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1.
Rev Neurol (Paris) ; 166(3): 328-32, 2010 Mar.
Artículo en Francés | MEDLINE | ID: mdl-19592058

RESUMEN

INTRODUCTION: Giant cell arteritis is the most frequent vasculitis and can cause stroke in about 4% of the patients. The mechanism is often hemodynamic in relation with an arterial stenosis or occlusion. Optimal treatment remains to be defined. Outcome is often poor. CASE REPORT: We report the case of a 78-year-old patient, with giant cell arteritis who developed neurological deterioration after the onset of the corticotherapy. Brain MRI revealed bilateral stroke caused by multiple preocclusive internal carotid stenosis. The patient was treated successfully with angioplasty and stenting. CONCLUSION: Endovascular treatment could constitute an interesting alternative for patients with giant cell arteritis associated with neurological deterioration after a first episode of stroke because of hemodynamic instability or at stroke recurrence. For these patients, the usual medical treatment appears to be insufficient.


Asunto(s)
Angioplastia , Arteritis de Células Gigantes/complicaciones , Arteritis de Células Gigantes/cirugía , Procedimientos Neuroquirúrgicos , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/cirugía , Procedimientos Quirúrgicos Vasculares , Anciano , Encéfalo/patología , Arteria Carótida Interna/cirugía , Estenosis Carotídea/complicaciones , Estenosis Carotídea/patología , Constricción Patológica/patología , Hemodinámica/fisiología , Humanos , Angiografía por Resonancia Magnética , Masculino , Stents
2.
Rev Neurol (Paris) ; 165(3): 268-72, 2009 Mar.
Artículo en Francés | MEDLINE | ID: mdl-18755486

RESUMEN

Ingestion of star fruit (Averrhoa carambola) can induce severe intoxication in subjects with chronic renal failure. Oxalate plays a key role in the neurotoxicity of star fruit. We report the cases of two patients with unknown chronic renal insufficiency who developed severe encephalopathy after ingestion of star fruit. The two patients developed intractable hiccups, vomiting, impaired consciousness and status epilepticus. Diffusion-weighted MR imaging showed cortical and thalamic hyperintense lesions related to epileptic status. They improved after being submitted to continuous hemofiltration which constitutes the most effective treatment during the acute phase.


Asunto(s)
Encefalopatías/inducido químicamente , Frutas/efectos adversos , Fallo Renal Crónico/complicaciones , Intoxicación por Plantas/patología , Anciano , Anciano de 80 o más Años , Encefalopatías/patología , Encefalopatías/terapia , Trastornos de la Conciencia/inducido químicamente , Escala de Coma de Glasgow , Hemofiltración , Hipo/inducido químicamente , Humanos , Imagen por Resonancia Magnética , Masculino , Intoxicación por Plantas/psicología , Intoxicación por Plantas/terapia , Estado Epiléptico/inducido químicamente , Tomografía Computarizada por Rayos X , Vómitos/inducido químicamente
3.
Rev Neurol (Paris) ; 164(5): 427-33, 2008 May.
Artículo en Francés | MEDLINE | ID: mdl-18555874

RESUMEN

INTRODUCTION: Few neurological diseases are linked with anti-glutamic acid decarboxylase antibodies (GAD-ab); stiff man syndrome is an example. Cerebellar ataxia is a new feature of this expanding spectrum. No therapeutic trial is yet available in these diseases. We here report on four patients suffering from cerebellar ataxia linked with GAD-ab and review the data in the literature on this recently described syndrome. METHOD: We conducted an open trial with monthly pulsed steroids. Steroid pulses were given six months followed with placebo for another six months. Main clinical and biological parameters were monitored monthly (International Cooperative Cerebellar Ataxia Rating Scale [ICARS] and GAD-ab). RESULT: The clinical response was found limited and inconstant. Transient decline in GAD-ab level was noted in two patients. Moreover, GAD-ab level was found highly variable and did not correlate with clinical parameters. DISCUSSION: Cerebellar ataxia with GAD-ab is an increasingly described syndrome. Outcome can be severe, leading to definitive cerebellar atrophy. Diagnosis is supported by high level of serum GAD-ab with intrathecal secretion. Experimental data have suggested a direct excitotoxic effect of GAD-ab on Purkinje cells. Response to various treatments is often disappointing. Improvement has been obtained with veinoglobulins in individual patients. A weak clinical and biological response was associated with monthly steroid pulses.


