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The incidence of cerebral haemorrhage was studied from a population-based stroke registry. The incidence was 12.3 per 100,000 per year in women and 13.9 per 100,000 per year in men, with a peak in the eighth decade and a male preponderance. Haemorrhages were deep seated and mostly due to hypertension. Recognised clinical characteristics of haemorrhage are acute onset, convulsion, vomiting, and disturbed consciousness. This study showed that cerebral haemorrhage may present with pure motor deficit or transient deficit preceding the stroke. The mortality was 51% in the first month, and 61% by two years. [ABSTRACT FROM AUTHOR]

Study Objectives: The aim of this study was to assess the frequency of past and current psychiatric disorders among patients referred to a sleep unit for polysomnography., Methods: A total of 152 patients referred to the Sleep Center of Timone Hospital in Marseille were included from January 12 to March 31, 2015. Clinical data were collected using the Mini International Neuropsychiatric Interview., Results: The final sample consisted of 102 patients. Polysomnography helped diagnose the following common sleep disorders: obstructive sleep apnea, restless legs syndrome, insomnia, and non-rapid eye movement sleep arousal disorder. Ninety patients (88%) had psychiatric disorders. All patients (27) without a common sleep disorder diagnosis had psychiatric disorders and among patients with a common sleep disorder diagnosis 84% had psychiatric disorders. Among the psychiatric disorders a past major depressive episode was the most frequent pathology., Conclusions: This study shows that patients referred to a sleep unit have a high prevalence of psychiatric disorders. This may be explained by residual symptoms of psychiatric illnesses, a diagnostic misdirection, a denial of psychiatric diagnosis, or an undiagnosed somatic symptom disorder. Finally, this study shows the importance of cross-disciplinary communication considering the diagnostic heterogeneity that may represent a sleep complaint., (© 2018 American Academy of Sleep Medicine.)

Aim: The aim of this study was to evaluate the practice of colonoscopy and sigmoidoscopy in France in 2000., Methods: A prospective study was conducted in November 2000 using questionnaires sent to all gastroenterologists practicing in France (N=2858) who were asked to reply to items concerning colonoscopies and sigmoidoscopies performed on two workdays chosen in advance. The response rate was 32.8%. Data were extrapolated to establish estimates for the entire year., Results: An estimated 894000 colonoscopies and 115320 sigmoidoscopies were performed in 2000. Single-use material was used in 22.1% of the procedures. Indications for endoscopy were mainly hematochezia (21.6%), gastrointestinal symptoms (35%) and surveillance of patients with a history of previous polypectomy (15%). Colorectal cancer screening was the indication for 20% of colonoscopies. Abnormal findings were reported for 54.8% of the endoscopies (polyps for 287218 procedures and cancer for 32799). Failure was noted in 4.9% of colonoscopies. The complication rate was 0.48%. Most polyps were adenomas (64.4%) or hyperplasic polyps (28.1%). The overall estimated number of colonoscopies with polypectomy was 224133., Conclusion: In 2000 there was an increased rate of colonoscopy for colorectal cancer screening (20%) but an overall decrease (2.5%) in the total number of colonoscopies compared to 1999. Abnormal findings were disclosed by 54.8% of the procedures. Extrapolation from these data indicates that colonoscopic screening enabled the diagnosis of 32799 colorectal cancers.

The aim of this study was to provide current data on case-fatality rates of malignant gliomas in the area of Burgundy (1,300,000 inhabitants). The ascertainment was specific according to imaging and histologic criteria, and was exhaustive because of the existence of a single University Hospital allowing both imaging and histologic diagnosis from stereotaxic cerebral biopsy. During six full years we collected 161 cases of malignant gliomas grades II to IV, 93 men (57.76%) and 68 women (42.23%). The mean age was 61 years. In all the age groups, there were a male predominance. Headache, epilepsy and motor deficit were the most frequent symptoms at onset. In most cases, the gliomas were localized within the frontal area. The post-surgical Karnofsky score was up to 70 in 40% of the cases. There were 89 glioblastomas with grade IV, 37 anaplastic astrocytomas, 13 gliomatous tumors with grade II and IV and six anaplastic oligodendrogliomas. This grading explains the very low survival rates, with a negative effect induced by age. Among the most relevant contributions of this study to the clinical features of malignant gliomas is an analysis of case-fatality rates, evaluation of health care services and therapeutic trials.

