José Bernardo Escribano Paredes

University Hospital of Geneva

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Emmanuel Carrera

University Hospital of Geneva

Jeremy J. Heit

Stanford University

Pierre Seners

Fondation de Rothschild

Gregory W. Albers

Stanford Medicine

Michael Mlynash

Stanford University

Maarten G. Lansberg

Stanford University

Velina Nedkova-Hristova

Bellvitge University Hospital

Nicole Yuen

Stanford University

Javier Martínez‐Poles

Hospital Universitario Rey Juan Carlos

Sebastián García‐Madrona

Instituto Ramón y Cajal de Investigación Sanitaria

Cooperative Institutions

Hospital Universitario Ramón y Cajal

Inserm

Instituto Cajal

Instituto Ramón y Cajal de Investigación Sanitaria

Universidad de Alcalá

Institut de Psychiatrie et Neurosciences de Paris

University of Geneva

Stanford University

University Hospital of Geneva

Université Toulouse III - Paul Sabatier

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Trombectomía mecánica más allá de 6 horas en ictus isquémico agudo con oclusión de gran vaso en territorio carotídeo: experiencia en un hospital terciario

Neurología (2021)

Elena Natera‐Villalba Antonio Culebras Sebastián García‐Madrona Rocío Vera-Lechuga Alicia de Felipe

La eficacia de la trombectomía mecánica en territorio carotídeo en las primeras 24 horas se ha probado con trabajos publicados recientemente. Revisión retrospectiva a partir de un registro prospectivo en nuestro centro de referencia de ictus para valorar la eficacia y seguridad del tratamiento endovascular realizado más allá de las 6 horas de evolución de los síntomas en pacientes con ictus isquémico agudo y oclusión de gran vaso en territorio carotídeo, entre noviembre de 2016 y abril de 2019. Se recopilaron datos de 59 pacientes (55,9% mujeres, mediana de edad 71 años). Treinta y tres pacientes fueron detectados al despertar. El 57,6% de los casos fueron traslados secundarios. La mediana de NIHSS basal fue 16. La mediana del ASPECTS fue 8 y el 94,9% de los pacientes presentó > 50% de tejido salvable. El 88,1% de los pacientes logró una recanalización satisfactoria, en 5 pacientes después de 24 horas de evolución. El 67,8% de los casos logró la independencia funcional a los 90 días de seguimiento. Los pacientes que no lograron la independencia funcional presentaban mayor edad, mayor proporción de fibrilación auricular, mayor tiempo punción-recanalización y mayor puntuación NIHSS, tanto basal como al alta. En nuestra experiencia la trombectomía mecánica después de las 6 horas se asoció con buenos resultados de funcionalidad a los 90 días. La edad, la puntuación NIHSS, el tiempo punción-recanalización y la prevalencia de fibrilación auricular fueron factores determinantes en el pronóstico funcional. La eficacia de este tratamiento por encima de las 24 horas merece ser estudiada. Thrombectomy in the carotid artery territory was recently shown to be effective up to 24 hours after symptoms onset. We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6 hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting > 50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24 hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. In our experience, mechanical thrombectomy beyond 6 hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24 hours after onset merits study.

10.1016/j.nrl.2020.08.019

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Citations (1)

Factors Associated With Fast Early Infarct Growth in Patients With Acute Ischemic Stroke With a Large Vessel Occlusion

Neurology (2023)

