Showing papers by "Maurice Giroud published in 2014"

Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: the Dijon Stroke Registry

Abstract: Background Recent data have suggested that stroke incidence in young people may be rising. In this population-based study, we aimed to determine whether the incidence of stroke in people aged Methods All cases of first-ever stroke (ischaemic stroke, spontaneous intracerebral haemorrhage, and undetermined stroke) occurring in Dijon, France, from 1985 to 2011 were prospectively collected from a population-based registry. Incidence rates were calculated and temporal trends were analysed by age groups and stroke subtypes using a Poisson regression to estimate incidence rate ratios (IRR). Risk factors and premorbid treatments were analysed. Results Over the 27-year study period, 4506 patients were recorded (53% women, mean age 74.6±14.4, 10.1% aged Conclusions Multiple factors may account for the increased incidence of ischaemic stroke in people aged

Post-stroke cognitive impairment: high prevalence and determining factors in a cohort of mild stroke.

Abstract: BACKGROUND Because of the aging population and a rise in the number of stroke survivors, the prevalence of post-stroke cognitive impairment (PSCI) is increasing. OBJECTIVE To identify the factors associated with 3-month PSCI. METHODS All consecutive stroke patients without pre-stroke dementia, mild cognitive disorders, or severe aphasia hospitalized in the Neurology Department of Dijon, University Hospital, France (November 2010 - February 2012) were included in this prospective cohort study. Demographics, vascular risk factors, and stroke data were collected. A first cognitive evaluation was performed during the hospitalization using the Mini-Mental State Exam (MMSE) and the Montreal Cognitive Assessment (MOCA). Patients assessable at 3 months were categorized as cognitively impaired if the MMSE score was ≤26/30 and MOCA <26/30 or if the neuropsychological battery confirmed PSCI when the MMSE and MOCA were discordant. Multivariable logistic models were used to determine factors associated with 3-month PSCI. RESULTS Among the 280 patients included, 220 were assessable at 3 months. The overall frequency of 3-month PSCI was 47.3%, whereas that of dementia was 7.7%. In multivariable analyses, 3-month PSCI was associated with age, low education level, a history of diabetes mellitus, acute confusion, silent infarcts, and functional handicap at discharge. MMSE and MOCA scores during hospitalization were associated with 3-month PSCI (OR = 0.63; 95% CI: 0.54-0.74; p < 0.0001 and OR = 0.67; 95% CI: 0.59-0.76; p < 0.0001, respectively). CONCLUSION Our study underlines the high frequency of PSCI in a cohort of mild stroke. The early cognitive diagnosis of stroke patients could be useful by helping physicians to identify those at a high risk of developing PSCI.

Long-Term Follow-Up Study of Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis Trial

Abstract: Background and Purpose—We aimed at comparing the long-term benefit–risk balance of carotid stenting versus endarterectomy for symptomatic carotid stenosis. Methods—Long-term follow-up study of patients included in Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S), a randomized, controlled trial of carotid stenting versus endarterectomy in 527 patients with recently symptomatic severe carotid stenosis, conducted in 30 centers in France. The main end point was a composite of any ipsilateral stroke after randomization or any procedural stroke or death. Results—During a median follow-up of 7.1 years (interquartile range, 5.1–8.8 years; maximum 12.4 years), the primary end point occurred in 30 patients in the stenting group compared with 18 patients in the endarterectomy group. Cumulative probabilities of this outcome were 11.0% (95% confidence interval, 7.9–15.2) versus 6.3% (4.0–9.8) in the endarterectomy group at the 5-year follow-up (hazard ratio, 1.85; 1.00–3....

Characteristics and outcomes of patients with multiple cervical artery dissection.

Abstract: Background and Purpose—Little is known about factors contributing to multiple rather than single cervical artery dissections (CeAD) and their associated prognosis. Methods—We compared the baseline characteristics and short-term outcome of patients with multiple to single CeAD included in the multicenter Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study. Results—Among the 983 patients with CeAD, 149 (15.2%) presented with multiple CeAD. Multiple CeADs were more often associated with cervical pain at admission (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.10–2.30), a remote history of head or neck surgery (OR, 1.87; 95% CI, 1.16–3.00), a recent infection (OR, 1.71; 95% CI, 1.12–2.61), and cervical manipulation (OR, 2.23; 95% CI, 1.26–3.95). On imaging, cervical fibromuscular dysplasia (OR, 3.97; 95% CI, 2.04–7.74) and the presence of a pseudoaneurysm (OR, 2.91; 95% CI, 1.86–4.57) were more often seen in patients with multiple CeAD. The presence of multiple rather than single C...

