SOFIA catheter for direct aspiration of large vessel occlusion stroke: A single-center cohort and meta-analysis.

BACKGROUND AND PURPOSE: Direct aspiration (DA) using large-bore distal aspiration catheters is an established strategy for the endovascular thrombectomy (EVT) of large-vessel occlusion stroke (LVOS). However, the performance of individual catheters like SOFIA has yet to be examined. METHODS: We present a cohort of 144 consecutive patients treated with first-line DA and SOFIA 6 F Plus catheter for LVOS. We also conducted a systematic review of the literature searching multiple databases for reports on thrombectomy with DA and SOFIA catheters and performed a meta-analysis of recanalization, safety, and clinical outcomes. RESULTS: In the study cohort a successful recanalization (mTICI 2b-3) rate of 75.7% was achieved with DA alone, the global rate for functional independence (90-day mRS 0-2) was 40.3%. For the metanalysis we selected nine articles that included a total of 758 patients treated with first-line thrombectomy with the SOFIA catheters. The mTICI 2b-3 rate was 71.6% (95%CI, 66.3-76.5%) while a rescue stent-retriever was used in 24.1% (95%CI, 17.7-31.9%) of cases. The overall mTICI2b-3 rate after DA and rescue therapy was 88.9% (95%CI, 82.6-93.1%). We found a pooled estimate of 45.6% (95%CI, 38.6-52.8%) for functional independence, a mortality within 90 days of 19% (95%CI, 14.1-25.0%) and a rate of 5.8% (95%CI, 4.2-8.0%) of symptomatic intracranial hemorrhage. CONCLUSION: The DA approach for LVOS with the SOFIA catheters is highly effective with an efficacy and safety profile comparable to those found in contemporary thrombectomy trials and observational studies that use other devices or approaches.

Long-lasting diagonistic dyspraxia suppressed by rTMS applied to the right motor cortex.

We describe the case of a 58-year-old patient with complete callosal agenesis, who developed after a stroke a long lasting and distressing diagonistic dyspraxia. We found two original treatments to relieve the patient from his left limb conflicting movements. Reinforcing left arm sensory input minimized dyspraxic movements but was difficult to apply daily and was found unsatisfactory by the patient. As left anarchic, unwished movements of diagonistic dyspraxia have been attributed to the lack of inhibition exerted by supplementary motor area on right motor cortex, we applied sham-controlled rTMS to the right motor cortex. This procedure provided a dramatic suppression of left-hand involuntary movements. To our knowledge, this is the first description of the successful treatment of diagonistic dyspraxia.

Caudate nucleus and social cognition: neuropsychological and SPECT evidence from a patient with focal caudate lesion.

Most studies in social cognition have focused on developmental diseases or analyzed the consequences of acquired frontal lesions on the integrity of Theory of Mind (ToM), but, to our knowledge, none to date has addressed the eventual consequences of damage to the basal ganglia on ToM. To investigate the possible consequences of such lesions on social cognition, we tested a selected patient, MVG, a 44-year-old man with a focal caudate nucleus (CN) lesion following stroke. In the aftermath of this stroke, MVG shows loss of empathy and difficulties recognizing emotions in others. The dual aims of this study were first, to evaluate the implications of CN on ToM and recognition of emotion, and second, to discuss these results as a consequence of a disconnection of the sub-cortical orbito-frontal (OF) loop due to caudate damage. We performed a complete neuropsychological assessment of MVG, as well as different tasks evaluating social cognition, such as the Faux-Pas Test and the Reading the Eyes in the Mind Test. No deficits were found in the neuropsychological tests. However, on tasks assessing social cognition, MVG showed impairments in the "warm" or "affective" part of ToM as well as in the ability to recognize negative emotions (i.e., sadness and fear). These results indicate that damage to the head of the left CN can lead to impairment of ToM and emotion recognition. Furthermore, the data shows that, in MVG, such impairment appears to be due to a disconnection of the sub-cortical OF circuit resulting from damage to the CN. Neuro-imaging data tends to confirm this hypothesis by bringing out a hypo-perfusion in both, the territory of his left CN and prefrontal (i.e., ventromedial) brain areas.

[Artistic creativity and dementia]. / Créativité artistique et démence.

Artistic creativity can be defined as the ability to produce both innovative and esthetic works. Though most dementias result in a loss of instrumental functions and a deterioration in artistic production, for some established artists, dementia, most often Alzheimer's disease, changed their style and technique but preserved their creativity and prolific artistic drive. Moreover, in some cases, mainly frontotemporal dementia, Parkinson's disease, and very occasionally strokes, the disease may favour the emergence of de novo artistic talent. This phenomenon has been conceptualized as a paradoxical facilitation, a disinhibition of brain areas devoted to visuospatial processing, greater freedom in a patient who becomes less bound by social conventions, enhancement of motivation and pleasure, etc. These neurological cases provide an opportunity to shed some light on the roots of artistic creation.