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1. Patent foramen ovale closure in stroke patients with migraine in the CLOSE trial. The CLOSE-MIG study

Author

Yannick Béjot, Benoit Guillon, Emmanuel Teiger, Caroline Arquizan, Serge Timsit, Olivier Detante, Geneviève Derumeaux, Emmanuel Touzé, Close investigators, Fabrice Vuillier, Sonia Alamowitch, Céline Guidoux, Gilles Chatellier, Denis Sablot, Pierre Aubry, Laurent Derex, Jean-Louis Mas, Anaïs Charles-Nelson, Sandrine Canaple, Evelyne Massardier, Igor Sibon, V. Domigo, Nelly Dequatre-Ponchelle, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), UFR Médecine [Santé] - Université Paris Cité (UFR Médecine UPCité), Université Paris Cité (UPCité), Centre hospitalier universitaire de Nantes (CHU Nantes), CIC - HEGP (CIC 1418), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), GHU Paris Psychiatrie et Neurosciences, Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Health Service and Performance Research (HESPER), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, CHU Rouen, Normandie Université (NU), CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de Neurologie [Brest], Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Registre Dijonnais des Accidents Vasculaires Cérébraux (AVC) - Dijon Stroke Registry, Centre d'épidémiologie des populations (CEP), Université de Bourgogne (UB)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Université de Bourgogne (UB)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Universitaire [Grenoble] (CHU), [GIN] Grenoble Institut des Neurosciences (GIN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Centre Hospitalier Saint Jean de Perpignan, Agence Régionale de Santé Occitanie (ARS Occitanie), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP - Hôpital Bichat - Claude Bernard [Paris], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de Neurosciences cognitives et intégratives d'Aquitaine (INCIA), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-SFR Bordeaux Neurosciences-Centre National de la Recherche Scientifique (CNRS), Troubles cognitifs dégénératifs et vasculaires - U 1171 (TCDV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Physiopathologie et imagerie des troubles neurologiques (PhIND), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Service de neurologie [Amiens], CHU Amiens-Picardie, Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559 (LNFP), Université de Picardie Jules Verne (UPJV), CHU Saint-Antoine [AP-HP], CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université Paris Cité - UFR Médecine [Santé] (UPCité UFR Médecine), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-SFR Bordeaux Neurosciences-Centre National de la Recherche Scientifique (CNRS), Service de Neurologie [CHU Saint-Antoine], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Adult, medicine.medical_specialty, Stroke patient, Aura, Septal Occluder Device, [SDV]Life Sciences [q-bio], Migraine Disorders, Foramen Ovale, Patent, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Ischaemic stroke, medicine, Humans, 030212 general & internal medicine, Closure (psychology), Foramen ovale (heart), business.industry, Middle Aged, medicine.disease, Clinical trial, Stroke, medicine.anatomical_structure, Treatment Outcome, Neurology, Migraine, Cardiology, Patent foramen ovale, Female, Neurology (clinical), business, 030217 neurology & neurosurgery, Platelet Aggregation Inhibitors
Abstract

International audience; Background and purpose The efficacy of patent foramen ovale (PFO) closure to reduce the frequency of migraine attacks remains controversial. Methods This was a planned sub-study in migraine patients enrolled in a randomized, clinical trial designed to assess the superiority of PFO closure plus antiplatelet therapy over antiplatelet therapy alone to prevent stroke recurrence in patients younger than 60 years with a PFO-associated cryptogenic ischaemic stroke. The main outcome was the mean annual number of migraine attacks in migraine patients with aura and in those without aura, as recorded at each follow-up visit by study neurologists. Results Of 473 patients randomized to PFO closure or antiplatelet therapy, 145 (mean age 41.9 years; women 58.6%) had migraine (75 with aura and 70 without aura). Sixty-seven patients were randomized to PFO closure and 78 to antiplatelet therapy. During a mean follow-up of about 5 years, there were no differences between antiplatelet-only and PFO closure groups in the mean annual number of migraine attacks, both in migraine patients with aura (9.2 [11.9] vs. 12.0 [19.1], p = 0.81) and in those without aura (12.1 [16.1] vs. 11.8 [18.4], p > 0.999). There were no differences between treatment groups regarding cessation of migraine attacks, migraine-related disability at 2 years and use of migraine-preventive drugs during follow-up. Conclusions In young and middle-aged adults with PFO-associated cryptogenic stroke and migraine, PFO closure plus antiplatelet therapy did not reduce the mean annual number of migraine attacks compared to antiplatelet therapy alone, in migraine patients both with and without aura.

Published
2021
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2. Cathodal Transcranial Direct Current Stimulation in Acute Ischemic Stroke: Pilot Randomized Controlled Trial

Author

Catherine Lamy, Martine Gavaret, Jean-Louis Mas, Rossella Letizia Mancusi, Guillaume Turc, David Calvet, Joseph Benzakoun, Jean-Claude Baron, V. Domigo, Estelle Pruvost-Robieux, Angela Marchi, and Catherine Oppenheim

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Transcranial Direct Current Stimulation, Neuroprotection, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Double-Blind Method, law, medicine.artery, Internal medicine, medicine, Humans, 030212 general & internal medicine, Acute ischemic stroke, Aged, Ischemic Stroke, Advanced and Specialized Nursing, Aged, 80 and over, medicine.diagnostic_test, Transcranial direct-current stimulation, business.industry, Magnetic resonance imaging, Middle Aged, Magnetic Resonance Imaging, Middle cerebral artery, Acute Disease, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract

Background and Purpose: In acute stroke, preventing infarct growth until complete recanalization occurs is a promising approach as an adjunct to reperfusion therapies to reduce infarct size and improve outcome. In rodent models, cathodal transcranial direct current stimulation (C-tDCS) decreases peri-infarct depolarizations and reduces infarct volume. We hypothesized that C-tDCS would nonpharmacologically reduce infarct growth in hyperacute middle cerebral artery territory stroke patients receiving reperfusion therapy. Methods: STICA (Cathodal Transcranial Direct Stimulation in Acute Middle Cerebral Artery Stroke) was a pilot single-center, double-blind, 2-arms 1:1 randomized trial evaluating the safety, feasibility, and efficacy of C-tDCS versus sham stimulation in patients eligible for recanalization therapies. Magnetic resonance imaging was obtained both on admission and 24 hours later. The primary end point was 24-hour infarct growth. Secondary outcomes were (1) National Institutes of Health Stroke Scale score difference between day 7 and admission and (2) 3-month modified Rankin Scale score. Results: Forty-five patients were randomized. Median magnetic resonance imaging-to-C-tDCS start time was 45 minutes; C-tDCS was started before completion of recanalization procedure in all patients. The intervention proved feasible in all patients. No major adverse effects occurred in either group. There was no significant difference between active and sham groups for any end point. However, an apparent trend towards smaller infarct growth in the C-tDCS arm was observed in the whole group (unadjusted median difference [IC 95% ]: −2.2 mL [−12.2 to 1.5]) and in the prespecified subsamples with moderate-to-severe stroke and large vessel occlusion (−5.7 mL [−21.6 to 2.6] and −7.7 mL [−24.2 to 2.6], respectively). Conclusions: C-tDCS was feasible and well tolerated. No significant difference was found between the active and sham groups. However, the data suggest potential benefits of C-tDCS in patients with National Institutes of Health Stroke Scale score of >10 or large vessel occlusion. Using the observed effect size and standard α=5% and β=20%, samples of 102 and 86, respectively, can be estimated for future trials in patients with these characteristics. Randomized trials particularly targeting these populations may be warranted.