Pierre Seners Nicole Yuen Jean‐Marc Olivot Michael Mlynash Jeremy J. Heit

The optimal methods for predicting early infarct growth rate (EIGR) in acute ischemic stroke with a large vessel occlusion (LVO) have not been established. We aimed to study the factors associated with EIGR, with a focus on the collateral circulation as assessed by the hypoperfusion intensity ratio (HIR) on perfusion imaging, and determine whether the associations found are consistent across imaging modalities.Retrospective multicenter international study including patients with anterior circulation LVO-related acute stroke with witnessed stroke onset and baseline perfusion imaging (MRI or CT) performed within 24 hours from symptom onset. To avoid selection bias, patients were selected from (1) the prospective registries of 4 comprehensive stroke centers with systematic use of perfusion imaging and including both thrombectomy-treated and untreated patients and (2) 1 prospective thrombectomy study where perfusion imaging was acquired per protocol, but treatment decisions were made blinded to the results. EIGR was defined as infarct volume on baseline imaging divided by onset-to-imaging time and fast progressors as EIGR ≥10 mL/h. The HIR, defined as the proportion of time-to-maximum (Tmax) >6 second with Tmax >10 second volume, was measured on perfusion imaging using RAPID software. The factors independently associated with fast progression were studied using multivariable logistic regression models, with separate analyses for CT- and MRI-assessed patients.Overall, 1,127 patients were included (CT, n = 471; MRI, n = 656). Median age was 74 years (interquartile range [IQR] 62-83), 52% were male, median NIH Stroke Scale was 16 (IQR 9-21), median HIR was 0.42 (IQR 0.26-0.58), and 415 (37%) were fast progressors. The HIR was the primary factor associated with fast progression, with very similar results across imaging modalities: The proportion of fast progressors was 4% in the first HIR quartile (i.e., excellent collaterals), ∼15% in the second, ∼50% in the third, and ∼77% in the fourth (p < 0.001 for each imaging modality). Fast progression was independently associated with poor 3-month functional outcome in both the CT and MRI cohorts (p < 0.001 and p = 0.030, respectively).The HIR is the primary factor associated with fast infarct progression, regardless of imaging modality. These results have implication for neuroprotection trial design, as well as informing triage decisions at primary stroke centers.

Stroke

10.1212/wnl.0000000000207908

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Radiologic and Histopathologic Features in an Intracranial Localized Castleman Disease

The Neurologist (2018)

José Bernardo Escribano Paredes Rodrigo Carrasco María López Gutiérrez Héctor Pian Arias Mónica García‐Cosío

Castleman disease (CD) is a rare pathologic process of unknown etiology, characterized by non-neoplastic lymph node enlargement. Two distinct histologic patterns are recognized; the hyaline-vascular type and the less common plasma cells type. Another intermediate type has been described. The clinical features are classified into 2 categories, localized (unicentric) and generalized (multicentric), the later associated with systemic manifestations and poor prognosis. CD affecting the central nervous system is extremely rare. We report a new case of localized intracranial CD and we accomplish a review of the literature.A 30-year-old man presented with a generalized tonic-clonic seizure. Computerized tomography and magnetic resonance imaging showed a small mass in the right temporoparietal convexity with homogenous enhancement after contrast administration. Extensive vasogenic edema in comparison with the size of the mass was also identified and based on the neuroradiologic finding, a suspected diagnosis of meningoangiomatosis was formulated. The mass was completely resected and his histologic examination identified the hyaline-vascular type of CD. One year after surgery, the patient remains seizure free, without evidence of systemic involvement or recurrence of the mass.Our case and review of the literature show the value of the extensive brain edema on neuroimaging finding to the differential diagnosis for a solitary mass arising from the meninges. We emphasize on the need for histologic examination when the diagnosis of meningioma is not entirely clear.

Meninges

Castleman disease

Hyaline

Etiology

10.1097/nrl.0000000000000203

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Incobotulinumtoxin A for Sialorrhea in Neurological Disorders: A Real-Life Experience

Toxins (2018)

Javier Martínez‐Poles Velina Nedkova-Hristova José Bernardo Escribano Paredes Sebastián García‐Madrona Elena Natera‐Villalba

Botulinum toxin type A is one of the most useful treatments of sialorrhea in neurological disorders. Evidence for the use of incobotulinumtoxin A (inco-A) in the treatment of sialorrhea is limited. Thirty-six patients with sialorrhea were treated with infiltrations of inco-A into both parotid glands. The severity of sialorrhea was evaluated by the Drooling Severity Scale (DSS), and the Drooling Frequency Scale (DFS). Patients’ perceptions of clinical benefit were recorded via the Patient Global Impression of Improvement (PGI-I) scale. Following treatment, there was a significant difference in both the DFS and the DSS (p < 0.001). Clinical benefits on the basis of the PGI-I were present in up to 90% of patients.