Two thousand three hundred and eighty-nine patients with first-ever stroke were registered in the population-based Dijon Stroke Registry over an 11-year period. There was a history of migraine in 49 cases (2%), with a majority of women (2.8% versus 1.1% men) with the following distribution: 27 cases among 1,380 large-artery cerebral infarctions (1.9%), 6 cases among 358 small-artery cerebral infarctions (1.6%), 6 cases among 412 cerebral infarctions due to cardiac embolism (1.4%), 7 cases among 191 cerebral hemorrhages (3. 6%) and 3 cases among 47 subarachnoid hemorrhages (6.3%). The male/female ratio was 0.58 for the 49 strokes with a history of migraine versus 1.27 for the 2,340 strokes with no history of migraine. Twelve migraine-induced ischemic strokes occurred with an infarction of the posterior area of the brain in young patients. The annual incidence was 0.80/100,000/year (confidence interval, CI = 0. 37-1.57) with a predominance of women (1.02/100,000/year, CI = 0. 52-1.25; men: 0.57/100,000/year; CI = 0.28-1.04). We conclude that a history of migraine is more frequent in women, in particular in those with hemorrhagic strokes, and that the incidence of migraine-induced stroke in our population-based study is higher in women, although it remains low.

Objective: To evaluate the frequency of headache in patients with hypothyroidism., Design: A prospective study of a cohort of patients with hypothyroidism., Setting: Outpatients or inpatients in a headache clinic and endocrinological clinic., Patients: 102 adults, ages 35 to 78 (83F, 19M) experiencing clinical and biological hypothyroidism., Results: Thirty-one patients with hypothyroidism of 102 (30%) presented with headache 1 to 2 months after the first symptoms of hypothyroidism. The headache was slight, nonpulsatile, continuous, bilateral, and salicylate responsive and disappeared with thyroid hormone therapy., Conclusion: The authors believe there is a prevalence of nonspecific headache in hypothyroidism and that it has a particular response to thyroid hormone therapy. Hypothyroidism is another cephalalgia with an endocrinological cause after menstrual cephalalgia. We suspect a metabolic or vascular pathophysiological process.

Objectives: The aim of this study was to re-evaluate the clinical features of stroke in children, their outcome and the place of the different mechanisms, in the light of CT-scan and magnetic resonance imaging., Methods: A 10-year review of the Dijon Childhood Neurology Clinic experience (1985-1995) identified 54 patients with arterial stroke. Diagnosis was established by CT-scan and angiography and by magnetic resonance imaging from 1987. When an hemorrhagic stroke was identified, a cerebral arteriogram and an investigation of the coagulation factors were performed. When an ischemic stroke was identified, the following tests were performed: an ultrasound examination of the cervical arteries, a cerebral arteriogram, a lumbar puncture, an investigation of the coagulation factors and lipid status, a measurement of homocystine in the plasma and the urine, an electrocardiogram, a Holter procedure and a cardiac echography., Results: During the 11 full calendar years of this study, we observed 54 stroke patients. There were 31 cases of ischemic stroke, representing some 57% of the total, as well as 23 cases of hemorrhagic stroke, representing 43% of the total. Of the 31 cases with ischemic stroke, 4 had no known predisposing condition, 6 occurred in children with pre-existing heart disease, 2 had moya-moya disease, 2 had leukemia, 2 had a carotid dissection, 1 had an hemolytic-uremic syndrome, and 14 were observed in patients with other associated conditions, such as infections (7 cases) or slight cranial trauma (7 cases). On CT-scan, a basal ganglia infarction was identified in 14 cases. Among the 23 hemorrhagic strokes, 9 were due to arteriovenous malformations, 2 to arterial aneurysm and 5 to cavernomas. Two cases occurred in hemophilia, 2 in idiopathic thrombocytopenic purpura, and 2 after throat infections. One case had no etiologic factor. Clinical course was marked by a low mortality rate even in hemorrhagic stroke, long-lasting seizures, and hemidystonia., Conclusion: This neuro-imaging survey focused on the real place of hemorrhage and basal ganglia infarctions in children under 16 years of age, compared to adulthood. Follow-up demonstrated good or complete resolution of neurological deficits despite the frequent late hemidystonia and late epilepsy.

