F. Chollet

Neuropsychological outcome after a first symptomatic ischaemic stroke with 'good recovery'

Background:u2002 Neuropsychological impairment after stroke when no motor, sensory or language deficits are left remains understudied. The primary aim of this study was to assess neuropsychological outcome in a specific population of patients after a first symptomatic stroke without previous cognitive decline and with a good motor, linguistic, and functional recovery (i.e. ‘good outcome’). The secondary aims were to identify the profile of this potential impairment and relations between brain lesions and neuropsychological outcome.

Pharmacological therapies in post stroke recovery: recommendations for future clinical trials

AbstractnStroke is a leading cause of serious long-term disability in adults and is the second leading cause of death worldwide. Early reperfusion and neuroprotection techniques have been the focus of much effort with the aim of very acute treatment of the stroke. Targeting different mechanisms, pharmacological therapies have the potential to reduce disability in a large fraction of patients who survive the acute stroke. The brain’s capacity to reorganize after stroke through plasticity mechanisms can be modulated by pharmacological agents. A number of therapeutic interventions are under study, including small molecules, growth factors, and monoclonal antibodies. Recently it has been shown that the SSRI fluoxetine improved motor deficit in patients with ischaemic stroke and hemiplegia which appeared to be independent of the presence of depression. In this context, it is of major importance to support innovative research in order to promote the emergence of new pharmacological treatments targeting neurological recovery after stroke, as opposed to acute de-occlusion and neuroprotection. This paper is the work of a group of 14 scientists with aim of (1) addressing key areas of the basic and clinical aspects of human brain plasticity after stroke and potential pharmacological targets for recovery, (2) asking questions about the most appropriate characteristics of clinical trials testing drugs in post stroke recovery and (3) proposing recommendations for future clinical trials.

Anodal tDCS Combined With Radial Nerve Stimulation Promotes Hand Motor Recovery in the Acute Phase After Ischemic Stroke

Background and Objective. The question of the best therapeutic window in which noninvasive brain stimulation (NIBS) could potentiate the plastic changes for motor recovery after a stroke is still unresolved. Most of the previous NIBS studies included patients in the chronic phase of recovery and very few in the subacute or acute phase. We investigated the effect of transcranial direct current stimulation (tDCS) combined with repetitive peripheral nerve stimulation (rPNS) on the time course of motor recovery in the acute phase after a stroke. Methods. Twenty patients enrolled within the first few days after a stroke were randomized in 2 parallel groups: one receiving 5 consecutive daily sessions of anodal tDCS over the ipsilesional motor cortex in association with rPNS and the other receiving the same rPNS combined with sham tDCS. Motor performance (primary endpoint: Jebsen and Taylor Hand Function Test [JHFT]) and transcranial magnetic stimulation cortical excitability measures were obtained at baseline (D1), at the end of the treatment (D5), and at 2 and 4 weeks’ follow-up (D15 and D30). Results. The time course of motor recovery of the 2 groups of patients was different and positively influenced by the intervention (Group × Time interaction P = .01). The amount of improvement on the JHFT was greater at D15 and D30 in the anodal tDCS group than in the sham group. Conclusion. These results show that early cortical neuromodulation with anodal tDCS combined with rPNS can promote motor hand recovery and that the benefit is still present 1 month after the stroke.

Carotidynia : a new case for an old controversy

Whereas International Headache society (IHS) criteria of carotidynia were defined in 1988, its validity as a distinct nosological entity has recently been questioned, leading this entity to be removed from the second IHS classification in 2004. We report the case of a 30‐year‐old woman who developed a pain located at the left carotid bulb, associated with typical findings on ultrasonography and MRI. We discuss new criteria and denomination of this clinical entity.

A Case of Logopenic Primary Progressive Aphasia with C9ORF72 Expansion and Cortical Florbetapir Binding

We report the case of a 65-year-old woman, clinically diagnosed with the logopenic variant of primary progressive aphasia (PPA), and carrier of C9ORF72 expansion, despite cerebrospinal fluid biomarkers suggesting Alzheimers disease (AD). She underwent structural MRI, metabolic PET, and amyloid PET imaging using florbetapir. Comparison with healthy controls revealed widespread hypometabolism, left sided cortical atrophy, and an increased cortical amyloid load. No difference in amyloid binding was found between the patient and predemential AD patients. This case provides evidence of amyloidopathy in a carrier of C9ORF72 expansion exhibiting a clinical profile of the logopenic variant of PPA.

