XVI. European Stroke Conference
Glasgow, United Kingdom
29 May - 1 June 2007

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Kind of presentation: Poster 
   
Poster Session I
Date: Wednedsay, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

03
Predictors of Adherence to Treatment in Secondary Stroke Prevention
S.E.Ireland    M.A.Arthur    E.  Gunn    W.  Oczkowski                                          
 

Hamilton Health Sciences & McMaster University

UNITED KINGDOM

Background: This study was conducted to determine to what extent demographic, social psychological, physiological, adherence, and family practitioner follow-up characteristics predict achievement of blood pressure and/or glycated hemoglobin targets in patients with TIA or stroke attending a stroke prevention clinic (SPC). Methods: Using a prospective cohort design, 313 patients were recruited from referrals to a SPC. Of the 313 baseline participants, 77 had confirmed TIA or stroke plus hypertension and/or diabetes (study group). At intake, all provided demographic data and were administered the Modified Mini Mental State and Mini Mental State (MMS) examinations, Trail Making Test, Clock Drawing Test, medication self-efficacy (SE) scale, Lubben Social Network Scale, and Geriatric Depression Scale. Family practitioner follow-up was ascertained 2 months later. The study group (n=77) completed tests of adherence, blood pressure and/or glycated hemoglobin 5 months after baseline. Results: TIA was confirmed in 65% and stroke in 35% of the study group. Mean age was 69 years. Fifty-three percent were male; 20% reported <9 years of education. Ninety-six percent had hypertension and 27% were diabetic. Twenty-three percent were not followed-up by family practitioners. Although 97% reported => 80% adherence to medication regimens, only 57% met targets. Logistic regression analysis identified 3 predictors of achieving therapeutic targets: 1) SE expectations (OR 1.61; 95% CI, 1.03-2.54; p=0.04), 2) MMS (OR 1.28; 95% CI, 1.06-1.54; p=0.009); and 3) self-reported adherence (OR 1.14; 95% CI, 1.01-1.29; p=0.03). Discussion: Three simple screening measures will identify patients who are at increased risk of not achieving targets. The inclusion of cognition, self-efficacy and adherence screening data in tailoring treatment plans and developing behavioural risk reduction programs has potential to contribute to improved risk factor management in this population

Kind of presentation: Poster 
   
Poster Session I
Date: Wednedsay, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

03
Predictors of Adherence to Treatment in Secondary Stroke Prevention
S.E.Ireland    M.A.Arthur    E.  Gunn    W.  Oczkowski                                          
 

Hamilton Health Sciences & McMaster University

UNITED KINGDOM

Background: This study was conducted to determine to what extent demographic, social psychological, physiological, adherence, and family practitioner follow-up characteristics predict achievement of blood pressure and/or glycated hemoglobin targets in patients with TIA or stroke attending a stroke prevention clinic (SPC). Methods: Using a prospective cohort design, 313 patients were recruited from referrals to a SPC. Of the 313 baseline participants, 77 had confirmed TIA or stroke plus hypertension and/or diabetes (study group). At intake, all provided demographic data and were administered the Modified Mini Mental State and Mini Mental State (MMS) examinations, Trail Making Test, Clock Drawing Test, medication self-efficacy (SE) scale, Lubben Social Network Scale, and Geriatric Depression Scale. Family practitioner follow-up was ascertained 2 months later. The study group (n=77) completed tests of adherence, blood pressure and/or glycated hemoglobin 5 months after baseline. Results: TIA was confirmed in 65% and stroke in 35% of the study group. Mean age was 69 years. Fifty-three percent were male; 20% reported <9 years of education. Ninety-six percent had hypertension and 27% were diabetic. Twenty-three percent were not followed-up by family practitioners. Although 97% reported => 80% adherence to medication regimens, only 57% met targets. Logistic regression analysis identified 3 predictors of achieving therapeutic targets: 1) SE expectations (OR 1.61; 95% CI, 1.03-2.54; p=0.04), 2) MMS (OR 1.28; 95% CI, 1.06-1.54; p=0.009); and 3) self-reported adherence (OR 1.14; 95% CI, 1.01-1.29; p=0.03). Discussion: Three simple screening measures will identify patients who are at increased risk of not achieving targets. The inclusion of cognition, self-efficacy and adherence screening data in tailoring treatment plans and developing behavioural risk reduction programs has potential to contribute to improved risk factor management in this population

Kind of presentation: Poster 
   
Poster Session I
Date: Wednedsay, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

03
Predictors of Adherence to Treatment in Secondary Stroke Prevention
S.E.Ireland    M.A.Arthur    E.  Gunn    W.  Oczkowski                                          
 

Hamilton Health Sciences & McMaster University

UNITED KINGDOM

Background: This study was conducted to determine to what extent demographic, social psychological, physiological, adherence, and family practitioner follow-up characteristics predict achievement of blood pressure and/or glycated hemoglobin targets in patients with TIA or stroke attending a stroke prevention clinic (SPC). Methods: Using a prospective cohort design, 313 patients were recruited from referrals to a SPC. Of the 313 baseline participants, 77 had confirmed TIA or stroke plus hypertension and/or diabetes (study group). At intake, all provided demographic data and were administered the Modified Mini Mental State and Mini Mental State (MMS) examinations, Trail Making Test, Clock Drawing Test, medication self-efficacy (SE) scale, Lubben Social Network Scale, and Geriatric Depression Scale. Family practitioner follow-up was ascertained 2 months later. The study group (n=77) completed tests of adherence, blood pressure and/or glycated hemoglobin 5 months after baseline. Results: TIA was confirmed in 65% and stroke in 35% of the study group. Mean age was 69 years. Fifty-three percent were male; 20% reported <9 years of education. Ninety-six percent had hypertension and 27% were diabetic. Twenty-three percent were not followed-up by family practitioners. Although 97% reported => 80% adherence to medication regimens, only 57% met targets. Logistic regression analysis identified 3 predictors of achieving therapeutic targets: 1) SE expectations (OR 1.61; 95% CI, 1.03-2.54; p=0.04), 2) MMS (OR 1.28; 95% CI, 1.06-1.54; p=0.009); and 3) self-reported adherence (OR 1.14; 95% CI, 1.01-1.29; p=0.03). Discussion: Three simple screening measures will identify patients who are at increased risk of not achieving targets. The inclusion of cognition, self-efficacy and adherence screening data in tailoring treatment plans and developing behavioural risk reduction programs has potential to contribute to improved risk factor management in this population

Kind of presentation: Poster 
   
Poster Session I
Date: Wednedsay, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

03
Predictors of Adherence to Treatment in Secondary Stroke Prevention
S.E.Ireland    M.A.Arthur    E.  Gunn    W.  Oczkowski                                          
 

Hamilton Health Sciences & McMaster University

UNITED KINGDOM

Background: This study was conducted to determine to what extent demographic, social psychological, physiological, adherence, and family practitioner follow-up characteristics predict achievement of blood pressure and/or glycated hemoglobin targets in patients with TIA or stroke attending a stroke prevention clinic (SPC). Methods: Using a prospective cohort design, 313 patients were recruited from referrals to a SPC. Of the 313 baseline participants, 77 had confirmed TIA or stroke plus hypertension and/or diabetes (study group). At intake, all provided demographic data and were administered the Modified Mini Mental State and Mini Mental State (MMS) examinations, Trail Making Test, Clock Drawing Test, medication self-efficacy (SE) scale, Lubben Social Network Scale, and Geriatric Depression Scale. Family practitioner follow-up was ascertained 2 months later. The study group (n=77) completed tests of adherence, blood pressure and/or glycated hemoglobin 5 months after baseline. Results: TIA was confirmed in 65% and stroke in 35% of the study group. Mean age was 69 years. Fifty-three percent were male; 20% reported <9 years of education. Ninety-six percent had hypertension and 27% were diabetic. Twenty-three percent were not followed-up by family practitioners. Although 97% reported => 80% adherence to medication regimens, only 57% met targets. Logistic regression analysis identified 3 predictors of achieving therapeutic targets: 1) SE expectations (OR 1.61; 95% CI, 1.03-2.54; p=0.04), 2) MMS (OR 1.28; 95% CI, 1.06-1.54; p=0.009); and 3) self-reported adherence (OR 1.14; 95% CI, 1.01-1.29; p=0.03). Discussion: Three simple screening measures will identify patients who are at increased risk of not achieving targets. The inclusion of cognition, self-efficacy and adherence screening data in tailoring treatment plans and developing behavioural risk reduction programs has potential to contribute to improved risk factor management in this population

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

18
What factors influence early recanalisation during thrombolysis in acute ischemic stroke?
L. Sekoranja    H. Yilmaz     K. Lovblad    R. Grandjean    P. Temperli    R. Sztajzel                            
 

University Hospital of Geneva

SWITZERLAND

Purpose: we evaluated the factors determining récanalisation after thrombolysis. Patients /methods: patients with acute ischemic stroke (AIS) of < 3 h underwent either IV or combined IV-IA lysis, if no recanalisation after 30’. CT-angiography was done in all p and monitoring with TCCD during 60’ in case of IV and during 30’ in case of IV-IA lysis. TIBI was used to assess the residual MCA flow before the lysis and to evaluate presence or absence of early recanalisation (TIBI >1 at 30’). Results: 54 patients, 30 M, mean age 68.1 y. 33 p had IV and 21 IV-IA lysis. 43 (80%) p had an MCA and 11 (20%) a T occlusion. Hypertension had 30 (55%), DM 8 (15%), and AF 23 p (43%); 18 (33%) were on ASA and 11 (20%) on statins. Thrombolytic was given within 60 to 230’. NIHSS ranged from 5 to 21. Fifteen (27%) p had a TIBI 0 before lysis, 9 a grade of 1(16%), 12 (22%) grade of 2 and 18 (33%) grade of 3; 17 (31%) p received contrast because of insufficient temporal window. After lysis 25 (46%) p improved > 4 points on NIHSS. Factors increasing the early recanalisation in univariate analysis: TIBI 1 to 3 respectively OR 8.1, 95% CI 1.1 to 59, p= 0.039; OR 8.7, CI 95% 1.3 to 59, p= 0.021 and OR 15.6; 95% CI 2.7 to 103, p= 0.002. The factors decreasing the early recanalisation: T occlusion OR 0.02, 95% CI 0.003 to 0.20, p 0.001; M1 occlusion OR 0.11 95% CI 0.02 to 0.6, p 0.011. In a multivariate analysis factors increasing the likelihood of early recanalisation: TIBI grades 1 to 3 respectively OR 11.9 95% CI 0.4 to 4.1, p= 0.025; OR 13.8, CI 95% 1.3 to 105, p= 0.014 and OR 24.7; 95% CI 0.07 to 1.1, p= 0.075 and atrial fibrillation OR 0.28, 95% CI 0.07 to 1.1, p 0.075. Conclusion : Presence of a residual flow of the MCA on TCCD (TIBI 1 to 3) was the best predictor of early recanalisation; presence of T or M1 segment occlusion on Angio-CT were associated with a lower one, however only on univariate analysis.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

18
What factors influence early recanalisation during thrombolysis in acute ischemic stroke?
L. Sekoranja    H. Yilmaz     K. Lovblad    R. Grandjean    P. Temperli    R. Sztajzel                            
 

University Hospital of Geneva

SWITZERLAND

Purpose: we evaluated the factors determining récanalisation after thrombolysis. Patients /methods: patients with acute ischemic stroke (AIS) of < 3 h underwent either IV or combined IV-IA lysis, if no recanalisation after 30’. CT-angiography was done in all p and monitoring with TCCD during 60’ in case of IV and during 30’ in case of IV-IA lysis. TIBI was used to assess the residual MCA flow before the lysis and to evaluate presence or absence of early recanalisation (TIBI >1 at 30’). Results: 54 patients, 30 M, mean age 68.1 y. 33 p had IV and 21 IV-IA lysis. 43 (80%) p had an MCA and 11 (20%) a T occlusion. Hypertension had 30 (55%), DM 8 (15%), and AF 23 p (43%); 18 (33%) were on ASA and 11 (20%) on statins. Thrombolytic was given within 60 to 230’. NIHSS ranged from 5 to 21. Fifteen (27%) p had a TIBI 0 before lysis, 9 a grade of 1(16%), 12 (22%) grade of 2 and 18 (33%) grade of 3; 17 (31%) p received contrast because of insufficient temporal window. After lysis 25 (46%) p improved > 4 points on NIHSS. Factors increasing the early recanalisation in univariate analysis: TIBI 1 to 3 respectively OR 8.1, 95% CI 1.1 to 59, p= 0.039; OR 8.7, CI 95% 1.3 to 59, p= 0.021 and OR 15.6; 95% CI 2.7 to 103, p= 0.002. The factors decreasing the early recanalisation: T occlusion OR 0.02, 95% CI 0.003 to 0.20, p 0.001; M1 occlusion OR 0.11 95% CI 0.02 to 0.6, p 0.011. In a multivariate analysis factors increasing the likelihood of early recanalisation: TIBI grades 1 to 3 respectively OR 11.9 95% CI 0.4 to 4.1, p= 0.025; OR 13.8, CI 95% 1.3 to 105, p= 0.014 and OR 24.7; 95% CI 0.07 to 1.1, p= 0.075 and atrial fibrillation OR 0.28, 95% CI 0.07 to 1.1, p 0.075. Conclusion : Presence of a residual flow of the MCA on TCCD (TIBI 1 to 3) was the best predictor of early recanalisation; presence of T or M1 segment occlusion on Angio-CT were associated with a lower one, however only on univariate analysis.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

18
What factors influence early recanalisation during thrombolysis in acute ischemic stroke?
L. Sekoranja    H. Yilmaz     K. Lovblad    R. Grandjean    P. Temperli    R. Sztajzel                            
 

University Hospital of Geneva

SWITZERLAND

Purpose: we evaluated the factors determining récanalisation after thrombolysis. Patients /methods: patients with acute ischemic stroke (AIS) of < 3 h underwent either IV or combined IV-IA lysis, if no recanalisation after 30’. CT-angiography was done in all p and monitoring with TCCD during 60’ in case of IV and during 30’ in case of IV-IA lysis. TIBI was used to assess the residual MCA flow before the lysis and to evaluate presence or absence of early recanalisation (TIBI >1 at 30’). Results: 54 patients, 30 M, mean age 68.1 y. 33 p had IV and 21 IV-IA lysis. 43 (80%) p had an MCA and 11 (20%) a T occlusion. Hypertension had 30 (55%), DM 8 (15%), and AF 23 p (43%); 18 (33%) were on ASA and 11 (20%) on statins. Thrombolytic was given within 60 to 230’. NIHSS ranged from 5 to 21. Fifteen (27%) p had a TIBI 0 before lysis, 9 a grade of 1(16%), 12 (22%) grade of 2 and 18 (33%) grade of 3; 17 (31%) p received contrast because of insufficient temporal window. After lysis 25 (46%) p improved > 4 points on NIHSS. Factors increasing the early recanalisation in univariate analysis: TIBI 1 to 3 respectively OR 8.1, 95% CI 1.1 to 59, p= 0.039; OR 8.7, CI 95% 1.3 to 59, p= 0.021 and OR 15.6; 95% CI 2.7 to 103, p= 0.002. The factors decreasing the early recanalisation: T occlusion OR 0.02, 95% CI 0.003 to 0.20, p 0.001; M1 occlusion OR 0.11 95% CI 0.02 to 0.6, p 0.011. In a multivariate analysis factors increasing the likelihood of early recanalisation: TIBI grades 1 to 3 respectively OR 11.9 95% CI 0.4 to 4.1, p= 0.025; OR 13.8, CI 95% 1.3 to 105, p= 0.014 and OR 24.7; 95% CI 0.07 to 1.1, p= 0.075 and atrial fibrillation OR 0.28, 95% CI 0.07 to 1.1, p 0.075. Conclusion : Presence of a residual flow of the MCA on TCCD (TIBI 1 to 3) was the best predictor of early recanalisation; presence of T or M1 segment occlusion on Angio-CT were associated with a lower one, however only on univariate analysis.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

18
What factors influence early recanalisation during thrombolysis in acute ischemic stroke?
L. Sekoranja    H. Yilmaz     K. Lovblad    R. Grandjean    P. Temperli    R. Sztajzel                            
 

