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Loganathan A, Zanframundo G, Yoshida A, Faghihi-Kashani S, Bauer Ventura I, Dourado E, Bozan F, Sambataro G, Yamano Y, Bae SS, Lim D, Ceribelli A, Isailovic N, Selmi C, Fertig N, Bravi E, Kaneko Y, Saraiva AP, Jovani V, Bachiller-Corral J, Cifrian J, Mera-Varela A, Moghadam-Kia S, Wolff V, Campagne J, Meyer A, Giannini M, Triantafyllias K, Knitza J, Gupta L, Molad Y, Iannone F, Cavazzana I, Piga M, De Luca G, Tansley S, Bozzalla-Cassione E, Bonella F, Corte TJ, Doyle TJ, Fiorentino D, Gonzalez-Gay MA, Hudson M, Kuwana M, Lundberg IE, Mammen AL, McHugh NJ, Miller FW, Montecucco C, Oddis CV, Rojas-Serrano J, Schmidt J, Scirè CA, Selva-O'Callaghan A, Werth VP, Alpini C, Bozzini S, Cavagna L, Aggarwal R. Agreement between local and central anti-synthetase antibodies detection: results from the Classification Criteria of Anti-Synthetase Syndrome project biobank. Clin Exp Rheumatol 2024; 42:277-287. [PMID: 38488094 DOI: 10.55563/clinexprheumatol/s14zq8] [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: 11/02/2023] [Accepted: 01/18/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES The CLASS (Classification Criteria of Anti-Synthetase Syndrome) project is a large international multicentre study that aims to create the first data-driven anti-synthetase syndrome (ASSD) classification criteria. Identifying anti-aminoacyl tRNA synthetase antibodies (anti-ARS) is crucial for diagnosis, and several commercial immunoassays are now available for this purpose. However, using these assays risks yielding false-positive or false-negative results, potentially leading to misdiagnosis. The established reference standard for detecting anti-ARS is immunoprecipitation (IP), typically employed in research rather than routine autoantibody testing. We gathered samples from participating centers and results from local anti-ARS testing. As an "ad-interim" study within the CLASS project, we aimed to assess how local immunoassays perform in real-world settings compared to our central definition of anti-ARS positivity. METHODS We collected 787 serum samples from participating centres for the CLASS project and their local anti-ARS test results. These samples underwent initial central testing using RNA-IP. Following this, the specificity of ARS was reconfirmed centrally through ELISA, line-blot assay (LIA), and, in cases of conflicting results, protein-IP. The sensitivity, specificity, positive likelihood ratio and positive and negative predictive values were evaluated. We also calculated the inter-rater agreement between central and local results using a weighted κ co-efficient. RESULTS Our analysis demonstrates that local, real-world detection of anti-Jo1 is reliable with high sensitivity and specificity with a very good level of agreement with our central definition of anti-Jo1 antibody positivity. However, the agreement between local immunoassay and central determination of anti-non-Jo1 antibodies varied, especially among results obtained using local LIA, ELISA and "other" methods. CONCLUSIONS Our study evaluates the performance of real-world identification of anti-synthetase antibodies in a large cohort of multi-national patients with ASSD and controls. Our analysis reinforces the reliability of real-world anti-Jo1 detection methods. In contrast, challenges persist for anti-non-Jo1 identification, particularly anti-PL7 and rarer antibodies such as anti-OJ/KS. Clinicians should exercise caution when interpreting anti-synthetase antibodies, especially when commercial immunoassays test positive for non-anti-Jo1 antibodies.
