RESUMO
BACKGROUND: Care pathways and long-term outcomes of acute stroke patients requiring mechanical ventilation have not been thoroughly studied. METHODS AND RESULTS: Stroke Prognosis in Intensive Care (SPICE) is a prospective multicenter cohort study which will be conducted in 34 intensive care units (ICUs) in the Paris, France area. Patients will be eligible if they meet all of the following inclusion criteria: (1) age of 18 years or older; (2) acute stroke (i.e., ischemic stroke, intracranial hemorrhage, or subarachnoid hemorrhage) diagnosed on neuroimaging; (3) ICU admission within 7 days before or after stroke onset; and (4) need for mechanical ventilation for a duration of at least 24 h. Patients will be excluded if they meet any of the following: (1) stroke of traumatic origin; (2) refusal to participate; and (3) privation of liberty by administrative or judicial decision. The primary endpoint is poor functional outcome at 1 year, defined by a score of 4 to 6 on the modified Rankin scale (mRS), indicating severe disability or death. Main secondary endpoints will include decisions to withhold or withdraw care, mRS scores at 3 and 6 months, and health-related quality of life at 1 year. CONCLUSIONS: The SPICE multicenter study will investigate 1-year outcomes, ethical issues, as well as care pathways of acute stroke patients requiring invasive ventilation in the ICU. Gathered data will delineate human resources and facilities needs for adequate management. The identification of prognostic factors at the acute phase will help to identify patients who may benefit from prolonged intensive care and rehabilitation. TRIAL REGISTRATION: NCT03335995.
Assuntos
Estado Funcional , Qualidade de Vida , Respiração Artificial , Acidente Vascular Cerebral/terapia , França , Acidente Vascular Cerebral Hemorrágico/terapia , Humanos , Unidades de Terapia Intensiva , AVC Isquêmico/fisiopatologia , AVC Isquêmico/terapia , Mortalidade , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Prognóstico , Acidente Vascular Cerebral/fisiopatologia , Hemorragia Subaracnóidea/fisiopatologia , Hemorragia Subaracnóidea/terapia , Suspensão de TratamentoRESUMO
Three surveys were performed in France, in March 1999, to analyze the management of acute stroke patients. Three hundred forty five Emergency departments, 93 departments of Neurology and 258 Rehabilitation units participated. Fifty per cent of patients with stroke arrive at the emergency department within 3 hours of symptom onset. Only 40 p. cent of the patients are admitted in a neurological department and 5 p. cent in an acute stroke unit. The mean length of acute hospital stay is often very long (more than three weeks) because of the delay to transfer to a rehabilitation unit. This study shows that acute stroke management is herogeneous and not structured in France.
Assuntos
Reabilitação do Acidente Vascular Cerebral , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , França/epidemiologia , Hospitalização , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Prevalência , Acidente Vascular Cerebral/epidemiologia , Inquéritos e QuestionáriosRESUMO
A case of HILV1-associated adult T cell leukaemia/lymphoma (ATLL) in à 21-year olf African woman is reported. The patient presented with lymphomatous meningoradiculopathy. The usual clinical features of ATLL were absent. Lumbar MRI showed a pial enhancement by DTPA-gadolinium of the conus medullaris which extended to the proximal cauda equina. Under systemic chemotherapy coupled with intrathecal chemotherapy the patient progressively improved, and at the second MRI examination complete disappearance of the lumbar enhancement was observed. MRI of the brain using axial and coronal T2-weighted sequences detected multifocal lesions of high-intensity signal in the subcortical white matter. ATLL is unusual in people of African origin. The ATLL-strongyloïdes infestation association has previously been reported, suggesting that parasitic infestation may be an important co-factor leading to the development of ATLL.
Assuntos
Leucemia-Linfoma de Células T do Adulto/complicações , Meningite Viral/etiologia , Radiculopatia/etiologia , Adulto , Feminino , Humanos , Leucemia-Linfoma de Células T do Adulto/líquido cefalorraquidiano , Imageamento por Ressonância Magnética , Meningite Viral/líquido cefalorraquidiano , Radiculopatia/diagnóstico , Estrongiloidíase/complicaçõesRESUMO
We report the assessment by MRI of a lumbosacral lymphomatous localization of adult T-cell leukemia/lymphoma (ATLL) with human T-cell lymphotropic virus-1 infection in an African patient. Brain MRI detected associated multifocal lesions of increased signal intensity in the subcortical white matter. These MRI abnormalities are compatible with reported necropsy findings in cases of ATLL with neurological complications.
