XV

XV. European Stroke Conference
Brussels, Belgium
16 - 19 May 2006

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Oral Session:Stroke and diabetes
Poster Session:
Date: Wednesday 17 May 2006 Time: 16:15 - 16:25 - Room: Room 1122
Chair: K. Spengos, Greece and E. Diez Tejedor, Spain

01
Type 1 Diabetes as a Risk Factor for Stroke in Men and Women Aged 15-49: A Nationwide Study from Sweden
X. Li J. Sundquist S.E.Johansson K. Sundquist

KAROLINSKA INSTITUTE

SWEDEN

Background Previous studies have made important contributions to a growing body of knowledge about type 1 diabetes and stroke risk; however, long-term longitudinal studies that control for concomitant risk factors like socioeconomic status are less common. The objective was to determine incident premature stroke risk by age among men and women in Sweden with and without type 1 diabetes, after accounting for socioeconomic status and geographic region. Methods The Swedish longitudinal neurological database at the Karolinska Institute, Stockholm, was used to identify all persons in Sweden aged 15 to 34 at onset of type 1 diabetes and aged 15 to 49 at time of incident premature nonfatal or fatal stroke during the study period (1987 to 2001). Standardized incidence ratios (SIRs) of incident premature nonfatal or fatal, ischemic or hemorrhagic stroke excluding subarachnoid hemorrhage were calculated and compared for persons with and without type 1 diabetes. Results Of the 12 299 persons whose records were followed after first hospitalization for type 1 diabetes during the study period, 106 experienced a stroke event. The overall SIR of premature stroke in persons with type 1 diabetes was 9.14 (95% CI, 7.48-11.06). In persons with type 1 diabetes, premature stroke was most common between age 30 and 39, and stroke incidence was higher in women than men throughout the whole period. Risk of stroke was increased by a factor of 51 among those with diabetic nephropathy. There was an upward trend in stroke incidence in both men and women with type 1 diabetes between 1987 and 2001. Conclusion Our data indicate that young to middle-aged persons with type 1 diabetes had a considerably higher risk of developing premature stroke than those without type 1 diabetes. Physicians should be aware that young to middle-aged persons with type 1 diabetes need specific attention to reduce the risk of premature stroke.

Oral Session:Stroke and diabetes
Poster Session:
Date: Wednesday 17 May 2006 Time: 16:15 - 16:25 - Room: Room 1122
Chair: K. Spengos, Greece and E. Diez Tejedor, Spain

01
Type 1 Diabetes as a Risk Factor for Stroke in Men and Women Aged 15-49: A Nationwide Study from Sweden
X. Li J. Sundquist S.E.Johansson K. Sundquist

KAROLINSKA INSTITUTE

SWEDEN

Oral Session:Stroke and diabetes
Poster Session:
Date: Wednesday 17 May 2006 Time: 16:15 - 16:25 - Room: Room 1122
Chair: K. Spengos, Greece and E. Diez Tejedor, Spain

01
Type 1 Diabetes as a Risk Factor for Stroke in Men and Women Aged 15-49: A Nationwide Study from Sweden
X. Li J. Sundquist S.E.Johansson K. Sundquist

KAROLINSKA INSTITUTE

SWEDEN

Oral Session:Stroke and diabetes
Poster Session:
Date: Wednesday 17 May 2006 Time: 16:15 - 16:25 - Room: Room 1122
Chair: K. Spengos, Greece and E. Diez Tejedor, Spain

01
Type 1 Diabetes as a Risk Factor for Stroke in Men and Women Aged 15-49: A Nationwide Study from Sweden
X. Li J. Sundquist S.E.Johansson K. Sundquist

KAROLINSKA INSTITUTE

SWEDEN

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

07
Stroke secondary to SLE is associated with altered cerebrovascular reactivity
R.J.Davey P. Emery J. Bamford

Leeds General Infirmary

UNITED KINGDOM

Background SLE is an autoimmune disease with frequent neuropsychiatric (NP) complications, including stroke. Brachial artery flow studies indicate that systemic endothelial dysfunction (ED), a precursor of atherosclerosis, is common in SLE. The pathogenesis of NP SLE is uncertain, but cerebrovascular ED is a candidate mechanism. Changes in cerebral blood flow induced by hypercapnia (cerebrovascular reactivity, CVR) reflect endothelial function in cerebral resistance vessels. We investigated the role of CVR in SLE. Methods Patients with SLE were assessed to identify NP syndromes according to American College of Rheumatology definitions. Both middle cerebral arteries were assessed by transcranial doppler ultrasound to ascertain mean CVR to hypercapnia (% increase in flow velocity/mmHg rise in end-tidal CO2). Findings were compared to those amongst healthy control subjects matched for age and gender. Results 57 subjects (54 female, 3 male) with SLE of median age 46 years were assessed, along with 67 control subjects. There was no significant difference in CVR between cases and controls (3.06 vs 3.06, p = 1.00). However, SLE patients with a history of stroke or TIA (n = 19) had a significantly higher CVR than those without (3.79 vs 2.70, p = 0.01). Other NP syndromes (mood disorders, headache, seizures, cognitive dysfunction, psychosis, chorea) were not associated with altered CVR. CVR was independent of SLE disease activity and treatment, antiphospholipid antibodies, smoking and hypertension. Conclusions •Although abnormal CVR is not linked to many NP SLE manifestations, increased CVR is associated with stroke or TIA. •In non-SLE studies, stroke has been associated with low CVR. Our results suggest a different stroke mechanism exists in SLE. •Increased CVR may reflect ED. Cerebral ischaemia may result from vasospasm or increased vascular permeability. Although ED in SLE is likely to be immune-mediated, its precise cause merits further study.

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

07
Stroke secondary to SLE is associated with altered cerebrovascular reactivity
R.J.Davey P. Emery J. Bamford

Leeds General Infirmary

UNITED KINGDOM

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

07
Stroke secondary to SLE is associated with altered cerebrovascular reactivity
R.J.Davey P. Emery J. Bamford

Leeds General Infirmary

UNITED KINGDOM

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

01
MRI-based thrombolysis within and beyond the 3 hour time window has an improved safety profile and is at least as effective as standard CT-based treatment
M. Köhrmann E. Jüttler C. Schwark J.B.Fiebach H.B.Huttner S. Siebert P.A.Ringleb W. Hacke P.D.Schellinger

University of Heidelberg

GERMANY

Background and Purpose : Intravenous rtPA is approved within 3h after stroke onset. Thus only a small percentage of patients can be treated. Meta-analyses and more recent studies suggest a benefit for a subset of patients even beyond 3h. We examined safety and efficacy of a stroke-MRI selection protocol within and beyond 3 hours compared to standard CT-based treatment. Methods: At our institution patients eligible for thrombolysis within 3h are selected either by CT- or MR-imaging and beyond 3h only by MRI. We assessed clinical outcome and occurrence of symptomatic ICH (sICH) in 400 consecutive patients treated wit rtPA. 18 patients were excluded from analysis because of violation of the algorithm (CT-based treatment beyond 3h). The remaining 382 patients were divided into three groups (1) n=209 CT-based treatment <3h (2) n=103 MRI-based <3h and (3) n=70 MRI-based >3h. Results: Stroke severity was similar in all 3 groups (median NIHSS score 13). Patients in group 3 had the best 90d outcome (41.4% favourable outcome vs 37.8% in group 1 and 33% in group 2; 55.7% independent outcome vs 47.8% and 50.5%) without an increased risk for sICH (5.7% vs 9.1% and 1%) or mortality (11.4% vs 21% and 12.6%). MRI selected patients overall had a significantly lower risk for sICH (2.8% vs 9.1% CT-based; p=0.018) and mortality (12.1% vs 21%; p=0.021). Time to treatment proved to be irrelevant for all outcomes in univariate and multivariate analyses. Discussion: Our data suggest that beyond 3h and maybe even within 3h patient selection is more important than time to treatment. Furthermore, MRI-based thrombolysis regardless of the time-window shows an improved safety profile regarding incidence of sICH and mortality, while being at least as effective as standard CT-based treatment within 3h.

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

University of Heidelberg

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

University of Heidelberg

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

University of Heidelberg

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

University of Heidelberg

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

University of Heidelberg

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

University of Heidelberg

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

University of Heidelberg

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

University of Heidelberg

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

09
Prevalence of Metabolic Syndrome in Hispanic Mestizo Patients with Ischemic Stroke. A Mexican Multicentric Ischemic Stroke Registry
C. Cantu J.L.Ruiz-Sandoval R. Rangel J. Villarreal A. Arauz L. Murillo F. Barinagarrementeria M. Lopez R. Leal S. Reyes
for PREMIER Collaborative Study Group

Mexican Stroke Association

MEXICO

Background and Purpose. The combination of vascular risk factors known as metabolic syndrome (MS) is receiving increased clinical attention. Data on metabolic syndrome in Hispanic Mestizo patients with stroke is unknown. This first Mexican ischemic stroke registry is being developed to improve our knowledge regarding risk factors profile, outcome, and long-term follow-up in patients with cerebral ischemia. Methods. We analyzed data from patients with acute cerebral ischemia who are being enrolled in a large multicentric stroke data bank in Mexico. Standardized data assessment was used by all centers which included information on demographics and risk factors including lipid profile. From November 2004 to December 2005, 586 had available data for the component conditions of the metabolic syndrome. Results. There were 518 cerebral infarctions (89%) and 64 TIAs (11%). Metabolic syndrome was documented in 284 patients (49%) including 136 (48%) men (age 66.6) and 148 (52%) women (age 69.5 ). Frequency of individual components of the MS: hypertension 89%; diabetes mellitus 64%; abnormal lipid profile 94% including hypertriglyceridemia in 73%, low HDL cholesterol in 76%, and combined in 57%; BMI > 25 in 85% (BMI > 30 in 35%). Previous ischemic stroke or AITs was more common in patients with MS (38%) compared with those without MS (25%)[P=0.001]. Stroke subtype classification in patients with MS was: large-artery atherosclerosis 30%, small-vessel disease 21%, cardioembolism 19%, concurrent etiology 8%, other 2%, and undetermined 19%. Clinical outcome at day 30 was worse in patients with metabolic syndrome: mRS 0–2 in 41% and mRS 3-6 in 59%, compared with mRS 0-1 in 51% and mRS 3-6 in 49% in patients without MS (p=0.017). Conclusions: Metabolic syndrome was documented in half of the Hispanic Mestizo patients with ischemic stroke with a high frequency of atherogenic dyslipidemia. MS was associated with previous ischemic stroke events and a poor outcome.

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Mexican Stroke Association

MEXICO

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Mexican Stroke Association

MEXICO

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Mexican Stroke Association

MEXICO

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Mexican Stroke Association

MEXICO

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Mexican Stroke Association

MEXICO

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Mexican Stroke Association

MEXICO

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Mexican Stroke Association

MEXICO

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Mexican Stroke Association

MEXICO

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Mexican Stroke Association

MEXICO

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

01
Voxel-Guided Morphometry (VGM) for intraindividual MRI morphometry after stroke
M. Kraemer T. Schormann O.W.Witte R.J.Seitz

St. Mauritius Therapieklinik Meerbusch

GERMANY

In our study, we examined volume alterations in brain areas adjacent to and remote from the lesion in 6 stroke patients with an incomplete MCA infarction. MRI scans were carried out 7 days and between 3 and 16 months after stroke onset. Patients were examined by a 3D FLASH MRI scan. Brains from the same patient at two different times were matched to each other using Voxel-Guided Morphometry (1) thus achieving sub-voxel accuracy between source and reference brain. This enabled exact reproducibility of results due to the completely automated procedure and the ability to determine the unique movement from source to the reference volume using the total gray-value information. The resulting deformation fields were visualized encoded in gray-values. The investigated brains exhibited a volume reduction in widespread cortical areas even remote from the lesion site and in the underlying white matter. Atrophy was also detected in the ipsilateral thalamus and caudate nucleus that were both not affected by the initial ischemia. These remote atrophic brain areas demonstrate, that secondary long-term brain volume alterations develop after acute cerebral ischemia probably due to degeneration of white matter projections. Remarkably, this secondary brain atrophy was accompanied by an improvement of the clinical state, marked by an improved European Stroke Scale in the follow-up examination. Obviously, secondary brain atrophy does not necessarily correlate with the clinical outcome. In summary, Voxel-Guided Morphometry demonstrates a widespread and locally differential brain atrophy in brain areas adjacent to and remote from the stroke lesion site. These volume changes do not necessarily correlate with the improvement of clinical outcome. References: (1) Voxel-guided morphometry ("VGM") and application to stroke. IEEE Trans Med Imaging. 2003, 22:62-74.

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

01
Voxel-Guided Morphometry (VGM) for intraindividual MRI morphometry after stroke
M. Kraemer T. Schormann O.W.Witte R.J.Seitz

St. Mauritius Therapieklinik Meerbusch

GERMANY

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

01
Voxel-Guided Morphometry (VGM) for intraindividual MRI morphometry after stroke
M. Kraemer T. Schormann O.W.Witte R.J.Seitz

St. Mauritius Therapieklinik Meerbusch

GERMANY

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

01
Voxel-Guided Morphometry (VGM) for intraindividual MRI morphometry after stroke
M. Kraemer T. Schormann O.W.Witte R.J.Seitz

St. Mauritius Therapieklinik Meerbusch

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

11
Intrathecal Baclofen in Stroke Related Disability
P. Abreu N. Fontes J. Correia E. Azevedo

Hospital de S.João

PORTUGAL

Background. More than 75% of stroke patients have motor sequelae, including spasticity, often resulting in incapacity to perform many ADL. Intrathecal baclofen (ITB) has shown the advantage over oral medication of effectively decreasing diffuse spasticity without causing untoward effects on arousal and cognition. Authors present results of this treatment in a series of stroke patients. Methods. Patients with residual deficits after stroke were evaluated before discharge from the acute event and at 3, 6 and 12 months. When there was severe spasticity refractory to oral medication and physical rehabilitation, persisting for at least 6 months, associated with important incapacity (mRankin Scale >2), patient was selected to 50-100mg ITB test, and if positive a ITB pump implantation was performed. Evaluation pre and post treatment included Ashworth Scale (AS), Penn spasm frequency scale (PSF), OT-reflex evaluation, muscle strength (Medical Research Council - MRC) score, and informal evaluation of ADL. Assessment of morbidity was also made. Results. Ten stroke patients, mean age 54 years, were selected for ITB pump implantation. All patients improved significantly in the AS, PSF and reflex scales. Improvement was noticed in MRC scale, but without statistical significance. Seven patients improved markedly in ADL. Average continuous ITB dose used was 282,5mg. Transient headache and vomiting were noticed in three patients after pump implantation, and low transient fever and local catheter infection was registered in one patient. Conclusions. ITB can be useful in some neurological diseases with refractory spasticity such as stroke. This treatment approach allows an improvement in motor functional status and quality of life, with a low morbidity, in properly selected stroke patients.

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

11
Intrathecal Baclofen in Stroke Related Disability
P. Abreu N. Fontes J. Correia E. Azevedo

Hospital de S.João

PORTUGAL

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

11
Intrathecal Baclofen in Stroke Related Disability
P. Abreu N. Fontes J. Correia E. Azevedo

Hospital de S.João

PORTUGAL

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

11
Intrathecal Baclofen in Stroke Related Disability
P. Abreu N. Fontes J. Correia E. Azevedo

Hospital de S.João

PORTUGAL

Oral Session:Acute stroke: complications and early outcome
Poster Session:
Date: Thursday 18 May 2006 Time: 15:50 - 16:00 - Room: Auditorium 500
Chair: S. Blecic, Belgium and D. Toni, Italy

12
Ischemic stroke in patients under 55: is female gender a prognostic factor for poor outcome?
P. Martinez B. Fuentes M.A. Ortega-Casarrubios F.J. Rodriguez de Rivera S. Martin R. Lobato M. Valenti E. Diez-Tejedor

Hospital Universitario La Paz. Universidad Autonoma de Madrid

SPAIN

Background: Female gender has been related to a higher mortality and disability after ischemic stroke than male, however, few studies have examined these differences in young stroke patients. Methods: Observational study with inclusion of consecutive stroke patients admitted to our Stroke Unit from January 1995 to February 2005. We selected patients under 55 years of age with acute cerebral infarction (CI), Vascular risk factors, subtype of stroke, neurological status at admission by the Canadian Stroke Scale (CSS), length of stay, in-hospital complications, mortality and functional outcome at discharge by the modified Rankin scale (mRS) were analysed to establish gender differences. Results: 381 patients were included, 230 males and 151 females. Valvular heart disease, previous CI, symptomatic migraine and thrombophilia were the risk factors more frequent in women than in men (P<0,001). Women had more cardioembolic infarcts, infarcts of unusual cause and infarcts of undetermined origin (P<0,05) than men. Although mortality was similar in both sexes, women had worse neurological status at admission and suffered more in-hospital complications. Women who survived remained more disabled (mRS >2) than men (Odds Ratio: 2,22; 95% CI, 1.15 to 4.27). Multiple logistic regression analyses showed that female gender was an independent predictor for disability and for the combination of death and disability at discharge together with severe neurological deficit at admission (CSS < or = 3) and systemic complications. Discussion: female gender is an independent factor for poor outcome, together with severe neurological deficit at admission and systemic complications, in ischemic stroke patients under 55 years of age. Female gender intrinsic factors could explain these results.

