Publications by authors named "Frédéric Ricolfi"

51 Publications

Detection of Myocardial Infarction by Cardiac Magnetic Resonance in Embolic Stroke Related to First Diagnosed Atrial Fibrillation.

J Stroke Cerebrovasc Dis 2021 Jun 10;30(6):105753. Epub 2021 Apr 10.

Department of Cardiology, Dijon University Hospital, 21000 Dijon, France. Electronic address:

Introduction: Elevated troponin levels are found in a significant number of patients who are diagnosed with acute embolic stroke (AES) after first diagnosed atrial fibrillation (AF). These myocardial injuries, which are known as cardiocerebral infarction (CCI), are potentially caused by coronary embolism and correspond to simultaneous cardiac and cerebral embolisms. However, this severe condition remains poorly understood. In this prospective study, we aimed to investigate the prevalence and the cardiac magnetic resonance (CMR) characteristics of CCI.

Materials And Methods: Consecutive patients with first diagnosed AF hospitalized for AES in a neurovascular intensive care unit from 2019 to 2020 were included. Troponin Ic kinetic were measured <72 h, MRI and coronary angiography or CT scan were performed <7 days after admission. Patients with significant coronary lesions were excluded.

Results: During the study period, 1150 patients with strokes were hospitalized in the neurovascular intensive care unit (ICU). Of these patients, 955 had an ischemic stroke and 97 had a transient ischemic attack. Among the 44 patients with AES and with first diagnosed AF, 34 patients underwent CMR and CMR analysis identified 12 MI. A significant rise in troponin (>0.10 µg/L) was observed in 35% of the total population (12/34 patients). More specifically, a rise was seen in 23% of the AES without MI group, 58% of the AES with MI. In addition, coronary embolism was identified in 3 patients who underwent coronary angiography (3/12) and MI was often (30%) localized in infero-latero-medial and infero-apical segments. Most AES were localized in the superficial sylvian territory.

Conclusion: We found a high prevalence of CMR-confirmed double embolization sites in the acute phase of an embolic stroke. Further studies are required to better characterize the pathophysiology, clinical course and prognostic value of CCI. Moreover, optimal management strategies, including antiplatelet therapy, remain to be determined.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105753DOI Listing
June 2021

Immediate post-operative aneurysm occlusion after endovascular treatment of intracranial aneurysms with coiling or balloon-assisted coiling in a prospective multicenter cohort of 1189 patients: Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm (ARETA) Study.

J Neurointerv Surg 2020 Dec 21. Epub 2020 Dec 21.

Interventional Neuroradiology, APHP, Paris, Île-de-France, France.

Background: Coiling, including balloon-assisted coiling (BAC), is the first-line therapy for ruptured and unruptured aneurysms. Its efficacy can be clinically evaluated by bleeding/rebleeding rate after coiling, and anatomically evaluated by aneurysm occlusion post-procedure and during follow-up. We aimed to analyze immediate post-coiling aneurysm occlusion and associated factors within the Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm (ARETA) population.

Methods: Between December 2013 and May 2015, 16 neurointerventional departments prospectively enrolled participants treated for ruptured and unruptured aneurysms (ClinicalTrials.gov: NCT01942512). Participant demographics, aneurysm characteristics, and endovascular techniques were recorded. In patients with aneurysms treated by coiling or BAC, immediate post-operative aneurysm occlusion was independently evaluated by a core lab using a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant.

Results: Of 1135 participants (age 53.8±12.8 years, 754 women (66.4%)), 1189 aneurysms were analyzed. Treatment modality was standard coiling in 645/1189 aneurysms (54.2%) and BAC in 544/1189 (45.8%). Immediate post-operative aneurysm occlusion was complete occlusion in 57.8%, neck remnant in 34.4%, and aneurysm remnant in 7.8%. Adequate occlusion (complete occlusion or neck remnant) was significantly more frequent in aneurysms with size <10 mm (93.1% vs 86.3%; OR 1.8, 95% CI 1.1 to 3.2; p=0.02) and in aneurysms with a narrow neck (95.8% vs 89.6%; OR 2.5, 95% CI 1.5 to 4.1; p=0.0004). Patients aged <70 years had significantly more adequate occlusion (92.7% vs 87.2%; OR 1.9, 95% CI 1.1 to 3.4; p=0.04).

Conclusions: Immediately after aneurysm coiling, including BAC, adequate aneurysm occlusion was obtained in 92.2%. Age <70 years, aneurysm size <10 mm, and narrow neck were factors associated with adequate occlusion.

Trial Registration Number: NCT01942512, http://www.clinicaltrials.gov.
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http://dx.doi.org/10.1136/neurintsurg-2020-017012DOI Listing
December 2020

Deep learning reconstruction versus iterative reconstruction for cardiac CT angiography in a stroke imaging protocol: reduced radiation dose and improved image quality.

Quant Imaging Med Surg 2021 Jan;11(1):392-401

Department of Cardiovascular and Interventional Radiology, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France.

Background: To assess the radiation dose and image quality of cardiac computed tomography angiography (CCTA) in an acute stroke imaging protocol using a deep learning reconstruction (DLR) method compared to a hybrid iterative reconstruction algorithm.

Methods: Retrospective analysis of 296 consecutive patients admitted to the emergency department for stroke suspicion. All patients underwent a stroke CT imaging protocol including a non-enhanced brain CT, a brain perfusion CT imaging if necessary, a CT angiography (CTA) of the supra-aortic vessels, a CCTA and a post-contrast brain CT. The CCTA was performed with a prospectively ECG-gated volume acquisition. Among all CT scans performed, 143 were reconstructed with an iterative reconstruction algorithm (AIDR 3D, adaptive iterative dose reduction three dimensional) and 146 with a DLR algorithm (AiCE, advanced intelligent clear-IQ engine). Image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and subjective image quality (IQ) scored from 1 to 4 were assessed. Dose-length product (DLP), volume CT dose index (CTDIvol) and effective dose (ED) were obtained.

Results: The radiation dose was significantly lower with AiCE than with AIDR 3D (DLP =106.4±50.0 176.1±37.1 mGy·cm, CTDIvol =6.9±3.2 11.5±2.2 mGy, and ED =1.5±0.7 2.5±0.5 mSv) (P<0.001). The median SNR and CNR were higher [9.9 (IQR, 8.1-12.3); and 12.6 (IQR, 10.5-15.5), respectively], with AiCE than with AIDR 3D [6.5 (IQR, 5.2-8.5); and 8.4 (IQR, 6.7-11.0), respectively] (P<0.001). SNR and CNR were increased by 51% and 49%, respectively, with AiCE compared to AIDR 3D. The image quality was significantly better with AiCE (mean IQ score =3.4±0.7) than with AIDR 3D (mean IQ score =3±0.9) (P<0.001).

Conclusions: The use of a DLR algorithm for cardiac CTA in an acute stroke imaging protocol reduced the radiation dose by about 40% and improved the image quality by about 50% compared to an iterative reconstruction algorithm.
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http://dx.doi.org/10.21037/qims-20-626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719916PMC
January 2021

High rate of cardiac thrombus diagnosed by adding cardiac imaging in acute stroke computed tomography protocol.