University Hospital of Geneva

SWITZERLAND

Purpose: we evaluated the factors determining récanalisation after thrombolysis. Patients /methods: patients with acute ischemic stroke (AIS) of < 3 h underwent either IV or combined IV-IA lysis, if no recanalisation after 30’. CT-angiography was done in all p and monitoring with TCCD during 60’ in case of IV and during 30’ in case of IV-IA lysis. TIBI was used to assess the residual MCA flow before the lysis and to evaluate presence or absence of early recanalisation (TIBI >1 at 30’). Results: 54 patients, 30 M, mean age 68.1 y. 33 p had IV and 21 IV-IA lysis. 43 (80%) p had an MCA and 11 (20%) a T occlusion. Hypertension had 30 (55%), DM 8 (15%), and AF 23 p (43%); 18 (33%) were on ASA and 11 (20%) on statins. Thrombolytic was given within 60 to 230’. NIHSS ranged from 5 to 21. Fifteen (27%) p had a TIBI 0 before lysis, 9 a grade of 1(16%), 12 (22%) grade of 2 and 18 (33%) grade of 3; 17 (31%) p received contrast because of insufficient temporal window. After lysis 25 (46%) p improved > 4 points on NIHSS. Factors increasing the early recanalisation in univariate analysis: TIBI 1 to 3 respectively OR 8.1, 95% CI 1.1 to 59, p= 0.039; OR 8.7, CI 95% 1.3 to 59, p= 0.021 and OR 15.6; 95% CI 2.7 to 103, p= 0.002. The factors decreasing the early recanalisation: T occlusion OR 0.02, 95% CI 0.003 to 0.20, p 0.001; M1 occlusion OR 0.11 95% CI 0.02 to 0.6, p 0.011. In a multivariate analysis factors increasing the likelihood of early recanalisation: TIBI grades 1 to 3 respectively OR 11.9 95% CI 0.4 to 4.1, p= 0.025; OR 13.8, CI 95% 1.3 to 105, p= 0.014 and OR 24.7; 95% CI 0.07 to 1.1, p= 0.075 and atrial fibrillation OR 0.28, 95% CI 0.07 to 1.1, p 0.075. Conclusion : Presence of a residual flow of the MCA on TCCD (TIBI 1 to 3) was the best predictor of early recanalisation; presence of T or M1 segment occlusion on Angio-CT were associated with a lower one, however only on univariate analysis.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

18
What factors influence early recanalisation during thrombolysis in acute ischemic stroke?
L. Sekoranja    H. Yilmaz     K. Lovblad    R. Grandjean    P. Temperli    R. Sztajzel                            
 

University Hospital of Geneva

SWITZERLAND

Purpose: we evaluated the factors determining récanalisation after thrombolysis. Patients /methods: patients with acute ischemic stroke (AIS) of < 3 h underwent either IV or combined IV-IA lysis, if no recanalisation after 30’. CT-angiography was done in all p and monitoring with TCCD during 60’ in case of IV and during 30’ in case of IV-IA lysis. TIBI was used to assess the residual MCA flow before the lysis and to evaluate presence or absence of early recanalisation (TIBI >1 at 30’). Results: 54 patients, 30 M, mean age 68.1 y. 33 p had IV and 21 IV-IA lysis. 43 (80%) p had an MCA and 11 (20%) a T occlusion. Hypertension had 30 (55%), DM 8 (15%), and AF 23 p (43%); 18 (33%) were on ASA and 11 (20%) on statins. Thrombolytic was given within 60 to 230’. NIHSS ranged from 5 to 21. Fifteen (27%) p had a TIBI 0 before lysis, 9 a grade of 1(16%), 12 (22%) grade of 2 and 18 (33%) grade of 3; 17 (31%) p received contrast because of insufficient temporal window. After lysis 25 (46%) p improved > 4 points on NIHSS. Factors increasing the early recanalisation in univariate analysis: TIBI 1 to 3 respectively OR 8.1, 95% CI 1.1 to 59, p= 0.039; OR 8.7, CI 95% 1.3 to 59, p= 0.021 and OR 15.6; 95% CI 2.7 to 103, p= 0.002. The factors decreasing the early recanalisation: T occlusion OR 0.02, 95% CI 0.003 to 0.20, p 0.001; M1 occlusion OR 0.11 95% CI 0.02 to 0.6, p 0.011. In a multivariate analysis factors increasing the likelihood of early recanalisation: TIBI grades 1 to 3 respectively OR 11.9 95% CI 0.4 to 4.1, p= 0.025; OR 13.8, CI 95% 1.3 to 105, p= 0.014 and OR 24.7; 95% CI 0.07 to 1.1, p= 0.075 and atrial fibrillation OR 0.28, 95% CI 0.07 to 1.1, p 0.075. Conclusion : Presence of a residual flow of the MCA on TCCD (TIBI 1 to 3) was the best predictor of early recanalisation; presence of T or M1 segment occlusion on Angio-CT were associated with a lower one, however only on univariate analysis.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

18
What factors influence early recanalisation during thrombolysis in acute ischemic stroke?
L. Sekoranja    H. Yilmaz     K. Lovblad    R. Grandjean    P. Temperli    R. Sztajzel                            
 

University Hospital of Geneva

SWITZERLAND

Purpose: we evaluated the factors determining récanalisation after thrombolysis. Patients /methods: patients with acute ischemic stroke (AIS) of < 3 h underwent either IV or combined IV-IA lysis, if no recanalisation after 30’. CT-angiography was done in all p and monitoring with TCCD during 60’ in case of IV and during 30’ in case of IV-IA lysis. TIBI was used to assess the residual MCA flow before the lysis and to evaluate presence or absence of early recanalisation (TIBI >1 at 30’). Results: 54 patients, 30 M, mean age 68.1 y. 33 p had IV and 21 IV-IA lysis. 43 (80%) p had an MCA and 11 (20%) a T occlusion. Hypertension had 30 (55%), DM 8 (15%), and AF 23 p (43%); 18 (33%) were on ASA and 11 (20%) on statins. Thrombolytic was given within 60 to 230’. NIHSS ranged from 5 to 21. Fifteen (27%) p had a TIBI 0 before lysis, 9 a grade of 1(16%), 12 (22%) grade of 2 and 18 (33%) grade of 3; 17 (31%) p received contrast because of insufficient temporal window. After lysis 25 (46%) p improved > 4 points on NIHSS. Factors increasing the early recanalisation in univariate analysis: TIBI 1 to 3 respectively OR 8.1, 95% CI 1.1 to 59, p= 0.039; OR 8.7, CI 95% 1.3 to 59, p= 0.021 and OR 15.6; 95% CI 2.7 to 103, p= 0.002. The factors decreasing the early recanalisation: T occlusion OR 0.02, 95% CI 0.003 to 0.20, p 0.001; M1 occlusion OR 0.11 95% CI 0.02 to 0.6, p 0.011. In a multivariate analysis factors increasing the likelihood of early recanalisation: TIBI grades 1 to 3 respectively OR 11.9 95% CI 0.4 to 4.1, p= 0.025; OR 13.8, CI 95% 1.3 to 105, p= 0.014 and OR 24.7; 95% CI 0.07 to 1.1, p= 0.075 and atrial fibrillation OR 0.28, 95% CI 0.07 to 1.1, p 0.075. Conclusion : Presence of a residual flow of the MCA on TCCD (TIBI 1 to 3) was the best predictor of early recanalisation; presence of T or M1 segment occlusion on Angio-CT were associated with a lower one, however only on univariate analysis.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

13
Biomarkers for diagnosis of acute Stroke
R. Ewerhart    P. Kiwitt    U. Missler    H. Grehl                                          
 

Evangelisches und Johanniter Klinikum Niederrhein, Duisburg

GERMANY

Background: Until now, the test of single biomarkers of peripheral blood for the diagnosis of a stroke has not been successful in clinical terms. A commercially available test system uses a panel base to measure four biomarkers (D-dimer, MMP-9, S-100beta and BNP), which allows the calculation of a dimensionless Multimarker IndexTM (MMX) by means of a mathematical algorithm. The aim of the prospective study was to investigate whether, in the case of patients with a stroke confirmed clinically and by scanning, the MMX was elevated compared with other neurological patients. Methods: Blood samples were investigated from 70 consecutive patients who had been admitted with clinical symptoms of an acute stroke to the stroke unit of an intensive care hospital and in whom a stroke could be demonstrated by a brain scan. As a control, 70 acutely ill neurological patients were chosen who exhibited neither clinical symptoms nor imaging evidence of a stroke. The samples were analyzed within one hour upon admission by the Triage® Stroke-Panel test system using the Triage MeterPlus (Biosite Inc., San Diego, CA, USA) instrument. Results: The stroke group had a significantly higher MMX value (mean 4.6; median 4.9; standard deviation 1.73) than the control group (mean 2.9; median 2.9; standard deviation 1.89) (p<0.001). Following correction for age and sex using multivariate analysis of variance, an average MMX value of 4.3 (95%CI: 4.0–4.8) was obtained in the case of the stroke group compared with an average MMX value of 3.0 (95%CI: 2.6–3.4) for the control group (p<0.05). A MMX value of >/=4.0 was observed in 53/70 of the stroke patients and 23/70 of the controls, affording a sensitivity of 0.757 and a specificity of 0.671 for stroke diagnosis. Conclusions: The calculated MMX value is elevated in patients with confirmed stroke compared to other acutely ill neurological patients. The use of the investigated test system could be helpful for the acute diagnosis of stroke.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

13
Biomarkers for diagnosis of acute Stroke
R. Ewerhart    P. Kiwitt    U. Missler    H. Grehl                                          
 

Evangelisches und Johanniter Klinikum Niederrhein, Duisburg

GERMANY

Background: Until now, the test of single biomarkers of peripheral blood for the diagnosis of a stroke has not been successful in clinical terms. A commercially available test system uses a panel base to measure four biomarkers (D-dimer, MMP-9, S-100beta and BNP), which allows the calculation of a dimensionless Multimarker IndexTM (MMX) by means of a mathematical algorithm. The aim of the prospective study was to investigate whether, in the case of patients with a stroke confirmed clinically and by scanning, the MMX was elevated compared with other neurological patients. Methods: Blood samples were investigated from 70 consecutive patients who had been admitted with clinical symptoms of an acute stroke to the stroke unit of an intensive care hospital and in whom a stroke could be demonstrated by a brain scan. As a control, 70 acutely ill neurological patients were chosen who exhibited neither clinical symptoms nor imaging evidence of a stroke. The samples were analyzed within one hour upon admission by the Triage® Stroke-Panel test system using the Triage MeterPlus (Biosite Inc., San Diego, CA, USA) instrument. Results: The stroke group had a significantly higher MMX value (mean 4.6; median 4.9; standard deviation 1.73) than the control group (mean 2.9; median 2.9; standard deviation 1.89) (p<0.001). Following correction for age and sex using multivariate analysis of variance, an average MMX value of 4.3 (95%CI: 4.0–4.8) was obtained in the case of the stroke group compared with an average MMX value of 3.0 (95%CI: 2.6–3.4) for the control group (p<0.05). A MMX value of >/=4.0 was observed in 53/70 of the stroke patients and 23/70 of the controls, affording a sensitivity of 0.757 and a specificity of 0.671 for stroke diagnosis. Conclusions: The calculated MMX value is elevated in patients with confirmed stroke compared to other acutely ill neurological patients. The use of the investigated test system could be helpful for the acute diagnosis of stroke.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

13
Biomarkers for diagnosis of acute Stroke
R. Ewerhart    P. Kiwitt    U. Missler    H. Grehl                                          
 

Evangelisches und Johanniter Klinikum Niederrhein, Duisburg

GERMANY

Background: Until now, the test of single biomarkers of peripheral blood for the diagnosis of a stroke has not been successful in clinical terms. A commercially available test system uses a panel base to measure four biomarkers (D-dimer, MMP-9, S-100beta and BNP), which allows the calculation of a dimensionless Multimarker IndexTM (MMX) by means of a mathematical algorithm. The aim of the prospective study was to investigate whether, in the case of patients with a stroke confirmed clinically and by scanning, the MMX was elevated compared with other neurological patients. Methods: Blood samples were investigated from 70 consecutive patients who had been admitted with clinical symptoms of an acute stroke to the stroke unit of an intensive care hospital and in whom a stroke could be demonstrated by a brain scan. As a control, 70 acutely ill neurological patients were chosen who exhibited neither clinical symptoms nor imaging evidence of a stroke. The samples were analyzed within one hour upon admission by the Triage® Stroke-Panel test system using the Triage MeterPlus (Biosite Inc., San Diego, CA, USA) instrument. Results: The stroke group had a significantly higher MMX value (mean 4.6; median 4.9; standard deviation 1.73) than the control group (mean 2.9; median 2.9; standard deviation 1.89) (p<0.001). Following correction for age and sex using multivariate analysis of variance, an average MMX value of 4.3 (95%CI: 4.0–4.8) was obtained in the case of the stroke group compared with an average MMX value of 3.0 (95%CI: 2.6–3.4) for the control group (p<0.05). A MMX value of >/=4.0 was observed in 53/70 of the stroke patients and 23/70 of the controls, affording a sensitivity of 0.757 and a specificity of 0.671 for stroke diagnosis. Conclusions: The calculated MMX value is elevated in patients with confirmed stroke compared to other acutely ill neurological patients. The use of the investigated test system could be helpful for the acute diagnosis of stroke.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

13
Biomarkers for diagnosis of acute Stroke
R. Ewerhart    P. Kiwitt    U. Missler    H. Grehl                                          
 

Evangelisches und Johanniter Klinikum Niederrhein, Duisburg

GERMANY

Background: Until now, the test of single biomarkers of peripheral blood for the diagnosis of a stroke has not been successful in clinical terms. A commercially available test system uses a panel base to measure four biomarkers (D-dimer, MMP-9, S-100beta and BNP), which allows the calculation of a dimensionless Multimarker IndexTM (MMX) by means of a mathematical algorithm. The aim of the prospective study was to investigate whether, in the case of patients with a stroke confirmed clinically and by scanning, the MMX was elevated compared with other neurological patients. Methods: Blood samples were investigated from 70 consecutive patients who had been admitted with clinical symptoms of an acute stroke to the stroke unit of an intensive care hospital and in whom a stroke could be demonstrated by a brain scan. As a control, 70 acutely ill neurological patients were chosen who exhibited neither clinical symptoms nor imaging evidence of a stroke. The samples were analyzed within one hour upon admission by the Triage® Stroke-Panel test system using the Triage MeterPlus (Biosite Inc., San Diego, CA, USA) instrument. Results: The stroke group had a significantly higher MMX value (mean 4.6; median 4.9; standard deviation 1.73) than the control group (mean 2.9; median 2.9; standard deviation 1.89) (p<0.001). Following correction for age and sex using multivariate analysis of variance, an average MMX value of 4.3 (95%CI: 4.0–4.8) was obtained in the case of the stroke group compared with an average MMX value of 3.0 (95%CI: 2.6–3.4) for the control group (p<0.05). A MMX value of >/=4.0 was observed in 53/70 of the stroke patients and 23/70 of the controls, affording a sensitivity of 0.757 and a specificity of 0.671 for stroke diagnosis. Conclusions: The calculated MMX value is elevated in patients with confirmed stroke compared to other acutely ill neurological patients. The use of the investigated test system could be helpful for the acute diagnosis of stroke.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

17
Costs of stroke borne by individuals and families: user-led development of a patient based cost measure
C. McKevitt    N. Fudge    A. Sriskantharajah    C. Coshall    C. Wolfe                                   
KCL Stroke Research Patients & Family Group

King's College London

UNITED KINGDOM

Background The high costs to the state/health service associated with stroke care are documented in several economic analyses. These provide little information about the costs borne by families/individuals. Our Stroke Research Patients and Family Group (PFG) identified personal costs resulting from stroke as a research priority but methods to assess these costs are not well developed. We report a user-led study to adapt an existing generic, but untested, cost questionnaire for completion by stroke patients. Method PFG discussions and 5 individual qualitative interviews were held to identify preferred research methods and specific cost items. These were used to develop a topic guide for a novel qualitative method, ‘guided conversations’, between 10 stroke survivors/carers. These were recorded, transcribed and analysed to finalise items for the cost measure. The existing generic questionnaire was adapted to incorporate stroke specific items, and reviewed by the PFG to ensure all topics were covered and approve wording. Results User-led qualitative methods led to identification of items to include in a questionnaire. These include: payment for adaptations, medications, alternative therapies, diabetic/organic food, nutritional supplements, clothing suitable for disability, transport; direct and indirect loss of family income. The cost measure was incorporated into a structured interview questionnaire with content validity, for use in a pilot study. Conclusion The PFG identified an under-researched area that they regard as important to understanding the consequences of stroke. Their participation led to the development of a cost measure relevant to the population under study. The measure is currently being piloted with people recruited to the South London Stroke Register.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

17
Costs of stroke borne by individuals and families: user-led development of a patient based cost measure
C. McKevitt    N. Fudge    A. Sriskantharajah    C. Coshall    C. Wolfe                                   
KCL Stroke Research Patients & Family Group