Hospital Universitario La Paz. Universidad Autonoma de Madrid

SPAIN

Hospital Universitario La Paz. Universidad Autonoma de Madrid

SPAIN

Hospital Universitario La Paz. Universidad Autonoma de Madrid

SPAIN

Hospital Universitario La Paz. Universidad Autonoma de Madrid

SPAIN

Hospital Universitario La Paz. Universidad Autonoma de Madrid

SPAIN

Hospital Universitario La Paz. Universidad Autonoma de Madrid

SPAIN

Hospital Universitario La Paz. Universidad Autonoma de Madrid

SPAIN

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

06
Sex Differences in The STEPS Stroke Project – Results From The Feasibility Study
P.U,Heuschmann T. Truelsen R. Bonita
For The STEPS Stroke Project

The STEPS Stroke International Stroke Surveillance coordinating unit

GERMANY

Background-The World Health Organization’s (WHOs) Stepwise approach to Stroke Surveillance project (STEPS Stroke) was pilot tested in different study sites in different countries in the year 2005. Data were analysed regarding sex differences in patient characteristics, stroke subtypes and hospital management. Methods- The present study presents hospital data (step 1) from 7 study sites in India (3), Mozambique (1), Russia (1), Nigeria (1), and Iran (1). Duration of data registration in study sites ranged from 2-13 months (median 8 months). All sites used the same definitions for stroke symptoms, subtype classification, and time to hospitalisation. Analyses were carried out at the WHO collaborating centre, Muenster University. Results-A total of 4,497 stroke patients with known sex were registered. Mean age of all patients was 63.5 years (y) (SD 15.3), ranging from 2-105y. Women were older compared to men (Mean age 65.0y (SD 15.5) versus 62.3y (SD 15.0), respectively; p<0.001). This pattern was found in all study sites. 39.6% of women and 48.7% of men were aged less than 65 years. Previous stroke was more often diagnosed in women compared to men (20.0% versus 17.9%, respectively; p<0.001). Women tended to be hospitalized more often within the first day after stroke compared to men (46.8% versus 43.2%, respectively; p<0.001). No statistically significant differences between women and men were found for stroke subtypes and for use of diagnostic techniques to verify stroke subtype. Conclusions-The STEPS Stroke project is a useful tool for investigating differences in acute stroke management among hospitalized stroke patients from different countries. More data are needed on potential sex differences with respect to clinical characteristics and risk factors of stroke patients.

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

06
Sex Differences in The STEPS Stroke Project – Results From The Feasibility Study
P.U,Heuschmann T. Truelsen R. Bonita
For The STEPS Stroke Project

The STEPS Stroke International Stroke Surveillance coordinating unit

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

06
Sex Differences in The STEPS Stroke Project – Results From The Feasibility Study
P.U,Heuschmann T. Truelsen R. Bonita
For The STEPS Stroke Project

The STEPS Stroke International Stroke Surveillance coordinating unit

GERMANY

Oral Session:Acute stroke: treatment concepts
Poster Session:
Date: Thursday 18 May 2006 Time: 16:10 - 16:20 - Room: Auditorium 500
Chair: M. Hommel, France and N. Bornstein, Israel

02
Microbubble potentiated transcranial color-coded duplex ultrasound enhances systemic thrombolysis in acute middle cerebral artery stroke
F. Perren J. Loulidi D. Poglia T. Landis R. Sztajzel

HUG, University Hospital and Medical School of Geneva

SWITZERLAND

Background and Objective: Transcranial Doppler ultrasound is reported to accelerate thrombolysis, and microbubbles, contained in an echocontrast agent (ECA) have been shown in vitro to potentiate this effect. Transcranial color-coded duplex (TCCD) allows to visualize basal cerebral arteries and thus localizes precisely blood clot site. We studied whether TCCD, combined with ECA enhances intravenous (IV) rtPA-thrombolysis in the acute phase of middle cerebral artery (MCA) stroke. Methods: Non-randomized stroke patients treated with 0.9mg/Kg TPA (10% bolus) within 3 hours of onset (group1) were compared in terms of MCA recanalization and/or clinical improvement to those in whom additional TCCD monitoring (60 minutes) alone (group2) or associated with continuous ECA injection (group3) was performed. Recanalization of the MCA was recorded pre- and post-thrombolysis using the Thrombolysis in brain ischemia (TIBI) grading system. Clinical outcome was assessed at admission and 24 hours after treatment using the NIHSS and improvement was considered when the score improved of at least >/=4 points. Results: Analysis of the 53 patients revealed significant improvement of the NIHSS (Kruskal-Wallis H=8.0; p<.005). Pairwise comparisons showed group3 (N=14) to improve the NIHSS significantly more than both group2 (N=16)(Mann-Whitney U=60; p<.03) and group1(N=23) (U=72; p<.002). Moreover, the flow signal improved more in group3 than in group2 (Mann-Whitney U=65; p<.03). Conclusion: The results of this pilot study show that the use of ECA in addition to TCCD monitoring lead to a greater clinical improvement than both iv-thrombolyses+TCCD monitoring and iv-thrombolysis alone. Moreover, the flow signal improves more when ECA is added to iv-thrombolysis+TCCD monitoring. This result encourages the evaluation of the thrombolytic effect of ECA on a larger clinical scale.

02
Microbubble potentiated transcranial color-coded duplex ultrasound enhances systemic thrombolysis in acute middle cerebral artery stroke
F. Perren J. Loulidi D. Poglia T. Landis R. Sztajzel

HUG, University Hospital and Medical School of Geneva

SWITZERLAND

02
Microbubble potentiated transcranial color-coded duplex ultrasound enhances systemic thrombolysis in acute middle cerebral artery stroke
F. Perren J. Loulidi D. Poglia T. Landis R. Sztajzel

HUG, University Hospital and Medical School of Geneva

SWITZERLAND

02
Microbubble potentiated transcranial color-coded duplex ultrasound enhances systemic thrombolysis in acute middle cerebral artery stroke
F. Perren J. Loulidi D. Poglia T. Landis R. Sztajzel

HUG, University Hospital and Medical School of Geneva

SWITZERLAND

02
Microbubble potentiated transcranial color-coded duplex ultrasound enhances systemic thrombolysis in acute middle cerebral artery stroke
F. Perren J. Loulidi D. Poglia T. Landis R. Sztajzel

HUG, University Hospital and Medical School of Geneva

SWITZERLAND

Oral Session:Brain Imaging – new developments
Poster Session:
Date: Thursday 18 May 2006 Time: 17:40 - 17:50 - Room: Room 1123
Chair: J.-C. Baron, UK and F. Aichner, Austria

05
Tissue at risk in patient with severe ICA or MCA stenosis can be easily assessed by fMRI with breath holding
C. Dannenberg H. Hentschel T. Goldhagen T. Scholle C. Disque A. Werner G. Gahn R. von Kummer

University Hospital, Technische Universität Dresden

GERMANY

Background/Purpose: Measurement of increase of cerebral blood flow velocity in patients with severe ICA- or MCA-stenosis by breath-holding transcranial Doppler ultrasound is used to evaluate the risk for ischemic events. It gives vessel flow, but no parenchyma information. It is impossible in about 15% of patients because transtemporal bone ultrasound window is missing. The aim of our study was to develop a simple, fast and reliable MRI method for cerebrovascular reactivity in healthy volunteers and test its sensitivity in patients with severe ICA- or MCA-stenosis. Methods: We optimised the MRI measurement protocol in 4 healthy volunteers and included so far 8 patients with moderate to severe ICA or MCA stenosis. We used BOLD imaging for breath-holding fMRI: EPI sequences, 30 transversal slices, TR 3 sec, 150 runs, Block design, 1,5T scanner (Sonata, Siemens), data analysis with Brainvoyager (Brain Innovation B.V.): general linear model, FDR < 0,05. We performed CE-MR angiography in all patients, perfusion MRI in 7 patients, additional breath-holding transcranial doppler ultrasound in 6 patients. Results: Breath-holding fMRI was successfully performed in all cases. All volunteers and 4 patients had no regional deficits of BOLD response. In 4 patients, different parts of vascular territories had a reduced BOLD response, 1 of these patients developed ischemic events in the involved brain area. TTP shortening in perfusion MRI was not able to predict the area of diminished BOLD response. Results of transcranial Doppler ultrasound during breath holding were in accordance with fMRI results. Conclusion: Breath-holding fMRI seems to be a useful and feasible technique in assessment of brain tissue at risk for infarction in patients with severe ICA- or MCA-stenosis. We are currently studying whether angioplasty can reduce the brain tissue volume with impaired cerebral vasoreactivity.

University Hospital, Technische Universität Dresden

GERMANY

University Hospital, Technische Universität Dresden

GERMANY

University Hospital, Technische Universität Dresden

GERMANY

University Hospital, Technische Universität Dresden

GERMANY

University Hospital, Technische Universität Dresden

GERMANY

University Hospital, Technische Universität Dresden

GERMANY

University Hospital, Technische Universität Dresden

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

02
HsCRP is independently associated with early carotid artery progression in women but not in men. The INVADE study
K. Sander C. Schulze-Horn C. Briesenick D. Sander

Technical University of Munich

GERMANY

Background and Purpose: High-sensitivity C-reactive protein (hsCRP) is known to be associated with atherosclerosis and cardiovascular events. Limited information exists regarding the importance of gender differences for the association between hsCRP and the progression of early stages of atherosclerosis. Therefore, we investigated the effect of hsCRP on early carotid atherosclerosis progression and major vascular risk factors in men and women. Methods: We analyzed the data of INVADE (Intervention project on cerebrovascular diseases and dementia in the community of Ebersberg, Bavaria), a prospective, population-based study. In addition to common risk factors, measurements of carotid intima-media-thickness (IMT) and hsCRP were performed at baseline and after 2 years. Results: Complete baseline data were available in 3387 patients including 2001 women. In this study population women were older, had higher systolic blood pressure, and cholesterol levels. The prevalence of smoking and ischemic heart disease was more frequent in men. The baseline carotid IMT was significantly higher in men as compared to women (0.823 mm versus 0.771 mm; p<0.0001). The interaction hsCRP x gender with baseline IMT was highly significant (F=6.54; p=0.01). The IMT progression was significantly associated with hsCRP only in women after risk factor adjustment (p=0.005) but not in men (p=0.39). Conclusions: The association between hsCRP and progression of early carotid atherosclerosis shows gender differences. In further studies analysing the role of inflammation for cardiovascular diseases and atherosclerosis these differences should be taken into account.

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

02
HsCRP is independently associated with early carotid artery progression in women but not in men. The INVADE study
K. Sander C. Schulze-Horn C. Briesenick D. Sander

Technical University of Munich

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

02
HsCRP is independently associated with early carotid artery progression in women but not in men. The INVADE study
K. Sander C. Schulze-Horn C. Briesenick D. Sander

Technical University of Munich

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

02
HsCRP is independently associated with early carotid artery progression in women but not in men. The INVADE study
K. Sander C. Schulze-Horn C. Briesenick D. Sander

Technical University of Munich

GERMANY

Oral Session:Acute stroke: treatment concepts
Poster Session:
Date: Thursday 18 May 2006 Time: 16:00 - 16:10 - Room: Auditorium 500
Chair: M. Hommel, France and N. Bornstein, Israel

01
Thrombolysis for acute ischemic stroke in patients older than 80 years: Results from SITS (Safe Implementation of Thrombolysis in Stroke) register
G. Ford V. Larrue N. Ahmed N.G.Wahlgren
SITS collaborators

SITS International and Karolinska University Ho

SWEDEN

Background and Purpose: SITS-ISTR (International Stroke Thrombolysis Register) is an internet-based register open to all countries. In Europe, i.v thrombolysis (rt-PA) for acute ischaemic stroke is provisionally licensed within 3h of onset for patients up to 80 years under the condition of registration in SITS-MOST (MOnitoring STudy). The risks and benefits of rt-PA in patients over 80 years are currently unknown. We examined outcomes and rates of symptomatic intracerebral haemorrhage (SICH) in ≤80 yr and >80 yr patients registered in SITS. Methods: 7392 patients entered SITS-ISTR (4961 within SITS-MOST) from 349 centres in 27 countries up to 31 December 2005 of which 643 (9.5%) were >80 years old. Data collected: baseline, demography, time delays, NIHSS at baseline, 2h, 24h and 7 days, imaging at baseline and within 22-36h after treatment, global outcome at 24 hours and 7 days, modified Rankin Score (mRS) at 3 months and adverse drug reactions. Definitions: SICH: primary ICH type 2 plus NIHSS worsening >/=4 points within 24h after treatment. Deaths and independence (mRS 0-2) were determined at 3 months. Results: Data are presented >80 vs. </=80 years. The median (Inter quartile range) age 83 (82-86) vs. 68 (59-75) years; females 63% vs. 40%, Pre-Stroke independency 91% vs. 95%, median NIHSS 15 (10-19) vs. 13 (8-18), mean stroke onset to treatment time 147 vs. 151 minutes. SICH rates: 2.0% (1.1-3.5) vs. 1.5 (1.2-1.8), mortality within 3 months: 31 (27- 36) vs. 15 (14- 16), independence at 3 months: 30 (26-34) vs. 52 (51- 53). Conclusions: Selected patients over 80 yr olds with severe acute ischaemic stroke treated with i.v rt-PA have almost similar rate of SICH but, as expected, a higher mortality and poorer functional outcome than younger patients. These observations suggest patients just over 80 years can be considered for thrombolysis but further trials are needed to define risks and benefits in the very elderly.

SITS International and Karolinska University Ho

SWEDEN

SITS International and Karolinska University Ho

SWEDEN

SITS International and Karolinska University Ho

SWEDEN

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

10
COMPARISON OF NON-INVASIVE OSCILLOMETRIC AND INTRA-ARTERIAL BLOOD PRESSURE MEASUREMENTS IN HYPERACUTE STROKE
E. Manios K. Xynos M. Saliaris C. Zafeiriou K. Kostopoulos E. Koroboki A. Peppa K. Vemmos

Acute Stroke Unit, Alexandra hospital, Athens University

GREECE

Background: Blood pressure (BP) management in acute stroke remains a matter of little consensus. Aim of our study was to compare non-invasive automatic oscillometric (NIAO) BP recordings to simultaneous direct intra-arterial BP measurements in order to test the accuracy of oscillometric readings in our study population. Methods: A total of 51 first-ever stroke patients underwent simultaneously NIAO and intra-arterial BP monitoring within 3 hours after symptom onset. Casual BP was measured in both arms using a standard mercury sphygmomanometer on hospital admission. Statistical analyses were performed using paired t-test and multivariate linear regression model. Results: The estimation of systolic BP using NIAO recordings significantly underestimated direct radial artery systolic BP by 8.7mmHg (CI: 5.2-12.3) and 12.0mmHg (CI: 4.3-19.7) in patients with IS and ICH respectively. In contrast, a significant upward bias of 6.1mmHg (CI: 4.1-8.1) and 6.2mmHg (CI: 0.3-12.1) was documented when NIAO diastolic BP recordings were compared to intra-arterial diastolic BP recordings in IS and ICH patients respectively. An increment of 10-mmHg in admission systolic BP was independently (p=0.001) associated with an increase of 2.35mmHg (CI: 0.97-3.37) in the difference between intra-arterial and NIAO systolic BP (dSBP). History of diabetes correlated significantly (p=0.029) with an increase of 7.469 mmHg (CI: 0.80-14.14) in dSBP. Discussion: Non-invasive automatic oscillometric BP measurements underestimate direct SBP recordings and overestimate direct DBP readings in acute stroke. The magnitude of the discrepancy between intra-arterial and oscillometric SBP recordings is even more prominent in patients with critically elevated SBP levels and diabetes.

