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  1. Article ; Online: Association between neurological outcome and poststroke comorbid mood and anxiety disorders: A real-life experience.

    Rabat, Yolaine / Houeze, Richard / Sagnier, Sharmila / Olindo, Stephane / Poli, Mathilde / Debruxelles, Sabrina / Renou, Pauline / Rouanet, François / Berthoz, Sylvie / Sibon, Igor

    Brain and behavior

    2021  Volume 11, Issue 6, Page(s) e02158

    Abstract: Introduction: Poststroke depression (PSD) and anxiety (PSA) are prevalent and have a strong impact on functional outcome. Beside stroke severity, little is known on their clinical determinants. This study investigated the association between stroke ... ...

    Abstract Introduction: Poststroke depression (PSD) and anxiety (PSA) are prevalent and have a strong impact on functional outcome. Beside stroke severity, little is known on their clinical determinants. This study investigated the association between stroke mechanism, neurological poststroke complications and remaining vascular risk factors and the presence of comorbid PSD and PSA, termed poststroke emotional distress (PSED).
    Methods: This was a retrospective analysis of a prospectively compiled medical records database of consecutive patients evaluated during a follow-up visit 3- to 4-month poststroke. HAD scale was used to define PSED category (PSD+PSA vs. NoPSD+NoPSA). Stroke mechanism and poststroke complications were identified clinically or using appropriate scales. Their association with PSED was tested using a multivariate logistic regression model.
    Results: The sample included 2,300 patients (male: 64.8%); 19% had a PSED and 56.39% were free of any depression or anxiety. The most frequent poststroke complications were fatigue/fatigability (58.4%), sleep problems (26.7%), and pain (20.4%). While no association was observed between PSED and stroke mechanism, higher functional disability (OR:1.572), lower cognitive abilities (OR:0.953), sleep problems (OR:2.334), pain (OR:1.478), fatigue/fatigability (OR:2.331), and abnormal movements (OR:2.380) were all independent risk factors. Persisting tobacco consumption (OR:1.360) was the only vascular significant risk factor.
    Conclusions: The frequency of comorbid PSED remains high (1/5 patient) despite improved awareness of these conditions. The association between poststroke complications and the presence of PSED emphasizes the need for standardized neurological and psychological evaluations at follow-up. These results foster the need to improve the management of addictive behaviors to reduce the burden of PSED.
    MeSH term(s) Anxiety/epidemiology ; Anxiety/etiology ; Anxiety Disorders/epidemiology ; Anxiety Disorders/etiology ; Depression/epidemiology ; Depression/etiology ; Humans ; Male ; Retrospective Studies ; Risk Factors ; Stroke/complications ; Stroke/epidemiology
    Language English
    Publishing date 2021-05-05
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2623587-0
    ISSN 2162-3279 ; 2162-3279
    ISSN (online) 2162-3279
    ISSN 2162-3279
    DOI 10.1002/brb3.2158
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  2. Article ; Online: Erdheim-Chester Disease: An Unusual Cause of Intracranial Vasculitis and Progressive Leukoencephalopathy.

    Sagnier, Sharmila / Debruxelles, Sabrina / Lepreux, Sébastien / Sibon, Igor

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

    2016  Volume 25, Issue 5, Page(s) e63–e65

    Abstract: Erdheim-Chester disease (ECD) is a non-Langerhans histiocytosis affecting multiple organs. Stroke as symptom onset of ECD with intracranial vasculitis is unusual. We report the case of a 64-year-old man who presented with an acute ischemic stroke ... ...