Published
2021

3. Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial

Author

Scott E Kasner, Balakumar Swaminathan, Pablo Lavados, Mukul Sharma, Keith Muir, Roland Veltkamp, Sebastian F Ameriso, Matthias Endres, Helmi Lutsep, Steven R Messé, J David Spence, Krassen Nedeltechev, Kanjana Perera, Gustavo Santo, Veronica Olavarria, Arne Lindgren, Shrikant Bangdiwala, Ashkan Shoamanesh, Scott D Berkowitz, Hardi Mundl, Stuart J Connolly, Robert G Hart, N Abdelhamid, D Abdul Rahman, M Abdul-Saheb, P Abreu, M Abroskina, F Abu Ahmad, S Accassat, M Acciaresi, A Adami, N Ahmad, F Ahmed, M Alberto Hawkes, F Alemseged, A Ali, R Altavilla, L Alwis, P Amarenco, S Amaro, LE Amaya Sanchez, A Amelia Pinto, SF Ameriso, H Amin, T Amino, AK Amjad, E Anagnostou, G Andersen, C Anderson, DC Anderson, M Andrea Falco, F Andres Mackinnon, D Andreu, M Androulakis, M Angel Gamero, G Angel Saredo, R Angeles Diaz, M Angels Font, S Anticoli, A Arauz, AA Arauz Gongora, P Araya, JF Arenillas Lara, S Arias Rivas, M Arnold, S Augustin, W Avelar, E Azevedo, V Babikian, A Bacellar, K Badalyan, HJ Bae, EM Baez Martinez, H Bagelmann, P Bailey, Z Bak, M Baker, A Balazs, D Baldaranov, I Balogun, T Balueva, Z Bankuti, M Bar, A Baranowska, J Bardutzky, S Barker Trejo, J Barlinn, F Baronnet, C Barroso, M Barteys, T Bartolottiova, A Barulin, M Bas, S Bashir, V Basile, R Bathe-Peters, R Bathula, C Batista, H Batur Caglayan, P Baumgartner, R Bazan, O Bazhenova, M Beaudry, J Beer, Y Behnam, C Beilei, A Beinlich, Y Bejot, A Belkin, OR Benavente, A Benjamin, V Berardi, D Bereczki, SD Berkowitz, J Berlingieri, W Berrios, J Berrouschot, M Bhandari, M Bhargavah, H Bicker, T Bicsak, M Bilik, D Bindila, J Birchenall, L Birnbaum, T Black, D Blacker, D Blacquiere, C Blanc-Labarre, C Blank, B Blazejewska-Hyzorek, S Bloch, E Bodiguel, E Bogdanov, L Boos, L Borcsik, N Bornstein, S Bouly, G Braga, I Bragado, MC Bravi, C Brokalaki, W Brola, R Brouns, D Bruce, J Brzoska-Mizgalska, B Buck, M Buksinska-Lisik, J Burke, M Burn, G Bustamante, L Cabrejo, K Cai, S Cajaraville, M Calejo, D Calvet, J Campillo, E Campos Costa, P Camps, H Can Alaydin, E Candeloro, C Canepa, CG Cantu Brito, M Cappellari, C Carcel, P Cardona Portela, F Cardoso, M Carek, M Carletti, J Carlos Portilla, P Caruso, I Casado-Naranjo, P Castellini, D Castro, F Castro Meira, A Cavallini, N Cayuela Caudevilla, S Cenciarelli, C Cereda, P Cerrone, A Chakrabarti, P Chaloulos-Iakovidis, A Chamorro, D Chandrasena, DI Chang, C Che, J Chembala, J Chen, Z Chen, T Chen, H Chen, X Chen, G Chen, L Chen, S Chen, B Cheripelli, M Chin, E Chiquete Anaya, M Chorazy, H Christensen, T Christensen, L Christian, F Chu, CS Chung, W Clark, R Clarke, S Claverie, E Clemente Agostoni, B Clissold, J Coelho, D Cohen, S Colakoglu, D Collas, R Condurso, SJ Connolly, D Consoli, C Constantin, AB Constantino Silva, L Contardo, A Corlobe, M Correia, C Correia, E Cortijo Garcia, B Coull, S Coutts, S Coveney, P Cras, R Crols, S Crozier, A Csanyi, L Csiba, K Csontos, R Csuha, L Cui, L Cunha, S Curtze, M Czerska, A Czlonkowska, M Czurko, M Czuryszkiewicz, M Dagnino, C Dai, A Daineko, G Dalek, D Damgaard, A Danese, K Dani, V Danku, W Dario Toledo, A Dávalos, A De Havenon, J De Keyser, N De Klippel, J De La Torre, A De Pauw, A De Smedt, R De Torres, MM De Vries Basson, J Dearborn, R Deganutto, M Degeorgia, I Deguchi, A Del Giudice, C Delcourt, R Delgado-Mederos, G Della Marca, B Delpont, S Deltour, DL Demets, M Dennis, J Desai, J Devine, I Dhollander, MT Di Mascio, M Diaconu, F Diaz Otero, J Dietzel, E Diez-Tejedor, N Ding, J Ding, M Diomedi, P Dioszeghy, M Distefano, V Domigo, E Dorodnicov, D Dossi, F Doubal, I Druzenko, P Du, J Du, T Duman, Y Duodu, D Dutta, L Dylewicz, J Eckstein, E Ehrensperger, S Ehrlich, G Einer Allende, B Elena Halac, S Elyas, M Endres, JM Engelbrecht, S Engelter, M Epinat, F Eren, M Esbjornsson, B Escribano, I Escudero, B Esisi, B Essa, M Esterbauer, N Evans, D Eveson, S Fabio, L Fang, S Fanta, M Fares, M Fatar, K Faust, A Favate, F Fazekas, M Federica Denaro, A Fedin, P Felipe Amaya, J Feng, K Ferencova, M Fernanda Gilli, MD Fernandez, PN Fernandez Pirrone, J Fernandez Vera, J Ferrari, A Ferreira, G Ferreira Junior, M Fidler, D Field, T Field, C Figueroa, J Fiksa, A Filipov, A Firstenfeld, L Fisch, U Fischer, M Fisselier, U Fiszer, F Fluri, G Fortea, K Fotherby, A Fraczek, E France, G Freitas, S Frey, M Frick, A Friedman, M Friedrich, G Frisullo, W Fryze, B Fuentes Gimeno, H Fujigasaki, K Fukuyama, A Furlan, G Furlanis, J Furnace, M Gabriel, E Gabriel Reich, RJ Gagliardi, F Galati, E Galli Giqueauk, A Gallina, E Gallinella, J Gallo, S Gangadharan, Y Gao, R Garcia Lopez, A Garcia Pastor, SM Garcia Sanchez, M Garnauf, P Garnier, D Gasecki, K Gasic, K Gasiorek, S Gasser, M Gaugg, M Gebreyohanns, K Gebura, J Geng, M Geniz Clavijo, K Georg Haeusler, R Geran, M Geremek, Z Gerocs, D Ghia, D Giannandrea, F Giatsidis, JA Gien Lopez, A Gil Nunez, L Gimenez, E Giralt, A Glabinski, D Gladstone, M Gliem, M Gluszkiewicz, R Goddeau, E Gogoleva, M Gokce, D Goldemund, K Golikov, A Gomes Neto, M Gomez Schneider, M Gomez-Choco, M Gomis, JF Gongora-Rivera, Y Gonysheva, L Gonzalez, ME Gonzalez Toledo, M Gottschal, I Gozdzik, S Grabowski, S Graf, D Green, D Greer, T Gregorio, S Greisenegger, I Greshnova, M Griebe, M Grzesik, J Guan, S Guarda, A Gueguen, C Guidoux, P Guillermo Povedano, B Guillon, V Guiraudg, G Gunathilagan, N Guryanova, V Gusev, G Gustavo Persi, R Gutiérrez, P Guyler, N Gyuker, V Hachinski, A Hajas, H Hallevi, G Hankey, GJ Hankey, L Hanouskova, L Hao, K Haraguchi, Y Haralur Sreekantaiah, S Haratz, D Hargroves, K Harkness, P Harmel, M Harrasser, RG Hart, M Harvey, R Hasan, Y Hasegawa, A Hassan, M Hattori, A Hatzitolios, M Hauk, T Hayashi, H Hayhoe, VS Hedna, M Heine, V Held, S Hellwig, J Henkner, N Henninger, S Hermans, J Hernandez, D Herrero, M Hervieu-Begue, R Herzig, L Hicken, M Hieber, M Hill, M Hirose, MC Hobeanu, B Hobson, M Hochstetter, J Hoe Heo, M Hoffmann, C Holmstedt, P Hon, KS Hong, Y Honma, A Horev, G Horgan, L Horvath, M Horvath, C Hoyer, D Huang, H Huang, B Huber, J Huhtakangas, M Hussain, S Igarashi, AM Iglesias Mohedano, J Ignacio Tembl, M Impellizzeri, Y Inanc, P Ioli, A Irina Aniculaesei, K Ishida, R Itabashi, H Iversen, A Jagolino, K Jakab, S Jander, H Janka, J Jankovych, J Jansen, L Jasek, M Javier Alet, L Javor, X Jin, P Jing, B Joachim, M Joan Macleod, M Johnson, J Jose Martin, C Joyner, K Judit Szabo, A Jun-Oconnell, R Jura, B Kaczorowska, J Kadlcikova, T Kahles, N Kakaletsis, I Kakuk, K Kalinowska, K Kaminska, C Kaneko, I Kanellos, P Kapeller, K Kapica-Topczewska, O Karasz, M Karlinski, JE Karlsson, K Kasa, E Kashaeva, SE Kasner, M Kaste, J Kasza, A Katalin Iljicsov, M Katsurayama, S Kaur, M Kawanishi, S Kaygorodtseva, K Ke, A Kei, J Keilitz, J Kellner, P Kelly, S Kelly, D Kemlink, M Kerekgyarto, I Keskinarkaus, D Khairutdinova, A Khanna, A Khaw, M Kholopov, C Khoumri, S Kirpicheva, H Kirshner, K Kitagawa, S Kittner, R Kivioja, F Klein, D Kleindorfer, T Kleinig, P Klivenyi, S Knecht, Y Kobayashi, A Kobayashi, M Koch, L Koehler, M Koivu, V Kolianov, I Koltsov, T Kondo, I Konkov, S Kopecky, E Korompoki, J Korpela, K Kosarz-Lanczek, A Koutroubi, K Kovacs, T Kovacs, H Kovacs, K Kowalczyk, M Kowalska, D Krajickova, M Kral, C Krarup Hansen, J Kraska, S Krebs, V Krejci, C Kremer, R Kreuzpointer, M Krzyzanowska, D Kucken, A Kulakowska, J Kunzmann, N Kurenkova, A Kuris, I Kurkowska-Jastrzebska, N Kurtenkova, O Kurushina, G Kusnick, M Kustova, T Kuwashiro, J Kwan Cha, A Lago, M Lagutenko, B Lajos, J Lambeck, C Lamy, A Landolfi, S Lanfranconi, W Lang, LB Lara Lezama, B Lara Rodriguez, T Largo, A Lasek-Bal, L Latte, V Lauer, P Lavados, R Le Bouc, R Leal Cantu, H Lechner, K Lecouturier, S Leder, J Lee, BC Lee, A Leger, E Leira, I Leisse, R Leker, G Lembo, L Lenskaya, J Leyden, G Li, M Li, S Li, J Li, G Liamis, H Liang, Z Liang, N Ligot, H Lin, R Lindert, A Lindgren, M Linna, T Litwin, K Liu, X Liu, L Llull, B Lohninger, M Longoni, C Loomis, D Lopes, M Lopez Fernandez, N Lopez Garza, A Lord, S Louw, R Lovasz, T Lowenkopf, Z Lu, SC Lubke-Detring, R Luder, S Lujan, B Luo, L Lupinogina, G Luschin, H Lutsep, A Lvova, J Ly, G.M. Grosse, H Ma, C Ma, M Machado, C Machado, S Macher, J Machetanz, F Macian-Montoro, E Mackey, A Mackey, G Maclean, J Maestre-Moreno, A Magadan, T Magyar, A Mahagney, A Majid, A Majjhoo, K Makaritsis, J Mandzia, M Mangas Guijarro, D Mangion, E Manios, S Mann, L Manning, C Manno, J Manuel Garcia, V Maqueda, M Mar Castellanos, M Mar Freijo, C Marando, S Marcela Lepera, J Marcos Couto, G Maria Bruera, L Maria Greco, A Maria Lorenzo, S Maria Obmann, A Maria Roa, C Marini, I Marinkovic, G Mario Sumay, C Mario Torres, M Marko, S Markova, H Markus, R Marsh, E Marsili, M Marta Esnaola, J Marta Moreno, J Marti-Fabregas, S Martina Angelocola, P Martínez Sánchez, N Martinez-Majander, S Martins, O Marzelik, S Mastrocola, G Matamala, A Matoltsy, B Matosevic, S Matsumoto, A Maud, G Mauri Cabdevila, Z May, Y Mayasi, A Mayr, T Mazzoli, K Mcarthur, L Mccullough, CE Medina Pech, F Medlin, M Mehdiratta, S Mehta, D Mehta, B Mehta, M Melis, E Melnikova, B Mendez, T Mendonca, JJ Mengual Chirifie, N Menon, A Mensch, E Meseguer, S Messe, K Metcalf, N Meyer, F Michas, N Micheletti, R Mikulik, H Milionis, B Miller, T Milling, C Minelli, J Minhas, M Minns, D Mircea, S Mishra, A Mismas, A Mistri, N Mitrovic, H Miyake, B Modrau, A Moey, C Molina, J Molina, A Molis, J Moller, S Molnar, F Moniche, C Monosi, V Monzani, M Moonis, R Morais, L Morales, A Morales, D Morar-Precup, F Moreton, C Moro, E Morozova, M Morton, T Morvan, E Morvan, T Motko, A Mowla, E Mozhejko, G Muddegowda, O Mudhar, T Mueller, C Muhl, KW Muir, H Mundl, S Munoz, C Murphy, S Murphy, A Murtuzova, T Musuka, J Mutzenbach, M Myint, W Mysliwy, M Naccarato, G Naeije, Y Nagakane, I Natarajan, D Navaratnam, A Nave, B Nazliel, K Nedeltchev, J Nel, H Nell, R Nemeth, L Nemeth, O Neto, K Ng, J Ngeh, L Nicolas Chialvo, T Nieminen, M Nikkanen, J Nikl, M Nikoforova, S Nishino, Y Nishiyama, X Njovane, S Nogawa, F Nombela, B Norrving, K Nosek, B Nowak, E Nowakowska-Sledz, G Ntaios, H Numminen, F Nunez, M Obadia, S Oberndorfer, A Obrezan, J Ochiai, W Oczkowski, MJ O'Donnell, A Odyniec, K Oh, M Ohira, Y Okamoto, M Okpala, S Okubo, L Olah, V Olavarria, J Oleszek, N Onat Demirci, V Ondar, G Ongun, K Ooyama, V Orosz, R Ortiz, G Osseby, E Österlund-Tauriala, C Ovesen, S Ozcekic Demirhan, J Ozdoba-Rot, S Ozturk, E Ozyurt, M Pablo Grecco, G Pablo Povedano, M Paciaroni, C Padiglioni, J Pagola, W Palasik, G Panczel, L Panos, G Papadopoulos, E Papadopoulou, A Papagiannis, V Papavasileiou, M Papina, JR Pardo De Donlebun, V Parisi, JM Park, J Pasten, N Patel, O Pavlik, M Pawelczyk, WF Peacock, H Pei, T Peisker, LF Pena Sedna, A Penn, S Pentek, E Pepper, L Pereira, K Perera, Y Perez, S Perez, P Perez Leguizamon, M Pernicka, R Perry, A Persico, Y Pesant, S Peska, D Peters, G Peters, L Pettigrew, T Phan, S Philippi, T Phinney, F Pico, A Pidal, B Piechowski-Jozwiak, A Pieroni, S Pineiro, V Piras, N Pizova, J Polanco, M Polin, A Polyakov, E Polychronopoulou, A Polymeris, D Popov, A Poppe, P Postorino, C Pozzerese, M Pradhan, L Prats, E Prazdnichkova, B Prendl, M Pretorius, P Profice, S Prokopenko, E Pudov, V Pujol Lereis, G Punzo Bravo, F Purroy, J Qiu, X Qu, V Quenardelle, H Quesada Garcia, L Radrizzani, A Radtke, T Raffelsberger, JM Ramirez Moreno, C Ramos-Estebanez, A Rani, P Rapantova, K Rashed, A Rasheed Nihara, J Rasmussen, L Redondo Robles, M Reif, P Reiner, P Rekova, A Renu, M Repetto, P Reyes, S Reyes Morales, JH Rha, J Ribeiro, S Ricci, C Richard, R Rigual, C Rinaldi, C Riveira Rodriguez, B Rizzato, TG Robinson, A Rocco, M Rodrigues, G Rodriguez, A Rodriguez Campello, F Rodriguez Lucci, M Rodriguez Yanez, C Roesler, C Roffe, R Roine, S Roine, A Roldan, F Romana Pezzella, M Romano, JS Roos, C Rosso, C Rostrup Kruuse, Y Roth, R Roukens, L Roveri, D Rozanski, J Rozniecki, C Rozsa, S Rudilosso, G Ruiz Ares, A Ruiz Franco, G Rum, J Ruuskanen, I Rybinnik, K Ryota, J Saarinen, V Saavedra, C Sabben, A Sabet, D Sagris, J Sahlas, N Sakai, P Salamanca, P Salgado, S Salig, T Salletmayr, M Salnikov, O Samoshkina, Y Samson, D Sanak, M Sànchez Cerón, P Santalucia, M Santamaria Cadavid, P Santiago, G Santo, B Sanz Cuesta, J Sargento, A Sarraj, K Sas, A Sas, O Satoshi, S Satsoglou, N Sattar, S Savitz, C Savopoulos, J Saw, M Sawicka, R Sawyer, T Scandura, N Schillinger, J Schindler, F Schlachetzki, I Schneider, R Schuppner, J Schurig, CJ Schwarzbach, M Sebejova, G Seidel, L Sekaran, D Selcuk, J Selvarajah, A Semerano, J Semjen, D Semushina, S Sen, M Seok Park, J Serena, O Serhat Tokgoz, W Serles, F Serrano, M Sevin, L Seynaeve, S Shah, N Shamalov, T Shang, M Sharma, A Sharrief, M Shazam Hussain, I Shchukin, W Shen, E Shepeleva, I Shinsuke, A Shmonin, A Shoamanesh, A Shuaib, A Shulga, G Sibolt, I Sibon, I Sicilia, M Siebert, E Sieczkowska, C Sila, AA Silva, D Silva, P Silva, Y Silva, M Silvestrini, Z Simony, A Simpkins, B Singh, D Sinha, I Sipos, O Skoda, P Skowron, M Skowronska, B Sliwinska, J Slonkova, A Smolkin, A Smyth, P Sobolewski, A Sobota, SI Sohn, M Soldatov, I Solganov, L Soloveva, E Solovyeva, N Sonntag, P Soors, M Sorgun, C Soriano, D Spence, K Spengos, L Sposato, G Staaf, K Stadler, L Stakhovskaya, K Stamatelopoulos, S Steinert, I Stetkarova, M Stiehm, R Stocker, J Stoinski, A Stoll, G Stotts, A Stumpp, P Sucapane, T Suenaga, X Sun, S Sundararajan, J Sung Kim, H Suzuki, N Svaneborg, G Szasz, W Szczuchniak, S Szczyrba, N Szegedi, A Szekely, Z Szewczyk, G Szilagyi, S Szlufik, K Szoboszlai, L Szpisjak, R Sztajzel, L Sztriha, SE Ta Wil, J Taggeselle, K Takamatsu, M Takao, W Taki, S Takizawa, M Talahma, A Tamayo, J Tan, D Tanne, A Tapanainen, T Tapiola, J Tarasiuk, T Tatlisumak, A Tayal, S Tcvetkova, P Teal, J Tejada Garcia, H Tejada Meza, D Tenora, M Terceno, A Terentiou, S Tezcan, D Thaler, A Thomson, E Thouvenot, M Tiainen, I Timberg, S Timsit, A Tinchon, D Tirschwell, C Togay Isikay, K Tokunaga, M Tolino, C Toloza, G Tomelleri, K Tomoyuki, LM Tomppo, Z Tong, L Tong, D Toni, J Torres, C Tossavainen, G Toth, A Tountopoulou, E Touze, M Tovar, K Toyoda, S Trillo, A Trommer, D Tropepi, D Tryambake, H Tu, S Tuetuencue, R Tumova, O Tumpula, G Turc, A Tutaj, J Tynkkynen, S Uchiyama, U Uchwat, L Uhrinyakova, R Ulku Acar, D Uluduz Ugurlu, X Urra, S Urui, M Usero Ruiz, D Vaclavik, K Vahedi, A Valikovics, J Valpas, P Van Acker, W Van Daele, G Vanderschueren, L Vanina Jure, R Varela, Z Varga, J Varvat, N Varvyanskaya, A Vasco Salgado, P Vasko, L Vass, S Vassilopoulou, I Vastagh, P Vazquez, L Vecsei, R Veltkamp, M Venti, M Verdugo, V Verocai, M Veronica Marroquin, C Veronica Simonsini, T Veverka, M Vigl, A Vila, C Vilar, JA Villanueva Osorio, J Virta, E Vitkova, B Voglsperger, J Volna, PA Von Weitzel-Mudersbach, N Vora, I Voznyuk, A Wach-Klink, A Wacongne, D Walters, Y Wang, J Wang, L Wang, X Wang, W Wang, N Wang, D Wang, H Wang, W Warnack, K Wartenberg, R Waters, M Waters, T Webb, J Weber, G Weiss, K Weissenborn, JI Weitz, B Weller, G Wen, G Weng, P Werner, D Werring, P Wester, W Whiteley, R Whiting, T Wijeratne, C Willems, L Wilson, C Wilson, T Winder, J Windt, A Winkler, A Winska-Tereszkiewicz, A Wisniewska, M Wittayer, A Wlodek, A Wojnarowska-Arendt, M Wolf, V Wolff, C Wolter, A Wong, H Wook Nah, H Worthmann, W Wu, S Wu, S Wunderlich, H Wurzinger, DG Wyse, B Xiao, W Xiaopeng, A Ximenez-Carrillo, L Xiong, Y Xiong, W Xiong, Y Xu, J Xu, Z Xu, B Yalo, T Yamada, M Yamasaki, L Yang, Y Yang, X Yang, Q Yang, B Yang, J Yang, I Yasuhiro, M Yee Lam, C Yegappan, S Yip, E Ylikallio, P Ylikotila, A Yongwon Jin, BW Yoon, Y Yoshida, L Yperzeele, H Yuan, H Yuasa, J Zalewska, C Zanferrari, E Zapata, D Zboznovits, I Zelenka, C Zhang, B Zhang, S Zhang, M Zhang, X Zhang, J Zhang, L Zhao, O Zhirnova, L Zhou, J Zielinska-Turek, I Zinchenko, M Ziomek, A Zitzmann, R Zweifler, J Zwiernik, Yperzeele, Laetitia, and NAVIGATE ESUS Investigators

