BACKGROUND:Spontaneous intracerebral hemorrhage (ICH) is a leading cause of disability and death worldwide. Understanding temporal trends in the burden of the disease is critical to evaluate the effectiveness of preventive strategies and identify targets for action. This study aimed to assess long-term temporal trends in incidence, attack rates, and early case fatality of ICH. METHODS:All cases of ICH among residents of Dijon, France, were prospectively recorded between 1985 and 2022 using a population-based registry. Annual incidence and attack rates were assessed, and temporal trends were analyzed by calculating incidence rate ratio (IRR) and attack rate ratio (ARR). Case fatality was measured at 30 days. RESULTS:A total of 1,015 ICH cases (mean age 73.5 ± 16.4 years old, 52.7% women) were recorded including 815 patients with a first-ever ICH and 200 cases of ICH as stroke recurrences. Age-standardized incidence increased progressively from 12.6/100,000/year in 1985-1991 to 20.8/100,000/year in 2011-2016 (IRR: 1.96, p < 0.001). A slight decrease was observed during period 2017-2022 (18.9/100,000/year, IRR: 0.81; 95% CI: 0.61-1.06, p = 0.11). A similar trend was noted in attack rates, with a peak during 2011-2016 (27.9/100,000/year; ARR: 1.79; 95% CI: 1.47-2.20, p < 0.001) and a decrease in the most recent period (23.2/100,000/year; ARR: 0.83; 95% CI: 0.69-0.99, p = 0.04). In men, a significant increase in incidence and attack rates was observed from 1985-1991 to 2011-2016, followed by a slight decline. In contrast, women showed a delayed increase in rates, with no decline in the most recent period. The 30-day case fatality rate declined between 1985 and 2010 (from 40.3% to 26.3%), followed by an increase thereafter, reaching 38.8% during the last study period. CONCLUSION:Our study revealed an overall increase in incidence and attack rates of ICH followed by a slight decline in recent years. Sex differences in trends warrant further investigation into the contributing factors and emphasize the continued need for prevention strategies to further reduce the burden of ICH. The recent increase in early case fatality rates highlights the need for specific acute-phase treatments of ICH.

OBJECTIVE:Investigate the efficacy of immediate-release (IR) amantadine in reducing the risk of peak-dose dyskinesia in early Parkinson's disease (PD) as add-on to levodopa. BACKGROUND:While the use of amantadine to manage dyskinesia in PD is well supported by controlled clinical trials, data on its efficacy in patients without motor complications remain limited. METHODS:This 22-month, multicenter, randomized, placebo-controlled trial (NCT01538329) enrolled early PD patients on stable levodopa (≥150 mg/day for ≤1 year) without motor complications. The study included three double-blind phases: an 18-month treatment phase with adjunct amantadine-IR (200 mg/day) or placebo (Period 1), a 3-month delayed-start phase where all participants received amantadine-IR (Period 2), and a 1-month washout with placebo (Period 3). The primary outcome was dyskinesia incidence at month 18; secondary outcomes included dyskinesia rates at the end of Periods 2 and 3 to assess potential long-lasting mechanisms of the drug. Exploratory outcomes investigated the potential effects of amantadine-IR on motor and non-motor symptoms and quality of life. RESULTS:A total of 207 patients were randomized to amantadine-IR (N = 99) or placebo (N = 108). Significantly fewer patients in the amantadine-IR group developed dyskinesia versus placebo during Period 1 (11% vs. 22%, P = 0.025), while the mean daily dose of levodopa (95% CI) increased by 70 (21-119) mg less (P = 0.005). The proportion of patients with dyskinesia was less in the amantadine-IR group versus placebo at the end of Periods 2 and 3, but the difference was not statistically significant (12% vs. 20%, P = 0.13 and 16% vs. 22%, P = 0.23, respectively). Mild but significant positive effects on freezing of gait, fatigue, and quality of life were observed during Period 1. The safety profile of amantadine-IR was in line with previous reports. CONCLUSIONS:Adjunctive amantadine-IR in early PD halved dyskinesia incidence over 18 months. Long-lasting mechanisms could not be demonstrated and merit further investigation. Exploratory positive findings on the potential benefit of amantadine-IR on symptoms like freezing of gait and fatigue also call for further investigation. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

