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Isan P, Mondot L, Casolla B, Fontaine D, Almairac F. Post-traumatic cerebral venous sinus thrombosis associated with epidural hematoma: A challenging clinical situation. Neurochirurgie 2022; 68:e40-e43. [DOI: 10.1016/j.neuchi.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/10/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022]
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Casolla B. Simulation for Neurology training: Acute setting and beyond. Rev Neurol (Paris) 2021; 177:1207-1213. [PMID: 34229869 DOI: 10.1016/j.neurol.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 10/20/2022]
Abstract
Simulation-based training is adapted for teaching neurology, and it can offer multiple programs for general and specialized neurologists. Indeed, simulation training is "learner-centered", assuring sessions tailored to each learner level, and provides a realistic, safe, controlled and reproducible environment to improve knowledge, technical and non-technical skills, including situational awareness, communication, teamwork and leadership. Indeed, simulation tools allow multidisciplinary sessions with different team members (nurses, physician associates, specialist trainees, technicians) participating with their experiences. Multidisciplinary scenarios maximize awareness on the "human factors" and contribute to the safety of future patients. Simulation sessions require clear learning objectives and debriefing points tailored to the learning groups, but instructors may vary the scenarios in real time according to learners' actions. Different simulation techniques are applied according to learning objectives. The simulation session always includes a briefing, a simulation scenario and a structured debriefing, driven by the instructor, which is crucial for learning consolidation. In neurology training, simulation methods are applicable for: i) training on emergency situations, where the neurologist team has to manage in frontline a specific medical emergency (stroke, status epilepticus, coma, neuromuscular respiratory failure); ii) improving technical skills (lumbar puncture, electroencephalography (EEG), cervical ultrasound and transcranial Doppler, endovascular thrombectomy procedures, neuroradiological investigations); iii) improving procedures and patient pathways (stroke pathway, telemedicine); and iv) training non-technical skills (communication, teamwork, leadership). This manuscript provides a brief overview on the general principles of simulation techniques and their potential application in neurology training, in the acute setting and beyond.
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Affiliation(s)
- B Casolla
- University Côte d'Azur (UCA), Department of Neurology, Stroke unit, CHU Nice, 06000 Nice, France.
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Casolla B, Cordonnier C. Intracerebral haemorrhage, microbleeds and antithrombotic drugs. Rev Neurol (Paris) 2020; 177:11-22. [PMID: 32747048 DOI: 10.1016/j.neurol.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/04/2020] [Accepted: 05/19/2020] [Indexed: 11/17/2022]
Abstract
Antithrombotic therapy is a cornerstone for secondary prevention of ischaemic events, cerebral and extra-cerebral. A number of clinical questions remain unanswered concerning the impact of antithrombotic drugs on the risk of first-ever and recurrent macro or micro cerebral haemorrhages, raising the clinical dilemma on the risk/benefit balance of giving antiplatelets and anticoagulants in patients with potential high risk of brain bleeds. High field magnetic resonance imaging (MRI) blood-weighted sequences, including susceptibility weighted imaging (SWI), have expanded the spectrum of these clinical questions, because of their increasing sensitivity in detecting radiological markers of small vessel disease. This review will summarise the literature, focusing on four main clinical questions: how do cerebral microbleeds impact the risk of cerebrovascular events in healthy patients, in patients with previous ischaemic stroke or transient ischaemic attack, and in patients with intracerebral haemorrhage? Is the risk/benefit balance of oral anticoagulants shifted by the presence of microbleeds in patients with atrial fibrillation after recent ischaemic stroke or transient ischaemic attack? Should we restart antiplatelet drugs after symptomatic intracerebral haemorrhage or not? Are oral anticoagulants allowed in patients with a history of atrial fibrillation and previous intracerebral haemorrhage?
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Affiliation(s)
- B Casolla
- University of Lille, Inserm, CHU of Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000 Lille, France.
