Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size.

Background: The use of thrombectomy in patients with acute stroke and a large infarct of unrestricted size has not been well studied.

Methods: We assigned, in a 1:1 ratio, patients with proximal cerebral vessel occlusion in the anterior circulation and a large infarct (as defined by an Alberta Stroke Program Early Computed Tomographic Score of ≤5; values range from 0 to 10) detected on magnetic resonance imaging or computed tomography within 6.5 hours after symptom onset to undergo endovascular thrombectomy and receive medical care (thrombectomy group) or to receive medical care alone (control group).

European Multicenter Study of ET-COVID-19.

Background And Purpose: Acute ischemic stroke and large vessel occlusion can be concurrent with the coronavirus disease 2019 (COVID-19) infection. Outcomes after mechanical thrombectomy (MT) for large vessel occlusion in patients with COVID-19 are substantially unknown. Our aim was to study early outcomes after MT in patients with COVID-19.

Clip-first policy versus coil-first policy for the exclusion of middle cerebral artery aneurysms.

Objective: Middle cerebral artery (MCA) aneurysms are a particular subset of intracranial aneurysms that can be excluded by clipping or coiling. A comparison of the results between these two methods is often limited by a selection bias in which wide-neck and large aneurysms are frequently treated with surgery. Here, the authors report the results of two centers using opposing policies in the management of MCA aneurysms: one center used a clip-first policy while the other used a coil-first policy, which limited the selection bias and ensured a good comparison of these two treatment modalities.

The value of a rapid contrast-enhanced angio-MRI protocol in the detection of head and neck paragangliomas in SDHx mutations carriers: a retrospective study on behalf of the PGL.EVA investigators.

Objectives: To assess the performance of a simplified MRI protocol consisting of a contrast-enhanced three-dimensional MR angiography (CE-MRA) in association with a post-contrast T1-weighted sequence (T1WIV) for the detection of HNPGLs in SDHx mutation carriers.

Methods: This retrospective sub-study is based on the multicenter PGL.EVA cohort, which prospectively enrolled SDHx mutation carriers from 2005 to 2009; 157 index cases or relatives were included.

Feasibility and validity of monitoring subarachnoid hemorrhage by a noninvasive MRI imaging perfusion technique: Pulsed Arterial Spin Labeling (PASL).

Background And Purpose: To evaluate the validity of pulsed arterial spin labeling (PASL) imaging with cerebral blood flow (CBF) quantification for monitoring subarachnoid hemorrhage (SAH); to describe changes in the perfusion signal in the absence of or following several classic complications.

Materials And Methods: Fifteen patients and 14 healthy volunteers were assigned to SAH and control populations, respectively. ASL imaging was performed three times: between Day 0 (D0, i.

Overestimation of moderate carotid stenosis assessed by both Doppler US and contrast enhanced 3D-MR angiography in the CARMEDAS study.

Purpose: To evaluate the agreement and diagnostic accuracy of Contrast enhanced magnetic resonance angiography (CE-MRA), Doppler ultrasound (DUS) and Digital subtraction angiography (DSA) in the assessment of carotid stenosis.

Methods: DUS, CE-MRA and DSA were performed in 56 patients included in the Carotide-angiographie par résonance magnétique-échographie-doppler-angioscanner (CARMEDAS) multicenter study with a carotid stenosis ≥ 50%. Three readers evaluated stenoses on CE-MRA and DSA (NASCET criteria).

[MRI aspects of anoxic-ischemic encephalopathy of the term and premature newborn].

These past few years have seen an increasing role of MRI in the investigation of neonatal cerebral anoxic-ischemic pathology. This is due not only to greater precision in diagnosing lesion extension, but also to earlier detection of lesions with the diffusion of weighted imagery. The aim of this iconographic review is to illustrate the main MRI aspects of anoxic-ischemic encephalopathy in a pedagogical way.

[Conventional and diffusion magnetic resonance imaging in the acute phase of severe traumatic brain injury].

Neuro-imaging is essential for the initial evaluation and subsequent control in the acute stage of severe head injury. In these indications tomodensitometry (TDM) has a pivotal role. Despite the well recognized contribution of magnetic resonance imaging (MRI) to the investigation of most of acute neurological pathologies, MRI is not still a routine procedure for the initial investigation of patients with acute head injury.

Supratentorial primitive neuroectodermal tumours of the brain: multidirectional differentiation does not influence prognosis. A clinicopathological report of 18 patients.

Aims: To examine the clinical and pathological characteristics of supratentorial primitive neuroectodermal tumours (PNETs) in a retrospective series of 18 patients, according to the strict definition of the World Health Organization classification of tumours that excludes other types of malignant embryonal tumours of the brain.