First described in December 2019 in Wuhan (China), COVID-19 disease rapidly spread worldwide, constituting the biggest pandemic in the last 100 years. Even if SARS-CoV-2, the agent responsible for COVID-19, is mainly associated with pulmonary injury, evidence is growing that this virus can affect many organs, including the heart and vascular endothelial cells, and cause haemostasis, CNS, and kidney and gastrointestinal tract abnormalities that can impact in the disease course and prognosis. In fact, COVID-19 may affect almost all the organs. Hence, SARS-CoV-2 is essentially a systemic infection that can present a large number of clinical manifestations, and it is variable in distribution and severity, which means it is potentially life-threatening. The goal of this comprehensive review paper in the series is to give an overview of non-pulmonary involvement in COVID-19, with a special focus on underlying pathophysiological mechanisms and clinical presentation.

The impacts of accumulating atmospheric greenhouse gases on the earth’s climate are now well established. As a result, there have been increases in ambient temperatures and resultant higher frequency and duration of temperature extremes and other extreme weather events, which have been linked to a wide range of adverse health outcomes. This topical narrative review provides a summary of published evidence on the links between climate change and stroke. There is consistent evidence of associations between stroke incidence and mortality and increasing ambient temperature and air pollution. Associations have also been shown for changes in barometric pressure, wildfires, and desert dust and sandstorms, but current evidence is limited. Flooding and other extreme weather events appear to primarily cause service disruption, but more direct links to stroke may emerge. Synergies between dietary changes that reduce stroke risk and may also reduce carbon footprint are being explored. We also discuss the impact on vulnerable populations, proposed pathophysiologic mechanisms, mitigation strategies, and current research priorities. In conclusion, climate change increasingly impacts the stroke community, warranting elevated attention.

BACKGROUND: Whether a strategy to target an LDL (low-density lipoprotein) cholesterol <70 mg/dL is more effective when LDL is reduced >50% from baseline rather than <50% from baseline has not been investigated. METHODS: The Treat Stroke to Target trial was conducted in France and South Korea in 61 sites between March 2010 and December 2018. Patients with ischemic stroke in the previous 3 months or transient ischemic attack within the previous 15 days and evidence of cerebrovascular or coronary artery atherosclerosis were randomly assigned to a target LDL cholesterol of <70 mg/dL or 100±10 mg/dL, using statin and/or ezetimibe as needed. We used the results of repeated LDL measurements (median, 5 [2–6] per patient) during 3.9 years (interquartile range, 2.1–6.8) of follow-up. The primary outcome was the composite of ischemic stroke, myocardial infarction, new symptoms requiring urgent coronary or carotid revascularization, and vascular death. Cox regression model including lipid-lowering therapy as a time-varying variable, after adjustment for randomization strategy, age, sex, index event (stroke or transient ischemic attack), and time since the index event. RESULTS: Among 2860 patients enrolled, patients in the lower target group who had >50% LDL cholesterol reduction from baseline during the trial had a higher baseline LDL cholesterol and a lower LDL cholesterol achieved as compared to patients who had <50% LDL cholesterol reduction (155±32 and 62 mg/dL versus 121±34 and 74 mg/dL, respectively, P <0.001 for both). In the <70 mg/dL target group, patients with >50% LDL reduction had a significant reduction in the primary outcome as compared to the higher target group (hazard ratio, 0.61 [95% CI, 0.43–0.88]; P =0.007) and patients with <50% LDL reduction from baseline had little reduction (hazard ratio, 0.96 [95% CI, 0.73–1.26]; P =0.75). CONCLUSIONS: In this post hoc analysis of the TST trial, targeting an LDL cholesterol of <70 mg/dL reduced the risk of primary outcome compared with 100±10 mg/dL provided LDL cholesterol reduction from baseline was superior to 50%, thereby suggesting that the magnitude of LDL cholesterol reduction was as important to consider as the target level to achieve. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01252875. URL: https://clinicaltrialsregister.eu ; Unique identifier: EUDRACT2009-A01280-57.

