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Constantinescu SM, Duprez T, Bonneville JF, Maiter D. How often should we perform magnetic resonance imaging (MRI) for the follow-up of pituitary adenoma? Ann Endocrinol (Paris) 2024:S0003-4266(24)00049-0. [PMID: 38604408 DOI: 10.1016/j.ando.2024.03.004] [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] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/14/2024] [Accepted: 03/23/2024] [Indexed: 04/13/2024]
Abstract
Magnetic resonance imaging (MRI) is the examination of choice for diagnosing and monitoring pituitary adenoma (also known as pituitary neuroendocrine tumor or PitNET), whether treated or not. However, repeating the examination too often (and sometimes unnecessarily) is costly, and worrying data on tissue accumulation (brain, bone, etc.) of gadolinium atoms dissociated from their carrier molecule (chelator) have led European authorities to ban contrast agents based on linear chelators of gadolinium, which are particularly susceptible to rapid dissociation, in favor of chemically more stable macrocyclic chelators. It is therefore important to determine the optimal frequency for pituitary MRI monitoring in order to safely assess the natural history or therapeutic response of pituitary adenomas. The aim of this article is to summarize the most recent data on optimal follow-up intervals depending on the type, size and location of the pituitary tumor and the clinical situation in general, in order to generate monitoring algorithms to guide clinicians.
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Affiliation(s)
| | - Thierry Duprez
- Department of Neuroradiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Dominique Maiter
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Constantinescu SM, Duprez T, Fomekong E, Raftopoulos C, Alexopoulou O, Maiter D. Natural history and surgical outcome of incidentally discovered clinically nonfunctioning pituitary macroadenomas. Endocr Connect 2023; 12:e230224. [PMID: 37887079 PMCID: PMC10620450 DOI: 10.1530/ec-23-0224] [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: 06/06/2023] [Accepted: 10/02/2023] [Indexed: 10/03/2023]
Abstract
Objectives The incidental diagnosis of nonfunctioning pituitary macroadenomas (NFPMAs) is becoming more prevalent with the spread of modern brain imaging techniques. We sought to uncover new data about their natural history and surgical outcome. Design This is a retrospective single-center observational study. Methods Among 210 patients seen for a NFPMA between 2010 and 2019, 70 (33%) were discovered incidentally (i-NFPMA). We analyzed outcomes in a total of 65 patients with available follow-up data. Results Mean age at diagnosis (± s.d.) was 60 ± 14 years and mean maximal diameter was 20.0 ± 7.3 mm. At diagnosis, 29 patients (45%) had pituitary hormone deficits (LH/FSH 41%, TSH 29%, ACTH 15%) and 12% had visual field deficits. 26 patients underwent initial surgery, while 12 had delayed surgery after initial surveillance. In the surveillance group, the risk of tumor growth was estimated at 10%/year. Patients with hormonal deficits at diagnosis experienced earlier growth at 24 months (P < 0.02). Overall, surgical resection of the i-NFPMA led to stable or improved endocrine function in 91% of patients, with only 6% postoperative permanent diabetes insipidus. Moreover, surgery was more effective in preserving intact endocrine function (10/12) than restoring altered endocrine function to normal (6/22, P = 0.03). Conclusion About one-third of NFPMAs are now discovered incidentally and a significant subset may be responsible for unrecognized endocrine and visual deficits. Under surveillance the risk of further tumor growth is significant (10%/year) and seems to occur faster in patients already harboring an endocrine deficit. Early surgical removal before onset of endocrine deficits appears to lead to better endocrine outcome.
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Affiliation(s)
- Stefan M Constantinescu
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Thierry Duprez
- Department of Radiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Edward Fomekong
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Orsalia Alexopoulou
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Dominique Maiter
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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London F, De Haan A, Benyahia Z, Landenne G, Duprez T, van Pesch V, El Sankari S. Cognitive trajectories in relapsing-remitting multiple sclerosis: Evidence of multiple evolutionary trends. Mult Scler Relat Disord 2023; 77:104848. [PMID: 37390678 DOI: 10.1016/j.msard.2023.104848] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/20/2023] [Accepted: 06/19/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Cognitive impairment (CI) frequently occurs in multiple sclerosis (MS) and is assumed to increase over time. However, recent studies have suggested that the evolution of cognitive status in patients with MS may be more heterogeneous than expected. Predicting CI remains also challenging, and longitudinal studies exploring the baseline determinants of cognitive performances are limited. No studies have explored the predictive value of patient-reported outcome measures (PROMs) regarding future CI. OBJECTIVE To explore the evolutionary patterns of cognitive status in a cohort of RRMS patients initiating a new disease modifying treatment (DMT), and to determine whether PROMs may have a predictive value for future CI. METHODS The present prospective study is a 12-month follow-up of a cohort of 59 RRMS patients who underwent yearly a comprehensive, multiparametric assessment combining clinical (with EDSS assessment), neuropsychological (BVMT-R, SDMT, CVLT-II), MRI-derived metrics and a set of self-reported questionnaires. Lesion and brain volumes were analyzed and processed by the automated MSmetrix® software (Icometrix®, Leuven, Belgium). Spearman's correlation coefficient was used to evaluate the association of collected variables. A longitudinal logistic regression analysis was performed to find baseline correlates of CI at 12 months (T1). RESULTS A total of 33 patients (56%) were defined as cognitively impaired at baseline, and 20 (38%) were defined as impaired at follow-up after 12 months. The mean raw scores and Z-scores of all the cognitive tests were significantly improved at T1 (p < 0.05). There was a statistically significant improvement in most PROM scores at T1 (p < 0.05) in comparison with baseline scores. Among the variables assessed, lower education and physical disability level at baseline correlated with impaired SDMT (OR: 1.68, p = 0.01; OR: 3.10, p = 0.02, respectively) and impaired BVMT-R (OR: 4.08, p=<0.001; OR: 4.82, p = 0.001, respectively) at T1. Neither baseline PROMs nor MRI volumetric parameters were predictive of cognitive performances at T1. CONCLUSIONS These findings provide additional evidence that evolution of CI in MS may be a dynamic phenomenon and will not usually follow an inevitable, declining trajectory, and do not support the utility of PROMs in predicting CI in RRMS. The present study is still ongoing to determine whether our findings are confirmed at 2 and 3 years of follow-up.
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Affiliation(s)
- Frédéric London
- Department of Neurology, CHU UCL Namur Site Godinne, Université Catholique de Louvain (UCLouvain), 1 Avenue G. Thérasse, Yvoir B-5530, Belgium.
| | - Alice De Haan
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Zohra Benyahia
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Gaëtane Landenne
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Thierry Duprez
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Vincent van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Souraya El Sankari
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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d’Abadie P, Michoux N, Duprez T, Schmitz S, Magremanne M, Van Eeckhout P, Gheysens O. Comparable Accuracy of Quantitative and Visual Analyses of [ 18F]FDG PET/CT for the Detection of Lymph Node Metastases from Head and Neck Squamous Cell Carcinoma. Diagnostics (Basel) 2023; 13:2638. [PMID: 37627898 PMCID: PMC10453437 DOI: 10.3390/diagnostics13162638] [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: 07/10/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND In head and neck squamous cell carcinoma (HNSCC), [18F]FDG PET/CT is recommended for detecting recurrent disease and in the initial staging for evaluating distant metastases, but its use in detecting cervical lymph metastases remains unclear. The aim of this study is to evaluate and compare the diagnostic accuracy of [8F]FDG-PET/CT using visual and semi-quantitative analyses for detecting the nodal involvement in HNSCC. METHODS We analyzed consecutive patients who underwent a preoperative [18F]FDG-PET/CT and neck dissection for HNSCC at our tertiary hospital. A blinded evaluation of the [18F]FDG uptake in each neck level was performed using a semi-quantitative approach (SUVmax and SUVR) and a visual grading system (uptake superior to the internal jugular vein for grade 1 and superior to the liver for grade 2). Analyses were compared to the histological results. RESULTS In our 211 patients, analyses demonstrated similar diagnostic accuracy using a semi-quantitative approach or a visual grading system. Regarding the visual grading system, [18F]FDG-PET/CT detected nodal metastases with a specificity of 83% for lymph nodes classified as grade 1 and 98% for those classified as grade 2. The sensitivity was moderate, ranging from 60 to 63%. CONCLUSIONS [18F]FDG PET/CT has a high specificity for detecting lymph node metastases in HNSCC and therefore must be considered in the nodal clinical staging.
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Affiliation(s)
- Philippe d’Abadie
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Nicolas Michoux
- Department of Radiology, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200 Brussels, Belgium; (N.M.); (T.D.)
| | - Thierry Duprez
- Department of Radiology, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200 Brussels, Belgium; (N.M.); (T.D.)
| | - Sandra Schmitz
- Department of Head and Neck Surgery, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Michèle Magremanne
- Department of Stomatology and Maxillofacial Surgery, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Pascal Van Eeckhout
- Department of Pathology, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200 Brussels, Belgium;
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Maggi P, Bulcke CV, Pedrini E, Bugli C, Sellimi A, Wynen M, Stölting A, Mullins WA, Kalaitzidis G, Lolli V, Perrotta G, El Sankari S, Duprez T, Li X, Calabresi PA, van Pesch V, Reich DS, Absinta M. B cell depletion therapy does not resolve chronic active multiple sclerosis lesions. EBioMedicine 2023; 94:104701. [PMID: 37437310 PMCID: PMC10436266 DOI: 10.1016/j.ebiom.2023.104701] [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: 01/23/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Chronic active lesions (CAL) in multiple sclerosis (MS) have been observed even in patients taking high-efficacy disease-modifying therapy, including B-cell depletion. Given that CAL are a major determinant of clinical progression, including progression independent of relapse activity (PIRA), understanding the predicted activity and real-world effects of targeting specific lymphocyte populations is critical for designing next-generation treatments to mitigate chronic inflammation in MS. METHODS We analyzed published lymphocyte single-cell transcriptomes from MS lesions and bioinformatically predicted the effects of depleting lymphocyte subpopulations (including CD20 B-cells) from CAL via gene-regulatory-network machine-learning analysis. Motivated by the results, we performed in vivo MRI assessment of PRL changes in 72 adults with MS, 46 treated with anti-CD20 antibodies and 26 untreated, over ∼2 years. FINDINGS Although only 4.3% of lymphocytes in CAL were CD20 B-cells, their depletion is predicted to affect microglial genes involved in iron/heme metabolism, hypoxia, and antigen presentation. In vivo, tracking 202 PRL (150 treated) and 175 non-PRL (124 treated), none of the treated paramagnetic rims disappeared at follow-up, nor was there a treatment effect on PRL for lesion volume, magnetic susceptibility, or T1 time. PIRA occurred in 20% of treated patients, more frequently in those with ≥4 PRL (p = 0.027). INTERPRETATION Despite predicted effects on microglia-mediated inflammatory networks in CAL and iron metabolism, anti-CD20 therapies do not fully resolve PRL after 2-year MRI follow up. Limited tissue turnover of B-cells, inefficient passage of anti-CD20 antibodies across the blood-brain-barrier, and a paucity of B-cells in CAL could explain our findings. FUNDING Intramural Research Program of NINDS, NIH; NINDS grants R01NS082347 and R01NS082347; Dr. Miriam and Sheldon G. Adelson Medical Research Foundation; Cariplo Foundation (grant #1677), FRRB Early Career Award (grant #1750327); Fund for Scientific Research (FNRS).
