La diplopie binoculaire peut constituer une gêne fonctionnelle importante pour les patients. Les causes pouvant donner cette atteinte sont très variées et peuvent menacer le pronostic vital. Effectuer la revue des pratiques au centre hospitalier universitaire de Dijon (CHU) concernant les patients hospitalisés en neurologie pour diplopie binoculaire et proposer un outil d'aide au raisonnement diagnostique. Notre étude est monocentrique et rétrospective, elle porte sur la description des caractéristiques démographiques, cliniques, étiologiques et paracliniques des patients admis pour diplopie binoculaire au CHU de Dijon sur une période comprise entre janvier 2017 et décembre 2021. La cause la plus fréquente de diplopie retrouvée était les accidents vasculaires cérébraux (36,08 %), suivie par les causes microvasculaires (17,25 %) et les causes indéterminées (9,41 %). Seuls 56,60 % des patients atteints de diplopie isolée bénéficiaient d'une consultation spécialisée ophtalmologique. L'imagerie par résonance magnétique cérébrale était l'examen le plus réalisé chez les patients et le plus informatif, cela permettait de retrouver une cause à la diplopie dans 46,29 % des cas. Les AVC étaient surreprésentés par rapport à la littérature dans notre étude ce qui pouvait s'expliquer par des critères d'inclusion larges des patients avec la diplopie comme motif principal ou associé d'hospitalisation. Une piste concernant l'amélioration de notre prise en charge serait d'adresser plus fréquemment les patients en consultation ophtalmologique spécialisée à la recherche d'une paralysie oculomotrice.

Introduction: Nerve autograft is the gold standard for reconstruction of peripheral nerve loss. The alternative is the interposition of a synthetic regeneration conduit. The purpose of the study was to evaluate the in vivo feasibility and interest of Adipose-Derived Stem Cells (ADSCs) using the Nanofat technique and chitosan conduit for peripheral nerve defect repair.Material and methods: In vivo, after the creation of a 10 mm defect of the sciatic nerve, 2 groups were defined according to the nerve repair in rats: "chitosan" group (n = 10) and "chitosan and ADSCs" group (n = 10) with a clinical and paraclinical evaluation at 7 weeks. Results: The in vivo results seem to show that the adjunction of ADSCs was favorable clinically, histologically and functionally compare to a chitosan reconstruction alone.Discussion: Peripheral nerve repair with defect using a chitosan conduit associated with ADSCs would constitute a surgical alternative in a single surgical step.& COPY; 2023 Elsevier Masson SAS. All rights reserved.

Les neuropathies associées à une immunoglobuline monoclonale M avec activité anti-myelin associated glycoprotein (MAG) sont les plus fréquentes neuropathies dysimmunes acquises. Ce sont des polyneuropathies sensitivomotrices démyélinisantes, symétriques et distales. L'objectif principal était de caractériser l'évolution de la démyélinisation des neuropathies anti-MAG. Les objectifs secondaires étaient d'étudier leur profil électrophysiologique et le comparer à une cohorte de polyradiculonévrites chroniques (PRNC). Nous nous sommes intéressés à l'évolution électrophysiologique des neuropathies anti-MAG à partir de deux patients connus depuis 11 et 14 ans en séparant leur suivi en deux périodes que nous avons comparées. Nous avons étudié les données cliniques et électrophysiologiques initiales des 10 patients suivis sur le CHU de Dijon depuis 2004 pour une polyneuropathie anti-MAG. Nous avons comparé leur profil électrophysiologique à celui d'une cohorte de PRNC lors des diagnostics initiaux. Le suivi des 2 patients montrait une dégradation significative des vitesses de conduction motrice (VCM) alors que les latences motrices distales (LMD) n'étaient pas différentes, les index de latence terminale (ITL) étaient supérieurs en seconde période. Les polyneuropathies anti-MAG étaient sensitivomotrices symétriques démyélinisantes à prédominance distale : le ralentissement prédominait sur les LMD par rapport aux VCM donnant des ITL bas. Dans les PRNC la démyélinisation était plus homogène avec des ITL plus élevés. Nos résultats étaient innovants par la mise en évidence d'une modification de la répartition de la démyélinisation au cours de l'évolution : elle se stabilisait en distalité des nerfs et évoluait sur les parties proximales. Nos résultats étaient concordants avec le profil classique des neuropathies anti-MAG avec une atteinte distale lors du diagnostic contrairement aux PRNC avec une atteinte homogène. Nous avons caractérisé l'évolution de la démyélinisation des neuropathies anti-MAG : celle-ci progresse vers la partie proximale des nerfs donnant un profil de démyélinisation plus homogène avec le temps.

