P Trouillas

Claude Bernard University Lyon 1, Villeurbanne, Rhône-Alpes, France

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Publications (206)842.67 Total impact

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    ABSTRACT: The purpose of this study was to systematically determine the correlations between the post-thrombolytic changes of hemostasis parameters and the occurrence of early intracerebral hemorrhage (ICH). In 72 consecutive patients with cerebral infarcts treated with rt-PA, plasma levels of fibrinogen, plasminogen, alpha2-antiplasmin, factor XIII, fibrin(ogen) degradation products (FDPs) and d-Dimers were measured at baseline, 2 and 24h after thrombolysis. Correlations were studied between the hemostasis events and early (less than 24h) hemorrhagic infarcts (HIs) or parenchymatous hematomas (PH). Of 72 patients, 6 patients (8.3%) had early PHs, 11 (15.3%) had early HIs, and 55 (76.4%) had no bleeding. Early HIs were not linked to any hemostasis parameter at any time. Univariate comparison of patients having early PHs with non-bleeding patients showed hemostasis abnormalities at 2h: high FDP (p=0.01), high Log FDP (p=0.01), low fibrinogen (p=0.01), and low Log fibrinogen (p=0.01). Logistic regression adjusted for age, NIHSS and diabetes confirmed these 2hour predictors: Log FDP (OR: 7.50; CI: 1.26 to 44.61, p=0.03), and Log fibrinogen (OR: 19.32; CI: 1.81 to 205.98, p=0.01). The decrease in fibrinogen less than 2g/L multiplies the odds of early PH by a factor 12.82. An early fibrinogen degradation coagulopathy involving an increase of FDP and a massive consumption of circulating fibrinogen is predictive of early parenchymal hematomas, indicating the occurrence of a particularly intense lysis of circulating fibrinogen. These results, if confirmed by future studies, suggest that early assays of fibrinogen and FDP may be useful in predicting the risk of post-thrombolytic intracerebral hematoma. Copyright © 2015 Elsevier B.V. All rights reserved.
    No preview · Article · Mar 2015 · Journal of the neurological sciences
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    ABSTRACT: Little is known, in man, in the post-thrombolytic molecular dynamics of haemostasis, particularly the effect of rt-PA on antifibrinolytic components such as alpha2 anti-plasmin and Factor XIII. The purpose of this study was to systematically determine changes in coagulation and fibrinolytic parameters after thrombolysis with rt-PA during 24h. We also aimed to correlate these parameters with different acute ischemic stroke subtypes and global outcome. Eighty consecutive patients with cerebral infarcts treated with rt-PA had their plasma levels of fibrinogen, plasminogen, alpha2-antiplasmin, Factor XIII, fibrin(ogen) degradation products (FDP) and D-Dimers measured at baseline (h0), 2 (h2) and 24h (h24) after initiation of thrombolysis. Correlations between the variations of these components were statistically studied, using the Spearman rank test or the Pearson test. These haemostatic parameters were also compared with cardioembolic and non cardioembolic patients, as well as between poor and favourable outcome patients. Between h0 and h2, a decrease in fibrinogen, plasminogen, alpha2-antiplasmin, and factor XIII was observed, while an increase in FDP and D-Dimers took place. These values returned to the initial levels at h24. At 2h, the decrease in fibrinogen was significantly correlated with that of plasminogen (0.48, p=0.01), alpha2-antiplasmin (0.48, p=0.004), and factor XIII (0.44, p=0.01); the decrease in plasminogen was significantly correlated with those of antifibrinolytic components, factor XIII (0.47, p=0.02) and alpha2-antiplasmin (r=0.77, p<0.001). These variations were independent of NIHSS. Cardioembolic infarcts showed a statistically significant greater h0-h2 decrease in plasminogen (p=0.04) and an h0-h2 increase in FDP (p=0.02). Poor outcome was linked to low plasminogen values at 2 and 24h. Supposed to be fibrin-specific, rt-PA induces a decrease in circulating fibrinogen, significantly linked to a decrease in plasminogen. A collateral increase in antifibrinolytic agents such as factor XIII and alpha2-antiplasmin is also observed. At 2h, a significant decrease in plasminogen and a significant increase in fibrin(ogen) degradation products (FDP) are observed in cardioembolic infarcts, and appear as early independent predictors of this aetiology. A low plasminogen value at 2h is potentially predictive of poor prognosis at 3months. Copyright © 2015 Elsevier B.V. All rights reserved.
    No preview · Article · Dec 2014 · Journal of the Neurological Sciences
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    Full-text · Article · Jul 2013 · Neurology
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    Full-text · Article · Jan 2013 · Journal of Neurology
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    ABSTRACT: Some observational and experimental studies have suggested a short-term relationship between air pollutants and ischaemic stroke; however, the results conflict. The objective of this study was to investigate the association between particulate matter less than 2·5 and 10 microns in aerodynamic diameter, nitrogen dioxide, sulphur dioxide and ozone, and short-term risk of ischaemic stroke in Lyon, France. The AVC69 study was a multicenter cohort study in which all consecutive adult patients admitted to one of the emergency or neurological departments of the Rhône area for suspicion of stroke were included during a seven-month period. Only patients with ischaemic stroke living within the study area, composed of Lyon and 18 neighbouring communities with homogenous air pollutants exposure, formed the basis of our study. We adopted a time-stratified case-crossover design to analyse the short-term effect (up to two-days) of air pollutants on ischaemic stroke incidence. Models were adjusted for temperature, variation of atmospheric pressure, minimal relative humidity, influenza epidemics, pollen count, and holidays. Stratified analyses by gender and class age were performed. Different lag times were analysed. 376 patients were included. Mean age was 76·6 years (±13·7). 53·7% were women. No association was observed between air pollutants and short-term risk of ischaemic stroke after adjustment for main confounding factors. Results remained unchanged whatever the gender or age. These results suggest a lack of association between air pollutant exposure and short-term risk of ischaemic stroke in a French urban area.
    No preview · Article · Feb 2012 · International Journal of Stroke
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    ABSTRACT: Internal carotid artery (ICA) dissection with tandem internal carotid and middle cerebral artery occlusion may carry a poor prognosis even if intravenous recombinant-tissular plasminogen activator is administered. A better outcome may be expected with the combination of intravenous thrombolysis and endovascular methods (stenting and thromboaspiration). This procedure was performed in 3 patients who had concurrent ICA dissection and intracerebral occlusion. Endovascular treatment was feasible and safe. All our patients had a good clinical outcome. This potential effective approach may need further validation.
    Full-text · Article · Mar 2010 · European Neurology