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Acute Stroke Unit, Alexandra hospital, Athens University

GREECE

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Acute Stroke Unit, Alexandra hospital, Athens University

GREECE

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Acute Stroke Unit, Alexandra hospital, Athens University

GREECE

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Acute Stroke Unit, Alexandra hospital, Athens University

GREECE

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Acute Stroke Unit, Alexandra hospital, Athens University

GREECE

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Acute Stroke Unit, Alexandra hospital, Athens University

GREECE

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Acute Stroke Unit, Alexandra hospital, Athens University

GREECE

Oral Session:Experimental studies
Poster Session:
Date: Friday 19 May 2006 Time: 10:30 - 10:40 - Room: Room 1121
Chair: P. Wester, Sweden and L. Hirt, Switzerland

13
Profound but transient deficits in learning and memory after global ischemia using a novel water maze test
A. von Euler O. Bendel J. Sandin T. Bueters G. von Euler

Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital

SWEDEN

In search for neuroprotective treatment after ischemic brain injury it is essential with reproducible experimental animal models with reliable methods of evaluation of outcome, not only post-mortem, but also functionally. The pyramidal CA1 neurons of the hippocampus are critically involved in spatial learning and memory. These neurons are especially vulnerable to cerebral ischemia, but in spite of this, it has been consistently difficult to show any learning and memory deficits in 2-vessel occlusion models of global ischemia. In the present study transient global ischemia was induced in adult male rats under general anaesthesia administered by artificial respiration to prevent respiratory arrest. Systemic blood pressure was reduced to below 50 mm Hg by instant adjustments of the halothane concentration, before and during 10 minutes of bilateral occlusion of the carotid arteries. Cerebral blood flow was monitored by laser-Doppler flowmetry. Learning and memory was assessed in a novel water T-maze with three successive left-right choices and also in a conventional Morris water maze. We found severe impairments in learning at 13 days after ischemia (DAI) and in memory, as tested 24 h afterwards. At 90 DAI the deficiency had disappeared and remained similar to controls up to 250 DAI. The impairment at 14 DAI was associated with a selective and profound cell death in CA1 as detected by TUNEL staining. Only about 3% of the CA1 neurons, as visualized with NeuN staining, remained at this time. The recovery of learning and memory performance at 90-125 DAI was associated with a reappearance of CA1 neurons suggesting that these newly formed neurons contributed to the functional improvement.

Oral Session:Experimental studies
Poster Session:
Date: Friday 19 May 2006 Time: 10:30 - 10:40 - Room: Room 1121
Chair: P. Wester, Sweden and L. Hirt, Switzerland

13
Profound but transient deficits in learning and memory after global ischemia using a novel water maze test
A. von Euler O. Bendel J. Sandin T. Bueters G. von Euler

Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital

SWEDEN

Oral Session:Experimental studies
Poster Session:
Date: Friday 19 May 2006 Time: 10:30 - 10:40 - Room: Room 1121
Chair: P. Wester, Sweden and L. Hirt, Switzerland

13
Profound but transient deficits in learning and memory after global ischemia using a novel water maze test
A. von Euler O. Bendel J. Sandin T. Bueters G. von Euler

Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital

SWEDEN

Oral Session:Experimental studies
Poster Session:
Date: Friday 19 May 2006 Time: 10:30 - 10:40 - Room: Room 1121
Chair: P. Wester, Sweden and L. Hirt, Switzerland

13
Profound but transient deficits in learning and memory after global ischemia using a novel water maze test
A. von Euler O. Bendel J. Sandin T. Bueters G. von Euler

Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital

SWEDEN

Oral Session:Experimental studies
Poster Session:
Date: Friday 19 May 2006 Time: 10:30 - 10:40 - Room: Room 1121
Chair: P. Wester, Sweden and L. Hirt, Switzerland

13
Profound but transient deficits in learning and memory after global ischemia using a novel water maze test
A. von Euler O. Bendel J. Sandin T. Bueters G. von Euler

Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital

SWEDEN

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

09
Effect of Hypothermia on Inflammatory Response after Poor Grade Aneurysmal Subarachnoid Hemorrhage: Preliminary Results
C. Muroi K. Frei Y. Yonekawa E. Keller

University Hospital of Zurich

SWITZERLAND

Background: Interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) are reported to reflect the inflammatory response. Cytokine production in the central nervous system (CNS) following aneurysmal subarachnoid hemorrhage (SAH) and its relation to clinical outcome and occurrence of vasospasm has been reported. Therapeutic hypothermia may attenuate inflammatory response but carries the risk of severe side effects. The aim was to assess the influence of hypothermia on IL-6 and TNF-alpha-levels systemically and in the cerebrospinal fluid (CSF) in patients with SAH. Methods: Daily CSF and plasma samples were collected. IL-6 and TNF-alpha was measured by enzyme-linked immunoabsorbent assay. In case of intractable intracranial hypertension and/or refractive vasospasm, hypothermia (33-34ºC) was induced by systemic endovascular cooling. Results: In 4 of 9 patients, hypothermia was applied. IL-6 levels in the CSF were lower in the hypothermia group: 5.56 (+/-0.84) ng/ml vs. 28.24 (+/-0.49) ng/ml, p=0.007 (Mann-Whitney Test). TNF-alpha levels in CSF were higher in the hypothermia group: 2.85 (+/-0.48) vs. 1.46 (+/-0.27) pg/ml, p<0.001. Systemic levels of IL-6 and TNF-alpha were lower in the patients with normothermia compared to hypothermia: 7.92 (+/-2.64) pg/ml vs. 38.45 (+/-7.30) pg/ml, and 1.08 (+/-0.12) vs. 2.36 (+/-0.45) pg/ml, both p<0.001. C-reactive protein-levels tended to be lower in patients with normothermia while leukocyte-counts were significantly higher. Time and course of systemic IL-6 correlated with CRP-level, while IL-6 in the CSF correlated more with the occurrence of vasospam. Discussion: The results support the beneficial effects of hypothermia regarding suppression of IL-6 in the CNS. High systemic levels of IL-6 in patients with hypothermia reflects its side effect. The impact on TNF-alpha remains unclear.

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

09
Effect of Hypothermia on Inflammatory Response after Poor Grade Aneurysmal Subarachnoid Hemorrhage: Preliminary Results
C. Muroi K. Frei Y. Yonekawa E. Keller

University Hospital of Zurich

SWITZERLAND

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

09
Effect of Hypothermia on Inflammatory Response after Poor Grade Aneurysmal Subarachnoid Hemorrhage: Preliminary Results
C. Muroi K. Frei Y. Yonekawa E. Keller

University Hospital of Zurich

SWITZERLAND

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

09
Effect of Hypothermia on Inflammatory Response after Poor Grade Aneurysmal Subarachnoid Hemorrhage: Preliminary Results
C. Muroi K. Frei Y. Yonekawa E. Keller

University Hospital of Zurich

SWITZERLAND

Oral Session:Etiology of stroke
Poster Session:
Date: Thursday 18 May 2006 Time: 11:50 - 12:00 - Room: Room 1123
Chair: H. Markus, UK and Y. Shinohara, Japan

06
Asymmetric Dimethylarginine in Cerebral Small Vessel Disease
U. Khan A. Hassan P. Vallance H. Markus

St. George's University of London

UNITED KINGDOM

Background: Endothelial dysfunction has been proposed as a causal mechanism in cerebral small vessel disease (SVD), especially leukoaraiosis. Asymmetric dimethylarginine (ADMA) is a circulating endogenous inhibitor of nitric oxide. We determined if ADMA was elevated in SVD and correlated with disease severity. It may act via interaction with homocysteine, a known risk factor for SVD, and therefore we also determined serum homocysteine. Methods: Plasma ADMA and serum homocysteine levels were determined in 47 consecutive SVD cases and 38 community controls. Markers of endothelial dysfunction (intercellular adhesion molecule 1 (ICAM1) and thrombomodulin (TM)) were also measured in a subgroup. SVD was graded on the basis of increasing leukoaraiosis severity and number of lacunes (>0.5mm diameter). Results: Mean (SD) ADMA was higher in SVD cases (0.814 µmol/l (0.145)) compared to controls (0.747 µmol/l (0.184), P=0.014 after controlling for age, gender, vascular risk factors and creatinine clearance. Mean (SD) homocysteine was higher in SVD cases (15.28 mmol/l (5.73)) compared to controls (12.49 mmol/l (4.15), P=0.035. There was a positive correlation between overall leukoaraiosis grade and both ADMA (P=0.050) and homocysteine (P=0.002). Homocysteine, but not ADMA (P=0.888) correlated with the number of lacunes (P=0.015). Controlling for ICAM1, TM and homocysteine resulted in the association between ADMA and SVD no longer being significant. Discussion: Elevated ADMA is an independent risk factor for SVD. It is a risk factor for leukoaraiosis severity but not the number of larger lacunar infarcts. Its effect may be mediated through endothelial dysfunction and via interaction with homocysteine. ADMA-lowering therapy may offer a novel treatment option in SVD with leukoaraiosis.

Oral Session:Etiology of stroke
Poster Session:
Date: Thursday 18 May 2006 Time: 11:50 - 12:00 - Room: Room 1123
Chair: H. Markus, UK and Y. Shinohara, Japan

06
Asymmetric Dimethylarginine in Cerebral Small Vessel Disease
U. Khan A. Hassan P. Vallance H. Markus

St. George's University of London

UNITED KINGDOM

Oral Session:Etiology of stroke
Poster Session:
Date: Thursday 18 May 2006 Time: 11:50 - 12:00 - Room: Room 1123
Chair: H. Markus, UK and Y. Shinohara, Japan

06
Asymmetric Dimethylarginine in Cerebral Small Vessel Disease
U. Khan A. Hassan P. Vallance H. Markus

St. George's University of London

UNITED KINGDOM

Oral Session:Etiology of stroke
Poster Session:
Date: Thursday 18 May 2006 Time: 11:50 - 12:00 - Room: Room 1123
Chair: H. Markus, UK and Y. Shinohara, Japan

06
Asymmetric Dimethylarginine in Cerebral Small Vessel Disease
U. Khan A. Hassan P. Vallance H. Markus

St. George's University of London

UNITED KINGDOM

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

01
Management of stroke in an extended stroke unit combined with a rehabilitation department and in general wards. Which aspects make the benefit ?
P. Desfontaines X. Masson A. Debrun P. Camelbeeck

Centre Hospitalier Chrétien - Liège

BELGIUM

Background. Several trials have shown that stroke unit (SU) care improves outcome for stroke patients. The aim of the study was to identify which aspects of the SU care were most responsible for the better outcome by comparison with the management in a general ward (GW). Method. 178 consecutive acute stroke patients were admitted in the SU during the first six months of 2005 and retrospectively compared with 134 consecutive acute stroke patients admitted in the GW within the last 6 months before the opening of the SU in 1998. We identified the differences in the investigation tools, medical and surgical treatments and rehabilitation cares given to the stroke patients. We analysed the association of these factors with the outcome, discharge to home or institutionalization within 3 months. Results. At 3 months, 12.0% of the SU patients were in institutions versus (vs) 25.8% of the GW patients (p=0.003), 77.6% of the SU patients were at home vs 51.7%of the GW patients (p=0.001) and 10.4% of the SU patients were dead vs 22.5% of the GW patients (p=0.004). 18% of the GW patients died during the hospitalization vs 7.4% of the SU patients (p=0.05). At 3 months, 82.5% of the SU patients had a modified Rankin score </= 2 vs 58.4% of the GW patients (p=0.01). Characteristic features of our SU were a standard protocol of management of stroke patients, an integrated physiotherapy and nursing, a teamwork and staff education program. Other significant differences with GW were an increased use of anticoagulation (22.4% in the SU vs 4.5% in GW, p=0.001) and fibrinolysis (9.5% in the SU vs 1.2% in the GW, p=0.004), and a shorter time to start the rehabilitation cares (more than 24 hours after admission in 60% of the cases in the GW vs 28% in the SU, p=0.001). Conclusion. A shorter time to start the rehabilitation therapy and the increased use of fibrinolysis and anticoagulation were the most important factors distinguishing SU from GW. This was mainly due to the presence of a protocole of an integrated management of stroke patients from the emergency department to the rehabilitation service.

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Centre Hospitalier Chrétien - Liège

BELGIUM

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Centre Hospitalier Chrétien - Liège

BELGIUM

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Centre Hospitalier Chrétien - Liège

BELGIUM

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

15
Prevalence and prognostic significance of electrolyte imbalance at stroke onset
L. Fofi S. Lorenzano L. Durastanti M. Prencipe D. Toni

University of Rome "La Sapienza", IRCCS S Raffaele

ITALY

Background: Identifying early predictors of poor outcome after stroke may be useful for improving patient treatment and outcome.Objective: We conducted a study on a continuous series of patients admitted to our Stroke Unit to evaluate the prevalence and influence of baseline electrolyte imbalance on the outcome of ischemic and hemorragic strokes. Methods: 615 patients [544 (88,4%) with ischemic and 71 (11,5%) with hemorrhagic stroke] were enrolled. Baseline electrolyte values were obtained to evaluate the relationship with short term outcome, where a clinically significant change was a difference between discharge and baseline NIHSS scores more than 4 points or death. Prevalence of cerebrovascular risk factors and pre-stroke therapy were also taken into account. Results: Hemorrhagic patients had lower potassium and sodium levels than ischemic patients, with respectively 3,9 vs 4,2 mEq/L and 138,9 vs 139,7 mEq/L (p<.001 and =.045, respectively). After adjusting for gender, females showed the same difference, while hemorrhagic males showed only lower potassium levels. At univariate analysis, in ischemic stroke patients abnormal natriemia (16%vs7,5%, p=0,016), atrial fibrillation (33%vs14,8%, p<0,0001) and history of previous stroke (7,2%vs1,5%, p=0,003) were more prevalent in the poor outcome group, while in hemorrhagic patients no statistically significant correlation was found. Multiple correspondence analysis evidenced that predictors of bad short term outcome were abnormal sodium and urea levels and smoke in ischemic patients, and abnormal potassium and urea levels in hemorrhagic patients. Conclusion: This study shows that electrolyte alterations might be a potential predictor of poor outcome in stroke, particulaly in ischemic patients.

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

15
Prevalence and prognostic significance of electrolyte imbalance at stroke onset
L. Fofi S. Lorenzano L. Durastanti M. Prencipe D. Toni

University of Rome "La Sapienza", IRCCS S Raffaele

ITALY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

15
Prevalence and prognostic significance of electrolyte imbalance at stroke onset
L. Fofi S. Lorenzano L. Durastanti M. Prencipe D. Toni

University of Rome "La Sapienza", IRCCS S Raffaele

ITALY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

15
Prevalence and prognostic significance of electrolyte imbalance at stroke onset
L. Fofi S. Lorenzano L. Durastanti M. Prencipe D. Toni

University of Rome "La Sapienza", IRCCS S Raffaele

ITALY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

15
Prevalence and prognostic significance of electrolyte imbalance at stroke onset
L. Fofi S. Lorenzano L. Durastanti M. Prencipe D. Toni

University of Rome "La Sapienza", IRCCS S Raffaele

ITALY

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

12
The effects of functional strength training on lower limb strength and function after stroke
E. Cooke V.M.Pomeroy S. Miller R.C.Tallis

St. George's University of London

UNITED KINGDOM

Background Stroke survivors are often left with permanent impairment, which impacts, on activities of daily living. This may be due to the fact that strength training is discouraged due to the incorrect belief that it will exacerbate abnormalities of movement control. The limited empirical evidence suggests that strength training might be beneficial. It is, however, too early to advocate resistive training from evidence of preliminary studies. Hypothesis Adding functional strength training to conventional therapy improves muscle function and gait more than either conventional therapy alone or increased intensity of conventional therapy Design A multi-centred, observer-blind randomised controlled trial Subjects Patients within three months of either an infarction or haemorrhage in the anterior circulation with some ability to move their leg and/or foot. A ‘power calculation’ has estimated the sample size Procedure Patients who provide written informed consent are recruited to the study. Subjects then participate in a baseline measurement sessions before being allocated randomly to one of three intervention groups 1.conventional therapy provided as normal for the clinical setting(control) 2.conventional therapy plus additional ‘neuro-facilitation’ physiotherapy (experimental 1) 3.conventional therapy plus additional functional strength training physiotherapy (experimental 2). All additional therapy is provided 1 hour a day, 4 times a week, for 6 weeks. Outcome Measures Outcome measures at 6 weeks and follow-up at 12 weeks. Primary outcomes are muscle strength (maximum torque) around the knee and walking speed. Secondary outcomes include normality of walking and health related quality of life (Euroqol) Progress In the 18 months since the study began 70 subjects have been recruited.

