Neuropsychological syndromes in multiple sclerosis

Síndromes neuropsicológicos en la esclerosis múltiple. Antecedentes: entre el 45-65% de los pacientes con esclerosis múltiple (EM) manifiestan déficits cognitivos en velocidad de procesamiento de la información (VPI), atención, memoria, funciones ejecutivas (FE) y visuoconstrucción. La alteración del lenguaje y la gnosis visual es infrecuente y poco reconocida. El objetivo es la descripción cognitiva, clínica y radiológica de cinco pacientes con EM con síndromes neuropsicológicos (SNPS). Método: revisión retrospectiva de pacientes de EM con SNPS estudiados mediante test específicos de atención, memoria, VPI, FE, visuoconstrucción, gnosis visual y lenguaje. Resultados: la muestra incluyó cuatro mujeres (3 EM remitente recurrente, 1 EM secundaria progresiva) y un varón con EM primaria progresiva (edades entre 30-55 años). Los déficits cognitivos fueron el síntoma inicial en 3 casos. Tres presentan agnosia aperceptiva y apraxia constructiva, uno alexia con agrafi a y el quinto afasia motora. Cuatro asocian disfunción cognitiva “típica” de EM. En resonancia magnética observamos alto volumen lesional en secuencias potenciadas en T1 y T2 y correlación entre los déficits cognitivos y la localización de las lesiones en 4 de ellos. Conclusiones: los SNPS pueden ser la queja inicial en la EM, con frecuencia se asocian a otros déficits cognitivos y manifiestan una estrecha relación con la localización de la lesión

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