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Biomedical subjects

G Devuyst

Publications and source records attributed to G Devuyst.

At least 37 records · Page 2Linked to original sources
PubMed2000

Motor strokes sparing the leg: different lesions and causes.

BACKGROUND: A considerable number of patients develop stroke without involvement of the lower limb. However, there are few reports about the motor syndrome when the leg is spared. OBJECTIVE: To study clinical findings, causative factors, and lesion topography in stroke patients with a motor deficit sparing the leg. PATIENTS AND METHODS: We studied 895 patients with paresis sparing the leg from the 3,901 patients enrolled in the Lausanne Stroke Registry. They were compared with 1,644 stroke patients with paresis involving the leg, by means of univariate and multivariate analysis. RESULTS: Eight hundred forty-four infarcts (94.3%) and 51 hemorrhages (5.7%) led to weakness sparing the leg. Different sites of lesion were found, but the majority were caused by superficial infarcts. Almost half of the lesions were confined to superficial branches of the middle cerebral artery territory, with 276 (30.8%) in the anterior (superior) and 138 (15.4%) in the posterior (inferior) middle cerebral artery. More than half of the infarcts had a presumed embolic source from large-artery disease or from the heart. In comparison with patients with paresis involving the leg, patients without leg involvement had a lower prevalence of small-artery disease (P<.001), but a higher prevalence of migraine (P<.001), transient ischemic attack (P = .001), atherosclerosis without stenosis (P = .005), large-artery disease (P<.001), and left hemispheric strokes (P<.001). They also had a lower frequency of hemorrhagic stroke. CONCLUSIONS: Patients without leg involvement had different stroke lesions and causes and were characterized by more superficial infarcts mainly caused by emboli from large-artery disease and atherosclerosis without stenosis.

Cardiovascular Diseases↗
PubMed2000

What is the significance of leukoaraiosis in patients with acute ischemic stroke?

BACKGROUND: Leukoaraiosis (LA) may have specific clinical correlates in patients with stroke, but this is not well investigated, so that the significance of LA in patients with stroke remains unclear. METHODS: In a study of 2289 patients with a first-ever acute ischemic stroke, LA was noted in 149 by the use of baseline computed tomography of the brain. These patients were compared with the non-LA group. Statistical tests, including Fisher exact test or a chi(2) test, were used to compare variables, and a multivariate approach using stepwise logistic regression was performed. RESULTS: Patients with LA were significantly older (73.7 vs 62.7 years; P<. 001), and had a higher incidence of hypertension (72.5% vs 47.1%; P<. 001) and subcortical or lacunar infarction (40.3% vs 25.4% and 21.5% vs 8.0%, respectively; P<.001) on neuroimaging studies, compared with the non-LA group. The most common cause of stroke in the LA group was presumed to be small-artery disease associated with hypertension (46% vs 13.5% in the non-LA group). Age and hypertension were very strongly associated with LA (respective odds ratios [95% confidence intervals], 1.06 [1.04-1.08] and 2.33 [1.60-3. 39]). In addition to these risk factors, a close relationship was found between LA and nonsevere stenosis (<50%) of the internal carotid artery (odds ratio, 2.23 [95% confidence interval, 1.32-3. 76]), although the significance of this association remains speculative. The outcome at 1 month after stroke was similar in both groups. CONCLUSION: Our results provide further evidence that LA is related primarily to small-vessel disease.

Adolescent↗
PubMed2000

Coexisting causes of ischemic stroke.