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Affiliation(s)
- Aravinthan Loganathan
- Royal National Hospital for Rheumatic Diseases, Bath; Department of Life Sciences, University of Bath, UK; and Arthritis Australia, Broadway, Glebe, NSW, Australia
| | - Giovanni Zanframundo
- Department of Internal Medicine and Therapeutics, Università di Pavia; and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Akira Yoshida
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Sara Faghihi-Kashani
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Eduardo Dourado
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, Aveiro; Aveiro Rheumatology Research Centre, Egas Moniz Health Alliance, Aveiro; and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal
| | - Francisca Bozan
- Hospital Clínico Universidad de Chile, Department of Medicine, Section of Rheumatology, Chile
| | - Gianluca Sambataro
- Regional Referral Center for Rare Lung Disease, Policlinico G. Rodolico-San Marco, University of Catania, Italy
| | - Yasuhiko Yamano
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Japan
| | - Sharon Sangmee Bae
- Department of Medicine, Division of Rheumatology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Darosa Lim
- Department of Dermatology, Perelman School of Medicine & Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Angela Ceribelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele; and Rheumatology and Clinical Immunology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Italy
| | - Natasa Isailovic
- Rheumatology and Clinical Immunology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Italy
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele; and Rheumatology and Clinical Immunology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Italy
| | - Noreen Fertig
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elena Bravi
- Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Yuko Kaneko
- Keio University School of Medicine, Tokyo, Japan
| | | | - Vega Jovani
- Department of Rheumatology, Hospital General Universitario Dr. Balmis Alicante, ISABIAL, Alicante, Spain
| | | | - Jose Cifrian
- Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | | | - Siamak Moghadam-Kia
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Alain Meyer
- Exploration Fonctionnelle Musculaire, Service de Physiologie, Service de Rhumatologie, Centre de Référence des Maladies Auto-Immunes Systémiques Rares RESO Hôpitaux Universitaires de Strasbourg, France
| | - Margherita Giannini
- Exploration Fonctionnelle Musculaire, Service de Physiologie, Service de Rhumatologie, Centre de Référence des Maladies Auto-Immunes Systémiques Rares RESO Hôpitaux Universitaires de Strasbourg, France
| | | | | | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Yair Molad
- Rabin Medical Center, Beilinson Hospital, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | | | - Matteo Piga
- University Clinic and AOU of Cagliari, Italy
| | - Giacomo De Luca
- IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Sarah Tansley
- Royal National Hospital for Rheumatic Diseases, Bath, and Department of Life Sciences, University of Bath, UK
| | - Emanuele Bozzalla-Cassione
- Department of Internal Medicine and Therapeutics, Università di Pavia, and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Tamera J Corte
- University of Sydney, NSW, and Royal Prince Alfred Hospital, NSW, Australia
| | - Tracy J Doyle
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Miguel Angel Gonzalez-Gay
- Medicine and Psychiatry Department, University of Cantabria, and Division of Rheumatology, IIS-Fundacion Jiménez Díaz, Madrid, Spain
| | - Marie Hudson
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | | | - Andrew L Mammen
- National Institute of Arthritis and Musculoskeletal and Skin Disorders, National Institutes of Health, Bethesda, MD, and Departments of Medicine and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Fredrick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, Università di Pavia; and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jorge Rojas-Serrano
- Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, México City, México
| | | | - Carlo Alberto Scirè
- IRCCS San Gerardo dei Tintori Foundation, Monza, and School of Medicine, University of Milano Bicocca, Milan, Italy
| | - Albert Selva-O'Callaghan
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Vall d'Hebron General Hospital, Universitat Autonoma de Barcelona, Spain
| | - Victoria P Werth
- Department of Dermatology, Perelman School of Medicine & Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Claudia Alpini
- Laboratory of Biochemical-Chemistry, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Sara Bozzini
- US Transplant Center, Laboratorio di Biologia Cellulare e Immunologia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Lorenzo Cavagna
- Department of Internal Medicine and Therapeutics, Università di Pavia; and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Naouri D, Allain S, Fery-Lemonier E, Wolff V, Derex L, Raynaud P, Costemalle V. Social inequalities and gender differences in health care management of acute ischemic strokes in France. Eur J Neurol 2022; 29:3255-3263. [PMID: 35789144 DOI: 10.1111/ene.15490] [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: 04/05/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION There are regional disparities in access to stroke units in France. Several studies have shown that living in disadvantaged areas is associated with higher frequency of stroke, worse severity at presentation, increased level of dependency, and higher mortality rates. However, few studies have explored the association between an individual's socioeconomic characteristics and stroke care. Our study aimed to determine if living standards are associated with stroke unit access for patients admitted to hospital for acute ischemic stroke. METHODS Using the EDP-Santé French administrative database, we selected all patients admitted to hospital for acute ischemic stroke between 2014 and 2017. Acute ischemic stroke corresponded to hospital stay with ICD-10 codes I63 or I64 as the main diagnosis. Multivariate logistic regression was used to identify if standard of living was associated with likelihood of admission to a stroke unit. RESULTS We identified 14 123 acute-care episodes, corresponding to 335 273 episodes in the general population when appropriately weighted. Of these, 52.9 % were admitted to a stroke unit. Being in the first (i.e., poorest) living standard quartile was associated with lower likelihood of admission to a stroke unit compared with the fourth (i.e., wealthiest) quartile, and was associated with a higher likelihood of paralysis and language disorder, and death at 1 year. CONCLUSION A low living standard was associated with lower likelihood of admission to a stroke unit as well as a greater chance of paralysis and aphasia at the end of hospitalization and a higher possibility of death at 1 year after stroke. Greater access to stroke units in disadvantaged people should be promoted.
