ABSTRACT
Marchiafava-Bignami disease (MBD) is a rare condition often associated with chronic alcohol abuse. Clinical presentation is diverse. Characteristic magnetic resonance imaging (MRI) changes in the corpus callosum are the mainstay of radiological diagnosis. We present a case of a 54-year-old man with chronic alcoholism and peripherally enhancing lesion in the body of the corpus callosum on MRI Brain. Open biopsy of the lesion showed necrosis and demyelination. He was diagnosed with Marchiafava-Bignami disease based on clinical, radiology and histopathology findings. Our case represents the only case in the literature with antemortem histopathology findings describing MBD.
Subject(s)
Corpus Callosum/diagnostic imaging , Corpus Callosum/pathology , Magnetic Resonance Imaging/methods , Marchiafava-Bignami Disease/diagnostic imaging , Marchiafava-Bignami Disease/pathology , Alcoholism/diagnostic imaging , Alcoholism/pathology , Diagnosis , Humans , Male , Middle AgedABSTRACT
OBJECTIVE: Takotsubo cardiomyopathy (TCM) is characterized by transient apical ventricular dysfunction typically induced by acute stress. Acute cerebral events including ischemic stroke (IS) or epileptic events (EEs) may be associated with massive catecholamine release. We aimed to identify the characteristics and outcomes of patients who experienced the Takotsubo syndrome complicated by IS or EE. METHODS: Between 2008 and 2013, 87 patients were admitted to our intensive care unit for TCM. Of these, 6 had previously experienced acute cerebral symptoms within 2 days of experiencing either IS or EE. Takotsubo syndrome was diagnosed on cardiac MRI, echocardiography, electrocardiography (ECG), biology and coronary angiography data. RESULTS: Five women and 1 man were included in the study. The mean age was 63.7 ± 20.1 years (range 44-84). Four of them (67%) initially presented an acute IS and 2 (33%) had EE. The suspected brain injury was found in the insular cortex for 4 patients and the posterior fossa for 2 patients. Hemiparesis, aphasia and cerebellar symptoms were the main neurological signs. Abnormal ECG findings including ST-segment elevation (33%) or T-wave inversion (50%) developed between a few hours and 48 h after the onset of the IS or EE. Peak troponin was 1.8 (0.79-14.11) µg/l. A transient reduction in the left ventricular ejection fraction (46 ± 12%) with apical hypokinesis was found using echocardiography. Two (33%) patients went on to develop acute heart failure. Coronary angiography confirmed the lack of significant coronary stenosis for all 6 patients. CONCLUSION: TCM can develop within the first few days after an acute cerebral event. It occurs predominantly in women with insular or posterior fossa lesions and is possibly induced by vegetative reactions.
Subject(s)
Stroke/complications , Takotsubo Cardiomyopathy/etiology , Takotsubo Cardiomyopathy/physiopathology , Adult , Aged , Aged, 80 and over , Echocardiography , Electrocardiography , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Takotsubo Cardiomyopathy/epidemiologyABSTRACT
Multiple sclerosis affects almost 100 000 people in France with a higher prevalence among women. It is the most common cause of non-traumatic disability in the young adult. Recent years have been marked by a better understanding of the physiopathology and risk factors, as well as by an increase in the number of available treatments.
Subject(s)
Multiple Sclerosis/physiopathology , Multiple Sclerosis/therapy , Brain/pathology , Humans , Magnetic Resonance Imaging , Multiple Sclerosis/diagnosis , Risk FactorsABSTRACT
OBJECTIVE: To evaluate the prevalence of headache at onset and its association with 1-month mortality in stroke patients. METHODS: All patients with stroke in Dijon, France (2006-2011), were prospectively identified using a population-based registry. Cox regression models were used to evaluate the association between headache and 30-day all-cause mortality. RESULTS: Among 1411 stroke patients, data about headache were obtained for 1391 (98.6%) of whom 1185 had an ischemic stroke (IS), 201 had an intracerebral hemorrhage (ICH) and five had a stroke of undetermined etiology. Headache was found in 253 (18.2%) patients and was more frequent in those with ICH than in those with IS (46.3% vs 13.5%, p < 0.001). Overall 30-day mortality was 11.7%, and was greater for patients with than those without headache (17.0% vs 10.5%, unadjusted HR 1.70; 95% CI 1.20-2.41, p = 0.003). In multivariable analysis, an association between headache and 30-day mortality was observed (HR 1.51; 95% CI 1.02-2.25, p = 0.042). In stratified analyses, headache was associated with 30-day mortality in ICH (HR 2.09; 95% CI 1.18-3.71, p = 0.011) but not in IS (HR 1.01; 95% CI 0.53-1.92, p = 0.97). CONCLUSION: Headache at stroke onset is associated with a higher risk of early mortality in patients with ICH.