BACKGROUND: Coexistence of multiple potential causes of cerebral infarct (MPCI) has been poorly studied. OBJECTIVE: To determine the risk factors, clinical findings, and topographical patterns of patients with at least 2 potential causes of cerebral infarct. DESIGN: Data analysis from a prospective acute stroke registry (the Lausanne Stroke Registry, Lausanne, Switzerland) in a community-based primary care center. RESULTS: Among 3525 patients with first-ever ischemic stroke consecutively admitted to a primary care stroke center, 250 patients (7%) had at least 2 MPCIs, with the following subgroups: large artery disease and a cardiac source of embolism (LAD + CSE) (43%), small artery disease and CSE (SAD + CSE) (34%), LAD + SAD (18%), and LAD + SAD + CSE (5%). Hypertension, cardiac ischemia, and a history of atrial fibrillation predominated in the LAD + SAD + CSE subgroup (P<.001), while cigarette smoking was more prevalent in the LAD + SAD subgroup (P<.05). A decreased level of consciousness and speech disorders were more common in the LAD + CSE subgroup (P<.001). Lacunar syndromes predominated in the LAD + SAD subgroup. Pure motor stroke was the most frequent lacunar syndrome in all subgroups, but sensory motor stroke predominated in the LAD + CSE subgroup (P<.05). The outcome at 1 month was worse in the LAD + CSE and SAD + CSE subgroups (P<.001). Other stroke characteristics and clinical features did not differ significantly between the 4 subgroups of patients with MPCI. CONCLUSIONS: Our findings suggest that MPCIs are uncommon. The most frequent association is LAD + CSE. Topographical patterns of stroke and clinical characteristics in patients with MPCI only rarely allow emphasis of a preeminent cause. Arch Neurol. 2000;57:1139-1144

Aged↗
PubMed2000

The matching pursuit: a new method of characterizing microembolic signals?

Detection of clinically silent circulating microemboli within cerebral arteries by transcranial Doppler ultrasound (US) is now being widely investigated in the hope of identifying patients at increased risk for stroke. However, the widespread application of embolus detection is still limited in clinical practice because current transcranial Doppler systems have not the required sensitivity and specificity to analyze microembolic signals, particularly to distinguish between gaseous, or solid brain emboli and artefacts. In this work, we proposed to investigate the potential of a new approach for the analysis of microembolic signals via the so-called matching pursuit, which is closely related to wavelet transform and is not subject to the same limitations as the fast Fourier transform. Our preliminary results clearly indicate that matching pursuit is well suited to this task.

Algorithms↗
PubMed1999

Clinical trial update: neuroprotection against acute ischaemic stroke.

One of the most recent advances and hopes in stroke therapy concerns neuroprotection, which has recently been investigated in several clinical trials. Furthermore, some new neuroprotective drugs, which are based on newly identified cellular and molecular mechanisms that underlie the development of focal ischaemic injury, will be tested in stroke patients in the future. It must be emphasized, however, that the concept and application of neuroprotection must remain within the frame of the global network and organization of acute stroke care, because neuroprotection at best may become only a link among many other management strategies for acute stroke.

Acute Disease↗
PubMed1998

Power Doppler imaging and color Doppler flow imaging for the evaluation of normal and pathological vertebral arteries.

Recently, an ultrasound method for vascular applications using the amplitude of the reflected echosignal for the generation of intravascular color signals has been introduced. We compared the utility of this power Doppler imaging (PDI) with conventional color Doppler flow imaging (CDFI) for examination of vertebral arteries (VA). Forty-nine patients with signs and symptoms suggesting ischemia within the posterior circulation were evaluated. Quality of blood flow visualization by PDI and CDFI at the different VA segments was classified according to a four point scale. Furthermore, combined sonographic findings were correlated with the results of digital substraction and/or magnetic resonance angiography (DSA, MRA). Power Doppler imaging provided a significantly superior visualization of the intertransversal VA, whereas display of the intracranial V4 segment was superior significantly on CDFI. Both methods were complementary for the evaluation of the VA at the origin. With respect to the angiographic findings, combined CDFI and PDI achieved a sensitivity of 90.63% and a specificity of 97.22% for the differentiation of healthy and pathologic VAs. Power Doppler imaging is complementary to CDFI for the sonographic assessment of VA disease. Combined use of PDI and CDFI achieves a high sensitivity and specificity, thus increasing diagnostic confidence.