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Affiliation(s)
- Pietro Maggi
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium; Neuroinflammation Imaging Lab (NIL), Université Catholique de Louvain, Brussels, Belgium; Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland.
| | - Colin Vanden Bulcke
- Neuroinflammation Imaging Lab (NIL), Université Catholique de Louvain, Brussels, Belgium
| | - Edoardo Pedrini
- Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Céline Bugli
- Plateforme Technologique de Support en Méthodologie et Calcul Statistique, Université Catholique de Louvain, Brussels, Belgium
| | - Amina Sellimi
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Maxence Wynen
- Neuroinflammation Imaging Lab (NIL), Université Catholique de Louvain, Brussels, Belgium
| | - Anna Stölting
- Neuroinflammation Imaging Lab (NIL), Université Catholique de Louvain, Brussels, Belgium
| | - William A Mullins
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Grigorios Kalaitzidis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valentina Lolli
- Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Gaetano Perrotta
- Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Souraya El Sankari
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thierry Duprez
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Xu Li
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vincent van Pesch
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Martina Absinta
- Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Duprez T, Vlassenbroek A, Peeters A, Poncelet PA, Levecque E, Austein F, Pahn G, Nae Y, Abdallah S, Coche E. Preliminary experience of CT imaging of the ischaemic brain penumbra through spectral processing of multiphasic CTA datasets. Sci Rep 2023; 13:11431. [PMID: 37454162 PMCID: PMC10349801 DOI: 10.1038/s41598-023-38370-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
To assess ischaemic penumbra through the post-processing of the spectral multiphasic CT Angiography (mCTA) data in acute ischaemic stroke (AIS) patients. Thirty one consecutive patients strongly suspected of severe Middle Cerebral Artery AIS presenting less than 6 h after onset of symptoms or with unknown time of onset of symptoms underwent a standardized CT protocol in spectral mode including Non Contrast CT, mCTA, and Perfusion CT (CTP) on a dual-layer MDCT system. Areas disclosing delayed enhancement on iodine density (ID) maps were highlighted by subtraction of the serial mCTA datasets. Two neuroradiologists independently rated the correspondence between delayed enhancing areas at mCTA and the penumbral/infarcted areas delineated by two validated CTP applications using a 5-levels scoring scale. Interobserver agreement between observers was evaluated by kappa statistics. Dose delivery was recorded for each acquisition. Averaged correspondence score between penumbra delineation using subtracted mCTA-derived ID maps and CTP ones was 2.76 for one application and 2.9 for the other with best interobserver agreement kappa value at 0.59. All 6 stroke mimics out of the 31 patients' cohort were correctly identified. Average dose delivery was 7.55 mSv for the whole procedure of which CTP accounted for 39.7%. Post-processing of spectral mCTA data could allow clinically relevant assessment of the presence or absence of ischaemic penumbra in AIS-suspected patients if results of this proof-of-concept study should be confirmed in larger patients'series.
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Affiliation(s)
- T Duprez
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - A Vlassenbroek
- CT/AMI Clinical Science, Philips Health Systems, Avenue du Bourgmestre Etienne Demunter 1, 1090, Brussels, Belgium.
| | - A Peeters
- Department of Neurology, Stroke Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - P A Poncelet
- Department of Medical Imaging, Grand Hôpital de Charleroi (GHdC), Grand'Rue, 3, 6000, Charleroi, Belgium
| | - E Levecque
- Department of Neurology, Stroke Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - F Austein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20426, Hamburg, Germany
| | - G Pahn
- PD CT/AMI Clinical Science, Philips GmbH Market DACH, Röntgenstraße 22-24, 22335, Hamburg, Germany
| | - Y Nae
- CT/AMI Clinical Science, Advanced Technologies Center, Philips Medical Systems Technologies Ltd., Building No. 34, P.O. Box 325, 3100202, Haifa, Israel
| | - S Abdallah
- CT/AMI Clinical Science, Advanced Technologies Center, Philips Medical Systems Technologies Ltd., Building No. 34, P.O. Box 325, 3100202, Haifa, Israel
| | - E Coche
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium
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Khalatyan G, Boschi A, Duprez T, Coutel M, Clément de Cléty S, Nassogne MC. Parinaud Syndrome Secondary to Cerebral Infarction in a COVID--Positive Child With Severe Diabetic Ketoacidosis. J Neuroophthalmol 2023; Publish Ahead of Print:00041327-990000000-00376. [PMID: 37318876 DOI: 10.1097/wno.0000000000001903] [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] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Garik Khalatyan
- Ophtalmology Department (GK, AB, MC), Neuroradiology Department (TD), Pediatric Emergency Department (SCdC), and Pediatric Neurology Department (M-CN), Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Kacar S, Duprez T, Gheysens O, Schmitz S, Van Eeckhout P. Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE): Case report of a 63-year-old male patient with a rare self-healing oral mucosal lesion. J Stomatol Oral Maxillofac Surg 2023:101514. [PMID: 37207961 DOI: 10.1016/j.jormas.2023.101514] [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] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023]
Abstract
Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE)/Riga Fede disease is a rare mucosal and submucosal benign reactive inflammatory process, usually involving the tongue. Trauma is believed to be a major factor amongst the multiple pathogenic mechanisms that have been hypothesized in TUGSE. The lesion presents as an isolated indurated or even ulcerated mass, which may mimic, clinically a squamous cell carcinoma (SCC). We herein report a case of TUGSE in a 63-year-old male referred by his treating physician for high suspicion of tongue malignancy. Histopathological examination confirmed the diagnosis of TUGSE, without any evidence of a neoplasic, infectious or hematologic process. TUGSE occurs in patients with an age range of 41-60 years. Sufficiently deep biopsies with comprehensive immunohistochemical and molecular analyses are mandatory to confirm the benign nature of the lesion and to, definitely, rule out malignancy. This report highlights the need for adequate histological differential diagnosis to avoid inappropriate heavy treatments in a benign condition.
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Affiliation(s)
- Serife Kacar
- Department of Pathology, Saint-Luc University Clinics, Université Catholique de Louvain, Belgium
| | - Thierry Duprez
- Department of Medical Imaging, Saint-Luc University Clinics, Université Catholique de Louvain, Belgium
| | - Olivier Gheysens
- Department of Nuclear Medicine, Saint-Luc University Clinics, Université Catholique de Louvain, Belgium
| | - Sandra Schmitz
- Department of Ear-Nose-Throat, Saint-Luc University Clinics, Université Catholique de Louvain, Belgium
| | - Pascal Van Eeckhout
- Department of Pathology, Saint-Luc University Clinics, Université Catholique de Louvain, Belgium.
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Santalucia R, Carapancea E, Vespa S, Germany Morrison E, Ghasemi Baroumand A, Vrielynck P, Fierain A, Joris V, Raftopoulos C, Duprez T, Ferrao Santos S, van Mierlo P, El Tahry R. Clinical added value of interictal automated electrical source imaging in the presurgical evaluation of MRI-negative epilepsy: A real-life experience in 29 consecutive patients. Epilepsy Behav 2023; 143:109229. [PMID: 37148703 DOI: 10.1016/j.yebeh.2023.109229] [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: 02/06/2023] [Revised: 04/09/2023] [Accepted: 04/20/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE During the presurgical evaluation, manual electrical source imaging (ESI) provides clinically useful information in one-third of the patients but it is time-consuming and requires specific expertise. This prospective study aims to assess the clinical added value of a fully automated ESI analysis in a cohort of patients with MRI-negative epilepsy and describe its diagnostic performance, by evaluating sublobar concordance with stereo-electroencephalography (SEEG) results and surgical resection and outcome. METHODS All consecutive patients referred to the Center for Refractory Epilepsy (CRE) of St-Luc University Hospital (Brussels, Belgium) for presurgical evaluation between 15/01/2019 and 31/12/2020 meeting the inclusion criteria, were recruited to the study. Interictal ESI was realized on low-density long-term EEG monitoring (LD-ESI) and, whenever available, high-density EEG (HD-ESI), using a fully automated analysis (Epilog PreOp, Epilog NV, Ghent, Belgium). The multidisciplinary team (MDT) was asked to formulate hypotheses about the epileptogenic zone (EZ) location at sublobar level and make a decision on further management for each patient at two distinct moments: i) blinded to ESI and ii) after the presentation and clinical interpretation of ESI. Results leading to a change in clinical management were considered contributive. Patients were followed up to assess whether these changes lead to concordant results on stereo-EEG (SEEG) or successful epilepsy surgery. RESULTS Data from all included 29 patients were analyzed. ESI led to a change in the management plan in 12/29 patients (41%). In 9/12 (75%), modifications were related to a change in the plan of the invasive recording. In 8/9 patients, invasive recording was performed. In 6/8 (75%), the intracranial EEG recording confirmed the localization of the ESI at a sublobar level. So far, 5/12 patients, for whom the management plan was changed after ESI, were operated on and have at least one-year postoperative follow-up. In all cases, the EZ identified by ESI was included in the resection zone. Among these patients, 4/5 (80%) are seizure-free (ILAE 1) and one patient experienced a seizure reduction of more than 50% (ILAE 4). CONCLUSIONS In this single-center prospective study, we demonstrated the added value of automated ESI in the presurgical evaluation of MRI-negative cases, especially in helping to plan the implantation of depth electrodes for SEEG, provided that ESI results are integrated into the whole multimodal evaluation and clinically interpreted.
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Affiliation(s)
- Roberto Santalucia
- Cliniques Universitaires Saint-Luc, Paediatric Neurology Unit, Brussels, Belgium; Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium; Centre Hospitalier Neurologique William Lennox (CHNWL), Clinical Neurophysiology, Ottignies, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium.
| | - Evelina Carapancea
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Simone Vespa
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Enrique Germany Morrison
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Amir Ghasemi Baroumand
- Medical Image and Signal Processing, Ghent University, Ghent, Belgium; Epilog NV, Ghent, Belgium
| | - Pascal Vrielynck
- Centre Hospitalier Neurologique William Lennox (CHNWL), Clinical Neurophysiology, Ottignies, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium
| | - Alexane Fierain
- Centre Hospitalier Neurologique William Lennox (CHNWL), Clinical Neurophysiology, Ottignies, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurology Unit, Brussels, Belgium
| | - Vincent Joris
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurosurgery Unit, Brussels, Belgium
| | - Christian Raftopoulos
- Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurosurgery Unit, Brussels, Belgium
| | - Thierry Duprez
- Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Medical Imaging Department, Neuroradiology Unit, Belgium
| | - Susana Ferrao Santos
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurology Unit, Brussels, Belgium
| | - Pieter van Mierlo
- Medical Image and Signal Processing, Ghent University, Ghent, Belgium; Epilog NV, Ghent, Belgium
| | - Riëm El Tahry
- Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurology Unit, Brussels, Belgium; WELBIO Department, WEL Research Institute, Avenue Pasteur 6, 1300 Wavre, Belgium
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10
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Chehade G, Lawson TM, Lelotte J, Daoud L, Di Perri D, Whenham N, Duprez T, Tajeddine N, Tissir F, Raftopoulos C. Long-term survival in patients with IDH-wildtype glioblastoma: clinical and molecular characteristics. Acta Neurochir (Wien) 2023; 165:1075-1085. [PMID: 36920664 DOI: 10.1007/s00701-023-05544-3] [Citation(s) in RCA: 3] [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: 12/30/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
BACKG ROUND Glioblastoma is an aggressive tumor that has a dismal prognosis even with multimodal treatment. However, some patients survive longer than expected. The objective of this study was to revisit patients diagnosed with glioblastoma according to the 2021 WHO classification and analyze clinical and molecular characteristics associated with long-term survival (LTS). METHODS We retrospectively analyzed 120 IDH-wildtype glioblastomas operated on at our institution between 2013 and 2018. We divided them into LTS patients, surviving more than 3 years, and non-LTS patients, and then compared their features. Additionally, we performed DNA methylation-based brain tumor classification in LTS patients. RESULTS Sixteen patients were long-term survivors. Age < 70 years, MGMT promoter methylation, extent of resection ≥ 95%, and administration of radiochemotherapy were associated with LTS (P = 0.005, P < 0.001, P = 0.048, and P = 0.008, respectively). In addition, when these factors were combined, the probability of LTS was 74% (95% CI: 62--84). The methylome analysis confirmed the diagnosis of glioblastoma in the majority of the tested LTS patients. Regarding subtypes, 29% of cases were mesenchymal (MES), 43% were RTK1, and 29% were RTK2. Interestingly, RTK1 and RTK2 cases tended to have longer overall survival than MES cases (P = 0.057). Moreover, the only tested LTS patient with an unmethylated MGMT promoter had an "adult-type diffuse high-grade glioma, IDH-wildtype, subtype E" rather than a glioblastoma. This tumor was characterized by multinucleated giant cells and a somatic mutation in POLE. CONCLUSIONS We suggest that glioblastoma patients with a combination of favorable prognostic factors can achieve LTS in 74% of cases. In addition, methylome analysis is important to ascertain the type of glioma in LTS patients, especially when the MGMT promoter is unmethylated.
