Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 6 de 6
Filter
1.
J Neuroradiol ; 48(6): 438-445, 2021 Nov.
Article in English | MEDLINE | ID: mdl-30986430

ABSTRACT

PURPOSE: To compare the evaluation of collaterals on multiphase computed tomography (CT) angiography using the score proposed by the reference study by Menon et al. and the Alberta Stroke Program Early CT (ASPECT) score for the prediction of favorable clinical outcome in patients with anterior ischemic stroke (IS). MATERIALS AND METHODS: Retrospective single center study including 199 patients with anterior ischemic stroke and evaluated using multiphase CT angiography. Collaterals were assessed using the reference score and ASPECT score. The early clinical outcome [National Institute of Health Stroke Score (NIHSS) over day 1] and later clinical outcome [90-day modified Rankin Scale (mRS)] were collected. The primary analysis related to the association between collateral scores and clinical outcome. RESULTS: Collaterals are an independent predictive factor of favorable clinical outcome with the two scores, ranging from an odds ratio (OR) [95% confidence interval (CI)] = 1.84 [1.23; 2.76], P = 0.003 for the reference score to an OR [95% CI] = 2.63 [1.21; 5.73], p = 0.015 for the phase 3 ASPECT score. The phase 3 ASPECT score offers better sensitivity (Se) for the prediction of a favorable clinical outcome [Se = 95%, specificity (Sp) = 37% for a threshold of 7/7] than the reference score (Se = 83%, Sp = 47% for a threshold of 4/5). CONCLUSION: This study demonstrates the value of the ASPECT score in analyzing collaterals using multiphase CT angiography for the prediction of clinical outcome.


Subject(s)
Brain Ischemia , Ischemic Stroke , Stroke , Brain Ischemia/diagnostic imaging , Cerebral Angiography , Collateral Circulation , Computed Tomography Angiography , Humans , Retrospective Studies , Stroke/diagnostic imaging , Stroke/therapy , Tomography, X-Ray Computed , Treatment Outcome
2.
Neurochirurgie ; 62(4): 183-9, 2016 Aug.
Article in English | MEDLINE | ID: mdl-27236731

ABSTRACT

OBJECTIVE: Deep brain mapping has been proposed for direct targeting in stereotactic functional surgery, aiming to personalize electrode implantation according to individual MRI anatomy without atlas or statistical template. We report our clinical experience of direct targeting in a series of 156 patients operated on using a dedicated Inversion Recovery Turbo Spin Echo sequence at 1.5-tesla, called White Matter Attenuated Inversion Recovery (WAIR). METHODS: After manual contouring of all pertinent structures and 3D planning of trajectories, 312 DBS electrodes were implanted. Detailed anatomy of close neighbouring structures, whether gray nuclei or white matter regions, was identified during each planning procedure. We gathered the experience of these 312 deep brain mappings and elaborated consistent procedures of anatomical MRI mapping for pallidal, subthalamic and ventral thalamic regions. We studied the number of times the central track anatomically optimized was selected for implantation of definitive electrodes. RESULTS: WAIR sequence provided high-quality images of most common functional targets, successfully used for pure direct stereotactic targeting: the central track corresponding to the optimized primary anatomical trajectory was chosen for implantation of definitive electrodes in 90.38%. CONCLUSION: WAIR sequence is anatomically reliable, enabling precise deep brain mapping and direct stereotactic targeting under routine clinical conditions.


Subject(s)
Deep Brain Stimulation , Electrodes, Implanted , Stereotaxic Techniques , White Matter/physiopathology , Brain Mapping , Deep Brain Stimulation/methods , Female , Globus Pallidus/surgery , Humans , Imaging, Three-Dimensional/methods , Magnetic Resonance Imaging/methods , Male
3.
Diagn Interv Imaging ; 94(1): 45-52, 2013 Jan.
Article in English | MEDLINE | ID: mdl-22835573

ABSTRACT

Posterior reversible encephalopathy syndrome (PRES) is a rare but severe condition of the central nervous system. It develops in a variety of clinical settings and it has diverse patterns of expression, which can sometimes make diagnosis difficult. Characteristic features are often demonstrated on computed tomography imaging and/or magnetic resonance imaging, meaning that when there is a suspicious clinical picture, this diagnosis should suggest itself. However, clinicians should be aware of some of the less typical features in order to more fully understand this condition, in which early treatment is key to good clinical progress.


