A 37 year-old man had headaches for 10 days, then a single tonic-clonic seizure and coma due to an extensive cerebral venous thrombosis. In spite of full-dose heparin treatment for 7 days, the clinical picture worsened along with... more
A 37 year-old man had headaches for 10 days, then a single tonic-clonic seizure and coma due to an extensive cerebral venous thrombosis. In spite of full-dose heparin treatment for 7 days, the clinical picture worsened along with increasing edema on CT-Scan. Direct thrombolytic treatment was then performed using transvenous catheterization and instillation of Urokinase (2.6 MU over 4 days). A near complete repermeabilization of the sinuses was obtained and the patient improved dramatically in a few days. The only adverse effect of Urokinase was hematuria. Based on our experience and review of the literature which includes 26 previous cases, direct thrombolytic therapy appears to be a relatively safe procedure. This treatment should be considered in a patient with extensive dural sinus thrombosis which fails to respond to heparin treatment.
Research Interests: Cognitive Science, Surgery, Medicine, Humans, Heparin, and 15 morePubmed, Drug Resistance, Male, Anesthesia, cerebral Venous sinus thrombosis, Urokinase, Clinical Sciences, Adult, Cerebral edema, Thrombosis, Fibrinolysis, Thrombolytic Therapy, Headaches, Injections, and Intracranial Embolism and Thrombosis
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Research Interests: Medicine and Martinique
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Background and Purpose— Limited information exists on stroke among black populations outside the United States and United Kingdom. Part 1 of the Etude Réalisée en Martinique et Centrée sur l’Incidence des Accidents vasculaires... more
Background and Purpose— Limited information exists on stroke among black populations outside the United States and United Kingdom. Part 1 of the Etude Réalisée en Martinique et Centrée sur l’Incidence des Accidents vasculaires cérebraux (ERMANCIA) provided strong epidemiologic data on the incidence of first-ever stroke in a black Caribbean population and showed a 40% greater incidence of stroke in Martinique than in continental France. In ERMANCIA part 2, we evaluated the long-term outcomes of our cohort. Methods— Survivors of a first stroke from this prospective, community-based, stroke incidence study were reassessed at 5 years according to standardized procedures and criteria, including the modified Rankin scale, Barthel Index, Montgomery-Asberg Depression-Rating Scale, Mini-Mental State Examination, treatment compliance, and blood pressure control. Results— Of the 293 survivors of the original 580 (50.5%) patients who were still alive 5 years after stroke, 262 (89.4%) were a...
Research Interests: Depression, Incidence Geometry, Medicine, France, Activities of Daily Living, and 15 morePopulation, Humans, Hypertension, Female, Male, Cohort, Martinique, Clinical Sciences, Aged, Middle Aged, Neurosciences, Cognition disorders, Disability Evaluation, modified Rankin Scale, and Cardiovascular medicine and haematology
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Involvement of intracranial arteries in giant cell arteritis is a rare condition but often carries a fatal prognosis. Corticosteroids seem to be insufficient to avoid ischemic cerebral complications, and could even promote the occurrence... more
Involvement of intracranial arteries in giant cell arteritis is a rare condition but often carries a fatal prognosis. Corticosteroids seem to be insufficient to avoid ischemic cerebral complications, and could even promote the occurrence of stroke. We report the case of a patient with giant cell arteritis who experienced recurrent cerebellar stroke caused by intracranial vertebrobasilar stenoses with a favorable outcome following treatment. A 77-year-old woman presented with a 3-month history of impaired general condition. She had new-onset headaches, jaw claudication and transient vertigo, especially when she woke-up. The brain MRI showed a recent cerebellar infarction. One week later, she was hospitalized for a clinical deterioration related to a recurrent cerebellar stroke caused by intracranial vertebro-basilar stenoses. Giant cell arteritis was confirmed on the temporal artery biopsy. A treatment with high-dose oral corticosteroids was begun associated with an intensive antiplatelet therapy. The clinical outcome was favorable with rapid improvement of gait imbalance together with a complete radiological regression of the intracranial stenoses. Ischemic stroke in giant cell intracranial arteritis is a severe condition without a well-defined treatment. Corticosteroid therapy improves intracranial stenoses caused by vasculitis but should be initially associated with an intensive antithrombotic therapy to avoid early recurrence of cerebral infarcts.
