article, General Environmental Science
Abstract

OBJECTIVES--To determine whether migraine is a risk factor for ischaemic stroke. DESIGN--A case-control study. SETTING--Two hospitals in Paris. SUBJECTS--212 patients with stroke (137 men and 75 women) and 212 controls matched for sex, age (to within five years), and history of hypertension. MAIN OUTCOME MEASURES--Ischaemic stroke, confirmed by brain computed tomography or magnetic resonance imaging, and history of headache, recorded with structured questionnaire during interview. RESULTS--Prevalence of migraine did not differ between patients with stroke and controls: 18/137 v 17/137 for men (odds ratio 1.1 (95% confidence interval 0.5 to 2.2), p = 0.86); 23/75 v 17/75 for women (odds ratio 1.6 (0.7 to 3.5), p = 0.24); and 41/212 v 34/212 for both sexes (odds ratio 1.3 (0.8 to 2.3), p = 0.33). When subjects were split into two age groups, however, prevalence of migraine was significantly higher among younger women (aged < 45) with stroke compared with their controls (13/20 v 6/20, odds ratio 4.3 (1.2 to 16.3), p = 0.03). Furthermore, the risk of ischaemic stroke was higher among younger women who smoked (7/20 v 1/20, odds ratio 10.2 (1.1 to 93.3)). CONCLUSIONS--Prevalence of migraine was not different between patients with stroke and matched controls except among women aged < 45, when migraine and stroke were significantly associated.

Published
1993
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32. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy: from stroke to vessel wall physiology

Author

M.-G. Bousser and E. Tournier-Lasserve

Subjects
Pathology, medicine.medical_specialty, Positional cloning, business.industry, Cerebral infarction, Dementia, Vascular, Cerebral arteries, Cerebral Infarction, Cerebral Arteries, medicine.disease, Stroke, Leukoencephalopathy, Psychiatry and Mental health, Editorial, Notch 3, Humans, Medicine, Surgery, Intracranial Arterial Diseases, Neurology (clinical), business, CADASIL, Lipohyalinosis
Abstract

Ischaemic stroke, which accounts for 85% of all strokes is characterised by its remarkable aetiopathogenic diversity, with three main varieties: atherothrombotic brain infarction, cardiac emboli, and small artery diseases, and with up to 40% of undetermined cause.1Small artery disease of the brain has long been thought to be restricted to hypertension related lipohyalinosis resulting in lacunar infarcts2 and eventually in Binswanger's encephalopathy, the archetype of subcortical vascular dementia.3 From 1976 onwards we were able to study a large French family, some members of whom were affected by a small artery disease of the brain reminiscent of Binswanger's disease but remarkable by the absence of hypertension and of other vascular risk factors.4-6 This familial cerebral arteriopathy was strikingly similar to eight others reported under various eponyms from 1955 to 1992.7-14 The extensive study of 57 members of this French family led us in 1993 to identify this small artery disease of the brain as a specific entity, to describe its main clinical and MRI features, to propose the acronym CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) and, using a positional cloning approach, to locate the responsible gene on chromosome 19.15 Linkage was later confirmed in many families,16-23 which allowed us in 1996 to refine the genetic mapping within a 2 cM interval.24 The next crucial step was the identification of the mutated gene as Notch 3, a gene previously unknown in humans25 which encodes for a large transmembrane receptor belonging to the Notch/lin 12 gene family which is known to be involved in cell fate specification …

Published
2001
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33. Cerebral Venous and Sinus Thrombosis

Author

K. Einhupl, M.-G. Bousser, S. F. T. M. de Bruijn, J. M. Ferro, I. Martinelli, F. Masuhr, and J. Stam

Subjects
medicine.medical_specialty, business.industry, Internal medicine, Cardiology, Medicine, Sinus thrombosis, business
Published
2010
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35. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients

Author

K, Einhäupl, J, Stam, M-G, Bousser, S F T M, De Bruijn, J M, Ferro, I, Martinelli, and F, Masuhr