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

12
The effects of functional strength training on lower limb strength and function after stroke
E. Cooke V.M.Pomeroy S. Miller R.C.Tallis

St. George's University of London

UNITED KINGDOM

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

12
The effects of functional strength training on lower limb strength and function after stroke
E. Cooke V.M.Pomeroy S. Miller R.C.Tallis

St. George's University of London

UNITED KINGDOM

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

12
The effects of functional strength training on lower limb strength and function after stroke
E. Cooke V.M.Pomeroy S. Miller R.C.Tallis

St. George's University of London

UNITED KINGDOM

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

06
Association between self-perceived psychological stress and ischemic stroke
K. Jood P. Redfors A. Rosengren C. Blomstrand C. Jern

Institute of Clinical Neuroscience, the Sahlgrenska Academy at Göteborg University

SWEDEN

ABSRTACT Background and purpose: A growing body of evidence suggests that psychological stress contributes to coronary artery disease. However, associations between stress and stroke are less clear. We examined the possible association between self-perceived psychological stress and ischemic stroke in a large case-control study. Methods: In the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS), 600 consecutive patients with acute ischemic stroke (18-69 years) and 600 age and sex matched controls were recruited. Ischemic stroke subtype was determined according TOAST criteria. Self-perceived psychological stress preceding the stroke was assessed retrospectively during the acute stage using a single-item questionnaire. Stroke outcome was assessed after 3 months using the modified Rankin Scale. Results: Permanent self-perceived psychological stress during the last year or longer, but not periodic stress, was associated with overall ischemic stroke (multivariate-adjusted odds ratio [OR] 2.85; 95% CI 1.89-4.29). Analyses by stroke subtype showed that this association was present for large vessel disease (OR, 4.06; 95% CI 1.61-10.19), small vessel disease (OR, 3.01; 95% CI 1.54-5.89), and cryptogenic stroke (OR, 3.72; 95% CI 2.18-6.35), but not for cardioembolic stroke (OR, 1.38; 95% CI 0.60-3.18). No significant association between stress and functional outcome at 3 month follow-up was observed. Conclusion: Results from this case-control study support that permanent psychological stress is an independent risk factor for ischemic stroke. While this association was observed for the ischemic stroke subtypes large vessel disease, small vessel disease and cryptogenic stroke, it was not observed for cardioembolic stroke, suggesting that stress may contribute to primary vascular mechanisms.

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

06
Association between self-perceived psychological stress and ischemic stroke
K. Jood P. Redfors A. Rosengren C. Blomstrand C. Jern

Institute of Clinical Neuroscience, the Sahlgrenska Academy at Göteborg University

SWEDEN

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

06
Association between self-perceived psychological stress and ischemic stroke
K. Jood P. Redfors A. Rosengren C. Blomstrand C. Jern

Institute of Clinical Neuroscience, the Sahlgrenska Academy at Göteborg University

SWEDEN

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

06
Association between self-perceived psychological stress and ischemic stroke
K. Jood P. Redfors A. Rosengren C. Blomstrand C. Jern

Institute of Clinical Neuroscience, the Sahlgrenska Academy at Göteborg University

SWEDEN

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

06
Association between self-perceived psychological stress and ischemic stroke
K. Jood P. Redfors A. Rosengren C. Blomstrand C. Jern

Institute of Clinical Neuroscience, the Sahlgrenska Academy at Göteborg University

SWEDEN

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

04
Presenting Characteristics in Patients With and Without Cervical Pseudoaneurysm due to Carotid Dissection. A Case-Control Study
D. Benninger J. Gandjour M. Arnold D. Georgiadis R.W.Baumgartner

University Hospital of Zürich

SWITZERLAND

Background The treatment of cervical pseudoaneurysm due to spontaneous dissection of the internal carotid artery (ICAD) is controversial. We performed a case-control study to compare the risk of ischemic events, local symptoms and signs such as Horner syndrome and cranial nerve palsy and other characteristics at presentation in sICAD patients with and without associated cervical pseudoaneurysm. Methods Consecutive patients with sICAD were included (n=222, 132 men; mean age 46 +/- 11 years) presenting 248 sICADs and 15 spontaneous vertebral artery dissections (sVAD). Thirty-four patients (22 men; mean age 46 +/- 11 years; sICAD, n=41; sVAD, n=8) had 41 ICA- and 5 VA-aneurysms. All patients underwent clinical, laboratory, color duplex ultrasound (CDS) of the cerebral arteries, MR imaging (MRI) of the neck, cerebral artery MR (MRA) and/or catheter angiography, and cerebral MRI in case of brain ischemia. Unpaired t-tests were used to compare parametric data between groups, and Chi-square tests or Fisher exact test for nominal data. Results Patients with cervical pseudoaneurysms presented more often multiple CAD (p=0.001) and normal cerebral artery ultrasound findings (p<0.001), and showed a trend to cause less often carotid territory ischemia and local symptoms and signs that was significant for ischemic events (p=0.001). There were no differences in demographics and prevalence of vascular risk factors between both groups. Discussion Our data indicate that sICAD with cervical aneurysms cause less carotid ischemia and in particular not more local symptoms and signs than their non-aneurysmatic counterparts supporting the view that conservative, non-invasive management is appropriate in most cases.

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

04
Presenting Characteristics in Patients With and Without Cervical Pseudoaneurysm due to Carotid Dissection. A Case-Control Study
D. Benninger J. Gandjour M. Arnold D. Georgiadis R.W.Baumgartner

University Hospital of Zürich

SWITZERLAND

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

04
Presenting Characteristics in Patients With and Without Cervical Pseudoaneurysm due to Carotid Dissection. A Case-Control Study
D. Benninger J. Gandjour M. Arnold D. Georgiadis R.W.Baumgartner

University Hospital of Zürich

SWITZERLAND

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

04
Presenting Characteristics in Patients With and Without Cervical Pseudoaneurysm due to Carotid Dissection. A Case-Control Study
D. Benninger J. Gandjour M. Arnold D. Georgiadis R.W.Baumgartner

University Hospital of Zürich

SWITZERLAND

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

04
Presenting Characteristics in Patients With and Without Cervical Pseudoaneurysm due to Carotid Dissection. A Case-Control Study
D. Benninger J. Gandjour M. Arnold D. Georgiadis R.W.Baumgartner

University Hospital of Zürich

SWITZERLAND

Oral Session:Acute stroke: complications and early outcome
Poster Session:
Date: Thursday 18 May 2006 Time: 15:30 - 15:40 - Room: Auditorium 500
Chair: S. Blecic, Belgium and D. Toni, Italy

10
Acute ischemic stroke care and outcomes in Poland – preliminary data from POLKARD (National Cardiovascular Disease Prevention and Treatment Program for 2003–2005) STROKE Registry
M.P.Niewada M. Skowrońska I. Sarzyńska-Długosz B. Kamiński D. Ryglewicz A. Czlonkowska

Institute of Psychiatry and Neurology, Warsaw

POLAND

Background: To estimate clinical presentation, the acute care and outcomes in stroke centers participating in POLKARD (National Cardiovascular Disease Prevention and Treatment Program for 2003-2005) STROKE Registry. Methods: WHO Step Stroke and Swedish Stroke Registry web-based questionnaire was used to collect data on ischemic stroke patients admitted to participating centers between June the 1st 2004 and May 31st 2005. To ensure the quality only centers reported at least 100 patients were analyzed. Patients characteristic, in-hospital care and early outcomes were analyzed for ischemic stroke (I63 coding in International Classification of Diseases, 10th revision). Results: There were 73 centers that met inclusion criteria and 20542 patients (51.4% women, mean age: 70.6 yrs) were included in the final analyses. Mean time from onset to admission: 812 minutes. 14391 (70.1%), 3138 (15.3%), 1088 (5.3%), 617 (3.0%) patients were alert, drowsy, stupor and in coma at admission, respectively. Risk factors distribution: history of stroke – 4577 (22.3%), history of TIA – 1230 (6.0%), hypertension – 14830 (72.2%), atrial fibrillation – 4989 (23.8%), history of myocardial infarction – 2270 (11.1%), diabetes – 4911 (23.9%), smoking –2976 (14.5%), hiperlipidemia – 5099 (24.8%), alcohol abuse – 1058 (5.2%). The ischemic stroke subtypes distribution of TOAST classification was as follows: large-artery atherosclerosis – 7396 (36.0%), cardioembolism - 2794 (13.6%), small-artery occlusion – 3887 (18.9%), stroke of other determined cause - 1726 (8.4%) and stroke of undetermined cause -4723 (23.0%). Thrombolytic therapy was introduced for 143 patients (0.7%). Mean modified Rankin score following stroke was calculated on 3.02. 2383 patients (11.6%) died and for 48,3% death was directly and 45.0% indirectly associated with stroke. Conclusions: Ischemic stroke represents significant clinical matter and needs further monitoring in Poland.

Institute of Psychiatry and Neurology, Warsaw

POLAND

Institute of Psychiatry and Neurology, Warsaw

POLAND

Institute of Psychiatry and Neurology, Warsaw

POLAND

Institute of Psychiatry and Neurology, Warsaw

POLAND

Institute of Psychiatry and Neurology, Warsaw

POLAND

Oral Session:Longterm outcome of stroke
Poster Session:
Date: Friday 19 May 2006 Time: 10:10 - 10:20 - Room: Room 1122
Chair: A. Algra, The Netherlands and V. Thijs, Belgium

11
Would first-day body temperature dynamics contribute independently to long-term handicap after acute ischemic stroke?
J. Mau S. Jayavel M. Yong

Heinrich Heine University Hospital, Insitute of Statistics in Medicine

GERMANY

Background and Aims. Studies of associations between body temperature (BTp) in acute ischemic stroke and long-term outcome have not led to satisfactory conclusions. The dynamics of BTp during the first day were expected to be more clearly linked to functional outcome than individual measurements of BTp at baseline or later. This was to be studied in a data base from a trial of thrombolytic treatment. Methods. In the first European Cooperative Acute Stroke Study (ECASS-I) patients had been randomized to either 1.1mg/kg IV rt-PA or placebo within 6 hours after symptom onset; 615 patients received trial medication. BTp was measured at baseline, and again after 2 and after 24 hours. Long-term handicap was graded on the modified Rankin scale around day 90. Good outcome was considered as no or negligible persisting handicap (grades 0 or 1), and poor outcome as severe or complete dependency (grades 4 or 5). Profiles of individual BTp readings were grouped as constant, either only early or only late rising, persistently rising, dropping in any way, concave, or convex. Stepwise multifactorial logistic regression included all anamnestic and baseline clinical, neurological, and neuroradiological assessments. Results. Constant and only late rising BTp profiles suggested reduced risks of poor outcome at levels of nominal significance, already. No impact on mortality was found after adjusting for thrombolytic treatment and known contributing factors. Instead, constant profiles still somewhat reduced the risk of poor outcome among 90-day survivors, OR=0.268 (95%CI 0.078-0.925; P=0.037), while profiles rising only late significantly reduced the risk of complete dependency or death among all first-day survivors, OR=0.427 (95%CI 0.232-0.767; P=0.0047), independently of all other known significant predictors and thrombolytic treatment. Conclusion. The dynamics of body temperature within the first 24-30 hours add to the known risk profiles of thrombolysis independently.

11
Would first-day body temperature dynamics contribute independently to long-term handicap after acute ischemic stroke?
J. Mau S. Jayavel M. Yong

Heinrich Heine University Hospital, Insitute of Statistics in Medicine

GERMANY

11
Would first-day body temperature dynamics contribute independently to long-term handicap after acute ischemic stroke?
J. Mau S. Jayavel M. Yong

Heinrich Heine University Hospital, Insitute of Statistics in Medicine

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

10
Acute hemorrhagic stroke care and outcomes in Poland –preliminary data from POLKARD (National Cardiovascular Disease Prevention and Treatment Program for 2003–2005) STROKE Registry
M.P.Niewada M. Skowrońska I. Sarzyńska-Długosz B. Kamiński D. Ryglewicz A. Czlonkowska

Medical University of Warsaw

POLAND

Background: To estimate clinical presentation, the acute care and outcomes in stroke centers participating in POLKARD (National Cardiovascular Disease Prevention and Treatment Program for 2003-2005) STROKE Registry. Methods: WHO Step Stroke and Swedish Stroke Registry web-based questionnaire was used to collect data on hemorrhagic stroke patients admitted to participating centers between June the 1st 2004 and May 31st 2005. To ensure the quality only centers reported at least 100 patients were analyzed. Patients characteristic, in-hospital care and early outcomes were analyzed for hemorrhagic stroke (I61 coding in International Classification of Diseases, 10th revision). Results: There were 73 centers that met inclusion criteria and 2478 patients (47.6% women, mean age: 67.3 yrs) were included in the final analyses. Mean time from onset to admission: 581 minutes. 1022 (41.2%), 617 (24.9%), 314 (12.7%), 444 (17.9%) patients were alert, drowsy, stupor and in coma at admission, respectively. Risk factors distribution: history of stroke – 348 (14.0%), history of TIA – 48 (1.9%), hypertension – 1831 (73.9%), atrial fibrillation – 290 (11.7%), history of myocardial infarction – 138 (5.6%), diabetes – 373 (15.1%), smoking –295 (11.9%), hiperlipidemia – 339 (13.7%), alcohol abuse – 234 (9.4%). Mean modified Rankin score following stroke was calculated on 4.22. 915 patients (36.9%) died and for 74,4% death was directly and 22.4% indirectly associated with stroke. Conclusions: Hemorrhagic stroke represents significant clinical matter and needs further monitoring in Poland.

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Medical University of Warsaw

POLAND

Background: To estimate clinical presentation, the acute care and outcomes in stroke centers participating in POLKARD (National Cardiovascular Disease Prevention and Treatment Program for 2003-2005) STROKE Registry. Methods: WHO Step Stroke and Swedish Stroke Registry web-based questionnaire was used to collect data on hemorrhagic stroke patients admitted to participating centers between June the 1st 2004 and May 31st 2005. To ensure the quality only centers reported at least 100 patients were analyzed. Patients characteristic, in-hospital care and early outcomes were analyzed for hemorrhagic stroke (I61 coding in International Classification of Diseases, 10th revision). Results: There were 73 centers that met inclusion criteria and 2478 patients (47.6% women, mean age: 67.3 yrs) were included in the final analyses. Mean time from onset to admission: 581 minutes. 1022 (41.2%), 617 (24.9%), 314 (12.7%), 444 (17.9%) patients were alert, drowsy, stupor and in coma at admission, respectively. Risk factors distribution: history of stroke – 348 (14.0%), history of TIA – 48 (1.9%), hypertension – 1831 (73.9%), atrial fibrillation – 290 (11.7%), history of myocardial infarction – 138 (5.6%), diabetes – 373 (15.1%), smoking –295 (11.9%), hiperlipidemia – 339 (13.7%), alcohol abuse – 234 (9.4%). Mean modified Rankin score following stroke was calculated on 4.22. 915 patients (36.9%) died and for 74,4% death was directly and 22.4% indirectly associated with stroke. Conclusions: Hemorrhagic stroke represents significant clinical matter and needs further monitoring in Poland.

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Medical University of Warsaw

POLAND

Background: To estimate clinical presentation, the acute care and outcomes in stroke centers participating in POLKARD (National Cardiovascular Disease Prevention and Treatment Program for 2003-2005) STROKE Registry. Methods: WHO Step Stroke and Swedish Stroke Registry web-based questionnaire was used to collect data on hemorrhagic stroke patients admitted to participating centers between June the 1st 2004 and May 31st 2005. To ensure the quality only centers reported at least 100 patients were analyzed. Patients characteristic, in-hospital care and early outcomes were analyzed for hemorrhagic stroke (I61 coding in International Classification of Diseases, 10th revision). Results: There were 73 centers that met inclusion criteria and 2478 patients (47.6% women, mean age: 67.3 yrs) were included in the final analyses. Mean time from onset to admission: 581 minutes. 1022 (41.2%), 617 (24.9%), 314 (12.7%), 444 (17.9%) patients were alert, drowsy, stupor and in coma at admission, respectively. Risk factors distribution: history of stroke – 348 (14.0%), history of TIA – 48 (1.9%), hypertension – 1831 (73.9%), atrial fibrillation – 290 (11.7%), history of myocardial infarction – 138 (5.6%), diabetes – 373 (15.1%), smoking –295 (11.9%), hiperlipidemia – 339 (13.7%), alcohol abuse – 234 (9.4%). Mean modified Rankin score following stroke was calculated on 4.22. 915 patients (36.9%) died and for 74,4% death was directly and 22.4% indirectly associated with stroke. Conclusions: Hemorrhagic stroke represents significant clinical matter and needs further monitoring in Poland.