    Abstract Erdheim-Chester disease (ECD) is a non-Langerhans histiocytosis affecting multiple organs. Stroke as symptom onset of ECD with intracranial vasculitis is unusual. We report the case of a 64-year-old man who presented with an acute ischemic stroke associated with a moderate leukoencephalopathy and intracranial arteries stenosis. Four years later, he developed movement disorders with dysarthria and cognitive impairment. Neuroradiological findings demonstrated a rapidly progressive and diffuse leukoencephalopathy associated with brain atrophy and infiltration of the intracranial vertebral artery wall. Brain postmortem evaluation confirmed the diagnosis of ECD. This diagnosis should be evoked in patients with cryptogenic stroke, progressive leukoencephalopathy, and infiltration of the arterial wall.
    MeSH term(s) Atrophy ; Autopsy ; Biopsy ; Brain/pathology ; Cause of Death ; Diffusion Magnetic Resonance Imaging ; Disease Progression ; Erdheim-Chester Disease/complications ; Erdheim-Chester Disease/diagnostic imaging ; Erdheim-Chester Disease/pathology ; Fatal Outcome ; Humans ; Immunohistochemistry ; Infarction, Middle Cerebral Artery/diagnostic imaging ; Infarction, Middle Cerebral Artery/etiology ; Infarction, Middle Cerebral Artery/pathology ; Leukoencephalopathy, Progressive Multifocal/diagnostic imaging ; Leukoencephalopathy, Progressive Multifocal/etiology ; Leukoencephalopathy, Progressive Multifocal/pathology ; Male ; Middle Aged ; Positron-Emission Tomography ; Vasculitis, Central Nervous System/diagnostic imaging ; Vasculitis, Central Nervous System/etiology ; Vasculitis, Central Nervous System/pathology
    Language English
    Publishing date 2016-05
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 1131675-5
    ISSN 1532-8511 ; 1052-3057
    ISSN (online) 1532-8511
    ISSN 1052-3057
    DOI 10.1016/j.jstrokecerebrovasdis.2016.01.042
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    Zs.A 3519: Show issues Location:
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  3. Article ; Online: Microstructural Gray Matter Integrity Deteriorates After an Ischemic Stroke and Is Associated with Processing Speed.

    Sagnier, Sharmila / Catheline, Gwenaëlle / Dilharreguy, Bixente / Linck, Pierre-Antoine / Coupé, Pierrick / Munsch, Fanny / Bigourdan, Antoine / Poli, Mathilde / Debruxelles, Sabrina / Renou, Pauline / Olindo, Stéphane / Rouanet, François / Dousset, Vincent / Tourdias, Thomas / Sibon, Igor

    Translational stroke research

    2022  Volume 14, Issue 2, Page(s) 185–192

    Abstract: Microstructural changes after an ischemic stroke (IS) have mainly been described in white matter. Data evaluating microstructural changes in gray matter (GM) remain scarce. The aim of the present study was to evaluate the integrity of GM on longitudinal ... ...

    Abstract Microstructural changes after an ischemic stroke (IS) have mainly been described in white matter. Data evaluating microstructural changes in gray matter (GM) remain scarce. The aim of the present study was to evaluate the integrity of GM on longitudinal data using mean diffusivity (MD), and its influence on post-IS cognitive performances. A prospective study was conducted, including supra-tentorial IS patients without pre-stroke disability. A cognitive assessment was performed at baseline and 1 year, including a Montreal Cognitive Assessment, an Isaacs set test, and a Zazzo cancelation task (ZCT): completion time and number of errors. A 3-T brain MRI was performed at the same two time-points, including diffusion tensor imaging for the assessment of GM MD. GM volume was also computed, and changes in GM volume and GM MD were evaluated, followed by the assessment of the relationship between these structural changes and changes in cognitive performances. One hundred and four patients were included (age 68.5 ± 21.5, 38.5% female). While no GM volume loss was observed, GM MD increased between baseline and 1 year. The increase of GM MD in left fronto-temporal regions (dorsolateral prefrontal cortex, superior and medial temporal gyrus, p < 0.05, Threshold-Free Cluster Enhancement, 5000 permutations) was associated with an increase time to complete ZCT, regardless of demographic confounders, IS volume and location, GM, and white matter hyperintensity volume. GM integrity deterioration was thus associated with processing speed slowdown, and appears to be a biomarker of cognitive frailty. This broadens the knowledge of post-IS cognitive impairment mechanisms.
    MeSH term(s) Humans ; Female ; Male ; Gray Matter/diagnostic imaging ; Diffusion Tensor Imaging ; Ischemic Stroke ; Processing Speed ; Prospective Studies ; White Matter/diagnostic imaging ; Brain/diagnostic imaging
    Language English
    Publishing date 2022-04-18
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2541897-X
    ISSN 1868-601X ; 1868-4483
    ISSN (online) 1868-601X
    ISSN 1868-4483
    DOI 10.1007/s12975-022-01020-9
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  4. Article ; Online: Normal-Appearing White Matter Deteriorates over the Year After an Ischemic Stroke and Is Associated with Global Cognition.

