Marco Pasi

Centre Hospitalier Universitaire de Tours

Background and objective Hematoma expansion (HE) is a major determinant of neurological deterioration and poor outcome in intracerebral hemorrhage (ICH) and represents an appealing therapeutic target. We analyzed the prognostic effect of different degrees of HE. Methods retrospective analysis of ICH patients admitted at eight academic institutions...

Background: Covert brain infarction (CBI) is highly prevalent and linked with stroke risk factors, increased mortality, and morbidity. Evidence to guide management is sparse. We sought to gain information on current practice and attitudes toward CBI and to compare differences in management according to CBI phenotype. Methods: We conducted a web-...

Background: Weather conditions have been shown to influence the occurrence of cardiovascular events. We tested the hypothesis that weather parameters may be associated with variations of case volume of endovascular treatment (EVT) for acute ischemic stroke. Methods: Individual data from the ETIS (Endovascular Treatment in Ischemic Stroke) French...

Background and Objectives Hypertensive cerebral small vessel disease (HTN-cSVD) is the predominant microangiopathy in patients with a combination of lobar and deep cerebral microbleeds (CMBs) and intracerebral hemorrhage (mixed ICH). We tested the hypothesis that cerebral amyloid angiopathy (CAA) is also a contributing microangiopathy in mixed ICH...

Objectives: Non-contrast computed tomography (NCCT) markers are robust predictors of parenchymal hematoma expansion in intracerebral hemorrhage (ICH). We investigated whether NCCT features can also identify ICH patients at risk of intraventricular hemorrhage (IVH) growth. Methods: Patients with acute spontaneous ICH admitted at four tertiary cen...

Background: Diffusion-weighted imaging lesion reversal (DWIR) is frequently observed after mechanical thrombectomy for acute ischemic stroke, but little is known about age-related differences and impact on outcome. We aimed to compare, in patients <80 versus ≥80 years old, (1) the effect of successful recanalization on DWIR and (2) the impact of D...

BACKGROUND Noncontrast computed tomography hypodensities are a validated predictor of hematoma expansion (HE) in intracerebral hemorrhage and a possible alternative to the computed tomography angiography (CTA) spot sign but their added value to available prediction models remains unclear. We investigated whether the inclusion of hypodensities impro...

Background: We aimed to evaluate different measures of adverse cardiovascular events between non-traumatic intracranial hemorrhage (ICrH) and ischemic stroke (IS) survivors with and without atrial fibrillation (AF). Methods: Using a national hospitalization database we compared incidences and risks of all-cause in-hospital death, cardiovascular...

Background and purpose To determine the influence of the cerebral small vessel disease (SVD) burden on collateral recruitment in patients treated with mechanical thrombectomy (MT) for anterior circulation acute ischemic stroke (AIS). Methods Patients with AIS due to large vessel occlusion (LVO) from the Thrombectomie des Artères Cérébrales (THRACE...

Background Cerebral amyloid angiopathy (CAA) is an age-related small vessel disease, characterised pathologically by progressive deposition of amyloid β in the cerebrovascular wall. The Boston criteria are used worldwide for the in-vivo diagnosis of CAA but have not been updated since 2010, before the emergence of additional MRI markers. We report...

Background Whether thrombectomy alone is equally as effective as intravenous alteplase plus thrombectomy remains controversial. We aimed to determine whether thrombectomy alone would be non-inferior to intravenous alteplase plus thrombectomy in patients presenting with acute ischaemic stroke. Methods In this multicentre, randomised, open-label, bl...

Background: Determine if early venous filling (EVF) after complete successful recanalization with mechanical thrombectomy in acute ischemic stroke is an independent predictor of symptomatic intracranial hemorrhage (sICH) and integrate EVF into a risk score for sICH prediction. Methods: Consecutive patients with anterior acute ischemic stroke tre...

