Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Reponsive to Steroids (CLIPPERS) (suivi rétrospectif d'une cohorte nationale de 15 patients, stratégies de prise en charge et hypothèses physiopathologiques)

Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids (CLIPPERS) est une pathologie inflammatoire du système nerveux central décrite pour la première fois par Pittock et al en 2010. Nous avons suivi rétrospectivement une cohorte nationale de 15 patients suspectés de CLIPPERS pendant une durée moyenne de 6 ans. Cette pathologie se caractérise par une symptomatologie récurrente d'atteinte du tronc cérébral visible en IRM sous la forme d'hypersignaux punctiformes et curvilinéaires en T1 après injection de gadolinium prédominant dans la région ponto-cérébelleuse. En anatomopathologie ces lésions correspondent à un infiltrat lympho-histiocytaire principalement composé de petits lymphocytes T CD3 et que quelques lymphocytes B, en position périvasculaire. L'excellente réponse clinique et radiologique au traitement par corticostéroïdes fait partie des critères diagnostiques. L'absence de marqueur diagnostic spécifique doit faire réaliser un large bilan paraclinique à la recherche d'autres pathologies dysimmunitaires, infectieuses ou tumorales. Aucune forme progressive n'était constatée. Seul un traitement par corticoïdes intraveineux permettait un contrôle des poussées et un relai oral évitait les rechutes au dessus de la dose de 25mg par jour. L'azathioprine et le méthotrexate pourraient être des alternatives intéressantes aux corticoïdes au long cours. Des études supplémentaires sont nécessaires afin de déterminer la place des traitements immunosuppresseurs. La physiopathologie de cette affection reste inconnue mais pourrait partager des points communs avec les lymphomes B cérébraux comme en témoignent certaines publications récentes. L' indication de la biopsie cérébrale reste à codifier, nous proposons un algorithme décisionnel de prise en charge devant un tableau clinico-radiologique compatible avec un CLIPPERSMONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

3D modelling of tyre-pavement contact pressure

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Punctate and curvilinear gadolinium enhancing lesions in the brain: a practical approach

International audienceINTRODUCTION:Cerebral punctate and curvilinear gadolinium enhancements (PCGE) correspond to opacification of small vessel lumen or its perivascular areas in case of blood-brain barrier (BBB) disruption. We will discuss the possible causes of intra-parenchymal central nervous system PCGE.METHODS:Our review is based on French database including patients presenting with central nervous system PCGE and literature search using PubMed database with the following keywords: punctate enhancement, linear enhancement, and curvilinear enhancement. Disorders which displayed linear leptomeningeal or periventricular enhancements without intra-parenchymal PCGE are excluded of this review.RESULTS:Among our 39 patients with PCGE, 16 different diagnoses were established. After combining our PCGE causes with those described in the literature, we propose a practical approach. Besides physiologic post-contrast enhancement of small vessels, three pathologic conditions may exhibit PCGE: (1) small collateral artery network seen in Moyamoya syndrome, (2) small veins congestions related to developmental or acquired venous outflow disturbance, and (3) disorders causing small vessels BBB disruption indicated by T2 and FLAIR hyperintensities in the corresponding areas of PCGE. Disruption of the BBB could be caused by a direct injury of the endothelial cell, as in posterior reversible encephalopathy syndrome, Susac syndrome, and radiochemotherapy-induced injuries, or by an angiocentric cellular infiltrate, as in inflammatory disorders, demyelinating diseases, host immune responses fighting against infections, prelymphoma states, lymphoma, and in CLIPPERS.CONCLUSION:PCGE may conceal several causes, including physiological and pathological conditions. Nevertheless, a practical approach could improve its management and limit the indications of brain biopsy to very specific situation

Target Door-to-Needle Time for Tissue Plasminogen Activator Treatment with Magnetic Resonance Imaging Screening Can Be Reduced to 45 min

International audienceOBJECTIVE: The purpose of this study was to demonstrate that the median door-to-needle (DTN) time for intravenous tissue plasminogen activator (tPA) treatment can be reduced to 45 min in a primary stroke centre with MRI-based screening for acute ischaemic stroke (AIS). METHODS: From February 2015 to February 2017, the stroke unit of Perpignan general hospital, France, implemented a quality-improvement (QI) process. During this period, patients who received tPA within 4.5 h after AIS onset were included in the QI cohort. Their clinical characteristics and timing metrics were compared each semester and also with those of 135 consecutive patients with AIS treated by tPA during the 1-year pre-QI period (pre-QI cohort). RESULTS: In the QI cohort, 274~patients (92.5%) underwent MRI screening. While the demographic and baseline characteristics were not significantly different between cohorts, the median DTN time was significantly lower in the QI than in the pre-QI cohort (52 vs. 84 min; p \textless 0.00001). Within the QI cohort, the median DTN time for each semester decreased from 65 to 44 min (p \textless 0.00001) and the proportion of treated patients with a DTN time <=45 min increased from 25 to 58.9% (p \textless 0.0001). Overall, DTN time improvement was associated with a better outcome at 3 months (patients with a modified Rankin Scale score between 0 and 2: 61.8% in the QI vs. 39.3% in the pre-QI cohort; p \textless 0.0001). CONCLUSIONS: A QI process can reduce the~DTN within 45 min with MRI as a screening tool