    Sagnier, Sharmila / Catheline, Gwenaëlle / Dilharreguy, Bixente / Linck, Pierre-Antoine / Coupé, Pierrick / Munsch, Fanny / Bigourdan, Antoine / Poli, Mathilde / Debruxelles, Sabrina / Renou, Pauline / Olindo, Stéphane / Rouanet, François / Dousset, Vincent / Tourdias, Thomas / Sibon, Igor

    Translational stroke research

    2022  Volume 13, Issue 5, Page(s) 716–724

    Abstract: Normal-appearing white matter (NAWM) is a hub of plasticity, but data relating to its influence on post-ischemic stroke (IS) outcome remain scarce. The aim of this study was to evaluate the relationship between NAWM integrity and cognitive outcome after ... ...

    Abstract Normal-appearing white matter (NAWM) is a hub of plasticity, but data relating to its influence on post-ischemic stroke (IS) outcome remain scarce. The aim of this study was to evaluate the relationship between NAWM integrity and cognitive outcome after an IS. A longitudinal study was conducted including supra-tentorial IS patients. A 3-Tesla brain MRI was performed at baseline and 1 year, allowing the analyses of mean fractional anisotropy (FA) and mean diffusivity (MD) in NAWM masks, along with the volume of white matter hyperintensities (WMH) and IS. A Montreal Cognitive Assessment (MoCA), an Isaacs set test, and a Zazzo's cancellation task were performed at baseline, 3 months and 1 year. Mixed models were built, followed by Tract-based Spatial Statistics (TBSS) analyses. Ninety-five patients were included in the analyses (38% women, median age 69 ± 20). FA significantly decreased, and MD significantly increased between baseline and 1 year, while cognitive scores improved. Patients who decreased their NAWM FA more over the year had a slower cognitive improvement on MoCA (β =  - 0.11, p = 0.05). The TBSS analyses showed that patients who presented the highest decrease of FA in various tracts of white matter less improved their MoCA performances, regardless of WMH and IS volumes, demographic confounders, and clinical severity. NAWM integrity deteriorates over the year after an IS, and is associated with a cognitive recovery slowdown. The diffusion changes recorded here in patients starting with an early preserved white matter structure could have long term impact on cognition.
    MeSH term(s) Aged ; Aged, 80 and over ; Cognition ; Diffusion Tensor Imaging ; Female ; Humans ; Ischemic Stroke ; Leukoaraiosis ; Longitudinal Studies ; Male ; Middle Aged ; White Matter/diagnostic imaging
    Language English
    Publishing date 2022-02-01
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2541897-X
    ISSN 1868-601X ; 1868-4483
    ISSN (online) 1868-601X
    ISSN 1868-4483
    DOI 10.1007/s12975-022-00988-8
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  5. Article ; Online: Early multidisciplinary prevention program of post-stroke shoulder pain: A randomized clinical trial.

    Glize, Bertrand / Cook, Amandine / Benard, Antoine / Sagnier, Sharmila / Olindo, Stéphane / Poli, Mathilde / Debruxelles, Sabrina / Renou, Pauline / Rouanet, François / Bader, Clément / Dehail, Patrick / Sibon, Igor

    Clinical rehabilitation

    2022  Volume 36, Issue 8, Page(s) 1042–1051

    Abstract: Objective: To evaluate if positioning the upper-limb promoting abduction, external rotation and flexion of the shoulder reduces the intensity of post-stroke shoulder pain at day-7 compared to usual clinical practice.: Design & setting: Prospective ... ...