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Medical University of Warsaw

POLAND

Background: To estimate clinical presentation, the acute care and outcomes in stroke centers participating in POLKARD (National Cardiovascular Disease Prevention and Treatment Program for 2003-2005) STROKE Registry. Methods: WHO Step Stroke and Swedish Stroke Registry web-based questionnaire was used to collect data on hemorrhagic stroke patients admitted to participating centers between June the 1st 2004 and May 31st 2005. To ensure the quality only centers reported at least 100 patients were analyzed. Patients characteristic, in-hospital care and early outcomes were analyzed for hemorrhagic stroke (I61 coding in International Classification of Diseases, 10th revision). Results: There were 73 centers that met inclusion criteria and 2478 patients (47.6% women, mean age: 67.3 yrs) were included in the final analyses. Mean time from onset to admission: 581 minutes. 1022 (41.2%), 617 (24.9%), 314 (12.7%), 444 (17.9%) patients were alert, drowsy, stupor and in coma at admission, respectively. Risk factors distribution: history of stroke – 348 (14.0%), history of TIA – 48 (1.9%), hypertension – 1831 (73.9%), atrial fibrillation – 290 (11.7%), history of myocardial infarction – 138 (5.6%), diabetes – 373 (15.1%), smoking –295 (11.9%), hiperlipidemia – 339 (13.7%), alcohol abuse – 234 (9.4%). Mean modified Rankin score following stroke was calculated on 4.22. 915 patients (36.9%) died and for 74,4% death was directly and 22.4% indirectly associated with stroke. Conclusions: Hemorrhagic stroke represents significant clinical matter and needs further monitoring in Poland.

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Medical University of Warsaw

POLAND

Background: To estimate clinical presentation, the acute care and outcomes in stroke centers participating in POLKARD (National Cardiovascular Disease Prevention and Treatment Program for 2003-2005) STROKE Registry. Methods: WHO Step Stroke and Swedish Stroke Registry web-based questionnaire was used to collect data on hemorrhagic stroke patients admitted to participating centers between June the 1st 2004 and May 31st 2005. To ensure the quality only centers reported at least 100 patients were analyzed. Patients characteristic, in-hospital care and early outcomes were analyzed for hemorrhagic stroke (I61 coding in International Classification of Diseases, 10th revision). Results: There were 73 centers that met inclusion criteria and 2478 patients (47.6% women, mean age: 67.3 yrs) were included in the final analyses. Mean time from onset to admission: 581 minutes. 1022 (41.2%), 617 (24.9%), 314 (12.7%), 444 (17.9%) patients were alert, drowsy, stupor and in coma at admission, respectively. Risk factors distribution: history of stroke – 348 (14.0%), history of TIA – 48 (1.9%), hypertension – 1831 (73.9%), atrial fibrillation – 290 (11.7%), history of myocardial infarction – 138 (5.6%), diabetes – 373 (15.1%), smoking –295 (11.9%), hiperlipidemia – 339 (13.7%), alcohol abuse – 234 (9.4%). Mean modified Rankin score following stroke was calculated on 4.22. 915 patients (36.9%) died and for 74,4% death was directly and 22.4% indirectly associated with stroke. Conclusions: Hemorrhagic stroke represents significant clinical matter and needs further monitoring in Poland.

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Medical University of Warsaw

POLAND

Background: To estimate clinical presentation, the acute care and outcomes in stroke centers participating in POLKARD (National Cardiovascular Disease Prevention and Treatment Program for 2003-2005) STROKE Registry. Methods: WHO Step Stroke and Swedish Stroke Registry web-based questionnaire was used to collect data on hemorrhagic stroke patients admitted to participating centers between June the 1st 2004 and May 31st 2005. To ensure the quality only centers reported at least 100 patients were analyzed. Patients characteristic, in-hospital care and early outcomes were analyzed for hemorrhagic stroke (I61 coding in International Classification of Diseases, 10th revision). Results: There were 73 centers that met inclusion criteria and 2478 patients (47.6% women, mean age: 67.3 yrs) were included in the final analyses. Mean time from onset to admission: 581 minutes. 1022 (41.2%), 617 (24.9%), 314 (12.7%), 444 (17.9%) patients were alert, drowsy, stupor and in coma at admission, respectively. Risk factors distribution: history of stroke – 348 (14.0%), history of TIA – 48 (1.9%), hypertension – 1831 (73.9%), atrial fibrillation – 290 (11.7%), history of myocardial infarction – 138 (5.6%), diabetes – 373 (15.1%), smoking –295 (11.9%), hiperlipidemia – 339 (13.7%), alcohol abuse – 234 (9.4%). Mean modified Rankin score following stroke was calculated on 4.22. 915 patients (36.9%) died and for 74,4% death was directly and 22.4% indirectly associated with stroke. Conclusions: Hemorrhagic stroke represents significant clinical matter and needs further monitoring in Poland.

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

17
A prior transient ischemic attack is independently associated with decreased in-hospital case fatality in diabetic and non-diabetic acute stroke patients
J. Zsuga R. Gesztelyi I. Fekete L. Mihálka L. Csiba D. Bereczki

University of Debrecen

HUNGARY

Background: The phenomenon of ischemic preconditioning (IP) is well established concerning healthy human hearts; however limited information is available about its occurrence or its integrity in diabetes mellitus following transient ischemic attacks (TIA) of the brain. Therefore we set out to assess if a prior cerebral ischemic episode (stroke or TIA) is able to confer protection as reflected by in-hospital case fatality, in the presence and absence of diabetes mellitus. Methods: We investigated 2874 acute stroke patients included in the prospective, hospital-based Debrecen Stroke Database; of whom 673 had previous stroke and 195 had prior TIA. Results: Following adjustment for active confounders, TIA in the history was associated with decreased odds for in-hospital case fatality in the un-stratified model (OR, 0.53; CI, 0.29 to 0.98, p=0.041) and following stratification by the absence (OR, 0.53; CI, 0.27 to 1.04, p=0.068) or the presence (OR, 0.36; CI, 0.075 to 1.77, p=0.211) of diabetes for patients having prior TIA. Conversely, IP phenomenon could be detected when stroke severity characterized by the Mathew score was chosen as the outcome measure (coefficient being 3.47; CI, 1.05 to 5.90 p=0.002). Discussion: These data suggest that TIA may have a cerebral ischemic preconditioning effect in the human brain. Whether the lack of statistical significance in diabetes is due to the effect of restricted power or the loss of IP is yet to be determined by future studies.

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

University of Debrecen

HUNGARY

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

University of Debrecen

HUNGARY

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

University of Debrecen

HUNGARY

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

University of Debrecen

HUNGARY

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

University of Debrecen

HUNGARY

Oral Session:Etiology of stroke
Poster Session:
Date: Thursday 18 May 2006 Time: 12:00 - 12:10 - Room: Room 1123
Chair: H. Markus, UK and Y. Shinohara, Japan

07
Prognosis of patients with cancer and stroke depends on stroke rather than on cancer
F. Taccone P. Redondo S. Jeangette M. Pandolfo S.A.Blecic

Erasme Hospital

BELGIUM

Background: Stroke is frequent in patients (pts) with systemic cancer (SC). Etiologies are related to SC and are premature Large Vessel Disease (LVD), Non Bacterial Thrombotic endocarditis (NBTE), Coagulation Disorders (CD) and Tumor embolism (TE) Objective: To find a difference between SC pts based upon the moment of stroke onset in the SC course. Design/Methods: 5048 pts with first stroke were admitted between1991 and 2005. Mean age was 66.4± 8.1 years. All risk factors were recorded and a complete stroke work-up was performed in all. In case of death all pts with SC had autopsy. Results: 777/5048 pts (15.4%) were found to have SC. 752 pts had history of SC and in 25 (0.5%) SC was eventually discovered during hospitalization. 522/ 752 pts (69.5%) had SC on remission or presumably cured. Average age of these pts was 66.9 ± 5 years (p= NS vs general population (GP)). Stroke occurred on an average time of 6 months (mo) [2-18] after the last SC treatment. 445 pts (85.2%) had LVD, 43 (8.2%) had SVD, 20 (3.8%) had atrial fibrillation (AF) and multiple causes were found in 20 (3.8%) (p<0.001 vs GP for all etiologies). NBTE and CD were never found. On a 2 years follow-up 4% had vascular recurrence or died. In none death was the consequence of SC and none recurred a SC. 230/752 (30.5%) pts had stroke while SC was active. LVD was found to be the cause in 168 pts (73%), 24 pts NBTE, AF in 17 pts (7.4%), 10 % had SVD. The medial survival of was 7.5 mo. Analyzed by SC types, no difference was found between the outcome of pts with SC and stroke and pts with SC alone. In 25 pts a stroke was the initial presentation of SC. Average age of these pts was 52,1±4.1 years (24-80). LVD was found in 12 pts (48%), CD in 3 pts, NBTE in 7. Within the first month 19 pts had a second stroke. The mortality rate was 88% (22/25) with a medial survival of 59.4 days (3-180) after index stroke. Conclusions: Stroke is a common event in pts with SC. History of SC could favor stroke by accelerating the development of LVD. Specific stroke etiologies are found in pts with active SC. Outcome is not modified by stroke in cancer pts, and is related to the SC specificity, except when stroke is the initial presentation of SC where the prognosis becomes particularly pejorative.

Oral Session:Etiology of stroke
Poster Session:
Date: Thursday 18 May 2006 Time: 12:00 - 12:10 - Room: Room 1123
Chair: H. Markus, UK and Y. Shinohara, Japan

07
Prognosis of patients with cancer and stroke depends on stroke rather than on cancer
F. Taccone P. Redondo S. Jeangette M. Pandolfo S.A.Blecic

Erasme Hospital

BELGIUM

Oral Session:Etiology of stroke
Poster Session:
Date: Thursday 18 May 2006 Time: 12:00 - 12:10 - Room: Room 1123
Chair: H. Markus, UK and Y. Shinohara, Japan

07
Prognosis of patients with cancer and stroke depends on stroke rather than on cancer
F. Taccone P. Redondo S. Jeangette M. Pandolfo S.A.Blecic

Erasme Hospital

BELGIUM

Oral Session:Etiology of stroke
Poster Session:
Date: Thursday 18 May 2006 Time: 12:00 - 12:10 - Room: Room 1123
Chair: H. Markus, UK and Y. Shinohara, Japan

07
Prognosis of patients with cancer and stroke depends on stroke rather than on cancer
F. Taccone P. Redondo S. Jeangette M. Pandolfo S.A.Blecic

Erasme Hospital

BELGIUM

Oral Session:Etiology of stroke
Poster Session:
Date: Thursday 18 May 2006 Time: 12:00 - 12:10 - Room: Room 1123
Chair: H. Markus, UK and Y. Shinohara, Japan

07
Prognosis of patients with cancer and stroke depends on stroke rather than on cancer
F. Taccone P. Redondo S. Jeangette M. Pandolfo S.A.Blecic

Erasme Hospital

BELGIUM

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

04
Post-stroke depression: a 24-month follow up
M. Altieri I. Maestrini V. Di Piero E . Sbardella A. Mercurio G.L.Lenzi

University of Rome " La Sapienza"

ITALY

Introduction: Depression is a frequent psychiatric complication after stroke and is linked to a higher degree of disability and recurrences. Nevertheless, its time course and causes are still debated. During a 24-month period after stroke, we investigated the occurrence, time course and predictors of depressive symptoms. Methods: all the consecutive acute stroke patients admitted to our ward were examined according to a standardized procedure. Patients with TIAs, severe disability (MRS score 5), serious comprehension difficulties or dementia and history of psychiatric disturbances were excluded. Depressive symptoms were assessed at 2 weeks and 2, 6, 12, 18 and 24 months after stroke with the Beck Depression Inventory using a cut-off >/= 10. Depression was diagnosed according to the DSM-IV criteria. Results: During a one-year period out of 116 stroke patients, 109 (age 64.5 +/- 10.2 years; m/f 77/32) were enrolled. During the entire follow-up 34 (31.2%) patients scored 10 or more in the BDI. Ten patients (29.4%) developed depression at 2 weeks, 5 (14.7%) at 2 months, 5 (14.7%) at 6 months, 6 (17.6%) at 12 months, 3 (8.8%) at 18 months, and 5 (14.7%) at 24 months. Depressive symptoms were associated with female sex (p=0.05), disability (0.03), and lesion location in the anterior circulation (p=0.05). Of those who were depressed at 6 months, 61% were also depressed at the end of follow up. Conclusion: Our data indicate that depressive symptoms are frequent after stroke, and often have a chronic course. The origin is multifactorial, as constitutional and clinical factors seem to be involved.

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

04
Post-stroke depression: a 24-month follow up
M. Altieri I. Maestrini V. Di Piero E . Sbardella A. Mercurio G.L.Lenzi

University of Rome " La Sapienza"

ITALY

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

04
Post-stroke depression: a 24-month follow up
M. Altieri I. Maestrini V. Di Piero E . Sbardella A. Mercurio G.L.Lenzi

University of Rome " La Sapienza"

ITALY

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

04
Post-stroke depression: a 24-month follow up
M. Altieri I. Maestrini V. Di Piero E . Sbardella A. Mercurio G.L.Lenzi

University of Rome " La Sapienza"

ITALY

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

04
Post-stroke depression: a 24-month follow up
M. Altieri I. Maestrini V. Di Piero E . Sbardella A. Mercurio G.L.Lenzi

University of Rome " La Sapienza"

ITALY

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

04
Post-stroke depression: a 24-month follow up
M. Altieri I. Maestrini V. Di Piero E . Sbardella A. Mercurio G.L.Lenzi

University of Rome " La Sapienza"

ITALY

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

13
Transcranial DC Stimulation (tDCS): a tool for double-blind sham-controlled clinical studies in neurorehabilitation
F. Hummel P. Gandiga C. Gerloff L.G.Cohen

Clinical Brain Research, Eberhard-Karls University Tuebingen 2 Human Cortical Physiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.

GERMANY

Background: Transcranial direct current stimulation (tDCS), a form of brain polarization, which influences motor function and learning processes, has been proposed as an adjuvant strategy to enhance functional recovery in Neurorehabilitation. Appropriate testing in neurorehabilitative studies requires double-blind sham-controlled study designs. In the present study, we determined, in more than 170 sessions, the effects of tDCS and sham stimulation (SHAM) on discomfort, duration of elicited sensations, attention and fatigue in a group of healthy volunteers and stroke patients. Methods: During different experimental session, tDCS or SHAM was applied to the motor cortex. Attention, fatigue, and discomfort were self rated by study participants using visual analog scales. Duration of perceived sensations and the ability of the study participants to distinguish tDCS from Sham sessions were determined. Investigators questioning the patients were blind to the intervention type. Results: In the present study, tDCS and SHAM elicited comparably minimal discomfort and duration of sensations in the absence of differences in attention or fatigue between the two conditions. The two interventional conditions (tDCS and Sham) could not be distinguished by study participants nor investigators. Discussion: Comparable attention and fatigue, ease of application simultaneously with motor tasks and training protocols and successful blinding of subjects and investigators supports the feasibility of using tDCS in double-blind, sham-controlled randomized trials in clinical Neurorehabilitation. Thus, tDCS has the potential to evolve into a useful tool, in addition to TMS, to modulate cortical activity in Neurorehabilitation.

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

13
Transcranial DC Stimulation (tDCS): a tool for double-blind sham-controlled clinical studies in neurorehabilitation
F. Hummel P. Gandiga C. Gerloff L.G.Cohen

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

13
Transcranial DC Stimulation (tDCS): a tool for double-blind sham-controlled clinical studies in neurorehabilitation
F. Hummel P. Gandiga C. Gerloff L.G.Cohen

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

13
Transcranial DC Stimulation (tDCS): a tool for double-blind sham-controlled clinical studies in neurorehabilitation
F. Hummel P. Gandiga C. Gerloff L.G.Cohen

GERMANY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

02
A short-term assessment of recombinant human granulocyte colony-stimulating factor (rhG-CSF) in treatment of acute cerebral infarction
J. Jun Zhang Min Deng Yuanjin Zhang Wei Sui Liping Wang Aping Sun Hongsong Song Ming Lu Dongsheng Fan

Peking University Third Hospital, Beijing

CHINA

Background In humans, bone marrow stem cells can be mobilized into the circulation using recombinant human granulocyte colony-stimulating factor (rhG-CSF), an approach that is effective in experimental stroke. And a randomized placebo-controlled pilot trial (STEMS) are performing by Sprigg et al. Objective To assess the safety and efficacy of rhG-CSF in treatment of acute cerebral infarction by a randomized and placebo-controlled clinical trial. Method 45 cases with acute cerebral infarction were randomly allocated to receive treatment by either rhG-CSF or placebo within 1 week of stroke onset. Among them, 15 cases were consecutively given rhG-CSF 2 g/kg for 5 days by subcutaneous injection. The other 30 cases were treated with placebo. The end points included NIH Stroke Scale and adverse reaction. Results On the 5th day in rhG-CSF treatment, there was markedly increase of WBC count, and CD34+ cell proportion (>1%, i.e. >106). For the treatment group, there was no significant difference between NIHSS score on the 10th day and that before treatment, but there was on the 20th day (P=0.004). For parallel group, no significant differences in NIHSS scores on both the 10th and 20th day compared with those before treatment. There were no significant differences between the two groups in terms of their respective NIHSS scores on the 10th and 20th day. No definite side effects were found in the treatment group during the 20 days. Conclusion There was a statistical difference on the 20th day during the treatment of acute cerebral infarction with rhG-CSF, showing that rhG-CSF is an effective drug in the treatment of acute cerebral infarction. Finding no statistical difference on the 10th day means that the efficacy of rhG-CSF can only be seen in the long run. Although there was no statistical difference between the two groups, the gap has widening tendency with time until the 20th day.