King's College London

UNITED KINGDOM

Background The high costs to the state/health service associated with stroke care are documented in several economic analyses. These provide little information about the costs borne by families/individuals. Our Stroke Research Patients and Family Group (PFG) identified personal costs resulting from stroke as a research priority but methods to assess these costs are not well developed. We report a user-led study to adapt an existing generic, but untested, cost questionnaire for completion by stroke patients. Method PFG discussions and 5 individual qualitative interviews were held to identify preferred research methods and specific cost items. These were used to develop a topic guide for a novel qualitative method, ‘guided conversations’, between 10 stroke survivors/carers. These were recorded, transcribed and analysed to finalise items for the cost measure. The existing generic questionnaire was adapted to incorporate stroke specific items, and reviewed by the PFG to ensure all topics were covered and approve wording. Results User-led qualitative methods led to identification of items to include in a questionnaire. These include: payment for adaptations, medications, alternative therapies, diabetic/organic food, nutritional supplements, clothing suitable for disability, transport; direct and indirect loss of family income. The cost measure was incorporated into a structured interview questionnaire with content validity, for use in a pilot study. Conclusion The PFG identified an under-researched area that they regard as important to understanding the consequences of stroke. Their participation led to the development of a cost measure relevant to the population under study. The measure is currently being piloted with people recruited to the South London Stroke Register.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

17
Costs of stroke borne by individuals and families: user-led development of a patient based cost measure
C. McKevitt    N. Fudge    A. Sriskantharajah    C. Coshall    C. Wolfe                                   
KCL Stroke Research Patients & Family Group

King's College London

UNITED KINGDOM

Background The high costs to the state/health service associated with stroke care are documented in several economic analyses. These provide little information about the costs borne by families/individuals. Our Stroke Research Patients and Family Group (PFG) identified personal costs resulting from stroke as a research priority but methods to assess these costs are not well developed. We report a user-led study to adapt an existing generic, but untested, cost questionnaire for completion by stroke patients. Method PFG discussions and 5 individual qualitative interviews were held to identify preferred research methods and specific cost items. These were used to develop a topic guide for a novel qualitative method, ‘guided conversations’, between 10 stroke survivors/carers. These were recorded, transcribed and analysed to finalise items for the cost measure. The existing generic questionnaire was adapted to incorporate stroke specific items, and reviewed by the PFG to ensure all topics were covered and approve wording. Results User-led qualitative methods led to identification of items to include in a questionnaire. These include: payment for adaptations, medications, alternative therapies, diabetic/organic food, nutritional supplements, clothing suitable for disability, transport; direct and indirect loss of family income. The cost measure was incorporated into a structured interview questionnaire with content validity, for use in a pilot study. Conclusion The PFG identified an under-researched area that they regard as important to understanding the consequences of stroke. Their participation led to the development of a cost measure relevant to the population under study. The measure is currently being piloted with people recruited to the South London Stroke Register.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

17
Costs of stroke borne by individuals and families: user-led development of a patient based cost measure
C. McKevitt    N. Fudge    A. Sriskantharajah    C. Coshall    C. Wolfe                                   
KCL Stroke Research Patients & Family Group

King's College London

UNITED KINGDOM

Background The high costs to the state/health service associated with stroke care are documented in several economic analyses. These provide little information about the costs borne by families/individuals. Our Stroke Research Patients and Family Group (PFG) identified personal costs resulting from stroke as a research priority but methods to assess these costs are not well developed. We report a user-led study to adapt an existing generic, but untested, cost questionnaire for completion by stroke patients. Method PFG discussions and 5 individual qualitative interviews were held to identify preferred research methods and specific cost items. These were used to develop a topic guide for a novel qualitative method, ‘guided conversations’, between 10 stroke survivors/carers. These were recorded, transcribed and analysed to finalise items for the cost measure. The existing generic questionnaire was adapted to incorporate stroke specific items, and reviewed by the PFG to ensure all topics were covered and approve wording. Results User-led qualitative methods led to identification of items to include in a questionnaire. These include: payment for adaptations, medications, alternative therapies, diabetic/organic food, nutritional supplements, clothing suitable for disability, transport; direct and indirect loss of family income. The cost measure was incorporated into a structured interview questionnaire with content validity, for use in a pilot study. Conclusion The PFG identified an under-researched area that they regard as important to understanding the consequences of stroke. Their participation led to the development of a cost measure relevant to the population under study. The measure is currently being piloted with people recruited to the South London Stroke Register.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

17
Costs of stroke borne by individuals and families: user-led development of a patient based cost measure
C. McKevitt    N. Fudge    A. Sriskantharajah    C. Coshall    C. Wolfe                                   
KCL Stroke Research Patients & Family Group

King's College London

UNITED KINGDOM

Background The high costs to the state/health service associated with stroke care are documented in several economic analyses. These provide little information about the costs borne by families/individuals. Our Stroke Research Patients and Family Group (PFG) identified personal costs resulting from stroke as a research priority but methods to assess these costs are not well developed. We report a user-led study to adapt an existing generic, but untested, cost questionnaire for completion by stroke patients. Method PFG discussions and 5 individual qualitative interviews were held to identify preferred research methods and specific cost items. These were used to develop a topic guide for a novel qualitative method, ‘guided conversations’, between 10 stroke survivors/carers. These were recorded, transcribed and analysed to finalise items for the cost measure. The existing generic questionnaire was adapted to incorporate stroke specific items, and reviewed by the PFG to ensure all topics were covered and approve wording. Results User-led qualitative methods led to identification of items to include in a questionnaire. These include: payment for adaptations, medications, alternative therapies, diabetic/organic food, nutritional supplements, clothing suitable for disability, transport; direct and indirect loss of family income. The cost measure was incorporated into a structured interview questionnaire with content validity, for use in a pilot study. Conclusion The PFG identified an under-researched area that they regard as important to understanding the consequences of stroke. Their participation led to the development of a cost measure relevant to the population under study. The measure is currently being piloted with people recruited to the South London Stroke Register.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

09
A pilot study investigating the comparison between familiar and unfamiliar environment on patient’s abilities to complete and process activities of daily living, post brain injury.
J. Scott                                                               
 

Hammersmith Hospitals NHS Trust

UNITED KINGDOM

Background Cognitive impairment is common post-brain injury and is associated with poor long-term outcomes. Environmental context is thought to impact on cognitive processing, and it is possible that the venue where cognitive abilities are assessed will influence the patients’ performance. The Assessment of Motor and Process Skills (AMPS) is an observational tool used to measure the quality of a person’s ability to perform activities of daily living, based on normative data for age and injury. Hypothesis Patients’ will perform better in terms of cognitive ability, at home compared to in hospital. Objective To compare the process abilities of patients with brain injury in hospital and at home using the AMPS, with a same subject design. Methods Patients admitted with brain injury, who had cognitive impairment but were orientated, were assessed in the hospital and at home within 48 hours using AMPS. The scores for process skill (the skills needed to organize and adapt actions to complete tasks) were compared at the end of the study. Results 7 out of the 8 patients assessed performed better within the hospital context. Median AMPS process score Interquartile range P= Home 0.16 0.2-0.54 0.05 Hospital 0.94 0.47-1.29 Discussion/Conclusion The structure and lack of external stimuli may account for the improved performance within the hospital context. Patients with cognitive processing deficits performed better within the hospital setting. This implies that the level of challenge therapists use to assess patients’ cognition through function may need to be higher in hospital to ensure sufficient process ability at home.

Kind of presentation: Oral 
Vascular biology  
 
Date: Thursday, 31 May 2007   Time: 11:20 - 11:30    Room: Room Carron
Chair: M. Endres, Germany and W.D. Heiss, Germany
 

06
Stroke risk factors and shrot-term stroke outcomes among Singaporeans of Chinese, Malay and Indian ethnicities in comparison to Caucasians.
V.K.SHARMA    G. TSIVGOULIS    B.PLCHAN    H.L.TEOH    S. VASSILOPOULOU    B.KCONG    K. SPENGOS    A.V.ALEXANDROV              
 

National University Hospital, Singapore and “Eginition Hospital”, University of Athens

SINGAPORE

Background and Purpose: Limited data exists regarding inter-ethnic differences among Asian stroke population. We documented risk factors, stroke subtypes and outcomes in our multiethnic Singaporean population and compared them to a Caucasian stroke cohort collected during the same time-period (January 2004-December 2005) and using the same criteria in Greece. Subjects and Methods: Consecutive ischemic strokes patients presenting to our tertiary centers over 2-year period were evaluated. Strokes were classified by TOAST and OCSP criteria. Functional independence at hospital discharge was defined by modified-Rankin Scale (mRS 0-2). Results: Ethnic distribution of the Singaporean population (n=481, mean age 64.1±11.9years) was Chinese (74%), Malays (17%) and Indians (9%). All Greek patients were Caucasians (n=228, mean age 60.1±14.7years). Prevalence of risk factors was similar among the three Asian ethnic groups except for diabetes (Chinese 39.8%, Malays 67.5% Indians 52.3%; p<0.001). Hypertension, diabetes mellitus, hypercholesterolemia and ischemic heart disease had a higher prevalence in the Asian population, while atrial fibrillation was more frequent in Caucasians (p<0.01). Prevalence of cardioembolic stroke was three-fold higher in the Caucasians (24.6%vs.7.9%), while lacunar stroke was more frequent in Asians (47.9%vs.28.5%, p<0.001). Large-artery atherosclerotic infarctions were more prevalent in Indians (25.0%) while lacunar infarctions occured more frequently in Chinese (51.8%, p<0.01). No differences were observed regarding in-hospital mortality and functional independence at discharge among three Singaporean ethnic groups as well as between Asian and Caucasian populations. Conclusion: Despite the differences in stroke subtypes classified by location or underlying etiology, short-term outcome measures were similar among different ethnicities in Asian and Caucasian stroke patients.

Kind of presentation: Oral 
Vascular biology  
 
Date: Thursday, 31 May 2007   Time: 11:20 - 11:30    Room: Room Carron
Chair: M. Endres, Germany and W.D. Heiss, Germany
 

06
Stroke risk factors and shrot-term stroke outcomes among Singaporeans of Chinese, Malay and Indian ethnicities in comparison to Caucasians.
V.K.SHARMA    G. TSIVGOULIS    B.PLCHAN    H.L.TEOH    S. VASSILOPOULOU    B.KCONG    K. SPENGOS    A.V.ALEXANDROV              
 

National University Hospital, Singapore and “Eginition Hospital”, University of Athens

SINGAPORE

Background and Purpose: Limited data exists regarding inter-ethnic differences among Asian stroke population. We documented risk factors, stroke subtypes and outcomes in our multiethnic Singaporean population and compared them to a Caucasian stroke cohort collected during the same time-period (January 2004-December 2005) and using the same criteria in Greece. Subjects and Methods: Consecutive ischemic strokes patients presenting to our tertiary centers over 2-year period were evaluated. Strokes were classified by TOAST and OCSP criteria. Functional independence at hospital discharge was defined by modified-Rankin Scale (mRS 0-2). Results: Ethnic distribution of the Singaporean population (n=481, mean age 64.1±11.9years) was Chinese (74%), Malays (17%) and Indians (9%). All Greek patients were Caucasians (n=228, mean age 60.1±14.7years). Prevalence of risk factors was similar among the three Asian ethnic groups except for diabetes (Chinese 39.8%, Malays 67.5% Indians 52.3%; p<0.001). Hypertension, diabetes mellitus, hypercholesterolemia and ischemic heart disease had a higher prevalence in the Asian population, while atrial fibrillation was more frequent in Caucasians (p<0.01). Prevalence of cardioembolic stroke was three-fold higher in the Caucasians (24.6%vs.7.9%), while lacunar stroke was more frequent in Asians (47.9%vs.28.5%, p<0.001). Large-artery atherosclerotic infarctions were more prevalent in Indians (25.0%) while lacunar infarctions occured more frequently in Chinese (51.8%, p<0.01). No differences were observed regarding in-hospital mortality and functional independence at discharge among three Singaporean ethnic groups as well as between Asian and Caucasian populations. Conclusion: Despite the differences in stroke subtypes classified by location or underlying etiology, short-term outcome measures were similar among different ethnicities in Asian and Caucasian stroke patients.

Kind of presentation: Oral 
Vascular biology  
 
Date: Thursday, 31 May 2007   Time: 11:20 - 11:30    Room: Room Carron
Chair: M. Endres, Germany and W.D. Heiss, Germany
 

06
Stroke risk factors and shrot-term stroke outcomes among Singaporeans of Chinese, Malay and Indian ethnicities in comparison to Caucasians.
V.K.SHARMA    G. TSIVGOULIS    B.PLCHAN    H.L.TEOH    S. VASSILOPOULOU    B.KCONG    K. SPENGOS    A.V.ALEXANDROV              
 

National University Hospital, Singapore and “Eginition Hospital”, University of Athens

SINGAPORE

Background and Purpose: Limited data exists regarding inter-ethnic differences among Asian stroke population. We documented risk factors, stroke subtypes and outcomes in our multiethnic Singaporean population and compared them to a Caucasian stroke cohort collected during the same time-period (January 2004-December 2005) and using the same criteria in Greece. Subjects and Methods: Consecutive ischemic strokes patients presenting to our tertiary centers over 2-year period were evaluated. Strokes were classified by TOAST and OCSP criteria. Functional independence at hospital discharge was defined by modified-Rankin Scale (mRS 0-2). Results: Ethnic distribution of the Singaporean population (n=481, mean age 64.1±11.9years) was Chinese (74%), Malays (17%) and Indians (9%). All Greek patients were Caucasians (n=228, mean age 60.1±14.7years). Prevalence of risk factors was similar among the three Asian ethnic groups except for diabetes (Chinese 39.8%, Malays 67.5% Indians 52.3%; p<0.001). Hypertension, diabetes mellitus, hypercholesterolemia and ischemic heart disease had a higher prevalence in the Asian population, while atrial fibrillation was more frequent in Caucasians (p<0.01). Prevalence of cardioembolic stroke was three-fold higher in the Caucasians (24.6%vs.7.9%), while lacunar stroke was more frequent in Asians (47.9%vs.28.5%, p<0.001). Large-artery atherosclerotic infarctions were more prevalent in Indians (25.0%) while lacunar infarctions occured more frequently in Chinese (51.8%, p<0.01). No differences were observed regarding in-hospital mortality and functional independence at discharge among three Singaporean ethnic groups as well as between Asian and Caucasian populations. Conclusion: Despite the differences in stroke subtypes classified by location or underlying etiology, short-term outcome measures were similar among different ethnicities in Asian and Caucasian stroke patients.

Kind of presentation: Oral 
Vascular biology  
 
Date: Thursday, 31 May 2007   Time: 11:20 - 11:30    Room: Room Carron
Chair: M. Endres, Germany and W.D. Heiss, Germany
 

06
Stroke risk factors and shrot-term stroke outcomes among Singaporeans of Chinese, Malay and Indian ethnicities in comparison to Caucasians.
V.K.SHARMA    G. TSIVGOULIS    B.PLCHAN    H.L.TEOH    S. VASSILOPOULOU    B.KCONG    K. SPENGOS    A.V.ALEXANDROV              
 

National University Hospital, Singapore and “Eginition Hospital”, University of Athens

SINGAPORE

Background and Purpose: Limited data exists regarding inter-ethnic differences among Asian stroke population. We documented risk factors, stroke subtypes and outcomes in our multiethnic Singaporean population and compared them to a Caucasian stroke cohort collected during the same time-period (January 2004-December 2005) and using the same criteria in Greece. Subjects and Methods: Consecutive ischemic strokes patients presenting to our tertiary centers over 2-year period were evaluated. Strokes were classified by TOAST and OCSP criteria. Functional independence at hospital discharge was defined by modified-Rankin Scale (mRS 0-2). Results: Ethnic distribution of the Singaporean population (n=481, mean age 64.1±11.9years) was Chinese (74%), Malays (17%) and Indians (9%). All Greek patients were Caucasians (n=228, mean age 60.1±14.7years). Prevalence of risk factors was similar among the three Asian ethnic groups except for diabetes (Chinese 39.8%, Malays 67.5% Indians 52.3%; p<0.001). Hypertension, diabetes mellitus, hypercholesterolemia and ischemic heart disease had a higher prevalence in the Asian population, while atrial fibrillation was more frequent in Caucasians (p<0.01). Prevalence of cardioembolic stroke was three-fold higher in the Caucasians (24.6%vs.7.9%), while lacunar stroke was more frequent in Asians (47.9%vs.28.5%, p<0.001). Large-artery atherosclerotic infarctions were more prevalent in Indians (25.0%) while lacunar infarctions occured more frequently in Chinese (51.8%, p<0.01). No differences were observed regarding in-hospital mortality and functional independence at discharge among three Singaporean ethnic groups as well as between Asian and Caucasian populations. Conclusion: Despite the differences in stroke subtypes classified by location or underlying etiology, short-term outcome measures were similar among different ethnicities in Asian and Caucasian stroke patients.

