Transvenous embolization is a recent treatment strategy for cerebrospinal fluid-venous fistulas (CSFVF), which are associated with spontaneous intracranial hypotension (SIH).
Participants were ...selected from a prospective database on patients with CSFVF that received transvenous Onyx embolization. All patients underwent a brain magnetic resonance imaging (MRI) before and after embolization with MRI follow-up performed at least 3 months after treatment. Clinical and MRI results after treatment were described.
Twenty-one consecutive patients (median age 63 years, IQR = 58-71; females: 15/21 = 71.5%) with 30 CSFVF were included. Most lesions were situated between T9 and L1 (19/30 = 63%), 70% were right-sided, and 38% of the patients had multiples fistulas. Embolization was successful in all cases. The mean MRI SIH score before and after treatment was 6 (±2.5) and 1.4 (±1.6), respectively (
< 0.0001). Twenty patients (90%) experienced improvement of their initial condition, of which 67% reported complete clinical recovery. The mean HIT-6 score decreased from 67 (±15) to 38 (±9) (
< 0.0001), the mean amount of monthly headache days from 23.5 (±10) and 3.2 (±6.6) (
< 0.0001), the visual assessment scale (VAS) for headache severity from 8 (±1.9) to 1.2 (±2) (
< 0.0001), and the mean VAS for perception quality of life improved from 2.6 (±2.5) to 8.6 (±1.8) (
< 0.0001). There were no major complications. The suspected rebound headache rate after treatment was 33%.
Transvenous embolization of CSFVF allowed high rates of clinical improvement with no morbidity related to the treatment.
Proximal large vessel occlusion (LVO) is present in up to 30% of minor strokes. The effectiveness of mechanical thrombectomy (MT) in the subgroup of minor stroke with LVO in the anterior circulation ...is still open to debate. Data about MT in this subgroup of patients are sparse, and their optimal management has not yet been defined. The purpose of this multicenter cohort study was to evaluate the effectiveness of MT in patients experiencing acute ischemic stroke (AIS) because of LVO in the anterior circulation, presenting with minor-to-mild stroke symptoms (National Institutes of Health Stroke Scale score of <8).
Multicenter cohort study involving 4 comprehensive stroke centers having 2 therapeutic approaches (urgent thrombectomy associated with best medical treatment BMT versus BMT first and MT if worsening occurs) about management of patients with minor and mild acute ischemic stroke harboring LVO in the anterior circulation. An intention-to-treat analysis was conducted. The primary end point was the rate of excellent outcome defined as the achievement of a modified Rankin Scale score of 0 to 1 at 3 months.
Three hundred one patients were included, 170 with urgent MT associated with BMT, and 131 with BMT alone as first-line treatment. Patients treated with MT were younger, more often received intravenous thrombolysis, and had shorter time to imaging. Twenty-four patients (18.0%) in the medical group had rescue MT because of neurological worsening. Overall, excellent outcome was achieved in 64.5% of patients, with no difference between the 2 groups. Stratified analysis according to key subgroups did not find heterogeneity in the treatment effect size.
Minor-to-mild stroke patients with LVO achieved excellent and favorable functional outcomes at 3 months in similar proportions between urgent MT versus delayed MT associated with BMT. There is thus an urgent need for randomized trials to define the effectiveness of MT in this patient subgroup.
Background. Uveitis is 20 times more frequent in multiple sclerosis (MS) patients than in the general population. Methods. A retrospective study of local multiple sclerosis (n=700) and uveitis ...cohorts (n=450) described the ophthalmological and neurological characteristics of patients with multiple sclerosis and uveitis. Results. Uveitis and multiple sclerosis were associated in seven patients. The time intervals between diagnoses of MS and uveitis ranged from 6 months to 15 years. Analysis of the patients’ characteristics revealed that multiple sclerosis was associated with an older age of onset than usually expected, that is, 39 years. Uveitis was bilateral in three cases and mainly posterior (5/10). Five patients presented with acute optic neuritis (two in one eye and three in both eyes). All eyes presenting with acute optic neuritis were also affected by uveitis (P=0.02), though not simultaneously. Conclusion. The ipsilateral association between optic neuritis and uveitis in this series of patients with multiple sclerosis may suggest a reciprocal potentiation between optic neuritis and uveitis in multiple sclerosis.