  • No preview · Article · Jan 2010 · Archives of neurology
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    ABSTRACT: There are a few reports of moyamoya disease (MMD) in the European Caucasian adult population. We present the clinical manifestations, the neuroradiological aspects, the treatment, and the outcome after surgical revascularization of four French patients with MMD. We identified four adults (age >18 years; three women and one man) with MMD who underwent digital subtraction catheter angiography at our institution from 1997 through 2006. The median age at symptom onset was 35 years (range, 22 to 41 years). The initial clinical presentation was intracerebral hemorrhage in three patients and ischemic stroke in one patient. Three patients underwent bilateral surgical revascularization and one patient underwent unilateral surgical revascularization. All patients underwent the same surgical revascularization procedure (encephalo-duro-arterio-myo-synangiosis). The mean (+/-SD) period of follow-up after diagnosis of MMD was 6 years and 9 months (+/-3 years and 5 months). No patient experienced any recurrent hemorrhagic or ischemic stroke. No perioperative stroke occurred. No patient was severely disabled or unable to walk. Three patients out of four were employed. Our data suggest safety and a potential benefit of surgical revascularization (indirect bypass surgery) in European adult patients with symptomatic MMD. Further long-term prospective multicenter studies are needed. The establishment of a registry would be useful in order to accumulate data in large numbers of European patients with this uncommon disease.
    No preview · Article · Oct 2009 · Journal of the neurological sciences