Int J Stroke 2020 Nov 3:1747493020967623. Epub 2020 Nov 3.

Cardiology Department, University Hospital, Dijon, France.

Background: Detection of left atrial appendage thrombus (LAAt) in acute stroke patients can be improved by cardiac computed tomography using prospective electrocardiogram-gated volume acquisition, which was added to the acute stroke computed tomography protocol in our institution in 2018.

Aims: To evaluate the factors and clinical management associated with LAAt in patients with acute ischemic stroke.

Methods: We retrospectively included 324 consecutive patients with ischemic stroke from November 2018 to October 2019. Clinical data and post-stroke management were compared in LAAt and no-LAAt patients.

Results: Thirty-five patients (10.8%; 95%CI 7.4-14.2) had LAAt and 289 had no-LAAt. LAAt patients were significantly older (82 ± 12 vs. 74 ± 14 yo for no-LAAt, p = 0.002), predominantly female (71% vs. 45%, p = 0.004), and were more likely to have previous atrial fibrillation (63% vs. 15%, p < 0.001) and previous stroke (32% vs. 14%, p = 0.005). There was no significant difference between groups in stroke localization or severity scales at admission or at hospital discharge. After multivariable analysis, female sex (odds ratio 2.51; 95%CI 1.09-5.77, p = 0.031), previous atrial fibrillation (odds ratio 4.87; 95%CI 2.11-11.22, p < 0.001), and left atrial volume >86 ml (odds ratio 5.33; 95%CI 1.70-16.69, p = 0.004) were independently associated with LAAt. More than a third of LAAt patients (37%) received acute heparin therapy compared to 13% of no-LAAt patients (p < 0.001). Moreover, despite comparable stroke severity at admission, the mortality rate was markedly higher in the LAAt group than in the no-LAAt group (37% vs. 13%, p < 0.001).

Conclusions: Cardiac computed tomography for left atrial appendage thrombus evaluation in routine acute stroke imaging protocol could be beneficial for decision-making with regard to the initiation of early anticoagulation.
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http://dx.doi.org/10.1177/1747493020967623DOI Listing
November 2020

Delayed thromboembolic events after coiling of unruptured intracranial aneurysms in a prospective cohort of 335 patients.

J Neurointerv Surg 2021 Jun 7;13(6):534-540. Epub 2020 Sep 7.

Neuroradiology, APHP, Le Kremlin-Bicetre, Île-de-France, France.

Background: Coiling is the first-line treatment for the management of unruptured intracranial aneurysms (UIAs), but delayed thromboembolic events (TEEs) can occur after such treatment. ARETA (Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm) is a prospective multicenter study conducted to analyze aneurysm recanalization. We analyzed delayed TEEs in the UIA subgroup.

Methods: Sixteen neurointerventional departments prospectively enrolled patients treated for ruptured and unruptured aneurysms between December 2013 and May 2015. Participant demographics, aneurysm characteristics, and endovascular techniques were recorded. Data were analyzed from participants with UIA treated by coiling or balloon-assisted coiling. We assessed the rates, timing, management, clinical outcomes, and risk factors for delayed TEEs using univariable and multivariable analyses.

Results: The rate of delayed TEEs was 2.4% (95% CI 1.0% to 4.6%) in patients with unruptured aneurysms, with all events occurring in the week following the procedure. In multivariate analysis, two factors were associated with delayed TEEs: autosomal dominant polycystic kidney disease (ADPKD): 20.0% in patients with ADPKD vs 1.9% in patients without ADPKD (OR 27.3 (95% CI 3.9 to 190.2), p=0.0008) and post-procedure aneurysm remnant: 9.4% in patients with post-procedure aneurysm remnant vs 1.6% in patients with adequate occlusion (OR 9.9 (95% CI 1.0 to 51.3), p=0.006). We describe modalities of management as well as clinical outcomes.

Conclusions: Delayed TEE is a relatively rare complication after coiling of UIAs. In this series, all occurred in the week following the initial procedure. Two factors were associated with delayed TEE: ADPKD and aneurysm remnant at procedure completion.

Clinical Trial Registration: NCT01942512.
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http://dx.doi.org/10.1136/neurintsurg-2020-016654DOI Listing
June 2021

Deep Learning Versus Iterative Reconstruction for CT Pulmonary Angiography in the Emergency Setting: Improved Image Quality and Reduced Radiation Dose.

Diagnostics (Basel) 2020 Aug 4;10(8). Epub 2020 Aug 4.

Department of Cardiovascular and Interventional Radiology, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France.

To compare image quality and the radiation dose of computed tomography pulmonary angiography (CTPA) subjected to the first deep learning-based image reconstruction (DLR) (50%) algorithm, with images subjected to the hybrid-iterative reconstruction (IR) technique (50%). One hundred forty patients who underwent CTPA for suspected pulmonary embolism (PE) between 2018 and 2019 were retrospectively reviewed. Image quality was assessed quantitatively (image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR)) and qualitatively (on a 5-point scale). Radiation dose parameters (CT dose index, CTDI; and dose-length product, DLP) were also recorded. Ninety-three patients were finally analyzed, 48 with hybrid-IR and 45 with DLR images. The image noise was significantly lower and the SNR (24.4 ± 5.9 vs. 20.7 ± 6.1) and CNR (21.8 ± 5.8 vs. 18.6 ± 6.0) were significantly higher on DLR than hybrid-IR images ( < 0.01). DLR images received a significantly higher score than hybrid-IR images for image quality, with both soft (4.4 ± 0.7 vs. 3.8 ± 0.8) and lung (4.1 ± 0.7 vs. 3.6 ± 0.9) filters ( < 0.01). No difference in diagnostic confidence level for PE between both techniques was found. CTDI (4.8 ± 1.4 vs. 4.0 ± 1.2 mGy) and DLP (157.9 ± 44.9 vs. 130.8 ± 41.2 mGy∙cm) were lower on DLR than hybrid-IR images. DLR both significantly improved the image quality and reduced the radiation dose of CTPA examinations as compared to the hybrid-IR technique.
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http://dx.doi.org/10.3390/diagnostics10080558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460033PMC
August 2020

Neurologic and neuroimaging findings in patients with COVID-19: A retrospective multicenter study.

Neurology 2020 09 17;95(13):e1868-e1882. Epub 2020 Jul 17.

