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Background: Although carotid web (CaW) is increasingly diagnosed as a cause of cryptogenic stroke, data are still limited to monocentric small sample cohort. To broaden knowledge on symptomatic CaW, CAROWEB registry has been recently implemented. Aims: In a large cohort of symptomatic CaW patients, we described epidemiologic characteristics, admission clinical and imaging features, and the current management including the secondary preventive strategy choice made in comprehensive French Stroke Units. Methods: CAROWEB is an ongoing French observational multicenter registry enrolling consecutive CaW patients diagnosed after an ipsilateral ischemic stroke (IS) or transient ischemic attack (TIA). Submitted cases were validated by two experienced neurologist and neuroradiologist. Clinical, imaging, and management features were collected for this study. Results: Between June 2019 and December 2021, 244 cases were submitted by 14 centers, 42 rejected, and 202 included (IS, 91.6%; TIA, 7.9%; retinal infarction, 0.5%; mean age, 50.8 ± 12.2 years; female, 62.9%; Caucasian, 47.5%; Afro-Caribbean, 20.3%). IS patients showed median (interquartile range (IQR)) admission National Institutes of Health Stroke Scale (NIHSS) score, 8 (2–15); intracranial artery occlusion, 71.8%; ipsilateral chronic cerebral infarction (CCI), 16.3%; and reperfusion treatment, 57.3%. CaW was not identified during the mechanical thrombectomy procedure in 30 of 85 (35.3%) patients. Secondary prevention was invasive in 55.6% (stenting, n = 80; surgery, n = 30). In multivariable analysis, the invasive therapeutic option was associated with ipsilateral CCI (odds ratio (OR): 4.24 (1.27–14.2), p = 0.019) and inversely associated with risk factors (OR: 0.47 (0.24–0.91), p = 0.025) and admission NIHSS score (OR: 0.93 (0.89–0.97), p = 0.001). Conclusion: CaW must be considered in all ethnic groups including Caucasians. Secondary prevention is heterogeneous in large French Stroke Centers. The absence of risk factors, milder severity strokes, and ipsilateral CCI were predictive variables of secondary invasive treatment. The high rate of invasive treatment suggests that medical treatment alone is deemed ineffective to avoid recurrence and emphasize the need of randomized trials. [ABSTRACT FROM AUTHOR]

Background and purpose: An early understanding of stroke mechanism may improve treatment and outcome in patients presenting with large vessel occlusion stroke (LVOS) treated with mechanical thrombectomy (MT). We aimed to investigate whether spontaneous external carotid artery (ECA) embolism detection during MT is associated with stroke etiology and clinical outcome. Methods: We retrospectively reviewed our prospectively maintained institutional database including consecutive patients with anterior circulation LVOS treated with MT between January 2015 and August 2020. Results: An ECA embolus was detected in 68 of 1298 patients (5.2%). The kappa coefficient for interobserver agreement was 0.89 (95% confidence interval [CI] 0.82–0.95). ECA embolism was significantly associated with intracranial internal carotid artery (ICA) occlusion (p < 0.001), cardioembolic etiology (p < 0.001) and a lower clot burden score (p < 0.001). Day‐1 variation of National Institutes of Health Stroke Scale score (adjusted odds ratio [OR] −2.7, 95% CI −4.9 to 0.3; p = 0.021) and delta Alberta Stroke Program Early Computed Tomography Score (adjusted OR 0.9, 95% CI 0.2 to 1.5; p = 0.004) were worse among patients with ECA emboli. There was no significant difference in 90‐day functional outcome between groups (adjusted OR 0.8, 95% CI 0.42 to 1.52; p = 0.50). Conclusion: In patients with anterior circulation LVOS treated with MT, ECA embolism was significantly associated with cardioembolic etiology, high thrombus burden and proximal intracranial ICA occlusions. This underexplored angiographic pattern might provide a valuable etiologic clue to the underlying cause of anterior circulation LVOS and may also help determine the appropriate revascularization strategy. [ABSTRACT FROM AUTHOR]