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Affiliation(s)
- Georges Chehade
- Department of Neurosurgery, Saint-Luc University Hospital, Université Catholique de Louvain, 10 Hippocrate Av, 1St Floor, Woluwe-Saint-Lambert, 1200, Brussels, Belgium.,Developmental Neurobiology, Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Tévi Morel Lawson
- Department of Neurosurgery, Saint-Luc University Hospital, Université Catholique de Louvain, 10 Hippocrate Av, 1St Floor, Woluwe-Saint-Lambert, 1200, Brussels, Belgium
| | - Julie Lelotte
- Department of Neuropathology, Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.,Department of Neuropathology, Institut de Pathologie et de Génétique, Charleroi, Belgium
| | - Lina Daoud
- Department of Neuropathology, Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Dario Di Perri
- Department of Radiotherapy, Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Whenham
- Department of Oncology, Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Thierry Duprez
- Department of Radiology, Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Tajeddine
- Cell Physiology, Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Fadel Tissir
- Developmental Neurobiology, Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.,College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Christian Raftopoulos
- Department of Neurosurgery, Saint-Luc University Hospital, Université Catholique de Louvain, 10 Hippocrate Av, 1St Floor, Woluwe-Saint-Lambert, 1200, Brussels, Belgium.
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11
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London F, El Sankari S, De Haan A, Benyahia Z, Landenne G, Duprez T, van Pesch V. Patient-reported outcome measurements in a selective cohort of relapsing-remitting multiple sclerosis patients: relationships with physical disability, cognitive impairment, and MRI-derived metrics. Acta Neurol Belg 2023:10.1007/s13760-023-02225-x. [PMID: 36877357 DOI: 10.1007/s13760-023-02225-x] [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: 10/04/2022] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND The added value of patient-reported outcome measures (PROMs) in addition to standard clinical outcome tools in the assessment of relapsing-remitting multiple sclerosis (RRMS) patients' status is increasingly recognized. PROMs facilitate the detection of hidden aspects of MS and help to integrate the patient's subjective experience of health-related quality of life (HRQoL) status and treatment satisfaction in a holistic way. However, the relationship between PROMs and clinical and cognitive status has been scarcely investigated up to now. OBJECTIVE To investigate the association of PROMs with physical and cognitive disability in a cohort of RRMS patients at initiation of a new disease-modifying treatment. METHODS In this cross-sectional bicenter study, 59 consecutive RRMS patients underwent neurological examination with EDSS assessment, comprehensive cognitive tests (BVMT-R, SDMT, CVLT-II) and a set of self-reported questionnaires. Lesion and brain volumes were analyzed and processed by the automated MSmetrix® software (Icometrix®, Leuven, Belgium). Spearman's correlation coefficient was used to evaluate the association of collected variables. A cross-sectional logistic regression analysis was performed to find baseline correlates of cognitive impairment. RESULTS Of the 59 RRMS patients (mean age 39 ± 9.8 years, 79.7% female, median EDSS 2.0), 33 (56%) had cognitive impairment. While almost all dimensions of health, explored by PROMs, were impacted in the overall sample, no significant difference was observed in patients with and without cognitive impairment. All PROMs were significantly associated with EDSS (R = 0.37-0.55; p < 0.05), except for the psychological component of MSIS-29, BDI and DEX-Q scores. No significant correlation was found between PROMs and cognitive performances. The cross-sectional logistic regression analysis included age, gender (female), education, EDSS, hippocampus and FLAIR lesion volumes as significant predictors of cognitive impairment. CONCLUSIONS The data highlight that PROMs provide valuable information on the well-being of PwMS closely paralleling the extent of MS-related disability, as measured by the EDSS. Additional research should determine the relevance of PROMs as longitudinal outcome measures.
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Affiliation(s)
- Frédéric London
- Department of Neurology, CHU UCL Namur Site Godinne, Université catholique de Louvain (UCLouvain), 1 avenue G. Thérasse, B-5530, Yvoir, Belgium.
| | - Souraya El Sankari
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Alice De Haan
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Zohra Benyahia
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Gaëtane Landenne
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Thierry Duprez
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Vincent van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
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12
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Lurquin F, Constantinescu SM, Furnica RM, Duprez T, Raftopoulos C, Daoud L, Lammens M, Maiter D. Ectopic sphenoidal ACTH-secreting adenoma revealed by 11C Methionine PET scan: case report. BMC Endocr Disord 2023; 23:43. [PMID: 36797716 PMCID: PMC9933249 DOI: 10.1186/s12902-023-01298-2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Ectopic ACTH pituitary adenomas (EAPA), located outside the sella turcica and deriving from cellular remnants of Rathke's pouch are a very rare cause of Cushing's syndrome (CS). The diagnosis is often difficult and delayed, even after comprehensive work-up. To our knowledge, we report for the first time an ectopic corticotroph tumor of the posterior wall of the sphenoid sinus, leading to false positive results of bilateral inferior petrosal sinus sampling (BIPPS) and which was finally localized by a co-registered11 C Methionine PET/MR imaging. CASE PRESENTATION A 48-year-old woman was referred for a high clinical suspicion of ACTH-dependent CS. Biological testing comprising low dose dexamethasone suppression and CRH stimulation tests were indicative of pituitary Cushing's disease, but comprehensive pituitary MRI did not reveal any pituitary adenoma. BIPSS confirmed however a central origin of ACTH secretion (central-to-peripheral ACTH ratio > 100) and revealed a significant right-to-left gradient (6.2), leading to a first right-sided exploratory hypophysectomy, that did not cure the patient. BIPSS images were reviewed and revealed preferential drainage of the left pituitary to the right petrosal sinus, leading us to a left sided exploratory hypophysectomy, which was again unsuccessful. A11 C Methionine PET/MRI was performed and revealed a hypermetabolic lesion adjacent to the posterior wall of the sphenoidal sinus. After surgical resection, this polypoid mass was identified as an ectopic ATCH-secreting pituitary adenoma expressing ACTH and T-Pit and complete remission of hypercortisolism was observed. CONCLUSIONS In conclusion, we report a case of ACTH-dependent Cushing's syndrome, caused by an ectopic corticotroph adenoma located in the sphenoidal sinus, which perfectly mimicked the biological features of a classical pituitary ACTH adenoma on a comprehensive hormonal evaluation including BIPPS, and the features of a benign naso-sinusal polyp at MRI. We report for the first time a key role of11 C Methionine PET co-registered to high resolution MRI for localizing ectopic adenomas, efficiently guiding surgical removal and leading to complete remission of hypercortisolism.
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Affiliation(s)
- F Lurquin
- Endocrinology and Nutrition Department, Cliniques Universitaires Saint-Luc, n°10, Avenue Hippocrate, 1200, Brussels, Belgium
| | - S M Constantinescu
- Endocrinology and Nutrition Department, Cliniques Universitaires Saint-Luc, n°10, Avenue Hippocrate, 1200, Brussels, Belgium.
| | - R M Furnica
- Endocrinology and Nutrition Department, Cliniques Universitaires Saint-Luc, n°10, Avenue Hippocrate, 1200, Brussels, Belgium
| | - T Duprez
- Department of Radiology, Cliniques Universitaires Saint Luc, UCLouvain, 1200, Brussels, Belgium
| | - C Raftopoulos
- Department of Neurosurgery, Cliniques Universitaires Saint Luc, UCLouvain, 1200, Brussels, Belgium
| | - L Daoud
- Department of Pathology, Cliniques Universitaires Saint Luc, UCLouvain, 1200, Brussels, Belgium
| | - M Lammens
- Department of Pathology, Cliniques Universitaires Saint Luc, UCLouvain, 1200, Brussels, Belgium
- Department of Pathology, Antwerp University Hospital, University of Antwerp, 2650, Antwerp, Belgium
| | - D Maiter
- Endocrinology and Nutrition Department, Cliniques Universitaires Saint-Luc, n°10, Avenue Hippocrate, 1200, Brussels, Belgium
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13
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Benkirane A, Warlop T, Ivanoiu A, Baret P, Wiame E, Haufroid V, Duprez T, Hantson P. Case report: Motor neuron disease phenotype associated with symptomatic copper deficiency: Challenging diagnosis and treatment. Front Neurol 2023; 13:1063803. [PMID: 36686537 PMCID: PMC9845570 DOI: 10.3389/fneur.2022.1063803] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/18/2022] [Indexed: 01/06/2023] Open
Abstract
Copper deficiency is an acquired condition that can lead to neurologic dysfunctions, such as myelopathy, motor neuron impairment, polyneuropathy, cognitive impairment, and optic nerve neuropathy. Associated biological findings are low serum copper and ceruloplasmin levels with low copper urinary excretion. We report the case of a previously healthy 59-year-old man who presented a complex neurological picture starting with symptoms and radiological signs consistent with degenerative myelopathy in the presence of persisting low serum copper and ceruloplasmin despite oral and intravenous copper supplementation. Over time, his symptoms evolved into a motor neuron disease evocating an amyotrophic lateral sclerosis (ALS) phenotype. The potential role of copper deficiency is discussed, together with the difficulties in biomonitoring copper supplementation.
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Affiliation(s)
- Adam Benkirane
- Department of Neurology, Cliniques Universitaires St-Luc, Brussels, Belgium,*Correspondence: Adam Benkirane
| | - Thibault Warlop
- Department of Neurology, Cliniques Universitaires St-Luc, Brussels, Belgium,Institute of Neurosciences, Université Catholique de Louvain, Brussels, Belgium
| | - Adrian Ivanoiu
- Department of Neurology, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Pierre Baret
- Hospital Pharmacy, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Elsa Wiame
- Laboratory of Physiological Chemistry, Université Catholique de Louvain and the Christian de Duve Institute of Cellular Pathology, Brussels, Belgium
| | - Vincent Haufroid
- Laboratory of Toxicology, Cliniques Universitaires St-Luc, Brussels, Belgium,Louvain Centre for Toxicology and Applied Pharmacology, Université Catholique de Louvain, Brussels, Belgium
| | - Thierry Duprez
- Department of Neuroradiology, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Philippe Hantson
- Louvain Centre for Toxicology and Applied Pharmacology, Université Catholique de Louvain, Brussels, Belgium,Department of Intensive Care, Cliniques Universitaires St-Luc, Brussels, Belgium
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14
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Blauen A, Lenfant C, Duprez T, Nassogne M. Erratum: Subacute brainstem ischemic syndrome in juvenile neurofibromatosis type 2: An under-recognized condition. Clin Case Rep 2023; 11:e6804. [PMID: 36619483 PMCID: PMC9811064 DOI: 10.1002/ccr3.6804] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 12/10/2022] [Indexed: 01/05/2023] Open
Abstract
[This corrects the article DOI: 10.1002/ccr3.6686.].