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Peking University Third Hospital, Beijing

CHINA

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Peking University Third Hospital, Beijing

CHINA

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Peking University Third Hospital, Beijing

CHINA

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Peking University Third Hospital, Beijing

CHINA

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Peking University Third Hospital, Beijing

CHINA

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Peking University Third Hospital, Beijing

CHINA

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Peking University Third Hospital, Beijing

CHINA

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Peking University Third Hospital, Beijing

CHINA

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

14
WELFARE MODELS FOR ACUTE STROKE:STROKE UNIT EFFICACY. DATA FROM EUROPEAN REGISTRY OF STROKE (E.R.O.S.) – FLORENCE UNITY
A. CRAMARO A. DI CARLO D. INZITARI

University of Florence

ITALY

BACKGROUND: to describe our stroke management and to show preliminar data collecting for the European Registry of Stroke and the differences between stroke unit and other wards MATERIALS AND METHODS: every acute first ischemic or haemorrhagic stroke admitted to Careggi Hospital has been evaluated by research team. For each patient, data about clinical status (including NIH scale, Glasgow Coma Scale and Barthel Index), therapy, imaging, rehabilitation were collected. 276 patients were enrolled: 122 were admitted to stroke unit, the others to general, neurology or neurosurgery ward. 23 out of 24 patients undergone to systemic or intra-arterial thrombolysis were admitted to stroke unit. Ischemic subtype of stroke was defined by TOAST classification; haemorrhagic stroke was defined as primary intracerebral haemorrhage or subarachnoidal haemorrhage. A 3 months follow up was performed RESULTS: Patients admitted to stroke unit were younger (p<0,001) and more frequently independent before stroke (p=0,002). Patients admitted to stroke unit were more frequently treated by physiotherapist and logotherapist (respectively p=0,001; p<0,001) and, more frequently, diagnostic instruments (MRI EcocolorDoppler Transcranial Doppler) were used. No differences about therapy in acute phase in the two groups. While other wards accepted more patients with lacunar syndrome, stroke unit admitted more patients with a total anterior cerebral infarct (p=0,001). No differences between mortality at 1 and 3 months DISCUSSION AND CONCLUSION: Although patients recovered in stroke unit were younger, they had a more severe pathogenetic subtype. Data analysis showed a trend for the reduction of death and institutionalised care (p=0,06) at three months follow up. The logistic regression analysis showed that the admission to a stroke unit reduces 3 months risk of death and institutionalised care (OR, 3,24; 95%CI, 1.19-8.79). This data was more strong in patients older than 80 (OR 4,64 95% CI 1,12-17,68)

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

14
WELFARE MODELS FOR ACUTE STROKE:STROKE UNIT EFFICACY. DATA FROM EUROPEAN REGISTRY OF STROKE (E.R.O.S.) – FLORENCE UNITY
A. CRAMARO A. DI CARLO D. INZITARI

University of Florence

ITALY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

14
WELFARE MODELS FOR ACUTE STROKE:STROKE UNIT EFFICACY. DATA FROM EUROPEAN REGISTRY OF STROKE (E.R.O.S.) – FLORENCE UNITY
A. CRAMARO A. DI CARLO D. INZITARI

University of Florence

ITALY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

19
Safe Implementation of Intravenous Thrombolysis in Turkey: Results of A Nation-wide Phase I Survey
Y. Krespi B. Bir N. Afşar D. Kaya B. Dora
For Turkish Neurological Association Stroke Working Group

Florence Nightingale Hospital

TURKEY

Background rtPA has recently been approved for intravenous (IV) thrombolysis in acute ischemic stroke in Turkey. The purpose of this study was to determine the background stroke care map of the country in order to to build-up a professional network system for the safe implementation of this therapy. Methods: A nation-wide, two-phase survey was planed by The Turkish Neurological Society “Stroke Working Group”. The first phase of the survey was conducted in cities of Turkey having a medical faculty. The first phase had two parts; the screening part, held on November 2004 and carried out by a structured telephone interviewing technique included all teaching and non teaching hospitals to find out target hospitals having the minimum infrastructure for IV thrombolytic therapy. In the second part, held in March 2005, all the target institutions were reevaluated with a face-to-face interview technique. Results: A total of 354 institutions were contacted in 35 provinces of Turkey. A response was obtained from 312 hospitals. 141 institutions were classified as target hospital and 101 (73%) are situated in 3 of the 7 geographical regions of the country, mainly in 16 cities (45%). In only 5% of the hospitals stroke care is delivered in a specialized unit, and in the remaining this takes place in a general or neurology ward. Sixty six percent of the centers have no previous experience with thrombolysis but only 8% declared themselves reluctant to this form of therapy. Ninety four and 96% of the hospitals were willing to participate to a national thrombolysis data-base and to follow national guidelines, respectively. Discussion: Many centers stated their will to use IV thrombolysis in acute stroke care and to join local organisations. This data encouraged the wide spread implementation of this therapy in our country.

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Florence Nightingale Hospital

TURKEY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Florence Nightingale Hospital

TURKEY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Florence Nightingale Hospital

TURKEY

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Florence Nightingale Hospital

TURKEY

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Hematoma, edema volume and hemodynamic changes in the acute and subacute phase of spontaneous intracranial hemorrhage
L. Csiba B. Fulesdi J. Settakis I. Fekete D. Bereczki

Debrecen University

HUNGARY

ICH (intracranial hemorrhage) is a common disorder, with an estimated frequency of 37 000-52 000 each year in the USA. The two most important new concepts are that haemorrhages continue to grow and expand over several hours after onset of symptoms-a process known as early haematoma growth-and that most of the brain injury and swelling that happens in the days after ICH is the result of inflammation caused by thrombin and other coagulation end-products. Ca. 38% of patients had an increase in haematoma volume within 3 h of onset. The authors review the mechanisms that lead to early haematoma growth during the acute stage of ICH and summarize their observation on ICH pts. Methods: 20 patients with supratentorial ICH were examined. Brain, hematoma and edema volumes were calculated from CT scans performed at admission and two weeks later and were compared with the values obtained from bilateral TCD recordings of the middle cerebral arteries. Results: TCD blood flow velocities (FV) did not change, cerebral perfusion pressure (CPP) and resistance area product (RAP) decreased (P=0.007 and P=0.003 respectively) while cerebral blood flow index (CBFI) remained constant (P=0.91) in the affected side, indicating preserved autoregulation. Hemorrhage volume did not correlate with RAP in the acute phase (r= 0.07 P=0,76), but in the subacute phase a significant positive correlation could be detected (r=0.44, P=0.04). Conclusions: The calculation of CPP, RAP and CBFI contributed more to the understanding of the hemodynamic changes developing after a spontaneous ICH than the absolute TCD velocity values. The sudden appearance of a new mass temporarily impairs cerebral circulation but cerebral autoregulation remains intact in small to middle size brain hemorrhages

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Hematoma, edema volume and hemodynamic changes in the acute and subacute phase of spontaneous intracranial hemorrhage
L. Csiba B. Fulesdi J. Settakis I. Fekete D. Bereczki

Debrecen University

HUNGARY

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Hematoma, edema volume and hemodynamic changes in the acute and subacute phase of spontaneous intracranial hemorrhage
L. Csiba B. Fulesdi J. Settakis I. Fekete D. Bereczki

Debrecen University

HUNGARY

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Hematoma, edema volume and hemodynamic changes in the acute and subacute phase of spontaneous intracranial hemorrhage
L. Csiba B. Fulesdi J. Settakis I. Fekete D. Bereczki

Debrecen University

HUNGARY

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Hematoma, edema volume and hemodynamic changes in the acute and subacute phase of spontaneous intracranial hemorrhage
L. Csiba B. Fulesdi J. Settakis I. Fekete D. Bereczki

Debrecen University

HUNGARY

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

03
Longer-term outcome of young adult stroke patients in a multiethnic population – an analysis from the South London Stroke Register
M.ABusch C. Coshall I. Burger C. Wolfe

King's College London, Division of Health and Social Care Research

UNITED KINGDOM

Background: Stroke is rare in young adults but can have a devastating effect on individual lives and a high public health impact due to long years of disability and lost productivity. This study aimed to determine the longer-term outcome of young adult stroke patients and to identify factors that influence outcome. Methods: A prospective population-based register of all incident strokes with annual follow-up in a multi-ethnic population of 234 533, of whom 21% are black. Data from all patients aged 15 to 45 years registered between 1995 and 2004 were used. Outcomes were case fatality, long-term survival and disability (Barthel Index <20). Statistical analysis included multivariable analysis to examine associations between patient characteristics and poor outcome. Results: Of 2764 registered incident strokes, 174 (6.3%) were in young adults (median age 38.5 years, 52.3% men, 40.8% black ethnicity). Stroke subtype was ischaemic in 41.4%, intracerebral haemorrhage in 23.6%, and subarachnoid haemorrhage in 33.9% of cases. Case fatality was 17.8% at 30 days and 19.5% from 3 months to 1 year. Haemorrhagic stroke was associated with higher fatality (OR 2.3, p<0.005), adjusting for other clinical and socio-demographic factors. Some disability was found in 31.9% and 41.4% of interviewed survivors after one and three years, respectively. Kaplan-Meier analysis showed better survival for black than white people and for ischaemic than for haemorrhagic stroke but no survival difference in relation to these or other factors was found in the multivariable model. Conclusion: Young adult stroke patients had a high case fatality but good long-term survival after three months, though persistent disability was frequent. Haemorrhagic stroke was the most common subtype and had a much poorer prognosis in the short term but did not independently influence longer-term outcome.

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

03
Longer-term outcome of young adult stroke patients in a multiethnic population – an analysis from the South London Stroke Register
M.ABusch C. Coshall I. Burger C. Wolfe

King's College London, Division of Health and Social Care Research

UNITED KINGDOM

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

03
Longer-term outcome of young adult stroke patients in a multiethnic population – an analysis from the South London Stroke Register
M.ABusch C. Coshall I. Burger C. Wolfe

King's College London, Division of Health and Social Care Research

UNITED KINGDOM

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

03
Longer-term outcome of young adult stroke patients in a multiethnic population – an analysis from the South London Stroke Register
M.ABusch C. Coshall I. Burger C. Wolfe

King's College London, Division of Health and Social Care Research

UNITED KINGDOM

Oral Session:Recovery and rehabilitation
Poster Session:
Date: Wednesday 17 May 2006 Time: 16:20 - 16:30 - Room: Auditorium 500
Chair: G. Özdemir, Turkey and A.Czlonkowska, Poland

09
Effects of cortical stimulation on visuomotor integration and force in stroke
F. Hummel B. Voller P. Celnik A. Floel P. Giraux C. Gerloff L. G.Cohen

Clinical Brain Research, Eberhard-Karls University Tuebingen

GERMANY

Background:Brain polarization by anodal transcranial DC stimulation (tDCS) applied to the primary motor cortex of the affected hemisphere (M1-affected) enhances beneficial training effects on complex activities of daily living (ADL) [1]. Which mechanisms underlie these tDCS-induced improvements? One possible mechanism involves upregulation of activity within M1-affected which could conceivably improve sensorimotor integration and/or force production as basic components of skilled motor functions that rely on M1 activity. Alternatively, tDCS could modulate nonspecific functions such as motivation or attention. These questions has been addressed in the present study. Methods:We investigated the effects of anodal tDCS applied to M1-affected on pinch force (PF), a function that relies predominantly on M1 activity, and on visuomotor integration determined by simple reaction times (RT) in patients with chronic stroke in a double-blind cross-over sham-controlled study design. Results:Anodal tDCS shortened reaction times (RT-Post-tDCS=256.6±13.9 msec) and improved pinch force (PF-Post-tDCS=124.8±24.0 N) in the paretic hand relative to baseline (RT-Base-tDCS=267.5±15.4 msec; PF-Base-tDCS=118.8±23.0 N) and to Sham (RT-Post-Sham=277.7±11.6 msec; PF-Post-Sham=111.2±19.8 N) in the absence of measurable changes in attention, fatigue and discomfort. Discussion:These findings suggest that the mechanisms underlying anodal tDCS-induced improvement in ADLs previously reported [1] are more likely related to direct effects on primary functions mediated by M1-affected than on nonspecific attentional or motivational influences. Further, they propose that tDCS, through modulation of activity in M1-affected, could benefit more impaired patients who cannot or have substantial difficulties in training complex ADLs but are able to train simpler motor tasks. [1] Hummel et al. Brain (2005) 128:490-9

09
Effects of cortical stimulation on visuomotor integration and force in stroke
F. Hummel B. Voller P. Celnik A. Floel P. Giraux C. Gerloff L. G.Cohen

Clinical Brain Research, Eberhard-Karls University Tuebingen

GERMANY

09
Effects of cortical stimulation on visuomotor integration and force in stroke
F. Hummel B. Voller P. Celnik A. Floel P. Giraux C. Gerloff L. G.Cohen

Clinical Brain Research, Eberhard-Karls University Tuebingen

GERMANY

09
Effects of cortical stimulation on visuomotor integration and force in stroke
F. Hummel B. Voller P. Celnik A. Floel P. Giraux C. Gerloff L. G.Cohen

Clinical Brain Research, Eberhard-Karls University Tuebingen

GERMANY

09
Effects of cortical stimulation on visuomotor integration and force in stroke
F. Hummel B. Voller P. Celnik A. Floel P. Giraux C. Gerloff L. G.Cohen

Clinical Brain Research, Eberhard-Karls University Tuebingen

GERMANY

09
Effects of cortical stimulation on visuomotor integration and force in stroke
F. Hummel B. Voller P. Celnik A. Floel P. Giraux C. Gerloff L. G.Cohen

Clinical Brain Research, Eberhard-Karls University Tuebingen

GERMANY

09
Effects of cortical stimulation on visuomotor integration and force in stroke
F. Hummel B. Voller P. Celnik A. Floel P. Giraux C. Gerloff L. G.Cohen

Clinical Brain Research, Eberhard-Karls University Tuebingen

GERMANY

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

09
ISCHEMIC STROKE AND TIA IN ATRIAL FIBRILLATION PATIENTS TAKING ORAL ANTICOAGULANT THERAPY: A CASE-CONTROL STUDY
A.M.Basile S. Tonello A. Corfini L. Costa L. Busson V. Argentiero M. Armani V. Pengo B. Tavolato

University of Padua

ITALY

Background: Ischemic stroke in atrial fibrillation (AF) is not fully suppressed by oral anticoagulant therapy (OAT) with target international normalized ratio (INR) of 2-3. Aims were to verify if TIA/ischemic stroke onset in AF patients on OAT is correlated with INR and to identify any associated risk factors and coagulation disorders. Methods: Thirty-one AF cases (mean age:78+/-7.3y; F/M:15/16) with acute TIA/ischemic stroke during OAT, were assessed wholly, including coagulation tests and transesophageal echocardiogram. Cases were divided into 2 groups on entry INR: INR>2 and INR<2. Previous 3 months’ INR values were collected. Cases were compared with a control group of AF patients on OAT without ischemic events: for each case, 3 age- and sex-matched controls were randomly taken from the Padova Thrombosis Centre database. Results: Of the 31 cases, 15 had entry INR>2 and 16 INR<2. Risk factors and comorbidities did not differ significantly between the 2 groups. Compared with controls, cases presented significantly more often with hypertension (87%vs67%;P=0.030), diabetes (45%vs16%;P=0.009), previous stroke (58%vs8%;P<0.001), and G20210A factor II mutation (16.0%vs3.4%;P=0.022). On logistic regression analysis, diabetes (OR:4.6;95%CI:1.1-18.8), previous stroke (OR:25.9;95%CI:6.1-109.8), and G20210A mutation (OR:11.5;95%CI:1.4-90.3) predicted cerebral ischemic events in AF during OAT, independently of all other factors. Cases had decreasing INR values with wide fluctuations in all measurements preceding stroke, while controls showed more stable anticoagulation intensity. Discussion: risk factors, comorbidities, and coagulation disorders contribute to ischemic stroke/TIA in AF during OAT. Anticoagulation intensity variability may affect the efficacy of such therapy.