Background: Human T-lymphotropic virus type 1 (HTLV-1) has been discovered in 1980 and has been linked to tropical spastic paraparesis (HAM/TSP) in 1985 in Martinique. There is no data on HAM/TSP incidence trends. We report, in the present work, the temporal trends incidence of HAM/TSP in Martinique over 25 years. Methods: Martinique is a Caribbean French West Indies island deserved by a unique Neurology Department involved in HAM/TSP diagnosis and management. A registry has been set up since 1986 and patients diagnosed for a HAM/TSP were prospectively registered. Only patients with a definite HAM/TSP onset between 1986 and 2010 were included in the present study. The 25-year study time was stratified in five-year periods. Crude incidence rates with 95% confidence interval (95%CI) were calculated using Poisson distribution for each period. Age-standardized rates were calculated using the direct method and the Martinique population census of 1990 as reference. Standardized incidence rate ratios with 95% CIs and P trends were assessed from simple Poisson regression models. Number of HTLV-1 infection among first-time blood donors was retrospectively collected from the central computer data system of the Martinique blood bank. The HTLV-1 seroprevalence into this population has been calculated for four 5-year periods between 1996 and 2015. Results: Overall, 153 patients were identified (mean age at onset, 53+/-13.1 years; female:male ratio, 4:1). Crude HAM/TSP incidence rates per 100,000 per 5 years (95%CI) in 1986–1990, 1991–1995, 1996–2000, 2001–2005 and 2006–2010 periods were 10.01 (6.78–13.28), 13.02 (9.34–16.70), 11.54 (8.13–14.95), 4.27 (2.24–6.28) and 2.03 (0.62–3.43). Age-standardized 5-year incidence rates significantly decreased by 69% and 87% in 2001–2005 and 2006–2010 study periods. Patients characteristics did not differ regarding 1986–2000 and 2001–2010 onset periods. Between 1996–2000 and 2011–2015 study periods, the HTLV-1 seroprevalence significantly decreased by 63%. Conclusion: Martinique faces a sudden and rapid decline of HAM/TSP incidence from 2001 in comparison to 1986–2000 periods. Reduction of HTLV-1 seroprevalence, that may result from transmission prevention strategy, could account for HAM/TSP incidence decrease. [ABSTRACT FROM AUTHOR]

Background: Few data on stroke outcomes and no data on stroke recurrence are available in Black mono-racial population with high socio-economic status. Aims: We investigated outcomes and stroke recurrence at one year in the Black Afro-Caribbean population of Martinique and examined potential predictors of poor prognosis and recurrence. Methods: Patients from ERMANCIA II (Etude Réalisée en MArtinique et Centrée sur l'Incidence des Accidents vasculaires cérébraux), a Black population-based and prospective observational study, were followed up at 28-days, three months and one year post stroke. Stroke characteristics, survival, disability (modified Rankin Scale>2), and stroke recurrence were assessed. A survival-based approach was used for time-to-event analysis, and multivariable regression analysis assessed the predictors of death, disability and stroke recurrence. Results: Of 544 first-ever stroke patients, cumulative risks of death increased from 17.6% (95% confidence interval, 14.5-20.4) at 28 days to 22.8% (18.6-25.0) at three months and to 31.3% (27.4-34.6) at one year. Disability rates in survivors decreased from 43.7% (39.5-47.2) at 28 days to 35% (30.9-38.4) at three months and to 28.8% (24.9-32.1) at one year. Cumulative risks of recurrent stroke were estimated to 2.1% (0.9-2.9) at 28 days, 4.5% (2.7-6.1) at three months and 9.3% (6.1-11.6) at one year. Age (odds ratio (OR), 1.08 (1.05-1.10)), admission NIHSS (OR, 1.22 (1.17-1.29)), metabolic syndrome (OR, 2.07 (1.22-3.52)) and recurrence (OR, 5.06 (1.87-13.7)) were independent predictors of death or disability at one year. Conclusion: Stroke Outcomes in Black Afro-Caribbean population with a high socio-economic status appear globally similar to outcomes reported in Caucasian population. After a first-ever stroke, the implementation of early programs of recurrence prevention seems crucial to reduce the risk of poor prognosis at one year. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy of mitoxantrone (MTX) on clinical and neuroradiological parameters of patients who had a relapse of neuromyelitis optica spectrum (NMOS) within the 12 previous months. Methods MTX (12 mg/m²) combined with methylprednisolone 1 g as three monthly courses followed by three quarterly courses was administered during an observational multicentre open study including 51 consecutive patients (28 NMO, 23 limited forms of NMO) of the French Caribbean and Guyana. The main outcome measure was the reduction of the annualised relapse rate (ARR), and the secondary outcome measures were alteration of disability measured by expanded disability status scale (EDSS) score, the time to onset of the first relapse, and the progression of neuroradiological lesions at 1 year of treatment. Results At 1 year of treatment, the ARR dropped from 1.82 to 0.37 (p<0.0001). The mean EDSS score improved by 1.3 points, going from 5.8 at baseline to 4.5 at 1 year (p<0.0001). The number of patients showing gadolinium (Gad)+ spinal cord lesions at baseline, that is, 46.9%, dropped to 10.6% (a 77.4% reduction; p=0.02). The median time to onset of the first relapse was 18 months. IgG-NMO seropositivity was a predictive factor of relapse (p=0.006). A case of acute myeloid leukaemia was observed after a mean time span of 4.8 years. Conclusions In this observational NMO study, MTX decreased dramatically the frequency of relapses, which is directly related to progression of disability or even death in this disorder. [ABSTRACT FROM AUTHOR]