Research Interests: Cognitive Science, Magnetic Resonance Imaging, Medicine, Stroke, Brain, and 15 moreHumans, Cerebellum, Female, Clinical Sciences, Aged, Gynecology, Antiplatelet Therapy, Basilar Artery, Giant Cell Arteritis, Vertebral artery, Magnetic resonance angiography, Cerebellar Diseases, Adrenal cortex hormones, Platelet Aggregation Inhibitors, and Vertebrobasilar insufficiency
Cannabis is the most consumed drug in the world particularly in young adults. Few reports have suggested a causal role of cannabis in the development of cerebral or cardiovascular events. We describe the first association of myocardial... more
Cannabis is the most consumed drug in the world particularly in young adults. Few reports have suggested a causal role of cannabis in the development of cerebral or cardiovascular events. We describe the first association of myocardial infarction and stroke after heavy cannabis consumption in a 45-year-old woman. Stroke occurred in relation with a right carotid and middle cerebral artery thrombosis after cannabis abuse. The patient was successfully treated with intravenous rt-PA. Two days after her admission, she presented a myocardial infarction due to a coronary thrombosis. Cerebral and coronary arteries were angiographically normal. Etiological tests were negative and a toxic cause in relation with cannabis consumption was concluded. Cannabis can be associated with vascular events by different mechanisms. Thrombosis may occur in cerebral and/or coronary arteries. We suggest that it might be useful to search for cannabis consumption systematically in young subjects victims of stroke and myocardial infarction.
Research Interests: Cognitive Science, Magnetic Resonance Imaging, Medicine, Stroke, Brain, and 15 moreHumans, Female, Young Adult, Anticoagulants, Cannabis, Clinical Sciences, Middle Aged, Gynecology, Myocardial Infarction, Tissue Plasminogen Activator, Cerebral Infarction, Magnetic resonance angiography, Cerebral Angiography, Carotid Arteries, and Cardiovascular Events
Background In Caucasian populations Neuromyelitis Optica (NMO-IgG) antibody has been detected in 27.1% / 78.2% of patients with relapsing-NMO (R-NMO). The prevalence reported for the disease in the Caribbean is 3.1/100,000 in the French... more
Background In Caucasian populations Neuromyelitis Optica (NMO-IgG) antibody has been detected in 27.1% / 78.2% of patients with relapsing-NMO (R-NMO). The prevalence reported for the disease in the Caribbean is 3.1/100,000 in the French West Indies (FWI) and 0.52 /100,000 in Cuba, but the NMO antibody status is unknown. Objective To assess the NMO-IgG antibody status of Cuban/FWI RNMO patients, comparing with European cases tested at the same laboratories. Methods Serum NMO-IgG antibodies were assayed in 48 R-NMO patients (Wingerchuck´s 1999 criteria): Cuba (24)/FWI (24), employing Lennon et al´s method. We compared the demographic, clinical, disability and laboratory data between NMO-IgG +/- patients. All the data were reviewed and collected blinded to the NMO-IgG status. Results Seropositivity of the NMO-IgG antibody demonstrated a lower rate in the Caribbean (33.3%), as compared with Caucasian patients from Spain/Italy (62.5%) and France (53.8%). Caribbean patients with NMO-IgG (...
Research Interests: Multiple sclerosis, Magnetic Resonance Imaging, Medicine, Cuba, Brain, and 15 moreHumans, Female, Male, Neuromyelitis Optica, Martinique, Recurrence, Clinical Sciences, Antibody, Adult, European Continental Ancestry Group, Disease Progression, Neurosciences, Autoantibodies, immunoglobulin G, and Disability Evaluation
Background Plasma exchange (PE) is increasingly undertaken in diseases involving humoral factors and is proven to be beneficial in acute demyelinating diseases. Spinal attacks in relapsing neuromyelitis optica (NMO) and in extensive... more
Background Plasma exchange (PE) is increasingly undertaken in diseases involving humoral factors and is proven to be beneficial in acute demyelinating diseases. Spinal attacks in relapsing neuromyelitis optica (NMO) and in extensive transverse myelitis (ETM) – a truncated form of NMO with spinal involvement – are usually devastating. Objective We retrospectively studied the outcome of PE-treated versus steroid-only treated spinal attacks in relapsing NMO and ETM. Methods We included 96 severe spinal attacks in 43 Afro-Caribbean patients. PE was given as an add-on therapy in 29 attacks. Expanded disability status score (EDSS) was obtained before attack, during the acute and residual stage. We defined the ΔEDSS as the rise from basal to residual EDSS. Results The ΔEDSS was found to be lower in the PE-treated group (1.2 ± 1.6 vs 2.6 ± 2.3; P < 0.01). A low basal impairment is associated with a better outcome. Improvement was obtained in both NMO-IgG negative and positive NMO attacks...