Subjects
Male, International Cooperation, 030204 cardiovascular system & hematology, antiplatelet therapy, law.invention, Neurology (clinical), ischemic stroke, anticoagulation, Cohort Studies, 0302 clinical medicine, Randomized controlled trial, Rivaroxaban, law, Stroke, education.field_of_study, Aspirin, Anticoagulant, Settore BIO/14, Middle Aged, 3. Good health, Treatment Outcome, N/A, Cardiology, Platelet aggregation inhibitor, Settore MED/26 - Neurologia, Female, medicine.drug, medicine.medical_specialty, medicine.drug_class, MEDLINE, Population, Foramen Ovale, Patent, Subgroup analysis, Article, Statistics, Nonparametric, 03 medical and health sciences, Double-Blind Method, Internal medicine, medicine, Humans, education, Aged, business.industry, medicine.disease, Human medicine, business, 030217 neurology & neurosurgery, Platelet Aggregation Inhibitors, Factor Xa Inhibitors
Abstract

Background: \ud Patent foramen ovale (PFO) is a contributor to embolic stroke of undetermined source (ESUS). Subgroup analyses from previous studies suggest that anticoagulation could reduce recurrent stroke compared with antiplatelet therapy. We hypothesised that anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, would reduce the risk of recurrent ischaemic stroke compared with aspirin among patients with PFO enrolled in the NAVIGATE ESUS trial.\ud \ud Methods: \ud NAVIGATE ESUS was a double-blinded, randomised, phase 3 trial done at 459 centres in 31 countries that assessed the efficacy and safety of rivaroxaban versus aspirin for secondary stroke prevention in patients with ESUS. For this prespecified subgroup analysis, cohorts with and without PFO were defined on the basis of transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE). The primary efficacy outcome was time to recurrent ischaemic stroke between treatment groups. The primary safety outcome was major bleeding, according to the criteria of the International Society of Thrombosis and Haemostasis. The primary analyses were based on the intention-to-treat population. Additionally, we did a systematic review and random-effects meta-analysis of studies in which patients with cryptogenic stroke and PFO were randomly assigned to receive anticoagulant or antiplatelet therapy.\ud \ud Findings: \ud Between Dec 23, 2014, and Sept 20, 2017, 7213 participants were enrolled and assigned to receive rivaroxaban (n=3609) or aspirin (n=3604). Patients were followed up for a mean of 11 months because of early trial termination. PFO was reported as present in 534 (7·4%) patients on the basis of either TTE or TOE. Patients with PFO assigned to receive aspirin had a recurrent ischaemic stroke rate of 4·8 events per 100 person-years compared with 2·6 events per 100 person-years in those treated with rivaroxaban. Among patients with known PFO, there was insufficient evidence to support a difference in risk of recurrent ischaemic stroke between rivaroxaban and aspirin (hazard ratio [HR] 0·54; 95% CI 0·22–1·36), and the risk was similar for those without known PFO (1·06; 0·84–1·33; pinteraction=0·18). The risks of major bleeding with rivaroxaban versus aspirin were similar in patients with PFO detected (HR 2·05; 95% CI 0·51–8·18) and in those without PFO detected (HR 2·82; 95% CI 1·69–4·70; pinteraction=0·68). The random-effects meta-analysis combined data from NAVIGATE ESUS with data from two previous trials (PICSS and CLOSE) and yielded a summary odds ratio of 0·48 (95% CI 0·24–0·96; p=0·04) for ischaemic stroke in favour of anticoagulation, without evidence of heterogeneity.\ud \ud Interpretation: \ud Among patients with ESUS who have PFO, anticoagulation might reduce the risk of recurrent stroke by about half, although substantial imprecision remains. Dedicated trials of anticoagulation versus antiplatelet therapy or PFO closure, or both, are warranted.\ud \ud Funding: \ud Bayer and Janssen.

Published
2018
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4. Aspects radio cliniques de l’angiopathie cérébrale aiguë réversible

Author

S. Godon-Hardy, V. Domigo, J.-F. Meder, Denis Trystram, Catherine Oppenheim, and F Brami

Subjects
medicine.medical_specialty, Radiological and Ultrasound Technology, medicine.diagnostic_test, business.industry, Cerebral arteries, Retrospective cohort study, Neurological disorder, medicine.disease, Magnetic resonance angiography, Surgery, Stenosis, Aneurysm, medicine, Radiology, Nuclear Medicine and imaging, Radiology, medicine.symptom, business, Vasoconstriction, Thunderclap headaches
Abstract

Purpose. To report clinical and imaging features of diffuse cerebral vasoconstriction and to discuss the role of non-invasive imaging modalities for the diagnosis and the follow-up. Patients and methods. Retrospective study including 13 consecutive patients with a diffuse cerebral vasoconstriction. Evaluation of the sensitivity of Doppler US and magnetic resonance angiography for the diagnosis. Results. The diagnosis is based on the association of a thunderclap headache, declenching factors found in 50% of cases and of stenosis involving middle and small cerebra arteries. In some cases cerebral hemorrhage may be present. Discussion. Diffuse cerebral vasoconstriction is a rare cause of thunder clap headhache, which needs to exclude other causes such as subarchnoid hemorrhage from aneurysm rupture. Non contrast CT of the head, frequently normal, may be falsely reassuring. It is therefore necessary to further assess the cerebral arteries to exclude an aneurysm but also to detect the presence of stenoses that would suggest the diagnosis. Non-invasive imaging modalities (MRA and Doppler US) are favored for detection and follow-up of proximal lesions.

