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Lanthier L, Plourde MÉ, Cauchon M. [Among patients with mild ischemic stroke or high-risk TIA, does combined clopidogrel-aspirin therapy initiated within 72hours after stroke onset and given for 21 days reduce the recurrence of stroke at 90 days compared to aspirin alone, and is it safe?]. Rev Med Interne 2024; 45:251-252. [PMID: 38388304 DOI: 10.1016/j.revmed.2024.02.002] [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: 01/27/2024] [Accepted: 02/03/2024] [Indexed: 02/24/2024]
Affiliation(s)
- L Lanthier
- Département de médecine spécialisé, service de médecine interne générale, université de Sherbrooke, Sherbrooke, QC, Canada.
| | - M-É Plourde
- Département de médecine nucléaire et radiobiologie, service de radio-oncologie, université de Sherbrooke, Sherbrooke, QC, Canada
| | - M Cauchon
- Département de médecine familiale et de médecine d'urgence, université Laval, Québec, QC, Canada
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Abid W, Bouhamed M, Hentati S, Masmoudi R, Feki I, Sallemi R, Masmoudi J. Othello syndrome: A case report and literature review. Encephale 2024; 50:115-117. [PMID: 37985257 DOI: 10.1016/j.encep.2023.08.014] [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] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/09/2023] [Accepted: 08/24/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Wissal Abid
- Psychiatry "A" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax 3020, Tunisia.
| | - Mariem Bouhamed
- Psychiatry "A" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax 3020, Tunisia
| | - Salma Hentati
- Psychiatry "A" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax 3020, Tunisia
| | - Rim Masmoudi
- Psychiatry "A" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax 3020, Tunisia
| | - Ines Feki
- Psychiatry "A" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax 3020, Tunisia
| | - Rim Sallemi
- Psychiatry "A" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax 3020, Tunisia
| | - Jawaher Masmoudi
- Psychiatry "A" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax 3020, Tunisia
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Fekri S, Mahmoudimehr P, Jafari Fesharaki M, Hosseinjani E, Abtahi SH, Nouri H. Retinal arterial occlusion and patent foramen ovale: A case study-based review. J Fr Ophtalmol 2024; 47:104021. [PMID: 37951744 DOI: 10.1016/j.jfo.2023.07.022] [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: 05/02/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To identify all reported cases of retinal artery occlusion (RAO) associated with patent foramen ovale (PFO) in the literature and present a similar case of CRAO from our clinic. METHODS PubMed database was searched for studies reporting RAO in individuals with PFO. Relevant data were tabulated and reviewed. We estimated each case's Risk of Paradoxical Embolism (RoPE) score. RESULTS 23 cases of CRAO (n=10; including ours), BRAO (n=10), and CILRAO (n=3) were reviewed. Most cases were under 50 years of age (78.3%). The reported predisposing factors were: hypertension (26.1%), migraine (17.3%), smoking (13.0%), recent immobilization (13.0%), strenuous exertion (8.7%), pregnancy (8.7%), and diabetes (4.3%). A high RoPE score (≥7; suggestive of paradoxical embolism via PFO) was estimated for 71.4% of patients. In most cases, the neurological and cardiovascular examinations, laboratory studies, and imaging were unremarkable, except for the PFO±atrial septal aneurysm (present in 21.7%). In only 28.6% of cases, transthoracic echocardiography (TTE) (± saline contrast) could visualize the PFO; transesophageal echocardiography (TEE) was necessary to detect the PFO in 71.4%. Approximately one-half of the patients underwent percutaneous closure of the PFO; no complications or subsequent acute ischemic events ensued. The visual prognosis was poorer for CRAO than for BRAO or CILRAO. CONCLUSION Timely diagnosis, acute management, and ensuring urgent initiation of stroke workup in cases with RAO or transient monocular vision loss are crucial. Clues to a possible paradoxical embolism as the cause include the absence of known cardiovascular risk factors, young age, migraine, recent immobility, vigorous exercise, and pregnancy.
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Affiliation(s)
- S Fekri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - P Mahmoudimehr
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Jafari Fesharaki
- Department of Cardiology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - E Hosseinjani
- Department of Cardiology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S-H Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - H Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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Fall M, Grenet G, Le HH, Kassaï B, Lega JC, Boussageon R, Mainbourg S, Marchant I, Gafsi J, Dieye AM, Gueyffier F. [Does aspirin have a place in primary cardiovascular prevention by the polypill ? Simulation study on a realistic virtual population]. Therapie 2023; 78:667-678. [PMID: 36841655 DOI: 10.1016/j.therap.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/19/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND The polypill strategy could become widely accepted in cardiovascular prevention due to reduced costs and its simplicity, which promote compliance. Aspirin is often included as a component of the polypill for primary prevention, but three powerful recent trials failed to show any favorable net benefit even in high-risk subgroups. Our objective is to estimate the net benefit associated with aspirin in primary cardiovascular prevention. METHODS We simulated the impact of different polypill compositions combining pravastatin, ramipril, hydrochlorothiazide, with or without aspirin, on a realistic French virtual population between 35 and 65 years old. We assessed how this impact on myocardial infarction and stroke varied according to gender, diabetes, and arterial hypertension. We identified the subgroup of individuals whose specific benefit from aspirin was greater than twice the risk of serious bleeding it induced. RESULTS The absolute benefit associated with aspirin was reduced by co-prescriptions. No subgroup of women benefited from aspirin, and the subgroup of women with a clear net benefit represented 128 women out of 529,421. Men at high risk of cardiovascular death, or with diabetes and hypertension, had a benefit from aspirin exceeding the risk of bleeding induced, but this risk represented more than half of the benefit. No subgroup analyzed did show a benefit greater than twice the risk of bleeding. The proportion of men whose expected benefit from aspirin was greater than twice the risk of bleeding represented 3% of all men. An optimal polypill strategy in primary prevention between the ages of 35 and 65, combining three drugs but not aspirin, can hope to save two out of three strokes and more than one out of two myocardial infarctions. It would prevent a major cardiovascular accident every 16 to 193 individuals treated according to the subgroups considered. CONCLUSION Until proven otherwise, aspirin has only a limited place in individuals between 35 and 65 years without a cardiovascular history. We showed how simulating therapeutic strategies on a realistic virtual population could be used for best applying available evidence.
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Affiliation(s)
- Mor Fall
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France; Laboratoire de pharmacologie & de pharmacodynamie, UMRED université Iba Der Thiam, BP A967 Thies, Sénégal; Centre hospitalier universitaire Aristide Le Dantec, pharmacie centrale, BP 3001 Dakar, Sénégal
| | - Guillaume Grenet
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France; Service hospitalo universitaire de pharmaco-toxicologie, 69002 Lyon France
| | - Hai-Ha Le
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France
| | - Behrouz Kassaï
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France; Service hospitalo universitaire de pharmaco-toxicologie, 69002 Lyon France
| | - Jean-Christophe Lega
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France
| | - Rémy Boussageon
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France
| | - Sabine Mainbourg
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France
| | - Ivanny Marchant
- Laboratorio de Modelamiento en Medicina, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile
| | - Johanne Gafsi
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France
| | - Amadou Moctar Dieye
- Service hospitalo universitaire de pharmaco-toxicologie, 69002 Lyon France; Laboratoire de pharmacologie & de pharmacodynamie, université Cheikh Anta Diop, BP 5005 Dakar, Sénégal
| | - François Gueyffier
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France; Pôle de santé publique, Hospices civils de Lyon, 69002 Lyon, France.
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Yang B, Zhao S, Liu J, Yuan L, Huang F, Wang H. Isolated hand weakness due to brain lesion. Hand Surg Rehabil 2022; 41:654-657. [PMID: 35970441 DOI: 10.1016/j.hansur.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/01/2022] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
When hand weakness is linked to a brain lesion, there is risk of misdiagnosis. A case of hand weakness related to stroke is presented. The electromyography report indicated a segmental lesion of the median nerve at the wrist. Thus, the patient was initially diagnosed with carpal tunnel syndrome, and was referred to the orthopedic department for release surgery. Because the symptom was immediate and did not include hand numbness, the orthopedic surgeon ruled out the previous diagnosis and ordered a head CT scan, which revealed stroke. Aspirin and other medications were given. Percutaneous carotid balloon angioplasty with stent implantation and percutaneous vertebral artery balloon angioplasty were performed. The weakness of the left hand was greatly improved. So far, only a few cases suggest that hand weakness may be linked to stroke. Therefore, physicians should pay attention to physical examination.
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Affiliation(s)
- B Yang
- Department of Orthopedics, Guangdong Provincial Hospital of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou 510120, Guangdong, China
| | - S Zhao
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Airport Road 12, Baiyun District, Guangzhou 510405, Guangdong, China
| | - J Liu
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Airport Road 12, Baiyun District, Guangzhou 510405, Guangdong, China
| | - L Yuan
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Airport Road 12, Baiyun District, Guangzhou 510405, Guangdong, China
| | - F Huang
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Airport Road 12, Baiyun District, Guangzhou 510405, Guangdong, China.
| | - H Wang
- Department of Orthopedics, Guangdong Provincial Hospital of Chinese Medicine, Dade Road 111, Yuexiu District, Guangzhou 510120, Guangdong, China.
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Raposeiras-Roubín S, Domínguez-Erquicia P, Abu-Assi E, Ledo-Piñeiro A, González-García A, Iglesias-Otero C, García-Campo E, Íñiguez-Romo A. Effect of mitral regurgitation on stroke risk in patients with non-rheumatic atrial fibrillation. Arch Cardiovasc Dis 2022:S1875-2136(22)00137-1. [PMID: 36030169 DOI: 10.1016/j.acvd.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/03/2022] [Accepted: 05/09/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) carries a thrombotic risk related to blood stasis in the left atrium. In patients with rheumatic valve disease and AF, the presence of severe mitral regurgitation (MR) has been shown to reduce the risk of atrial thrombosis and stroke. However, in patients without rheumatic disease, the results are controversial. AIM To analyse the association between MR and the incidence of stroke in patients with non-rheumatic AF. METHODS We analysed data from the retrospective CardioCHUVI-AF registry, which includes 15,720 patients with AF (without mechanical prostheses or rheumatic valvular disease) in the Vigo area of Spain, during 2014-2018. We grouped the patients according to MR grades: 0-2 (n=15,194) and 3-4 (n=526). We performed univariate and multivariable competitive risk analyses to analyse the association between MR and stroke, with death as the competitive event. RESULTS During a median (interquartile range [IQR]) follow-up of 4.9 (2.8-4.9) years, 859 patients (5.5%) suffered a stroke. The stroke incidence was 1.3 per 100 person-years (95% confidence interval [95% CI]: 1.2-1.4), with no difference between the MR groups. In univariate analysis, no relationship was observed between MR grade and stroke (subdistribution hazard ratio [sHR]: 1.12, 95% CI: 0.79-1.60; P=0.53); likewise after multivariable analysis (sHR: 0.98, 95% CI: 0.68-1.41; P=0.90). This same relationship was evaluated in subgroups of interest (patients with and without: oral anticoagulation, CHA2DS2-VASc≥2, prior heart failure, aortic valve disease, left ventricular ejection fraction≤40%, and moderate-severe left atrial dilation), with results consistent with the overall population. CONCLUSION In our large registry of patients with non-rheumatic AF, we did not find a protective effect of grade 3-4 MR on the risk of stroke.
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Duloquin G, Graber M, Baptiste L, Mohr S, Garnier L, Ndiaye M, Thomas Q, Hervieu-Bègue M, Osseby GV, Giroud M, Béjot Y. [Acute management of spontaneous intracerebral hemorrhage]. Rev Med Interne 2021; 43:293-300. [PMID: 34953622 DOI: 10.1016/j.revmed.2021.11.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/14/2021] [Indexed: 11/16/2022]
Abstract
Intracerebral hemorrhage accounts for approximately 15% of the 115,000 strokes occurring each year in France. Although therapeutic strategies are more limited than for ischemic stroke, major points in the management of intracerebral hemorrhage can reduce short term morbidity and mortality by limiting the expansion of the hematoma and the occurrence of early complications, and long term patients' outcome by reducing the risk of recurrence. This article aims to update the key elements that contribute to improve of the prognosis of intracerebral hemorrhage patients.
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Affiliation(s)
- G Duloquin
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - M Graber
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - L Baptiste
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - S Mohr
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - L Garnier
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - M Ndiaye
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - Q Thomas
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - M Hervieu-Bègue
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - G-V Osseby
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - M Giroud
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - Y Béjot
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France.