Asunto(s)
Antiinflamatorios/uso terapéutico , Ataxia Cerebelosa/tratamiento farmacológico , Ataxia Cerebelosa/inmunología , Glutamato Descarboxilasa/inmunología , Esteroides/uso terapéutico , Adulto , Anciano , Autoanticuerpos/inmunología , Ataxia Cerebelosa/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad
4.
Stroke ; 34(7): 1593-7, 2003 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-12829873

RESUMEN

BACKGROUND AND PURPOSE: Stroke incidence increases with increasing age and has an impact on daily living in many areas. With increasing life expectancy, old people will constitute the majority of stroke victims. We present the first stroke study focusing on very old patients in a black Caribbean population (Martinique, French West Indies). METHODS: All Martinican patients suffering from their first-ever stroke during 1 calendar year between June 1, 1998, and May 31, 1999, were included. Epidemiological, clinical, neuroimaging, management, and outcome data during the first month were collected and compared between very old patients (>or=85 years) and patients aged <85 years. RESULTS: One hundred patients aged >or=85 years and 480 patients aged <85 years were included (sex ratio, women/men, 2.84 and 0.85, respectively; mean+/-SD age, 88.8+/-3.6 and 65.8+/-13.3 years, respectively). The incidence of first-ever stroke was 1.64/1000 per year in the Martinique population and 18.2/1000 per year in patients aged >or=85 years. Elderly patients showed a significantly lower proportion of diabetes (19.1% versus 32.2%; P=0.012) and smoking (0% versus 8.4%; P=0.004) and a higher proportion of peripheral artery disease (23.4% versus 11.4%; P=0.002). Prevalence of hypertension was identical in the 2 groups (70%). There were no significant differences in stroke types or ischemic stroke subtypes between the 2 groups. Active medical care was poorer in older than in younger patients (hospitalization rate, 89% versus 94.4%; admission to neurological ward, 8% versus 23.8%; rate of performance of a CT scan, 82% versus 94%). The 30-day case fatality rate was approximately twice as high in elderly patients (31% versus 16.7%; P=0.0009), and disability (Rankin Scale score >or=3) in survivors was markedly higher (78% versus 48%; P<0.0001). CONCLUSIONS: In Martinique, the incidence of first-ever stroke in very old black Caribbean patients seems similar to that in white patients. They have the same pathological type and subtype of stroke as do young patients. The poorer stroke outcome found in the elderly during the first month may be related in large part to less active management than in younger patients.


Asunto(s)
Accidente Cerebrovascular/epidemiología , Enfermedad Aguda , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Población Negra , Comorbilidad , Femenino , Humanos , Hipertensión/epidemiología , Incidencia , Masculino , Martinica/epidemiología , Prevalencia , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Accidente Cerebrovascular/clasificación , Accidente Cerebrovascular/terapia , Encuestas y Cuestionarios , Resultado del Tratamiento
5.
Stroke ; 32(12): 2741-7, 2001 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-11739966

RESUMEN

BACKGROUND AND PURPOSE: The ERMANCIA (Etude Réalisée en Martinique et Centrée sur l'Incidence de Accidents vasculaires cérébraux) study was designed to provide the first comparable epidemiological data on stroke in a black Caribbean population. METHODS: ERMANCIA was a prospective community-based study performed in Martinique (French West Indies) from June 1, 1998, to May 31, 1999. The black at-risk population was approximately 360 000. Multiple sources were used to identify hospitalized and nonhospitalized patients with first-ever stroke. RESULTS: Five hundred eighty patients (285 men and 295 women; mean+/-SD age, 71.2+/-14 years) suffered from a first-ever in a lifetime stroke, yielding a crude annual incidence of 164/100 000 per year (95% CI, 151 to 177). The rates adjusted by age and sex to the French population (1999 census) and to the European population were 202 (95% CI, 185 to 218) and 151 (95% CI, 139 to 164), respectively. Thirty-eight patients (6.5%) were not hospitalized during the acute phase of the stroke; 92.8% had CT scan. Pathological types of strokes were infarction (79.8%, including 23% of lacunar strokes), intracerebral hemorrhage (14.3%), subarachnoid hemorrhage (3.4%), and undetermined (2.4%). The main risk factors for stroke were hypertension (69.1%) and diabetes (29.5%). The 30-day case fatality rate was 19.3% (15.8% for cerebral infarction and 37.3% for intracerebral hemorrhage). CONCLUSIONS: In Martinique, the ERMANCIA population-based study showed a high stroke incidence and a high prevalence of hypertension and diabetes in the stroke population compared with those observed in continental France. Epidemiological data on stroke in African Caribbeans from Martinique are comparable to those reported in blacks from the United States and United Kingdom.


Asunto(s)
Accidente Cerebrovascular/epidemiología , Adolescente , Adulto , África/etnología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Población Negra , Niño , Preescolar , Comorbilidad , Diabetes Mellitus/epidemiología , Métodos Epidemiológicos , Diseño de Investigaciones Epidemiológicas , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/epidemiología , Incidencia , Masculino , Martinica/epidemiología , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Distribución por Sexo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Tasa de Supervivencia , Tomografía Computarizada por Rayos X/estadística & datos numéricos
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