Subjects
Adult, Venous Thrombosis, Sinus Thrombosis, Intracranial, Heparin, Contraindications, Germany, Advisory Committees, Anticoagulants, Humans, Thrombolytic Therapy, Societies, Medical, Randomized Controlled Trials as Topic
Abstract

Cerebral venous and sinus thrombosis (CVST) is a rather rare disease which accounts for1% of all strokes. Diagnosis is still frequently overlooked or delayed as a result of the wide spectrum of clinical symptoms and the often subacute or lingering onset. Current therapeutic measures which are used in clinical practice include the use of anticoagulants such as dose-adjusted intravenous heparin or body weight-adjusted subcutaneous low-molecular-weight heparin (LMWH), the use of thrombolysis and symptomatic therapy including control of seizures and elevated intracranial pressure.We searched MEDLINE (National Library of Medicine), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library to review the strength of evidence to support these interventions and the preparation of recommendations on the therapy of CVST based on the best available evidence. Review articles and book chapters were also included. Recommendations were reached by consensus. Where there was a lack of evidence but consensus was clear we stated our opinion as good practice points.Patients with CVST without contraindications for anticoagulation (AC) should be treated either with body weight-adjusted subcutaneous LMWH or with dose-adjusted intravenous heparin (level B recommendation). Concomitant intracranial haemorrhage (ICH) related to CVST is not a contraindication for heparin therapy. The optimal duration of oral anticoagulant therapy after the acute phase is unclear. Oral AC may be given for 3 months if CVST was secondary to a transient risk factor, for 6-12 months in patients with idiopathic CVST and in those with "mild" thrombophilia, such as heterozygous factor V Leiden or prothrombin G20210A mutation and high plasma levels of factor VIII. Indefinite AC should be considered in patients with recurrent episodes of CVST and in those with one episode of CVST and 'severe' thrombophilia, such as antithrombin, protein C or protein S deficiency, homozygous factor V Leiden or prothrombin G20210A mutation, antiphospholipid antibodies and combined abnormalities (good practice point). There is insufficient evidence to support the use of either systemic or local thrombolysis in patients with CVST. If patients deteriorate despite adequate AC and other causes of deterioration have been ruled out, thrombolysis may be a therapeutic option in selected cases, possibly in those without large ICH and threatening herniation (good practice point). There are no controlled data about the risks and benefits of certain therapeutic measures to reduce an elevated intracranial pressure (with brain displacement) in patients with severe CVST. However, in severe cases with impending herniation craniectomy can be used as a life-saving intervention (good practice point).

Published
2010

36. Transesophageal echocardiographic detection of aortic arch disease in patients with cerebral infarction

Author

Pierre Amarenco, M Baudrimont, Ariel Cohen, and M G Bousser

Subjects
Male, Aortic arch, medicine.medical_specialty, Biopsy, Embolism, Autopsy, Esophagus, medicine.artery, Internal medicine, Ascending aorta, medicine, Humans, Prospective Studies, cardiovascular diseases, Aged, Aged, 80 and over, Advanced and Specialized Nursing, medicine.diagnostic_test, Aortic Arch Syndromes, Vascular disease, Cerebral infarction, business.industry, Muscles, Echogenicity, Cerebral Infarction, Middle Aged, medicine.disease, Cholesterol, medicine.anatomical_structure, Echocardiography, cardiovascular system, Cardiology, Female, Neurology (clinical), Radiology, Cardiology and Cardiovascular Medicine, business
Abstract

Ulcerated plaques in the aortic arch are frequent autopsy findings in patients with cerebral infarctions, particularly those of unknown cause. It has been suggested that they could be a source of cerebral emboli. Using transesophageal echocardiography, we prospectively studied 12 consecutive patients with cerebral infarction of undetermined cause after noninvasive workup to evaluate the frequency of aortic plaques or mural thrombi that could embolize in cerebral arteries. Six patients (50%) had an intraluminal echogenic mass of the aortic arch, mainly located at the junction of the ascending aorta and arch. This material was pedunculated (in one patient) or broad based (in five patients) with a markedly irregular surface and intraluminal extension from 3 to 15 mm. In addition, we found cholesterol emboli in two of the four patients who underwent quadriceps biopsy. These results show that transesophageal echocardiography has capabilities in detecting such lesions and point to the aortic arch as a possible source of cerebral emboli in patients with cerebral infarction of unknown cause.

