Prospective assessment of aneurysmal rupture risk scores in patients with subarachnoid hemorrhage: a multicentric cohort.

PURPOSE: The natural evolution of unruptured intracranial aneurysms (UIA) is indeed difficult to predict at the individual level. OBJECTIVE: In a large prospective multicentric European cohort, we aimed to evaluate whether the PHASES, UCAS, and ELPASS scores in patients with aneurysmal subarachnoid hemorrhage would have predicted a high risk of aneurysmal rupture or growth. METHODS: Academic centers treating patients with intracranial aneurysms were invited to prospectively collect de-identified data from all patients admitted at their institution for a subarachnoid hemorrhage-related to intracranial aneurysmal rupture between January 1 and March 31, 2021 through a trainee-led research collaborative network. Each responding center was provided with an electronic case record form (CRF) which collected all the elements of the PHASES, ELAPSS, and UCAS scores. RESULTS: A total of 319 patients with aneurysmal subarachnoid hemorrhage were included at 17 centers during a 3-month period. One hundred eighty-three aneurysms (57%) were less than 7 mm. The majority of aneurysms were located on the anterior communicating artery (n = 131, 41%). One hundred eighty-four patients (57%), 103 patients (32%), and 58 (18%) were classified as having a low risk of rupture or growth, according to the PHASES, UCAS, and ELAPSS scores, respectively. CONCLUSION: In a prospective study of European patients with aneurysmal subarachnoid hemorrhage, we showed that 3 common risk-assessment tools designed for patients with unruptured intracranial aneurysms would have not identified most patients to be at high or intermediate risk for rupture, questioning their use for decision-making in the setting of unruptured aneurysms.

Glioma-grade diagnosis using in-phase and out-of-phase T1-weighted magnetic resonance imaging: A prospective study.

PURPOSE: The purpose of this prospective study was to determine whether chemical shift gradient-echo magnetic resonance imaging (MRI) could predict glioma grade. MATERIALS AND METHODS: A total of 69 patients with 69 gliomas were prospectively included. There were 41 men and 28 women with a mean age of 50±(SD) years (range: 16-82years). All patients had MRI of the brain including chemical shift gradient-echo sequence, further referred to as in- and out-of phase sequence (IP/OP). Intravoxel fat content was estimated by signal loss ratio (SLR=[IP-OP]/2IP), between in- and out-of-phase images, using a region of interest placed on the viable portion of the gliomas. Association between SLR and glioma grade was searched for using Wilcoxon and Mann-Whitney U tests and diagnostic capabilities using area under the receiver operating characteristic (AUROC) curves. RESULTS: A significant association was found between SLR value and glioma grade (P<0.0001). SLR>9‰ allowed complete discrimination between grade III and grade II glioma with 100% specificity (95% CI: 85-100%), 100% sensitivity (95% CI: 78-100%) and 100% accuracy (95% CI: 90-100%) (AUROC=1). A SLR>20‰ allowed discriminating between grade IV and grade III glioma with 75% specificity (95% CI: 57-89%), 73% sensitivity (95% CI: 45-92%) and 72% accuracy (95% CI: 57-84%) (AUC=0.825, 95% CI: 0.702-0.948). The AUROC for the diagnosis of high-grade glioma (grade III and IV vs. grade II) was 1. CONCLUSION: Chemical shift gradient echo MRI provides accurate grading of gliomas. This simple method should be used as a biomarker to predict glioma grade.

[Acquired hemophilia A associated with chronic myelomonocytic leukemia successfully treated by rituximab and azacitidine]. / Hémophilie A acquise associée à une leucémie myélomonocytaire chronique traitée efficacement par rituximab et azacitidine.

INTRODUCTION: Acquired hemophilia A is a factor VIII deficiency related to anti-factor VIII immunoglobulins. We are reporting the case of a patient with acquired hemophilia A related to chronic myelomonocytic leukemia. CASE REPORT: A 74-years old woman had a spontaneous calf hematoma with compression syndrome. Coagulation tests revealed an extended partial thromboplastin time and a factor VIII deficiency with circulating factor VIII antibodies. Chronic myelomonocytic leukemia was diagnosed in the same time. Initial management included hemostatic transfusion and steroids and was completed rituximab and azacitidine. Evolution was favorable. CONCLUSION: We report a case of acquired hemophilia A complicating a chronic myelomonocytic leukemia. Management with steroids, rituximab and azacitidine was successful. Useful of rituximab during acquired hemophilia is proposed.