Kind of presentation: Oral 
Vascular biology  
 
Date: Thursday, 31 May 2007   Time: 11:20 - 11:30    Room: Room Carron
Chair: M. Endres, Germany and W.D. Heiss, Germany
 

06
Stroke risk factors and shrot-term stroke outcomes among Singaporeans of Chinese, Malay and Indian ethnicities in comparison to Caucasians.
V.K.SHARMA    G. TSIVGOULIS    B.PLCHAN    H.L.TEOH    S. VASSILOPOULOU    B.KCONG    K. SPENGOS    A.V.ALEXANDROV              
 

National University Hospital, Singapore and “Eginition Hospital”, University of Athens

SINGAPORE

Background and Purpose: Limited data exists regarding inter-ethnic differences among Asian stroke population. We documented risk factors, stroke subtypes and outcomes in our multiethnic Singaporean population and compared them to a Caucasian stroke cohort collected during the same time-period (January 2004-December 2005) and using the same criteria in Greece. Subjects and Methods: Consecutive ischemic strokes patients presenting to our tertiary centers over 2-year period were evaluated. Strokes were classified by TOAST and OCSP criteria. Functional independence at hospital discharge was defined by modified-Rankin Scale (mRS 0-2). Results: Ethnic distribution of the Singaporean population (n=481, mean age 64.1±11.9years) was Chinese (74%), Malays (17%) and Indians (9%). All Greek patients were Caucasians (n=228, mean age 60.1±14.7years). Prevalence of risk factors was similar among the three Asian ethnic groups except for diabetes (Chinese 39.8%, Malays 67.5% Indians 52.3%; p<0.001). Hypertension, diabetes mellitus, hypercholesterolemia and ischemic heart disease had a higher prevalence in the Asian population, while atrial fibrillation was more frequent in Caucasians (p<0.01). Prevalence of cardioembolic stroke was three-fold higher in the Caucasians (24.6%vs.7.9%), while lacunar stroke was more frequent in Asians (47.9%vs.28.5%, p<0.001). Large-artery atherosclerotic infarctions were more prevalent in Indians (25.0%) while lacunar infarctions occured more frequently in Chinese (51.8%, p<0.01). No differences were observed regarding in-hospital mortality and functional independence at discharge among three Singaporean ethnic groups as well as between Asian and Caucasian populations. Conclusion: Despite the differences in stroke subtypes classified by location or underlying etiology, short-term outcome measures were similar among different ethnicities in Asian and Caucasian stroke patients.

Kind of presentation: Oral 
Vascular biology  
 
Date: Thursday, 31 May 2007   Time: 11:20 - 11:30    Room: Room Carron
Chair: M. Endres, Germany and W.D. Heiss, Germany
 

06
Stroke risk factors and shrot-term stroke outcomes among Singaporeans of Chinese, Malay and Indian ethnicities in comparison to Caucasians.
V.K.SHARMA    G. TSIVGOULIS    B.PLCHAN    H.L.TEOH    S. VASSILOPOULOU    B.KCONG    K. SPENGOS    A.V.ALEXANDROV              
 

National University Hospital, Singapore and “Eginition Hospital”, University of Athens

SINGAPORE

Background and Purpose: Limited data exists regarding inter-ethnic differences among Asian stroke population. We documented risk factors, stroke subtypes and outcomes in our multiethnic Singaporean population and compared them to a Caucasian stroke cohort collected during the same time-period (January 2004-December 2005) and using the same criteria in Greece. Subjects and Methods: Consecutive ischemic strokes patients presenting to our tertiary centers over 2-year period were evaluated. Strokes were classified by TOAST and OCSP criteria. Functional independence at hospital discharge was defined by modified-Rankin Scale (mRS 0-2). Results: Ethnic distribution of the Singaporean population (n=481, mean age 64.1±11.9years) was Chinese (74%), Malays (17%) and Indians (9%). All Greek patients were Caucasians (n=228, mean age 60.1±14.7years). Prevalence of risk factors was similar among the three Asian ethnic groups except for diabetes (Chinese 39.8%, Malays 67.5% Indians 52.3%; p<0.001). Hypertension, diabetes mellitus, hypercholesterolemia and ischemic heart disease had a higher prevalence in the Asian population, while atrial fibrillation was more frequent in Caucasians (p<0.01). Prevalence of cardioembolic stroke was three-fold higher in the Caucasians (24.6%vs.7.9%), while lacunar stroke was more frequent in Asians (47.9%vs.28.5%, p<0.001). Large-artery atherosclerotic infarctions were more prevalent in Indians (25.0%) while lacunar infarctions occured more frequently in Chinese (51.8%, p<0.01). No differences were observed regarding in-hospital mortality and functional independence at discharge among three Singaporean ethnic groups as well as between Asian and Caucasian populations. Conclusion: Despite the differences in stroke subtypes classified by location or underlying etiology, short-term outcome measures were similar among different ethnicities in Asian and Caucasian stroke patients.

Kind of presentation: Oral 
Vascular biology  
 
Date: Thursday, 31 May 2007   Time: 11:20 - 11:30    Room: Room Carron
Chair: M. Endres, Germany and W.D. Heiss, Germany
 

06
Stroke risk factors and shrot-term stroke outcomes among Singaporeans of Chinese, Malay and Indian ethnicities in comparison to Caucasians.
V.K.SHARMA    G. TSIVGOULIS    B.PLCHAN    H.L.TEOH    S. VASSILOPOULOU    B.KCONG    K. SPENGOS    A.V.ALEXANDROV              
 

National University Hospital, Singapore and “Eginition Hospital”, University of Athens

SINGAPORE

Background and Purpose: Limited data exists regarding inter-ethnic differences among Asian stroke population. We documented risk factors, stroke subtypes and outcomes in our multiethnic Singaporean population and compared them to a Caucasian stroke cohort collected during the same time-period (January 2004-December 2005) and using the same criteria in Greece. Subjects and Methods: Consecutive ischemic strokes patients presenting to our tertiary centers over 2-year period were evaluated. Strokes were classified by TOAST and OCSP criteria. Functional independence at hospital discharge was defined by modified-Rankin Scale (mRS 0-2). Results: Ethnic distribution of the Singaporean population (n=481, mean age 64.1±11.9years) was Chinese (74%), Malays (17%) and Indians (9%). All Greek patients were Caucasians (n=228, mean age 60.1±14.7years). Prevalence of risk factors was similar among the three Asian ethnic groups except for diabetes (Chinese 39.8%, Malays 67.5% Indians 52.3%; p<0.001). Hypertension, diabetes mellitus, hypercholesterolemia and ischemic heart disease had a higher prevalence in the Asian population, while atrial fibrillation was more frequent in Caucasians (p<0.01). Prevalence of cardioembolic stroke was three-fold higher in the Caucasians (24.6%vs.7.9%), while lacunar stroke was more frequent in Asians (47.9%vs.28.5%, p<0.001). Large-artery atherosclerotic infarctions were more prevalent in Indians (25.0%) while lacunar infarctions occured more frequently in Chinese (51.8%, p<0.01). No differences were observed regarding in-hospital mortality and functional independence at discharge among three Singaporean ethnic groups as well as between Asian and Caucasian populations. Conclusion: Despite the differences in stroke subtypes classified by location or underlying etiology, short-term outcome measures were similar among different ethnicities in Asian and Caucasian stroke patients.

Kind of presentation: Oral 
Vascular biology  
 
Date: Thursday, 31 May 2007   Time: 11:20 - 11:30    Room: Room Carron
Chair: M. Endres, Germany and W.D. Heiss, Germany
 

06
Stroke risk factors and shrot-term stroke outcomes among Singaporeans of Chinese, Malay and Indian ethnicities in comparison to Caucasians.
V.K.SHARMA    G. TSIVGOULIS    B.PLCHAN    H.L.TEOH    S. VASSILOPOULOU    B.KCONG    K. SPENGOS    A.V.ALEXANDROV              
 

National University Hospital, Singapore and “Eginition Hospital”, University of Athens

SINGAPORE

Background and Purpose: Limited data exists regarding inter-ethnic differences among Asian stroke population. We documented risk factors, stroke subtypes and outcomes in our multiethnic Singaporean population and compared them to a Caucasian stroke cohort collected during the same time-period (January 2004-December 2005) and using the same criteria in Greece. Subjects and Methods: Consecutive ischemic strokes patients presenting to our tertiary centers over 2-year period were evaluated. Strokes were classified by TOAST and OCSP criteria. Functional independence at hospital discharge was defined by modified-Rankin Scale (mRS 0-2). Results: Ethnic distribution of the Singaporean population (n=481, mean age 64.1±11.9years) was Chinese (74%), Malays (17%) and Indians (9%). All Greek patients were Caucasians (n=228, mean age 60.1±14.7years). Prevalence of risk factors was similar among the three Asian ethnic groups except for diabetes (Chinese 39.8%, Malays 67.5% Indians 52.3%; p<0.001). Hypertension, diabetes mellitus, hypercholesterolemia and ischemic heart disease had a higher prevalence in the Asian population, while atrial fibrillation was more frequent in Caucasians (p<0.01). Prevalence of cardioembolic stroke was three-fold higher in the Caucasians (24.6%vs.7.9%), while lacunar stroke was more frequent in Asians (47.9%vs.28.5%, p<0.001). Large-artery atherosclerotic infarctions were more prevalent in Indians (25.0%) while lacunar infarctions occured more frequently in Chinese (51.8%, p<0.01). No differences were observed regarding in-hospital mortality and functional independence at discharge among three Singaporean ethnic groups as well as between Asian and Caucasian populations. Conclusion: Despite the differences in stroke subtypes classified by location or underlying etiology, short-term outcome measures were similar among different ethnicities in Asian and Caucasian stroke patients.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

11
Agreement in dysphagia detection: a reproducibility study in acute stroke patients
M.G.Celani    E. Righetti    A. Tufi    A. Sgoifo    L. Amendola    D. Capecchi    L. Guerra    C. Ottaviani    M.G.Scucchi    S. Ricci
 

UOCD Neurologia e Ictus, Ospedale Città della Pieve, USL 2 dell' Umbria

ITALY

Background: Up to half of acute stroke patients have dysphagia, which precludes safe oral nutrition. A standard clinical assessment of dysphagia, (using the Bedside Swallowing Assessment) is recommended in all patients with acute stroke; if available, more sensitive and specific instrumental techniques can be utilised in selected centres. However, the reproducibility of this evaluation by nurses has not been studied. Our aim was to test interobserver agreement in diagnosing dysphagia in a consecutive series of stroke patients. Material and Methods: when a patient with acute stroke was admitted to our SU, the nurse in charge, as a part of routine evaluation, administered a BSA, and registered the result on a special form; when a different nurse began to work (not later than 8 hours from the first evaluation), he or she repeated the test, being blind on the opinion of the former colleague, and reported the results on a new form. Each patient was categorised in two ways: 1) presence or absence of dysphagia; 2) severity of dysphagia (4 grades, from no dysphagia to severe dysphagia). Data were stored by another member of the stroke team, registered on a database, and analysed with K statistics. Results: Until now, 88 evaluations are available. The mean time interval between the 2 BSAs was 3h10m. Nurses agreed on 80 cases for 1st categorisation; K was 0.81 (95% CIs 0.68 to 0.93). However, agreement was lower for severity of dysphagia: unweighted K 0.65, 95% CIs 0.51 to 0.79; linear weighted kappa 0.71 (95% CIs 0.58 to 0.84); clinically weighted K 0.64 (95% CIs 0.62 to 0.66) Conclusion: The diagnosis of dysphagia vs normal swallowing is reproducible, but agreement is slightly worse when severity of dysphagia is taken into account; since this parameter is used to choose the way the patient is fed (i.e. differents levels of thickening of foods vs NG tube), specific training to nurses dealing with acute stroke patients is warranted.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

11
Agreement in dysphagia detection: a reproducibility study in acute stroke patients
M.G.Celani    E. Righetti    A. Tufi    A. Sgoifo    L. Amendola    D. Capecchi    L. Guerra    C. Ottaviani    M.G.Scucchi    S. Ricci
 

UOCD Neurologia e Ictus, Ospedale Città della Pieve, USL 2 dell' Umbria

ITALY

Background: Up to half of acute stroke patients have dysphagia, which precludes safe oral nutrition. A standard clinical assessment of dysphagia, (using the Bedside Swallowing Assessment) is recommended in all patients with acute stroke; if available, more sensitive and specific instrumental techniques can be utilised in selected centres. However, the reproducibility of this evaluation by nurses has not been studied. Our aim was to test interobserver agreement in diagnosing dysphagia in a consecutive series of stroke patients. Material and Methods: when a patient with acute stroke was admitted to our SU, the nurse in charge, as a part of routine evaluation, administered a BSA, and registered the result on a special form; when a different nurse began to work (not later than 8 hours from the first evaluation), he or she repeated the test, being blind on the opinion of the former colleague, and reported the results on a new form. Each patient was categorised in two ways: 1) presence or absence of dysphagia; 2) severity of dysphagia (4 grades, from no dysphagia to severe dysphagia). Data were stored by another member of the stroke team, registered on a database, and analysed with K statistics. Results: Until now, 88 evaluations are available. The mean time interval between the 2 BSAs was 3h10m. Nurses agreed on 80 cases for 1st categorisation; K was 0.81 (95% CIs 0.68 to 0.93). However, agreement was lower for severity of dysphagia: unweighted K 0.65, 95% CIs 0.51 to 0.79; linear weighted kappa 0.71 (95% CIs 0.58 to 0.84); clinically weighted K 0.64 (95% CIs 0.62 to 0.66) Conclusion: The diagnosis of dysphagia vs normal swallowing is reproducible, but agreement is slightly worse when severity of dysphagia is taken into account; since this parameter is used to choose the way the patient is fed (i.e. differents levels of thickening of foods vs NG tube), specific training to nurses dealing with acute stroke patients is warranted.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

11
Agreement in dysphagia detection: a reproducibility study in acute stroke patients
M.G.Celani    E. Righetti    A. Tufi    A. Sgoifo    L. Amendola    D. Capecchi    L. Guerra    C. Ottaviani    M.G.Scucchi    S. Ricci
 

UOCD Neurologia e Ictus, Ospedale Città della Pieve, USL 2 dell' Umbria

ITALY

Background: Up to half of acute stroke patients have dysphagia, which precludes safe oral nutrition. A standard clinical assessment of dysphagia, (using the Bedside Swallowing Assessment) is recommended in all patients with acute stroke; if available, more sensitive and specific instrumental techniques can be utilised in selected centres. However, the reproducibility of this evaluation by nurses has not been studied. Our aim was to test interobserver agreement in diagnosing dysphagia in a consecutive series of stroke patients. Material and Methods: when a patient with acute stroke was admitted to our SU, the nurse in charge, as a part of routine evaluation, administered a BSA, and registered the result on a special form; when a different nurse began to work (not later than 8 hours from the first evaluation), he or she repeated the test, being blind on the opinion of the former colleague, and reported the results on a new form. Each patient was categorised in two ways: 1) presence or absence of dysphagia; 2) severity of dysphagia (4 grades, from no dysphagia to severe dysphagia). Data were stored by another member of the stroke team, registered on a database, and analysed with K statistics. Results: Until now, 88 evaluations are available. The mean time interval between the 2 BSAs was 3h10m. Nurses agreed on 80 cases for 1st categorisation; K was 0.81 (95% CIs 0.68 to 0.93). However, agreement was lower for severity of dysphagia: unweighted K 0.65, 95% CIs 0.51 to 0.79; linear weighted kappa 0.71 (95% CIs 0.58 to 0.84); clinically weighted K 0.64 (95% CIs 0.62 to 0.66) Conclusion: The diagnosis of dysphagia vs normal swallowing is reproducible, but agreement is slightly worse when severity of dysphagia is taken into account; since this parameter is used to choose the way the patient is fed (i.e. differents levels of thickening of foods vs NG tube), specific training to nurses dealing with acute stroke patients is warranted.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

11
Agreement in dysphagia detection: a reproducibility study in acute stroke patients
M.G.Celani    E. Righetti    A. Tufi    A. Sgoifo    L. Amendola    D. Capecchi    L. Guerra    C. Ottaviani    M.G.Scucchi    S. Ricci
 

