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FLAIR vascular hyperintensities are thought to represent leptomeningeal collaterals in acute ischemic stroke. However, whether all-FLAIR vascular hyperintensities or FLAIR vascular hyperintensities-DWI mismatch, ie, FLAIR vascular hyperintensities beyond the DWI lesion, best reflects collaterals remains debated. We aimed to compare the value of FLAIR vascular hyperintensities-DWI mismatch versus all-FLAIR vascular hyperintensities for collateral assessment using PWI-derived collateral flow maps as a reference.We retrospectively reviewed the registries of 6 large stroke centers and included all patients with acute stroke with anterior circulation large-vessel occlusion who underwent MR imaging with PWI before thrombectomy. Collateral status was graded from 1 to 4 on PWI-derived collateral flow maps and dichotomized into good (grades 3-4) and poor (grades 1-2). The extent of all-FLAIR vascular hyperintensities and FLAIR vascular hyperintensities-DWI mismatch was assessed on the 7 cortical ASPECTS regions, ranging from 0 (absence) to 7 (extensive), and associations with good collaterals were compared using receiver operating characteristic curves.Of the 209 included patients, 133 (64%) and 76 (36%) had good and poor collaterals, respectively. All-FLAIR vascular hyperintensity extent was similar between collateral groups (In acute ischemic stroke with large-vessel occlusion, the extent of FLAIR vascular hyperintensities does not reliably reflect collateral status unless one accounts for DWI.

Resume Introduction Le syndrome d’encephalopathie posterieure reversible (PRES) associe des symptomes neurologiques d’apparition brutale a des hypersignaux de la substance blanche a l’IRM cerebrale en T2 Flair. Le PRES peut survenir au cours de maladies auto-immunes, rarement au cours de vascularites systemiques. Nous rapportons un cas de PRES au cours d’une granulomatose avec polyangeite (ex-maladie de Wegener). Observation Une patiente de 22 ans etait traitee par bolus de methylprednisolone pour une granulomatose avec polyangeite avec atteinte neurologique. Dans les suites du deuxieme bolus, la patiente presentait des crises convulsives, une cecite, un syndrome confusionnel associes a une hypertension arterielle et une insuffisance renale aigue. L’IRM cerebrale montrait des hypersignaux T2 Flair occipitotemporaux bilateraux. Les signes cliniques et radiologiques etaient rapidement resolutifs suite a un traitement associant antiepileptiques, antihypertenseurs, corticotherapie per os et cyclophosphamide. Discussion La survenue de PRES au cours de vascularites systemiques est rare et six cas de PRES associes a une granulomatose avec polyangeite ont ete anterieurement rapportes. Il semble important de depister l’existence d’une hypertension arterielle chez un patient traite par corticotherapie pour une vascularite systemique, car ceci pourrait constituer un facteur favorisant de survenue du PRES.

