PubMed Health⌕ Search

Biomedical subjects

Marie Girot

Publications and source records attributed to Marie Girot.

7 recordsLinked to original sources
PubMed2007

Predictors of outcome in patients with cerebral venous thrombosis and intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Although intracerebral hemorrhages are frequent in patients with cerebral venous thrombosis, and lead to worse outcome, predictors of outcome in cerebral venous thrombosis patients with intracerebral hemorrhages have never been evaluated in adequately powered studies. METHODS: This study was conducted as a part of the International Study on Cerebral Vein and Dural Sinus Thrombosis. We evaluated predictors of outcome in cerebral venous thrombosis patients who had an "early intracerebral hemorrhage," ie, intracerebral hemorrhages already present at time of diagnosis of cerebral venous thrombosis by a logistic regression analysis, with a modified Rankin scale 3 to 6 at month 6 as dependent variable. The same analysis was performed with "delayed intracerebral hemorrhages," ie, intracerebral hemorrhages that occurred after the diagnosis of cerebral venous thrombosis, as dependent variable. RESULTS: Of 624 patients recruited in International Study on Cerebral Vein and Dural Sinus Thrombosis, 245 (39%) had an early intracerebral hemorrhage: at month 6, 51 (21%) of them had a modified Rankin Scale 3 to 6. Independent predictors of having modified Rankin scale 3 to 6 at month 6 were older age (adjusted odds ratio for 1-year increase in age, 1.05; 95% CI, 1.02 to 1.08); male gender (adjusted odds ratio, 3.25; 95% CI, 1.29 to 8.16); having a deep cerebral venous system thrombosis (adjusted odds ratio, 5.43; 95% CI, 1.67 to 17.61) or a right lateral sinus thrombosis (adjusted odds ratio, 2.56; 95% CI, 1.03 to 6.40); and having a motor deficit (adjusted odds ratio, 2.94; 95% CI, 1.21 to 7.10). Of the 36 patients who had a delayed intracerebral hemorrhage, those who had a modified Rankin scale 3 to 6 at month 6 were less likely to have received heparin at the acute stage, and more likely to have had early intracerebral hemorrhage. CONCLUSIONS: Among patients with early intracerebral hemorrhage, those who were older, men, had a thrombosis of the deep cerebral venous system or of the right lateral sinus, and a motor deficit were at higher risk for death or dependency at month 6. This subgroup of patients with predictors of poor outcome can be the target for new therapeutic strategies.

Adolescent↗
PubMed2006

Prognostic value of hyperintense vessel signals on fluid-attenuated inversion recovery sequences in acute cerebral ischemia.

BACKGROUND: Fluid-attenuated inversion recovery (FLAIR) sequences may reveal hyperintense vessel signals (HVS) at the acute stage of cerebral ischemia. The aim of this study was to test the hypothesis that HVS are associated with a worse outcome. METHODS: We included 30 consecutive patients admitted within 12 h after onset of hemispheric cerebral ischemia. The outcome was assessed with the modified Rankin Scale at month 1. RESULTS: Proximal HVS were present in 9 patients and distal HVS in 16. All patients with proximal occlusions on time-of-flight sequences had distal HVS on FLAIR. Patients with poor outcome at month 1 (modified Rankin Scale 3-6) more frequently had had HVS on MRI (12/13 vs. 4/17; p< 0.001). CONCLUSION: Distal HVS found on FLAIR sequences within 12 h of acute cerebral ischemia are associated with a worse 1-month outcome.

Adult↗
PubMed2005

Fluid-attenuated inversion recovery (FLAIR) sequences for the assessment of acute stroke: inter observer and inter technique reproducibility.

BACKGROUND AND PURPOSE: Diffusion-weighted magnetic resonance (MR) imaging (DWI), and three-dimensional (3D) time-of-flight (TOF) MR angiography (MRA), are highly sensitive for the early detection of stroke and arterial occlusion. However, only a few studies have evaluated the sensitivity of conventional MR sequences that are usually included in the imaging protocol. The aim of this study was to evaluate interobserver and intertechnique reproducibility of Fluid-Attenuated Inversion Recovery (FLAIR) sequences for the diagnosis of early brain ischemia and arterial occlusion. METHODS: Over a 30-month period, brain MR examinations were performed in 34 patients within 12 hours after stroke onset. Imaging protocol included FLAIR sequences, DWI and 3D TOF MRA. Ten observers including radiologists and neurologists, performed separately a visual interpretation of FLAIR images for the detection of brain ischemia and arterial occlusion seen as an arterial high signal. DWI and 3D TOF MRA were used as reference and interpreted independently by two senior radiologists. Interobserver agreement was assessed for image quality, detectability and conspicuity of lesions whereas intertechnique agreement was only judged for lesion detectability. RESULTS: On FLAIR sequences, interobserver agreement for the detection of brain ischemia and arterial occlusion was excellent (kappa = 0.81 and 0.87 respectively). The concordance between FLAIR and DWI sequences for the detection of brain ischemia and between FLAIR and 3D TOF MRA for the detection of arterial occlusion were judged as excellent for all observers (kappa = 0.91 and 0.89 respectively). CONCLUSION: Although DWI is the most sensitive technique with which to detect acute stroke, FLAIR imaging may also be useful to demonstrate both acute ischemia and arterial occlusion with an excellent interobserver reproducibility.

Adult↗
PubMed2005

Secondary prevention after ischemic stroke. Evolution over time in practice.

