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O Godefroy

Publications and source records attributed to O Godefroy.

At least 19 recordsLinked to original sources
PubMed2005

[Acetylcholinesterase inhibitor treatment for Alzheimer's disease: the experience in Picardy].

INTRODUCTION: Despite numerous advances in the management of patients with Alzheimer's disease (AD), the proportion of patients treated according to current recommendations remains unknown. METHODS: In order to examine this point, we performed a study assessing the proportion of AD patients receiving one acetylcholinesterase inhibitor. This study was performed in Picardy (1.9 millions of inhabitants) in 2000 and 2001. The number of patients receiving one acetylcholinesterase inhibitor (tacrine, donepezil, rivastigmine and galantamine) was determined using data from health insurance and from pharmaceutical companies. RESULTS: The prevalence of AD was estimated to vary from 10751 patients in 2000, to 10990 in 2001. The number of treated patients was 1798 in 2000 and 2572 in 2001 and this corresponded to 16.7 percent (95CI: 2.5) and 23.4 percent (95CI: 3.4) of prevalent cases, respectively. Following the exclusion of patients with moderate to severe AD (estimated to represent 25 percent of patients), the proportion of treated patients reached 22.4 percent (95CI: 2.3) in 2000 and 31.3 percent (95CI: 3.1) in 2001. CONCLUSIONS: Despite a significant increase between 2000 and 2001, this study shows that less than a third of AD patients with mild to moderate dementia were treated with acetylcholinesterase inhibitors. Although numerous factors might have affected our estimations, this study shows that effective care of AD patients remains largely insufficient.

Aged↗
PubMed2004

[Sarcoidosis revealed by a spinal cord lesion].

Spinal neurosarcoidosis is rarely a presenting symptom. This case deals with a 45-year-old african woman who presented with a regressive spinal cord compression treated by parenteral corticosteroid. Different relapses allowed to diagnose multiple sclerosis. Spinal MRI scan showed diffuse enlargement of the cord with intense intramedullary enhancement from C3 to T1 and an aspect of large spinal cord from C7 to D1. Cranial MRI scan was normal. Radiographs and CT scan of the chest revealed an interstital syndrome without mediastinal lymphadenopathy (subgroup III). The serum angiotensin converting enzyme level was elevated in the blood as the cerebrospinal fluid. CSF fluid showed a lymphocytic meningitis. The bronchio-alveolar lavage found an hyperlymphocytosis with a high CD4/CD8 ratio. The neurological status and biological parameters were improved with oral corticotherapy treatment. This case report that a spinal cord involvement can reveal a sarcoidosis especially in the African race. Finally, in spite of lack of biopsy, the diagnosis is supported by clinical, biological and neuroradiological arguments.

Female↗
PubMed2004

[Frontal dysexecutive syndromes].

Investigation of executive functions is an approach which began with the early description of behavioral disorders induced by frontal damage. The development of neuropsychology has led to the description of a large variety of cognitive disorders. This type of approach has generated a large number of tests which are still used in clinical practice. More recently, theoretical approaches have proposed an organization of executive processes and have documented the diversity of executive functions and related anatomy. These studies have deeply influenced the clinical approach, the assessment and the diagnosis of executive disorders. For clinical practice, these data favor specific assessment of certain key behavioral and cognitive deficits investigated with a battery of tests.

Cognition↗
PubMed2003

Percutaneous transluminal angioplasty of proximal vertebral artery stenosis: long-term clinical follow-up of 16 consecutive patients.

We report long-term (average 30 months) clinical and radiological follow-up of 16 consecutive patients with uni- or bilateral proximal vertebral artery stenosis who underwent percutaneous transluminal angioplasty (PTA), without stenting, between 1995 and 1998. Assessment was performed by an independent neurologist. All patients but one remained asymptomatic during follow-up; moderate restenosis was observed in four. PTA of the proximal vertebral artery is safe but in the absence of knowledge of the natural history of atherosclerotic vertebral artery stenosis, whether it is beneficial or not remains unproven. The decision as to whether to perform this procedure is individual.

Adult↗
PubMed2003

Cerebral venous thrombosis 3-year clinical outcome in 55 consecutive patients.