Adolescent↗
PubMed1997

Prevention of stroke recurrence with presumed paradoxical embolism.

Paradoxical cerebral embolism (PCE) through a patent foramen ovale (PFO) should be considered as a cause of ischemic stroke, particularly in young patients without an alternative cause for stroke. PCE is even more important that it is potentially treatable. However, PCE remains often presumed because it rests upon the rarely demonstrated findings of a deep venous thrombosis and a thrombus lodged in the PFO. Recent studies have shown a rather low stroke recurrence rate in patients with PFO and stroke but suggest that some subgroups of patients with a higher stroke recurrence risk-exist according clinical, echocardiographical and radiological characteristics. For these subgroups, it seems that a more invasive treatment should be required. There are four therapeutic options; antiaggregants, anticoagulation, transcatheter closure of PFO, and surgical closure of PFO. However, these treatments have yet to be evaluated in clinical trials.

Cerebrovascular Disorders↗
PubMed1997

Status of patent foramen ovale, atrial septal aneurysm, atrial septal defect and aortic arch atheroma as risk factors for stroke.

During the last few years, there has been emphasis on the role of the interatrial septum and the aortic arch atheroma in the genesis of stroke. The causal relationship of these disorders with stroke is still controversial because direct evidence may be lacking. The diagnosis is often presumed and based on indirect signs, i.e. by visualization of the interatrial septal or aortic arch abnormalities which are detectable by transesophageal echocardiography. The optimal therapeutic strategy including some more invasive treatments, such as surgery, is uncertain. In this article, we review the current knowledge concerning the interatrial septum and aortic arch disorders as risk factors for stroke and current therapeutic strategies.

Aorta, Thoracic↗
PubMed1997

Complementarity of contrast transcranial Doppler and contrast transesophageal echocardiography for the detection of patent foramen ovale in stroke patients.

All studies concerning the detection of patent foramen ovale (PFO) have compared transthoracic or transesophageal echocardiography (c-TEE) to transcranial Doppler ultrasound after contrast injection (c-TCD), but combining both techniques in the search of PFO has received no consideration. Our study aims to substantiate this claim in 37 patients with cryptogenic stroke. It includes two protocols for the detection of PFO to assess the complementarity of c-TCD and c-TEE performed simultaneously or separately. Firstly, we used a standardized protocol, performing c-TCD alone. Secondly, we used a standardized and a simultaneous protocol which associated c-TCD with c-TEE. When c-TCD and/or c-TEE found right-to-left shunts, they were classified as minimal, intermediate and massive. c-TCD revealed all PFO detected by c-TEE in 24 patients out of 37 (65%). Furthermore, c-TCD was positive for a PFO in 5 other patients whereas c-TEE was negative. The degree of right-to-left interatrial shunting varied according to the protocol: c-TCD performed alone found 15 massive, 4 intermediate and 5 minimal shunts whereas 10, 9 and 5, respectively, were detected by c-TCD when it was combined with c-TEE. In contrast, c-TEE revealed 8 massive, 8 intermediate and 8 minimal shunts. c-TCD can identify minimal shunts missed by c-TEE and could be more relevant to detect massive shunts, particularly when not performed simultaneously with c-TEE because no sedation is required for c-TCD alone as opposed to c-TEE: thus patients are more cooperative and produce a better Valsalva strain. c-TEE confirms pulmonary shunts suspected by c-TCD and determines the morphologic characteristics of the interatrial septum. While previous studies opposed c-TEE against c-TCD for the detection of a PFO, we think that both techniques are complementary and that it is interesting to associate them, particularly when they are deferred, to increase the ability of detecting PFO and to specify the degree of right-to-left shunting.

Adult↗
PubMed1996

Surgical prophylaxis of recurrent stroke in patients with patent foramen ovale: a pilot study.