Introduction L’incidence des spondylodiscites infectieuses a pyogenes (SDI) ne cesse d’augmenter depuis deux decennies, en lien avec une plus grande frequence des comorbidites et de meilleurs outils diagnostiques. Le traitement repose sur une antibiotherapie prolongee. Une duree de 6 semaines a ete validee dans un essai randomise de non-inferiorite. Malgre tout, cette proposition reste debattue. Nous rapportons ici 5 annees d’experience d’antibiotherapie « courte ». Materiels et methodes Etude observationnelle retrospective multicentrique de mai 2011 a mai 2016. La selection des cas possibles a ete faite a partir du Programme de medicalisation des systemes d’information. Les criteres d’inclusion etaient : adulte avec diagnostic confirme de SDI par imagerie, documentation microbiologique, antibiotherapie de 6 semaines. Les criteres de non-inclusion etaient : infection fongique, a mycobacterie ou a Brucella , presence de materiel d’osteosynthese rachidien, suivi de moins de 6 mois ou deces dans les 6 semaines de traitement. Un echec etait defini comme la survenue avant un an du deces ou d’une recidive de l’infection liee a la meme bacterie. Les donnees clinico-biologiques, radiologiques et de suivi ont ete decrites. Resultats Au total, 110 patients ont ete inclus. L’âge median etait de 67 ans (ecart inter-quartile, EIQ 60–81) avec une predominance masculine (68 %). Le score de Charlson ajuste median etait a 4 (EIQ 3–6). Le delai diagnostique median etait de 16 jours (EIQ 7–31), 82 % des patients avaient une temperature > 38 °C et 85 % des douleurs rachidiennes, seulement 67 % presentaient les deux. Les hemocultures etaient positives chez 84 patients (76 %), 23 avaient une endocardite associee. La CRP mediane etait de 130,4 mg/L (EIQ 75–237). L’atteinte rachidienne etait respectivement lombosacree, thoracique ou cervicale dans 64 (58 %), 38 (34 %), et 17 cas (15 %), 18 patients avaient plusieurs localisations. Staphylococcus aureus etait implique dans 44 cas (40 %), devant les streptocoques (36 cas, 32 %), les enterobacteries (17), et les Staphylocoques a coagulase negative (SCN) (16) avec culture plurimicrobienne dans 8 cas. Un relais oral de l’antibiotherapie avant 7 jours a ete fait chez 38 patients. Avec une mediane de suivi de 356 jours (EIQ 215–423), seulement 4 echecs ont ete constates (3,6 %) : 2 patients âges decedes de causes non liees a la SDI, et 2 recidives precoces (7 jours et 3 mois apres l’arret des antibiotiques) dans un contexte de traitement conservateur de chambre implantable infectee a SCN. Conclusion Cette etude confirme le faible nombre d’echecs therapeutiques en cas de traitement court des SDI en situation de vie reelle, y compris dans le groupe des patients avec relais oral precoce.

Summary Introduction Ophthalmologic examination may rule out an ocular wound in the event of orbital traumatism. Some lesions are obvious but others may not be detected. We report a case of superior oblique muscle trochlea trauma. This infrequent pathology is illustrated with a scanned imagery and magnetic resonance imaging (MRI). Observation The initial penetrating trauma was caused by a hook in the medial canthus. The wound was sutured in the emergency unit. Three days later, oblique diplopia developed. Three weeks later, abnormal ocular movements appeared when contracting the frontal muscle. The patient then decided to consult. One month after the traumatism, the orthoptic assessment confirmed the presence of an acquired Brown syndrome suggesting a lesion of the superior oblique muscle. Orbital MRI could not find the trochlea and revealed a thickening by retraction of the posterior portion of the muscle and a hypotrophic aspect of the anterior portion. A fracture of the right orbital edge was revealed by the scanner. Surgical exploration was performed. Discussion The trochlea is located very anteriorly and likely to be affected in the event of an internal palpebral wound. A direct traumatism of the pulley and/or the superior oblique muscle leads to an acquired Brown syndrome. This observation stresses the importance of surgical wound exploration for the supero-medial palpebral area as well as using MRI which allows proving the diagnosis.

Pachymeningitis is an inflammatory process that thickens the dura mater. This disease has various etiologies including infectious, neoplastic, or autoimmune diseases. We present the case of a patient who developed cranial pachymeningitis with a clinical and biological picture suggestive of a neurological form of vasculitis. A 51-year-old woman developed rhinitis, otitis media, headaches, and deterioration of her condition after a course of recombinant hepatitis B vaccine. After a booster dose of the vaccine, she developed unilateral visual loss and impairment of multiple cranial nerves. Blood analysis showed inflammation and presence of antimyeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA). Cranial magnetic resonance imaging (MRI) showed pachymeningitis. A complete remission was obtained with immunosuppressive therapy. The initial clinical presentation and subsequent remission under immunosuppressive therapy were suggestive of a vasculitis with nervous system involvement. Though vasculitis was not proven histologically in this patient, we believe that MPO-ANCA-related autoimmunity provoked the patient's disease as already reported in similar cases. As pachymeningitis is a fibrosing process, early recognition and treatment of an autoimmune etiology, even in the absence of previous pulmonary or renal involvement, is required to prevent definitive neurological impairment.