Published
2009
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5. 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

6. Cyclosporine in acute ischemic stroke

Author

Laurent Derex, Norbert Nighoghossian, Yves Berthezène, Pierre Amarenco, E Bodiguel, Sylvain Rheims, Frédéric Philippeau, Marie-Hélène Mahagne, Catherine Oppenheim, T.-H. Cho, Vincent Guiraud, Benoit Guillon, Hubert Desal, S. Cakmak, Nathan Mewton, Hassan Hosseini, Mathieu Sevin-Allouet, Fabien Chauveau, Elodie Ong, Yannick Béjot, Guillaume Turc, Laura Mechtouff, Catherine Lamy, V. Domigo, Frédéric Ricolfi, Michel Ovize, Jean-Louis Mas, Agnès Jacquin, Thomas Ritzenthaler, Igor Sibon, Maurice Giroud, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL)

Subjects
Male, Randomization, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Pilot Projects, Placebo, law.invention, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Drug Therapy, law, Interquartile range, medicine, Clinical endpoint, 80 and over, Humans, Thrombolytic Therapy, Single-Blind Method, Stroke, 030304 developmental biology, Aged, Aged, 80 and over, 0303 health sciences, business.industry, Cyclosporine/*administration & dosage, Thrombolysis, Middle Aged, medicine.disease, Thrombolytic Therapy/*trends, Stroke/*diagnosis/*drug therapy, Arterial occlusion, 3. Good health, Anesthesia, Combination, Cyclosporine, Brain Ischemia/*diagnosis/*drug therapy, Drug Therapy, Combination, Female, Neurology (clinical), business, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract

International audience; OBJECTIVES: We examined whether IV administration of cyclosporine in combination with thrombolysis might reduce cerebral infarct size. METHODS: Patients aged 18 to 85 years, presenting with an anterior-circulation stroke and eligible for thrombolytic therapy, were enrolled in this multicenter, single-blinded, controlled trial. Fifteen minutes after randomization, patients received either an IV bolus injection of 2.0 mg/kg cyclosporine (Sandimmune, Novartis) or placebo. The primary endpoint was infarct volume on MRI at 30 days. Secondary endpoints included infarct volume according to the site (proximal/distal) of arterial occlusion and recanalization after thrombolysis. RESULTS: From October 2009 to July 2013, 127 patients were enrolled. The primary endpoint was assessed in 110 of 127 patients. The reduction of infarct volume in the cyclosporine compared with the control group was overall not significant (21.8 mL [interquartile range, IQR 5.1, 69.2 mL] vs 28.8 mL [IQR 7.7, 95.0 mL], respectively; p = 0.18). However, in patients with proximal occlusion and effective recanalization, infarct volume was significantly reduced in the cyclosporine compared with the control group (14.9 mL [IQR 1.3, 23.2 mL] vs 48.3 mL [IQR 34.5, 118.2 mL], respectively; p = 0.009). CONCLUSIONS: Cyclosporine was generally not effective in reducing infarct size. However, a smaller infarct size was observed in patients with proximal cerebral artery occlusion and efficient recanalization. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that in patients with an acute anterior-circulation stroke, thrombolysis plus IV cyclosporine does not significantly decrease 30-day MRI infarct volume compared with thrombolysis alone.

Published
2015
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7. Critères diagnostiques en échographie-Doppler des dissections artérielles cervicales à la phase aiguë

Author

Catherine Oppenheim, MP Gobin-Metteil, Denis Trystram, J.-F. Meder, F. Brami-Zylberberg, V. Domigo, and Olivier Naggara

Subjects
Radiological and Ultrasound Technology, Radiology, Nuclear Medicine and imaging
Abstract

Resume Objectif Evaluer la valeur de l’echo-Doppler dans le diagnostic initial des dissections arterielles cervicales. Materiel et methode Etude retrospective de 31 patients d’âge moyen 45 ans, adresses pour suspicion de dissection arterielle cervicale confirmee en IRM qui a diagnostique 46 arteres dissequees (35 carotides internes et 11 vertebrales) chez 31 patients. Dix patients presentaient des dissections multiples. Les criteres diagnostiques evalues en echo-Doppler etaient les signes echographiques directs d’hematome parietal: elargissement du calibre externe de l’artere, reduction de la lumiere circulante, hematome hypo et/ou isoechogene, lambeau intimal. Les criteres associes recherches etaient la topographie de la lesion et en presence d’une occlusion d’un axe, la dissection associee d’un autre. Resultats En echo-Doppler, on distinguait les segments arteriels visualisables en echographie (carotide interne sus-bulbaire, vertebrale de V0 a V3) des segments non visualisables pour lesquels seul un enregistrement Doppler pulse etait possible (carotide intra-petreuse, vertebrale en V3V4). Avec les criteres retenus, le diagnostic de dissection etait porte sur l’echo-Doppler initial dans 83 % des cas sur les segments visualisables et dans 30 % des segments non visualisables. Conclusion Les signes directs d’hematome parietal sur les segments arteriels visualisables en echographie ont une bonne sensibilite. Le choix de confronter l’image de l’hematome parietal en echo-Doppler et en IRM limitait l’analyse des resultats a la seule sensibilite sans appreciation de la specificite des criteres retenus. La presence de dissections multiples doit etre systematiquement recherchee puisque rencontree dans 30 % des cas de notre serie.

Published
2006
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8. Accident vasculaire cérébral ischémique et tenseur de diffusion

Author

J.L. Mas, Daniel Fredy, J.-F. Meder, Emmanuel Touzé, Sebastian Rodrigo, V. Domigo, C. Lamy, Catherine Oppenheim, and O Naggara

Subjects
Physics, Radiological and Ultrasound Technology, business.industry, Radiology, Nuclear Medicine and imaging, Neurology (clinical), Nuclear medicine, business, Diffusion MRI
Abstract

Resume Objectif Comparer les sensibilites respectives d’une sequence en tenseur de diffusion (9 directions) avec une sequence de diffusion standard (3 directions) pour la visualisation de lesions ischemiques recentes. Materiels et methodes 41 patients (18 deficits transitoires, 23 deficits persistants, IRM ≤ 48 heures) suspects d’accident ischemique ont beneficie de deux sequences de diffusion (gradients de diffusion appliques dans 3 directions, 2 excitations, duree: 40 secondes et 9 directions, 1 excitation, duree: 50 secondes, autres parametres identiques). Pour ces deux sequences, les variables suivantes ont ete comparees (test de Wilcoxon): nombre de lesions ischemiques recentes, etendue, valeur absolue du signal et de l’ADC, valeur relative du signal et ratio d’ADC. L’anisotropie fractionnee a ete mesuree au sein de la lesion sur la sequence a 9 directions. Resultats 24 patients avaient des lesions ischemiques sur les 2 sequences. Chez 4 d’entre eux (dont un AIT), la sequence a 9 directions montrait plus de lesions ( Conclusion La sequence en tenseur de diffusion qui permet des mesures d’anisotropie, montre davantage de lesions que la sequence de diffusion standard et pourrait ainsi la remplacer en routine clinique.

Published
2006
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9. Diffusion-weighted MR imaging in transient ischaemic attacks

Author

Catherine Oppenheim, Olivier Naggara, J.L. Mas, David Calvet, C. Lamy, V. Domigo, and JL Méder

Subjects
Adult, Male, medicine.medical_specialty, Transient ischaemic attacks, Predictive Value of Tests, Humans, Medicine, Effective diffusion coefficient, Radiology, Nuclear Medicine and imaging, In patient, cardiovascular diseases, Diffusion-Weighted MR Imaging, Aged, Neuroradiology, Analysis of Variance, medicine.diagnostic_test, business.industry, Ultrasound, Magnetic resonance imaging, Interventional radiology, General Medicine, Middle Aged, nervous system diseases, Diffusion Magnetic Resonance Imaging, Logistic Models, Ischemic Attack, Transient, Cerebrovascular Circulation, Female, Radiology, business
Abstract

The purpose of this study was to determine frequency and the characteristics of diffusion-weighted imaging (DWI) abnormalities in patients with transient ischaemic attack (TIA). We analysed data of 98 consecutive patients (mean age: 60.6+/-15.4 years, 56 men) admitted between January 2003 and April 2004 for TIA. Age, gender, symptom type and duration, delay from onset to magnetic resonance imaging (MRI), probable or possible TIA and cause of TIA were compared in patients with (DWI+) and without (DWI-) lesions on DWI. Volume and apparent diffusion coefficient (ADC) values of DWI lesions were computed. DWI revealed ischaemic lesions in 34 patients (34.7%). Lesions were small (mean volume: 1.9 cm(3)+/-3.3), and ADC was moderately decreased (mean ADC ratio: 79.5%). The diagnosis of TIA was considered as probable in all DWI+ patients. A multiple logistic regression model demonstrated that TIA duration greater than or equal to 60 min (OR, 7.6; 95% CI, 2.3-25.7), aphasia (OR, 9.2; 95% CI, 2.7-31.4) and motor deficit (OR, 5.1; 95% CI, 1.5-17.8) were independent predictors of DWI lesions. Prolonged TIA duration, aphasia and motor deficits are associated with DWI lesions. More than half of TIA patients with symptoms lasting more than 60 min have DWI lesions.

Published
2006
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10. Clinical and Magnetic Resonance Imaging Predictors of Very Early Neurological Response to Intravenous Thrombolysis in Patients With Middle Cerebral Artery Occlusion

Author

Marion Apoil, Emmanuel Touzé, Catherine Oppenheim, Marie Tisserand, Olivier Naggara, Guillaume Turc, David Calvet, Jean-Claude Baron, and V. Domigo

Subjects
Male, thrombolysis, medicine.medical_specialty, Time Factors, acute stroke, medicine.medical_treatment, Nervous System, Tissue plasminogen activator, Disability Evaluation, Fibrinolytic Agents, Predictive Value of Tests, Risk Factors, Modified Rankin Scale, Internal medicine, Antithrombotic, Odds Ratio, medicine, Humans, Thrombolytic Therapy, Infusions, Intravenous, Stroke, Aged, Original Research, Aged, 80 and over, Neurologic Examination, Cardiovascular Surgery, medicine.diagnostic_test, business.industry, Infarction, Middle Cerebral Artery, Magnetic resonance imaging, Recovery of Function, Thrombolysis, Middle Aged, medicine.disease, Surgery, Diffusion Magnetic Resonance Imaging, Logistic Models, Treatment Outcome, Tissue Plasminogen Activator, Predictive value of tests, Multivariate Analysis, outcome, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Fibrinolytic agent, medicine.drug
Abstract

Background The early identification of patients who are unlikely to respond to intravenous recombinant tissue plasminogen activator ( IV ‐ tPA ) could help select candidates for additional intra‐arterial therapy or add‐on antithrombotic drugs during the acute stage of stroke. Given that very early neurological improvement ( VENI ) is a reliable surrogate of early recanalization, we assessed the clinical and magnetic resonance imaging predictors of lack of VENI . Methods and Results We reviewed consecutive ischemic stroke patients with middle cerebral artery occlusion and treated within 4.5 hours by IV ‐ tPA between 2003 and 2012 in our center, where magnetic resonance imaging is systematically implemented as first‐line diagnostic workup. Lack of VENI was defined as a NIHSS ) score 1 hour after start of IV ‐ tPA . Poor outcome was defined as a 3‐month modified R ankin scale ≥2. Associations between lack of VENI and potential determinants were assessed in logistic regression models. In all, 186 patients were included (median baseline NIHSS score, 16; median onset to treatment time, 155 minutes). One hundred forty‐three patients (77%) had no VENI . The variables significantly associated with lack of VENI in multivariable analysis were baseline NIHSS ( OR , 1.08; 95% CI , 1.01 to 1.16 per 1‐point increase; P =0.03), onset to treatment time >120 minutes ( OR , 2.94; 95% CI, 1.31 to 6.63; P =0.009) and diffusion weighted imaging—Alberta Stroke Programme Early CT Score ≤5 ( OR , 3.60; 95% CI , 1.14 to 11.35; P =0.03). Patients without VENI were more likely to have a modified Rankin Scale ≥2 than those without VENI (68% versus 24%; OR , 5.01; 95% CI , 2.12 to 11.82) and less likely to have recanalization after 24 hours ( OR , 0.41; 95% CI , 0.19 to 0.88). Conclusions Lack of VENI provides an early estimate of 3‐month outcome and recanalization after IV ‐ tPA . Baseline NIHSS , onset to treatment time, and diffusion weighted imaging—Alberta Stroke Programme Early CT Score could help to predict lack of VENI and, in turn, might help early selection of candidates for complementary reperfusion strategies.

Published
2013
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11. [Clinical and imaging features of diffuse cerebral vasoconstriction]

Author

F, Brami, V, Domigo, S, Godon-Hardy, D, Trystram, C, Oppenheim, and J F, Méder

Subjects
Adult, Male, Cerebrovascular Disorders, Young Adult, Acute Disease, Humans, Female, Middle Aged, Magnetic Resonance Imaging, Retrospective Studies
Abstract

To report clinical and imaging features of diffuse cerebral vasoconstriction and to discuss the role of non-invasive imaging modalities for the diagnosis and the follow-up.Retrospective study including 13 consecutive patients with a diffuse cerebral vasoconstriction. Evaluation of the sensitivity of Doppler US and magnetic resonance angiography for the diagnosis.The diagnosis is based on the association of a thunderclap headache, declenching factors found in 50% of cases and of stenosis involving middle and small cerebra arteries. In some cases cerebral hemorrhage may be present.Diffuse cerebral vasoconstriction is a rare cause of thunder clap headhache, which needs to exclude other causes such as subarchnoid hemorrhage from aneurysm rupture. Non contrast CT of the head, frequently normal, may be falsely reassuring. It is therefore necessary to further assess the cerebral arteries to exclude an aneurysm but also to detect the presence of stenoses that would suggest the diagnosis. Non-invasive imaging modalities (MRA and Doppler US) are favored for detection and follow-up of proximal lesions.

