Etiology, 3-Month Functional Outcome and Recurrent Events in Non-Traumatic Intracerebral Hemorrhage.

BACKGROUND AND PURPOSE Knowledge about different etiologies of non-traumatic intracerebral hemorrhage (ICH) and their outcomes is scarce. METHODS We assessed prevalence of pre-specified ICH etiologies and their association with outcomes in consecutive ICH patients enrolled in the prospective Swiss Stroke Registry (2014 to 2019). RESULTS We included 2,650 patients (mean±standard deviation age 72±14 years, 46.5% female, median National Institutes of Health Stroke Scale 8 [interquartile range, 3 to 15]). Etiology was as follows: hypertension, 1,238 (46.7%); unknown, 566 (21.4%); antithrombotic therapy, 227 (8.6%); cerebral amyloid angiopathy (CAA), 217 (8.2%); macrovascular cause, 128 (4.8%); other determined etiology, 274 patients (10.3%). At 3 months, 880 patients (33.2%) were functionally independent and 664 had died (25.1%). ICH due to hypertension had a higher odds of functional independence (adjusted odds ratio [aOR], 1.33; 95% confidence interval [CI], 1.00 to 1.77; P=0.05) and lower mortality (aOR, 0.64; 95% CI, 0.47 to 0.86; P=0.003). ICH due to antithrombotic therapy had higher mortality (aOR, 1.62; 95% CI, 1.01 to 2.61; P=0.045). Within 3 months, 4.2% of patients had cerebrovascular events. The rate of ischemic stroke was higher than that of recurrent ICH in all etiologies but CAA and unknown etiology. CAA had high odds of recurrent ICH (aOR, 3.38; 95% CI, 1.48 to 7.69; P=0.004) while the odds was lower in ICH due to hypertension (aOR, 0.42; 95% CI, 0.19 to 0.93; P=0.031). CONCLUSIONS Although hypertension is the leading etiology of ICH, other etiologies are frequent. One-third of ICH patients are functionally independent at 3 months. Except for patients with presumed CAA, the risk of ischemic stroke within 3 months of ICH was higher than the risk of recurrent hemorrhage

Prise en charge précoce d'une crise d'épilepsie inaugurale

L’épilepsie est l’une des maladies neurologiques les plus fréquentes touchant près de 1% de la population. La prise en charge d’une crise d’épilepsie aux urgences est souvent limitée aux examens de routine, c’est à dire un examen neurologique et un CT scan. Les patients sont ensuite orientés vers un neurologue installé ou reçoivent une convocation en policlinique afin de poursuivre les investigations. A l’issue de leur visite aux urgences, les patients ont souvent peu conscience de la sévérité de l’événement présenté et jusqu’à 30% des patients ne se présenteront pas à leur prochain rendez-vous. Notre étude a pour but d’évaluer deux prises en charge distinctes des crises inaugurales, comparant un suivi actif et adapté au patient (ECPC) et un suivi standard (SPC). Le suivi ECPC inclus un suivi clinique, électroencéphalographique et radiologique dans un délai court et adapté au patient

Case Report and Review of the Literature: Fatal Reversible Cerebral Vasoconstriction Syndrome

Background: A fatal outcome occurs in 2% of patients with Reversible Cerebral Vasoconstriction Syndrome (RCVS). Due to its rarity, guidelines for the management of the most severe forms of RCVS are lacking. Case presentation: Here, we describe the case of a 55 year-old woman who died from complications of RCVS and reviewed patients with fatal outcome reported in the literature. In our patient, the first episode of neurological deterioration was preceded by an increase of cerebral blood flow velocities assessed with transcranial Doppler. A fatal evolution could not be prevented despite therapeutic escalation consisting of multiple non-invasive and invasive treatments including cervical sympathetic bloc and continuous arterial infusion of nimodipine at the site of severe vasoconstriction. Conclusion: This case and the review of literature illustrate the challenges in the management of patients with severe RCVS. We describe here how monitoring of cerebral blood flow might help anticipate clinical worsening at the beginning of the disease and propose novel invasive and non-invasive therapeutic strategies based on monitoring of neurophysiological parameters

A Unique Case of Acquired Hemophilia A Presenting with Transient Ischemic Attack

Acquired hemophilia A (AHA) is a rare but serious condition, usually associated with significant spontaneous or traumatic bleeding and a high mortality rate. In this report, we describe the case of an elderly patient presenting a transient ischemic attack concurrently with AHA. A thrombotic event in AHA is occasionally associated with the use of bypassing agents for treatment, but a spontaneous thrombotic event has not ever been described

Plasmatic biomarkers of inflammation correlate with 18FDG-PET-CT and microembolic signals in patients with carotid stenosis

Aim: To determine whether plasmatic biomarkers correlate with 18fluoro-2-deoxy-D-glucose (FDG) positron emission tomography/computed tomography (PET-CT) and presence of microembolic signals (MES) detected by transcranial Doppler in patients with carotid stenosis.Methods: 18FDG-PET-CT and MES detection was performed in consecutive patients with 50% to 99% symptomatic or asymptomatic carotid stenosis. Uptake index was defined by a target to background ratio (TBR) between maximum standardized uptake value of the carotid plaque and the average uptake of the jugular veins. The analysis of biomarkers included adhesion molecules [intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule 1, P-selectin and E-selectin], interleukins (IL-1, IL-6), chemokines (RANTES, monocyte chemoattractant protein 1), cytokines (tumor necrosis factor α), matrix-metalloproteases (MMP), myeloperoxidase, and lipoprotein-associated phospholipase A2.Results: There were 54 symptomatic and 57 asymptomatic patients. TBR values were significantly higher in the symptomatic compared to the asymptomatic (median 2.1 vs. 1.8, P = 0.002) and in the MES positive (MES+) compared to the MES negative (MES-) group (MES+, n = 19, median 2.3 and MES-, n = 88, median 1.8, P = 0.01). The best threshold for TBR values was of 1.9. We found a significant correlation between higher 18FDG uptake (TBR ≥ 1.9) and the plasmatic levels of chemokine RANTES (P = 0.03) and higher levels of ICAM-1 in MES+ patients (P = 0.03). Interestingly MMP-2 levels were more important in patients with lower TBR values (P = 0.02) and MMP-3 and P-selectin in those who were MES- (respectively P = 0.001 and P = 0.009).Conclusion: In the present study, ICAM-1 was associated with the presence of thrombotically active atherosclerotic plaques, while RANTES mainly correlated with the inflammatory process. MMP-2, MMP-3 and P-selectin levels were more important in patients with stable plaques

18FDG-PET-CT: an imaging biomarker of high-risk carotid plaques. Correlation to symptoms and microembolic signals

We investigated whether uptake of (18)fluoro-2-deoxy-d-glucose (18FDG) positron emission tomography-computed tomography (PET-CT) correlated to clinical symptoms and presence of microembolic signals (MES) detected by transcranial Doppler in patients with carotid stenosis