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L Pierot

Publications and source records attributed to L Pierot.

At least 19 recordsLinked to original sources
PubMed2006

[ADEM: a rare and serious demyelinating disorder of adults].

Acute Disseminated Encephalomyelitis is a serious demyelinating disorder of childhood that typically occurs following vaccination or a viral prodrome. Some etiologies remain unrecognized, and multiple mechanisms of immune response may explain the pathophysiology of this syndrome. Based on a report of two adult cases presenting with neurologic deficit and ataxia, we report our experience with this syndrome that may affect adults without evident infectious disorder. Prompt treatment is important to avoid rapid progression.

Adrenal Cortex Hormones↗
PubMed2006

Follow-up of intracranial aneurysms selectively treated with coils: Prospective evaluation of contrast-enhanced MR angiography.

BACKGROUND AND PURPOSE: The aim of this study was to determine the feasibility and usefulness of contrast-enhanced MR angiography (CE-MRA) for the follow-up of intracranial aneurysms treated with detachable coils, by comparing CE-MRA with digital subtraction angiography (DSA) and 3D time-of- flight (TOF) MRA. METHODS: Thirty-two patients with 42 treated aneurysms were included in the study; 6 had been treated for multiple aneurysms. All MRAs were performed with a 1.5T unit within 48 hours of DSA. We performed 2 types of acquisition: a 3D TOF sequence and CE-MRA. Twenty-eight patients were included 1 year after endovascular treatment, and 4 patients, after 3 years or more. DSA was the technique of reference for the detection of a residual neck or residual aneurysm. RESULTS: Compared with DSA, the sensitivity of MRA was good. For the detection of residual neck, there was no significant difference between the results of 3D TOF MRA (sensitivity, 75%-87.5%; specificity, 92.9%, according to both readers) and CE-MRA (sensitivity, 75%-82.1%; specificity, 85.7%-92.9%). For the detection of residual aneurysm, sensitivity and specificity of both techniques were the same, respectively 80%-100% and 97.3%-100%. Therefore, CE-MRA was not better than 3D TOF MRA for the detection of residual neck or residual aneurysm. For large treated aneurysms, there was no difference between decisions regarding further therapy after CE and 3D TOF MRA, even though CE-MRA with a short echotime and enhancement gave fewer artifacts and better visualization of recanalization than 3D TOF MRA. The interpretation of transverse source images and the detection of coil mesh packing seemed easier with 3D TOF imaging. CONCLUSION: This prospective study did not show that CE-MRA was significantly better than 3D TOF MRA for depicting aneurysm or neck remnants after selective endovascular treatment using coils. For aneurysms treated with coils, 3D TOF MRA seems a valid and useful technique for the follow-up of coiled aneurysms.

Adult↗
PubMed2006

Endovascular treatment of intracranial aneurysms with matrix detachable coils: immediate posttreatment results from a prospective multicenter registry.

BACKGROUND AND PURPOSE: Endovascular treatment of intracranial aneurysms by using detachable coils has become an accepted alternative to surgery. To reduce the rate of aneurysm recanalization after treatment, biologically active polyglycolic/polylactic acid-covered platinum coils have been proposed. A prospective and multicenter registry was conducted in France to evaluate the safety and short-term and long-term efficacy of Matrix detachable coils. This first analysis is focused on the safety and short-term efficacy. METHODS: Two hundred sixty-one patients having ruptured or unruptured aneurysms treated via endovascular approach were included in this registry. Patients with giant aneurysms or in poor clinical condition (Glasgow Coma Scale < 10) were excluded. Because of various protocol violations, clinical analysis was conducted in 236 patients having 244 aneurysms. Technical and clinical complications were systematically recorded. Angiographic analysis was performed by a core laboratory by using the Raymond Grading Scale on 224 patients having 232 aneurysms. RESULTS: Complete occlusion was achieved in 102 aneurysms (44.0%); neck remnant, in 58 aneurysms (25.0%); and aneurysm remnant, in 72 aneurysms (31.0%). Technical and clinical complications related to the procedure were encountered in 43 patients (18.2%). Postoperative modification of the clinical status was observed in 12 patients (5.1%). Two patients died (0.8%), 6 had a permanent deficit (2.5%), and 4 had a transient deficit (1.7%). Treatment-related mortality was 0.8% and permanent morbidity was 2.5%. CONCLUSION: Endovascular treatment of intracranial aneurysms by using Matrix detachable coils is feasible and demonstrated initial angiographic results and overall morbidity and mortality rates that are within the ranges found in the literature in the use of bare platinum coils.

Adolescent↗
PubMed2005

An evaluation of immediate sheath removal and use of the Angio-Seal vascular closure device in neuroradiological interventions.

