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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]

Ischemic stroke is an important disease with high morbidity and mortality. Systemic fibrinolysis is well studied and has become the accepted international standard of acute therapy. Intra-arterial lysis and intravascular mechanical treatment options are becoming increasingly important. The time window for acute therapies is limited to a few hours after the onset of symptoms. A substantial proportion of stroke is preceeded by a transient ischemic attack (TIA). The immediate identification of the cause of such a TIA and initiation of treatment can prevent as much as 80% of subsequent strokes. Recent clinical trials attempt to treat more patients with more individualized strategies. [ABSTRACT FROM AUTHOR]

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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.)

Transient monocular blindness is an acute episode of ischemic origin in which one eye has profound visual loss, followed by full recovery within one hour. Transient monocular blindness most often occurs in the setting of retinal ischemia secondary to carotid embolism, but other mechanisms have been reported, including thrombosis (most often in the setting of giant cell arteritis), hemodynamic disorders (secondary to severe carotid stenosis) or vasospasm. Transient monocular blindness is considered a transient ischemic attack originating in the carotid arteries and must benefit from the same management as transient ischemic attack involving the brain, in order to prevent a subsequent stroke., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Introduction: Clinical presentation of Eagle syndrome (ES) is very variable and non-specific, making its diagnosis difficult. It is usually limited to pain. Transient neurological manifestations are exceptional. We report one case in which the diagnosis of ES has been made based on neurological events occurring during left anterolateral head bending, without pain., Observation: A 47-year-old man presented with transient neurological events progressing since two years, half-right body paresthesia and reduced field of vision on the left side type, triggered by left anterolateral head flexion and regressive in neutral position. Transcranial Doppler and CT angiography of the supra-aortic trunks were performed in neutral position and in right and left head rotation that showed a disruption of the left sylvian flow and an extrinsic compression of the left internal carotid artery, due to a musculoskeletal impediment involving the lower end of the temporal styloid process. Complete recovering was achieved after surgical resection of this process. A control CT angiography confirmed the cessation of the compression., Discussion: ES has non-specific and highly variable clinical manifestations making diagnosis difficult or leading to misdiagnosis. ES should be considered in any transient neurological deficit, especially when occurring during head rotation. Treatment relies on surgical resection of the excessively long styloid process., (Copyright © 2016 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.)

Introduction: Moyamoya disease is a rare chronic cerebrovascular disease. The objective of this article is to report the different clinical and radiological presentations and describe treatments and clinical course of this disease., Methods: We searched for patients with Moyamoya disease diagnosed at a French university hospital. The diagnosis was based on arteriographic records showing uni- or bilateral stenosis of distal intracranial internal carotid arteries or middle cerebral arteries associated with a classic collateral network imparting a puff of smoke aspect. Data about clinical and radiological symptoms were analyzed for all identified patients., Results: Ten patients were recorded between 2009 and 2014 including one child and nine adults. The initial presentation was intracerebral hemorrhage in two patients, ischemic stroke in six, and either exercice-related transient ischemic attacks or syncope in two. Recurrent events were noted in four patients. Four patients had one or several recurrent vascular events. Eight patients were given medical treatment and none underwent surgery. Secondary Moyamoya syndrome was suspected in two patients, all the others one were considered idiopathic., Conclusion: Moyamoya disease is a rare but potentially severe illness. The initial presentation is more frequently an ischemic stroke; recurrences are frequent. The diagnosis is based on arteriography, which is also recommended to search for a cause., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)