Subject(s)
Magnetic Resonance Imaging , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Posterior Leukoencephalopathy Syndrome/pathology , Tomography, X-Ray Computed , Humans
4.
Neurochirurgie ; 53(2-3 Pt 2): 141-51, 2007 Jun.
Article in French | MEDLINE | ID: mdl-17507055

ABSTRACT

MRI is the best radiological technique to explore cavernomas, vascular malformations affecting the entire central nervous system. The presence of blood degradation products produces a specific aspect which enables excellent contrast resolution. Certain diagnosis can be established with MRI which can also be used to follow growth and modifications, particularly in familial forms. In the emergency setting, the first exam is often a CT-scan for patients presenting acute neurological sign(s) and/or with a clinical suspicion of hemorrhagic stroke. Angiography is generally not contributive because cavernomas are occult vascular malformations. Nevertheless, this exam is often necessary when an associated vascular abnormality is suspected, particularly a developmental venous abnormality.


Subject(s)
Central Nervous System Neoplasms/diagnostic imaging , Hemangioma, Cavernous, Central Nervous System/diagnostic imaging , Central Nervous System Neoplasms/diagnosis , Cerebral Angiography , Hemangioma, Cavernous, Central Nervous System/diagnosis , Humans , Magnetic Resonance Imaging , Tomography, X-Ray Computed
5.
J Thorac Cardiovasc Surg ; 121(4): 642-8, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11279403

ABSTRACT

OBJECTIVES: We sought to prevent postoperative swallowing disorder, aspiration, and sputum retention in cases of recurrent laryngeal or vagus nerve section occurring during lung cancer resection. METHODS: In 14 of 25 consecutive patients, type I thyroplasty and thoracic operations were performed during the same period of anesthesia. All patients had a preoperative laryngeal computed tomographic scan providing us with indispensable measurements for vocal fold medialization under general anesthesia (ie, without intraoperative phonatory control). Nine remaining patients had a type I thyroplasty delayed from thoracic operations because of intraoperative doubt about laryngeal innervation injury, and 2 did not need a laryngeal operation. Main postoperative records consisted of swallowing ability, respiratory complications, and quality of voice. RESULTS: No swallowing disorder, aspiration, or sputum retention occurred in cases of concomitant laryngeal and thoracic operations. Of these 14 patients, a single case (7%) of major complication (vocal fold overmedialization) occurred and required an early and successful revision thyroplasty; one case of cervical hematoma that did not require surgical drainage was considered a minor complication (7%). Twelve (86%) patients who underwent the concomitant association of both operations were fully satisfied with their quality of voice. CONCLUSIONS: Type I thyroplasty and thoracic operation can be advantageously associated in case of injury to laryngeal motor innervation to prevent postoperative swallowing disability and dramatic respiratory complications.


Subject(s)
Lung Neoplasms/surgery , Recurrent Laryngeal Nerve Injuries , Respiration Disorders/etiology , Thoracic Surgical Procedures/methods , Thyroid Gland/surgery , Vagus Nerve Injuries , Vocal Cord Paralysis/complications , Adenocarcinoma/surgery , Aged , Carcinoma, Adenoid Cystic/surgery , Carcinoma, Squamous Cell/surgery , Female , Humans , Incidence , Larynx/diagnostic imaging , Male , Middle Aged , Respiration Disorders/epidemiology , Respiration Disorders/prevention & control , Retrospective Studies , Survival Rate , Thoracic Surgical Procedures/adverse effects , Tomography, X-Ray Computed , Vocal Cord Paralysis/epidemiology , Vocal Cord Paralysis/etiology , Vocal Cord Paralysis/prevention & control
6.
Bull Acad Natl Med ; 179(1): 27-37; discussion 37-40, 1995 Jan.
Article in French | MEDLINE | ID: mdl-7788445

ABSTRACT

According to many ethical and humanitarian arguments, the diagnosis of "brain death" is more and more an emergency. The forensic criteria include abolition of consciousness, abolition of brain stem reflexes, abolition of spontaneous breathing joined to electrocerebral silence. However using EEG criteria of electrical silence may be unreliable because of technical artefacts or depressed electrical activity due to drug intoxication and hypothermia. Venous angiography was used in 125 cases: our experience proves reliability and efficiency of angiographic criteria for diagnosis of brain death. For organ transplant, it is better to be as fast as possible: transplanted organ will be better and it reduces the cost of a long useless intensive care. When it is necessary, we suggest to allow the choice between EEG and angiography.


Subject(s)
Brain Death/diagnosis , Cerebral Veins/diagnostic imaging , Electroencephalography , Humans , Radiography , Retrospective Studies
SELECTION OF CITATIONS
SEARCH DETAIL
...