91 research outputs found

    Laser interstitial thermal therapy is effective and safe for the treatment of brain tumors in NF1 patients after cerebral revascularization for moyamoya angiopathy: a report on two cases

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    BackgroundThe co-occurrence of moyamoya vasculopathy and extra-optic pathway tumors is rare in neurofibromatosis type 1 (NF1), with only four cases described in the literature. Brain surgery in these patients may be challenging because of the risk of brain infarction after skin and dural incision. Given its percutaneous and minimally invasive nature, laser interstitial thermal therapy (LITT) is an ideal option for the treatment of brain tumors in these patients. Here, we report on two patients with NF1 and moyamoya syndrome (MMS) treated for a brain glioma with LITT, after cerebral revascularization.CasesThe first patient, with familial NF1, underwent bilateral indirect revascularization with multiple burr holes (MBH) for symptomatic MMS. Two years later, she was diagnosed with a left temporal tumor, with evidence of radiologic progression over 10 months. The second patient, also with familial NF1, developed unilateral MMS when he was 6 years old and was treated with MBH. At the age of 15 years, MRI showed a right cingular lesion, growing on serial MRIs. Both patients underwent LITT with no perioperative complications; they are progression free at 10 and 12 months, respectively, and the tumors have decreased in volume.DiscussionWhile the association of extra-optic neoplasm and moyamoya angiopathy is seldom reported in NF1, tumor treatment is challenging in terms of both avoiding stroke and achieving oncological control. Here, we show in 2 cases, that LITT could be a safe and effective option in these rare conditions

    Diagnostic performance of dynamic 3D magnetic resonance angiography in daily practice for the detection of intracranial arteriovenous shunts in patients with non-traumatic intracranial hemorrhage

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    IntroductionIdentification of treatable causes of intracranial hemorrhage (ICH) such as intracranial arteriovenous shunt is crucial to prevent recurrence. However, diagnostic approaches vary considerably across centers, partly because of limited knowledge of the diagnostic performance of first-line vascular imaging techniques. We assessed the diagnostic performance of dynamic three-dimensional magnetic resonance angiography (dynamic 3D MRA) in daily practice to detect intracranial arteriovenous shunts in ICH patients against subsequent digital subtraction angiography (DSA) as reference standard.MethodsWe reviewed all adult patients who underwent first-line dynamic 3D MRA and subsequent DSA for non-traumatic ICH between January 2016 and September 2021 in a tertiary center. Sensitivity, specificity, accuracy, positive and negative predictive values of dynamic 3D MRA for the detection of intracranial arteriovenous shunt were calculated with DSA as reference standard.ResultsAmong 104 included patients, 29 (27.9%) had a DSA-confirmed arteriovenous shunt [19 pial arteriovenous malformations, 10 dural arteriovenous fistulae; median onset-to-DSA: 17 (IQR: 3–88) days]. The sensitivity and specificity of dynamic 3D MRA [median onset-to-dynamic 3D MRA: 14 (3–101) h] for the detection of intracranial arteriovenous shunt were 66% (95% CI: 48–83) and 91% (95% CI: 84–97), respectively. The corresponding accuracy, positive and negative predictive values were 84% (95% CI: 77–91), 73% (95% CI: 56–90), and 87% (95% CI: 80–95), respectively.ConclusionThis study suggests that although first-line evaluation with dynamic 3D MRA may be helpful for the detection of intracranial arteriovenous shunts in patients with ICH, additional vascular imaging work-up should not be withheld if dynamic 3D MRA is negative. Comparative prospective studies are needed to determine the best imaging strategy to diagnose arteriovenous shunts after non-traumatic ICH