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Allagbé I, Le Faou AL, Thomas D, Airagnes G, Limosin F, Chagué F, Zeller M. Tobacco-related cardiovascular risk in women: New issues and therapeutic perspectives. Arch Cardiovasc Dis 2021; 114:694-706. [PMID: 34593343 DOI: 10.1016/j.acvd.2021.06.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Smoking is the main modifiable risk factor for stroke and myocardial infarction, particularly in women; its prevalence in France is evolving, and new patterns of nicotine consumption have emerged. AIMS To present contemporary data on smoking prevalence and the use of electronic cigarettes, and to describe current knowledge of the cardiovascular risk specificities and the effectiveness of withdrawal methods in women. METHOD We identified studies by searching the MEDLINE bibliographic database between 1995 and 2020, and the Weekly Epidemiological Bulletin (Bulletin Épidémiologique Hebdomadaire) published by the French health authorities. RESULT In recent years, smoking prevalence among French women has decreased overall, except in the oldest age group (aged>55 years). At the same time, the incidence of hospitalization for cardiovascular events has increased worryingly among women smokers aged<65 years. Active smoking in women is associated with an increased risk of premature myocardial infarction, and a risk of stroke that increases with the number of cigarettes consumed per day; it is also responsible for increased cardiovascular events in women taking oestrogen-progestin contraception. Quitting smoking reverses these effects in the long term, and women are just as likely to quit smoking as men. CONCLUSIONS Stopping smoking must be a priority objective for women smokers, for primary and secondary prevention, and they should systematically be offered a validated method of cessation or even electronic cigarettes.
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Affiliation(s)
- Ingrid Allagbé
- Team Physiopathlogy and Epidemiology Cerebro-Cardiovascular (PEC2), EA 7460, University of Burgundy Franche-Comté, Faculté des Sciences de Santé, 7, boulevard Jeanne d'Arc, 21000 Dijon, France; Outpatient Addiction Centre, Georges Pompidou European Hospital, AP-HP, University of Paris, 75015 Paris, France
| | - Anne-Laurence Le Faou
- Outpatient Addiction Centre, Georges Pompidou European Hospital, AP-HP, University of Paris, 75015 Paris, France; Fédération Hospitalo-Universitaire Network of Research in Substance Use Disorder, Ile-de-France, Paris, France
| | - Daniel Thomas
- Institut de Cardiologie, hôpital Pitié-Salpêtrière, AP-HP, Université Paris-VI-Sorbonne, 75013 Paris, France
| | - Guillaume Airagnes
- Outpatient Addiction Centre, Georges Pompidou European Hospital, AP-HP, University of Paris, 75015 Paris, France; Population-based Epidemiologic Cohorts, UMS 011, Inserm, 94807 Villejuif, France
| | - Frédéric Limosin
- DMU Psychiatry and Addictology, Corentin Celton Hospital, AP-HP, University of Paris, 92130 Issy-les-Moulineaux, France; Psychiatry and Neurosciences Centre, U894, Inserm, 75014 Paris, France
| | - Frédéric Chagué
- Cardiology Department, Dijon University Hospital, 21000 Dijon, France
| | - Marianne Zeller
- Team Physiopathlogy and Epidemiology Cerebro-Cardiovascular (PEC2), EA 7460, University of Burgundy Franche-Comté, Faculté des Sciences de Santé, 7, boulevard Jeanne d'Arc, 21000 Dijon, France.
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Dubé C, Jin Y, Powers BG, Li G, Labelle A, Rivers MS, Gumboc IM, Bussières AE. Vision Evaluation Tools for Adults With Acquired Brain Injury: A Scoping Review. Can J Occup Ther 2021; 88:340-351. [PMID: 34658251 PMCID: PMC8640270 DOI: 10.1177/00084174211042955] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background. Unrecognized visual deficits (VDs) following an acquired brain
injury (ABI) may impact clients’ rehabilitation. Little is known about evaluation tools
used in vision rehabilitation. Purpose. To systematically explore the
literature describing evaluation tools used for VD on adults with ABI.
Method. Using a scoping review methodology, we searched in MEDLINE(Ovid),
Embase, CINAHL, PsycINFO, and the grey literature from inception to 2020. Quantitative and
thematic analyses were performed. Findings. Of the 83 studies reporting on 86
evaluation tools, 47% used multiple tools to assess VD. Tools were mostly used by
occupational therapists and psychologists to evaluate intermediate, intermediate to high,
and high-level visual skills. Clinicians tend to select specific tools that focus on
different levels of the hierarchy of visual skills. Implications. Future
research should investigate the optimal timeframe for assessment of VD and the
psychometric properties of tools to ensure comprehensive VD evaluation.
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Affiliation(s)
- Camille Dubé
- Corresponding author: Camille Dubé,
McGill University Faculty of Medicine, School of Physical and Occupational Therapy, 3654
Prom Sir-William-Osler, Hosmer House 205, Montreal, QC H3G 1Y5, Canada.
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10
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Plu-Bureau G, Mounier-Vehier C. [Menopausal hormone therapy an cardiovascular risk. Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines]. Gynecol Obstet Fertil Senol 2021; 49:438-447. [PMID: 33757923 DOI: 10.1016/j.gofs.2021.03.017] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cardiovascular risk is one of the major challenges of menopausal hormone therapy (MHT). Thus, during a consultation of menopause, it is essential to considering the classic cardiovascular risk factors but also those more specific to women in order to evaluate the level of cardiovascular risk: high risk, intermediate risk or low risk. Cardiovascular disease (myocardial infarction or ischemic stroke) are rare disease in women compared to men. However, they represent the leading cause of death in women after menopause in France. Publications of randomized trials have widely questioned the expected benefit of MHT on arterial risk. It should be noted that almost all of these trials concerned the combination of orally conjugated equine estrogens (ECE) associated or not with medroxyprogesterone acetate. Meta-analyses of all randomized trials show an increased risk of ischemic stroke associated with the use of oral MHT while the use of transdermal estrogen therapy combined with progesterone will be safe. The risk of coronary heart disease is not increased and appears to be significantly reduced when the MHT is started less than 10 years after menopause or before the age of 60. These results suggest that the timing of initiation of the MHT, the type of MHT and all of the risk factors should be carefully considered before starting MHT.
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Affiliation(s)
- G Plu-Bureau
- Unité de gynécologie médicale, hôpital Port-Royal, Paris, France; Université de Paris, Paris, France; Inserm U1153, équipe EPOPEE, Paris, France.
| | - C Mounier-Vehier
- Unité de médecine vasculaire et HTA, institut Cœur-Poumon, CHU de Lille, Lille, France
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Arregle F, Martel H, Philip M, Gouriet F, Casalta JP, Riberi A, Torras O, Casalta AC, Camoin-Jau L, Lavagna F, Renard S, Ambrosi P, Lepidi H, Collart F, Hubert S, Drancourt M, Raoult D, Habib G. Infective endocarditis with neurological complications: Delaying cardiac surgery is associated with worse outcome. Arch Cardiovasc Dis 2021; 114:527-536. [PMID: 33935000 DOI: 10.1016/j.acvd.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is associated with a high mortality rate, related in part to neurological complications. Studies suggest that valvular surgery should be performed early when indicated, but is often delayed by the presence of neurological complications. AIM To assess the effect of delaying surgery in patients with IE and neurological complications and to identify factors predictive of death. METHODS In a prospective, single-centre study in a referral centre for IE, all patients with IE underwent systematic screening for neurological complications. The primary outcome was 6-month death. In patients presenting with neurological complications, the prognosis according to surgical status was analysed and a Cox regression model used to identify variables predictive of death. RESULTS Between April 2014 and January 2018, 351 patients with a definite diagnosis of left-sided IE were included. Ninety-four patients (26.8%) presented with at least one neurological complication. Fifty-nine patients (17.7%) died during 6-month follow-up. Six-month mortality rates did not differ significantly between patients with and without neurological complications (P=0.60). Forty patients had a temporary surgical contraindication because of neurological complications. During the period of surgical contraindication, seven of these patients (17.5%) died, six (15.0%) presented a new embolic event, and 12 (30.0%) presented cardiac or septic deterioration. In multivariable analysis, predictive factors of death in patients presenting with neurological complications were temporary surgical contraindication (hazard ratio 7.36, 95% confidence interval 1.61-33.67; P=0.010) and presence of a mechanical prosthetic valve (hazard ratio 16.40, 95% confidence interval 2.22-121.17; P=0.006). CONCLUSIONS Patients with a temporary surgical contraindication due to neurological complications had a higher risk of death and frequent major complications while waiting for surgery. When indicated, the decision to postpone surgery in the early phase should be weighed against the risk of infectious or cardiac deterioration.
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Affiliation(s)
- Florent Arregle
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Helene Martel
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Mary Philip
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Frederique Gouriet
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France
| | - Jean Paul Casalta
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France
| | - Alberto Riberi
- Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France
| | - Olivier Torras
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | | | - Laurence Camoin-Jau
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France; Department of Hematology, La Timone Hospital, 13005 Marseille, France
| | - Flora Lavagna
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Sebastien Renard
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Pierre Ambrosi
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Hubert Lepidi
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France
| | - Frederic Collart
- Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France
| | - Sandrine Hubert
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Michel Drancourt
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France
| | - Didier Raoult
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France
| | - Gilbert Habib
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France.
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Olié V, Carcaillon-Bentata L, Thiam MM, Haeghebaert S, Caserio-Schönemann C. Emergency department admissions for myocardial infarction and stroke in France during the first wave of the COVID-19 pandemic: National temporal trends and regional disparities. Arch Cardiovasc Dis 2021; 114:371-380. [PMID: 33893038 DOI: 10.1016/j.acvd.2021.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic and the national lockdown have led to significant changes in the use of emergency care by the French population. AIMS To describe the national and regional temporal trends in emergency department (ED) admissions for myocardial infarction (MI) and stroke, before, during and after the first national lockdown. METHODS The weekly numbers of ED admissions for MI and stroke were collected from the OSCOUR® network, which covers 93.3% of all ED admissions in France. National and regional incidence rate ratios from 02 February until 31 May (2020 versus 2017-2019) were estimated using Poisson regression for MI and stroke, before, during and after lockdown. RESULTS A decrease in ED admissions was observed for MI (-20% for ST-segment elevation MI and-25% for non-ST-segment elevation MI) and stroke (-18% for ischaemic and-22% for haemorrhagic) during the lockdown. The decrease became significant earlier for stroke than for MI. No compensatory increase in ED admissions was observed at the end of the lockdown for these diseases. Important regional disparities in ED admissions were observed, without correlation with the regional levels of COVID-19 cases. The impact of lockdown on ED admissions was particularly significant in six regions (Ile-de France, Occitanie, Provence-Alpes-Côte d'Azur, Nouvelle Aquitaine, Hauts-de-France and Bretagne). CONCLUSIONS The decrease in ED admissions for MI and stroke observed during the lockdown was probably caused by fear of COVID-19 and augmented by the lockdown, and was heterogeneous across the French territory. ED admissions were slow to return to the usual levels from previous years, without a compensatory increase. These results underline the need to reinforce messages directed at the population to encourage them to seek care without delay in case of cardiovascular symptoms.
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Affiliation(s)
- Valérie Olié
- Santé Publique France (French Public Health Agency), 94415 Saint-Maurice, France.
| | | | - Marie-Michèle Thiam
- Santé Publique France (French Public Health Agency), 94415 Saint-Maurice, France
| | - Sylvie Haeghebaert
- Santé Publique France (French Public Health Agency), 94415 Saint-Maurice, France
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13
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Grasland M, Turmel N, Chesnel C, Haddad R, Le Breton F, Amarenco G, Hentzen C. [Neurological complications of coitus: Review of literature]. Prog Urol 2021; 31:392-405. [PMID: 33581982 DOI: 10.1016/j.purol.2021.01.005] [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: 12/18/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Sexual activity is composed of different phases (excitation, plateau, resolution). Each phase is associated with cardiovascular, respiratory, muscular and hormonal modification which can have an influence on the nervous system. This impact has been studied many times in literature, but no study has synthetized the complications related to coitus or orgasm. METHOD Systematic review of literature on neurological complications, except headache, of coitus based on Medline and Embase. RESULTS We screened 1424 articles and selected 46 for this review. 7 (15 %) were clinical or epidemiologic studies, 6 (13 %) were reviews of literature and 33 (72 %) were cases or series of cases reports. 12 articles (26 %) talked about strokes, 10 (22 %) about subarachnoid hemorrhage, 9 (20 %) about reversible cerebral vasoconstriction syndrome. We found 3 (7 %) articles for each of the following complication: intraparenchymal, hematoma and epilepsy. Autonomic hypereflexia was treated in 3 articles (7 %). Only 1 article was included concerning ictus, spinal cord injury, neuralgia and cataplexia. These events can be considered as rare as emergencies related to sexual activity represent only 0.1 % of all emergencies and among these, 12 % are neurological. 31 of the reported cases concerned vascular events (stroke or hemorrhage) and 18 (58 %) of these patients had a patent malformation (aneurism, intracardiac shunt, foramen ovale). CONCLUSION This is one of the first review of literature trying to synthetise the neurological complications of coitus. Many articles exist in literature. It is necessary to prevent the occurrence of these complications in a population already at risk of neurological events.