  • No preview · Article · Jun 2009 · Journal Européen des Urgences
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    ABSTRACT: Melatonin's neuroprotective action has been demonstrated in experimental models of brain ischaemia. The relationship between stroke and melatonin levels has been based on scarce and small sample size studies. In addition, the changes have not been correlated with the age of patients. We compared levels of nocturnal urinary melatonin and its metabolite, 6-sulfatoxymelatonin (aMT6S) in a large series of acute ischaemic stroke patients and healthy volunteers. Consecutive ischaemic stroke patients with a first episode of anterior circulation stroke were recruited. Urine samples were collected in 127 patients on day 1 poststroke and in a control population including 216 healthy volunteers, from 20:00 to 08:00 hr. Melatonin and aMT6S were measured by radioimmunoassay. Differences in melatonin and aMT6S levels between ischaemic stroke patients and healthy volunteers were assessed by gender and age categories, using the Student's t-test. Melatonin excretion was decreased in stroke patients compared with healthy volunteers (74.1 +/- 13.9 versus 211.9 +/- 31.0 ng/hr; P = 0.0004), whereas aMT6S level was not significantly reduced (6371 +/- 1028 versus 4469 +/- 508 ng/hr; P = 0.10). Conversely, the stratification by age showed a significant reduction of both melatonin and aMT6S levels among ischaemic stroke patients over 70 yr (P = 0.001 and P = 0.03 respectively). The impact of melatonin at the acute stage of stroke on clinical severity and lesion size needs further assessment, as melatonin may have potential neuroprotective effects.
    Full-text · Article · May 2009 · Journal of Pineal Research
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    ABSTRACT: Tuberothalamic artery infarction (TTAI) results mainly in a myriad of neuropsychological symptoms such as memory impairment, euphoria, apathy, verbal perseverations, constructional apraxia and lack of spontaneity. Language disturbances, acalculia, buccofacial and limb apraxia occur prominently after left TTAI while visual spatial processing deficits and hemispatial neglect occur prominently after the right one. Some cases of TTAI causing Horner's syndrome in addition of these wide-ranging neurobehavioral symptoms have been reported. Here, we report a case of TTAI with an ipsilateral ptosis as main clinical manifestation. This finding suggests that a Horner's syndrome can be the main feature of TTAI when neuropsychological manifestations are inconspicuous.
    No preview · Article · Feb 2009 · Neurological Sciences
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    ABSTRACT: The benefit of recanalization in basilar artery occlusion (BAO) has been established. The baseline extent of brain stem damage may also influence the outcome. We investigated whether a baseline diffusion-weighted imaging (DWI) score may provide additional prognostic value in BAO. We analyzed baseline clinical and DWI parameters in consecutive patients treated with endovascular procedures for acute BAO. Brain stem DWI lesions were assessed by using a semiquantitative score based on arterial territory segmentation. Outcome at 3 months was dichotomized according to the modified Rankin Scale (mRS) as favorable (mRS, 0-2) or unfavorable (mRS, 3-6). Spearman rank correlation tests assessed the correlation between DWI and clinical variables. Univariate and multivariate logistic regression analyses were used to identify clinical and MR imaging predictors of outcome. Twenty-nine patients were included. The brain stem DWI score (median, 3; range, 0-14) was correlated with the baseline National Institutes of Health Stroke Scale (NIHSS) score and the presence and length of coma (r = 0.67, 0.49, and 0.53, respectively; P < .01). Recanalization was achieved in 76%. A higher baseline NIHSS score (P = .02) and brain stem DWI score (P = .03), a lower Glasgow Coma Scale score (P = .04), and the presence of coma (P = .05) were associated with poor outcome in univariate analysis. Multivariate analysis showed that the brain stem DWI score was the only independent baseline predictor for clinical outcome (P = .026). Baseline brain stem DWI lesion score is an independent marker of outcome in BAO.
    Full-text · Article · Sep 2008 · American Journal of Neuroradiology
