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Background and purpose: Asymptomatic intracranial hemorrhage (aICH) is a common occurrence after endovascular treatment (EVT) for acute ischemic stroke (AIS). The aims of this study were to address its impact on 3‐month functional outcome and to identify risk factors for aICH after EVT. Methods: Patients with AIS attributable to anterior circulation large vessel occlusion who underwent EVT were enrolled in a multicenter prospective registry. Based on imaging performed 22–36 h post‐EVT, we included patients with no intracranial hemorrhage (ICH) or aICH. Poor outcome defined as a 3‐month modified Rankin Scale (mRS) score 4–6 and overall 3‐month mRS score distribution were compared according to presence/absence of aICH, and aICH subtype using logistic regression. We assessed the risk factors of aICH using a multivariate logistic regression model. Results: Of the 1526 patients included in the study, 653 (42.7%) had aICH. Patients with aICH had a higher rate of poor outcome: odds ratio (OR) 1.88 (95% confidence interval [CI] 1.44–2.44). Shift analysis of mRS score found a fully adjusted OR of 1.79 (95% CI 1.47–2.18). Hemorrhagic infarction (OR 1.63 [95% CI 1.22–2.18]) and parenchymal hematoma (OR 2.99 [95% CI 1.77–5.02]) were associated with higher risk of poor outcome. Male sex, diabetes, coronary artery disease, baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early Computed Tomography Score, number of passes and onset to groin puncture time were independently associated with aICH. Conclusions: Patients with aICH, irrespective of the radiological pattern, have a worse functional outcome at 3 months compared with those without ICH after EVT for AIS. The number of EVT passes and the time from onset to groin puncture are factors that could be modified to reduce deleterious ICH. [ABSTRACT FROM AUTHOR]

Background and purpose: Better characterization of the thrombus could be useful to determine acute ischaemic stroke (AIS) aetiology and predict response to thrombolysis and endovascular therapy (EVT). To test the hypothesis that susceptibility vessel sign (SVS) on baseline magnetic resonance imaging (MRI) is related to red blood cell (RBC) content of AIS thrombi, the total haemoglobin contents (HbCs) of AIS thrombi retrieved by EVT from patients with or without SVS or two‐layered SVS (TLSVS) were compared. Methods: Baseline MRI of 84 anterior AIS patients was reviewed by neuro‐radiologists blinded to clinical and biochemical data. Thrombi from these patients were retrieved by EVT and analysed for HbC by quantitative enzyme‐linked immunosorbent assay and measurement of haem concentration. Results: Susceptibility vessel sign and TLSVS were respectively observed in 85.7% and 50.0% of cases. The median HbC content was 253 µg/mg thrombus (interquartile range 177–333) and the median haem content was 219 µg/mg thrombus (131–264). Thrombus HbC and haem content were highly correlated with thrombus RBC content determined by flow cytometry (r = 0.94). Thrombi from patients with TLSVS weighed more [31.1 (16.5–68.3) mg vs. 17.7 (11.7–33.3) mg; P = 0.005] and had a higher HbC content [278 (221–331) µg/mg vs. 196 (139–301) µg/mg; P = 0.010] compared to thrombi from patients without TLSVS. There was no difference in thrombus weight or HbC content according to SVS status. Conclusions: Our study shows that TLSVS is significantly associated with a higher thrombus weight and RBC content, as determined by quantitative assays. [ABSTRACT FROM AUTHOR]

Background: Neurologic involvement occurs in approximately 25% of patients with primary Sjögren''s syndrome. Manifestations are diverse and can affect the entire neuroaxis. Central nervous system dysfunction involves the brain as well as the spinal cord and may recur over time. Due to a variety of presentations, Sjögren''s syndrome with neurologic involvement may be difficult to diagnose. Methods: We report 4 cases of patients with primary Sjögren''s syndrome who presented with atypical neurologic manifestations. Results: The first case describes a patient with a pseudotumoral lesion. The second patient was a 54-year-old woman suffering from a multiple mononeuropathy. The third case describes a 66-year-old man whose primary Sjögren''s syndrome presented as progressive multiple sclerosis, and the fourth case reports a 57-year-old woman patient suffering from myelitis along with progressive cognitive disorders. Conclusions: Neurologic impairment in Sjögren''s syndrome is probably underestimated and the diagnosis is often delayed. Primary Sjögren''s syndrome should be suspected in patients presenting with atypical clinical and radiologic neurologic manifestations. [ABSTRACT FROM AUTHOR]

Objectifs L’étude a porté sur 90 patients atteints d’une malformation artérioveineuse intracrânienne traitée par radiochirurgie avec l’accélérateur Novalis ® , avec une technique d’arcthérapie dynamique. Patients et méthodes Soixante et un patients avaient reçu auparavant un traitement : embolisation, chirurgie, radiochirurgie. Les malformations artérioveineuses étaient majoritairement de moins de 3 cm et superficielles. La dose médiane sur l’isodose 80 % était de 22 Gy. Le volume cible était de 0,01 à 11,1 cm 3 . Le nombre médian d’arcs était de cinq. Le recul moyen était de 54 mois. Résultats L’oblitération a été obtenue chez 6,7 % des patients avec un délai moyen de 30 mois. La dose délivrée était prédictive de l’oblitération. Trente-quatre patients ont été concernés par des événements indésirables : épilepsie (18 %), hémorragie cérébrale (10 %), céphalées (9 %), hémianopsie (3 %), accident vasculaire cérébral ischémique (3 %), déficit moteur (1 %). En analyse multifactorielle, le mode de révélation par épilepsie ou céphalées, un volume de tissu sain recevant 12 Gy de 2 cm 3 ou plus et un grade de Spetzler-Martin 4 ou plus étaient prédictifs d’événements indésirables. En analyse unifactorielle, ces mêmes facteurs ainsi que l’âge au moment du diagnostic ne dépassant 30 ans, la taille de 3 cm ou plus, le volume de la malformation artérioveineuse intracrânienne, le volume de l’isodose 80 %, le volume de tissu sain recevant 20 Gy étaient prédictifs d’événement indésirable. Il existait une tendance pour les indices d’homogénéité, de conformation et de Paddick. L’épilepsie révélatrice, une radiochirurgie antérieure, le volume de l’isodose 80 %, l’indice d’homogénéité, les volumes sains recevant 12 Gy et 20 Gy, une taille de plus de 3 cm, une malformation artérioveineuse intracrânienne profonde, un grade de Spetzler-Martin de 4 ou plus étaient prédictifs de radionécrose. Conclusion Ces résultats sont comparables à ceux d’autres séries. La limitation du volume de tissu sain irradié et la discussion de l’irradiation des patients jeunes atteints de malformation artérioveineuse intracrânienne n’ayant pas saigné semblent les meilleures pistes pour limiter les effets indésirables de la radiochirurgie. L’accélérateur Novalis ® , performant pour l’épargne des tissus sains et l’homogénéité de dose, est adapté à la radiochirurgie des malformations artérioveineuses intracrâniennes. [ABSTRACT FROM AUTHOR]