Importance Evidence regarding efficacy and safety of thrombectomy in acute ischemic stroke (AIS) due to medium or distal vessel occlusions (MDVOs) is lacking. Objective To evaluate the benefit of thrombectomy, in addition to medical treatment over medical treatment alone, in patients with an AIS related to a primary and isolated MDVO. Design, Setting, and Participants Randomized clinical trial conducted at 22 stroke centers in France from November 2021 to April 2025, with planned enrollment of 488 patients. The trial has been stopped after the planned interim analysis on the recommendation of the data and safety monitoring board for futility and increased rate of symptomatic intracranial hemorrhage with thrombectomy. Eligible adult patients had an AIS due to a primary MDVO within 8 hours of symptom onset or within 24 hours of last seen well if no hyperintense signal was present on fluid-attenuated inversion recovery imaging. Intervention Thrombectomy in addition to medical treatment (n = 123) or medical treatment alone (n = 121). Main Outcomes and Measures The primary end point was a good clinical outcome at 3 months, defined as a modified Rankin Scale score of 0 to 2, assessed by an independent, blinded assessor. Secondary end points included mortality rate at 3 months and adverse and serious adverse events. Results Of the 244 patients randomized (median age, 75 years [IQR, 67-81]; 56% male; median National Institutes of Health Stroke Scale score, 8 [IQR, 6-12]), 100 of the 123 patients in the thrombectomy group (81%) received thrombectomy and none of the 121 patients in the control group received thrombectomy; 217 (89%) completed follow-up. At 3 months, 72 of 116 patients (62%) in the thrombectomy group had a good clinical outcome vs 81 of 119 patients (68%) in the control group (odds ratio, 0.73 [95% CI, 0.40-1.31]; P = .29; adjusted absolute difference, −6.8% [95% CI, −19.4% to 5.7%]). The incidence of symptomatic intracranial hemorrhages was higher among the 100 patients who actually received thrombectomy than in those who did not (11% vs 3%, P = .008), as was incidence of subarachnoid hemorrhages (13% vs 2%, P < .001) and embolus migration (5% vs 1%, P = .04). Mortality rate did not significantly differ between the 2 groups (6% vs 8%; P = .49). Conclusions and Relevance Thrombectomy did not lead to a higher rate of good clinical outcome at 3 months compared with medical treatment alone in patients with acute ischemic stroke related to an MDVO. Hemorrhagic complications were more frequent after thrombectomy. Trial Registration ClinicalTrials.gov Identifier: NCT05030142

BACKGROUND:Non-ischemic cerebral enhancing (NICE) lesions following aneurysm endovascular therapy are exceptionally rare, with unknown longitudinal evolution. OBJECTIVE:To evaluate the radiological behavior of individual NICE lesions over time. METHODS:Patients included in a retrospective national multicentric inception cohort were analyzed. NICE lesions were defined, using MRI, as delayed onset punctate, nodular, or annular foci enhancements with peri-lesion edema, distributed in the vascular territory of the aneurysm treatment, with no other confounding disease. Lesion burden and the longitudinal behavior of individual lesions were assessed. RESULTS:Twenty-two patients were included, with a median initial lesion burden of 36 (IQR 17-54) on the first MRI scan. Of the 22 patients with at least one follow-up MRI scan, 16 (73%) had new lesions occurring mainly within the first 200 weeks after the date of the procedure. The median number of new lesions per MRI was 6 (IQR 2-16). Among the same 22 patients, 7 (32%) had recurrent lesions. The median persistent enhancement of a NICE lesion was 13 weeks (IQR 6-30). No factor was predictive of early regression of enhancement activity with lesion regression kinetics mainly being patient-dependent. CONCLUSIONS:The behavior of individual NICE lesions was found to be highly variable with an overall patient-dependent regression velocity.

