Élaboration d’un score radio-clinique prédictif de l’évolution neurologique après rupture de malformation artério-veineuse cérébrale

Background and Purpose: Brain arteriovenous malformations (BAVMs) are a leading cause of intracranial hemorrhage in young adults. We aimed to design a scale predictive of neurological outcome after BAVM rupture. Materials and Methods: 135 patients with 139 BAVM rupture events were included. Independent predictors of long-term poor outcome (modified Rankin scale [mRS] > 3 more than one year after admission) were identified. A risk stratification scale was developed and compared to the intracerebral hemorrhage (ICH) score to predict poor outcome and delta-mRS (difference between follow-up and baseline pre-hemorrhage mRS). The score was also compared to the ICH score for prediction of in-hospital mortality. Results: Multivariate logistic regression analysis determined that consciousness level (odd ratio [OR] 6.5, 95% confidence interval (CI) [3.09-13.7], P-value 3 plus d’un an après l’admission) ont été identifiés. Un score stratifiant les patients en fonction du risque d’évolution défavorable a été développé et comparé au score ICH (Intracerebral Hemorrhage) pour la prédiction de l’évolution neurologique défavorable à long terme et le delta-mRS (différence entre le mRS de suivi et le mRS avant l’hémorragie). Le score a également été comparé au score ICH pour la prédiction de la mortalité intra-hospitalière. Résultats : L’analyse multivariée a montré que l’état de conscience (odd ratio [OR] 6,5; intervalle de confiance (IC)95% [3,09-13,7], p<10-3 ), le volume de l’hématome (OR 1,84; IC95% [1,21-2,8], p=0,005) et l’hémorragie intra-ventriculaire (OR 7,46; IC95% [2,66-21], p<10-3) étaient des facteurs indépendants associés à une évolution défavorable. Un score simplifié en 12 points (de 0 à 11) dédié à la rupture de MAVc a été élaboré en combinant ces critères. Le score prédisait mieux l’évolution défavorable (p=0,009) que le score ICH. Le score prédisait également mieux le delta mRS et la mortalité intra-hospitalière. Conclusion : Nous proposons un score à l'admission dédié à la stratification des patients en fonction du risque d'évolution défavorable après rupture de MAVc

Idiopathic Intracranial Hypertension: Glymphedema of the Brain

Background: During the last decade, our understanding of cerebrospinal fluid (CSF) physiology has dramatically improved, thanks to the discoveries of both the glymphatic system and lymphatic vessels lining the dura mater in human brains

Superficial middle cerebral vein connection to the cavernous sinus is not infrequent in brain arteriovenous malformations: an argument against their congenital origin?

International audienceIntroductionThe aim of this study was to test the hypothesis that the superficial middle cerebral vein (SMCV) is frequently absent or fails to connect with the cavernous sinus (CS) in the presence of brain arteriovenous malformations (AVMs), a frequently reported argument for the congenital origin of brain AVMs.MethodsThe SMCV was retrospectively compared between patients with a brain AVM and a control group. The presence or absence of the SMCV, its direct or indirect connection to the CS and its termination in a laterocavernous sinus (LCS), paracavernous sinus (PCS), or directly in the CS was studied on digital subtraction angiography.ResultsOne hundred twenty-five left or right side carotid angiograms from 70 patients with a brain AVM were compared to 125 angiograms from 74 controls. The SMCV was present in 88 (70.4 %) cases in the brain AVM group and 96 (76.8 %) cases in controls (p = 0.25). The SMCV was connected directly or indirectly to the CS in 65 (52 %) cases in the brain AVM group and 65 (52 %) cases in controls (p = 1). When comparing the subgroup of carotid angiograms ipsilateral to a supratentorial AVM, no statistically significant difference was found with controls. In three of six cases in which a SMCV drained an AVM, the vein terminated directly or indirectly in the CS.ConclusionsNo difference of SMCV presence and direct or indirect connection to the CS was found between patients with AVM and a control group. SMCV anatomy does not support the congenital origin of brain AVMs

Predictive score for complete occlusion of intracranial aneurysms treated by flow-diverter stents using machine learning