Sialorrhea

Drooling

10.3390/toxins10060217

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Citations (19)

Intravenous r-tPA Before Thrombectomy Versus Thrombectomy Alone in Strokes With Unknown Time of Onset

Stroke (2022)

José Bernardo Escribano Paredes Alexander Salerno Julian Klug Elisabeth Dirren Nicolae Sanda

10.1161/strokeaha.121.037741

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Citations (1)

Teaching Video NeuroImages: Palatal myoclonus in leukodystrophies

Neurology (2020)

Javier Martínez‐Poles José Bernardo Escribano Paredes Sebastián García‐Madrona Velina Nedkova-Hristova Adriano Jiménez‐Escrig

A 22-year-old man with Alexander disease type II diagnosed by a compatible MRI with bilateral white matter hyperintensities and brainstem atrophy (figure) and mutation c.236G>A (p.Arg79His) in the GFAP gene presented with recent onset continuous palatal myoclonus without ear clicking (video 1).

10.1212/wnl.0000000000008795

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Abstract TMP68: Core/perfusion Mismatch In Acute Ischemic Stroke With M2 Occlusion: Prevalence And Associated Factors.

Stroke (2023)

Pierre Seners Nicole Yuen Jeremy J. Heit José Bernardo Escribano Paredes Emmanuel Carrera

Background: The benefit of mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with M2 occlusion is uncertain. Observational studies suggest that perfusion imaging may help select optimal M2 candidates for MT. We aimed to study the prevalence and factors associated with core/perfusion mismatch, as assessed by both CT and MRI, in an unselected population of AIS with M2 occlusion. Methods: Retrospective observational study including AIS patients with M2 occlusion and baseline perfusion imaging (MRI or CT) performed within 24hrs from last seen well. To avoid selection bias, patients were selected from the prospective registries of 3 centers with systematic use of perfusion imaging, including both MT-treated and untreated patients. Core/perfusion mismatch was defined as mismatch ratio (Tmax>6s/ core volume) >1.8 and mismatch volume (Tmax>6s - core volume) >15mL. Results: Overall, 156 and 196 patients were included in the MRI and CT cohorts, respectively. Last-seen-well to imaging time was 5.6hrs (IQR 3.9-9.7) and 3.5hrs (1.5-9.8) in the MRI and CT cohorts, and 103/156 (66%) and 134/196 (68%) had proximal M2 occlusions (the remainder had distal M2 occlusions). Median ASPECT score was 7 (5-8) and 8 (7-9), and core/perfusion mismatch was present in 70/156 (45%) and 167/196 (85%) patients. In both cohorts, mismatch was less frequent in distal M2 occlusions and among patients with lower ASPECTS (Figure). Multivariable analysis showed higher ASPECT scores (OR=3.09, 95%CI=2.11-4.52, P <0.001 and OR=2.41, 95%CI 1.63-3.58, P <0.001 in the MRI and CT cohorts) and proximal M2 occlusion (with distal M2 as a reference: OR=3.94, 95%CI=1.68-9.26, P =0.002 and OR=32.78, 95%CI 8.36-128.47, P <0.001 in the MRI and CT cohorts) were independently associated with core/perfusion mismatch. Conclusion: Perfusion imaging may be useful in triaging M2 patients, particularly for those with ASPECT score <8 and distal M2 occlusions. This has implication for trials.

Stroke

First pass

10.1161/str.54.suppl_1.tmp68

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Citations (0)

Septo-optic dysplasia plus syndrome with hand mirror movements

Revue Neurologique (2019)

José Bernardo Escribano Paredes Adriano Jiménez‐Escrig Velina Nedkova-Hristova Javier Martínez‐Poles Sebastián García‐Madrona

Neuromyelitis Optica

Optic neuritis

Aquaporin 4

Seroprevalence