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BMC Neurology (2)
Journal of Cerebral Blood Flow & Metabolism (1)
Defer, Gilles (3)
Babin, Emmanuel (1)
Blanc, Frédéric (1)
Cogez, Julien (1)
Collongues, Nicolas (1)
Derache, Nathalie (1)
Gauberti, Maxime (1)
Labauge, Pierre (1)
Montagne, Axel (1)
Ribeiro, Espartaco (1)
Touzé, Emmanuel (1)
Viader, Fausto (1)
Vivien, Denis (1)
de Seze, Jérôme (1)
Year of Publication
Impact of tissue plasminogen activator on the neurovascular unit: from clinical data to experimental evidence
Journal of Cerebral Blood Flow & Metabolism
About 15 million strokes occur each year worldwide. As the number one cause of morbidity and acquired disability, stroke is a major drain on public health-care funding, due to long hospital stays followed by ongoing support in the community or nursing-home care. Although during the last 10 years we have witnessed a remarkable progress in the understanding of the pathophysiology of ischemic stroke, reperfusion induced by recombinant tissue-type plasminogen activator (tPA—Actilyse) remains the only approved acute treatment by the health authorities. The objective of the present review is to provide an overview of our present knowledge about the impact of tPA on the neurovascular unit during acute ischemic stroke.
acute stroke; clinical trials; excitotoxicity; interventional neuroradiology; neurovascular unit; thrombolysis
Inflammatory-like presentation of CADASIL: a diagnostic challenge
de Seze, Jérôme
CADASIL is an autosomal dominant genetic leukoencephalopathy linked to mutations in the Notch3 gene. In rare cases, widespread brain lesions on T2 MRI mimicking multiple sclerosis are observed. From a national registry of 268 patients with adult-onset leukodystrophy, we identified two patients with an atypical presentation of CADASIL without co-occurrence of another systemic disease.
Patient 1 experienced progressive gait disability and patient 2 relapsing optic neuritis and sensory-motor deficit in the leg. Both patients responded to corticotherapy and patient 2 was also responsive to glatiramer acetate. No oligoclonal bands were found in the CSF, and MRI showed myelitis and lesions with gadolinium enhancement in brain (patient 1) or incomplete CADASIL phenotype (patient 2).
In rare cases, an inflammatory-like process can occur in CADASIL. In these patients, immunomodulatory treatments, including corticosteroids, could be effective.
CADASIL; Multiple sclerosis; Leukoencephalopathy; Notch3; Cerebral vasculitis
Stroke in hereditary hemorrhagic telangiectasia patients. New evidence for repeated screening and early treatment of pulmonary vascular malformations: two case reports
Paradoxical embolism due to pulmonary arteriovenous malformations is the main mechanism of brain infarction in patients with hereditary hemorrhagic telangiectasia. International Guidelines have recently been published to clarify the performance of screening tests and the effectiveness of treatment for pulmonary arteriovenous malformations.
We present two cases of hereditary hemorrhagic telangiectasia patients of our hospital who experienced an acute stroke secondary to paradoxical embolism.
These two cases show that the guidelines must be followed to prevent the occurrence of ischemic stroke in patients with hereditary hemorrhagic telangiectasia, and that although they may be adequate in most cases, there are some patients who need a more personalized approach.
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