The present study reports eight additional mutations in the connexin32 gene associated with the X-linked form of Charcot-Marie-Tooth disease. One of these mutations was found twice in two apparently unrelated families. This form of the disease is demyelinating and dominant. However, patient selection for mutational screening should not be limited to these criteria since presentation can either be familial or sporadic, and some patients may be incorrectly classified as suffering from an 'axonal' form. These new mutations complete our previously published work on 12 other mutations and enable meaningful observation in a representative sample of the French population. Mutations are found in all regions of the gene. The most frequently observed mutations were those affecting arginines and mainly involved CpG sequences. Compared with other sources, some of the mutations were present at a higher frequency in the French population.

Background and Purpose: The aim of this study was to demonstrate the different results obtained from a population-based and a hospital-based stroke study in the same city., Methods: Between January 1 and December 31, 1993, we collected information on all of the first strokes in the population of the city of Dijon, in conjunction with the Dijon Stroke Registry, collecting the first-ever strokes from patients living in Dijon as well as on all the first strokes in residents and nonresidents of Dijon who were treated at Dijon University Hospital. Demographic details, medical history, vascular risk factors, stroke subtype, as diagnosed by CT scan, and mortality rates were compared between the strokes observed in the population of the city of Dijon among residents as well as nonresidents in Dijon who were treated at Dijon University Hospital., Results: We collected information on 210 strokes observed in the population of Dijon city, 171 Dijon residents and 395 non-Dijon city residents hospitalized at the University Hospital of Dijon. These three groups were quite different. The residents of Dijon treated for stroke at the University Hospital were younger and their incidence of cerebral hemorrhage, cardiac arrhythmia, ischemic heart disease and case fatality rate were higher than those from the Dijon Stroke Registry., Conclusions: Type of stroke data bank is very important in order to describe cerebrovascular disease. Hospital-based studies tend to include more severe strokes, those occurring in a younger population, and those having a higher mortality. Population-based studies, on the other hand, give a somewhat different picture of stroke.

Our motivation for undertaking the present survey was to determine the incidence, the distribution, and the clinical features of ischemic and hemorrhagic strokes in children under 16 years old, in a well-defined population-based study. The survey was carried out on the population of the City of Dijon (150,000 inhibitants) from January 1, 1985 to December 31, 1993, collecting prospectively both in adulthood and in childhood (23,877 resident children). Diagnosis of stroke was established on the basis of clinical features and the mechanism was identified by CT scan from 1985 to 1987, and by CT scan and magnetic resonance imaging from 1987 to 1993. When a hemorrhagic stroke was identified, a cerebral arteriogram and an investigation of the coagulation factors were performed. When an ischemic stroke was identified, the following were performed: an ultrasound examination of the cervical arteries, a cerebral arteriogram, a lumbar puncture, an investigation of the coagulation factors and lipid status, a measurement of homocysteine in the plasma and the urine, an electrocardiogram (EKG), a Holter procedure, and a cardiac echography. During the 9 full calendar years of this study we observed 28 stroke patients from a population of 23,877 resident children. There were 17 cases of ischemic stroke, representing some 61% percent of the total, as well as 11 cases of hemorrhagic stroke, 39% percent of the total. The average annual incidence rate was 13.02/100,000 for all strokes, 7.91/100,000 for ischemic strokes, and 5.11/100,000 for hemorrhagic strokes.(ABSTRACT TRUNCATED AT 250 WORDS)