The frequency of corticospinal tract (CST) T2/FLAIR hyperintensity in disorders with neuroglial antibodies is unclear. Herein, we retrospectively reviewed brain MRIs of 101 LGI1-antibody encephalitis ...patients, and observed CST hyperintensity in 30/101 (30%). It was mostly bilateral (93%), not associated with upper motor neuron signs/symptoms (7%), and frequently decreased over time (39%). In a systematic review including patients with other neuroglial antibodies, CST hyperintensity was reported in 110 with neuromyelitis optica (94%), myelin oligodendrocyte glycoprotein-associated disease (2%), Ma2-antibody (3%) and GAD65-antibody paraneoplastic neurological syndrome (1%). CST hyperintensity is not an infrequent finding in LGI1-Ab encephalitis and other disorders with neuroglial antibodies.
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•Brain MRI corticospinal tract hyperintensity elicits a broad differential diagnosis.•Its overall frequency in brain disorders with neuroglial antibodies is unclear.•It is present in 30% among 101 patients with LGI1-antibody encephalitis.•In the literature it is reported in 110 patients with diverse neuroglial antibodies.•Corticospinal tract hyperintensity is not rare in autoimmune brain disorders.
Precise localization and understanding of the origin of cerebrospinal fluid (CSF) leak is crucial to allow targeted treatment. We report the technical feasibility and utility of dorsal-decubitus ...dynamic computed tomography (DDDCT) myelography to localize posteriorly located dural defects in patients with suspicion of posterolateral dural tears.
This study reports a series of four consecutive patients with posteriorly located SLEC and suspicion of posterolateral CSF leak who received DDDCT to localize the site of the leak. Patients were collected between October 2022 and October 2023. The technique of DDDCT and its efficacy to detect the site of CSF leak are reported.
In all four patients (three females, one male, mean age 39 years), DDDCT myelography was technically successful and precisely demonstrated the site of the CSF leak. In one patient with both anterior and posterior SLEC, DDDCT allowed to exclude the presence of a posteriorly located leak, while a subsequent ventral decubitus dynamic CT myelography localized the leak. Leak sites were all thoracic, except for one that was cervical. Information obtained from the DDDCT myelography was considered useful to target the treatment of the leak.
Based on our experience, DDDCT provided sufficient spatial and temporal resolution to pinpoint fast CSF leaks and it may be considered to localize posterolateral dural defects.
Les neurofilaments chaînes légères et la GFAP sont les seuls biomarqueurs sériques dont les valeurs sont corrélées aux caractéristiques cliniques et radiologiques de la SEP. Leur valeur pronostique ...au long cours est incertaine.
Étudier la valeur pronostique des NfL et de la GFAP sériques à 6 ans dans une cohorte de patients présentant une SEP-RR.
Une cohorte de SEP-RR a été suivie pendant 6 ans. L’association des valeurs sériques de NfL et GFAP avec les principales caractéristiques de la maladie a été analysée. La valeur pronostique a été étudiée à l’aide d’une analyse de survie sur les 2 critères suivants : conversion en SEP-SP et progression du handicap (augmentation de l’EDSS).
Cent trente-trois SEP-RR (femmes : 80 %, 42 % non traités, âge de début : 31 ans) ont été inclus. La durée d’évolution de la maladie au prélèvement était de 7 ans (EDSS moyen : 1,3). Soixante-quinze pour cent des patients étaient « inactifs » (pas de poussée à ±3 mois). Après un suivi moyen de 6,4 ans, l’EDSS moyen était de 2, et 15 patients avaient converti en SEP-SP (37 avaient vu leur EDSS augmenter). Seule la GFAP sérique était associée à l’EDSS des patients à l’inclusion. Aucun biomarqueur n’était associé à la progression du handicap ou la convsersion en SEP-SP.