BACKGROUND: Selective embolization is an effective and reputedly safe method of managing pregnancy-related bleeding. However, we report an ischemic uterine necrosis after arterial embolization. CASE: The patient had heavy postpartum bleeding treated by embolization of the uterine arteries using polyvinyl alcohol particles (diameter 150–250 and 300–600 μm) and gelatin sponge pledgets. Her postoperative recovery was complicated by menorrhagia and pelvic pain. Because of the persistent menorrhagia and risk of infection, a hysterectomy was performed. Histopathology of the hysterectomy specimen revealed massive ischemic myometrial necrosis. CONCLUSION: This complication is most likely related to the small size of the particles used. In the management of postpartum bleeding by arterial embolization, the material of choice is gelatin sponge pledgets, and the use of small particles should be avoided.

Objectives To evaluate sonographic features following uterine artery embolization and to assess using ultrasound the efficacy of embolization as the primary treatment of fibroids. Design Fifty-eight women (mean age, 44.5 years; range, 33–65 years) suffering from symptoms due to fibroids (menometrorrhagia, bulk-related symptoms, pelvic pain) were followed-up after uterine artery embolization by ultrasound examination at 3 months, 6 months, 1 year and 2 years with assessment of volume and vascularization of fibroids as well as uterine vascularization. Results Fifty-eight patients were examined at 3 months, 46 at 6 months, 36 at 1 year and 19 at 2 years. Most patients were improved or free of symptoms at 3 months (90%), 6 months (92%) and 1 year (87%) and all monitored patients were free of symptoms at 2 years. Clinical failure of treatment occurred in only two cases (3%). Progressive significant reduction in fibroid size with reference to the baseline was demonstrated during follow-up from 3 months (−29%) to 24 months (−86%). Absence of intrafibroid vessels was observed in all except three cases as early as 3 months, whereas perifibroid vessels persisted in 21 cases. No changes in uterine vascularization or uterine artery resistance were noted. Conclusions Uterine artery embolization is a valuable endovascular method for the treatment of fibroids, resulting in marked reduction in fibroid size and disappearance of intrafibroid vessels without reduction in uterine vascularization which is well depicted by sonography. Copyright © 2002 ISUOG

Resumen Los tres ejes de la neurorradiologia operatoria (embolizacion, quimioperfusion intraarterial selectiva, revascularizacion) representan indicaciones terapeuticas multiples (neurocirugia, neurologia, otorrinolaringologia maxilofacial y plastica, cirugia vascular, hematologia y oncologia). Estas intervenciones pueden preparar a la cirugia, completar o reemplazarla. Son tecnicas poco invasivas que constituyen un progreso para el enfermo, la atencion medica, los costes de salud y la duracion de la hospitalizacion. Postoperatorio en general simple y ausencia casi total de riesgo infeccioso constituyen algunas de las ventajas en campos sensibles como los cerebromeningeos. Actualmente, la neurorradiologia operatoria, en patologia otorrinolaringologica, es una especialidad en plena expansion. Las indicaciones de la arteriografia con objetivo diagnostico de la zona cervicofacial han sido reducidas de forma importante por el desarrollo de las tecnicas de diagnostico por imagenes no invasivas como la TC la RM. No obstante, la arteriografia es todavia irremplazable para el estudio de la angioarquitectura de las malformaciones vasculares, los acufenos vasculares, los tumores hipervascularizados y, en un grado menor, las relaciones de los ejes carotideos o vertebrales con algunos procesos expansivos, infecciosos o tumorales. El desarrollo considerable de la angiografia operatoria constituye actualmente la indicacion mayor para la exploracion angiografica. La angiografia operatoria otorrinolaringologica consiste esencialmente en una embolizacion. Se utiliza en dos circunstancias principales: la embolizacion de hemostasia y la embolizacion de desvascularizacion lesional que puede ser preoperatoria o exclusiva. El principio de la embolizacion consiste en depositar en la luz arterial y/o capilar un material extrano con el objetivo de ocluirla. Un embolo asi introducido se bloquea en un lugar determinado del vaso. La desvascularizacion obtenida y la duracion de la oclusion dependen de la naturaleza del embolo. Despues de una recapitulacion de los grandes principios de la embolizacion, se abordaran sus indicaciones: hemostasia, tratamiento de los acufenos, quimioembolizacion tumoral y tratamiento de las malformaciones vasculares.

