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Raineau M, Crowe AM, Beccaria K, Luscan R, Simon F, Roux CJ, Ferroni A, Kossorotoff M, Harroche A, Castelle M, Gatbois E, Bourgeois M, Roy M, Blanot S. Pediatric intracranial empyema complicating otogenic and sinogenic infection. Int J Pediatr Otorhinolaryngol 2024; 177:111860. [PMID: 38224655 DOI: 10.1016/j.ijporl.2024.111860] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To describe and compare clinical and microbiological features, surgical and medical management, and outcomes of children with otogenic and sinogenic intracranial empyema (IE) in an institution with an established multidisciplinary protocol. To use the study findings to inform and update the institutional algorithm. METHODS Retrospective analysis was carried out on the electronic healthcare records of all children with oto-sinogenic IE admitted in a 5-year period. RESULTS A total of 76 patients were identified and treated according to an institutional protocol. Two distinct groups were identified: intracranial empyema related to otogenic infection (OI-IE, n = 36) or sinogenic infection (SI-IE, n = 40). SI-IE was seen in older children and had a significantly higher morbidity. Sub-dural IE was seen in a minority (n = 16) and only in SI-IE and required urgent collaborative ENT-neurosurgery. Extra-dural IE occurred more frequently and was seen in both SI-IE and OI-IE. No death and overall low morbidity were observed. Particularities found in SI-IE and OI-IE groups (as thrombosis, microbiology, antibiotic treatment, duration and outcome) permitted the delineation of these groups in our updated algorithm. CONCLUSION The presence of a collaborative multidisciplinary protocol permits the step-wise co-ordination of care for these complex patients in our institution. All patients received prompt imaging, urgent surgical intervention, and antibiotic treatment. Microbiological identification was possible for each patient and antibiotic rationalization was permitted through use of Polymerase chain reaction (PCR) testing in cases of sterile cultures. Of note, intracranial empyema related to sinogenic infection is shown to have significantly more severe clinical presentation, a higher morbidity, and a longer duration of antibiotic therapy than that related to otogenic infection. Study findings allowed for the update and clarification of the institutional protocol, which now clearly demarcates the clinical presentation, biological evidence, radiology, surgical and medical treatments in children with oto-sinogenic IE.
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Affiliation(s)
- Mégane Raineau
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Ann-Marie Crowe
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Kevin Beccaria
- Pediatric Neurosurgery Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Romain Luscan
- Pediatric ENT Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Francois Simon
- Pediatric ENT Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Charles-Joris Roux
- Pediatric Radiology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Agnès Ferroni
- Clinical Microbiology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, French Center for Pediatric Stroke, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Annie Harroche
- Clinical Hematology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Martin Castelle
- Pediatric Immunology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Edith Gatbois
- Hospitalization at Home Department, Assistance Publique des Hôpitaux de Paris, Hôpital Armand Trousseau - Sorbonne Université, Paris, France.
| | - Marie Bourgeois
- Pediatric Neurology Department, French Center for Pediatric Stroke, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Mickaela Roy
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Stéphane Blanot
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
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Wicker C, Roux CJ, Goujon L, de Feraudy Y, Hully M, Brassier A, Bérat CM, Chemaly N, Wiedemann A, Damaj L, Abi-Warde MT, Dobbelaere D, Roubertie A, Cano A, Arion A, Kaminska A, Da Costa S, Bruneel A, Vuillaumier-Barrot S, Boddaert N, Pascreau T, Borgel D, Kossorotoff M, Harroche A, de Lonlay P. Association between acute complications in PMM2-CDG patients and haemostasis anomalies: Data from a multicentric study and suggestions for acute management. Mol Genet Metab 2023; 140:107674. [PMID: 37542768 DOI: 10.1016/j.ymgme.2023.107674] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES Patients with PMM2-CDG develop acute events (stroke-like episodes (SLEs), thromboses, haemorrhages, seizures, migraines) associated with both clotting factors (factor XI) and coagulation inhibitors (antithrombin, protein C and protein S) deficiencies. The aim of the study was to correlate acute events to haemostasis and propose practical guidelines. METHODS In this multicentric retrospective study, we evaluated clinical, radiological, haemostasis and electroencephalography data for PMM2-CDG patients hospitalized for acute events. Cerebral events were classified as thrombosis, haemorrhage, SLE, or "stroke mimic" (SM: normal brain imaging or evoking a migraine). RESULTS Thirteen patients had a total of 31 acute episodes: 27 cerebral events with 7 SLEs, 4 venous thromboses, 4 haemorrhages (3 associated with thrombosis), 15 SMs at a mean age of 7.7 years; 4 non-cerebral thromboses, one of which included bleeding. A trigger was frequently involved (infection, head trauma). Although sometimes normal at baseline state, factor XI, antithrombin and protein C levels decreased during these episodes. No correlation between haemostasis anomalies and type of acute event was found. DISCUSSION Acute events in PMM2-CDG are not negligible and are associated with haemostasis anomalies. An emergency protocol is proposed for their prevention and treatment (https://www.filiere-g2m.fr/urgences). For cerebral events, brain Magnetic Resonance Imaging with perfusion weight imaging and diffusion sequences, electroencephalogram and haemostasis protein levels guide the treatment: anticoagulation, antithrombin or fresh frozen plasma supplementation, antiepileptic therapy. Preventing bleeding and thrombosis is required in cases of surgery, prolonged immobilization, hormone replacement therapy. CONCLUSION Acute events in PMM2-CDG are associated with abnormal haemostasis, requiring practical guidance.
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Affiliation(s)
- Camille Wicker
- Centre de Référence des Maladies Héréditaires du Métabolisme, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, G2M, MetabERN, Paris, France; Centre de Compétence des Maladies Héréditaires du Métabolisme, Hôpital Universitaire de Strasbourg, Strasbourg, France
| | - Charles-Joris Roux
- Université Paris Cité, Paris, France; Service de Radiologie Pédiatrique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, Paris, France
| | - Louise Goujon
- Centre de Référence des Maladies Héréditaires du Métabolisme, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, G2M, MetabERN, Paris, France
| | - Yvan de Feraudy
- Service de Neurologie Pédiatrique, Hôpital Universitaire de Strasbourg, Strasbourg, France
| | - Marie Hully
- Service de Neurologie Pédiatrique, Médecine physique et réadaptation de l'enfant, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, Paris, France
| | - Anais Brassier
- Centre de Référence des Maladies Héréditaires du Métabolisme, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, G2M, MetabERN, Paris, France
| | - Claire-Marine Bérat
- Centre de Référence des Maladies Héréditaires du Métabolisme, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, G2M, MetabERN, Paris, France
| | - Nicole Chemaly
- Service de Neurologie Pédiatrique, Médecine physique et réadaptation de l'enfant, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, Paris, France
| | - Arnaud Wiedemann
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Universitaire de Nancy, Nancy, France
| | - Lena Damaj
- Centre de Compétence des Maladies Héréditaires du Métabolisme, Hôpital Universitaire de Rennes, Renne, France
| | - Marie-Thérèse Abi-Warde
- Centre de Compétence des Maladies Héréditaires du Métabolisme, Hôpital Universitaire de Strasbourg, Strasbourg, France; Service de Neurologie Pédiatrique, Hôpital Universitaire de Strasbourg, Strasbourg, France
| | - Dries Dobbelaere
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Universitaire Jeanne de Flandre de Lille, MetabERN, Lille, France
| | - Agathe Roubertie
- Centre de Compétence des Maladies Héréditaires du Métabolisme, Hôpital Universitaire de Montpellier, Montpellier, France
| | - Aline Cano
- Centre de Référence des Maladies Héréditaires du Métabolisme, service de Neurologie pédiatrique, Hôpital Universitaire d'enfants La Timone de Marseille, MetabERN, Marseille, France
| | - Alina Arion
- Centre de Compétence des Maladies Héréditaires du Métabolisme, Hôpital Universitaire de Caen, Caen, France
| | - Anna Kaminska
- Service d'Exploration Fonctionnelle, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, G2M, MetabERN, Paris, France
| | - Sabrina Da Costa
- Centre de Référence d'Endocrinologie des Maladies Rares, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, Paris, France
| | - Arnaud Bruneel
- Département de Biochimie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Bichat, Paris, France
| | - Sandrine Vuillaumier-Barrot
- Département de Biochimie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Bichat, Paris, France
| | - Nathalie Boddaert
- Université Paris Cité, Paris, France; Service de Radiologie Pédiatrique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, Paris, France
| | - Tiffany Pascreau
- Laboratoire d'Hématologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Paris, France
| | - Delphine Borgel
- Laboratoire d'Hématologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Paris, France
| | - Manoelle Kossorotoff
- Centre national de référence de l'AVC de l'enfant, Service de Neurologie Pédiatrique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Inserm U1266, Paris, France
| | - Annie Harroche
- Centre de Référence Maladies Hémorragiques constitutionnelles, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, Paris, France
| | - P de Lonlay
- Centre de Référence des Maladies Héréditaires du Métabolisme, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, G2M, MetabERN, Paris, France; Université Paris Cité, Paris, France; INSERM, Institut Necker-Enfants Malades, France.
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3
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Bilgin C, Ibrahim M, Azzam AY, Ghozy S, Elswedy A, Kobeissi H, Sobhi Jabal M, Kadirvel R, Boulouis G, Naggara O, Fiehler J, Psychogios M, Lee S, Wildgruber M, Kemmling A, Al-Mufti F, Kossorotoff M, Sporns PB, Kallmes DF. Mechanical Thrombectomy for Pediatric Large Vessel Occlusions : A Systematic Review and Meta-analysis. Clin Neuroradiol 2023; 33:635-644. [PMID: 36592199 DOI: 10.1007/s00062-022-01246-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/22/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Acute intracranial large vessel occlusion (LVO) is an important cause of morbidity and mortality among children; however, unlike in adults, no clinical trial has investigated the benefit of mechanical thrombectomy (MT) in pediatric LVO. Thus, MT remains an off-label procedure for pediatric stroke. PURPOSE To investigate the efficacy and safety of MT in pediatric LVO. METHODS A systematic literature search was conducted in Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, and Cochrane Central Register of Clinical Trials databases. Studies reporting safety and efficacy outcomes for endovascular treatment of pediatric LVO were included. Data regarding recanalization, functional outcome, symptomatic intracranial hemorrhage (sICH), and mortality were extracted from the included studies. Functional outcome was assessed with the modified Rankin scale (mRS). A fixed or random-effects model was used to calculate pooled event rates and 95% confidence intervals (CI). RESULTS In this study 11 studies comprising 215 patients were included. The successful recanalization rate was 90.3% (95% CI = 85.77-95.11%), and complete recanalization was achieved in 52.7% (95% CI = 45.09-61.62%) of the cases. The favorable (mRS = 0-2) and excellent (mRS = 0-1) outcome rates were 83.3% (95% CI = 73.54-94.50%) and 59.5% (95% CI = 44.24-80.06%), respectively. The overall sICH prevalence was 0.59% (95% CI = 0-3.30%) and mortality rate was 3.2% (95% CI = 0.55-7.38%). CONCLUSION In our meta-analysis, MT demonstrated a promising safety and efficacy profile for pediatric patients, with consistently high efficacy outcomes and low complication rates. Our results support the utilization of MT in pediatric LVOs; however, prospective studies are still needed to further establish the role of pediatric MT as a first-line treatment strategy.
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Affiliation(s)
- Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
| | | | - Ahmed Y Azzam
- Faculty of Medicine, October 6 University, 6th of October City, Egypt
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Adam Elswedy
- Uppsala University Faculty of Medicine, Uppsala, Sweden
| | - Hassan Kobeissi
- College of Medicine, Central Michigan University, Mt. Pleasant, MI, USA
| | | | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Grégoire Boulouis
- Department of Neuroradiology, Université de Tours, CHRU Bretonneau, Tours, France
- French Center for Pediatric Stroke, Pediatric Neurology, APHP-University Hospital Necker-Enfants malades, Paris, France
| | - Olivier Naggara
- Department of Neuroradiology, Université de Paris City, INSERM U1266, GHU Paris, Sainte-Anne Hospital, Paris, France
- French Center for Pediatric Stroke, Pediatric Neurology, APHP-University Hospital Necker-Enfants malades, Paris, France
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- Department of Radiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Sarah Lee
- Stanford Stroke Center, Stanford University, Palo Alto, CA, USA
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - André Kemmling
- Department of Neuroradiology, University Hospital Marburg, Marburg, Germany
| | - Fawaz Al-Mufti
- Department of Neurology, Westchester Medical Center, Valhalla, NY, USA
| | - Manoelle Kossorotoff
- French Center for Pediatric Stroke, Pediatric Neurology, APHP-University Hospital Necker-Enfants malades, Paris, France
| | - Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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4
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Durrleman C, Grevent D, Aubart M, Kossorotoff M, Roux CJ, Kaminska A, Rio M, Barcia G, Boddaert N, Munnich A, Nabbout R, Desguerre I. Clinical and radiological description of 120 pediatric stroke-like episodes. Eur J Neurol 2023; 30:2051-2061. [PMID: 37046408 DOI: 10.1111/ene.15821] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND AND PURPOSE Stroke-like episodes (SLEs) are defined as acute onset of neurological symptoms mimicking a stroke and radiological lesions non-congruent to vascular territory. We aimed to analyze the acute clinical and radiological features of SLEs to determine their pathophysiology. METHODS We performed a monocenter retrospective analysis of 120 SLEs in 60 children over a 20-year period. Inclusion criteria were compatible clinical symptoms and stroke-like lesions on brain magnetic resonance imaging (MRI; performed for all 120 events) with focal hyperintensity on diffusion-weighted imaging in a non-vascular territory. RESULTS Three groups were identified: children with mitochondrial diseases (n = 22) involving mitochondrial DNA mutations (55%) or nuclear DNA mutations (45%); those with other metabolic diseases or epilepsy disorders (n = 22); and those in whom no etiology was found despite extensive investigations (n = 16). Age at first SLE was younger in the group with metabolic or epilepsy disorders (18 months vs. 128 months; p < 0.0001) and an infectious trigger was more frequent (69% vs. 20%; p = 0.0001). Seizures occurred in 75% of episodes, revealing 50% episodes of SLEs and mainly leading to status epilepticus (90%). Of the 120 MRI scans confirming the diagnosis, 28 were performed within a short and strict 48-h period and were further analyzed to better understand the underlying mechanisms. The scans showed primary cortical hyperintensity (n = 28/28) with decreased apparent diffusion coefficient in 52% of cases. Systematic hyperperfusion was found on spin labeling sequences when available (n = 18/18). CONCLUSION Clinical and radiological results support the existence of a vicious circle based on two main mechanisms: energy deficit and neuronal hyperexcitability at the origin of SLE.
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Affiliation(s)
- Chloe Durrleman
- Pediatric Neurology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - David Grevent
- Pediatric Imaging Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
- Lumiere Platform, Université Paris Cité, Paris, France
| | - Melodie Aubart
- Pediatric Neurology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Charles-Joris Roux
- Pediatric Imaging Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Anna Kaminska
- Neurophysiology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Marlene Rio
- Genetic Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Giulia Barcia
- Genetic Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Nathalie Boddaert
- Pediatric Imaging Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
- Lumiere Platform, Université Paris Cité, Paris, France
| | - Arnold Munnich
- Genetic Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Rima Nabbout
- Pediatric Neurology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Isabelle Desguerre
- Pediatric Neurology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
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5
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Grapin M, Mirand A, Pinquier D, Basset A, Bendavid M, Bisseux M, Jeannoël M, Kireche B, Kossorotoff M, L'Honneur AS, Robin L, Ville Y, Renolleau S, Lemee V, Jarreau PH, Desguerre I, Lacaille F, Leruez-Ville M, Guillaume C, Henquell C, Lapillonne A, Schuffenecker I, Aubart M. Severe and fatal neonatal infections linked to a new variant of echovirus 11, France, July 2022 to April 2023. Euro Surveill 2023; 28:2300253. [PMID: 37261730 PMCID: PMC10236930 DOI: 10.2807/1560-7917.es.2023.28.22.2300253] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 05/17/2023] [Accepted: 06/01/2023] [Indexed: 06/02/2023] Open
Abstract
We report nine severe neonatal infections caused by a new variant of echovirus 11. All were male, eight were twins. At illness onset, they were 3-5 days-old and had severe sepsis and liver failure. This new variant, detected in France since April 2022, is still circulating and has caused more fatal neonatal enterovirus infections in 2022 and 2023 (8/496; 1.6%, seven associated with echovirus 11) compared with 2016 to 2021 (7/1,774; 0.4%). National and international alerts are warranted.
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Affiliation(s)
- Mathilde Grapin
- Paediatric Intensive Care Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
- These authors contributed equally to the work and share the first authorship
| | - Audrey Mirand
- These authors contributed equally to the work and share the first authorship
- Clermont-Ferrand University Hospital, 3IHP - Infection Inflammation et Interaction Hôtes Pathogènes Virology Department, French Reference Centre for enteroviruses and parechovirus, coordination laboratory, Clermont-Ferrand, France
- Auvergne University, LMGE UMR CNRS 6023, Team Epidemiology and pathophysiology of enterovirus Infection, Clermont-Ferrand, France
| | - Didier Pinquier
- Neonatal and Paediatric Intensive Care Units, Rouen University Hospital, Rouen, France
| | - Aurélie Basset
- Neonatal Intensive Care Unit, Cochin-Port Royal University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Matthieu Bendavid
- Paediatric Intensive Care Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Maxime Bisseux
- Clermont-Ferrand University Hospital, 3IHP - Infection Inflammation et Interaction Hôtes Pathogènes Virology Department, French Reference Centre for enteroviruses and parechovirus, coordination laboratory, Clermont-Ferrand, France
- Auvergne University, LMGE UMR CNRS 6023, Team Epidemiology and pathophysiology of enterovirus Infection, Clermont-Ferrand, France
| | - Marion Jeannoël
- Hospices Civils de Lyon, Virology Department, French Reference Centre for enteroviruses and parechoviruses, associated laboratory, Lyon, France
| | - Bérengère Kireche
- Neonatal and Paediatric Intensive Care Units, Orléans Regional Hospital, Orléans, France
| | - Manoelle Kossorotoff
- Paediatric Neurology Department, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Anne-Sophie L'Honneur
- Virology laboratory, Cochin University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Lila Robin
- Neonatal and Paediatric Intensive Care Units, Orléans Regional Hospital, Orléans, France
| | - Yves Ville
- Obstetrics and Fetal Medicine Department, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Sylvain Renolleau
- Paediatric Intensive Care Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Véronique Lemee
- Virology Department, Rouen University Hospital, Rouen, France
| | - Pierre-Henri Jarreau
- Neonatal Intensive Care Unit, Cochin-Port Royal University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Isabelle Desguerre
- Paediatric Neurology Department, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Florence Lacaille
- Pediatric Gastroenterology-Hepatology-Nutrition Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France
| | - Marianne Leruez-Ville
- Clinical Microbiology laboratory and Virology unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | | | - Cécile Henquell
- Clermont-Ferrand University Hospital, 3IHP - Infection Inflammation et Interaction Hôtes Pathogènes Virology Department, French Reference Centre for enteroviruses and parechovirus, coordination laboratory, Clermont-Ferrand, France
- Auvergne University, LMGE UMR CNRS 6023, Team Epidemiology and pathophysiology of enterovirus Infection, Clermont-Ferrand, France
| | - Alexandre Lapillonne
- Neonatal Intensive Care Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Isabelle Schuffenecker
- These authors contributed equally to the work and share the last authorship
- Hospices Civils de Lyon, Virology Department, French Reference Centre for enteroviruses and parechoviruses, associated laboratory, Lyon, France
| | - Mélodie Aubart
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Imagine Institute, Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
- These authors contributed equally to the work and share the last authorship
- Paediatric Neurology Department, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
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6
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Goetz V, Yang DD, Abid H, Roux CJ, Levy R, Kossorotoff M, Desguerre I, Angoulvant F, Aubart M. Neurological features related to influenza virus in the pediatric population: a 3-year monocentric retrospective study. Eur J Pediatr 2023:10.1007/s00431-023-04901-9. [PMID: 36947244 DOI: 10.1007/s00431-023-04901-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/23/2023]
Abstract
Influenza virus is generally characterized by fever, myalgia, and respiratory symptoms. Neurological entities have already been described, such as acute necrotizing encephalitis (ANE). We aimed to highlight the non-exceptional nature and explore the clinical spectrum and evolution of neurological features related to influenza virus in children. This monocentric observational study included patients under 18 years old, positive for influenza virus, between January 2017 and April 2019 in a pediatric university hospital. Patients were classified into two groups: those with or without a previous significant neurological or metabolic disorder. Two hundred eighty-nine children were identified with influenza infection. Thirty seven had a neurological manifestation: 14 patients who had previous significant neurological or metabolic disorder and 23 patients with no medical history. We identified several clinical patterns: 22 patients had seizures, 7 behavior disorders, 5 disturbances of consciousness, and 3 motor deficits. Four were diagnosed with a known influenza-associated neurological syndrome: 1 ANE, 1 cytotoxic lesion of the corpus callosum, 1 hemiconvulsion-hemiplegia-epilepsia syndrome, and 1 recurrent encephalitis in the context of a RANBP2 mutation. The neurological outcome was favorable in most cases. None of the patients with previous significant disorder retained sequalae or had a recurrence. Two patients had a fatal outcome, and both had a predisposing disorder. CONCLUSION Various neurological manifestations can be associated with influenza virus. Certain entities led to a poor prognosis, but in most cases, symptoms improved within a few days. The severity of the neurological manifestations correlated with previous neurological or metabolic disorders. WHAT IS KNOWN • Influenza viruses are well known pathogens with a seasonal epidemic evolution, particularly affecting children. These viruses cause acute fever with respiratory symptoms, associated with myalgia and headaches. Neurological presentation in influenza-virus infection is a well-established possibility as influenza virus is considered to be responsible for 27 to 36% of childhood encephalitis. Some specific and severe entity as acute necrotizing encephalitis, cytotoxic lesion of the corpus callosum, or Hemiconvulsion-hemiplegia-epilepsy syndrome are well described. WHAT IS NEW • In a French monocentric cohort of 37 children with influenza-related neurologic manifestations, the majority of these manifestations, including seizure, drowsiness, motor deficiency, hallucination… are self limiting and do not lead to after-effects. In rare cases (4/37), they may reveal severe encephalitis requiring rapid and appropriate treatment. Otherwise, comparison of a group of 14 children with underlying neurological or metabolic disorder with a group of 23 children free of any significant disorder show that the severity of the neurological manifestations was largely related to previous neurological or metabolic disorders highlighting the importance of vaccination in this population.
