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Reyes S, Jabouley A, Alili N, De Sanctis MH, Machado C, Taleb A, Herve D, Dias-Gastellier N, Chabriat H. Psychological impact of COVID-19 containment on CADASIL patients. J Neurol 2023; 270:2370-2379. [PMID: 36869886 PMCID: PMC9985090 DOI: 10.1007/s00415-023-11648-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION COVID-19 restrictive containment was responsible for major psychological distress and alteration of quality of life (QoL) in the general population. Their impact in a group of patients having cerebral small vessel disease (SVD) and at high risk of stroke and disability was unknown. OBJECTIVE We aimed to determine the potential psychological impact of strict containment during the COVID-19 pandemic in a sample of CADASIL patients, a rare SVD caused by NOTCH3 gene mutations. METHODS Interviews of 135 CADASIL patients were obtained just after the end of the strict containment in France. Depression, QoL and negative subjective experience of the containment were analysed, as well as predictors of posttraumatic and stressor-related manifestations, defined as an Impact Event Scale-Revised score ≥ 24, using multivariable logistic analysis. RESULTS Only 9% of patients showed a depressive episode. A similar proportion had significant posttraumatic and stressor-related disorder manifestations independently associated only with socio-environment factors, rather than clinical ones: living alone outside a couple (OR 7.86 (1.87-38.32), unemployment (OR 4.73 (1.17-18.70)) and the presence of 2 or more children at home (OR 6.34 (1.35-38.34). CONCLUSION Psychological impact of the containment was limited in CADASIL patients and did not appear related to the disease status. About 9% of patients presented with significant posttraumatic and stressor-related disorder manifestations which were predicted by living alone, unemployment, or exhaustion related to parental burden.
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Affiliation(s)
- S Reyes
- CNVT and Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Hopital Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, GHU-Paris-Nord, APHP, 2 Rue Ambroise Paré, 75010, Paris, France
| | - A Jabouley
- CNVT and Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Hopital Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, GHU-Paris-Nord, APHP, 2 Rue Ambroise Paré, 75010, Paris, France
| | - N Alili
- CNVT and Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Hopital Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, GHU-Paris-Nord, APHP, 2 Rue Ambroise Paré, 75010, Paris, France
| | - M H De Sanctis
- CNVT and Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Hopital Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, GHU-Paris-Nord, APHP, 2 Rue Ambroise Paré, 75010, Paris, France
| | - C Machado
- CNVT and Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Hopital Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, GHU-Paris-Nord, APHP, 2 Rue Ambroise Paré, 75010, Paris, France
| | - A Taleb
- CNVT and Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Hopital Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, GHU-Paris-Nord, APHP, 2 Rue Ambroise Paré, 75010, Paris, France
| | - D Herve
- CNVT and Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Hopital Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, GHU-Paris-Nord, APHP, 2 Rue Ambroise Paré, 75010, Paris, France
| | - N Dias-Gastellier
- CNVT and Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Hopital Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, GHU-Paris-Nord, APHP, 2 Rue Ambroise Paré, 75010, Paris, France
| | - H Chabriat
- CNVT and Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Hopital Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, GHU-Paris-Nord, APHP, 2 Rue Ambroise Paré, 75010, Paris, France. .,INSERM U1141-FHU-NeuroVasc, Paris, France.
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2
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Lebenberg J, Guichard JP, Guillonnet A, Hervé D, Alili N, Taleb A, Dias-Gastellier N, Chabriat H, Jouvent E. The Epidermal Growth Factor Domain of the Mutation Does Not Appear to Influence Disease Progression in CADASIL When Brain Volume and Sex Are Taken into Account. AJNR Am J Neuroradiol 2022; 43:715-720. [PMID: 35487587 PMCID: PMC9089269 DOI: 10.3174/ajnr.a7499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE By studying the evolution of brain volume across the life span in male and female patients, we aimed to understand how sex, brain volume, and the epidermal growth factor repeat domain of the mutation, the 3 major determinants of disability in CADASIL, interact in driving disease evolution. MATERIALS AND METHODS We used validated methods to model the evolution of normalized brain volume with age in male and female patients using nonparametric regression in a large, monocentric cohort with prospectively collected clinical and high-resolution MR imaging data. We used k-means clustering to test for the presence of different clinical course profiles. RESULTS We included 229 patients (mean age, 53 [SD, 12] years; 130 women). Brain volume was larger in women (mean size, 1024 [SD, 62] cm3 versus 979 [SD, 50] cm3; P < .001) and decreased regularly. In men, the relationship between brain volume and age unexpectedly suggested an increase in brain volume around midlife. Cluster analyses showed that this finding was related to the presence of a group of older male patients with milder symptoms and larger brain volumes, similar to findings of age-matched women. This group did not show specific epidermal growth factor repeat domain distribution. CONCLUSIONS Our results demonstrate a detrimental effect of male sex on brain volume throughout life in CADASIL. We identified a subgroup of male patients whose brain volume and clinical outcomes were similar to those of age-matched women. They did not have a specific distribution of the epidermal growth factor repeat domain, suggesting that yet-unidentified predictors may interact with sex and brain volume in driving disease evolution.
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Affiliation(s)
- J Lebenberg
- the Centre de Neurologie Vasculaire Translationel (J.L., D.H., N.A., A.T., N.D.-G., H.C.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiere, Paris, France; L'Institut National de la Santé et de la RechercheMédicale INSERM U1141, Université Paris Cité, Paris, France
- Federation Hospitalo-Universitaire NeuroVasc (J.L., N.D.-G., D.H., H.C., E.J.), Paris, France
| | | | | | - D Hervé
- the Centre de Neurologie Vasculaire Translationel (J.L., D.H., N.A., A.T., N.D.-G., H.C.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiere, Paris, France; L'Institut National de la Santé et de la RechercheMédicale INSERM U1141, Université Paris Cité, Paris, France
- Federation Hospitalo-Universitaire NeuroVasc (J.L., N.D.-G., D.H., H.C., E.J.), Paris, France
| | - N Alili
- the Centre de Neurologie Vasculaire Translationel (J.L., D.H., N.A., A.T., N.D.-G., H.C.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiere, Paris, France; L'Institut National de la Santé et de la RechercheMédicale INSERM U1141, Université Paris Cité, Paris, France
| | - A Taleb
- the Centre de Neurologie Vasculaire Translationel (J.L., D.H., N.A., A.T., N.D.-G., H.C.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiere, Paris, France; L'Institut National de la Santé et de la RechercheMédicale INSERM U1141, Université Paris Cité, Paris, France
| | - N Dias-Gastellier
- the Centre de Neurologie Vasculaire Translationel (J.L., D.H., N.A., A.T., N.D.-G., H.C.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiere, Paris, France; L'Institut National de la Santé et de la RechercheMédicale INSERM U1141, Université Paris Cité, Paris, France
- Federation Hospitalo-Universitaire NeuroVasc (J.L., N.D.-G., D.H., H.C., E.J.), Paris, France
| | - H Chabriat
- the Centre de Neurologie Vasculaire Translationel (J.L., D.H., N.A., A.T., N.D.-G., H.C.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiere, Paris, France; L'Institut National de la Santé et de la RechercheMédicale INSERM U1141, Université Paris Cité, Paris, France
- Federation Hospitalo-Universitaire NeuroVasc (J.L., N.D.-G., D.H., H.C., E.J.), Paris, France
| | - E Jouvent
- From the Department of Neurology (E.J.)
- Federation Hospitalo-Universitaire NeuroVasc (J.L., N.D.-G., D.H., H.C., E.J.), Paris, France
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3
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Bersano A, Kraemer M, Burlina A, Mancuso M, Finsterer J, Sacco S, Salvarani C, Caputi L, Chabriat H, Oberstein SL, Federico A, Tournier-Lasserve E, Hunt D, Dichgans M, Arnold M, Debette S, Markus HS. Correction to: Heritable and non-heritable uncommon causes of stroke. J Neurol 2020; 268:2808-2809. [PMID: 32556534 DOI: 10.1007/s00415-020-09948-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - M Kraemer
- Department of Neurology Alfried, Krupp-Hospital, Essen, Germany.,Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - A Burlina
- Neurological Unit, St. Bassano Hospital, Bassano del Grappa, Italy
| | - M Mancuso
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - J Finsterer
- Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria
| | - S Sacco
- Department of Neurology, Avezzano Hospital, University of L'Aquila, L'Aquila, Italy
| | - C Salvarani
- University of Modena and Reggio Emilia, and Azienda USL-IRCCS, Reggio Emilia, Italy
| | - L Caputi
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - H Chabriat
- Department of Neurology and CERVCO, DHU Neurovasc, INSERM U1141, University of Paris, Paris, France
| | - S Lesnik Oberstein
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - A Federico
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - E Tournier-Lasserve
- Department of Genetics, Lariboisière Hospital and INSERM U1141, Paris-Diderot University, Paris, France
| | - D Hunt
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - M Dichgans
- Institute for Stroke and Dementia Research, Klinikum Der Universität München, Munich, Germany
| | - M Arnold
- Inserm Centre Bordeaux Population Health (U1219), University of Bordeaux, Bordeaux, France
| | - S Debette
- Department of Neurology, INSELSPITAL, University Hospital Bern, Bern, Switzerland
| | - H S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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4
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Mancuso M, Arnold M, Bersano A, Burlina A, Chabriat H, Debette S, Enzinger C, Federico A, Filla A, Finsterer J, Hunt D, Lesnik Oberstein S, Tournier-Lasserve E, Markus HS. Monogenic cerebral small-vessel diseases: diagnosis and therapy. Consensus recommendations of the European Academy of Neurology. Eur J Neurol 2020; 27:909-927. [PMID: 32196841 DOI: 10.1111/ene.14183] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Guidelines on monogenic cerebral small-vessel disease (cSVD) diagnosis and management are lacking. Endorsed by the Stroke and Neurogenetics Panels of the European Academy of Neurology, a group of experts has provided recommendations on selected monogenic cSVDs, i.e. cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL), autosomal dominant High Temperature Requirement A Serine Peptidase 1 (HTRA1), cathepsin-A-related arteriopathy with strokes and leukoencephalopathy (CARASAL), pontine autosomal dominant microangiopathy and leukoencephalopathy (PADMAL), Fabry disease, mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) and type IV collagen (COL4)A1/2. METHODS We followed the Delphi methodology to provide recommendations on several unanswered questions related to monogenic cSVD, including genetic testing, clinical and neuroradiological diagnosis, and management. RESULTS We have proposed 'red-flag' features suggestive of a monogenic disease. General principles applying to the management of all cSVDs and specific recommendations for the individual forms of monogenic cSVD were agreed by consensus. CONCLUSIONS The results provide a framework for clinicians involved in the diagnosis and management of monogenic cSVD. Further multicentre observational and treatment studies are still needed to increase the level of evidence supporting our recommendations.