From the Hôpitaux Universitaires de Strasbourg (S.K., F.L., S.B., F.-D.A., T.W.), Service d'imagerie 2, Hôpital de Hautepierre; Engineering Science, Computer Science and Imaging Laboratory (S.K., N.M.), UMR 7357, University of Strasbourg-CNRS; Service de Neurologie (M. Anheim), Hôpitaux Universitaires de Strasbourg; Institut de Génétique et de Biologie Moléculaire et Cellulaire (M. Anheim), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch; Fédération de Médecine Translationnelle de Strasbourg (M. Anheim), Université de Strasbourg; Hôpitaux universitaires de Strasbourg (H.M., F.M., J.H.), Service de Médecine Intensive Réanimation, Nouvel Hôpital Civil; INSERM (French National Institute of Health and Medical Research) (H.M., F.M.), UMR 1260, Regenerative Nanomedicine, Fédération de Médecine Translationnelle de Strasbourg; Médecine Intensive-Réanimation (M.S., F.S.), Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg; Service de Neuroradiologie (H.O., F.B., J.M.), Hôpitaux Civils de Colmar; Service d'Imagerie (A. Khalil, A.G.), Unité de Neuroradiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard; Université Paris Diderot (A. Khalil), Paris; Service de Neurologie (S. Carré, C.L.), Centre Hospitalier de Haguenau; Service de Radiologie (M. Alleg), Centre Hospitalier de Haguenau; Service de Neuroradiologie, (E.S., R.A., F.Z.) Hôpital Central, CHU de Nancy; CHIC Unisanté (L.J., P.N., Y.T.M.), Hôpital Marie Madeleine, Forbach; Neuroimaging Department (G.H., J. Benzakoun, C.O., G. Boulouis, M.E.-G., B.K.), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Université de Paris, INSERM U1266, F-75014; CHU Rennes (J.-C.F., B.C.-N.), Department of Neuroradiology; CHU Rennes (A.M.), Medical Intensive Care Unit; Department of Neuroradiology (P.-O.C., F.R., P.T.), University Hospital of Dijon, Hôpital François Mitterrand; Service de Radiologie (C.B.), CHU de Saint-Etienne; Service de Réanimation (X.F.), CH de Roanne; Service de Neuroradiologie (G.F., S.S.), CHU de Limoges; Radiology Department (I.d.B., G. Bornet), Hôpital Privé d'Antony; Department of Diagnostic and Interventional Neuroradiology (H.D.), University Hospital, Nantes; Neuroradiology Department (J. Berge), CHU de Bordeaux; Service de Neuroradiologie (A. Kazémi), CHU de Lille; Assistance Publique Hôpitaux de Paris (N.P.), Service de Neuroradiologie, Hôpital Pitié-Salpêtrière; Sorbonne Université (N.P.), Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, F-75013; Service de Neuroradiologie Diagnostique (A.L.), Foundation A. Rothschild Hospital, Paris; EA CHIMERE 7516 (J.-M.C.), Université de Picardie Jules Verne; Service de NeuroRadiologie, pôle Imagerie Médicale, Centre Hospitalo-Universitaire d'Amiens; Hôpitaux Universitaires de Strasbourg (P.-E.Z., M.M.), UCIEC, Pôle d'Imagerie, Strasbourg; Observatoire Français de la Sclérose en Plaques (J.-C.B.), Lyon; Nephrology and Transplantation Department (S. Caillard), Hôpitaux Universitaires de Strasbourg; Inserm UMR S1109 (S. Caillard), LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg; Hôpitaux Universitaires de Strasbourg (O.C., P.M.M.), Service d'Anesthésie-Réanimation, Nouvel Hôpital Civil; Hôpitaux Universitaires de Strasbourg (S.F.-K.), Laboratoire de Virologie Médicale; Radiology Department (M.O.), Nouvel Hôpital Civil, Strasbourg University Hospital; CHU de Strasbourg (N.M.), Service de Santé Publique, GMRC, F-67091 Strasbourg; Immuno-Rhumatologie Moléculaire (S.F.-K., J.H.), INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg; MRI Center (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France.

Objective: To describe neuroimaging findings and to report the epidemiologic and clinical characteristics of patients with coronavirus disease 2019 (COVID-19) with neurologic manifestations.

Methods: In this retrospective multicenter study (11 hospitals), we included 64 patients with confirmed COVID-19 with neurologic manifestations who underwent a brain MRI.

Results: The cohort included 43 men (67%) and 21 women (33%); their median age was 66 (range 20-92) years. Thirty-six (56%) brain MRIs were considered abnormal, possibly related to severe acute respiratory syndrome coronavirus. Ischemic strokes (27%), leptomeningeal enhancement (17%), and encephalitis (13%) were the most frequent neuroimaging findings. Confusion (53%) was the most common neurologic manifestation, followed by impaired consciousness (39%), presence of clinical signs of corticospinal tract involvement (31%), agitation (31%), and headache (16%). The profile of patients experiencing ischemic stroke was different from that of other patients with abnormal brain imaging: the former less frequently had acute respiratory distress syndrome ( = 0.006) and more frequently had corticospinal tract signs ( = 0.02). Patients with encephalitis were younger ( = 0.007), whereas agitation was more frequent for patients with leptomeningeal enhancement ( = 0.009).

Conclusions: Patients with COVID-19 may develop a wide range of neurologic symptoms, which can be associated with severe and fatal complications such as ischemic stroke or encephalitis. In terms of meningoencephalitis involvement, even if a direct effect of the virus cannot be excluded, the pathophysiology seems to involve an immune or inflammatory process given the presence of signs of inflammation in both CSF and neuroimaging but the lack of virus in CSF.

Clinicaltrialsgov Identifier: NCT04368390.
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http://dx.doi.org/10.1212/WNL.0000000000010112DOI Listing
September 2020

Rebleeding and bleeding in the year following intracranial aneurysm coiling: analysis of a large prospective multicenter cohort of 1140 patients-Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) Study.

J Neurointerv Surg 2020 Dec 16;12(12):1219-1225. Epub 2020 Jun 16.

Interventional Neuroradiology, CHU Bicêtre, Le Kremlin-Bicetre, Île-de-France, France.

Background: Endovascular treatment is the first line therapy for the management of ruptured and unruptured intracranial aneurysms, but delayed aneurysm rupture leading to bleeding/rebleeding can occur subsequently. ARETA (Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm) is a prospective, multicenter study conducted to analyze aneurysm recanalization. We analyzed delayed bleeding and rebleeding in this large cohort.

Methods: 16 neurointerventional departments prospectively enrolled patients treated for ruptured and unruptured aneurysms between December 2013 and May 2015 (ClinicalTrials.gov: NCT01942512). Participant demographics, aneurysm characteristics and endovascular techniques were recorded. Data were analyzed from participants with ruptured or unruptured aneurysms treated by coiling or balloon-assisted coiling. Rates of bleeding and rebleeding were analyzed and associated factors were studied using univariable and multivariable analyses.

Results: The bleeding rate was 0.0% in patients with unruptured aneurysms and 1.0% (95% CI 0.3% to 1.7%) in patients with ruptured aneurysms. In multivariate analysis, two factors were associated with rebleeding occurrence: incomplete aneurysm occlusion after initial treatment (2.0% in incomplete aneurysm occlusion vs 0.2% in complete aneurysm occlusion, OR 10.2, 95% CI 1.2 to 83.3; p=0.03) and dome-to-neck ratio (1.5±0.5 with rebleeding vs 2.2±0.9 without rebleeding, OR 0.2, 95% CI 0.04 to 0.8; p=0.03). Modalities of management of aneurysm rebleeding as well as clinical outcomes are described.

Conclusions: Aneurysm coiling affords good protection against bleeding (for unruptured aneurysms) and rebleeding (for ruptured aneurysms) at 1 year with rates of 0.0% and 1.0%, respectively. Aneurysm occlusion and dome-to-neck ratio are the two factors that appear to play a role in the occurrence of rebleeding.
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http://dx.doi.org/10.1136/neurintsurg-2020-015971DOI Listing
December 2020

Brain MRI Findings in Severe COVID-19: A Retrospective Observational Study.

