Long-Term Disabilities of Survivors of Out-of-Hospital Cardiac Arrest: The Hanox Study.

BACKGROUND: Long-term outcomes of awakened survivors of out-of-hospital cardiac arrest (OHCA) are poorly known. RESEARCH QUESTION: What are the month (M) 18 outcomes of survivors of out-of-hospital cardiac arrest (OHCA) who awakened during the first 2 weeks' post-OHCA and their poor-outcome risk factors? STUDY DESIGN AND METHODS: All OHCA survivors with a Glasgow Coma Scale score ≥12 during the first 2 weeks' post-OHCA were enrolled in six ICUs and followed up at M3, M6, M12, and M18. The primary outcome measure was Glasgow Outcome Scale-Extended (GOS-E) score at M18. Secondary outcome measures included evaluation at M18 of neurologic, behavioral, and cognitive disabilities; health-related quality of life (HR-QOL), anxiety and depression; and poor-outcome risk factors (GOS-E score ≤ 6). RESULTS: Among the 139 included patients, 98 were assessable for the primary outcome measure. At M18, 64 (65%) had full recovery or minor disabilities (GOS-E score > 6), 18 (18%) had moderate disabilities but were autonomous for daily-life activities (GOS-E score = 6), 12 (12%) had poor autonomy (GOS-E score < 6 but > 1), and four had died. Percentages of patients with GOS-E scores > 6 increased significantly over the 18-month study period. At M18, no patients had major neurologic disabilities, 20% had cognitive disabilities, 32% had anxiety symptoms, 25% had depression symptoms, and their HR-QOL was impaired compared with a sex- and age-matched population. Low-flow time, Sequential Organ Failure Assessment score at admission, coma duration > 3 days after cardiac arrest, and mechanical ventilation on days 3 and 7 were associated with poor functional outcome. INTERPRETATION: Among patients who awoke (Glasgow Coma Scale score ≥12) in the 14 days following OHCA, 35% had moderate to severe disabilities or had died at M18. Interestingly, patients improved until M18 post-OHCA. Risk factors associated with poor functional outcome were low-flow time, clinical severity at ICU admission, prolonged coma duration, and mechanical ventilation. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT02292147; URL: www.clinicaltrials.gov.

Contribution of corticospinal tract and functional connectivity in hand motor impairment after stroke.

BACKGROUND: Motor outcome after stroke is associated with reorganisation of cortical networks and corticospinal tract (CST) integrity. However, the relationships between motor severity, CST damage, and functional brain connectivity are not well understood. Here, the main objective was to study the effect of CST damage on the relationship between functional motor network connectivity and hand motor function in two groups of stroke patients: the severely (n=8) and the mildly impaired (n=14). METHODS: Twenty-two carotid stroke patients with motor deficits were studied with magnetic resonance imaging (MRI) at 3 weeks, at 3 and 6 months. Healthy subjects (n=28) were scanned once. The CST injury was assessed by fractional anisotropy values. Functional connectivity was studied from a whole-hand grip task fMRI in a cortical and cerebellar motor network. Functional connectivity indexes were computed between these regions at each time point. The relationship between hand motor strength, ipsilesional CST damage and functional connectivity from the primary motor cortex (M1) was investigated using global and partial correlations. FINDINGS: In mildly impaired patients, cortico-cortical connectivity was disturbed at three weeks but returned to a normal pattern after 3 months. Cortico-cerebellar connectivity was still decreased at 6 months. In severely impaired patients, the cortico-cortical connectivity tended to return to a normal pattern, but the cortico-cerebellar connectivity was totally abolished during the follow-up. In the entire group of patients, the hand motor strength was correlated to the ipsilesional functional connectivity from M1. Partial correlations revealed that these associations were not anymore significant when the impact of CST damage was removed, except for the ipsilesional M1-contralateral cerebellum connectivity. CONCLUSION: Functional brain connectivity changes can be observed, even in severely impaired patients with no recovery. Upper limb function is mainly explained by the CST damage and by the ipsilesional cortico-cerebellar connectivity.

[Daily life activities following cerebrovascular infarct]. / La vie quotidienne après un infarctus cérébral.

Cerebro-vascular disease is the first cause of handicap in France. Disabilities in daily life activities are due to motor, visual and cognitive impairments following a stroke. Difficulties arise while grooming, getting dressed, eating, moving around ... the WHO presents with a new classification of functioning, that has been followed by a recent law in France. The aim is to place the handicapped citizen in daily life and not just to list his/her deficiencies. Rehabilitation after stroke has to establish functional objectives early so as to include daily life goals in re-education.

Cerebral anoxia and disability.

OBJECTIVES: To describe the sequelae of cerebral anoxia following out-of-hospital cardiac arrest, to study the functional outcome and to seek a link between the acute stage and the disability. METHOD: A retrospective study was performed. The initial findings and the neurological and neuropsychological status are recorded of 12 patients admitted to the rehabilitation unit for after-effects of cerebral anoxia following out-of-hospital cardiac arrest. RESULTS: After clinical and neuropsychological assessment, all patients displayed cognitive impairment. Two groups of patients appeared: seven patients were severely disabled with a dysexecutive and behavioural frontal lobe syndrome and memory deficit; five out of the seven also presented an extra-pyramidal syndrome; the other five patients presented behavioural dysfunction related to frontal lobe disorder but were independent in daily life activities. No correlation was found between the acute stage data and the outcome. CONCLUSION: Neurological and neuropsychological impairment after cerebral anoxia may be severe but seems difficult to predict. A dysexecutive syndrome was noted in all 12 patients.

[Semiology of sensorial integration: visual disorders of cerebral origin]. / Sémiologie de l'intégration sensorielle: troubles visuels d'origine cérébrale.

Visual disorders occur after lesions of brain areas involved in visual processing. Bilateral lesions located in occipital, temporal or parietal lobes leads to cerebral blindness, visual agnosia, prosopagnosia, alexia or visuospatial disorders. These visual disorders are difficult to understand by the patient. They see but do not recognise, or they can't see but their eyes are normal, spectacles can not improve their disorders. The diagnosis will be done after a systematic ophthalmologic, neurologic and neuropsychologic examination.