Prise en charge de l’infarctus cérébral à la phase initiale

Ischemic stroke accounts for 80% of overall stroke, and is one of the leading causes of death, disability and dementia in worldwide. Management of patients with acute ischemic stroke dramatically improved over time with the implementation of intensive care stroke units, the development of acute recanalization strategies, the optimization of the management of post-stroke complications, and the prevention of early stroke recurrence. The objective of this article is to provide a general overview of the current management of patients with acute ischemic stroke aiming at improving post-stroke outcome.

Stroke in women: When gender matters

Stroke in women may be considered as a distinct entity due to numerous differences compared with men, including specific epidemiological, etiological, and outcome features along with unique pathophysiological mechanisms. Stroke is the second cause of death in women worldwide with sex-specific causes of stroke in youger women such as pregnancy, post-partum period, oral contraception and migraine. Substitutive hormone treatment in older women is no more recommended in regard of the increased thromboembolic risk it generates. Venous thrombolysis with rtPA and mechanical thrombectomy are now proven to be as efficacious in women as in men. After a stroke, women present poorer quality of life tha…

Temporal Trends in the Incidence of Ischemic Stroke in Young Adults: Dijon Stroke Registry

<b><i>Introduction:</i></b> Stroke is associated with major consequences in terms of socioeconomic impact and lost disability-adjusted life in young victims, thus justifying a careful surveillance of epidemiological trends. This study aimed to assess changes in the incidence of ischemic stroke in young adults over a long period. <b><i>Methods:</i></b> All cases of first-ever ischemic stroke that occurred among adults aged 18–55 years were prospectively recorded using the population-based Dijon Stroke Registry, from 1985 to 2017. Sex-specific annual incidence rates were calculated and were presented according to 6 time periods. Incidence rate r…

sj-pdf-1-wso-10.1177_1747493020967623 - Supplemental material for High rate of cardiac thrombus diagnosed by adding cardiac imaging in acute stroke computed tomography protocol

Supplemental material, sj-pdf-1-wso-10.1177_1747493020967623 for High rate of cardiac thrombus diagnosed by adding cardiac imaging in acute stroke computed tomography protocol by Angélique ernard Thibault Leclercq, Pierre-Olivier Comby Gauthier Duloquin, Frédéric Ricolfi, Yannick Béjot and Charles Guenancia in International Journal of Stroke

Air pollution and stroke. A new modifiable risk factor is in the air

Abstract Evidence from epidemiological studies has demonstrated that outdoor air pollution is now a well-known major problem of public health, mainly in low and middle income countries. Contrasting with myocardial infarction , there are few data on the association of air pollution and stroke. Methods We propose a narrative literature review of the effects and the underlying biological mechanisms of short- and long-term exposure to air pollutants on stroke risk and mortality, using the following key-words: stroke, cerebrovascular events, ischemic and haemorrhage stroke, transient ischaemic attack , mortality, air pollution and air pollutants. Results Twenty-one papers were selected. Air poll…

Incidence of Acute Ischemic Stroke With Visible Arterial Occlusion

Background and Purpose: Because of several methodological limitations, previous studies focusing on the prevalence of large vessel occlusion in ischemic stroke (IS) patients provided conflicting results. We evaluated the incidence of IS with a visible arterial occlusion using a comprehensive population-based registry. Methods: Patients with acute IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013–2017). All arterial imaging exams were reviewed to assess arterial occlusion. Annual incidence rates of IS (first-ever and recurrent events) and IS with a visible occlusion were calculated. Results: One thousand sixty cases of IS were recorde…

sj-pdf-1-wso-10.1177_1747493020967623 - Supplemental material for High rate of cardiac thrombus diagnosed by adding cardiac imaging in acute stroke computed tomography protocol

Supplemental material, sj-pdf-1-wso-10.1177_1747493020967623 for High rate of cardiac thrombus diagnosed by adding cardiac imaging in acute stroke computed tomography protocol by Angélique ernard Thibault Leclercq, Pierre-Olivier Comby Gauthier Duloquin, Frédéric Ricolfi, Yannick Béjot and Charles Guenancia in International Journal of Stroke

Superficial Siderosis of the Central Nervous System associated with Hemophilia A: A case report