BACKGROUND:The increased maternal cardiocerebrovascular risk after a pregnancy complicated by hypertensive disorders of pregnancy, is well documented in the literature. Recent evidence has suggested a shorter timeframe for the development of these postnatal outcomes, which could have major clinical implications.OBJECTIVE:This study aimed to determine the risk of and time to onset of maternal cardiovascular and cerebrovascular outcomes after a pregnancy complicated by hypertensive disorders of pregnancy.STUDY DESIGN:This study included 2,227,711 women, without preexisting chronic hypertension, who delivered during the period 2008 to 2010: 37,043 (1.66%) were diagnosed with preeclampsia, 34,220 (1.54%) were diagnosed with gestational hypertension, and 2,156,448 had normotensive pregnancies. Hospitalizations for chronic hypertension, heart failure, coronary heart disease, cerebrovascular disease, and peripheral arterial disease were studied. A classical Cox regression was performed to estimate the average effect of hypertensive disorders of pregnancy over 10 years compared with normotensive pregnancy; moreover, an extended Cox regression was performed with a step function model to estimate the effect of the exposure variable in different time intervals: <1, 1 to 3, 3 to 5, and 5 to 10 years of follow-up.RESULTS:The risk of chronic hypertension after a pregnancy complicated by preeclampsia was 18 times higher in the first year (adjusted hazard ratio, 18.531; 95% confidence interval, 16.520-20.787) to only 5 times higher at 5 to 10 years after birth (adjusted hazard ratio, 4.921; 95% confidence interval, 4.640-5.218). The corresponding risks of women with gestational hypertension were 12 times higher (adjusted hazard ratio, 11.727; 95% confidence interval, 10.257-13.409]) and 6 times higher (adjusted hazard ratio, 5.854; 95% confidence interval, 5.550-6.176), respectively. For other cardiovascular and cerebrovascular outcomes, there was also a significant effect with preeclampsia (heart failure: adjusted hazard ratio, 6.662 [95% confidence interval, 4.547-9.762]; coronary heart disease: adjusted hazard ratio, 3.083 [95% confidence interval, 1.626-5.844]; cerebrovascular disease: adjusted hazard ratio, 3.567 [95% confidence interval, 2.600-4.893]; peripheral arterial disease: adjusted hazard ratio, 4.802 [95% confidence interval, 2.072-11.132]) compared with gestational hypertension in the first year of follow-up. A dose-response effect was evident for the severity of preeclampsia with the averaged 10-year adjusted hazard ratios for developing chronic hypertension after early, preterm, and late preeclampsia being 10, 7, and 6 times higher, respectively.CONCLUSION:The risks of cardiovascular and cerebrovascular outcomes were the highest in the first year after a birth complicated by hypertensive disorders of pregnancy. We found a significant relationship with both the severity of hypertensive disorders of pregnancy and the gestational age of onset suggesting a possible dose-response relationship for the development of cardiovascular and cerebrovascular outcomes. These findings call for an urgent focus on research into effective postnatal screening and cardiocerebrovascular risk prevention for women with hypertensive disorders of pregnancy.

Background: We evaluated whether pre-existing brain damage may explain greater severity in cognitivelyimpaired patients with ischemic stroke (IS). Methods: IS patients were retrieved from the population-based registry of Dijon, France. Pre-existing damage (leukoaraiosis, old vascular brain lesions, cortical and central brain atrophy) was assessed on initial CT-scan. Association between prestroke cognitive status defined as no impairment, mild cognitive impairment (MCI), or dementia, and clinical severity at IS onset assessed with the NIHSS score was evaluated using ordinal regression analysis. Mediation analysis was performed to assess pre-existing brain lesions as mediators of the relationship between cognitive status and severity. Results: Among the 916 included patients (mean age 76.8 +/- 15.0 years, 54.3% women), those with pre-existing MCI (n = 115, median NIHSS [IQR]: 6 [2-15]) or dementia (n = 147, median NIHSS: 6 [3-15]) had a greater severity than patients without (n = 654, median NIHSS: 3 [1-9]) in univariate analysis (OR=1.69; 95% CI: 1.182.42, p = 0.004, and OR=2.06; 95% CI: 1.49-2.84, p < 0.001, respectively). Old cortical lesion (OR=1.53, p = 0.002), central atrophy (OR=1.41, p = 0.005), cortical atrophy (OR=1.90, p < 0.001) and moderate (OR=1.41, p = 0.005) or severe (OR=1.84, p = 0.002) leukoaraiosis were also associated with greater severity. After adjustments, pre-existing MCI (OR=1.52; 95% CI: 1.03-2.26, p = 0.037) or dementia (OR=1.94; 95% CI: 1.32-2.86, p = 0.001) remained associated with higher severity at IS onset, independently of confounding factors including imaging variables. Association between cognitive impairment and severity was not mediated by pre-existing visible brain damages. Conclusion: Impaired brain ischemic tolerance in IS patients with prior cognitive impairment could involve other mechanisms than pre-existing visible brain damage.