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Affiliation(s)
- M Grasland
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne université, 75020 Paris, France.
| | - N Turmel
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne université, 75020 Paris, France
| | - C Chesnel
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne université, 75020 Paris, France
| | - R Haddad
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne université, 75020 Paris, France
| | - F Le Breton
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne université, 75020 Paris, France
| | - G Amarenco
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne université, 75020 Paris, France
| | - C Hentzen
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne université, 75020 Paris, France
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14
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Girard B, Davoudi O, Tatry M, Tassart M. [Secondary blepharospasm, analysis and pathophysiology of blepharospasm. French translation of the article]. J Fr Ophtalmol 2021; 44:151-162. [PMID: 33431190 DOI: 10.1016/j.jfo.2020.06.011] [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: 05/14/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To localize the brain structures involved in blepharospasm. MATERIALS AND METHODS This is a retrospective consecutive series of brain MRI's of patients with secondary blepharospasm whose immediate past medical history included cerebrovascular accident or head trauma. RESULTS Six patients, including 4 with CVA with ischemic or hemorrhagic lesions of the thalamus and caudate nuclei and 2 with head trauma with contusive sequellae to the tectal plate and frontal cortical and cerebellar atrophy. CONCLUSION According to the literature, brain lesions associated with blepharospasm involve mainly the thalamus, head of the caudate nucleus, corpus striatum, globus pallidus, internal capsule, cerebral cortex and cerebellum. This study demonstrates that blepharospasm is associated with a lesion of a complex neural network - cortex-thalamus-globus pallidus-cortex - and does not correspond to a single, unique lesion. This network is connected with ascending and descending sensory-motor pathways and motor nuclei.
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Affiliation(s)
- B Girard
- Service d'ophtalmologie de l'hôpital Tenon, Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - O Davoudi
- Service d'ophtalmologie de l'hôpital Tenon, AP-HP, Paris, France; Service d'ophtalmologie de l'Hôpital Tenon, APHP, université de Clermont-Ferrand, Clermont-Ferrand, France
| | - M Tatry
- Service d'ophtalmologie de l'hôpital Tenon, Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - M Tassart
- Service de radiologie de l'hôpital Tenon, GHU Sorbonne université, AP-HP, Paris, France
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Vansimaeys C, Zuber M, Pitrat B, Farhat W, Join-Lambert C, Tamazyan R, Bungener C. [Network model of mental disorders: Application and interest in post-stroke depression]. Encephale 2020; 47:334-340. [PMID: 33189350 DOI: 10.1016/j.encep.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/24/2020] [Accepted: 08/08/2020] [Indexed: 11/28/2022]
Abstract
In contrast to the classic models in psychopathology, the network model considers that the temporal interactions between symptoms are the causes of their occurrence. This model could also be particularly suitable for understanding the processes involved in post-stroke depression. The aim of this paper is to perform a network analysis in order to describe the temporal dynamic of the links existing between depression symptoms during the acute phase after stroke. Twenty-five patients (64% male, mean age 58.1±14.9 years old) hospitalized for a minor stroke (no neurocognitive or motor impairment) were involved in an Ecological Momentary Assessment methodology-based study. They used a smartphone application in order to complete four brief questionnaires each day during the week after hospital discharge. The questionnaire included 7-point Likert scales to measure the severity of the following depressive symptoms: sadness, anhedonia, fatigue, diminished concentration ability, negative thoughts on oneself, pessimism. We used Multilevel Vector Autoregressive analysis to describe the temporal links between those symptoms. We used the software R 3.6.0 with the mlVAR package. The p-value was set at .05. The results show two independent symptoms networks. The first one involves the anhedonia, fatigue, negative thoughts on oneself and sadness. It shows that: anhedonia predicts the activation of later fatigue (β=0.135, P=0.037) and later negative thoughts (β=0.152, P=0.019); negative thoughts predict later negative thoughts (β=0.143, P=0.028) and later sadness (β=0.171, P=0.021); fatigue predicts later fatigue (β=0.261, P<0.000). Pessimism and diminished concentration ability compose the second network, and the results show that pessimism predicts later pessimism (β=0.215, P=0.012) and later diminished concentration ability (β=0.178, P=0.045). On the one hand, anhedonia thus plays an important role in the initial and progressive activation of the other symptoms of its network. On the other hand, the cognitive symptoms (negative thoughts and pessimism) cause the deterioration of the mood and the deficit of attentional abilities. Using behavioral and cognitive strategies to support patients after hospital discharge would reduce the risk of depressive complications after a stroke. This study provides convincing empirical elements for the interest of the network model for research in psychopathology and the clinical implications and perspectives allowed by network analysis.
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Affiliation(s)
- C Vansimaeys
- Université de Paris, LPPS, 92100 Boulogne-Billancourt, France; LITEM, université Evry, IMT-BS, université Paris-Saclay, 91025 Evry, France.
| | - M Zuber
- Service de neurologie et neurovasculaire, groupe hospitalier Paris Saint-Joseph, université de Paris, Paris, France
| | - B Pitrat
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, Paris, France
| | - W Farhat
- Service de neurologie et neurovasculaire, groupe hospitalier Paris Saint-Joseph, université de Paris, Paris, France
| | - C Join-Lambert
- Service de neurologie et neurovasculaire, groupe hospitalier Paris Saint-Joseph, université de Paris, Paris, France
| | - R Tamazyan
- Service de neurologie et neurovasculaire, groupe hospitalier Paris Saint-Joseph, université de Paris, Paris, France
| | - C Bungener
- Université de Paris, LPPS, 92100 Boulogne-Billancourt, France
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Abstract
Cardiovascular disease is the leading cause of death worldwide. Conceptually, endothelial dysfunction, inflammatory conditions and oxidative stress are at the forefront of the onset and development of most cardiovascular diseases, particularly coronary artery disease and heart failure. Serum albumin has many physiological properties, including in particular antioxidant, anti-inflammatory, anticoagulant and anti-platelet aggregation activity. It also plays an essential role in the exchange of fluids across the capillary membrane. Hypoalbuminemia is a powerful prognostic marker in the general population as well as in many disease states. In the more specific context of cardiovascular disease, low serum albumin is independently associated with the development of various deleterious conditions such as coronary artery disease, heart failure, atrial fibrillation, stroke and venous thromboembolism. Low serum albumin has also emerged as a potent prognostic parameter in patients with cardiovascular disease regardless of usual prognostic markers. Remarkably, its potent prognostic value persists after adjusting for causative confounders such as malnutrition and inflammation. This prognostic value probably refers primarily to the syndrome of malnutrition-inflammation and the severity of comorbidities. Nevertheless, several recent meta-analyses strongly support the hypothesis that hypoalbuminemia may act as an unrecognized, potentially modifiable risk factor contributing to the emergence and progression of cardiovascular disease, primarily by exacerbating oxidative stress, inflammation and platelet aggregation, and by favouring peripheral congestion and pulmonary edema. Currently, it is unknown whether prevention and correction of low serum albumin offers a benefit to patients with or at risk for cardiovascular disease, and further studies are critically needed in this setting.
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Affiliation(s)
- S Arques
- Service de Cardiologie, Centre hospitalier Edmond Garcin, Avenue des Soeurs Gastine, 13400 Aubagne, France.
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17
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Ferreira TF, Dehanov S, Godinho F. Post-stroke psychosis with atypical features. Encephale 2020; 47:85-86. [PMID: 32928531 DOI: 10.1016/j.encep.2020.04.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/27/2020] [Indexed: 10/23/2022]
Affiliation(s)
- T F Ferreira
- Mental Health Department, Hospital Professor Doutor-Fernando-Fonseca, IC-19, 2720-276 Amadora, Portugal.
| | - S Dehanov
- Mental Health Department, Hospital Professor Doutor-Fernando-Fonseca, IC-19, 2720-276 Amadora, Portugal
| | - F Godinho
- Hospital Espírito Santo, Largo Senhor da Pobreza, 7000-811 Évora, Portugal
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Alwawi DA, Dean E, Heldstab A, Lawson LM, Peltzer J, Dunn W. A Qualitative Study of Stroke Survivors' Experience of Sensory Changes. Can J Occup Ther 2020; 87:298-306. [PMID: 32696659 DOI: 10.1177/0008417420941975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND. Previous literature examined tactile and proprioceptive changes after stroke; however, the lived experience of changes in all sensory systems is still a gap in the literature. PURPOSE. To gain understanding of stroke survivors' experience of sensory changes and how sensory changes impact participation in daily life activities. METHOD. This study utilized a qualitative description method. Researchers used semi-structured interviews with probing questions. Inductive content analysis approach was used to analyze the data. Researchers recruited 13 stroke survivors ≤75 years old who participated in a community-based stroke program. FINDINGS. Emerging themes included daily life impact of sensory function changes, and experience and timing of sensory changes. Participants experienced changes in various sensory systems including touch and proprioception, visual, auditory, and taste. Survivors also reported sensitivity to environmental stimuli. Sensory changes affect survivors' participation in different aspects of daily life activities. Most participants experienced sensory changes right after their stroke. IMPLICATIONS. Results from this study inform health care providers about stroke survivors' sensory needs to help them design interventions that match their needs.
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Miton N, Godart F, Milani G, Jalal Z, Karsenty C, Baruteau AE, Gronier C, Aldebert P, Douchin S, Lucron H, Chalard A, Houeijeh A, Petit J, Hascoet S, Thambo JB, Dauphin C. Patent foramen ovale closure in children without cardiopathy: Child-PFO study. Arch Cardiovasc Dis 2020; 113:513-524. [PMID: 32680737 DOI: 10.1016/j.acvd.2020.03.021] [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: 07/09/2019] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Closure of patent foramen ovale is well-managed in adults, but is performed less frequently in children. AIM To analyse all patent foramen ovale closures performed in the past 20 years in French paediatric centres. METHODS Retrospective study of patent foramen ovale closures in children without cardiopathy in nine centres between 2000 and 2019. RESULTS Forty-one procedures were carried out in children (median age: 14.9 years). Thirty-one patent foramen ovales were closed after a transient ischaemic attack or stroke, six for a left-to-right shunt and four for other reasons. Transthoracic echocardiography was used for 72.2% of the diagnoses and transoesophageal echocardiography for 27.8%. A substantial degree of shunting was found in 42.9% of patients and an atrial septal aneurysm in 56.2%. General anaesthesia with transoesophageal echocardiography guidance was performed in 68.3% of the procedures; local anaesthesia and transthoracic echocardiography or intracardiac echocardiography was performed in 31.7%. The success rate was 100%. The median fluoroscopy time was 4.14minutes: 3.55minutes with transoesophageal echocardiography; and 4.38minutes with transthoracic echocardiography (P=0.67). There was only one periprocedural complication (2.4%). Postoperatively, 80,5% of patients were treated with aspirin and 12,2% with an anticoagulant. The rate of complete occlusion was 56.8% immediately after the procedure, 68.6% at 1 year and 92.3% at the last follow-up. There were no delayed complications or cases of recurrent stroke during follow-up (median follow-up: 568 days). CONCLUSION Closure of patent foramen ovale in children appears to be safe and effective, as we noted a low rate of immediate complications, no delayed complications and no stroke recurrence in this indication.