Published
2009

12. MR Imaging–Based Decision in Thrombolytic Therapy for Stroke on Awakening: Report of 2 Cases

Author

J.-F. Meder, Denis Trystram, C. Iosif, V. Domigo, and Catherine Oppenheim

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Central nervous system disease, Stroke onset, Image Processing, Computer-Assisted, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Thrombolytic Therapy, Wakefulness, Dominance, Cerebral, Stroke, Anamnesis, Neurologic Examination, business.industry, Vascular disease, Brain, Infarction, Middle Cerebral Artery, Thrombolysis, Middle Aged, medicine.disease, Image Enhancement, Prognosis, Mr imaging, Magnetic Resonance Imaging, Surgery, Circadian Rhythm, Diffusion Magnetic Resonance Imaging, Treatment Outcome, Tissue Plasminogen Activator, Female, Neurology (clinical), Radiology, business, Sleep, Blood Flow Velocity, Magnetic Resonance Angiography
Abstract

SUMMARY: Patients with stroke on awakening are denied the potential benefit of thrombolysis on the grounds that the onset time is unknown. Relying on clinical and MR imaging to indicate the most appropriate treatment could be more rational. We report 2 cases of stroke with unknown onset time. In both cases, anamnesis and MR imaging indicated that we might still be within 6 hours from stroke onset, with salvageable tissue. Arterial recanalization was successfully performed in both cases.

Published
2008

13. [Cervical arteries dissection: diagnostic Color Doppler US criteria at the acute phase]

Author

M P, Gobin-Metteil, C, Oppenheim, V, Domigo, D, Trystram, F, Brami-Zylberberg, O, Naggara, and J F, Meder

Subjects
Adult, Carotid Artery Diseases, Male, Vertebral Artery Dissection, Aortic Dissection, Acute Disease, Humans, Female, Middle Aged, Ultrasonography, Doppler, Color, Neck, Retrospective Studies
Abstract

To estimate the value of duplex color-coded ultrasonography in the initial diagnosis of acute cervical artery dissection.Retrospective study of 31 patients, mean age 45, sex ratio=1, referred for clinical suspicion of cervical artery dissection, confirmed by MRI. 46 dissected arteries were imaged. Ten patients presented multiple dissections. The evaluated sonographic diagnostic criteria were the direct signs of intra-mural hematoma: localized increased diameter of the artery, narrowed lumen, hypo and/or isoechoic intra-mural hematoma, intimal flap. The associated criteria studied were: the location of intra-mural hematoma and in case of an occlusion, the dissection of an other artery.We analyzed separately the arterial segments visualized in B-mode ultrasound (supra-bulbar internal carotid artery, vertebral artery from V0 to V3) and the arterial segments evaluated only by pulsed Doppler (intrapetrosal carotid artery, V3-V4 of the vertebral artery). With the above criteria, on arterial segments visualized in B-mode ultrasound, the diagnosis of dissection was done in 83% of cases during the initial examination but in only 30% of the arterial segments non visualized on ultrasonography.The direct signs of intra-mural hematoma on internal carotid and vertebral segments imaged by B-mode ultrasonography have a good sensitivity. Because results were compared to MRI, the specificity could not be assessed. In case of occlusion of an artery, multiple dissections are a strong argument for the diagnosis.

Published
2006

14. Reversible cerebral angiopathy: efficacy of nimodipine

Author

Catherine Lamy, Denis Trystram, V. Domigo, Emmanuel Touzé, Mathieu Zuber, and Jean-Louis Mas

Subjects
Adult, Male, medicine.medical_specialty, Neurology, Vasodilator Agents, Angiopathy, Central nervous system disease, medicine, Humans, Stroke, Nimodipine, Neuroradiology, Retrospective Studies, business.industry, Vascular disease, Headache, Vasospasm, Middle Aged, medicine.disease, Cerebrovascular Disorders, Anesthesia, Female, Neurology (clinical), business, Magnetic Resonance Angiography, medicine.drug
Abstract

Reversible cerebral angiopathy (RCA) is responsible for disabling headache and potential stroke complications. Most patients respond poorly to analgesics. We describe four patients with typical RCA whose headache rapidly disappeared after IV nimodipine treatment was initiated.

Published
2005

15. Extensive spinal epidural CSF collection after lumbar puncture

Author

Catherine Oppenheim, Emmanuel Touzé, Siham Ait Oussous, V. Domigo, Jean-Louis Mas, C. Rodriguez, Jean-François Meder, and Olivier Naggara

Subjects
medicine.medical_specialty, medicine.diagnostic_test, Lumbar puncture, business.industry, Both lower legs, Spinal cord, Low back pain, Extravasation, Epidural space, Surgery, Dissection, medicine.anatomical_structure, Spinal epidural, Cases, medicine, Neurology (clinical), medicine.symptom, business
Abstract

We performed a lumbar puncture in a 38-year-old woman. A few hours later, she reported headache and severe low back pain radiating down both lower legs. Neurologic examination was normal. Spine MRI demonstrated an extensive epidural CSF collection extending from cervical level to sacral region, without spinal cord signal changes (figure, MRI1). Follow-up MRI 4 days later showed complete resolution of the epidural collection (MRI2). Extensive dissection of CSF in the epidural space can occur after puncture of the dura from extravasation from the thecal sac,1 and may spontaneously resolve in a few days.

Published
2013
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16. Early and late seizures after cryptogenic ischemic stroke in young adults

Author

Caroline Arquizan, F. Semah, J.L. Mas, C. Lamy, Joël Coste, Denis Trystram, and V. Domigo

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Neurology, Neurological disorder, Comorbidity, Risk Assessment, Epilepsy, Recurrence, Risk Factors, Seizures, Convulsion, medicine, Odds Ratio, Humans, Multicenter Studies as Topic, Prospective Studies, Risk factor, Sex Distribution, Stroke, Proportional Hazards Models, business.industry, Hazard ratio, Odds ratio, Middle Aged, medicine.disease, Survival Analysis, Europe, Logistic Models, Anesthesia, Disease Progression, Female, Neurology (clinical), medicine.symptom, business, Follow-Up Studies
Abstract

Objectives: To assess the incidence and predictive factors of early and late seizures after ischemic stroke in young adults.Methods: A total of 581 patients (aged 18 to 55 years) with recent cryptogenic ischemic stroke were prospectively enrolled at 30 neurology departments and followed for 37.8 ± 9.7 months. Early seizures (occurring within 7 days of stroke) were assessed by chart review and late seizures were prospectively recorded at each follow-up visit. Clinical and brain imaging findings were reviewed by two neurologists and two neuroradiologists who were blinded to the occurrence of seizures.Results: Fourteen of the 581 patients (2.4%) developed early seizures, 71% of which occurred within the first 24 hours. Rankin scale ≥3 (odds ratio [OR] 3.9, 95% CI 1.2 to 12.7) and cortical involvement (OR 7.7, 95% CI 1.0 to 61.1) were independently associated with early seizures. Late seizures occurred only in patients with hemispheric stroke (n = 20). The risk of first late seizure was 3.1% (95% CI 1.4 to 4.8) within 1 year and 5.5% (95% CI 3.1 to 7.9) within 3 years. The mean delay between stroke and first late seizure was 12.9 months (0.3 to 33.9). Late seizures were associated with early seizure (hazard ratio [HR] 5.1, 95% CI 1.8 to 14.8), cortical signs (HR 4.5, 95% CI 1.6 to 13.1), and size of infarct superior to one-half hemisphere (HR 9.7, 95% CI 3.1 to 30.8). Eleven of the 20 patients with late seizure experienced recurrences (multiple in eight) on antiepileptic drug treatment. Most of them were seizure free at the end of the follow-up.Conclusion: Epilepsy is rarely a major problem in young cryptogenic ischemic stroke survivors. Early seizures are associated with stroke disability and cortical involvement. Early seizures, cortical signs, and large infarct are independent risk factors for late seizures.

Published
2003

17. Ischaemic stroke in a sportsman who consumed MaHuang extract and creatine monohydrate for body building

Author

Pierre Amarenco, K Vahedi, V Domigo, and M.-G. Bousser

Subjects
Weakness, medicine.diagnostic_test, business.industry, Creatine, medicine.disease, Duplex scanning, Psychiatry and Mental health, chemistry.chemical_compound, Blood pressure, chemistry, Anesthesia, Aphasia, medicine, Surgery, Neurology (clinical), Creatine Monohydrate, medicine.symptom, business, Letters to the Editor, Stroke, Cerebral angiography
Abstract

We report the first case of extensive cerebral infarct in a young sportsman consuming high doses of MaHuang extract and creatine monohydrate. This should alert the sport community to possible serious adverse effects of energy supplements. A 33 year old man had a severe aphasia on awakening in the morning of 23 January 1999. He did not complain of headache or of other symptoms. He was referred to our department on 26 January 1999. He had a Wernicke aphasia with a slight right sided face and arm weakness and a right Babinski sign. His blood pressure was 140/60 and his pulse 54 per minute. Brain CT showed signs of extensive left middle cerebral artery infarct. Cervical ultrasound duplex scanning and cerebral angiography were normal. Cerebral …

Published
2000

18. Should hepatitis B vaccine be contra-indicated in myasthenia gravis?

Author

François-Jérôme Authier, Jean-Denis Degos, Anne-Catherine Bachoud-Lévi, Romain K. Gherardi, and V Domigo

Subjects
Autoimmune disease, Adult, Hepatitis B vaccine, business.industry, Immunology, Vaccination, Active immunization, medicine.disease, Virology, Myasthenia gravis, Immunopathology, Myasthenia Gravis, medicine, Immunology and Allergy, Humans, Female, Hepatitis B Vaccines, Viral disease, Complication, business
Published
1999

19. RI-WP-4 Prise en charge peri-interventionnelle des syndromes d’ehlers danlos vasculaires

Author

L. Bellmann, Olivier Naggara, Denis Trystram, J.-F. Meder, J. Perdu, and V. Domigo

Subjects
Radiological and Ultrasound Technology, Radiology, Nuclear Medicine and imaging
Abstract

Objectifs pedagogiques Preciser les caracteristiques du syndrome d’Ehlers Danlos vasculaire et de ces complications notamment au decours des gestes endovasculaires. Preciser les mesures qui pourraient permettre d’ameliorer la prise en charge peri-interventionnelle de ces patients. Messages a retenir Une prise en charge globale, specifique et specialisee depuis l’induction anesthesique jusqu’au suivi post-interventionel pourrait permettre de reduire la frequence de survenue et la morbidite de ces complications.

Published
2007
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20. Angiopathie cerebrale aigue benigne. A propos de 11 cas

Author

S. Godon-Hardy, J.-F. Meder, F. Brami-Zylberberg, E. Meary, V. Domigo, and Catherine Oppenheim

Subjects
Radiological and Ultrasound Technology, Radiology, Nuclear Medicine and imaging
Abstract

Objectifs Presenter les aspects radiocliniques de l’angiopathie cerebrale aigue benigne (ACAB). Preciser la place de l’IRM/ARM dans le diagnostic de cette entite rare. Materiels et methodes Etude retrospective de 11 cas d’ACAB. Ont ete analyses : le terrain (migraine, tabac, HTA), les facteurs declenchants (post-partum, effort, prise de toxique, stress) et les anomalies retrouvees a l’IRM (anomalies des vaisseaux et du parenchyme, hemorragie meningee), le delai de reversibilite des lesions. Ces resultats ont ete correles aux donnees de la litterature. Resultats La symptomatologie inaugurale est dominee par des cephalees explosives repetitives (n = 10/11). Un facteur declenchant est retrouve dans 5 cas. L’examen clinique est normal chez 6 patients (deficit n = 2, raideur meningee n = 3). En imagerie, on note : la presence de stenoses des arteres intracrâniennes de moyen calibre situees sur les axes anterieurs +/-posterieur, un hematome (n = 2), une hemorragie meningee focale (n = 3), des anomalies de la substance blanche sous corticale (n = 2). Le bilan biologique est normal. Le delai de reversibilite des lesions sur le suivi en IRM/ARM est de 1 a 5 semaines. Conclusion L’ACAB est une cause rare de cephalees aigues. L’IRM permet d’en faire le diagnostic et d’eliminer les causes plus frequentes : rupture d’anevrisme, thrombophlebite.