Introduction The ongoing ageing population is associated with an increase in the number of patients suffering a stroke, transient ischaemic attack (TIA) or myocardial infarction (MI). In these patients, implementing secondary prevention is a critical challenge and new strategies need to be developed to close the gap between clinical practice and evidence-based recommendations. We describe the protocol of a randomised clinical trial that aims to evaluate the efficiency and effectiveness of an intensive multidisciplinary follow-up of patients compared with standard care. Methods and analysis The DiVa study is a randomised, prospective, controlled, multicentre trial including patients >18 years old with a first or recurrent stroke (ischaemic or haemorrhagic) or TIA, or a type I or II MI, managed in one of the participating hospitals of the study area, with a survival expectancy >12 months. Patients will be randomised with an allocation ratio of 1:1 in two parallel groups: one group assigned to a multidisciplinary, nurse-based and pharmacist-based 2-year follow-up in association with general practitioners, neurologists and cardiologists versus one group with usual follow-up. In each group for each disease (stroke/TIA or MI), 430 patients will be enrolled (total of 1720 patients) over 3 years. The primary outcome will be the incremental costutility ratio at 24 months between intensive and standard follow-up in a society perspective. Secondary outcomes will include the incremental cost-utility ratio at 6 and 12 months, the incremental cost-effectiveness ratio at 24 months, reduction at 6, 12 and 24 months of the rates of death, unscheduled rehospitalisation and iatrogenic complications, changes in quality of life, net budgetary impact at 5 years of the intensive follow-up on the national health insurance perspective and analysis of factors having positive or negative effects on the implementation of the project in the study area. Ethics and dissemination Ethical approval was obtained and all patients receive information about the study and give their consent to participate before randomisation. Results of the main trial and each of the secondary analyses will be submitted for publication in a peer-reviewed journal. Trial registration number ClinicalTrials.gov Identifier: NCT04188457. Registered on 6 December 2019.

Stroke is a leading cause of death and adult disability globally. In addition to traditional risk factors, environmental risk factors have emerged over the recent past and are becoming increasingly important. The disproportionate rise of stroke incidence in low- and middle-income countries has been attributed, at least in part, to environmental factors. This narrative review provides details on the interplay between the environment and health generally and stroke specifically, covering topics including air pollution, atmospheric brown clouds, desert dust storms, giant wildfires, chemical contamination, biological aggressors, urbanization, and climate change. It also covers some beneficial environmental effects such as can be harnessed from the exposure to green spaces. It concludes with a summary of pragmatic actions that can be taken to help address some of these challenges at individual, community, and political advocacy levels.

The COVID-19 pandemic modified the management of myocardial infarction (MI) and stroke. We aimed to evaluate the effect of the COVID-19 pandemic on the volume and spatial distribution of hospitalizations for MI and stroke, before, during and after the first nationwide lockdown in France in 2020, compared with 2019. Hospitalization data were extracted from the French National Discharge database. Patient’s characteristics were compared according to COVID-19 status. Changes in hospitalization rates over time were measured using interrupted time series analysis. Possible spatial patterns of over or under-hospitalization rates were investigated using Moran’s indices. We observed a rapid and significant drop in hospitalizations just before the beginning of the lockdown with a nadir at 36.5% for MI and 31.2% for stroke. Hospitalization volumes returned to those seen in 2019 four weeks after the end of the lockdown, except for MI, which rebounded excessively. Older age, male sex, elevated rate of hypertension, diabetes, obesity and mortality characterized COVID-19 patients. There was no evidence of a change in the spatial pattern of over- or under-hospitalization clusters over the three periods. After a steep drop, only MI showed a significant rebound after the first lockdown with no change in the spatial distribution of hospitalizations.