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Affiliation(s)
- M Mancuso
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - M Arnold
- Department of Neurology, INSELSPITAL, University Hospital Bern, Bern, Switzerland
| | - A Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - A Burlina
- Neurological Unit, St. Bassiano Hospital, Bassano del Grappa, Italy
| | - H Chabriat
- Department of Neurology and CERVCO, DHU Neurovasc, INSERM U1141, University of Paris, Paris, France
| | - S Debette
- Department of Neurology, INSERM Centre Bordeaux Population Health (U1219), Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - C Enzinger
- Department of Neurology and Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - A Federico
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - A Filla
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Napoli, Italy
| | - J Finsterer
- Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria
| | - D Hunt
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - S Lesnik Oberstein
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - E Tournier-Lasserve
- Department of Genetics, Lariboisière Hospital and INSERM U1141, Paris-Diderot University, Paris, France
| | - H S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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5
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Chabriat H, Joutel A, Tournier‐Lasserve E, Bousser MG. CADASIL: yesterday, today, tomorrow. Eur J Neurol 2020; 27:1588-1595. [DOI: 10.1111/ene.14293] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/28/2020] [Indexed: 12/27/2022]
Affiliation(s)
- H. Chabriat
- Department of Neurology and CERVCO Reference Center for Rare Vascular Diseases of the Eye and Brain Hôpital Lariboisiére, APHP Paris France
- INSERM U 1141 Paris France
- University of Paris Paris France
| | - A. Joutel
- University of Paris Paris France
- Institute of Psychiatry and Neurosciences of Paris INSERM U1266 Paris France
| | - E. Tournier‐Lasserve
- INSERM U 1141 Paris France
- University of Paris Paris France
- Molecular Genetics Department and CERVCO Reference Center for Rare Vascular Diseases of the Eye and Brain Hopital Lariboisiére, APHP Paris France
| | - M. G. Bousser
- Department of Neurology and CERVCO Reference Center for Rare Vascular Diseases of the Eye and Brain Hôpital Lariboisiére, APHP Paris France
- University of Paris Paris France
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Bersano A, Kraemer M, Burlina A, Mancuso M, Finsterer J, Sacco S, Salvarani C, Caputi L, Chabriat H, Oberstein SL, Federico A, Lasserve ET, Hunt D, Dichgans M, Arnold M, Debette S, Markus HS. Heritable and non-heritable uncommon causes of stroke. J Neurol 2020; 268:2780-2807. [PMID: 32318851 DOI: 10.1007/s00415-020-09836-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/15/2022]
Abstract
Despite intensive investigations, about 30% of stroke cases remains of undetermined origin. After exclusion of common causes of stroke, there is a number of rare heritable and non-heritable conditions, which often remain misdiagnosed, that should be additionally considered in the diagnosis of cryptogenic stroke. The identification of these diseases requires a complex work up including detailed clinical evaluation for the detection of systemic symptoms and signs, an adequate neuroimaging assessment and a careful family history collection. The task becomes more complicated by phenotype heterogeneity since stroke could be the primary or unique manifestation of a syndrome or represent just a manifestation (sometimes minor) of a multisystem disorder. The aim of this review paper is to provide clinicians with an update on clinical and neuroradiological features and a set of practical suggestions for the diagnostic work up and management of these uncommon causes of stroke. The identification of these stroke causes is important to avoid inappropriate and expensive diagnostic tests, to establish appropriate management measures, including presymptomatic testing, genetic counseling, and, if available, therapy. Therefore, physicians should become familiar with these diseases to provide future risk assessment and family counseling.
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Affiliation(s)
- A Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - M Kraemer
- Department of Neurology Alfried, Krupp-Hospital, Essen, Germany.,Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - A Burlina
- Neurological Unit, St. Bassano Hospital, Bassano del Grappa, Italy
| | - M Mancuso
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - J Finsterer
- Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria
| | - S Sacco
- Department of Neurology, Avezzano Hospital, University of L'Aquila, L'Aquila, Italy
| | - C Salvarani
- University of Modena and Reggio Emilia, and Azienda USL-IRCCS, Reggio Emilia, Italy
| | - L Caputi
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - H Chabriat
- Department of Neurology and CERVCO, DHU Neurovasc, INSERM U1141, University of Paris, Paris, France
| | - S Lesnik Oberstein
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - A Federico
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - E Tournier Lasserve
- Department of Genetics, Lariboisière Hospital and INSERM U1141, Paris-Diderot University, Paris, France
| | - D Hunt
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - M Dichgans
- Institute for Stroke and Dementia Research, Klinikum Der Universität München, Munich, Germany
| | - M Arnold
- Inserm Centre Bordeaux Population Health (U1219), University of Bordeaux, Bordeaux, France
| | - S Debette
- Department of Neurology, INSELSPITAL, University Hospital Bern, Bern, Switzerland
| | - H S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Chabriat H, Jouvent E. Imaging of the aging brain and development of MRI signal abnormalities. Rev Neurol (Paris) 2020; 176:661-669. [PMID: 32229042 DOI: 10.1016/j.neurol.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/14/2019] [Accepted: 12/16/2019] [Indexed: 02/04/2023]
Abstract
Major changes occur at the cerebral level with aging. Cerebral atrophy develops progressively. Multiple lesions related to small-vessel diseases are detected in association with cerebral atrophy including white-matter hyperintensities, lacunes, microbleeds, dilated perivascular spaces and cerebral, including cortex, atrophy. The clinical impact and predictive value of these Imaging makers were examined.
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Affiliation(s)
- H Chabriat
- Inserm U1161 and DHU NeuroVasc, department of neurology, Paris University, Lariboisiere Hospital,Assistance Publique-Hopitaux de Paris, Paris, France.
| | - E Jouvent
- Inserm U1161 and DHU NeuroVasc, department of neurology, Paris University, Lariboisiere Hospital,Assistance Publique-Hopitaux de Paris, Paris, France
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8
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Girard-Stein L, Dumurgier J, Paquet C, Chabriat H. Clinical features related to CSF level of amyloid Aβ42 and Aβ40 proteins in presence of lobar microbleeds. Rev Neurol (Paris) 2020; 176:864-867. [PMID: 32183983 DOI: 10.1016/j.neurol.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/20/2020] [Accepted: 02/07/2020] [Indexed: 10/24/2022]
Abstract
In presence of lobar microbleeds, the exact clinical features related to the level of Aβ42, Aβ40 and to the Aβ40/Aβ42 ratio in the cerebrospinal fluid (CSF) are poorly known. We analyzed in 28 consecutive patients with such lesions, whose clinical or additional magnetic resonance imaging features are related to these biomarkers. The results showed that the presence of absence of hypertension, the extent or the antero-posterior distribution of white matter hyperintensities, the presence or absence of vascular lesions in the deepest parts of the brain, and the presence of dementia are related to variations of Aβ42, Aβ40 or of the Aβ40/Aβ42 ratio in the cerebrospinal fluid.
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Affiliation(s)
- L Girard-Stein
- Département de Neurologie, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; Centre de Neurologie Cognitive, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - J Dumurgier
- Centre de Neurologie Cognitive, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; Inserm NeuroDiderot (U1141), GenMedStroke Lab Université Paris Diderot, Faculté de Médecine-Site Villemin, 10, avenue de Verdun, 75010 Paris, France
| | - C Paquet
- Centre de Neurologie Cognitive, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; Inserm NeuroDiderot (U1141), GenMedStroke Lab Université Paris Diderot, Faculté de Médecine-Site Villemin, 10, avenue de Verdun, 75010 Paris, France
| | - H Chabriat
- Département de Neurologie, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; Centre de Neurologie Cognitive, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France.