Background: Impingement of an elongated styloid process (ESP) or calcified stylohyoid ligament on surrounding neck structures defines Eagle syndrome. The vascular variant, also called stylocarotid syndrome, results from impingement of vascular structures and remains poorly known among physicians.Research Design: We report our own experience and review the literature in order to clarify the diagnostic and therapeutic management. Patients with vascular events in relation to an ESP and hospitalized at our institution were extracted from our databank and retrospectively reviewed. We also performed a comprehensive review of the literature on Eagle syndrome using PubMed (R) and Google Scholar, analysing the presentation, management, and follow-up.Results: We report five cases of the vascular variant of Eagle syndrome: one carotid perforation, one focal arteriopathy, one with both acute and chronic dissection and two acute internal carotid dissection. Vascular compression, whether permanent or transient, is also reported in the literature. Management varies, although styloidectomy is deemed appropriate for symptomatic compression, while stenting is preferred in cases of perforation.Conclusions: A common definition of Eagle syndrome is required for better diagnosis and management. The choice of styloidectomy is understandable for compression but remains to be investigated in other cases.

BACKGROUND:Whether the optimization of cerebral oxygenation based on regional cerebral oxygen saturation (rSO2) monitoring reduces the occurrence of cerebral ischemic lesions is unknown. METHODS:This multicenter, randomized, controlled trial recruited adults admitted for scheduled carotid endarterectomy. Patients were randomized between the standard of care or optimization of cerebral oxygenation based on rSO2 monitoring using near-infrared spectroscopy. In the intervention group, in case of a decrease in rSO2 in the intervention, the following treatments were sequentially recommended: (1) increasing oxygenotherapy, (2) reducing the tidal volume, (3) legs up-raising, (4) performing a fluid challenge and (5) initiating vasopressor support. The primary endpoint was the number of new cerebral ischemic lesions detected using magnetic resonance imaging pre- and postoperatively. Secondary endpoints included new neurological deficits and mortality on day 120 after surgery. RESULTS:Among the 879 patients who were randomized, 665 (75.7%) were men. There was no statistically significant difference between groups for the mean number of new cerebral ischemic lesions per patient up to 3 days after surgery: 0.35 (±1.05) in the standard group vs. 0.58 (±2.83), in the NIRS group; mean difference, 0.23 [95% CI, -0.06 to 0.52]; estimate, 0.22 [95% CI, -0.06 to 0.50]. New neurological deficits up to day 120 after hospital discharge were not different between the groups: 15 (3,39%) in the standard group vs. 42 (5,49%) in the NIRS group; absolute difference, 2,10 [95% CI, -0,62 to 4,82]. There was no significant difference between groups for the median [IQR] hospital length of stay: 4.0 [4.0-6.0] in the standard group vs. 5.0 [4.0-6.0] in the NIRS group; mean difference, -0.11 [95% CI, -0.65 to 0.44]. The mortality rate on day 120 was not different between the standard group (0.68%) vs. the NIRS group (0.92%); absolute difference = 0.24% [95% CI, -0.94 to 1.41]. CONCLUSIONS:Among patients undergoing carotid endarterectomy, optimization of cerebral oxygenation based on rSO2 did not reduce the occurrence of cerebral ischemic lesions postoperatively compared with controlled hypertensive therapy. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT01415648.

Les anévrysmes intracrâniens larges et géants de la carotide interne représentent une pathologie complexe et polymorphe dont le pronostic fonctionnel et vital, variable selon les topographies, est globalement péjoratif en l'absence de traitement. Ils échappent aux thérapeutiques conventionnelles et nécessitent le recours à des traitements endovasculaires de seconde ligne comme l'occlusion carotidienne ou la diversion de flux (Flow Diverter). Ces deux techniques illustrent des approches diamétralement opposées, la première ayant pour effet d'occlure l'axe porteur (approche « déconstructive ») et la seconde de le reconstruire (approche « reconstructive »). Notre objectif était de comparer ces traitements en termes de sécurité et d'efficacité. Nous avons réalisé une étude observationnelle, rétrospective, monocentrique, en incluant 48 patients porteurs d'anévrysmes larges et géants de la carotide interne et traités par l'une de ces deux options entre 2007 et 2021 en analysant les taux de complications neurovasculaires péri-opératoires (< 30 jours) et les résultats radio-cliniques à 1 an. Les complications neuro-vasculaires péri-opératoires, majoritairement ischémiques, étaient plus fréquentes dans le groupe traité par diversion de flux sans différence significative (30% vs 5,56%, p = 0,067). Le groupe traité par occlusion carotidienne présentait un meilleur taux d'occlusion complète à 3 mois semblant corrélé à un meilleur taux d'amélioration clinique à 1 an de façon significative. Dans notre centre, l'occlusion carotidienne semblait donc présenter un meilleur profil de sécurité et d'efficacité par rapport à la diversion de flux dans le traitement des anévrysmes larges et géants de la carotide interne bien qu'aucune différence significative n'ait été montrée pour les critères de sécurité (figures 1-2) (références 1 à 13)