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Affiliation(s)
- Noelie Miton
- Department of Cardiology, M3C Regional Reference CHD Centre, Gabriel Montpied University Hospital, 63000 Clermont-Ferrand, France
| | - François Godart
- Paediatric Cardiology and Congenital Heart Disease, Institut Coeur Poumon, Lille University, 59000 Lille, France
| | - Guiti Milani
- Paediatric Cardiology Department, Necker-Enfants Malades Hospital, AP-HP, M3C National Reference CHD Centre, Paris Descartes University, Sorbonne Paris, 75015 Paris, France
| | - Zakaria Jalal
- Department of Paediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), 33604 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux Université, 33600 Pessac, France; Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, 33600 Pessac, France
| | - Clément Karsenty
- Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse University, 31432 Toulouse, France; Paediatric and Congenital Cardiology, Children's Hospital, CHU Toulouse, Toulouse University, 31300 Toulouse, France
| | - Alban-Elouen Baruteau
- L'institut du Thorax, INSERM, CNRS, Nantes University, CHU Nantes, 44007 Nantes, France; Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - Céline Gronier
- Groupe d'Exploration Cardiovasculaire, Clinique de l'Orangerie, 67000 Strasbourg, France
| | - Philippe Aldebert
- Paediatric and Congenital Medico-Surgical Cardiology Department, M3C Regional Reference CHD Centre, AP-HM, La Timone University Hospital, 13005 Marseille, France
| | - Stéphanie Douchin
- Department of Cardiology, M3C Regional Reference CHD Centre, CHU Grenoble, 38700 La Tronche, France
| | - Hugues Lucron
- Paediatric Cardiology, M3C Antilles-Guyane Centre, University Hospital (CHU de Martinique), 97200 Fort-de-France, France
| | - Aurélie Chalard
- Department of Cardiology, M3C Regional Reference CHD Centre, Gabriel Montpied University Hospital, 63000 Clermont-Ferrand, France
| | - Ali Houeijeh
- Paediatric Cardiology and Congenital Heart Disease, Institut Coeur Poumon, Lille University, 59000 Lille, France
| | - Jérome Petit
- Paris-Sud Faculty of Medicine, INSERM U999, Marie-Lannelongue Hospital, M3C National Reference CHD Centre, Paris-Sud University, Paris-Saclay University, 92350 Le Plessis-Robinson, France
| | - Sébastien Hascoet
- Paris-Sud Faculty of Medicine, INSERM U999, Marie-Lannelongue Hospital, M3C National Reference CHD Centre, Paris-Sud University, Paris-Saclay University, 92350 Le Plessis-Robinson, France
| | - Jean-Benoit Thambo
- Department of Paediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), 33604 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux Université, 33600 Pessac, France; Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, 33600 Pessac, France
| | - Claire Dauphin
- Department of Cardiology, M3C Regional Reference CHD Centre, Gabriel Montpied University Hospital, 63000 Clermont-Ferrand, France.
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Ouin E, Jouvent E. [Clinico-radiological spectrum of cerebral small vessel diseases]. Rev Med Interne 2020; 41:459-468. [PMID: 32540119 DOI: 10.1016/j.revmed.2020.02.013] [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: 12/04/2019] [Revised: 02/06/2020] [Accepted: 02/13/2020] [Indexed: 11/18/2022]
Abstract
Cerebral small vessel diseases are frequent and can be seen through all ages. Although the most frequent forms related to age and hypertension or to cerebral amyloid angiopathy are mainly observed in subjects over 50 years of age, rarer forms may affect young people, sometimes even children. Some familial or inflammatory forms can be particularly misleading with some presentations very difficult to relate to a microvascular origin. Cerebral small vessel diseases thus raise both daily therapeutic issues and much rarer diagnostic questions, sometimes extremely complex. Our aim was to review the main clinical initial presentations and the clinico-radiological spectrum of associated underlying conditions.
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Affiliation(s)
- E Ouin
- Inserm U1141, service de neurologie et centre des maladies vasculaires rares du cerveau et de l'œil (CERVCO), hôpital Lariboisière, université de Paris, AP-HP, 75475 Paris, France; Département de neurologie, hôpitaux universitaires d'Amiens, Amiens, France
| | - E Jouvent
- Inserm U1141, service de neurologie et centre des maladies vasculaires rares du cerveau et de l'œil (CERVCO), hôpital Lariboisière, université de Paris, AP-HP, 75475 Paris, France.
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Savsin M, Dubourg D, Coppieters Y, Collart P. [Analysis of comorbidities in hospitalized patients for ischemic stroke and their effects on lethality]. Ann Cardiol Angeiol (Paris) 2020; 69:31-36. [PMID: 31542203 DOI: 10.1016/j.ancard.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/07/2019] [Accepted: 07/22/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of the study consists of analyzing the comorbidities of acute ischemic stroke and those influencing its hospital lethality. METHODS We considered patients from Wallonia aged 25 years or more and admitted to a Belgian hospital for an acute ischemic stroke in 2013 and 2014. The analyzed medico-administrative data are taken from the Minimum Hospital Summary. A factorial correspondence analysis (FCA) was used to demonstrate the comorbidities profiles. A logistic regression was used to analyse the comorbidities influencing hospital lethality by ischemic stroke. RESULTS The stroke risk factors vary according to the age. Cardiac problems are more common in older people aged 85 years or more. High blood pressure, hypercholesterolemia and diabetes are more present between 65- and 84-year-olds. Overweight is more present between 55 and 74-year-olds. People who are addicted to alcohol or tobacco are often 65 years or younger. The logistic regression showed that age and heart problems are the risk factors that increase lethality. However there is a lethality diminution in the presence of high blood pressure, hypercholesterolemia, overweight and addiction to alcohol or tobacco. CONCLUSION This study demonstrates that medico-administrative databases and factorial statistical methods are perfectly adapted to confirm the ischemic stroke risk factors. This type of study will allow to target with more precision the secondary and tertiary prevention actions of stroke.
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Affiliation(s)
- M Savsin
- Centre de recherche épidémiologie, biostatistiques et recherche clinique, école de santé publique, université libre de Bruxelles (U.L.B.), Route de Lennik 808, CP 596, 1070 Brussels, Belgique.
| | - D Dubourg
- Agence pour une vie de qualité, rue de la Rivelaine 21, 6061 Charleroi, Belgique.
| | - Y Coppieters
- Centre de recherche épidémiologie, biostatistiques et recherche clinique, école de santé publique, université libre de Bruxelles (U.L.B.), Route de Lennik 808, CP 596, 1070 Brussels, Belgique.
| | - P Collart
- Centre de recherche épidémiologie, biostatistiques et recherche clinique, école de santé publique, université libre de Bruxelles (U.L.B.), Route de Lennik 808, CP 596, 1070 Brussels, Belgique; Agence pour une vie de qualité, rue de la Rivelaine 21, 6061 Charleroi, Belgique.
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Guedeney P, Collet JP. [What antithrombotic treatment should we prescribe after transvalvular aortic valve implantation?]. Ann Cardiol Angeiol (Paris) 2019; 68:462-7. [PMID: 31653334 DOI: 10.1016/j.ancard.2019.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 11/20/2022]
Abstract
The performance and indications of transvalvular aortic valve implantation or TAVI has considerably expanded and is now the first therapeutic line option in the management of severe aortic stenosis. The targeted population shares both high risk of ischemic complications, particularly stroke or subclinical leaflet thrombosis of the bioprothesis, as well as hemorrhagic complications, strongly correlated to death. Based on previous experience with intracoronary stents, a dual antiplatelet therapy has been recommended by experts' consensus. This paradigm is now challenged by the observed increased risk of hemorrhagic complications without a reduction of ischemic events. Moreover, the role of non-vitamin K oral anticoagulant in patients undergoing TAVI remains to be determined. Several large ongoing randomized controlled trials will likely change our practice within the next coming year.
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Abstract
BACKGROUND. Neuro-occupation was coined to conflate three distinctly different concepts: the brain, context, and occupation. Discussing neuro-occupation has been more of an academic exercise rather than cogently researched for everyday practice, perhaps due to the seemingly incongruity among the concepts. PURPOSE. This article traces the self-organization approach, an assumption of complex systems, to understand how the concepts can be conflated. METHOD. Deductive category application, a qualitative descriptive method for tracing theoretical assumptions, was drawn from the lived experiences of 11 Iranian participants with cerebrovascular accidents. Matrix construction aided collection of data for analysis. FINDINGS. The self-organization approach, underpinning neuro-occupation, was shown to be traceable, explaining how occupational participation may be influenced by the brain circular causality and perturbations provided by the context. IMPLICATIONS. By understanding the dynamics of self-organization, occupational therapists can identify and create salient features that may motivate and enable clients to enhance occupational participation.
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Vacher P, Charlanes A, Chesnel C, Pagès A, Malot C, Le Breton F, Amarenco G, Manceau P. [Interest of transcranial stimulation in pelvic and perineal disorders]. Prog Urol 2019; 29:349-59. [PMID: 31036483 DOI: 10.1016/j.purol.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/26/2019] [Accepted: 03/08/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this article was to describe the diagnostic and therapeutic value of transcranial stimulation in pelvic and perineal disorders. METHODS A literature review (Medline database and Google scholar) with no time limit was performed using keywords: "transcranial direct stimulation", "transcranial magnetic stimulation", "neurogenic bladder", "urinary incontinence", "Parkinson disease", "multiple sclerosis", "stroke", "muscle spasticity", "pelvic pain", "visceral pain". RESULTS Twelve articles have been selected. Transcranial magnetic or electrical stimulation is a noninvasive neuromodulation technique widely used to establish brain maps to highlight causal relationships between brain and function. Regarding pelvic-perineal disorders, repeated transcranial stimulation has shown significant effects for the treatment of overactive bladder in Parkinson's disease (P<0.05) and multiple sclerosis, but also for the treatment of refractory chronic pelvic pain (P=0.026). Finally, therapeutic effects have also been demonstrated in irritable bowel syndrome. No evidence of efficacy was found on genito-sexual disorders. CONCLUSION Data from the literature suggest that transcranial stimulation is a noninvasive treatment that may have a role in the management of pelvic and perineal disorders. Its promising field of action would require prospective and randomized studies on a larger scale.
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Boursier V, Join Lambert C, Tamazyan R, Farhat W, Bruandet M, Zuber M. [Improving blood pressure control after a stroke: The place of therapeutic education in the acute phase]. J Med Vasc 2019; 44:19-27. [PMID: 30770081 DOI: 10.1016/j.jdmv.2018.11.006] [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: 08/28/2018] [Accepted: 11/27/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES At the Paris Saint-Joseph Hospital Group neurovascular unit, the therapeutic patient education program "Treatment of high blood pressure after stroke" involved integrating a vascular physician. The objectives were to include a significant number of patients, to integrate learning self-measurement, and to make an initial analysis of the results concerning patient knowledge, self-measurement practices, adherence to treatment, and control of blood pressure. METHODS Eighty-six patients under 90 years of age admitted to the neurovascular unit were included in the program between January 1 and October 31, 2017, and participated in an in-hospital educational diagnostic interview followed by an initial session. During this period, 30 patients were reviewed within 3 to 6 months after discharge, with a post-session evaluation for 22 of them. Patient satisfaction was assessed with a questionnaire. A questionnaire was also proposed to the staff. RESULTS The mean blood pressure of the 22 patients reviewed was on target and they had improved their level of knowledge. The number of sphygmomanometers increased from 5 to 20, but the practice of cycles was not yet mastered. Levels of observed compliance changed little. Patients and paramedics appreciated the program and were convinced of its usefulness. These results do not support a direct effect of therapeutic patient education on blood pressure control, but the observed results are positive and encouraging.
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Affiliation(s)
- V Boursier
- Service de neurologie et neurovasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - C Join Lambert
- Service de neurologie et neurovasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - R Tamazyan
- Service de neurologie et neurovasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - W Farhat
- Service de neurologie et neurovasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - M Bruandet
- Service de neurologie et neurovasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - M Zuber
- Service de neurologie et neurovasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
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Binhas M, Zakine C, Khelil N, Mekacher L, Wafo E, Lebonhomme JJ, Iung B. [Cardiac papillary fibroelastoma and stroke during pregnancy: Case report]. Ann Cardiol Angeiol (Paris) 2019; 68:129-131. [PMID: 30686471 DOI: 10.1016/j.ancard.2018.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 10/16/2018] [Indexed: 10/27/2022]
Abstract
Stroke occurring during pregnancy is linked to high mortality. Stroke may be directly related to pregnancy (e.g. eclampsia, cerebral venous thrombosis), but all the other causes of stroke are possible. Brain magnetic resonance imaging that is not contraindicated during pregnancy remains the reference in this context. We report the case of a woman with severe headache associated with visual disturbances, without hypertension or proteinuria at 32 weeks of pregnancy. MRI revealed multiple recent cerebral vascular accidents. An echocardiogram detected a papillary fibroelastoma of 5mm. Maternal fetal experts determined it safe to continue the pregnancy. Childbirth at 39 weeks was normal uneventful for the newborn and mother. In the postpartum, despite the theoretical operative indication to resect the small residual papillary fibroelastoma, the patient was followed expectantly because of the stable neuro-cardiologic state. A fibroelastoma can be revealed by a stroke during pregnancy. In the postpartum period, an expectant attitude can be reasonably chosen in case of small size of the fibroelastoma.