UOCD Neurologia e Ictus, Ospedale Città della Pieve, USL 2 dell' Umbria

ITALY

Background: Up to half of acute stroke patients have dysphagia, which precludes safe oral nutrition. A standard clinical assessment of dysphagia, (using the Bedside Swallowing Assessment) is recommended in all patients with acute stroke; if available, more sensitive and specific instrumental techniques can be utilised in selected centres. However, the reproducibility of this evaluation by nurses has not been studied. Our aim was to test interobserver agreement in diagnosing dysphagia in a consecutive series of stroke patients. Material and Methods: when a patient with acute stroke was admitted to our SU, the nurse in charge, as a part of routine evaluation, administered a BSA, and registered the result on a special form; when a different nurse began to work (not later than 8 hours from the first evaluation), he or she repeated the test, being blind on the opinion of the former colleague, and reported the results on a new form. Each patient was categorised in two ways: 1) presence or absence of dysphagia; 2) severity of dysphagia (4 grades, from no dysphagia to severe dysphagia). Data were stored by another member of the stroke team, registered on a database, and analysed with K statistics. Results: Until now, 88 evaluations are available. The mean time interval between the 2 BSAs was 3h10m. Nurses agreed on 80 cases for 1st categorisation; K was 0.81 (95% CIs 0.68 to 0.93). However, agreement was lower for severity of dysphagia: unweighted K 0.65, 95% CIs 0.51 to 0.79; linear weighted kappa 0.71 (95% CIs 0.58 to 0.84); clinically weighted K 0.64 (95% CIs 0.62 to 0.66) Conclusion: The diagnosis of dysphagia vs normal swallowing is reproducible, but agreement is slightly worse when severity of dysphagia is taken into account; since this parameter is used to choose the way the patient is fed (i.e. differents levels of thickening of foods vs NG tube), specific training to nurses dealing with acute stroke patients is warranted.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

11
Agreement in dysphagia detection: a reproducibility study in acute stroke patients
M.G.Celani    E. Righetti    A. Tufi    A. Sgoifo    L. Amendola    D. Capecchi    L. Guerra    C. Ottaviani    M.G.Scucchi    S. Ricci
 

UOCD Neurologia e Ictus, Ospedale Città della Pieve, USL 2 dell' Umbria

ITALY

Background: Up to half of acute stroke patients have dysphagia, which precludes safe oral nutrition. A standard clinical assessment of dysphagia, (using the Bedside Swallowing Assessment) is recommended in all patients with acute stroke; if available, more sensitive and specific instrumental techniques can be utilised in selected centres. However, the reproducibility of this evaluation by nurses has not been studied. Our aim was to test interobserver agreement in diagnosing dysphagia in a consecutive series of stroke patients. Material and Methods: when a patient with acute stroke was admitted to our SU, the nurse in charge, as a part of routine evaluation, administered a BSA, and registered the result on a special form; when a different nurse began to work (not later than 8 hours from the first evaluation), he or she repeated the test, being blind on the opinion of the former colleague, and reported the results on a new form. Each patient was categorised in two ways: 1) presence or absence of dysphagia; 2) severity of dysphagia (4 grades, from no dysphagia to severe dysphagia). Data were stored by another member of the stroke team, registered on a database, and analysed with K statistics. Results: Until now, 88 evaluations are available. The mean time interval between the 2 BSAs was 3h10m. Nurses agreed on 80 cases for 1st categorisation; K was 0.81 (95% CIs 0.68 to 0.93). However, agreement was lower for severity of dysphagia: unweighted K 0.65, 95% CIs 0.51 to 0.79; linear weighted kappa 0.71 (95% CIs 0.58 to 0.84); clinically weighted K 0.64 (95% CIs 0.62 to 0.66) Conclusion: The diagnosis of dysphagia vs normal swallowing is reproducible, but agreement is slightly worse when severity of dysphagia is taken into account; since this parameter is used to choose the way the patient is fed (i.e. differents levels of thickening of foods vs NG tube), specific training to nurses dealing with acute stroke patients is warranted.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

11
Agreement in dysphagia detection: a reproducibility study in acute stroke patients
M.G.Celani    E. Righetti    A. Tufi    A. Sgoifo    L. Amendola    D. Capecchi    L. Guerra    C. Ottaviani    M.G.Scucchi    S. Ricci
 

UOCD Neurologia e Ictus, Ospedale Città della Pieve, USL 2 dell' Umbria

ITALY

Background: Up to half of acute stroke patients have dysphagia, which precludes safe oral nutrition. A standard clinical assessment of dysphagia, (using the Bedside Swallowing Assessment) is recommended in all patients with acute stroke; if available, more sensitive and specific instrumental techniques can be utilised in selected centres. However, the reproducibility of this evaluation by nurses has not been studied. Our aim was to test interobserver agreement in diagnosing dysphagia in a consecutive series of stroke patients. Material and Methods: when a patient with acute stroke was admitted to our SU, the nurse in charge, as a part of routine evaluation, administered a BSA, and registered the result on a special form; when a different nurse began to work (not later than 8 hours from the first evaluation), he or she repeated the test, being blind on the opinion of the former colleague, and reported the results on a new form. Each patient was categorised in two ways: 1) presence or absence of dysphagia; 2) severity of dysphagia (4 grades, from no dysphagia to severe dysphagia). Data were stored by another member of the stroke team, registered on a database, and analysed with K statistics. Results: Until now, 88 evaluations are available. The mean time interval between the 2 BSAs was 3h10m. Nurses agreed on 80 cases for 1st categorisation; K was 0.81 (95% CIs 0.68 to 0.93). However, agreement was lower for severity of dysphagia: unweighted K 0.65, 95% CIs 0.51 to 0.79; linear weighted kappa 0.71 (95% CIs 0.58 to 0.84); clinically weighted K 0.64 (95% CIs 0.62 to 0.66) Conclusion: The diagnosis of dysphagia vs normal swallowing is reproducible, but agreement is slightly worse when severity of dysphagia is taken into account; since this parameter is used to choose the way the patient is fed (i.e. differents levels of thickening of foods vs NG tube), specific training to nurses dealing with acute stroke patients is warranted.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

11
Agreement in dysphagia detection: a reproducibility study in acute stroke patients
M.G.Celani    E. Righetti    A. Tufi    A. Sgoifo    L. Amendola    D. Capecchi    L. Guerra    C. Ottaviani    M.G.Scucchi    S. Ricci
 

UOCD Neurologia e Ictus, Ospedale Città della Pieve, USL 2 dell' Umbria

ITALY

Background: Up to half of acute stroke patients have dysphagia, which precludes safe oral nutrition. A standard clinical assessment of dysphagia, (using the Bedside Swallowing Assessment) is recommended in all patients with acute stroke; if available, more sensitive and specific instrumental techniques can be utilised in selected centres. However, the reproducibility of this evaluation by nurses has not been studied. Our aim was to test interobserver agreement in diagnosing dysphagia in a consecutive series of stroke patients. Material and Methods: when a patient with acute stroke was admitted to our SU, the nurse in charge, as a part of routine evaluation, administered a BSA, and registered the result on a special form; when a different nurse began to work (not later than 8 hours from the first evaluation), he or she repeated the test, being blind on the opinion of the former colleague, and reported the results on a new form. Each patient was categorised in two ways: 1) presence or absence of dysphagia; 2) severity of dysphagia (4 grades, from no dysphagia to severe dysphagia). Data were stored by another member of the stroke team, registered on a database, and analysed with K statistics. Results: Until now, 88 evaluations are available. The mean time interval between the 2 BSAs was 3h10m. Nurses agreed on 80 cases for 1st categorisation; K was 0.81 (95% CIs 0.68 to 0.93). However, agreement was lower for severity of dysphagia: unweighted K 0.65, 95% CIs 0.51 to 0.79; linear weighted kappa 0.71 (95% CIs 0.58 to 0.84); clinically weighted K 0.64 (95% CIs 0.62 to 0.66) Conclusion: The diagnosis of dysphagia vs normal swallowing is reproducible, but agreement is slightly worse when severity of dysphagia is taken into account; since this parameter is used to choose the way the patient is fed (i.e. differents levels of thickening of foods vs NG tube), specific training to nurses dealing with acute stroke patients is warranted.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

11
Agreement in dysphagia detection: a reproducibility study in acute stroke patients
M.G.Celani    E. Righetti    A. Tufi    A. Sgoifo    L. Amendola    D. Capecchi    L. Guerra    C. Ottaviani    M.G.Scucchi    S. Ricci
 

UOCD Neurologia e Ictus, Ospedale Città della Pieve, USL 2 dell' Umbria

ITALY

Background: Up to half of acute stroke patients have dysphagia, which precludes safe oral nutrition. A standard clinical assessment of dysphagia, (using the Bedside Swallowing Assessment) is recommended in all patients with acute stroke; if available, more sensitive and specific instrumental techniques can be utilised in selected centres. However, the reproducibility of this evaluation by nurses has not been studied. Our aim was to test interobserver agreement in diagnosing dysphagia in a consecutive series of stroke patients. Material and Methods: when a patient with acute stroke was admitted to our SU, the nurse in charge, as a part of routine evaluation, administered a BSA, and registered the result on a special form; when a different nurse began to work (not later than 8 hours from the first evaluation), he or she repeated the test, being blind on the opinion of the former colleague, and reported the results on a new form. Each patient was categorised in two ways: 1) presence or absence of dysphagia; 2) severity of dysphagia (4 grades, from no dysphagia to severe dysphagia). Data were stored by another member of the stroke team, registered on a database, and analysed with K statistics. Results: Until now, 88 evaluations are available. The mean time interval between the 2 BSAs was 3h10m. Nurses agreed on 80 cases for 1st categorisation; K was 0.81 (95% CIs 0.68 to 0.93). However, agreement was lower for severity of dysphagia: unweighted K 0.65, 95% CIs 0.51 to 0.79; linear weighted kappa 0.71 (95% CIs 0.58 to 0.84); clinically weighted K 0.64 (95% CIs 0.62 to 0.66) Conclusion: The diagnosis of dysphagia vs normal swallowing is reproducible, but agreement is slightly worse when severity of dysphagia is taken into account; since this parameter is used to choose the way the patient is fed (i.e. differents levels of thickening of foods vs NG tube), specific training to nurses dealing with acute stroke patients is warranted.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

11
Agreement in dysphagia detection: a reproducibility study in acute stroke patients
M.G.Celani    E. Righetti    A. Tufi    A. Sgoifo    L. Amendola    D. Capecchi    L. Guerra    C. Ottaviani    M.G.Scucchi    S. Ricci
 

UOCD Neurologia e Ictus, Ospedale Città della Pieve, USL 2 dell' Umbria

ITALY

Background: Up to half of acute stroke patients have dysphagia, which precludes safe oral nutrition. A standard clinical assessment of dysphagia, (using the Bedside Swallowing Assessment) is recommended in all patients with acute stroke; if available, more sensitive and specific instrumental techniques can be utilised in selected centres. However, the reproducibility of this evaluation by nurses has not been studied. Our aim was to test interobserver agreement in diagnosing dysphagia in a consecutive series of stroke patients. Material and Methods: when a patient with acute stroke was admitted to our SU, the nurse in charge, as a part of routine evaluation, administered a BSA, and registered the result on a special form; when a different nurse began to work (not later than 8 hours from the first evaluation), he or she repeated the test, being blind on the opinion of the former colleague, and reported the results on a new form. Each patient was categorised in two ways: 1) presence or absence of dysphagia; 2) severity of dysphagia (4 grades, from no dysphagia to severe dysphagia). Data were stored by another member of the stroke team, registered on a database, and analysed with K statistics. Results: Until now, 88 evaluations are available. The mean time interval between the 2 BSAs was 3h10m. Nurses agreed on 80 cases for 1st categorisation; K was 0.81 (95% CIs 0.68 to 0.93). However, agreement was lower for severity of dysphagia: unweighted K 0.65, 95% CIs 0.51 to 0.79; linear weighted kappa 0.71 (95% CIs 0.58 to 0.84); clinically weighted K 0.64 (95% CIs 0.62 to 0.66) Conclusion: The diagnosis of dysphagia vs normal swallowing is reproducible, but agreement is slightly worse when severity of dysphagia is taken into account; since this parameter is used to choose the way the patient is fed (i.e. differents levels of thickening of foods vs NG tube), specific training to nurses dealing with acute stroke patients is warranted.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

11
Agreement in dysphagia detection: a reproducibility study in acute stroke patients
M.G.Celani    E. Righetti    A. Tufi    A. Sgoifo    L. Amendola    D. Capecchi    L. Guerra    C. Ottaviani    M.G.Scucchi    S. Ricci
 

UOCD Neurologia e Ictus, Ospedale Città della Pieve, USL 2 dell' Umbria

ITALY

Background: Up to half of acute stroke patients have dysphagia, which precludes safe oral nutrition. A standard clinical assessment of dysphagia, (using the Bedside Swallowing Assessment) is recommended in all patients with acute stroke; if available, more sensitive and specific instrumental techniques can be utilised in selected centres. However, the reproducibility of this evaluation by nurses has not been studied. Our aim was to test interobserver agreement in diagnosing dysphagia in a consecutive series of stroke patients. Material and Methods: when a patient with acute stroke was admitted to our SU, the nurse in charge, as a part of routine evaluation, administered a BSA, and registered the result on a special form; when a different nurse began to work (not later than 8 hours from the first evaluation), he or she repeated the test, being blind on the opinion of the former colleague, and reported the results on a new form. Each patient was categorised in two ways: 1) presence or absence of dysphagia; 2) severity of dysphagia (4 grades, from no dysphagia to severe dysphagia). Data were stored by another member of the stroke team, registered on a database, and analysed with K statistics. Results: Until now, 88 evaluations are available. The mean time interval between the 2 BSAs was 3h10m. Nurses agreed on 80 cases for 1st categorisation; K was 0.81 (95% CIs 0.68 to 0.93). However, agreement was lower for severity of dysphagia: unweighted K 0.65, 95% CIs 0.51 to 0.79; linear weighted kappa 0.71 (95% CIs 0.58 to 0.84); clinically weighted K 0.64 (95% CIs 0.62 to 0.66) Conclusion: The diagnosis of dysphagia vs normal swallowing is reproducible, but agreement is slightly worse when severity of dysphagia is taken into account; since this parameter is used to choose the way the patient is fed (i.e. differents levels of thickening of foods vs NG tube), specific training to nurses dealing with acute stroke patients is warranted.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

04
pure dysarthria and dysarthria-facial paresis syndrome
K. Yonemura    Y. Hashimoto    M. Uchino                                                 
 

Kumamoto City Hospital

JAPAN

Background: Pure dysarthria (PD) and dysarthria-facial paresis (DFP) are rarely encountered clinical stroke syndromes, and seem to be regarded as an atypical lacunar syndrome. We sought to clarify the clinical characteristics of PD and DFP in acute ischemic stroke patients. Methods: We selected patients with PD or DFP from 1,043 consecutive patients with first-ever acute ischemic stroke admitted over a 7-year period. Vascular risk factors, emboligenic heart disease, occlusive cerebral artery disease, infarct size and location, stroke subtype according to the TOAST classification, and outcome data were evaluated. Acute infarcts were all identified by diffusion-weighted MRI (DWI). Results: A total of 34 patients were reviewed. They consisted of 16 patients with PD and 18 patients with DFP. Hypertension was the most frequent in the vascular risk factors (13 patients with PD and 14 patients with DFP). Emboligenic heart disease and/or cerebral artery disease were detected in 13 (38%) patients (5 with PD and 8 with DFP). DWI identified infarcts on the cortical motor area, centrum ovale, or corona radiata in 25 (74%) patients (12 with PD and 13 with DFP), whereas brainstem infarct was demonstrated only in 1 patients with PD. 18 (53%) patients (11 with PD and 7 with DFP) had infarcts <15mm in maximal diameter, and 15 (44%) patients (10 with PD and 5 with DFP) met the diagnostic criteria of lacunar stroke. Neurological deterioration occurred after hospitalization in 2 patients with DFP, but patients were discharged usually with mild or no disability. Discussions: Infarcts in the higher levels of cerebral hemisphere are responsible for the majority of the PD and DFP syndromes. The predictive value of these syndromes for lacunar stroke is rather low, particularly in DFP.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

04
pure dysarthria and dysarthria-facial paresis syndrome
K. Yonemura    Y. Hashimoto    M. Uchino                                                 
 