Published
1992
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37. Verbal memory impairment in subcortical ischemic vascular disease: a descriptive analysis in CADASIL

Author

S, Epelbaum, S, Benisty, S, Reyes, M, O'Sullivan, E, Jouvent, M, Düring, D, Hervé, C, Opherk, K, Hernandez, A, Kurtz, A, Viswanathan, M G, Bousser, M, Dichgans, and H, Chabriat

Subjects
Adult, Male, Memory Disorders, Dementia, Vascular, Mental Recall, Humans, CADASIL, Female, Middle Aged, Verbal Learning, Magnetic Resonance Imaging, Brain Ischemia
Abstract

In the elderly, the high prevalence of Alzheimer's disease neuropathology presents a major challenge to the investigation of memory decline in common diseases such as small vessel disease. CADASIL represents a unique clinical model to determine the spectrum of memory impairment in subcortical ischemic vascular dementia (SIVD). One hundred and forty CADASIL patients underwent detailed clinical, neuropsychological and imaging analyses. The Free and Cued Selective Reminding Test was used as a measure of verbal memory. Forty-four out of 140 CADASIL patients (31.4%) presented with memory impairment according to this test. Eight out of 44 (18.2%) subjects with memory impairment matched the definition of the amnestic syndrome of hippocampal type. While alterations in spontaneous recall were related to the severity of subcortical ischemic lesions, the profile of memory impairment, particularly the sensitivity to cueing was found related to other factors such as hippocampal atrophy.

Published
2009

38. 'Crossed cerebellar diaschisis' in human supratentorial brain infarction

Author

J C, Baron, M G, Bousser, D, Comar, and P, Castaigne

Subjects
Adult, Aged, 80 and over, Brain Infarction, Adolescent, Middle Aged, Functional Laterality, Oxygen Consumption, Regional Blood Flow, Case-Control Studies, Cerebellum, Positron-Emission Tomography, Humans, Aged, Retrospective Studies
Published
2009

39. Late onset hereditary episodic ataxia

Author

Florence Riant, E. Tournier-Lasserve, Monique Boukobza, M.-G. Bousser, Damak M, and Katayoun Vahedi

Subjects
Gait Ataxia, Male, Cerebellum, Ataxia, Physiology, Late onset, medicine, Humans, Age of Onset, Carbonic Anhydrase Inhibitors, Genetics, Episodic ataxia, Cerebellar ataxia, Genetic heterogeneity, Brain, Exons, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Pedigree, Acetazolamide, Psychiatry and Mental health, medicine.anatomical_structure, Haplotypes, Surgery, Cerebellar atrophy, Female, Neurology (clinical), Calcium Channels, medicine.symptom, Age of onset, Psychology
Abstract

Objective: Episodic ataxias (EA) are hereditary paroxysmal neurological diseases with considerable clinical and genetic heterogeneity. So far seven loci have been reported and four different genes have been identified. Analysis of additional sporadic or familial cases is needed to better delineate the clinical and genetic spectrum of EA. Methods: A two generation French family with late onset episodic ataxia was examined. All consenting family members had a brain MRI with volumetric analysis of the cerebellum. Haplotype analysis was performed for the EA2 locus (19p13), the EA5 locus (2q22), the EA6 locus (5p13) and the EA7 locus (19q13). Mutation screening was performed for all exons of CACNA1A (EA2), EAAT1 (EA6) and the coding sequence of KCNA1 (EA1). Results: Four family members had episodic ataxia with onset between 48 and 56 years of age but with heterogeneity in the severity and duration of symptoms. The two most severely affected had daily attacks of EA with a slowly progressive and disabling permanent cerebellar ataxia and a poor response to acetazolamide. Brain MRI showed in three affected members a decrease in the ratio of cerebellar volume:total intracranial volume, indicating cerebellar atrophy. No deleterious mutation was found in CACNA1A, SCA6, EAAT1 or KCNA1. In addition, the EA5 locus was excluded. Conclusions: A new phenotype of episodic ataxia has been described, characterised clinically by a late onset and progressive permanent cerebellar signs, and genetically by exclusion of the genes so far identified in EA.