Incidence and outcome of cerebrovascular events related to cervical artery dissection: the Dijon Stroke Registry.

Abstract: BackgroundReliable epidemiological data on the true incidence of cerebrovascular events related to spontaneous cervical artery dissection, including stroke and transient ischemic attack, are scarce...

Growth hormone treatment for childhood short stature and risk of stroke in early adulthood

Abstract: Objectives: We investigated the incidence of stroke and stroke subtypes in a population-based cohort of patients in France treated with growth hormone (GH) for short stature in childhood. Methods: Adult morbidity data were obtained in 2008–2010 for 6,874 children with idiopathic isolated GH deficiency or short stature who started GH treatment between 1985 and 1996. Cerebrovascular events were validated using medical reports and imaging data and classified according to standard definitions of subarachnoid hemorrhage, intracerebral hemorrhage, and ischemic stroke. Case ascertainment completeness was estimated with capture-recapture methods. The incidence of stroke and of stroke subtypes was calculated and compared with population values extracted from registries in Dijon and Oxford, between 2000 and 2012. Results: Using both Dijon and Oxford population-based registries as references, there was a significantly higher risk of stroke among patients treated with GH in childhood. The excess risk of stroke was mainly attributable to a very substantially and significantly higher risk of hemorrhagic stroke (standardized incidence ratio from 3.5 to 7.0 according to the registry rates considered, and accounting or not accounting for missed cases), and particularly subarachnoid hemorrhage (standardized incidence ratio from 5.7 to 9.3). Conclusions: We report a strong relationship between hemorrhagic stroke and GH treatment in childhood for isolated growth hormone deficiency or childhood short stature. Patients treated with GH worldwide should be advised about this association and further studies should evaluate the potentially causal role of GH treatment in these findings.

A de novo nonsense PDGFB mutation causing idiopathic basal ganglia calcification with laryngeal dystonia

Abstract: Idiopathic basal ganglia calcification (IBGC) is characterized by brain calcification and a wide variety of neurologic and psychiatric symptoms. In families with autosomal dominant inheritance, three causative genes have been identified: SLC20A2, PDGFRB, and, very recently, PDGFB. Whereas in clinical practice sporadic presentation of IBGC is frequent, well-documented reports of true sporadic occurrence are rare. We report the case of a 20-year-old woman who presented laryngeal dystonia revealing IBGC. Her healthy parents' CT scans were both normal. We identified in the proband a new nonsense mutation in exon 4 of PDGFB, c.439C>T (p.Gln147*), which was absent from the parents' DNA. This mutation may result in a loss-of-function of PDGF-B, which has been shown to cause IBGC in humans and to disrupt the blood-brain barrier in mice, resulting in brain calcification. The c.439C>T mutation is located between two previously reported nonsense mutations, c.433C>T (p.Gln145*) and c.445C>T (p.Arg149*), on a region that could be a hot spot for de novo mutations. We present the first full demonstration of the de novo occurrence of an IBGC-causative mutation in a sporadic case.

Association between serum concentration of vitamin D and 1-year mortality in stroke patients.

Abstract: Background: The prevalence of 25-hydroxyvitamin D [25(OH)D] deficiency is high in patients presenting with an acute stroke, and it may be associated with greater

Frequency and Predictors of Stroke After Acute Myocardial Infarction Specific Aspects of In-Hospital and Postdischarge Events

Abstract: Background and Purpose—Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with decreased survival. This study aimed to investigate the frequency, characteristics, and factors associated with in-hospital and postdischarge stroke in patients with AMI. Methods—Eight thousand four hundred eighty-five consecutive patients admitted to a cardiology intensive care unit for AMI, between January 2001 and July 2010. Stroke/transient ischemic attack were collected during 1-year follow-up. Results—One hundred twenty-three in-hospital strokes were recorded: 65 (52.8%) occurred on the first day after admission for AMI, and 108 (87%) within the first 5 days. One hundred six patients (86.2%-incidence rate 1.25%) experienced in-hospital ischemic stroke, and 14 patients (11.4%-incidence rate 0.16%) were diagnosed with an in-hospital hemorrhagic stroke. In-hospital ischemic stroke subtypes according to the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification sho...

Association between periodontal disease and non-fatal ischemic stroke: a case-control study.