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Affiliation(s)
- Violette Goetz
- Pediatric Neurology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France
| | - David-Dawei Yang
- Pediatric Emergency Department, Necker-Enfants alades Hospital, APHP, Université de Paris Citém, Paris, France
| | - Hanene Abid
- Virology Laboratory, Necker-Enfants alades Hospital, APHP, Université de Paris Citém, Paris, France
| | - Charles-Joris Roux
- Paediatric Radiology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France
| | - Raphael Levy
- Paediatric Radiology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France
| | - Isabelle Desguerre
- Pediatric Neurology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France
| | - François Angoulvant
- Pediatric Emergency Department, Necker-Enfants alades Hospital, APHP, Université de Paris Citém, Paris, France.
- INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France.
| | - Mélodie Aubart
- Pediatric Neurology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France.
- INSERM U1163 Institut HU Imagine, Laboratory of Human Genetics of Infectious Disease, Paris, France.
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7
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El Hajj R, Stanzelova A, de Marcellus C, Kossorotoff M, Remangeon F, Roux CJ, Touzé R, Toubiana J, Benaboud S, Oualha M, Moulin F, Collignon C. Severe atypical Lemierre syndrome caused by methicillin-sensitive Staphylococcus aureus: Two pediatric case reports. Arch Pediatr 2023:S0929-693X(23)00037-4. [PMID: 36990936 DOI: 10.1016/j.arcped.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/12/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Lemierre syndrome is typically associated with ear, nose, and throat (ENT) infections caused by Fusobacterium necrophorum. Since 2002, cases of atypical Lemierre-like syndrome secondary to Staphylococcus aureus have been reported. CASES We report two pediatric cases of atypical Lemierre syndrome with a similar presentation: exophthalmia, absence of pharyngitis, metastatic lung infection, and intracranial venous sinus thrombosis. Both patients had a favorable outcome following treatment with antibiotics, anticoagulation, and corticosteroids. CONCLUSION Regular therapeutic monitoring of antibiotic levels helped to optimize antimicrobial treatment in both cases.
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Affiliation(s)
- R El Hajj
- Pediatrics, André Mignot Hospital, Versailles, France
| | - A Stanzelova
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants Malades University Hospital, Paris, France; Université de Paris Cité, Paris, France
| | - C de Marcellus
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - M Kossorotoff
- Pediatric Neurology, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - F Remangeon
- Université de Paris Cité, Paris, France; Pediatric Otorhinolaryngology Department, APHP, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - C-J Roux
- Pediatric Radiology, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - R Touzé
- Ophthalmology Department and Reference Center for Rare Ophthalmological Diseases (OPHTARA), AP-HP, University Hospital Necker-Enfants Malades, Paris, France; Université de Paris Cité, Paris, France
| | - J Toubiana
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants Malades University Hospital, Paris, France; Université de Paris Cité, Paris, France
| | - S Benaboud
- Pharmacology Department, Cochin Hospital, AP-HP Centre-Université de Paris, Paris, France
| | - M Oualha
- Université de Paris Cité, Paris, France; Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - F Moulin
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - C Collignon
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France.
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8
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Narcy L, Durand S, Grimaud M, Leboucq N, Grevent D, Cambonie G, Couloigner V, Rivier F, Meyer P, Kossorotoff M. Cerebral sinovenous thrombosis associated with head/neck infection in children: Clues for improved management. Dev Med Child Neurol 2023; 65:215-222. [PMID: 35765978 DOI: 10.1111/dmcn.15331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/11/2022] [Accepted: 06/02/2022] [Indexed: 01/06/2023]
Abstract
AIM To compare paediatric patients with cerebral sinovenous thrombosis (CSVT) with and without head/neck infection to improve management of the condition. METHOD We conducted a bicentric retrospective study of consecutive children (neonates excluded) with radiologically confirmed CSVT, comparing children with a concurrent head/neck infection and children with other causes. RESULTS A total of 84 consecutive patients (46 males and 38 females) with a median age of 4 years 6 months (range 3 months-17 years 5 months) were included. Associated head/neck infection was identified in 65.4% of cases and represented the main identified CSVT aetiology. Children in the head/neck infection group displayed a milder clinical presentation and less extensive CSVT. Median time to complete recanalization was significantly shorter in this group (89 days [interquartile range 35-101] vs 112.5 days [interquartile range 83-177], p = 0.005). These findings were even more pronounced in the subgroup of patients with otogenic infection and no neurological sign. INTERPRETATION As CSVT in the setting of an otogenic infection and no neurological sign seems to represent a milder condition with a shorter course, these results suggest adapting current recommendations: consider earlier control imaging in paediatric otogenic CSVT, and shorter anticoagulant treatment if recanalization is obtained. WHAT THIS PAPER ADDS Children with cerebral sinovenous thrombosis related to head/neck infections have a milder clinical presentation. They also have a shorter recanalization time, especially if there is otogenic infection without neurological symptoms.
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Affiliation(s)
- Lucie Narcy
- Paediatric Neurology Department, APHP, University Hospital Necker-Enfants Malades, Paris, France.,Sorbonne Université, Paris, France
| | - Sabine Durand
- Paediatric and Neonatal Intensive Care Unit, CHU Arnaud de Villeneuve, Montpellier, France
| | - Marion Grimaud
- Paediatric Intensive Care Unit, APHP, University Hospital Necker-Enfants Malades, Paris, France
| | - Nicolas Leboucq
- Paediatric Imaging Department, CHU Arnaud de Villeneuve, Montpellier, France
| | - David Grevent
- Paediatric Imaging Department, APHP, University Hospital Necker-Enfants Malades, Paris, France
| | - Gilles Cambonie
- Paediatric and Neonatal Intensive Care Unit, CHU Arnaud de Villeneuve, Montpellier, France
| | - Vincent Couloigner
- Paediatric Otorhinolaryngology Department, APHP, University Hospital Necker-Enfants Malades, Paris, France
| | - François Rivier
- Paediatric Neurology Department, Phymedexp, Montpellier University, Inserm, CNRS, University Hospital Montpellier, Montpellier, France
| | - Pierre Meyer
- Paediatric Neurology Department, Phymedexp, Montpellier University, Inserm, CNRS, University Hospital Montpellier, Montpellier, France
| | - Manoelle Kossorotoff
- Paediatric Neurology Department, APHP, University Hospital Necker-Enfants Malades, Paris, France.,French Centre for Paediatric Stroke, APHP, University Hospital Necker-Enfants Malades, Paris, France
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9
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Roth H, Ränsch R, Kossorotoff M, Chahine A, Tirel O, Brossier D, Wroblewski I, Orliaguet G, Chabrier S, Mortamet G. Post traumatic cerebral sinovenous thrombosis in children: A retrospective and multicenter study. Eur J Paediatr Neurol 2023; 43:12-15. [PMID: 36746017 DOI: 10.1016/j.ejpn.2023.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 12/26/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Abstract
CONTEXT Cerebral sinovenous thrombosis (CSVT) is a rare but life-threatening condition in the pediatric population and there is no pediatric guidelines regarding anticoagulation for post traumatic CSVT. OBJECTIVE This study aims to describe a cohort of children with post traumatic CSVT and the use of anticoagulant therapy in this population. METHODS A multicenter retrospective study. Patients admitted with post traumatic CSVT in the six participating Pediatric Intensive Care Unit were included. RESULTS Overall, 29 patients (median age 8.2 years [IQR 4.8-14.6], n = 22 (76%) males) were included in the study (Table 1). CSVT was observed within the first 24 h after admission for a half of the patients (n = 14, 50%). Anticoagulation was initiated in 18 patients (62%). No patient received thrombolytic therapy or endovascular treatment. The presence of epidural hematoma was associated with the absence of anticoagulation (n = 0 versus n = 10, p = 0.003). One patient (3%) died of extracranial injury (not related with adverse event of anticoagulation) and in survivors, median Pediatric Overall Performance Category Outcome (POPC) score at discharge from PICU was 2 [IQR 2-4] (i.e., mild disability). Regarding the outcomes of patients, we found no association according to the anticoagulation status (p = 1). Overall, 23 patients (79%) had a follow-up cerebral imaging with a median delay of 42 days [IQR 6-63] after admission. CSVT was still seen in 9 patients (31%). We found no difference regarding the persistence of CSVT between patients according to the anticoagulation status (p = 0.36). The median duration of anticoagulant treatment was 58 days [IQR 44-91] and one patient (3%) experienced adverse event related to anticoagulation. CONCLUSION There were minimal adverse events in patients with post traumatic CSVT treated with therapeutic anticoagulation. However, the effect of anticoagulation on outcomes needs to be confirmed in further studies.
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Affiliation(s)
- Helena Roth
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, 38000, Grenoble, France.
| | - Roman Ränsch
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, 38000, Grenoble, France.
| | - Manoelle Kossorotoff
- French Centre for Paediatric Stroke, Pediatric Neurology Department, Necker-Enfants Maladies University Hospital, Assistance Publique Hôpitaux de Paris, 75015, Paris, France.
| | - Adela Chahine
- Pediatric Intensive Care Unit, Toulouse University Hospital, 31000, Toulouse, France.
| | - Olivier Tirel
- Pediatric Intensive Care Unit, Rennes University Hospital, 35000, Rennes, France.
| | - David Brossier
- Pediatric Intensive Care Unit, Caen University Hospital, 14000, Caen, France; Université Caen Normandie, Medical School, Caen, F-14000, France.
| | - Isabelle Wroblewski
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, 38000, Grenoble, France.
| | - Gilles Orliaguet
- Department of Pediatric Anaesthesia and Intensive Care, Necker University Hospital, AP-HP, Centre - Université Paris Cité, France; EA 7323 Université de Paris "Pharmacologie et évaluation des Thérapeutiques Chez L'enfant et La Femme Enceinte", Paris, France.
| | - Stéphane Chabrier
- French Centre for Paediatric Stroke, Pediatric Physical and Rehabilitation Medicine Department, Saint-Etienne University Hospital, 42000, Saint-Etienne, France.
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, 38000, Grenoble, France; Univ. Grenoble-Alpes, 38000, Grenoble, France.
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10
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Eisermann M, Fillon L, Saitovitch A, Boisgontier J, Vinçon-Leite A, Dangouloff-Ros V, Blauwblomme T, Bourgeois M, Dangles MT, Coste-Zeitoun D, Vignolo-Diard P, Aubart M, Kossorotoff M, Hully M, Losito E, Chemaly N, Zilbovicius M, Desguerre I, Nabbout R, Boddaert N, Kaminska A. Periodic electroencephalographic discharges and epileptic spasms involve cortico-striatal-thalamic loops on Arterial Spin Labeling Magnetic Resonance Imaging. Brain Commun 2022; 4:fcac250. [PMID: 36324869 PMCID: PMC9598541 DOI: 10.1093/braincomms/fcac250] [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: 11/13/2021] [Revised: 06/15/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022] Open
Abstract
Periodic discharges are a rare peculiar electroencephalogram pattern, occasionally associated with motor or other clinical manifestations, usually observed in critically ill patients. Their underlying pathophysiology remains poorly understood. Epileptic spasms in clusters and periodic discharges with motor manifestations share similar electroencephalogram pattern and some aetiologies of unfavourable prognosis such as subacute sclerosing panencephalitis or herpes encephalitis. Arterial spin labelling magnetic resonance imaging identifies localizing ictal and inter-ictal changes in neurovascular coupling, therefore assumed able to reveal concerned cerebral structures. Here, we retrospectively analysed ictal and inter-ictal arterial spin labelling magnetic resonance imaging in patients aged 6 months to 15 years (median 3 years 4 months) with periodic discharges including epileptic spasms, and compared these findings with those of patients with drug-resistant focal epilepsy who never presented periodic discharges nor epileptic spasms as well as to those of age-matched healthy controls. Ictal electroencephalogram was recorded either simultaneously with arterial spin labelling magnetic resonance imaging or during the close time lapse of patients' periodic discharges, whereas inter-ictal examinations were performed during the patients' active epilepsy but without seizures during the arterial spin labelling magnetic resonance imaging. Ictal arterial spin labelling magnetic resonance imaging was acquired in five patients with periodic discharges [subacute sclerosing panencephalitis (1), stroke-like events (3), West syndrome with cortical malformation (1), two of them also had inter-ictal arterial spin labelling magnetic resonance imaging]. Inter-ictal group included patients with drug-resistant epileptic spasms of various aetiologies (14) and structural drug-resistant focal epilepsy (8). Cortex, striatum and thalamus were segmented and divided in six functional subregions: prefrontal, motor (rostral, caudal), parietal, occipital and temporal. Rest cerebral blood flow values, absolute and relative to whole brain, were compared with those of age-matched controls for each subregion. Main findings were diffuse striatal as well as cortical motor cerebral blood flow increase during ictal examinations in generalized periodic discharges with motor manifestations (subacute sclerosing panencephalitis) and focal cerebral blood flow increase in corresponding cortical-striatal-thalamic subdivisions in lateralized periodic discharges with or without motor manifestations (stroke-like events and asymmetrical epileptic spasms) with straight topographical correlation with the electroencephalogram focus. For inter-ictal examinations, patients with epileptic spasms disclosed cerebral blood flow changes in corresponding cortical-striatal-thalamic subdivisions (absolute-cerebral blood flow decrease and relative-cerebral blood flow increase), more frequently when compared with the group of drug-resistant focal epilepsies, and not related to Vigabatrin treatment. Our results suggest that corresponding cortical-striatal-thalamic circuits are involved in periodic discharges with and without motor manifestations, including epileptic spasms, opening new insights in their pathophysiology and new therapeutical perspectives. Based on these findings, we propose a model for the generation of periodic discharges and of epileptic spasms combining existing pathophysiological models of cortical-striatal-thalamic network dynamics.
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Affiliation(s)
- Monika Eisermann
- Correspondence to: Monika Eisermann Clinical Neurophysiology, Hôpital Necker Enfants Malades AP-HP, Paris Université, 149 rue de Sèvres75015 Paris, France E-mail:
| | | | - Ana Saitovitch
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, F-75015, Paris, France
- Université de Paris, Institut Imagine INSERM U1163, F-75015, France
- INSERM U1299 Trajectoires développementales & psychiatrie, Paris, France
| | - Jennifer Boisgontier
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, F-75015, Paris, France
- Université de Paris, Institut Imagine INSERM U1163, F-75015, France
- INSERM U1299 Trajectoires développementales & psychiatrie, Paris, France
| | - Alice Vinçon-Leite
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, F-75015, Paris, France
- Université de Paris, Institut Imagine INSERM U1163, F-75015, France
- INSERM U1299 Trajectoires développementales & psychiatrie, Paris, France
| | - Volodia Dangouloff-Ros
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, F-75015, Paris, France
- Université de Paris, Institut Imagine INSERM U1163, F-75015, France
- INSERM U1299 Trajectoires développementales & psychiatrie, Paris, France
| | - Thomas Blauwblomme
- Pediatric Neurosurgery, Hôpital Necker, APHP, Paris France, Université de Paris, Paris, France, INSERM U1163, IHU Imagine, Paris, France
| | - Marie Bourgeois
- Pediatric Neurosurgery, Hôpital Necker, APHP, Paris France, Université de Paris, Paris, France, INSERM U1163, IHU Imagine, Paris, France
| | - Marie-Thérèse Dangles
- Clinical Neurophysiology, Hôpital Necker Enfants Malades, AP-HP, Paris Université, Paris, France
| | - Delphine Coste-Zeitoun
- Clinical Neurophysiology, Hôpital Necker Enfants Malades, AP-HP, Paris Université, Paris, France
| | - Patricia Vignolo-Diard
- Clinical Neurophysiology, Hôpital Necker Enfants Malades, AP-HP, Paris Université, Paris, France
| | - Mélodie Aubart
- Pediatric Neurology Department, Hôpital Necker Enfants Malades, AP-HP, INSERM U1163, Paris Université, Institut Imagine, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, Necker Enfants Malades Hospital, AP-HP, Paris Université, Paris, France
| | - Marie Hully
- Pediatric Neurology Department, Necker Enfants Malades Hospital, AP-HP, Paris Université, Paris, France
| | - Emma Losito
- Clinical Neurophysiology, Hôpital Necker Enfants Malades, AP-HP, Paris Université, Paris, France
| | - Nicole Chemaly
- Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Member of EPICARE Network, Institute Imagine INSERM 1163, Université de Paris, Paris, France
| | - Monica Zilbovicius
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, F-75015, Paris, France
- Université de Paris, Institut Imagine INSERM U1163, F-75015, France
- INSERM U1299 Trajectoires développementales & psychiatrie, Paris, France
| | - Isabelle Desguerre
- Pediatric Neurology Department, Hôpital Necker Enfants Malades, AP-HP, INSERM U1163, Paris Université, Institut Imagine, Paris, France
| | - Rima Nabbout
- Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Member of EPICARE Network, Institute Imagine INSERM 1163, Université de Paris, Paris, France
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11
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Hak JF, Boulouis G, Kerleroux B, Benichi S, Stricker S, Gariel F, Garzelli L, Meyer P, Kossorotoff M, Boddaert N, Girard N, Vidal V, Dangouloff Ros V, Blauwblomme T, Naggara O. Noninvasive Follow-up Imaging of Ruptured Pediatric Brain AVMs Using Arterial Spin-Labeling. AJNR Am J Neuroradiol 2022; 43:1363-1368. [PMID: 36007951 PMCID: PMC9451641 DOI: 10.3174/ajnr.a7612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Brain AVMs represent the main etiology of pediatric intracranial hemorrhage. Noninvasive imaging techniques to monitor the treatment effect of brain AVMs remain an unmet need. In a large cohort of pediatric ruptured brain AVMs, we aimed to investigate the role of arterial spin-labeling for the longitudinal follow-up during treatment and after complete obliteration by analyzing CBF variations across treatment sessions. MATERIALS AND METHODS Consecutive patients with ruptured brain AVMs referred to a pediatric quaternary care center were prospectively included in a registry that was retrospectively queried for children treated between 2011 and 2019 with unimodal or multimodal treatment (surgery, radiosurgery, embolization). We included children who underwent an arterial spin-labeling sequence before and after treatment and a follow-up DSA. CBF variations were analyzed in univariable analyses. RESULTS Fifty-nine children with 105 distinct treatment sessions were included. The median CBF variation after treatment was -43 mL/100 mg/min (interquartile range, -102-5.5), significantly lower after complete nidal surgical resection. Following radiosurgery, patients who were healed on the last DSA follow-up demonstrated a greater CBF decrease on intercurrent MR imaging, compared with patients with a persisting shunt at last follow-up (mean, -62 [SD, 61] mL/100 mg/min versus -17 [SD, 40.1] mL/100 mg/min; P = .02). In children with obliterated AVMs, recurrences occurred in 12% and resulted in a constant increase in CBF (mean, +89 [SD, 77] mL/100 mg/min). CONCLUSIONS Our results contribute data on the role of noninvasive arterial spin-labeling monitoring of the response to treatment or follow-up after obliteration of pediatric AVMs. Future research may help to better delineate how arterial spin-labeling can assist in decisions regarding the optimal timing for DSA.