Objectif Déterminer l'influence de la maladie des petites artères cérébrales (MPA) sur le recrutement des collatérales leptoméningées chez les patients traités par thrombectomie mécanique (TM) à la phase aigüe d'un AVC ischémique de la circulation antérieure. Méthodes Les patients avec occlusion des gros vaisseaux traités par TM dans l'essai clini...

Objectifs Peu de données sur une large cohorte, de l'extravasation de produit de contraste iodé (EPDC) dans l'accident ischémique constitué (AIC), après thrombectomie. Nous avons évalué l'incidence, les facteurs prédictifs et le pronostic de l'EPDC post-thrombectomie. Matériel et méthode Evaluation de 288 patients ayant présenté un AIC traité par...

Background Recent studies in the general stroke population treated with endovascular treatment (EVT) reported that higher pre-treatment lesional volumes were independently associated with poor neurological outcome and functional dependence after stroke. However, it has been not evaluated in older patients. Aim We test the association between the p...

Background. Although anxiety is common in several neurological conditions, it has been poorly investigated after spontaneous intracerebral haemorrhage (ICH). Aims. In consecutive ICH survivors, we assessed the long-term prevalence of anxiety and its clinical and radiological determinants. Methods. Using the Hospital Anxiety and Depression scale (HA...

Introduction: I ntracranial vertebral dissections have polymorphs clinical presentations and can lead to haemorrhagic complications if they are intracranial. We here describe a case of a thrombosed dissecting aneurysm of postero-inferior cerebellar artery (PICA) revealed by a Wallenberg syndrome preceded by headaches. Case: A 23-year-old patient...

Background Cognitive impairment and depressive symptoms are highly prevalent after Intracerebral Hemorrhage (ICH). We leveraged Latent Profile Analysis (LPA) to identify profiles for cognitive decline and depression onset after ICH. We also investigated differences in clinical, genetic and neuroimaging characteristics across patients’ profiles. Me...

Objective This study aimed at identifying the incidence, predictors, and impact on long-term mortality and dementia of early-onset delirium in a cohort of patients with spontaneous intracerebral hemorrhage. Methods We prospectively recruited consecutive patients in the Prognosis of InTra-Cerebral Hemorrhage (PITCH) cohort and analyzed incidence ra...

Objective Neuropsychiatric (NP) symptoms are prominent features of cognitive decline, but they have been understudied in patients with spontaneous intracerebral haemorrhage (ICH). In ICH survivors, we aimed at assessing NP symptoms prevalence and profiles, and their influence on long-term outcomes. Methods We analysed data from consecutive 6-month...

Background and Purpose Intracerebral hemorrhage (ICH) is an acute manifestation of cerebral small vessel disease (CSVD), usually cerebral amyloid angiopathy or hypertensive arteriopathy. CSVD-related imaging findings are associated with increased depression incidence in the general population. Neuroimaging may, therefore, provide insight on depress...

Background and Purpose The computed tomography angiography spot sign is associated with hematoma expansion, case fatality, and poor functional outcome in spontaneous supratentorial intracerebral hemorrhage (ICH). However, no data are available on the spot sign in spontaneous cerebellar ICH. Methods We investigated consecutive patients with spontan...

Introduction Intracerebral haemorrhage (ICH) in young adults is rare but has devastating consequences. We investigated long-term mortality rates, causes of death and predictors of long-term mortality in young spontaneous ICH survivors. Patients and methods We included consecutive patients aged 18–55 years from the Prognosis of Intracerebral Haemor...

Background and purpose: Cerebral amyloid angiopathy (CAA) is a common pathology of the leptomeningeal and cortical small vessels associated with hemorrhagic and non-hemorrhagic brain injury. Given previous evidence for CAA-related loss of cortical thickness and white matter volume, we hypothesized that CAA might also cause tissue loss in the basal...

Contexte : Les hémorragies intracérébrales spontanées (HIC) présentent une mortalité élevée et un pronostic fonctionnel sombre à court terme. Les données concernant la mortalité et le pronostic fonctionnel au long cours des HIC sont limitées. Les objectifs principaux de cette thèse étaient d’évaluer chez les survivants à une HIC: (i) le taux de mor...