Methods And Results: Eleven children and seven adults with supratentorial PNETs were diagnosed between 1993 and 2002 and their medical records were reviewed. An immunohistochemical study was performed on formalin-fixed paraffin-embedded tissue of 18 primary tumours and five recurrences with antibodies for neuronal (neuron specific enolase, synaptophysin, neurofilament, chromogranin A), epithelial [epithelial membrane antigen (EMA), cytokeratin], glial [glial fibrillary acidic protein (GFAP)], muscle (desmin, h-caldesmon, alpha-smooth muscle actin, myogenin) differentiation and with two anti-CD99 antibodies.

[Emergency imaging of cerebrovascular accidents].

Over the last 25 years, advances in neuroimaging have significantly changed the evaluation and management of acute stroke syndromes. In the seventies, computed tomography (CT) could differentiate between ischemic and hemorrhagic stroke. Magnetic resonance imaging (MRI) is nowadays the imaging modality of choice in the initial assessment of acute stroke.

Treatment of epistaxis in Rendu-Osler-Weber disease by in situ Ethibloc injections.

After a brief review of Rendu-Osler-Weber disease, we present the results from a series of 13 patients treated by Ethibloc injections for epistaxis. Based on a review of the literature, typical treatments are presented along with discussion of their efficacy and side effects. In our series, 90% of patients improved after only one injection.

[Trismus, pseudobulbar syndrome and cerebral deep venous thrombosis].

We report a case of cerebral deep venous thrombosis that manifested clinically by a pseudobulbar syndrome with major trismus, abnormal movements and static cerebellar syndrome. To our knowledge, only three other cases of deep cerebral venous thrombosis associated with cerebellar or pseudobulbar syndrome have been published since 1985. The relatively good prognosis in our patient could be explained by the partially intact internal cerebral veins as well as use of early anticoagulant therapy.

Use of half-dose gadolinium-enhanced MRI and magnetization transfer saturation in brain tumors.

The aim of this study was to search if half-dose gadolinium (Gd)-enhanced MR imaging with magnetization transfer saturation (MT) can replace standard-dose T1-weighted spin echo (SE) without MT saturation in brain tumors. Thirty patients with a total of 33 brain tumors (14 gliomas, 13 meningiomas, 6 metastases) were prospectively studied using T1-weighted SE half-dose of Gd with MT, and T1-weighted SE standard-dose Gd without MT. The contrast-to-noise ratio (CNR) of the two sequences was calculated and four radiologists reviewed qualitatively the images of the two sequences.

[Unusual complication of rendu-osler-weber disease: paramedian bulbar syndrome].

We report a case of arteriovenous malformation of the brainstem, revealed by a progressive right pyramidal syndrome and an atrophy of the left hemi-tongue in a man presenting a Rendu-Osler-Weber disease. After embolization the clinical course was stationary.

[Post-traumatic intracranial arterial aneurysm. Two cases with review of the literature].

Post-traumatic intracranial aneurysms are rare entity, which can appear following even benign head injuries. Their clinical manifestations are various, from a typical SAH to an uncommon intracerebral hematoma. Medical history runs usually from a couple of days to several years.

Predictibility of the cervical origin of the anterior spinal artery.

The anatomic study (under a surgical microscope) of 25 brains that had previously been injected with colored latex confirmed the fact that in the majority of cases, the anterior spinal artery results from the merging of two arterioles which both derive from two vertebral arteries. This bilateral nature is determined by the symmetric origin of the posterior inferior cerebellar arteries. When the conformation is asymmetrical, a single anterior spinal artery branches off from the vertebral artery that supplies the closest posterior inferior cerebellar artery.

The anterolateral transpetrosal approach to the clivus and the pons. Preoperative embolisation of the inferior petrosal sinus.

Resection of skull base tumors is a real challenge in the field of neurosurgery. Anterior petrosectomy gives one of the best approaches to reach the clivus and the pons while avoiding cerebral retractions which are responsable for postoperative complications. Using a subtemporal extradural or an infratemporal preauricular route, the anterolateral transpetrosal approaches produce a resection of the anterior pyramidal bone around the petrous carotid artery.

[Vascular complications during surgery of lumbar disk herniation. Apropos of 3 personal cases and 37 cases from a national investigation].

Three personal cases of iatrogenic vascular complications (two arterial wounds and one arteriovenous fistula) induced by lumbar herniation surgery led to a French national investigation among vascular and neurosurgical units where 37 other such cases have been discovered over 10 years (1984-1994). In 23 cases, the initial symptomatology was collapses by arterial (22 cases) or venous (one case) hemorrhage requiring emergency vascular repair surgery; in 17 cases an arterio-venous fistula was found in a period varying from a few hours to 5 years after surgery; it was revealed by cardiac failure, lower limb edema or abdominal thrill. Among the 40 cases, 77% occurred at the L4-L5 level; the mortality was 5%, and the morbidity was 27%.