We set out to assess the effect of using an arteriotomy closure device in patients at high risk of access site complications. One-hundred nineteen patients with femoral artery access were prospectively included in five centers in France (56 males, 63 females, age range 20-84 years). The neurointerventional procedures were embolization of intracranial aneurysm (71.4%), carotid angioplasty (11.8%), cerebral angioplasty (1.7%), thrombolysis (0.8%), and other procedures (14.3%). Sheaths were removed and the closure device deployed immediately postprocedure. One patient developed a false aneurysm, and one developed a small hematoma. Neither required treatment. Postdevice deployment bleeding was experienced in three patients (2.5%), requiring minimal management. There were no major complications. Three patients died of causes unrelated to the vessel closure. Patient comfort was 2.2 on a scale of 1 (none) to 10 (severe). The results showed that immediate sheath removal followed by use of the closure device is safe in patients undergoing neurointerventional procedures and offers a low level of patient discomfort. In selected patients, early hospital discharge was possible.

Adult↗
PubMed2005

Anterior and non-anterior ruptured aneurysms: memory and frontal lobe function performance following coiling.

Our aim was to compare memory and frontal function performance between two groups of patients treated with Guglielmi detachable coil (GDC) following intracranial ruptured aneurysm. The subgroups drawn following the localization of the aneurysm consisted of 19 patients presenting with anterior communicating artery aneurysms and 16 patients exhibiting middle cerebral artery and posterior communicating artery aneurysms. The 35 patients and 35 normal controls were administered extensive neuropsychological assessment. Additionally, a scale of qualitative changes of mood was presented to the patients and patients' relatives. The patients showed a better general performance on memory compared with the executive function performance, which was similarly impaired in both groups. We suggest that executive functions are more vulnerable to differently located lesions than memory functions.

Adult↗
PubMed2004

[Cerebral arteriovenous malformations: evaluation of the hemorrhagic risk and its morbidity].

Evaluation of the hemorrhagic risk associated with intracranial arteriovenous malformation is a keypoint question for physicians involved in the management of these patients. Indeed, this hemorrhagic risk including its morbid-mortality consequences has to be balanced with the therapeutic risk. All the published studies have estimated the annual bleeding risk between 2 to 4%; a first hemorrhagic event is associated with an increased risk of a new bleeding. Mortality associated with AVM bleeding is estimated between 10 to 15%, with a 50% risk of morbidity. Factors associated with an increased risk of bleeding include existence of aneurysms (intranidal or flow related pedicular, proximal or distal) and some venous drainage patterns such as deep venous drainage or venous stenosis.

Cerebral Hemorrhage↗
PubMed2002

Thromboembolic events after endovascular treatment of unruptured intracranial aneurysms in two patients with antiphospholipid-antibody syndrome.

Antiphospholipid antibodies (APAs) are circulating immunoglobulins associated with a hypercoagulable state. The antiphospholipid syndrome combines APAs and clinical manifestations, including arterial or venous thromboses and/or recurrent spontaneous fetal loss. The main risk incurred by endovascular treatment of intracranial aneurysms is the occurrence of thromboembolic events. We report two cases of patients with antiphospholipid syndrome who developed thromboembolic complications after the endovascular treatment of unruptured intracranial aneurysms.

Adult↗
PubMed2002

Longitudinal study of motor recovery after stroke: recruitment and focusing of brain activation.

BACKGROUND AND PURPOSE: The goal of this study was to characterize cortical reorganization after stroke and its relation with the site of the stroke-induced lesion and degree of motor recovery using functional MRI (fMRI). METHODS: Fourteen stroke patients with an affected upper limb were studied longitudinally. Three fMRI sessions were performed over a period of 1 to 6 months after stroke. Upper limb recovery, Wallerian degeneration of the pyramidal tract, and responses to transcranial magnetic stimulation were assessed. RESULTS: Two main patterns of cortical reorganization were found. Pattern 1 was focusing, in which, after initial recruitment of additional ipsilateral and contralateral areas, activation gradually developed toward a pattern of activation restricted to the contralateral sensorimotor cortex in 9 patients. Five patients were found to have pattern 2, persistent recruitment, in which there was an initial and sustained recruitment of ipsilateral activity. Occurrence of recruitment or focusing seemed to depend mainly on whether the primary motor cortex (M1) was lesioned; persistent recruitment was observed in 3 of 4 patients with M1 injury, and focusing was seen in 8 of 10 patients with spared M1. These patterns had no relation to the degree of recovery; in particular, focusing did not imply recovery. However, there was a clear relation between the degree of recovery and the degree of Wallerian degeneration. CONCLUSIONS: These results suggest that ipsilateral recruitment after stroke corresponds to a compensatory corticocortical process related to the lesion of the contralateral M1 and that the process of compensatory recruitment will persist if M1 is lesioned; otherwise, it will be transient.