Published
2006
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22. Imagerie de diffusion et accident ischemique transitoire

Author

Catherine Oppenheim, Emmanuel Touzé, Catherine Lamy, M. Alison, J.-F. Meder, Daniel Fredy, M. Zuber, N. Seiler, V. Domigo, Sebastian Rodrigo, and J.L. Mas

Subjects
Radiological and Ultrasound Technology, Radiology, Nuclear Medicine and imaging
Abstract

Objectifs Evaluer l’apport de l’imagerie de diffusion chez les patients suspects d’accident ischemique transitoire (AIT). Materiels et methodes Les auteurs ont analyse retrospectivement les donnees cliniques et IRM de diffusion (delai IRM/symptoms : moy. 45 heures, min-max 3 heures-10 jours) de 81 patients consecutifs (âge : 59 ans, 67 % hommes) hospitalises pour un AIT en 2003. Le diagnostic d’AIT (criteres NINDS) a ete classe en probable (70 %) ou possible (30 %). Les variables âge, sexe, duree des symptomes, delai symptomes/IRM, probabilite clinique d’AIT, episodes multiples/unique ont ete comparees entre les groupes sans et avec lesions ischemiques en diffusion (Dif⊕). Resultats Trente sur quatre vingt un patients (37 %) avaient au moins une lesion recente en diffusion (multiples 43 %), compatible avec la symptomatologie chez 28. Les lesions etaient de petite taille (volume moyen : 1,8 ce, min-max 0,1-13), l’ADC moderement diminue (rADC moyen : 81 %). La probabilite d’observer une lesion en diffusion etait significativement plus importante si l’AIT etait cliniquement probable (probable : 46 % Dif⊕ ; possible : 9 % Dif⊕), d’une duree ≥60 minutes ( Conclusion L’imagerie de diffusion revele une lesion ischemique recente chez plus de la moitie des AIT dont le deficit persiste plus d’une heure.

Published
2004
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23. P-32 Comparaison tenseur de diffusion et diffusion standard chez les patients suspects d’accident ischémique aigü

Author

V. Domigo, Daniel Fredy, C Lamy, Sebastian Rodrigo, Catherine Oppenheim, J.L. Mas, Emmanuel Touzé, J.-F. Meder, and Olivier Naggara

Subjects
Radiological and Ultrasound Technology, Radiology, Nuclear Medicine and imaging, Neurology (clinical)
Abstract

Objectifs Grâce a une meilleure resolution angulaire, l’imagerie en tenseur de diffusion pourrait ameliorer la sensibilite de detection des lesions ischemiques arterielles. L’objectif est de comparer une sequence en tenseur (9 directions) avec une sequence de diffusion standard (3 directions) pour la visualisation de lesions ischemiques. Materiels et methodes 41 patients (19 deficits transitoires, 22 deficits persistants, IRM Resultats 24 patients avaient des lesions ischemiques sur les 2 sequences. Chez 4 d’entre eux, la sequence 9 directions montraient plus de lesions ( Conclusion La sequence en tenseur de diffusion montre davantage de lesions que la sequence de diffusion standard. La sequence a 9 directions, qui permet par ailleurs des mesures d’anisotropie, pourrait remplacer en routine clinique la sequence de diffusion a trois directions.

Published
2004
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24. CO-22 Hémorragie sous-arachnoïdienne : un mode de révélation rare de thrombophlébite cérébrale

Author

V. Domigo, D Leys, J.-F. Meder, J.-Y. Gauvrit, M.A. Mackowiak-Cordoliani, Denis Trystram, Catherine Oppenheim, J.P. Pruvo, Daniel Fredy, C Lamy, and J.L. Mas

Subjects
Radiological and Ultrasound Technology, Radiology, Nuclear Medicine and imaging, Neurology (clinical)
Abstract

Introduction En raison de ses modes de revelation polymorphes, la thrombophlebite cerebrale est un diagnostic parfois difficile. L’hemorragie sous arachnoidienne (HSA) est un mode de revelation rare (etudes de cas) des thrombophlebites cerebrales, qui peut conduire a un retard diagnostique et therapeutique. Observations Nous rapportons trois observations de thrombophlebites cerebrales revelees par une HSA chez des patients (1 homme, 2 femmes) presentant des cephalees inhabituelles (n=3) associees a des crises partielles secondairement generalisees (n = 2). L’HSA etait diffuse (n=1), hemispherique droite (n = 1) ou localisee a la fissure interhemispherique (n = 1), sans signe d’ischemie parenchymateuse en IRM (n=2) ou TDM (n = 1). Le diagnostic de thrombose veineuse cerebrale a dans les trois cas ete confirme par arteriographie cerebrale, eliminant une autre cause d’HSA (anevrisme, fistule durale). Sous heparinotherapie a dose efficace, les patients se sont rapidement ameliores avec recanalisation sinusienne. Conclusion En cas d’HSA, une thrombophlebite cerebrale doit etre recherchee systematiquement afin d’eviter tout retard diagnostique et therapeutique. L’indication d’une angiographie, pour eliminer une autre cause d’HSA avant decision therapeutique, sera discutee. L’existence d’une HSA ne semble pas contre-indiquer le traitement en urgence de la thrombophlebite par anti-coagulants a dose efficace.

Published
2004
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25. Is carotid web an arterial wall dysplasia? A histological series.

Author

Wang LZ, Calvet D, Julia P, Domigo V, Mohamedi N, Alsac JM, El Batti S, Messas E, Mirault T, Bruneval P, and Goudot G

Subjects
Humans, Female, Adult, Hyperplasia complications, Hyperplasia pathology, Retrospective Studies, Carotid Arteries pathology, Stroke etiology, Fibromuscular Dysplasia complications, Fibromuscular Dysplasia pathology, Atherosclerosis pathology, Thrombosis pathology
Abstract

Introduction: Described for 60 years under various names, the carotid web is a suspected cause of cryptogenic stroke, especially in young patients. The web creates an intraluminal protrusion that may contribute to turbulent flow and thrombus embolization into cerebral arteries. Although the carotid web has frequently been related to arterial fibrodysplasia, its natural history and pathological description remain unclear., Patients: Among all consecutive patients admitted to the stroke unit of Sainte-Anne Hospital and referred to the vascular surgery department from January 2015 to December 2022, we retrospectively identified 9 patients with a carotid web. The surgical specimens of the 9 patients were submitted to systematic pathological analysis., Results: The patients with a histologically confirmed carotid web were young (median age was 42 years), prominently women (7/9), and presenting with low cardiovascular risk. Eight patients had a stroke proven by a magnetic resonance imaging, and 1 had transient monocular amaurosis. The typical pathological lesion supporting the imaging pattern of the carotid web was a focal eccentric intimal hyperplasia forming a protruding lesion characterized by a population of vascular smooth muscle cells intermingled in an abundant, most often loose extracellular matrix. Pathologically proven thrombus was observed in 4 cases. Importantly atherosclerosis was absent., Conclusion: Histological features in our 9 cases strengthen carotid web characterization as a homogeneous pattern of localized intimal hyperplasia. It is a unique entity consistent with intimal fibroplasia, distinct from medial fibromuscular dysplasia and early atherosclerosis., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Published
2023
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26. Case report: Meningitis: a cause of reversible cerebral vasoconstriction syndrome?

Author

Oukhai F, Domigo V, Benzakoun J, Wolff M, Ducros A, Mas JL, and Calvet D

Abstract

Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headache and reversible cerebral arteries vasoconstriction. The pathophysiology remains unclear, but many triggers were reported., Case Reports: We reported two cases of patients with meningitis who developed RCVS confirmed by brain imaging. They presented clinical and CSF features of meningitis that are suspected to be infectious, but no agent was identified. Headache and artery irregularities were resolved with the improvement of CSF., Conclusion: These cases suggest that in the context of meningitis, modification or atypical headaches should lead to brain imaging to rule out RCVS. We hypothesized that CSF inflammation may trigger cerebral arteries vasoconstriction., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Oukhai, Domigo, Benzakoun, Wolff, Ducros, Mas and Calvet.)

Published
2023
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27. Initiation and development of a percutaneous left atrial appendage closure programme: A French centre's experience and literature review.

Author

Albert E, Puscas T, Seret G, Tence N, Amet D, Varlet E, M'Barek DR, Picard F, Otmani A, Sabbah L, Le Guen J, Bodiguel E, Domigo V, Soulat G, Spaulding C, and Marijon E

Subjects
Male, Humans, Aged, Aged, 80 and over, Female, Cohort Studies, Treatment Outcome, Hemorrhage, Observational Studies as Topic, Stroke etiology, Atrial Appendage, Atrial Fibrillation, Thromboembolism etiology
Abstract

Background: Percutaneous left atrial appendage closure may be considered in selected patients with atrial fibrillation at significant risk of both thromboembolism and haemorrhage., Aims: To report the experience of a tertiary French centre in percutaneous left atrial appendage closure and to discuss the outcomes compared with previously published series., Methods: This was a retrospective observational cohort study of all patients referred for percutaneous left atrial appendage closure between 2014 and 2020. Patient characteristics, procedural management and outcomes were reported, and the incidence of thromboembolic and bleeding events during follow-up were compared with historical incidence rates., Results: Overall, 207 patients had left atrial appendage closure (mean age 75.3±8.6 years; 68% men; CHA 2 DS 2 -VASc score 4.8±1.5 ; HAS-BLED score 3.3±1.1), with a 97.6% (n=202) success rate. Twenty (9.7%) patients had at least one significant periprocedural complication, including six (2.9%) tamponades and three (1.4%) thromboembolisms. Periprocedural complication rates decreased from earlier to more recent periods (from 13% before 2018 to 5.9% after; P=0.07). During a mean follow-up of 23.1±20.2 months, 11 thromboembolic events were observed (2.8% per patient-year), a 72% risk reduction compared with the estimated theoretical annual risk. Conversely, 21 (10%) patients experienced bleeding during follow-up, with almost half of the events occurring during the first 3 months. After the first 3 months, the risk of major bleeding was 4.0% per patient-year, a 31% risk reduction compared with the expected estimated risk., Conclusion: This real-world evaluation emphasizes the feasibility and benefit of left atrial appendage closure, but also illustrates the need for multidisciplinary expertise to initiate and develop this activity., (Copyright © 2023. Published by Elsevier Masson SAS.)

Published
2023
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28. Patent foramen ovale closure in stroke patients with migraine in the CLOSE trial. The CLOSE-MIG study.

Author

Mas JL, Guillon B, Charles-Nelson A, Domigo V, Derex L, Massardier E, Arquizan C, Vuillier F, Timsit S, Béjot Y, Detante O, Sablot D, Guidoux C, Sibon I, Dequatre-Ponchelle N, Touzé E, Canaple S, Alamowitch S, Aubry P, Teiger E, Derumeaux G, and Chatellier G

Subjects
Adult, Female, Humans, Middle Aged, Platelet Aggregation Inhibitors therapeutic use, Treatment Outcome, Brain Ischemia, Foramen Ovale, Patent complications, Foramen Ovale, Patent surgery, Migraine Disorders complications, Migraine Disorders prevention & control, Septal Occluder Device, Stroke complications, Stroke prevention & control
Abstract

Background and Purpose: The efficacy of patent foramen ovale (PFO) closure to reduce the frequency of migraine attacks remains controversial., Methods: This was a planned sub-study in migraine patients enrolled in a randomized, clinical trial designed to assess the superiority of PFO closure plus antiplatelet therapy over antiplatelet therapy alone to prevent stroke recurrence in patients younger than 60 years with a PFO-associated cryptogenic ischaemic stroke. The main outcome was the mean annual number of migraine attacks in migraine patients with aura and in those without aura, as recorded at each follow-up visit by study neurologists., Results: Of 473 patients randomized to PFO closure or antiplatelet therapy, 145 (mean age 41.9 years; women 58.6%) had migraine (75 with aura and 70 without aura). Sixty-seven patients were randomized to PFO closure and 78 to antiplatelet therapy. During a mean follow-up of about 5 years, there were no differences between antiplatelet-only and PFO closure groups in the mean annual number of migraine attacks, both in migraine patients with aura (9.2 [11.9] vs. 12.0 [19.1], p = 0.81) and in those without aura (12.1 [16.1] vs. 11.8 [18.4], p > 0.999). There were no differences between treatment groups regarding cessation of migraine attacks, migraine-related disability at 2 years and use of migraine-preventive drugs during follow-up., Conclusions: In young and middle-aged adults with PFO-associated cryptogenic stroke and migraine, PFO closure plus antiplatelet therapy did not reduce the mean annual number of migraine attacks compared to antiplatelet therapy alone, in migraine patients both with and without aura., (© 2021 European Academy of Neurology.)

Published
2021
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29. Cathodal Transcranial Direct Current Stimulation in Acute Ischemic Stroke: Pilot Randomized Controlled Trial.