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Affiliation(s)
- D Naouri
- Department for Research, Studies, Evaluation and Statistics (DREES), French Health and Social Affairs Ministry, Paris, France
| | - S Allain
- Department for Research, Studies, Evaluation and Statistics (DREES), French Health and Social Affairs Ministry, Paris, France
| | - E Fery-Lemonier
- Department for Research, Studies, Evaluation and Statistics (DREES), French Health and Social Affairs Ministry, Paris, France
| | - V Wolff
- Société Française de Neuro-Vasculaire (SFNV).,Service de neuro-vasculaire, Hôpital de Hautepierre, Strasbourg.,UR3072, Université de Strasbourg, Strasbourg
| | - L Derex
- Société Française de Neuro-Vasculaire (SFNV).,Stroke center, neurology department, neurological hospital, Hospices Civils de Lyon, France.,Research on Healthcare Performance (RESHAPE) U 1290 - INSERM, Université de Lyon, France
| | - P Raynaud
- Department for Research, Studies, Evaluation and Statistics (DREES), French Health and Social Affairs Ministry, Paris, France
| | - V Costemalle
- Department for Research, Studies, Evaluation and Statistics (DREES), French Health and Social Affairs Ministry, Paris, France
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Pop R, Hasiu A, Mangin PH, Severac F, Mihoc D, Nistoran D, Manisor M, Simu M, Chibbaro S, Gheoca R, Quenardelle V, Rouyer O, Wolff V, Beaujeux R. Postprocedural Antiplatelet Treatment after Emergent Carotid Stenting in Tandem Lesions Stroke: Impact on Stent Patency beyond Day 1. AJNR Am J Neuroradiol 2021; 42:921-925. [PMID: 33602749 DOI: 10.3174/ajnr.a6993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/10/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Postprocedural dual-antiplatelet therapy is frequently withheld after emergent carotid stent placement during stroke thrombectomy. We aimed to assess whether antiplatelet regimen variations increase the risk of stent thrombosis beyond postprocedural day 1. MATERIALS AND METHODS Retrospective review was undertaken of all consecutive thrombectomies for acute stroke with tandem lesions in the anterior circulation performed in a single comprehensive stroke center between January 9, 2011 and March 30, 2020. Patients were included if carotid stent patency was confirmed at day 1 postprocedure. The group of patients with continuous dual-antiplatelet therapy from day 1 was compared with the group of patients with absent/discontinued dual-antiplatelet therapy. RESULTS Of a total of 109 tandem lesion thrombectomies, 96 patients had patent carotid stents at the end of the procedure. The early postprocedural stent thrombosis rate during the first 24 hours was 14/96 (14.5%). Of 82 patients with patent stents at day 1, in 28 (34.1%), dual-antiplatelet therapy was either not initiated at day 1 or was discontinued thereafter. After exclusion of cases without further controls of stent patency, there was no significant difference in the rate of subacute/late stent thrombosis between the 2 groups: 1/50 (2%) in patients with continuous dual-antiplatelet therapy versus 0/22 (0%) in patients with absent/discontinued dual-antiplatelet therapy (P = 1.000). In total, we observed 88 patient days without any antiplatelet treatment and 471 patient days with single antiplatelet treatment. CONCLUSIONS Discontinuation of dual-antiplatelet therapy was not associated with an increased risk of stent thrombosis beyond postprocedural day 1. Further studies are warranted to better assess the additional benefit and optimal duration of dual-antiplatelet therapy after tandem lesion stroke thrombectomy.
