Early successful reperfusion after endovascular therapy reduces malignant middle cerebral artery infarction occurrence in young patients with large diffusion-weighted imaging lesions.

BACKGROUND AND PURPOSE: Malignant middle cerebral artery infarction (MMI) is a severe complication of acute ischaemic stroke (AIS). The aim of our study was to assess whether successful reperfusion after endovascular therapy (EVT) in AIS with clinical and imaging predictors of MMI decreased its occurrence. METHODS: Data were collected between January 2014 and July 2018 in a monocentric prospective AIS registry of patients treated with EVT. Patients selected were <65 years old with severe anterior circulation AIS with a National Institutes of Health Stroke Scale score >15, baseline Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score ≤ 6 and baseline diffusion-weighted imaging lesion volume >82 mL within 6 h of symptom onset. Successful reperfusion was defined as a Thrombolysis in Cerebral Ischemia score ≥ 2b. Occurrence of MMI was the primary endpoint. RESULTS: A total of 66 EVT-treated patients were included in our study. MMI occurred in 27 patients (41%). In unadjusted analysis, successful reperfusion was associated with fewer MMIs (31.8% vs. 65.0%; P = 0.015) and with more favorable outcome at 3 months (50% vs. 20%; P = 0.023). In multivariate analysis, successful reperfusion was associated with an adjusted odds ratio (95% confidence intervals) of 0.35 (0.10-1.12) for MMI and 2.77 (0.84-10.43) for 3-month favorable outcome occurrence. CONCLUSIONS: Early successful reperfusion performed in patients with AIS with clinical and imaging predictors of MMI was associated with decreased MMI occurrence. Reperfusion status might be considered in evaluating the need for craniectomy in patients with early predictors of MMI.

Body orientation and regulation of the center of gravity during movement under water.

Professional divers were instructed to adopt a vertical posture under water with their feet fixed to the ground and to perform a fast forward or backward upper trunk bending movement in response to a tone. Kinematic and EMG analyses were performed. It was first noted that the divers adopted a forward inclined, erect posture, suggesting that the verticality was misevaluated, although the effects of gravity were still exerted on the otoliths. Second, the upper trunk movements were still accompanied by opposite movements of lower segments and, as a result, the center of gravity displacement was still minimized, although not so accurately as on the ground. The EMG pattern consisting of early activation of a set of trunk, thigh, and shank muscles continued to occur under water. These results suggest that "axial synergies" associated with upper trunk movements are learned motor habits that regulate the center of gravity position regardless of the equilibrium constraints.

[Quantitative approach of postural asynergia in cerebellar diseases]. / Approche quantitative de l'asynergie posturale en pathologie cérébelleuse.

In his original description of cerebellar asynergia, Babinski, in 1899, presented a patient with cerebellar dysfunction performing a backward upper trunk bending. When the patient tried to bend his head and trunk, his lower limbs stayed almost motionless, because the associated flexion of the knee and hip, usually observed in a normal subject, did not take place. To reassess the possibility that asynergia may actually be a symptom of cerebellar dysfunction, a combined kinematic and electromyographic (EMG) analysis of the upper-trunk bending was performed on 3 patients suffering from progressive cerebellar ataxia of late onset and showing a significant atrophy of the vermis on MRI examination. Compared with 3 age and sex-matched control subjects, a significant slowing down of the upper-trunk displacement and a marked reduction of the associated displacement of hip and knee was observed. EMG recordings of three pairs of antagonistic muscles at trunk level (rectus abdominis, erectores spinae), at thigh level (vastus lateralis, semi membranosus), and at leg level (tibialis anterior, gastrocnemius lateralis), showed that the reciprocal activation pattern characteristic of a normal fast movement was absent at the thigh level in the cerebellar patients. This lack of reciprocal activation of the thigh muscles during the upper-trunk bending might explain the reduction of the compensatory displacement of the hip and knee. It might also represent an essential feature of cerebellar dysfunction in provoking axial asynergia between the upper-trunk, which is the moving segment, and the leg, which is the supporting segment during equilibrium control and during whole body displacement.

Axial synergies under microgravity conditions.

Fast forward and backward upper trunk movements were analyzed and compared under microgravity and under preflight and postflight conditions. The kinematic analysis showed that the upper trunk movements were accompanied by hip and knee movements in the opposite direction both under microgravity and under normal gravitational conditions. This suggests that the center of mass position with respect to the feet is still regulated under microgravity when the feet are attached to the floor. The EMG analysis during backward movements shows that under preflight conditions a set of muscles (ErSp, BF, Sol) in the back of the body are activated early on. Under microgravity, the early Sol activation was replaced by an early TA activation, which was still present at the first postflight recording and was then replaced by the early Sol activation observed under preflight conditions. This finding shows that the EMG pattern underlying the axial synergies is flexible and that adaptive changes take place both under microgravity and after return to Earth.

[Strategy and synergy: two levels of equilibrium control during movement. Effects of the microgravity]. / Stratégie et synergie: deux niveaux de contrôle de l'équilibre au cours du mouvement. Effets de la microgravité.

Equilibrium is ensured during forward or backward upper trunk movements by displacing the hip and knee simultaneously in opposite directions. When fast movements are performed, a muscle synergy characterized by the early activation of a set of trunk, thigh and leg muscles precedes the onset of the kinematic changes. The question which is addressed concerns the possibility that two levels of equilibrium control might exist during upper trunk movements: the strategy level, which is relatively invariant, is characterized by the displacement in opposite directions of the upper and low segments, and the muscle synergy level at which the strategy is implemented, which may be adaptable to the environmental constraints. When upper trunk movements are performed under microgravity with the subject's feet fixed to the floor of the space cabin, the displacement of upper and lower body segments in opposite directions still occurs, although this is no longer necessary to maintain the equilibrium. This kinematic strategy seems to be aimed at regulating the centre of inertia position with respect to the feet. The muscle synergies associated with these kinematic changes are modified, however, under microgravity. After returning to the ground, the previous synergies do not reappear immediately, but only after a few days. This suggests that a short period of learning is needed to change the synergy. These data are compatible with the hypothesis that two levels of equilibrium control actually exist during upper trunk movements, the strategy level, which is kinematic and invariant, and the synergy level, which is adaptable to the environmental constraints through a short learning process.