Risk factors for primary cerebral hemorrhage remain uncertain. The population-based Stroke Registry of Dijon provides data on the risk factors. Among residents of Dijon (France), 130 cases of primary cerebral hemorrhage hospitalized from 1985 to 1992 were matched with 130 controls by age and sex. The following data were collected: history of hypertension, alcohol consumption, tobacco consumption, history of coagulation disorder, diabetes mellitus, dyslipidemia, and infectious disease in the 7 days before admission. The following parameters were measured on admission: blood pressure, blood glucose, cholesterol, triglycerides, hematocrit, fibrinogen, prothrombin levels, platelet counts, prothrombin time, bilirubin, transaminases, gamma-glutamyltransferase, and alkaline phosphatase. Electrocardiogram and Doppler ultrasound examination of cervical arteries were performed. Statistical analysis was performed by means of relative risk ratio for paired samples when dealing with proportions, and Student's t test for quantitative variables. A stepwise discriminant analysis was carried out to establish the relative weight of the different risk factors and their discriminant values. Among the qualitative data, the significant factors were history of hypertension, alcohol consumption, cardiac arrhythmia, atherosclerosis of carotid arteries and a previous infectious disease in the 7 days before admission. Among the quantitative data, the significant factors were early hypertension, high blood glucose levels, high hematocrit, and low cholesterol levels, in the acute stage of the stroke. After multifactorial analysis, only two factors were significant: hypertension and low cholesterol levels. Our population-based case-control study showed that hypertension and low cholesterol levels are the two discriminant risk factors for both lobar and basal ganglia primary cerebral hemorrhage. Therefore, treatment of hypercholesterolemia may increase risk of cerebral hemorrhage.

To evaluate the prevalence, the aetiological profile and the neurological consequences at day 15 of a transient ischaemic attack (TIA) before a cerebral infarction, we undertook survey from 1985 to 1991, on 1,149 cases with cerebral infarction observed on the population of Dijon. On 1,149 cases, 275 (24%) were preceded by a TIA. Fifty seven cases were lacunar infarcts (20.7%) and 218 were cortical infarcts (79.3%). On the aetiological point of view, the group with 275 infarctions preceded by a TIA was statistically different from the group of 874 infarctions without any TIA, with higher blood pressure, cardiac arrhythmia, tobacco abuse and ischaemic cardiac disease history. Only 65 out of 275 infarctions preceded by one TIA (23.6%) had a perfect territorial relationship between the 2 attacks, and 210 out of 275 (76.4%) had no territorial relationship. While the Barthel score at day 15 was similar within the 2 groups, inversely, pseudo-bulbar syndrome was significantly more frequent in the first group. Former TIA does not increase the general handicap resulting from a cerebral infarct, nevertheless it gives rise to a pseudo-bulbar syndrome.

We evaluated prospectively the occurrence of seizures within 15 days of a first stroke or transient ischemic episode in 1,640 patients to study relation between seizures and type of stroke. Seizures occurred in 90 patients (5.4%), including 36 (4.4%) of 814 with infarct owing to atheroma, 21 (16.6%) of 126 with infarct owing to cardiogenic embolus, 3 (1%) of 273 owing to lacunar infarct, 5 (1.9%) of 259 owing to transient ischemic attack (TIA), 21 (16.2%) of 129 owing to supratentorial hematoma, and 4 (16.6%) of 24 owing to subarachnoid hemorrhage. Thirteen (14.6%) of 89 subcortical infarcts were associated with seizures. Seizures were the initial sign of stroke in 80 (89%) of 90 cases and were usually single and partial. Seizure symptoms were most often motor, sensory, or visual.

To evaluate the relationship between atrial fibrillation (AF) and mortality of the cerebral infarction, we have studied in a population survey, 540 cerebral infarctions, whose 162 were with AF (30%) and 378 without AF (70%). The group with AF differs significantly from that without AF, by the higher frequency of women (62% versus 35%), older subjects (75.4 +/- 10.2 years old versus 69.1 +/- 9.7 years old), a severe loss of consciousness, a more frequent subcortical infarction on CT-Scan. During a period of 24 months, 139 patients died, 64 among the 162 patients with AF (40%), 75 among the 378 patients without AF (20%). Rates of death are different in the 2 groups with, in the group with AF, at 1, 6, 18 and 24 months a rate of 20, 24, 37 and 40 percent. To the opposite, in the group without AF, the rates are 8, 12, 16 and 20 percent. The authors try to research the factors that may explain the mortality linked to AF, and they insist on the necessity to look for AF on admission for a stroke, to identify a subgroup of stroke patients with a high risk of death.