    Abstract Objective: To evaluate if positioning the upper-limb promoting abduction, external rotation and flexion of the shoulder reduces the intensity of post-stroke shoulder pain at day-7 compared to usual clinical practice.
    Design & setting: Prospective single-center randomized clinical trial using a superiority design comparing two preventive strategies of post-stroke shoulder pain in a stroke unit.
    Subjects: Patients were included within 2 days from a first symptomatic ischemic stroke affecting shoulder motor function.
    Interventions: Intervention group included specific positioning of the shoulder in abduction, external rotation and flexion in bed, chair and during mobilization. Control group referred to usual practice i.e. positioning using a standard support scarf.
    Main measures: Primary outcome was the intensity of shoulder pain assessed by the visual analog scale (VAS) (0-100) at day-7 post-stroke. Other outcomes measured at day-7 and 2 months post-stroke were the VAS, motor function, spasticity, depression, functional independence and rates of complex regional Pain syndrome (CRPS).
    Results: 76 patients (49 males; mean age = 68.3) were randomized. The shoulder pain at day-7 was not different between the control group (16.1, SD = 27.4) and the intervention group (10.3, SD = 21.5,
    Conclusions: This study failed to demonstrate the benefit of a specific positioning tool in reducing the intensity of post-stroke shoulder pain which was lower than previously reported in the literature.
    MeSH term(s) Aged ; Humans ; Male ; Prospective Studies ; Range of Motion, Articular ; Shoulder ; Shoulder Pain/diagnosis ; Shoulder Pain/etiology ; Shoulder Pain/prevention & control ; Stroke/complications ; Stroke Rehabilitation ; Treatment Outcome ; Upper Extremity
    Language English
    Publishing date 2022-05-03
    Publishing country England
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 639276-3
    ISSN 1477-0873 ; 0269-2155
    ISSN (online) 1477-0873
    ISSN 0269-2155
    DOI 10.1177/02692155221098733
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    Zs.A 2297: Show issues Location:
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  6. Article ; Online: Severity of Small Vessel Disease Biomarkers Reduces the Magnitude of Cognitive Recovery after Ischemic Stroke.

    Sagnier, Sharmila / Catheline, Gwenaëlle / Munsch, Fanny / Bigourdan, Antoine / Poli, Mathilde / Debruxelles, Sabrina / Renou, Pauline / Olindo, Stéphane / Rouanet, François / Dousset, Vincent / Tourdias, Thomas / Sibon, Igor

    Cerebrovascular diseases (Basel, Switzerland)

    2021  Volume 50, Issue 4, Page(s) 456–463

    Abstract: Objective: The objective of this study was to evaluate the impact of radiological biomarkers suggestive of cerebral small vessel disease (SVD) on the evolution of cognitive performances after an ischemic stroke (IS).: Methods: We studied patients ... ...