Background Non-ischemic cerebral enhancing (NICE) lesions are exceptionally rare following aneurysm endovascular therapy (EVT). Objective To investigate the presenting features and longitudinal follow-up of patients with NICE lesions following aneurysm EVT. Methods Patients included in a retrospective national multicentre inception cohort were analysed. NICE lesions were defined, using MRI, as delayed onset punctate, nodular or annular foci enhancements with peri-lesion edema, distributed in the vascular territory of the aneurysm EVT, with no other confounding disease. Results From a pool of 58 815 aneurysm endovascular treatment procedures during the study sampling period (2006–2019), 21/37 centres identified 31 patients with 32 aneurysms of the anterior circulation who developed NICE lesions (mean age 45±10 years). Mean delay to diagnosis was 5±9 months, with onset occurring a month or less after the index EVT procedure in 10 out of 31 patients (32%). NICE lesions were symptomatic at time of onset in 23 of 31 patients (74%). After a mean follow-up of 25±26 months, 25 patients (81%) were asymptomatic or minimally symptomatic without disability (modified Rankin Scale (mRS) score 0–1) at last follow-up while 4 (13%) presented with mild disability (mRS score 2). Clinical follow-up data were unavailable for two patients. Follow-up MRI (available in 27 patients; mean time interval after onset of 22±22 months) demonstrated persistent enhancement in 71% of cases. Conclusions The clinical spectrum of NICE lesions following aneurysm EVT therapy spans a wide range of neurological symptoms. Clinical course is most commonly benign, although persistent long-term enhancement is frequent.

Background and Purpose: Although the efficacy of endovascular treatment (EVT) in patients with anterior circulation ischemic stroke (AIS) is well documented, early neurological deterioration after EVT remains a serious issue associated with poor outcome. Besides obvious causes, such as lack of reperfusion, procedural complications, or parenchymal hemorrhage, early neurological deterioration may remain unexplained (UnEND). Our aim was to investigate predictors of UnEND after EVT in patients with AIS. Methods: Patients who underwent EVT for AIS, with an initial National Institutes of Health Stroke Scale score >5, Alberta Stroke Program Early CT Score ≥6, and included in a multicenter prospective observational registry were analyzed. Predictors of UnEND, defined as ≥4-point increase in the National Institutes of Health Stroke Scale score between baseline and day 1 after EVT, were determined via center-adjusted analyses. Results: Among the 1925 included in the analysis, 128 UnEND (6.6%) were recorded. In multivariate analysis, predictors of UnEND were diabetes mellitus (odds ratio [OR], 2.17 [95% CI, 1.32–3.56]), prestroke modified Rankin Scale score ≥2 (OR, 2.22 [95% CI, 1.09–4.55]), general anesthesia (OR, 2.55 [95% CI, 1.51–4.30]), admission systolic blood pressure (OR, 1.10 [95% CI, 1.01–1.20]), age (OR, 1.38 [95% CI, 1.14–1.67]), number of passes (OR, 1.16 [95% CI, 1.04–1.28]), direct admission or not to a comprehensive stroke center (OR, 0.49 [95% CI, 0.30–0.81]), and initial National Institutes of Health Stroke Scale score (OR, 0.65 [95% CI, 0.52–0.81]). Conclusions: Severely impaired AIS patients with nonmodifiable factors are more likely to develop UnEND. Some modifiable predictors of UnEND such as the number of EVT passes could be the object of improvement in AIS management.