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Osman O, Labrune P, Reiner P, Sarov M, Nasser G, Riant F, Tournier-lasserve E, Chabriat H, Denier C. Leukoencephalopathy with calcifications and cysts (LCC): 5 cases and literature review. Rev Neurol (Paris) 2020; 176:170-179. [DOI: 10.1016/j.neurol.2019.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 11/25/2022]
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10
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Brice S, Jabouley A, Reyes S, Machado C, Rogan C, Gastellier N, Chabriat H, Tezenas du Montcel S. Profil évolutif cognitif au cours de l’angiopathie Cadasil. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hervé D, Kossorotoff M, Bresson D, Blauwblomme T, Carneiro M, Touze E, Proust F, Desguerre I, Alamowitch S, Bleton JP, Borsali A, Brissaud E, Brunelle F, Calviere L, Chevignard M, Geffroy-Greco G, Faesch S, Habert MO, De Larocque H, Meyer P, Reyes S, Thines L, Tournier-Lasserve E, Chabriat H. French clinical practice guidelines for Moyamoya angiopathy. Rev Neurol (Paris) 2018. [PMID: 29519672 DOI: 10.1016/j.neurol.2017.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Roriz M, Crassard I, Lechtman S, Saadoun D, Champion K, Wechsler B, Chabriat H, Sène D. Can anticoagulation therapy in cerebral venous thrombosis associated with Behçet's disease be stopped without relapse? Rev Neurol (Paris) 2018. [PMID: 29523353 DOI: 10.1016/j.neurol.2017.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is as yet no consensus on the treatment of cerebral venous thrombosis (CVT) in Behçet's disease, and the place of anticoagulation is also still being debated. This report is of a series of seven patients with Behçet's disease (BD)-associated CVT, for which anticoagulation was stopped, and discusses the possibility of stopping anticoagulation during follow-up while receiving optimal treatment for BD. The diagnosis of BD was established during follow-up, which lasted a median of 120 [range: 60-1490] days after CVT diagnosis. The median duration of anticoagulation therapy was 29.5 months. On stopping anticoagulation, concomitant treatment then included colchicine, steroids and azathioprine, all introduced after BD was diagnosed. With a median follow-up of 25 months after anticoagulation interruption, only one relapse of CVT was observed. No relapse of CVT or other venous thrombosis was observed in the six patients treated by steroids associated with an immunosuppressant or colchicine. Our results emphasize that corticosteroids are essential for the treatment of BD-associated CVT, and that anticoagulant therapy may be safely stopped during follow-up in the presence of optimal BD treatment (steroids alone or with immunosuppressive drugs).
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Affiliation(s)
- M Roriz
- Internal Medicine Department, Lariboisière Hospital, Paris VII University, 2 rue Ambroise Paré, 75475 Paris, France.
| | - I Crassard
- Neurology Department, Lariboisière Hospital, Paris VII University, DHU NeuroVasc, 2 rue Ambroise Paré, 75475 Paris, France
| | - S Lechtman
- Internal Medicine Department, Lariboisière Hospital, Paris VII University, 2 rue Ambroise Paré, 75475 Paris, France
| | - D Saadoun
- Internal Medicine Department, La Pitié-Salpétrière Hospital, Paris VI University, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - K Champion
- Internal Medicine Department, Lariboisière Hospital, Paris VII University, 2 rue Ambroise Paré, 75475 Paris, France
| | - B Wechsler
- Internal Medicine Department, La Pitié-Salpétrière Hospital, Paris VI University, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - H Chabriat
- Neurology Department, Lariboisière Hospital, Paris VII University, DHU NeuroVasc, 2 rue Ambroise Paré, 75475 Paris, France
| | - D Sène
- Internal Medicine Department, Lariboisière Hospital, Paris VII University, 2 rue Ambroise Paré, 75475 Paris, France
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13
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Marques C, Roriz M, Chabriat H, Buffon-Porcher F, Cognat E. Differential diagnosis between sarcoidosis and granulomatosis with polyangiitis in a patient with leptomeningeal, cavernous sinus and pituitary lesions. QJM 2017; 110:691-692. [PMID: 29025147 DOI: 10.1093/qjmed/hcx135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Marques
- Department of Internal Medicine and Clinical Immunology, GH Pitié-Salpêtrière, APHP, Paris
| | - M Roriz
- Department of Internal Medicine, GH Saint-Louis Lariboisière Fernand-Widal, APHP, Paris
- University Paris Diderot-Paris 7, Paris
| | - H Chabriat
- University Paris Diderot-Paris 7, Paris
- Department of Neurology, GH Saint-Louis Lariboisière Fernand-Widal, APHP, Paris
- DHU NeuroVasc Sorbonne Paris-Cité
| | - F Buffon-Porcher
- Department of Neurology, GH Saint-Louis Lariboisière Fernand-Widal, APHP, Paris
- DHU NeuroVasc Sorbonne Paris-Cité
| | - E Cognat
- Cognitive Neurology Center, GH Saint-Louis Lariboisière Fernand-Widal, Paris
- INSERM UMR-S942, INSERM, Paris, France
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14
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Delorme S, De Guio F, Reyes S, Jabouley A, Chabriat H, Jouvent E. Reaction Time Is Negatively Associated with Corpus Callosum Area in the Early Stages of CADASIL. AJNR Am J Neuroradiol 2017; 38:2094-2099. [PMID: 28912283 DOI: 10.3174/ajnr.a5378] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/23/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Reaction time was recently recognized as a marker of subtle cognitive and behavioral alterations in the early clinical stages of CADASIL, a monogenic cerebral small-vessel disease. In unselected patients with CADASIL, brain atrophy and lacunes are the main imaging correlates of disease severity, but MR imaging correlates of reaction time in mildly affected patients are unknown. We hypothesized that reaction time is independently associated with the corpus callosum area in the early clinical stages of CADASIL. MATERIALS AND METHODS Twenty-six patients with CADASIL without dementia (Mini-Mental State Examination score > 24 and no cognitive symptoms) and without disability (modified Rankin Scale score ≤ 1) were compared with 29 age- and sex-matched controls. Corpus callosum area was determined on 3D-T1 MR imaging sequences with validated methodology. Between-group comparisons were performed with t tests or χ2 tests when appropriate. Relationships between reaction time and corpus callosum area were tested using linear regression modeling. RESULTS Reaction time was significantly related to corpus callosum area in patients (estimate = -7.4 × 103, standard error = 3.3 × 103, P = .03) even after adjustment for age, sex, level of education, and scores of depression and apathy (estimate = -12.2 × 103, standard error = 3.8 × 103, P = .005). No significant relationship was observed in controls. CONCLUSIONS Corpus callosum area, a simple and robust imaging parameter, appears to be an independent correlate of reaction time at the early clinical stages of CADASIL. Further studies will determine whether corpus callosum area can be used as an outcome in future clinical trials in CADASIL or in more prevalent small-vessel diseases.
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Affiliation(s)
- S Delorme
- From the University Paris Diderot (S.D., F.D.G., H.C., E.J.), Sorbonne Paris Cité, UMR-S 1161 INSERM, Paris, France
| | - F De Guio
- From the University Paris Diderot (S.D., F.D.G., H.C., E.J.), Sorbonne Paris Cité, UMR-S 1161 INSERM, Paris, France.,DHU NeuroVasc Sorbonne Paris Cité (F.D.G., H.C., E.J.), Paris, France
| | - S Reyes
- Department of Neurology (S.R., A.J., H.C., E.J.), AP-HP, Lariboisière Hospital, Paris, France
| | - A Jabouley
- Department of Neurology (S.R., A.J., H.C., E.J.), AP-HP, Lariboisière Hospital, Paris, France
| | - H Chabriat
- From the University Paris Diderot (S.D., F.D.G., H.C., E.J.), Sorbonne Paris Cité, UMR-S 1161 INSERM, Paris, France.,DHU NeuroVasc Sorbonne Paris Cité (F.D.G., H.C., E.J.), Paris, France.,Department of Neurology (S.R., A.J., H.C., E.J.), AP-HP, Lariboisière Hospital, Paris, France
| | - E Jouvent
- From the University Paris Diderot (S.D., F.D.G., H.C., E.J.), Sorbonne Paris Cité, UMR-S 1161 INSERM, Paris, France .,DHU NeuroVasc Sorbonne Paris Cité (F.D.G., H.C., E.J.), Paris, France.,Department of Neurology (S.R., A.J., H.C., E.J.), AP-HP, Lariboisière Hospital, Paris, France
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Affiliation(s)
- L Bicart-Sée
- Department of Neurology, GH Saint-Louis-Lariboisière-Fernand Widal, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, F-75475 Paris, France
| | - M Roriz
- Department of Internal Medicine, GH Saint-Louis-Lariboisière-Fernand Widal, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot, F-75475 Paris, France
| | - H Chabriat
- Department of Neurology, GH Saint-Louis-Lariboisière-Fernand Widal, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, F-75475 Paris, France.
| | - F Buffon-Porcher
- Department of Neurology, GH Saint-Louis-Lariboisière-Fernand Widal, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, F-75475 Paris, France.
| | - E Cognat
- Department of Neurology, GH Saint-Louis-Lariboisière-Fernand Widal, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, F-75475 Paris, France.