Prevention of recurrent stroke in adults with patent foramen ovale represents a therapeutic challenge. Antiplatelet or anticoagulant treatment is widely introduced, but its exact indication is not known. In this pilot study, eight men and three women with previous ischemic cerebral events underwent direct surgical closure of the patent foramen ovale. Mean age was 39.4 (from 30 to 58) years. No coexisting cause of stroke was found after extensive investigations, including blood and coagulation tests, echocardiography, 24-hour three-lead electrocardiographic monitoring, extracranial and transcranial Doppler ultrasonography, and cerebral angiography. Criteria for operation also included at least two of the following: atrial septal aneurysm, multiple cerebral infarcts, a history of multiple cerebral events, and Valsalva strain before stroke. Before operation, one patient had two shunts (1 patent foramen ovale, 1 intrapulmonary shunt). No intraoperative or postoperative complications occurred, but a few hours after operation transient arrhythmias developed in two patients without atrial fibrillation, hemodynamic instability, or embolism. During a median follow-up of 12.2 months, no patient had recurrent stroke. All patients prospectively underwent brain magnetic resonance imaging and contrast echocardiography with simultaneous transcranial Doppler ultrasonography. A residual right-to-left interatrial shunt, smaller than the preoperative one, was observed in only one patient, whereas no lesion was seen on magnetic resonance imaging. Our study suggests that surgical closure of patent foramen ovale in patients with presumed paradoxic embolism is safe, with no recurrent stroke in the first year of follow-up. Further studies are needed to evaluate the long-term prognosis of patients with versus without operation and to define the role of operation as an alternative to prolonged antithrombotic treatment.

Adult↗
PubMed1996

Prognosis after stroke followed by surgical closure of patent foramen ovale: a prospective follow-up study with brain MRI and simultaneous transesophageal and transcranial Doppler ultrasound.

BACKGROUND: The risk of stroke and the long-term prognosis of recurrent strokes in young patients with patent foramen ovale (PFO) are not well known. For this reason, the treatment of these patients remains empirical. An alternative treatment to prolonged antithrombotic therapy may be surgical closure of the PFO. METHODS: Thirty patients (20 men and 10 women) with stroke and PFO were prospectively selected among 138 patients with stroke and PFO for a study of surgical closure of PFO at our center. Eligible patients were < 60 years old, had negative results of a systematic search for another cause of stroke (first criterion), and met two of the four following criteria: (1) recurrent clinical cerebrovascular events or multiple ischemic lesions on brain MR, (2) PFO associated with an atrial septal aneurysm, (3) > 50 microbubbles counted in the left atrium on contrast transesophageal echocardiography (TEE), and (4) Valsalva maneuver or cough preceding the stroke. Patients selected in this manner for surgery were considered to be a subgroup with a higher risk of stroke recurrence. RESULTS: All patients had a direct suture of PFO while under cardiopulmonary bypass without recorded early or delayed significant complication. All patients underwent a new brain MRI and TEE simultaneous with transcranial Doppler ultrasonography after contrast injection at 8 +/- 3 months after surgery. After a mean follow-up of 2 years without antithrombotic treatment, no recurrent cerebrovascular event (stroke or transient ischemic attack [TIA]) and no new lesion on MRI had developed. Postoperative contrast TEE and transcranial Doppler ultrasonography showed that two patients had residual interatrial right-to-left shunting, although much smaller than before surgery, associated with single versus double continuous suture. CONCLUSIONS: Our study of 30 selected stroke patients with surgical suture of PFO showed a stroke recurrence rate of 0% and no significant complication. Residual right-to-left shunting may be avoided by double continuous suture of the PFO. In the absence of controlled studies to guide individual therapeutic decisions, our findings show that PFO closure can be done safely and may be considered to avoid recurrence in selected patients with long life expectancy and presumed paradoxic embolism.

Adult↗