Published
2009

40. Apathy: a major symptom in CADASIL

Author

Ananth C. Viswanathan, Carole Dufouil, V. Czernecki, K. Hernandez, Sarah Benisty, Sonia Reyes, Ophélia Godin, Michael O'Sullivan, Hugues Chabriat, Martin Dichgans, A. Kurtz, Eric Jouvent, and M G Bousser

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, CADASIL, Neuropsychological Tests, Leukoencephalopathy, Cohort Studies, Modified Rankin Scale, Genetic model, medicine, Image Processing, Computer-Assisted, Dementia, Humans, Apathy, Prospective Studies, Psychiatry, Aged, Psychiatric Status Rating Scales, Depression, Dementia, Vascular, CADASIL Syndrome, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Hyperintensity, Affect, Quality of Life, Female, Neurology (clinical), medicine.symptom, Psychology
Abstract

Objective: The frequency and impact of apathy in subcortical ischemic vascular dementia (SIVD) remain undetermined. The frequency, clinical, neuropsychological, and imaging correlates of apathy were assessed in a large cohort of patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, a genetic model of SIVD. Methods: Apathy was diagnosed based on Neuropsychiatric Inventory assessment. Degree of disability was assessed by modified Rankin scale, cognitive impairment by Mattis Dementia Rating Scale (MDRS) and Mini-Mental State Examination (MMSE), autonomy by the Instrumental Activities of Daily Living (IADL) scale, and quality of life by SEP-59 self-questionnaire. Validated imaging methods were used to determine the total burden of cerebral lesions. Results: Among 132 patients, 54 (41%) were apathetic. Apathetic patients were older than nonapathetic subjects, had a lower MMSE and MDRS score, had more global disability, and were more limited in IADL. Apathetic patients were more frequently depressed compared to nonapathetic patients and more frequently presented additional neuropsychiatric symptoms. Multiple regression modeling showed a significant and independent association between apathy and a lower score of overall quality of life and between apathy and a higher load of white matter and lacunar lesions. Conclusions: The results suggest that apathy is common in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), appears in association with cognitive impairment, global functional disability, and severe neuropsychiatric symptoms during the course of the disease, and can occur separately from depression. Apathy has an independent impact on the overall quality of life in CADASIL. CADASIL = cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th edition; IADL = Instrumental Activities of Daily Living; ICC = intracranial cavity; LL = lacunar lesions; MDRS = Mattis Dementia Rating Scale; MMSE = Mini-Mental State Examination; mRS = modified Rankin scale; NA = not applicable because of insufficient observations; nCM = number of cerebral microhemorrhages; nLL = normalized volume of lacunar lesions; NPI = Neuropsychiatric Inventory; nWMH = normalized volume of white matter hyperintensities; QOL = quality of life; SIVD = subcortical ischemic vascular dementia; TIA = transient ischemic attack; WMH = white matter hyperintensities.

Published
2009

41. A double-blind, placebo-controlled, randomized, multicenter study to investigate CHInese Medicine Neuroaid Efficacy on Stroke recovery (CHIMES Study)

Author

M.-G. Bousser, S. B. Tan, Christopher Chen, Jose C. Navarro, Geoffrey A. Donnan, Narayanaswamy Venketasubramanian, Niphon Poungvarin, D. Picard, Alejandro C. Baroque, Hui Meng Chang, Bernard P.L. Chan, and Robert Gan

Subjects
Research design, medicine.medical_specialty, business.industry, Cerebral infarction, medicine.medical_treatment, Neuroaid, Traditional Chinese medicine, Placebo, medicine.disease, law.invention, Stroke, Neuroprotective Agents, Neurology, Multicenter study, Randomized controlled trial, Double-Blind Method, law, Research Design, Physical therapy, Medicine, Humans, Medicine, Chinese Traditional, business, Stroke recovery, Drugs, Chinese Herbal
Abstract