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16
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Lyoubi-Idrissi AL, Jouvent E, Poupon C, Chabriat H. Diffusion magnetic resonance imaging in cerebral small vessel disease. Rev Neurol (Paris) 2017; 173:201-210. [PMID: 28392060 DOI: 10.1016/j.neurol.2017.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 12/04/2016] [Accepted: 03/09/2017] [Indexed: 01/13/2023]
Abstract
Cerebral small vessel disease (SVD) is frequent in the elderly, and accounts for a wide spectrum of clinical and radiological manifestations. This report summarizes the most important findings obtained using diffusion MRI (DWI) in SVD. With DWI and apparent diffusion coefficient (ADC) maps, recent ischemic lesions can easily be detected after acute stroke in SVD, while even multiple simultaneous lesions may be observed. Microstructural changes are frequent in SVD, with increases in diffusivity and decreases in anisotropy being the most reliable findings observed, mainly in white matter. These tissue changes are associated with clinical severity and especially executive dysfunction. They can also precede the usual MRI markers of SVD, such as white matter hyperintensities, microbleeds and lacunes. Thus, DWI may reveal surrogate markers of SVD progression and offer a better understanding of their underlying mechanisms.
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Affiliation(s)
- A L Lyoubi-Idrissi
- Department of Neurology, université de Paris Denis Didérot, DHU NeuroVasc Sorbonne Paris-Cité, GH Saint-Louis-Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; CEA, Neurospin, 91191 Gif-sur-Yvette, France.
| | - E Jouvent
- Department of Neurology, université de Paris Denis Didérot, DHU NeuroVasc Sorbonne Paris-Cité, GH Saint-Louis-Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; CEA, Neurospin, 91191 Gif-sur-Yvette, France; Inserm UMR 1161, faculté de médecine, Villemin, 75010 Paris, France
| | - C Poupon
- CEA, Neurospin, 91191 Gif-sur-Yvette, France
| | - H Chabriat
- Department of Neurology, université de Paris Denis Didérot, DHU NeuroVasc Sorbonne Paris-Cité, GH Saint-Louis-Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; CEA, Neurospin, 91191 Gif-sur-Yvette, France; Inserm UMR 1161, faculté de médecine, Villemin, 75010 Paris, France
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17
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Seiler S, Pirpamer L, Gesierich B, Hofer E, Duering M, Pinter D, Jouvent E, Fazekas F, Mangin JF, Chabriat H, Ropele S, Schmidt R. Lower Magnetization Transfer Ratio in the Forceps Minor Is Associated with Poorer Gait Velocity in Older Adults. AJNR Am J Neuroradiol 2017; 38:500-506. [PMID: 27979793 DOI: 10.3174/ajnr.a5036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 10/12/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Gait disturbances in the elderly are disabling and a major public health issue but are poorly understood. In this multimodal MR imaging study, we used 2 voxel-based analysis methods to assess the voxelwise relationship of magnetization transfer ratio and white matter hyperintensity location with gait velocity in older adults. MATERIALS AND METHODS We assessed 230 community-dwelling participants of the Austrian Stroke Prevention Family Study. Every participant underwent 3T MR imaging, including magnetization transfer imaging. Voxel-based magnetization transfer ratio-symptom mapping correlated the white matter magnetization transfer ratio of each voxel with gait velocity. To assess a possible relationship between white matter hyperintensity location and gait velocity, we applied voxel-based lesion-symptom mapping. RESULTS We found a significant association between the magnetization transfer ratio within the forceps minor and gait velocity (β = 0.134; 95% CI, 0.011-0.258; P = .033), independent of demographics, general physical performance, vascular risk factors, and brain volume. White matter hyperintensities did not significantly change this association. CONCLUSIONS Our study provides new evidence for the importance of magnetization transfer ratio changes in gait disturbances at an older age, particularly in the forceps minor. The histopathologic basis of these findings is yet to be determined.
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Affiliation(s)
- S Seiler
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| | - L Pirpamer
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| | - B Gesierich
- Institute for Stroke and Dementia Research (B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - E Hofer
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
- Institute of Medical Informatics, Statistics and Documentation (E.H.), Medical University of Graz, Graz, Austria
| | - M Duering
- Institute for Stroke and Dementia Research (B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - D Pinter
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| | - E Jouvent
- Department of Neurology (E.J., H.C.), Institut National de la Santé et de la Recherche Médicale, UMR-740, Centre Hospitalo-Universitaire Lariboisière, Paris, France
| | - F Fazekas
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| | - J-F Mangin
- Neurospin (J.-F.M.), Commissariat à l'Energie Atomique et aux Energies Alternatives Saclay, Gif/Yvette, France
| | - H Chabriat
- Department of Neurology (E.J., H.C.), Institut National de la Santé et de la Recherche Médicale, UMR-740, Centre Hospitalo-Universitaire Lariboisière, Paris, France
| | - S Ropele
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| | - R Schmidt
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
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18
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Quintaine V, Chabriat H, Jouvent E, Yelnik A. MRI ameliorates the prediction of further clinical evolution even months after ischemic stroke. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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De Guio F, Reyes S, Duering M, Pirpamer L, Chabriat H, Jouvent E. Decreased T1 contrast between gray matter and normal-appearing white matter in CADASIL. AJNR Am J Neuroradiol 2014; 35:72-6. [PMID: 23868154 DOI: 10.3174/ajnr.a3639] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CADASIL is the most frequent hereditary small-vessel disease of the brain. The clinical impact of various MR imaging markers has been repeatedly studied in this disorder, but alterations of contrast between gray matter and normal-appearing white matter remain unknown. The aim of this study was to evaluate the contrast alterations between gray matter and normal-appearing white matter on T1-weighted images in patients with CADASIL compared with healthy subjects. MATERIALS AND METHODS Contrast between gray matter and normal-appearing white matter was assessed by using histogram analyses of 3D T1 high-resolution MR imaging in 23 patients with CADASIL at the initial stage of the disease (Mini-Mental State Examination score > 24 and modified Rankin scale score ≤ 1; mean age, 53.5 ± 11.1 years) and 30 age- and sex-matched controls. RESULTS T1 contrast between gray matter and normal-appearing white matter was significantly reduced in patients compared with age- and sex-matched controls (patients: 1.35 ± 0.08 versus controls: 1.43 ± 0.04, P < 10(-5)). This reduction was mainly driven by a signal decrease in normal-appearing white matter. Contrast loss was strongly related to the volume of white matter hyperintensities. CONCLUSIONS Conventional 3D T1 imaging shows significant loss of contrast between gray matter and normal-appearing white matter in CADASIL. This probably reflects tissue changes in normal-appearing white matter outside signal abnormalities on T2 or FLAIR sequences. These contrast alterations should be taken into account for image interpretation and postprocessing.
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Affiliation(s)
- F De Guio
- From University Paris Diderot, Sorbonne Paris Cité, Paris, France
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20
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Gobron C, Erginay A, Massin P, Lutz G, Tessier N, Vicaut E, Chabriat H. Microvascular retinal abnormalities in acute intracerebral haemorrhage and lacunar infarction. Rev Neurol (Paris) 2013; 170:13-8. [PMID: 24269117 DOI: 10.1016/j.neurol.2013.07.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 07/10/2013] [Accepted: 07/18/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Retinal microvascular changes have been previously associated with cerebral MRI markers of small vessel disease (SVD). Whether retinal changes differ between patient with intracerebral haemorrhage (ICH) and patients with lacunar infarction (LI) caused by small vessel disease has been poorly investigated. OBJECTIVE The study aims to compare the frequency of retinal changes between patients with LI and patients with ICH at the acute stage of stroke-related SVD. METHODS Microvascular wall signs (arteriolar occlusion, arteriovenous nicking, focal arterial narrowing) and retinopathy lesions (microanevrysms, cotton wool spots, retinal haemorrhages, hard exudates) were assessed by retinography up to three months after stroke onset. RESULTS Forty-eight non-diabetic patients with acute stroke-related to SVD (26 LI, 22 ICH) were recruited prospectively in the study. Retinal wall signs (arteriovenous nicking, and focal arterial narrowing) were found in more than three quarters of subjects and most often bilaterally in both groups. Retinopathy lesions (cotton wool spots, retinal haemorrhages) were found more frequently in ICH patients than in LI patients (22.2% vs. 15.4%, 50% vs. 34% respectively, P>0.005). The frequency of bilateral cotton wool spots and of bilateral retinal haemorrhages was significantly higher in ICH patients than in LI patients (12.5% vs. 0%, P=0.012, 41.2% vs. 7.7%, P=0.029 respectively). CONCLUSION These results confirm the high frequency of microvascular alterations in patients with hypertension-related SVD leading to LI or ICH and suggest that retinal tissue alterations are more frequent in ICH than in LI. Further investigations are needed to investigate the mechanisms underlying this difference.
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Affiliation(s)
- C Gobron
- Physiological department, CHU Lariboisière Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Neurology department and stroke unit, CHU Lariboisière Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - A Erginay
- Ophthalmology department, CHU Lariboisiere Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - P Massin
- Ophthalmology department, CHU Lariboisiere Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - G Lutz
- Neurology department and stroke unit, CHU Lariboisière Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - N Tessier
- Clinical research unit, CHU Lariboisière Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré 75475 Paris cedex 10, France
| | - E Vicaut
- Clinical research unit, CHU Lariboisière Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré 75475 Paris cedex 10, France
| | - H Chabriat
- Neurology department and stroke unit, CHU Lariboisière Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Inserm U740, faculty of medicine, university Paris Diderot, Paris, France.