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Affiliation(s)
- M Binhas
- Service d'anesthésie, Grand hôpital de l'Est Francilien, site de Marne-la-Vallée, 2-4, rue de la Gondoire, 77600 Jossigny, France.
| | - C Zakine
- Service de cardiologie, Grand hôpital de l'Est Francilien, site de Marne-la-Vallée, 2-4, rue de la Gondoire, 77600 Jossigny, France
| | - N Khelil
- Service d'anesthésie, Grand hôpital de l'Est Francilien, site de Marne-la-Vallée, 2-4, rue de la Gondoire, 77600 Jossigny, France
| | - L Mekacher
- Service d'obstétrique, Grand hôpital de l'Est Francilien, site de Marne-la-Vallée, 2-4, rue de la Gondoire, 77600 Jossigny, France
| | - E Wafo
- Service d'obstétrique, Grand hôpital de l'Est Francilien, site de Marne-la-Vallée, 2-4, rue de la Gondoire, 77600 Jossigny, France
| | - J J Lebonhomme
- Service d'anesthésie, Grand hôpital de l'Est Francilien, site de Marne-la-Vallée, 2-4, rue de la Gondoire, 77600 Jossigny, France
| | - B Iung
- UFR de médecine Paris VII, service de cardiologie, CHU de Bichat Claude-Bernard, Denis-Diderot, 46, rue Henri-Huchard, 75877 Paris, France
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Plu-Bureau G, Sabbagh E, Hugon-Rodin J. [Hormonal contraception and vascular risk: CNGOF Contraception Guidelines]. ACTA ACUST UNITED AC 2018; 46:823-833. [PMID: 30389542 DOI: 10.1016/j.gofs.2018.10.007] [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: 10/04/2018] [Indexed: 12/15/2022]
Abstract
Venous thromboembolism and arterial ischemic events are the main deleterious diseases associated with the use of combined hormonal contraceptives (CHC). Even though their composition has been substantially improved, the vascular risk persists with the most recent CHCs use. If the vascular risk associated with CHCs containing 50μg EE is significantly higher than with those containing less than 50μg, there is no evidence that the CHCs containing either 30 or 20μg of EE induce different venous risks. CHC containing gestodene, desogestrel, drospirenone or cyproterone acetate are associated with a higher risk of venous thrombosis compared with levonorgestrel-containing CHCs. CHC containing norgestimate are associated with similar venous thrombosis risk than CHC containing levonorgestrel. Venous thrombosis risk of non-oral routes of administration of CHC appears to be equivalent to the risk of CHC containing gestodene or desogestrel, but this result is based on a small number of epidemiological studies. Before prescribing a CHC, it is important to determine all vascular risk factors. Family history of ischemic arterial event or venous thromboembolism disease should be routinely sought before any CHC prescription. All CHCs are contraindicated in women with biological thrombophilia, in women with combined vascular risk factors, in women with first-degree family history of arterial or venous event (under age 50) as well as in women suffering of migraine with aura. Progestin-only contraceptives are not associated with vascular risk (arterial or venous) outside of medroxyprogesterone acetate. In women with higher vascular risk, progestin-only contraceptives (administered by oral, sous-cutaneous or intra-uterine routes) can be prescribed.
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Affiliation(s)
- G Plu-Bureau
- Unité de gynécologie endocrinienne, hôpital Port-Royal, 53, avenue de l'Observatoire, 75679 Paris 14, France; Université Paris Descartes, 75005 Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), 75000 Paris, France.
| | - E Sabbagh
- Unité de gynécologie endocrinienne, hôpital Port-Royal, 53, avenue de l'Observatoire, 75679 Paris 14, France
| | - J Hugon-Rodin
- Unité de gynécologie endocrinienne, hôpital Port-Royal, 53, avenue de l'Observatoire, 75679 Paris 14, France; Université Paris Descartes, 75005 Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), 75000 Paris, France
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Abstract
Cardiovascular diseases are the leading cause of death worldwide. Conceptually, endothelial dysfunction, inflammatory status and oxidative stress are at the forefront in the onset and development of most cardiovascular diseases, particularly coronary artery disease and heart failure. Serum albumin, the most abundant plasma protein, has many physiological properties, including anti-inflammatory, antioxidant and antiplatelet aggregation activity. It also plays an essential role in the fluid exchange across the capillary membrane. Definite evidence is that hypo-albuminemia is a powerful prognostic marker in the general population as well as in many pathological settings. In the more specific context of cardiovascular diseases, serum albumin is independently associated with the development of a variety of deleterious conditions such as coronary artery disease, heart failure, atrial fibrillation and stroke. Serum albumin has also emerged as a powerful prognostic parameter in patients with coronary artery disease, heart failure, congenital heart disease, infective endocarditis, cardiovascular surgery and stroke, regardless of usual prognostic markers. This prognostic value probably refers mainly to the malnutrition-inflammation syndrome and the severity of comorbidities. Nevertheless, hypo-albuminemia may act as an unknown and modifiable risk factor that contributes to the emergence and the pejorative evolution of cardiovascular diseases, mainly by exacerbation of inflammation, oxidative stress and platelet aggregation, and by pulmonary and myocardial edema. This article provides an overview of the physiological properties of serum albumin, the prevalence, causes, prognostic value and potential contribution to the emergence and aggravation of cardiovascular disease of hypoalbuminemia, as well as its clinical implications.
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Affiliation(s)
- S Arques
- Service de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs-Gastine, 13400 Aubagne, France.
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Charlier P. [Sudden death in Versailles: A review of a cardiovascular treatrise by Dionis (1710)]. Ann Cardiol Angeiol (Paris) 2018; 67:54-57. [PMID: 28506581 DOI: 10.1016/j.ancard.2017.03.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 03/22/2017] [Indexed: 06/07/2023]
Abstract
In 1710, the surgeon Pierre Dionis publishes a Dissertation on sudden death. Echoing and expanding the work of his Roman colleague Jean Marie Lancisi, he describes and analyzes dozens of cases of sudden death observed by him. A large number of cases was followed by autopsies allowing clinicopathological confrontation. Are proposed causes of death (pulmonary embolism, myocardial infarction, hemorrhagic stroke, arterial rupture, etc.), pathophysiological mechanisms based on the ancient theory of humors, and preventive actions to avoid these unexpected deaths. In this article, we oppose these old data to those of current literature.
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Affiliation(s)
- P Charlier
- Équipe d'anthropologie médicale et médicolégale, UFR des sciences de la santé, UVSQ, EA 4569 Paris-Descartes, 78180 Montigny-Le-Bretonneux, France; CASH/IPES, 403, boulevard de la République, 92000 Nanterre, France.
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30
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Padberg I, Schneider A, Grittner U, Olma MC, Liman T, Siegerink B. Pulmonary dysfunction and development of different cardiovascular outcomes in the general population. Arch Cardiovasc Dis 2018; 111:246-56. [PMID: 29113786 DOI: 10.1016/j.acvd.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/04/2017] [Accepted: 07/29/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pulmonary dysfunction and cardiovascular disease are major causes of impaired health status in later life, and co-development of these diseases has been reported. AIM To better understand the pathobiology involved in the co-development of these diseases. METHODS We investigated the impact of pulmonary dysfunction on the development of cardiovascular disease among people aged≥50 years in the English longitudinal study of ageing (ELSA). Hazard ratios were estimated by Cox proportional hazards regression models, with and without a time-dependent update of exposure and confounders. Pulmonary function was divided into three categories, with the least affected category as the reference. RESULTS People with pulmonary dysfunction were at higher risk of developing cardiovascular disease than those with normal pulmonary function: the hazard ratio for pulmonary dysfunction versus healthy in the time-dependent crude analysis of model 1, adjusted for age, body mass index, sex, angina pectoris and heart arrhythmia, was 1.49 (95% confidence interval 1.2-1.9). The effect varied with the precise definition of pulmonary dysfunction and the subtype of the cardiovascular disease, and decreased after correction for some additional confounders but not after correction for inflammatory biomarkers. CONCLUSIONS A history of pulmonary disease increased the risk of developing cardiovascular disease, but inflammation did not seem to alter the effect of pulmonary dysfunction on cardiovascular disease development. This insight may lead to better understanding and treatment of cardiovascular comorbidities in pulmonary disease; it also indicates that the potentially beneficial effect of targeted anti-inflammatory drugs for pulmonary disease, in terms of reducing cardiovascular risk in these patients, may be limited.
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Benamer H, Bouzid MA, Dufay A, Akodad M, Russel S, Halna du Fretay X, Haziza F. [Ischemic stroke related to spontaneous]. Ann Cardiol Angeiol (Paris) 2017; 66:415-420. [PMID: 29096901 DOI: 10.1016/j.ancard.2017.10.002] [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: 11/26/2022]
Abstract
Cardiovascular disease in women is a particularly complex pathology especially in the youngest population. The clinical presentation of acute coronary syndromes is sometimes misleading and does not necessarily point to the potential presence of cardiac disease given the frequent absence of cardiovascular risks. Such complexity results in delayed diagnosis, which worsens the outcome of myocardial infarction and generates complications related to the absence of coronary revascularization. We report the case of a patient who suffered an (undiagnosed) apical myocardial infarction that went undetected and was complicated by a voluminous intraventricular thrombus with embolus migration in the cerebral circulation resulting in an ischemic accident. The combination of these two pathologies make their therapeutic management particularly difficult. As widely reported in the literature, the outcome of myocardial infarction in women is poorer than in their male counterparts for a number of reasons. We can assume that in the youngest patients, another physiopathological mechanism is often involved, namely, the occurrence of hematoma and spontaneous coronary dissection. Diagnosis is often difficult even with coronary angiography diagnosis. As shown in the case reported here, initial examination results, if not thoroughly analyzed, may be erroneously interpreted as normal. It is also likely that the presence of hematoma or coronary wall dissection without any plaque rupture may negatively influence the outcome owing to the implementation of inappropriate treatments. In conclusion, in patients presenting with an ischemic cerebral accident, meticulous cardiac examination must be performed even in young women with no cardiovascular risk factors given that the occurrence of hematoma or coronary dissection may contribute to the formation of mural thrombi in the setting of myocardial infarction. Cardiac MRI seems to be particularly effective in the diagnosis of myocardial infarction complicated by the presence of intracavitary thrombi.
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Affiliation(s)
- H Benamer
- ICPS groupe Ramsay, 6, avenue du Noyer-Lambert, 91300 Massy, France; ICV-GVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, 40, rue Worth, 92150 Sureness, France.
| | - M A Bouzid
- ICV-GVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, 40, rue Worth, 92150 Sureness, France
| | - A Dufay
- Hôpital Foch, 40, rue Worth, 92150 Sureness, France
| | - M Akodad
- ICPS groupe Ramsay, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - S Russel
- Hôpital Foch, 40, rue Worth, 92150 Sureness, France
| | - X Halna du Fretay
- Hôpital Foch, 40, rue Worth, 92150 Sureness, France; Centre hospitalier universitaire Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Unité cardiologique de la Reine-Blanche, 555, avenue Jacqueline-Auriol, 45770 Saran, France
| | - F Haziza
- Hôpital Foch, 40, rue Worth, 92150 Sureness, France
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32
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Arques S, Roux E. [Usefulness of spectral tissue Doppler (E/e' ratio) in the management of patients with atrial fibrillation]. Ann Cardiol Angeiol (Paris) 2017; 66:303-308. [PMID: 29025686 DOI: 10.1016/j.ancard.2017.09.011] [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: 05/22/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
Atrial fibrillation is the most common cardiac rhythm disorder encountered in daily clinical practice. It carries high morbidity and mortality rates, mainly related to sudden death, heart failure and stroke. Validation of noninvasive markers in the diagnosis of heart failure with preserved ejection fraction and risk stratification is therefore attractive in this clinical setting. The spectral tissue Doppler-derived E/e' ratio is a simple and user-friendly index which has been validated in the assessment of left ventricular diastolic pressures, regardless of rhythm. A septal E/e' >11 is associated with invasive left ventricular diastolic pressures >15mmHg in patients with atrial fibrillation. Several studies have reported the clinical relevance of abnormal values of E/e' at rest and during exercise in the diagnosis and risk stratification of heart failure with preserved ejection fraction in patients with atrial fibrillation. There is now convincing evidence that increased E/e' is associated with adverse outcome in patients with atrial fibrillation and predicts the recurrence of arrhythmia after cardioversion or catheter ablation. In conclusion, we recommend the measurement of E/e' in each patient with atrial fibrillation referred for clinically indicated transthoracic Doppler echocardiography.
