RESUMO
BACKGROUND AND PURPOSE: The reasons for poor clinical outcome after thrombectomy for acute stroke, concerning around half of all patients, are misunderstood. We developed a hierarchic algorithm based on DWI to better identify patients at high risk of disability. MATERIALS AND METHODS: Our single-center, retrospective study included consecutive patients with acute ischemic stroke who underwent thrombectomy for large anterior artery occlusion and underwent pretreatment DWI. The primary outcome was the mRS at 3 months after stroke onset. Multivariable regression was used to identify independent clinical and imaging predictors of poor prognosis (mRS > 2) at 3 months, and a hierarchic algorithm predictive of disability was developed. RESULTS: A total of 149 patients were analyzed. In decreasing importance, DWI lesion volume of >80 mL, baseline NIHSS score of >14, age older than 75 years, and time from stroke onset to groin puncture of >4 hours were independent predictors of poor prognosis. The predictive hierarchic algorithm developed from the multivariate analysis predicted the risk of disability at 3 months for up to 100% of patients with a high predictive value. The area under the receiver operating characteristic curve was 0.87. CONCLUSIONS: The DWI-based hierarchic algorithm we developed is highly predictive of disability at 3 months after thrombectomy and is easy to use in routine practice.
Assuntos
Algoritmos , Imagem de Difusão por Ressonância Magnética/métodos , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Resultado do Tratamento , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicaçõesRESUMO
BACKGROUND: Bradykinin-mediated angioedema (AE) is a complication associated with thrombolysis for acute ischemic stroke. Risk factors are unknown and management is discussed. OBJECTIVES: To clarify risk factors associated with bradykinin-mediated AE after thrombolysis for acute ischemic stroke. METHODS: In a case-control study conducted at a French reference centre for bradykinin angiÅdema, patients with thrombolysis for acute ischemic stroke and a diagnosis of bradykinin-mediated angiÅdema, were compared to controls treated with thrombolysis treatment without angiÅdema. RESULTS: Fifty-three thrombolysis-related AE were matched to 106 control subjects. The sites of attacks following thrombolysis for ischemic stroke mainly included tongue (34/53, 64%) and lips (26/53, 49%). The upper airways were involved in 37 (70%) cases. Three patients required mechanical ventilation. Patients with bradykinin-mediated angiÅdema were more frequently women [33 (62%) vs. 44 (42%); P = 0.01], had higher frequency of prior ischemic stroke [12 (23%) vs. 9 (8%); P = 0.01], hypertension [46 (87%) vs. 70 (66%); P = 0.005], were more frequently treated with angiotensin-converting enzyme inhibitor [37 (70%) vs. 28 (26%); P < 0.001] and were more frequently hospitalized in intensive care medicine [ICU; 11 (21%) vs. 5 (5%); P = 0.004]. In multivariate analysis, factors associated with thrombolysis-related AE were female sex [odds ratio (OR), 3.04; 95% confident interval (CI), 1.32-7.01; P = 0.009] and treatment with angiotensin-converting enzyme inhibitors [(OR), 6.08; 95% (CI), 2.17-17.07; P < 0.001]. CONCLUSIONS: This case-control study points out angiotensin-converting enzyme inhibitors and female sex as risk factors of bradykinin AE associated with thrombolysis for ischemic stroke.
Assuntos
Angioedema/induzido quimicamente , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Isquemia Encefálica/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Idoso , Bradicinina , Estudos de Casos e Controles , Feminino , França , Humanos , Masculino , Fatores de Risco , Fatores SexuaisRESUMO
BACKGROUND AND PURPOSE: Identifying occlusion location is crucial for determining the optimal therapeutic strategy during the acute phase of ischemic stroke. The purpose of this study was to assess the diagnostic efficacy of MR imaging, including conventional sequences plus time-resolved contrast-enhanced MRA in comparison with DSA for identifying arterial occlusion location. MATERIALS AND METHODS: Thirty-two patients with 34 occlusion levels referred for thrombectomy during acute cerebral stroke events were consecutively included from August 2010 to December 2012. Before thrombectomy, we performed 3T MR imaging, including conventional 3D-TOF and gradient-echo T2 sequences, along with time-resolved contrast-enhanced MRA of the extra- and intracranial arteries. The 3D-TOF, gradient-echo T2, and time-resolved contrast-enhanced MRA results were consensually assessed by 2 neuroradiologists and compared with prethrombectomy DSA results in terms of occlusion location. The Wilcoxon test was used for statistical analysis to compare MR imaging sequences with DSA, and the κ coefficient was used to determine intermodality agreement. RESULTS: The occlusion level on the 3D-TOF and gradient-echo T2 images differed significantly from that of DSA (P < .001 and P = .002, respectively), while no significant difference was observed between DSA and time-resolved contrast-enhanced MRA (P = .125). κ coefficients for intermodality agreement with DSA (95% CI, percentage agreement) were 0.43 (0.3%-0.6; 62%), 0.32 (0.2%-0.5; 56%), and 0.81 (0.6%-1.0; 88%) for 3D-TOF, gradient-echo T2, and time-resolved contrast-enhanced MRA, respectively. CONCLUSIONS: The time-resolved contrast-enhanced MRA sequence proved reliable for identifying occlusion location in acute stroke with performance superior to that of 3D-TOF and gradient-echo T2 sequences.
