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Background The novel coronavirus (COVID-19) has presented a significant and urgent threat to global health and there has been a need to identify prognostic factors in COVID-19 patients. The aim of this study was to determine whether chest CT characteristics had any prognostic value in patients with COVID-19. Methods A retrospective analysis of COVID-19 patients who underwent a chest CT-scan was performed in four medical centers. The prognostic value of chest CT results was assessed using a multivariable survival analysis with the Cox model. The characteristics included in the model were the degree of lung involvement, ground glass opacities, nodular consolidations, linear consolidations, a peripheral topography, a predominantly inferior lung involvement, pleural effusion, and crazy paving. The model was also adjusted on age, sex, and the center in which the patient was hospitalized. The primary endpoint was 30-day in-hospital mortality. A second model used a composite endpoint of admission to an intensive care unit or 30-day in-hospital mortality. Results A total of 515 patients with available follow-up information were included. Advanced age, a degree of pulmonary involvement ≥ 50% (Hazard Ratio 2.25 [95% Cl: 1.378 to 3.671], p= 0.001), nodular consolidations and pleural effusions were associated with lower 30-day in-hospital survival rates. An exploratory subgroup analysis showed a 60.6% mortality rate in patients over 75 with ≥ 50% lung involvement on a CT-scan. Conclusions Chest CT findings such as the percentage of pulmonary involvement ≥ 50%, pleural effusion and nodular consolidation were strongly associated with 30-day mortality in COVID-19 patients. CT examinations are essential for the assessment of severe COVID-19 patients and their results must be considered when making care management decisions.

Ulnar neuropathy at the elbow (UNE) involves mechanical compression and irritation of the ulnar nerve (UN) caused by environmental and dynamic abnormalities that can however also be found in asymptomatic patients. Using high-resolution ultrasound, we aimed to assess and compare the relevance of morphological and dynamic variants of the UN and its surrounding structures (UN abnormalities) in symptomatic and asymptomatic patients.UN abnormalities in patients with UNE were assessed using high-resolution ultrasound and compared against unaffected arms (patients or healthy volunteers).We studied 234 arms of 117 individuals (89 with UNE and 145 control). Eighty-one percent of the arms with UNE compared to 40% of control (p=0.00001) showed UN abnormalities. While it was dislocated in 49% of arms with UNE compared to in 23% of control (p=0.004).The two-fold higher frequency of occurrence of UN abnormalities in arms with UNE indicates their causative or at least contributory role in such neuropathies. High-resolution ultrasound should be part of the initial evaluation of UNE in order to assess the etiology of the conflict.

Background and Purpose— Because of the small number of yearly cases of ruptured cerebral aneurysms, endovascular treatment is not performed in Martinique. Therefore, patients from Martinique are sent 7000 km to Paris on commercial flights as soon as possible, where treatment is performed. Nontransportable patients are treated locally with either surgery or symptomatic care. The objective of our study was to assess patient outcomes and safety of this treatment strategy. Methods— We retrospectively examined all cases of aneurysmal subarachnoid hemorrhage in Martinique diagnosed during 2004 to 2013. Medical case records were searched for the type and location of treatment, clinical status, and transfer duration. Results— A total of 119 patients had an aneurysmal subarachnoid hemorrhage during the 10-year period. Of these, 91 were transferred to Paris, 12 were surgically treated locally, and 16 received symptomatic treatment. None of the transferred patients experienced any hemorrhagic recurrence, and none suffered a significant complication related to the air transportation. The median time between aneurysmal subarachnoid hemorrhage diagnosis and arrival at the referral center was 32 hours. The 30-day case fatality rate for treated cases was 14.6% (8.8% for those treated in Paris and 58.3% for those treated locally). Conclusions— Our treatment strategy for aneurysmal subarachnoid hemorrhage resulted in a 30-day case fatality rate similar to those observed elsewhere, despite an 8-hour flight and a median treatment delay of 32 hours. This strategy therefore seems to be safe and reliable for isolated regions with small populations.

Arterial spin labeling (ASL) is one of the most recent magnetic resonance imaging (MRI) sequences used to assess brain perfusion noninvasively. It can be used in the acute phase of ischemic stroke (IS) to identify ischemic penumbra.1 In patients in acute phase of IS, thrombus assessment is of major clinical relevance because the presence and location of the thrombus may determine therapeutic strategy.2 An arterial bright signal (ABS), at the level of vascular occlusions, can be observed on raw data of ASL sequence performed for stroke. The aim of this study is to evaluate the relevance of this MRI sign in patients admitted for IS. With the approval of the local ethics committee, we retrospectively analyzed MRI sequences of patients with an IS suspicion admitted in the Department of Neuroradiology (University Hospital of Martinique) from December 2011 to August 2014. MRI (GE Optima MR450W 1.5 T) was performed within 6 hours from stroke onset and included diffusion weighted imaging sequence, echo planar imaging T2* (EPI T2*), fluid attenuated inversion recovery (FLAIR) and MR angiography (Willis time of flight (TOF)). ASL sequence was performed only in case of doubtful diffusion weighted imaging or to highlight a mismatch before a thrombolytic treatment. ASL scans were performed using a pseudocontinuous mode with a repetition time of 4554 ms, an echo time of 10 ms, a postlabeling delay of 1525 ms, and a total acquisition time of 4 minutes. Main judgment criteria were the assessment and the concordance of ABS compared with other sequences (TOF, EPI T2*, and FLAIR). Moreover, a vessel occlusion was diagnosed if an artery was missing on Willis TOF. An intra-arterial clot could be diagnosed on T2* (as a focal hyposignal) and on FLAIR sequences (as a focal hypersignal). ABS was diagnosed according to 2 different patterns upstream …