DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

A European Perspective on the German System for Thrombectomy in Stroke Patients

Imaginal retraining is a noncomputerized variant of cognitive bias modification, an intervention aimed at reducing craving in substance use disorders and behavioral addictions. We conducted a dismantling study to elucidate which of its multiple components are effective and hence essential ingredients of the training and which are ineffective (and hence perhaps dispensable) in reducing craving. We randomized 187 smokers to one out of six conditions that instructed participants to perform a brief intervention. In four of these, participants were instructed to perform isolated components of the imaginal retraining protocol, and in the two other conditions participants either suppressed or simply observed (control condition) the image of a cigarette. Before and after the intervention, participants were asked to rate their level of craving and how pleasant they found three smoking-related images. We examined within-group changes by means of paired t-tests separately across conditions (trial registration: DRKS00021044). Mental distancing from cigarettes (without a corresponding actual physical movement; non-motor retraining) led to a significant decline in craving (paired t-test), which remained significant when compared to the control condition. The effects of other components of the retraining were less consistent. The present study shows that a single therapeutic 'dose' of distinct components involved in imaginal retraining can reduce craving for cigarettes. Future trials should investigate the effectiveness of components of imaginal retraining not yet tested (e.g., mood induction) and whether combinations and repetition of single components strengthen or dilute efficacy

Apport pronostique de l'IRM (1TESLA) de diffusion et de perfusion a la phase hyperaigue des accidents vasculaires cérebraux ischémiques

Objectif : Definir chez des patients victimes d'un AVD ischemique a un stade hyperaigu (<6 heures) des valeurs pronostiques grace aux sequences d'IRM de diffusion, de perfusion et d'angio MR. Materiels et methodes : Une etude prospective chez 12 patients porteurs d'un AVC ischemique a compris un bilan TDM et IRM (T2, flair, diffusion et perfusion, angioMR), dans les 6 premieres heures puis a J+4 et une IRM a 4 mois. Resultats : Nous avons etabli des correlations entre les volumes lesionnels definis par les differentes sequences d'IRM et les scores cliniques initiaux et finaux. Les sequences de diffusion et de perfusion a J0 sont tres bien correlees au volume infarci defini sur la sequence T2 de l'IRM a 4 mois, mais egalement au score clinique final. Les patients presentant une occlusion proximale sur l'angioMR, ont tous une evolution clinique plus defavorable. Conclusion : A un stade hyperaigu de l'AVC ischemique, les sequences de diffusion, de perfusion et d'angioMR paraissent predictives de la taille finale de l'infarctus et du devenir clinique a long terme. Les differents coefficients de diffusion et de perfusion etudies (ADC, TTP, VSC) devraient permettre d'etablir des donnees parametriques dans l'ischemie cerebrale et l'identification de plusieurs groupes relevant de therapeutiques differentes (techniques de desobstruction ou de repermeabilisation vasculaire et traitement neuroprotecteurs).ST ETIENNE-BU Médecine (422182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Middle cerebral artery aneurysms: Feasibility, clinical and anatomical results of the endovascular treatment by WEB flow Disruption. Preliminary evaluation in a multicenter study

info:eu-repo/semantics/publishe

Cerebral Hemodynamic Changes Induced by a Lumbar Puncture in Good-Grade Subarachnoid Hemorrhage

Background: Patients with good-grade subarachnoid hemorrhage (SAH) are those without initial neurological deficit. However, they can die or present severe deficit due to secondary insult leading to brain ischemia. After SAH, in a known context of energy crisis, vasospasm, hydrocephalus and intracranial hypertension contribute to unfavorable outcome. Lumbar puncture (LP) is sometimes performed in an attempt to reduce intracranial pressure (ICP) and release headaches. We hypothesize that in good-grade SAH patients, a 20-ml LP releases headaches, reduces ICP and improves cerebral blood flow (CBF) as measured with O15 PET scan. Methods: Six good-grade (WFNS grade 1or 2) SAH patients (mean age 48 years, 2 women, 4 men) were prospectively included. All aneurysms (4 anterior communicating artery and 2 right middle cerebral artery) were coiled at day 1. Patients were managed according to our local protocol. LP was performed for severe headache (VAS >7) despite maximal painkiller treatment. Patients were included when the LP was clinically needed. The 20-ml LP was done in the PET scan (mean delay between SAH and LP: 3.5 days). LP allows hydrostatic measurement of ICP. Arterial blood pressure (ABP) was noninvasively gauged with photoplethysmography. Every signal was monitored and analyzed off-line. Regional CBF (rCBF) was measured semiquantitatively with O15 PET before and after LP. Then we calculated the difference between baseline and post-LP condition for each area: positive value means augmentation of rCBF after the LP, negative value means reduction of rCBF. Individual descriptive analysis of CBF was first performed for each patient; then a statistical group analysis was done with SPM for all voxels using t statistics converted to Z scores (p 3.2). Results: A 20-ml LP yielded a reduction in pain (–4), a drop in ICP (24.3 ± 12.5 to 6.9 ± 4.7 mm Hg), but no change in ABP. Descriptive and statistical image analysis showed a heterogeneous and biphasic change in cerebral hemodynamics: rCBF was not kept constant and either augmented or decreased after the drop in ICP. Hence, cerebrovascular reactivity was spatially heterogeneous within the brain. rCBF seems to augment in the brain region roughly close to the bleed and to be reduced in the rest of the brain, with a rough plane of symmetry. Conclusions: In good-grade SAH, LP releases headaches and lowers ICP. LP and the drop in ICP have a heterogeneous and biphasic effect on rCBF, suggesting that cerebrovascular reactivity is not spatially homogeneous within the brain

Reversible Cerebral Vasoconstriction Syndrome with Intracranial Hypertension: Should Decompressive Craniectomy Be Considered

Background: Reversible cerebral vasoconstriction syndrome (RCVS) is a rare cause of intracerebral hemorrhage (ICH) causing intracranial hypertension. Methods: Case report. Results: We report a case of RCVS-related ICH leading to refractory intracranial hypertension. A decompressive craniectomy was performed to control intracranial pressure. We discuss here the management of RCVS with intracranial hypertension. Decompressive craniectomy was preformed to avoid the risky option of high cerebral perfusion pressure management with the risk of bleeding, hemorrhagic complications, and high doses of norepinephrine. Neurological outcome was good. Conclusion: RCVS has a complex pathophysiology and can be very difficult to manage in cases of intracranial hypertension. Decompressive craniectomy should probably be considered

Endovascular WEB flow disruption in middle cerebral artery aneurysms: preliminary feasibility, clinical, and anatomical results in a multicenter study.

The endovascular treatment of middle cerebral artery (MCA) aneurysms with unfavorable anatomy (wide neck, unfavorable morphology) is frequently challenging. Flow disruption with the WEB is a potentially interesting endovascular treatment for this type of aneurysm.Clinical TrialJournal ArticleMulticenter StudySCOPUS: ar.jinfo:eu-repo/semantics/publishe