The Dijon Vascular Project experiment aims to reduce the risk of unscheduled re-hospitalization for stroke and myocardial infarction. It involves hospital and private healthcare professionals working in the Côte-d'Or and South Haut-Marnais hospital grouping area. Within this system, hospital and private practice nurses are essential links in the patient's circle of care and fundamental contacts for post-stroke or post-MI follow-up: through their interventions, they contribute to preventing the risks of complications and recurrences.

BackgroundFacial asymmetry when crying at birth (then called asymmetric crying facies or ACF) or when smiling or speaking loudly in adulthood is the consequence of the agenesis or hypoplasia of the muscle of one of the labial commissures. This developmental disorder of complex mechanism is well known by pediatricians to be a warning sign for underlying developmental disorders of variable severity.Case reportAn 80-year-old man with medical history of renal agenesis was hospitalized for a transient motor deficit of the right face and arm revealing a lacunar stroke. Clinical examination showed an isolated left facial asymmetry upon smiling or talking out loud which had been known since childhood and was not related to the stroke, leading to the diagnosis of ACF. Cardiac ultrasound revealed a patent foramen. Chromosomal investigations could not be performed.Discussion and conclusionACF is a rare disorder that may conceal associated congenital disorders such as heart, skeletal, or renal malformations. Its causing mechanisms are to this day still poorly understood but may include a genetic component as shown by familial cases and the identification of 22q11.2 deletions or trisomy 18 in some patients. Knowledge of this disorder seems highly relevant for adult neurologists, first because of the differential diagnosis with facial palsy, but mostly because it will allow them to screen patients for other congenital disorders such as heart malformations. Conversely, cardiologists and cardiac surgeon may search for an ACF when faced with a patient with a congruent heart defect.

Background. The impact of the COVID-19 pandemic on hospitalization for cardiac infections is not well known. We aimed to evaluate the nationwide trends in hospital stays for myocarditis and endocarditis cases before, during and after the nationwide lockdown for the COVID-19 pandemic in France. We then aimed to describe the proportion of myocarditis and endocarditis patients with and without COVID-19 and their clinical characteristics. Methods. Hospitalized cases of cardiac infection were extracted from the French National Discharge database, which collects the medical records of all patients discharged from all public and private hospitals in France. Age, sex, and available cardiovascular risk factors were compared between stays with and without COVID-19 during the lockdown. Results. The number of myocarditis cases was 11% higher in 2020, compared to the average of the three prior years. In 2020, 439 of 3727 cases of myocarditis were associated with COVID-19. For endocarditis, there was an increase in cases by 7% in 2020 versus prior years. For endocarditis, 3% (240 of 8128 cases) of patients with endocarditis had COVID-19. For myocarditis, older age, hypertension, diabetes, obesity, and atrial fibrillation were more frequent in patients with COVID-19 than in those without. For endocarditis, only hypertension was more frequent in patients with COVID-19 than in those without. Conclusion. Our study reports an increase in hospitalizations for both myocarditis and endocarditis in 2020, possibly related to the COVID-19 pandemic. Interestingly, the trends differ according to the COVID-19 status. Knowledge of the factors associating myocarditis or endocarditis and COVID-19 may improve the quality and the type of monitoring for people with COVID-19, the identification of patients at risk of cardiac infections, and the treatment of COVID-19 patients.