Kumamoto City Hospital

JAPAN

Background: Pure dysarthria (PD) and dysarthria-facial paresis (DFP) are rarely encountered clinical stroke syndromes, and seem to be regarded as an atypical lacunar syndrome. We sought to clarify the clinical characteristics of PD and DFP in acute ischemic stroke patients. Methods: We selected patients with PD or DFP from 1,043 consecutive patients with first-ever acute ischemic stroke admitted over a 7-year period. Vascular risk factors, emboligenic heart disease, occlusive cerebral artery disease, infarct size and location, stroke subtype according to the TOAST classification, and outcome data were evaluated. Acute infarcts were all identified by diffusion-weighted MRI (DWI). Results: A total of 34 patients were reviewed. They consisted of 16 patients with PD and 18 patients with DFP. Hypertension was the most frequent in the vascular risk factors (13 patients with PD and 14 patients with DFP). Emboligenic heart disease and/or cerebral artery disease were detected in 13 (38%) patients (5 with PD and 8 with DFP). DWI identified infarcts on the cortical motor area, centrum ovale, or corona radiata in 25 (74%) patients (12 with PD and 13 with DFP), whereas brainstem infarct was demonstrated only in 1 patients with PD. 18 (53%) patients (11 with PD and 7 with DFP) had infarcts <15mm in maximal diameter, and 15 (44%) patients (10 with PD and 5 with DFP) met the diagnostic criteria of lacunar stroke. Neurological deterioration occurred after hospitalization in 2 patients with DFP, but patients were discharged usually with mild or no disability. Discussions: Infarcts in the higher levels of cerebral hemisphere are responsible for the majority of the PD and DFP syndromes. The predictive value of these syndromes for lacunar stroke is rather low, particularly in DFP.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

04
pure dysarthria and dysarthria-facial paresis syndrome
K. Yonemura    Y. Hashimoto    M. Uchino                                                 
 

Kumamoto City Hospital

JAPAN

Background: Pure dysarthria (PD) and dysarthria-facial paresis (DFP) are rarely encountered clinical stroke syndromes, and seem to be regarded as an atypical lacunar syndrome. We sought to clarify the clinical characteristics of PD and DFP in acute ischemic stroke patients. Methods: We selected patients with PD or DFP from 1,043 consecutive patients with first-ever acute ischemic stroke admitted over a 7-year period. Vascular risk factors, emboligenic heart disease, occlusive cerebral artery disease, infarct size and location, stroke subtype according to the TOAST classification, and outcome data were evaluated. Acute infarcts were all identified by diffusion-weighted MRI (DWI). Results: A total of 34 patients were reviewed. They consisted of 16 patients with PD and 18 patients with DFP. Hypertension was the most frequent in the vascular risk factors (13 patients with PD and 14 patients with DFP). Emboligenic heart disease and/or cerebral artery disease were detected in 13 (38%) patients (5 with PD and 8 with DFP). DWI identified infarcts on the cortical motor area, centrum ovale, or corona radiata in 25 (74%) patients (12 with PD and 13 with DFP), whereas brainstem infarct was demonstrated only in 1 patients with PD. 18 (53%) patients (11 with PD and 7 with DFP) had infarcts <15mm in maximal diameter, and 15 (44%) patients (10 with PD and 5 with DFP) met the diagnostic criteria of lacunar stroke. Neurological deterioration occurred after hospitalization in 2 patients with DFP, but patients were discharged usually with mild or no disability. Discussions: Infarcts in the higher levels of cerebral hemisphere are responsible for the majority of the PD and DFP syndromes. The predictive value of these syndromes for lacunar stroke is rather low, particularly in DFP.

Kind of presentation: Oral 
Acute stroke: treatment concepts  
 
Date: Thursday, 31 May 2007   Time: 16:50 - 17:00    Room: Room Carron
Chair: R. Baumgartner, Switzerland and G. Donnan, Australia
 

12
DEGRADATION OF EXTRACELLULAR RNA BY INTRAVENOUS RNase PROVIDES NEUROPROTECTIVE EFFECTS IN ISCHEMIC STROKE
M. Walberer    S. Fischer    C. Friedrich    G. Bachmann    C.  Mueller    E. Stolz    F. Blaes    K.T.Preissner    T. Gerriets       
 

Dep. of Exp. Neurology + Dep. of Biochemistry, Univ. Giessen; Kerckhoff-Clinic Bad Nauheim

GERMANY

Objective: Recent studies indicate that release of intracellular RNA during ischemic cell necrosis exerts deleterious effects within the surrounding tissue. This novel and hitherto unrecognized mechanism leads to VEGF-mediated blood-brain barrier (BBB) damage and thus contributes to ischemic brain damage in acute stroke (S. Fischer et al. Manuscript submitted). Extracellular RNA can be degraded by RNase. The present study aimed to determine potential neuroprotective effects of intravenous RNase application in vivo. Methods: Ninety-seven Wistar-rats were treated intravenously with RNase (13, 42, 125, 375, 1125 or 3750 µg/kg) or placebo (NaCl 0.9%). The MCA was occluded for 90 min using the suture-technique. Infarct volume was determined after 5h and 24h on magnetic resonance images (Bruker PharmaScan 7.0 Tesla). Vasogenic brain edema was determined using the wet-dry method. Results: Intravenous application of RNase was well tolerated. It provided a robust and dose-dependent reduction of ischemic lesion volume and brain edema at 5 and 24h after stroke onset. The maximum effect was observed at 42µg/kg. Conclusion: The present study corroborates the recently discovered mechanism of RNA-mediated BBB damage. RNase-treatment, however, did not only reduce vasogenic brain edema but also significantly reduced infarct volume. Further research should explore the therapeutic potential of RNase in stroke and other diseases leading to BBB-damage, such as brain trauma or tumor.

Kind of presentation: Oral 
Acute stroke: treatment concepts  
 
Date: Thursday, 31 May 2007   Time: 16:50 - 17:00    Room: Room Carron
Chair: R. Baumgartner, Switzerland and G. Donnan, Australia
 

12
DEGRADATION OF EXTRACELLULAR RNA BY INTRAVENOUS RNase PROVIDES NEUROPROTECTIVE EFFECTS IN ISCHEMIC STROKE
M. Walberer    S. Fischer    C. Friedrich    G. Bachmann    C.  Mueller    E. Stolz    F. Blaes    K.T.Preissner    T. Gerriets       
 

Dep. of Exp. Neurology + Dep. of Biochemistry, Univ. Giessen; Kerckhoff-Clinic Bad Nauheim

GERMANY

Objective: Recent studies indicate that release of intracellular RNA during ischemic cell necrosis exerts deleterious effects within the surrounding tissue. This novel and hitherto unrecognized mechanism leads to VEGF-mediated blood-brain barrier (BBB) damage and thus contributes to ischemic brain damage in acute stroke (S. Fischer et al. Manuscript submitted). Extracellular RNA can be degraded by RNase. The present study aimed to determine potential neuroprotective effects of intravenous RNase application in vivo. Methods: Ninety-seven Wistar-rats were treated intravenously with RNase (13, 42, 125, 375, 1125 or 3750 µg/kg) or placebo (NaCl 0.9%). The MCA was occluded for 90 min using the suture-technique. Infarct volume was determined after 5h and 24h on magnetic resonance images (Bruker PharmaScan 7.0 Tesla). Vasogenic brain edema was determined using the wet-dry method. Results: Intravenous application of RNase was well tolerated. It provided a robust and dose-dependent reduction of ischemic lesion volume and brain edema at 5 and 24h after stroke onset. The maximum effect was observed at 42µg/kg. Conclusion: The present study corroborates the recently discovered mechanism of RNA-mediated BBB damage. RNase-treatment, however, did not only reduce vasogenic brain edema but also significantly reduced infarct volume. Further research should explore the therapeutic potential of RNase in stroke and other diseases leading to BBB-damage, such as brain trauma or tumor.

Kind of presentation: Oral 
Acute stroke: treatment concepts  
 
Date: Thursday, 31 May 2007   Time: 16:50 - 17:00    Room: Room Carron
Chair: R. Baumgartner, Switzerland and G. Donnan, Australia
 

12
DEGRADATION OF EXTRACELLULAR RNA BY INTRAVENOUS RNase PROVIDES NEUROPROTECTIVE EFFECTS IN ISCHEMIC STROKE
M. Walberer    S. Fischer    C. Friedrich    G. Bachmann    C.  Mueller    E. Stolz    F. Blaes    K.T.Preissner    T. Gerriets       
 

Dep. of Exp. Neurology + Dep. of Biochemistry, Univ. Giessen; Kerckhoff-Clinic Bad Nauheim

GERMANY

Objective: Recent studies indicate that release of intracellular RNA during ischemic cell necrosis exerts deleterious effects within the surrounding tissue. This novel and hitherto unrecognized mechanism leads to VEGF-mediated blood-brain barrier (BBB) damage and thus contributes to ischemic brain damage in acute stroke (S. Fischer et al. Manuscript submitted). Extracellular RNA can be degraded by RNase. The present study aimed to determine potential neuroprotective effects of intravenous RNase application in vivo. Methods: Ninety-seven Wistar-rats were treated intravenously with RNase (13, 42, 125, 375, 1125 or 3750 µg/kg) or placebo (NaCl 0.9%). The MCA was occluded for 90 min using the suture-technique. Infarct volume was determined after 5h and 24h on magnetic resonance images (Bruker PharmaScan 7.0 Tesla). Vasogenic brain edema was determined using the wet-dry method. Results: Intravenous application of RNase was well tolerated. It provided a robust and dose-dependent reduction of ischemic lesion volume and brain edema at 5 and 24h after stroke onset. The maximum effect was observed at 42µg/kg. Conclusion: The present study corroborates the recently discovered mechanism of RNA-mediated BBB damage. RNase-treatment, however, did not only reduce vasogenic brain edema but also significantly reduced infarct volume. Further research should explore the therapeutic potential of RNase in stroke and other diseases leading to BBB-damage, such as brain trauma or tumor.

Kind of presentation: Oral 
Acute stroke: treatment concepts  
 
Date: Thursday, 31 May 2007   Time: 16:50 - 17:00    Room: Room Carron
Chair: R. Baumgartner, Switzerland and G. Donnan, Australia
 

12
DEGRADATION OF EXTRACELLULAR RNA BY INTRAVENOUS RNase PROVIDES NEUROPROTECTIVE EFFECTS IN ISCHEMIC STROKE
M. Walberer    S. Fischer    C. Friedrich    G. Bachmann    C.  Mueller    E. Stolz    F. Blaes    K.T.Preissner    T. Gerriets       
 

Dep. of Exp. Neurology + Dep. of Biochemistry, Univ. Giessen; Kerckhoff-Clinic Bad Nauheim

GERMANY

Objective: Recent studies indicate that release of intracellular RNA during ischemic cell necrosis exerts deleterious effects within the surrounding tissue. This novel and hitherto unrecognized mechanism leads to VEGF-mediated blood-brain barrier (BBB) damage and thus contributes to ischemic brain damage in acute stroke (S. Fischer et al. Manuscript submitted). Extracellular RNA can be degraded by RNase. The present study aimed to determine potential neuroprotective effects of intravenous RNase application in vivo. Methods: Ninety-seven Wistar-rats were treated intravenously with RNase (13, 42, 125, 375, 1125 or 3750 µg/kg) or placebo (NaCl 0.9%). The MCA was occluded for 90 min using the suture-technique. Infarct volume was determined after 5h and 24h on magnetic resonance images (Bruker PharmaScan 7.0 Tesla). Vasogenic brain edema was determined using the wet-dry method. Results: Intravenous application of RNase was well tolerated. It provided a robust and dose-dependent reduction of ischemic lesion volume and brain edema at 5 and 24h after stroke onset. The maximum effect was observed at 42µg/kg. Conclusion: The present study corroborates the recently discovered mechanism of RNA-mediated BBB damage. RNase-treatment, however, did not only reduce vasogenic brain edema but also significantly reduced infarct volume. Further research should explore the therapeutic potential of RNase in stroke and other diseases leading to BBB-damage, such as brain trauma or tumor.

Kind of presentation: Oral 
Acute stroke: treatment concepts  
 
Date: Thursday, 31 May 2007   Time: 16:50 - 17:00    Room: Room Carron
Chair: R. Baumgartner, Switzerland and G. Donnan, Australia
 

12
DEGRADATION OF EXTRACELLULAR RNA BY INTRAVENOUS RNase PROVIDES NEUROPROTECTIVE EFFECTS IN ISCHEMIC STROKE
M. Walberer    S. Fischer    C. Friedrich    G. Bachmann    C.  Mueller    E. Stolz    F. Blaes    K.T.Preissner    T. Gerriets       
 

Dep. of Exp. Neurology + Dep. of Biochemistry, Univ. Giessen; Kerckhoff-Clinic Bad Nauheim

GERMANY

Objective: Recent studies indicate that release of intracellular RNA during ischemic cell necrosis exerts deleterious effects within the surrounding tissue. This novel and hitherto unrecognized mechanism leads to VEGF-mediated blood-brain barrier (BBB) damage and thus contributes to ischemic brain damage in acute stroke (S. Fischer et al. Manuscript submitted). Extracellular RNA can be degraded by RNase. The present study aimed to determine potential neuroprotective effects of intravenous RNase application in vivo. Methods: Ninety-seven Wistar-rats were treated intravenously with RNase (13, 42, 125, 375, 1125 or 3750 µg/kg) or placebo (NaCl 0.9%). The MCA was occluded for 90 min using the suture-technique. Infarct volume was determined after 5h and 24h on magnetic resonance images (Bruker PharmaScan 7.0 Tesla). Vasogenic brain edema was determined using the wet-dry method. Results: Intravenous application of RNase was well tolerated. It provided a robust and dose-dependent reduction of ischemic lesion volume and brain edema at 5 and 24h after stroke onset. The maximum effect was observed at 42µg/kg. Conclusion: The present study corroborates the recently discovered mechanism of RNA-mediated BBB damage. RNase-treatment, however, did not only reduce vasogenic brain edema but also significantly reduced infarct volume. Further research should explore the therapeutic potential of RNase in stroke and other diseases leading to BBB-damage, such as brain trauma or tumor.

Kind of presentation: Oral 
Acute stroke: treatment concepts  
 
Date: Thursday, 31 May 2007   Time: 16:50 - 17:00    Room: Room Carron
Chair: R. Baumgartner, Switzerland and G. Donnan, Australia
 

12
DEGRADATION OF EXTRACELLULAR RNA BY INTRAVENOUS RNase PROVIDES NEUROPROTECTIVE EFFECTS IN ISCHEMIC STROKE
M. Walberer    S. Fischer    C. Friedrich    G. Bachmann    C.  Mueller    E. Stolz    F. Blaes    K.T.Preissner    T. Gerriets       
 

Dep. of Exp. Neurology + Dep. of Biochemistry, Univ. Giessen; Kerckhoff-Clinic Bad Nauheim

GERMANY

Objective: Recent studies indicate that release of intracellular RNA during ischemic cell necrosis exerts deleterious effects within the surrounding tissue. This novel and hitherto unrecognized mechanism leads to VEGF-mediated blood-brain barrier (BBB) damage and thus contributes to ischemic brain damage in acute stroke (S. Fischer et al. Manuscript submitted). Extracellular RNA can be degraded by RNase. The present study aimed to determine potential neuroprotective effects of intravenous RNase application in vivo. Methods: Ninety-seven Wistar-rats were treated intravenously with RNase (13, 42, 125, 375, 1125 or 3750 µg/kg) or placebo (NaCl 0.9%). The MCA was occluded for 90 min using the suture-technique. Infarct volume was determined after 5h and 24h on magnetic resonance images (Bruker PharmaScan 7.0 Tesla). Vasogenic brain edema was determined using the wet-dry method. Results: Intravenous application of RNase was well tolerated. It provided a robust and dose-dependent reduction of ischemic lesion volume and brain edema at 5 and 24h after stroke onset. The maximum effect was observed at 42µg/kg. Conclusion: The present study corroborates the recently discovered mechanism of RNA-mediated BBB damage. RNase-treatment, however, did not only reduce vasogenic brain edema but also significantly reduced infarct volume. Further research should explore the therapeutic potential of RNase in stroke and other diseases leading to BBB-damage, such as brain trauma or tumor.

Kind of presentation: Oral 
Acute stroke: treatment concepts  
 
Date: Thursday, 31 May 2007   Time: 16:50 - 17:00    Room: Room Carron
Chair: R. Baumgartner, Switzerland and G. Donnan, Australia
 

12
DEGRADATION OF EXTRACELLULAR RNA BY INTRAVENOUS RNase PROVIDES NEUROPROTECTIVE EFFECTS IN ISCHEMIC STROKE
M. Walberer    S. Fischer    C. Friedrich    G. Bachmann    C.  Mueller    E. Stolz    F. Blaes    K.T.Preissner    T. Gerriets       
 

Dep. of Exp. Neurology + Dep. of Biochemistry, Univ. Giessen; Kerckhoff-Clinic Bad Nauheim

GERMANY

Objective: Recent studies indicate that release of intracellular RNA during ischemic cell necrosis exerts deleterious effects within the surrounding tissue. This novel and hitherto unrecognized mechanism leads to VEGF-mediated blood-brain barrier (BBB) damage and thus contributes to ischemic brain damage in acute stroke (S. Fischer et al. Manuscript submitted). Extracellular RNA can be degraded by RNase. The present study aimed to determine potential neuroprotective effects of intravenous RNase application in vivo. Methods: Ninety-seven Wistar-rats were treated intravenously with RNase (13, 42, 125, 375, 1125 or 3750 µg/kg) or placebo (NaCl 0.9%). The MCA was occluded for 90 min using the suture-technique. Infarct volume was determined after 5h and 24h on magnetic resonance images (Bruker PharmaScan 7.0 Tesla). Vasogenic brain edema was determined using the wet-dry method. Results: Intravenous application of RNase was well tolerated. It provided a robust and dose-dependent reduction of ischemic lesion volume and brain edema at 5 and 24h after stroke onset. The maximum effect was observed at 42µg/kg. Conclusion: The present study corroborates the recently discovered mechanism of RNA-mediated BBB damage. RNase-treatment, however, did not only reduce vasogenic brain edema but also significantly reduced infarct volume. Further research should explore the therapeutic potential of RNase in stroke and other diseases leading to BBB-damage, such as brain trauma or tumor.