Background: Fluid attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) document slowed vascular flow at the level and after the occlusion site patients with acute ischemic stroke (AIS). We aimed to assess the accuracy of FVH for the confirmation and location of a large vessel occlusion (LVO). Methods: Three radiologists reviewed the FLAIR sequence of the admission MRI exam of patients with suspected AIS at a single academic center. Readers were provided with the main clinical deficit with National Institute of Health Stroke Severity score and were asked to identify and locate an LVO when appropriate. Kappa coefficients were calculated for agreement along with diagnosis performances of FVH to recognize and locate an LVO with digital subtracted angiography (DSA) as gold standard. Results: Among 125 patients screened with MRI for a suspected AIS, 96 (81%) were diagnosed with AIS and 47 (38%) patients had an anterior LVO of whom 25 (20%) had a DSA for mechanical thrombectomy. Kappa coefficients for intra- and inter-readers were good to excellent. Overall, the sensitivity and the specificity of the FVH to predict an anterior LVO was 0.98 (95% confidence interval [CI]: 0.94–1) and 0.86 (95% CI: 0.79–0.96), respectively, while PPV and NPV were 0.87 (95% CI: 0.85–0.95) and 0.98 (0.97–1), respectively. FVH also showed good to excellent accuracy for identifying M1 and M2 versus internal carotid artery occlusion site. Conclusion: We found that FVH demonstrated excellent diagnostic performances for the identification of LVO and its level with good to excellent reproducibility. This MRI radio marker of occlusion provides additional arguments and may speed-up the detection of potential candidates for MT.

Background and purpose Hemorrhagic transformation (HT) is a complication of stroke that can occur spontaneously or after treatment. We aimed to assess the inter‐ and intrarater reliability of HT diagnosis. Methods Studies assessing the reliability of the European Cooperative Acute Stroke Study (ECASS) classification of HT or of the presence (yes/no) of HT were systematically reviewed. A total of 18 raters independently examined 30 post‐thrombectomy computed tomography scans selected from the Aspiration versus STEnt‐Retriever (ASTER) trial. They were asked whether there was HT (yes/no), what the ECASS classification of the particular scan (0/HI1/HI2/PH1/PH2) (HI indicates hemorrhagic infarctions and PH indicates parenchymal hematomas) was and whether they would prescribe an antiplatelet agent if it was otherwise indicated. Agreement was measured with Fleiss’ and Cohen's κ statistics. Results The systematic review yielded four studies involving few (≤3) raters with heterogeneous results. In our 18‐rater study, agreement for the presence of HT was moderate [ κ = 0.55; 95% confidence interval (CI), 0.41–0.68]. Agreement for ECASS classification was only fair for all five categories, but agreement improved to substantial ( κ = 0.72; 95% CI, 0.69–0.75) after dichotomizing the ECASS classification into 0/HI1/HI2/PH1 versus PH2. The inter‐rater agreement for the decision to reintroduce antiplatelet therapy was moderate for all raters, but substantial among vascular neurologists ( κ = 0.70; 95% CI, 0.57–0.84). Conclusion The ECASS classification may involve too many categories and the diagnosis of HT may not be easily replicable, except in the presence of a large parenchymal hematoma.

The authors present the case of a 48-year-old man admitted for acute onset of paraplegia in a patient suffering from backaches for 1 week.The rapidly progressive motor disturbances had been evolving for approximately 12 hours.The entire spinal MRI showed an epidural mass at T4-T6 associated with extensive lesions of spondylodiscitis and a T7-T8 vertebral body loss of height.A large six-level laminectomy was performed.A tumoral etiology couldn't be entirely excluded intraoperatively so that no fusion has been done at that time.The pathological exam revealed acute inflammatory lesions with no argument in favor of a tumoral process.Bacteriological exam of the pathological specimen and stools cultures were positive for Salmonella brandenburg.An episode of gastroenteritis after the ingestion of a pizza has been evoked.The antibiotic medication was prescribed for 12 weeks.Postoperative evolution was favorable with a possible march between bars 6 weeks after.The authors emphasize the pseudo-tumoral presentation in an immunocompetent patient, the lack of complications and the post-ingestion mechanism.

•This is a case of severe reversible cerebral vasoconstriction syndrome. •An improvement was coincident with the administration of IV milrinone. •There was no need for an invasive intra-arterial procedure.