    Abstract Objective: The objective of this study was to evaluate the impact of radiological biomarkers suggestive of cerebral small vessel disease (SVD) on the evolution of cognitive performances after an ischemic stroke (IS).
    Methods: We studied patients with a supratentorial IS recruited consecutively to a prospective monocentric longitudinal study. A cognitive assessment was performed at baseline, 3 months, and 1 year and was based on a Montreal Cognitive Assessment, an Isaacs set test of verbal fluency (IST), and a Zazzo's cancellation task (ZCT) for the evaluation of attentional functions and processing speed. The following cerebral SVD biomarkers were detected on a 3-T brain MRI performed at baseline: white matter hyperintensities (WMHs), deep and lobar microbleeds, enlarged perivascular spaces in basal ganglia and centrum semiovale, previous small deep infarcts, and cortical superficial siderosis (cSS). Generalized linear mixed models were used to evaluate the relationship between these biomarkers and changes in cognitive performances.
    Results: A total of 199 patients (65 ± 13 years, 68% male) were analyzed. Overall, the cognitive performances improved, more significantly in the first 3 months. Severe WMH was identified in 34% of the patients, and focal cSS in 3.5%. Patients with severe WMH and focal cSS had overall worse cognitive performances. Those with severe WMH had less improvement over time for IST (β = -0.16, p = 0.02) and the number of errors to ZCT (β = 0.19, p = 0.02), while those with focal cSS had less improvement over time for ZCT completion time (β = 0.14, p = 0.01) and number of errors (β = 0.17, p = 0.008), regardless of IS volume and location, gray matter volume, demographic confounders, and clinical and cardiovascular risk factors.
    Conclusion: The severity of SVD biomarkers, encompassing WMH and cSS, seems to reduce the magnitude of cognitive recovery after an IS. The detection of such SVD biomarkers early after stroke might help to identify patients with a cognitive vulnerability and a higher risk of poststroke cognitive impairment.
    MeSH term(s) Aged ; Cerebral Small Vessel Diseases/complications ; Cerebral Small Vessel Diseases/diagnostic imaging ; Cognition ; Cognitive Dysfunction/diagnosis ; Cognitive Dysfunction/etiology ; Cognitive Dysfunction/physiopathology ; Cognitive Dysfunction/psychology ; Early Diagnosis ; Female ; Humans ; Ischemic Stroke/diagnosis ; Ischemic Stroke/etiology ; Ischemic Stroke/physiopathology ; Ischemic Stroke/psychology ; Longitudinal Studies ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neuropsychological Tests ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Recovery of Function ; Risk Assessment ; Risk Factors ; Severity of Illness Index
    Language English
    Publishing date 2021-04-07
    Publishing country Switzerland
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1069462-6
    ISSN 1421-9786 ; 1015-9770
    ISSN (online) 1421-9786
    ISSN 1015-9770
    DOI 10.1159/000513916
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    Zs.A 3181: Show issues Location:
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    Zs.MO 226: Show issues

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  7. Article ; Online: Etiologic and prognostic value of external carotid artery thrombus detection during endovascular therapy for anterior circulation proximal occlusions.

    Courret, Thomas / Tourdias, Thomas / Papaxanthos, Jean / Labreuche, Julien / Gariel, Florent / Liegey, Jean-Sebastien / Olindo, Stephane / Renou, Pauline / Berge, Jerome / Barreau, Xavier / Sagnier, Sharmila / Menegon, Patrice / Lucas, Ludovic / Briau, Pierre / Poli, Mathilde / Debruxelles, Sabrina / Rouanet, François / Dousset, Vincent / Sibon, Igor /
    Marnat, Gaultier

    European journal of neurology

    2022  Volume 30, Issue 2, Page(s) 380–388

    Abstract: Background and purpose: An early understanding of stroke mechanism may improve treatment and outcome in patients presenting with large vessel occlusion stroke (LVOS) treated with mechanical thrombectomy (MT). We aimed to investigate whether spontaneous ... ...

    Abstract Background and purpose: An early understanding of stroke mechanism may improve treatment and outcome in patients presenting with large vessel occlusion stroke (LVOS) treated with mechanical thrombectomy (MT). We aimed to investigate whether spontaneous external carotid artery (ECA) embolism detection during MT is associated with stroke etiology and clinical outcome.
    Methods: We retrospectively reviewed our prospectively maintained institutional database including consecutive patients with anterior circulation LVOS treated with MT between January 2015 and August 2020.
    Results: An ECA embolus was detected in 68 of 1298 patients (5.2%). The kappa coefficient for interobserver agreement was 0.89 (95% confidence interval [CI] 0.82-0.95). ECA embolism was significantly associated with intracranial internal carotid artery (ICA) occlusion (p < 0.001), cardioembolic etiology (p < 0.001) and a lower clot burden score (p < 0.001). Day-1 variation of National Institutes of Health Stroke Scale score (adjusted odds ratio [OR] -2.7, 95% CI -4.9 to 0.3; p = 0.021) and delta Alberta Stroke Program Early Computed Tomography Score (adjusted OR 0.9, 95% CI 0.2 to 1.5; p = 0.004) were worse among patients with ECA emboli. There was no significant difference in 90-day functional outcome between groups (adjusted OR 0.8, 95% CI 0.42 to 1.52; p = 0.50).
    Conclusion: In patients with anterior circulation LVOS treated with MT, ECA embolism was significantly associated with cardioembolic etiology, high thrombus burden and proximal intracranial ICA occlusions. This underexplored angiographic pattern might provide a valuable etiologic clue to the underlying cause of anterior circulation LVOS and may also help determine the appropriate revascularization strategy.
    MeSH term(s) Humans ; Prognosis ; Carotid Artery, External ; Retrospective Studies ; Treatment Outcome ; Stroke/therapy ; Thrombosis/etiology ; Thrombectomy/methods ; Endovascular Procedures/methods ; Carotid Artery, Internal/diagnostic imaging ; Carotid Artery, Internal/surgery
    Language English
    Publishing date 2022-11-20
    Publishing country England
    Document type Journal Article
    ZDB-ID 1280785-0
    ISSN 1468-1331 ; 1351-5101 ; 1471-0552
    ISSN (online) 1468-1331
    ISSN 1351-5101 ; 1471-0552
    DOI 10.1111/ene.15623
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 4738: Show issues Location:
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    Zs.MO 592: Show issues

