Sténose du sinus transverse et hypertension intracrânienne idiopathique (aspects diagnostiques, pronostiques et thérapeutiques)

Lors de la réalisation d imagerie cérébrale, une sténose du sinus transverse (SST) est fréquemment découverte chez les sujets présentant une hypertension intracrânienne idiopathique (HII), pathologie d étiologie inconnue touchant préférentiellement les jeunes femmes obèses. Nous avons repris les données cliniques et radiologiques des 26 sujets ayant consulté pour HII dans le service de neurologie sur 69 mois. La prévalence de la SST était de 57% dont 38% à caractère bilatéral. Chez les sujets présentant une SST, la présentation clinique était plus sévère, sans corrélation avec les valeurs de pression d ouverture du liquide céphalo-rachidien. Parmi les 18 sujets suivis, il existait une amélioration clinique et une stabilité des signes radiologiques, la présence d une SST initiale n étant pas associée à un caractère évolutif spécifique. Malgré son caractère rétrospectif et sa puissance limitée, cette étude monocentrique et exhaustive confirme la prévalence significative de la SST dans l HII et sa possible association à des formes cliniques plus sévères. La SST est-elle cause ou conséquence de l HII ? Sa place dans la physiopathologie de l HII reste débattue. La présence d une SST fait néanmoins discuter de nouvelles approches thérapeutiques telles que le stenting, dont la place reste à définir dans le traitement de l HII.Transverse sinus stenosis (TSS) is a radiological sign identified in the majority of patients with idiopathic intracranial hypertension (IIH), pathology of unknown aetiology, typically affecting young obese women. We studied clinical and radiological data of 26 patients who consulted for IIH in our department of neurology during 69 months. The prevalence of TSS was 57%, 38% of these were bilateral TSS. Clinical signs were more severe among patients with TSS but these signs were not correlated with a highter opening pressure of cephalo-spinal fluid. Eighteen patients were followed, clinical signs improved whereas radiological signs did not change. The presence of TSS was not associated with specific evolution. Despite its retrospective nature, this exhaustive and monocentric study confirm the highter prevalence of TSS in IIH and a possible association with more severe clinical forms. Cause or result of IIH ? The place of TSS in the physiopathology of IIH is still discussed. The significative prevalence of TSS opens the way to new treatments such as stenting of TSS which place among more conventionnal treatments of IIH is not actually well-defined.ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

Successful Thrombectomy Improves Functional Outcome in Tandem Occlusions with a Large Ischemic Core

International audienceBackground: Emergent stenting in tandem occlusions and mechanical thrombectomy (MT) of acute ischemic stroke related to large vessel occlusion (LVO-AIS) with a large core are tested independently. We aim to assess the impact of reperfusion with MT in patients with LVO-AIS with a large core and a tandem occlusion and to compare the safety of reperfusion between large core with tandem and nontandem occlusions in current practice. Methods: We analyzed data of all consecutive patients included in the prospective Endovascular Treatment in Ischemic Stroke Registry in France between January 2015 and March 2023 who presented with a pretreatment ASPECTS (Alberta Stroke Program Early CT Score) of 0–5 and angiographically proven tandem occlusion. The primary end point was a favorable outcome defined by a modified Rankin Scale (mRS) score of 0–3 at 90 days. Results: Among 262 included patients with a tandem occlusion and ASPECTS 0–5, 203 patients (77.5%) had a successful reperfusion (modified Thrombolysis in Cerebral Infarction grade 2b-3). Reperfused patients had a favorable shift in the overall mRS score distribution (adjusted odds ratio [aOR], 1.57 [1.22–2.03]; P < 0.001), higher rates of mRS score 0–3 (aOR, 7.03 [2.60–19.01]; P < 0.001) and mRS score 0–2 at 90 days (aOR, 3.85 [1.39–10.68]; P = 0.009) compared with nonreperfused. There was a trend between the occurrence of successful reperfusion and a decreased rate of symptomatic intracranial hemorrhage (aOR, 0.5 [0.22–1.13]; P = 0.096). Similar safety outcomes were observed after large core reperfusion in tandem and nontandem occlusions. Conclusions: Successful reperfusion was associated with a higher rate of favorable outcome in large core LVO-AIS with a tandem occlusion, with a safety profile similar to nontandem occlusion