Assuntos
Angiografia Cerebral/métodos , Infarto Cerebral/diagnóstico , Meios de Contraste , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Angiografia por Ressonância Magnética/métodos , Meglumina , Compostos Organometálicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Infarto Cerebral/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , TrombectomiaRESUMO
BACKGROUND AND PURPOSE: Little is known about the consequences of arterial wall damage that may be due to mechanical endovascular thrombectomy. Our aim was to perform 1-year MR angiographic and clinical follow-up of patients treated with mechanical endovascular thrombectomy using the Solitaire device. MATERIALS AND METHODS: Patients with stroke treated between August 2010 and July 2012 were prospectively evaluated with a minimum follow-up of 1 year after mechanical endovascular thrombectomy. Angiographic follow-up was performed on a 3T MR imaging scanner and included intracranial artery TOF MRA and supra-aortic artery gadolinium-enhanced MRA. Images were assessed to detect arterial abnormalities (stenosis, occlusion, dilation) and were compared with the final post-mechanical endovascular thrombectomy run to differentiate delayed and pre-existing abnormalities. Clinical evaluation was performed with the mRS and the 36-Item Short-Form Health Survey questionnaire quality-of-life scale. RESULTS: Thirty-nine patients were angiographically assessed at the mean term of 19 ± 4 months. MRA showed intracranial artery abnormalities in 10 patients, including 5 delayed intracranial artery abnormalities in 4 patients (4 stenoses and 1 dilation), 4 cases of pre-existing intracranial artery stenosis, and 2 occlusions. Pre-existing etiologic cervical artery stenosis or occlusion was observed in 2 patients. All these patients remained asymptomatic during the follow-up period. A significant clinical improvement was observed at 1-year follow-up in comparison with 3-month follow-up (P < .0001), with a good outcome achieved in 62.5% of patients and an acceptable quality of life restored. CONCLUSIONS: One-year follow-up identifies delayed asymptomatic arterial abnormalities in patients treated with the Solitaire device.
Assuntos
Artérias Cerebrais/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia/efeitos adversos , Trombectomia/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia/métodos , Resultado do TratamentoAssuntos
Isquemia Encefálica/diagnóstico por imagem , Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/anormalidades , Adulto , Isquemia Encefálica/complicações , Artéria Carótida Interna/diagnóstico por imagem , Dissecação da Artéria Carótida Interna/complicações , Feminino , Humanos , Angiografia por Ressonância Magnética , RadiografiaRESUMO
We report a 35-year-old man with a stroke as the presenting feature of Fabry's disease. Cerebrovascular manifestation can be the first manifestation of this disease and must be systematically evoked by the neurologist. The neurological follow-up of these patients must be systematic.
Assuntos
Doença de Fabry/complicações , Doença de Fabry/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Adulto , Biomarcadores/sangue , Diagnóstico Diferencial , Doença de Fabry/genética , Seguimentos , Testes Genéticos , Humanos , Isoenzimas/uso terapêutico , Masculino , Mutação , Fatores de Risco , Acidente Vascular Cerebral/genética , Resultado do Tratamento , alfa-Galactosidase/genética , alfa-Galactosidase/uso terapêuticoRESUMO
BACKGROUND: Lithium salts can induce a dysfunction of the neuromuscular junction. CASE REPORT: A patient given lithium for bipolar psychosis developed a state of major fatigue revealing a myasthenia syndrome which resolved progressively after lithium withdrawal. DISCUSSION: In the literature, we found 4 cases of neuromuscular junction disorders in patients treated with lithium. A myasthenia syndrome was induced by lithium in 3 cases and underlying myasthenia was disclosed by lithium in the last one. The long-term course in our patient was in favor of an induced syndrome rather than underlying myasthenia. We discuss the pathophysiological mechanisms. Lithium is a commonly prescribed drug. Clinicians should be aware of the possibility of neuromuscular junction disorder in patients taking lithium who develop muscle fatigue.
Assuntos
Antimaníacos/efeitos adversos , Lítio/efeitos adversos , Miastenia Gravis/induzido quimicamente , Ansiolíticos/uso terapêutico , Benzodiazepinas , Transtorno Bipolar/tratamento farmacológico , Carbamazepina/uso terapêutico , Fadiga/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/induzido quimicamente , Junção Neuromuscular/efeitos dos fármacosRESUMO
Isolated palsy of the musculocutaneous nerve, terminal branch of the lateral cord of the brachial plexus, is rare. It is responsible for sensory loss of the distal forearm and weakness of elbow flexion. It occurs after shoulder or clavicle surgery, trauma (fracture, dislocation, blows on the shoulder), violent exercice or extension of the forearm, prolonged positioning of the shoulder in extension-abduction-external rotation and phlebotomy. Different mechanisms such as stretching, compression or direct nerve injury are encountered. We report 5 cases with isolated musculocutaneous nerve palsy, including bilateral palsy caused by violent forearm extension. In other cases, mechanisms were an extensive stretching during surgery and compression caused by prolonged supine position. Different injury locations and causes described in literature are reviewed.