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  8. Article ; Online: Trendelenburg Positioning in Large Vessel Ischaemic Stroke: A Pre-Post Observational Study Using Propensity Score Matching.

    Gauthier, Alexandre / Gérardin, Patrick / Renou, Pauline / Sagnier, Sharmila / Debruxelles, Sabrina / Poli, Mathilde / Rouanet, François / Olindo, Stéphane / Sibon, Igor

    Cerebrovascular diseases (Basel, Switzerland)

    2018  Volume 46, Issue 1-2, Page(s) 24–32

    Abstract: Background: Along with pharmacological and mechanical recanalization, improving cerebral perfusion through the recruitment of collateral vessels during the acute phase of ischaemic stroke (IS) is a clinical challenge. Our objective was to assess the ... ...

    Abstract Background: Along with pharmacological and mechanical recanalization, improving cerebral perfusion through the recruitment of collateral vessels during the acute phase of ischaemic stroke (IS) is a clinical challenge. Our objective was to assess the effectiveness and safety of Trendelenburg positioning (TP), a procedure intended to increase cerebral blood flow, on the outcome of IS.
    Methods: Two cohorts of patients with an acute supratentorial IS related to a large artery occlusion were compared. In the first cohort (n = 119), we used standard positioning (0 to +30°); in the second cohort (n = 90), we used TP (0 to -15°). The primary outcome measure was the improvement of National Institutes of Health Stroke Scale (NIHSS) score between admission and day 2. Factors associated with an improvement ≥4 points of NIHSS score were assessed using multiple logistic regression and propensity score (PS) matching analyses.
    Results: TP was significantly associated with a greater improvement of NIHSS score within 48 h following stroke onset (4.0 ± 5.7 vs. 1.8 ± 5.9, p = 0.011) but also at discharge (p = 0.005). Multiple logistic regression analysis suggested that TP was an independent predictor of early neurological improvement (adjusted OR 1.81, 95% CI 1.00-3.27) in a model controlling recanalization and haemoglobin level. In addition, PS matching analysis confirmed the possible effectiveness of TP (unadjusted OR 1.99, 95% CI 1.04-3.82), especially in male subjects. The effect of TP was more pronounced in patients with admission mean arterial blood pressure ≥100 mm Hg, those exhibiting a good collateral vessel network on admission CT-angiography or experiencing an effective recanalization. Furthermore, TP was not associated with life-threatening complications.
    Conclusion: TP could be an effective and safe strategy in patients with large IS resulting from the proximal occlusion of a large vessel.
    MeSH term(s) Aged ; Aged, 80 and over ; Brain Ischemia/diagnosis ; Brain Ischemia/physiopathology ; Brain Ischemia/therapy ; Cerebrovascular Circulation ; Collateral Circulation ; Disability Evaluation ; Female ; Head-Down Tilt ; Humans ; Male ; Middle Aged ; Patient Positioning/methods ; Recovery of Function ; Severity of Illness Index ; Stroke/diagnosis ; Stroke/physiopathology ; Stroke/therapy ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2018-07-27
    Publishing country Switzerland
    Document type Journal Article ; Observational Study
    ZDB-ID 1069462-6
    ISSN 1421-9786 ; 1015-9770
    ISSN (online) 1421-9786
    ISSN 1015-9770
    DOI 10.1159/000490423
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    Zs.MO 226: Show issues