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Affiliation(s)
- Aglaë Blauen
- Department of Child Neurology, Cliniques Universitaires Saint‐LucUniversité Catholique de LouvainBrusselsBelgium
| | - Christine Lenfant
- Department of Radiology, Cliniques Universitaires Saint‐LucUniversité Catholique de LouvainBrusselsBelgium
| | - Thierry Duprez
- Department of Radiology, Cliniques Universitaires Saint‐LucUniversité Catholique de LouvainBrusselsBelgium
| | - Marie‐Cécile Nassogne
- Department of Child Neurology, Cliniques Universitaires Saint‐LucUniversité Catholique de LouvainBrusselsBelgium
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15
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Vanesse P, Georgery H, Duprez T, Gérard L, Collienne C, Verroken A, Crombé F, Morelle J, Hantson P. Severe Neurological Involvement in an Adult with Shiga Toxin-Producing Escherichia coli-Hemolytic Uremic Syndrome Treated with Eculizumab. Case Rep Nephrol Dial 2023; 13:7-14. [PMID: 36741549 PMCID: PMC9891842 DOI: 10.1159/000528893] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/22/2022] [Indexed: 01/28/2023] Open
Abstract
A 68-year-old man with a medical history of hypertension was admitted to the emergency department for diffuse abdominal pain preceded by bloody diarrhea. Upon admission, neurological examination was normal, but he suddenly developed a left-sided hemiparesis. After a normal brain computed tomography, intravenous thrombolysis was administered for a suspicion of ischemic stroke. In the first laboratory investigations, hemoglobin was 16.9 g/dL, platelets 121 × 109/L (150-450), and serum creatinine 1.17 mg/dL. By the second hospital day, the platelet level dropped to 79 × 109/L, with haptoglobin at 0.12 g/L, 3% schistocytes, and normal ADAMTS13 activity (57%). Serum creatinine increased to 1.84 mg/dL with oliguria. The suspicion of thrombotic microangiopathy was supported by the identification of Shiga toxin genes stx1 and stx2 on a rectal swab and the isolation of an eaeA-negative Shiga toxin-producing E. coli O113:H4. The patient presented a generalized tonic-clonic seizure, and orotracheal intubation was required for decreased consciousness. Plasma exchange therapy was started, and eculizumab was given 6 days after symptoms onset. Brain magnetic resonance imaging (MRI) on day 13 showed symmetric hyperintensities within basal ganglia that disappeared on a second MRI on day 37. At 2-month follow-up, the patient had made a complete neurological and renal recovery and eculizumab therapy was stopped.
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Affiliation(s)
- Pauline Vanesse
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Hélène Georgery
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Thierry Duprez
- Department of Neuroradiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Ludovic Gérard
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Christine Collienne
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alexia Verroken
- Department of Microbiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Florence Crombé
- Department of Microbiology and Infection Control, Belgian National Reference Centre for STEC/VTEC, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Johann Morelle
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Philippe Hantson
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Louvain Centre for Toxicology and Applied Pharmacology, UCLouvain, Brussels, Belgium
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16
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Blauen A, Lenfant C, Duprez T, Nassogne M. Subacute brainstem ischemic syndrome in juvenile neurofibromatosis type 2: An underrecognized condition. Clin Case Rep 2022; 10:e6686. [PMID: 36483869 PMCID: PMC9723389 DOI: 10.1002/ccr3.6686] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
We report the case of a teenager with a neurofibromatosis Type 2 (NF2) presenting a locked-in syndrome due to a brainstem ischemic syndrome. The presence of sudden or rapidly worsening onset of neurological deficits in NF2 patients, should evoke this underknown entity and not only tumors as predisposed by NF2.
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Affiliation(s)
- Aglaë Blauen
- Department of Child NeurologyCliniques Universitaires Saint‐Luc, Université Catholique de LouvainBrusselsBelgium
| | - Christine Lenfant
- Department of RadiologyCliniques Universitaires Saint‐Luc, Université Catholique de LouvainBrusselsBelgium
| | - Thierry Duprez
- Department of RadiologyCliniques Universitaires Saint‐Luc, Université Catholique de LouvainBrusselsBelgium
| | - Marie‐Cécile Nassogne
- Department of RadiologyCliniques Universitaires Saint‐Luc, Université Catholique de LouvainBrusselsBelgium
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17
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Van Migem S, Devresse A, Pichierri V, Georgery H, Duprez T, Hantson P. Rapidly Reversible Leukoencephalopathy After Acute Kidney Graft Rejection in a Patient With Systemic Lupus Erythematosus. EXP CLIN TRANSPLANT 2022; 20:1126-1130. [PMID: 36718011 DOI: 10.6002/ect.2022.0297] [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: 02/01/2023]
Abstract
The finding of white matter damage on brain magnetic resonance imaging may correspond to a wide variety of etiologies. The differential diagnosis may be particularly difficultin immunocompromised patients with a specific autoimmune disease or who are receiving medications after a solid-organ transplant. Herein, we describe the case of a 22-year-old woman who developed serious neurological complications after an acute rejection of a kidney graft that she had received a few months previous to treat a systemic lupus erythematosus-related nephritis.We discuss the possible hypotheses underlying the development of acute leukoencephalopathy in this setting.
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Affiliation(s)
- Simon Van Migem
- From the Department of Intensive Care, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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18
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Constantinescu SM, Wilms G, Furnica RM, Duprez T, Maiter D. Conservative management of complicated Rathke's cleft cyst mimicking pituitary apoplexy. Endocrinol Diabetes Metab Case Rep 2022; 2022:21-0214. [PMID: 35916193 PMCID: PMC9346314 DOI: 10.1530/edm-21-0214] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Summary Complicated Rathke's cleft cyst (RCC) is a rare occurrence of symptomatic bleeding or growth of a previously asymptomatic (and often undiagnosed) intrasellar cyst derived from remnants of Rathke's pouch, situated on the midline between the adeno- and neurohypophysis. Symptoms may be identical to those of pituitary apoplexy: acute onset of headache, hypopituitarism, and neurological disturbances. Both syndromes may also exhibit a similar appearance of a large haemorrhagic sellar mass at initial radiological evaluation. We report on two patients who presented with headache and complete hypopituitarism. Based on the initial MRI, they were first diagnosed with pituitary apoplexy but managed conservatively with hormone therapy alone because of the absence of severe visual or neurological threat. Upon follow-up at 4 months, clinical evolution was good in both patients but their pituitary mass had not reduced in size and, after careful radiologic reviewing, was more indicative of a large midline complicated RCC. In conclusion, the diagnosis of complicated RCC is challenging because it can mimic pituitary apoplexy clinically, biologically, and radiologically. Clinicians should distinguish between the two entities using specific radiological signs or evolution of the mass at MRI if the patient does not undergo surgery. To our knowledge, we report conservative management of this rare condition for the first time, though it seems appropriate in the absence of neurological compromise or visual compression. Long-term follow-up is however mandatory. Learning points Complicated Rathke's cleft cyst can mimic pituitary apoplexy, presenting with sudden onset of headache, hypopituitarism, and visual and neurological compromise in the most severe cases. At diagnosis, pituitary MRI may not be able to differentiate between the two entities, showing a large haemorrhagic mass inside the sella, with little or no normal pituitary tissue visible. Patients are often diagnosed with apoplexy at this stage and may undergo pituitary surgery. When surgery has not been performed initially in these patients, repeat imaging at 3-6 months is unchanged and does not show the expected involution usually seen after adenoma apoplexy. Conservative management with hormonal replacement seems a valid option in the absence of visual or neurological deficits that would require trans-sphenoidal surgery.
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Affiliation(s)
- S M Constantinescu
- Department of Endocrinology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - G Wilms
- Department of Radiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - R M Furnica
- Department of Endocrinology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - T Duprez
- Department of Radiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - D Maiter
- Department of Endocrinology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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19
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Coutel M, Flamant R, El Sankari S, Belkhir L, Duprez T, Boschi A. Relapsing-remitting Optic Neuropathy in an HIV-infected Patient: Secondary Auto-immune Optic Neuropathy or Infectious Optic Neuropathy? A Case Report and Review of the Literature. Neuroophthalmology 2022; 46:236-241. [DOI: 10.1080/01658107.2021.1933078] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Maëlle Coutel
- Department of Ophthalmology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Roxane Flamant
- Department of Ophthalmology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Souraya El Sankari
- Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Leila Belkhir
- Department of Infectiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Thierry Duprez
- Department of Radiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Antonella Boschi
- Department of Ophthalmology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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20
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Dompmartin A, van der Vleuten CJM, Dekeuleneer V, Duprez T, Revencu N, Désir J, Te Loo DMWM, Flucke U, Eijkelenboom A, Schultze Kool L, Vikkula M, Boon L. GNA11-mutated Sturge-Weber Syndrome has distinct neurologic and dermatologic features. Eur J Neurol 2022; 29:3061-3070. [PMID: 35715928 DOI: 10.1111/ene.15452] [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: 12/21/2021] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sturge-Weber syndrome (SWS) is a neurocutaneous disorder characterized by clinical manifestations involving the brain, eye and skin. SWS is commonly caused by somatic mutations in G protein subunit Alpha Q (GNAQ). Subunit Alpha 11 (GNA11) mutations have been reported in 5 cases. It is not clear if their phenotypic features differ. METHODS Within two European multidisciplinary centers we looked for patients with clinical characteristics of SWS and a GNA11 mutation. Clinical and radiological data was collected retrospectively and prospectively. RESULTS We identified three patients with SWS associated with a somatic GNA11 mutation. They had disseminated capillary malformation (CM) and hyper- or hypotrophy of an extremity. At birth, the CMs of the face, trunk and limbs were pink and patchy, and slowly darkened with age evolving to purple color. Two of the patients had glaucoma. All had neurological symptoms and moderate brain atrophy at a lower degree of severity than classically associated with SWS. Susceptibility-Weighted Images (SWI) and contrast-enhanced (CE) Fluid Attenuated Inversion Recovery (FLAIR) MR views demonstrated best sensitivity to reveal the pial angiomas. CONCLUSIONS We differentiate two distinct clinical/radiological phenotypes of SWS; GNAQ- and GNA11-SWS. The classical GNAQ-SWS is characterized by a homogeneous dark-red CM commonly associated with underlying soft tissue hypertrophy. The CM in GNA11-SWS is more reticulate and darkens with time; neurological picture is milder. SWI and post contrast FLAIR sequences appear to be necessary to demonstrate the leptomeningeal angiomatosis. Yet, anti-epileptic medication or future targeted therapies may be useful, like in classic SWS.