Évaluation à 4 ans de la filière « Urgences AVC » de l’Hôpital Purpan (Toulouse) et analyse de 69 patients consécutifs traités par rt-PA intra-veineux

Resume Introduction L’obtention en 2002 de l’AMM europeenne pour l’utilisation du rt-PA dans la fibrinolyse des AVC ischemiques Methodes Nous rapportons la mise en place et l’activite depuis 2002 de la filiere « Urgences AVC » de l’hopital Purpan (Toulouse). Resultats 10,2 p. 100 des AVC de tous types (ischemiques et hemorragiques) hospitalises dans le service de Neurologie ont ete pris en charge par la filiere dans l’optique d’un traitement fibrinolytique. Parmi eux, 25,6 p. 100 ont ete traites par rt-PA (2,6 p. 100 des AVC de tous types) avec un score moyen de NIHSS a l’admission de 15,8 [5 ; 25]. L’imagerie utilisee pour selectionner les candidats a la thrombolyse etait le scanner dans 90 p. 100 des cas. Le delai moyen de traitement etait de 2 h 25 et celui intra-hospitalier de 40 minutes. Deux patients (3 p. 100) ont presente une hemorragie intra-cerebrale symptomatique. Le taux de deces etait de 18,8 p. 100. A 3 mois, 53,5 p. 100 des patients etaient « independants » (Rankin Conclusion Ces resultats confirment la faisabilite, la reproductibilite, l’efficacite et la surete du traitement thrombolytique par rt-PA dans les AVC ischemiques inferieurs a 3 heures dans notre centre. La mise en place d’une filiere « Urgences AVC » est un outil necessaire pour traiter le plus grand nombre de patients dans les meilleurs delais.

Measuring Autonomy and Functional Recovery after Stroke Implications for Clinical Trials Testing Medications during Rehabilitation

Stroke is a leading cause of death and disability in the world. This life-changing disease affects the patient, family, and society at large. It is a leading cause of human suffering and among the primary reasons for long-term, institutionalized care. The economic impact of stroke is huge; besides direct healthcare costs including rehabilitation, indirect costs such as lost productivity of patients and family caregivers and disability payments are huge. 1 The management of patients who have had a stroke is complex with several phases of care that take priority during the course of the illness including (1) emergency treatment of the stroke itself, (2) prevention and treatment of neurological and medical complications, (3) prevention of recurrent stroke, and (4) maximization of recovery including rehabilitation. Stroke is not a homogenous illness, which means outcomes vary greatly among patients. Outcomes after stroke are affected by variables such as age and sex, the type and cause of stroke, the presence of comorbid diseases, concomitant interventions, prestroke functioning and cognitive behavior, and societal factors. 2

Neuropsychological outcome after carbon monoxide exposure following a storm: a case-control study

BackgroundThe cognitive consequences of carbon monoxide (CO) poisoning are well described. However, most studies have been carried out without an ad-hoc group of control subjects. The main aim of this study was to evaluate cognitive and psychiatric outcome after CO exposure during the storm Klaus in the South West of France (January 2009) in a homogeneous group of patients compared to a group of 1:1 paired controls.MethodsPatients and controls were asked to fill out questionnaires about quality of life and cognitive complaints. They then underwent a cognitive assessment derived from the Carbon Monoxide Neuropsychological Screening Battery. Psychiatric assessment was performed using subtests of the Mini International Neuropsychiatric Interview.Results38 patients and 38 paired controls were included (mean age 38.8 years) and evaluated 51 days after the poisoning. No difference was found between groups on the cognitive complaint questionnaire but patients had a lower quality of life than controls. Patients showed significantly lower cognitive performance than controls on processing speed, mental flexibility, inhibition and working and verbal episodic memories. Patients were more depressed than controls, and suffered more from post-traumatic stress disorder.ConclusionsWe report the first study investigating cognitive and psychiatric outcome in consecutive patients after CO poisoning during a natural disaster, using a group comparison method. CO poisoning during storms needs to be dealt with adequately and clinicians should be aware of its possible consequences.

Cortical superficial siderosis and acute convexity subarachnoid hemorrhage in cerebral amyloid angiopathy

Acute convexity subarachnoid hemorrhage (cSAH) and cortical superficial siderosis (cSS) are neuroimaging markers of cerebral amyloid angiopathy (CAA) that may arise through similar mechanisms. The prevalence of cSS in patients with CAA presenting with acute cSAH versus lobar intracerebral hemorrhage (ICH) was compared and the physiopathology of cSS was explored by examining neuroimaging associations.

Diagnostic précoce de la maladie d’Alzheimer

INTRODUCTIONnDiagnosis of Alzheimers disease (AD) remains difficult to establish, and can only be considered as certain thanks to anatomopathological evidence, or genetic mutations. Current diagnostic criteria rely on innovative imaging and biological tools, in order to detect pathological cues from very early stages, and with best sensibility and sensitivity.nnnSTATE OF ARTnAdvances in neuro-imaging enabled the development of different tools to help establishing the diagnosis, such as cerebral atrophy assessment on magnetic resonance imaging (MRI), and cerebral metabolism study on positron emission tomography (PET). Besides, the increasing use of in vivo biological markers, combined to clinical criteria, enables to discriminate patients from healthy controls at even earlier stages. This includes studies on tau and beta-amyloid proteins concentrations in the cerebrosinal fluid, and amyloid-specific radioligands uptake. Familial forms of Alzheimer represent a great model for studying early or even pre-symptomatic AD, as genetic analyses constitute a diagnosis of certainty, even though they usually evolve earlier and faster.nnnPERSPECTIVES, CONCLUSIONnDiagnostic tools are more and more numerous and performant. According to patients clinical heterogeneity, it appears essential to associate different method to investigate, in order to make a diagnosis as early and as reliable as possible.