    Anaesth Crit Care Pain Med

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    PURPOSE: To provide recommendations for the anaesthetic and peri-operative management for thrombectomy procedure in stroke patients DESIGN: A consensus committee of 15 experts issued from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et Réanimation, SFAR), the Association of French-language Neuro-Anaesthetists (Association des Neuro-Anesthésistes Réanimateurs de Langue Francaise, ANARLF), the French Neuro-Vascular Society (Société Francaise de Neuro-Vasculaire, SFNV), the French Neuro-Radiology Society (Société Francaise de Neuro-Radiologie, SFNR) and the French Study Group on Haemostasis and Thrombosis (Groupe Français d'Études sur l'Hémostase et la Thrombose, GFHT) was convened, under the supervision of two expert coordinators from the SFAR and the ANARLF. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guideline elaboration process was conducted independently of any industry funding. The authors were required to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide their assessment of quality of evidence. METHODS: Four fields were defined prior to the literature search: (1) Peri-procedural management, (2) Prevention and management of secondary brain injuries, (3) Management of antiplatelet and anticoagulant treatments, (4) Post-procedural management and orientation of the patient. Questions were formulated using the PICO format (Population, Intervention, Comparison, and Outcomes) and updated as needed. Analysis of the literature was then conducted and the recommendations were formulated according to the GRADE methodology. RESULTS: The SFAR/ANARLF/SFNV/SFNR/GFHT guideline panel drew up 18 recommendations regarding anaesthetic management of mechanical thrombectomy procedures. Due to a lack of data in the literature allowing to conclude with high certainty on relevant clinical outcomes, the experts decided to formulate these guidelines as "Professional Practice Recommendations" (PPR) rather than "Formalized Expert Recommendations". After two rounds of rating and several amendments, a strong agreement was reached on 100% of the recommendations. No recommendation could be formulated for two questions. CONCLUSIONS: Strong agreement among experts was reached to provide a sizable number of recommendations aimed at optimising anaesthetic management for thrombectomy in patients suffering from stroke

    Etude en tenseur de diffusion de la maladie d'Alzheimer débutante

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    PARIS5-BU Méd.Cochin (751142101) / SudocPARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

    Physiopathologie et diagnostic des dissections des artères cervico-encéphaliques (contribution de l'imagerie par résonance magnétique de la paroi artérielle)