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Affiliation(s)
| | | | | | - Thierry Duprez
- Cliniques universitaires Saint-Luc, Radiology, Brussels, Belgium
| | - Nicole Revencu
- Cliniques universitaires Saint-Luc, Human Genetics, Brussels, Belgium
| | - Julie Désir
- Erasmus Hospital, Human Genetics Brussels, Brussels, Belgium
| | - D Maroeska W M Te Loo
- Radboudumc, Pediatric Haematology & center vascular anomalies Nijmegen, Gelderland, Netherlands
| | - Uta Flucke
- Radboudumc, Pathology & Center of vascular anomaies Nijmegen, Gelderland, Netherlands
| | - Astrid Eijkelenboom
- Radboudumc, Pathology & Center of vascular anomaies Nijmegen, Gelderland, Netherlands
| | - Leo Schultze Kool
- Radboudumc, Radiology & center for vascular anomalies Nijmegen, Gelderland, Netherlands
| | | | - Laurence Boon
- Cliniques universitaires Saint-Luc, Center for vascular anomalies, division of Plastic surgery, Brussels, Belgium
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Mossakowski M, Jacobs S, Hanseeuw B, Duprez T, Van Marcke C. Acute leukoencephalopathy and thyroiditis induced by capecitabine. Acta Neurol Belg 2022; 122:1373-1375. [PMID: 35152372 DOI: 10.1007/s13760-022-01893-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/05/2022] [Indexed: 01/16/2023]
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22
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Costa E, Joris V, Vaz G, Santos SF, El-Tahry R, Duprez T, Raftopoulos C. The trans superior temporal gyrus approach for selective amygdalohippocamptectomy. World Neurosurg 2021; 159:e244-e251. [PMID: 34923179 DOI: 10.1016/j.wneu.2021.12.034] [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: 11/06/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Different surgical approaches have been described for selective amygdalohippocampectomy (SeAH) in patients with pharmacoresistant temporal lobe epilepsy (TLE). We report the results of the innovative trans-superior temporal gyrus (trans-STG) approach in a monocentric patients' series. METHODS We reviewed the patients' characteristics, post-operative outcomes, and complications in a series of 8 consecutive TLE patients operated on using the trans-STG approach and recruited between November 2015 and April 2017. RESULTS Over a mean 2,5-year follow-up period, 7/8 patients (87,5%) remained seizure-free (Engel 1). Only one (12,5%) was not cured (Engel 3) without clear explanation for treatment failure. Mean operative time was 237 minutes, representing a shortage of 80 minutes when compared to our historic trans-sylvian approach. No peri-operative death was recorded nor visual field defect/visual acuity impairment due to the approach. One patient suffered from a left posterior thalamo-capsular stroke. CONCLUSION Trans-STG approach is feasible, fast, and safefor SeAH in drug refractory TLE patients. This approach allows preservation of the optic radiation but cuts part of the uncinate fasciculus and potentially the anterior aspect of the anterior bundle of the midlle longitudinal fasciculus.
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Affiliation(s)
- Emmanuel Costa
- Department of Neurosurgery, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Vincent Joris
- Department of Neurosurgery, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Geraldo Vaz
- Department of Neurosurgery, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Susana Ferrao Santos
- Department of Neurology, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Riëm El-Tahry
- Department of Neurology, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Thierry Duprez
- Department of Radiology and Medical Imaging, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Christian Raftopoulos
- Department of Neurosurgery, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium.
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Leempoel J, Sellimi A, Gonzalez Rodriguez de Azero N, Persu A, Duprez T. Combination of acute hypertensive striatocapsular hemorrhage and mirror previous asymptomatic slit-like hemorrhage in a young patient: a new radiological clue for cerebral small vessel disease? Acta Neurol Belg 2021; 121:1371-1373. [PMID: 34160792 DOI: 10.1007/s13760-021-01725-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
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24
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Hemptinne C, Coche A, Duprez T, Demaerel P, Raftopoulos C, Boschi A. Optic Neuropathy Revealing Severe Superficial Siderosis in the Setting of Long-standing Low-grade Intracranial Neoplasm. Neuroophthalmology 2021; 46:171-177. [DOI: 10.1080/01658107.2021.1958870] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Coralie Hemptinne
- Ophthalmology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Adrienne Coche
- Ophthalmology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Thierry Duprez
- Neuroradiology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | | | - Antonella Boschi
- Ophthalmology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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25
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Coutel M, Duprez T, Huart C, Wacheul E, Boschi A. Invasive Fungal Sinusitis with Ophthalmological Complications: Case Series and Review of the Literature. Neuroophthalmology 2021; 45:193-204. [PMID: 34194126 DOI: 10.1080/01658107.2020.1779315] [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] [Indexed: 10/23/2022] Open
Abstract
Invasive fungal sinusitis can lead to dramatic complications in immunocompromised patients and requires prompt diagnosis. Here we report three cases with ophthalmological complications secondary to invasive fungal sinusitis in immunocompromised patients. From an ophthalmological point of view, these cases illustrate different clinical presentations, evolutions, complications, treatments, prognoses, and highlight different pathophysiological mechanisms. Diagnoses were delayed in all cases. In none of the cases did patients recover better vision than counting fingers at 24 months follow up, and two patients died. This case series highlights key points useful for quickly recognising this highly morbid infection in immunocompromised patients.
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Affiliation(s)
- Maëlle Coutel
- Ophthalmology Department, Cliniques Universitaires Saint-Luc, Woluwé-Saint-Lambert, Belgium
| | - Thierry Duprez
- Neuroradiology Department, Cliniques Universitaires Saint-Luc, Woluwé-Saint-Lambert, Belgium
| | - Caroline Huart
- ENT Department, Cliniques Universitaires Saint-Luc, Woluwé-Saint-Lambert, Belgium
| | - Emilie Wacheul
- Anatomopathology Department, Cliniques Universitaires Saint-Luc, Woluwé-Saint-Lambert, Belgium
| | - Antonella Boschi
- Ophthalmology Department, Cliniques Universitaires Saint-Luc, Woluwé-Saint-Lambert, Belgium
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26
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Pichon L, Ivanoiu A, Duprez T, Lacomblez D, Wilms G. NEURO-IMAGE: MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome). Acta Neurol Belg 2021; 122:1597-1598. [PMID: 33948900 DOI: 10.1007/s13760-021-01694-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/23/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Louise Pichon
- Radiology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Bruxelles, Belgium.
| | - Adrian Ivanoiu
- Neurology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Bruxelles, Belgium
| | - Thierry Duprez
- Radiology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Bruxelles, Belgium
| | - Douglas Lacomblez
- Radiology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Bruxelles, Belgium
| | - Guido Wilms
- Radiology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Bruxelles, Belgium
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27
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Hanset N, Tsevi MY, Duprez T, Ivanoiu A, Devresse A, Demoulin N, Kanaan N. Infliximab for relapsing neurosarcoidosis recurring after kidney transplantation: a case report. Acta Clin Belg 2021; 76:149-151. [PMID: 31486719 DOI: 10.1080/17843286.2019.1664093] [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: 12/17/2022]
Abstract
Neurological involvement of sarcoidosis is a rare condition, and its occurrence in the context of transplantation is exceptional. Moreover, treatment can be challenging. We report the unusual case of a patient transplanted with a kidney for end-stage renal disease secondary to sarcoidosis who experienced a neurological recurrence of the disease under immunosuppressive treatment, translating in behavioural aggressiveness, social withdrawal and weight loss. He relapsed thrice under corticosteroids but responded finally to infliximab. This case highlights the potential of sarcoidosis to recur neurologically after kidney transplantation despite immunosuppressive treatment. Also, treatment of relapsing neurosarcoidosis can be challenging and may benefit from TNF-α blockers.
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Affiliation(s)
- Nicolas Hanset
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Mawufemo Yawovi Tsevi
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Thierry Duprez
- Division of Radiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Adrian Ivanoiu
- Division of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Arnaud Devresse
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Nathalie Demoulin
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Nada Kanaan
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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28
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Sellimi A, London F, Duprez T, Peeters A. Occlusion de l’artère de Percheron : revue de 25 cas. Rev Neurol (Paris) 2021. [DOI: 10.1016/j.neurol.2021.02.282] [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: 10/21/2022]
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29
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Mambour N, Maiter D, Duprez T, Costa E, Fomekong E, Raftopoulos C, Bugli C, Boschi A. Functional Prognostic value of optical coherence tomography in optic chiasmal decompression: A preliminary study. J Fr Ophtalmol 2021; 44:321-330. [PMID: 33514457 DOI: 10.1016/j.jfo.2020.06.041] [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: 04/11/2020] [Revised: 06/07/2020] [Accepted: 06/18/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess the predictive value for functional recovery of Ganglion Cell Complex Layer (GCC) and Retinal Nerve Fiber Layer (RNFL) measurements obtained by Optical Coherence Tomography (OCT) in patients undergoing chiasmal decompression and to define potential OCT thresholds for visual recovery. METHODS We measured preoperative GCC and RNFL thickness in patients with a sellar and/or perisellar tumor compressing the optic chiasm. Visual recovery was defined as recovery of mean deviation (MD) and pattern standard deviation (PSD) using Humphrey visual field testing after 12 successful decompressions (24 eyes). Receiver operating characteristic curve (ROC) analysis was used to identify the best thresholds. RESULTS Robust global and focal OCT thresholds were found. Superior GCC≥63μm had the best functional prognostic value (AUC=1) for visual improvement. Mean GCC ≥ 67μm and mean RNFL≥75μm also had excellent predictive values (AUC>0.9). CONCLUSION In this preliminary study, significant preoperative OCT thresholds for early visual recovery after chiasmal decompression were identified, mainly regarding GCC measurements. Further studies on larger cohorts with closely scheduled follow-up could refine our results.
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Affiliation(s)
- N Mambour
- Cliniques universitaires Saint-Luc, UC Louvain, 10, avenue Hippocrate, Brussels, Belgium.
| | - D Maiter
- Cliniques universitaires Saint-Luc, UC Louvain, 10, avenue Hippocrate, Brussels, Belgium
| | - T Duprez
- Cliniques universitaires Saint-Luc, UC Louvain, 10, avenue Hippocrate, Brussels, Belgium
| | - E Costa
- Cliniques universitaires Saint-Luc, UC Louvain, 10, avenue Hippocrate, Brussels, Belgium
| | - E Fomekong
- Cliniques universitaires Saint-Luc, UC Louvain, 10, avenue Hippocrate, Brussels, Belgium
| | - C Raftopoulos
- Cliniques universitaires Saint-Luc, UC Louvain, 10, avenue Hippocrate, Brussels, Belgium
| | - C Bugli
- Plateforme technologique de support en méthodologie et calcul statistique, 20, voie du Roman-Pays, Louvain-La-Neuve, Belgium
| | - A Boschi
- Cliniques universitaires Saint-Luc, UC Louvain, 10, avenue Hippocrate, Brussels, Belgium
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30
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Collette F, Hamoir M, Van Eeckhout P, D’Abadie P, Duprez T, Schmitz S, Machiels J. Metastatic cutaneous apocrine adenocarcinoma successfully treated with systemic anti-androgen therapy-A case report. Clin Case Rep 2020; 8:3472-3478. [PMID: 33363954 PMCID: PMC7752452 DOI: 10.1002/ccr3.3434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/17/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022] Open
Abstract
Primary cutaneous apocrine adenocarcinoma (PCAC) is an extremely rare neoplasm involving the sweat glands. Due to a lack of cases, there is no consensus for the systemic treatment of locally advanced or metastatic PCAC. Anti-androgen therapy may have activity in inoperable or metastatic PCAC with high androgen receptor (AR) expression.