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  9. Article ; Online: Clinical Predictors of Stroke Mimics in Patients Treated with Recombinant Tissue Plasminogen Activator according to a Normal Multimodal Computed Tomography Imaging.

    Olindo, Stephane / Chardonnet, Martin / Renou, Pauline / Coignion, Cyrielle / Debruxelles, Sabrina / Poli, Mathilde / Sagnier, Sharmila / Rouanet, François / Sibon, Igor

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

    2018  Volume 27, Issue 2, Page(s) 454–459

    Abstract: Background: Multimodal computed tomography imaging (MCTI) is increasingly used for rapid assessment of acute stroke. We investigated characteristics and final diagnoses of patients treated with recombinant tissue plasminogen activator (rt-PA) while ... ...

    Abstract Background: Multimodal computed tomography imaging (MCTI) is increasingly used for rapid assessment of acute stroke. We investigated characteristics and final diagnoses of patients treated with recombinant tissue plasminogen activator (rt-PA) while admission imaging was unremarkable.
    Methods: From our prospectively collected stroke database (2013-2016), we identified consecutive patients treated with rt-PA on the basis of an unremarkable brain MCTI and assessed with a 24-hour follow-up brain magnetic resonance imaging (MRI). Demographic data, medical history, score on the 15-item National Institute of Health Stroke Scale, and final diagnosis were considered. Absence of MRI infarction and alternate diagnosis defined stroke mimics (SMs). Univariable and multivariable logistic regression analyses identified factors predictive of SMs.
    Results: Sixty-eight (47.9%) SMs, 63 (44.4%) strokes, and 11 (7.7%) aborted strokes were found. SMs had more often aphasia (P = .003) and hemianopia (P = .0008), whereas upper limb weakness (ULW) (P = .03) and limb ataxia (P = .002) were more prevalent in strokes. Headache (adjusted odds ratio [Adj. OR], 3.89 [95% confidence interval {CI} 1.44-10.47]), relevant history of epilepsy, migraine, dementia or depression (Adj. OR 3.66 [95% CI 1.31-10.18]), unilateral sensory loss (Adj. OR 2.60 [95% CI 1.05-6.45]), and hemianopia (Adj. OR 4.94 [95% CI 1.46-16.77]) were independent predictors of SMs whereas ULW (Adj. OR 3.16 [95% CI 1.28-7.82]) and ataxia (Adj. OR 3.81 [95% CI 1.43-10.13]) predicted stroke. Sensitivity of hemianopia or aphasia for SMs was 52.9%, with specificity of 84.1%, positive predictive value of 78.3%, and negative predictive value of 62.4%.
    Conclusions: Hemianopia and/or aphasia with normal MCTI suggest SMs. Diffusion-weighted MRI might be discussed before rt-PA administration in patients with such a clinical pattern.
    MeSH term(s) Adult ; Aged ; Cerebral Angiography/methods ; Chi-Square Distribution ; Computed Tomography Angiography ; Databases, Factual ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging ; Female ; Fibrinolytic Agents/administration & dosage ; Fibrinolytic Agents/adverse effects ; Humans ; Logistic Models ; Male ; Middle Aged ; Multidetector Computed Tomography ; Multivariate Analysis ; Odds Ratio ; Perfusion Imaging/methods ; Predictive Value of Tests ; Recombinant Proteins/administration & dosage ; Retrospective Studies ; Risk Factors ; Stroke/diagnostic imaging ; Stroke/drug therapy ; Thrombolytic Therapy/adverse effects ; Thrombolytic Therapy/methods ; Tissue Plasminogen Activator/administration & dosage ; Tissue Plasminogen Activator/adverse effects ; Treatment Outcome ; Unnecessary Procedures
    Chemical Substances Fibrinolytic Agents ; Recombinant Proteins ; Tissue Plasminogen Activator (EC 3.4.21.68)
    Language English
    Publishing date 2018-02
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 1131675-5
    ISSN 1532-8511 ; 1052-3057
    ISSN (online) 1532-8511
    ISSN 1052-3057
    DOI 10.1016/j.jstrokecerebrovasdis.2017.09.024
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  10. Article ; Online: Immune-Thrombotic Thrombocytopenic Purpura is a Rare Cause of Ischemic Stroke in Young Adults: Case Reports and Literature Review.