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

University of Padua

ITALY

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

University of Padua

ITALY

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

University of Padua

ITALY

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

University of Padua

ITALY

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

University of Padua

ITALY

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

University of Padua

ITALY

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

University of Padua

ITALY

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

University of Padua

ITALY

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

18
Secondary remote lesions following focal ischemic damage of sensorymotor cortex in adult rat
P. Holmberg S. Liljequist A. Wagner

Karolinska institutet

SWEDEN

BACKGROUND We have recently developed a model of focal cerebral ischemia in rat, this model produce a reproducible and transient neurological deficit.It is induced by extradural compression and leads to an ischemic lesion. The lesion produces a neurological deficit presented as a left side hemiparesis. The functional disturbance is accompanied by moderate brain damage in the sensorimotor cortex.The aims of the present study are to develop the compression model further by describing the locations of secondary remote lesions and the development of these lesions over time. In addition we report data about physiological parameters important for the interpretation of our findings. METHODS Rats were subjected to a beam-walking test before and after surgery to measure neurological deficits. After the brain area of interest had been identified the defined area of the skull was cut out, leaving the dura intact. A plexiglass piston was lowered 3mm at the rate of 1mm/min. The compression was kept for 30 min. The temperature was kept constant. Blood gas analysis, blood glucose, electrolytes, Laser Doppler Flow (LDF) and intracranial pressure were measured. Following different time points the animals were anaesthetized the brain removed and cryoprotected. Serial sections were cut and degenerating neurons were detected with Fluoro-Jade and examined. RESULTS Physiological measurements did not differ significantly between different time points.Secondary lesion areas were found both in Thalamus and Hippocampus.The cell lesions were most pronounced on day 5. No secondary lesion was presented in any animal on day 1. DISCUSSION The study of secondary remote lesions in experimental stroke has been limited, depending in part by the large size lesion produced by many stroke models. We think that this model might be a valuable tool for future studies concerning the mechanisms behind secondary remote lesions and how these lesions affect cognitive and behavioural parameters.

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

18
Secondary remote lesions following focal ischemic damage of sensorymotor cortex in adult rat
P. Holmberg S. Liljequist A. Wagner

Karolinska institutet

SWEDEN

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

18
Secondary remote lesions following focal ischemic damage of sensorymotor cortex in adult rat
P. Holmberg S. Liljequist A. Wagner

Karolinska institutet

SWEDEN

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

05
Variants of the basal vein of Rosenthal and perimesencephalic nonaneurysmal haemorrhage
T. Daenekindt G. Wilms V. Thijs F. Van Calenbergh

University Hospital Leuven

BELGIUM

Background and Purpose—The cause of a perimesencephalic nonaneurysmal subarachnoid hemorrhage (PMH) is not known. Earlier studies reported a possible contribution of a primitive variant of the basal vein of Rosenthal (BVR) in the pathogenesis of PMH. We compared the variants of BVR between patients with PMH and aneurysmal subarachnoid hemorrhage (SAH) by studying the venous phase of the digital substraction angiography (DSA). Methods—Two observers reviewed the DSAs of 59 patients with PMH and 59 patients with SAH. The variants of BVR were classified into: (1) normal continuous: BVR is continuous with the deep middle cerebral vein and drains mainly to the vein of Galen (VG); (2) normal discontinuous: drainage anterior to uncal veins and posterior to VG; (3) primitive variant: drainage to other veins than VG. Results—118 patients were enrolled with a mean age of 49+/-12 years. There were 31 males and 28 females in both groups. Patients with PMH were older than patients with SAH (52 versus 46, p=0.01). Primitive variants were found in 21% on the left side, and 29% on the right side (p=0.27). There was no association between PMH and the presence of a primitive variant on the left (25% in PMH versus 19 % in SAH, p=0.65) or on the right side (31% in PMH versus 30% in SAH, p=0.92) in univariate analysis. After correction for age and sex, variants on neither side were associated with PMH (OR 1.4 , p=0.53 for left variants, OR 1.2 , p=0.67 for right variants). Conclusions—In this large controlled study we were unable to confirm a contribution of a primitive variant of the basal vein of Rosenthal in the pathogenesis of PMH. Key Words: basal vein of Rosenthal, perimesencephalic hemorrhage, subarachnoid hemorrhage, angiography

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

05
Variants of the basal vein of Rosenthal and perimesencephalic nonaneurysmal haemorrhage
T. Daenekindt G. Wilms V. Thijs F. Van Calenbergh

University Hospital Leuven

BELGIUM

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

05
Variants of the basal vein of Rosenthal and perimesencephalic nonaneurysmal haemorrhage
T. Daenekindt G. Wilms V. Thijs F. Van Calenbergh

University Hospital Leuven

BELGIUM

Oral Session:
Poster Session: First Visit
Date: Wednesday 17 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

05
Variants of the basal vein of Rosenthal and perimesencephalic nonaneurysmal haemorrhage
T. Daenekindt G. Wilms V. Thijs F. Van Calenbergh

University Hospital Leuven

BELGIUM

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Prevalence and characterization of cognitive impairment in subacute stroke
A. Jaillard B. Naegele S. Trabucco-Miguel K. Garambois O. Detante M. Hommel

UnCentre Hospitalier Universitaire de Grenoble

FRANCE

Background. Cognitive impairment (CI), outside dementia, is an important problem after stroke which may hinder functional recovery. Indeed, CI was reported in patients with apparent good recovery, leading to limitations in participation in previous social and professional activities. However the prevalence of CI may vary from 30 to 70%. We aim to (1) To evaluate the prevalence of CI after subacute stroke (2) To determine impaired cognitive domains. Methodology. Patients with first-ever infarction had prospectively neuropsychological evaluation within 1 month after ischemic stroke documented by diffusion MRI sequence if age >/=18 years and Mini Mental state Evaluation (MMSE) was>/=23/30. Evaluation included NIHSS and at day 1 & 15, and Rankin score at 6 months. Neuropsychological tests investigated depression, instrumental functions, memory, executive functions and explored the central executive of working memory (WM) using the PASAT and OWEN tests. Moderate CI was determined by scores <1 SD and severe CI by scores <2 SD. Results. We studied 177 patients and 81 controls. In patients, mean age was 50.6 years, mean MMSE 28.4, and mean Beck depression score was 8.4. Among the patients, 93.2% were impaired in at leat one cognitive test, 84.2% in WM, 82.2% in executive functions and 61.8% in memory. Patients were significantely impaired in comparison with the controls for all tests but short term memory. The cognitive profile of stroke versus control subjects was at best predicted by WM tests, i.e. the PASAT (OR = 0.57 per point; p=0.01) and the spatial WM Owen test (OR = 1.245 per error; p=0.003) after adjsutment for age, sex, level of education and depression. Discussion. Most of patients had CI within 1 month after stroke, WM impairment being the outstanding feature.

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Prevalence and characterization of cognitive impairment in subacute stroke
A. Jaillard B. Naegele S. Trabucco-Miguel K. Garambois O. Detante M. Hommel

UnCentre Hospitalier Universitaire de Grenoble

FRANCE

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Prevalence and characterization of cognitive impairment in subacute stroke
A. Jaillard B. Naegele S. Trabucco-Miguel K. Garambois O. Detante M. Hommel

UnCentre Hospitalier Universitaire de Grenoble

FRANCE

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Prevalence and characterization of cognitive impairment in subacute stroke
A. Jaillard B. Naegele S. Trabucco-Miguel K. Garambois O. Detante M. Hommel

UnCentre Hospitalier Universitaire de Grenoble

FRANCE

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Prevalence and characterization of cognitive impairment in subacute stroke
A. Jaillard B. Naegele S. Trabucco-Miguel K. Garambois O. Detante M. Hommel

UnCentre Hospitalier Universitaire de Grenoble

FRANCE

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Prevalence and characterization of cognitive impairment in subacute stroke
A. Jaillard B. Naegele S. Trabucco-Miguel K. Garambois O. Detante M. Hommel

UnCentre Hospitalier Universitaire de Grenoble

FRANCE

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

23
Assessing the impact of the requirement for consent in a hospital-based stroke study
C. Jackson L. Crossland M. Dennis J. Wardlaw C. Sudlow

University of Edinburgh, Western General Hospital

UNITED KINGDOM

Background We attempted to recruit all subjects attending our hospital with a stroke or transient ischaemic attack into a hospital-based cohort study. Ethical approval required patients or their relatives to give consent for: use of data for research; follow-up via the patient’s general practitioner; follow-up by postal questionnaire; and storage of a research blood sample. We investigated how the need for consent may have biased our cohort. Methods We compared our cohort with a stroke audit occurring in our hospital at the same time, recruiting the same target population, but with no requirement for consent. We obtained numbers of consenters, refusers, and those missed (consent not sought for logistical reasons). We compared several characteristics (age, sex, OCSP stroke subtype, socioeconomic status, admission to stroke unit) of consenters vs non-consenters (refusers + those missed) and consenters vs refusers. Results Of 1202 patients included in the audit over an 18 month period, 1049 (87%) consented to inclusion in the cohort study. Only 11 (0.9%) refused any participation, while 4% did not consent to a research blood sample or questionnaire follow-up. 12% were missed. Compared with non-consenters, consenters were more likely to have TIAs or mild strokes, be admitted to the stroke unit, and to be less socioeconomically deprived, but age and sex distributions were similar. Refusers were slightly older than consenters (mean 78 vs 71 years). We found no other significant differences, but the number of refusers was very small. Conclusions Very few patients refused inclusion in our cohort, but the need for consent introduced bias. An opt-out system for observational studies would minimise bias and reduce the considerable time and costs associated with the consent process.

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

23
Assessing the impact of the requirement for consent in a hospital-based stroke study
C. Jackson L. Crossland M. Dennis J. Wardlaw C. Sudlow

University of Edinburgh, Western General Hospital

UNITED KINGDOM

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

23
Assessing the impact of the requirement for consent in a hospital-based stroke study
C. Jackson L. Crossland M. Dennis J. Wardlaw C. Sudlow

University of Edinburgh, Western General Hospital

UNITED KINGDOM

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

23
Assessing the impact of the requirement for consent in a hospital-based stroke study
C. Jackson L. Crossland M. Dennis J. Wardlaw C. Sudlow

University of Edinburgh, Western General Hospital

UNITED KINGDOM

Oral Session:
Poster Session: Second Visit
Date: Wednesday 17 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

23
Assessing the impact of the requirement for consent in a hospital-based stroke study
C. Jackson L. Crossland M. Dennis J. Wardlaw C. Sudlow

University of Edinburgh, Western General Hospital

UNITED KINGDOM

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

18
Value of Electroencephalography and Transcranial Doppler Monitoring during Autologous Bone Marrow Mononuclear Cells Transplantation In Acute Ischemic Stroke
M.L.Mendonca D.C.Bezerra G.R.de Freitas S.A.Silva R. Mendez-Otero C. Andre R. Borojevic C. Gonzalez C. Falcao H.F.Dohmann

Pro Cardiaco Hospital

BRAZIL

Objective: to assess the feasibility and usefulness of Transcranial Doppler (TCD) and electroencephalography (EEG) monitoring during autologous bone marrow mononuclear cells (BMMC) transplantation for acute stroke. Methods: This phase I open label trial was designed assess the feasibility and safety of BMMC in 10 patients and 5 controls with an ischemic stroke including the territory of the middle cerebral artery (MCA) with spontaneous recanalization confirmed by Magnetic Resonance Angiography, and with a NIHSS score between 4 and 20. Between the third and tenth day after stroke onset, bone marrow cells were aspirated from the posterior iliac crest. On the same day, 30 million BMMC were injected in the MCA via catheter angiography. Brain perfusion with 99mTc-ECD SPECT; PWI/DWI-MRI and brain PET-FDG were performed at baseline and after 7 days, 3 and 6 months of BMMC injection. Results: We report the results of the first 5 treated patients. No EEG abnormalities were detected during BMMC injection. In 4 patients we could detect a mean of 85,5 ± SD 94,9 microembolic signals (MES) during BMMC injection. In one of the patients a high number (228) of MES were detected at the start of the infusion, but after warming the cells at room temperature for 2 minutes the injection procedure could be resumed with no MES recording thereafter. Clinical and neuroimaging assessments at follow-up did not show any new abnormalities compared to baseline. Conclusion: TCD and EEG monitoring appear to be useful adjuncts to increase the safety of BMMC injection. If a high number of MES is detected during the procedure, warming the cells at room temperature seems to be helpful.

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Pro Cardiaco Hospital

BRAZIL

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Pro Cardiaco Hospital

BRAZIL

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Pro Cardiaco Hospital

BRAZIL

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Pro Cardiaco Hospital

BRAZIL

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Pro Cardiaco Hospital

BRAZIL

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Pro Cardiaco Hospital

BRAZIL

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Pro Cardiaco Hospital

BRAZIL

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Pro Cardiaco Hospital

BRAZIL

Oral Session:
Poster Session: Second Visit
Date: Thursday 18 May 2006   Time: 18:00 - 19:30 - Room:
Chair:

Pro Cardiaco Hospital

BRAZIL

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

05
Do hypoperfusion and diffusion changes associated with a high-grade carotid stenosis cause a correctable cognitive deficit?
L. Soinne J. Helenius I. Tikkala E. Saimanen O. Salonen M. Hietanen P.J.Lindsberg M. Kaste

Helsinki University Central Hospital

FINLAND

Background: A high-grade carotid stenosis may impair ipsilateral cerebral perfusion in perfusion-weighted MR imaging (PWI) in part of the subjects and induce a tendency for higher ipsilateral apparent diffusion coefficient (ADC) levels in diffusion-weighted MR imaging (DWI). These findings are improved by carotid endarterectomy (CEA). We aimed to find out whether these features are associated with changes in cognitive performance. Methods: Of the 44 patients (aged 64.3 ± 8.8 years) with a high-grade carotid stenosis (mean ± SD 78.1 ± 8.6 %), 23 were asymptomatic and 21 symptomatic. A neuropsychological battery as well as PWI and DWI were performed thrice: preoperatively, and 4 and 100 days after endarterectomy. Perfusion maps were created blindedly and evaluated by two independent observers, and ADC values representing selected regions of interest were determined for each hemisphere. Healthy volunteers (n=22) matched for sex, age, and education underwent the same three-staged neuropsychological evaluation sequence. Results: Preoperatively, in DWI the ipsilateral ADC values were higher (for white matter 0.69 vs. 0.66, p<.001, ANOVA) and in PWI the mean transit times longer (6.0 vs. 4.9 s, p<.001, ANOVA) than in subsequent measurements. Ten patients (23 %) had a visible ipsilateral perfusion deficit (six out of ten had left-hemisphere and four right-hemisphere deficits). Six patients had DWI deficits at baseline, and two new lesions (4.5 %) were detected in postoperative scans. Baseline cognitive performance of patients tended to be lower than in controls. The postoperative course of cognitive improvement ie. learning effect was comparable to controls regardless of preoperative deficits in PWI or change in ADC values. Discussion: Despite a tendency for lower-level cognitive functioning in patients with a high-grade carotid stenosis, the postoperative course of cognition after CEA displays a comparable learning effect as in healthy controls regardless of changes in cerebral perfusion and diffusion.

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

Helsinki University Central Hospital

FINLAND

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

Helsinki University Central Hospital

FINLAND

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

Helsinki University Central Hospital

FINLAND

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

Helsinki University Central Hospital

FINLAND

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

Helsinki University Central Hospital

FINLAND

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

Helsinki University Central Hospital

FINLAND

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

Helsinki University Central Hospital

FINLAND

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

11
S-100B and NSE identify subtypes of ischemic stroke in the acute phase
G. Andsberg B. Romner J. Malm K. Strandberg E. Danielsson B. Norrving A. Lindgren

Clinical Sciences, Lund

SWEDEN

Background: One important task for the clinician is to design specific treatments for individual stroke patients. It is important to distinguish patients with cardiac embolic and carotid artery disease from patients with small vessel disease. Today there are no biochemical markers in clinical use to help the clinician to identify ischemic subtypes of stroke. Method: We sampled serum, from 103 patients, daily for the first 5 days after the onset of ischemic stroke. Protein S-100B and neuron-specific enolase (NSE) levels were analysed by the use of immunoluminometric assays (Liason). Stroke subtypes were determined with the TOAST classification. Patients with small-vessel occlusion were defined as a small-vessel disease group (SVD; n=34), patients with large-artery disease or cardioembolism as a non-small-vessel disease group (NSVD; n=54), and patients with stroke of undetermined etiology as a cryptogenic group (CRY; n=15). Values are presented as median, the 25th and 75th percentiles. Results: The measurements of S-100B showed significantly higher levels in the NSVD as compared to the SVD group at each time point (day 1: 0,12 (0,08-0,22) vs 0,08 (0,06-0,12), day 2: 0,15 (0,09-0,56) vs 0,10 (0,07-0,14), day 3: 0,19 (0,11-0,60) vs 0,10 (0,08-0,14), day 4: 0,20 (0,10-0,53) vs 0,09 (0,07-0,13), day 5: 0,16 (0,10-0,45) vs 0,09 (0,06-0,15)), whereas for NSE the levels were significantly higher at day 4 and 5 in the NSVD as compared to SVD group (day 4: 11,9 (10,4-15,1) vs 9,2 (7,9-10,7), day 5: 11,5 (10,1-17,3) vs 9,2 (7,4-10,7)). Discussion: This is one of the largest reported studies of multiple biochemical markers of brain damage in ischemic stroke. Measurments of S100B and NSE have a potential to distinguish subtypes of acute ischemic stroke.