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Affiliation(s)
- Fanny Collette
- Institut Roi Albert IIDepartment of Medical OncologyCliniques universitaires Saint‐Luc and Institut de Recherche Clinique et Expérimentale (POLE MIRO)Université catholique de LouvainBrusselsBelgium
| | - Marc Hamoir
- Institut Roi Albert IIDepartment of Head and Neck SurgeryCliniques universitaires Saint‐Luc and Institut de Recherche Clinique et Expérimentale (POLE MIRO)Université catholique de LouvainBrusselsBelgium
| | - Pascal Van Eeckhout
- Institut Roi Albert IIDepartment of PathologyCliniques universitaires Saint‐LucBrusselsBelgium
| | - Philippe D’Abadie
- Institut Roi Albert IIDepartment of Nuclear MedicineCliniques universitaires Saint‐Luc and Institut de Recherche Clinique et Expérimentale (POLE MIRO)Université catholique de LouvainBrusselsBelgium
| | - Thierry Duprez
- Institut Roi Albert IIDepartment of Medical ImagingCliniques universitaires Saint‐LucBrusselsBelgium
| | - Sandra Schmitz
- Institut Roi Albert IIDepartment of Head and Neck SurgeryCliniques universitaires Saint‐Luc and Institut de Recherche Clinique et Expérimentale (POLE MIRO)Université catholique de LouvainBrusselsBelgium
| | - Jean‐Pascal Machiels
- Institut Roi Albert IIDepartment of Medical OncologyCliniques universitaires Saint‐Luc and Institut de Recherche Clinique et Expérimentale (POLE MIRO)Université catholique de LouvainBrusselsBelgium
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Levecque E, Goffette P, Duprez T, Peeters A. Idiopathic internal carotid artery vasospasm successfully treated with balloon angioplasty. Acta Neurol Belg 2020; 120:1477-1479. [PMID: 32712848 DOI: 10.1007/s13760-020-01427-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Emmanuelle Levecque
- Stroke Unit, Department of Neurology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Pierre Goffette
- Interventional Radiology Unit, Department of Radiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Thierry Duprez
- Neuroradiology Unit, Department of Radiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - André Peeters
- Stroke Unit, Department of Neurology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
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Sandron J, Hantson P, Duprez T. Intracranial brain parenchymal spread of mucormycosis through olfactory tract: a diffusion-weighted imaging-based concept. Acta Radiol Open 2020; 9:2058460120980999. [PMID: 33489314 PMCID: PMC7768863 DOI: 10.1177/2058460120980999] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/25/2020] [Indexed: 11/15/2022] Open
Abstract
Mucormycosis is an opportunistic fungal infection involving among others the paranasal sinuses, nasal fossa and brain parenchyma. Mucor can invade the brain parenchyma by either contiguous spread from the paranasal sinuses or through vascular invasion. We report a case of fatal rhino-cerebral mucormycosis in whom cytotoxic edema at magnetic resonance diffusion-weighted imaging was symmetrically restricted to both neocortical and paleocortical primary areas of olfactory projection at earliest phase of the disease process. Shortly later tissue damage extended into the whole brain. This undescribed observation raised the hypothesis of preferential way of brain invasion by Mucor through the olfactory tract.
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Affiliation(s)
- J. Sandron
- Department of Neuroradiology, Clinique Universitaire St-Luc, Bruxelles, Belgium
| | - Ph. Hantson
- Department of Neuroradiology, Clinique Universitaire St-Luc, Bruxelles, Belgium
| | - T. Duprez
- Department of Neuroradiology, Clinique Universitaire St-Luc, Bruxelles, Belgium
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Dufour I, Duprez T, Wertz M, Saussoy P, Ackermans N, El Sankari S, van Pesch V, Van Den Neste E. Improvement in progressive multifocal leukoencephalopathy after pembrolizumab-induced immune reconstruction inflammatory syndrome in a patient with follicular lymphoma. EJHaem 2020; 1:585-588. [PMID: 35845001 PMCID: PMC9175693 DOI: 10.1002/jha2.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/12/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) may develop in follicular lymphoma patients treated with bendamustine-rituximab. In this report, treatment with pembrolizumab successfully inhibited the clinical progression of PML by promoting radiologically demonstrated immune restoration inflammatory syndrome (IRIS), allowing complete clearance of the virus. These findings may further support the use of pembrolizumab in PML with special consideration for the potential occurrence of IRIS.
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Affiliation(s)
- Inès Dufour
- Department of HematologyUniversité catholique de Louvain, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Thierry Duprez
- Department of Radiology and Medical ImagingUniversité catholique de Louvain, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Marie Wertz
- Department of NeurologyClinique Notre‐Dame de GrâceGosseliesBelgium
| | - Pascale Saussoy
- Hematology LaboratoryUniversité catholique de Louvain, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Nathalie Ackermans
- Department of NeurologyUniversité catholique de Louvain, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Souraya El Sankari
- Department of NeurologyUniversité catholique de Louvain, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Vincent van Pesch
- Department of NeurologyUniversité catholique de Louvain, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Eric Van Den Neste
- Department of HematologyUniversité catholique de Louvain, Cliniques universitaires Saint‐LucBrusselsBelgium
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Mahiat C, Capes A, Duprez T, Whenham N, Duck L, Labriola L. Central diabetes insipidus induced by temozolomide: A report of two cases. J Oncol Pharm Pract 2020; 27:1040-1045. [PMID: 32990192 DOI: 10.1177/1078155220961551] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Central diabetes insipidus is a heterogeneous condition characterized by decreased release of antidiuretic hormone by the neurohypophysis resulting in a urine concentration deficit with variable degrees of polyuria. The most common causes include idiopathic diabetes insipidus, tumors or infiltrative diseases, neurosurgery and trauma. Temozolomide is an oral DNA-alkylating agent capable of crossing the blood-brain barrier and used as chemotherapy primarily to treat glioblastoma and other brain cancers. CASES Two men (aged 38 and 54 years) suddenly developed polyuria and polydispsia approximately four weeks after the initiation of temozolomide for a glioblastoma. Plasma and urine parameters demonstrated the presence of a urinary concentration defect. MANAGEMENT The clinical and laboratory abnormalities completely resolved with intranasal desmopressin therapy, allowing the continuation of temozolomide. The disorder did not relapse after cessation of temozolomide and desmopressin and relapsed in one patient after rechallenge with temozolomide. DISCUSSION Our report highlights the importance of a quick recognition of this exceptional complication, in order to initiate promptly treatment with desmopressin and to maintain therapy with temozolomide.
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Affiliation(s)
- Cédric Mahiat
- Department of Oncology, Clinique Saint-Pierre, Ottignies, Belgium
| | - Antoine Capes
- Department of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Thierry Duprez
- Department of Medical Imaging, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Nicolas Whenham
- Department of Oncology, Clinique Saint-Pierre, Ottignies, Belgium.,Department of Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Lionel Duck
- Department of Oncology, Clinique Saint-Pierre, Ottignies, Belgium
| | - Laura Labriola
- Department of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Guilmot A, Maldonado Slootjes S, Sellimi A, Bronchain M, Hanseeuw B, Belkhir L, Yombi JC, De Greef J, Pothen L, Yildiz H, Duprez T, Fillée C, Anantharajah A, Capes A, Hantson P, Jacquerye P, Raymackers JM, London F, El Sankari S, Ivanoiu A, Maggi P, van Pesch V. Immune-mediated neurological syndromes in SARS-CoV-2-infected patients. J Neurol 2020; 268:751-757. [PMID: 32734353 PMCID: PMC7391231 DOI: 10.1007/s00415-020-10108-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [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: 06/01/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 01/01/2023]
Abstract
Background Evidence of immune-mediated neurological syndromes associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection is limited. We therefore investigated clinical, serological and CSF features of coronavirus disease 2019 (COVID-19) patients with neurological manifestations. Methods Consecutive COVID-19 patients with neurological manifestations other than isolated anosmia and/or non-severe headache, and with no previous neurological or psychiatric disorders were prospectively included. Neurological examination was performed in all patients and lumbar puncture with CSF examination was performed when not contraindicated. Serum anti-gangliosides antibodies were tested when clinically indicated. Results Of the 349 COVID-19 admitted to our center between March 23rd and April 24th 2020, 15 patients (4.3%) had neurological manifestations and fulfilled the study inclusion/exclusion criteria. CSF examination was available in 13 patients and showed lymphocytic pleocytosis in 2 patients: 1 with anti-contactin-associated protein 2 (anti-Caspr2) antibody encephalitis and 1 with meningo-polyradiculitis. Increased serum titer of anti-GD1b antibodies was found in three patients and was associated with variable clinical presentations, including cranial neuropathy with meningo-polyradiculitis, brainstem encephalitis and delirium. CSF PCR for SARS-CoV-2 was negative in all patients. Conclusions In SARS-Cov-2 infected patients with neurological manifestations, CSF pleocytosis is associated with para- or post-infectious encephalitis and polyradiculitis. Anti-GD1b and anti-Caspr2 autoantibodies can be identified in certain cases, raising the question of SARS-CoV-2-induced secondary autoimmunity.
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Affiliation(s)
- Antoine Guilmot
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hippocrate 10, 1200, Brussels, Belgium
| | - Sofia Maldonado Slootjes
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hippocrate 10, 1200, Brussels, Belgium
| | - Amina Sellimi
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hippocrate 10, 1200, Brussels, Belgium
| | - Maroussia Bronchain
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hippocrate 10, 1200, Brussels, Belgium
| | - Bernard Hanseeuw
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hippocrate 10, 1200, Brussels, Belgium
| | - Leila Belkhir
- Department of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Jean Cyr Yombi
- Department of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Julien De Greef
- Department of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Lucie Pothen
- Department of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Halil Yildiz
- Department of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thierry Duprez
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Catherine Fillée
- Department of Biology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ahalieyah Anantharajah
- Department of Biology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Antoine Capes
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Philippe Hantson
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Philippe Jacquerye
- Department of Neurology, Clinique Saint-Pierre Ottignies, Ottignies-Louvain-la-Neuve, Belgium
| | - Jean-Marc Raymackers
- Department of Neurology, Clinique Saint-Pierre Ottignies, Ottignies-Louvain-la-Neuve, Belgium
| | - Frederic London
- Department of Neurology, CHU UCL Namur Site Godinne, Yvoir, Belgium
| | - Souraya El Sankari
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hippocrate 10, 1200, Brussels, Belgium
| | - Adrian Ivanoiu
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hippocrate 10, 1200, Brussels, Belgium
| | - Pietro Maggi
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hippocrate 10, 1200, Brussels, Belgium
| | - Vincent van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hippocrate 10, 1200, Brussels, Belgium.
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Slootjes SM, Lejeune T, Duprez T, Lawson TM, Peeters A. Levodopa-responsive Holmes head titubation caused by midbrain cavernoma hemorrhage. Neurol Sci 2020; 42:381-382. [PMID: 32719901 DOI: 10.1007/s10072-020-04627-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Sofia Maldonado Slootjes
- Department of Neurology, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Thierry Lejeune
- Department of Physical medicine and Rehabilitation, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Thierry Duprez
- Department of Radiology, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Tévi Morel Lawson
- Department of Neurosurgery, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - André Peeters
- Department of Neurology, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
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Baudar C, Duprez T, Kassab A, Miller N, Rutgers MP. COVID-19 as triggering co-factor for cortical cerebral venous thrombosis? J Neuroradiol 2020; 48:65-67. [PMID: 32603768 PMCID: PMC7320695 DOI: 10.1016/j.neurad.2020.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Coline Baudar
- ESO Stroke Unit, Europe Hospitals, avenue de Fré 206, 1180 Brussels, Belgium
| | - Thierry Duprez
- Radiology Department, UCLouvain Hospital, avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Amandine Kassab
- ESO Stroke Unit, Europe Hospitals, avenue de Fré 206, 1180 Brussels, Belgium
| | - Nathalie Miller
- Biology Department, Europe Hospitals, avenue de Fré 206, 1180 Brussels, Belgium
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Janssen H, Nannoni S, Francois O, Dewaele T, De Blauwe S, Vanhooren G, Ghekiere J, Kager J, Peeters A, Goffette P, Hammer F, Duprez T, Demeestere J, Lemmens R, Cornelissen S, Heye S, Yperzeele L, Baar I, Voormolen M, Van der Zijden T, Mondelaers A, Andersson T, Pottel H, Odier C, Karkri F, Michel P, Vanacker P. Multicenter, retrospective analysis of endovascular treatment for acute ischemic stroke in nonagenarians. J Stroke Cerebrovasc Dis 2020; 29:104817. [PMID: 32689620 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/22/2019] [Revised: 03/04/2020] [Accepted: 03/14/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND With the increasing age of acute stroke patients being admitted to hospitals, more data are needed on indications, complications and outcome of endovascular treatment (EVT) in the very elderly. METHODS Retrospective observational study with data collection from Belgian, Swiss, Canadian comprehensive stroke centers and Swedish EVT National database. All patients with acute ischemic stroke were eligible if aged older than or ≥90 years and treated with EVT ± pretreatment with intravenous thrombolysis (IVT). Safety assessment comprised presence of periprocedural complications, hemorrhagic transformation or other adverse events (<7days). Efficacy and outcome measures were successful recanalization (modified Treatment In Cerebral Infarction (mTICI) score ≥2b), favorable clinical outcome (modified Rankin Score (mRS) 0-2) and 3-months mortality. RESULTS Inclusion of 112 nonagenarians (mean age 93.3 ± 2.5 years; 76.8% women; pre-mRS ≤2 in 69.4%). Pretreatment with IVT was performed in 54.7%. In 74.6% successful recanalization (mTICI ≥2b) was achieved. Favorable outcome (mRS ≤2) was seen in 16.4% and 3-months mortality was 62.3%. Multivariate logistic regression analysis showed younger age (odds ratio [OR] 2.99; 1.29-6.95; P = .011) and lower prestroke mRS (OR 13.46; 2.32-78.30; P = .004) as significant predictors for good clinical outcome at 90 days. CONCLUSIONS Our observational study on EVT in nonagenarians demonstrates the need for careful patient selection. A substantial proportion of nonagenarians shows an unfavorable clinical outcome and high mortality, despite acceptable recanalization rates. A high prestroke disability (mRS) and advancing age predict an unfavorable outcome. Treatment decisions should be made on case-by-case evaluation, keeping in mind limited chances of favorable outcome and high risk of mortality.