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Affiliation(s)
- J F Hak
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
| | - G Boulouis
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
| | - B Kerleroux
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
| | - S Benichi
- Department of Pediatric Neurosurgery (S.B., S.S., T.B.), Institut Imagine, L'Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Assistance Publique-Hôpitaux de Paris, Necker Hospital-Sick Children, Paris, France
| | - S Stricker
- Department of Pediatric Neurosurgery (S.B., S.S., T.B.), Institut Imagine, L'Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Assistance Publique-Hôpitaux de Paris, Necker Hospital-Sick Children, Paris, France
| | - F Gariel
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (F.G.), University Hospital of Bordeaux, Bordeaux, France
| | - L Garzelli
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
| | - P Meyer
- Pediatric Neurointensive Care Unit (P.M.)
| | - M Kossorotoff
- Department of Pediatric Neurology (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire, Necker Hospital-Sick Children, Paris, France
- INSERM U894, French Center for Pediatric Stroke (M.K., T.B., O.N.), L'Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - N Boddaert
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Université de Paris (N.B., V.D.R.), L'Institut National de la Santé et de la Recherche Médicale, ERL, Paris, France
- Institut Imagine (N.B., V.D.R.),Université de Paris,Unité Mixte de Recherche 1163, Paris, France
| | - N Girard
- Departments of Neuroradiology (N.G.)
| | - V Vidal
- Radiology (V.V.), University Hospital La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - V Dangouloff Ros
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Université de Paris (N.B., V.D.R.), L'Institut National de la Santé et de la Recherche Médicale, ERL, Paris, France
- Institut Imagine (N.B., V.D.R.),Université de Paris,Unité Mixte de Recherche 1163, Paris, France
| | - T Blauwblomme
- Department of Pediatric Neurosurgery (S.B., S.S., T.B.), Institut Imagine, L'Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Assistance Publique-Hôpitaux de Paris, Necker Hospital-Sick Children, Paris, France
- INSERM U894, French Center for Pediatric Stroke (M.K., T.B., O.N.), L'Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - O Naggara
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
- INSERM U894, French Center for Pediatric Stroke (M.K., T.B., O.N.), L'Institut National de la Santé et de la Recherche Médicale, Paris, France
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12
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Rossi M, Durrleman C, Hayat M, Roux CJ, Kossorotoff M, Gitiaux C, Mazuet C, Moulin F, Collignon C. Infant botulism: Report of a misleading case and important key messages. Arch Pediatr 2022; 29:395-397. [DOI: 10.1016/j.arcped.2022.05.012] [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: 12/30/2021] [Revised: 03/28/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
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13
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Martin GC, Brousse V, Connes P, Grevent D, Kossorotoff M, Da Costa L, Bourdeau H, Charlot K, Boutonnat-Faucher B, Allali S, De Montalembert M, Bremond-Gignac D, Vidal PP, Robert MP. Retinal atrophy and markers of systemic and cerebrovascular severity in homozygous sickle cell disease. Eur J Ophthalmol 2022; 32:3258-3266. [DOI: 10.1177/11206721221090794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction While paramacular retinal atrophy (PRA) is known to be found in 48% of eyes of adults and 42% of eyes of children with homozygous SCD (SS-SCD), the aim of this study is to assess the association between PRA and red blood cell (RBC) deformability, hematological markers and brain imaging abnormalities in SS-SCD. Methods This study is a subset of DREAM2, a prospective observational study performed between August 2015 and August 2016. Children (5–17 years) with SS-SCD and no history of large vessel vasculopathy, were included. Ophthalmological characteristics including visual acuity, fundus examination, OCT of central and temporal retina (with several retinal thickness measurements) were explored in relation with RBC deformability (ektacytometry), hematological and biochemical (hemolysis parameters), and neurological (cerebral oxygenation estimated by Near Infrared Spectroscopy, brain magnetic resonance imaging) investigations. Results 17 children (5 boys; mean age: 13 years) with complete ophthalmological investigations were included in the analysis; 8 exhibited PRA. RBC deformability was found to be significantly lower in children with PRA for measurements made at 1.69 Pa (0.16 a.u ± 0.02 vs 0.21 a.u ± 0.03, p = 0.02) and above, as well as cerebral oxygenation (59.25% ± 9.9 vs 71.53% ± 4.9, p = 0.02). A significant positive correlation was found between temporal retinal thickness and hemoglobin level (ρ = 0.65, p = 0.007), hematocrit (ρ = 0.53, p = 0.04) and RBC deformability at 3 Pa (ρ = 0.75, p = 0.005) and above. Conclusions These results suggest that PRA could be an early marker of systemic severity and cerebral oxygenation in SCD. Whether it could help predicting cerebral vasculopathy requires further investigations.
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Affiliation(s)
- Gilles C. Martin
- Ophthalmology Department and Rare Ophthalmological Diseases Reference Centre (OPHTARA), Necker-Enfants Malades University Hospital, APHP, Paris, France
- Borelli Centre, CNRS-SSA-ENS Paris Saclay-Paris University, Paris, France
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Valentine Brousse
- General Pediatrics Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
- Institut National de la transfusion sanguine, UMR_S1134, Inserm, Paris, France
- LABEX GR-Ex, France
| | - Philippe Connes
- Faculté de Médecine Rockefeller, Laboratoire inter-universitaire de Biologie de la Motricité (LIBM EA7424), Equipe « Biologie Vasculaire et du Globule Rouge », Université Claude Bernard Lyon 1, Lyon, France
| | - David Grevent
- Radiology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Lydie Da Costa
- Institut National de la transfusion sanguine, UMR_S1134, Inserm, Paris, France
- LABEX GR-Ex, France
- AP-HP, Hôpital Robert Debré, service d’Hématologie Biologique, Paris, France
| | - Hélène Bourdeau
- Pediatric Neurology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Keyne Charlot
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels Institut de Recherche Biomédicale des Armées, France
| | | | - Slimane Allali
- General Pediatrics Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
- LABEX GR-Ex, France
| | - Mariane De Montalembert
- General Pediatrics Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
- LABEX GR-Ex, France
| | - Dominique Bremond-Gignac
- Ophthalmology Department and Rare Ophthalmological Diseases Reference Centre (OPHTARA), Necker-Enfants Malades University Hospital, APHP, Paris, France
- INSERM UMRS 1138, Team 17, Centre de Recherche des Cordeliers, Sorbonne Paris University, France
| | - Pierre-Paul Vidal
- Borelli Centre, CNRS-SSA-ENS Paris Saclay-Paris University, Paris, France
| | - Matthieu P. Robert
- Ophthalmology Department and Rare Ophthalmological Diseases Reference Centre (OPHTARA), Necker-Enfants Malades University Hospital, APHP, Paris, France
- Borelli Centre, CNRS-SSA-ENS Paris Saclay-Paris University, Paris, France
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14
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Kerleroux B, Husson B, Boulouis G, Chabrier S, Ozanne A, Eugene F, Bourcier R, Raynaud N, Hak JF, Naggara O, Kossorotoff M, KidClot group OBOT. Recanalization treatment for pediatric acute ischemic stroke: a nationwide french registry. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.01.056] [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] [Indexed: 10/18/2022]
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15
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Charbit-Henrion F, Goguyer-Deschaumes R, Borensztajn K, Mirande M, Berthelet J, Rodrigues-Lima F, Khiat A, Frémond ML, Bader-Meunier B, Rodari MM, Seabra L, Rice GI, Legendre M, Drummond D, Berteloot L, Roux CJ, Boddaert N, Drabent P, Molina TJ, Lacaille F, Kossorotoff M, Cerf-Bensussan N, Parlato M, Hadchouel A. Systemic inflammatory syndrome in children with FARSA deficiency. Clin Genet 2022; 101:552-558. [PMID: 35132614 PMCID: PMC9303323 DOI: 10.1111/cge.14120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/13/2022] [Accepted: 01/30/2022] [Indexed: 11/27/2022]
Abstract
Variants in aminoacyl-tRNA synthetases (ARSs) genes are associated to a broad spectrum of human inherited diseases. Patients with defective PheRS, encoded by FARSA and FARSB, display brain abnormalities, interstitial lung disease and facial dysmorphism. We investigated four children from two unrelated consanguineous families carrying two missense homozygous variants in FARSA with significantly reduced PheRS-mediated aminoacylation activity. In addition to the core ARS-phenotype, all patients showed an inflammatory profile associated with autoimmunity and interferon score, a clinical feature not ascribed to PheRS-deficient patients to date. JAK inhibition improved lung disease in one patient. Our findings expand the genetic and clinical spectrum of FARSA-related disease. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Fabienne Charbit-Henrion
- Université de Paris, Imagine Institute, Laboratory of Intestinal Immunity, Inserm, UMR1163, Paris, France
| | - Roman Goguyer-Deschaumes
- Université de Paris, Imagine Institute, Laboratory of Intestinal Immunity, Inserm, UMR1163, Paris, France
| | - Keren Borensztajn
- Sorbonne Université, Inserm, Childhood genetic disorders, Hôpital Trousseau, Paris, France
| | - Marc Mirande
- Laboratoire de Biologie et Pharmacologie Appliquée, UMR8113 CNRS, ENS Paris-Saclay, Université Paris-Saclay, Gif-sur-Yvette, France
| | | | - Fernando Rodrigues-Lima
- Université de Paris, Unité de Biologie Fonctionnelle et Adaptative, CNRS UMR 8251, Paris, France
| | - Anis Khiat
- Université de Paris, Imagine Institute, Laboratory of Intestinal Immunity, Inserm, UMR1163, Paris, France
| | - Marie-Louise Frémond
- Université de Paris, Imagine Institute, Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France
| | - Brigitte Bader-Meunier
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service d'immuno-hématologie pédiatrique, Paris, France
| | - Marco M Rodari
- Université de Paris, Imagine Institute, Laboratory of Intestinal Immunity, Inserm, UMR1163, Paris, France
| | - Luis Seabra
- Université de Paris, Imagine Institute, Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France
| | - Gillian I Rice
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Marie Legendre
- Laboratoire de Biologie et Pharmacologie Appliquée, UMR8113 CNRS, ENS Paris-Saclay, Université Paris-Saclay, Gif-sur-Yvette, France
| | - David Drummond
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Pneumologie Pédiatrique, Paris, France
| | - Laureline Berteloot
- APHP, Hôpital Universitaire Necker-Enfants Malades, Service d'imagerie pédiatrique Paris, France
| | - Charles-Joris Roux
- APHP, Hôpital Universitaire Necker-Enfants Malades, Service d'imagerie pédiatrique Paris, France
| | - Nathalie Boddaert
- APHP, Hôpital Universitaire Necker-Enfants Malades, Service d'imagerie pédiatrique Paris, France
| | - Philippe Drabent
- APHP, Hôpital Universitaire Necker-Enfants Malades, Service d'anatomopathologie, Paris, France
| | - Thierry Jo Molina
- APHP, Hôpital Universitaire Necker-Enfants Malades, Service d'anatomopathologie, Paris, France
| | - Florence Lacaille
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de gastroentérologie et hépatologie pédiatriques, Paris, France
| | - Manoelle Kossorotoff
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Neurologie Pédiatrique, Paris, France
| | - Nadine Cerf-Bensussan
- Université de Paris, Imagine Institute, Laboratory of Intestinal Immunity, Inserm, UMR1163, Paris, France
| | - Marianna Parlato
- Université de Paris, Imagine Institute, Laboratory of Intestinal Immunity, Inserm, UMR1163, Paris, France
| | - Alice Hadchouel
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Kossorotoff M, denier C, Husson B, Ozanne A, Bellesme C, Kerleroux B, NAGGARA OLIVIER. Abstract 63: Recanalization Treatments In Pediatric Stroke: Safety And Efficacy Data Issued From The French KidClot Study. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Safety and efficacy of recanalization treatments,
i.e.
intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT), have to be refined in pediatric stroke.
Methods:
The French KIDCLOT multisourcing nationwide retrospective study (NCT03887143) collected data of consecutive children aged >28 days and <18 years old with acute arterial ischemic stroke who had a recanalization treatment, during a 41 month-period.
Results:
68 patients, 44 boys (64.7%), median age at stroke onset 11.5 years old, were included. Pre-stroke mRS was 0 for 89.7%. Main stroke etiologies were cardio-embolic (30.9%), focal cerebral arteriopathy (FCA, 25%), cervical (carotid/vertebral) arteriopathy (13.2%), and thrombotic (11.8%). 70 pediatric procedures were recorded: IVT alone (n=31), MT alone (n=23), combined IVT and MT (n=14), and DSA without recanalization treatment (n=4). Median stroke onset to first recanalization treatment delay was shorter in adult stroke units than in pediatric wards (188 vs. 264 minutes respectively, p=0.0087). An early complication was reported for 6 procedures, including two significant intracranial hemorrhages. After MT, cardio-embolic stroke patients achieved good arterial recanalization more frequently than FCA patients (88.9% vs 33.3%). Although high initial severity markers (median NIHSScore=13.5, decreased consciousness in 52.2%, decompressive craniectomy in 17.1%), outcome was relatively good in the 65/68 survivors (median mRS=1 and PSOM=1.2 at 12 month-follow-up).
Conclusions:
This study provides encouraging safety data despite severe stroke presentations. It suggests potential ways to improve recanalization treatments efficacy in children: reducing management delays in pediatric wards and optimizing etiological orientation since the hyperacute phase, as cardio-embolic strokes seem to display a better recanalization rate profile.
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Affiliation(s)
| | | | | | | | - Celine Bellesme
- Pediatric Neurology, APHP Hosp Bicetre, Le Kremlin Bicetre, France
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17
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Devianne J, Legris N, Crassard I, Bellesme C, Bejot Y, Guidoux C, Pico F, Germanaud D, Obadia M, Rodriguez D, Tuppin P, Kossorotoff M, Denier C. Epidemiology, Clinical Features, and Outcome in a Cohort of Adolescents With Cerebral Venous Thrombosis. Neurology 2021; 97:e1920-e1932. [PMID: 34544816 DOI: 10.1212/wnl.0000000000012828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/02/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We aimed to analyze the epidemiologic, clinical, and paraclinical features of adolescents with cerebral venous thrombosis (CVT) and its therapeutic management and outcome. METHODS This multicenter retrospective cohort included patients 10 to 18 years of age hospitalized for a first episode of CVT in 2 French regions between 1999 and 2019. The number of cases was compared to the number recorded by the French health insurance system. The CVT registry of the Lariboisière hospital allowed comparisons with adults. RESULTS One hundred two patients were included (52.9% female; median age 15.1 years). Estimated incidence was 0.37 to 0.38 per 100,000 adolescents per year; 45.5% of patients presented with focal deficits or seizures or in a coma. Male patients were younger than female patients (14.2 vs 15.6 years; p < 0.01) and more often admitted to intensive care (52.1% vs 24.1%; p = 0.0,035). The lateral sinus was the most common CVT location (72.3%), and 29.4% of adolescents had associated venous infarction or hematoma. Most patients (94.1%) received anticoagulation. Treatment also included an endovascular procedure (2.9%), decompressive craniectomy (4.9%), and CSF shunt (6.9%). The most frequently identified CVT-associated condition was local infection in male (18.6%) and systemic disease in female (14.8%; p < 0.001) patients. The proportion of CVTs in adolescents without an identified associated condition or risk factor was low (1.9% vs 11.4% in adults; p < 0.002). Adverse outcome at 1 year was more frequent than in adults (33.3% vs 11.8%; p = 0.0,001). DISCUSSION CVT in adolescents is rare and complex with specific epidemiology, including differences in clinical presentation and associated conditions between sexes, and more severe outcomes than in adults. Careful specialized management and follow-up are therefore recommended.
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Affiliation(s)
- Julia Devianne
- From the Stroke Units and Departments of Neurology of Hôpital Bicêtre (J.D., N.L., C.D.), Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Saclay University; Hôpital Lariboisière (I.C.), AP-HP, Paris; Pediatric Neurology and Stroke Unit (C.B.), AP-HP, Hôpital Bicêtre; University Région Bourgogne (Y.B.), Hôpital de Dijon; Hôpital Bichat (C.G.), AP-HP, Paris; Hôpital André Mignot (F.P.), Versailles; Hôpital Armand Trousseau (D.R.), AP-HP; Hôpital Fondation Rothschild (M.O.); Hôpital Robert Debré (D.G.), AP-HP; French National Health Insurance (CNAM) (P.T.); and Pediatric Neurology Unit and French Center for Pediatric Stroke (M.K.), AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Nicolas Legris
- From the Stroke Units and Departments of Neurology of Hôpital Bicêtre (J.D., N.L., C.D.), Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Saclay University; Hôpital Lariboisière (I.C.), AP-HP, Paris; Pediatric Neurology and Stroke Unit (C.B.), AP-HP, Hôpital Bicêtre; University Région Bourgogne (Y.B.), Hôpital de Dijon; Hôpital Bichat (C.G.), AP-HP, Paris; Hôpital André Mignot (F.P.), Versailles; Hôpital Armand Trousseau (D.R.), AP-HP; Hôpital Fondation Rothschild (M.O.); Hôpital Robert Debré (D.G.), AP-HP; French National Health Insurance (CNAM) (P.T.); and Pediatric Neurology Unit and French Center for Pediatric Stroke (M.K.), AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Isabelle Crassard
- From the Stroke Units and Departments of Neurology of Hôpital Bicêtre (J.D., N.L., C.D.), Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Saclay University; Hôpital Lariboisière (I.C.), AP-HP, Paris; Pediatric Neurology and Stroke Unit (C.B.), AP-HP, Hôpital Bicêtre; University Région Bourgogne (Y.B.), Hôpital de Dijon; Hôpital Bichat (C.G.), AP-HP, Paris; Hôpital André Mignot (F.P.), Versailles; Hôpital Armand Trousseau (D.R.), AP-HP; Hôpital Fondation Rothschild (M.O.); Hôpital Robert Debré (D.G.), AP-HP; French National Health Insurance (CNAM) (P.T.); and Pediatric Neurology Unit and French Center for Pediatric Stroke (M.K.), AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Celine Bellesme
- From the Stroke Units and Departments of Neurology of Hôpital Bicêtre (J.D., N.L., C.D.), Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Saclay University; Hôpital Lariboisière (I.C.), AP-HP, Paris; Pediatric Neurology and Stroke Unit (C.B.), AP-HP, Hôpital Bicêtre; University Région Bourgogne (Y.B.), Hôpital de Dijon; Hôpital Bichat (C.G.), AP-HP, Paris; Hôpital André Mignot (F.P.), Versailles; Hôpital Armand Trousseau (D.R.), AP-HP; Hôpital Fondation Rothschild (M.O.); Hôpital Robert Debré (D.G.), AP-HP; French National Health Insurance (CNAM) (P.T.); and Pediatric Neurology Unit and French Center for Pediatric Stroke (M.K.), AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Yannick Bejot
- From the Stroke Units and Departments of Neurology of Hôpital Bicêtre (J.D., N.L., C.D.), Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Saclay University; Hôpital Lariboisière (I.C.), AP-HP, Paris; Pediatric Neurology and Stroke Unit (C.B.), AP-HP, Hôpital Bicêtre; University Région Bourgogne (Y.B.), Hôpital de Dijon; Hôpital Bichat (C.G.), AP-HP, Paris; Hôpital André Mignot (F.P.), Versailles; Hôpital Armand Trousseau (D.R.), AP-HP; Hôpital Fondation Rothschild (M.O.); Hôpital Robert Debré (D.G.), AP-HP; French National Health Insurance (CNAM) (P.T.); and Pediatric Neurology Unit and French Center for Pediatric Stroke (M.K.), AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Celine Guidoux
- From the Stroke Units and Departments of Neurology of Hôpital Bicêtre (J.D., N.L., C.D.), Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Saclay University; Hôpital Lariboisière (I.C.), AP-HP, Paris; Pediatric Neurology and Stroke Unit (C.B.), AP-HP, Hôpital Bicêtre; University Région Bourgogne (Y.B.), Hôpital de Dijon; Hôpital Bichat (C.G.), AP-HP, Paris; Hôpital André Mignot (F.P.), Versailles; Hôpital Armand Trousseau (D.R.), AP-HP; Hôpital Fondation Rothschild (M.O.); Hôpital Robert Debré (D.G.), AP-HP; French National Health Insurance (CNAM) (P.T.); and Pediatric Neurology Unit and French Center for Pediatric Stroke (M.K.), AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Fernando Pico
- From the Stroke Units and Departments of Neurology of Hôpital Bicêtre (J.D., N.L., C.D.), Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Saclay University; Hôpital Lariboisière (I.C.), AP-HP, Paris; Pediatric Neurology and Stroke Unit (C.B.), AP-HP, Hôpital Bicêtre; University Région Bourgogne (Y.B.), Hôpital de Dijon; Hôpital Bichat (C.G.), AP-HP, Paris; Hôpital André Mignot (F.P.), Versailles; Hôpital Armand Trousseau (D.R.), AP-HP; Hôpital Fondation Rothschild (M.O.); Hôpital Robert Debré (D.G.), AP-HP; French National Health Insurance (CNAM) (P.T.); and Pediatric Neurology Unit and French Center for Pediatric Stroke (M.K.), AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - David Germanaud
- From the Stroke Units and Departments of Neurology of Hôpital Bicêtre (J.D., N.L., C.D.), Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Saclay University; Hôpital Lariboisière (I.C.), AP-HP, Paris; Pediatric Neurology and Stroke Unit (C.B.), AP-HP, Hôpital Bicêtre; University Région Bourgogne (Y.B.), Hôpital de Dijon; Hôpital Bichat (C.G.), AP-HP, Paris; Hôpital André Mignot (F.P.), Versailles; Hôpital Armand Trousseau (D.R.), AP-HP; Hôpital Fondation Rothschild (M.O.); Hôpital Robert Debré (D.G.), AP-HP; French National Health Insurance (CNAM) (P.T.); and Pediatric Neurology Unit and French Center for Pediatric Stroke (M.K.), AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Michael Obadia
- From the Stroke Units and Departments of Neurology of Hôpital Bicêtre (J.D., N.L., C.D.), Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Saclay University; Hôpital Lariboisière (I.C.), AP-HP, Paris; Pediatric Neurology and Stroke Unit (C.B.), AP-HP, Hôpital Bicêtre; University Région Bourgogne (Y.B.), Hôpital de Dijon; Hôpital Bichat (C.G.), AP-HP, Paris; Hôpital André Mignot (F.P.), Versailles; Hôpital Armand Trousseau (D.R.), AP-HP; Hôpital Fondation Rothschild (M.O.); Hôpital Robert Debré (D.G.), AP-HP; French National Health Insurance (CNAM) (P.T.); and Pediatric Neurology Unit and French Center for Pediatric Stroke (M.K.), AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Diana Rodriguez
- From the Stroke Units and Departments of Neurology of Hôpital Bicêtre (J.D., N.L., C.D.), Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Saclay University; Hôpital Lariboisière (I.C.), AP-HP, Paris; Pediatric Neurology and Stroke Unit (C.B.), AP-HP, Hôpital Bicêtre; University Région Bourgogne (Y.B.), Hôpital de Dijon; Hôpital Bichat (C.G.), AP-HP, Paris; Hôpital André Mignot (F.P.), Versailles; Hôpital Armand Trousseau (D.R.), AP-HP; Hôpital Fondation Rothschild (M.O.); Hôpital Robert Debré (D.G.), AP-HP; French National Health Insurance (CNAM) (P.T.); and Pediatric Neurology Unit and French Center for Pediatric Stroke (M.K.), AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Philippe Tuppin
- From the Stroke Units and Departments of Neurology of Hôpital Bicêtre (J.D., N.L., C.D.), Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Saclay University; Hôpital Lariboisière (I.C.), AP-HP, Paris; Pediatric Neurology and Stroke Unit (C.B.), AP-HP, Hôpital Bicêtre; University Région Bourgogne (Y.B.), Hôpital de Dijon; Hôpital Bichat (C.G.), AP-HP, Paris; Hôpital André Mignot (F.P.), Versailles; Hôpital Armand Trousseau (D.R.), AP-HP; Hôpital Fondation Rothschild (M.O.); Hôpital Robert Debré (D.G.), AP-HP; French National Health Insurance (CNAM) (P.T.); and Pediatric Neurology Unit and French Center for Pediatric Stroke (M.K.), AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Manoelle Kossorotoff
- From the Stroke Units and Departments of Neurology of Hôpital Bicêtre (J.D., N.L., C.D.), Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Saclay University; Hôpital Lariboisière (I.C.), AP-HP, Paris; Pediatric Neurology and Stroke Unit (C.B.), AP-HP, Hôpital Bicêtre; University Région Bourgogne (Y.B.), Hôpital de Dijon; Hôpital Bichat (C.G.), AP-HP, Paris; Hôpital André Mignot (F.P.), Versailles; Hôpital Armand Trousseau (D.R.), AP-HP; Hôpital Fondation Rothschild (M.O.); Hôpital Robert Debré (D.G.), AP-HP; French National Health Insurance (CNAM) (P.T.); and Pediatric Neurology Unit and French Center for Pediatric Stroke (M.K.), AP-HP, Hôpital Necker-Enfants malades, Paris, France
| | - Christian Denier
- From the Stroke Units and Departments of Neurology of Hôpital Bicêtre (J.D., N.L., C.D.), Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Saclay University; Hôpital Lariboisière (I.C.), AP-HP, Paris; Pediatric Neurology and Stroke Unit (C.B.), AP-HP, Hôpital Bicêtre; University Région Bourgogne (Y.B.), Hôpital de Dijon; Hôpital Bichat (C.G.), AP-HP, Paris; Hôpital André Mignot (F.P.), Versailles; Hôpital Armand Trousseau (D.R.), AP-HP; Hôpital Fondation Rothschild (M.O.); Hôpital Robert Debré (D.G.), AP-HP; French National Health Insurance (CNAM) (P.T.); and Pediatric Neurology Unit and French Center for Pediatric Stroke (M.K.), AP-HP, Hôpital Necker-Enfants malades, Paris, France.