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Chabriat H, Maeder P, Gass A, Michel P, Bracoud L, Hennerici MG. Results of the PERFORM magnetic resonance imaging study. J Neurol 2013; 260:3071-6. [DOI: 10.1007/s00415-013-7111-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 09/10/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
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Stapf C, Hervé D, Guichard JP, Bresson D, Soumaré A, Tzourio C, Riant F, Tournier-Lasserve E, Chabriat H, Schneble HM. Abstract 183: Antithrombotic Therapy and Bleeding Risk in a Prospective Cohort Study of Patients with Cerebral Cavernous Malformations (CCM). Stroke 2013. [DOI: 10.1161/str.44.suppl_1.a183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND:
Cerebral cavernous malformation (CCM) are the most frequently diagnosed vascular malformations in the brain and are often asymptomatic. The potential risk of hemorrhage often precludes antithrombotic treatment in patients with cardiovascular disease, but no systematic study has been undertaken to evaluate the effect of blood-thinning therapy on the risk of CCM hemorrhage.
PATIENTS AND METHODS:
We prospectively followed consecutive patients with a diagnosis of one or more CCMs in a prospective database since 2008. Retrospective data collection was used for patients with a diagnostic event or imaging studies done prior to first assessment. Symptomatic hemorrhage and other focal neurological events during prospective follow-up were defined according to the current guidelines of the Angioma Alliance Scientific Advisory board
RESULTS:
A total of 87 patients were prospectively enrolled in our cohort (50 women (57%), mean age 44.8 years (SD +/- 17.6), mean follow up 3.9 years) harboring a total of 738 CCMs. N=55 patients (63%) had a single CCM, and 32 patients (37%) had multiple CCMs. Longitudinal follow-up included 16 (18%) patients receiving long-term antithrombotic therapy by antiplatelet treatment (n=11) or oral anticoagulants (n=5). During 5536 lesion-years of observation, none of the patients under antithrombotic therapy experienced CCM hemorrhage on follow up.
CONCLUSION:
Our observational data suggest long-term antithrombotic treatment by antiplatelet drugs or warfarin does not increase the frequency of CCM-related hemorrhage. Patients harboring single or multiple CCMs suffering ischemic stroke or heart disease should not be withheld antithrombotic therapy.
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Affiliation(s)
- C Stapf
- Hôpital Lariboisière, Paris, France
| | - D Hervé
- Hôpital Lariboisière, Paris, France
| | | | - D Bresson
- Hôpital Lariboisière, Paris, France
| | | | | | - F Riant
- Hôpital Lariboisière, Paris, France
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Schneble HM, Reiner P, Guichard JP, Bresson D, Chabriat H, Stapf C. Abstract TP298: Acute Intracerebral Hemorrhage: Prospective Evaluation ofaA Pragmatic Stepwise Diagnostic Algorithm for Underlying Vascular Pathologies. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.atp298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND:
Intracerebral hemorrhage (ICH) is one of the deadliest form of stroke, but the diagnostic work-up has only been insufficiently defined. We tested the unsefulness of a pragmatic step-wise diagnostic algorithm including CT/CTA, MRI/MRA, and digital subtraction angiography (DSA) on the detection of acutely treatment-relevant underlying pathologies.
PATIENTS AND METHODS:
We analyzed 114 consecutive patients (42% women, mean age 66 years +/-12) hospitalized for spontaneous ICH. All patients had initial CT with or without CTA. Those without evident underlying cause and no contraindication underwent MRI/MRA. Finally, diagnostic DSA was performed in cases without evident ICH etiology on prior imaging.
RESULTS:
Of the 114 ICH patients, 2 showed deep ICH with CT evidence of severe small vessel disease. In 2 cases, CTA revealed cerebral venous thrombosis. The remaining 107 (95%) patients without contraindication (n=2 had a pacemaker) underwent subsequent MRI/MRA allowing detection of underlying small vessel disease in 36 (32%) and 14 (12%) with acutely treatment relevant pathology: one cerebral venous thrombosis, six secondary hemorrhagic infarcts, three cavernous malformations, two brain tumors, and two patients had reversible acute vasoconstriction syndrome. Fifty-seven patients (50%) remained without diagnosis of any underlying pathology and underwent DSA revealing 2 dural arteriovenous fistula, 2 arteriovenous malformation, 1 moyamoya syndrome, 1 ruptured aneurysm, and 1 acute cerebral vasoconstriction syndrome.
CONCLUSION:
Our findings suggest the diagnostic sensitivity of brain CT alone is insufficient for the diagnostic work-up in ICH patients. A pragmatic, stepwise imaging algorithm based on additional CTA, MRI/MRA and DSA lead to the diagnosis of an underlying pathology in 52%, including the detection of acutely treatment-relevant pathologies in 19% (22 of 114 patients).
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Affiliation(s)
| | - P Reiner
- Hôpital Lariboisière, Paris, France
| | | | - D Bresson
- Hôpital Lariboisière, Paris, France
| | | | - C Stapf
- Hôpital Lariboisière, Paris, France
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Reiner P, Crassard I, Roos C, Rossignol M, Guichard JP, Chabriat H, Bousser MG. Cerebral Venous Thrombosis and Spontaneous Intracranial Hypotension (S39.003). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s39.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Reyes S, Kurtz A, Hervé D, Tournier-Lasserve E, Chabriat H. Presymptomatic genetic testing in CADASIL. J Neurol 2012; 259:2131-6. [PMID: 22418996 DOI: 10.1007/s00415-012-6468-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 02/22/2012] [Accepted: 02/22/2012] [Indexed: 10/28/2022]
Abstract
Genetic counselling has been poorly investigated in cerebrovascular diseases. Characteristics, motivations and long-term outcome of presymptomatic tests (PT) in subjects at risk of CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) were investigated at the National Centre for Rare Vascular Diseases of the Brain and/or Retina (CERVCO). Sociodemographic, motivational and psychological variables were collected between 2003 and 2010 for PT applicants. Multidisciplinary consultations (with a geneticist, neurologist and psychologist) were proposed over a 6 month period. When PT showed a deleterious mutation of the NOTCH3 gene, cognitive performances, mood, autonomy and quality of life were also assessed. Over 7 years, only 33 subjects asked for a PT of CADASIL. They were predominantly women, lived as a couple, had children and were of high sociocultural level. The dropout rate after the first step of the procedure was 63%. The characteristics of the 11 subjects who reached the end of the procedure did not differ from the 22 who dropped out. Six were carriers of the deleterious mutation and were still asymptomatic after a mean follow-up of 19 months. They did not experience any particular negative event and all of them indicated a high score of overall quality of life. Indeed, two carriers gave birth to their first child. These initial data in CADASIL show that PT is rarely requested and that there is a high dropout rate. Our study also highlights that a multidisciplinary and multistep procedure in genetic counselling testing appears useful to obtain minimal harmful consequences of genetic testing.
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Affiliation(s)
- S Reyes
- Department of Neurology and CERVCO, GH Saint-Louis-Lariboisière-Fernand Widal, APHP et Université Paris, 7 Denis Diderot, Paris, France
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Kossorotoff M, Hervé D, Toulgoat F, Renaud C, Presles E, Chabriat H, Chabrier S. Paediatric moyamoya in mainland France: a comprehensive survey of academic neuropaediatric centres. Cerebrovasc Dis 2011; 33:76-9. [PMID: 22134052 DOI: 10.1159/000333424] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 09/09/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Epidemiological data of paediatric moyamoya disease/syndrome (MMD/MMS) in non-Asian populations are scarce. METHODS A questionnaire was sent to every French neuropaediatric academic centre to estimate the prevalence, incidence, familial form rate and location of paediatric MMD/MMS cases. Specific paediatric data were also retrieved from the most recent nationwide Japanese study. RESULTS A 100% response rate was obtained. The prevalence of paediatric MMD/MMS was estimated at 0.39/100,000 children (95% CI: 0.28-0.49), and the incidence was estimated at 0.065/100,000 children/year (95% CI: 0.025-0.12), with 7.5% familial cases. The prevalence was homogenous within the different administrative areas. CONCLUSIONS This comprehensive survey of MMD/MMS in academic neuropaediatric centres suggests that the prevalence of the disease in children in France is approximately 1/20th of that estimated in Asia.
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Affiliation(s)
- M Kossorotoff
- Paediatric Neurology Department, Hôpital Necker-Enfants Malades, APHP, Paris, France.
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Jouvent E, Reyes S, Mangin JF, Roca P, Perrot M, Thyreau B, Hervé D, Dichgans M, Chabriat H. Apathy is related to cortex morphology in CADASIL. A sulcal-based morphometry study. Neurology 2011; 76:1472-7. [PMID: 21518996 DOI: 10.1212/wnl.0b013e31821810a4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Apathy is a debilitating symptom in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), the pathophysiology of which remains poorly understood. The aim of this study was to evaluate the neuroanatomic correlates of apathy, using new MRI postprocessing methods based on the identification of cortical sulci, in a large cohort of patients with CADASIL. METHODS A total of 132 patients with genetically confirmed diagnosis were included in this prospective cohort study. Global cognitive performances were assessed by the Mattis Dementia Rating Scale (MDRS) and disability by the modified Rankin score (mRS). Apathy was defined according to standard criteria. Depth, width, and cortical thickness of 10 large sulci of the frontal lobe in each hemisphere were measured. Logistic regression modeling was used to evaluate the links between apathy and cortical thickness, depth, or width of the different sulci. All models were adjusted for age, gender, level of education, MDRS, mRS, depression, and global brain volume. RESULTS Complete MRI datasets of high quality were available in 119 patients. Depth of the posterior cingulate sulcus exhibited the strongest association with apathy in fully adjusted models (right: p value = 0.0006; left: p value = 0.004). Depth and width of cortical sulci in mediofrontal and orbitofrontal areas were independently associated with apathy. By contrast, cortical thickness was not. CONCLUSIONS Cortical morphology in mediofrontal and orbitofrontal areas, by contrast to cortical thickness, is strongly and independently associated with apathy. These results suggest that apathy is related to a reduction of cortical surface rather than of cortical thickness secondary to lesion accumulation in CADASIL.
