Focal cortical atrophy following transient meningeal enhancement in a progressive multiple sclerosis.

Recent studies identified chronic leptomeningeal enhancement (LME) in late-acquired FLAIR sequences in secondary progressive (SP) multiple sclerosis (MS). These LMEs correlate with focal cortical inflammation and demyelination observed by pathology, which are supposed to drive long-term cortical atrophy. We report a spontaneously remitting meningeal uptake in a patient suffering from SP MS.

Estimation of intrathecal IgG synthesis: simulation of the risk of underestimation.

Objective: The low level of passively diffused IgG through the blood-brain barrier is sufficient to blur the estimation of intrathecal IgG synthesis (ITS). Therefore, this estimation requires a mathematical calculation derived from empirical laws, but the range of normal values in healthy controls is wide enough to prevent a precise calculation. This study investigated the precision of various methods of ITS estimations and their application to two clinical situations: plasma exchange and immune suppression targeting ITS.

No evidence of disease activity (NEDA) in MS should include CSF biology - Towards a 'Disease-Free Status Score'.

The concept of NEDA (no evidence of disease activity) was forged to describe relapse-free patients under treatment with recent drugs, but this goal is reached by less than half of all patients and not sustained over time. However a complete remission of disease is expected to be associated with the normalization of CSF biomarkers. On pathophysiological grounds, we propose to add the criterion of no evidence of biological activity in CSF to design a future 'disease-free status score'.

Compartmentalized intrathecal immunoglobulin synthesis during HIV infection - a model of chronic CNS inflammation?

HIV infects the central nervous system (CNS) during primary infection and persists in resident macrophages. CNS infection initiates a strong local immune response that fails to control the virus but is responsible for by-stander lesions involved in neurocognitive disorders. Although highly active anti-retroviral therapy now offers an almost complete control of CNS viral proliferation, low-grade CNS inflammation persists.

[Postoperative dissection of the vertebral artery in two steps].

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.

Middle cerebral artery dissection: diagnostic and prognostic value of transcranial color-coded sonography.

We report 2 patients with ischemic stroke related to an initial severe focal narrowed middle cerebral artery caused by a dissection mechanism, a presentation that has received little attention to date. Diagnostic modalities and follow-up using transcranial color-coded sonography are reported and discussed. Results with transcranial color-coded sonography were correlated with computed tomographic angiography, showing the great value of this radiation-free arterial monitoring process in this setting, especially in young adults.

Postpartum four-vessel cervical artery dissection.

A postpartum four-vessel cervical artery dissection with no stroke is reported. This transient vasculopathy took place in the autoimmune context of the HELLP syndrome combined with the reversible posterior leucoencephalopathy syndrome. Correlations between the clinical, radiological and biological entities are discussed.

[Impact of a stroke-unit on rtPA use in a community hospital: a 3-year prospective study].

Introduction: Although intravenous thrombolysis has been used for ischemic strokes since 2004 in our community hospital located in Pau (southwest of France), a specifically dedicated stroke-unit (SU) was created only recently in June 2010. We decided to collect prospective data to compare the use and efficacy of intravenous thrombolysis before and after the opening of this dedicated stroke unit.

Methods: Stroke patients with internal carotid artery territory involvement treated with intravenous thrombolysis were compared between two similar periods.

[Mutism and acute behavioral disorders revealing MELAS syndrome].

Introduction: MELAS syndrome (mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes) is a rare genetic mitochondrial disease which can cause cerebral (cerebrovascular accident, migraine, mental deterioration..), sensorial (bilateral symmetrical deafness) and peripheral (muscular involvement, neuropathy) disorders potentially associated with diabetes, renal or cardiac disorders, or growth retardation.

Investigation of PK-PD drug-drug interaction between acenocoumarol and amoxicillin plus clavulanic acid.

A pharmacokinetic-pharmacodynamic (PK-PD) drug-drug interaction between acenocoumarol and amoxicillin + clavulanic acid antibiotic was assessed in eight healthy volunteers, using a population PK-PD) model. Each subject received at day 1 a single dose of 8 mg of acenocoumarol. Then 1 g of amoxicillin + 250 mg of clavulanic acid was given from days 3 to 9.

[Central post-stroke pain].

Central post-stroke pain (CPSP) is known since the famous Dejerine-Roussy syndrome and its description has not improved. The subject has however been revived over the last decade thanks to advances in central nervous system imaging with magnetic resonance imaging (MRI), the description of allodynia functional phenomena with fMRI, the study of opioid receptors, and above all, the analysis of pain pathways by laser-evoked potentials. Progress has also occurred in CPSP treatment with motor cortex stimulation, which probably opens a period of neuromodulation of the cortical areas controlling pain.

[Intracranial extension of extracranial vertebral artery dissections. A review of 16 cases].

Introduction: Vertebral artery (VA) dissections can involve both the extracranial and intracranial portions of the VA. Intradural extension explains the occurrence of subarachnoid hemorrage (SAH). We have studied the rate of this extension, the risk of associated SAH and the therapeutic repercussions at the acute stage.