Ornithine transcarbamylase deficiency (OTCD) is the most common urea cycle disorder. This condition usually presents in neonates or children. This report describes the clinical case of a 21 year old woman who was diagnosed in adulthood during the course of an unexplained coma. After recovery from the coma, she presented very unusual neuropsychological disorders involving memory and the meaning of certain words, suggesting a semantic deficit. The discovery of OTCD in adulthood is rare and the neuropsychological consequences may be unique.

Le syndrome d'encephalopathie posterieure reversible (SEPR) est une entite clinique et radiologique recemment identifiee, dont le diagnostic est parfois difficile (Hinchey et al., 1996). Cette encephalopathie posterieure survient generalement dans des contextes evocateurs (eclampsie, traitement immunosuppresseur, encephalopathie hypertensive), mais ces derniers peuvent manquer, et le retard diagnostique peut empecher une prise en charge therapeutique efficace.

Uterine artery embolization (UAE) is a successful and safe treatment for symptomatic leiomyomas. However, rare complications such as premature menopause and uterine necrosis can arise because of embolization of non-target tissues. We studied the feasibility of using contrast-enhanced sonography with intravenous SonoVue just before, during and after complete occlusion of both uterine arteries. In a patient with multiple, large, symptomatic leiomyomas, contrast-enhanced imaging established that the UAE was technically successful and that myometrial vascularity was not reduced. Our case suggests that ultrasound contrast agents may have a role in monitoring UAE and thus may help prevent ischemic complications. Further studies are required to confirm this.

Developmental dyslexia is a frequent language-based learning disorder characterized by difficulty in reading. The predominant etiologic view postulates that reading impairment is related to phonological and orthographic dysfunction. The aim of this fMRI study was to evaluate the neural bases of phonological processing impairment in remediated dyslexic adults (DD). We used a rhyming words judgment task contrasted with an unreadable fonts font-matching judgment task to compare patterns of activation and functional asymmetry in DD and normal-reading young adults. We found evidence of a link between asymmetry in inferior frontal gyrus and performance during the phonological processing. We also observed that DD recruit a network including regions involved in articulatory control in order to achieve rhyme judgment suggesting that, due to a lack of hemispheric specialization, DD recruit the latter network to achieve rhyme judgment.

Purpose to evaluate the feasibility and to compare the results of different algorithms of tractography by diffusion weighted (DWI) magnetic resonance imaging (MRI) coupled with retinotopy by functional MRI (fMRI) at 1,5 tesla, to study the optic radiations. Methods one healthy subject had: (1) a fMRI with visual stimulations by sectorial contrast alternating checkerboard patterns (2) a DWI MRI and (3) anatomical acquisitions. Optic radiations were tracked by both deterministic and probabilistic algorithms, using anatomical and functional data. Results the optic radiations reconstructions agreed with literature data. The deterministic reconstruction algorithm is conceivable in current practice, and can correctly tracked the optic radiations with a good view of the Meyer loop, unlike the probabilistic reconstruction algorithm, whose post treatment is long and results disappointing. Conclusion tractography coupled with the retinotopy is feasible at 1,5 tesla to study the optic radiations with deterministic reconstruction algorithm but not with probabilistic algorithm.

International audience; PURPOSE: To evaluate the agreement and diagnostic accuracy of Contrast enhanced magnetic resonance angiography (CE-MRA), Doppler ultrasound (DUS) and Digital subtraction angiography (DSA) in the assessment of carotid stenosis. METHODS: DUS, CE-MRA and DSA were performed in 56 patients included in the Carotide-angiographie par résonance magnétique-échographie-doppler-angioscanner (CARMEDAS) multicenter study with a carotid stenosis ≥ 50%. Three readers evaluated stenoses on CE-MRA and DSA (NASCET criteria). Velocities criteria were used for stenosis estimation on DUS. RESULTS: CE-MRA had a sensitivity and specificity of 96-98% and 66-83% respectively for carotid stenoses ≥ 50% and a sensitivity and specificity of 94% and 76-84% respectively for carotid stenoses ≥ 70%. The interobserver agreement of CE-MRA was excellent, except for moderate stenoses (50-69%). DUS had a sensitivity and specificity of 88 and 75% respectively for carotid stenoses ≥ 50% and a sensitivity and specificity of 83 and 86% respectively for carotid stenoses ≥ 70%. Combined concordant CE-MRA and DUS had a sensitivity and specificity of 100 and 85-90% respectively for carotid stenoses ≥ 50% and a sensitivity and specificity of 96-100% and 80-87% respectively for carotid stenoses ≥ 70%. The positive predictive value of the association CE-MRA and DUS for carotid stenoses ≥ 70% is calculated between 77 and 82% while the negative predictive value is calculated between 97 and 100%. CE-MRA and DUS have concordant findings in 63-72%, and the overestimations cases were recorded only for carotid stenosis ≤ 69%. CONCLUSION: Combined DUS-CE-MRA is excellent for evaluation of severe stenosis but remains debatable in moderate stenosis (50-69%) due to the risk of overestimations.