Molecular and epidemiological investigation of a colistin-resistant OXA-23-/NDM-1-producing Acinetobacter baumannii outbreak in the Southwest Indian Ocean Area

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Futile inter-hospital transfer for mechanical thrombectomy in a semi-rural context: analysis of a 6-year prospective registry

International audienceBACKGROUND AND PURPOSE:Inter-hospital transfer for mechanical thrombectomy (MT) might result in the transfer of patients who finally will not undergo MT (ie, futile transfers [FT]). This study evaluated FT frequency in a primary stroke center (PSC) in a semi-rural area and at 156 km from the comprehensive stroke center (CSC).METHODOLOGY:Retrospective analysis of data collected in a 6-year prospective registry concerning patients admitted to our PSC within 4.5 hours of acute ischemic stroke (AIS) symptom onset, with MR angiography indicating the presence of large vessel occlusion (LVO) without large cerebral infarction (DWI-ASPECT ≥5), and selected for transfer to the CSC to undergo MT. Futile transfer rate and reasons were determined, and the relevant time measures recorded.RESULTS:Among the 529 patients screened for MT, 278 (52.6%) were transferred to the CSC. Futile transfer rate was 45% (n=125/278) and the three main reasons for FT were: clinical improvement and reperfusion on MRI on arrival at the CSC (58.4% of FT); clinical worsening and/or infarct growth (16.8%); and longer than expected inter-hospital transfer time (11.2%). Predictive factors of FT due to clinical improvement/reperfusion on MRI could not be identified. Baseline higher NIHSS (21 vs 17; P=0.01) and lower DWI-ASPECT score (5 vs 7; P=0.001) were associated with FT due to clinical worsening/infarct growth on MRI.CONCLUSIONS:In our setting, 45% of transfers for MT were futile. None of the baseline factors could predict FT, but the initial symptom severity was associated with FT caused byclinical worsening/infarct growth

A Clinico-Radiological Study of Cerebral Amyloid Angiopathy-Related Inflammation

International audienceOBJECTIVE:To describe the clinico-radiological features and long-term prognosis in patients with cerebral amyloid angiopathy-related inflammation (CAA-ri).METHODS:Twenty-eight CAA-ri patients were recruited retrospectively from 6 neurological centers. We recorded the clinico-radiological and biological data, at baseline and during follow-up. Baseline characteristics associated with relapse risk and prognosis were assessed.RESULTS:Five patients had pathologically confirmed CAA-ri whereas 23 had probable (n = 21) or possible (n = 2) CAA-ri. The mean age was 72 years; main clinical symptoms included confusion (54%), hemiparesis (36%), and aphasia (29%). Cerebral MRI disclosed a brain parenchymal lesion (89%), which was usually multifocal (82%) and bilateral (89%). It was associated with gadolinium enhancement (84%), small ischemic lesions (39%), cortical superficial siderosis (CSS; 50%), and a high number of microbleeds (mean 240 ± 277). An isolated leptomeningeal involvement was observed in 3 patients with pathological confirmation. Despite a favorable initial evolution after treatment, we observed a 42% risk of relapse, mostly within the first year (83%). After a mean follow-up of 2 years, 29% died and 25% had a marked disability. Disseminated CSS was associated with death.CONCLUSION:Despite an apparently favorable initial evolution, CAA-ri is characterized by a poor prognosis. Diagnostic criteria should consider patients with isolated leptomeningeal involvement

Results of IRC water penetration study will help industry tailor wall assemblies to climate

Dr. Michael A. Lacasse: https://orcid.org/0000-0001-7640-3701Dr. Michael A. Lacasse: https://orcid.org/0000-0001-7640-3701Aussi disponible en fran\ue7ais: Une \ue9tude de l'IRC sur la p\ue9n\ue9tration de la pluie aidera l'industrie \ue0 construire des murs en fonction du climatPeer reviewed: NoNRC publication: Ye