Les immunoglobulines intraveineuses (IgIV) ont prouvé leur efficacité dans le traitement des symptômes des polyradiculonévrites inflammatoires démyélinisantes chroniques (PIDC). Mais l'amélioration de l'électroneuromyogramme reste débattue. Analyser l'évolution des paramètres électroneuromyographiques chez les patients traités par IgIV pour une PIDC, et rechercher une corrélation entre l'évolution de ces paramètres et l'évolution clinique. Tous les patients traités par au moins trois cures d'IgIV pour une PIDC entre 2010 et 2020 au centre hospitalo-universitaire de Dijon ont été inclus. Les sujets ont été répartis en deux groupes (évolution favorable ou non) selon la variation de scores cliniques avant et après les trois cures. Les données de l'électroneuromyogramme pré et post-thérapeutique ont été recueillies et comparées entre elles (pré-thérapeutique versus post-thérapeutique) puis entre les deux groupes. Sur les 57 patients inclus, aucune amélioration significative des paramètres de l'électroneuromyogramme (ENMG) n'a été retrouvée après les trois cures. On notait même une dégradation de l'amplitude du nerf sural après les cures. Il n'y avait pas non plus de différence significative concernant la variation des paramètres de l'ENMG entre les 40 patients ayant évolué favorablement cliniquement et les 17 patients n'ayant pas évolué favorablement. Cette étude n'a pas retrouvé d'amélioration significative de l'ENMG chez les patients traités par IgIV pour une PIDC, ni de corrélation entre l'évolution clinique et électrophysiologique. On retrouvait une dégradation de l'amplitude du nerf sural, témoin de la dégénérescence axonale, après les cures. Les IgIV n'empêchent donc pas l'évolution naturelle électrophysiologique des PIDC. L'ENMG est un mauvais marqueur d'évolution de la PIDC et sa place dans le suivi des patients semble limité, ce dernier devant rester avant tout clinique.

Objective To assess the efficiency and relevance of clinical exome sequencing (cES) as a first-tier or second-tier test for the diagnosis of progressive neurological disorders in the daily practice of Neurology and Genetic Departments. Methods Sixty-seven probands with various progressive neurological disorders (cerebellar ataxias, neuromuscular disorders, spastic paraplegias, movement disorders and individuals with complex phenotypes labelled ‘other’) were recruited over a 4-year period regardless of their age, gender, familial history and clinical framework. Individuals could have had prior genetic tests as long as it was not cES. cES was performed in a proband-only (60/67) or trio (7/67) strategy depending on available samples and was analysed with an in-house pipeline including software for CNV and mitochondrial-DNA variant detection. Results In 29/67 individuals, cES identified clearly pathogenic variants leading to a 43% positive yield. When performed as a first-tier test, cES identified pathogenic variants for 53% of individuals (10/19). Difficult cases were solved including double diagnoses within a kindred or identification of a neurodegeneration with brain iron accumulation in a patient with encephalopathy of suspected mitochondrial origin. Conclusion This study shows that cES is a powerful tool for the daily practice of neurogenetics offering an efficient (43%) and appropriate approach for clinically and genetically complex and heterogeneous disorders.