Radiology 2020 11 16;297(2):E242-E251. Epub 2020 Jun 16.

From the Hôpitaux Universitaires de Strasbourg, Service d'Imagerie 2, Hôpital de Hautepierre, Strasbourg, France (S.K.).

Background Brain MRI parenchymal signal abnormalities have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Purpose To describe the neuroimaging findings (excluding ischemic infarcts) in patients with severe coronavirus disease 2019 (COVID-19) infection. Materials and Methods This was a retrospective study of patients evaluated from March 23, 2020, to April 27, 2020, at 16 hospitals. Inclusion criteria were () positive nasopharyngeal or lower respiratory tract reverse transcriptase polymerase chain reaction assays, () severe COVID-19 infection defined as a requirement for hospitalization and oxygen therapy, () neurologic manifestations, and () abnormal brain MRI findings. Exclusion criteria were patients with missing or noncontributory data regarding brain MRI or brain MRI showing ischemic infarcts, cerebral venous thrombosis, or chronic lesions unrelated to the current event. Categorical data were compared using the Fisher exact test. Quantitative data were compared using the Student test or Wilcoxon test. < .05 represented a significant difference. Results Thirty men (81%) and seven women (19%) met the inclusion criteria, with a mean age of 61 years ± 12 (standard deviation) (age range, 8-78 years). The most common neurologic manifestations were alteration of consciousness (27 of 37, 73%), abnormal wakefulness when sedation was stopped (15 of 37, 41%), confusion (12 of 37, 32%), and agitation (seven of 37, 19%). The most frequent MRI findings were signal abnormalities located in the medial temporal lobe in 16 of 37 patients (43%; 95% confidence interval [CI]: 27%, 59%), nonconfluent multifocal white matter hyperintense lesions seen with fluid-attenuated inversion recovery and diffusion-weighted sequences with variable enhancement, with associated hemorrhagic lesions in 11 of 37 patients (30%; 95% CI: 15%, 45%), and extensive and isolated white matter microhemorrhages in nine of 37 patients (24%; 95% CI: 10%, 38%). A majority of patients (20 of 37, 54%) had intracerebral hemorrhagic lesions with a more severe clinical presentation and a higher admission rate in intensive care units (20 of 20 patients [100%] vs 12 of 17 patients without hemorrhage [71%], = .01) and development of the acute respiratory distress syndrome (20 of 20 patients [100%] vs 11 of 17 patients [65%], = .005). Only one patient had SARS-CoV-2 RNA in the cerebrospinal fluid. Conclusion Patients with severe coronavirus disease 2019 and without ischemic infarcts had a wide range of neurologic manifestations that were associated with abnormal brain MRI scans. Eight distinctive neuroradiologic patterns were described. © RSNA, 2020.
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http://dx.doi.org/10.1148/radiol.2020202222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301613PMC
November 2020

Cerebral microbleeds and acute myocardial infarction: Screening and disease progression.

Int J Cardiol Heart Vasc 2020 Jun 29;28:100531. Epub 2020 May 29.

University Hospital Center Dijon Bourgogne, Cardiology Department, Dijon, France.

Introduction: Cerebral microbleeds (CMB) are associated with intracerebral haemorrhage. Therefore they may represent a concern if anticoagulant and/or antiplatelet therapy is needed. The aim of this study was to determine the prevalence of CMB in patients with acute myocardial infarction (AMI), and to follow their progression at 3 months under dual antiplatelet therapy (DAPT).

Methods: This prospective study included patients aged over 60 hospitalized in intensive cardiac care unit in our city for AMI. These patients underwent a first brain Magnetic resonance imaging (MRI) within 72 h of admission, that was repeated 3 months.

Results: 108 patients were included between November 2016 and December 2018. The prevalence of CMB was 21.3%, with a female predominance of 65.2% vs 32.1% (p = 0.004). Diabetes is significantly associated with the presence of CMB, 45.5% vs 21.2% (p = 0.021). Patients with at least one acute CMB had higher haemorrhagic risk as evaluated with CRUSADE score (40.5 ± 13.6 vs 31.2 ± 14.8 (p = 0.004).Multivariate analysis showed that only female sex was associated with the presence of a CMB on the initial MRI. On repeated MRI, an increase in CMB was observed in 6% of patients.Our results suggest that discharge treatment with anticoagulant in combination with antiplatelet therapy may be an independent predictor of early progression of CMB.

Conclusion: Our study confirms the high prevalence of CMB in patients over 60 years with AMI. The association of anticoagulant with DAPT, 3 months after stenting, may be an independent factor of CMB progression.
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http://dx.doi.org/10.1016/j.ijcha.2020.100531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262454PMC
June 2020

Flow Diverters for Intracranial Aneurysms: The DIVERSION National Prospective Cohort Study.

Stroke 2019 12 7;50(12):3471-3480. Epub 2019 Oct 7.

Department of Interventional Neuroradiology (F.T.), Hospices Civils de Lyon, France.

Background and Purpose- Flow diverters are used for endovascular therapy of intracranial aneurysms. We did a nationwide prospective study to investigate the safety and effectiveness of flow diversion at 12 months. Methods- DIVERSION was a national prospective cohort study including all flow diverters placement between October 2012 and February 2014 in France. The primary end point was the event-free survival rate at 12 months, defined as the occurrence of morbidity (intracranial hemorrhage, ischemic stroke, noncerebral hemorrhage, or neurological deficit due to mass effect), retreatment, or death within 12 months post-treatment. A quality control was carried out on 100% of the collected data and of at least 10% of the included patients in each center, chosen at random. All reported serious events were adjudicated by an independent Data Safety and Monitoring Board. Satisfactory occlusion was defined as 3 or 4 on Kamran scale by an independent imaging core laboratory at 12 months. Results- We enrolled 398 patients harboring 477 intracranial aneurysms. At least 1 morbidity-mortality event was noted in 95 of 408 interventions representing an event-free survival rate of 75.7% (95% CI, 71.1-79.7). The rate of permanent-related serious events and mortality was 5.9% and 1.2% at 12 months, respectively. Multivariate analysis showed that high baseline blood pressure (hazard ratio, 2.54; 95% CI, 1.35-4.79; =0.039), diabetes mellitus (hazard ratio, 3.70; 95% CI, 1.60-8.6; =0.0022), and larger aneurysms (hazard ratio, 1.07; 95% CI, 1.04-1.11; <0.0001) were associated with the occurrence of a neurological deficit. The satisfactory occlusion rate at 12 months was 79.9%, and the absence of high baseline blood pressure (odds ratio, 2.01; 95% CI, 1.12-3.71; =0.0193) and postprocedural satisfactory occlusion (odds ratio, 2.75; 95% CI, 1.49-5.09; =0.0012) were associated with a 12-month satisfactory occlusion. Conclusions- A satisfactory occlusion was achieved in almost 80% of cases after flow diverter treatment with a permanent-related serious event and mortality rates of 5.9% and 1.2% at 12 months, respectively.
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http://dx.doi.org/10.1161/STROKEAHA.119.024722DOI Listing
December 2019

Increasing early ambulation disability in spontaneous intracerebral hemorrhage survivors.