Background: Few data are available on the relationship between fluid-attenuated inversion recovery vascular hyperintensities and proximal middle cerebral artery occlusion prognosis. Objectives: To assess a fluid-attenuated inversion recovery vascular hyperintensities score (FVHS) and explore its relationship with recanalization status and clinical outcomes after intravenous thrombolysis. Design: Retrospective study. Setting: Stroke unit in a university hospital. Patients: Consecutive patients with proximal middle cerebral artery occlusion, thrombolysed within 6 hours, were selected from our prospective database. The FVHS (range, 0-10; divided into low, medium, and high thirds) was quantified on the magnetic resonance image obtained at admission. Recanalization rates, infarction size (Alberta Stroke Program Early CT Score applied to diffusion weighted imaging [ASPECTS-DWI]), and 3-month functional outcomes (modified Rankin Scale score) were determined. Poor outcomes and large infarctions were defined as a modified Rankin Scale score higher than 2 and an ASPECTS-DWI score of 5 or lower, respectively. Main Outcome Measures: Interaction among FVHS, recanalization status, and outcomes. Results: Thirty-four patients had a low FVHS (⩽4), 32 had a medium FVHS (5 or 6), and 39 had a high FVHS (⩾7). The rate of poor functional outcome (modified Rankin Scale score >2) was higher for the group with low FVHSs than those with medium FVHSs and high FVHSs (82.3% vs 43.7% and 43.5%, respectively; P<.001). The rate of 24-hour large infarctions (ASPECTS-DWIscore ⩽5) was higher for those with low FVHSs than those with medium and high FVHSs (88.2% vs 56.2% and 51.3%, respectively; P=.002). The recanalization rate was not associated with FVHS. Multivariate analysis retained low FVHS as an independent early predictor of poor clinical outcome (odds ratio=9.91; 95% CI, 2.01-48.93; P=.004) and large infarction (odds ratio=6.99; 95% CI, 1.78-27.46; P=.005).Low FVHS remained associated with poor outcomes regardless of recanalization status. Early recanalization in patients with a low FVHS decreased the poor functional outcome rate from 100% to 64.7% (P=.02). Conclusions: The FVHS is an early independent prognostic marker for patients with proximal middle cerebral artery occlusion. Synergy between FVHS and recanalization status appears to be a critical determinant of final outcomes, supporting intensive reperfusion treatment for patients with a low FVHS. [ABSTRACT FROM AUTHOR]

Purpose: Opportunistic pharmacy-based screening of atrial fibrillation (AF) appears effective, but the proportion of detected citizens is unknown. The aim of our real-life study was to determine rates of screening in a community population according to age group and gender. Methods: We conducted four community campaigns of pharmacy-based single-time point AF screening that involved individuals ≥65 years. We used a single-lead and hand-held device MyDiagnostick (6229 EV Maastricht, The Netherlands) that generates a 60-s ECG trace. All pharmacies of the communities (n = 54) were involved. Rates of screening were assessed on the base of the French National Institute for Statistics and Economic Studies data and were expressed as percentage and 95% Confidence interval (CI). Results: We screened 4208 individuals (Mean age, 74.2 ± 6.6 years; females, 60.2%). The screening rate in citizens aged ≥65 years was 17.2% (16.6–17.7), and higher in females than in males (17.9% [17.3–18.6] versus 16.0 [15.3–16.8], p < 0.001). The 70–74 age group showed the highest rate (25.7% [24.4–27]) compared to other groups. After 74 years, screening rates decreased steadily with age and dropped to 4.8% [3.8–6.1] in very elderly (≥90). Among the 188 (4.47%) positive screening, 117 (2.78%) showed an AF that was unknown in 53 (1.26%). Increasing age (OR: 1.05 [1.00–1.09], p = 0.04), male sex (OR: 4.30 [2.33–7.92], p < 0.0001) and high CHA2DS2-Vasc (OR: 1.59 [1.21–2.09], p = 0.0008) were independent predictors of unknown AF. Conclusion: Single-lead AF detection performed in community pharmacies result in screening one in six elderly citizens. Although male sex and elderly predicted unknown AF diagnosis, they were less involved in such designed campaigns. [ABSTRACT FROM AUTHOR]

Human T lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is associated with accumulation of HTLV- I-infected T cells in the central nervous system (CNS). However, data on HTLV-I proviral load in the CNS at the asymptomatic stage are still lacking. We measured HTLV-I proviral load in cerebrospinal fluid (CSF) cells from 17 patients with HAM/TSP and 25 asymptomatic carriers. The percentage of HTLV-I-infected cells in CSF cells and the CSF cell:peripheral blood mononuclear cell HTLV-I proviral load ratio were always >10% and >1, respectively, in the patients with HAM/TSP but were always <10% and <1, respectively, in the asymptomatic carriers. We propose that determination of HTLV-I proviral load in CSF cells should be included as a new parameter for the diagnosis of HAM/TSP. [ABSTRACT FROM AUTHOR]