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Affiliation(s)
- R Pop
- From the Interventional Neuroradiology Department (R.P., A.H., D.M., D.N., M.M., R.B.), Strasbourg University Hospitals, Strasbourg, France
- Institut de Chirurgie Minime Invasive Guidée par l'Image (R.P., R.B.), Strasbourg, France
| | - A Hasiu
- From the Interventional Neuroradiology Department (R.P., A.H., D.M., D.N., M.M., R.B.), Strasbourg University Hospitals, Strasbourg, France
| | - P H Mangin
- Institut National de la Santé et de la Recherche Médicale (P.H.M.), University of Strasbourg, l'Établissement français du sang Grand-Est, BPPS UMR-S1255, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - F Severac
- Public Healthcare Department (F.S.), Strasbourg University Hospitals, Strasbourg, France
| | - D Mihoc
- From the Interventional Neuroradiology Department (R.P., A.H., D.M., D.N., M.M., R.B.), Strasbourg University Hospitals, Strasbourg, France
| | - D Nistoran
- From the Interventional Neuroradiology Department (R.P., A.H., D.M., D.N., M.M., R.B.), Strasbourg University Hospitals, Strasbourg, France
| | - M Manisor
- From the Interventional Neuroradiology Department (R.P., A.H., D.M., D.N., M.M., R.B.), Strasbourg University Hospitals, Strasbourg, France
| | - M Simu
- Neurology Department (M.S.), Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - S Chibbaro
- Neurosurgery Department (S.C.), Strasbourg University Hospitals, Strasbourg, France
| | - R Gheoca
- Stroke Unit (R.G., V.Q., O.R., V.W.), Strasbourg University Hospitals, Strasbourg, France
| | - V Quenardelle
- Stroke Unit (R.G., V.Q., O.R., V.W.), Strasbourg University Hospitals, Strasbourg, France
| | - O Rouyer
- Stroke Unit (R.G., V.Q., O.R., V.W.), Strasbourg University Hospitals, Strasbourg, France
| | - V Wolff
- Stroke Unit (R.G., V.Q., O.R., V.W.), Strasbourg University Hospitals, Strasbourg, France
| | - R Beaujeux
- From the Interventional Neuroradiology Department (R.P., A.H., D.M., D.N., M.M., R.B.), Strasbourg University Hospitals, Strasbourg, France
- Institut de Chirurgie Minime Invasive Guidée par l'Image (R.P., R.B.), Strasbourg, France
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4
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Pop R, Hasiu A, Bolognini F, Mihoc D, Quenardelle V, Gheoca R, Schluck E, Courtois S, Delaitre M, Musacchio M, Pottecher J, Chamaraux-Tran TN, Sellal F, Wolff V, Lebedinsky PA, Beaujeux R. Stroke Thrombectomy in Patients with COVID-19: Initial Experience in 13 Cases. AJNR Am J Neuroradiol 2020; 41:2012-2016. [PMID: 32816767 DOI: 10.3174/ajnr.a6750] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/26/2020] [Indexed: 01/06/2023]
Abstract
We performed a retrospective review in both comprehensive stroke units of a region affected early by the coronavirus disease 2019 (COVID-19) pandemic, between March 1 and April 26, 2020, including patients with COVID-19 who underwent mechanical thrombectomy for ischemic stroke. We identified 13 cases, representing 38.2% of 34 thrombectomies performed during this period. We observed increased mortality and a high incidence of thrombotic complications during hospitalization. Given the high rate of infected patients, systematic use of full personal protection measures seems justified.
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Affiliation(s)
- R Pop
- From the Interventional Neuroradiology Department (R.P., A.H., D.M., R.B.) .,Institut de Chirurgie Minime Invasive Guidée par l'Image (R.P., R.B.), Strasbourg, France
| | - A Hasiu
- From the Interventional Neuroradiology Department (R.P., A.H., D.M., R.B.)
| | - F Bolognini
- Diagnostic and Interventional Neuroradiology Department (F.B., M.D., M.M., P.A.L.)
| | - D Mihoc
- From the Interventional Neuroradiology Department (R.P., A.H., D.M., R.B.)
| | | | | | - E Schluck
- Neurology Department (E.S., S.C.), Emile Muller Hospital, Mulhouse, France
| | - S Courtois
- Neurology Department (E.S., S.C.), Emile Muller Hospital, Mulhouse, France
| | - M Delaitre
- Diagnostic and Interventional Neuroradiology Department (F.B., M.D., M.M., P.A.L.)
| | - M Musacchio
- Diagnostic and Interventional Neuroradiology Department (F.B., M.D., M.M., P.A.L.)
| | - J Pottecher
- Department of Anesthesia (J.P., T.-N.C.-T.), Strasbourg University Hospitals, Strasbourg, France
| | - T-N Chamaraux-Tran
- Department of Anesthesia (J.P., T.-N.C.-T.), Strasbourg University Hospitals, Strasbourg, France
| | - F Sellal
- Neurology Department (F.S.), Hôpitaux Civils de Colmar, Colmar, France
| | - V Wolff
- Stroke Unit (V.Q., R.G., V.W.)
| | - P A Lebedinsky
- Diagnostic and Interventional Neuroradiology Department (F.B., M.D., M.M., P.A.L.)