International audienceBackground: Complete occlusion of an intracranial aneurysm (IA) after the deployment of a flow-diverter stent is currently unpredictable. The aim of this study was to develop a predictive occlusion score based on pretreatment clinical and angiographic criteria.Methods: Consecutive patients with ≥6 months follow-up were included from 2008 to 2019 and retrospectively analyzed. Each IA was evaluated using the Raymond-Roy occlusion classification (RROC) and dichotomized as occluded (A) or residual (B/C); 80% of patients were randomly assigned to the training sample. Feature selection and binary outcome prediction relied on logistic regression and threshold maximizing class separation selected by a CART tree algorithm. The feature selection was addressed by a genetic algorithm selected from the 30 pretreatment available variables.Results: The study included 146 patients with 154 IAs. Feature selection yielded a combination of six variables with a good cross-validated accuracy on the test sample, a combination we labeled DIANES score (IA diameter, indication, parent artery diameter ratio, neck ratio, side-branch artery, and sex). A score of more than -6 maximized the ability to predict RROC=A with sensitivity of 87% (95% CI 79% to 95%) and specificity of 82% (95% CI 64% to 96%) in the training sample. Accuracy was 86% (95% CI 79% to 94%). In the test sample, sensitivity and specificity were 89% (95% CI 77% to 98%) and 60% (95% CI 33% to 86%), respectively. Accuracy was 81% (95% CI 69% to 91%).Conclusion: A score was developed as a grading scale for prediction of the final occlusion status of IAs treated with a flow-diverter stent

S100B Serum Elevation Predicts In-Hospital Mortality After Brain Arteriovenous Malformation Rupture

International audienceBackground and Purpose- S100B protein serum elevation has been associated with poor prognosis in neurologically ill patients. The purpose of this study is to determine whether elevation of S100B is associated with increased in-hospital mortality after brain arteriovenous malformation rupture. Methods- This is a retrospective study of patients admitted for brain arteriovenous malformation rupture. The study population was divided into derivation and validation cohorts. Univariate followed by multivariate logistic regression was used to determine whether elevation of S100B serum levels above 0.5 µg/L during the first 48 hours after admission (S100Bmax48) was associated with in-hospital mortality. Results- Two hundred and three ruptures met inclusion criteria. Twenty-three led to in-hospital mortality (11%). Mean S100Bmax48 was 0.49±0.62 µg/L. In the derivation cohort (n=101 ruptures), multivariate analysis found Glasgow coma scale score ≤8 (odds ratio, 21; 95% CI, 2-216; 0.001) and an S100Bmax48>0.5 µg/L (odds ratio, 19; 95% CI, 2-188; P=0.001) to be associated with in-hospital mortality. When applied to the validation cohort (n=102 ruptures), the same model found only S100Bmax48>0.5 µg/L (odds ratio, 8; 95% CI, 1.5-44; P=0.01) to be associated with in-hospital mortality. Conclusions- Elevated S100B protein serum level is strongly associated with in-hospital mortality after brain arteriovenous malformation rupture

Secondary S100B Protein Increase Following Brain Arteriovenous Malformation Rupture is Associated with Cerebral Infarction

Early S100B protein serum elevation is associated with poor prognosis in patients with ruptured brain arteriovenous malformations (BAVM). The purpose of this study is to determine whether a secondary elevation of S100B is associated with early complications or poor outcome in this population. This is a retrospective study of patients admitted for BAVM rupture. A secondary increase of S100B was defined as an absolute increase by 0.1 &mu;g/L within 30 days of admission. Fisher&rsquo;s and unpaired t tests followed by multivariate analysis were performed to identify markers associated with this increase. Two hundred and twenty-one ruptures met inclusion criteria. Secondary S100B protein serum elevation was found in 17.1% of ruptures and was associated with secondary infarction (p &lt; 0.001), vasospasm-related infarction (p &lt; 0.001), intensive care (p = 0.009), and hospital length of stay (p = 0.005), but not with early rebleeding (p = 0.07) or in-hospital mortality (p = 0.99). Secondary infarction was the only independent predictor of secondary increase of S100B (OR 9.9; 95% CI (3&ndash;35); p &lt; 0.001). Secondary elevation of S100B protein serum levels is associated with secondary infarction in ruptured brain arteriovenous malformations