Introduction En France, l'ensemble de la population a été placée en confinement total du 17 mars au 11 mai 2020 pendant la première vague de la pandémie de COVID-19. Les objectifs de cette étude étaient d’évaluer l'impact de la pandémie de COVID-19 sur les hospitalisations pour accidents vasculaires cérébraux (AVC) et accidents ischémiques transitoires (AIT) avant, pendant et après le premier confinement national dans deux régions françaises, Grand-Est (la plus touchée par l’épidémie) et Occitanie (la plus moins touchée par l’épidémie). Méthodes Tous les patients admis pour un AVC/AIT entre janvier et juin 2017-2020 dans tous les hôpitaux publics et privés des régions Grand-Est et Occitanie ont été inclus. Les données ont été extraites de la base de données PMSI nationale. Les taux d'hospitalisation observés en avril 2020 ont été comparés entre les deux régions et aux taux des trois années précédentes (2017-2019). Résultats Dans la région Grand-Est, le nombre mensuel d'hospitalisations pour AVC a significativement diminué de 18 % en avril 2020 par rapport à avril 2019, alors que l'Occitanie a connu une diminution plus faible et non significative (9 %). Après avril, le nombre mensuel d'hospitalisations pour AVC/AIT a augmenté pour atteindre des valeurs similaires à celles des années précédentes. La remontée s'est produite très rapidement dans le Grand-Est et plus lentement en Occitanie. Les patients atteints d'AVC/AIT hospitalisés dans le Grand-Est présentaient plus souvent une hypertension artérielle, une obésité, une hypercholestérolémie, un tabagisme et une fibrillation auriculaire, mais étaient moins souvent hospitalisés dans une unité neurovasculaire que ceux hospitalisés en Occitanie. Discussion/Conclusion La réduction marquée des taux d'hospitalisation pour AVC/AIT dans la région la plus touchée par le COVID-19 en France suggère que le confinement a été un obstacle à l'hospitalisation pour AVC/AIT. Il semble donc nécessaire de réactiver les messages de prévention auprès du grand public et de maintenir des filières de soins efficaces pour les AVC lors de crises sanitaires comme celle de la COVID-19.

Background: In atherosclerotic stroke, lipid-lowering treatment with a target LDL (low-density lipoprotein) cholesterol of <70 compared with 100±10 mg/dL reduced the risk of subsequent cardiovascular events. This post hoc analysis explored the relative effects of the combination of statin and ezetimibe (dual therapy) and statin monotherapy in achieving the lower LDL cholesterol target and in reducing the risk of major vascular events, as compared with the higher target group. Methods: Patients with ischemic stroke in the previous 3 months or transient ischemic attack within the previous 15 days and evidence of cerebrovascular or coronary artery atherosclerosis were randomly assigned to a target LDL cholesterol of <70 or 100±10 mg/dL, using statin and/or ezetimibe as needed. The primary outcome was the composite of ischemic stroke, myocardial infarction, new symptoms requiring urgent coronary or carotid revascularization, and vascular death. Cox regression model including lipid-lowering therapy as a time varying variable, after adjustment for randomization strategy, age, sex, index event (stroke or transient ischemic attack), and time since the index event. Results: Among 2860 patients enrolled, patients who were on dual therapy during the trial in the lower target group had a higher baseline LDL cholesterol as compared to patients on statin monotherapy (141±38 versus 131±36, respectively, P <0.001). In patients on dual therapy and on statin monotherapy, the achieved LDL cholesterol was 66.2 and 64.1 mg/dL respectively, and the primary outcome was reduced during dual therapy as compared with the higher target group (HR, 0.60 [95% CI, 0.39–0.91]; P =0.016) but not during statin monotherapy (HR, 0.92 [95% CI, 0.70–1.20]; P =0.52), with no significant increase in intracranial bleeding. Conclusions: In the TST trial (Treat Stroke to Target), targeting an LDL cholesterol of < 70 mg/dL with a combination of statin and ezetimibe compared with 100±10 mg/dL consistently reduced the risk of subsequent stroke. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01252875. URL: clinicaltrialsregister.eu ; Unique identifier: EUDRACT2009-A01280-57.