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Affiliation(s)
- S Arques
- Service de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs-Gastine, 13400 Aubagne, France.
| | - E Roux
- Service de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs-Gastine, 13400 Aubagne, France
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Abstract
Paradoxical embolism should be suspected in front of a clinical phenomenon of thromboembolism associated with an anatomical right-to-left shunt. Others potential cardiac sources of thromboembolism must be ruled out. Strokes constitute the most frequent clinical manifestations of paradoxical embolism. Right-to-left left shunts are in connection with intracardiac defects (atrial septal defect and patent foramen ovale) or pulmonary arteriovenous malformations. The probability that a discovered PFO is stroke-related can be evaluated by a score. Therapeutic approaches for secondary prevention of recurrent stroke include antithrombotic and/or percutaneous treatments. The choice strategy begins to be clearer with the recent results of randomized controlled studies.
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Affiliation(s)
- P Aubry
- Département de cardiologie, groupe hospitalier Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France; Service de cardiologie, centre hospitalier de Gonesse, 95500 Gonesse, France.
| | - H Demian
- Service de cardiologie, centre hospitalier de Gonesse, 95500 Gonesse, France
| | - E Brochet
- Département de cardiologie, groupe hospitalier Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France
| | - J-M Juliard
- Département de cardiologie, groupe hospitalier Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France
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Akodad M, Garot P. [Left atrial appendage closure and embolic events]. Ann Cardiol Angeiol (Paris) 2017; 66:441-446. [PMID: 29106834 DOI: 10.1016/j.ancard.2017.10.003] [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: 10/18/2022]
Abstract
Atrial fibrillation (AF) is frequent and responsible for embolic events. Currently, the gold standard to prevent such embolic events is anticoagulant therapy with vitamin K antagonist (VKA) or direct oral anticoagulant in nonvalvular AF. Recently, left atrial appendage closure was proposed as an alternative to anticoagulant inpatient with high embolic risk and contraindication to anticoagulant therapy. Data from randomized trials were consistent with a non-inferiority of left atrial appendage closure in comparison to VKA in terms of stroke and cardiovascular death. However, despite improvements in procedure results and complications reduction, this invasive strategy has to be performed with optimal security as this strategy is a preventive treatment in high-risk patients. These improvements may allow an extension of indications of left atrial appendage closure to lower profile risk patients as an alternative to anticoagulant. Indeed, anticoagulant is a risky therapy with hemorrhagic events and observance is a real issue in an asymptomatic population. Finally, there is a lack of data in recent literature comparing left atrial appendage closure to direct oral anticoagulant, widely used in daily practice, as well as cost-effectiveness of this procedure in comparison to anticoagulant.
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Affiliation(s)
- M Akodad
- Service Angio, institut cardiovasculaire Paris-Sud (ICPS), hôpital Jacques Cartier, Ramsay-Generale de santé, Massy, France
| | - P Garot
- Service Angio, institut cardiovasculaire Paris-Sud (ICPS), hôpital Jacques Cartier, Ramsay-Generale de santé, Massy, France.
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De Bortoli M, Maillet A, Skopinski S, Sassoust G, Constans J, Boulon C. [Cerebral vasoreactivity: Concordance of breath holding test and acetazolamide injection in current practice: 20 cases of asymptomatic carotid artery stenosis]. J Med Vasc 2017; 42:272-281. [PMID: 28964386 DOI: 10.1016/j.jdmv.2017.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/30/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cerebral vasoreactivity (CVR) is the ability of the brain's vascular system to keep cerebral blood inflow stable. Impaired CVR is a risk marker of stroke in patients with asymptomatic carotid stenosis. The gold standard to assess CVR with transcranial ultrasound is acetazolamide (ACTZ) injection. The breath holding test (BHT) might be easier to perform. CVR proved to be efficient in laboratory conditions but not in routine practice. OBJECTIVES To study the validity of BHT versus ACTZ in routine practice in a vascular exploration unit in patients with asymptomatic carotid stenosis. METHODS Study of concordance of BHT and ACTZ, to assess CVR in patients consecutively explored on the same day. RESULTS Eighteen patients with 20 carotid stenosis were included. The temporal window was missing in 20% of cases. Only 11 out of the 20 procedures were analyzed. Concordance was low between BHT and ACTZ to assess CVR (k=0.3714). CONCLUSION BHT cannot replace ACTZ injection. It might be a first-step test so that ACTZ injection might be avoided if CVR is normal. Our present results must be confirmed by further study enrolling many more patients.
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Affiliation(s)
- M De Bortoli
- Service de médecine vasculaire, hôpital St-André, 1, rue Jean-Burguet, 33075 Bordeaux, France.
| | - A Maillet
- Service de médecine vasculaire, hôpital St-André, 1, rue Jean-Burguet, 33075 Bordeaux, France
| | - S Skopinski
- Service de médecine vasculaire, hôpital St-André, 1, rue Jean-Burguet, 33075 Bordeaux, France
| | - G Sassoust
- Service de chirurgie vasculaire, hôpital Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - J Constans
- Service de médecine vasculaire, hôpital St-André, 1, rue Jean-Burguet, 33075 Bordeaux, France
| | - C Boulon
- Service de médecine vasculaire, hôpital St-André, 1, rue Jean-Burguet, 33075 Bordeaux, France
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Nasri A, Mansour M, Brahem Z, Kacem A, Hassan AA, Derbali H, Messelmani M, Zaouali J, Mrissa R. Stroke disclosing primary aldosteronism: Report on three cases and review of the literature. Ann Endocrinol (Paris) 2017; 78:9-13. [PMID: 28168953 DOI: 10.1016/j.ando.2016.07.993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/06/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES There is a growing evidence of increased risk of cerebrovascular events in primary aldosteronism (PA). Nevertheless, acute neurologic ailment as presenting feature of PA is uncommon. Our aim is to highlight the diagnosis challenges in stroke unmasking PA and to discuss the underlying physiopathology and management dilemmas. MATERIALS AND METHODS We hereby describe three consecutive rare cases of stroke revealing PA. All patients had brain imaging and thorough biological and morphological assessment to rule out other etiologies of stroke. The diagnosis of primary aldosteronism was established according to the Endocrine Society Clinical Practice Guideline, with a review of the literature on the spectrum of neurologic manifestations in PA. RESULTS We report on three cases, two women and a man, presenting with ischemic or hemorrhagic stroke, of early onset in two of them. All of the reported patients had hypertension and hypokaliemia. This association prompted the assessment of renin angiotensin aldosterone system (RAAS) disclosing PA, which was due to bilateral adenomas in the first one or bilateral adrenal hyperplasia in the two others. All patients refused the surgical option and received spironolactone with recurrence of stroke in one of them due to treatment incompliance. CONCLUSION Although cerebrovascular events are quite common in PA, their occurrence as initial feature can be misleading. The association of hypokaliemia and refractory hypertension in ischemic or hemorrhagic strokes should prompt an assessment of the RAAS to rule out PA and initiate adequate management as soon as possible in order to avoid further complications.
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Affiliation(s)
- Amina Nasri
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia.
| | - Malek Mansour
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Zeineb Brahem
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Amel Kacem
- Department of Medicine, Regional Hospital of Jendouba, Tunisia
| | - Ahmed Abou Hassan
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Hager Derbali
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Meriem Messelmani
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Jamel Zaouali
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Ridha Mrissa
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
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Isnard R, Bauer F, Cohen-Solal A, Damy T, Donal E, Galinier M, Hagège A, Jourdain P, Leclercq C, Sabatier R, Trochu JN, Cohen A. Non-vitamin K antagonist oral anticoagulants and heart failure. Arch Cardiovasc Dis 2016; 109:641-650. [PMID: 27836786 DOI: 10.1016/j.acvd.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 04/04/2016] [Revised: 07/14/2016] [Accepted: 08/05/2016] [Indexed: 12/31/2022]
Abstract
Thromboembolism contributes to morbidity and mortality in patients with heart failure (HF), and atrial fibrillation (AF) is one of the main factors promoting this complication. As they share many risk factors, HF and AF frequently coexist, and patients with both conditions are at a particularly high risk of thromboembolism. Non-vitamin K antagonist oral anticoagulants (NOACs) are direct antagonists of thrombin (dabigatran) and factor Xa (rivaroxaban, apixaban and edoxaban), and were designed to overcome the limitations of vitamin K antagonists. Compared with warfarin in non-valvular AF, NOACs demonstrated non-inferiority with better safety, most particularly for intracranial haemorrhages. Therefore, the European Society of Cardiology guidelines recommend NOACs for most patients with non-valvular AF. Subgroups of patients with both AF and HF from the pivotal studies investigating the safety and efficacy of NOACs have been analysed and, for each NOAC, results were similar to those of the total analysis population. A recent meta-analysis of these subgroups has confirmed the better efficacy and safety of NOACs in patients with AF and HF - particularly the 41% decrease in the incidence of intracranial haemorrhages. The prothrombotic state associated with HF suggests that patients with HF in sinus rhythm could also benefit from treatment with NOACs. However, in the absence of clinical trial data supporting this indication, current guidelines do not recommend anticoagulant treatment of patients with HF in sinus rhythm. In conclusion, recent analyses of pivotal studies support the use of NOACs in accordance with their indications in HF patients with non-valvular AF.
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Affiliation(s)
- Richard Isnard
- Department of Cardiology, AP-HP, Pitié-Salpêtrière Hospital, Faculty of Medicine Pierre-et-Marie-Curie, University Paris 6, UMRS Inserm-UPMC 1166 and Institute of Cardiometabolism and Nutrition (ICAN), 75013 Paris, France.
| | - Fabrice Bauer
- Department of Cardiology, Inserm U1096, Rouen University Hospital, 76031 Rouen, France
| | - Alain Cohen-Solal
- Department of Cardiology, Paris Diderot University, Sorbonne Paris Centre, UMRS 942, Lariboisière Hospital, 75013 Paris, France
| | - Thibaud Damy
- UPEC, Mondor Amyloidosis Network, Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Inserm U955, DHU ATVB, 94010 Créteil, France
| | - Erwan Donal
- Department of Cardiology, Rennes University Hospital, University of Rennes 1, LTSI, Inserm UMR 1099, University of Rennes 1, 35033 Rennes, France
| | - Michel Galinier
- Équipe 7 « Obésité et Insuffisance Cardiaque : Approches Moléculaires et Cliniques », Inserm UMR 1048 - I2MC, Faculty of Medicine, University Paul-Sabatier - Toulouse 3, 31432 Toulouse, France
| | - Albert Hagège
- Department of Cardiology, AP-HP, Georges-Pompidou European Hospital, Paris Descartes University, PRES Paris Cité, 75015 Paris, France
| | - Patrick Jourdain
- École du Cœur et des Anticoagulants, UTIC, CHR Dubos, 95300 Pontoise, France
| | - Christophe Leclercq
- Department of Cardiology, Rennes University Hospital, CIC-IT, 35033 Rennes, France
| | - Rémi Sabatier
- Department of Cardiology, Caen University Hospital, 14003 Caen, France
| | - Jean-Noël Trochu
- Department of Cardiology and Vascular Diseases, Inserm UMR 1087, CIC 1413, Nantes University, Institut du Thorax, CHU de Nantes, 44093 Nantes, France
| | - Ariel Cohen
- Faculty of Medicine Pierre-et-Marie-Curie, University Paris 6, Department of Cardiology, AP-HP, Saint-Antoine Hospital, 75012 Paris, France
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Charfi N, Trabelsi S, Turki M, Mâalej Bouali M, Zouari L, Dammak M, Ben Thabet J, Mhiri C, Mâalej M. [Impact of physical disability and concomitant emotional disturbances on post-stroke quality of life]. Encephale 2016; 43:429-434. [PMID: 27663046 DOI: 10.1016/j.encep.2016.05.014] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/25/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The physical and/or psycho-cognitive changes after stroke may lead to a decline in the quality of life (QOL) of patients. The aims of our study were to evaluate the QOL of stroke survivors and to investigate its relationships with the physical disability degree and the emotional disorders (anxiety and depression). METHODS We conducted a cross-sectional study, which included 147 patients, followed for stroke that had occurred over the past year, in the outpatient neurology department at the university hospital Habib Bourguiba of Sfax (Tunisia). For each patient, we collected socio-demographic characteristics and clinical and therapeutic data. The quality of life of our patients was assessed using the SF-36 scale. The HAD scale was used to screen for anxiety and depression, whereas the modified Rankin scale was used to measure the degree of disability. RESULTS The average age of our patients was 60.58 years. The overall mean score of the SF-36 ranged from 20.81 to 89.81 with an average of 55.27. Impaired QOL was found in 68% of patients. The study of the dimensional average scores revealed that only two dimensions of the SF-36 were not altered: physical pain and life and relationship with others. The physical component was slightly more altered than the mental component (41.4 and 42.9 respectively). A minimal disability was found in 32% of patients, while a moderate and severe disability was found in 19% and 21.1% of patients. Anxiety was detected in 55.1% of patients and depression in 67.3% of them. Impaired mental component QOL was significantly correlated with the presence of anxiety (P=0.008) and depression (P<<0.05). The severe degree of disability had a significant negative impact on all areas of QOL except that of life and relationships with others. CONCLUSION It appears from our study that among the important effects of stroke is the constant deterioration of QOL in its various dimensions. The occurrence of emotional disturbances such as anxiety and depression and the degree of physical disability seem to be predictors of QOL impairment. Therefore, special attention should be given to such patients at higher risk of decline in their QOL.