Kind of presentation: Oral 
Acute stroke: treatment concepts  
 
Date: Thursday, 31 May 2007   Time: 16:50 - 17:00    Room: Room Carron
Chair: R. Baumgartner, Switzerland and G. Donnan, Australia
 

12
DEGRADATION OF EXTRACELLULAR RNA BY INTRAVENOUS RNase PROVIDES NEUROPROTECTIVE EFFECTS IN ISCHEMIC STROKE
M. Walberer    S. Fischer    C. Friedrich    G. Bachmann    C.  Mueller    E. Stolz    F. Blaes    K.T.Preissner    T. Gerriets       
 

Dep. of Exp. Neurology + Dep. of Biochemistry, Univ. Giessen; Kerckhoff-Clinic Bad Nauheim

GERMANY

Objective: Recent studies indicate that release of intracellular RNA during ischemic cell necrosis exerts deleterious effects within the surrounding tissue. This novel and hitherto unrecognized mechanism leads to VEGF-mediated blood-brain barrier (BBB) damage and thus contributes to ischemic brain damage in acute stroke (S. Fischer et al. Manuscript submitted). Extracellular RNA can be degraded by RNase. The present study aimed to determine potential neuroprotective effects of intravenous RNase application in vivo. Methods: Ninety-seven Wistar-rats were treated intravenously with RNase (13, 42, 125, 375, 1125 or 3750 µg/kg) or placebo (NaCl 0.9%). The MCA was occluded for 90 min using the suture-technique. Infarct volume was determined after 5h and 24h on magnetic resonance images (Bruker PharmaScan 7.0 Tesla). Vasogenic brain edema was determined using the wet-dry method. Results: Intravenous application of RNase was well tolerated. It provided a robust and dose-dependent reduction of ischemic lesion volume and brain edema at 5 and 24h after stroke onset. The maximum effect was observed at 42µg/kg. Conclusion: The present study corroborates the recently discovered mechanism of RNA-mediated BBB damage. RNase-treatment, however, did not only reduce vasogenic brain edema but also significantly reduced infarct volume. Further research should explore the therapeutic potential of RNase in stroke and other diseases leading to BBB-damage, such as brain trauma or tumor.

Kind of presentation: Oral 
Acute stroke: treatment concepts  
 
Date: Thursday, 31 May 2007   Time: 16:50 - 17:00    Room: Room Carron
Chair: R. Baumgartner, Switzerland and G. Donnan, Australia
 

12
DEGRADATION OF EXTRACELLULAR RNA BY INTRAVENOUS RNase PROVIDES NEUROPROTECTIVE EFFECTS IN ISCHEMIC STROKE
M. Walberer    S. Fischer    C. Friedrich    G. Bachmann    C.  Mueller    E. Stolz    F. Blaes    K.T.Preissner    T. Gerriets       
 

Dep. of Exp. Neurology + Dep. of Biochemistry, Univ. Giessen; Kerckhoff-Clinic Bad Nauheim

GERMANY

Objective: Recent studies indicate that release of intracellular RNA during ischemic cell necrosis exerts deleterious effects within the surrounding tissue. This novel and hitherto unrecognized mechanism leads to VEGF-mediated blood-brain barrier (BBB) damage and thus contributes to ischemic brain damage in acute stroke (S. Fischer et al. Manuscript submitted). Extracellular RNA can be degraded by RNase. The present study aimed to determine potential neuroprotective effects of intravenous RNase application in vivo. Methods: Ninety-seven Wistar-rats were treated intravenously with RNase (13, 42, 125, 375, 1125 or 3750 µg/kg) or placebo (NaCl 0.9%). The MCA was occluded for 90 min using the suture-technique. Infarct volume was determined after 5h and 24h on magnetic resonance images (Bruker PharmaScan 7.0 Tesla). Vasogenic brain edema was determined using the wet-dry method. Results: Intravenous application of RNase was well tolerated. It provided a robust and dose-dependent reduction of ischemic lesion volume and brain edema at 5 and 24h after stroke onset. The maximum effect was observed at 42µg/kg. Conclusion: The present study corroborates the recently discovered mechanism of RNA-mediated BBB damage. RNase-treatment, however, did not only reduce vasogenic brain edema but also significantly reduced infarct volume. Further research should explore the therapeutic potential of RNase in stroke and other diseases leading to BBB-damage, such as brain trauma or tumor.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

05
The effect of acute hyperhomocysteinaemia on cerebral blood flow of healthy elderly volunteers
S.R.Hart    A.A.Mangoni    C. Swift    C. Deane    R. Sherwood    A. Wierzbicki    S.H.Jackson                     
 

Div of Clinical Neuroscience, University of Edinburgh

UNITED KINGDOM

BACKGROUND: Mildly increased plasma homocysteine is an independent risk factor for ischaemic stroke. However, the underlying fundamental causal arterial mechanisms in vivo linking hyperhomocysteinaemia with cerebrovascular disease remain unclear. OBJECTIVE: To test the hypothesis that acute increases in plasma homocysteine produced by methionine are associated with an acute decrease in cerebral arterial blood flow velocity (CABFV) measured by transcranial Doppler (TCD) ultrasound. By contrast, the simultaneous response of peripheral arterial distensibility was measured by pulse wave velocity (PWV) and digital volume pulse (DVP). DESIGN: A double-blind, cross-over, placebo controlled design was used and cerebral blood flow velocity and peripheral arterial distensibility and plasma homocysteine concentrations were measured between 12 and 20 hours after methionine loading or placebo. RESULTS: Between 13 and 16 hours after initial exposure to a methionine loading test, mean CABFV showed a significant 5.1% decrease in mean blood flow velocity (34.1±0.3 m/s vs 36.0±0.3 m/s, p <0.01) compared to placebo (Sample size = 8). However, between 17 and 20 hours after methionine exposure, CABFV showed no significant sustained change, compared to placebo (36.1±1.0 m/s vs 35.3±0.3 m/s, p < 0.1). There was no significant change in peripheral arterial distensibility measured by PWV during hyperhomocysteinaemia compared to placebo (9.9±0.2m/s vs 10.1±0.2m/s, p<0.5) and no difference in DVP, stiffness index (83.7±1.8% vs 83.7±1.6%, p<0.1). CONCLUSION: In healthy elderly volunteers, acute hyperhomocysteinaemia resulted in a significant initial decrease in CABFV but no sustained reduction in cerebral blood flow velocity. There was no significant simultaneous change in peripheral arterial distensibility suggesting that elderly cerebral arterial response to hyperhomocysteinaemia is different to that of peripheral arteries.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

05
The effect of acute hyperhomocysteinaemia on cerebral blood flow of healthy elderly volunteers
S.R.Hart    A.A.Mangoni    C. Swift    C. Deane    R. Sherwood    A. Wierzbicki    S.H.Jackson                     
 

Div of Clinical Neuroscience, University of Edinburgh

UNITED KINGDOM

BACKGROUND: Mildly increased plasma homocysteine is an independent risk factor for ischaemic stroke. However, the underlying fundamental causal arterial mechanisms in vivo linking hyperhomocysteinaemia with cerebrovascular disease remain unclear. OBJECTIVE: To test the hypothesis that acute increases in plasma homocysteine produced by methionine are associated with an acute decrease in cerebral arterial blood flow velocity (CABFV) measured by transcranial Doppler (TCD) ultrasound. By contrast, the simultaneous response of peripheral arterial distensibility was measured by pulse wave velocity (PWV) and digital volume pulse (DVP). DESIGN: A double-blind, cross-over, placebo controlled design was used and cerebral blood flow velocity and peripheral arterial distensibility and plasma homocysteine concentrations were measured between 12 and 20 hours after methionine loading or placebo. RESULTS: Between 13 and 16 hours after initial exposure to a methionine loading test, mean CABFV showed a significant 5.1% decrease in mean blood flow velocity (34.1±0.3 m/s vs 36.0±0.3 m/s, p <0.01) compared to placebo (Sample size = 8). However, between 17 and 20 hours after methionine exposure, CABFV showed no significant sustained change, compared to placebo (36.1±1.0 m/s vs 35.3±0.3 m/s, p < 0.1). There was no significant change in peripheral arterial distensibility measured by PWV during hyperhomocysteinaemia compared to placebo (9.9±0.2m/s vs 10.1±0.2m/s, p<0.5) and no difference in DVP, stiffness index (83.7±1.8% vs 83.7±1.6%, p<0.1). CONCLUSION: In healthy elderly volunteers, acute hyperhomocysteinaemia resulted in a significant initial decrease in CABFV but no sustained reduction in cerebral blood flow velocity. There was no significant simultaneous change in peripheral arterial distensibility suggesting that elderly cerebral arterial response to hyperhomocysteinaemia is different to that of peripheral arteries.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

05
The effect of acute hyperhomocysteinaemia on cerebral blood flow of healthy elderly volunteers
S.R.Hart    A.A.Mangoni    C. Swift    C. Deane    R. Sherwood    A. Wierzbicki    S.H.Jackson                     
 

Div of Clinical Neuroscience, University of Edinburgh

UNITED KINGDOM

BACKGROUND: Mildly increased plasma homocysteine is an independent risk factor for ischaemic stroke. However, the underlying fundamental causal arterial mechanisms in vivo linking hyperhomocysteinaemia with cerebrovascular disease remain unclear. OBJECTIVE: To test the hypothesis that acute increases in plasma homocysteine produced by methionine are associated with an acute decrease in cerebral arterial blood flow velocity (CABFV) measured by transcranial Doppler (TCD) ultrasound. By contrast, the simultaneous response of peripheral arterial distensibility was measured by pulse wave velocity (PWV) and digital volume pulse (DVP). DESIGN: A double-blind, cross-over, placebo controlled design was used and cerebral blood flow velocity and peripheral arterial distensibility and plasma homocysteine concentrations were measured between 12 and 20 hours after methionine loading or placebo. RESULTS: Between 13 and 16 hours after initial exposure to a methionine loading test, mean CABFV showed a significant 5.1% decrease in mean blood flow velocity (34.1±0.3 m/s vs 36.0±0.3 m/s, p <0.01) compared to placebo (Sample size = 8). However, between 17 and 20 hours after methionine exposure, CABFV showed no significant sustained change, compared to placebo (36.1±1.0 m/s vs 35.3±0.3 m/s, p < 0.1). There was no significant change in peripheral arterial distensibility measured by PWV during hyperhomocysteinaemia compared to placebo (9.9±0.2m/s vs 10.1±0.2m/s, p<0.5) and no difference in DVP, stiffness index (83.7±1.8% vs 83.7±1.6%, p<0.1). CONCLUSION: In healthy elderly volunteers, acute hyperhomocysteinaemia resulted in a significant initial decrease in CABFV but no sustained reduction in cerebral blood flow velocity. There was no significant simultaneous change in peripheral arterial distensibility suggesting that elderly cerebral arterial response to hyperhomocysteinaemia is different to that of peripheral arteries.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

05
The effect of acute hyperhomocysteinaemia on cerebral blood flow of healthy elderly volunteers
S.R.Hart    A.A.Mangoni    C. Swift    C. Deane    R. Sherwood    A. Wierzbicki    S.H.Jackson                     
 

Div of Clinical Neuroscience, University of Edinburgh

UNITED KINGDOM

BACKGROUND: Mildly increased plasma homocysteine is an independent risk factor for ischaemic stroke. However, the underlying fundamental causal arterial mechanisms in vivo linking hyperhomocysteinaemia with cerebrovascular disease remain unclear. OBJECTIVE: To test the hypothesis that acute increases in plasma homocysteine produced by methionine are associated with an acute decrease in cerebral arterial blood flow velocity (CABFV) measured by transcranial Doppler (TCD) ultrasound. By contrast, the simultaneous response of peripheral arterial distensibility was measured by pulse wave velocity (PWV) and digital volume pulse (DVP). DESIGN: A double-blind, cross-over, placebo controlled design was used and cerebral blood flow velocity and peripheral arterial distensibility and plasma homocysteine concentrations were measured between 12 and 20 hours after methionine loading or placebo. RESULTS: Between 13 and 16 hours after initial exposure to a methionine loading test, mean CABFV showed a significant 5.1% decrease in mean blood flow velocity (34.1±0.3 m/s vs 36.0±0.3 m/s, p <0.01) compared to placebo (Sample size = 8). However, between 17 and 20 hours after methionine exposure, CABFV showed no significant sustained change, compared to placebo (36.1±1.0 m/s vs 35.3±0.3 m/s, p < 0.1). There was no significant change in peripheral arterial distensibility measured by PWV during hyperhomocysteinaemia compared to placebo (9.9±0.2m/s vs 10.1±0.2m/s, p<0.5) and no difference in DVP, stiffness index (83.7±1.8% vs 83.7±1.6%, p<0.1). CONCLUSION: In healthy elderly volunteers, acute hyperhomocysteinaemia resulted in a significant initial decrease in CABFV but no sustained reduction in cerebral blood flow velocity. There was no significant simultaneous change in peripheral arterial distensibility suggesting that elderly cerebral arterial response to hyperhomocysteinaemia is different to that of peripheral arteries.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

05
The effect of acute hyperhomocysteinaemia on cerebral blood flow of healthy elderly volunteers
S.R.Hart    A.A.Mangoni    C. Swift    C. Deane    R. Sherwood    A. Wierzbicki    S.H.Jackson                     
 

Div of Clinical Neuroscience, University of Edinburgh

UNITED KINGDOM

BACKGROUND: Mildly increased plasma homocysteine is an independent risk factor for ischaemic stroke. However, the underlying fundamental causal arterial mechanisms in vivo linking hyperhomocysteinaemia with cerebrovascular disease remain unclear. OBJECTIVE: To test the hypothesis that acute increases in plasma homocysteine produced by methionine are associated with an acute decrease in cerebral arterial blood flow velocity (CABFV) measured by transcranial Doppler (TCD) ultrasound. By contrast, the simultaneous response of peripheral arterial distensibility was measured by pulse wave velocity (PWV) and digital volume pulse (DVP). DESIGN: A double-blind, cross-over, placebo controlled design was used and cerebral blood flow velocity and peripheral arterial distensibility and plasma homocysteine concentrations were measured between 12 and 20 hours after methionine loading or placebo. RESULTS: Between 13 and 16 hours after initial exposure to a methionine loading test, mean CABFV showed a significant 5.1% decrease in mean blood flow velocity (34.1±0.3 m/s vs 36.0±0.3 m/s, p <0.01) compared to placebo (Sample size = 8). However, between 17 and 20 hours after methionine exposure, CABFV showed no significant sustained change, compared to placebo (36.1±1.0 m/s vs 35.3±0.3 m/s, p < 0.1). There was no significant change in peripheral arterial distensibility measured by PWV during hyperhomocysteinaemia compared to placebo (9.9±0.2m/s vs 10.1±0.2m/s, p<0.5) and no difference in DVP, stiffness index (83.7±1.8% vs 83.7±1.6%, p<0.1). CONCLUSION: In healthy elderly volunteers, acute hyperhomocysteinaemia resulted in a significant initial decrease in CABFV but no sustained reduction in cerebral blood flow velocity. There was no significant simultaneous change in peripheral arterial distensibility suggesting that elderly cerebral arterial response to hyperhomocysteinaemia is different to that of peripheral arteries.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

05
The effect of acute hyperhomocysteinaemia on cerebral blood flow of healthy elderly volunteers
S.R.Hart    A.A.Mangoni    C. Swift    C. Deane    R. Sherwood    A. Wierzbicki    S.H.Jackson                     
 