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Kossorotoff M, Blauwblomme T. Refining revascularization surgery indications for paediatric moyamoya angiopathy: Age also matters. Eur J Paediatr Neurol 2021; 35:A1. [PMID: 34838447 DOI: 10.1016/j.ejpn.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Manoelle Kossorotoff
- French Centre for Paediatric Stroke, Paediatric Neurology Department, APHP University Hospital Necker-Enfants Malades, Paris, France.
| | - Thomas Blauwblomme
- French Centre for Paediatric Stroke, Paediatric Neurosurgery Department, APHP University Hospital Necker-Enfants Malades, Paris, France; University of Paris, Paris, France
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Hak JF, Boulouis G, Kerleroux B, Benichi S, Stricker S, Gariel F, Garzelli L, Meyer P, Kossorotoff M, Boddaert N, Vidal V, Girard N, Dangouloff-Ros V, Brunelle F, Fullerton H, Hetts SW, Blauwblomme T, Naggara O. Pediatric brain arteriovenous malformation recurrence: a cohort study, systematic review and meta-analysis. J Neurointerv Surg 2021; 14:611-617. [PMID: 34583986 DOI: 10.1136/neurintsurg-2021-017777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/19/2021] [Accepted: 08/31/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Recurrence following obliteration of brain arteriovenous malformations (AVMs) is common in children surgically treated, but recurrences following endovascular (EVT) and radiosurgical approaches are scantily reported. OBJECTIVE To analyze the rates and risk factors for AVM recurrence after obliteration in a single-center cohort of children with ruptured AVMs treated with multimodal approaches, and to carry out a comprehensive review and meta-analysis of current data. METHODS Children with ruptured AVMs between 2000 and 2019 enrolled in a prospective registry were retrospectively screened and included after angiographically determined obliteration to differentiate children with/without recurrence. A complementary systematic review and meta-analysis of studies investigating AVM recurrence in children between 2000 and 2020 was aggregated to explore the overall recurrence rates across treatment modalities by analyzing surgery versus other treatments. RESULTS Seventy children with obliterated AVMs were included. AVM recurrences (n=10) were more commonly treated with EVT as final treatment (60% in the recurrence vs 13.3% in the no-recurrence group, p=0.018). Infratentorial locations were associated with earlier and more frequent recurrences (adjusted relative risk=4.62, 95% CI 1.08 to 19.04; p=0.04).In the aggregate analysis, the pooled rate of AVM recurrence was 10.9% (95% CI 8.7% to 13.5%). Younger age at presentation was associated with more frequent recurrences (RR per year increase, 0.97, 95% CI 0.93 to 0.99; p=0.046). CONCLUSION Location of infratentorial AVMs and younger age at presentation may be associated with earlier and more frequent recurrences. The higher rates of recurrence in patients with AVMs obliterated with EVT questions its role in an intent-to-cure approach and reinforces its position as an adjunct to surgery and/or radiosurgery.
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Affiliation(s)
- Jean-Francois Hak
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, APHP, Necker Sick Children Hospital, Paris, Paris, France .,Department of Neuroradiology, INSERM UMR 1266 IMA-BRAIN, GHU Paris, Paris, France
| | - Gregoire Boulouis
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, APHP, Necker Sick Children Hospital, Paris, Paris, France.,Department of Neuroradiology, INSERM UMR 1266 IMA-BRAIN, GHU Paris, Paris, France
| | - Basile Kerleroux
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, APHP, Necker Sick Children Hospital, Paris, Paris, France.,Department of Neuroradiology, INSERM UMR 1266 IMA-BRAIN, GHU Paris, Paris, France
| | - Sandro Benichi
- Department of Pediatric Neurosurgery, Institut Imagine, INSERM UMR 1163, APHP, Necker Sick Children Hospital, Paris, France
| | - Sarah Stricker
- Department of Pediatric Neurosurgery, Institut Imagine, INSERM UMR 1163, APHP, Necker Sick Children Hospital, Paris, France
| | - Florent Gariel
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, APHP, Necker Sick Children Hospital, Paris, Paris, France.,Department of Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, France
| | - Lorenzo Garzelli
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, APHP, Necker Sick Children Hospital, Paris, Paris, France
| | - Philippe Meyer
- Department of Pediatric Neuro ICU, APHP, Necker Sick Children Hospital, Paris, France
| | - Manoelle Kossorotoff
- Department of Pediatric Neurology, APHP University Necker Children Hospital, Paris, France.,French Center for Pediatric Stroke, INSERM U894, APHP, Necker Sick Children Hospital, Paris, France
| | - Nathalie Boddaert
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, APHP, Necker Sick Children Hospital, Paris, Paris, France
| | - Vincent Vidal
- Department of Radiology, University Hospital La Timone, AP-HM, Marseille, France
| | - Nadine Girard
- Department of Neuroradiology, University Hospital La Timone, AP-HM, Marseille, France
| | - Volodia Dangouloff-Ros
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, APHP, Necker Sick Children Hospital, Paris, Paris, France
| | - Francis Brunelle
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, APHP, Necker Sick Children Hospital, Paris, Paris, France
| | - Heather Fullerton
- Department of Neurology, University of California San Francisco, San Francisco, California, USA.,Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery, Institut Imagine, INSERM UMR 1163, APHP, Necker Sick Children Hospital, Paris, France.,French Center for Pediatric Stroke, INSERM U894, APHP, Necker Sick Children Hospital, Paris, France
| | - Olivier Naggara
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, APHP, Necker Sick Children Hospital, Paris, Paris, France.,Department of Neuroradiology, INSERM UMR 1266 IMA-BRAIN, GHU Paris, Paris, France.,French Center for Pediatric Stroke, INSERM U894, APHP, Necker Sick Children Hospital, Paris, France
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20
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Hak JF, Boulouis G, Kerleroux B, Benichi S, Stricker S, Gariel F, Garzelli L, Meyer P, Kossorotoff M, Boddaert N, Vidal V, Girard N, Dangouloff Ros V, Brunelle F, Blauwblomme T, Naggara O. Arterial Spin Labeling for the Etiological Workup of Intracerebral Hemorrhage in Children. Stroke 2021; 53:185-193. [PMID: 34517772 DOI: 10.1161/strokeaha.120.032690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Pediatric nontraumatic intracerebral hemorrhage accounts for half of stroke in children. Early diagnostic of the causative underlying lesion is the first step toward prevention of hemorrhagic recurrence. We aimed to investigate the performance of arterial spin labeling sequence (ASL) in the acute phase etiological workup for the detection of an arteriovenous shunt (AVS: including malformation and fistula), the most frequent cause of pediatric nontraumatic intracerebral hemorrhage. METHODS Children with a pediatric nontraumatic intracerebral hemorrhage between 2011 and 2019 enrolled in a prospective registry were retrospectively included if they had undergone ASL-magnetic resonance imaging before any etiological treatment. ASL sequences were reviewed using cerebral blood flow maps by 2 raters for the presence of an AVS. The diagnostic performance of ASL was compared with admission computed tomography angiography, other magnetic resonance imaging sequences including contrast-enhanced sequences and subsequent digital subtraction angiography. RESULTS A total of 121 patients with pediatric nontraumatic intracerebral hemorrhage were included (median age, 9.9 [interquartile range, 5.8-13]; male sex 48.8%) of whom 76 (63%) had a final diagnosis of AVS. Using digital subtraction angiography as an intermediate reference, visual ASL inspection had a sensitivity and a specificity of, respectively, 95.9% (95% CI, 88.5%-99.1%) and 79.0% (95% CI, 54.4%-94.0%). ASL had a sensitivity, specificity, and accuracy of 90.2%, 97.2%, and 92.5%, respectively for the detection of the presence of an AVS, with near perfect interrater agreement (κ=0.963 [95% CI, 0.912-1.0]). The performance of ASL alone was higher than that of other magnetic resonance imaging sequences, individually or combined, and higher than that of computed tomography angiography. CONCLUSIONS ASL has strong diagnostic performance for the detection of AVS in the initial workup of intracerebral hemorrhage in children. If our findings are confirmed in other settings, ASL may be a helpful diagnostic imaging modality for patients with pediatric nontraumatic intracerebral hemorrhage. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: 3618210420, 2217698.
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Affiliation(s)
- Jean François Hak
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Université de Paris, INSERM UMR 1266 IMA-BRAIN, Department of Interventional Neuroradiology, GHU Paris, France (J.F.H., G.B., B.K., O.N.)
| | - Grégoire Boulouis
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Université de Paris, INSERM UMR 1266 IMA-BRAIN, Department of Interventional Neuroradiology, GHU Paris, France (J.F.H., G.B., B.K., O.N.)
| | - Basile Kerleroux
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Université de Paris, INSERM UMR 1266 IMA-BRAIN, Department of Interventional Neuroradiology, GHU Paris, France (J.F.H., G.B., B.K., O.N.)
| | - Sandro Benichi
- The Department of Pediatric Neurosurgery, Institut Imagine, INSERM UMR 1163 (S.B., S.S., T.B.), University hospital Necker-Enfants-malades, Paris, France
| | - Sarah Stricker
- The Department of Pediatric Neurosurgery, Institut Imagine, INSERM UMR 1163 (S.B., S.S., T.B.), University hospital Necker-Enfants-malades, Paris, France
| | - Florent Gariel
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Department of Neuroradiology, University Hospital of Bordeaux, France (F.G.)
| | - Lorenzo Garzelli
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France
| | - Philippe Meyer
- Pediatric Neuro ICU (P.M.), University hospital Necker-Enfants-malades, Paris, France
| | - Manoelle Kossorotoff
- French Center for Pediatric Stroke, INSERM U894 (M.K., T.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Department of Pediatric Neurology (M.K.), AP-HP, University hospital Necker-Enfants-malades, Paris, France
| | - Nathalie Boddaert
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France
| | - Vincent Vidal
- Department of Radiology (V.V.), University Hospital La Timone Hospital, AP-HM, Marseille, France
| | - Nadine Girard
- the Department of Neuroradiology (N.G.), University Hospital La Timone Hospital, AP-HM, Marseille, France
| | - Volodia Dangouloff Ros
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France
| | - Francis Brunelle
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France
| | - Thomas Blauwblomme
- The Department of Pediatric Neurosurgery, Institut Imagine, INSERM UMR 1163 (S.B., S.S., T.B.), University hospital Necker-Enfants-malades, Paris, France.,French Center for Pediatric Stroke, INSERM U894 (M.K., T.B., O.N.), University hospital Necker-Enfants-malades, Paris, France
| | - Olivier Naggara
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,French Center for Pediatric Stroke, INSERM U894 (M.K., T.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Université de Paris, INSERM UMR 1266 IMA-BRAIN, Department of Interventional Neuroradiology, GHU Paris, France (J.F.H., G.B., B.K., O.N.)
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Winter S, Lechapt E, Gricourt G, N‘debi M, Boddaert N, Moshous D, Blauwblomme T, Kossorotoff M, Fouyssac F, Chareyre J, Demontant V, Chretien F, Woerther PL, Pawlotsky JM, Blanche S, Neven B, Rodriguez C. Fatal encephalitis caused by Newcastle disease virus in a child. Acta Neuropathol 2021; 142:605-608. [PMID: 34304282 DOI: 10.1007/s00401-021-02344-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 12/18/2022]
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Brousse V, Pondarre C, Kossorotoff M, Arnaud C, Kamdem A, de Montalembert M, Boutonnat-Faucher B, Allali S, Bourdeau H, Charlot K, Bertil S, Da Costa L, Connes P, Grévent D, Verlhac S. Brain injury pathophysiology study by a multimodal approach in children with sickle cell anemia with no intra or extra cranial arteriopathy. Haematologica 2021; 107:958-965. [PMID: 33882639 PMCID: PMC8968884 DOI: 10.3324/haematol.2020.278226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Indexed: 11/28/2022] Open
Abstract
Despite its high prevalence in children with sickle cell anemia (SCA), the pathophysiology of silent cerebral infarcts (SCI) remains elusive. The main objective of this study was to explore the respective roles of major determinants of brain perfusion in SCA children with no past or current history of intracranial or extracranial vasculopathy. We used a multimodal approach based notably on perfusion imaging arterial spin labeling (ASL) magnetic resonance imaging (MRI) and near infra-red spectroscopy (NIRS), as well as biomarkers reflecting blood rheology and endothelial activation. Out of 59 SCA patients (mean age 11.4±3.9 yrs), eight (13%) had a total of 12 SCI. Children with SCI had a distinctive profile characterized by decreased blood pressure, impaired blood rheology, increased P-selectin levels, and marked anemia. Although ASL perfusion and oximetry values did not differ between groups, comparison of biological and clinical parameters according to the level of perfusion categorized in terciles showed an independent association between high perfusion and increased sP-selectin, decreased red blood cell deformability, low hemoglobin F level, increased blood viscosity and no -thalassemia deletion. NIRS measurements did not yield additional novel results. Altogether, these findings argue for early MRI detection of SCI in children with no identified vasculopathy and suggest a potential role for ASL as an additional screening tool. Early treatment targeting hemolysis, anemia and endothelial dysfunction should reduce the risk of this under diagnosed and serious complication.
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Affiliation(s)
- Valentine Brousse
- AP-HP, Hôpital Necker Enfants Malades, Service de Pédiatrie Générale et Maladies infectieuses, Paris, France; LABEX GR-Ex, F-75015, France; Institut National de la transfusion sanguine, UMR_S1134, Inserm, F-75015 Paris, France; AP-HP, Hôpital Universitaire Robert Debré, Immuno-hématologie, Paris.
| | - Corinne Pondarre
- Centre Intercommunal de Créteil, Service de Pédiatrie, Créteil, France; Inserm U955, Paris XII University, Créteil
| | | | - Cecile Arnaud
- Centre Intercommunal de Créteil, Service de Pédiatrie, Créteil
| | - Annie Kamdem
- Centre Intercommunal de Créteil, Service de Pédiatrie, Créteil
| | - Mariane de Montalembert
- AP-HP, Hôpital Necker Enfants Malades, Service de Pédiatrie Générale et Maladies infectieuses, Paris, France; LABEX GR-Ex, F-75015
| | | | - Slimane Allali
- AP-HP, Hôpital Necker Enfants Malades, Service de Pédiatrie Générale et Maladies infectieuses, Paris, France; LABEX GR-Ex, F-75015, France; Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeu_cal Implica_ons, Paris Descartes - Sorbonne Paris Cite ́ University, Imagine Institute, Inserm U1163, Paris
| | - Hélène Bourdeau
- AP-HP, Hôpital Robert Debré, service d'Hématologie Biologique, F-75019, Paris
| | - Keyne Charlot
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge
| | - Sebastien Bertil
- AP-HP, Service d'hématologie biologique, Hôpital Européen Georges Pompidou, Paris
| | - Lydie Da Costa
- LABEX GR-Ex, F-75015, France; AP-HP, Hôpital Robert Debré, service d'Hématologie Biologique, F-75019, Paris, France; Université de Paris, F-75010 Paris; Hematim UR 4666, F-80000 Amiens
| | - Philippe Connes
- LABEX GR-Ex, F-75015, France; Laboratoire LIBM EA7424, Equipe « Biologie Vasculaire et du Globule Rouge », Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; Institut Universitaire de France, Paris
| | - David Grévent
- AP-HP, Hôpital Necker Enfants Malades, Service d'Imagerie Pédiatrique, Paris
| | - Suzanne Verlhac
- Centre Hospitalier Intercommunal de Créteil, Service d'Imagerie Médicale, Créteil, France; AP-HP, Hôpital Universitaire Robert Debré, Service d'Imagerie Médicale, Paris
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Boulouis G, Stricker S, Benichi S, Hak JF, Gariel F, Kossorotoff M, Garcelon N, Harroche A, Alias Q, Garzelli L, Bajolle F, Boddaert N, Meyer P, Blauwblomme T, Naggara O. Mortality and functional outcome after pediatric intracerebral hemorrhage: cohort study and meta-analysis. J Neurosurg Pediatr 2021; 27:661-667. [PMID: 33836498 DOI: 10.3171/2020.9.peds20608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The clinical outcome of pediatric intracerebral hemorrhage (pICH) is rarely reported in a comprehensive way. In this cohort study, systematic review, and meta-analysis of patients with pICH, the authors aimed to describe the basic clinical outcomes of pICH. METHODS Children who received treatment for pICH at the authors' institution were prospectively enrolled in the cohort in 2008; data since 2000 were retrospectively included, and data through October 2019 were analyzed. The authors then searched PubMed and conducted a systematic review of relevant articles published since 1990. Data from the identified populations and patients from the cohort study were pooled into a multicategory meta-analysis and analyzed with regard to clinical outcomes. RESULTS Among 243 children screened for inclusion, 231 patients were included. The median (IQR) age at ictus was 9.6 (4.6-12.5) years, and 128 patients (53%) were male. After a median (IQR) follow-up of 33 (13-63) months, 132 patients (57.4%) had a favorable clinical outcome, of whom 58 (44%) had no residual symptoms. Nineteen studies were included in the meta-analysis. Overall, the proportion of children with complete recovery was 27% (95% CI 19%-36%; Q = 49.6; I2 = 76%); of those with residual deficits, the complete recovery rate was 48.1% (95% CI 40%-57%; Q = 75.3; I2 = 81%). When pooled with the cohort study, the aggregate case-fatality rate at the last follow-up was 17.3% (95% CI 12%-24%; Q = 101.6; I2 = 81%). CONCLUSIONS Here, the authors showed that 1 in 6 children died after pICH, and the majority of children had residual neurological deficits at the latest follow-up. Results from the cohort study also indicate that children with vascular lesions as the etiology of pICH had significantly better clinical functional outcomes.