    Tomich, Cyrielle / Debruxelles, Sabrina / Delmas, Yahsou / Sagnier, Sharmila / Poli, Mathilde / Olindo, Stéphane / Renou, Pauline / Rouanet, François / Sibon, Igor

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

    2018  Volume 27, Issue 11, Page(s) 3163–3171

    Abstract: Introduction: Immune thrombotic thrombocytopenic purpura (i-TTP), related to acquired ADAMTS-13 dysfunction, can lead to various neurological symptoms including ischemic stroke. To date the clinical, radiological, and biological characteristics of ... ...

    Abstract Introduction: Immune thrombotic thrombocytopenic purpura (i-TTP), related to acquired ADAMTS-13 dysfunction, can lead to various neurological symptoms including ischemic stroke. To date the clinical, radiological, and biological characteristics of patients having a stroke as the inaugural manifestation of i-TTP are largely unknown.
    Methods: Probable immune-TTP was defined by a low ADAMTS-13 activity associated with the presence of ADAMTS-13 inhibitors and/or favorable clinicobiological response under immunological treatments. The clinical, radiological, biological data and outcome under treatment are described in a cohort of 17 patients coming from 3 local cases and a literature review.
    Results: Fourteen of the 17 patients were female and the mean age was 41 years. None of the patients had the classical pentad of TTP. Only 41% had a combination of thrombocythemia and hemolysis. Stroke was multifocal in 35% and included large artery strokes. No adverse event was observed following intravenous thrombolysis. Refractory and relapsing forms were observed in 47%.
    Discussion: The clinical, radiological, and biological presentation of patients with stroke as the inaugural presentation of i-TTP is heterogeneous. This diagnosis should be discussed in every young adult with ischemic stroke of undetermined source.
    MeSH term(s) ADAMTS13 Protein/immunology ; Adrenal Cortex Hormones/therapeutic use ; Adult ; Aged ; Autoantibodies/blood ; Biomarkers/blood ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/etiology ; Diffusion Magnetic Resonance Imaging ; Disability Evaluation ; Female ; Humans ; Male ; Middle Aged ; Plasma Exchange ; Purpura, Thrombocytopenic, Idiopathic/blood ; Purpura, Thrombocytopenic, Idiopathic/complications ; Purpura, Thrombocytopenic, Idiopathic/diagnosis ; Purpura, Thrombocytopenic, Idiopathic/therapy ; Purpura, Thrombotic Thrombocytopenic/blood ; Purpura, Thrombotic Thrombocytopenic/complications ; Purpura, Thrombotic Thrombocytopenic/diagnosis ; Purpura, Thrombotic Thrombocytopenic/therapy ; Risk Factors ; Stroke/diagnostic imaging ; Stroke/etiology ; Treatment Outcome
    Chemical Substances Adrenal Cortex Hormones ; Autoantibodies ; Biomarkers ; ADAMTS13 Protein (EC 3.4.24.87) ; ADAMTS13 protein, human (EC 3.4.24.87)
    Language English
    Publishing date 2018-09-12
    Publishing country United States
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 1131675-5
    ISSN 1532-8511 ; 1052-3057
    ISSN (online) 1532-8511
    ISSN 1052-3057
    DOI 10.1016/j.jstrokecerebrovasdis.2018.07.017
    Database MEDical Literature Analysis and Retrieval System OnLINE

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