Rationale Traditional Chinese Medications (TCM) have been reported to have beneficial effects in stroke patients, but were not rigorously evaluated by GCP standards. Aim This study tests the hypothesis that Neuroaid, a TCM widely used in China post-stroke, is superior to placebo in reducing neurological deficit and improving functional outcome in patients with acute cerebral infarction of an intermediate severity. Design This is a multicenter, randomised, double-blind, placebo-controlled study of Neuroaid in ischemic stroke patients with National Institute of Health Stroke Scale (NIHSS) 6–14 treated within 48 h of stroke onset. Neuroaid or placebo is taken (4 capsules) 3 times daily for 3 months. Treatments are assigned using block randomization, stratified for centers, via a central web-randomization system. With a power of 90% and two-sided test of 5% type I error, a sample size is 874. Allowing for a drop-out rate of up to 20%, 1100 individuals should be enrolled in this study. Study Outcomes The primary efficacy endpoint is the modified Rankin Scale (mRS) grades at 3 months. Secondary efficacy endpoints are the NIHSS score at 3 months; difference of NIHSS scores between baseline and 10 days, and between baseline and 3 months; difference of NIHSS sub-scores between baseline and 10 days, and between baseline and 3 months; mRS at 10 days, 1 month, and 3 months; Barthel index at 3 months; Mini Mental State Examination at 10 days and 3 months. Safety outcomes include complete blood count, renal and liver panels, and electrocardiogram. Study registration: ClinicalTrials.gov identifier: NCT00554723.

Published
2009

42. [Age-related macular degeneration and risk of stroke]

Author

V, Biousse, M-G, Bousser, and A, Gaudric

Subjects
Stroke, Aging, Macular Degeneration, Risk Factors, Humans, Middle Aged, Article, Aged
Abstract

La dégénérescence maculaire liée à l' âge (DMLA) et les accidents vasculaires cérébraux (AVC) affectent un nombre important de sujets de plus de 40 ans à travers le monde et contribuent largement aux dépenses de la santé. Les causes de la DMLA restent mystérieuses et de nombreuses études épidémiologiques ont suggéré une association entre DMLA et facteurs de risque cardio-vasculaire associés aux AVC. Il a également été suggéré que les patients atteints de DMLA ont un risque plus important d' AVC que la population générale du même âge. Les arguments en faveur de cette association entre DMLA et AVC sont résumés dans cet article.

Published
2008

43. Comparison of idraparinux with vitamin K antagonists for prevention of thromboembolism in patients with atrial fibrillation: a randomised, open-label, non-inferiority trial

Author

M G, Bousser, J, Bouthier, H R, Büller, A T, Cohen, H, Crijns, B L, Davidson, J, Halperin, G, Hankey, S, Levy, V, Pengo, P, Prandoni, M H, Prins, W, Tomkowski, C, Torp-Pedersen, C, Thorp-Pedersen, D, Chilson, ACS - Amsterdam Cardiovascular Sciences, and Vascular Medicine

Subjects
Male, medicine.medical_specialty, Vitamin K, Ximelagatran, medicine.drug_class, Idraparinux, Oligosaccharides, Hemorrhage, Kaplan-Meier Estimate, Risk Factors, Thromboembolism, Internal medicine, Atrial Fibrillation, medicine, Humans, Single-Blind Method, Stroke, Aged, Intention-to-treat analysis, business.industry, Acenocoumarol, Standard treatment, Anticoagulant, Hazard ratio, Warfarin, Anticoagulants, General Medicine, medicine.disease, Treatment Outcome, Anesthesia, Female, business, Factor Xa Inhibitors, medicine.drug
Abstract