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Affiliation(s)
- N Charfi
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie.
| | - S Trabelsi
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie
| | - M Turki
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie
| | | | - L Zouari
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie
| | - M Dammak
- Service de neurologie, CHU Habib Bourguiba, Sfax, Tunisie
| | - J Ben Thabet
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie
| | - C Mhiri
- Service de neurologie, CHU Habib Bourguiba, Sfax, Tunisie
| | - M Mâalej
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie
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Cacoub P, Desbois AC, Commarmond C, Domont F, Saadoun D. [Revisiting the scope of extrahepatic manifestations of hepatitis C virus infection]. Rev Med Interne 2016; 37:383-6. [PMID: 26611430 DOI: 10.1016/j.revmed.2015.10.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/24/2015] [Indexed: 12/15/2022]
Affiliation(s)
- P Cacoub
- UMR 7211, inflammation-immunopathologie-biothérapie (DHU i2B), Sorbonne universités, UPMC université Paris 06, 75005 Paris, France; Inserm, UMR_S 959, 75013 Paris, France; CNRS, FRE3632, 75005 Paris, France; Département de médecine interne et immunologie clinique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
| | - A-C Desbois
- Inserm, UMR_S 959, 75013 Paris, France; CNRS, FRE3632, 75005 Paris, France; Département de médecine interne et immunologie clinique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - C Commarmond
- Inserm, UMR_S 959, 75013 Paris, France; CNRS, FRE3632, 75005 Paris, France; Département de médecine interne et immunologie clinique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - F Domont
- UMR 7211, inflammation-immunopathologie-biothérapie (DHU i2B), Sorbonne universités, UPMC université Paris 06, 75005 Paris, France; Inserm, UMR_S 959, 75013 Paris, France; Département de médecine interne et immunologie clinique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - D Saadoun
- UMR 7211, inflammation-immunopathologie-biothérapie (DHU i2B), Sorbonne universités, UPMC université Paris 06, 75005 Paris, France; Inserm, UMR_S 959, 75013 Paris, France; CNRS, FRE3632, 75005 Paris, France; Département de médecine interne et immunologie clinique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
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Jecko V, Penchet G, Champeaux C. [Pial synangiosis for moyamoya disease. The Bordeaux experience]. Neurochirurgie 2016; 62:190-6. [PMID: 27113323 DOI: 10.1016/j.neuchi.2015.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/27/2015] [Accepted: 12/18/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Different surgical methods may be used for the treatment of moyamoya disease. The authors report their experience with pial synangiosis revascularization. MATERIAL AND METHODS We reviewed the clinical, surgical as well as radiographic records of all patients who underwent cerebral revascularization surgery using pial synangiosis for a symptomatic moyamoya disease at a single institution, Bordeaux University Hospital. RESULTS Over a 6-year period (2007-2013), 17 procedures were performed in 9 patients. Median age at presentation was 11.5 years and six patients presented with an ischemic event. As regards previous medical history, five patients were diagnosed with moyamoya syndrome. Median time between the symptoms onset and the first surgical procedure was 5.9 months. The average age of the first surgery was 11.8 years and the median time between the two synangiosis was 3.5 months. One patient died of a malignant ischemic stroke after the second procedure. At long-term follow-up, no patient experienced any symptoms recurrence. CONCLUSION Pial synangiosis typically results in an increase in collaterals from the superficial temporal artery or middle meningeal artery to the brain. It is a simple and effective surgical technique to prevent further moyamoya manifestation and to stabilize or improve the neurologic prognosis.
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Affiliation(s)
- V Jecko
- Service de neurochirurgie, hôpital Pellegrin, 33076 Bordeaux, France
| | - G Penchet
- Service de neurochirurgie, hôpital Pellegrin, 33076 Bordeaux, France
| | - C Champeaux
- Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, 1345, Govan road, Glasgow G51 4TF, Royaume-Uni.
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Sohtaoğlu M, E Kızıltan M, Gündüz A, Bozluolçay M. Startle responses after different stimulus modalities differ in stroke. Neurophysiol Clin 2016; 46:193-9. [PMID: 26917356 DOI: 10.1016/j.neucli.2015.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/27/2015] [Accepted: 12/29/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The auditory startle reaction (ASR) and startle reflex to somatosensory inputs (SSS) are stereotypical responses to sudden and unexpected stimuli, which are generated in the caudal brainstem reticular formation. Changes of ASR are relatively well known in stroke. Here, we aimed to investigate central pathways of SSS and plasticity changes of SSS circuits in different stages and localizations of stroke, by comparing with ASR. METHODS We prospectively included 39 patients with stroke between June 2009 and June 2013, and 23 age and gender-matched healthy subjects. ASR and SSS were recorded over orbicularis oculi, sternocleidomastoid, biceps brachii (BB), and abductor policis brevis muscles (APB) using surface electrodes. RESULTS There were supratentorial and infratentorial lesions in both acute and chronic stages. Overall, ASR probability was similar between groups (P=0.981). However, ASR probability was increased for BB and APB recordings on symptomatic sides of stroke patients with high amplitudes and long durations, most prominently on symptomatic sides of pontine strokes. Latencies and presence rates of SSS did not differ between any subgroups of stroke and healthy subjects. CONCLUSION ASR is facilitated in arm and hand muscles on symptomatic sides of stroke patients, whereas SSS did not show any significant changes according to stroke.
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Affiliation(s)
- Melis Sohtaoğlu
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, 34098 K.M. Pasa, Istanbul, Turkey
| | - Meral E Kızıltan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, 34098 K.M. Pasa, Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, 34098 K.M. Pasa, Istanbul, Turkey.
| | - Melda Bozluolçay
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, 34098 K.M. Pasa, Istanbul, Turkey
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Kintoki Mbala F, Longo-Mbenza B, Mbungu Fuele S, Zola N, Motebang D, Nakin V, Lueme Lokotola C, Simbarashe N, Nge Okwe A. [Impact of seasons, years El Nino/La Nina and rainfalls on stroke-related morbidity and mortality in Kinshasa]. ACTA ACUST UNITED AC 2016; 41:4-11. [PMID: 26826750 DOI: 10.1016/j.jmv.2015.12.002] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 11/28/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The significant impact of seasonality and climate change on stroke-related morbidity and mortality is well established, however, some findings on this issue are conflicting. The objective was to determine the impact of gender, age, season, year of admission, temperature, rainfall and El Nino phenomenon on ischemic and hemorrhagic strokes and fatal cases of stroke. METHODS The study was carried out at the teaching hospital of Kinshasa, DRC, between January 1998 and December 2004. Rainy and dry seasons, elevated temperatures, indices of rainfalls El Nino years 1998, 2002 and 2004, but La Nina years 1999-2000 and neutral/normal years 2001 and 2003 were defined. RESULTS Among 470 incident strokes, 34.5% of victims (n=162) died. Traditional seasons (small dry season, small rainy season, great dry season, great rainy season) and temperatures did not significantly (P>0.005) impact on stroke incidence. However, there was a positive association between the decrease in rainfall, El Nino, and incident ischemic strokes, but a significant positive association between the increase in rainfall, La Nina, and incident hemorrhagic strokes. Using logistic regression analysis, age ≥ 60 years (OR: 1.7, 95% CI: 1.2-2.5; P=0.018) and El Nino years (OR: 2, 95% CI: 1.2-3.3; P=0.009) were identified as the independent predictors of fatal strokes. CONCLUSION Early warning systems should be developed to predict the impact of seasons and climate variability on stroke morbidity and mortality.
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Affiliation(s)
- F Kintoki Mbala
- Service de cardiologie, cliniques universitaires de Kinshasa, Kinshasa, République démocratique du Congo
| | - B Longo-Mbenza
- Faculty of Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha 5117 Eastern Cape, Afrique du Sud.
| | - S Mbungu Fuele
- Laboratoire d'épidémiologie clinique et de biostatistique, Lomo Medical, Kinshasa, République démocratique du Congo
| | - N Zola
- Faculté de médecine, université Simon Kimbangu, Kinshasa, République démocratique du Congo
| | - D Motebang
- Faculté de médecine, université Simon Kimbangu, Kinshasa, République démocratique du Congo
| | - V Nakin
- Faculté de médecine, université Simon Kimbangu, Kinshasa, République démocratique du Congo
| | - C Lueme Lokotola
- Faculty of Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha 5117 Eastern Cape, Afrique du Sud
| | - N Simbarashe
- Faculté d'agronomie, université de Lubumbashi, Lubumbashi, République démocratique du Congo
| | - A Nge Okwe
- Risk and Vulnerability Assessment Centre, Walter Sisulu University, Mthatha, Afrique du Sud
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Yger M, Crozier S, Dubourdieu S, Vivien B, Dolveck F, Samson Y. Triage practices in stroke units: Physicians' perceptions and ethical issues. Rev Neurol (Paris) 2016; 172:146-51. [PMID: 26563667 DOI: 10.1016/j.neurol.2015.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 08/06/2015] [Accepted: 09/01/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We aimed to explore acute stroke admission decisions and to discuss ethical issues in triage practices in stroke units (SUs) in France. METHODS In this study, 337 questionnaires were sent to physicians involved in acute admission to SUs in Île-de-France (neurologists and physicians from emergency medical services). The questionnaires comprised questions about physicians' perceptions of the reasonable allocation of SU beds and admission criteria for patients in SU in clinical vignettes illustrating complex situations. RESULTS In total, 162 questionnaires were fully completed. There were some discrepancies in perceptions and reporting practices between emergency physicians and neurologists concerning patient admission criteria. Triage choices were more frequently declared by emergency physicians than by neurologists and were related to the difficulty of obtaining a positive response for the admission of certain complex patients (particularly those with comorbidities). CONCLUSIONS Despite recommendations stating that all patients with stroke should be admitted to SUs, this study has shown that triage practices exist in stroke admission decisions. The triage depends on the role and perceptions of each physician in acute stroke management. These decisions suggest reflections on the applicability of distributive justice theories and on ethical issues in triage practices in medicine.
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Beyaert C, Vasa R, Frykberg GE. Gait post-stroke: Pathophysiology and rehabilitation strategies. Neurophysiol Clin 2015; 45:335-55. [PMID: 26547547 DOI: 10.1016/j.neucli.2015.09.005] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [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: 07/10/2015] [Revised: 09/14/2015] [Accepted: 09/22/2015] [Indexed: 12/16/2022] Open
Abstract
We reviewed neural control and biomechanical description of gait in both non-disabled and post-stroke subjects. In addition, we reviewed most of the gait rehabilitation strategies currently in use or in development and observed their principles in relation to recent pathophysiology of post-stroke gait. In both non-disabled and post-stroke subjects, motor control is organized on a task-oriented basis using a common set of a few muscle modules to simultaneously achieve body support, balance control, and forward progression during gait. Hemiparesis following stroke is due to disruption of descending neural pathways, usually with no direct lesion of the brainstem and cerebellar structures involved in motor automatic processes. Post-stroke, improvements of motor activities including standing and locomotion are variable but are typically characterized by a common postural behaviour which involves the unaffected side more for body support and balance control, likely in response to initial muscle weakness of the affected side. Various rehabilitation strategies are regularly used or in development, targeting muscle activity, postural and gait tasks, using more or less high-technology equipment. Reduced walking speed often improves with time and with various rehabilitation strategies, but asymmetric postural behaviour during standing and walking is often reinforced, maintained, or only transitorily decreased. This asymmetric compensatory postural behaviour appears to be robust, driven by support and balance tasks maintaining the predominant use of the unaffected side over the initially impaired affected side. Based on these elements, stroke rehabilitation including affected muscle strengthening and often stretching would first need to correct the postural asymmetric pattern by exploiting postural automatic processes in various particular motor tasks secondarily beneficial to gait.