Neurology 2018 06 4;90(23):e2017-e2024. Epub 2018 May 4.

From the Dijon Stroke Registry (Y.B., C.B., B.D., C. Chazalon, A.D., G.-V.O., M.-H.B., M.G.), EA7460 Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases, Department of Neurology, University Hospital of Dijon, University of Burgundy; University of Lille (C. Cordonnier), Inserm U 1171, Degenerative and Vascular Cognitive Disorders, CHU Lille; and Department of Neuroradiology (P.T., F.R.), University Hospital and Medical School of Dijon, University of Burgundy, France.

Objective: To evaluate temporal trends in early ambulatory status in patients with spontaneous intracerebral hemorrhage (ICH).

Methods: All patients with ICH between 1985 and 2011 were prospectively registered in a population-based registry in Dijon, France, and included in the study. Outcomes of ICH survivors were assessed at discharge from their stay in an acute care ward with the use of a 4-grade ambulation scale. Time trends in ambulation disability and place of discharge were analyzed in 3 periods (1985-1993, 1994-2002, and 2003-2011). Multivariable ordinal and logistic regression models were applied.

Results: Five hundred thirty-one patients with ICH were registered, of whom 200 (37.7%) died in the acute care ward. While the proportion of deaths decreased over time, that of patients with ambulation disability increased (odds ratio [OR] 1.67, 95% confidence interval [CI] 0.87-3.23, = 0.124 for 1994-2002; and OR 1.97, 95% CI, 1.08-3.60, = 0.027 for 2003-2011 vs 1985-1993 in ordinal logistic regression). The proportion of patients dependent in walking rose (OR 2.11, 95% CI 1.16-3.82, = 0.014 for 1994-2002; and OR 2.73; 95% CI 1.54-4.84, = 0.001 for 2003-2011), and the proportion of patients discharged to home decreased (OR 0.49, 95% CI 0.24-0.99, = 0.048 for 1994-2002; and OR 0.32, 95% CI 0.16-0.64, = 0.001 for 2003-2011).

Conclusion: The decrease in in-hospital mortality of patients with ICH translated into a rising proportion of patients with ambulation disability at discharge. A lower proportion of patients returned home. These results have major implications for the organization of postacute ICH care.
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http://dx.doi.org/10.1212/WNL.0000000000005633DOI Listing
June 2018

CT analysis of the aorta in giant-cell arteritis: a case-control study.

Eur Radiol 2018 Sep 29;28(9):3676-3684. Epub 2018 Mar 29.

Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France.

Objectives: Giant cell arteritis (GCA) is a large-vessel vasculitis whose diagnosis is confirmed by temporal artery biopsy. However, involvement of large vessels, especially the aorta, can be shown by imaging, which plays an increasing role in GCA diagnosis. The threshold above which aortic wall thickening, as measured by computed tomography (CT), is considered pathological is controversial, with values ranging from 2 to 3 mm. This study assessed aortic morphology by CT scan and its diagnostic value in GCA.

Methods: Altogether, 174 patients were included (64 with GCA, 43 with polymyalgia rheumatica and 67 controls). All patients had a CT scan at diagnosis or at inclusion for controls. Aortic wall thickness, aortic diameter and scores for atheroma were measured. Assessor was blinded to each patient's group.

Results: Aortic diameters and atheroma scores were similar between groups. Aortic wall thickness was greater in the GCA group, even after the exclusion of GCA patients with aortic wall thickness ≥3 mm. The receiver operating characteristic (ROC) curve showed that a wall thickness of 2.2 mm was the optimal threshold to diagnose GCA (sensitivity, 67%; specificity, 98%).

Conclusions: Measuring aortic wall thickness by CT scan is effective to diagnose GCA. The optimal threshold to regard aortic wall thickening as pathological was ≥2.2 mm.

Key Points: • Imaging, including CT scan, plays an increasing role in GCA diagnosis • CT measurement of aortic wall thickness is useful to diagnose GCA • A 2.2-mm threshold allows the diagnosis of thickened aortic wall in GCA.
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http://dx.doi.org/10.1007/s00330-018-5311-8DOI Listing
September 2018

Liver Fat Content in People with Pituitary Diseases: Influence of Serum IGF1 Levels.

Horm Metab Res 2018 Apr 24;50(4):303-307. Epub 2017 Oct 24.

Service de Diabétologie et d'Endocrinologie, Université de Bourgogne-Franche Comté, INSERM - LNC UMR1231, CHU du Bocage, BP 77908, 21079 Dijon cedex, France.

Non-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, metabolic syndrome, and type 2 diabetes. NAFLD is also seen in patients with endocrinopathies. However, the relationship between endocrine diseases and the development of NAFLD is not well known. In this study, we set out to determine whether liver fat content (LFC) was associated with IGF1 levels in people with pituitary diseases (PD). Eighty-nine patients with pituitary diseases and 74 healthy controls were included in this study. LFC was measured using MRI. Hepatic steatosis was defined as LFC>5.5%. Patients with PD were older, and had a higher BMI than healthy controls. LFC was significantly higher in people with PD than in controls (6.5% vs. 3.2%; p<0.001). LFC was negatively associated with the IGF1 level. The prevalence of steatosis was higher in PD patients than in controls (36.3% vs. 14.8%; p=0.002). In multivariate analysis, which included patients and controls, the predictive variables for steatosis were age, BMI and IGF1 levels, whereas the presence of pituitary diseases and gender were not associated with steatosis. Our data showed that LFC was strongly associated with IGF1 levels. These results suggest that steatosis associated with PD is probably a consequence of a low IGF1 level in these patients.
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http://dx.doi.org/10.1055/s-0043-120673DOI Listing
April 2018

Subarachnoid Hemorrhage Revealing Moyamoya Syndrome in a Patient With May-Hegglin Anomaly.

Neurologist 2017 Sep;22(5):204-205

*Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy Departments of †Neurorehabilitation ‡Neuroimaging, University Hospital of Dijon, France.

Introduction: Moyamoya syndrome is a rare progressive cerebrovascular occlusive disease for which several associated conditions have been described.

Case Report: We report the case of a 76-year-old woman with a history of May-Hegglin anomaly who presented with an isolated unusual diffuse headache. Initial laboratory investigations showed only thrombocytopenia (platelet count 95000/μL). Unenhanced brain computed tomography scan revealed a small subarachnoid hemorrhage in the left frontal lobe. Computed tomography angiography showed occlusion of the terminal portion of the left internal carotid artery (ICA) and narrowing of the terminal portion of the right ICA with abnormal collateral vessels. Conventional angiography confirmed the tight stenosis of the extremity of the right ICA, and the occlusion of the left ICA, associated with an extensive collateral network consistent with moyamoya syndrome. No aneurysm was identified.

Conclusions: The rarity of these 2 diseases makes a fortuitous association very unlikely. We thus concluded that this observation could be the first reported case of May-Hegglin anomaly as a cause of moyamoya syndrome.
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http://dx.doi.org/10.1097/NRL.0000000000000150DOI Listing
September 2017

Impact of restrictive fluid protocol on hypoxemia after aneurysmal subarachnoid hemorrhage.