The immediate infectious pancreato-biliary complications of endoscopic retrograde cholangiopancreatography (ERCP) warranting transfer to a surgical unit are analyzed, in order to evaluate their frequency and severity as well as means of treatment and prevention. Thirty complications of this type were observed in a series of 3226 ERCP performed with or without endoscopic sphincterotomy (ES) over a six year period (0.9%). ES had been performed in 12 of 30 cases, but the complication could not be attributed to the procedure. Post-ERCP complications included: acute cholangitis: 16 cases (53%); acute cholecystitis: 8 cases (26%); acute pancreatitis: 4 cases (13%); infected pancreatic pseudocyst: 2 cases (6%). The global mortality rate was 16.6% (five patients): Four of the deaths were due to septic complications. Twenty-seven of the 30 patients underwent surgery, and three of them died (11%). Acute cholangitis was responsible for most of the deaths (four of five) and the mortality appeared related to the long interval before surgery (three of four deaths). Strict adherence to good endoscopic procedures (aseptic conditions, injection without excessive pressure, antibiotic prophylaxis) and decompression of the biliary tract (nasobiliary drain or transhepatic catheter) should help reduce the frequency of post-ERCP complications, and especially cholangitis, which appears to benefit from early surgical treatment.

We investigated the relation of plasma lipids to the risk for cortical infarction with (22 cases) or without (38 cases) cardiac arrhythmias, for lacunar infarction (28 cases) and transient ischaemic attacks (TAI) (15 cases). In the group of cortical infarction with or without cardiac arrhythmias, we observed a maximum increase of total cholesterol, of very low density lipoprotein (VLDL) and low density lipoprotein (LDL), triglycerides, total Apolipoprotein (Apo) B, LDL-Apo B and Apo-A1. On the contrary, we observed a decrease of total ApoE, HDL-ApoE, a distribution of LDL in a single layer and the presence of LDL of small weight. TAI is different from the former group by a low level of HDL and the lack of abnormalities of Apo-A1, and on the distribution and the weight of LDL. Finally, lacunar infarction presents a normal plasma lipoprotein profile. These data suggest that previously demonstrated differences in LDL-cholesterol levels between patients with ischaemic stroke and control subjects may apply to patients with cortical but not lacunar infarction. The presence or not of a cardiac arrhythmia doesn't give a special lipoprotein profile, and TAI has no changes on the distribution and the weight of LDL. Therefore, separation of ischaemic strokes into types based on mechanism as large vessel atherosclerosis versus small vessel atherosclerosis may help clarify lipid-related risk factors in cerebrovascular disease.

The age- and sex-specific incidence and survival rates over two years of intracerebral and subarachnoid haemorrhages, cortical infarcts, lacunes and transient ischaemic attacks (TIA) in a town of 140,000 inhabitants, are reported. During the five years, (1985 to 1989), 984 patients suffering from first stroke were registered by the Dijon Stroke Registry. The diagnosis was established by a CT-Scan in 88% of cases. Intracerebral haemorrhages (ICH) account for 8.8% of strokes, subarachnoid haemorrhages (SH) for 1.5%, cortical infarcts (CI) for 45.6%, lacunes for 16.7%, TIA for 15.8%, and 11% were undetermined. The annual average incidence rates per 100,000 are 13.4 for ICH, 2.0 for SH, 69.0 for Cl, 30.0 for lacunes and 25.5 for TIA. The survival rates for the acute stage (up to four weeks) differ between ICH and SH (46% and 67%), and the other types of strokes: 77% for Cl, 90% for lacunes and 98% for TIA. The survival rates of unclassified stroke are similar to ICH rates. At two years, survival rates of lacune and TIA are the highest. The divergences between public hospital based data and population-registry data are discussed. A population registry is necessary for studying the natural history of stroke.