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Affiliation(s)
- C Beyaert
- EA3450, Université de Lorraine, Faculty of Medicine, 54500 Vandœuvre-lès-Nancy, France; Motion Analysis Laboratory, L.-Pierquin Rehabilitation Center, 54000 Nancy, France.
| | - R Vasa
- RV Foundation, Centre for Brain and Spinal Injury Rehab, Mumbai, India
| | - G E Frykberg
- Department of Neuroscience/Rehabilitation Medicine, Uppsala University, 75158 Uppsala, Sweden
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Fauchier L, Philippart R, Clementy N, Bourguignon T, Angoulvant D, Ivanes F, Babuty D, Bernard A. How to define valvular atrial fibrillation? Arch Cardiovasc Dis 2015; 108:530-9. [PMID: 26184867 DOI: 10.1016/j.acvd.2015.06.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [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: 06/03/2015] [Accepted: 06/08/2015] [Indexed: 12/21/2022]
Abstract
Atrial fibrillation (AF) confers a substantial risk of stroke. Recent trials comparing vitamin K antagonists (VKAs) with non-vitamin K antagonist oral anticoagulants (NOACs) in AF were performed among patients with so-called "non-valvular" AF. The distinction between "valvular" and "non-valvular" AF remains a matter of debate. Currently, "valvular AF" refers to patients with mitral stenosis or artificial heart valves (and valve repair in North American guidelines only), and should be treated with VKAs. Valvular heart diseases, such as mitral regurgitation, aortic stenosis (AS) and aortic insufficiency, do not result in conditions of low flow in the left atrium, and do not apparently increase the risk of thromboembolism brought by AF. Post-hoc analyses suggest that these conditions probably do not make the thromboembolic risk less responsive to NOACs compared with most forms of "non-valvular" AF. The pathogenesis of thrombosis is probably different for blood coming into contact with a mechanical prosthetic valve compared with what occurs in most other forms of AF. This may explain the results of the only trial performed with a NOAC in patients with a mechanical prosthetic valve (only a few of whom had AF), where warfarin was more effective and safer than dabigatran. By contrast, AF in the presence of a bioprosthetic heart valve or after valve repair appears to have a risk of thromboembolism that is not markedly different from other forms of "non-valvular" AF. Obviously, we should no longer consider the classification of AF as "valvular" (or not) for the purpose of defining the aetiology of the arrhythmia, but for the determination of a different risk of thromboembolic events and the need for a specific antithrombotic strategy. As long as there is no better new term or widely accepted definition, "valvular AF" refers to patients with mitral stenosis or artificial heart valves. Patients with "non-valvular AF" may have other types of valvular heart disease. One should emphasize that "non-valvular AF" does not exclude patients with some types of valvular heart disease from therapy with NOACs.
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Affiliation(s)
- Laurent Fauchier
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France.
| | - Raphael Philippart
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France
| | - Nicolas Clementy
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France
| | - Thierry Bourguignon
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France
| | - Denis Angoulvant
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France
| | - Fabrice Ivanes
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France
| | - Dominique Babuty
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France
| | - Anne Bernard
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France
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Bourgeois-Marcotte J, Flamand-Roze C, Denier C, Monetta L. [LAST-Q: Adaptation and normalisation in Quebec of the Language Screening Test]. Rev Neurol (Paris) 2015; 171:433-6. [PMID: 25917163 DOI: 10.1016/j.neurol.2015.03.008] [Citation(s) in RCA: 9] [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] [Received: 09/23/2014] [Revised: 01/20/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
Abstract
The goal of the present study was to adapt and to establish normative data for the recently developed Language Screening Test (LAST; Flamand-Roze et al., 2011) in the French-Canadian population according to age and level of education. After an adaptation process, 100 French-Canadian speakers were evaluated with the LAST-Q. As expected, a perfect score of 15/15 was obtained for all high level education participants, and a score of 14/15 was obtained for all participants with a lowest level of education or aged 80 years or more. Thanks to this adaptation, LAST-Q can be used in acute patients in stroke unit in Quebec.
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Affiliation(s)
- J Bourgeois-Marcotte
- Département de réadaptation, faculté de médecine, université Laval, 1050, avenue de la Médecine, Québec, G1V 0A6, Canada
| | - C Flamand-Roze
- CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
| | - C Denier
- Faculté de médecine Paris Sud, hôpital de Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre cedex, France
| | - L Monetta
- Département de réadaptation, faculté de médecine, université Laval, 1050, avenue de la Médecine, Québec, G1V 0A6, Canada; Centre de recherche de l'institut universitaire en santé mentale de Québec (CRIUSMQ), 2601, de la Canardière, Québec, G1J 2G3, Canada.
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Meimoun M, Bayle N, Baude M, Gracies JM. [Intensity in the neurorehabilitation of spastic paresis]. Rev Neurol (Paris) 2015; 171:130-40. [PMID: 25572141 DOI: 10.1016/j.neurol.2014.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/24/2014] [Accepted: 09/05/2014] [Indexed: 12/21/2022]
Abstract
Neurorestoration of motor command in spastic paresis requires a double action of stimulation and guidance of central nervous system plasticity. Beyond drug therapies, electrical stimulation and cell therapies, which may stimulate plasticity without precisely guiding it, two interventions seem capable of driving plasticity with a double stimulation and guidance component: the lesion itself (lesion-induced plasticity) and durable behavior modifications (behavior-induced plasticity). Modern literature makes it clear that the intensity of the neuronal and physical training is a primary condition to foster behavior-induced plasticity. When it comes to working on movement, intensity can be achieved by the combination of two key components, one is the difficulty of the trained movement, the other is the number of repetitions or the daily duration of the practice. A number of recent studies shed light on promising recovery prospects, particularly using the emergence of new technologies such as robot-assisted therapy and concepts such as guided self-rehabilitation contracts.
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Affiliation(s)
- M Meimoun
- Laboratoire analyse et restauration du mouvement, service de rééducation neurolocomotrice, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-De-Lattre-De-Tassigny, 94010 Créteil, France.
| | - N Bayle
- Laboratoire analyse et restauration du mouvement, service de rééducation neurolocomotrice, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-De-Lattre-De-Tassigny, 94010 Créteil, France
| | - M Baude
- Laboratoire analyse et restauration du mouvement, service de rééducation neurolocomotrice, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-De-Lattre-De-Tassigny, 94010 Créteil, France
| | - J-M Gracies
- Laboratoire analyse et restauration du mouvement, service de rééducation neurolocomotrice, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-De-Lattre-De-Tassigny, 94010 Créteil, France
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Vellieux G, Evrard S, Guedin P, Lapergue B. [Endovascular therapy in the treatment of acute ischemic stroke: what the cardiologist should know]. Ann Cardiol Angeiol (Paris) 2014; 63:428-36. [PMID: 25440765 DOI: 10.1016/j.ancard.2014.09.029] [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: 10/24/2022]
Abstract
INTRODUCTION Interventional cardiology procedures are regularly exposed to ischemic neurological complications. IV fibrinolysis is the only approved treatment in ischemic stroke but is very often contraindicated in these situations. Many techniques of interventional neuroradiology (mechanical thrombectomy) have been developed over the past years and are used to treat these patients. OBSERVATION We report the case of two patients who were admitted in emergency for ischemic stroke with contraindication to IV fibrinolysis (cardioversion for atrial fibrillation under anticoagulation; 24 hours after carotid surgery). These patients were treated by endovascular thrombectomy procedure. DISCUSSION After validation of IV fibrinolysis within 4.5 hours after stroke onset, techniques of mechanical thrombectomy have gradually been developed, either as a complementary treatment or as an alternative in the case of CI to fibrinolysis. These endovascular thrombectomy devices currently allow recanalization of proximal cerebral occlusions, which correlates with a favorable clinical prognosis. A review of the literature is provided, along with a discussion about the techniques currently being improved, their advantages and disadvantages and the selection of patients that can benefit from endovascular procedures. CONCLUSION In the case of a sudden occurrence of a neurological deficit during a cardiovascular procedure, a "thrombolysis alert" should be triggered. This will permit the rapid establishment of a clinico-radiological report for selecting stroke patients eligible for a procedure of recanalization by thrombolysis and/or mechanical thrombectomy.
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Affiliation(s)
- G Vellieux
- Unité de neurovasculaire, service de neurologie, hôpital Foch, université Versailles - Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France
| | - S Evrard
- Unité de neurovasculaire, service de neurologie, hôpital Foch, université Versailles - Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France
| | - P Guedin
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, université Versailles - Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France
| | - B Lapergue
- Unité de neurovasculaire, service de neurologie, hôpital Foch, université Versailles - Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France.
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Rozec B, Cinotti R, Le Teurnier Y, Marret E, Lejus C, Asehnoune K, Blanloeil Y. [Epidemiology of cerebral perioperative vascular accidents]. ACTA ACUST UNITED AC 2014; 33:677-89. [PMID: 25447778 DOI: 10.1016/j.annfar.2014.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/24/2013] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Stroke is a well-described postoperative complication, after carotid and cardiac surgery. On the contrary, few studies are available concerning postoperative stroke in general non-cardiac non-carotid surgery. The high morbid-mortality of stroke justifies an extended analysis of recent literature. ARTICLE TYPE Systematic review. DATA SOURCES Firstly, Medline and Ovid databases using combination of stroke, cardiac surgery, carotid surgery, general non-cardiac non-carotid surgery as keywords; secondly, national and European epidemiologic databases; thirdly, expert and French health agency recommendations; lastly, reference book chapters. RESULTS In cardiac surgery, with an incidence varying from 1.2 to 10% according to procedure complexity, stroke occurs peroperatively in 50% of cases and during the first 48 postoperative hours for the others. The incidence of stroke after carotid surgery is 1 to 20% according to the technique used as well as operator skills. Postoperative stroke is a rare (0.15% as mean, extremes around 0.02 to 1%) complication in general surgery, it occurs generally after the 24-48th postoperative hours, exceptional peroperatively, and 40% of them occurring in the first postoperative week. It concerned mainly aged patient in high-risk surgeries (hip fracture, vascular surgery). Postoperative stroke was associated to an increase in perioperative mortality in comparison to non-postoperative stroke operated patients. CONCLUSION Postoperative stroke is a quality marker of the surgical teams' skill and has specific onset time and induces an increase of postoperative mortality.
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Affiliation(s)
- B Rozec
- Service d'anesthésie et de réanimation chirurgicale, hôpital G.-et-R.-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France.
| | - R Cinotti
- Service d'anesthésie et de réanimation chirurgicale, hôpital G.-et-R.-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France
| | - Y Le Teurnier
- Service d'anesthésie et de réanimation chirurgicale, hôpital G.-et-R.-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France
| | - E Marret
- Département d'anesthésie-réanimation, institut hospitalier franco-britannique, 4, rue Kléber, 92300 Levallois-Perret, France
| | - C Lejus
- Service d'anesthésie et de réanimation chirurgicale, Hôtel-Dieu, CHU de Nantes, 44093 Nantes cedex 1, France
| | - K Asehnoune
- Service d'anesthésie et de réanimation chirurgicale, Hôtel-Dieu, CHU de Nantes, 44093 Nantes cedex 1, France
| | - Y Blanloeil
- Service d'anesthésie et de réanimation chirurgicale, hôpital G.-et-R.-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France
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Bien JY, Morel J, Demasles S, Abboud K, Molliex S. [Postoperative dissection of the vertebral artery in two steps]. ACTA ACUST UNITED AC 2014; 33:696-9. [PMID: 25447780 DOI: 10.1016/j.annfar.2014.07.750] [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: 05/25/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022]
Abstract
The diagnosis of perioperative vertebral artery dissection can be difficult because of non-specific clinical signs. We report a case revealed by a tegmento-thalamic stroke after an abdominal second surgical look. The interest of this observation is related to a particular evolution in two steps separated by a 2-month-interval and an intercurrent cervical manipulation. After the second anesthesia, neck pain associated with a third cranial nerve palsy and a supranuclear ophtalmoplegia revealed a tegmento-thalamic ischemic stroke due to vertebral artery dissection. We discuss here the different factors possibly involved in the pathophysiology of postoperative vertebral artery dissection: positioning, cervical manipulation, subclavian central venous access and cisplatin toxicity. Vertebral artery dissection should be discussed in case of postoperative neck pain, especially with non-typical symptomatology.
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Affiliation(s)
- J-Y Bien
- Service d'anesthésie réanimation, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France.
| | - J Morel
- Service d'anesthésie réanimation, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France
| | - S Demasles
- Service de neurologie, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France
| | - K Abboud
- Service de chirurgie digestive et cancérologique, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France
| | - S Molliex
- Service d'anesthésie réanimation, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France
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