Abstract: Objective. This study aimed to investigate the association between clinical and radiological markers of periodontal disease and ischemic stroke and to assess the potential influence of inflammatory response on the observed associations. Methods. A prospective case-control study including a series of 48 cases with a minor ischemic stroke and 47 controls was conducted at the University Hospital of Dijon. Vascular risk factors, clinical dental examination (plaque index, gingival index, percentage of pockets >5 mm, percentage of bleeding on probing (BOP) sites), dental panoramic (bone loss) and biological parameters (CRP, total cholesterol, HDL, LDL, fasting glucose) were collected. Conditional regression analyses were performed to identify factors associated with ischemic stroke. Results. The prevalence of hypertension, high CRP and glucose levels and overall odontological variables was higher in stroke patients. In multivariable analyses, hypertension (OR = 12.56; 95% CI = 2.29–69.96, p = 0.004), C...

Geomagnetic Storms Can Trigger Stroke: Evidence From 6 Large Population-Based Studies in Europe and Australasia

Abstract: Background and Purpose—Although the research linking cardiovascular disorders to geomagnetic activity is accumulating, robust evidence for the impact of geomagnetic activity on stroke occurrence is limited and controversial. Methods—We used a time-stratified case-crossover study design to analyze individual participant and daily geomagnetic activity (as measured by Ap Index) data from several large population-based stroke incidence studies (with information on 11 453 patients with stroke collected during 16 031 764 person-years of observation) in New Zealand, Australia, United Kingdom, France, and Sweden conducted between 1981 and 2004. Hazard ratios and corresponding 95% confidence intervals (CIs) were calculated. Results—Overall, geomagnetic storms (Ap Index 60+) were associated with 19% increase in the risk of stroke occurrence (95% CI, 11%–27%). The triggering effect of geomagnetic storms was most evident across the combined group of all strokes in those aged 50%:...

Mortality following stroke during and after acute care according to neighbourhood deprivation: a disease registry study

Abstract: Background Neighbourhood deprivation has been shown to be inversely associated with mortality 1 month after stroke. Whether this disadvantage begins while patients are still receiving acute care is unclear. We aimed to study mortality after stroke specifically in the period while patients are under acute care and the ensuing period when they are discharged to home or other care settings. Methods Our sample includes 1760 incident strokes (mean age 75, 48% men, 86% ischaemic) identified between 1998 and 2010 by the population-based stroke registry of Dijon (France). We used Cox regression to study all-cause mortality up to 90 days after stroke occurrence. Results Overall, 284 (16.1%) patients died during the 90 days following stroke. Prior to stroke, risk factors prevalence (eg, high blood pressure and diabetes) and acute care management did not vary across deprivation levels. There was no association between deprivation and mortality while patients were in acute care (HR comparing the highest to the lowest tertiles of deprivation: 1.01, 95% CI 0.71 to 1.43). After discharge, however, age and gender adjusted mortality gradually increased with deprivation (HR 2.08, 95% CI 1.07 to 4.02). This association was not modified when stroke type and severity were accounted for. Conclusions The gradient of higher poststroke mortality with increasing neighbourhood deprivation was noticeable only after acute hospital discharge. Quality of postacute care and social support are potential determinants of these variations.

Prevalence and prognostic value of headache on early mortality in acute stroke: The Dijon Stroke Registry:

Abstract: ObjectiveTo evaluate the prevalence of headache at onset and its association with 1-month mortality in stroke patients.MethodsAll patients with stroke in Dijon, France (2006–2011), were prospectively identified using a population-based registry. Cox regression models were used to evaluate the association between headache and 30-day all-cause mortality.ResultsAmong 1411 stroke patients, data about headache were obtained for 1391 (98.6%) of whom 1185 had an ischemic stroke (IS), 201 had an intracerebral hemorrhage (ICH) and five had a stroke of undetermined etiology. Headache was found in 253 (18.2%) patients and was more frequent in those with ICH than in those with IS (46.3% vs 13.5%, p < 0.001). Overall 30-day mortality was 11.7%, and was greater for patients with than those without headache (17.0% vs 10.5%, unadjusted HR 1.70; 95% CI 1.20–2.41, p = 0.003). In multivariable analysis, an association between headache and 30-day mortality was observed (HR 1.51; 95% CI 1.02–2.25, p = 0.042). In stratified an...