BACKGROUND: Vitamin K antagonists, the current standard treatment for prophylaxis against stroke and systemic embolism in patients with atrial fibrillation, require regular monitoring and dose adjustment; an unmonitored, fixed-dose anticoagulant regimen would be preferable. The aim of this randomised, open-label non-inferiority trial was to compare the efficacy and safety of idraparinux with vitamin K antagonists. METHODS: Patients with atrial fibrillation at risk for thromboembolism were randomly assigned to receive either subcutaneous idraparinux (2.5 mg weekly) or adjusted-dose vitamin K antagonists (target of an international normalised ratio of 2-3). Assessment of outcome was done blinded to treatment. The primary efficacy outcome was the cumulative incidence of all stroke and systemic embolism. The principal safety outcome was clinically relevant bleeding. Analyses were done by intention to treat; the non-inferiority hazard ratio was set at 1.5. This trial is registered with ClinicalTrials.gov, number NCT00070655. FINDINGS: The trial was stopped after randomisation of 4576 patients (2283 to receive idraparinux, 2293 to receive vitamin K antagonists) and a mean follow-up period of 10.7 (SD 5.4) months because of excess clinically relevant bleeding with idraparinux (346 cases vs 226 cases; 19.7 vs 11.3 per 100 patient-years; p

Published
2008

44. Clinical and brain MRI follow-up study of a family with COL4A1 mutation

Author

E. Tournier-Lasserve, Pascale Massin, Monique Boukobza, M.-G. Bousser, K. Vahedi, and Douglas B. Gould

Subjects
Adult, Collagen Type IV, Genetic Markers, Male, Pathology, medicine.medical_specialty, DNA Mutational Analysis, Disease, Asymptomatic, White matter, Fatal Outcome, medicine, Dementia, Humans, Genetic Predisposition to Disease, Perivascular space, Stroke, Aged, Cerebral Hemorrhage, medicine.diagnostic_test, business.industry, Dementia, Vascular, Microcirculation, Brain, Magnetic resonance imaging, Cerebral Arteries, Middle Aged, medicine.disease, Magnetic Resonance Imaging, medicine.anatomical_structure, Mutation (genetic algorithm), Mutation, Disease Progression, Female, Neurology (clinical), medicine.symptom, business, Follow-Up Studies
Abstract

Objective: To better delineate the clinical spectrum and the natural history of COL4A1 mutations, a newly defined genetic cause of small vessel disease including the brain and retina. Methods: Clinical and brain MRI follow-up study of a family with COL4A1 mutation. Results: During a 7-year period, two affected members died from intracranial hemorrhage. Four other members had a COL4A1 mutation (age ranges 25 to 74 years). None reported stroke or retinal hemorrhage or hematuria and none had dementia according to Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Follow-up brain MRI showed grade 3 diffuse leukoencephalopathy in three out of four patients. All had dilated perivascular spaces and three out of four had silent microbleeds mainly in the deep white matter. MRI signal abnormalities did not change in severity, number, or location between baseline and follow-up imaging. Conclusions: COL4A1 mutation carriers have great diversity in the clinical expression of the disease within the same family. Some affected family members may remain asymptomatic during several years of follow-up and have no evidence of progression of vascular changes on brain MRI. GLOSSARY: FSE = T2 fast spin echo; GE = gradient echo; PVS = perivascular spaces; TE = echo time; TI = inversion time; TR = repetition time.

Published
2007

45. [Patent foramen ovale and migraine]

Author

M G, Bousser

Subjects
Migraine with Aura, Humans, Heart Septal Defects, Atrial
Abstract

Recent epidemiological data suggest a bidirectional link between patent foramen ovale (PFO) and migraine with aura (MA) with a relative risk of 2 for PFO in subjects with MA and for MA in subjects with PFO. There is no evidence for a link between PFO and migraine without aura. This link is not systematic and applies only to subsets of PFO, mostly large ones, and to subsets of patients with MA. Although comorbidity cannot be ruled out, it may be that this link is partly causal and that some large PFOs may favor MA attacks in genetically predisposed subjects, by allowing vasoactive substances, platelet emboli or paradoxical emboli to bypass the lung filter and trigger the cortical spreading depression of the aura. The first double blind randomised trial of PFO closure in refractory MA, "MIST", has failed to show a benefit on the primary efficacy end point: cessation of attacks during the analysis period included between 3 and 6 months after the procedure. There is thus at present no scientific reason to look for PFO or to close PFO in migraine patients.