Objective: Black and Hispanic survivors of Intracerebral Hemorrhage (ICH) are at higher risk of recurrent intracranial bleeding. MRI-based markers of chronic Cerebral Small Vessel Disease (CSVD) are consistently associated with recurrent ICH. We therefore sought to investigate whether racial/ethnic differences in MRI-defined CSVD subtype and sever...

Background and Purpose We explored whether high-degree magnetic resonance imaging–visible perivascular spaces in centrum semiovale (CSO) are more prevalent in cerebral amyloid angiopathy (CAA) than hypertensive small vessel disease and their relationship to brain amyloid retention in patients with primary intracerebral hemorrhage (ICH). Methods On...

Background and purpose: Whole-brain network connectivity has been shown to be a useful biomarker of cerebral amyloid angiopathy and related cognitive impairment. We evaluated an automated DTI-based method, peak width of skeletonized mean diffusivity, in cerebral amyloid angiopathy, together with its association with conventional MRI markers and co...

Introduction: Intracerebral Hemorrhage (ICH) is an acute manifestation of underlying Cerebral Small Vessel Disease (CSVD), usually Cerebral Amyloid Angiopathy (CAA) or Hypertensive Arteriopathy (HTNA). CSVD-related imaging and histopathology findings were previously associated with increased depression incidence in the general population. CSVD eval...

Introduction: The Boston criteria are used worldwide for in vivo diagnosis of cerebral amyloid angiopathy (CAA). Given substantial advances in CAA research, we aimed to update the Boston criteria and externally validate their diagnostic accuracy across the spectrum of CAA-related presentations and across international sites. Methods: As part of an...

Objectives . The Montreal Cognitive Assessment (MoCA) is a cognitive screening test largely employed in vascular cognitive impairment, but there are no data about MoCA longitudinal changes in patients with cerebral small vessel disease (SVD). We aimed to describe changes in MoCA performance in patients with mild cognitive impairment (MCI) and SVD d...

Cerebral microbleeds (CMBs) are defined as hypointense foci visible on T2*-weighted and susceptible-weighted MRI sequences. CMBs are increasingly recognised with the widespread use of MRI in healthy individuals as well as in the context of cerebrovascular disease or dementia. They can also be encountered in major critical medical conditions such as...

Objective: We aimed to analyze the relationship of lacunes with cortical cerebral microinfarcts (CMI), to assess their association with vascular dysfunction and to evaluate their effect on the risk of incident intracerebral hemorrhage (ICH) in cerebral amyloid angiopathy (CAA). Methods: The count and topography of lacunes (deep/lobar), CMIs and...

Background The epileptogenicity of recombinant tissue-plasminogen activator (rt-PA) has been suggested, but seizures were not evaluated in randomised controlled trials.Objective To evaluate whether rt-PA was associated with early seizures in a cohort of consecutive patients with cerebral ischaemia.Method We included consecutive adults with ischaemi...

Objective To determine whether mixed location intracerebral hemorrhages/microbleeds (Mixed-ICH) is a risk factor for vascular unfavorable outcome compared to cerebral amyloid angiopathy-related ICH (CAA-ICH) or strictly deep hypertensive intracerebral hemorrhage/microbleeds (HTN-ICH). Methods 300 patients with spontaneous ICH were included. Clinic...

Objective To identify in patients who survived 6 months after a spontaneous intracerebral haemorrhage (ICH) baseline characteristics and new clinical events associated with functional decline. Methods In a single-centre study, we prospectively included 6-month survivors with a modified Rankin Scale (mRS) score 0–3. We defined functional decline by...

Objective There is little evidence to guide patient selection for subdural hemorrhage (SDH) evacuation. This study was designed to assess the benefit of surgical evacuation of SDH, identify predictors of functional outcome, and create a bedside score to guide the clinical management of SDH. Methods A cohort of 331 patients presenting to a single c...