An early diagnosis and heparin therapy have contributed to a decreased mortality in cerebral venous thrombosis (CVT). However, predictors of outcome are difficult to identify, because most studies suffered heterogeneity in diagnostic findings and treatments, retrospective design, and recruitment bias. The aim of this study was to evaluate the clinical outcome in 55 consecutive patients with CVT admitted over a 4-year period. The study population consisted of 42 women and 13 men, with a median age of 39 years (range 16-68). The diagnosis was performed with MRI in 53 patients, and angiography in 2. The outcome was assessed with the modified Rankin scale (mRs). After a median follow-up of 36 months (range: 12-60), 45 patients were independent (mRS 0-2), and 10 were dependent or dead (mRS 3-6). Of 48 survivors, 7 had seizures, 6 motor deficits, 5 visual field defects, 29 headache (migraine in 14, tension headache in 13, other in 2). The logistic regression analysis found focal deficits and cancer at time of diagnosis, as independent predictors of dependence or death at year 3, and isolated intra-cranial hypertension as an independent predictor of survival and independence. Mortality rates are low in the absence of cancer and focal deficits, and more than 80 % of survivors are independent after 3 years. However, 3/4 of survivors have residual symptoms. Therefore, despite a low mortality rate, CVT remains a serious disorder.

Adult↗
PubMed2002

Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke.

OBJECTIVE: To determine the 3-year outcome in 287 young adults (15 to 45 years old) consecutively admitted between 1992 and 1996 for an ischemic stroke. METHODS: Follow-up was obtained with clinical examinations or telephone interviews, and data were recorded about risk factors, associated disorders, causes of stroke, and current treatments. Functional outcomes were classified with the modified Rankin Scale (mRS). Endpoints were stroke recurrence, myocardial infarction, epileptic seizures, and death. RESULTS: After a mean follow-up of 3 years, no patient was lost to follow-up; 25.4% of the follow-up visits were performed by telephone interview. The authors found 1) an annual mortality rate of 4.5% during the first year and then of 1.6%; 2) an annual stroke recurrence rate of 1.4% during the first year and then of 1.0%; 3) a 0.2% annual rate of myocardial infarct; 4) epileptic seizures occurring in 6.6% of patients, during the first year in most patients; 5) independence (mRS = 0 to 2) in 94.0% of patients; 6) 4.2% of patients lost their job after stroke despite an mRS score of < or =1; 7) 7.0% of patients reported divorce; and 8) only 22.2% of smokers gave up smoking. CONCLUSION: Although young patients who experience ischemic strokes have a low risk of stroke recurrence and myocardial infarction, some patients do not regain independence.

Adolescent↗
PubMed2002

Vascular aphasias: main characteristics of patients hospitalized in acute stroke units.

BACKGROUND AND PURPOSE: Aphasia is frequent in stroke patients and is associated with poor prognosis. However, characteristics and determinants of vascular aphasias remain controversial. The aim of this study was to evaluate aphasia characteristics at the acute stage in patients admitted to a stroke unit. METHODS: The study was performed in 308 patients consecutively assessed with a standardized aphasia battery. RESULTS: Aphasia was observed in 207 patients; global and nonclassified aphasias accounted for 50% of aphasic syndromes at the acute stage, whereas classic aphasias (Wernicke's, Broca's, transcortical, and subcortical aphasias) were less frequent. Age differed across aphasic syndromes in ischemic stroke patients only; patients with conduction aphasia were younger, and patients with subcortical aphasia were older. Sex did not significantly differ across aphasic syndromes. The presence of a previous stroke was more frequent in nonclassified aphasia. CONCLUSIONS: This study shows (1) that vascular aphasias are frequently severe or nonclassic at the acute stage, a finding explained in part by the presence of a previous stroke; (2) that the age effect is due mainly to its influence on infarct location; and (3) that the main determinant of aphasia characteristics is lesion location.

Adolescent↗
PubMed2001

The thalamus interrupts top-down attentional control for permitting exploratory shiftings to sensory signals.

When attention is involuntarily drawn in a direction different to that of the target, slower motor response times are observed (i.e. the meridian effect). Previous data suggested that the thalamus might participate in the generation of visual salience. What may be the role of the thalamus in the capture by luminance transients when attentional control is in action? A single experiment was administrated in a group of ten healthy volunteers as well as in a group of three patients with unilateral thalamic infarcts. Subjects participated in a task where attentional control was interrupted by a distractor. The meridian effect was present only in the performance of the healthy volunteers and when distractors occurred in the ipsilesional (intact) hemifield of the thalamic patients. These results suggest that when an important signal appears during attentional focalization, the thalamus interrupts current focalization and permits the compilation of an attentional program in the midbrain aiming at generating an orienting response towards the source of this signal.