J Crit Care 2017 12 17;42:152-156. Epub 2017 Jul 17.

Service d'Anesthésie Réanimation, CHU de Dijon, Dijon, France, BP 77908, 21709 Dijon Cedex, France. Electronic address:

Purpose: In patients with aneurysmal subarachnoid hemorrhage (aSAH), acute cardiac dysfunction and triple-H-therapy, can lead to hypoxemia. Our aim was to assess impact of a protocoled fluid restrictive approach on hypoxemia in these patients.

Methods: We included prospectively ICU patients with aSAH admitted within 24h after the bleed. The study was divided into 2 phases. The first phase, from January to December 2012, was designated as control group (group C). The second phase, from February 2014 to January 2015, was designated as study group (group S). Between these periods, a protocoled fluid intake approach was implemented to maintain as low as possible the cumulative fluid balances.

Results: Effective fluid restriction was obtained: at day 3 cumulative fluid balances were respectively for group C and group S, 1559±2402ml and 759±1855ml (p=0.04); and 2211±4918ml vs 529±2806ml (p=0.04) at day 7. We observed reduction in proportion of hypoxemic patient in group S compared to group C, at day 3 (22% vs 40%, p=0.047) and at day 7 (28% vs 57%, p=0.007).

Conclusions: Fluid restrictive management of patients with aSAH decreases number of hypoxemic patients at day 3 and day 7.
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http://dx.doi.org/10.1016/j.jcrc.2017.07.031DOI Listing
December 2017

Reduced Regional Cortical Thickness Rate of Change in Donepezil-Treated Subjects With Suspected Prodromal Alzheimer's Disease.

J Clin Psychiatry 2016 Dec;77(12):e1631-e1638

Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France.

Objective: Cortical thinning, previously identified during prodromal stages of Alzheimer's disease (AD), is a "candidate" biomarker implemented in AD clinical therapy trials. We investigated the effect of donepezil treatment on cortical thickness in mild cognitively impaired subjects with the amnestic syndrome of the hippocampal type, a prodromal at-risk group for progression to AD dementia.

Methods: Data were from a longitudinal analysis of a community-based multicenter suspected prodromal AD cohort diagnosed by the Free and Cued Selective Reminding Test (81 donepezil vs 92 placebo) enrolled in a double-blind, randomized, placebo-controlled parallel group design using donepezil (10 mg/day). The study started in November 2006 and concluded in August 2010. All subjects underwent 2 brain structural magnetic resonance imaging (MRI) scans, at baseline and at the end of the trial. Structural MRI images had been processed using the automated pipeline for longitudinal segmentation and surface reconstruction implemented in FreeSurfer. The primary outcome measure of this post hoc study was the annualized percentage change (APC) of cortical thickness.

Results: The donepezil group exhibited reduced APC cortical thinning compared to placebo in the rostral anterior cingulate (right: P = .048; left: P = .032), the orbitofrontal (right: P = .012; left: P < .048), and the right inferior frontal (P = .022) cortices and in the right insula (P = .010). These results were not statistically significant after Bonferroni correction likely due to insufficient power for cortical thickness measurements in the study group powered for the predefined hippocampus outcome.

Conclusions: Our findings support the hypothesis that cortical thickness is a reliable candidate surrogate outcome in early predementia AD trials. In addition, donepezil treatment may have an impact on cortical structure/morphology in areas innervated by the medial and lateral cholinergic pathways.

Trial Registration: ClinicalTrials.gov identifier: NCT00403520.
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http://dx.doi.org/10.4088/JCP.15m10413DOI Listing
December 2016

Impact of Mechanical Thrombectomy on the Organization of the Management of Acute Ischemic Stroke.

Eur Neurol 2016 16;75(1-2):41-7. Epub 2016 Jan 16.

Stroke Registry of Dijon (Inserm, InVS, EA4184), University of Burgundy, Dijon, France.

Background: Several trials and meta-analyses have recently demonstrated the superiority of endovascular therapy over standard medical treatment in patients presenting with acute ischemic stroke. In order to offer the best possible treatment to a maximum number of patients, many stroke care networks probably have to be reorganized. After analyzing the reliability of data in the literature, an algorithm is suggested for a pre-hospital and in-hospital alert system to improve the timeliness of subsequent treatment: a drip-and-ship approach.

Summary: Five recent well-designed randomized studies have demonstrated the benefit of endovascular therapy associated with intravenous fibrinolysis by recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke with confirmation by recent meta-analyses. The keys for success are a very short time to reperfusion, within 6 h, a moderate to severe pre-treatment deficit (National Institute of Health around 17), cerebral imaging able to identify proximal large vessel occlusion in the anterior circulation, a limited infarct core and a reversible penumbra, the use of the most recent devices (stent retriever) and a procedure that avoids general anesthesia, which reduces blood pressure. To meet these goals, every country must build a national stroke infrastructure plan to offer the best possible treatment to all patients eligible for intravenous fibrinolysis and endovascular therapy. The plan may include the following actions: inform the population about the first symptoms of stroke, provide the call number to improve the timeliness of treatment, increase the number of comprehensive stroke centers, link these to secondary and primary stroke centers by telemedicine, teach and train paramedics, emergency doctors and radiologists to identify the stroke infarct, proximal large vessel occlusion and the infarct core quickly, train a new generation of endovascular radiologists to improve access to this therapy.

Key Message: After 20 years of rt-PA, this new evidence-based therapy is a revolution in stroke medicine that will benefit patients. However, a new robust and multi-disciplinary care strategy is necessary to transfer the scientific data into clinical practice. It will require reorganization of the stroke infrastructure, which will include comprehensive stroke centers and secondary and primary stroke centers. The winners will be patients with severe stroke.
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http://dx.doi.org/10.1159/000443638DOI Listing
December 2016

Virtual Endoscopy to Plan Transtympanic Approach to Labyrinthine Windows.

Otol Neurotol 2015 Sep;36(8):1338-42

*Department of Otolaryngology-Head and Neck Surgery, Dijon University Hospital; †Electronic, Imaging and Computer Science Research Laboratory, CNRS, Burgundy University; and ‡Department of Radiology, Dijon University Hospital, Dijon; and §Department of Preclinical Imaging, Biophysics, Nuclear Medicine, Strasbourg University Hospital, Strasbourg, France.

Objective: The aim of this study was to evaluate the position and the accessibility of labyrinthine windows through the external auditory canal (EAC) by virtual endoscopy based on computed tomographic scan images.

Study Design: Prospective cross-sectional study.

Setting: Tertiary referral center.

Patients: Sixty-three high-resolution temporal bone computed tomographic scans were obtained from 34 adult patients undergoing various otologic procedures.

Intervention: Images were analyzed by the virtual endoscopy function included in Osirix (www.osirix-viewer.com). The endoscope was constrained in the EAC. The visible surfaces of target anatomic structures were assessed on multiplanar reconstruction views.