Abstract Superficial Siderosis of the Central Nervous System (SSCNS) is a condition secondary to the deposition of hemosiderin within the subpial layers of central nervous system leading to its progressive degeneration, clinically responsible for hearing impairment, cerebellar ataxia and pyramidal syndrome. Here we report the case of a 61-year-old man with medical history of congenital hemophilia A presenting with typical clinical features of SSCNS associated with extensive hypo-intensity on fast 2D gradient-echo-weighted sequences, along the spinal cord, posterior fossa's structures and cerebral cortex. Interestingly, although his disorder was revealed by a lumbar spinal stenosis, presurgi…

Current characteristics and early functional outcome of older stroke patients: a population-based study (Dijon Stroke Registry)

Abstract Background the ongoing growing and ageing population is associated with an increase in older patients suffering a stroke. We aimed to assess the current profile of these patients in a population-based setting. Methods all patients with acute stroke were prospectively identified among residents of Dijon, France, between 2013 and 2017, using a population-based registry. Characteristics and early outcome of patients were compared according to age groups. Results 1,288 stroke cases were recorded (median age: 81.1 years, interquartile range: 66.1–86.7, 54% women). Patients aged 75–85 years and those >85 years accounted for 27.6 and 33.9% of overall cases. Increasing age was assoc…

Association Between Fatigue and Cognitive Impairment at 6 Months in Patients With Ischemic Stroke Treated With Acute Revascularization Therapy.

Background: Fatigue is a frequent symptom after stroke. We aimed to determine the association between fatigue and cognitive performance in patients with ischemic stroke who received acute revascularization therapy (IV thrombolysis and/or mechanical thrombectomy).Methods: Seventy patients were prospectively included in the stroke unit of the University Hospital of Dijon, France. A follow-up was performed at 6 months with clinical examination, fatigue assessment by the Fatigue Severity Scale (FSS), and a comprehensive neuropsychological evaluation. Patients with fatigue (FSS score >4) were compared with patients without fatigue. Neuropsychological factors associated with fatigue at 6 month…

Ischemic Stroke With Atrial Fibrillation: Characteristics and Time Trends 2006 to 2017 in the Dijon Stroke Registry.

Background and Purpose: Because of the aging population, an increase in the prevalence of atrial fibrillation (AF) is currently observed, thus leading to a rise in AF-related ischemic stroke (IS). We analyzed the current prevalence of AF among patients with IS, their characteristics, and temporal trends from 2006 to 2017 in the population-based Dijon Stroke Registry. Methods: We used data from the Dijon Stroke Registry, an ongoing population-based study that records all cases of acute stroke among residents of the city of Dijon. All patients with IS between 2006 and 2017 were included. Previous AF was defined if it was mentioned in the medical file before stroke and newly diagnosed AF if i…

Influence of Preexisting Cognitive Impairment on Clinical Severity of Ischemic Stroke: The Dijon Stroke Registry.

Background and Purpose— The ongoing ageing population is associated with an increasing number of patients with stroke who have preexisting cognitive impairment. This study aimed to evaluate clinical severity in patients with ischemic stroke according to prestroke cognitive status. Methods— Patients with ischemic stroke were prospectively identified among residents of Dijon, France using a population-based registry (2013–2017). Prestroke cognitive status (no impairment, mild cognitive impairment [MCI], or dementia) was recorded, and severity at stroke onset was measured using the National Institutes of Health Stroke Scale (NIHSS) score. Association between prestroke cognitive status and sev…

Response by Béjot and Duloquin to Letter Regarding Article, "Incidence of Acute Ischemic Stroke With Visible Arterial Occlusion: A Population-Based Study (Dijon Stroke Registry)".

High rate of cardiac thrombus diagnosed by adding cardiac imaging in acute stroke computed tomography protocol

Background Detection of left atrial appendage thrombus (LAAt) in acute stroke patients can be improved by cardiac computed tomography using prospective electrocardiogram-gated volume acquisition, which was added to the acute stroke computed tomography protocol in our institution in 2018. Aims To evaluate the factors and clinical management associated with LAAt in patients with acute ischemic stroke. Methods We retrospectively included 324 consecutive patients with ischemic stroke from November 2018 to October 2019. Clinical data and post-stroke management were compared in LAAt and no-LAAt patients. Results Thirty-five patients (10.8%; 95%CI 7.4–14.2) had LAAt and 289 had no-LAAt. LAAt patie…