INTRODUCTION:Amputation of the hand is a rare and extremely intense trauma. Replanting and allografting after this type of injury require a major reorganization of the brain. Brain plasticity, though better known in the context of disorders of the central nervous system, is just as indispensable when the extremities are damaged.MATERIALS AND METHODS:A 17-year-old patient underwent replantation of the nondominant hand after transmetaphyseal amputation after traumatic injury. After 18 days in hospital and subsequent treatment in a physical rehabilitation center, the patient attended clinical and radiology follow-up sessions over the next 2 years.RESULTS:The management of this patient led to an excellent functional outcome in conjunction with successful social and professional reintegration. Electromyography at 18 months confirmed nerve regrowth. Functional magnetic resonance imaging was done at 2 years to evaluate cerebral plasticity. Motor function, largely dependent on the primary motor area, is aided by the addition of secondary and accessory motor areas for both simple and complex movements. A change in sensory information is stimulation in its own right hemisphere and increases solicitation of the contralateral precentral and postcentral gyrus.CONCLUSIONS:There seems to be a real reversible dynamic plasticity under the balance of inhibitory and excitatory influences exerted on the cortical neurons. Any disruption of this balance requires the brain to adapt to the new circumstances to reestablish the hand as a functioning part of the body.

Analizamos la prevalencia, etiología y diagnóstico de los pacientes con plexopatía cervicobraquial o lumbosacra de nuestro centro, atendidos durante una década.Análisis descriptivo, retrospectivo y observacional de adultos con diagnóstico de plexopatía, atendidos en la consulta monográfica de electromiografía, desde febrero de 2008 hasta diciembre de 2018 (ambos inclusive).Setenta y siete pacientes (95,1%), edad media: 55,94 años ± 16,9 DE, 49 hombres (60,5%). Prevalencia: 2,37 por 100.000 habitantes/año. La plexopatía más frecuente es la cervical (84%). Las etiologías más frecuentes: traumática en el 35% (27 pacientes), Parsonage-Turner 20,9% (17 pacientes), tumoral en el 14,8% (12 pacientes) e idiopática en el 13,5% (11 pacientes). De los 12 pacientes con plexopatía de causa oncológica solo en 4 (33,3%) de los casos se confirmó la presencia de infiltración tumoral por prueba de neuroimagen. De los 77 pacientes con prueba de neuroimagen hecha (TAC o RM) el 85,2% (69 pacientes) no muestra enfermedad de plexo en la RMN o la TAC, p = 0,004, mostrando una imagen normal. Los servicios que más atienden a estos pacientes son: traumatología (36,36%), neurología (11,68%), rehabilitación (10,38%) y oncología (4%).La prevalencia de las lesiones de plexo en nuestra área es de 2,37 por 100.000 habitantes/año. La etiología más frecuente en nuestra serie es la traumática en ambos sexos, asociándose a pacientes más jóvenes (menores de 55 años), aunque más de un tercio de la serie tiene etiología desconocida. La localización más frecuente es la cervicobraquial, donde además las pruebas de neuroimagen tienen más valor localizador.We analyse the prevalence, aetiology, and diagnosis of cervical-brachial and lumbo-sacral plexopathies at our hospital over a 10-year period.We conducted an observational, descriptive, retrospective analysis of adult patients diagnosed with plexopathy and attended at our centre's specialist electromyography clinic between February 2008 and December 2018, inclusive.We included 77 patients (95.1% of the cases identified), with a mean (standard deviation) age of 55.94 (16.9) years; 49 patients (60.5%) were men. Prevalence amounted to 2.37 cases per 100 000 person-years. Cervical plexopathy was the most frequent type (84% of cases). The most frequent aetiologies were trauma (27 patients; 35%), Parsonage-Turner syndrome (17 patients; 20.9%), neoplasm (12 patients; 14.8%), and idiopathic (11 patients, 13.5%). Of the 12 patients with neoplastic aetiology, neuroimaging only confirmed tumour infiltration in 4 cases (33.3%). Of the 77 patients who underwent neuroimaging studies (CT or MRI), findings were normal in 69 (85.2%; P = .004). The hospital departments most frequently attending these patients were traumatology (36.36%), neurology (11.68%), rehabilitation (10.38%), and oncology (4%).The prevalence of plexopathies in our health district amounts to 2.37 cases per 100,000 person-years. In our series, the most frequent aetiology in both sexes was trauma, which was associated with younger age (under 55 years), although aetiology was unknown in more than one-third of patients. The cervical-brachial plexus was most frequently affected, and lesions to this region are more easily located with neuroimaging studies.