Adaptation, Physiological↗
PubMed2002

Selective endovascular treatment of intracranial aneurysms using micrus microcoils: preliminary results in a series of 78 patients.

PURPOSE: To determine the safety and reliability of a new platinum microcoil (Micrus), in the treatment of intracranial aneurysms. PATIENTS AND METHODS: Seventy-eight patients (28 male and 50 female patients; age range, 28-83 years; mean age, 44 years) with 80 intracranial aneurysms were treated in 10 centers in Belgium and France. All aneurysms were smaller than 15 mm. Nine aneurysms (11%) were located in the posterior circulation and 71 (89%) in the anterior. Fifty aneurysms (63%) were ruptured and 30 (37%) unruptured. Micrus microcoil is a new platinum coil. It is electrically detached with a time of detachment close to 5 seconds. RESULTS: The degree of occlusion of the aneurysm was classified as total in 49 aneurysms (61%), subtotal in 28 cases (35%) and incomplete in 3 cases (4%). Technical complications were encountered in 10 patients (13%) including parent artery occlusion and thromboembolism (4 cases), coil migration (2 cases) and non-detachment of the coil (2 cases). The immediate morbidity rate was 1.3% and mortality rate 1.3%. CONCLUSION: Micrus microcoils are effective and safe in the selective treatment of ruptured and unruptured intracranial aneurysms. Spherical microcoils are helpful to create a good basket in the aneurysmal sac at the beginning of treatment.

Adult↗
PubMed2002

[Imaging of skull base tumors in adults].

The skull base is divided into three parts: anterior, central and posterior. Numerous foramina are located in the skull base and transmit important neurovascular structures. Numerous types of tumor can be observed at the skull base. They are classified as anterior, central and posterior skull base tumors. They are also divided into three groups according to their origin: tumors arising from the skull base itself, intracranial tumors and extracranial tumors invading the skull base. Imaging is very important for diagnosis, treatment and follow-up of patients with skull base tumors. Magnetic resonance imaging is the most useful modality as it visualizes the lesion on different planes and permits the planning of therapy. Computed tomography depicts the osseous lesions more precisely and may be necessary before surgery. Catheter angiography is now in most cases replaced by magnetic resonance angiography. Interventional neuroradiology is necessary if the lesion is highly vascularized or if a vessel is encased in the tumor.

Adult↗
PubMed2001

Neuroimaging features of spontaneous intracranial hypotension.

We reviewed the cranial MRI and radionuclide cisternograms of four adults with postural headache indicating spontaneous intracranial hypotension (SIH). All four underwent clinical and radiological follow-up. MRI showed diffuse, thin meningeal enhancement; bilateral subdural fluid collections; and morphological abnormalities secondary to "sagging" of the brain. Radionuclide cisternography revealed direct or indirect signs of leakage of cerebrospinal fluid (CSF) along the spinal axis, and the symptoms resolved after the leak treated by epidural injection of blood at a level indicated by the cisternogram. The diffuse meningeal enhancement decreased but persisted on follow-up MRI, although the patients were asymptomatic. All morphologic abnormalities resolved during 3-5 months follow-up.

Adult↗
PubMed2001

Follow-up of intracranial aneurysms treated with detachable coils: comparison of gadolinium-enhanced 3D time-of-flight MR angiography and digital subtraction angiography.

PURPOSE: To compare three-dimensional (3D) time-of-flight magnetic resonance (MR) angiography with digital subtraction angiography (DSA) in the follow-up of intracranial aneurysms treated with selective endovascular placement of detachable coils. MATERIALS AND METHODS: Sixty-eight consecutive patients with intracranial aneurysms were included in the prospective study. The goal was to evaluate 3D time-of-flight MR angiography versus DSA for the detection of a residual aneurysm neck or residual flow inside the coil mesh. RESULTS: Eighty-one MR angiographic and 83 DSA examinations were performed; 15 patients were examined with both modalities twice. MR angiography was not possible in two patients. In another patient, the quality of MR angiography was not sufficient to assess the treated aneurysm. In 72 of the remaining 80 MR angiographic and DSA examinations, there was good correlation between the two modalities. In 54 cases, neither image type showed remnants or recurrence, but in 18, both showed residual aneurysm. In eight cases, the MR angiographic and DSA results differed. In one of these cases, MR angiography depicted residual aneurysm but DSA depicted an arterial loop. In seven cases, a small (<3-mm) remnant was not detected at MR angiography. CONCLUSION: Because very small aneurysm remnants or recurrences probably are not clinically important, MR angiography is an option for following up intracranial aneurysms treated with detachable coils and may partly replace DSA.

Adult↗