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Affiliation(s)
- Grégoire Boulouis
- 1Service d'imagerie Morphologique et Fonctionnelle, GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, INSERM, Université de Paris.,Departments of2Pediatric Radiology
| | | | | | - Jean-François Hak
- 1Service d'imagerie Morphologique et Fonctionnelle, GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, INSERM, Université de Paris.,Departments of2Pediatric Radiology
| | - Florent Gariel
- 1Service d'imagerie Morphologique et Fonctionnelle, GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, INSERM, Université de Paris.,Departments of2Pediatric Radiology
| | | | | | - Annie Harroche
- 8Hematology, Haemophilia Care Centre, Hôpital Necker Enfants Malades, AP-HP, Université de Paris
| | | | - Lorenzo Garzelli
- 1Service d'imagerie Morphologique et Fonctionnelle, GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, INSERM, Université de Paris.,Departments of2Pediatric Radiology
| | - Fanny Bajolle
- 5Unité Médico-Chirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de référence Malformations Cardiaques Congénitales Complexes-M3C
| | - Nathalie Boddaert
- Departments of2Pediatric Radiology.,9INSERM U1163, Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, and INSERM U1000; and
| | | | - Thomas Blauwblomme
- 3Pediatric Neurosurgery.,10French Center for Pediatric Stroke, Paris, France
| | - Olivier Naggara
- 1Service d'imagerie Morphologique et Fonctionnelle, GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, INSERM, Université de Paris.,Departments of2Pediatric Radiology.,10French Center for Pediatric Stroke, Paris, France
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24
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de Marcellus C, Dupic L, Roux CJ, El Aouane El Ghomari I, Parize P, Luscan R, Moulin F, Kossorotoff M. Case Report: Cerebrovascular Events Associated With Bacterial and SARS-CoV-2 Infections in an Adolescent. Front Neurol 2021; 12:606617. [PMID: 33897582 PMCID: PMC8060448 DOI: 10.3389/fneur.2021.606617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/12/2021] [Indexed: 01/19/2023] Open
Abstract
Neurologic manifestations associated with Covid-19 are increasingly reported, especially stroke and acute cerebrovascular events. Beyond cardiovascular risk factors associated with age, some young adults without medical or cardiovascular history had stroke as a presenting feature of Covid-19. Suggested stroke mechanisms in this setting are inflammatory storm, subsequent hypercoagulability, and vasculitis. To date, a handful of pediatric stroke cases associated with Covid-19 have been reported, either with a cardioembolic mechanism or a focal cerebral arteriopathy. We report the case of an adolescent who presented with febrile meningism and stupor. Clinical, biological, and radiological features favored the diagnosis of Lemierre syndrome (LS), with Fusobacterium necrophorum infection (sphenoid sinusitis and meningitis) and intracranial vasculitis. The patient had concurrent SARS-CoV-2 infection. Despite medical and surgical antimicrobial treatment, stroke prevention, and venous thrombosis prevention, he presented with severe cerebrovascular complications. Venous thrombosis and stroke were observed, with an extension of intracranial vasculitis, and lead to death. As both F. necrophorum and SARS-CoV-2 enhance inflammation, coagulation, and activate endothelial cells, we discuss how this coinfection may have potentiated and aggravated the usual course of LS. The potentiation by SARS-CoV-2 of vascular and thrombotic effects of a bacterial infection may represent an underreported cerebrovascular injury mechanism in Covid-19 patients. These findings emphasize the variety of mechanisms underlying stroke in this disease. Moreover, in the setting of SARS-CoV-2 pandemic, we discuss in what extent sanitary measures, namely, lockdown and fear to attend medical facilities, may have delayed diagnosis and influenced outcomes. This case also emphasizes the role of clinical assessment and the limits of telemedicine for acute neurological condition diagnosis.
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Affiliation(s)
- Charles de Marcellus
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France.,Université de Paris, Paris, France
| | - Laurent Dupic
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France.,Université de Paris, Paris, France
| | - Charles-Joris Roux
- Pediatric Radiology Department, APHP University Hospital Necker-Enfants Malades, Paris, France
| | | | - Perrine Parize
- Department of Infectious Diseases and Tropical Medicine, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - Romain Luscan
- Université de Paris, Paris, France.,Pediatric Otorhinolaryngology Department, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - Florence Moulin
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France.,Université de Paris, Paris, France
| | - Manoelle Kossorotoff
- French Center for Pediatric Stroke, Pediatric Neurology Department, APHP University Hospital Necker-Enfants Malades, Paris, France.,Inserm U1266, Paris, France
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25
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Stricker S, Boulouis G, Benichi S, Bourgeois M, Gariel F, Garzelli L, Hak JF, Alias Q, Kerleroux B, Beccaria K, Chivet A, de Saint Denis T, James S, Paternoster G, Zerah M, Kossorotoff M, Boddaert N, Brunelle F, Meyer P, Puget S, Naggara O, Blauwblomme T. Acute surgical management of children with ruptured brain arteriovenous malformation. J Neurosurg Pediatr 2021; 27:437-445. [PMID: 33482644 DOI: 10.3171/2020.8.peds20479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Rupture of brain arteriovenous malformation (AVM) is the main etiology of intracerebral hemorrhage (ICH) in children. Ensuing intracranial hypertension is among the modifiable prognosis factors and sometimes requires emergency hemorrhage evacuation (HE). The authors aimed to analyze variables associated with HE in children with ruptured AVM. METHODS This study was a single-center retrospective analysis of children treated for ruptured AVM. The authors evaluated the occurrence of HE, its association with other acute surgical procedures (e.g., nidal excision, decompressive hemicraniectomy), and clinical outcome. Variables associated with each intervention were analyzed using univariable and multivariable models. Clinical outcome was assessed at 18 months using the ordinal King's Outcome Scale for Childhood Head Injury. RESULTS A total of 104 patients were treated for 112 episodes of ruptured AVM between 2002 and 2018. In the 51 children (45.5% of cases) who underwent HE, 37 procedures were performed early (i.e., within 24 hours after initial cerebral imaging) and 14 late. Determinants of HE were a lower initial Glasgow Coma Scale score (adjusted odds ratio [aOR] 0.83, 95% CI 0.71-0.97 per point increase); higher ICH/brain volume ratio (aOR 18.6, 95% CI 13-26.5 per percent increase); superficial AVM location; and the presence of a brain herniation (aOR 3.7, 95% CI 1.3-10.4). Concurrent nidal surgery was acutely performed in 69% of Spetzler-Martin grade I-II ruptured AVMs and in 25% of Spetzler-Martin grade III lesions. Factors associated with nidal surgery were superficial AVMs, late HE, and absent alteration of consciousness at presentation. Only 8 cases required additional surgery due to intracranial hypertension. At 18 months, overall mortality was less than 4%, 58% of patients had a favorable outcome regardless of surgical intervention, and 87% were functioning independently. CONCLUSIONS HE is a lifesaving procedure performed in approximately half of the children who suffer AVM rupture. The good overall outcome justifies intensive initial management.
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Affiliation(s)
| | - Grégoire Boulouis
- 2Université de Paris.,3INSERM U1266, Department of Neuroradiology, Sainte-Anne Hospital, GHU Paris Psychiatry and Neurosciences; and
| | | | | | - Florent Gariel
- 3INSERM U1266, Department of Neuroradiology, Sainte-Anne Hospital, GHU Paris Psychiatry and Neurosciences; and
| | - Lorenzo Garzelli
- 3INSERM U1266, Department of Neuroradiology, Sainte-Anne Hospital, GHU Paris Psychiatry and Neurosciences; and
| | | | | | - Basile Kerleroux
- 2Université de Paris.,3INSERM U1266, Department of Neuroradiology, Sainte-Anne Hospital, GHU Paris Psychiatry and Neurosciences; and
| | | | | | | | | | | | | | | | - Nathalie Boddaert
- 1APHP, Necker Hospital.,2Université de Paris.,4INSERM U1163, Imagine Institute, Paris, France
| | | | | | | | - Olivier Naggara
- 1APHP, Necker Hospital.,2Université de Paris.,3INSERM U1266, Department of Neuroradiology, Sainte-Anne Hospital, GHU Paris Psychiatry and Neurosciences; and
| | - Thomas Blauwblomme
- 1APHP, Necker Hospital.,2Université de Paris.,4INSERM U1163, Imagine Institute, Paris, France
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26
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Boulouis G, Hak JF, Kerleroux B, Benichi S, Stricker S, Gariel F, Alias Q, Bourgeois M, Meyer P, Kossorotoff M, Garzelli L, Garcelon N, Boddaert N, Morotti A, Blauwblomme T, Naggara O. Hemorrhage Expansion After Pediatric Intracerebral Hemorrhage. Stroke 2021; 52:588-594. [PMID: 33423517 DOI: 10.1161/strokeaha.120.030592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Significant hemorrhage expansion (sHE) is a known predictor of poor outcome after an intracerebral hemorrhage (ICH) in adults but remains poorly reported in children. In a large inception cohort, we aimed to explore the prevalence of sHE, its associations with clinical outcomes, and its clinical-imaging predictors in children. METHODS Children admitted between January 2000 and March 2020 at a quaternary care pediatric hospital were screened for inclusion. Sample was restricted to children with 2 computed tomography scans within 72 hours of ICH onset, and a minimal clinical follow-up of months. sHE was defined as an increase from baseline ICH volume by 6 cc or 33% on follow-up computed tomography. Clinical outcome was assessed at 12 months with the King's Outcome Scale for Childhood Head Injury score and defined as favorable for scores ≥5. RESULTS Fifty-two children met inclusion criteria, among which 8 (15%) demonstrated sHE, and 18 (34.6%) any degree of expansion. Children with sHE had more frequent coagulation disorders (25.0% versus 2.3%; P=0.022). After multivariable adjustment, only the presence of coagulation disorders at baseline remained independently associated with sHE (adjusted odds ratio, 14.4 [95% CI, 1.04-217]; P=0.048). sHE was independently associated with poor outcome (King's Outcome Scale for Childhood Head Injury <5A, odds ratio, 5.77 [95% CI, 1.01-38.95]; P=0.043). CONCLUSIONS sHE is a frequent phenomenon after admission for a pediatric ICH and more so in children with coagulation defects. As sHE was strongly associated with poorer clinical outcomes, these data mandate a baseline coagulation work up and questions the need for protocolized repeat head computed tomography in children admitted for pediatric ICH.
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Affiliation(s)
- Gregoire Boulouis
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris, Unité mixte de recherche S1266, Institut National de la Santé Et de la Recherche Médicale, Université de Paris, Paris, France (G.B., J.-F.H., B.K., F.G., L.G., O.N.).,Pediatric Radiology Department (G.B., J.-F.H., B.K., F.G., Q.A., L.G., N.B., O.N.)
| | - Jean-François Hak
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris, Unité mixte de recherche S1266, Institut National de la Santé Et de la Recherche Médicale, Université de Paris, Paris, France (G.B., J.-F.H., B.K., F.G., L.G., O.N.).,Pediatric Radiology Department (G.B., J.-F.H., B.K., F.G., Q.A., L.G., N.B., O.N.)
| | - Basile Kerleroux
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris, Unité mixte de recherche S1266, Institut National de la Santé Et de la Recherche Médicale, Université de Paris, Paris, France (G.B., J.-F.H., B.K., F.G., L.G., O.N.).,Pediatric Radiology Department (G.B., J.-F.H., B.K., F.G., Q.A., L.G., N.B., O.N.)
| | - Sandro Benichi
- Pediatric Neurosurgery Department (S.B. S.S., M.B., T.B.)
| | - Sarah Stricker
- Pediatric Neurosurgery Department (S.B. S.S., M.B., T.B.)
| | - Florent Gariel
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris, Unité mixte de recherche S1266, Institut National de la Santé Et de la Recherche Médicale, Université de Paris, Paris, France (G.B., J.-F.H., B.K., F.G., L.G., O.N.).,Pediatric Radiology Department (G.B., J.-F.H., B.K., F.G., Q.A., L.G., N.B., O.N.)
| | - Quentin Alias
- Pediatric Radiology Department (G.B., J.-F.H., B.K., F.G., Q.A., L.G., N.B., O.N.)
| | | | | | - Manoelle Kossorotoff
- French Center for Pediatric Stroke (M.K., T.B., O.N.).,Pediatric Neurology Department (M.K.)
| | - Lorenzo Garzelli
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris, Unité mixte de recherche S1266, Institut National de la Santé Et de la Recherche Médicale, Université de Paris, Paris, France (G.B., J.-F.H., B.K., F.G., L.G., O.N.).,Pediatric Radiology Department (G.B., J.-F.H., B.K., F.G., Q.A., L.G., N.B., O.N.)
| | - Nicolas Garcelon
- INSERM UMR1163, Imagine Institute, Data Science Platform, Paris-Descartes University, France (N.G., N.B.)
| | - Nathalie Boddaert
- Pediatric Radiology Department (G.B., J.-F.H., B.K., F.G., Q.A., L.G., N.B., O.N.).,Pediatric Neurology Department (M.K.).,INSERM UMR1163, Imagine Institute, Data Science Platform, Paris-Descartes University, France (N.G., N.B.).,Hôpital Necker Enfants Malades, Assistance Publique - Hopitaux de Paris (AP-HP), Université de Paris, Paris, France (N.B.).,INSERM UMR 1000, Paris, France (N.B.)
| | - Andrea Morotti
- ASST Valcamonica, Ospedale di Esine, UOSD Neurologia, Esine, Italy (A.M.)
| | - Thomas Blauwblomme
- Pediatric Neurosurgery Department (S.B. S.S., M.B., T.B.).,French Center for Pediatric Stroke (M.K., T.B., O.N.)
| | - Olivier Naggara
- GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris, Unité mixte de recherche S1266, Institut National de la Santé Et de la Recherche Médicale, Université de Paris, Paris, France (G.B., J.-F.H., B.K., F.G., L.G., O.N.).,Pediatric Radiology Department (G.B., J.-F.H., B.K., F.G., Q.A., L.G., N.B., O.N.).,French Center for Pediatric Stroke (M.K., T.B., O.N.)
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27
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Boulouis G, Stricker S, Benichi S, Hak JF, Gariel F, Alias Q, de Saint Denis T, Kossorotoff M, Bajolle F, Garzelli L, Beccaria K, Paternoster G, Bourgeois M, Garcelon N, Harroche A, Mancusi RL, Boddaert N, Puget S, Brunelle F, Blauwblomme T, Naggara O. Etiology of intracerebral hemorrhage in children: cohort study, systematic review, and meta-analysis. J Neurosurg Pediatr 2021; 27:357-363. [PMID: 33385999 DOI: 10.3171/2020.7.peds20447] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Understanding the etiological spectrum of nontraumatic pediatric intracerebral hemorrhage (pICH) is key to the diagnostic workup and care pathway. The authors aimed to evaluate the etiological spectrum of diseases underlying pICH. METHODS Children treated at the authors' institution for a pICH were included in an inception cohort initiated in 2008 and retrospectively inclusive to 2000, which was analyzed in October 2019. They then conducted a systematic review of relevant articles in PubMed published between 1990 and 2019, identifying cohorts with pICH. Identified populations and patients from the authors' cohort were pooled in a multicategory meta-analysis. RESULTS A total of 243 children with pICH were analyzed in the cohort study. The final primary diagnosis was an intracranial vascular lesion in 190 patients (78.2%), a complication of a cardiac disease in 17 (7.0%), and a coagulation disorder in 14 (5.8%). Hematological and cardiological etiologies were disproportionately more frequent in children younger than 2 years (p < 0.001). The systematic review identified 1309 children in 23 relevant records pooled in the meta-analysis. Overall, there was significant heterogeneity. The dominant etiology was vascular lesion, with an aggregate prevalence of 0.59 (95% CI 0.45-0.64; p < 0.001, Q = 302.8, I2 = 92%). In 18 studies reporting a detailed etiological spectrum, arteriovenous malformation was the dominant etiology (68.3% [95% CI 64.2%-70.9%] of all vascular causes), followed by cavernoma (15.7% [95% CI 13.0%-18.2%]). CONCLUSIONS The most frequent etiology of pICH is brain arteriovenous malformation. The probability of an underlying vascular etiology increases with age, and, conversely, hematological and cardiac causes are dominant causes in children younger than 2 years.
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Affiliation(s)
- Grégoire Boulouis
- 1Service d'imagerie Morphologique et Fonctionnelle, GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris.,2Pediatric Radiology Department
| | | | | | - Jean-François Hak
- 1Service d'imagerie Morphologique et Fonctionnelle, GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris.,2Pediatric Radiology Department
| | - Florent Gariel
- 1Service d'imagerie Morphologique et Fonctionnelle, GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris.,2Pediatric Radiology Department
| | | | | | | | - Fanny Bajolle
- 5Unité Médico-Chirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de référence Malformations Cardiaques Congénitales Complexes-M3C
| | - Lorenzo Garzelli
- 1Service d'imagerie Morphologique et Fonctionnelle, GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris.,2Pediatric Radiology Department
| | | | | | | | | | - Annie Harroche
- 7Department of Hematology, Haemophilia Care Centre, Hôpital Necker Enfants Malades, AP-HP, Université de Paris
| | - Rossella Letizia Mancusi
- 8Délégation à la recherche clinique et à l'Innovation (DRCI), GHU Paris Psychiatrie et Neurosciences, Paris; and
| | - Nathalie Boddaert
- 2Pediatric Radiology Department.,9INSERM U1163, Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, and INSERM U1000, Paris, France
| | | | - Francis Brunelle
- 1Service d'imagerie Morphologique et Fonctionnelle, GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris.,2Pediatric Radiology Department
| | | | - Olivier Naggara
- 1Service d'imagerie Morphologique et Fonctionnelle, GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris.,2Pediatric Radiology Department
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28
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Garzelli L, Shotar E, Blauwblomme T, Sourour N, Alias Q, Stricker S, Mathon B, Kossorotoff M, Gariel F, Boddaert N, Brunelle F, Meyer P, Naggara O, Clarençon F, Boulouis G. Risk Factors for Early Brain AVM Rupture: Cohort Study of Pediatric and Adult Patients. AJNR Am J Neuroradiol 2020; 41:2358-2363. [PMID: 33122204 DOI: 10.3174/ajnr.a6824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/06/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Whether architectural characteristics of ruptured brain AVMs vary across the life span is unknown. We aimed to identify angioarchitectural features associated with brain AVMs ruptured early in life. MATERIALS AND METHODS Patients with ruptured brain AVMs referred to 2 distinct academic centers between 2000 and 2018 were pooled and retrospectively analyzed. Imaging was retrospectively reviewed for angioarchitectural characteristics, including nidus size, location, Spetzler-Martin grade, venous drainage, and arterial or nidal aneurysm. Angioarchitecture variations across age groups were analyzed using uni- and multivariable models; then cohorts were pooled and analyzed using Kaplan-Meier and Cox models to determine factors associated with earlier rupture. RESULTS Among 320 included patients, 122 children (mean age, 9.8 ± 3.8 years) and 198 adults (mean age, 43.3 ± 15.7 years) were analyzed. Pediatric brain AVMs were more frequently deeply located (56.3% versus 21.2%, P < .001), with a larger nidus (24.2 versus 18.9 mm, P = .002), were less frequently nidal (15.9% versus 23.5%, P = .03) and arterial aneurysms (2.7% versus 17.9%, P < .001), and had similar drainage patterns or Spetzler-Martin grades. In the fully adjusted Cox model, supratentorial, deep brain AVM locations (adjusted relative risk, 1.19; 95% CI, 1.01-1.41; P = .03 and adjusted relative risk, 1.43; 95% CI, 1.22-1.67; P < .001, respectively) and exclusively deep venous drainage (adjusted relative risk, 1.46, 95% CI, 1.21-1.76; P < .001) were associated with earlier rupture, whereas arterial or nidal aneurysms were associated with rupture later in life. CONCLUSIONS The angioarchitecture of ruptured brain AVMs significantly varies across the life span. These distinct features may help to guide treatment decisions for patients with unruptured AVMs.