Objective We sought to determine whether MRI-based Cerebral Small Vessel Disease (CSVD) burden assessment, in addition to clinical and CT data, improved prediction of cognitive impairment after spontaneous Intracerebral Hemorrhage (ICH). Methods We analyzed data from ICH survivors enrolled in a single-center prospective study. We employed three va...

Background Patients treated at off-hours for acute conditions have increased mortality rates. This effect has been poorly evaluated in patients treated by mechanical thrombectomy (MT).Objective This study aimed at comparing outcomes between patients treated at off-hours and at working hours by MT for acute stroke due to large-vessel occlusion in th...

The above article was published online with inverted given and family names. The correct presentation has been corrected above. The original article has been corrected.

Background: Factors associated with long-term mortality after spontaneous intracerebral hemorrhage (ICH) have been poorly investigated. Aim: Our objective was to identify variables associated with long-term mortality in a prospective cohort of 30-day ICH survivors. Methods: We prospectively included consecutive 30-day spontaneous ICH survivors...

Background Primary angiitis of the CNS (PACNS) is a process causing variously combined neurological disturbances. Its rarity and kaleidoscopic presentation make it difficult to diagnose and even to suspect.Objective(1) To provide an up-to-date review on PACNS and (2) to create a preliminary screening algorithm based on clinical and radiological fir...

Background The central vein sign (CVS) is an imaging biomarker able to differentiate multiple sclerosis (MS) from other conditions causing similar appearance lesions on magnetic resonance imaging (MRI), including cerebral small vessel disease (CSVD). However, the impact of vascular risk factors (VRFs) for CSVD on the percentage of CVS positive (CVS...

Résumé Les crises héraldiques sont des événements rares correspondant à la survenue d’une crise épileptique précédant un accident vasculaire cérébral hémorragique ou ischémique. Les mécanismes physiopathologiques expliquant la survenue de ces crises restent encore mal connus. Nous rapportons le cas d’un homme de 87 ans hospitalisé devant la survenu...

Background and purpose: For survivors of oral anticoagulation therapy (OAT)-associated intracerebral hemorrhage (OAT-ICH) who are at high risk for thromboembolism, the benefits of OAT resumption must be weighed against increased risk of recurrent hemorrhagic stroke. The ε2/ε4 alleles of the apolipoprotein E (APOE) gene, MRI-defined cortical superf...

Background and purpose: The efficiency of prehospital care chain response and the adequacy of hospital resources are challenged amid the coronavirus disease 2019 (COVID-19) outbreak, with suspected consequences for patients with ischemic stroke eligible for mechanical thrombectomy (MT). Methods: We conducted a prospective national-level data col...

Objective To investigate the prevalence, predictors, and clinical relevance of cortical superficial siderosis (cSS) progression in cerebral amyloid angiopathy (CAA). Methods Consecutive patients with symptomatic CAA meeting Boston criteria in a prospective cohort underwent baseline and follow-up MRI within 1 year. cSS progression was evaluated on...

Introduction The prevalence of modifiable vascular risk factors is increasing in young adults and may contribute to the growing frequency of stroke in this population. The neuropathology and end-organ damage profile of young adult stroke patients with clinically advanced atherosclerosis or arteriosclerosis has not been studied. Methods This retros...

Objective: Patients with mixed location intracerebral hemorrhages/microbleeds (Mixed-ICH) have predominantly hypertensive vasculopathy rather than cerebral amyloid angiopathy (CAA), but the long-term outcomes in Mixed-ICH is unknown. In this study, we aimed to determine whether Mixed-ICH is a risk factor for vascular unfavorable outcome compared to...

Background: Guidelines regarding recommendations for surgical treatment of spontaneous cerebellar intracerebral haemorrhage (ICH) differ. We aimed to systematically review the literature to assess treatment strategies and outcomes. Methods: We searched PubMed and Embase between 1970 and 2019 for randomised or otherwise controlled studies and obs...