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Affiliation(s)
- E Jouvent
- Service de Neurologie, Hôpital Lariboisière, 2 rue Ambroise Paré, Paris, France
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Zhu YC, Dufouil C, Mazoyer B, Soumaré A, Ricolfi F, Tzourio C, Chabriat H. Frequency and location of dilated Virchow-Robin spaces in elderly people: a population-based 3D MR imaging study. AJNR Am J Neuroradiol 2011; 32:709-13. [PMID: 21349956 DOI: 10.3174/ajnr.a2366] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE dVRS have been previously associated with aging and cerebrovascular diseases. However, little is known about their prevalence and topographic distribution in the general elderly population. MATERIALS AND METHODS dVRS were evaluated by using high-resolution 3D MR imaging in 1826 subjects enrolled in the 3C-Dijon MR imaging study. On T1-weighted MR imaging, dVRS were detected according to 3D imaging criteria and rated by using 4-level severity scores based in the BG or in the WM. The number and anatomic location of large dVRS (≥3 mm) were recorded. RESULTS dVRS were observed in the BG or WM in every subject. The severity of dVRS was significantly associated with higher age in both the BG and WM, whereas sex was related to the severity of dVRS only in the BG. Large dVRS were detected in 33.2% of participants. Status cribrosum was found in 1.3% of participants. dVRS were also highly prevalent within the hippocampus (44.5%) and hypothalamus (11.6%). CONCLUSIONS dVRS are always detected in the BG or WM in elderly people, and large dVRS are also prevalent. The topographic distribution of dVRS is not uniform within the brain and may depend on anatomic or pathologic characteristics interacting with aging and sex.
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Affiliation(s)
- Y-C Zhu
- From INSERM U708, Paris, France
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Maeder P, Bracoud L, Chabriat H, Gass A, Michel P, Hennerici M. Design, data management, and population baseline characteristics of the PERFORM magnetic resonance imaging project. J Neurol 2010; 258:795-803. [PMID: 21128081 PMCID: PMC3090565 DOI: 10.1007/s00415-010-5841-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 10/22/2010] [Accepted: 11/15/2010] [Indexed: 11/29/2022]
Abstract
Quantitative information from magnetic resonance imaging (MRI) may substantiate clinical findings and provide additional insight into the mechanism of clinical interventions in therapeutic stroke trials. The PERFORM study is exploring the efficacy of terutroban versus aspirin for secondary prevention in patients with a history of ischemic stroke. We report on the design of an exploratory longitudinal MRI follow-up study that was performed in a subgroup of the PERFORM trial. An international multi-centre longitudinal follow-up MRI study was designed for different MR systems employing safety and efficacy readouts: new T2 lesions, new DWI lesions, whole brain volume change, hippocampal volume change, changes in tissue microstructure as depicted by mean diffusivity and fractional anisotropy, vessel patency on MR angiography, and the presence of and development of new microbleeds. A total of 1,056 patients (men and women ≥ 55 years) were included. The data analysis included 3D reformation, image registration of different contrasts, tissue segmentation, and automated lesion detection. This large international multi-centre study demonstrates how new MRI readouts can be used to provide key information on the evolution of cerebral tissue lesions and within the macrovasculature after atherothrombotic stroke in a large sample of patients.
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Affiliation(s)
- P Maeder
- Centre Hospitalier Universitaire Vaudois, Service de Radiologie, Lausanne, Switzerland.
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Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a dominantly inherited small artery disease that leads to dementia and disability in mid-life. The clinical presentation of CADASIL is variable between and within affected families and is characterized by symptoms including migraine with aura, subcortical ischemic events, mood disturbances, apathy, and cognitive impairment. The mean age at onset of symptoms is 45 years, with variable duration of the disease ranging from 10 to 40 years. In 1996, linkage studies mapped and identified mutations in the NOTCH3 gene on chromosome 19 as causative in CADASIL. Head magnetic resonance imaging (MRI) is always abnormal in participants with NOTCH3 mutations after age 35. Magnetic resonance imaging shows on T2-weighted images or fluid attenuation inversion recovery (FLAIR) sequence, widespread areas of increased signal in the white matter associated with focal hyperintensities in basal ganglia, thalamus, and brainstem. The pathologic hallmark of CADASIL is the presence of electron-dense granules in the media of arterioles that can be identified by electron microscopic evaluation of skin biopsies.
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Affiliation(s)
- D Hervé
- Service de Neurologie, Centre de Référence des maladies Vasculaires rares du Cerveau et de l'Oeil (CERVCO), Hôpital Lariboisière, Paris, France.
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Troude P, Dozol A, Schneble HM, Houdart E, Chabriat H, Segouin C. Optimiser les scanners cérébraux à la phase aiguë de prise en charge des AVC en unités de soins intensifs dans un hôpital universitaire. Rev Epidemiol Sante Publique 2010. [DOI: 10.1016/j.respe.2010.02.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Teodorczuk A, Firbank MJ, Pantoni L, Poggesi A, Erkinjuntti T, Wallin A, Wahlund LO, Scheltens P, Waldemar G, Schrotter G, Ferro JM, Chabriat H, Bazner H, Visser M, Inzitari D, O'Brien JT. Relationship between baseline white-matter changes and development of late-life depressive symptoms: 3-year results from the LADIS study. Psychol Med 2010; 40:603-610. [PMID: 19671212 DOI: 10.1017/s0033291709990857] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Growing evidence suggests that cerebral white-matter changes and depressive symptoms are linked directly along the causal pathway. We investigated whether baseline severity of cerebral white-matter changes predict longer-term future depressive outcomes in a community sample of non-disabled older adults. METHOD In the Leukoaraiosis and Disability in the Elderly (LADIS) study, a longitudinal multi-centre pan-European study, 639 older subjects underwent baseline structural magnetic resonance imaging (MRI) and clinical assessments. Baseline severity of white-matter changes was quantified volumetrically. Depressive outcomes were assessed in terms of depressive episodes and depressive symptoms, as measured by the Geriatric Depression Scale (GDS). Subjects were clinically reassessed annually for up to 3 years. Regression models were constructed to determine whether baseline severity of white-matter changes predicted future depressive outcomes, after controlling for confounding factors. RESULTS Baseline severity of white-matter changes independently predicted depressive symptoms at both 2 (p<0.001) and 3 years (p=0.015). Similarly, white-matter changes predicted incident depression (p=0.02). Over the study period the population became significantly more disabled (p<0.001). When regression models were adjusted to account for the influence of the prospective variable transition to disability, baseline severity of white-matter changes no longer predicted depressive symptoms at 3 years (p=0.09) or incident depression (p=0.08). CONCLUSIONS Our results support the vascular depression hypothesis and strongly implicate white-matter changes in the pathogenesis of late-life depression. Furthermore, the findings indicate that, over time, part of the relationship between white-matter changes and depression may be mediated by loss of functional activity.
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Affiliation(s)
- A Teodorczuk
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne NE4 5PL, UK.
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Dumurgier J, Paquet C, Benisty S, Kiffel C, Lidy C, Mouton-Liger F, Chabriat H, Laplanche JL, Hugon J. Relations entre les biomarqueurs du LCR et le niveau d’études dans la maladie d’Alzheimer : impact de la réserve cognitive. Rev Neurol (Paris) 2010. [DOI: 10.1016/s0035-3787(10)70017-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mewald Y, Peters N, Zieren N, Düring M, Pachai C, Chabriat H, Dichgans M. The role of callosal volume as a MRI marker in subcortical ischaemic vascular dementia: a study in CADASIL. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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36
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Düring M, Peters N, Zieren N, Mewald Y, O'Sullivan M, Saemann P, Herve D, Olart E, Viswanathan A, Pachai C, Chabriat H, Dichgans M. Voxelbasierte Identifizierung strategischer Lakunen für die subkortikale ischämische vaskuläre Demenz. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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37
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Peters N, Zieren N, Düring M, Gschwendtner A, Pachai C, Chabriat H, Dichgans M. Depression as a confounding factor in subcortical ischaemic vascular dementia: results from a cross-sectional study in CADASIL. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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38
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Zieren N, Düring M, Gschwendtner A, Pachai C, Chabriat H, Dichgans M, Peters N. Impact of educational level and lesion volume on cognitive performance in subcortical ischaemic vascular dementia: a study in CADASIL. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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39
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Blahak C, Baezner H, Pantoni L, Poggesi A, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Langhorne P, O'Brien J, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D, Hennerici MG. Deep frontal and periventricular age related white matter changes but not basal ganglia and infratentorial hyperintensities are associated with falls: cross sectional results from the LADIS study. J Neurol Neurosurg Psychiatry 2009; 80:608-13. [PMID: 19204027 DOI: 10.1136/jnnp.2008.154633] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Global age related white matter changes (ARWMC) are associated with progressive gait disturbances and falls, hypothesised to result from interruptions of cortico-subcortical circuits controlling balance, posture and locomotion. METHODS The location of ARWMC in a large cohort of elderly non-disabled individuals with reported falls was analysed, using the cross sectional data of the Leukoaraiosis and Disability (LADIS) study. Detailed anatomical distributions of ARWMC assessed by MRI studies were analysed with respect to falls and balance performance. RESULTS The severity of global ARWMC was significantly associated with a history of falls in the year prior to study inclusion (22.2% in the mild, 31.6% in the moderate and 37.3% in the severe ARWMC group according to the Fazekas scale; p = 0.002). Analysing the anatomical distribution of ARWMC, using the semiquantitative Scheltens scale, in multivariate analysis, periventricular (p = 0.006) and frontal deep (p = 0.033) ARWMC were independently associated with falls. Furthermore, logistic regression identified frontal deep (p = 0.003) ARWMC, but not basal ganglia and infratentorial hyperintensities, as significantly associated with balance disturbances. CONCLUSION The association of frontal and periventricular ARWMC with falls supports the hypothesis that interruption of frontal subcortical motor circuits lead to balance disturbances and hence to an increased risk for falls in ARWMC.