En dépit de certaines limites (faible effectif, faible taux de conversion et de progression de l’EDSS, pas de recueil systématique des IRMs), notre étude ne semble pas confirmer certaines données récentes suggérant notamment que la GFAP est un biomarqueur valide de pronostic à long terme dans le domaine de la SEP.
Les NfL et la GFAP sérique ne semblent pas permettre d’identifier précisément, en conditions de vie réelle, les patients avec une SEP-RR à risque de conversion et/ou de progression du handicap.
Les plasmaphérèses sont un traitement de choix dans les atteintes inflammatoires du système nerveux central résistantes à la corticothérapie.
Évaluer les facteurs pronostiques de réponse au ...traitement par plasmaphérèses dans les atteintes inflammatoires du système nerveux central.
Nous avons inclus de manière rétrospective tous les patients ayant bénéficié de plasmaphérèses pour une atteinte inflammatoire du système nerveux central sur une période de 8 ans (de janvier 2011 à janvier 2019), au CHU de Montpellier. Nous avons analysé pour chaque patient les données cliniques, les caractéristiques du liquide céphalorachidien, les caractéristiques radiologiques, le diagnostic étiologique retenu, le traitement initial, le délai d’introduction et la durée des plasmaphérèses. La réponse clinique a été évaluée à 1 mois et 6 mois. Les patients étaient classés “répondeurs” au traitement lorsque l’EDSS était amélioré d’au moins 50 % à 6 mois ou lorsque l’acuité visuelle était améliorée d’au moins 2 points à 6 mois s’il s’agissait d’une NORB. Ils étaient classés “non répondeurs” s’ils ne satisfaisaient pas à ces critères.
Trente six patients ont été inclus dont 15 myélites, 16 NORB, et 5 encéphalites/encéphalomyétites. Les données à 6 mois étaient disponibles pour 30 patients. Les patients répondeurs au traitement à 6 mois (n=16) avaient bénéficié plus précocement de plasmaphérèses. Ils avaient plus fréquemment des bandes oligoclonales et une réaction lymphocytaire à l’analyse du LCR. Les patients dont la présentation était médullaire avaient plus fréquemment un tableau de myélite segmentaire.
L’initiation précoce du traitement par plasmaphérèses apparait comme un facteur prédictif majeur de réponse clinique. Nos résultats rejoignent en ce sens les précédentes études sur le sujet.
Les plasmaphérèses en association avec la corticothérapie doivent être envisagées précocement dans atteintes inflammatoires sévères du système nerveux central.
Highlights • The association between supine sleep position and increased obstructive sleep apnea is well known. • In the present study, severe obstructive sleep apnea syndrome (OSAS) in people with ...Parkinson's disease is associated with a reduced number of position changes at night. • In the present study, severe OSAS in people with PD is associated with an increased supine sleep position at night. • For people with PD, treating the difficulties of turning around in bed may be helpful.
Multiple sclerosis (MS) is the most common chronic inflammatory, demyelinating disorder. Given its variable prognosis, the identification of new prognostic biomarkers is needed.
The aims of our study ...were to assess the prognostic values of CSF β-amyloid-42 (Aβ42) and β-amyloid-40 (Aβ40) levels in MS patients.
Eighty-nine (55 RRMS, 34 PPMS) patients with a recent diagnosis and 27 controls were included in this single-centre retrospective study. Clinical, MRI and CSF data have been collected and were analysed to evaluate the potential value of CSF Aβ42 and Aβ40 levels as MS biomarkers.
CSF Aβ levels as well as Aβ42/Aβ40 ratio were identical in MS patients and controls. Although CSF Aβ42 and Aβ40 levels were higher in PPMS than in RRMS and in patients with higher EDSS, a multivariate analysis including age and EDSS demonstrated that only age of patients was associated with CSF amyloid levels. Additionally, 55 RRMS patients were followed for 3 years. We found no association between baseline amyloid levels and 3-year disability.
Our data do not support an association between CSF amyloid levels and MS status and disease severity. We suggest that CSF amyloid levels are not a prognostic biomarker in recently diagnosed RRMS.
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