Results: The optimal angles of the virtual endoscope position showed a relatively high interindividual variability in the axial plane (64 ± 2.4 degrees for the oval window [OW] and 60 ± 2.5 degrees for the round window [RW]) position, but a low interindividual variation was noted in the coronal plane (107 ± 1.5 degrees for the OW and 112 ± 1.7 degrees for the RW). The RW was accessible in 87% of cases. The OW accessibility could be staged as follows: 1, invisible stapedial superstructure (10% of cases); 2, stapedial posterior crus partly visible (33%); 3, entire posterior crus and pyramid visible (44%); 4, posterior and anterior crus visible (13%).

Conclusion: Virtual endoscopy through the EAC can evaluate the accessibility of the OW or RW via a transcanal route. This technique seems to be helpful in preplanning minimally invasive procedures by this approach such as cochlear implantation.
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http://dx.doi.org/10.1097/MAO.0000000000000808DOI Listing
September 2015

Cyclosporine in acute ischemic stroke.

Neurology 2015 Jun 6;84(22):2216-23. Epub 2015 May 6.

From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France.

Objectives: We examined whether IV administration of cyclosporine in combination with thrombolysis might reduce cerebral infarct size.

Methods: Patients aged 18 to 85 years, presenting with an anterior-circulation stroke and eligible for thrombolytic therapy, were enrolled in this multicenter, single-blinded, controlled trial. Fifteen minutes after randomization, patients received either an IV bolus injection of 2.0 mg/kg cyclosporine (Sandimmune, Novartis) or placebo. The primary endpoint was infarct volume on MRI at 30 days. Secondary endpoints included infarct volume according to the site (proximal/distal) of arterial occlusion and recanalization after thrombolysis.

Results: From October 2009 to July 2013, 127 patients were enrolled. The primary endpoint was assessed in 110 of 127 patients. The reduction of infarct volume in the cyclosporine compared with the control group was overall not significant (21.8 mL [interquartile range, IQR 5.1, 69.2 mL] vs 28.8 mL [IQR 7.7, 95.0 mL], respectively; p = 0.18). However, in patients with proximal occlusion and effective recanalization, infarct volume was significantly reduced in the cyclosporine compared with the control group (14.9 mL [IQR 1.3, 23.2 mL] vs 48.3 mL [IQR 34.5, 118.2 mL], respectively; p = 0.009).

Conclusions: Cyclosporine was generally not effective in reducing infarct size. However, a smaller infarct size was observed in patients with proximal cerebral artery occlusion and efficient recanalization.

Classification Of Evidence: This study provides Class I evidence that in patients with an acute anterior-circulation stroke, thrombolysis plus IV cyclosporine does not significantly decrease 30-day MRI infarct volume compared with thrombolysis alone.
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http://dx.doi.org/10.1212/WNL.0000000000001639DOI Listing
June 2015

[Lifelines of stroke].

Rev Prat 2015 Jan;65(1):51-3

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January 2015

Navigation-guided transmodiolar approach for auditory nerve implantation via the middle ear in humans.

Audiol Neurootol 2015 18;20(2):128-35. Epub 2015 Mar 18.

Department of Otolaryngology - Head and Neck Surgery, Dijon University Hospital, Dijon, France.

The aim of this study was to assess the surgical feasibility of a transmodiolar approach via the middle ear cavity for an auditory nerve implantation in humans. In the first part of the study, 6 adult human temporal bones underwent a navigator-guided transmodiolar implantation via the middle ear space after a radical mastoidectomy. In the second part, 122 temporal bone CT scans were analyzed for anatomical parameters relevant to this approach. The nerve implantation was feasible in all temporal bones in laboratory conditions, with a mean target registration error of 0.065 ± 0.0583 mm (n = 6). Evaluation of anatomical parameters on CT scans also supported the feasibility. There was a significant interindividual variation of the modiolar axis and the entry point in relation to visible anatomical landmarks, highlighting the necessity for surgical preplanning.
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http://dx.doi.org/10.1159/000366513DOI Listing
January 2016

[If I had a stroke in 2015].

Presse Med 2015 May 2;44(5):502-8. Epub 2015 Mar 2.

CHU de Dijon, Samu 21, 21000 Dijon, France.

The management of stroke is now recognized as a real medical emergency as well as myocardial infarct, because we have now an efficacious treatment in cerebral infarct, intravenous fibrinolysis that decreases the risk of death and motor and cognitive handicap. The second characteristic is its very important frequency, and its risk that increases in young people. This medical emergency enforces the care systems because it needs a speedy network for the patient, his family and the care professionals, useful for intravenous fibrinolysis before 3 hours after 80 years and before 4 hours and a half before 80 years. It is necessary to start treatment as soon as possible because it is most effective when given early. The consequences to avoid the lost of chance, need several actions: inform the public about the interest of FAST score to identify the first signs (facial palsy, palsy of arm, aphasia and time of stroke onset); call 15; translate the patient towards an appropriate medical center; use tele-stroke when the hospital has no neurologist; and manage the patient in a stroke unit, to introduce in a second time secondary prevention thanks to therapeutical education. Therefore, stroke care is a real multiprofessional emergency around the neurologist.
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http://dx.doi.org/10.1016/j.lpm.2014.11.015DOI Listing
May 2015

Donepezil decreases annual rate of hippocampal atrophy in suspected prodromal Alzheimer's disease.

Alzheimers Dement 2015 Sep 14;11(9):1041-9. Epub 2015 Jan 14.

INSERM, CNRS, UMR-S975, Institut du Cerveau et de la Moelle Epinière (ICM), Paris, France; Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, Paris, France; Neuroradiology Department, Hôpital de la Salpêtrière, Paris, France.

Introduction: The purpose of this study was to study the effect of donepezil on the rate of hippocampal atrophy in prodromal Alzheimer's disease (AD).

Methods: A double-blind, randomized, placebo-controlled parallel group design using donepezil (10 mg/day) in subjects with suspected prodromal AD. Subjects underwent two brain magnetic resonance imaging scans (baseline and final visit). The primary efficacy outcome was the annualized percentage change (APC) of total hippocampal volume (left + right) measured by an automated segmentation method.

Results: Two-hundred and sixteen only subjects were randomized across 28 French expert clinical sites. In the per protocol population (placebo = 92 and donepezil = 82), the donepezil group exhibited a significant reduced rate of hippocampal atrophy (APC = -1.89%) compared with the placebo group (APC = -3.47%), P < .001. There was no significant difference in neuropsychological performance between treatment groups.

Discussion: A 45% reduction of rate of hippocampal atrophy was observed in prodromal AD following 1 year of treatment with donepezil compared with placebo.
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http://dx.doi.org/10.1016/j.jalz.2014.10.003DOI Listing
September 2015

Spontaneous resolution of perforator aneurysms of the posterior circulation.

J Neurosurg 2014 Nov 22;121(5):1107-11. Epub 2014 Aug 22.

Departments of Neuroradiology and.