Adult↗
PubMed2000

The anatomy of aphasia revisited.

OBJECTIVE: To determine lesion locations associated with the various types of aphasic disorders in patients with stroke. BACKGROUND: The anatomy of aphasia has been challenged by several recent studies. Discrepancies are likely to be due to methodologic issues. METHODS: We examined 107 patients with a standardized aphasia battery and MRI. Three examiners blinded to the clinical data rated signal abnormalities in 69 predetermined regions of interest. The statistical procedure used classification tree testing, which selected regions associated with each aphasic disorder. RESULTS: 1) Nonfluent aphasia depended on the presence of frontal or putaminal lesions; 2) repetition disorder on insula-external capsule lesions; 3) comprehension disorder on posterior lesions of the temporal gyri; 4) phonemic paraphasia on external capsule lesions extending either to the posterior part of the temporal lobe or to the internal capsule; 5) verbal paraphasia on temporal or caudate lesions; and 6) perseveration on caudate lesions. These analyses correctly classified 67% to 94% of patients. CONCLUSIONS: Lesion location is the main determinant of aphasic disorders at the acute stage. Most clinical-radiologic correlations supported the classic anatomy of aphasia.

Adolescent↗
PubMed2000

[Functional anatomy of the third ventricle. Neuropsychological data].

The functional structures surrounding the third ventricle explain the occurrence of neuropsychological disorders when a tumor develops in this area. The functional environment of the third ventricle is involved in memory, motor executive control, endocrine and vegetative regulations. The types of memory deficit, the behavioural and emotional regulations, the interhemispheric transfer, and the regulation of executive functions are analyzed and correlated to the concerned anatomical structures. The review of the literature collected few specific considerations in neuropsychological dysfunctions occurring with tumors of the third ventricle. A retrospective study was conducted in 17 patients of the national series operated on for a third ventricle lesion : long-term memory and executive functions were frequently impaired in the patients, and the deficits were underestimated by usual follow-up. More systematic utilization of preoperative and postoperative test batteries is necessary for a better evaluation of neuropsychological disorders after third ventricle surgery.

Adolescent↗
PubMed1999

Control functions of the frontal lobes. Modularity of the central-supervisory system?

Lesions of the prefrontal cortex result in a wide variety of neuropsychological disorders. Despite recent advances, the executive processes and their functional architecture remain poorly specified. This study assessed control processes operating in novel, conflicting and combined tasks in patients with lesion of the prefrontal or posterior cortices. Experiments used two-choice reaction time tests with similar perceptuo-motor and decision processes. It mainly showed (1) impaired short term memory in posterior patients, and (2) impairment of response inhibition and tasks combination in some frontal patients. Selective deficits with double dissociations were evidenced on novel, conflicting and combined tasks. This study provides additional evidence for the prominent role of the frontal lobes in control processes. The demonstration of selective deficits of specific control processes suggests that executive functions depend on multiple separable control processes, and that their operations can be specified in cognitive terms.

Adult↗
PubMed1999

Internal carotid arterial stenosis: CT angiography with volume rendering.

PURPOSE: To determine the reliability of helical computed tomography (CT) with volume rendering for evaluation of internal carotid arterial stenosis. MATERIALS AND METHODS: In 22 patients, 44 carotid arteries were evaluated with helical CT and selective conventional angiography. CT data were displayed on volume-rendered and maximum intensity projection (MIP) images. Stenoses were measured separately on axial, volume-rendered, and MIP images and on conventional angiograms. Each artery was then graded as having no stenosis, mild (< 30%) stenosis, moderate (30%-70%) stenosis, severe (> 70%) stenosis, near occlusion, or occlusion. RESULTS: One case of stenosis was not assessable at axial CT because of an inappropriate scanning plane; four cases were not assessable at MIP CT because of mural calcifications. All carotid arteries were assessable on volume-rendered images despite no depiction of the residual lumen at the site of narrowing in three cases of near occlusion. Correlations between angiography and helical CT were good. Axial, volume-rendered, and MIP images enabled correct classification of stenosis in 88%, 89%, and 90% of arteries, respectively. CT with volume rendering was slightly more sensitive for determining candidates for endarterectomy (i.e., those with > 70% stenosis and near occlusion); sensitivity was 100% and specificity, 92%. CONCLUSION: CT angiography with volume rendering enabled accurate evaluation of carotid disease, even when dense calcifications were present. However, no definite advantage over currently available techniques for CT measurement of stenosis severity was found.