Published
2007

46. Brain infarction following 5-fluorouracil and cisplatin therapy

Author

M.-G. Bousser, T. Debrouker, O. Heinzlef, M. El Amrani, E. Roullet, and Pierre Amarenco

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Central nervous system disease, Fatal Outcome, Antineoplastic Combined Chemotherapy Protocols, medicine, Humans, Stroke, Aged, Cisplatin, Chemotherapy, business.industry, Cerebral infarction, Vascular disease, Cancer, Cerebral Infarction, Middle Aged, medicine.disease, Surgery, Oropharyngeal Neoplasms, Fluorouracil, Anesthesia, Female, Neurology (clinical), business, medicine.drug
Abstract

Five patients with oropharyngeal cancer treated with 5-fluorouracil and cisplatin had ischemic stroke within 2 to 5 days after the drug infusion. This occurred during the second course of chemotherapy in three patients, and during the third course in two patients. There may be a relation between treatment and brain infarction because 1) there was no other cause identified despite extensive tests, including postmortem examination in one patients; 2) there was a short delay between treatment infusion and stroke; and 3) there was a similar pattern of ischemic stroke after the second or third course of chemotherapy.

Published
1998
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47. [CADASIL with minimal symptoms after 60 years]

Author

A, Mourad, M, Levasseur, M G, Bousser, and H, Chabriat

Subjects
Male, Disease Progression, Humans, CADASIL, Female, Middle Aged, Cognition Disorders, Aged
Abstract

CADASIL is a hereditary cerebral arteriopathy leading to progressive disability and dementia usually observed at 60 years.We report four patients aged60 years with typical Notch3 mutations leading to CADASIL who did not have dementia or disability. Three of them presented with only transient neurological manifestations. MRI results showed extensive hyperintense signals in the white-matter on T2-weighted images contrasting with very few lacunar infarcts.These observations suggest that silent or symptomatic infarcts, which were rare in the present cases may be responsible for the clinical severity in this disorder.

Published
2006

48. [Neuro-ophthalmologic initial presentation of sarcoidosis]

Author

C, Lamirel, I, Badelon, O, Gout, K, Berthet, F, Héran, L, Laloum, I, Cochereau, A, Gaudric, M-G, Bousser, and C, Vignal-Clermont

Subjects
Adult, Male, Eye Diseases, Sarcoidosis, Optic Nerve Diseases, Humans, Female, Middle Aged, Retrospective Studies
Abstract

To describe different forms of neuro-ophthalmologic onset of sarcoidosis: clinical signs, means of diagnosis, treatment, and progression.Retrospective study of 13 patients with neuro-ophthalmologic initial onset of sarcoidosis diagnosed in three departments between 1997 and 2003.There were ten women and three men, with a mean age of 36 years. Six patients suffered from diplopia. In three cases, the cavernous sinus was involved; the three other patients with diplopia had meningoradiculitis. Nine patients had infiltration of the anterior visual pathway: the optic nerve was involved in five cases, the chiasm in two cases, and two patients had papilledema. Two patients also had both symptoms. The dosage of the angiotensin-converting enzyme level was evaluated in 11 patients and was elevated in six cases. Nine patients underwent a lumbar puncture; the cerebrospinal fluid protein was high in seven cases. Chest radiography and CT were abnormal in nine cases of 11. Ten patients had histological proof of sarcoidosis; the three others had enough evidence to support this diagnosis. All of them were treated with systemic corticosteroids. The diplopia improved for the six patients. Among the seven patients with optic nerve or chiasmal infiltration, one recovered completely, two were partially improved, and four remained stable.Diplopia and anterior visual pathway abnormalities can be the manifestation of initial onset of sarcoidosis; therefore this diagnosis must be kept in mind when these frequent neuro-ophthalmologic signs are encountered. Complementary exams, mainly biopsy of the involved areas with histological analysis, are needed to confirm this diagnosis. Corticosteroid treatment is generally followed by improvement, but relapses may occur.