This is a case report of successful arterial embolization of a dural fistula using absolute alcohol. In this two-part embolization of a dural fistula of the left sagittal venous sinus, the use of n-BCA (n-butyl-cyanoacrylate) was followed by 1 ml of absolute alcohol four months later. The first procedure, using n-BCA via the external carotid, permitted exclusion of the arterial supply coming from the medial meningeal and occipital arteries. Persistence of the blood supply through the internal carotid prompted us to perform the second procedure, to occlude the tentorium marginalis artery, using 1 ml of 95% ethanol. This was followed by a cranial nerve (III) palsy that was reversible. The three-month follow-up was satisfactory, although arteriography after one year showed revascularization of the fistula, which was successfully treated by Onyx. Routinely used in the treatment of superficial vascular malformations, the use of absolute alcohol intracerebrally appears to be unreliable, with results that were only temporary.

Ophthalmologic examination may rule out an ocular wound in the event of orbital traumatism. Some lesions are obvious but others may not be detected. We report a case of superior oblique muscle trochlea trauma. This infrequent pathology is illustrated with a scanned imagery and magnetic resonance imaging (MRI).The initial penetrating trauma was caused by a hook in the medial canthus. The wound was sutured in the emergency unit. Three days later, oblique diplopia developed. Three weeks later, abnormal ocular movements appeared when contracting the frontal muscle. The patient then decided to consult. One month after the traumatism, the orthoptic assessment confirmed the presence of an acquired Brown syndrome suggesting a lesion of the superior oblique muscle. Orbital MRI could not find the trochlea and revealed a thickening by retraction of the posterior portion of the muscle and a hypotrophic aspect of the anterior portion. A fracture of the right orbital edge was revealed by the scanner. Surgical exploration was performed.The trochlea is located very anteriorly and likely to be affected in the event of an internal palpebral wound. A direct traumatism of the pulley and/or the superior oblique muscle leads to an acquired Brown syndrome. This observation stresses the importance of surgical wound exploration for the supero-medial palpebral area as well as using MRI which allows proving the diagnosis.

Malformations of cortical development are increasingly recognized as important causes of epilepsy, developmental delay and other neurological disorders. Our purpose is to present the relevance of the MRI in these pathologies with the clinical, genetic and therapeutic aspects. This classification is based on the three fundamental events of cortical formation: proliferation of neurons and glie in the periventricular zone, migration of postmitotic neurons to the periphery, subsequent cortical organization. MR analysis evaluates particularly the cortical thickness, sulcal and cortical morphology, gray-white matter junction, and looks for gray matter in abnormal location. These data coupled with the familial history, the seizure characteristics and genetic findings should allow an appropriate classification of the lesions. MR imaging allows the detection and classification of cortical malformations. MR imaging findings are primordial to consider surgery when the epilepsy becomes refractory to the anti-epileptic drugs. An adequate classification of these malformations should help to provide to the family an appropriate counseling both in terms of genetics and outcome.