Author

Pruvost-Robieux E, Benzakoun J, Turc G, Marchi A, Mancusi RL, Lamy C, Domigo V, Oppenheim C, Calvet D, Baron JC, Mas JL, and Gavaret M

Subjects
Acute Disease, Aged, Aged, 80 and over, Double-Blind Method, Female, Humans, Male, Middle Aged, Ischemic Stroke diagnostic imaging, Ischemic Stroke physiopathology, Ischemic Stroke therapy, Magnetic Resonance Imaging, Transcranial Direct Current Stimulation
Abstract

Background and Purpose: In acute stroke, preventing infarct growth until complete recanalization occurs is a promising approach as an adjunct to reperfusion therapies to reduce infarct size and improve outcome. In rodent models, cathodal transcranial direct current stimulation (C-tDCS) decreases peri-infarct depolarizations and reduces infarct volume. We hypothesized that C-tDCS would nonpharmacologically reduce infarct growth in hyperacute middle cerebral artery territory stroke patients receiving reperfusion therapy., Methods: STICA (Cathodal Transcranial Direct Stimulation in Acute Middle Cerebral Artery Stroke) was a pilot single-center, double-blind, 2-arms 1:1 randomized trial evaluating the safety, feasibility, and efficacy of C-tDCS versus sham stimulation in patients eligible for recanalization therapies. Magnetic resonance imaging was obtained both on admission and 24 hours later. The primary end point was 24-hour infarct growth. Secondary outcomes were (1) National Institutes of Health Stroke Scale score difference between day 7 and admission and (2) 3-month modified Rankin Scale score., Results: Forty-five patients were randomized. Median magnetic resonance imaging-to-C-tDCS start time was 45 minutes; C-tDCS was started before completion of recanalization procedure in all patients. The intervention proved feasible in all patients. No major adverse effects occurred in either group. There was no significant difference between active and sham groups for any end point. However, an apparent trend towards smaller infarct growth in the C-tDCS arm was observed in the whole group (unadjusted median difference [IC95%]: −2.2 mL [−12.2 to 1.5]) and in the prespecified subsamples with moderate-to-severe stroke and large vessel occlusion (−5.7 mL [−21.6 to 2.6] and −7.7 mL [−24.2 to 2.6], respectively)., Conclusions: C-tDCS was feasible and well tolerated. No significant difference was found between the active and sham groups. However, the data suggest potential benefits of C-tDCS in patients with National Institutes of Health Stroke Scale score of >10 or large vessel occlusion. Using the observed effect size and standard α=5% and β=20%, samples of 102 and 86, respectively, can be estimated for future trials in patients with these characteristics. Randomized trials particularly targeting these populations may be warranted.

Published
2021
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30. Spontaneous Cervical Artery Dissection in Vascular Ehlers-Danlos Syndrome: A Cohort Study.

Author

Adham S, Billon C, Legrand A, Domigo V, Denarié N, Charpentier E, Jeunemaitre X, and Frank M

Subjects
Adult, Female, Humans, Male, Middle Aged, Carotid Artery, Internal, Dissection epidemiology, Carotid Artery, Internal, Dissection etiology, Carotid Artery, Internal, Dissection physiopathology, Carotid Artery, Internal, Dissection therapy, Ehlers-Danlos Syndrome complications, Ehlers-Danlos Syndrome epidemiology, Ehlers-Danlos Syndrome physiopathology, Ehlers-Danlos Syndrome therapy, Stroke epidemiology, Stroke etiology, Stroke physiopathology, Stroke therapy, Vertebral Artery Dissection epidemiology, Vertebral Artery Dissection etiology, Vertebral Artery Dissection physiopathology, Vertebral Artery Dissection therapy
Abstract

Background and Purpose: Vascular Ehlers-Danlos syndrome is a rare inherited connective tissue disorder because of pathogenic variants in the COL3A1 gene. Arterial complications can affect all anatomic areas and about 25% involve supra-aortic trunks (SATs) but no systematic assessment of cervical artery lesions has been made. The primary objective was to determine an accurate prevalence of spontaneous SAT lesions in a large series of patients with vascular Ehlers-Danlos syndrome at diagnosis and during follow-up. Secondary objectives were to study their neurological consequences (transient ischemic attack or stroke) and the possible relationships with sex, genotype, ascertainment status., Methods: A retrospective review of a monocentric cohort of patients with molecularly proven vascular Ehlers-Danlos syndrome followed in a tertiary referral center from 2000 to 2017., Results: One hundred forty-four patients were analyzed, 56.9% (n=82) had SAT lesions: 64.6% females, 74.4% index-case patients. Most lesions were identified in early arterial assessment (48% at first work-up, mean age of 35.7±13.0 years). Cumulative incidence of a first identification of a SAT lesion was 41.7% at 40 years old. On the complete period of survey, 183 SAT lesions (with 132 dissections and 33 aneurysms) were identified, mainly in internal carotid arteries (56.3%) and vertebral arteries (28.9%), more rarely in patients with COL3A1 null mutations ( P =0.008). Transient ischemic attack or stroke were reported in n=16 (19.5%) of the 82 patients with SAT lesions without relation with age, sex, treatment, or hypertension., Conclusions: Cervical artery lesions are frequent and mostly asymptomatic in patients with vascular Ehlers-Danlos syndrome. Local dissections and aneurysms are the most frequent type of lesions, but transient ischemic attack or stroke seem rare.

Published
2021
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31. Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry.

Author

Ntaios G, Michel P, Georgiopoulos G, Guo Y, Li W, Xiong J, Calleja P, Ostos F, González-Ortega G, Fuentes B, Alonso de Leciñana M, Díez-Tejedor E, García-Madrona S, Masjuan J, DeFelipe A, Turc G, Gonçalves B, Domigo V, Dan GA, Vezeteu R, Christensen H, Christensen LM, Meden P, Hajdarevic L, Rodriguez-Lopez A, Díaz-Otero F, García-Pastor A, Gil-Nuñez A, Maslias E, Strambo D, Werring DJ, Chandratheva A, Benjamin L, Simister R, Perry R, Beyrouti R, Jabbour P, Sweid A, Tjoumakaris S, Cuadrado-Godia E, Campello AR, Roquer J, Moreira T, Mazya MV, Bandini F, Matz K, Iversen HK, González-Duarte A, Tiu C, Ferrari J, Vosko MR, Salzer HJF, Lamprecht B, Dünser MW, Cereda CW, Quintero ÁBC, Korompoki E, Soriano-Navarro E, Soto-Ramírez LE, Castañeda-Méndez PF, Bay-Sansores D, Arauz A, Cano-Nigenda V, Kristoffersen ES, Tiainen M, Strbian D, Putaala J, and Lip GYH

Subjects
Aged, Aged, 80 and over, Brain Ischemia diagnostic imaging, Brain Ischemia therapy, COVID-19, Cohort Studies, Coronavirus Infections diagnostic imaging, Coronavirus Infections therapy, Disability Evaluation, Female, Humans, Male, Middle Aged, Pandemics, Pneumonia, Viral diagnostic imaging, Pneumonia, Viral therapy, Propensity Score, Recovery of Function, Registries, Stroke diagnostic imaging, Stroke therapy, Survival Analysis, Time-to-Treatment, Tomography, X-Ray Computed, Treatment Outcome, Brain Ischemia complications, Coronavirus Infections complications, Pneumonia, Viral complications, Stroke complications
Abstract

Recent case-series of small size implied a pathophysiological association between coronavirus disease 2019 (COVID-19) and severe large-vessel acute ischemic stroke. Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways. We pooled all consecutive patients hospitalized with laboratory-confirmed COVID-19 and acute ischemic stroke in 28 sites from 16 countries. To assess whether stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke are different between patients with COVID-19 and non-COVID-19, we performed 1:1 propensity score matching analyses of our COVID-19 patients with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. Between January 27, 2020, and May 19, 2020, 174 patients (median age 71.2 years; 37.9% females) with COVID-19 and acute ischemic stroke were hospitalized (median of 12 patients per site). The median National Institutes of Health Stroke Scale was 10 (interquartile range [IQR], 4-18). In the 1:1 matched sample of 336 patients with COVID-19 and non-COVID-19, the median National Institutes of Health Stroke Scale was higher in patients with COVID-19 (10 [IQR, 4-18] versus 6 [IQR, 3-14]), P =0.03; (odds ratio, 1.69 [95% CI, 1.08-2.65] for higher National Institutes of Health Stroke Scale score). There were 48 (27.6%) deaths, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors with available information about disability status, 49 (51%) had severe disability at discharge. In the propensity score-matched population (n=330), patients with COVID-19 had higher risk for severe disability (median mRS 4 [IQR, 2-6] versus 2 [IQR, 1-4], P <0.001) and death (odds ratio, 4.3 [95% CI, 2.22-8.30]) compared with patients without COVID-19. Our findings suggest that COVID-19 associated ischemic strokes are more severe with worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.

Published
2020
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32. Pathophysiology of carotid-cavernous fistulas in vascular Ehlers-Danlos syndrome: a retrospective cohort and comprehensive review.

Author

Adham S, Trystram D, Albuisson J, Domigo V, Legrand A, Jeunemaitre X, and Frank M

Subjects
Carotid-Cavernous Sinus Fistula pathology, Cavernous Sinus pathology, Cavernous Sinus physiopathology, Ehlers-Danlos Syndrome pathology, Humans, Retrospective Studies, Carotid-Cavernous Sinus Fistula physiopathology, Ehlers-Danlos Syndrome physiopathology
Abstract

Background: Vascular Ehlers-Danlos syndrome (vEDS) is a rare condition characterized by connective tissue fragility. Direct spontaneous carotid-cavernous fistula (sCCF) is reportedly pathognomonic of vEDS. We conducted this study to understand the possible mechanisms of occurrence of sCCF in this subset of patients., Methods: We conducted a retrospective analysis of a monocentric vEDS cohort along with a literature review regarding sCCF in this condition., Results: Of 133 patients regularly followed in our centre between 2000 and 2017, 13 (9.8%) had a diagnosis of direct sCCF (92.3% female, median age 33.0 years, interquartile range (IQR) [26.0-39.5]). There were 7 Glycine missense and 6 splice-site variants but no variant leading to haploinsufficiency. The literature search identified 97 vEDS patients with direct sCCF (79.4% female, 7.2% sex not reported, median age 31.0 years, IQR [24.0-39.0]). Increased carotid circumferential wall stress, higher carotid distensibility and lower carotid intima-media thickness could contribute to a higher risk for direct sCCF in vEDS. There is no predictive factor for the occurrence of sCCF apart from female sex in vEDS., Conclusions: In vEDS, anatomical and pathophysiological features of the intra-cavernous internal carotid artery make it prone to shunting in the cavernous sinus, due either to a spontaneous rupture or to a spontaneous dissection with pseudoaneurysm formation. Direct sCCF in seemingly healthy young individuals should be highly suggestive of vEDS and prompt further investigation.

Published
2018
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33. Cyclosporine in acute ischemic stroke.

Author

Nighoghossian N, Berthezène Y, Mechtouff L, Derex L, Cho TH, Ritzenthaler T, Rheims S, Chauveau F, Béjot Y, Jacquin A, Giroud M, Ricolfi F, Philippeau F, Lamy C, Turc G, Bodiguel E, Domigo V, Guiraud V, Mas JL, Oppenheim C, Amarenco P, Cakmak S, Sevin-Allouet M, Guillon B, Desal H, Hosseini H, Sibon I, Mahagne MH, Ong E, Mewton N, and Ovize M

Subjects
Aged, Aged, 80 and over, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pilot Projects, Single-Blind Method, Brain Ischemia diagnosis, Brain Ischemia drug therapy, Cyclosporine administration & dosage, Stroke diagnosis, Stroke drug therapy, Thrombolytic Therapy trends
Abstract

Objectives: We examined whether IV administration of cyclosporine in combination with thrombolysis might reduce cerebral infarct size., Methods: Patients aged 18 to 85 years, presenting with an anterior-circulation stroke and eligible for thrombolytic therapy, were enrolled in this multicenter, single-blinded, controlled trial. Fifteen minutes after randomization, patients received either an IV bolus injection of 2.0 mg/kg cyclosporine (Sandimmune, Novartis) or placebo. The primary endpoint was infarct volume on MRI at 30 days. Secondary endpoints included infarct volume according to the site (proximal/distal) of arterial occlusion and recanalization after thrombolysis., Results: From October 2009 to July 2013, 127 patients were enrolled. The primary endpoint was assessed in 110 of 127 patients. The reduction of infarct volume in the cyclosporine compared with the control group was overall not significant (21.8 mL [interquartile range, IQR 5.1, 69.2 mL] vs 28.8 mL [IQR 7.7, 95.0 mL], respectively; p = 0.18). However, in patients with proximal occlusion and effective recanalization, infarct volume was significantly reduced in the cyclosporine compared with the control group (14.9 mL [IQR 1.3, 23.2 mL] vs 48.3 mL [IQR 34.5, 118.2 mL], respectively; p = 0.009)., Conclusions: Cyclosporine was generally not effective in reducing infarct size. However, a smaller infarct size was observed in patients with proximal cerebral artery occlusion and efficient recanalization., Classification of Evidence: This study provides Class I evidence that in patients with an acute anterior-circulation stroke, thrombolysis plus IV cyclosporine does not significantly decrease 30-day MRI infarct volume compared with thrombolysis alone., (© 2015 American Academy of Neurology.)

