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• Cette étude a inclus 160 068 patients atteints d'arthrose et 160 068 patients sans arthrose. • L'incidence à 10 ans des AVC et des AIT était significativement plus élevée chez les patients arthrosiques que chez les patients sans arthrose. • L'arthrose a été associée positivement à l'AVC et à l'AIT. Cette étude avait pour objectif d'explorer la relation entre l'arthrose et l'incidence des accidents vasculaires cérébraux (AVC) et des accidents ischémiques transitoires (AIT) au Royaume-Uni. L'étude a inclus des patients ayant reçu un diagnostic initial d'arthrose dans l'un des 256 cabinets de médecine générale du Royaume-Uni entre 1997 et 2016 (date index). Des patients sans arthrose ont été appariés (1:1) aux patients avec arthrose selon des scores de propension fondés sur le sexe, l'âge, l'année index, le cabinet généraliste et les facteurs de risque vasculaire consignés dans les 12 mois précédant la date index (hypertension, obésité, diabète sucré, dyslipidémie et fibrillation atriale). Pour les patients sans arthrose, une date de consultation aléatoire entre 1997 et 2016 a été sélectionnée comme date index. La relation entre l'arthrose et l'incidence des AVC et AIT a été analysée au moyen de courbes de Kaplan-Meier et de régressions de Cox. Cette étude a inclus 160 068 patients atteints d'arthrose et 160 068 patients sans arthrose (61,6 % de femmes, âge moyen [écart-type] 64,2 [14,2] ans). L'incidence à 10 ans des AVC (4,5 % contre 3,0 %) et des AIT (3,3 % contre 2,0 %) était significativement plus élevée chez les patients avec arthrose. Les analyses de régression de Cox ont également fait apparaître une association positive entre arthrose et AVC (hazard ratio [HR] 1,45, intervalle de confiance [IC] à 95 % 1,39–1,51) et AIT (HR 1,55, IC 95 % 1,47–1,63). Ces observations suggèrent une possible association de l'arthrose avec une augmentation de l'incidence des AVC et des AIT. Des études longitudinales complémentaires sont nécessaires pour confirmer ou infirmer ces résultats. [ABSTRACT FROM AUTHOR]

Summary Objectives The diagnosis of transient neurological attacks (TNA) relies on medical history. Transient ischemic attack is often considered until proven otherwise, because of lack of objective paraclinical tools that can help discriminate TIA from differential diagnoses such as migraine aura. This may lead to needless and potentially harmful stroke secondary prevention in many cases. This study aimed at determining the yield of occipital transcranial magnetic stimulation (oTMS) in discriminating TNA of vascular origin from migraine aura without headache (MAWH). Methods Ten patients with acute TNA of vascular origin and ten patients with migraine aura without headache (MAWH), without prior history of migrainous headache, were prospectively included. TNA of vascular origin were considered for individuals presenting unilateral focal symptoms with full resolution within 24 hours and positive diffusion weighted imaging (DWI+). For individuals with MAWH, diagnostic criteria were either ICHD-III beta or Fischer criteria for a first episode of MAWH. All participants underwent one session of oTMS. Induction and threshold of phosphene induction were recorded. Results In TNA of vascular origin, MRI disclosed cortical lesions in nine and one sub-cortical lesion. Phosphenes were induced in 9/10 subjects with MAWH with a mean threshold of 66% of the maximal intensity, whereas oTMS induced phosphenes in only one subject with TNA of vascular origin at a threshold of 85%. Conclusions In this pilot study, oTMS was found to be an effective tool to discriminate between MAWH and transient neurological symptoms of vascular origin. [ABSTRACT FROM AUTHOR]

Objectives: Cardiovascular diseases represent the leading cause of death worldwide. In a previous survey, we have shown that the management of patients with atherosclerosis by general practitioners depends on the locations of the disease. The aim of this survey was to assess general practice residents' (GPR) knowledge on three clinical presentations which are ischemic stroke, coronary artery disease (CAD), and peripheral artery disease (PAD)., Materials and Methods: Between May 2017 and September 2017, a national self-administered survey that we previously used to assess the GPs' knowledge was emailed to GPRs from French medicine faculties. The questionnaire was composed of three clinical cases dealing with transient ischemic attack (TIA), stable angina (SA) and intermittent claudication (IC). Each clinical case was explored by seven similar questions. The primary endpoint was the number of GPRs who correctly answered 5 of the 7 questions for each clinical case., Results: Five hundred and fifty-three GPRs (10%) answered the questionnaire entirely. There is a significant difference between TIA knowledge (19.9% of correct answers) which is greater than SA knowledge (0.9%) and IC knowledge (0.4%). The diagnosis was correctly done by 525 (94.9%) GPRs for TIA, 513 (92.8%) for SA, and 532 (96.2%) for IC. The main difficulties encountered by the GPRs concerned complementary investigations and treatment., Conclusion: As for general practitioners, this study reveals a difference in GPRs' knowledge depending on the location of the atherosclerosis. Considering the results, the improvement of initial training and continuing medical education (CME) in general medicine would be desirable., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Introduction: Characteristics of patients hospitalized for transient ischemic attack (TIA) management before and during this hospitalization and follow-up are not well documented on very large populations., Methods: Among the 51 million beneficiaries of the French national health insurance general scheme (77% of French population), those subjects hospitalized for a first TIA in 2010 were included using the national health insurance information system (SNIIRAM). The frequencies of comorbidities during the previous five years and drug treatments received during the previous year and the first month after discharge were estimated from the SNIIRAM and then compared to data derived from the permanent randomized sample of all health insurance beneficiaries based on standardized morbidity ratios (SMR). The three-year outcome and factors associated with at least one readmission for TIA or ischemic stroke during the three months following the first hospitalization were investigated., Results: A total of 18,181 patients were included (mean age: 69 years, 55% of women). The crude incidence of hospitalized TIA was 0.36 per 1000. Before hospitalization, patients presented a significantly higher rate of carotid and cerebral atherosclerosis (2.4% SMR=1.4), atrial fibrillation (9.1%, SMR=1.3), ischemic heart disease (13.7%, SMR=1.3), valvular heart disease (9.7%, SMR=1.5), and treatment with platelet aggregation inhibitors (29%, SMR=1.4), antihypertensives (60%, SMR=1.2) and antidiabetics (16%, SMR=1.5). These SMR decreased with age. One month after discharge from hospital, 82% of patients still alive filled at least one prescription for antithrombotic therapy (platelet aggregation inhibitor: 74%, vitamin K antagonist: 12%), one class of antihypertensive in 57% of patients, an antiarrhythmic in 9% of patients, an antidiabetic treatment in 14% of patients and a lipid-lowering agent in 53%. During the month following discharge from hospital, 3.2% of patients were readmitted at least once for TIA, 1.9% were readmitted for ischemic stroke and 1.5% of patients died. These figures were 3.9%, 2.4% and 2.9% at three months, and 7.2%, 5% and 16.3% at three years, respectively. On multivariate analysis, factors associated with readmission for TIA or ischemic stroke were age ≥ 65 years and antidiabetic treatment before hospitalization. In contrast, male gender, admission to a stroke unit and length of stay were associated with a lower readmission rate., Conclusions: These results illustrate the value of administrative databases to study TIA. Hospitalizations for TIA were relatively frequent and the recurrence rate was similar to that reported in similar recent studies. Level of primary and secondary prevention must be improved., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)