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Affiliation(s)
- L Garzelli
- From the Department of Neuroradiology (L.G., O.N., G.B.), Sainte-Anne University Hospital, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1266, Paris, France.,Departments of Neuroradiology (L.G., F.C.)
| | - E Shotar
- Department of Neuroradiology (E.S., N.S., F.C.)
| | - T Blauwblomme
- Department of Pediatric Neurosurgery (T.B., S.S.), French Center for Pediatric Stroke.,Université de Paris (T.B., N.B., F.B., O.N., G.B.), Paris, France
| | - N Sourour
- Department of Neuroradiology (E.S., N.S., F.C.)
| | - Q Alias
- Department of Pediatric Imaging (Q.A., N.B., F.B., O.N., G.B.)
| | - S Stricker
- Department of Pediatric Neurosurgery (T.B., S.S.), French Center for Pediatric Stroke
| | - B Mathon
- Neurosurgery (B.M.), Sorbonne University, Paris, France.,Neurosurgery (B.M.), Pitié-Salpêtrière University Hospital, Public Assistance-Paris Hospitals, Paris, France.,Brain and Spine Institute (B.M.), Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1127; Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
| | - M Kossorotoff
- Department of Pediatric Neurology (M.K.), French Center for Pediatric Stroke
| | - F Gariel
- Department of Neuroimaging (F.G.), Pellegrin Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - N Boddaert
- Department of Pediatric Imaging (Q.A., N.B., F.B., O.N., G.B.).,Université de Paris (T.B., N.B., F.B., O.N., G.B.), Paris, France
| | - F Brunelle
- Department of Pediatric Imaging (Q.A., N.B., F.B., O.N., G.B.).,Université de Paris (T.B., N.B., F.B., O.N., G.B.), Paris, France
| | - P Meyer
- Department of Anesthesiology (P.M.), Necker-Enfants Malades University Hospital, Public Assistance-Paris Hospitals, Paris, France
| | - O Naggara
- From the Department of Neuroradiology (L.G., O.N., G.B.), Sainte-Anne University Hospital, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1266, Paris, France.,Department of Pediatric Imaging (Q.A., N.B., F.B., O.N., G.B.).,Université de Paris (T.B., N.B., F.B., O.N., G.B.), Paris, France
| | - F Clarençon
- Departments of Neuroradiology (L.G., F.C.).,Department of Neuroradiology (E.S., N.S., F.C.)
| | - G Boulouis
- From the Department of Neuroradiology (L.G., O.N., G.B.), Sainte-Anne University Hospital, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1266, Paris, France .,Department of Pediatric Imaging (Q.A., N.B., F.B., O.N., G.B.).,Université de Paris (T.B., N.B., F.B., O.N., G.B.), Paris, France
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29
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Aubart M, Gitiaux C, Roux CJ, Levy R, Schuffenecker I, Mirand A, Bach N, Moulin F, Bergounioux J, Leruez-Ville M, Rozenberg F, Sterlin D, Musset L, Antona D, Boddaert N, Zhang SY, Kossorotoff M, Desguerre I. Severe Acute Flaccid Myelitis Associated With Enterovirus in Children: Two Phenotypes for Two Evolution Profiles? Front Neurol 2020; 11:343. [PMID: 32411086 PMCID: PMC7198806 DOI: 10.3389/fneur.2020.00343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/07/2020] [Indexed: 12/19/2022] Open
Abstract
Acute flaccid myelitis (AFM) is an acute paralysis syndrome defined by a specific inflammation of the anterior horn cells of the spinal cord. From 2014, worrying waves of life-threatening AFM consecutive to enterovirus infection (EV-D68 and EV-A71) have been reported. We describe 10 children displaying an AFM with an EV infection, the treatments performed and the 1 to 3-years follow-up. Two groups of patients were distinguished: 6 children (“polio-like group”) had severe motor disability whereas 4 other children (“brainstem group”) displayed severe brainstem weakness requiring ventilation support. Electrodiagnostic studies (n = 8) support the presence of a motor neuronopathy associated to myelitis. The best prognosis factor seems to be the motor recovery after the first 4 weeks of the disease.
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Affiliation(s)
- Melodie Aubart
- Department of Paediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France.,INSERM 1163, Imagine Institute, Paris, France
| | - Cyril Gitiaux
- Department of Paediatric Neurophysiology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France.,INSERM U955-Team 10, Department of Neurosciences, Mondor Biomedical Research Institute, Paris-Est University, Créteil, France
| | - Charles Joris Roux
- Department of Paediatric Radiology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Raphael Levy
- Department of Paediatric Radiology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Isabelle Schuffenecker
- Laboratory of Virology, National Reference Center for Enterovirus, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Audrey Mirand
- Laboratory of Virology, National Reference Center for Enterovirus Associated Laboratory, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nathalie Bach
- Paediatric Department, CHU Caen-Normandie, Caen, France
| | - Florence Moulin
- Intensive Care Unit, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Jean Bergounioux
- Intensive Care Unit, CHU Raymond Poincaré, Paris Saclay University, AP-HP, Garches, France
| | - Marianne Leruez-Ville
- Laboratory of Virology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Flore Rozenberg
- Laboratory of Virology, Cochin Hospital, University of Paris, AP-HP, Paris, France
| | - Delphine Sterlin
- Laboratory of Immunology, Pitié-Salpétrière Hospital, Sorbonne University, AP-HP, Paris, France
| | - Lucile Musset
- Laboratory of Immunology, Pitié-Salpétrière Hospital, Sorbonne University, AP-HP, Paris, France
| | - Denise Antona
- Direction des maladies infectieuses, Santé publique France, Saint-Maurice, France
| | - Nathalie Boddaert
- INSERM U955-Team 10, Department of Neurosciences, Mondor Biomedical Research Institute, Paris-Est University, Créteil, France.,Department of Paediatric Radiology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | | | - Manoelle Kossorotoff
- Department of Paediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Isabelle Desguerre
- Department of Paediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
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Rubinato E, Rondeau S, Giuliano F, Kossorotoff M, Parodi M, Gherbi S, Steffan J, Jonard L, Marlin S. MED12 missense mutation in a three-generation family. Clinical characterization of MED12-related disorders and literature review. Eur J Med Genet 2020; 63:103768. [DOI: 10.1016/j.ejmg.2019.103768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 07/23/2019] [Accepted: 09/15/2019] [Indexed: 10/26/2022]
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Aloui C, Guey S, Pipiras E, Kossorotoff M, Guéden S, Corpechot M, Bessou P, Pedespan JM, Husson M, Hervé D, Riant F, Kraemer M, Steffann J, Quenez O, Tournier-Lasserve E. Xq28 copy number gain causing moyamoya disease and a novel moyamoya syndrome. J Med Genet 2020; 57:339-346. [PMID: 31924698 DOI: 10.1136/jmedgenet-2019-106525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/23/2019] [Revised: 11/22/2019] [Accepted: 12/12/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND The molecular anomalies causing moyamoya disease (MMD) and moyamoya syndromes (MMS) are unknown in most patients. OBJECTIVE This study aimed to identify de novo candidate copy number variants (CNVs) in patients with moyamoya. METHODS Rare de novo CNVs screening was performed in 13 moyamoya angiopathy trios using whole exome sequencing (WES) reads depth data and whole genome high density SNP array data. WES and SNP array data from an additional cohort of 115 unrelated moyamoya probands were used to search for recurrence of these rare de novo CNVs. RESULTS Two de novo CNVs were identified in two unrelated probands by both methods and confirmed by qPCR. One of these CNVs, located on Xq28, was detected in two additional families. This interstitial Xq28 CNV gain is absent from curated gold standard database of control genomic variants and gnomAD databases. The critical region contains five genes, including MAMLD1, a major NOTCH coactivator. Typical MMD was observed in the two families with a duplication, whereas in the triplicated patients of the third family, a novel MMS associating moyamoya and various systemic venous anomalies was evidenced. CONCLUSION The recurrence of this novel Xq28 CNV, its de novo occurrence in one patient and its familial segregation with the affected phenotype in two additional families strongly suggest that it is pathogenic. In addition to genetic counselling application, its association with pulmonary hypertension is of major importance for clinical care. These data also provide new insights into the genomic architecture of this emblematic, non-atherosclerotic, large vessel disease.
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Affiliation(s)
- Chaker Aloui
- Université de Paris, NeuroDiderot, Inserm UMR1141, Paris, France
| | - Stéphanie Guey
- Université de Paris, NeuroDiderot, Inserm UMR1141, Paris, France
| | - Eva Pipiras
- Université de Paris, NeuroDiderot, Inserm UMR1141, Paris, France.,Department of Cytogenetics, Embryology and Histology, AP-HP Hôpital Jean-Verdier, Bondy, France
| | - Manoelle Kossorotoff
- French Center for Pediatric Stroke, Department of Pediatric Neurology, APHP, University Hospital Necker-Enfants Malades, Paris, France
| | - Sophie Guéden
- Department of Pediatric Neurology, CHU Angers, Angers, France
| | - Michaelle Corpechot
- Service de Génétique Moléculaire Neurovasculaire, AP-HP Hôpital Lariboisière, Paris, France
| | - Pierre Bessou
- Service d'imagerie anténatale, de l'enfant et de la femme, Groupe Hospitalier Pellegrin-Hôpital des enfants, Bordeaux, France
| | - Jean-Michel Pedespan
- Service de neuropédiatrie, Groupe Hospitalier Pellegrin-Hôpital des enfants, Bordeaux, France
| | - Marie Husson
- Service de neuropédiatrie, Groupe Hospitalier Pellegrin-Hôpital des enfants, Bordeaux, France
| | - Dominique Hervé
- Université de Paris, NeuroDiderot, Inserm UMR1141, Paris, France.,Service de Neurologie, AP-HP Hôpital Lariboisière, Paris, France
| | - Florence Riant
- Service de Génétique Moléculaire Neurovasculaire, AP-HP Hôpital Lariboisière, Paris, France
| | - Markus Kraemer
- Department of Neurology, Alfried Krupp Hospital, Essen, Germany.,Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Julie Steffann
- Université Paris Descartes, Imagine INSERM UMR1163, Service de Génétique Moléculaire, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Olivier Quenez
- Normandie University, UNIROUEN, Inserm U1245 and Rouen University Hospital, Department of Genetics, Normandy Center for Genomic and Personalized Medicine, Rouen, France
| | - Elisabeth Tournier-Lasserve
- Université de Paris, NeuroDiderot, Inserm UMR1141, Paris, France .,Service de Génétique Moléculaire Neurovasculaire, AP-HP Hôpital Lariboisière, Paris, France
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Rambaud T, Legris N, Bejot Y, Bellesme C, Lapergue B, Jouvent E, Pico F, Smadja D, Zuber M, Crozier S, Lamy C, Spelle L, Tuppin P, Kossorotoff M, Denier C. Acute ischemic stroke in adolescents. Neurology 2019; 94:e158-e169. [PMID: 31831601 DOI: 10.1212/wnl.0000000000008783] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/30/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Adolescence represents a transition period between childhood and adulthood, and only limited information exists about stroke characteristics in this population. Our aim was to describe the clinical and neuroradiologic features, etiologies, initial management, and outcome of ischemic stroke in adolescents. METHODS This retrospective cohort study evaluated all consecutive patients 10 to 18 years with a first-ever ischemic stroke hospitalized between 2007 and 2017 in 10 French academic centers representing a population of ≈10 million. Extracted data from the national database served as validation. RESULTS A total of 60 patients were included (53% male, median age 15.2 years). Diagnosis at first medical contact was misevaluated in 36%, more frequently in posterior than anterior circulation strokes (55% vs 20% respectively, odds ratio 4.8, 95% confidence interval 1.41-16.40, p = 0.01). Recanalization treatment rate was high (n = 19, 32%): IV thrombolysis (17%), endovascular therapy (11.7%), or both IV and intra-arterial thrombolysis (3.3%); safety was good (only 1 asymptomatic hemorrhagic transformation). Despite thorough etiologic workup, 50% of strokes remained cryptogenic. The most common determined etiologies were cardioembolism (15%), vasculitis and autoimmune disorders (12%, occurring exclusively in female patients), and arterial dissections (10%, exclusively in male patients). Recurrent ischemic cerebrovascular events occurred in 12% (median follow-up 19 months). Recurrence rate was 50% in patients with identified vasculopathy but 0% after cryptogenic stroke. Functional outcome was favorable (Rankin Scale score 0-2 at day 90) in 80% of cases. CONCLUSIONS Ischemic strokes in adolescents harbor both pediatric and adult features, emphasizing the need for multidisciplinary collaboration in their management. Recanalization treatments appear feasible and safe.
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Affiliation(s)
- Thomas Rambaud
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Nicolas Legris
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Yannick Bejot
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Céline Bellesme
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Bertrand Lapergue
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Eric Jouvent
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Fernando Pico
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Didier Smadja
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Mathieu Zuber
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Sophie Crozier
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Catherine Lamy
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Laurent Spelle
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Philippe Tuppin
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Manoelle Kossorotoff
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Christian Denier
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France.
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Alias Q, Boulouis G, Blauwblomme T, Benichi S, Beccaria K, Gariel F, Garzelli L, Meyer P, Kossorotoff M, Boddaert N, Brunelle F, Naggara O. First Line Onyx Embolization in Ruptured Pediatric Arteriovenous Malformations : Safety and Efficacy. Clin Neuroradiol 2019; 31:155-163. [PMID: 31802150 DOI: 10.1007/s00062-019-00861-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/16/2019] [Accepted: 11/18/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Brain arteriovenous malformations (bAVM) are the main cause of pediatric intracerebral hemorrhage (pICH). Embolization with Onyx (ev3, Irvine, CA, USA) in children with ruptured bAVM has been infrequently reported. The aim of this study was to assess the safety and efficacy profile of Onyx embolization as first line endovascular treatment of ruptured pediatric bAVMs. METHODS Children with non-traumatic pICH due to bAVM rupture at a pediatric quaternary care center were prospectively enrolled in a registry and retrospectively analyzed between 2013 and 2018. Clinical and demographic data, treatment modalities and clinical imaging follow-up were retrieved, and detailed procedural data were retrospectively assessed by two investigators. The safety (procedural morbidity and mortality) and efficacy (obliteration and interval rebleeding) were evaluated. RESULTS In this study 29 children treated for a bAVM by Onyx embolization were included (14 girls, 48%; median age 11.1 years, interquartile range, IQR 8.1-12.7 years) with a total of 72 endovascular sessions (median of 2 sessions per patient IQR 1-3). The AVMs were deeply located in 23 patients (79%). No systemic complications occurred, and no child experienced embolization-related persistent neurological deficits. Non-clinically relevant complications were observed during five procedures, unrelated to Onyx. After a mean follow-up of 31 months from rupture complete obliteration rates were 100%, 89%, 29%, 14% in bAVM Spetzler Martin grades I, II, III and IV-V, respectively. CONCLUSION It was found that Onyx embolization is safe and represents a good option for an initial treatment approach, in a sequential treatment strategy for pediatric ruptured brain AVMs. Younger age may not be an argument to deny Onyx embolization.
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Affiliation(s)
- Quentin Alias
- Pediatric Radiology, Necker Children Hospital, Paris, France
| | - Grégoire Boulouis
- Pediatric Radiology, Necker Children Hospital, Paris, France.,INSERM UMR 1266 IMA-BRAIN, Department of Neuroradiology, CHSA, Université de Paris, Paris, France
| | - Thomas Blauwblomme
- Pediatric Neurosurgery Department, Necker Children Hospital, APHP, Paris, France.,Institut Imagine, INSERM UMR 1163, Université De Paris, Paris, France
| | - Sandro Benichi
- Pediatric Neurosurgery Department, Necker Children Hospital, APHP, Paris, France.,Institut Imagine, INSERM UMR 1163, Université De Paris, Paris, France
| | - Kevin Beccaria
- Pediatric Neurosurgery Department, Necker Children Hospital, APHP, Paris, France.,Institut Imagine, INSERM UMR 1163, Université De Paris, Paris, France
| | - Florent Gariel
- Pediatric Radiology, Necker Children Hospital, Paris, France.,INSERM UMR 1266 IMA-BRAIN, Department of Neuroradiology, CHSA, Université de Paris, Paris, France.,Pediatric Neurosurgery Department, Necker Children Hospital, APHP, Paris, France.,Institut Imagine, INSERM UMR 1163, Université De Paris, Paris, France.,Department of Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | | | - Philippe Meyer
- Pediatric Neuro ICU, Necker Children Hospital, APHP, Paris, France
| | - Manoelle Kossorotoff
- Department of Pediatric Neurology, French Centre for Pediatric Stroke, APHP University Necker Children Hospital, Paris, France
| | | | | | - Olivier Naggara
- Pediatric Radiology, Necker Children Hospital, Paris, France. .,INSERM UMR 1266 IMA-BRAIN, Department of Neuroradiology, CHSA, Université de Paris, Paris, France.
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Welfringer-Morin A, Moulin F, Drummond D, Oualha M, De Saint Blanquat L, Bendavid M, Aoust L, Belahda A, Kossorotoff M, Fertitta L, Bellon N, Hadj-Rabia S, Delacourt C, Leclerc-Mercier S, Frassati-Biaggi A, De Prost N, Oro S, Renolleau S, Bodemer C. Nécrolyse épidermique toxique de l’enfant : deux observations inhabituelles d’évolution fatale. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.186] [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] [Indexed: 11/30/2022]
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Pascreau T, de la Morena-Barrio ME, Lasne D, Serrano M, Bianchini E, Kossorotoff M, Boddaert N, Bruneel A, Seta N, Vicente V, de Lonlay P, Corral J, Borgel D. Elevated thrombin generation in patients with congenital disorder of glycosylation and combined coagulation factor deficiencies. J Thromb Haemost 2019; 17:1798-1807. [PMID: 31271700 DOI: 10.1111/jth.14559] [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: 11/16/2018] [Revised: 06/25/2019] [Accepted: 07/01/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Congenital disorders of glycosylation are rare inherited diseases affecting many different proteins. The lack of glycosylation notably affects the hemostatic system and leads to deficiencies of both procoagulant and anticoagulant factors. OBJECTIVE To assess the hemostatic balance in patients with multiple coagulation disorders by using a thrombin generation assay. METHOD We performed conventional coagulation assays and a thrombin generation assay on samples from patients with congenital disorder of glycosylation. The thrombin generation assay was performed before and after activation of the protein C system by the addition of soluble thrombomodulin. RESULTS A total of 35 patients were included: 71% and 57% had low antithrombin and factor XI levels, respectively. Protein C and protein S levels were abnormally low in 29% and 26% of the patients, respectively, whereas only 11% displayed low factor IX levels. Under baseline conditions, the thrombin generation assay revealed a significantly higher endogenous thrombin potential and thrombin peak in patients, relative to controls. After spiking with thrombomodulin, we observed impaired involvement of the protein C system. Hence, 54% of patients displayed a hypercoagulant phenotype in vitro. All the patients with a history of stroke-like episodes or thrombosis displayed this hypercoagulant phenotype. CONCLUSION A thrombin generation assay revealed a hypercoagulant in vitro phenotype under baseline condition; this was accentuated by impaired involvement of the protein C system. This procoagulant phenotype may thus reflect the risk of severe vascular complications. Further research will have to determine whether the thrombin generation assay is predictive of vascular events.
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Affiliation(s)
- Tiffany Pascreau
- Laboratoire d'Hématologie, AP-HP, Hôpital Necker-Enfants malades, Paris, France
- INSERM UMR-S1176, Le Kremlin-Bicêtre, France
| | - Maria E de la Morena-Barrio
- Servicio de Hematología y Oncología Médica, Centro Regional de Hemodonación, Hospital Universitario Morales Meseguer, Universidad de Murcia, IMIB-Arrixaca, CIBERER, Murcia, Spain
| | - Dominique Lasne
- Laboratoire d'Hématologie, AP-HP, Hôpital Necker-Enfants malades, Paris, France
- INSERM UMR-S1176, Le Kremlin-Bicêtre, France
| | - Mercedes Serrano
- Department of Pediatric Neurology, Institute of Pediatric Research-Hospital Sant Joan de Déu, U-703 Center for Biomedical Research on Rare Diseases, Barcelona, Spain
- Department of Genetic Medicine, Institute of Pediatric Research-Hospital Sant Joan de Déu, U-703 Center for Biomedical Research on Rare Diseases, Barcelona, Spain
| | | | - Manoelle Kossorotoff
- Paediatric Neurology Department, French Center for Paediatric Stroke, AP-HP, Hôpital Necker-Enfants-Malades, Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Department, AP-HP, Hôpital Necker-Enfants-Malades, Paris, France
- Institut Imagine, INSERM U1000 and UMR 1163, Paris, France
| | - Arnaud Bruneel
- Biochimie Métabolique, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Nathalie Seta
- Biochimie Métabolique, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Vicente Vicente
- Servicio de Hematología y Oncología Médica, Centro Regional de Hemodonación, Hospital Universitario Morales Meseguer, Universidad de Murcia, IMIB-Arrixaca, CIBERER, Murcia, Spain
| | - Pascale de Lonlay
- Reference Center of Metabolism, Imagine Institute, AP-HP, Hôpital Necker-Enfants Maladies, University Paris-Descartes, Paris, France
| | - Javier Corral
- Servicio de Hematología y Oncología Médica, Centro Regional de Hemodonación, Hospital Universitario Morales Meseguer, Universidad de Murcia, IMIB-Arrixaca, CIBERER, Murcia, Spain
| | - Delphine Borgel
- Laboratoire d'Hématologie, AP-HP, Hôpital Necker-Enfants malades, Paris, France
- INSERM UMR-S1176, Le Kremlin-Bicêtre, France
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Pinard A, Guey S, Guo D, Cecchi AC, Kharas N, Wallace S, Regalado ES, Hostetler EM, Sharrief AZ, Bergametti F, Kossorotoff M, Hervé D, Kraemer M, Bamshad MJ, Nickerson DA, Smith ER, Tournier-Lasserve E, Milewicz DM. The pleiotropy associated with de novo variants in CHD4, CNOT3, and SETD5 extends to moyamoya angiopathy. Genet Med 2019; 22:427-431. [PMID: 31474762 DOI: 10.1038/s41436-019-0639-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 05/22/2019] [Accepted: 08/13/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Moyamoya angiopathy (MMA) is a cerebrovascular disease characterized by occlusion of large arteries, which leads to strokes starting in childhood. Twelve altered genes predispose to MMA but the majority of cases of European descent do not have an identified genetic trigger. METHODS Exome sequencing from 39 trios were analyzed. RESULTS We identified four de novo variants in three genes not previously associated with MMA: CHD4, CNOT3, and SETD5. Identification of additional rare variants in these genes in 158 unrelated MMA probands provided further support that rare pathogenic variants in CHD4 and CNOT3 predispose to MMA. Previous studies identified de novo variants in these genes in children with developmental disorders (DD), intellectual disability, and congenital heart disease. CONCLUSION These genes encode proteins involved in chromatin remodeling, and taken together with previously reported genes leading to MMA-like cerebrovascular occlusive disease (YY1AP1, SMARCAL1), implicate disrupted chromatin remodeling as a molecular pathway predisposing to early onset, large artery occlusive cerebrovascular disease. Furthermore, these data expand the spectrum of phenotypic pleiotropy due to alterations of CHD4, CNOT3, and SETD5 beyond DD to later onset disease in the cerebrovascular arteries and emphasize the need to assess clinical complications into adulthood for genes associated with DD.