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    ABSTRACT: Description L\'hématome intracérébral est essentiellement considéré comme une maladie vasculaire, liée à la structure des vaisseaux. Un traitement récent, le facteur VII, a montré indirectement l\'importance de l\'hémostase dans cette affection. Objectif Explorer certains aspects de l\'hémostase dans une série d\'hématomes intra-cérébraux spontanés. Méthode : Des tests d\'hémostase ont été réalisés chez des patients porteurs d\'un hématome intra-cérébral spontané. Les taux de fibrinogène et des produits de dégradation de fibrinogène (PDF) ont été dosés à l\'entrée, tandis que la numération des thrombocytes, l\'International Normalized Ratio (INR), le temps de céphaline activée (TCA) ont été par ailleurs déterminés. Résultats Treize patients successifs ont été étudiés. Chez 3 patients, une élévation des facteurs de dégradation du fibrinogène a été observée (3/13 soit 23%). Un cas de thrombopénie associée à l\'augmentation des PDF a été noté. Conclusion Dans un sous-groupe non négligeable d\'hématomes, il existe une fibrinolyse concomitante dans les 24 premières heures. Ce phénomène est soit primitif, soit secondaire à la rupture vasculaire. Background Intracerebral haematoma is considered as an essentially vascular disease related to the structure of vessels. A recent treatment, VII factor has indirectly shown the importance of haemostasis in this ailment. Objective explored certain aspects of haemostasis in a series of intracerebral spontaneous haematomas. Method Haemostasis tests have been achieved among patients with a spontaneous intracerebral haematoma. The rate of fibrinogen and fibrinogen degradation products (FDP) have been measured at the admission, while the count of thrombocyts, and INR and ACT have also been determined. Results Thirteen successive patients have been studied. In three patients, an elevation of fibrinogen degradation factors has been observed (3/13 or 23%). A case of thrombopenia associated with the increase of FDP has been recorded. Conclusion In a considerable subgroup of haematomas, one could observe a concomitant fibrinolysis during the first 24 hours. This phenomenon is either initial or secondary to a vascular rupture.
    No preview · Article · Aug 2008 · African Journal of Neurological Sciences
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    ABSTRACT: Intracranial angioplasty stenting may be an efficient therapy in patients with intracranial atherosclerotic symptomatic vertebrobasilar artery stenosis unresponsive to optimal medical therapy. We present our experience in this setting. RESULTS: The study included 12 cases (8 men, 4 women), with an age range of 43-78 years (mean 62.6 years). Intracranial stenosis that resulted in qualifying stroke or transient ischemic attack involved the vertebral artery (n = 4), lower basilar artery (n = 1) and mid basilar artery (n = 5). Tandem stenosis included the intracranial vertebral artery and basilar artery (n = 1) and both intracranial vertebral arteries (n = 1). The degree of stenosis ranged between 70 and 90% in the basilar and vertebral arteries. Angioplasty + stenting was performed in all lesions. A successful procedure resulting in 30% of residual stenosis was found in 14 vessels. A periprocedural adverse event occurred in 1 case and was related to a brain hemorrhage. The mean patient follow-up was 15 +/- 3 months; 10 patients remained symptom free. All patients underwent a percutaneous endovascular balloon angioplasty and stent placement. CONCLUSIONS: This study supports the safety and the potential efficiency of stent-assisted angioplasty in patients resistant to optimal prevention. Randomized larger prospective trials are needed to confirm the benefit of this approach.
    No preview · Article · Aug 2008 · European Neurology
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    ABSTRACT: Recurrent cerebral venous thrombosis (CVT), as a manifestation of paraneoplastic angiitis and revealing of nodular lymphocyte predominant Hodgkin's disease (NLPHD), is an extremely rare condition. We herein report a 55-year-old man who developed recurrent CVT despite efficacious anticoagulant therapy and subsequent stenting of the superior longitudinal sinus. Progressive neurological deterioration ensued and a body scan revealed axillary lymph nodes. Pathological analysis led to a diagnosis of NLPHD. Conventional angiography showed CVT and multiple arterial narrowings. A paraneoplastic primary cerebral angiitis with prominent venous structure involvement was suspected. Immunotherapy using rituximab and steroids provided a dramatic recovery. This case of CVT due to paraneoplastic cerebral angiitis is a rare condition and represents a new, very rare manifestation of nodular lymphocyte predominant Hodgkin's disease.
    No preview · Article · Jun 2008 · Journal of Neuro-Oncology