| | - R Beaujeux
- From the Interventional Neuroradiology Department (R.P., A.H., D.M., R.B.).,Institut de Chirurgie Minime Invasive Guidée par l'Image (R.P., R.B.), Strasbourg, France
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5
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Pop R, Quenardelle V, Hasiu A, Mihoc D, Sellal F, Dugay MH, Lebedinsky PA, Schluck E, LA Porta A, Courtois S, Gheoca R, Wolff V, Beaujeux R. Impact of the COVID-19 outbreak on acute stroke pathways - insights from the Alsace region in France. Eur J Neurol 2020; 27:1783-1787. [PMID: 32399995 PMCID: PMC7273043 DOI: 10.1111/ene.14316] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 01/06/2023]
Abstract
Background and purpose To date, no study has attempted to quantify the impact of the COVID‐19 outbreak on the incidence and treatment of acute stroke. Methods This was a retrospective review of acute stroke pathway parameters in all three stroke units in the Alsace region during the first month of the outbreak (1–31 March 2020), using the similar period from 2019 as a comparator. A secondary detailed analysis of all stroke alerts and stroke unit admissions was performed in the centre with the largest case volume. Results Compared to the same period in 2019, in March 2020 there were 39.6% fewer stroke alerts and 33.3% fewer acute revascularization treatments [40.9% less intravenous thrombolysis (IVT) and 27.6% less mechanical thrombectomy (MT)]. No marked variation was observed in the number of stroke unit admissions (−0.6%). The proportion of patients with acute revascularization treatments (IVT or MT) out of the total number of stroke unit admissions was significantly lower in March 2020 (21.3%) compared to 2019 (31.8%), P = 0.034. There were no significant differences in time delays or severity of clinical symptoms for patients treated by IVT or MT, nor in the distribution of final diagnosis amongst stroke alerts and stroke unit admissions. Conclusion These results suggest that the overall incidence of stroke remained the same, but fewer patients presented within the therapeutic time window. Increased public awareness and corrective measures are needed to mitigate the deleterious effects of the COVID‐19 outbreak on acute stroke care.
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Affiliation(s)
- R Pop
- Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France.,Institut de Chirurgie Minime Invasive Guidée par l'Image, Strasbourg, France
| | - V Quenardelle
- Stroke Unit, Strasbourg University Hospitals, Strasbourg, France
| | - A Hasiu
- Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France
| | - D Mihoc
- Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France
| | - F Sellal
- Neurology Department, Hôpitaux Civils de Colmar, Colmar, France
| | - M H Dugay
- Neurology Department, Hôpitaux Civils de Colmar, Colmar, France
| | - P A Lebedinsky
- Interventional Neuroradiology Department, Hôpitaux Civils de Colmar, Colmar, France
| | - E Schluck
- Neurology Department, Mulhouse and South Alsace Region Hospital Group, Mulhouse, France
| | - A LA Porta
- Neurology Department, Mulhouse and South Alsace Region Hospital Group, Mulhouse, France
| | - S Courtois
- Neurology Department, Mulhouse and South Alsace Region Hospital Group, Mulhouse, France
| | - R Gheoca
- Stroke Unit, Strasbourg University Hospitals, Strasbourg, France
| | - V Wolff
- Stroke Unit, Strasbourg University Hospitals, Strasbourg, France
| | - R Beaujeux
- Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France.,Institut de Chirurgie Minime Invasive Guidée par l'Image, Strasbourg, France
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6
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Pop R, Zinchenko I, Quenardelle V, Mihoc D, Manisor M, Richter JS, Severac F, Simu M, Chibbaro S, Rouyer O, Wolff V, Beaujeux R. Predictors and Clinical Impact of Delayed Stent Thrombosis after Thrombectomy for Acute Stroke with Tandem Lesions. AJNR Am J Neuroradiol 2019; 40:533-539. [PMID: 30765378 DOI: 10.3174/ajnr.a5976] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/23/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There are very few published data on the patency of carotid stents implanted during thrombectomies for tandem lesions in the anterior circulation. We aimed to communicate our experience of stenting in the acute setting with systematic follow-up of stent patency and discuss predictors and clinical repercussions of delayed stent thrombosis. MATERIALS AND METHODS We performed a retrospective study of stroke thrombectomies in a single center between January 2009 and April 2018. Patient files were reviewed to extract patient characteristics, procedural details, imaging studies, and clinical information. Predictors of delayed stent thrombosis and clinical outcome at discharge were analyzed using univariate and multivariate analyses. RESULTS We identified 81 patients treated for tandem lesions: 63 (77.7%) atheromas, 17 (20.9%) dissections, and 1 (1.2%) carotid web. TICI 2b-3 recanalization was achieved in 70 (86.4%) cases. Thirty-five patients (43.2%) were independent (mRS score ≤ 2) at discharge. Among 73 patients with intracranial recanalization and patent stents at the end of the procedure, delayed stent thrombosis was observed in 14 (19.1%). Among 59 patients with patent stents, 44 had further imaging controls (median, 105 days; range, 2-2407 days) and 1 (1.6%) had 50% in-stent stenosis with no retreatment. Stent occlusion rates were 11/39 (28.2%) for periprocedural aspirin treatment versus 3/34 (8.8%) for aspirin and clopidogrel (P = .04). Delayed stent thrombosis was independently associated with higher admission NIHSS scores (OR, 1.1; 95% CI, 1.01-1.28), diabetes (OR, 6.07; 95% CI, 1.2-30.6), and the presence of in-stent thrombus on the final angiographic run (OR, 6.2; 95% CI, 1.4-27.97). Delayed stent thrombosis (OR, 19.78; 95% CI, 2.78-296.83), higher admission NIHSS scores (OR, 1.27, 95% CI, 1.12-1.51), and symptomatic hemorrhagic transformation (OR, 23.65; 95% CI, 1.85-3478.94) were independent predictors of unfavorable clinical outcome at discharge. CONCLUSIONS We observed a non-negligible rate of delayed stent thrombosis with significant negative impact on clinical outcome. Future studies should systematically measure and report stent patency rates.