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Affiliation(s)
- C Blahak
- Department of Neurology, Universitätsklinikum Mannheim, Theodor-Kutzer Ufer 1-3, D-68167 Mannheim, Germany.
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40
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Benisty S, Gouw AA, Porcher R, Madureira S, Hernandez K, Poggesi A, van der Flier WM, Van Straaten ECW, Verdelho A, Ferro J, Pantoni L, Inzitari D, Barkhof F, Fazekas F, Chabriat H. Location of lacunar infarcts correlates with cognition in a sample of non-disabled subjects with age-related white-matter changes: the LADIS study. J Neurol Neurosurg Psychiatry 2009; 80:478-83. [PMID: 19211595 DOI: 10.1136/jnnp.2008.160440] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In cerebral small vessel disease, white-matter hyperintensities (WMH) and lacunes are both related to cognition. Still, their respective contribution in older people remains unclear. The purpose of this study is to assess the topographic distribution of lacunes and determine whether it has an impact on cognitive functions in a sample of non-disabled patients with age-related white-matter changes. METHODS Data were drawn from the baseline evaluation of the LADIS (Leucoaraioisis and Disability study) cohort of non-disabled subjects beyond 65 years of age. The neuropsychological evaluation was based on the Mini Mental Status Examination (MMSE), a modified Alzheimer Diseases Assessment Scale for global cognitive functions, and compound Z scores for memory, executive functions, speed and motor control. WMH were rated according to the Fazekas scale; the number of lacunes was assessed in the following areas: lobar white matter, putamen/pallidum, thalamus, caudate nucleus, internal/external capsule, infratentorial areas. An analysis of covariance was performed after adjustment for possible confounders. RESULTS Among 633 subjects, 47% had at least one lacune (31% at least one within basal ganglia). The presence of lacunes in the thalamus was associated with lower scores of MMSE (beta = -0.61; p = 0.043), and worse compound scores for speed and motor control (beta = -0.25; p = 0.006), executive functions (beta = -0.19; p = 0.022) independently of the cognitive impact of WMH. There was also a significant negative association between the presence of lacunes in putamen/pallidum and the memory compound Z score (beta = -0.13; p = 0.038). By contrast, no significant negative association was found between cognitive parameters and the presence of lacunes in internal capsule, lobar white matter and caudate nucleus. CONCLUSION In non-disabled elderly subjects with leucoaraisosis, the location of lacunes within subcortical grey matter is a determinant of cognitive impairment, independently of the extent of WMH.
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Affiliation(s)
- S Benisty
- Department of Neurology, Lariboisière-Fernand Widal Hospital, APHP, Paris, France
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Reyes S, Viswanathan A, Godin O, Dufouil C, Benisty S, Hernandez K, Kurtz A, Jouvent E, O'Sullivan M, Czernecki V, Bousser MG, Dichgans M, Chabriat H. Apathy: A major symptom in CADASIL. Neurology 2009; 72:905-10. [DOI: 10.1212/01.wnl.0000344166.03470.f8] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Arnold M, Pannier B, Chabriat H, Nedeltchev K, Stapf C, Buffon F, Crassard I, Thomas F, Guize L, Baumgartner RW, Bousser MG. Vascular risk factors and morphometric data in cervical artery dissection: a case-control study. J Neurol Neurosurg Psychiatry 2009; 80:232-4. [PMID: 19151021 DOI: 10.1136/jnnp.2008.151324] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Limited knowledge exists on vascular risk factors, body height and weight in patients with spontaneous cervical artery dissection (sCAD). PATIENTS AND METHODS In this case-control study, major vascular risk factors, body weight, body height and body mass index (BMI) of 239 patients obtained from a prospective hospital-based sCAD registry were compared with 516 age- and sex-matched healthy controls undergoing systematic health examinations in the Clinical and Preventive Investigations Center, Paris. Gender-specific analyses were performed. RESULTS The mean body height was higher in sCAD patients than in controls (171.3 cm (SD 8.6) vs 167.7 cm (8.9); p<0.0001) and sCAD patients had a significantly lower mean body weight (67.5 (12.2) kg vs 69.3 (14.6) kg; p<0.001) and mean BMI (22.9 (3.3) kg/m2 vs 24.5 (4.2) kg/m2; p<0.0001) than controls. The overall frequency of hypertension, diabetes, current smoking, past smoking and hypercholesterolaemia did not differ significantly between sCAD patients and controls. The mean total plasma cholesterol level was identical in both groups (5.5 mmol/l, SD 1.1). Gender specific subgroup analyses showed similar results for men and women. CONCLUSION Patients with sCAD had a higher body height and a lower body weight and BMI than controls, while major vascular risk factors were similar in sCAD patients and controls.
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Affiliation(s)
- M Arnold
- Assistance Publique, Hôpitaux de Paris, Department of Neurology, University Hospitals Lariboisière, Paris, France.
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Boukobza M, Crassard I, Bousser MG, Chabriat H. MR imaging features of isolated cortical vein thrombosis: diagnosis and follow-up. AJNR Am J Neuroradiol 2008; 30:344-8. [PMID: 19095790 DOI: 10.3174/ajnr.a1332] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE To our knowledge, very few MR imaging data have been reported in isolated cortical venous thrombosis (ICoVT). The purpose of this study was to describe MR imaging features, including T2*gradient-echo (GE) sequence, in presumed ICoVT. MATERIALS AND METHODS MR imaging examinations were performed in 8 patients with ICoVT (MR venography was performed in all patients and digital substraction angiography in 4) at the time of diagnosis and during the follow-up at 15 days (4 patients) and at 3 (8 patients), 6 (6 patients), 12 (3 patients), and 18 months (1 patient). We assessed the presence of a magnetic susceptibility effect (MSE) on T2*GE imaging at each site of cerebral venous thrombosis and the presence or absence of a normal flow void and iso-, hypo-, or hyperintense signal intensity on T1, T2, diffusion-weighted imaging (DWI), and fluid-attenuated inversion recovery (FLAIR) images. Parenchymal signal-intensity changes were also assessed on the same sequences. RESULTS MSE was detected on T2*GE imaging at the site of a cortical vein in all subjects at the first MR imaging examination. The occluded vein appeared as hyperintense in 3 patients, iso- to slightly hyperintense in 1 on T1, hypointense in 6 on FLAIR images, and as signal-intensity loss on DWI in 3. At follow-up, persisting signal-intensity abnormalities on T2*GE imaging were detected at the venous sites in all patients, whereas signal-intensity changes on T1- and T2-weighted images were no longer present. Parenchymal hyperintensities on FLAIR and DWI (increased apparent diffusion coefficient [ADC]) were observed in close vicinity to the thrombosis in 6/8 patients. Petechial hemorrhages (n = 3) or hematoma (n = 2) was present on T2*GE imaging in 5/8 patients. During the follow-up, all cerebral tissue signal-intensity changes on T1, T2, and FLAIR images decreased both in volume and intensity. ADC values normalized within the tissue after 3 months in all patients. CONCLUSIONS On T2*GE imaging, MSE of hemoglobin products within the thrombus was observed both at the early and late phases of ICoVT and appears to be of high diagnostic value compared with the other signal intensity changes detected on standard MR imaging.