  • No preview · Article · May 2008 · Atherosclerosis Supplements

  • No preview · Article · Mar 2008 · Journal Européen des Urgences
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    No preview · Article · Feb 2008 · European Neurology
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    ABSTRACT: Background: Intracerebral haematoma is considered as an essentially vascular disease related to the structure of vessels. A recent treatment, VII factor has indirectly shown the importance of haemostasis in this ailment. Objective: explored certain aspects of haemostasis in a series of intracerebral spontaneous haematomas. Method: Haemostasis tests have been achieved among patients with a spontaneous intracerebral haematoma. The rate of fibrinogen and fibrinogen degradation products (FDP) have been measured at the admission, while the count of thrombocyts, and INR and ACT have also been determined. Results: Thirteen successive patients have been studied. In three patients, an elevation of fibrinogen degradation factors has been observed (3/13 or 23%). A case of thrombopenia associated with the increase of FDP has been recorded. Conclusion: In a considerable subgroup of haematomas, one could observe a concomitant fibrinolysis during the first 24 hours. This phenomenon is either initial or secondary to a vascular rupture. © 2002 African Journal of Neurological Sciences. All rights reserved.
    No preview · Article · Jan 2008 · African Journal of Neurological Sciences
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    ABSTRACT: Introduction La vascularisation des noyaux antérieur, ventro-latéral antérieur et ventro-latéral intermédiaire du thalamus est principalement assurée par l’artère tubéro-thalamique qui est une branche de l’artère communicante postérieure. Observation Nous rapportons le cas d’une patiente de 74 ans, hypertendue, dyslipidémique, porteuse d’une valvulopathie mitrale, sous traitement médicamenteux, admise dans notre service pour un ptosis gauche d’installation brutale et une désorientation temporo-spatiale. L’examen neurologique était normal hormis ce ptosis isolé, sans myosis ni autre anomalie de paires crâniennes associée. Il n’y avait ni ophtalmoplégie, ni paralysie faciale, ni déficit sensitivo-moteur des 4 membres, ni syndrome cérébello-vestibulaire, pas plus que de syndrome méningé, de trouble de vigilance ou de mouvements anormaux. L’IRM avec ARM montra un infarctus aigu et unique de la partie antéro-latérale du thalamus gauche, correspondant au territoire de l’artère tubéro-thalamique. Il n’y avait pas d’argument pour une dissection, une sténose artérielle ou une malformation vasculaire. La radio pulmonaire était normale. Le test à la Néosynéphrine a permis d’obtenir une correction transitoire du ptosis confirmant qu’il s’agissait bien d’un syndrome de Claude Bernard Horner (CBH) partiel. Un bilan neuropsychologique réalisé à J10 a trouvé une perturbation modérée des capacités mnésiques et du langage. Discussion L’infarctus tubéro-thalamique se manifeste classiquement par une sémiologie frontale : apathie, euphorie, troubles attentionnels, persévérations etc. avec des signes de latéralisation selon l’hémisphère touché : aphasie, amnésie, troubles visuo-spatiaux, héminégligence, associés de manière inconstante à une hémiparésie et/ou hémihypoesthésie d’évolution en général régressive. Quelques rares cas comportant un CBH sont rapportés dans la littérature. Conclusion Un syndrome de CBH peut être satellite d’un infarctus de l’artère tubéro-thalamique. Cette présentation clinique est certes rare mais doit être évoquée devant tout CBH d’installation brutale chez un sujet à risque vasculaire.
    No preview · Article · Apr 2007 · Revue Neurologique

Publication Stats

7k Citations
842.67 Total Impact Points

Institutions

  • 1996-2015
    • Claude Bernard University Lyon 1
      Villeurbanne, Rhône-Alpes, France
  • 2008-2013
    • University of Lyon
      Lyons, Rhône-Alpes, France
  • 2001-2012
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
    • Hospital Clínic de Barcelona
      Barcino, Catalonia, Spain
  • 1990-2008
    • CHU de Lyon - Hôpital Neurologique et Neurochirurgical Pierre Wertheimer
      Lyons, Rhône-Alpes, France
  • 2004-2006
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France
  • 2003
    • Beth Israel Deaconess Medical Center
      Boston, Massachusetts, United States
  • 2002
    • Centre Hospitalier de Bourg-en-Bresse
      Bourg, Rhône-Alpes, France
  • 2000-2001
    • Cancer Research Center of Lyon
      Lyons, Rhône-Alpes, France
  • 1977
    • Institut National de la Transfusion Sanguine, Paris
      Lutetia Parisorum, Île-de-France, France