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

11
S-100B and NSE identify subtypes of ischemic stroke in the acute phase
G. Andsberg B. Romner J. Malm K. Strandberg E. Danielsson B. Norrving A. Lindgren

Clinical Sciences, Lund

SWEDEN

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

11
S-100B and NSE identify subtypes of ischemic stroke in the acute phase
G. Andsberg B. Romner J. Malm K. Strandberg E. Danielsson B. Norrving A. Lindgren

Clinical Sciences, Lund

SWEDEN

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

11
S-100B and NSE identify subtypes of ischemic stroke in the acute phase
G. Andsberg B. Romner J. Malm K. Strandberg E. Danielsson B. Norrving A. Lindgren

Clinical Sciences, Lund

SWEDEN

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

11
S-100B and NSE identify subtypes of ischemic stroke in the acute phase
G. Andsberg B. Romner J. Malm K. Strandberg E. Danielsson B. Norrving A. Lindgren

Clinical Sciences, Lund

SWEDEN

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

11
S-100B and NSE identify subtypes of ischemic stroke in the acute phase
G. Andsberg B. Romner J. Malm K. Strandberg E. Danielsson B. Norrving A. Lindgren

Clinical Sciences, Lund

SWEDEN

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

11
S-100B and NSE identify subtypes of ischemic stroke in the acute phase
G. Andsberg B. Romner J. Malm K. Strandberg E. Danielsson B. Norrving A. Lindgren

Clinical Sciences, Lund

SWEDEN

Oral Session:Dementia/cognition and gait
Poster Session:
Date: Thursday 18 May 2006 Time: 11:50 - 12:00 - Room: Auditorium 500
Chair: D. Inzitari, Italy and J.-M. Orgogozo, France

06
The Prognostic Value of Working Memory in Subacute Stroke: does it Work?
A. Jaillard S. Trabucco-Miguel B. Naegele K. Garambois O. Detante M. Hommel

UnCentre Hospitalier Universitaire de Grenoble

FRANCE

Background. Cognitive impairment (CI), outside dementia, is an important problem after stroke which might be a key endpoint in prognosis after stroke. CI, and especially working memory (WM) impairment, may limit the participation in social and professional activities. in patients with apparent good recovery. The aim of our study was to evaluate the prognostic value of CI in recovery at 6 months. Methodology. Patients with first-ever infarction had prospectively neuropsychological evaluation within 1 month after ischemic stroke documented by MRI if Mini Mental state Evaluation (MMSE) was>/=23/30. Evaluation included NIHSS and at day 1 & 15, Rankin score at 6 months. Neuropsychological tests investigated depression, instrumental functions, memory, executive functions and explored the central executive of working memory (WM) using the PASAT and OWEN tests. The Rankin scored “0 – 1” (versus >/=2) 6 months after stroke was considered as the indicator of complete recovery. Statistical analysis were performed using logistic regression to evaluate the prognostic value of the Rankin score. Results. Among the 177 stroke patients (mean age 50.6 years) evaluated 14.5 (+/- 8.4) days after stroke, the Rankin score </=1 at 6 months was predicted by depression (OR = 0.89 per point of Beck depression index; p=0.001), NIHSS score at day 15 (OR = 0.75 per point; p=0.04), categorical fluency (OR = 1.1 per point; p=0.001), and Owen spatial WM (OR = 0.98 per between error; p=0.03). Discussion. Impairment of the central executive of WM is a key feature in the evaluation of the prognosis of clinical recovery. These results should lead us to include WM assessment in the pronostic evaluation of stroke patients without serious neurological after-effects.

06
The Prognostic Value of Working Memory in Subacute Stroke: does it Work?
A. Jaillard S. Trabucco-Miguel B. Naegele K. Garambois O. Detante M. Hommel

UnCentre Hospitalier Universitaire de Grenoble

FRANCE

06
The Prognostic Value of Working Memory in Subacute Stroke: does it Work?
A. Jaillard S. Trabucco-Miguel B. Naegele K. Garambois O. Detante M. Hommel

UnCentre Hospitalier Universitaire de Grenoble

FRANCE

06
The Prognostic Value of Working Memory in Subacute Stroke: does it Work?
A. Jaillard S. Trabucco-Miguel B. Naegele K. Garambois O. Detante M. Hommel

UnCentre Hospitalier Universitaire de Grenoble

FRANCE

06
The Prognostic Value of Working Memory in Subacute Stroke: does it Work?
A. Jaillard S. Trabucco-Miguel B. Naegele K. Garambois O. Detante M. Hommel

UnCentre Hospitalier Universitaire de Grenoble

FRANCE

06
The Prognostic Value of Working Memory in Subacute Stroke: does it Work?
A. Jaillard S. Trabucco-Miguel B. Naegele K. Garambois O. Detante M. Hommel

UnCentre Hospitalier Universitaire de Grenoble

FRANCE

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Long-term disability and resource use after stroke – a follow-up analysis from the South London Stroke Register
M.A. Busch N. Fudge C. Coshall I. Burger A. Rudd C. McKevitt C. Wolfe

King's College London, Divison of Health and Social Care Research

UNITED KINGDOM

Background: Many stroke survivors suffer from long-term disability and require continuous support and input from health and social services. To guide allocation of resources and planning of services, information about patient needs and current resource provision is crucial. This study aimed to assess the need for and provision of resources and services in the long term after stroke. Methods: A prospective population-based register of all incident strokes with annual follow-up in a multi-ethnic population of 234 533. Data from all patients registered between 1995 and 2003 were used. Outcomes were disability; institutionalised care; use of formal or informal domiciliary care, community support services, and community rehabilitation. Multivariable analysis was used to examine associations between patient characteristics and resource use. Results: Over 9 years, 2563 patients with incident stroke were registered (median age 73.1 years (range 15-106), 49.2% men, 17.8% black ethnicity, 54.9% manual occupational class). At 1, 3 and 5 years after their stroke, 26%, 35.6%, and 23.8% of interviewed survivors had at least moderate (Barthel Index<15) and 12.9%, 20% and 10.9% severe (<10) disability, respectively; 22.9%, 11.7% and 10.4% received community rehabilitation, with physiotherapy being the most common type; 12.7%, 15% and 14.9% were living in institutionalised care. At 3 and 5 years post stroke, 76.8% and 79.7% of those living at home had some support from informal, 24.1% and 21.8% from formal carers for everyday activities; 16.9% and 18.7% received community services such as meals on wheels or day centre care. Conclusions: Stroke survivors in south London had high levels of persisting disability and support with everyday activities. Resource use remained comparatively stable after the first year post stroke except for community rehabilitation.

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Long-term disability and resource use after stroke – a follow-up analysis from the South London Stroke Register
M.A. Busch N. Fudge C. Coshall I. Burger A. Rudd C. McKevitt C. Wolfe

King's College London, Divison of Health and Social Care Research

UNITED KINGDOM

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Long-term disability and resource use after stroke – a follow-up analysis from the South London Stroke Register
M.A. Busch N. Fudge C. Coshall I. Burger A. Rudd C. McKevitt C. Wolfe

King's College London, Divison of Health and Social Care Research

UNITED KINGDOM

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Long-term disability and resource use after stroke – a follow-up analysis from the South London Stroke Register
M.A. Busch N. Fudge C. Coshall I. Burger A. Rudd C. McKevitt C. Wolfe

King's College London, Divison of Health and Social Care Research

UNITED KINGDOM

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Long-term disability and resource use after stroke – a follow-up analysis from the South London Stroke Register
M.A. Busch N. Fudge C. Coshall I. Burger A. Rudd C. McKevitt C. Wolfe

King's College London, Divison of Health and Social Care Research

UNITED KINGDOM

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Long-term disability and resource use after stroke – a follow-up analysis from the South London Stroke Register
M.A. Busch N. Fudge C. Coshall I. Burger A. Rudd C. McKevitt C. Wolfe

King's College London, Divison of Health and Social Care Research

UNITED KINGDOM

Oral Session:
Poster Session: First Visit
Date: Thursday 18 May 2006   Time: 12:30 - 14:00 - Room:
Chair:

06
Long-term disability and resource use after stroke – a follow-up analysis from the South London Stroke Register
M.A. Busch N. Fudge C. Coshall I. Burger A. Rudd C. McKevitt C. Wolfe

King's College London, Divison of Health and Social Care Research

UNITED KINGDOM

Oral Session:Acute stroke: complications and early outcome
Poster Session:
Date: Thursday 18 May 2006 Time: 14:20 - 14:30 - Room: Auditorium 500
Chair: S. Blecic, Belgium and D. Toni, Italy

03
Leukoaraiosis and lacunes are associated with symptomatic intracerebral hemorrhage in patients with acute ischemic stroke receiving systemic thrombolysis: the CASES study
V. Palumbo J.M.Boulanger A.M.Buchan M.D.Hill
on behalf of the CASES Investigators

University of Calgary

ITALY

Background: The presence of leukoaraiosis (LA) on baseline computed tomography (CT) is commonly considered related to hemorrhagic complications in patients with acute ischemic stroke treated with intravenous thrombolysis. We aim to evaluate whether the presence of LA, lacunes and old infarcts is associated to symptomatic intracerebral hemorrhage (sICH), by systematically reviewing the CT scans in the CASES study. Methods: Out of 936 CT scans, 820 were available for reading. LA was evaluated with Van Swieten Score (VSS), applied separately to each hemisphere. A VSS>4 accounted for the presence of severe LA (based on the sum of the score in the 2 hemispheres), while the number of lacunes was dichotomized into 2 or more versus 1 or none. A reliability test was performed in 40 scans. The remaining 780 scans were evaluated independently by 2 readers, blind to clinical information and follow-up imaging. Logistic regression was used to determine if an interaction existed between presence and degree of LA and risk of sICH. Similarly, the predictive role of lacunes and old infarcts was explored. Results: An overall sICH rate of 3.5% was observed. The rate of sICH increased in patients with severe LA (6/71, 8.4%) and in presence of 2 or more lacunes (7/70, 10%). A significant association was observed between sICH risk and both severe LA (RR=2.7 [95% confidence interval 1.1-6.5], p=0.03) and multiple lacunes (RR=3.4 [95% confidence interval 1.5-7.6], p=0.008). No relation was found with presence of old infarcts. In the multivariable logistic regression there was a preserved effect and only elevated blood glucose was also a predictor of sICH. Conclusion: The presence of multiple lacunes and severe LA significantly increases the risk of sICH in the CASES population.

University of Calgary

ITALY

University of Calgary

ITALY

University of Calgary

ITALY

Oral Session:Acute stroke: clinical patterns and practise
Poster Session:
Date: Thursday 18 May 2006 Time: 11:50 - 12:00 - Room: Room 1121
Chair: H. Mattle, Switzerland and J.L. Marti-Vilalta, Spain

06
Diagnostic sensitivity of Recognition of Stroke in the Emergency Room (ROSIER) scale compared to other stroke recognition instruments in an Emergency Room setting
G.A.Ford A. Mohd Nor

Newcastle University

UNITED KINGDOM

Background. Early stroke recognition in the Emergency Room (ER) is important. We developed the ROSIER to aid early recognition of stroke in the ER. We compared the performance of ROSIER to existing paramedic stroke scales; MASS (Melbourne Ambulance Stroke Screen), FAST (Face Arm Speech Test), CPSS (Cincinnati Pre-Hospital Stroke Scale), LAPSS (Los Angeles Pre-Hospital Stroke Screen). Methods. Data were prospectively collected on all patients with suspected stroke or TIA with symptoms seen in the ER over a 9 month period. ROSIER was completed by ER physicians prior to brain CT/MRI. Patients with suspected stroke, irrespective of the ROSIER score were then transferred to the Acute Stroke Unit. All patients were examined by a research neurologist (95%) or senior stroke unit physician. Diagnostic sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each scale; ROSIER (loss of consciousness, seizure, face/arm/leg weakness, speech disturbance, visual field defect, glucose > 3.5 mmol/l); CPSS (face/arm weakness, speech disturbance); (FAST (face/arm weakness, speech disturbance, Glasgow Coma Score >6); LAPSS (face/ arm / grip weakness, glucose 2.8- 22.2 mmol/l, age > 45 years, no seizure activity, symptoms < 24hr, patient not wheelchair bound or bedridden); MASS (combined CPSS and LAPSS items). Results. 160 suspected stroke patients were seen; 88 stroke (91% ischaemic), 59 non-stroke, 13 TIA with symptoms, age (mean, SD) stroke (71 +/- 14), non-stroke (72 +/- 16) years. Commonest stroke mimics were syncope (24%), seizure (14%), sepsis (14%) and somatisation disorders (12%). Diagnostic profiles were (sensitivity, specificity, PPV, NPV); ROSIER 93%, 83%, 90%, 88%; FAST (82%, 83%, 89%, 73%); CPSS (85%, 79%, 88%, 75%); LAPSS (59%, 85%, 87%, 55%); MASS (78%, 85%, 90%, 69%). Conclusions. The ROSIER scale demonstrates greater sensitivity than existing pre-hospital stroke recognition instruments in the ER setting.

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Diagnostic sensitivity of Recognition of Stroke in the Emergency Room (ROSIER) scale compared to other stroke recognition instruments in an Emergency Room setting
G.A.Ford A. Mohd Nor

Newcastle University

UNITED KINGDOM

Oral Session:Acute stroke: treatment concepts
Poster Session:
Date: Thursday 18 May 2006 Time: 17:30 - 17:40 - Room: Auditorium 500
Chair: M. Hommel, France and N. Bornstein, Israel

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TRENDS OF ANTITHROMBOTIC USE IN PATIENTS WITH NON-VALULAR ATRIAL FIBRILLATION IN THE COMMUNITY AND IN A TEACHNG HOSPITAL
V. Peppes K. Takis J. Revela K. Xynos M. Saliaris C. Zafeiriou M. Synetou K. Vemmos

Alexandra Hospital, University of Athens

GREECE

Background: Limited data are available concerning trends in use of oral anticoagulants (OAC) or aspirin over time in patients with atrial fibrillation (AF). The objective^ of this study was to evaluate physicians’ attitudes in current clinical practice of OAC or aspirin use among patients with AF. Methods: Medical records of hospitalized patients for the years 1991, 1996 and 2001 were searched to identify cases with AF diagnosis in a University Hospital. Stroke risk stratification was based on Atrial Fibrillation Investigators guidelines in high risk and low risk group. Antithrombotics were recorded a) for the last week prior to admission (attitude of primary community physicians) and b) recommendation on hospital discharge (attitude of academic physicians). Statistical analysis by X^2 test for trend was used. Results: Based on our inclusion criteria we recruited 192, 181, and 191 cases with AF for the years 1991, 1996, and 2001 respectively. In the high risk group OAC use by community physicians increased from 15.7% in 1991 to 37.6% in 2001 (X^2 for trend 15.9, p<0.001), while the corresponding percentages for academic physicians were 15.1% in 1991 to 60.7% in 2001 (X^2 for trend 70.1, p<0.001). A substantial proportion of high risk patients in 2001 were on aspirin (29%) or no therapy (33.5%) in the community setting, while the corresponding values for patients discharged from an academic hospital were 22.5% and 16.8%. In the low risk group conversely the majority of AF patients were on OAC (61%) in the community setting and in academic practice (83%). Discussion:Despite the increased use of OAC over time for primary prevention in AF patients, many patients were treated inappropriately based on risk stratification criteria, especially those under primary care physicians.

Alexandra Hospital, University of Athens

GREECE

Alexandra Hospital, University of Athens

GREECE

Alexandra Hospital, University of Athens

GREECE

Alexandra Hospital, University of Athens

GREECE

Alexandra Hospital, University of Athens

GREECE