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Affiliation(s)
- Helena Janssen
- Ghent University, Department of neurology, Gent, Belgium.
| | | | | | | | | | | | | | | | - André Peeters
- Cliniques Universitaires Saint-Luc, Brussel, Belgium
| | | | - Frank Hammer
- Cliniques Universitaires Saint-Luc, Brussel, Belgium
| | | | | | | | | | - Sam Heye
- University Hospital Leuven, Leuven, Belgium
| | | | - Ingrid Baar
- Antwerp University Hospital, Edegem, Belgium
| | | | | | | | - Tommy Andersson
- Ghent University, Department of neurology, Gent, Belgium; AZ Groeninge Kortrijk and Karolinska Sweden
| | - Hans Pottel
- University of Leuven campus Kortrijk, Kortrijk, Belgium
| | - Céline Odier
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Fatine Karkri
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Patrik Michel
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Peter Vanacker
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Antwerp University Hospital, Edegem, Belgium; AZ Groeninge Kortrijk, Antwerp University Hospital and University Antwerp, Antwerpen, Belgium
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Duchêne G, Abarca-Quinones J, Feza-Bingi N, Leclercq I, Duprez T, Peeters F. Double Diffusion Encoding for Probing Radiation-Induced Microstructural Changes in a Tumor Model: A Proof-of-Concept Study With Comparison to the Apparent Diffusion Coefficient and Histology. J Magn Reson Imaging 2020; 52:941-951. [PMID: 32147929 DOI: 10.1002/jmri.27119] [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] [Received: 12/20/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Microstructure analyses are gaining interest in cancer MRI as an alternative to the conventional apparent diffusion coefficient (ADC), of which the determinants remain unclear. PURPOSE To assess the sensitivity of parameters calculated from a double diffusion encoding (DDE) sequence to changes in a tumor's microstructure early after radiotherapy and to compare them with ADC and histology. STUDY TYPE Cohort study on experimental tumors. ANIMAL MODEL Sixteen WAG/Rij rats grafted with one rhabdomyosarcoma fragment in each thigh. Thirty-one were imaged at days 1 and 4, of which 17 tumors received a 20 Gy radiation dose after the first imagery. FIELD STRENGTH/SEQUENCE 3T. Diffusion-weighted imaging, DDE with flow compensated, and noncompensated measurements. ASSESSMENTS 1) To compare, after irradiation, DDE-derived parameters (intracellular fraction, cell size, and cell density) to their histological counterparts (fraction of stained area, minimal Feret diameter, and nuclei count, respectively). 2) To compare percentage changes in DDE-derived parameters and ADC. 3) To evaluate the evolution of DDE-derived parameters describing perfusion. STATISTICAL TESTS Wilcoxon rank sum test. RESULTS 1) Intracellular fraction, cell size, and cell density were respectively lower (-24%, P < 0.001), higher (+7.5%, P < 0.001) and lower (-38%, P < 0.001) in treated tumors as compared to controls. Fraction of stained area, minimal Feret diameter, and nuclei count were respectively lower (-20%, P < 0.001), higher (+28%, P < 0.001), and lower (-34%, P < 0.001) in treated tumors. 2) The magnitude of ADC's percentage change due to irradiation (16.4%) was superior to the one of cell size (8.4%, P < 0.01) but inferior to those of intracellular fraction (35.5%, P < 0.001) and cell density (42%, P < 0.001). 3) After treatment, the magnitude of the vascular fraction's decrease was higher than the increase of flow velocity (33.3%, vs. 13.3%, P < 0.001). DATA CONCLUSION The DDE sequence allows quantitatively monitoring the effects of radiotherapy on a tumor's microstructure, whereas ADC only reveals global changes. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 4. J. Magn. Reson. Imaging 2020;52:941-951.
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Affiliation(s)
- Gaëtan Duchêne
- Department of medical imaging, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Jorge Abarca-Quinones
- Department of medical imaging, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,MRI unit, Department of medical imaging, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Natacha Feza-Bingi
- Department of medical imaging, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Laboratory of Hepato-gastroenterology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Isabelle Leclercq
- Department of medical imaging, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,MRI unit, Department of medical imaging, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Laboratory of Hepato-gastroenterology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Thierry Duprez
- Department of medical imaging, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,MRI unit, Department of medical imaging, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Frank Peeters
- MRI unit, Department of medical imaging, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Hemptinne C, Boschi A, Duprez T, Ivanoiu A, Coutel M. Case of Susac's syndrome initially diagnosed as multiple sclerosis. J Fr Ophtalmol 2020; 43:e119-e122. [DOI: 10.1016/j.jfo.2019.09.004] [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: 04/15/2019] [Revised: 09/02/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
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De Baerdemaeker K, Mabiglia C, Hantson P, Di Fazio V, Duprez T, Kozyreff A, van Pesch V, Sellimi A. Acute Susac Syndrome in a Recent User of Adulterated Cocaine: Levamisole as a Triggering Factor? Case Rep Neurol 2020; 12:78-83. [PMID: 32231548 PMCID: PMC7098328 DOI: 10.1159/000506043] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/16/2020] [Indexed: 12/12/2022] Open
Abstract
Susac syndrome (SS) is a central nervous system vasculitis characterized by the clinical triad of encephalopathy, sensorineural hearing loss, and visual disturbance caused by branch retinal artery occlusion. It is considered as an inflammatory disorder, and an autoimmune etiology is suggested. A 29-year-old man with a history of recent cocaine abuse developed the clinical features of SS. Toxicological analysis including hair testing revealed that cocaine had been adulterated with levamisole. After an initial clinical improvement following corticosteroid therapy, the introduction of mycophenolate mofetil was justified a few weeks later by the progression (or relapse) of the retinal injury, followed by complete recovery. The presence of levamisole has been documented in patients with multifocal inflammatory leukoencephalopathy (MIL). Further investigations are needed to determine if levamisole as an adulterant of cocaine could also play a role in the development of rapidly progressive leukoencephalopathy in young men, with Susac or Susac-like syndromes as possible variants of MIL.
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Affiliation(s)
- Klara De Baerdemaeker
- Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Chiara Mabiglia
- Department of Neuroradiology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Philippe Hantson
- Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Vincent Di Fazio
- National Institute for Criminology and Criminalistics, Brussels, Belgium
| | - Thierry Duprez
- Department of Neuroradiology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Alexandra Kozyreff
- Department of Ophthalmology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Vincent van Pesch
- Department of Neurology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Amina Sellimi
- Department of Neurology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
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Boccuni L, Meyer S, D'cruz N, Kessner SS, Marinelli L, Trompetto C, Peeters A, Van Pesch V, Duprez T, Sunaert S, Feys H, Thijs V, Nieuwboer A, Verheyden G. Premotor dorsal white matter integrity for the prediction of upper limb motor impairment after stroke. Sci Rep 2019; 9:19712. [PMID: 31873186 PMCID: PMC6928144 DOI: 10.1038/s41598-019-56334-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/26/2019] [Accepted: 12/08/2019] [Indexed: 01/01/2023] Open
Abstract
Corticospinal tract integrity after stroke has been widely investigated through the evaluation of fibres descending from the primary motor cortex. However, about half of the corticospinal tract is composed by sub-pathways descending from premotor and parietal areas, to which damage may play a more specific role in motor impairment and recovery, particularly post-stroke. Therefore, the main aim of this study was to investigate lesion load within corticospinal tract sub-pathways as predictors of upper limb motor impairment after stroke. Motor impairment (Fugl-Meyer Upper Extremity score) was evaluated in 27 participants at one week and six months after stroke, together with other clinical and demographic data. Neuroimaging data were obtained within the first week after stroke. Univariate regression analysis indicated that among all neural correlates, lesion load within premotor fibres explained the most variance in motor impairment at six months (R2 = 0.44, p < 0.001). Multivariable regression analysis resulted in three independent, significant variables explaining motor impairment at six months; Fugl-Meyer Upper Extremity score at one week, premotor dorsal fibre lesion load at one week, and age below or above 70 years (total R2 = 0.81; p < 0.001). Early examination of premotor dorsal fibre integrity may be a promising biomarker of upper limb motor impairment after stroke.
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Affiliation(s)
- Leonardo Boccuni
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium. .,University of Genova, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genova, Italy.