ObjectivesThe first wave of Covid-19 in spring 2020 and the strict lockdown set up at this time had a major impact on the activity of vascular surgeons, with delays in scheduled interventions, but also with a more difficult to explain major reduction in the activity of vascular urgencies. We sought to objectify this decrease of activity at the national level, and to detect a possible "rebound-effect" after the end of lockdown, by evaluating the national data up to four months after the end of the lockdown.Material and methodsData were extracted from the Computerized Medical Information Systems Programme (PMSI), including the rates of hospitalization for a number of diagnoses, which we classified in several categories: aortic dissection, aortic aneurysm rupture, acute lower limb ischemia, critical lower limb ischemia, as well as the number of major or transmetatarsal amputations using the coding of the Common Classification of Medical Acts (CCAM). We studied the data over the months of January to September 2020, this period including the first peak of the COVID-19 pandemic, the first national lockdown and the four months following the end of the lockdown, and compared the results with the average of the three previous years, 2017 to 2019, measured over the same months.ResultsA significant reduction of all the hospital admissions for aortic and peripheral vascular emergencies was observed, with an overall decrease of 8.9% across the study period and a reduction of 29.3% during the lockdown. No "rebound-effect" was observed at the end of the period of lockdown, except briefly and moderately for aortic aneurysm ruptures. We did not observe an increase in the number of amputations. For all the data studied, the numbers gradually returned to levels and variations similar to those of the previous years.ConclusionThis national analysis of the volumes of hospital admissions for aortic and peripheral vascular surgical emergencies during and after the first national lockdown in France in 2020 suggested that many patients did not have access to emergency medical care and to secondary prevention during the lockdown for various supposed reasons: true decreased incidence, problems of access to healthcare or diagnostic issues related to the medical context, with a probable increase in extra-hospital mortality related to these pathologies. ObjectivesThe first wave of Covid-19 in spring 2020 and the strict lockdown set up at this time had a major impact on the activity of vascular surgeons, with delays in scheduled interventions, but also with a more difficult to explain major reduction in the activity of vascular urgencies. We sought to objectify this decrease of activity at the national level, and to detect a possible "rebound-effect" after the end of lockdown, by evaluating the national data up to four months after the end of the lockdown. The first wave of Covid-19 in spring 2020 and the strict lockdown set up at this time had a major impact on the activity of vascular surgeons, with delays in scheduled interventions, but also with a more difficult to explain major reduction in the activity of vascular urgencies. We sought to objectify this decrease of activity at the national level, and to detect a possible "rebound-effect" after the end of lockdown, by evaluating the national data up to four months after the end of the lockdown. Material and methodsData were extracted from the Computerized Medical Information Systems Programme (PMSI), including the rates of hospitalization for a number of diagnoses, which we classified in several categories: aortic dissection, aortic aneurysm rupture, acute lower limb ischemia, critical lower limb ischemia, as well as the number of major or transmetatarsal amputations using the coding of the Common Classification of Medical Acts (CCAM). We studied the data over the months of January to September 2020, this period including the first peak of the COVID-19 pandemic, the first national lockdown and the four months following the end of the lockdown, and compared the results with the average of the three previous years, 2017 to 2019, measured over the same months. Data were extracted from the Computerized Medical Information Systems Programme (PMSI), including the rates of hospitalization for a number of diagnoses, which we classified in several categories: aortic dissection, aortic aneurysm rupture, acute lower limb ischemia, critical lower limb ischemia, as well as the number of major or transmetatarsal amputations using the coding of the Common Classification of Medical Acts (CCAM). We studied the data over the months of January to September 2020, this period including the first peak of the COVID-19 pandemic, the first national lockdown and the four months following the end of the lockdown, and compared the results with the average of the three previous years, 2017 to 2019, measured over the same months. ResultsA significant reduction of all the hospital admissions for aortic and peripheral vascular emergencies was observed, with an overall decrease of 8.9% across the study period and a reduction of 29.3% during the lockdown. No "rebound-effect" was observed at the end of the period of lockdown, except briefly and moderately for aortic aneurysm ruptures. We did not observe an increase in the number of amputations. For all the data studied, the numbers gradually returned to levels and variations similar to those of the previous years. A significant reduction of all the hospital admissions for aortic and peripheral vascular emergencies was observed, with an overall decrease of 8.9% across the study period and a reduction of 29.3% during the lockdown. No "rebound-effect" was observed at the end of the period of lockdown, except briefly and moderately for aortic aneurysm ruptures. We did not observe an increase in the number of amputations. For all the data studied, the numbers gradually returned to levels and variations similar to those of the previous years. ConclusionThis national analysis of the volumes of hospital admissions for aortic and peripheral vascular surgical emergencies during and after the first national lockdown in France in 2020 suggested that many patients did not have access to emergency medical care and to secondary prevention during the lockdown for various supposed reasons: true decreased incidence, problems of access to healthcare or diagnostic issues related to the medical context, with a probable increase in extra-hospital mortality related to these pathologies. This national analysis of the volumes of hospital admissions for aortic and peripheral vascular surgical emergencies during and after the first national lockdown in France in 2020 suggested that many patients did not have access to emergency medical care and to secondary prevention during the lockdown for various supposed reasons: true decreased incidence, problems of access to healthcare or diagnostic issues related to the medical context, with a probable increase in extra-hospital mortality related to these pathologies.