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Affiliation(s)
- R Pop
- From the Interventional Neuroradiology Department (R.P., D.M., M.M., J.S.R., R.B.)
- Institut Hopitalo-Universitaire Strasbourg (R.P., R.B.), Strasbourg, France
| | | | | | - D Mihoc
- From the Interventional Neuroradiology Department (R.P., D.M., M.M., J.S.R., R.B.)
| | - M Manisor
- From the Interventional Neuroradiology Department (R.P., D.M., M.M., J.S.R., R.B.)
| | - J S Richter
- From the Interventional Neuroradiology Department (R.P., D.M., M.M., J.S.R., R.B.)
- EA3072, FMTS (J.S.R., O.R., V.W.), University of Strasbourg, Strasbourg, France
| | | | - M Simu
- Neurology Department (M.S.), Victor Babes University of Medicine, Timisoara, Romania
| | - S Chibbaro
- Neurosurgery Department (S.C.), Strasbourg University Hospitals, Strasbourg, France
| | - O Rouyer
- Stroke Unit (I.Z., V.Q., O.R., V.W.)
- EA3072, FMTS (J.S.R., O.R., V.W.), University of Strasbourg, Strasbourg, France
| | - V Wolff
- Stroke Unit (I.Z., V.Q., O.R., V.W.)
- EA3072, FMTS (J.S.R., O.R., V.W.), University of Strasbourg, Strasbourg, France
| | - R Beaujeux
- From the Interventional Neuroradiology Department (R.P., D.M., M.M., J.S.R., R.B.)
- Institut Hopitalo-Universitaire Strasbourg (R.P., R.B.), Strasbourg, France
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Rondeau-Lutz M, Baldeyrou M, Saban L, Kup H, Wolff V, Pinis K, Weber J. Annonce d’une maladie grave et interprétariat professionnel : la gestion des émotions. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Jouanjus E, Raymond V, Lapeyre-Mestre M, Wolff V. What is the Current Knowledge about the Cardiovascular Risk for Users of Cannabis-Based Products? A Systematic Review. Clin Ther 2017. [DOI: 10.1016/j.clinthera.2017.05.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Wolff V. Angiopatie cerebrali tossiche. Neurologia 2016. [DOI: 10.1016/s1634-7072(15)76143-x] [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: 12/01/2022] Open
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10
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Zinchenko I, Quenardelle V, Lauer V, Marescaux C, Geny B, Wolff V. Stroke in pregnant and postpartum women: description of 14 cases among a series of 334 ischaemic strokes in young adults. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1486] [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: 10/22/2022]
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11
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Zinchenko I, Lauer V, Quenardelle V, Rouyer O, Marescaux C, Geny B, Wolff V. Sex differences in characteristics of ischaemic strokes in a prospective series of 334 young patients. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.345] [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: 10/22/2022]
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12
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Godefroy J, Noblet V, Wolff V, Lauer V, Rouyer O, Marescaux C, Dromson G, Namer IJ. Scintigraphie de perfusion cérébrale positionnelle : résultats physiologiques et applications cliniques. Médecine Nucléaire 2014. [DOI: 10.1016/j.mednuc.2014.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Bataillard M, Kilic-Huck U, Wolff V, Ghobadi M, Pelt M, Ruppert E, Bourgin P. Lorsqu’un syndrome des jambes sans repos (SJSR) d’apparition brutale peut révéler un infarctus du tronc cérébral. Rev Neurol (Paris) 2014. [DOI: 10.1016/j.neurol.2014.01.617] [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: 10/25/2022]
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14
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Bindila-Perisse D, Diaconu M, Lauer V, Sabau-Philippi S, Rouyer O, Marescaux C, Wolff V. La vie après l’UNV des patients suivis en hôpital de jour neurovasculaire après un AVC : étude sur 3 mois au sein de l’UNV de Strasbourg. Rev Neurol (Paris) 2014. [DOI: 10.1016/j.neurol.2014.01.623] [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: 10/25/2022]
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15
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Ruppert E, Kilic-Huck U, Wolff V, Comtet H, Lefebvre F, Bataillard M, Bourgin P. Symptômes sensitifs : syndrome des jambes sans repos (SJSR) et infarctus du tronc cérébral. Rev Neurol (Paris) 2014. [DOI: 10.1016/j.neurol.2014.01.654] [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: 10/25/2022]
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16