Background and Purpose— The differentiation between cerebral amyloid angiopathy (CAA) and hypertensive small vessel disease in primary intracerebral hemorrhage is mainly based on hemorrhagic neuroimaging markers in the supratentorial regions, and the cause for cerebellar microbleeds remains unknown. Our aim was to investigate whether superficial ce...

Background and objective: Cerebral amyloid angiopathy (CAA) accounts for the majority of lobar intracerebral hemorrhage (ICH); however, the risk factors for dementia conversion after ICH occurrence in CAA patients is unknown, especially in the long-term period after ICH. Therefore, we aimed to unravel the predictors for late post-ICH dementia (6 m...

Objective: To assess potential mechanisms of cortical superficial siderosis (cSS), a central MRI biomarker in cerebral amyloid angiopathy (CAA), we performed a collaborative meta-analysis of APOE associations with cSS presence and severity. Methods: We pooled data from published studies reporting APOE genotype and MRI assessment of cSS in 3 dist...

Background and Purpose— Hematoma location within the cerebellum may help identify the dominant small vessel disease type (cerebral amyloid angiopathy [CAA] versus nonamyloid small vessel disease). However, it is unknown whether this holds true for cerebral microbleeds (CMBs) within the cerebellum. We tested the hypothesis that cerebellar CMBs restr...

Indexes derived from diffusion tensor imaging (DTI) are sensitive to changes of both T2-hyperintense and normal-appearing brain white matter (WM) in elderly subjects with variable cognitive status. We investigated correlations between global cognitive performance and DTI-derived indexes along the WM tracts in the brain of patients with vascular mil...

Background and Purpose— We investigated cortical superficial siderosis (cSS) progression and its clinical relevance for incident lobar intracerebral hemorrhage (ICH) risk, in probable cerebral amyloid angiopathy presenting with neurological symptoms and without ICH at baseline. Methods— Consecutive patients meeting modified Boston criteria for pro...

Background Spontaneous cerebellar-intracerebral hemorrhage (ICH) can be associated with both cerebral amyloid angiopathy (CAA) and hypertensive small vessel disease (HTN-SVD, i.e. arteriolosclerosis). To better understand the underlying microangiopathy of cerebellar-ICH, we aimed to evaluate the spatial distribution of supratentorial cerebral micro...

Background: We aimed to investigate cortical superficial siderosis as an MRI predictor of lobar intracerebral hemorrhage (ICH) recurrence risk in cerebral amyloid angiopathy (CAA), in a large prospective MRI cohort and a systematic review. Methods: We analyzed a single-center MRI prospective cohort of consecutive CAA-related ICH survivors. Using...

Background: Cerebral amyloid angiopathy (CAA) is known for its hemorrhagic manifestations, but ischemic features of the disease are also recognized such as white matter hyperintensities (WMH). We aimed to investigate the interrelationship between two emerging ischemic markers related to CAA: lacunes and cortical microinfarcts (CMI). Methods: CMI we...

Background and Objectives: Acute DWI lesions are frequently found in patients with intracerebral hemorrhage (ICH). We aim to identify whether these patients have a higher risk of death, recurrent ICH or ischemic stroke compared to those without DWI positive lesions. Methods: We identified 214 prospectively enrolled patients with acute ICH admitted...

Background: The CT angiography (CTA) spot sign is associated with hematoma expansion, mortality and poor functional outcome in supratentorial and pontine spontaneous intracerebral hemorrhage (ICH). However, no studies are available on the spot sign in patients with spontaneous cerebellar ICH. We therefore aim to assess its association with hematoma...

Introduction: Oral Anticoagulation Therapy (OAT) resumption after ICH is a dilemma due to increased risk of recurrent ICH, particularly after lobar ICH caused by underlying Cerebral Amyloid Angiopathy (CAA). Apolipoprotein E ( APOE ) ε2/ε4 alleles are risk factors for recurrent CAA-related ICH. Hypothesis: APOE genotype predicts lobar ICH recurrenc...