Une polyarthrite rhumatoïde érosive et évolutive chez les patients atteints d’hépatopathie chronique compliquée d’hypertension portale associant varices œsophagiennes et ascite pose de sérieux problèmes de prise en charge. Il n’existe pas dans la littérature de conduite thérapeutique validée. Nous rapportons les cas d’une femme et d’un homme âgés respectivement de 52 et 66 ans chez qui ces situations pathologiques sont réunies. Les perfusions de tocilizumab à la posologie de 4 mg/kg, en monothérapie, ont permis d’obtenir un sevrage en cortisoniques, une rémission à la fois clinique et structurale avec une tolérance hépatique satisfaisante à 10 et 18 mois.

Background and Purpose— We evaluated temporal trends in stroke incidence between men and women to determine whether changes in the distribution of vascular risk factors have influenced sex differences in stroke epidemiology. Methods— Patients with first-ever stroke including ischemic stroke, spontaneous intracerebral hemorrhage, subarachnoid hemorrhage, and undetermined stroke between 1987 and 2012 were identified through the population-based registry of Dijon, France. Incidence rates were calculated for age groups, sex, and stroke subtypes. Sex differences and temporal trends (according to 5-year time periods) were evaluated by calculating incidence rate ratios (IRRs) with Poisson regression. Results— Four thousand six hundred and fourteen patients with a first-ever stroke (53.1% women) were recorded. Incidence was lower in women than in men (112 versus 166 per 100 000/y; IRR, 0.68; P<0.001), especially in age group 45 to 84 years, and for both ischemic stroke and intracerebral hemorrhage. From 1987 to 2012, the lower incidence of overall stroke in women was stable (IRR ranging between 0.63 and 0.72 according to study periods). When considering stroke subtype, a slight increase in the incidence of ischemic stroke was observed in both men (IRR, 1.011; 95% confidence interval, 1.005–1.016; P=0.001) and women (IRR, 1.013; 95% confidence interval, 1.007–1.018; P=0.001). The sex gap in incidence remained unchanged in ischemic stroke and intracerebral hemorrhage. Conversely, the lower subarachnoid hemorrhage incidence in women vanished with time because of an increasing incidence. Conclusions— The sex gap in stroke incidence did not change with time except for subarachnoid hemorrhage. Despite lower rates, more women than men experience an incident stroke each year because of a longer life expectancy.

Background and Purpose— We evaluated temporal trends in stroke incidence between men and women to determine whether changes in the distribution of vascular risk factors have influenced sex differences in stroke epidemiology. Methods— Patients with first-ever stroke including ischemic stroke, spontaneous intracerebral hemorrhage, subarachnoid hemorrhage, and undetermined stroke between 1987 and 2012 were identified through the population-based registry of Dijon, France. Incidence rates were calculated for age groups, sex, and stroke subtypes. Sex differences and temporal trends (according to 5-year time periods) were evaluated by calculating incidence rate ratios (IRRs) with Poisson regression. Results— Four thousand six hundred and fourteen patients with a first-ever stroke (53.1% women) were recorded. Incidence was lower in women than in men (112 versus 166 per 100 000/y; IRR, 0.68; P <0.001), especially in age group 45 to 84 years, and for both ischemic stroke and intracerebral hemorrhage. From 1987 to 2012, the lower incidence of overall stroke in women was stable (IRR ranging between 0.63 and 0.72 according to study periods). When considering stroke subtype, a slight increase in the incidence of ischemic stroke was observed in both men (IRR, 1.011; 95% confidence interval, 1.005–1.016; P =0.001) and women (IRR, 1.013; 95% confidence interval, 1.007–1.018; P =0.001). The sex gap in incidence remained unchanged in ischemic stroke and intracerebral hemorrhage. Conversely, the lower subarachnoid hemorrhage incidence in women vanished with time because of an increasing incidence. Conclusions— The sex gap in stroke incidence did not change with time except for subarachnoid hemorrhage. Despite lower rates, more women than men experience an incident stroke each year because of a longer life expectancy.