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A high proviral load of human T cell lymphotropic virus type 1 (HTLV-1) in peripheral blood mononuclear cells (PBMCs) has been reported in patients with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The aim of the... more
A high proviral load of human T cell lymphotropic virus type 1 (HTLV-1) in peripheral blood mononuclear cells (PBMCs) has been reported in patients with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The aim of the present study was to investigate the role of HTLV-1 proviral load in PBMCs (expressed as the number of copies per 10(6) PBMCs) in HAM/TSP disease course. One hundred consecutive HAM/TSP patients were recruited and assigned on the basis of the disability score and disease duration to either a rapid (n=38) or a slow (n=62) progression group. Thirty-four asymptomatic HTLV-1 carriers were also included. HTLV-1 proviral load was quantified in all HAM/TSP patients and asymptomatic subjects. The mean HTLV-1 proviral load was 6-fold lower in asymptomatic carriers than in HAM/TSP patients (18,224+/-24,811 vs. 107,905+/-96,651, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001) and significantly higher in rapid progression patients than in slow progression patients (146,469+/-98,943 vs. 84,270+/-87,912, p=0.0002). HTLV-1 proviral load in HAM/TSP patients was independent of age at the time of study, age at onset, and disease duration, and was not related to ophthalmological-associated disease or Chisholm grade. A high level of pulmonary lymphocytosis correlated with high HTLV-1 proviral load level (p=0.01). Our results suggest that the level of HTLV-1 proviral load in PBMCs parallels the course of HTLV-1 infection, being low in asymptomatic carriers and high and very high, respectively, in slow and rapid progression HAM/TSP patients. The magnitude of the HTLV-1 proviral load in PBMCs can be used as a biological marker of disease progression and could be a useful marker of disease activity in the monitoring of therapeutic trials.
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But Mesure de l’epaisseur des fibres nerveuses retiniennes peripapillaires, de la vision des contrastes, et de la perimetrie par technologie a doublement de frequence (FDTP : Frequency Doubling Technology Perimetry) au cours de la... more
But Mesure de l’epaisseur des fibres nerveuses retiniennes peripapillaires, de la vision des contrastes, et de la perimetrie par technologie a doublement de frequence (FDTP : Frequency Doubling Technology Perimetry) au cours de la sclerose en plaques (SEP) en tenant compte des antecedents de neuropathies optiques. Materiels et Methodes L’epaisseur de la couche des fibres nerveuses retiniennes peripapillaires a ete mesuree en tomographie a coherence optique avec le Stratus OCT equipe de la version 4.0 du logiciel. Les donnees ont ete acquises avec le protocole Fast RNFL (Retinal Nerve Fiber Layer). L’etude de la fonction visuelle a comporte pour chaque œil une mesure de l’acuite visuelle, de la vision des contrastes (tests de Pelli-Robson et de Sloan : 1.25% et 2.5 %) et une FDTP. Participants : Patients atteints de SEP remittentes (n = 30, 60 yeux). Yeux avec antecedents de neuropathie optique (SEP NO) (n = 31 yeux) et yeux sans antecedents de neuropathie optique (SEP non-NO) (n = 29 yeux). Groupe temoin (n = 23, 46 yeux). Resultats L’epaisseur moyenne des fibres nerveuses retiniennes peripapillaires etait respectivement dans le groupe SEP, les yeux du groupe SEP NO, les yeux du groupe SEP non-NO et le groupe temoin de 88.2 +/− 18.9 μm, 80.81+/− 18.4 μm, 96.7+/− 15.8 μm et de 106 +/− 12.2 μm (p = 0.0011). L’epaisseur moyenne des fibres nerveuses retiniennes peripapillaires etait correlee avec l’acuite visuelle et les scores de la vision des contrastes. Nous n’avons pas retrouve de correlation entre l’epaisseur moyenne des fibres nerveuses retiniennes peripapillaires et l’evolution de la SEP. Discussion La SEP s’accompagne d’une alteration de la fonction visuelle meme en l’absence de la survenue d’une neuropathie optique aigue. Conclusion La forte correlation entre l’aspect fonctionnel et anatomique mesuree avec l’OCT confirme la valeur de cet examen pour apprecier l’atteinte infraclinique du nerf optique, cependant la nature de sa correlation avec le handicap global de la SEP reste a preciser.