In a consecutive series of 984 first-ever strokes (from 1985 to 1989) in a population based study, 165 (16.7%) had lacunar infarction confirmed by CT-scan or M.R.I. The annual incidence was 35.6/100,000 in women, and 47.8/100,000 in men. Survival rates were 90% at 1 month, and 78% at 2 years. The rate of recurrent strokes was 11% at 2 years. The natural history of lacunar infarction could be drawn in this study which was population-based; 29% of lacunar infarctions are indeed not managed in hospitals. Lacunar infarctions should be identified as such in therapeutic trials since their course is clearly different from other types of strokes.

Since 1985, a stroke registry has registered every stroke in this town, of about 140,000 inhabitants. A CT Scan and numerous sources of information have allowed to achieve an exhaustive survey. The annual incidence of stroke has been 145/100,000. The annual specific incidence for age is 170/100,000 in men, 126/100,000 in women. The annual specific incidence for age and sex has shown a female preponderance until 30 and a male preponderance after this age. At 80, the rates became equal. Sixty-eight per cent of stroke were due to an infarct, 12 p. 100 to lacunae, 5 p. 100 to subarachnoid hemorrhage and 15% to cerebral hemorrhage. A preponderance of young people was found in subarachnoid hemorrhage, of the fifth decade in cerebral hemorrhage, while infarct rose up with age in the 2 sexes. Infarcts appeared predominantly during winter, while transient ischemic attacks appeared more often during summer. Cerebral hemorrhage had a constant incidence over the year. Mortality was high, mainly during the first month with 12.5 p. 100 during the first week, 21.5 p. 100 during the first month, and 30 p. 100 the first year. Our results appear to set in the mean of white occidental countries as opposed to Japan. They emphasize the important and underestimated place of lacunae and the seasonal variations of several causal varieties of stroke.

Since 1985 there has been a Stroke Registry in Dijon to record every stroke occurring in the population of a city of 140,000 inhabitants. The survey has been exhaustive and included the numerous sources of information as well as CT scanning. The annual incidence is 145/100,000 with an annual specific incidence of 170/100,000 in men, 126/100,000 in women. The annual specific incidence shows a female preponderance until 30 years of age, after which the males lead from the age of 30 to 80, when the rates become equal. Sixty-eight percent of strokes produced by infarct, 12% by lacunae, 5% by subarachnoid hemorrhage and 15% by cerebral hemorrhage. Differences exist in this distribution, with the preponderance of young people in subarachnoid hemorrhage, and cerebral hemorrhage is commoner in the 5th decade while infarct increases with age in both sexes. Infarct appears commoner during winter, transient ischemic attacks during summer, while cerebral hemorrhage has a constant incidence during the year. Mortality is high mainly during the 1st month with 12.5% during the 1st week, 21.5% the 1st month and 30% the 1st year. Our results are in the mean similar to white occidental countries, but opposite to those observed in Japan; they emphasize the importance of the lacunar syndrome, and the seasonal variations in different types of stroke.

Beginning in 1985, the Dijon Stroke Registry has identified every case of stroke occurring in this city of 140,000 inhabitants. The systematic use of a CT scan and multiple other sources of information ranging from hospital doctors to general practitioners make it possible for us to have virtually exhaustive data on stroke incidence. The gross incidence was 170 per 100,000 among men and 126 per 100,000 among women. Specific incidence by age and sex shows female predominance up to 30 years of age, and male predominance among victims from 30 to 80 years old. Beyond 80, rates were identical for both sexes. In 68% of the cases, the strokes were caused by infarct; in 12%, by lacunae; in 15%, by cerebral hemorrhage; in 5%, by subarachnoid hemorrhage. Significant differences existed in this distribution according to age, with a clear predominance of young people among those having subarachnoid hemorrhage, while, for those over 40, cerebral hemorrhages were frequent; the proportion of infarct increased with age for both sexes. A peak of incidence for infarct appeared during winter, while transient ischemic accident was more frequent in summer. Cerebral hemorrhage had a similar incidence throughout the year. Mortality was high during the first month (12.5% during the first week, 21.5% during the first month), and reached 30% during the first year. These results are comparable to those generally observed among white occidental populations. They confirm the limited incidence of hemorrhages (contrary to what has been observed in Japan), emphasize the important and often underestimated role of lacunar syndromes, and the seasonal variations specific to each mechanism.