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Pérez A, De Saint Martin A, Astruc D, Desprez P, Wolff V, Fischbach M, Laugel V. Accidents vasculaires cérébraux de l’enfant et du nouveau-né : étude rétrospective sur 161 patients hospitalisés au CHU de Strasbourg de janvier 2003 à décembre 2012. Rev Neurol (Paris) 2014. [DOI: 10.1016/j.neurol.2014.01.423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Hacquard A, Bataillard M, Laurent T, Izzie Jacques N, Elizabeth R, Bourgin P, Wolff V. Syndrome des jambes sans repos (SJSR) et infarctus cérébraux (IC) : physiopathologie et corrélations radio cliniques. Rev Neurol (Paris) 2014. [DOI: 10.1016/j.neurol.2014.01.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Wolff V, Rouyer O, Schlagowski A, Zoll J, Raul JS, Marescaux C, Geny B. Étude de l’effet du THC sur la respiration mitochondriale du cerveau de rat. Une piste de réflexion pour expliquer le lien entre la consommation de cannabis et la survenue d’infarctus cérébral chez l’homme. Rev Neurol (Paris) 2014. [DOI: 10.1016/j.neurol.2014.01.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pop R, Manisor M, Wolff V, Rouyer O, Kehrli P, Marescaux C, Beaujeux R. Évaluation angiographique régionale des collatérales piales : élément prédictif de l’évolution de l’infarctus en cas d’occlusion sylvienne traitée par voie endovasculaire. J Neuroradiol 2014. [DOI: 10.1016/j.neurad.2014.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kremer L, Keller A, Sabau-Philippi S, Bataillard M, Wolff V. Polyangéite microscopique révélée par des hématomes cérébraux à répétition. Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.206] [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: 10/27/2022]
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Quenardelle V, Lauer-Ober V, Rouyer O, beaujeux R, Delplancq H, Marescaux C, Wolff V. Quels diagnostics différentiels d’AVC en filière « thrombolyse » ? Étude prospective sur un an au sein de l’UNV de Strasbourg. Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nisand G, Wolff V, Binder-Foucard, Chiérici P. Priorité nationale de santé publique et financement des hôpitaux : la filière thrombolyse des accidents vasculaires cérébraux. Rev Epidemiol Sante Publique 2013. [DOI: 10.1016/j.respe.2013.01.037] [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: 10/27/2022] Open
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Bing F, Manisor M, Boujan F, Habashy M, Lauer V, Wolff V, Marescaux C, Modreanu A, Papry I, Jahn C, Aloraini Z, Foudi F, Mertz L, Freys G, Beaujeux R. AVC ischémiques vertébro-basilaires et thrombolyse intra-artérielle. J Neuroradiol 2012. [DOI: 10.1016/j.neurad.2012.01.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Griffon C, Ndiaye N, Wolff V, Calon B, Langer B, Bui E, Grunenberger F, Bourgarit A, Schlienger J, Goichot B. Thromboses veineuses cérébrales et grossesse : une série de huit patientes. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.03.107] [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: 10/28/2022]
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Ikka L, Boujan F, Boyer P, Habashy M, Ong C, Modreanu A, Jahn C, Kehrli P, Wolff V, Beaujeux R. Fistule artérioveineuses durale intracrânienne de type III avec œdème parenchymateux : à propos de deux cas embolisés à l’Onyx®. J Neuroradiol 2010. [DOI: 10.1016/j.neurad.2010.01.031] [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: 10/19/2022]
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Sparsa L, Blanc F, Lauer V, Cretin B, Marescaux C, Wolff V. [Recurrent ischemic strokes revealing Lyme meningovascularitis]. Rev Neurol (Paris) 2008; 165:273-7. [PMID: 18760428 DOI: 10.1016/j.neurol.2008.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 03/25/2008] [Accepted: 06/05/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Infectious vascularitis is an unusual cause of ischemic stroke (IS). We report a case of Lyme meningovascularitis complicated with multiple IS. CASE REPORT A 64-year-old man, without any cardiovascular risk factor, was admitted for a right hemiparesia with a left thalamic hypodensity on the initial cerebral CT scan. No cause for this presumed IS could be identified. Later, the patient developed cognitive impairment and a bilateral cerebellar syndrome. Multiple infarcts and multiple intracranial stenosis were seen on cerebral MRI with magnetic resonance angiography (MRA). Cerebrospinal fluid tests showed meningitis and positive Lyme serology with an intrathecal specific anti-Borrelia antibody index. Antibiotic treatment was followed by good biological and partial clinicoradiological outcome. CONCLUSION The diagnosis of Lyme neuroborreliosis should be entertained as a possible cause of IS in highly endemic zones.