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Research Interests: Ophthalmology, Multiple sclerosis, Optical coherence tomography, Medicine, Color Perception, and 15 moreBiological Sciences, Humans, Optic Nerve, Female, Male, Color Vision, Retina, Neuromyelitis Optica, Adult, Cross Section, Optic Disk, Cross Sectional Studies, Control Group, Medical and Health Sciences, and Nerve fibers
Research Interests: Microbiology, Immunology, Medical Microbiology, Infectious Diseases, Medicine, and 15 morePopulation, Humans, Female, Male, Risk factors, Martinique, Ethnic Groups, Middle Aged, Disease Progression, Risk Factors, Case Control Study, Case Control Studies, alleles, Human leukocyte antigen, and Genetic predisposition to disease
ABSTRACT Highlights ► We describe a case of M1-MCA cardioembolic occlusion admitted 13 h after the symptoms onset. ► Because MRI showed a franck clinical and FLAIR-DWI mismatch, we performed an IV thrombolysis, with a very good clinical... more
ABSTRACT Highlights ► We describe a case of M1-MCA cardioembolic occlusion admitted 13 h after the symptoms onset. ► Because MRI showed a franck clinical and FLAIR-DWI mismatch, we performed an IV thrombolysis, with a very good clinical and angiographic result. ► Very late IV thrombolysis is feasable in carefully selected stroke cases.
Research Interests: Cardiology, Magnetic Resonance Imaging, Medicine, Stroke, Humans, and 15 moreFemale, Atrial Fibrillation, Brain Ischemia, Ischemic Stroke, Anticoagulants, Clinical Sciences, Aged, Occlusion, Tissue Plasminogen Activator, Neurosciences, Thrombolytic Therapy, Magnetic resonance angiography, Cerebral Angiography, Diffusion magnetic resonance imaging, and Thrombolysis
... Alexandra Diirr,1 Didier Smadja,4 Geraldine Cancel,1 Agnes Lezin,5 Giovanni Stevanin,1 Jacqueline Mikol,2 Rimy Bellance,4 Georges-Gabriel Buisson,4 ... Clinical heterogeneity exists between as well as within families (Colan et ai,... more
... Alexandra Diirr,1 Didier Smadja,4 Geraldine Cancel,1 Agnes Lezin,5 Giovanni Stevanin,1 Jacqueline Mikol,2 Rimy Bellance,4 Georges-Gabriel Buisson,4 ... Clinical heterogeneity exists between as well as within families (Colan et ai, 1981; Harding, 1982; Orozco Diaz et al., 1990 ...
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HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a neurodegenerative disease of the central nervous system induced by human T-lymphotropic virus type 1. As a potential therapeutic approach, we previously suggested... more
HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a neurodegenerative disease of the central nervous system induced by human T-lymphotropic virus type 1. As a potential therapeutic approach, we previously suggested reducing the proviral load by modulating lysine deacetylase activity using valproic acid (VPA) and exposing virus-positive cells to the host immune response. We conducted a single-center, 2-year, open-label trial, with 19 HAM/TSP volunteers treated with oral VPA. Proviral load, CD38/HLA-DR expression, and CD8+ lysis efficiency were not significantly affected by VPA. Mean scores of HAM/TSP disability did not differ between baseline and final visit. Walking Time Test increased significantly (> 20%) in 3 patients and was in keeping with minor VPA side effects (drowsiness and tremor). Walking Time Test improved rapidly after VPA discontinuation. We conclude that long-term treatment with VPA is safe in HAM/TSP.
Research Interests: Hematology, Biology, Treatment, Enzyme Inhibitors, Medicine, and 15 moreHumans, Female, Blood, Male, Clinical Sciences, Aged, Middle Aged, Valproic Acid, Adult, Time Factors, Long Term, Severity of Illness Index, discontinuation, Cardiovascular medicine and haematology, and Paediatrics and reproductive medicine
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This study aimed to describe a syndrome that the authors call human T-lymphotropic virus type I-related chronic interstitial keratitis. A consecutive series of 194 human T-lymphotropic virus type I-infected patients (divided into 119... more
This study aimed to describe a syndrome that the authors call human T-lymphotropic virus type I-related chronic interstitial keratitis. A consecutive series of 194 human T-lymphotropic virus type I-infected patients (divided into 119 patients with human T-lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis and 75 asymptomatic human T-lymphotropic virus type I carriers) was systematically examined. Twenty patients (10.3%) had bilateral anterior stromal lesions made up of approximately 10 elevated, rounded or cloudy whitish opacities that were more or less confluent. The opacities were characteristically situated at the periphery of the anterior stroma, and the visual axis remained unaffected. The interstitial keratitis was chronic and unresponsive to topical administration of corticosteroids. It was mainly observed in patients affected by human T-lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis among whom there were 18 cases (15.1%), as opposed to two cases (2.7%) in asymptomatic carriers. A new cause of interstitial keratitis is reported. Human T-lymphotropic virus type I infection may have a much broader spectrum of ocular manifestations than previously described. As with the other manifestations of human T-lymphotropic virus type I infection, corneal lesions could be linked to a lymphoplasmocytic infiltration of the stroma leading to corneal opacities.