Background and Objectives:In pooled analyses of endarterectomy trials for symptomatic carotid stenosis, several subgroups experienced no net benefit from revascularization. The validated SCAIL score includes stenosis severity and inflammation measured by Positron-Emission Tomography (PET) and improves the identification of patients with recurrent stroke compared with lumen-stenosis alone. We investigated if the SCAIL score improves the identification of recurrent stroke in subgroups with uncertain benefit from revascularization in endarterectomy trials.Methods:We did an individual-participant data pooled analysis of three prospective cohort studies (DUCASS, 2008-2011; BIOVASC, 2014-2018; Barcelona Plaque Study, 2015-2018). Eligible patients had a recent non-severe (modified Rankin Score≤3) anterior circulation ischaemic stroke/TIA and either: ipsilateral mild carotid stenosis (<50%); ipsilateral moderate carotid stenosis (50-69%) plus at least one of female sex, age <65 years, diabetes mellitus, TIA, or delay >14 days to revascularization; or monocular loss of vision. Patients underwent co-registered carotid 18F-FDG PET/CT angiography (≤7 days from inclusion). The primary outcome was 90-day ipsilateral ischaemic stroke. Multivariable Cox regression modelling was performed.Results:We included 135 patients. All patients started optimal modern-era medical treatment at admission and 62 (45.9%) underwent carotid revascularization (36 within the first 14 days and 26 beyond). At 90 days, 18 (13.3%) patients had experienced at least one stroke recurrence. The risk of recurrence increased progressively according to the SCAIL score (0.0% in patients scoring 0-1, 15.1% scoring 2-3 and 26.7% scoring 4-5; p=0.04). The adjusted (age, smoking, hypertension, diabetes mellitus, carotid revascularization, antiplatelets and statins) Hazard Ratio for ipsilateral recurrent stroke per 1-point SCAIL increase was 2.16 (95% CI 1.32-3.53; p=0.002). A score ≥2 had a sensitivity of 100% for recurrence.Discussion:The SCAIL score improved the identification of early recurrent stroke in subgroups that did not experience benefit in endarterectomy trials. Randomized trials are needed to test if a combined stenosis-inflammation strategy will improve selection for carotid revascularization where benefit is currently uncertain.Classification of Evidence:This study provides Class II evidence that in patients with recent anterior circulation ischemic stroke who do not benefit from carotid revascularization, the SCAIL score accurately distinguishes those at risk for recurrent ipsilateral ischemic stroke.
The purpose of this paper is to emphasize the influence of the mesencephalic oculomotor system regulation on orthostatic postural regulation. The body at rest is never immobile but it swings continuously. The amplitudes and the frequencies of body sway give an indication of the function of the different sensorimotor loops which are involved in body balance. An apparatus, the statokinesimeter, allows us to record these motions by means of displacement of the body's centre of gravity with respect to the centre of the basis. In the case of head or cervical injuries, the brain stem is often implicated giving a partial nuclear unilateral lesion of the III nucleus; double vision of a few degrees with picture separation of never more than 4° occurs. A compensory deviation of the head follows. A conflict between afferents from the III, IV, VI, VIII, XI and supraspinal nuclei occurs. The amplitude and the frequency of the body sway change. A form of treatment is proposed for the ‘pseudo‐vertigo’ of post‐concussional syndrome.
The study of the consequences of head injury and trauma to the cervical spine using modern methods of investigation, and the correlation of the results with the clinical findings is of interest in many fields of medical practice including that of the industrial medical officer, the forensic pathologist and the physician, not forgetting the many other specialists, such as ENT surgeons, ophthalmologists, neurologists, psychiatrists and orthopaedic surgcons. The latter are interested in finding functional tests allowing them to formulate a diagnosis which will allow them to treat the victim of a head injury who complains of the post-concussional syndrome.The purpose of this article is to describe the attempts to measure objectively certain sympto'ms of this syndrome, and in particular the vertigo which poses so many problems in treatment, and indeed to attempt to establish whether it is a real entity. As a result of our
Three posture asymmetries and their connections were assessed by a statistical study as rigorous as possible on the subjects of a sample from a population considered as normal after negative criteria. The comparison of probabilities observed with random probabilities shows that there is less than one chance in a thousand to make an error by rejecting the hypothesis that the asymmetries of the orthostatic posture are random. The definition of the limits of these asymmetries thus fits in the search for the conditions of a clinical examination of the posture.
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