Publications (68) View all
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Article: Transcranial color-coded sonography to predict recurrent transient ischaemic attack/stroke.
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ABSTRACT: BACKGROUND AND PURPOSE: Patients with transient ischaemic attack (TIA) with a high risk of imminent stroke can be identified with the ABCD(2) score and findings on MRI and CT angiography. The predictive value of transcranial color-coded sonography (TCCS) has not been evaluated in this setting. METHODS: A retrospective analysis was conducted of patients consecutively treated for TIA or minor stroke in a TIA clinic within 24 h of symptom onset. Agreement between TCCS and MRI three-dimensional time-of-flight images for the diagnosis of proximal (internal carotid artery, vertebral artery, basilar artery, circle of Willis and main stem of the middle cerebral artery) >50% stenosis or occlusion of the intracranial symptomatic artery was evaluated. The sensitivity, specificity, predictive values and likelihood ratio of TCCS for predicting recurrent TIA/stroke at 7 days were calculated. RESULTS: Of 159 patients with a TIA or minor stroke within the last 24 h, 142 had a readable acoustic temporal bone window (89.3%). TCCS and MRI were performed within 4 h of each other in 116 patients. MRI showed a symptomatic proximal intracranial steno-occlusive lesion in six patients. Agreement between MRI and TCCS was perfect (κ coefficient = 1). Recurrent TIA/stroke occurred in 10 patients (eight TIA and two minor strokes). All recurrences occurred within 24 h of symptom onset. A symptomatic proximal intracranial steno-occlusive lesion was found on TCCS in 4/10 patients with recurrence and 3/132 patients without recurrence [sensitivity 40%; specificity 97.7%; likelihood ratio 18.1; odds ratio (95% CI) adjusted for ABCD(2) score 31.5 (4.5-218.6)]. CONCLUSION: Our study shows that TCCS can be used to guide triage of patients with TIA.European Journal of Neurology 05/2013; · 3.69 Impact Factor -
Article: Intracranial Artery Stenosis or Occlusion Predicts Ischemic Recurrence after Transient Ischemic Attack.
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ABSTRACT: BACKGROUND AND PURPOSE:Patterns of DWI findings that predict recurrent ischemic events after TIA are well-established, but similar assessments of intracranial MRA findings are not available. We sought to determine the imaging characteristics of MRA that are predictive of early recurrent stroke/TIA in patients with TIA.MATERIALS AND METHODS:We performed a retrospective analysis of 129 consecutive patients with a clinical diagnosis of TIA in whom MR imaging was done within 24 hours of symptom onset. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of >50% stenosis or occlusion of symptomatic intracranial arteries for recurrent stroke/TIA at 7 days after TIA. We used logistic regression analysis to adjust for the clinical ABCD(2) score. We performed this analysis for symptomatic steno-occlusive lesions at any site and symptomatic steno-occlusive lesions on proximal large intracranial arteries (internal carotid artery, vertebral artery, basilar artery, and circle of Willis).RESULTS:Forty-two (32.5%) patients had acute ischemic lesions on DWI; 16 (12.4%) had significant MRA lesions, of which 11 (8.5%) were on proximal vessels. Nine patients had early recurrence (TIA, 7; minor stroke, 2). Only patients with proximal MRA lesions were at higher risk of early recurrence independent of the ABCD(2) score (adjusted odds ratio, 5.5; 95% confidence interval, 1.1-27.8; P = .04).CONCLUSIONS:Proximal lesions of cerebral arteries seen on MRA were predictive of recurrent stroke/TIA at 7 days. These findings suggest that MRA could be used to improve the selection of patients with TIA at high risk of early recurrent stroke/TIA.American Journal of Neuroradiology 06/2012; · 2.93 Impact Factor -
Article: Brain infections.
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ABSTRACT: Brain infections are relatively rare, but they are potentially serious and have a poor prognosis. The cornerstone of the diagnosis is cerebrospinal fluid (CSF) analysis. Imaging is not systematic, but the indications of imaging are broad, particularly when faced with suspected focal damage, depending on the characteristics of the patient (child, immunosuppressed patient, geographic origin, etc.). It is based on MRI, which allows for aetiological diagnosis and an extension evaluation. In addition, in a certain number of cases, the type of infection is not known and it is up to the MRI via use of an exhaustive technique to diagnose an infectious origin when faced with a mass syndrome. This technical mastery, associated with knowledge of major brain infections, their method of contamination and their particular appearance on the MRI, should make it possible for the radiologist to fulfill his or her diagnostic role.Diagnostic and interventional imaging. 06/2012; 93(6):473-90. -
Article: Enlargement of the inferior intercavernous sinus: a new sign for the diagnosis of craniospinal hypotension.
American Journal of Neuroradiology 11/2011; 32(10):E194. · 2.93 Impact Factor -
Article: [Iatrogenic venous cerebral air embolism without pulmonary manifestation: A retrograde mechanism?].
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ABSTRACT: Air embolism is a rare complication of various invasive medical procedures. Venous cerebral air embolism is usually the consequence of paradoxical embolism. We report a case of isolated cerebral air embolism resulting from a non-paradoxical mechanism. A few minutes after his central venous catheter had been accidentally disconnected, a 63-year-old man developed left-sided rhythmic jerking movements followed by left hemiplegia. There were no associated cardiologic or pulmonary signs. Brain CT showed air bubbles in the right frontal cortical sulci. The brain MRI DWI and FLAIR sequences showed a high intensity right frontal cortical lesion without reduction in ADC. Transesophageal echocardiogram did not find a patent foramen ovale. In this case of venous cerebral air embolism, the lack of any cardiopulmonary manifestation, the lack of a patent foramen ovale and the neuroradiological findings are not in favor of the hypothesis of paradoxical embolism. The hypothesis of retrograde venous cerebral air embolism is discussed.Revue Neurologique 12/2010; 167(8-9):615-8. · 0.49 Impact Factor