The authors present the cases of 3 patients with ruptured perforator aneurysms of the posterior circulation. Patients were 39, 55, and 59 years old. None of the patients had relevant past medical or family history. All presented with World Federation of Neurosurgical Societies Grade I and Fisher Grade 2 or 3 subarachnoid hemorrhage. Initial angiography results were normal. A second cerebral angiogram in each case revealed a small (< 3 mm) aneurysm of perforator arteries of the posterior circulation. Patients were successfully managed conservatively. None of the patients developed symptomatic vasospasm, rebleeding, or hydrocephaly. Control angiograms at 3 months showed spontaneous resolution of the aneurysm in all cases. Rupture of perforator aneurysms of the posterior circulation is a rare condition and it may be underdiagnosed because of limitations of imaging techniques. Treatments can lead to complications in highly functional territories and should be considered wisely, especially due to the fact that the causes and natural history of such aneurysms are unknown and spontaneous healing remains a possibility.
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http://dx.doi.org/10.3171/2014.7.JNS132411DOI Listing
November 2014

Collateral circulation in acute stroke: assessing methods and impact: a literature review.

J Neuroradiol 2014 May 6;41(2):97-107. Epub 2014 Mar 6.

Service de neuroradiologie, hôpital Bocage, CHU de Dijon, 2, boulevard Maréchal-de-Lattre-de-Tassigny, 21079 Dijon, France.

Collateral circulation plays an important role in the clinical and radiological outcome after acute ischemic stroke. Several modalities are used to evaluate these alternative pathways with a growing interest in recent years. We conducted a literature review of studies evaluating collaterals at the acute phase of a carotid territory ischemic stroke. Most of them were based on conventional angiography and CT angiography, several on the basis of MRI and transcranial Doppler and, more recently, on the basis of dynamic CT angiography, which seems to be the most appropriate modality. Populations studied in these publications are often heterogeneous (especially concerning the occlusion site and the treatments performed) and many classifications have been proposed.
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http://dx.doi.org/10.1016/j.neurad.2014.02.001DOI Listing
May 2014

Endovascular treatment of acute ischemic stroke in France: a nationwide survey.

J Neuroradiol 2014 Mar 23;41(1):71-9. Epub 2014 Jan 23.

Department of radiology, hôpital Maison-Blanche, université de Champagne-Ardenne, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France. Electronic address:

Background And Purpose: Developments in endovascular treatment have opened new promising prospects for treating acute ischemic stroke. In France, EVT is increasingly used, especially when intravenous thrombolysis is contraindicated or has failed. However, it has not been documented how neurointerventional centers are organized practically for the treatment of AIS. The present survey aims to address this.

Materials And Methods: The centers in France that are authorized to perform EVT for AIS were invited to participate to an electronic survey. The survey was composed of 33 questions, divided into 6 subheadings: (1) general information, (2) imaging modalities, (3) patient selection, (4) anesthesiology, (5) endovascular procedure and (6) imaging follow-up.

Results: The response rate was high at 93.9%. Neuroradiology centers are organized to perform mechanical thrombectomy around the clock in 80.6% of the institutions. MRI was the most commonly used imaging modality to examine acute stroke, alone in 64.5% or in combination with CT in 22.6%. The median number of neurointerventionalists was 3 per center and the median number of procedures performed in 2012 was 925. Since the medical treatment is complex, an anesthesiologist is often required during the procedure (87.1%). Technical issues are also developed in the manuscript.

Conclusions: This survey shows that French neuroradiology departments have made important efforts to implement EVT of AIS with a high quality of care for the patients; the majority of the centers used MRI to evaluate the disease and anesthesiologists are involved in order to optimize medical care during EVT.
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http://dx.doi.org/10.1016/j.neurad.2013.12.002DOI Listing
March 2014

Solitaire FR as a first-line device in acute intracerebral occlusion: a single-centre retrospective analysis.

J Neuroradiol 2014 Mar 30;41(1):80-6. Epub 2013 Dec 30.

Service de neuroradiologie et d'imagerie des urgences, CHU de Dijon, bocage central, 14, rue Paul-Gaffarel, 21000 Dijon, France.

Introduction: Analysing the clinical and angiographical effectiveness of the Solitaire FR as a mechanical thrombectomy device in acute intracerebral occlusion.

Methods: Sixty-two patients were retrospectively included between January 2010 and March 2012. All of them underwent mechanical thrombectomy with the Solitaire FR device with or without intravenous thrombolysis. Twenty-five patients had an occlusion of the basilar artery, 1 had a posterior cerebral artery occlusion. There were 16 M1 middle cerebral artery occlusions, 9 carotid T occlusions and 11 tandem occlusions. Clinical status was evaluated using the National Institute of Health Stroke Scale (NIHSS) before and 24 hours after treatment and at discharge. The Modified Rankin Scale (mRS) was evaluated at 3 months.

Results: Mean age of patients was 64.8 years. Mean NIHSS score on admission was 19.8. Stand-alone thrombectomy was used in 47 patients (75.8%). Recanalization was successful (TICI score 2b or 3) in 23 of 26 (88.5%) patients with posterior circulation occlusion and in 23 of 36 (63.9%) patients with anterior circulation occlusion. NIHSS improved by more than 10 points for 15 of 59 patients with initial NIHSS over 10. MRS was 0-2 in 25 of 62 patients (40.3%). Overall, 23 patients out of 62 died (37%). No complications related to the Solitaire device occurred.

Conclusion: These results confirm that the Solitaire FR device is safe and effective in stand-alone thrombectomy.
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http://dx.doi.org/10.1016/j.neurad.2013.10.002DOI Listing
March 2014

Venous stenting as a treatment for pacemaker-induced superior vena cava syndrome.

Arch Cardiovasc Dis 2013 Nov 12;106(11):624-6. Epub 2012 Jul 12.

CHU du Bocage, Dijon, France. Electronic address:

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http://dx.doi.org/10.1016/j.acvd.2012.01.013DOI Listing
November 2013

Bone marrow fat quantification of osteoporotic vertebral compression fractures: comparison of multi-voxel proton MR spectroscopy and chemical-shift gradient-echo MR imaging.

Acta Radiol 2011 Nov 23;52(9):1032-6. Epub 2011 Sep 23.

Department of Radiology, University Hospital, Dijon, France.

Background: Only a few studies have used in/opposed phase method for a quantitative evaluation of fat fraction in the spine.

Purpose: To compare multivoxel proton MR spectroscopy and chemical-shift gradient-echo MR imaging for bone marrow fat quantification in vertebral compression fractures (VCF).

Material And Methods: Vertebral marrow fat quantification in fifteen patients was measured at 3.0-T. Multi-voxel proton spectroscopy (MRS) and in/opposed-phase MR imaging using a fat map build with a triple-echo gradient-echo sequence was used. All the patients had benign vertebral collapse. Bone marrow fat content was evaluated by both techniques in compressed (acute or chronic) and in non-compressed vertebrae.

Results: The percentage of fat fraction measured by the triple-echo sequence was well correlated with those calculated by MRS (r(2) = 0.85; P < 10(-4)). There was a significant decrease of fat fraction in acute VCF versus both chronic VCF (P < 10(-9)) and non-fractured vertebrae (P < 10(-7)). There was no significant difference in fat fraction evaluated by both techniques between non-fractured vertebrae and chronic VCF.

Conclusion: We have validated the in/opposed phase method compared with MRS for vertebral bone marrow fat quantification. The fat mapping using a triple-echo gradient-echo sequence allows distinguishing acute and chronic benign VCF.
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http://dx.doi.org/10.1258/ar.2011.100412DOI Listing
November 2011