Adult↗
PubMed1999

Confusional state in stroke: relation to preexisting dementia, patient characteristics, and outcome.

BACKGROUND AND PURPOSE: Acute confusional state (ACS) is frequent in hospitalized stroke patients. We previously showed that 16% of patients admitted for a stroke have preexisting dementia. The extent to which preexisting cognitive decline is associated with a risk of ACS at the acute stage of stroke remains to be systematically examined. The aim of this study was to evaluate the prevalence of ACS in acute stroke patients, to study the influence of preexisting cognitive decline and other patient characteristics, and to evaluate the influence of ACS on outcome. METHODS: We diagnosed ACS using DSM-IV criteria and the Delirium Rating Scale with a cutoff of 10 in 202 consecutive stroke patients aged 40 years or older (median age, 75 years; range, 42 to 101 years). Cognitive functioning before stroke was assessed with the Informant Questionnaire on Cognitive Decline in the Elderly. RESULTS: Forty-nine stroke patients (24.3%; 95% CI, 18.3% to 30.2%) had an ACS during hospitalization. Using logistic regression analysis, we found preexisting cognitive decline (P=0.006) and metabolic or infectious disorders (P=0.008) to be independent predictors of ACS. Functional, but not vital, prognosis was worse in patients with ACS at discharge and 6 months after stroke. CONCLUSIONS: ACS occurs in one fourth of stroke patients older than 40 years. Its occurrence requires inquiry for a preexisting cognitive decline, which usually remains unrecognized in the absence of a systematic evaluation.

Acute Disease↗
PubMed1999

Preliminary experience using contrast-enhanced MR angiography to assess vertebral artery structure for the follow-up of suspected dissection.

BACKGROUND AND PURPOSE: Important advances have been made recently in MR angiography with the use of contrast medium injection, which has proved valuable for the imaging of vertebral arteries (VAs) obtained during short scanning times. Our purpose was to assess the feasability of contrast-enhanced fast 3D MR angiography for imaging VAs and to evaluate the long-term follow-up of VA dissections. METHODS: Sixteen consecutive patients with 18 angiographically documented VA dissections (seven occlusive dissections and 11 stenotic dissections, including two each with a pseudoaneurysm) were followed up using both contrast-enhanced 3D MR angiography and cervical T1-weighted MR imaging at a median delay of 22 months. Ten patients underwent MR imaging at the acute phase as well, and nine underwent early follow-up angiography at a median delay of 3 months. MR angiographic findings were determined by consensus, focussing on image quality, presence of residual stenosis, luminal irregularities, and occlusion. RESULTS: Of the 32 VAs, a segment of the artery was not assessable on contrast-enhanced MR angiography in each of four small VAs. A central signal void artifact of cervical arteries was seen in one patient and motion artifacts were seen in two, but images could be interpreted. A venous enhancement was detected in 10 of 16 examinations, but this did not prevent image analysis. Ten of 11 stenotic dissections returned to normal, whereas one stenotic dissection progressed to occlusion. Two pseudoaneurysms detected by initial angiography resolved spontaneously; one was revealed only by delayed MR angiography, and one was detected on an early MR angiogram and proved resolved on a late MR angiogram. Of the seven initially occluded VAs, five reopened, with a hairline residual lumen in each of three. CONCLUSION: This preliminary experience showed that contrast-enhanced MR angiography is a promising tool for imaging VAs; it allows the assessment of VA dissection changes over time. Most lesions tended to heal spontaneously, but persisting occlusion or pseudoaneurysm could be detected during the late course.

Adult↗
PubMed1998

[Prognosis of cerebral ischemic accidents].

One of the roles of neurologists is to determine the prognosis in patients with cerebral infarction. However, it remains difficult to determine the prognosis at the individual level. Patients with cerebral infarction are at risk of death, stroke recurrence, intercurrent complications and sequelae. A clinical improvement may occur years after stroke onset, especially for neuropsychological deficits. Predictors of outcome may lead to a more appropriate management of stroke patients and an optimization of the reinsertion.

Brain Ischemia↗