Rev Neurol France
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Letter Case Reports
A case of thoracic actinomycosis presenting as sudden paraplegia.
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Movement disorders are extremely common and diverse in autoimmune encephalitis (AE) and paraneoplastic neurological syndromes (PNS). They can sometimes represent the main neurological disorder of a given patient, or just be part of a larger neurological syndrome. Early diagnosis of AE or PNS is essential, as the associated abnormal movements can be effectively treated with immunomodulators. ⋯ Such features are likely to rely on specific mechanisms, the knowledge of which could lead to new therapeutic proposals. Also, the growing body of work on AE and PNS provides a better understanding of the links between immunity and neuronal degeneration, and immunity and genetic specificities. Thus, the purpose of this article is to present the current knowledge and different subtypes of movement disorders associated with AE and PNS, as well as the mechanisms that can lead to neuronal dysfunction.
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The ischemic penumbra is a transient and potentially reversible condition. Therefore, infarct progression and its counterpart penumbral salvage are highly variable and result from the interaction of 3 major factors: collateral flow, revascularization delay and success. Multimodal brain imaging now offers in clinical practice an exhaustive characterization of the acute ischemic injury: vessel site occlusion, infarction/critical hypoperfusion volume, and collateral flow. ⋯ In addition randomized controlled trial that did enroll patients based on the presence of a target mismatch on multimodal imaging demonstrated a higher benefit of revascularisation treatment by comparison with those who did not. This year the results of the randomized trial, Diffusion-weighted Imaging or Computerized Tomography Perfusion Assessment with Clinical Mismatch in the Triage of Wake-up and Late Presenting Strokes Undergoing Neurointervention with Trevo (DAWN)demonstrated for the first time that revascularization treatment for BI complicating an ICA or a proximal MCA M1 was still beneficial from 6 to 24hours after onset among patient who did have per their clinical exam and the multimodal brain imaging have a persistent penumbra. With this as a background we will discuss the yield of imaging for the selection of patients for a revascularization therapy.
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Early recanalization of occluded vessels in patients with acute ischemic stroke (AIS) by either intravenous thrombolysis (IVT) or endovascular revascularization has been shown to be associated with improved clinical outcomes and reduced mortality. Since the initial report regarding endovascular treatment (EVT) of AIS in 1983, endovascular techniques have been tremendously improved, advancing from intra-arterial administration of thrombolytic drugs to stent retrievers. IVT has been evaluated in several large randomized trials and has been shown to improve clinical outcomes at 90 days if treatment was initiated within 3h of stroke onset, while its benefit at 3-4.5h was subsequently demonstrated in the European Cooperative Acute Stroke Study (ECASS) III. ⋯ Currently, the European and US guidelines recommend MT with stent retrievers as a first-line treatment in the management of AIS. The recent publication of the DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late-Presenting Strokes Undergoing Neurointervention (DAWN) trial is expected to lead to extension of the time window for patients carefully selected by imaging. Thus, optimizing the selection of patients as well as the EVT procedures and techniques used is still an important goal to be evaluated in further trials.
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ALS is now understood to be a complex multisystem neurodegenerative disease because areas other than the motor cortices of the brain undergo degeneration. Frontotemporal dementia (FTD) may be associated with motor neuron disease, and the transactive response DNA-binding protein 43 (TDP-43) is a major pathological substrate underlying both diseases. ⋯ These findings would allow the development of potential biomarkers and therapeutic targets for these devastating diseases. This review summarizes the key points leading up to our current understanding of the genetic, clinical and neuropathological overlap between FTD and ALS.