INTRODUCTION:Moyamoya syndrome is a rare progressive cerebrovascular occlusive disease for which several associated conditions have been described.CASE REPORT:We report the case of a 76-year-old woman with a history of May-Hegglin anomaly who presented with an isolated unusual diffuse headache. Initial laboratory investigations showed only thrombocytopenia (platelet count 95000/μL). Unenhanced brain computed tomography scan revealed a small subarachnoid hemorrhage in the left frontal lobe. Computed tomography angiography showed occlusion of the terminal portion of the left internal carotid artery (ICA) and narrowing of the terminal portion of the right ICA with abnormal collateral vessels. Conventional angiography confirmed the tight stenosis of the extremity of the right ICA, and the occlusion of the left ICA, associated with an extensive collateral network consistent with moyamoya syndrome. No aneurysm was identified.CONCLUSIONS:The rarity of these 2 diseases makes a fortuitous association very unlikely. We thus concluded that this observation could be the first reported case of May-Hegglin anomaly as a cause of moyamoya syndrome.

Introduction > Although secondary prevention in patients with arterial vascular diseases has improved, a gap between recommendations and clinical practice may exist. Objectives > We aimed to evaluate temporal trends in the premorbid use of preventive treatments in patients with ischemic cerebrovascular events (ICVE) and prior vascular disease. Methods > Patients with acute ICVE (ischemic stroke/TIA) were identified through the population-based stroke registry of Dijon, France (1985-2010). Only those with history of arterial vascular disease were included and were classified into four groups: patients with previous coronary artery disease only (CAD), previous peripheral artery disease only (PAD), previous ICVE only, and patients with at least two different past vascular diseases (polyvascular group). We assessed trends in the proportion of patients who were treated with antihypertensive treatments and antithrombotics at the time of their ICVE using multivariable logistic regression models. Results > Among the 5309 patients with acute ICVE, 2128 had a history of vascular disease (mean age 77.3 +/- 11.9, 51% men; 25.1% CAD 7.5% PAD, 39.8% ICVE, and 27.5% poylvascular). A total of 45.8% of them were on antithrombotics, 64.1% on antihypertensive treatment, and 34.4% on both. Compared with period 1985-1993, periods 1994-2002 and 2003-2010 were associated with a greater frequency of prior-to-ICVE use of antithrombotics (adjusted OR = 5.94; 95% CI: 4.61-7.65, P < 0.01, and adjusted OR = 6.92; 95% CI: 5.33-8.98, P < 0.01, respectively) but not of antihypertensive drugs. Consistent results were found when analyses were stratified according to the type of history of arterial vascular disease. Conclusion > Patients with ICVE and previous vascular disease were still undertreated with recommended preventive therapies.

Some advances in technologies can help clinicians to better understand diseases and to modify their attitude towards management of their patients in terms of therapeutic strategies. Cerebral microbleeds (CMBs) are recently discovered lesions that have had a significant effect on neurologists' conceptions about cerebral vasculopathies, and about which many questions still need to be answered for clinical practice. CMBs were first described in the 1990s, after the development of magnetic resonance imaging (MRI) sequences called gradient echo T2*. CMBs appear as small round hypointense lesions with a black appearance and a diameter of <5-10 mm; they are typically located either in the deep brain (basal ganglia) or in the corticosubcortical regions (lobar CMBs). In some patients, the CMB topography is mixed (Fig. 1). To distinguish between a CMB