Published
2006

49. Dilation of Virchow-Robin spaces in CADASIL

Author

Françoise Gray, Rodica Cumurciuc, M G Bousser, Hugues Chabriat, D. Reizine, and Jean-Pierre Guichard

Subjects
Adult, Male, Pathology, medicine.medical_specialty, CADASIL, Severity of Illness Index, Cerebral Ventricles, White matter, Epilepsy, Basal ganglia, medicine, Dementia, Humans, Perivascular space, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Middle Aged, medicine.disease, Magnetic Resonance Imaging, medicine.anatomical_structure, Neurology, Migraine, Case-Control Studies, Female, Neurology (clinical), business, Dilatation, Pathologic
Abstract

To precise the severity of dilated Virchow-Robin spaces (VRS) in CADASIL patients and to determine their correlation with clinical presentation and other abnormalities on cerebral Magnetic Resonance Imaging (MRI). Dilated VRS were previously associated with aging, hypertension, dementia, epilepsy or migraine. We already reported increased frequency of enlarged VRS in CADASIL patients when compared with family members without the affected haplotype. We analysed clinical and MRI data from 50 CADASIL patients collected prospectively in our center. The presence of dilated VRS was assessed in the subcortical white matter of temporal lobes, the centrum semi-ovale and the basal ganglia. Their severity in each region was evaluated according to the scale proposed by Heier. We compared the clinical data, the severity of white matter abnormalities and the presence of microbleeds in patients with and without dilated VRS. Seventy-eight percent of patients in our series had dilated VRS, mostly located in the lentiform nuclei (94%) and subcortical white matter of the temporal lobes (66%). The severity of these lesions was variable but not correlated neither to the extent of white matter abnormalities nor to the clinical presentation in our patients. Only the age was found to be related to the extent of dilated VRS. Dilated VRS are frequent in CADASIL and mostly located in the temporal white matter and basal ganglia. The dilation of perivascular spaces does not seem to be directly related to the occurrence of ischemic or hemorrhagic lesions in CADASIL. In contrast, the relation with age suggests that either aging, progression of vascular wall alterations during the course of the disease, or both of these processes can favour the extension of VRS in CADASIL.

Published
2006

50. [Antithrombotic drugs in the prevention of ischemic stroke]

Author

M G, Bousser

Subjects
Stroke, Fibrinolytic Agents, Heart Diseases, Intracranial Embolism, Humans, Cerebral Infarction, Platelet Aggregation Inhibitors, Brain Ischemia
Abstract

Stroke prevention cannot be dissociated from cardiovascular prevention in general. It is based on the correction of vascular risk factors, particularly hypertension and tobacco smoking, and on antithrombotic drugs which tackle the thrombo-embolic process which is the immediate cause of the ischemic event. Ischemic strokes exhibit considerable etiopathogenic diversity, the underlying cause modifying thrombus composition. In atherothrombotic brain infarction, platelets play a major role and antiplatelet drugs have a benefit/risk ratio better than that of oral anticoagulants, with a 25% reduction in the combined risk of ischemic stroke, myocardial infarction and vascular death. Antiplatelet drugs are also used in small artery diseases of the brain although the role of thrombosis is unknown and no specific trial has been devoted to this variety of cerebrovascular disease. In emboligenic cardiac diseases, atrial fibrillation in particular, stasis of the dilated left atrium favors coagulation phenomena, hence the much better efficacy of oral anticoagulants (presently vitamin K antagonists) both in primary and secondary prevention with a 70% risk reduction in cerebral infarction, compared with only 20% for aspirin. The expected benefit of antithrombotic drugs must be weighed against their inherent hemorrhagic risk, which is greatest for oral anticoagulants, slightly less for association of antiplatelet drugs and even less for each antiplatelet drug given alone. The use of antithrombotic drugs allows a targeted prevention of cerebral infarction. It is based on a triple case by case evaluation: that of the cause and of the risk it carries, that of the benefit expected from antithrombotic drugs, and that of their inherent hemorrhagic risk.

Published
2006

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