L’apparition de lésions cérébrales non ischémiques prenant le contraste (non-ischemic cerebral enhancing : NICE lesions) a été décrit après le traitement endovasculaire d’anévrysmes intracrâniens. L’objectif de cette étude est de présenter les résultats préliminaires du registre rétrospectif des lésions NICE de la Société Française de Neuroradiologie (SFNR). Un questionnaire standardisé a été adressé sous l’égide de la SFNR à tous les centres de neuroradiologie interventionnelle en France (n = 37). Les centres participants ont rapporté les cas de lésions NICE avec les données démographiques, cliniques et d’imagerie. Vingt centres ont répondu, parmi lesquels 16 avaient rencontré au moins 1 cas de lésions NICE. Les données concernant 17 patients traités pour 18 anévrysmes ont été collectées. Le recueil de données concernant 8 autres patients est en cours. Quatorze femmes et 3 hommes ont été inclus. L’âge moyen au moment du traitement était de 47 ± 10 ans. Cinq des 18 anévrysmes étaient rompus, 1 était compressif et 12 ont été découverts fortuitement. Treize anévrysmes ont été traités par coiling avec ou sans remodeling au ballon, 1 par coiling et stenting, 3 par stent de diversion de flux et 1 par dispositif de diversion de flux intra-sacculaire. Le délai moyen de découverte des lésions NICE était de 8 ± 11 mois (entre 1 et 50 mois). Onze des 17 patients étaient symptomatiques au moment de la découverte des lésions. Deux des 6 patients initialement asymptomatiques ont développé des troubles neurologiques secondairement. Les céphalées étaient le symptôme le plus fréquent, retrouvé chez 9 des 17 patients. La dernière IRM de suivi a été réalisée avec un délai moyen de 20 ± 14 mois. Au moins une prise de contraste résiduelle a été retrouvée chez 9 patients sur ce dernier examen. Les lésions NICE sont rares après traitement endovasculaire d’anévrysmes intracrâniens. Ceci est le premier registre national de cette complication.

BACKGROUND Understanding the pathophysiologic mechanism of intracranial aneurysm (IA) formation is a prerequisite to assess the potential risk of rupture. Nowadays, there are neither reliable biomarkers nor diagnostic tools to predict the formation or the evolution of IA. Increasing evidence suggests a genetic component of IA but genetics studies have failed to identify genetic variation causally related to IA. OBJECTIVE To develop diagnostic and predictive tools for the risk of IA formation and rupture. METHODS The French ICAN project is a noninterventional nationwide and multicentric research program. Each typical IA of bifurcation will be included. For familial forms, further IA screening will be applied among first-degree relatives. By accurate phenotype description with high-throughput genetic screening, we aim to identify new genes involved in IA. These potential genetic markers will be tested in large groups of patients. Any relevant pathway identified will be further explored in a large cohort of sporadic carriers of IA, which will be well documented with clinical, biological, and imaging data. EXPECTED OUTCOMES Discovering genetic risk factors, better understanding the pathophysiology, and identifying molecular mechanisms responsible for IA formation will be essential bases for the development of biomarkers and identification of therapeutic targets. DISCUSSION Our protocol has many assets. A nationwide recruitment allows for the inclusion of large pedigrees with familial forms of IA. It will combine accurate phenotyping and comprehensive imaging with high-throughput genetic screening. Last, it will enable exploiting metadata to explore new pathophysiological pathways of interest by crossing clinical, genetic, biological, and imaging information.