Background: 25-Hydroxyvitamin D (25(OH)D) deficiency is a frequent condition in patients who suffer a stroke, and several studies suggested that it may be associated with a poorer prognosis. The aim of this study was to investigate specifically the association between 25(OH)D levels and functional outcome at 3 months in ischemic stroke patients treated with intravenous thrombolysis. Methods: Consecutive ischemic stroke patients who received intravenous thrombolysis were enrolled between 2010 and 2013. Baseline characteristics were collected, and serum concentrations of 25(OH)D were measured within the first 24 hours after admission and were analyzed according to the quartiles of their distribution (<25 nmol/L versus >= 25 nmol/L). Multivariable ordinal logistic regression was used to evaluate the association between 25(OH)D and 3-month functional outcome assessed by the modified Rankin score. Results: Three hundred fifty-two patients were included (mean age 68.6 +/- 15.8, 50.7% women, mean 25(OH)D level 45 +/- 25 nmol/L). The characteristics of the patients only differed with regard to higher premorbid functional impairment in patients with low 25(OH)D. In univariate analysis, the risk of functional impairment in patients with low 25(OH)D levels was greater than that in patients with higher 25(OH) D levels (odds ratio [OR] 2.10, 95% confidence interval [CI]: 1.35-3.27, P = .001). This association was still observed after adjustment for confounding variables (OR 1.70, 95% CI: 1.06-2.71, P = .027). Conclusion: A low serum 25(OH)D level is associated with worse functional outcome in patients with acute ischemic stroke treated with intravenous thrombolysis. Further investigations are required to understand the underlying mechanisms of this association.

Le syndrome de Guillain-Barré (SGB) est une pathologie auto-immune dont la défaillance respiratoire est la principale complication à la phase aiguë de la maladie. L’objectif de l’étude était d’évaluer les facteurs cliniques, biologiques et électrophysiologiques associés à une assistance respiratoire par ventilation non invasive ou intubation à la phase aiguë du Guillain-Barré. Cette étude de cohorte, rétrospective et observationnelle, a recensé tous les cas de syndrome de Guillain-Barré pris en charge au CHU de Dijon de janvier 2005 à mars 2014. Les 2 groupes assistance ou non assistance ventilatoire ont été étudiés en analyse uni- puis multivariée pour des paramètres cliniques, biologiques et électrophysiologiques. Parmi les 79 patients, une assistance ventilatoire était nécessaire dans 21,5 % des cas avec un délai moyen de 5,3 jours. En analyses multivariées, une parésie initiale sévère (force motrice ≤ 3/5) des membres supérieurs (OR = 30,9), une perturbation du bilan hépatique (OR = 5,8) et de l’immunofixation des protéines sériques (OR = 5,1) ainsi que la présence de blocs de conductions sur le nerf tibial (OR = 16,4) étaient significativement associés au recours à une assistance ventilatoire à la phase aiguë du SGB. La parésie sévère des membres supérieurs est un facteur de risque connu d’assistance ventilatoire. En revanche, les perturbations du bilan hépatique et de l’immunofixation des protéines sériques sont largement méconnues et pourtant associés à une ventilation assistée. Seul le bloc de conduction tibial était un facteur de risque sous réserve de possibles biais de réalisation technique. L’identification rapide de données cliniques et paracliniques simples permet d’identifier précocement les sujets à risque de décompensation respiratoire dans le Guillain-barré pour améliorer la prise en charge.