Torticollis in children must always instigate a search for trauma. Many other etiologies can be found. The authors report a case of postmedicinal atlantoaxial rotatory pseudoluxation (AARP) occurring in a child. This child had fallen down in the morning with head trauma followed by headache. Clinically, a stiff neck with an irreducible right rotation of his neck, and an osteotendinous hyperreflexia were noted. There was a C1-C2 rotatory dislocation with no traumatic lesion on the cervical CT scan. After a few hours, the torticollis spontaneously reduced and then reappeared on the left side. This clinical fluctuation and the absorption of metoclopramide (Primpéran) started in the morning for acute gastroenteritis provided the diagnosis of AARP. This entity was confirmed by the good clinical and radiological follow-up and was caused by the substantial ligament laxity of the craniovertebral junction encountered in children. The analysis of medical imaging and the systematic search for a medicinal cause helped make the right diagnosis.

To evaluate the efficacy of percutaneous sclerotherapy for the treatment of venous malformations (VMs) with regards to cosmetic and functional outcome as a function of their size and to review the complications.A retrospective study was performed between January 1997 and January 2002 on 68 patients (45 females and 23 males) ranging in age from 3 to 60 Years at the CHRU of Tours.Percutaneous sclerotherapy was a very effective treatment for small and medium-size VMs, for which the aim was to achieve cure. Aetoxisclerol and Ethibloc are the sclerosing agents used. They were associated with minimal side effects and no major complication. For larger lesions, the treatment was more complex and combined stronger and also more dangerous agents like absolute ethanol and Histoacryl. The aim was then a decrease of cosmetic and functional problems.Percutaneous sclerotherapy with Aetoxisclerol, Ethibloc, absolute ethanol or Histoacryl, either alone or before surgery, is a safe and effective method of managing soft-tIssue venous malformations.

Cerebrospinal fluid (CSF) fistulae can produce leakage through a defect in the bony skull and meninges into the contiguous air-filled cavities at the base of the skull. The major risk is central nervous system infection. When abundant clear rhinorrhea or otorrhea is present, the diagnosis is obvious and imaging is used to localize the fistula. Computed tomography (CT) with millimetric slices and magnetic resonance imaging (MRI) are the most effective diagnostic tools. CT cisternography, an invasive procedure, should only be used when the diagnosis remains uncertain following CT scan and MRI. When CSF leakage is sparse or intermittent, the diagnosis can be made by measuring beta-2 transferrine in the escaping fluid. CT scan followed by MRI are also useful for making the diagnosis and locating the fistula when exterior leakage is absent. CT scan alone is effective for assessing isolated otorrhea. If the diagnosis remains uncertain after all these studies have been used, the patient should be closely followed clinically and isotopic study or surgery should be considered.

Selective embolization is an effective and reputedly safe method of managing pregnancy-related bleeding. However, we report an ischemic uterine necrosis after arterial embolization.The patient had heavy postpartum bleeding treated by embolization of the uterine arteries using polyvinyl alcohol particles (diameter 150-250 and 300-600 microm) and gelatin sponge pledgets. Her postoperative recovery was complicated by menorrhagia and pelvic pain. Because of the persistent menorrhagia and risk of infection, a hysterectomy was performed. Histopathology of the hysterectomy specimen revealed massive ischemic myometrial necrosis.This complication is most likely related to the small size of the particles used. In the management of postpartum bleeding by arterial embolization, the material of choice is gelatin sponge pledgets, and the use of small particles should be avoided.

Among the many causes of sciatica, endometriosis, a rare aetiology, should be considered in menstruating women in view of the diagnostic strategy and ensuing therapeutic implications. We report a case of sciatic nerve involvement with endometriosis in contact with the nerve in the left sciatic notch. Exploration by MRI was invaluable for the diagnosis, revealing a signal on the stem of the nerve suggestive of a lesion with haemorrhagic content.

Osmotic stresses from 0 to −8 bars were applied to 15 mm long intact roots of maize seedlings. The endogenous abscisic acid (ABA) levels were measured by gas chromatography/mass spectrometry (GC/MS) in the 10 mm long root using a stable isotope dilution technique. After a 30-min incubation in 1 mM 3,3-dimethylglutaric acid (3,3-DGA) buffer at pH 6.0 (0 bar), the ABA level in the tissues was 25% of the initial level, while a 10-fold higher amount of ABA was found in the medium. When using sorbitol solutions, the ABA levels, both in the root tips and medium. became higher starting from a threshold concentration of the osmoticum corresponding to −3 bars.