| | - C Cordonnier
- University of Lille, Inserm, CHU of Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000 Lille, France
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Leys D, Dequatre-Ponchelle N, Ferrigno M, Henon H, Mounier-Vehier F, Moulin S, Casolla B, Tortuyaux R, Chochoi M, Moreau C, Girard-Buttaz I, Pruvo JP, Goldstein P, Cordonnier C. Access to mechanical thrombectomy for cerebral ischaemia: A population-based study in the North-of-France. Rev Neurol (Paris) 2019; 175:519-527. [PMID: 31208814 DOI: 10.1016/j.neurol.2018.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 12/18/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Hospitals admitting acute strokes should offer access to mechanical thrombectomy (MT), but local organisations are still based on facilities available before MT was proven effective. MT rates and outcomes at population levels are needed to adapt organisations. We evaluated rates of MT and outcomes in inhabitants from the North-of-France (NoF) area. METHOD We prospectively evaluated rates of MT and outcomes of patients at 3 months, good outcomes being defined as a modified Rankin scale (mRS) 0 to 2 or like the pre-stroke mRS. RESULTS During the study period (2016-2017), 666 patients underwent MT (454, 68.1% associated with intravenous thrombolysis [IVT]). Besides, 1595 other patients received IVT alone. The rate of MT was 81 (95% confidence interval [CI] 72-90) per million inhabitants-year, ranging from 36 to 108 between districts. The rate of IVT was 249 (95% CI 234-264) per million inhabitants-year, ranging from 155 to 268. After 3 months, 279 (41.9%) patients who underwent MT had good outcomes, and 167 (25.1%) had died. Patients living outside the district of Lille where the only MT centre is, were less likely to have good outcomes at 3 months, after adjustment on age, sex, baseline severity, and delay. CONCLUSION The rate of MT is one of the highest reported up to now, even in low-rate districts, but outcomes were significantly worse in patients living outside the district of Lille, and this is not only explained by the delay.
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Affiliation(s)
- D Leys
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance.
| | | | - M Ferrigno
- University of Lille, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
| | - H Henon
- Inserm U1171, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
| | - F Mounier-Vehier
- Stroke unit, Lens hospital, neurology clinic, 59800 Lille, France
| | - S Moulin
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
| | - B Casolla
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
| | - R Tortuyaux
- Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
| | - M Chochoi
- Neurology clinic, CHU Lille, 59800 Lille, France
| | - C Moreau
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Neurology clinic, CHU Lille, 59800 Lille, France
| | - I Girard-Buttaz
- Stroke unit, Valenciennes hospital, neurology clinic, 59800 Lille, France
| | - J-P Pruvo
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Neuroradiology department, CHU Lille, 59800 Lille, France
| | - P Goldstein
- Emergency department, SAMU 59, CHU Lille, 59800 Lille, France
| | - C Cordonnier
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
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Zangari R, Zanier ER, Torgano G, Bersano A, Beretta S, Beghi E, Casolla B, Checcarelli N, Lanfranconi S, Maino A, Mandelli C, Micieli G, Orzi F, Picetti E, Silvestrini M, Stocchetti N, Zecca B, Garred P, De Simoni MG. Early ficolin-1 is a sensitive prognostic marker for functional outcome in ischemic stroke. J Neuroinflammation 2016; 13:16. [PMID: 26792363 PMCID: PMC4721111 DOI: 10.1186/s12974-016-0481-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/11/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Several lines of evidence support the involvement of the lectin pathway of complement (LP) in the pathogenesis of acute ischemic stroke. The aim of this multicenter observational study was to assess the prognostic value of different circulating LP initiators in acute stroke. METHODS Plasma levels of the LP initiators ficolin-1, -2, and -3 and mannose-binding lectin (MBL) were measured in 80 stroke patients at 6 h only and in 85 patients at 48 h and later. Sixty-one age- and sex-matched healthy individuals served as controls. Stroke severity was measured on admission using the National Institutes of Health Stroke Scale (NIHSS). The outcome was measured at 90 days by the modified Rankin Scale (mRS). RESULTS Ficolin-1 was decreased in patients compared with controls measured at 6 h (median 0.13 vs 0.33 μg/ml, respectively, p < 0.0001). At 48 h, ficolin-1 was significantly higher (0.45 μg/ml, p < 0.0001) compared to the 6 h samples and to controls. Likewise, ficolin-2 was decreased at 6 h (2.70 vs 4.40 μg/ml, p < 0.0001) but not at 48 h. Ficolin-3 was decreased both at 6 and 48 h (17.3 and 18.23 vs 21.5 μg/ml, p < 0.001 and <0.05, respectively). For MBL no difference was detected between patients and controls or within patients at the different time points. In multivariate analysis, early ficolin-1 was independently associated with unfavorable mRS outcome (adjusted odds ratio (OR): 2.21, confidence interval (CI) 95 % 1.11-4.39, p = 0.023). Early ficolin-1 improved the discriminating ability of an outcome model including NIHSS and age (area under the curve (AUC) 0.95, CI 95 % 0.90-0.99, p = 0.0001). CONCLUSIONS The ficolins are consumed within 6 h after stroke implicating activation of the LP. Early ficolin-1 is selectively related to 3-month unfavorable outcome.