Introduction: Survivors of Intracerebral Hemorrhage (ICH) are at high risk for cognitive impairment. Previous studies clarified that Cerebral Small Vessel Disease (CSVD) is a primary contributor to post-ICH dementia, but these observations have failed to transform clinical or research practice standards to date. We sought to determine whether a val...

Background: Guidelines for management of subdural hemorrhage (SDH) are based on small studies which account for only factors of presentation. Our aim was to characterize which patients benefit from surgical evacuation as a function of demographic, baseline functional, clinical, and radiographic information. Methods: Patients who did and did not und...

Objective: To test the hypothesis that patients with concomitant lobar and deep intracerebral hemorrhages/microbleeds (mixed ICH) have predominantly hypertensive small vessel disease (HTN-SVD) rather than cerebral amyloid angiopathy (CAA), using in vivo amyloid imaging. Methods: Eighty Asian patients with primary ICH without dementia were includ...

Background and Purpose— We aimed to explore the association between presence of cerebral cortical microinfarcts (CMIs) on magnetic resonance imaging and other small-vessel disease neuroimaging biomarkers in cerebral amyloid angiopathy (CAA) and to analyze the role of CMIs on individual cognitive domains and dementia conversion. Methods— Participan...

Spontaneous intracerebral, non-traumatic intracerebral hemorrhage (ICH) results from arterial bleeding and formation of a brain hematoma. While 20% of all ICH cases result from a defined underlying cause (e.g., vascular malformation, coagulopathy, and tumors), the majority of ICHs are related to the rupture of damaged small- and medium-sized arteri...

BACKGROUND: Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). A trial of combination antiplatelet therapy in a Chinese population has shown a reduction in the risk of recurrent stroke. We tested this combin...

Background and purpose: We evaluated whether lacunes in centrum semiovale (lobar lacunes) were associated with cerebral amyloid angiopathy (CAA) markers in an Asian intracerebral hemorrhage (ICH) population. Methods: One hundred ten patients with primary ICH were classified as CAA-ICH (n=24; mean age, 70.9±13.9) or hypertensive ICH (n=86; mean a...

Aims The DSM-5 introduced the term “major neurocognitive disorders” (NCDs) to replace the previous term “dementia.” However, psychometric and functional definitions of NCDs are missing. We aimed to apply the DSM-5 criteria for diagnosing the transition to NCD to patients with mild cognitive impairment (MCI) and small vessel disease (SVD), and to de...

Purpose of review: This review aims to help neurologists managing atrial fibrillation (AF) patients who had an ischemic stroke and/or with intracranial hemorrhage (ICH) markers, therefore at high embolic/hemorrhagic risks. Recent findings: Implantable loop recorders have substantially improved the accuracy of AF detection. Recent research yielde...

Introduction: Intracerebral hemorrhage (ICH) is the most feared complication of anticoagulation. Risk markers, causes, characteristics, and outcome of acute direct oral anticoagulants (DOAC) ICH are an active field of investigation. We assessed these characteristics in patients with acute DOAC-ICH vs. vitamin K antagonist-associated ICH (VKA-ICH) a...

Background: Previous pathologic reports have suggested that the underlying vasculopathy in cerebellar intracerebral hemorrhage (ICH) patients may be related to the location of the bleed whithin the cerebellum. We sought to determine whether the location of hematoma in the cerebellum (deep and superficial regions) was suggestive of a particular hemo...

Background: Lacunar infarcts located in centrum-semiovale and lobar regions were more frequent in Caucasians with intracerebral hemorrhage related to cerebral amyloid angiopathy (CAA-ICH) while deep-seated lacunes in ICH related to hypertension (HTN-ICH), but these associations have never been validated in Asian patients. In the present study, we e...

Background: Recent MRI-based work suggested that the predominant type of cerebral small vessel disease (SVD) in patients with a combination of lobar and deep intracerebral hemorrhage (ICH)/microbleed (MB) locations (Mixed-ICH) was hypertensive (HTN) SVD. We sought to use in vivo amyloid imaging to test the hypothesis that mixed-ICH is related to HT...