Objective To report our experience with the Embolus Retriever with Interlinked Cage (ERIC) stentriever for use in mechanical endovascular thrombectomy (MET). Methods Thirty-four consecutive patients with acute stroke (21 men and 13 women; median age 66 years) determined appropriate for MET were treated with ERIC and prospectively included over a 6-month period at three different centers. The ERIC device differs from typical stentrievers in that it is designed with a series of interlinked adjustable nitinol cages that allow for fast thrombus capture, integration, and withdrawal. The evaluated endpoints were successful revascularization (Thrombolysis in Cerebral Infarction (TICI) 2b–3) and good clinical outcomes at 3 months (modified Rankin Scale (mRS) 0–2). Results Locations of the occlusions included the middle cerebral artery (13 patients), terminal carotid artery (11 patients), basilar artery (1 patient), and tandem occlusions (9 patients). IV thrombolysis was performed in 20/34 (58.8%) patients. Median times from symptom onset to recanalization and from puncture to recanalization were 325.5 min (180–557) and 78.5 min (14–183), respectively. Used as the first-line device, ERIC achieved a successful recanalization in 20/24 (83.3%) patients. Successful recanalization was associated with lower National Institutes of Health Stroke Scale scores at 24 h (8±6.5 vs 21.5±2.1; p=0.008) and lower mRS at 3 months (2.7±2.1 vs 5.3±1.1; p=0.04). Three procedural complications and four asymptomatic hemorrhages were recorded. Good clinical outcomes at 3 months were seen in 15/31 (48.4%) patients. Conclusions The ERIC device is an innovative stentriever allowing fast, effective, and safe MET.

OBJECTIVE The pathophysiological mechanisms responsible for the formation of intracranial aneurysms (IAs) remain only partially elucidated. However, current evidence suggests a genetic component. The purpose of this study was to investigate the specific anatomical variations in the arterial complex that are associated with the presence of anterior communicating artery (ACoA) aneurysms in the familial forms of IAs. METHODS This multicenter study investigated bifurcation IAs in patients who had a sporadic ACoA IA without a family history of IA (SACAA group), in patients who had an ACoA IA with a family history of IA (FACAA group), and in their healthy first-degree relatives (HFDRs). Through the use of MR angiography (MRA) reconstructions, the symmetry of the A1 segments and the angle between the A1 and A2 segments were analyzed on 3D models for each group. These measurements were then compared among the 3 groups. RESULTS Twenty-four patients with SACAA, 24 patients with FACAA, and 20 HFDRs were included in the study. Asymmetrical configuration of the A1 segments was more frequent in the FACAA group than in the HFDR group (p = 0.002). The aneurysm-side A1-A2 angle was lower in the FACAA group (p = 0.003) and SACAA group (p = 0.007) than in the HFDR group. On the contralateral side, there was no difference in A1-A2 angles between groups. CONCLUSIONS The anatomical shape of the ACoA complex seems to be similarly associated with the presence of ACoA IAs in both the FACAA and SACAA groups. This highlights the role played by hemodynamic constraints in aneurysm formation and questions the hypothesis of the hereditary character of these anatomical shapes.

L’étiologie des infarctus cérébraux du sujet jeune reste indéterminée dans près de 50 % des cas. La consommation de cannabis a été associée à des cas d’infarctus cérébraux, mais la fréquence et la nature de cette association restent mal connus. Évaluer la fréquence de la consommation du cannabis dans une population d’infarctus cérébraux du sujet jeune, et déterminer les caractéristiques cliniques et paracliniques, le pronostic et les mécanismes associés à cette consommation. Cent quatorze patients consécutifs âgés de 15 à 55 ans, hospitalisés pour infarctus cérébral, ont bénéficié d’un dépistage urinaire et par interrogatoire de la consommation de cannabis. Les données cliniques, étiologiques et le pronostic ont été comparés entre les consommateurs de cannabis et les non-consommateurs. Le mode de consommation, la présence d’un vasospasme intracrânien, et l’imputabilité de l’AVC à la consommation de cannabis ont été étudiés. L’âge médian était de 44 ans. Le dépistage du cannabis était positif dans 16 % des cas. Les consommateurs étaient plus jeunes, et avaient un taux de récidive d’AVC plus élevé que les non-consommateurs. Plus de la moitié n’avait pas interrompu le cannabis à 3 mois de l’AVC. L’imputabilité de l’AVC à la consommation de cannabis était probable ou certaine chez 50 % des consommateurs. Un vasospasme intracrânien était prouvé dans 11 % des cas. Le taux de consommation de cannabis dans notre cohorte est plus élevé que dans la population générale. La majorité sont des consommateurs chroniques. Les effets vasoactifs et arythmogènes du cannabis font partie des mécanismes potentiels. Les taux élevés de récidive et de poursuite du cannabis en post-AVC soulignent l’importance du dépistage du cannabis dans l’AVC du sujet jeune, et d’une prise en charge addictologique. La consommation de cannabis est fréquente et associée à un pronostic défavorable chez les sujets jeunes victimes d’infarctus cérébral. Les mécanismes physiopathologiques sont multiples. Une prise en charge addictologique spécifique est nécessaire chez ces patients.