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    Les techniques d IRM permettent une approche diagnostique et physiopathologique de l enjeu majeur de santé publique qu est l accident vasculaire cérébral (AVC). L IRM a révolutionné sa prise en charge, la décision thérapeutique et l évaluation de son efficacité depuis une dizaine d années. Ces techniques suscitent donc une recherche active visant à optimiser leur apport dans les étiologies les plus courantes de l AVC, comme l athérosclérose ou la dissection des artères cervicales (DAC), pathologie impliquée dans 20% des AVC du sujet jeune. 1) Dans un premier temps, nous avons évalué l apport pour le diagnostic précoce de DAC de l IRM conventionnelle cérébrale à 1.5T. Plus de 75% des hématomes disséquant des artères carotides ou vertébrales ont une extension distale ou une localisation au niveau de la base du crâne, pouvant les faire méconnaitre lors de l exploration différée de l étage cervical, exploration multimodale dont la sensibilité est elle-même limitée. L IRM cérébrale utilisant les séquences de routine du bilan d un accident vasculaire cérébral permet un diagnostic précoce de dissection des artères carotides internes, avant même la réalisation d une imagerie dédiée. Si l absence de mise en évidence d un hématome mural sur cet examen ne permet pas d exclure le diagnostic, l IRM cérébrale, lorsqu elle est positive, peut contribuer à une meilleure identification précoce des patients qui ne sont pas initialement suspect de DAC ou dans les institutions où l imagerie des artères cervicales n est pas réalisée dans le même temps que l IRM cérébrale. 2) Dans un second temps, nous avons évalué l apport de l IRM haute résolution avec antennes de surface dédiées dans l exploration de patients suspects de dissection vertébrale. L IRM haute résolution est une technique en plein essor, offrant une résolution de 500 x 500 dans le plan, développée pour l analyse de la plaque d athéromateuse mais utilisable en recherche et en routine clinique dans les dissections artérielles cervicales. La dissection des artères vertébrales est, pour des raisons techniques et anatomiques, un diagnostic difficile. Pour les patients suspects de dissection vertébrale et présentant un bilan d imagerie, échographie doppler et IRM, non concluant, l IRM haute résolution centrée sur les anomalies artérielles mises en évidence par ces premiers examens permet de dépister plus de dissection et d éliminer des hématomes qui n en sont pas. Elle distingue clairement plexus veineux périvertébraux et dissection et met en évidence l hématome disséquant, y compris lorsqu il siège au niveau de segments tortueux ou fixés dans le canal osseux transversaire. 3) Dans un troisième temps, nous avons évalué l aspect des dissections carotidiennes aigues en IRM-HR. Les patients porteurs de dissection carotidienne spontanée présentent un aspect en IRM-HR de l artère disséquée similaire à celui rencontré dans des maladies inflammatoires de la paroi artérielle comme l artérite à cellules géantes et la maladie de Takayasu ; cet aspect est rarement rencontré en cas de dissection traumatique. Cette sémiologie, associée à un syndrome inflamatoire biologique, suggère une artériopathie transitoire sous jacente à la dissection carotidienne. Ces travaux montrent que l IRM, examen non invasif et multiparamétrique, utilisé de manière conventionnelle ou en protocole haute résolution, offre des stratégies de prise en charge innovantes et des perspectives diagnostiques de plus en plus fine, préfigurant la routine clinique à haut champ.Stroke is a common and serious disorder, the leading cause of death and disability. Magnetic resonance imaging (MRI) has become a major actor for diagnosis, treatment decision and physiopathological comprehension of vascular disorders. Therefore, an active research attempt to optimize MR diagnosis and prognosis contribution in the most common stroke etiologies, such as atherosclerosis, or cervical artery dissection (CAD). Cervical arterial dissection is the most frequent cause of stroke in young adults, accounting for nearly 20% of the cases. MRI has become the reference method for evaluating patients who are suspected of having CAD, by using cervical axial T1- weighted images with fat suppression and cervical contrast-enhanced MR angiography. This method allows clinicians to almost completely forego invasive digital subtraction angiography. However, an early and reliable identification of acute CAD might be impaired (limited spatial resolution, tortuous anatomy, thick bone and adjacent veins). In this work, we firstly hypothesized that standard brain magnetic resonance imaging (MRI) could allow the early détection of CAD of the upper portion of carotid and vertébral arteries. Nearly 75% of CAD were included within the field of view of brain MRI and more than three-quarters of such acute CAD could be diagnosed using brain MRI only. Stroke brain MRI can allow early detection of carotid artery dissection, before dedicated imaging of the cervical arteries is performed. Although the absence of mural hematoma does not completely rule out CAD, stroke brain MRI can contribute to a better and earlier identification of stroke patients that are suitable candidates for anticoagulation treatment or revascularization therapy. Secondly, we evaluated the added value of high resolution MRI (HR-MRI) for the diagnosis of vertebral artery dissection (VAD). The emergence of high-resolution rapid imaging methods has enabled magnetic resonance imagers to noninvasively image the fine internal structure of cervical arterial walls, with a high in plane resolution (500 x 500 ). If HR-MRI can be used to identify the major components of atherosclerotic plaque, that is, the lipid core, mural hemorrhage, calcifications, and the fibrous cap, this technique can also be routinely used for the diagnosis of dissection or inflammatory arterial disease. In patients referred with suspected VAD dissection, it is not rare for the initial DUS and standard fat-suppressed T1-WI to be inconclusive. VAD then remains presumptive and treatment is initiated without a definite diagnosis. In patients with a high suspicion of VAD and discordant or doubtful baseline DUS and MRI findings, our results encourage the use of HR-MRI as a second-line screening, particularly because the distinction between the vertebral artery wall and perivertebral venous structures is easily made. Thirdly, using HR-MRI we searched for evidence of peri-arterial inflammation in spontaneous CAD. Based on previously used criteria to distinguish between traumatic (tCAD) and spontaneous CAD (sCAD), we found that sCAD patients were more likely to present biological inflammation, a history of recent infection, and multiple dissections.We have also shown that symptomatic spontaneous CAD with mural hematoma is more frequently associated with the presence of peri arterial edema compared to traumatic mural hematoma. Interestingly, the radiological findings of peri arterial edema are similar to those observed in inflammatory diseases, such as Takayasu s disease and giant cell arteritis. This study indicates that imaging and biological markers of inflammation are associated with sCAD. Further investigations with more specific inflammatory markers are warranted to corroborate the role of inflammation in sCAD. Both standard and high resolution MRI of the wall of cervical arteries, non invasive and multiparametric tools, can be successfully performed in the clinical setting in cervical artery dissection and provide innovative strategies for patient care.LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