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Affiliation(s)
- M Boukobza
- Department of Neuroradiology, Hopital Lariboisiere, AP-HP, Paris, France
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Miranda B, Madureira S, Verdelho A, Ferro J, Pantoni L, Salvadori E, Chabriat H, Erkinjuntti T, Fazekas F, Hennerici M, O'Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitarion D. Self-perceived memory impairment and cognitive performance in an elderly independent population with age-related white matter changes. J Neurol Neurosurg Psychiatry 2008; 79:869-73. [PMID: 18077477 DOI: 10.1136/jnnp.2007.131078] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine whether self-perceived memory impairment is associated with the severity of white matter changes (WMC) and is related to cognitive impairment. METHODS Data were drawn from the multinational Leukoaraiosis and Disability Study (LADIS), which investigates the impact of WMC on global functioning. WMC severity was rated using the Fazekas scale. Medial temporal lobe atrophy (MTA) was scored visually and mean values were calculated. The neuropsychological battery consisted of the Mini-Mental State Examination, a modified version of the VADAS-Cog, Trail making and Stroop tests. A question about self-perceived memory impairment was used as a measure for presence of memory complaints. Cognitive performance was analysed test-by-test and in three main domains: memory, executive functions and speed/motor control. The Geriatric Depression Scale (GDS) was used as a measure of depressive symptoms. RESULTS Six hundred and thirty-eight subjects were included in this study. No association was found between memory complaints and the severity of WMC. Subjects with memory complaints (n = 399) had a higher GDS score [t((637)) = -7.15; p<0.02] and performed worse on almost all cognitive tests and on the three cognitive domains. Multiple linear regression showed that the worse performance on the memory domain was associated with memory complaints independently of depressive symptoms, WMC severity and MTA (R(2) = 0.183; F = 17.09, beta = -0.126; p<0.05). CONCLUSION In a sample of non-disabled elderly subjects with WMC, self-perceived memory impairment is significantly associated with objective memory impairment independently of the WMC severity, depressive symptoms and MTA.
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Affiliation(s)
- B Miranda
- Serviço de Neurologia, Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal.
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Laforêt P, Petiot P, Nicolino M, Orlikowski D, Caillaud C, Pellegrini N, Froissart R, Petitjean T, Maire I, Chabriat H, Hadrane L, Annane D, Eymard B. Dilative arteriopathy and basilar artery dolichoectasia complicating late-onset Pompe disease. Neurology 2008; 70:2063-6. [PMID: 18505979 DOI: 10.1212/01.wnl.0000313367.09469.13] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Strokes related to intracranial aneurysm or arteriopathy have been reported in a few patients with late-onset Pompe disease. These reports suggested that cerebral vessel involvement could be an underrecognized complication of this disease. METHODS We report cerebral artery involvement in three French patients with late-onset Pompe disease. RESULTS The first patient died at age 35 years from complications of a giant fusiform aneurysm of the basilar artery, and her 34-year-old sister showed evidence of dolichoectatic basilar artery on magnetic resonance angiography. A dilative arteriopathy complicated with carotid artery dissection was diagnosed in the third patient, aged 50 years. Two patients are currently being treated with enzyme replacement therapy (alglucosidase alfa), and regular angiographic follow-up showed the absence of progression of vascular abnormalities in one of them. CONCLUSION These observations, combined with previously reported cases, confirm that Pompe disease should be recognized as a predisposing condition to dilative arteriopathy and cerebral aneurysm formation, although the real incidence of these vascular complications remains unknown.
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Affiliation(s)
- P Laforêt
- Institut de Myologie, Bâtiment Babinski, Groupe Hospitalier Pitié-Salpêtrière, 75651 Paris Cedex 13, France.
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Baezner H, Blahak C, Poggesi A, Pantoni L, Inzitari D, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Langhorne P, O'Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Hennerici MG. Association of gait and balance disorders with age-related white matter changes: the LADIS study. Neurology 2008; 70:935-42. [PMID: 18347315 DOI: 10.1212/01.wnl.0000305959.46197.e6] [Citation(s) in RCA: 288] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In the Leukoaraiosis and Disability (LADIS) Study, 11 European centers are evaluating the role of age-related white matter changes (ARWMC) as an independent determinant of the transition to disability in the elderly (65 to 84 years). We aimed at determining the influence of ARWMC on different objective measures of gait and balance. METHODS Six hundred thirty-nine nondisabled individuals were prospectively enrolled and are being followed-up for 3 years. Subjects are graded in three standardized categories of ARWMC (mild, moderate, and severe) according to central MRI reading. Quantitative tests of gait and balance include the Short Physical Performance Battery (SPPB; range: 0 [poor] to 12 [normal]), a timed 8-m walk, and a timed single leg stance test. RESULTS In cross-sectional analysis, deficiencies in gait and balance performance were correlated with the severity of ARWMC (SPPB: 10.2 +/- 2.1 in the mild, 9.9 +/- 2.0 in the moderate, 8.9 +/- 2.6 in the severe group; p < 0.001). Walking speed correlated with the severity of ARWMC (1.24 +/- 0.28 m/second in the mild, 1.18 +/- 0.32 m/second in the moderate, and 1.09 +/- 0.31 m/second in the severe group; p < 0.001). Balance was best in individuals with mild ARWMC (single leg stance time: 18.9 +/- 10.8 seconds) compared with moderate and severe ARWMC (16.4 +/- 10.8 and 13.6 +/- 11.2 seconds) (p < 0.001). Physically inactive individuals had a higher risk of a pathologic SPPB score (moderate vs mild ARWMC: odds ratio 1.60, 95% CI 1.02 to 2.52; severe vs mild ARWMC: odds ratio 1.75, 95% CI 1.09 to 2.80). CONCLUSIONS Our findings support a strong association between the severity of age-related white matter changes and the severity of gait and motor compromise. Physical activity might have the potential to reduce the risk of limitations in mobility.
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Affiliation(s)
- H Baezner
- Mannheim University Hospital, University of Heidelberg, Department of Neurology, Theodor Kutzer Ufer, D-68135 Mannheim, Germany.
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Teodorczuk A, O'Brien JT, Firbank MJ, Pantoni L, Poggesi A, Erkinjuntti T, Wallin A, Wahlund LO, Gouw A, Waldemar G, Schmidt R, Ferro JM, Chabriat H, Bäzner H, Inzitari D. White matter changes and late-life depressive symptoms: longitudinal study. Br J Psychiatry 2007; 191:212-7. [PMID: 17766760 DOI: 10.1192/bjp.bp.107.036756] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence from cross-sectional studies suggests a link between cerebral age-related white matter changes and depressive symptoms in older people, although the temporal association remains unclear. AIMS To investigate age-related white matter changes on magnetic resonance imaging (MRI) as an independent predictor of depressive symptoms at 1 year after controlling for known confounders. METHOD In a pan-European multicentre study of 639 older adults without significant disability, MRI white matter changes and demographic and clinical variables, including cognitive scores, quality of life, disability and depressive symptoms, were assessed at baseline. Clinical assessments were repeated at 1 year. RESULTS Using logistic regression analysis, severity of white matter changes was shown to independently and significantly predict depressive symptoms at 1 year after controlling for baseline depressive symptoms, quality of life and worsening disability (P<0.01). CONCLUSIONS White matter changes pre-date and are associated with the development of depressive symptoms. This has implications for treatment and prevention of depression in later life.
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Affiliation(s)
- A Teodorczuk
- Institute for Ageing and Health, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK.
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Viswanathan A, Gschwendtner A, Guichard JP, Buffon F, Cumurciuc R, O'Sullivan M, Holtmannspötter M, Pachai C, Bousser MG, Dichgans M, Chabriat H. Lacunar lesions are independently associated with disability and cognitive impairment in CADASIL. Neurology 2007; 69:172-9. [PMID: 17620550 DOI: 10.1212/01.wnl.0000265221.05610.70] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary arteriopathy caused by mutations of the Notch3 gene. The disease is characterized by T2-hyperintense lesions (subcortical white matter lesions), T1-hypointense lesions (lacunar lesions), and T2*-weighted gradient-echo (GE) lesions (cerebral microhemorrhages [CMs]) visualized on clinical MRI sequences and is considered as a model of "pure" subcortical ischemic vascular dementia. Although numerous studies have investigated the impact of white matter lesions in patients with CADASIL, the clinical importance of lacunar lesions remains unknown. Our purpose was to examine the influence of the visible MRI markers in the disease, including the load of lacunar lesions on cognitive impairment and disability in CADASIL. METHODS We collected clinical data from 147 consecutive patients enrolled in an ongoing two-center prospective cohort study. Degree of disability was assessed by modified Rankin scale and Barthel index. Degree of cognitive impairment was assessed by Mattis Dementia Rating Scale and Mini-Mental Status Examination. T1-weighted, fluid-attenuated inversion recovery, and GE images were obtained on a 1.5-T MRI. Volume and location of lacunar lesions, white matter hyperintensities (WMHs), and CMs were assessed. RESULTS There was a significant independent association between age, volume of lacunar lesions, and global cognitive function scales when analyzed in a multivariable model. In contrast, WMHs and CMs had no independent influence on cognitive function. Disability in this cohort was associated with volume of lacunar lesions, CMs, systolic blood pressure, and age but not with WMHs. CONCLUSIONS Among the lesions observed on conventional MRI in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), the overall lacunar lesion burden seems to have the most important impact on cognitive function and disability. These findings suggest that preventive strategies to decrease the risk of lacunar lesions as observed on MRI may reduce disease-related impairment in CADASIL. These results suggest that lacunar lesions may also play a key role in disability and cognitive impairment in more common forms of small-vessel disease.
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Affiliation(s)
- A Viswanathan
- Departments of Neurology, Centre Hospitalier Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, France
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Chabriat H. Imagerie des micro-angiopathies cérébrales. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90917-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Dutray A, Castelnovo G, Bouly S, Chabriat H, Bousser M, Labauge P. G - 25 Prévalence de la maladie de CADASIL et formes atypiques. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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