Smoking Status and Severity of Ischemic Stroke. A Population-Based Study

Abstract: We aimed to investigate the impact of smoking status on clinical severity in patients with ischemic stroke event (IS). Patients were prospectively identified among residents of the city of Dijon, France (ca. 151,000 inhabitants), using a population-based registry, between 2006 and 2011. Demographic and clinical data were recorded. The initial clinical severity was quantified by the means of the National Institutes of Health Stroke Scale (NIHSS). Multivariable ordinal logistic regression was used to assess the effect of smoking status on severity. Among the 1,056 recorded patients with IS, data about smoking status were available for 973 (92.1%), of whom 658 (67.3%) were non-smokers, 187 (19.2%) were current smokers, and 128 (13.2%) were former smokers. Compared with non-smoking, former smoking was associated with less severe IS (OR 0.55; 95% CI 0.38-0.82, p = 0.003), whereas this association was not found for current smokers (OR 0.97; 95% CI 0.69-1.36, p = 0.856). Further work is needed to understand the underlying mechanisms of this finding.

The impact of World and European Football Cups on stroke in the population of Dijon, France: a longitudinal study from 1986 to 2006.

Abstract: Background: Acute stress may trigger vascular events. We aimed to investigate whether important football competitions involving the French football team increased the occurrence of stroke. Methods: We retrospectively retrieved data of fatal and nonfatal stroke during 4 World Football Cups (1986, 1998, 2002, and 2006) and 4 European Championships (1992, 1996, 2000, and 2004), based on data from the population-based Stroke Registry of Dijon, France. One period of exposure was analyzed: the period of competition extended to 15 days before and after the competitions. The number of strokes was compared between exposed and unexposed corresponding periods of preceding and following years using Poisson regression. Results: A total of 175 strokes were observed during the exposed periods compared with 192 and 217 strokes in the unexposed preceding and following periods. Multivariate regression analyses showed an overall 30% significant decrease in stroke numbers between periods of competition and unexposed periods of following year (risk ratio (RR) 5 1.3; 95% confidence interval [CI] 5 1.0-1.6; P 5.029) but not with that of preceding year (RR 5 1.1; 95% CI 5 .9-1.3; P 5.367). This was mostly explained by a 40% decrease in stroke numbers during European Championships, compared with the unexposed following periods (RR 5 1.4; 95% CI 5 1.0-1.9; P 5.044) in stratified analyses by football competitions. Conclusions: Watching European football competitions had a positive impact in the city of Dijon with a decrease of stroke numbers. European championship is possibly associated with higher television audience and long-lasting euphoria although other factors may be involved. Further studies using nationwide data are recommended to vali

Évaluation du jugement temporel après l’introduction d’un stimulus émotionnel de nature olfactive : apport dans le diagnostic différentiel entre la maladie d’Alzheimer et les troubles de l’humeur

Abstract: La multiplicite des termes et des theories concernant les emotions rend leur evaluation particulierement complexe. La majorite des evaluations actuelles ne prend en compte que l’experience psychique de l’individu et omet la part implicite des processus emotionnels. Les procedures d’amorcage permettent d’etudier ce type de traitement inconscient. En nous appuyant sur les paradigmes d’amorcage affectif et les modeles d’horloge interne, nous avons elabore un paradigme d’amorcage emotionnel. Il consiste en une tâche de jugement temporel apres l’introduction d’un stimulus emotionnel. En temps normal, l’introduction d’un tel stimulus va creer une activation de l’horloge interne par les reactions physiologiques qui l’accompagnent et generer une surestimation temporelle. Dans le cas d’une atteinte frontale et en absence d’un systeme d’anticipation et de regulation emotionnelle, un syndrome d’hypofonctionnement limbique est attendu. Il se traduit dans le test d’amorcage emotionnel par une surestimation temporelle moins importante que la normale. A l’inverse une atteinte temporale se caracterise par un effet d’amorcage plus important et une surestimation temporelle. Il correspondrait a un syndrome d’hyperfonctionnement limbique. L’interet de ce paradigme a ete etudie dans le diagnostic differentiel entre la maladie d’Alzheimer et les troubles de l’humeur ou l’on attend un dysfonctionnement limbique inverse du fait des regions atteintes. Cet article a pour but de presenter cette premiere recherche effectuee et donc un premier apport d’un test evaluant le traitement emotionnel implicite. L’objectif final est de pouvoir ensuite generaliser l’utilisation de ce test a l’observation d’autres pathologies afin de mieux comprendre les troubles emotionnels et les repercussions comportementales qui les composent.

Une polyradiculonévrite atypique

Abstract: La Presse Medicale - In Press.Proof corrected by the author Available online since samedi 20 juillet 2013