Evaluation of an intravenous-endovascular strategy in patients with acute proximal middle cerebral artery occlusion.

BACKGROUND AND PURPOSE: IVT administered in acute ischemic stroke provides low recanalization rates in proximal intracranial occlusions, with consequently poor clinical outcome. The safety and efficacy of an IES by using mechanical thrombectomy after IVT failure were assessed in acute MCA occlusions. MATERIALS AND METHODS: Patients presenting with acute MCA occlusion within 4.5 hours with an NIHSS score between 8 and 25 and a DWI ASPECTS of >5 were eligible. From September 2009 to September 2010, mechanical thrombectomy by using the Solitaire FR device was systematically performed if no clinical improvement was observed 1 hour after the initiation of IVT (IES group). Results in terms of clinical outcome were compared with those from an IVT series from January 2007 to August 2009 (IVT group). RESULTS: Alteplase was administered in 123 patients with proximal intracranial occlusion. Fifty-six had a confirmed MCA occlusion: 32 were included in the IVT group; and 24, in the IES group. At 24 hours, the median NIHSS improvement was 8.5 points in the IES group (25%-75% CI, 1.5-13) and 3 points in the IVT group (25%-75% CI, 1-5) (P = .001). At 3 months, 17/22 (77%) patients from the IES group and 15/30 (50%) from the IVT group had an mRS score of ≤2. After adjustment for confounding variables, IES was strongly associated with favorable clinical outcome (77% versus 50%; adjusted odds ratio = 11.9; 95% CI, 1.6-89.1; P < .02). No symptomatic intracranial hemorrhage was observed. CONCLUSIONS: IES by using systematic mechanical thrombectomy after IVT failure safely improves the clinical outcome at 3 months and could represent an interesting alternative in the management of patients with acute MCA occlusion.

[Isolated palsy of the hypoglossal nerve complicating infectious mononucleosis]. / Paralysie isolée du nerf hypoglosse compliquant une mononucléose infectieuse.

INTRODUCTION: Neurological complications of infectious mononucleosis are rare. Various disorders have been described: meningitis, encephalitis, peripheral neuropathy. Isolated cranial nerve palsy has rarely been reported. OBSERVATION: A 16-year-old man was admitted for isolated and unilateral hypoglossal nerve palsy, four weeks after infectious mononucleosis. Cerebral MRI, cerebrospinal fluid study and electromyography were normal. IgM anti-VCA were positive. Two months later, without treatment, the tongue had almost fully recovered. CONCLUSION: To the best of our knowledge, only seven cases of isolated palsy of the hypoglossal nerve complicating infectious mononucleosis have been previously reported.

Adolescencia prevenida: diferencias en indicadores de riesgo en adolscentes chaqueños medidas a través del IRIS / Prevented adolescence: differences in adolescent risk indicators Chaco measured by IRIS

Esta investigación busca describir y comparar diferencias detectadas en los indicadores de riesgo, evaluados por el “Inventario de Riesgo Suicida – IRIS”, en relación al sexo y a la edad de un grupo de adolescentes, estudiantes de escuelas agrícolas y, que residen en el Dpto. de Villa Hayes. La muestra es autoseleccionada, compuesta por n=89 adolescentes, varones n=35 y mujeres n=54. Las variables comparadas de los indicadores medidos a través del IRIS, valoran los niveles de riesgo suicida presente, clasificándolos en riesgo alto, moderado y bajo. El diseño es de tipo transversal, exploratorio – descriptivo– comparativo. Se utilizó un análisis cuali/cuantitativo para describir y comparar las diferencias encontradas mediante el Paquete de Análisis Estadísticos SPSS versión 15.0 para Windows. Se concluye que en los adolescentes chaqueños se observan diferencias en relación al sexo y edad, en los factores de riesgo y en la estimación de los niveles de riesgo.