[Management of stroke. The value of the Dijon Stroke Registry]

Since 1985, the Stroke Registry of Dijon has performed a prospective, specific and exhaustive collection of stroke episodes occurring in patients living in the city of Dijon. The first aim of such a register is descriptive epidemiology to determine the natural history of strokes which would be impossible without this methodology. This procedure can also be used as a tool for research and evaluation. Therefore, over the past 9 years the Stroke Registry of Dijon has observed a 15% decrease of the incidence of cerebral haemorrhage, due to early diagnosis and treatment of arterial hypertension. Inversely, the incidence of cerebral infarct increased 8.5% during the same period due to the increased frequency of cardiac emboli. Mortality decreased in the same period from 22% to 15%, due to active treatments during the acute stage and to a decrease of the early severity of stroke at admission to hospital. The severity of the handicap decreased dramatically during the same period. Several case-control studies have shown the negative role of hyperglycaemia and cardiac arrhythmia on mortality in the acute stage of strokes. The role of dyslipidaemia has been evaluated in the aetiology of the different mechanisms of stroke, demonstrating the role of hypocholesterolaemia in the genesis of cerebral haemorrhage. Some interventions performed by the Registry in the population of the city of Dijon have shown that early diagnosis and treatment of transient ischemic attacks with anticoagulants may decrease the occurrence of cerebral infarction. Then, the evaluation of access to health care permitted to observe that the choice between public hospitals, private hospitals and home was dependent on age, troubles of consciousness, and severity of the neurological deficit. Therefore, the Stroke Registry of Dijon participates in improving our knowledge of the natural history of strokes, and to the evaluation of diagnostic and therapeutic strategies.