Introduction: There is paucity of studies analyzing DWI in MRI sequences when imaging MRI; cytomegalovirus (CMV) meningoencephalitis. The main objective of this study is to demon Encephalitis strate that DWI sequence is mandatory when imaging immunocompromised patients presenting with encephalitic symptoms, as this sequence can reveal very peculiar lesions in the setting of CMV encephalitis.Patients and method: Three CSF PCR CMV positive cases were identified in a 13-year retrospective study with MRI scans including T1, FLAIR, DWI with automated ADC calculation, and T1 with contrast injection, and were reviewed by a senior neuroradiologist.Results: Our three cases presented multiple high-signal intensity punctiform lesions in DWI, which uniformly were in restricted diffusion. Each patient had multiple lesions (mean 19.3, range 12-30): 96.5% were supratentorial and 3.5% were infratentorial. Among supratentorial lesions, 62.5% were subependymal, 28.6% were periventricular and 8.9% were subcortical. Some lesions remained in a long lasting restricted diffusion state. All cases had FLAIR curvilinear periventricular high signal intensities. No contrast uptake was found.Discussion: Punctiform DWI lesions had a clear ventricle wall tropism, consistent with classical autopsy findings. The classical histological knowledge-compatible explanation for long lasting diffusion restriction is non-lethal cytotoxic edema owing to CMV inclusions.Conclusion: Subependymal and periventricular punctiform restricted diffusion lesions in the setting of meningoencephalitis in immunocompromised patients seem highly evocative of CMV encephalitis. The diffusion sequence probably reveals focal lesions constitutive of cellular viral inclusions. (C) 2016 Elsevier Masson SAS. All rights reserved.

La thrombectomie associée à la fibrinolyse est validée par plusieurs études dans le traitement de l’infarctus cérébral. L’anticoagulation contre indique la fibrinolyse et le devenir des patients pris en charge par voie endovasculaire seule dans ce contexte est mal connu. Une étude récente a montré des données rassurantes sur la sécurité et la morbi-mortalité de la thrombectomie mécanique chez les patients sous anticoagulants (TM-AC) à dose efficace. L’objectif de notre travail est de confronter ces résultats à ceux de la cohorte nantaise. Le groupe TM-AC a été comparé aux patients fibrinolysés par voie intraveineuse et thrombectomisés par voie endovasculaire (FIV-TM) sur la période d’octobre 2014 à août 2015. Ces données ont été obtenues par le registre fibrinolyse/thrombectomie du CHU de Nantes. Les critères étudiés étaient la survenue d’une transformation hémorragique et le score de Rankin à trois mois. Les facteurs associés au risque de transformation hémorragique et au pronostic ont aussi été analysés. Le groupe TM-AC (n = 14) était globalement comparable au groupe FIV-TM (n = 31) hormis l’âge moyen et le NIHSS initial, significativement plus élevés dans le groupe TM-AC. Une transformation hémorragique symptomatique a été rapporté une fois dans le groupe TM-AC et aucune dans le groupe FIV-TM (p < 0,01). Il y a eu 5 décès contre 2 dans le groupe FIV-TM (p = 0,014) et le score de Rankin moyen pour les survivants était de 3,1 dans le groupe TM-AC contre 1,8 dans le groupe FIV-TM (p = 0,05). Dans notre cohorte, une récanalisation TICI 2B-3 a été obtenue dans plus de 70 % des cas, avec une seule transformation hémorragique. Cependant, le devenir à 3 mois montre une mortalité à 35,7 % et un score de Rankin supérieur à 2 pour 50 % des survivants. Ces résultats s’opposent à ceux plutôt favorable observés dans la seule étude publiée à ce jour. La sécurité de la thrombectomie sous anticoagulant doit être plus précisément étudiée devant ces résultats discordants. Il semble nécessaire de cibler au mieux la population sous anticoagulant pouvant tirer bénéfice de la thrombectomie.