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Affiliation(s)
- Amélie Pinard
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stéphanie Guey
- INSERM UMR-S1161, Génétique et physiopathologie des maladies cérébro-vasculaires, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Dongchuan Guo
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alana C Cecchi
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Natasha Kharas
- Department of Neurobiology and Anatomy, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephanie Wallace
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ellen S Regalado
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ellen M Hostetler
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Anjail Z Sharrief
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Françoise Bergametti
- INSERM UMR-S1161, Génétique et physiopathologie des maladies cérébro-vasculaires, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Manoelle Kossorotoff
- AP-HP, French Center for Pediatric Stroke and Pediatric Neurology Department, University Hospital Necker-Enfants Malades, Paris, France
| | - Dominique Hervé
- AP-HP, Service de neurologie, Centre de Référence des Maladies Vasculaires Rares du Cerveau et de L'œil, Groupe Hospitalier Lariboisière Saint Louis, Paris, France
| | - Markus Kraemer
- Department of Neurology Alfried Krupp-Hospital, Essen and Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Michael J Bamshad
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA.,Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | | | - Edward R Smith
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elisabeth Tournier-Lasserve
- INSERM UMR-S1161, Génétique et physiopathologie des maladies cérébro-vasculaires, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,AP-HP, Service de génétique moléculaire neurovasculaire, Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'œil, Groupe Hospitalier Saint-Louis Lariboisière, Paris, France
| | - Dianna M Milewicz
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
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Hervé D, Ibos-Augé N, Calvière L, Rogan C, Labeyrie MA, Guichard JP, Godin O, Kossorotoff M, Habert MO, Lasserve ET, Chevret S, Chabriat H. Predictors of clinical or cerebral lesion progression in adult moyamoya angiopathy. Neurology 2019; 93:e388-e397. [PMID: 31239360 PMCID: PMC6669931 DOI: 10.1212/wnl.0000000000007819] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/11/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To identify independent predictors of clinical or cerebral lesion progression in a large sample of adult patients with moyamoya angiopathy (MMA) prior to decisions regarding revascularization surgery. METHODS Ninety participants (median age, 37.5 years) were assessed at baseline and followed for a median time of 42.8 months. Incident ischemic and hemorrhagic strokes, death, as well as any incident ischemic and hemorrhagic lesions on MRI were recorded. Multiple demographic, clinical, and cerebral imaging measures at baseline were considered as potential predictors of clinical or cerebral tissue change at follow-up. Data were analyzed based on the Andersen-Gill counting process model, followed by internal validation of the prediction model. RESULTS Among multiple potential predictive measures considered in the analysis, Asian origin, a history of TIAs, and a reduction in hemodynamic reserve, as detected by imaging, were found to be significantly associated with an increased risk of combined clinical and imaging events. While the model estimated the risk of clinical or cerebral lesion progression to be approximately 0.5% per year when none of these factors was present, this risk exceeded 20% per year when all factors were present. CONCLUSION A simple combination of demographic, clinical, and cerebral perfusion imaging measures may aid in predicting the risk of incident stroke and cerebral lesion progression in adult patients with MMA. These results may help to improve therapeutic decisions and aid in the design of future trials in adults with this rare condition.
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Affiliation(s)
- Dominique Hervé
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France.
| | - Nathanaelle Ibos-Augé
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Lionel Calvière
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Christina Rogan
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Marc Antoine Labeyrie
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Jean Pierre Guichard
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Ophélia Godin
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Manoelle Kossorotoff
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Marie Odile Habert
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Elisabeth Tournier Lasserve
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Sylvie Chevret
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Hugues Chabriat
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France.
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Durrleman C, Naggara O, Grevent D, Belot A, Desgranges M, Boyer O, Chabrier S, Bader-Meunier B, Kossorotoff M. Reversible cerebral vasoconstriction syndrome in paediatric patients with systemic lupus erythematosus: implications for management. Dev Med Child Neurol 2019; 61:725-729. [PMID: 30246466 DOI: 10.1111/dmcn.14031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 12/18/2022]
Abstract
Microvascular brain injury is well recognized in neuropsychiatric systemic lupus erythematosus (SLE), but cerebral large artery involvement is being debated. Three females with SLE, aged 9 to 14 years, had immunosuppressive treatment intensification because of lupus nephritis. Within the following days or weeks, they presented with intense cephalalgia - isolated or associated with neurological symptoms - and no or mild hypertension. Magnetic resonance angiography showed multiple stenoses within the circle of Willis. One patient had subsequent small subcortical cerebral infarction. Two patients were treated for neuropsychiatric SLE; one patient was treated for reversible cerebral vasoconstriction syndrome (RCVS). Angiography normalized within a few weeks in all three patients. Retrospectively, clinical and radiological features suggest that RCVS was the most likely diagnosis in all patients. Multidisciplinary analysis of clinical and angiographic features is recommended, as RCVS is rare in children and its recognition may help to adjust treatment. WHAT THIS PAPER ADDS: Reversible vasoconstriction syndrome was observed in paediatric systemic lupus erythematosus. Thorough imaging analysis was necessary to address this diagnosis in paediatric patients.
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Affiliation(s)
- Chloé Durrleman
- Paediatric Neurology, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Olivier Naggara
- Neuroradiology, Centre Hospitalier Sainte-Anne, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Paediatric Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Paris, France.,Université Paris-Descartes, Paris, France
| | - David Grevent
- Paediatric Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Alexandre Belot
- Paediatric Rheumatology, Nephrology and Dermatology Department, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, Institut National de la Santé et de la Recherche Médicale, Lyon, France
| | | | - Olivia Boyer
- Université Paris-Descartes, Paris, France.,Paediatric Nephrology, MARHEA, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Stéphane Chabrier
- French Centre for Paediatric Stroke, Paediatric Physical and Rehabilitation Medicine Department, CHU Saint-Étienne, Saint-Étienne, France.,Sainbiose, Institut National de la Santé et de la Recherche Médicale, Université Saint-Étienne, Université Lyon, Saint-Étienne, France
| | - Brigitte Bader-Meunier
- Université Paris-Descartes, Paris, France.,Paediatric Immunology, Hematology and Rheumatology, Institut National de la Santé et de la Recherche Médicale, U1163, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Manoelle Kossorotoff
- Paediatric Neurology, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Paris, France.,French Centre for Paediatric Stroke, Hôpital Universitaire Necker-Enfants Malades, Paris, France
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Kossorotoff M, De Montalembert M, Brousse V, Lasne D, Curis E, Smadja DM, Lacroix R, Bertil S, Masson E, Desguerre I, Bonnet D, Gaussem P. CD34+ Hematopoietic Stem Cell Count Is Predictive of Vascular Event Occurrence in Children with Sickle Cell Disease. Stem Cell Rev Rep 2019; 14:694-701. [PMID: 29931411 DOI: 10.1007/s12015-018-9835-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Sickle cell disease (SCD) complications mostly result from vascular dysfunction, concerning systemic microvasculature and cerebral large vessels. The aim of this cohort study was to identify potential circulating biomarkers predictive for further vascular event occurrence in pediatric SCD. METHODS We consecutively enrolled 108 children with SCD at steady state, aged 3-18 years old (median 9.8 years). Hematology, coagulation, hemolysis, endothelial, platelet and vascular activation parameters were recorded at inclusion. Neurovascular and systemic vascular events were prospectively recorded during a mean follow-up period of 27 months. RESULTS Patients at steady state displayed significantly higher hemolysis and platelet activation markers, higher leukocyte, CD34+ hematopoietic stem cell and microvesicle counts, and a pro-coagulant profile compared to controls matched for age and ethnicity. Circulating endothelial cell or nucleosome level did not differ. During the follow-up period, 36 patients had at least one neurovascular (n = 12) or systemic vascular event (n = 25). In a multivariate model, high CD34+ cell count was the best predictor for the occurrence of a vascular event (OR 1.2 for 1000 cell/mL increase, 95% CI [1.049-1.4], p = 0.013, sensitivity 53%, specificity 84% for a threshold of 8675 cells/mL). CONCLUSION CD34+ cell count at steady state is a promising biomarker of further vascular event in children with SCD.
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Affiliation(s)
- Manoelle Kossorotoff
- Inserm UMR-S1140, Faculté de Pharmacie, Paris, France. .,AP-HP, Child Neurology, French center for pediatric stroke, Hôpital Universitaire Necker-Enfants malades, 149 rue de Sèvres, 75015, Paris, France.
| | - Mariane De Montalembert
- AP-HP, Pediatric Sickle Cell Clinic, Hôpital Universitaire Necker-Enfants malades and Laboratory of Excellence, GR-Ex, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Valentine Brousse
- AP-HP, Pediatric Sickle Cell Clinic, Hôpital Universitaire Necker-Enfants malades and Laboratory of Excellence, GR-Ex, Paris, France
| | - Dominique Lasne
- Inserm UMR-S1140, Faculté de Pharmacie, Paris, France.,AP-HP, Laboratoire d'hématologie, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Emmanuel Curis
- Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Laboratoire de biomathématiques, plateau iB2, Faculté de Pharmacie, Paris, France
| | - David M Smadja
- Inserm UMR-S1140, Faculté de Pharmacie, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,AP-HP, Service d'hématologie biologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Romaric Lacroix
- Inserm UMR-S1076, UFR de Pharmacie, Aix Marseille Université, Marseille, France
| | - Sebastien Bertil
- AP-HP, Service d'hématologie biologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Elodie Masson
- Inserm UMR-S1076, UFR de Pharmacie, Aix Marseille Université, Marseille, France
| | - Isabelle Desguerre
- AP-HP, Child Neurology, French center for pediatric stroke, Hôpital Universitaire Necker-Enfants malades, 149 rue de Sèvres, 75015, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Damien Bonnet
- Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,AP-HP, M3C-Necker, Cardiologie Congénitale et Pédiatrique, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Pascale Gaussem
- Inserm UMR-S1140, Faculté de Pharmacie, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,AP-HP, Service d'hématologie biologique, Hôpital Européen Georges Pompidou, Paris, France
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Cavallin M, Mine M, Philbert M, Boddaert N, Lepage JM, Coste T, Lopez-Gonzalez V, Sanchez-Soler MJ, Ballesta-Martínez MJ, Remerand G, Pasquier L, Guët A, Chelly J, Lascelles K, Prieto-Morin C, Kossorotoff M, Tournier Lasserve E, Bahi-Buisson N. Further refinement of COL4A1 and COL4A2 related cortical malformations. Eur J Med Genet 2018; 61:765-772. [DOI: 10.1016/j.ejmg.2018.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 09/27/2018] [Accepted: 10/07/2018] [Indexed: 01/01/2023]
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Atallah V, Meot M, Kossorotoff M, Galmiche-Rolland L, Lardeux C, Neven B, Bodemer C, Bonnet D. A case of reversible pulmonary arterial hypertension associated with incontinentia pigmenti. Pulm Circ 2018; 8:2045894018793983. [PMID: 30036148 PMCID: PMC6131310 DOI: 10.1177/2045894018793983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Incontinentia pigmenti (IP) is a multisystemic disorder in which pulmonary arterial hypertension (PAH) is a severe and rarely reported association. The prognosis has been poor in reported cases. In our patient, IP was diagnosed during the neonatal period with a combination of cutaneous, ophthalmic, and neurological symptoms. The infant experienced severe collapse with bradycardia during general anesthesia to treat retinal telangiectasia. Echocardiography after resuscitation revealed suprasystemic pulmonary hypertension (PH). Right heart catheterization (RHC) confirmed precapillary PAH not responding to acute vasodilatation test. Lung biopsy was performed to exclude alveolo-capillary dysplasia. Upfront triple therapy with endothelin receptor antagonist, PDE5 inhibitors, and prostacyclin was started. Due to a potential inflammatory mechanism of this acute PAH in the setting of IP, TNF-alpha blockers and steroids were associated. The evolution was favorable with progressive normalization of the pulmonary artery pressure confirmed by RHC after six months. Doses of PAH drugs were tapered down, and finally all PAH treatments could be stopped after 18 months. Subsequent controls including physical exams and echocardiograms did not show signs of PH. This unusual reversible case of pediatric PAH without associated congenital heart disease or portal hypertension highlights the potential reversibility of pediatric PH when an inflammatory mechanism can be suspected. This is the first reported case of non-fatal isolated PAH associated with IP.
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Affiliation(s)
- Veronique Atallah
- 1 Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France
| | - Mathilde Meot
- 1 Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France
| | - Manoelle Kossorotoff
- 2 Department of Pediatric Neurology, Necker Enfants Malades Hospital, Paris, France
| | | | - Claude Lardeux
- 1 Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France
| | - Benedicte Neven
- 4 Department of Immunology, Necker Enfants Malades Hospital, Paris, France
| | - Christine Bodemer
- 5 Department of Dermatology, National Reference Centre for Genodermatoses (MAGEC), Necker Enfants malades Hospital, Paris, France.,6 UMR 1163, Imagine Institute, University René Descartes, PRES Sorbonne Paris, France
| | - Damien Bonnet
- 1 Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France.,6 UMR 1163, Imagine Institute, University René Descartes, PRES Sorbonne Paris, France
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Hervé D, Kossorotoff M, Bresson D, Blauwblomme T, Carneiro M, Touze E, Proust F, Desguerre I, Alamowitch S, Bleton JP, Borsali A, Brissaud E, Brunelle F, Calviere L, Chevignard M, Geffroy-Greco G, Faesch S, Habert MO, De Larocque H, Meyer P, Reyes S, Thines L, Tournier-Lasserve E, Chabriat H. French clinical practice guidelines for Moyamoya angiopathy. Rev Neurol (Paris) 2018. [PMID: 29519672 DOI: 10.1016/j.neurol.2017.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Blauwblomme T, Mathon B, Naggara O, Kossorotoff M, Bourgeois M, Puget S, Meyer P, Brousse V, de Montalembert M, Brunelle F, Zerah M, Sainte-Rose C. Long-term Outcome After Multiple Burr Hole Surgery in Children With Moyamoya Angiopathy: A Single-Center Experience in 108 Hemispheres. Neurosurgery 2018; 80:950-956. [PMID: 28327981 DOI: 10.1093/neuros/nyw161] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 03/21/2016] [Accepted: 12/22/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Multiple burr hole (MBH) surgery is a simple, safe, and effective indirect technique of revascularization in moyamoya angiopathy (MM). However, it is not yet recognized as a first-line treatment. OBJECTIVE To assess the long-term outcome and perioperative complications in a large single-center cohort of children with MM who underwent burr hole surgery. METHODS This study is a retrospective analysis of children who underwent surgery for MM in a national reference center for pediatric stroke between 1999 and 2015. Sixty-four children (108 hemispheres, median age 7 years) were consecutively treated. The indication for revascularization was previous stroke or transient ischemic attack (TIA) or rapidly progressive disease on brain magnetic resonance imaging (MRI) and digital subtraction angiography. Children were followed with clinical examinations, telephone interviews, and MRI with any clinical recurrence of stroke or TIA used as the primary endpoint. Surgical mortality and morbidity were documented. RESULTS Sixty-four patients were operated (bilateral MBH n = 39, unilateral procedure n = 25). At a mean follow-up of 4.2 years and 270.6 patient years, 89.1% of patients had not suffered any recurrent stroke or TIA. A second surgery was required in 5 cases after unilateral revascularization, and in 3 cases after bilateral MBH. Mortality associated with the procedure was 0. Postoperative Matsushima angiographic grading was the only predictive factor of ischemic recurrence ( P = .036). CONCLUSION In pediatric MM, MBH compares favorably to other indirect or direct revascularization techniques in children in the prevention of stroke or TIA.
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Affiliation(s)
- Thomas Blauwblomme
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France
| | | | - Olivier Naggara
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,INSERM U894, Department of Neuroradiology, Sainte-Anne Hospital, Paris, France.,APHP, Department of Pediatric Neurology, French Center for Pediatric Stroke, Necker Hospital, Paris, France
| | - Manoelle Kossorotoff
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Pediatric Neurology, French Center for Pediatric Stroke, Necker Hospital, Paris, France.,APHP, Department of Anesthesiology, Necker Hospital, Paris, France
| | - Marie Bourgeois
- APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France
| | - Stéphanie Puget
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France
| | - Philippe Meyer
- APHP, Department of Anesthesiology, Necker Hospital, Paris, France
| | - Valentine Brousse
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,Reference Centre for Sickle Cell Disease, Necker Hospital, Paris, France
| | - Marianne de Montalembert
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,Reference Centre for Sickle Cell Disease, Necker Hospital, Paris, France
| | - Francis Brunelle
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Neuroradiology, Necker Hospital, Paris, France
| | - Michel Zerah
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France.,French National Reference Centre for Pediatric Stroke, Paris, France
| | - Christian Sainte-Rose
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France
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Chareyre J, Hully M, Simonnet H, Musset L, Barnerias C, Kossorotoff M, Quijano-Roy S, Desguerre I, Gitiaux C. Acute axonal neuropathy subtype of Guillain Barré syndrome in a French pediatric series: Adequate follow-up may require repetitive electrophysiological studies. Eur J Paediatr Neurol 2017; 21:891-897. [PMID: 28754297 DOI: 10.1016/j.ejpn.2017.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/30/2017] [Accepted: 07/10/2017] [Indexed: 12/27/2022]
Abstract
Different subtypes of Guillain Barré Syndromes (GBSs) are defined by their electrophysiological characteristics, acute inflammatory demyelinating neuropathy (AIDP), and acute motor/motor-sensory axonal forms (AMAN/AMSAN) with either reversible nerve conduction failure (RCF) or axonal degeneration. Our aim was to describe initial clinical and electrophysiological characteristics of axonal forms of GBS in a pediatric population and their short- and long-term evolution. Electroneuromyogram (ENMG) results were collected at diagnosis and at two months of evolution and interpreted using the recently proposed pattern of RCF vs axonal degeneration. Clinical evaluation was standardized using the GBS disability scale ("GBSds") at diagnosis, and then at 3, 6, and 12 months of evolution. Outcome was compared to those of patients with AIDP diagnosed within the same period. Eleven patients were included, among whom eight patients presenting with AMAN and three with AMSAN. Two subgroups were identified according to severity. Three patients had a severe form (GBSds ≥2 at 12 months), two of them presenting an axonal degeneration on ENMG studies. Seven patients had a less severe form (GBSds ≤1 at 12 months), five of them with RCF on ENMG studies. Axonal forms had a more severe evolution than demyelinating forms (n = 17) at 3 months (median GBSds 3 and 2, respectively), 6 months (2 and 0), and 12 months (1 and 0), (p < 0,05). Axonal forms of GBS in children have a more severe global outcome than demyelinating forms. Axonal degeneration in two successive early ENMGs may be a prognostic factor of poor outcome.
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Affiliation(s)
- Judith Chareyre
- Service de neurologie pédiatrique et maladies métaboliques, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie Hully
- Service de neurologie pédiatrique et maladies métaboliques, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hina Simonnet
- Service de neurologie pédiatrique et maladies métaboliques, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucile Musset
- Département d'immunologie, Hôpital La Pitié Salpetrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christine Barnerias
- Service de neurologie pédiatrique et maladies métaboliques, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de référence des pathologies neuromusculaires "Garches-Necker-Mondor-Hendaye", FILNEMUS, France
| | - Manoelle Kossorotoff
- Service de neurologie pédiatrique et maladies métaboliques, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Susana Quijano-Roy
- Centre de référence des pathologies neuromusculaires "Garches-Necker-Mondor-Hendaye", FILNEMUS, France; Service de pédiatrie, Hôpital de Garches, Garches, France
| | - Isabelle Desguerre
- Service de neurologie pédiatrique et maladies métaboliques, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de référence des pathologies neuromusculaires "Garches-Necker-Mondor-Hendaye", FILNEMUS, France
| | - Cyril Gitiaux
- Centre de référence des pathologies neuromusculaires "Garches-Necker-Mondor-Hendaye", FILNEMUS, France; Service d'explorations fonctionnelles, Laboratoire de neurophysiologie clinique, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Dangouloff-Ros V, Hadj-Rabia S, Oliveira Santos J, Bal E, Desguerre I, Kossorotoff M, An I, Smahi A, Bodemer C, Munnich A, Steffann J, Boddaert N. Severe neuroimaging anomalies are usually associated with random X inactivation in leucocytes circulating DNA in X-linked dominant Incontinentia Pigmenti. Mol Genet Metab 2017; 122:140-144. [PMID: 28711407 DOI: 10.1016/j.ymgme.2017.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/02/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
Incontinentia Pigmenti (IP) is a skin disorder with neurological impairment in 30% of cases. The most common disease causing mutation is a deletion of exons 4-10 of the IKBKG gene, located on chromosome Xq28, with skewed X-chromosome inactivation in females, but few cases of random X-inactivation have been reported. We have correlated brain anomalies with X-chromosome inactivation status determined on leucocytes circulating DNA. We reviewed MRI of 18 girls with genetically proven IP. We found three patterns of MRI, normal MRI (n=5), mild white matter abnormalities with cortical and corpus callosum atrophy (n=6), and severe cortical abnormalities suggesting a vascular disease (n=7). Most patients with severe abnormalities had random X-inactivation (6/7,86%), while 80% (4/5) of patients with normal MRI and 100% (6/6) of patients with mild white matter abnormalities had skewed inactivation. These results suggest that skewed chromosome X-inactivation may protect brain from damage, while in case of random inactivation, expression of the mutated IKBKG gene may lead to severe brain lesions.