| | - Sarah Meyer
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Nicholas D'cruz
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Simon S Kessner
- University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany
| | - Lucio Marinelli
- University of Genova, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genova, Italy
| | - Carlo Trompetto
- University of Genova, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genova, Italy
| | - André Peeters
- Cliniques Universitaires Saint-Luc, Department of Neurology, Brussels, Belgium
| | - Vincent Van Pesch
- Cliniques Universitaires Saint-Luc, Department of Neurology, Brussels, Belgium
| | - Thierry Duprez
- Cliniques Universitaires Saint-Luc, Department of Radiology, Brussels, Belgium
| | - Stefan Sunaert
- KU Leuven - University of Leuven, Department of Imaging and Pathology, Leuven, Belgium
| | - Hilde Feys
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, Stroke Division, Melbourne, Australia.,Austin Health, Department of Neurology, Melbourne, Australia
| | - Alice Nieuwboer
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Geert Verheyden
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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Duchêne G, Abarca‐Quinones J, Leclercq I, Duprez T, Peeters F. Insights into tissue microstructure using a double diffusion encoding sequence on a clinical scanner: Validation and application to experimental tumor models. Magn Reson Med 2019; 83:1263-1276. [DOI: 10.1002/mrm.28012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022]
Affiliation(s)
| | - Jorge Abarca‐Quinones
- Université Catholique de Louvain Brussels Belgium
- Cliniques Universitaires Saint‐Luc Brussels Belgium
| | - Isabelle Leclercq
- Université Catholique de Louvain Brussels Belgium
- Cliniques Universitaires Saint‐Luc Brussels Belgium
| | - Thierry Duprez
- Université Catholique de Louvain Brussels Belgium
- Cliniques Universitaires Saint‐Luc Brussels Belgium
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Joris V, Ribeiro Vaz JG, Lelotte J, Duprez T, Raftopoulos C. Large Epileptogenic Type IIIb Dysplasia: A Radiological and Anatomopathological Challenge. World Neurosurg 2019; 129:330-333. [DOI: 10.1016/j.wneu.2019.06.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 01/12/2023]
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Burlacu MC, Maiter D, Duprez T, Delgrange E. T2-weighted magnetic resonance imaging characterization of prolactinomas and association with their response to dopamine agonists. Endocrine 2019; 63:323-331. [PMID: 30267354 DOI: 10.1007/s12020-018-1765-3] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Recent work supports the use of T2-weighted MRI intensity as a tool for treatment stratification in acromegaly. Our study aimed to establish if the pattern of T2 intensity could be a predictor of hormonal and/or tumoral response to dopamine agonists (DAs) in prolactinomas. METHODS This was a retrospective study performed in two academic centers. We characterized the magnetic resonance T2-weighted aspect of prolactinomas (signal intensity and homogeneity in the whole tumors) before DA therapy and correlated this pattern to the prolactin (PRL) concentration at diagnosis and to hormonal and tumoral responses after 1 year of medical treatment. We separately analyzed a subgroup of prolactinomas visually very bright in more than 50% of the surface ("cystic" tumors). RESULTS Out of 70 prolactinomas, 80% were T2 hyperintense and 40% were heterogeneous. At diagnosis, heterogeneous prolactinomas were more frequent in men (68% vs. 28.9%, p ≤ 0.011), larger (median area 304.5 mm2 vs. 56.5 mm2, p ≤ 0.021), taller (mean height 18.6 mm vs. 9.9 mm, p < 0.001), more secreting (median PRL ULN_area 23 µg/L/cm2 vs. 12.6 µg/L/cm2, p ≤ 0.032) and had poorer hormonal response to DA as compared with homogeneous prolactinomas. "Cystic" tumors were diagnosed almost exclusively in women and secreted less prolactin, but showed similar hormonal and tumoral response as "non-cystic" tumors. In homogeneous prolactinomas, the T2-weighted intensity ratio was correlated to prolactin secretion, although not significantly, and did not predict hormonal and tumoral response to DA. CONCLUSIONS Our study confirms that hypo/isointense prolactinoma is a rare finding and suggests for the first time that the heterogeneity of prolactinoma T2 signal at diagnosis might be correlated with a different clinical behavior and could be used as a negative predictor factor of hormonal response to DA.
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Affiliation(s)
- M C Burlacu
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium.
| | - D Maiter
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - T Duprez
- Department of Neuroradiology, Cliniques Universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - E Delgrange
- Department of Endocrinology, CHU Mont-Godinne-Dinant, Université catholique de Louvain, Yvoir, Belgium
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London F, Duprez T, van Pesch V. Response to correspondence: "Interferon alpha might be an alternative therapeutic choice for refractory neuro-Behçet's disease" - Authors reply. Mult Scler Relat Disord 2018; 29:154. [PMID: 30885371 DOI: 10.1016/j.msard.2018.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Frédéric London
- Department of Neurology, Cliniques Universitaires St-Luc, Université catholique de Louvain (UCLouvain), 10 avenue Hippocrate, Brussels 1200, Belgium; Department of Neurology, CHU UCLouvain Namur, Université catholique de Louvain (UCLouvain), 1 avenue G. Thérasse, Yvoir 5530, Belgium.
| | - Thierry Duprez
- Department of Radiology, Neuroradiology section, Cliniques Universitaires St-Luc, Université catholique de Louvain (UCLouvain), 10 avenue Hippocrate, Brussels 1200, Belgium
| | - Vincent van Pesch
- Department of Neurology, Cliniques Universitaires St-Luc, Université catholique de Louvain (UCLouvain), 10 avenue Hippocrate, Brussels 1200, Belgium
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De Bruyn N, Meyer S, Kessner SS, Essers B, Cheng B, Thomalla G, Peeters A, Sunaert S, Duprez T, Thijs V, Feys H, Alaerts K, Verheyden G. Functional network connectivity is altered in patients with upper limb somatosensory impairments in the acute phase post stroke: A cross-sectional study. PLoS One 2018; 13:e0205693. [PMID: 30312350 PMCID: PMC6185852 DOI: 10.1371/journal.pone.0205693] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/28/2018] [Indexed: 11/19/2022] Open
Abstract
Background Aberrant functional connectivity in brain networks associated with motor impairment after stroke is well described, but little is known about the association with somatosensory impairments. Aim The objective of this cross-sectional observational study was to investigate the relationship between brain functional connectivity and severity of somatosensory impairments in the upper limb in the acute phase post stroke. Methods Nineteen first-ever stroke patients underwent resting-state functional magnetic resonance imaging (rs-fMRI) and a standardized clinical somatosensory profile assessment (exteroception and higher cortical somatosensation) in the first week post stroke. Integrity of inter- and intrahemispheric (ipsilesional and contralesional) functional connectivity of the somatosensory network was assessed between patients with severe (Em-NSA< 13/32) and mild to moderate (Em-NSA> 13/32) somatosensory impairments. Results Patients with severe somatosensory impairments displayed significantly lower functional connectivity indices in terms of interhemispheric (p = 0.001) and ipsilesional intrahemispheric (p = 0.035) connectivity compared to mildly to moderately impaired patients. Significant associations were found between the perceptual threshold of touch assessment and interhemispheric (r = -0.63) and ipsilesional (r = -0.51) network indices. Additional significant associations were found between the index of interhemispheric connectivity and light touch (r = 0.55) and stereognosis (r = 0.64) evaluation. Conclusion Patients with more severe somatosensory impairments have lower inter- and ipsilesional intrahemispheric connectivity of the somatosensory network. Lower connectivity indices are related to more impaired exteroception and higher cortical somatosensation. This study highlights the importance of network integrity in terms of inter- and ipsilesional intrahemispheric connectivity for somatosensory function. Further research is needed investigating the effect of therapy on the re-establishment of these networks.
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Affiliation(s)
- Nele De Bruyn
- KU Leuven—University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- * E-mail:
| | - Sarah Meyer
- KU Leuven—University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Simon S. Kessner
- University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany
| | - Bea Essers
- KU Leuven—University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Bastian Cheng
- University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany
| | - Götz Thomalla
- University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany
| | - Andre Peeters
- Cliniques Universitaires Saint-Luc, Department of Neurology, Brussels, Belgium
| | - Stefan Sunaert
- KU Leuven—University of Leuven, Department of Imaging and Pathology, Leuven, Belgium
- University Hospitals Leuven, Department of Radiology, Leuven, Belgium
| | - Thierry Duprez
- Cliniques Universitaires Saint-Luc, Department of Radiology, Brussels, Belgium
| | - Vincent Thijs
- University of Melbourne, Florey Institute of Neuroscience and Mental Health, Victoria, Australia
- University of Melbourne, Department of Neurology, Austin Health, Victoria, Australia
| | - Hilde Feys
- KU Leuven—University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Kaat Alaerts
- KU Leuven—University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Geert Verheyden
- KU Leuven—University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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Del Gaudio N, Vaz G, Duprez T, Raftopoulos C. Comparison of Dural Peeling versus Duraplasty for Surgical Treatment of Chiari Type I Malformation: Results and Complications in a Monocentric Patients' Cohort. World Neurosurg 2018; 117:e595-e602. [DOI: 10.1016/j.wneu.2018.06.093] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
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Pétillon P, Wilms G, Raftopoulos C, Duprez T. Spinal intradural extramedullary cavernous hemangioma. Neuroradiology 2018; 60:1085-1087. [PMID: 30090980 DOI: 10.1007/s00234-018-2073-6] [Citation(s) in RCA: 4] [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] [Received: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 11/28/2022]
Abstract
Spinal intradural extramedullary cavernous hemangiomas are very rare. Mixed intensities on T1- andT2-weighted images due to repeated hemorrhages and poor to absent contrast-enhancement are the most common imaging features of the disease allowing accurate differentiation from the far more frequent meningiomas and schwannomas of similar location.
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Affiliation(s)
- Philippe Pétillon
- Cliniques Universitaires Saintt-Luc (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Guido Wilms
- Cliniques Universitaires Saintt-Luc (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium. .,Department of Radiology, UZLeuven Campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
| | - Christian Raftopoulos
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Thierry Duprez
- Cliniques Universitaires Saintt-Luc (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium
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Boccuni L, Meyer S, Kessner SS, De Bruyn N, Essers B, Cheng B, Thomalla G, Peeters A, Sunaert S, Duprez T, Marinelli L, Trompetto C, Thijs V, Verheyden G. Is There Full or Proportional Somatosensory Recovery in the Upper Limb After Stroke? Investigating Behavioral Outcome and Neural Correlates. Neurorehabil Neural Repair 2018; 32:691-700. [PMID: 29991331 DOI: 10.1177/1545968318787060] [Citation(s) in RCA: 9] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Proportional motor recovery in the upper limb has been investigated, indicating about 70% of the potential for recovery of motor impairment within the first months poststroke. OBJECTIVE To investigate whether the proportional recovery rule is applicable for upper-limb somatosensory impairment and to study underlying neural correlates of impairment and outcome at 6 months. METHODS A total of 32 patients were evaluated at 4 to 7 days and 6 months using the Erasmus MC modification of the revised Nottingham Sensory Assessment (NSA) for impairment of (1) somatosensory perception (exteroception) and (2) passive somatosensory processing (sharp/blunt discrimination and proprioception); (3) active somatosensory processing was evaluated using the stereognosis component of the NSA. Magnetic resonance imaging scans were obtained within 1 week poststroke, from which lesion load (LL) was calculated for key somatosensory tracts. RESULTS Somatosensory perception fully recovered within 6 months. Passive and active somatosensory processing showed proportional recovery of 86% (95% CI = 79%-93%) and 69% (95% CI = 49%-89%), respectively. Patients with somatosensory impairment at 4 to 7 days showed significantly greater thalamocortical and insulo-opercular tracts (TCT and IOT) LL ( P < .05) in comparison to patients without impairment. Sensorimotor tract disruption at 4 to 7 days did not provide significant contribution above somatosensory processing score at 4 to 7 days when predicting somatosensory processing outcome at 6 months. CONCLUSIONS Our sample of stroke patients assessed early showed full somatosensory perception but proportional passive and active somatosensory processing recovery. Disruption of both the TCT and IOT early after stroke appears to be a factor associated with somatosensory impairment but not outcome.
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Affiliation(s)
- Leonardo Boccuni
- 1 KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.,2 University of Genova, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genova, Italy
| | - Sarah Meyer
- 1 KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Simon S Kessner
- 3 University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany
| | - Nele De Bruyn
- 1 KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Bea Essers
- 1 KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Bastian Cheng
- 3 University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany
| | - Götz Thomalla
- 3 University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany
| | - André Peeters
- 4 Cliniques Universitaires Saint-Luc, Department of Neurology, Brussels, Belgium
| | - Stefan Sunaert
- 5 KU Leuven - University of Leuven, Department of Imaging and Pathology, Leuven, Belgium; University Hospitals Leuven, Department of Radiology, Leuven, Belgium
| | - Thierry Duprez
- 6 Cliniques Universitaires Saint-Luc, Department of Radiology, Brussels, Belgium
| | - Lucio Marinelli
- 2 University of Genova, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genova, Italy.,7 Department of Neuroscience, Ospedale Policlinico San Martino, Genova, Italy
| | - Carlo Trompetto
- 2 University of Genova, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genova, Italy.,7 Department of Neuroscience, Ospedale Policlinico San Martino, Genova, Italy
| | - Vincent Thijs
- 8 University of Melbourne, Florey Institute of Neuroscience and Mental Health, Victoria, Australia; Department of Neurology, Austin Health, Victoria, Australia
| | - Geert Verheyden
- 1 KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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