BACKGROUND AND OBJECTIVE: An optimal management of vascular risk factors, associated with antithrombotic drugs and carotid surgery when appropriate, reduces the risk of a new vascular event after stroke. Although secondary prevention is not optimal in many patients in practice, the question of whether there is an improvement over time remains unanswered. The aim of our study was to test the hypothesis that secondary prevention measures after cerebral ischemia improve over time. METHOD: We included 123 consecutive patients in 1994, and 125 consecutive patients in 2002, who were admitted to a neurological department for any reason and had had an episode of cerebral ischemia less than 6 years earlier. We compared the groups for the management of arterial hypertension, hypercholesterolemia, diabetes mellitus and smoking. We recorded the values of blood pressure, biological parameters, and presence of antithrombotic therapy, lipid-lowering and anti-hypertensive drugs. Whether patients were properly treated or not, was determined by a comparison between their current treatment and guidelines available when recruited. RESULTS: Prevention was not optimal in 96 of 123 (78%) patients in 1994, and in 77 of 125 (62 %) in 2002. Vascular risk factors were better identified and managed in 2002 than in 1994, especially for hypercholesterolemia. Antithrombotic therapies, statins and antihypertensive drugs, except calcium channel blockers, were more often used in 2002. The proportion of patients in whom arterial hypertension and hypercholesterolemia were identified was higher in 2002, but the proportion of patients identified as diabetics remained stable. However, the proportion of patients with blood pressure >140/90 mmHg, glycemia >or = 126 mg/dl, total cholesterol level > or = 240 mg/dl, or being current smokers, were significantly lower in 2002 than in 1994. CONCLUSION: Although most of patients with previous cerebral ischemia did not receive an optimal management of their risk factors in 2002, there was an improvement over an 8-year period.

Aged↗
PubMed2004

Comparison of secondary vascular prevention in practice after cerebral ischemia and coronary heart disease.

BACKGROUND: Secondary prevention measures in patients with cerebral ischemia or coronary heart disease (CHD) consist of vascular risk factors management and antithrombotic therapy. The aim of this study was to compare how secondary prevention measures are applied in practice between patients with a history of CHD or cerebral ischemia. METHOD: We compared vascular risk factors management and antithrombotic therapy between patients with a history of CHD and patients with a history of cerebral ischemia that occurred 2 months to 6 years earlier. Whether patients were properly treated or not was determined by a comparison between their current treatments and European guidelines for stroke and CHD management. RESULTS: We included 107 consecutive patients with a history of cerebral ischemia and 85 consecutive patients with a history of CHD. We found that: (i). most patients did not receive an appropriate secondary prevention in both groups: 76 of 107 patients with previous cerebral ischemia (71 %) and 73 of 85 patients with CHD (85.9 %); (ii). identification of risk factors, such as hypercholesterolemia, diabetes mellitus and smoking, did not differ between both groups, but arterial hypertension was more frequent in CHD patients; (iii). an inappropriate management of risk factors was more frequent in patients with TIA vs. ischemic stroke, and angina pectoris vs. myocardial infarction; (iv). arterial hypertension and hypercholesterolemia were the 2 more frequent risk factors that were not properly treated; (v). more than half diabetic patients had hyperglycemia > or= 126 mg/dl in both groups; (vi). patients with previous CHD had twice more frequently stopped smoking than those with cerebral ischemia. CONCLUSION: Many patients were not properly treated in both groups, and differences between practice and guidelines were more frequent in the CHD group, where guidelines are more strict.

Aged↗
PubMed2003

Cerebral magnetic resonance imaging within 6 hours of stroke onset: inter- and intra-observer reproducibility.

BACKGROUND: Magnetic resonance imaging (MRI) provides valuable pathophysiological information during the very first hours of cerebral ischemia. However, the reliability of prime-time MRI in the setting of emergency care remains unknown. AIM: To evaluate the reproducibility between and within observers of the assessment of MRI scans in stroke patients. METHOD: We performed a MRI scan within 6 h of stroke onset, with time-of-flight (TOF), T2* gradient echo, FLAIR, diffusion- (DWI) and perfusion- (PWI) weighted images, in 17 consecutive patients. Four observers, blinded to the clinical history, separately performed a visual assessment of all scans, and repeated the assessment 2-8 days later. Two neuroradiologists made volumetric measures of diffusion and perfusion abnormalities using a semi-automatic technique 2 weeks after the 2nd visual assessment. We evaluated: (i) in the whole set of MRI scans, the quality of scans and their ability to identify primary hemorrhages on T2* gradient echo sequences; (ii) in patients with acute cerebral ischemia only, the inter- and intra-observer agreement for the presence of arterial occlusion and cerebral abnormalities on TOF sequences, and (iii) on DWI and PWI sequences, the relationship between visual and automatic assessments for the presence of a mismatch (defined as the difference between the perfusion and diffusion abnormalities) of >20%. Statistics used the kappa (kappa) method. RESULTS: The median delay between clinical onset and MRI was 285 min. Two patients had primary cerebral hemorrhages, 1 a post-ictal deficit, and 14 cerebral ischemia. The quality of the scans was judged as appropriate for all scans in all sequences except for FLAIR. All observers identified the 2 patients with hemorrhages. The inter- and intra-observer reliability was substantial to excellent (kappa values ranging from 0.63 to 1.00) for all sequences. The agreement between visual and automatic assessments for the presence of a mismatch of >20% was excellent in all observers. CONCLUSION: The visual assessment of T2* gradient echo, TOF, diffusion and perfusion sequences at the acute stage of stroke is reproducible between and within observers. The visual assessment is as good as the volumetric assessment to detect a mismatch of >20%.

Adult↗