Published
2015
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34. Clinical and magnetic resonance imaging predictors of very early neurological response to intravenous thrombolysis in patients with middle cerebral artery occlusion.

Author

Apoil M, Turc G, Tisserand M, Calvet D, Naggara O, Domigo V, Baron JC, Oppenheim C, and Touzé E

Subjects
Aged, Aged, 80 and over, Disability Evaluation, Female, Humans, Infarction, Middle Cerebral Artery diagnosis, Infarction, Middle Cerebral Artery physiopathology, Infusions, Intravenous, Logistic Models, Male, Middle Aged, Multivariate Analysis, Neurologic Examination, Odds Ratio, Predictive Value of Tests, Recovery of Function, Risk Factors, Time Factors, Treatment Outcome, Diffusion Magnetic Resonance Imaging, Fibrinolytic Agents administration & dosage, Infarction, Middle Cerebral Artery drug therapy, Nervous System physiopathology, Thrombolytic Therapy, Tissue Plasminogen Activator administration & dosage
Abstract

Background: The early identification of patients who are unlikely to respond to intravenous recombinant tissue plasminogen activator (IV-tPA) could help select candidates for additional intra-arterial therapy or add-on antithrombotic drugs during the acute stage of stroke. Given that very early neurological improvement (VENI) is a reliable surrogate of early recanalization, we assessed the clinical and magnetic resonance imaging predictors of lack of VENI., Methods and Results: We reviewed consecutive ischemic stroke patients with middle cerebral artery occlusion and treated within 4.5 hours by IV-tPA between 2003 and 2012 in our center, where magnetic resonance imaging is systematically implemented as first-line diagnostic workup. Lack of VENI was defined as a <40% decrease in baseline National Institutes of Health Stroke Scale (NIHSS) score 1 hour after start of IV-tPA. Poor outcome was defined as a 3-month modified Rankin scale ≥2. Associations between lack of VENI and potential determinants were assessed in logistic regression models. In all, 186 patients were included (median baseline NIHSS score, 16; median onset to treatment time, 155 minutes). One hundred forty-three patients (77%) had no VENI. The variables significantly associated with lack of VENI in multivariable analysis were baseline NIHSS (OR, 1.08; 95% CI, 1.01 to 1.16 per 1-point increase; P=0.03), onset to treatment time >120 minutes (OR, 2.94; 95% CI, 1.31 to 6.63; P=0.009) and diffusion weighted imaging--Alberta Stroke Programme Early CT Score ≤5 (OR, 3.60; 95% CI, 1.14 to 11.35; P=0.03). Patients without VENI were more likely to have a modified Rankin Scale ≥2 than those without VENI (68% versus 24%; OR, 5.01; 95% CI, 2.12 to 11.82) and less likely to have recanalization after 24 hours (OR, 0.41; 95% CI, 0.19 to 0.88)., Conclusions: Lack of VENI provides an early estimate of 3-month outcome and recanalization after IV-tPA. Baseline NIHSS, onset to treatment time, and diffusion weighted imaging--Alberta Stroke Programme Early CT Score could help to predict lack of VENI and, in turn, might help early selection of candidates for complementary reperfusion strategies.

Published
2013
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36. Abrupt regression of a meningioma after discontinuation of cyproterone treatment.

Author

Gonçalves AM, Page P, Domigo V, Méder JF, and Oppenheim C

Subjects
Female, Humans, Magnetic Resonance Imaging, Meningeal Neoplasms pathology, Meningioma pathology, Middle Aged, Remission Induction, Alopecia drug therapy, Androgen Antagonists adverse effects, Cyproterone adverse effects, Meningeal Neoplasms chemically induced, Meningioma chemically induced
Abstract

The multiplicity of meningiomas or abrupt lesion growth in patients treated with cyproterone acetate suggests that this progestative treatment may promote lesion growth. We report the rapid regression of an incidental meningioma after discontinuation of a 10-year cyproterone acetate treatment. This unique observation suggests that conservative management of meningiomas may be the best option among users of high doses of cyproterone acetate, given that spontaneous regression may occur after hormonal treatment discontinuation.

Published
2010
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37. MR imaging-based decision in thrombolytic therapy for stroke on awakening: report of 2 cases.

Author

Iosif C, Oppenheim C, Trystram D, Domigo V, and Méder JF

Subjects
Adult, Blood Flow Velocity physiology, Dominance, Cerebral physiology, Female, Humans, Infarction, Middle Cerebral Artery diagnosis, Male, Middle Aged, Neurologic Examination, Prognosis, Time Factors, Treatment Outcome, Circadian Rhythm physiology, Diffusion Magnetic Resonance Imaging, Image Enhancement, Image Processing, Computer-Assisted, Infarction, Middle Cerebral Artery drug therapy, Magnetic Resonance Angiography, Magnetic Resonance Imaging, Sleep physiology, Thrombolytic Therapy methods, Tissue Plasminogen Activator therapeutic use, Wakefulness physiology
Abstract

Patients with stroke on awakening are denied the potential benefit of thrombolysis on the grounds that the onset time is unknown. Relying on clinical and MR imaging to indicate the most appropriate treatment could be more rational. We report 2 cases of stroke with unknown onset time. In both cases, anamnesis and MR imaging indicated that we might still be within 6 hours from stroke onset, with salvageable tissue. Arterial recanalization was successfully performed in both cases.

Published
2008
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38. Reversible cerebral angiopathy: efficacy of nimodipine.

Author

Zuber M, Touzé E, Domigo V, Trystram D, Lamy C, and Mas JL

Subjects
Adult, Cerebrovascular Disorders complications, Cerebrovascular Disorders pathology, Female, Headache complications, Headache pathology, Humans, Magnetic Resonance Angiography methods, Male, Middle Aged, Retrospective Studies, Cerebrovascular Disorders drug therapy, Headache drug therapy, Nimodipine therapeutic use, Vasodilator Agents therapeutic use
Abstract

Reversible cerebral angiopathy (RCA) is responsible for disabling headache and potential stroke complications. Most patients respond poorly to analgesics. We describe four patients with typical RCA whose headache rapidly disappeared after IV nimodipine treatment was initiated.

Published
2006
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39. Subarachnoid hemorrhage as the initial presentation of dural sinus thrombosis.

Author

Oppenheim C, Domigo V, Gauvrit JY, Lamy C, Mackowiak-Cordoliani MA, Pruvo JP, and Méder JF

Subjects
Adult, Aged, Angiography, Digital Subtraction, Anticoagulants therapeutic use, Echo-Planar Imaging, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Sinus Thrombosis, Intracranial drug therapy, Subarachnoid Hemorrhage diagnosis, Dura Mater blood supply, Sinus Thrombosis, Intracranial complications, Subarachnoid Hemorrhage etiology
Abstract

Cerebral venous thrombosis (CVT) can be difficult to diagnose because of its wide spectrum of clinical manifestations. Its diagnosis may be further complicated when patients initially present with acute subarachnoid hemorrhage (SAH). We report on four patients with SAH revealing a CVT and discuss the role of imaging for diagnostic and pretherapeutic workup. In three women and one man presenting with severe headaches, images initially suggested SAH with no associated parenchymal bleeding. In all patients, SAH involved the sulci of the convexity and spared the basal cisterns. Digital subtracted angiography showed occlusion of intracranial venous sinuses but did not reveal any other cause of SAH. All patients improved with anticoagulant therapy. Risk factors for CVT and SAH, namely, head trauma and oral contraception, were identified in two patients. These cases highlight the fact SAH may reveal a CVT, which should be considered in the diagnostic workup of SAH, especially when the basal cisterns are not involved.

Published
2005

40. Spontaneous intracerebral hematoma on diffusion-weighted images: influence of T2-shine-through and T2-blackout effects.

Author

Silvera S, Oppenheim C, Touzé E, Ducreux D, Page P, Domigo V, Mas JL, Roux FX, Frédy D, and Meder JF

Subjects
Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Diffusion Magnetic Resonance Imaging methods, Hematoma pathology, Intracranial Hemorrhages pathology
Abstract

Background and Purpose: On diffusion-weighted (DW) images, primary hematomas are initially mainly hyperintense, and then hypointense during the first few days after stroke onset. As in other brain disorders, variations in the T2 relaxation time of the hematoma influence the DW imaging signal intensity. Our aim was to evaluate the contribution of the T2 signal intensity and apparent diffusion coefficient (ADC) changes to signal intensity displayed by DW imaging through the course of hematoma., Methods: The MR images of 33 patients with primary intracranial hemorrhage were retrospectively reviewed. Variations in T2-weighted echo planar images, DW imaging signal intensity, and apparent diffusion coefficient (ADC) ratios (core of hematoma/contralateral hemisphere) were analyzed according to the putative stages of hematoma, as seen on T1- and T2-weighted images., Results: On both T2-weighted echo planar and DW images, the core of the hematomas was hyperintense at the hyperacute (oxyhemoglobin, n = 11) and late subacute stages (extracellular methemoglobin, n = 4), while being hypointense at the acute (deoxyhemoglobin, n = 11) and early subacute stages (extracellular methemoglobin, n = 7). There was a positive correlation between the signal intensity ratio on T2-weighted echo planar and DW images (r = 0.93, P < .05). ADC ratios were significantly decreased in the whole population and in each of the first three stages of hematoma, without any correlation between DW imaging findings and ADC changes (r = 0.09, P = .6)., Conclusion: Our results confirm that the core of hematomas is hyperintense on DW images with decreased ADC values at the earliest time point, and may thus mimic arterial stroke on DW images. T2 shine-through and T2 blackout effects contribute to the DW imaging findings of hyperintense and hypointense hematomas, respectively, while ADC values are moderately but consistently decreased during the first three stages of hematoma.

Published
2005

41. Early and late seizures after cryptogenic ischemic stroke in young adults.

Author

Lamy C, Domigo V, Semah F, Arquizan C, Trystram D, Coste J, and Mas JL

Subjects
Adult, Comorbidity, Disease Progression, Europe, Female, Follow-Up Studies, Humans, Logistic Models, Male, Middle Aged, Multicenter Studies as Topic statistics & numerical data, Odds Ratio, Proportional Hazards Models, Prospective Studies, Recurrence, Risk Assessment, Risk Factors, Sex Distribution, Survival Analysis, Seizures epidemiology, Stroke epidemiology
Abstract

Objectives: To assess the incidence and predictive factors of early and late seizures after ischemic stroke in young adults., Methods: A total of 581 patients (aged 18 to 55 years) with recent cryptogenic ischemic stroke were prospectively enrolled at 30 neurology departments and followed for 37.8 +/- 9.7 months. Early seizures (occurring within 7 days of stroke) were assessed by chart review and late seizures were prospectively recorded at each follow-up visit. Clinical and brain imaging findings were reviewed by two neurologists and two neuroradiologists who were blinded to the occurrence of seizures., Results: Fourteen of the 581 patients (2.4%) developed early seizures, 71% of which occurred within the first 24 hours. Rankin scale >or=3 (odds ratio [OR] 3.9, 95% CI 1.2 to 12.7) and cortical involvement (OR 7.7, 95% CI 1.0 to 61.1) were independently associated with early seizures. Late seizures occurred only in patients with hemispheric stroke (n = 20). The risk of first late seizure was 3.1% (95% CI 1.4 to 4.8) within 1 year and 5.5% (95% CI 3.1 to 7.9) within 3 years. The mean delay between stroke and first late seizure was 12.9 months (0.3 to 33.9). Late seizures were associated with early seizure (hazard ratio [HR] 5.1, 95% CI 1.8 to 14.8), cortical signs (HR 4.5, 95% CI 1.6 to 13.1), and size of infarct superior to one-half hemisphere (HR 9.7, 95% CI 3.1 to 30.8). Eleven of the 20 patients with late seizure experienced recurrences (multiple in eight) on antiepileptic drug treatment. Most of them were seizure free at the end of the follow-up., Conclusion: Epilepsy is rarely a major problem in young cryptogenic ischemic stroke survivors. Early seizures are associated with stroke disability and cortical involvement. Early seizures, cortical signs, and large infarct are independent risk factors for late seizures.

Published
2003
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