Introduction:Strategy for the acute management of minor ischemic stroke (IS) with large vessel occlusion (LVO) is under debate, especially the benefits of mechanical thrombectomy. The frequency of minor IS with LVO among overall patients is not well established. This study aimed to assess the proportion of minor IS and to depict characteristics of patients according to the presence of LVO in a comprehensive population-based setting.Methods:Patients with acute IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013–2017). All arterial imaging exams were reviewed to assess arterial occlusion. Minor stroke was defined as that with a National Institutes of Health Stroke Scale (NIHSS) score of <6. Proportion of patients with LVO was estimated in the minor IS population. The clinical presentation of patients was compared according to the presence of an LVO.Results:Nine hundred seventy-one patients were registered, including 582 (59.9%) patients with a minor IS. Of these patients, 23 (4.0%) had a LVO. Patients with minor IS and LVO had more severe presentation [median 3 (IQR 2–5) vs. 2 (IQR 1–3), p = 0.001] with decreased consciousness (13.0 vs. 1.6%, p<0.001) and cortical signs (56.5 vs. 30.8%, p = 0.009), especially aphasia (34.8 vs. 15.4%, p = 0.013) and altered item level of consciousness (LOC) questions (26.1 vs. 11.6%, p = 0.037). In multivariable analyses, only NIHSS score (OR = 1.45 per point; 95% CI: 1.11–1.91, p = 0.007) was associated with proximal LVO in patients with minor IS.Conclusion:Large vessel occlusion (LVO) in minor stroke is non-exceptional, and our findings highlight the need for emergency arterial imaging in any patients suspected of acute stroke, including those with minor symptoms because of the absence of obvious predictors of proximal LVO.

Intracerebral hemorrhage accounts for approximately 15% of the 115,000 strokes occurring each year in France. Although therapeutic strategies are more limited than for ischemic stroke, major points in the management of intracerebral hemorrhage can reduce short term morbidity and mortality by limiting the expansion of the hematoma and the occurrence of early complications, and long term patients' outcome by reducing the risk of recurrence. This article aims to update the key elements that contribute to improve of the prognosis of intracerebral hemorrhage patients.

The Dijon Vascular Project experiment aims to reduce the risk of unscheduled re-hospitalization for stroke and myocardial infarction. It involves hospital and private healthcare professionals working in the Côte-d'Or and South Haut-Marnais hospital grouping area. Within this system, hospital and private practice nurses are essential links in the patient's circle of care and fundamental contacts for post-stroke or post-MI follow-up: through their interventions, they contribute to preventing the risks of complications and recurrences.

Superficial Siderosis of the Central Nervous System (SSCNS) is a condition secondary to the deposition of hemosiderin within the subpial layers of central nervous system leading to its progressive degeneration, clinically responsible for hearing impairment, cerebellar ataxia and pyramidal syndrome. Here we report the case of a 61-year-old man with medical history of congenital hemophilia A presenting with typical clinical features of SSCNS associated with extensive hypo-intensity on fast 2D gradient-echo-weighted sequences, along the spinal cord, posterior fossa's structures and cerebral cortex. Interestingly, although his disorder was revealed by a lumbar spinal stenosis, presurgical imaging and subclinical hearing impairment preceding the surgery suggest another underlying cause. As a comprehensive work-up performed in our department ruled-out usual causes of SSCNS, this case reinforces the question of the ability for hemophilia A to generate SSCNS on its own.