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Affiliation(s)
- Volodia Dangouloff-Ros
- Department of Pediatric Radiology, Hôpital Necker Enfants Malades, AP-HP, 149 rue de Sèvres, 75105 Paris, France; INSERM U1000, 149 rue de Sèvres, 75015 Paris, France; UMR 1163, Institut Imagine, 24 boulevard du Montparnasse, 75015 Paris, France; University René Descartes, PRES Sorbonne Paris Cité, 12 rue de l'Ecole de Médecine, Paris, France.
| | - Smail Hadj-Rabia
- University René Descartes, PRES Sorbonne Paris Cité, 12 rue de l'Ecole de Médecine, Paris, France; Department of Pediatric Dermatology, Hôpital Necker Enfants Malades, AP-HP, 149 rue de Sèvres, 75105 Paris, France
| | - Judite Oliveira Santos
- UMR 1163, Institut Imagine, 24 boulevard du Montparnasse, 75015 Paris, France; Genetic unit, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, France
| | - Elodie Bal
- UMR 1163, Institut Imagine, 24 boulevard du Montparnasse, 75015 Paris, France; Genetic unit, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, France
| | - Isabelle Desguerre
- UMR 1163, Institut Imagine, 24 boulevard du Montparnasse, 75015 Paris, France; University René Descartes, PRES Sorbonne Paris Cité, 12 rue de l'Ecole de Médecine, Paris, France; Department of Pediatric Neurology, Hôpital Necker Enfants Malades, AP-HP, 149 rue de Sèvres, 75105 Paris, France
| | - Manoelle Kossorotoff
- University René Descartes, PRES Sorbonne Paris Cité, 12 rue de l'Ecole de Médecine, Paris, France; Department of Pediatric Neurology, Hôpital Necker Enfants Malades, AP-HP, 149 rue de Sèvres, 75105 Paris, France
| | - Isabelle An
- Department of Neurology, Hôpital de la Pitié-Salpêtrière, AP-HP, 47-83 boulevard de l'hôpital, 75013 Paris, France; University Pierre et Marie Curie, Sorbonne Universités, 4 place Jussieu, 75005 Paris, France
| | - Asma Smahi
- UMR 1163, Institut Imagine, 24 boulevard du Montparnasse, 75015 Paris, France; Genetic unit, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, France
| | - Christine Bodemer
- University René Descartes, PRES Sorbonne Paris Cité, 12 rue de l'Ecole de Médecine, Paris, France; Department of Pediatric Dermatology, Hôpital Necker Enfants Malades, AP-HP, 149 rue de Sèvres, 75105 Paris, France
| | - Arnold Munnich
- UMR 1163, Institut Imagine, 24 boulevard du Montparnasse, 75015 Paris, France; University René Descartes, PRES Sorbonne Paris Cité, 12 rue de l'Ecole de Médecine, Paris, France; Genetic unit, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, France
| | - Julie Steffann
- UMR 1163, Institut Imagine, 24 boulevard du Montparnasse, 75015 Paris, France; University René Descartes, PRES Sorbonne Paris Cité, 12 rue de l'Ecole de Médecine, Paris, France; Genetic unit, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, France
| | - Nathalie Boddaert
- Department of Pediatric Radiology, Hôpital Necker Enfants Malades, AP-HP, 149 rue de Sèvres, 75105 Paris, France; INSERM U1000, 149 rue de Sèvres, 75015 Paris, France; UMR 1163, Institut Imagine, 24 boulevard du Montparnasse, 75015 Paris, France; University René Descartes, PRES Sorbonne Paris Cité, 12 rue de l'Ecole de Médecine, Paris, France
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Groeschel S, Hertz-Pannier L, Delion M, Loustau S, Husson B, Kossorotoff M, Renaud C, Nguyen The Tich S, Chabrier S, Dinomais M. Association of transcallosal motor fibres with function of both hands after unilateral neonatal arterial ischemic stroke. Dev Med Child Neurol 2017; 59:1042-1048. [PMID: 28815625 DOI: 10.1111/dmcn.13517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 12/30/2022]
Abstract
AIM The objective of this study was to investigate the involvement of the motor fibres of the corpus callosum after unilateral neonatal arterial ischemic stroke (NAIS) of the middle cerebral artery territory and the relationship to both ipsilesional and contralesional hand function. METHOD Using high-resolution structural magnetic resonance imaging (MRI), functional MRI, and magnetic resonance diffusion-tractography, we compared the midsagittal area of the motor part of the corpus callosum (defined by the fibres connecting the precentral gyri) between 33 7-year-old children after unilateral NAIS and 31 typically developing 7-year-old children. Hand motor performance was assessed by the box and blocks test. RESULTS Children after NAIS showed on average significantly smaller motor corpus callosum area compared to typically developing children (p<0.001, without differences of the non-motor corpus callosum area). In addition, there was a significant positive association between the motor part of the corpus callosum and both contralesional (Pr(>|t|)=0.034) and ipsilesional hand motor performance (Pr(>|t|)=0.006) after controlling for lesion volume and sex. In a post-hoc analysis the additional contribution of corticospinal tract damage was evaluated. INTERPRETATION Compared to typically developing children, children after NAIS exhibited a smaller motor part of their corpus callosum associated with reduced contralesional but also ipsilesional manual dexterity. These results indicate that the affection of transcallosal motor fibres in unilateral NAIS might be of functional relevance and an important part of the involved structural network that should be elucidated in further studies.
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Affiliation(s)
- Samuel Groeschel
- Experimental Pediatric Neuroimaging, Department of Child Neurology, University Hospital Tübingen, Tuebingen, Germany
| | | | - Matthieu Delion
- Département de neurochirurgie and Laboratoire d'anatomie, Faculté de médecine Angers, LUNAM Université d'Angers, Angers, France
| | - Sébastien Loustau
- Laboratoire Angevin de Recherche en Maths (LAREMA), LUNAM Université d'Angers, Angers, France
| | - Béatrice Husson
- Pediatric Radiology Department, University Hospital Bicêtre, Assistance-Publique-Hopitaux de Paris, Paris-Sud University, Paris, France
| | - Manoelle Kossorotoff
- Paediatric Neurology Department, French Center for Paediatric Stroke, University Hospital Necker-Enfants-Malades, AP-HP, Paris, France
| | - Cyrille Renaud
- CHU Saint-Étienne, Inserm, Univ Lyon, Centre national de référence de l'AVC de L'Enfant, Service de médecine physique et de réadaption pédiatrique, Saint-Étienne, France
| | - Sylvie Nguyen The Tich
- Pediatric Neurology Department and Environment Périnatale et Santé, University Hospital, Lille, France
| | - Stéphane Chabrier
- CHU Saint-Étienne, Inserm, Univ Lyon, Centre national de référence de l'AVC de L'Enfant, Service de médecine physique et de réadaption pédiatrique, Saint-Étienne, France
| | - Mickael Dinomais
- CHU Angers, Département de Médecine Physique et de Réadaption and LUNAM, Université d'Angers, Laboratoire Angevin de Rechereche en Ingénierie des Systèmes (LARIS), Angers, France
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47
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Tabone L, Mediamolle N, Bellesme C, Lesage F, Grevent D, Ozanne A, Naggara O, Husson B, Desguerre I, Lamy C, Denier C, Kossorotoff M. Regional Pediatric Acute Stroke Protocol. Stroke 2017; 48:2278-2281. [DOI: 10.1161/strokeaha.117.016591] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 04/22/2017] [Accepted: 04/26/2017] [Indexed: 12/13/2022]
Abstract
Background and Purpose—
To evaluate hyperacute management of pediatric arterial ischemic stroke, setting up dedicated management pathways is the first recommended step to prove the feasibility and safety of such treatments. A regional pediatric stroke alert protocol including 2 centers in the Paris-Ile-de-France area, France, was established.
Methods—
Consecutive pediatric patients (28 days–18 years) with confirmed arterial ischemic stroke who had acute recanalization treatment (intravenous r-tPA [recombinant tissue-type plasminogen activator], endovascular procedure, or both) according to the regional pediatric stroke alert were retrospectively reviewed during a 40-month period.
Results—
Thirteen children, aged 3.7 to 16.6 years, had recanalization treatment. Median time from onset to magnetic resonance imaging was 165 minutes (150–300); 9 out of 13 had large-vessel occlusion. Intravenous r-tPA was used in 11 out of 13 patients, with median time from onset to treatment of 240 minutes (178–270). Endovascular procedure was performed in patients time-out for intravenous r-tPA (n=2) or after intravenous r-tPA inefficiency (n=2). No intracranial or peripheral bleeding was reported. One patient died of malignant stroke; outcome was favorable in 11 out of 12 survivors (modified Rankin Scale score 0–2).
Conclusions—
Hyperacute recanalization treatment in pediatric stroke, relying on common protocols and adult/pediatric ward collaboration, is feasible. Larger systematic case collection is encouraged.
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Affiliation(s)
- Laurence Tabone
- From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N)
| | - Nicolas Mediamolle
- From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N)
| | - Celine Bellesme
- From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N)
| | - Fabrice Lesage
- From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N)
| | - David Grevent
- From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N)
| | - Augustin Ozanne
- From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N)
| | - Olivier Naggara
- From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N)
| | - Beatrice Husson
- From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N)
| | - Isabelle Desguerre
- From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N)
| | - Catherine Lamy
- From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N)
| | - Christian Denier
- From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N)
| | - Manoelle Kossorotoff
- From the Department of Pediatric Intensive Care Unit (L.T., F.L., I.D.), Department of Pediatric Radiology (D.G., O.N.), and French Center for Pediatric Stroke, Pediatric Neurology (M.K.), APHP-Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Neurology (N.M., C.B.), Department of Pediatric Radiology (B.H.), Department of Interventional Radiology (A.O.), and Department of Neurology (C.D.), APHP-Bicêtre Hospital, Le Kremlin-Bicêtre, France; and Department of Neuroradiology (O.N)
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48
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Santoro C, Di Rocco F, Kossorotoff M, Zerah M, Boddaert N, Calmon R, Vidaud D, Cirillo M, Cinalli G, Mirone G, Giugliano T, Piluso G, D'Amico A, Capra V, Pavanello M, Cama A, Nobili B, Lyonnet S, Perrotta S. Moyamoya syndrome in children with neurofibromatosis type 1: Italian-French experience. Am J Med Genet A 2017; 173:1521-1530. [DOI: 10.1002/ajmg.a.38212] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 02/17/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Claudia Santoro
- Dipartimento della Donna; del Bambino e di Chirurgia Generale e Specialistica; Università degli Studi della Campania “Luigi Vanvitelli,”; Naples Italy
- Department of Biochemistry; Biophysics and General Pathology; Università degli Studi della Campania “Luigi Vanvitelli,”; Naples Italy
| | - Federico Di Rocco
- Service de neurochirurgie pédiatrique; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris; Hôpital Necker-Enfants-Malades; Paris France
| | - Manoelle Kossorotoff
- Pediatric Neurology; French Centre for Pediatric Stroke; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris; Hôpital Necker Enfants-Malades; Paris France
| | - Michel Zerah
- Service de neurochirurgie pédiatrique; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris; Hôpital Necker-Enfants-Malades; Paris France
| | - Nathalie Boddaert
- Department of Pediatric Radiology; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris; Hôpital Necker Enfants Malades; Paris France
- Sorbonne Paris Cité; Institut Imagine; INSERM U1000 and UMR 1163; Paris France
| | - Raphael Calmon
- Department of Pediatric Radiology; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris; Hôpital Necker Enfants Malades; Paris France
| | - Dominique Vidaud
- Service de Biochimie et Génétique Moléculaire; Hôpital Cochin, Assistance Publique-Hôpitaux de Paris; Paris France
- Génétique et Biothérapie des Maladies Dégénératives et Prolifératives du Système Nerveux Faculté des Sciences Pharmaceutiques et Biologiques; Paris France
| | - Mario Cirillo
- Dipartimento di Scienze Mediche; Chirurgiche; Neurologiche; Metaboliche e dell’ Invecchiamento; Università degli Studi della Campania “Luigi Vanvitelli,”; Naples Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery; Santobono Children's Hospital; Naples Italy
| | - Giuseppe Mirone
- Department of Pediatric Neurosurgery; Santobono Children's Hospital; Naples Italy
| | - Teresa Giugliano
- Department of Biochemistry; Biophysics and General Pathology; Università degli Studi della Campania “Luigi Vanvitelli,”; Naples Italy
| | - Giulio Piluso
- Department of Biochemistry; Biophysics and General Pathology; Università degli Studi della Campania “Luigi Vanvitelli,”; Naples Italy
| | - Alessandra D'Amico
- Dipartimento di Scienze Biomediche avanzate; Università Federico II; Naples Italy
| | | | | | | | - Bruno Nobili
- Dipartimento della Donna; del Bambino e di Chirurgia Generale e Specialistica; Università degli Studi della Campania “Luigi Vanvitelli,”; Naples Italy
| | - Stanislas Lyonnet
- Genetic Department; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris; Hôpital Necker Enfants-Malades; Paris France
- Sorbonne Paris Cité; Institut Imagine; INSERM UMR-1163; Paris France
| | - Silverio Perrotta
- Dipartimento della Donna; del Bambino e di Chirurgia Generale e Specialistica; Università degli Studi della Campania “Luigi Vanvitelli,”; Naples Italy
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49
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Guey S, Grangeon L, Brunelle F, Bergametti F, Amiel J, Lyonnet S, Delaforge A, Arnould M, Desnous B, Bellesme C, Hervé D, Schwitalla JC, Kraemer M, Tournier-Lasserve E, Kossorotoff M. De novo mutations in CBL causing early-onset paediatric moyamoya angiopathy. J Med Genet 2017; 54:550-557. [PMID: 28343148 DOI: 10.1136/jmedgenet-2016-104432] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 11/04/2016] [Revised: 01/12/2017] [Accepted: 01/17/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Moyamoya angiopathy (MMA) is characterised by a progressive stenosis of the terminal part of the internal carotid arteries and the development of abnormal collateral deep vessels. Its pathophysiology is unknown. MMA can be the sole manifestation of the disease (moyamoya disease) or be associated with various conditions (moyamoya syndrome) including some Mendelian diseases. We aimed to investigate the genetic basis of moyamoya using a whole exome sequencing (WES) approach conducted in sporadic cases without any overt symptom suggestive of a known Mendelian moyamoya syndrome. METHODS A WES was performed in four unrelated early-onset moyamoya sporadic cases and their parents (trios). Exome data were analysed under dominant de novo, autosomal recessive and X-linked hypotheses. A panel of 17 additional sporadic cases with early-onset moyamoya was available for mutation recurrence analysis. RESULTS We identified two germline de novo mutations in CBL in two out of the four trio probands, two girls presenting with an infancy-onset severe MMA. Both mutations were predicted to alter the ubiquitin ligase activity of the CBL protein that acts as a negative regulator of the RAS pathway. These two germline CBL mutations have previously been described in association with a developmental Noonan-like syndrome and susceptibility to juvenile myelomonocytic leukaemia (JMML). Notably, the two mutated girls never developed JMML and presented only subtle signs of RASopathy that did not lead to evoke this diagnosis during follow-up. CONCLUSIONS These data suggest that CBL gene screening should be considered in early-onset moyamoya, even in the absence of obvious signs of RASopathy.
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Affiliation(s)
- Stéphanie Guey
- INSERM UMR-S1161, Génétique et physiopathologie des maladies cérébro-vasculaires, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Lou Grangeon
- INSERM UMR-S1161, Génétique et physiopathologie des maladies cérébro-vasculaires, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Francis Brunelle
- AP-HP Department of Pediatric Radiology, University Hospital Necker-Enfants malades, Paris Descartes University, Paris, France.,Department of Neuroradiology, University Hospital Necker-Enfants malades, Paris Descartes University, Paris, France
| | - Françoise Bergametti
- INSERM UMR-S1161, Génétique et physiopathologie des maladies cérébro-vasculaires, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jeanne Amiel
- AP-HP, Department of Genetic, University Hospital Necker-Enfants malades, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Imagine Institute, Paris, France
| | - Stanislas Lyonnet
- AP-HP, Department of Genetic, University Hospital Necker-Enfants malades, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Imagine Institute, Paris, France
| | - Audrey Delaforge
- AP-HP, Service de génétique moléculaire neurovasculaire, Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'œil, Groupe Hospitalier Saint-Louis Lariboisière, Paris, France
| | - Minh Arnould
- INSERM UMR-S1161, Génétique et physiopathologie des maladies cérébro-vasculaires, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Béatrice Desnous
- AP-HP, Department of Pediatric Neurology, Robert-Debré University Hospital, Paris, France
| | - Céline Bellesme
- AP-HP, Department of Pediatric Neurology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Dominique Hervé
- INSERM UMR-S1161, Génétique et physiopathologie des maladies cérébro-vasculaires, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,AP-HP, Groupe Hospitalier Saint-Louis Lariboisière, Service de Neurologie, Paris, France
| | - Jan C Schwitalla
- Department of Neurology, Alfried-Krupp-Hospital Essen, Essen, Germany
| | - Markus Kraemer
- Department of Neurology, Alfried-Krupp-Hospital Essen, Essen, Germany
| | - Elisabeth Tournier-Lasserve
- INSERM UMR-S1161, Génétique et physiopathologie des maladies cérébro-vasculaires, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,AP-HP, Service de génétique moléculaire neurovasculaire, Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'œil, Groupe Hospitalier Saint-Louis Lariboisière, Paris, France
| | - Manoelle Kossorotoff
- French Center for Pediatric Stroke, University Hospital Necker-Enfants malades, Paris, France.,AP-HP, French Center for Pediatric Stroke and Pediatric Neurology Department, University Hospital Necker-Enfants malades, Paris, France
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50
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Mortamet G, Kossorotoff M, Baptiste A, Boddaert N, Castelle M, Hubert P, Lesage F, Renolleau S, Oualha M. Description and Contribution of Brain Magnetic Resonance Imaging in Nontraumatic Critically Ill Children. J Child Neurol 2016; 31:1584-1590. [PMID: 27591003 DOI: 10.1177/0883073816666737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/05/2016] [Accepted: 08/02/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The authors aimed to collect all brain magnetic resonance imaging (MRI) performed in critically ill children in the authors' medical pediatric intensive care unit over a 2-year period (2012-2013) to (1) describe the findings and (2) assess its contribution on practical patient care. METHODS This is a single-center and retrospective study. All children without traumatic brain injury who underwent a brain MRI during pediatric intensive care unit stays were included. To assess the exam's contribution, the patient's medical condition at the time of the MRI exam was blindly and separately exposed to a pediatric neurologist and a pediatric intensivist. RESULTS During the study period, 87 patients (7.5%) underwent a brain MRI. Median age was 4 months and 13 children (14.9%) died in pediatric intensive care unit. The most common final diagnosis was postanoxic encephalopathy. Brain MRI was abnormal in 68 patients (78.2%). No serious adverse event occurred during the transport. The neurologist and the intensivist considered brain MRI as indicated during pediatric intensive care unit stay in 65 (74.7%) and 68 patients (78.2%). They deemed that brain MRI had a diagnostic contribution in 76 (87.4%) and 60 (69.0%) patients, respectively. A therapeutic change consecutive to MRI findings occurred in 19 patients (21.8%) and MRI results were associated with a decision to withdraw life-sustaining treatment in 21 patients (24.1%). CONCLUSION Brain MRI is one component of neuromonitoring, and this study suggests a substantial diagnostic contribution, although its therapeutic impact appears limited to specific diagnoses.
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Affiliation(s)
- Guillaume Mortamet
- Service de Réanimation et de Surveillance continue médico-chirurgicales Pédiatriques, Hôpital Necker, Assistance Publique-des Hôpitaux de Paris, Paris, France .,Université de Montréal, Montréal, Québec, Canada
| | - Manoelle Kossorotoff
- Service de Neurologie Pédiatrique, Centre National de Référence de l'Accident Vasculaire Cérébral de l'Enfant, Hôpital Necker-Enfants malades, Assistance Publique -des Hôpitaux de Paris, Paris, France
| | - Amandine Baptiste
- Unité de Recherche Clinique/Centre d'Investigation Clinique Paris Descartes Necker, Hôpital Necker, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Nathalie Boddaert
- Service de Radiologie Pédiatrique, Hôpital Necker, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Martin Castelle
- Service de Réanimation et de Surveillance continue médico-chirurgicales Pédiatriques, Hôpital Necker, Assistance Publique-des Hôpitaux de Paris, Paris, France
| | - Philippe Hubert
- Service de Réanimation et de Surveillance continue médico-chirurgicales Pédiatriques, Hôpital Necker, Assistance Publique-des Hôpitaux de Paris, Paris, France
| | - Fabrice Lesage
- Service de Réanimation et de Surveillance continue médico-chirurgicales Pédiatriques, Hôpital Necker, Assistance Publique-des Hôpitaux de Paris, Paris, France
| | - Sylvain Renolleau
- Service de Réanimation et de Surveillance continue médico-chirurgicales Pédiatriques, Hôpital Necker, Assistance Publique-des Hôpitaux de Paris, Paris, France
| | - Mehdi Oualha
- Service de Réanimation et de Surveillance continue médico-chirurgicales Pédiatriques, Hôpital Necker, Assistance Publique-des Hôpitaux de Paris, Paris, France
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