BACKGROUND:Several trials and meta-analyses have recently demonstrated the superiority of endovascular therapy over standard medical treatment in patients presenting with acute ischemic stroke. In order to offer the best possible treatment to a maximum number of patients, many stroke care networks probably have to be reorganized. After analyzing the reliability of data in the literature, an algorithm is suggested for a pre-hospital and in-hospital alert system to improve the timeliness of subsequent treatment: a drip-and-ship approach.SUMMARY:Five recent well-designed randomized studies have demonstrated the benefit of endovascular therapy associated with intravenous fibrinolysis by recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke with confirmation by recent meta-analyses. The keys for success are a very short time to reperfusion, within 6 h, a moderate to severe pre-treatment deficit (National Institute of Health around 17), cerebral imaging able to identify proximal large vessel occlusion in the anterior circulation, a limited infarct core and a reversible penumbra, the use of the most recent devices (stent retriever) and a procedure that avoids general anesthesia, which reduces blood pressure. To meet these goals, every country must build a national stroke infrastructure plan to offer the best possible treatment to all patients eligible for intravenous fibrinolysis and endovascular therapy. The plan may include the following actions: inform the population about the first symptoms of stroke, provide the call number to improve the timeliness of treatment, increase the number of comprehensive stroke centers, link these to secondary and primary stroke centers by telemedicine, teach and train paramedics, emergency doctors and radiologists to identify the stroke infarct, proximal large vessel occlusion and the infarct core quickly, train a new generation of endovascular radiologists to improve access to this therapy.KEY MESSAGE:After 20 years of rt-PA, this new evidence-based therapy is a revolution in stroke medicine that will benefit patients. However, a new robust and multi-disciplinary care strategy is necessary to transfer the scientific data into clinical practice. It will require reorganization of the stroke infrastructure, which will include comprehensive stroke centers and secondary and primary stroke centers. The winners will be patients with severe stroke.

Lobar microbleeds (MBs) are occasionally visible on gradient-echo T2*-weighted (T2*-w) magnetic resonance imagings (MRIs) in patients with deep intracerebral hemorrhages (ICHs). This study investigated the contribution of nascent lobar MBs to occurrences of deep ICHs.We prospectively analyzed nascent lobar MBs in patients admitted to our hospital who were treated with index strokes between April 2004 and November 2009. Numbers of nascent lobar MBs were counted on T2*-w MRI scans around 1 year after index strokes and compared with previous MRIs on admission. Deep ICH occurrence–free rate curves were generated by the Kaplan−Meier method using the log-rank test. The odds ratio (OR) for deep ICH occurrence was derived from a multivariate logistic regression model using nascent lobar MBs and risk factors.We investigated MRIs (interscan interval: 14.6 ± 5.9 months) of 508 patients (207 women, 68.9 ± 11.5 years), with a follow-up period of 44.1 ± 15.4 months. Repeated T2*-w MRIs demonstrated 157 nascent lobar MBs in 62 of 508 patients. The occurrence rate of deep ICHs (1.9% per year) was significantly higher in patients with nascent lobar MBs than in those without (.5% per year, P = .012). Multivariate analyses revealed that the rate of nascent lobar MBs was significantly elevated in patients with deep ICH-type stroke recurrences (OR: 3.85, P = .020), adjusted by the presence of hypertension, diabetes mellitus, use of antithrombotic drugs, severity of white matter lesions, age, and gender.Though a cohort study limited the power of analyses, our findings suggested that lobar MBs might be associated with deep ICH.

We aimed to investigate associations between serum thyroid stimulating hormone (TSH) levels and both severity and outcome after ischemic stroke (IS). A total of 731 patients consecutive IS patients were enrolled (mean age 69.4 ± 15.4, 61.6% men), and serum TSH levels were measured at admission and analyzed according to the tertiles of their distribution (<0.822 vs. 0.822-1.6 vs. >1.6 mUI/l). Associations between TSH and both severity at admission (National Institutes of Health Stroke Scale (NIHSS) scores <5 vs. ≥5) and functional outcome at discharge assessed by the modified Rankin Scale were analyzed using logistic regression and ordinal logistic regression models, respectively. High TSH levels were independently associated with both a decreased risk of NIHSS score ≥5 at admission (prevalence proportion ratio = 0.62; 95% CI 0.41-0.94, p = 0.024 for tertile 3 vs. tertile 1). In addition, patients with high TSH levels had a better functional outcome at discharge (OR 0.43; 95% CI 0.30-0.60, p < 0.001 for tertile 2 vs. tertile 1; OR 0.39; 95% CI 0.27-0.56, p < 0.001 for tertile 3 vs. tertile 1). The mechanisms underlying these associations and their potential exploitation in terms of therapeutic strategies need to be explored.