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Affiliation(s)
- L Sparsa
- Département de neurologie, hôpital Civil, hôpitaux universitaires, 1, place de l'Hôpital, 6700 Strasbourg, France
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Aubert S, Sellal F, Rouyer O, Chakfe N, Marescaux C, Wolff V. Œdème cérébral vasogénique par syndrome de reperfusion post-endartérectomie carotidienne. Rev Neurol (Paris) 2007; 163:840-4. [PMID: 17878813 DOI: 10.1016/s0035-3787(07)91469-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Reperfusion (or hyperperfusion) syndrome may be a possible complication of carotid artery endarterectomy or angioplasty. OBSERVATION We report the case of a 54-year-old man who underwent a right carotid endarterectomy for an asymptomatic carotid stenosis and developed reperfusion syndrome a few days after surgery. The symptoms were marked by a prolonged partial epileptic status and then left hemiplegia lasting several days. Brain MRI with Diffusion sequences was normal, whereas there was a right frontoparietal hypersignal in FLAIR sequences, suggesting the presence of brain vasogenic oedema. Clinical and neuroradiological outcomes were good, confirming the relative good prognosis attributed to vasogenic brain oedema in previous similar publications. This condition may be misdiagnosed as cytotoxic brain oedema, another possible complication of carotid endarterectomy, whose management and prognosis are different. CONCLUSION When a focal neurological deficit or epileptic seizures follow carotid artery endarterectomy, it is important to consider reperfusion syndrome. MRI (with FLAIR and Diffusion sequences) will show a vasogenic brain oedema, with a better prognosis than what can be expected with cytotoxic oedema.
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Affiliation(s)
- S Aubert
- Département de neurologie, hôpital civil, 1 place de l'Hôpital, 67100 Strasbourg
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Wolff V. Migraine et Céphalées. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)91172-8] [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: 12/01/2022]
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Blanc F, Wolff V, Talmant V, Attali P, Germain P, Flori E, Toutain A, Dollfus H, Tranchant C. Late onset stroke and myocardial infarction in Williams syndrome. Eur J Neurol 2006; 13:e3-4. [PMID: 17116204 DOI: 10.1111/j.1468-1331.2006.01475.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schröder NWJ, Meister D, Wolff V, Christan C, Kaner D, Haban V, Purucker P, Hermann C, Moter A, Göbel UB, Schumann RR. Chronic periodontal disease is associated with single-nucleotide polymorphisms of the human TLR-4 gene. Genes Immun 2005; 6:448-51. [PMID: 15875057 DOI: 10.1038/sj.gene.6364221] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Periodontitis is an inflammatory disease affecting the connective tissue surrounding the teeth leading to tooth loss. Pathogens associated with periodontitis interact with Toll-like receptors (TLRs) to induce cytokines causing and aggravating disease. We screened 197 individuals suffering from generalized periodontitis for the presence of Asp299Gly and Thr399Ile of TLR-4 as well as Arg753Gln of TLR-2 in comparison to matched controls. Single-nucleotide polymorphisms (SNPs) of TLR-4 were elevated among patients (odd's ratio 3.650, 95% CI 1.573-8.467, P < or = 0.0001), while no difference was observed for TLR-2. TLR-4 SNPs were correlated with chronic periodontitis (odd's ratio 5.562, 95% CI 2.199-14.04, P < or = 0.0001), but not with aggressive periodontitis. This observation was confirmed employing a group of periodontally healthy probands over 60 years of age. These data demonstrate that genetic variants of TLR-4 may act as risk factors for the development of generalized chronic periodontitis in humans.
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Affiliation(s)
- N W J Schröder
- Institute for Microbiology and Hygiene, Charité University Medical Center Berlin, Berlin, Germany
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Wolff V, Saint Maurice JP, Ducros A, Guichard JP, Woimant F. [Akinetic mutism and anterior bicerebral infarction due to abnormal distribution of the anterior cerebral artery]. Rev Neurol (Paris) 2002; 158:377-80. [PMID: 11976602] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- V Wolff
- Service de Neurologie, hôpital Lariboisière, Paris, France
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Wolff V. [Environmental hazards due to gas and dust-like emissions]. Offentl Gesundheitswes 1972; 34:348-54. [PMID: 4262670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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