    Acute enlargement, morphological changes, and rupture of intracranial infectious aneurysm in infective endocarditis. Serial imaging

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    International audienceA 72-year-old man received a transcatheter aortic valve implantation (TAVI) 2 years ago for leakage of the degenerative bioprosthesis with Corevalve n°31 implantation, presented infective endocarditis (IE) (streptococcus sanguinis) of the bioprosthetic aortic valve. One month after antibiotic treatment was initiated, he presented a left-sided hemiplegia, a right frontal hematoma. MRI/contrast-enhanced magnetic resonance angiography (CE-MRA) revealed 2 infectious intracranial aneurysms (IIAs) of the right (10 mm) and left middle cerebral artery (MCA) (M2 segment, 5 mm). The right MCA IIA was treated within 1 day by glue-embolization. Seven days later, the patient acutely developed motor aphasia. CE-MRA showed significant enlargement (15 mm) and morphologic change of the ruptured left MCA IIA. This IIA was treated with Onyx-embolization. This case adds additional evidence that IIAs, during IE, can show rapid growth and morphological change over a 7 day course and emphasizes the imperative need of close imaging follow-up when IIAs are managed by antibiotic therapy

    Neuroimaging of Pediatric Intracerebral Hemorrhage.

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    Hemorrhagic strokes account for half of all strokes seen in children, and the etiologies of these hemorrhagic strokes differ greatly from those seen in adult patients. This review gives an overview about incidence and etiologies as well as presentation of children with intracerebral hemorrhage and with differential diagnoses in the emergency department. Most importantly it describes how neuroimaging of children with intracerebral hemorrhage should be tailored to specific situations and clinical contexts and recommends specific imaging protocols for acute and repeat imaging. In this context it is important to keep in mind the high prevalence of underlying vascular lesions and adapt the imaging protocol accordingly, meaning that vascular imaging plays a key role regardless of modality. Magnetic resonance imaging (MRI), including advanced sequences, should be favored whenever possible at the acute phase

    Intracranial solitary fibrous tumor: imaging findings

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    ERMAInternational audienceOBJECTIVE: To study the neuroimaging features of intracranial solitary fibrous tumors (ISFTs). MATERIALS AND METHODS: Retrospective study of neuroimaging features of 9 consecutive histopathologically proven ISFT cases. Location, size, shape, density, signal intensity and gadolinium uptake were studied at CT and MRI. Data collected from diffusion-weighted imaging (DWI) (3 patients), perfusion imaging and MR spectroscopy (2 patients), and DSA (4 patients) were also analyzed. RESULTS: The tumors most frequently arose from the intracranial meninges (7/9), while the other lesions were intraventricular. Tumor size ranged from 2.5 to 10 cm (mean=6.6 cm). They presented multilobular shape in 6/9 patients. Most ISFTs were heterogeneous (7/9) with areas of low T2 signal intensity that strongly enhanced after gadolinium administration (6/8). Erosion of the skull was present in about half of the cases (4/9). Components with decreased apparent diffusion coefficient were seen in 2/3 ISFTs on DWI. Spectroscopy revealed elevated peaks of choline and myo-inositol. MR perfusion showed features of hyperperfusion. CONCLUSION: ISFT should be considered in cases of extra-axial, supratentorial, heterogeneous, hypervascular tumor. Areas of low T2 signal intensity that strongly enhance after gadolinium injection are suggestive of this diagnosis. Restricted diffusion and elevated peak of myo-inositol may be additional valuable features
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