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Affiliation(s)
- R Zangari
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
- Department of physiopathology and transplant, Milan University and Neuro ICU Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - E R Zanier
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
| | - G Torgano
- Emergency Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - A Bersano
- Cerebrovascular Disease Unit, IRCCS-Istituto Neurologico Carlo Besta, Milan, Italy.
| | - S Beretta
- Department of Neurology, San Gerardo Hospital, Milan Center for Neuroscience, University of Milano Bicocca, Monza, Italy.
| | - E Beghi
- Department of physiopathology and transplant, Milan University and Neuro ICU Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - B Casolla
- Department NESMOS, University of Rome "La Sapienza", Rome, Italy.
| | | | - S Lanfranconi
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - A Maino
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - C Mandelli
- Emergency Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - G Micieli
- C. Mondino National Neurological Institute, Pavia, Italy.
| | - F Orzi
- Department NESMOS, University of Rome "La Sapienza", Rome, Italy.
| | - E Picetti
- Division of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - M Silvestrini
- Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
| | - N Stocchetti
- Department of physiopathology and transplant, Milan University and Neuro ICU Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - B Zecca
- Emergency Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - P Garred
- Laboratory of Moleclar Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - M G De Simoni
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
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Ducroquet A, Leys D, Saabi AA, Richard F, Cordonnier C, Girot M, Deplanque D, Casolla B, Allorge D, Bordet R. Influence of Chronic Ethanol Consumption on the Neurological Severity in Patients With Acute Cerebral Ischemia. Stroke 2013; 44:2324-6. [DOI: 10.1161/strokeaha.113.001355] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Casolla B, Dequatre-Ponchelle N, Rossi C, Henon H, Leys D, Cordonnier C. Heavy alcohol intake and intracerebral hemorrhage: Characteristics and effect on outcome. Neurology 2012; 79:1109-15. [DOI: 10.1212/wnl.0b013e3182698d00] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Epilepsy often follows a focal insult, and develops with a time delay so to reveal a complex cascade of events. Both clinical and experimental findings suggest that the initial insult triggers a self-promoted pathological process, currently named epileptogenesis. An early phase reflects the complex response of the nervous system to the insult, which includes pro-injury and pro-repair mechanisms. Successively, the sprouting and probably neurogenesis and gliosis set up the stage for the onset of spontaneous seizures. Thus, local changes in excitability would cause a functional change within a network, and the altered circuitry would favor the seizures. A latent or clinically silent period, as long as years, may precede epilepsy. In spite of the substantial knowledge on the biochemical and morphological changes associated with epileptogenesis, the mechanisms supposedly underlying the process are still uncertain. The uncertainty refers mostly to the silent period, a stage in which most, if not all, the receptor and ion changes are supposedly settled. It is tempting to explore the nature of the factors promoting the epileptogenesis within the notional field of neurodegeneration. Specifically, several observations converge to support the hypothesis that a prion-like mechanism promotes the "maturation" process underlying epileptogenesis. The mechanism, consistently with data from different neurodegenerative diseases, is predictably associated with deposition of self-aggregating misfolded proteins and changes of the ubiquitin proteasome and autophagy-lysosome pathways.
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Van Waes V, Darnaudéry M, Marrocco J, Gruber SH, Talavera E, Mairesse J, Van Camp G, Casolla B, Nicoletti F, Mathé AA, Maccari S, Morley-Fletcher S. Impact of early life stress on alcohol consumption and on the short- and long-term responses to alcohol in adolescent female rats. Behav Brain Res 2011; 221:43-9. [PMID: 21376087 DOI: 10.1016/j.bbr.2011.02.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 02/22/2011] [Indexed: 12/31/2022]
Abstract
We examined the interaction between early life stress and vulnerability to alcohol in female rats exposed to prenatal restraint stress (PRS rats). First we studied the impact of PRS on ethanol preference during adolescence. PRS slightly increased ethanol preference per se, but abolished the effect of social isolation on ethanol preference. We then studied the impact of PRS on short- and long-term responses to ethanol focusing on behavioral and neurochemical parameters related to depression/anxiety. PRS or unstressed adolescent female rats received 10% ethanol in the drinking water for 4 weeks from PND30 to PND60. At PND60, the immobility time in the forced-swim test did not differ between PRS and unstressed rats receiving water alone. Ethanol consumption had no effect in unstressed rats, but significantly reduced the immobility time in PRS rats. In contrast, a marked increase in the immobility time was seen after 5 weeks of ethanol withdrawal only in unstressed rats. Hippocampal levels of neuropeptide Y (NPY) and mGlu1a metabotropic glutamate receptors were increased at the end of ethanol treatment only in unstressed rats. Ethanol treatment had no effect on levels of corticotropin-releasing hormone (CRH) in the hippocampus, striatum, and prefrontal cortex of both groups of rats. After ethanol withdrawal, hippocampal levels of mGlu1 receptors were higher in unstressed rats, but lower in PRS rats, whereas NPY and CRH levels were similar in the two groups of rats. These data indicate that early life stress has a strong impact on the vulnerability and responsiveness to ethanol consumption during adolescence.
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Affiliation(s)
- V Van Waes
- NeuroPlasticity Team, UMR 8576, Functional and Structural Glycobiology Unit, CNRS/University Lille North of France, 59655 Villeneuve d'Ascq, France
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