Div of Clinical Neuroscience, University of Edinburgh

UNITED KINGDOM

BACKGROUND: Mildly increased plasma homocysteine is an independent risk factor for ischaemic stroke. However, the underlying fundamental causal arterial mechanisms in vivo linking hyperhomocysteinaemia with cerebrovascular disease remain unclear. OBJECTIVE: To test the hypothesis that acute increases in plasma homocysteine produced by methionine are associated with an acute decrease in cerebral arterial blood flow velocity (CABFV) measured by transcranial Doppler (TCD) ultrasound. By contrast, the simultaneous response of peripheral arterial distensibility was measured by pulse wave velocity (PWV) and digital volume pulse (DVP). DESIGN: A double-blind, cross-over, placebo controlled design was used and cerebral blood flow velocity and peripheral arterial distensibility and plasma homocysteine concentrations were measured between 12 and 20 hours after methionine loading or placebo. RESULTS: Between 13 and 16 hours after initial exposure to a methionine loading test, mean CABFV showed a significant 5.1% decrease in mean blood flow velocity (34.1±0.3 m/s vs 36.0±0.3 m/s, p <0.01) compared to placebo (Sample size = 8). However, between 17 and 20 hours after methionine exposure, CABFV showed no significant sustained change, compared to placebo (36.1±1.0 m/s vs 35.3±0.3 m/s, p < 0.1). There was no significant change in peripheral arterial distensibility measured by PWV during hyperhomocysteinaemia compared to placebo (9.9±0.2m/s vs 10.1±0.2m/s, p<0.5) and no difference in DVP, stiffness index (83.7±1.8% vs 83.7±1.6%, p<0.1). CONCLUSION: In healthy elderly volunteers, acute hyperhomocysteinaemia resulted in a significant initial decrease in CABFV but no sustained reduction in cerebral blood flow velocity. There was no significant simultaneous change in peripheral arterial distensibility suggesting that elderly cerebral arterial response to hyperhomocysteinaemia is different to that of peripheral arteries.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

05
The effect of acute hyperhomocysteinaemia on cerebral blood flow of healthy elderly volunteers
S.R.Hart    A.A.Mangoni    C. Swift    C. Deane    R. Sherwood    A. Wierzbicki    S.H.Jackson                     
 

Div of Clinical Neuroscience, University of Edinburgh

UNITED KINGDOM

BACKGROUND: Mildly increased plasma homocysteine is an independent risk factor for ischaemic stroke. However, the underlying fundamental causal arterial mechanisms in vivo linking hyperhomocysteinaemia with cerebrovascular disease remain unclear. OBJECTIVE: To test the hypothesis that acute increases in plasma homocysteine produced by methionine are associated with an acute decrease in cerebral arterial blood flow velocity (CABFV) measured by transcranial Doppler (TCD) ultrasound. By contrast, the simultaneous response of peripheral arterial distensibility was measured by pulse wave velocity (PWV) and digital volume pulse (DVP). DESIGN: A double-blind, cross-over, placebo controlled design was used and cerebral blood flow velocity and peripheral arterial distensibility and plasma homocysteine concentrations were measured between 12 and 20 hours after methionine loading or placebo. RESULTS: Between 13 and 16 hours after initial exposure to a methionine loading test, mean CABFV showed a significant 5.1% decrease in mean blood flow velocity (34.1±0.3 m/s vs 36.0±0.3 m/s, p <0.01) compared to placebo (Sample size = 8). However, between 17 and 20 hours after methionine exposure, CABFV showed no significant sustained change, compared to placebo (36.1±1.0 m/s vs 35.3±0.3 m/s, p < 0.1). There was no significant change in peripheral arterial distensibility measured by PWV during hyperhomocysteinaemia compared to placebo (9.9±0.2m/s vs 10.1±0.2m/s, p<0.5) and no difference in DVP, stiffness index (83.7±1.8% vs 83.7±1.6%, p<0.1). CONCLUSION: In healthy elderly volunteers, acute hyperhomocysteinaemia resulted in a significant initial decrease in CABFV but no sustained reduction in cerebral blood flow velocity. There was no significant simultaneous change in peripheral arterial distensibility suggesting that elderly cerebral arterial response to hyperhomocysteinaemia is different to that of peripheral arteries.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

08
Public Awareness of Stroke in the Czech Republic: General Knowledge, Risk Factors, Warning Signs, and Response
R. Mikulik    D. Vaclavik    D. Hrdlicka    J. Kryza                                          
 

St.Anne Univ. Hospital in Brno, Neurology Dept., Ostrava Vitkovice CEGEDIM

CZECH REPUBLIC

Background—Effective stroke treatment depends on public knowledge. The goal of this prospective study, the first ever in the Czech Republic, was to determine public awarness of stroke in a nation-wide sample and the predictors of correct response. Methods—Between November and December of 2005, survey using a 3-stage random sampling method, which included area, household, and household member sampling, was conducted throughout the Czech Republic. Participants >40 years old were personally interviewed via a structured and standardized questionnaire concerning general knowledge, risk factors, warning signs of stroke, and correct response to stroke as assessed by the Stroke Action Test (STAT). Predictors of scoring >50% on STAT were identified by multiple regression. Results—A total of 650 households were contacted, yielding 592 interviews (91% response rate). Mean age was 58±12, 55% women. Sixty-nine percent thought a stroke was serious condition, and 57% thought it could be treated. Also 54% correctly named ≥2 risk factors and 46% named ≥2 warning signs. The average STAT-score was 27% and 18% scored >50%. The predictors of such a score were age (for each 10 year increment, OR 1.4, 95%CI 1.1-1.6), knowing that stroke is serious disease (OR 1.9, 95%CI 1.1-3.2), and knowing that stroke can be treated (OR 2.0, 95%CI 1.3-3.2). Conclusion—Knowledge about stroke in the Czech Republic was fair, yet response to warning signs was poor. Our study is the first to identify that correct response was influenced by knowledge that stroke is a serious and treatable disease and not by recognition of stroke symptoms. This highlights new directions and audiences for public awareness campaigns.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

08
Public Awareness of Stroke in the Czech Republic: General Knowledge, Risk Factors, Warning Signs, and Response
R. Mikulik    D. Vaclavik    D. Hrdlicka    J. Kryza                                          
 

St.Anne Univ. Hospital in Brno, Neurology Dept., Ostrava Vitkovice CEGEDIM

CZECH REPUBLIC

Background—Effective stroke treatment depends on public knowledge. The goal of this prospective study, the first ever in the Czech Republic, was to determine public awarness of stroke in a nation-wide sample and the predictors of correct response. Methods—Between November and December of 2005, survey using a 3-stage random sampling method, which included area, household, and household member sampling, was conducted throughout the Czech Republic. Participants >40 years old were personally interviewed via a structured and standardized questionnaire concerning general knowledge, risk factors, warning signs of stroke, and correct response to stroke as assessed by the Stroke Action Test (STAT). Predictors of scoring >50% on STAT were identified by multiple regression. Results—A total of 650 households were contacted, yielding 592 interviews (91% response rate). Mean age was 58±12, 55% women. Sixty-nine percent thought a stroke was serious condition, and 57% thought it could be treated. Also 54% correctly named ≥2 risk factors and 46% named ≥2 warning signs. The average STAT-score was 27% and 18% scored >50%. The predictors of such a score were age (for each 10 year increment, OR 1.4, 95%CI 1.1-1.6), knowing that stroke is serious disease (OR 1.9, 95%CI 1.1-3.2), and knowing that stroke can be treated (OR 2.0, 95%CI 1.3-3.2). Conclusion—Knowledge about stroke in the Czech Republic was fair, yet response to warning signs was poor. Our study is the first to identify that correct response was influenced by knowledge that stroke is a serious and treatable disease and not by recognition of stroke symptoms. This highlights new directions and audiences for public awareness campaigns.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

08
Public Awareness of Stroke in the Czech Republic: General Knowledge, Risk Factors, Warning Signs, and Response
R. Mikulik    D. Vaclavik    D. Hrdlicka    J. Kryza                                          
 

St.Anne Univ. Hospital in Brno, Neurology Dept., Ostrava Vitkovice CEGEDIM

CZECH REPUBLIC

Background—Effective stroke treatment depends on public knowledge. The goal of this prospective study, the first ever in the Czech Republic, was to determine public awarness of stroke in a nation-wide sample and the predictors of correct response. Methods—Between November and December of 2005, survey using a 3-stage random sampling method, which included area, household, and household member sampling, was conducted throughout the Czech Republic. Participants >40 years old were personally interviewed via a structured and standardized questionnaire concerning general knowledge, risk factors, warning signs of stroke, and correct response to stroke as assessed by the Stroke Action Test (STAT). Predictors of scoring >50% on STAT were identified by multiple regression. Results—A total of 650 households were contacted, yielding 592 interviews (91% response rate). Mean age was 58±12, 55% women. Sixty-nine percent thought a stroke was serious condition, and 57% thought it could be treated. Also 54% correctly named ≥2 risk factors and 46% named ≥2 warning signs. The average STAT-score was 27% and 18% scored >50%. The predictors of such a score were age (for each 10 year increment, OR 1.4, 95%CI 1.1-1.6), knowing that stroke is serious disease (OR 1.9, 95%CI 1.1-3.2), and knowing that stroke can be treated (OR 2.0, 95%CI 1.3-3.2). Conclusion—Knowledge about stroke in the Czech Republic was fair, yet response to warning signs was poor. Our study is the first to identify that correct response was influenced by knowledge that stroke is a serious and treatable disease and not by recognition of stroke symptoms. This highlights new directions and audiences for public awareness campaigns.

Kind of presentation: Poster 
   
Poster Session I
Date: Wednesday, 30 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

08
Public Awareness of Stroke in the Czech Republic: General Knowledge, Risk Factors, Warning Signs, and Response
R. Mikulik    D. Vaclavik    D. Hrdlicka    J. Kryza                                          
 

St.Anne Univ. Hospital in Brno, Neurology Dept., Ostrava Vitkovice CEGEDIM

CZECH REPUBLIC

Background—Effective stroke treatment depends on public knowledge. The goal of this prospective study, the first ever in the Czech Republic, was to determine public awarness of stroke in a nation-wide sample and the predictors of correct response. Methods—Between November and December of 2005, survey using a 3-stage random sampling method, which included area, household, and household member sampling, was conducted throughout the Czech Republic. Participants >40 years old were personally interviewed via a structured and standardized questionnaire concerning general knowledge, risk factors, warning signs of stroke, and correct response to stroke as assessed by the Stroke Action Test (STAT). Predictors of scoring >50% on STAT were identified by multiple regression. Results—A total of 650 households were contacted, yielding 592 interviews (91% response rate). Mean age was 58±12, 55% women. Sixty-nine percent thought a stroke was serious condition, and 57% thought it could be treated. Also 54% correctly named ≥2 risk factors and 46% named ≥2 warning signs. The average STAT-score was 27% and 18% scored >50%. The predictors of such a score were age (for each 10 year increment, OR 1.4, 95%CI 1.1-1.6), knowing that stroke is serious disease (OR 1.9, 95%CI 1.1-3.2), and knowing that stroke can be treated (OR 2.0, 95%CI 1.3-3.2). Conclusion—Knowledge about stroke in the Czech Republic was fair, yet response to warning signs was poor. Our study is the first to identify that correct response was influenced by knowledge that stroke is a serious and treatable disease and not by recognition of stroke symptoms. This highlights new directions and audiences for public awareness campaigns.

Kind of presentation: Oral 
Experimental studies  
 
Date: Thursday, 31 May 2007   Time: 12:00 - 12:10    Room: Room Alsh
Chair: C. Eschenfelder, Germany and L. Hirt, Switzerland
 

10
CALPAIN ACTIVATION PLAYS A ROLE IN THE PATHOPHYSIOLOGY OF FOCAL CEREBRAL ISCHEMIA AND DETERMINES LOST OF TISSUE VIABILITY AT THE ISCHEMIC PENUMBRA.
M. Gutiérrez    M. Alonso de Leciñana    M. Salinas    J. Masjuan    I. Ayuso    E. Díez Tejedor                            
 

La Paz University Hospital and Ramón y Cajal University Hospital. Madrid

SPAIN

Background and aims Calpains are calcium-dependent intracellular cysteine-proteases implicated in the pathophysiology of global cerebral ischemia causing proteolysis of different substrates: eIF4G cleavage by calpain induces down-regulation of translation and protein synthesis, and cleavege of p35, leads to abnormal activation of CdK5 that destroyes cytoskeletal proteins. We investigate calpain activation after focal cerebral ischemia Materials and methods Long- Evans rats were subjected to middle cerebral artery occlusion (MCAO) for 5min (n=4), 30min (n=4), 1h (n=5), 3h (n=4), 24h (n=3), 72h (n=6), 7 days (n=3). Samples were obtained from the cortex at the infarct core, the boundary zone between the core and the normal tissue in the affected hemisphere (penumbra) and from symmetrical areas in the contralateral hemisphere. Calpain activation in terms of espectrin degradation and cleavage of its substrates eIF4G and p35 was determined by immunoblot. The ischemic lesion was measured in H&E stained brain sections in rats subjected to the same procedure (n=6 each group). Results Calpain activation was observed after 1h of ischemia. At 3h activated calpain is demonstrated at the infarct core but not at the penumbra and after 24 h calpain activation is maximal in all the ischemic area. Parallel degradation of eIF4G and p35 was observed. Conclusions Calpain activation depends on the duration, and probably the severity, of focal cerebral ischemia and is maximal at the infarct core. Lowest degree of calpain activation and degradation of eIF4G and p35 in some areas of ischemic tissue identifies the existence of ischemic penumbra, while maximal activation may indicate irreversible damage.

Kind of presentation: Oral 
Experimental studies  
 
Date: Thursday, 31 May 2007   Time: 12:00 - 12:10    Room: Room Alsh
Chair: C. Eschenfelder, Germany and L. Hirt, Switzerland
 

10
CALPAIN ACTIVATION PLAYS A ROLE IN THE PATHOPHYSIOLOGY OF FOCAL CEREBRAL ISCHEMIA AND DETERMINES LOST OF TISSUE VIABILITY AT THE ISCHEMIC PENUMBRA.
M. Gutiérrez    M. Alonso de Leciñana    M. Salinas    J. Masjuan    I. Ayuso    E. Díez Tejedor                            
 

La Paz University Hospital and Ramón y Cajal University Hospital. Madrid

SPAIN

Background and aims Calpains are calcium-dependent intracellular cysteine-proteases implicated in the pathophysiology of global cerebral ischemia causing proteolysis of different substrates: eIF4G cleavage by calpain induces down-regulation of translation and protein synthesis, and cleavege of p35, leads to abnormal activation of CdK5 that destroyes cytoskeletal proteins. We investigate calpain activation after focal cerebral ischemia Materials and methods Long- Evans rats were subjected to middle cerebral artery occlusion (MCAO) for 5min (n=4), 30min (n=4), 1h (n=5), 3h (n=4), 24h (n=3), 72h (n=6), 7 days (n=3). Samples were obtained from the cortex at the infarct core, the boundary zone between the core and the normal tissue in the affected hemisphere (penumbra) and from symmetrical areas in the contralateral hemisphere. Calpain activation in terms of espectrin degradation and cleavage of its substrates eIF4G and p35 was determined by immunoblot. The ischemic lesion was measured in H&E stained brain sections in rats subjected to the same procedure (n=6 each group). Results Calpain activation was observed after 1h of ischemia. At 3h activated calpain is demonstrated at the infarct core but not at the penumbra and after 24 h calpain activation is maximal in all the ischemic area. Parallel degradation of eIF4G and p35 was observed. Conclusions Calpain activation depends on the duration, and probably the severity, of focal cerebral ischemia and is maximal at the infarct core. Lowest degree of calpain activation and degradation of eIF4G and p35 in some areas of ischemic tissue identifies the existence of ischemic penumbra, while maximal activation may indicate irreversible damage.

Kind of presentation: Oral 
Experimental studies  
 
Date: Thursday, 31 May 2007   Time: 12:00 - 12:10    Room: Room Alsh
Chair: C. Eschenfelder, Germany and L. Hirt, Switzerland
 

10
CALPAIN ACTIVATION PLAYS A ROLE IN THE PATHOPHYSIOLOGY OF FOCAL CEREBRAL ISCHEMIA AND DETERMINES LOST OF TISSUE VIABILITY AT THE ISCHEMIC PENUMBRA.
M. Gutiérrez    M. Alonso de Leciñana    M. Salinas    J. Masjuan    I. Ayuso    E. Díez Tejedor                            
 

La Paz University Hospital and Ramón y Cajal University Hospital. Madrid

SPAIN

Background and aims Calpains are calcium-dependent intracellular cysteine-proteases implicated in the pathophysiology of global cerebral ischemia causing proteolysis of different substrates: eIF4G cleavage by calpain induces down-regulation of translation and protein synthesis, and cleavege of p35, leads to abnormal activation of CdK5 that destroyes cytoskeletal proteins. We investigate calpain activation after focal cerebral ischemia Materials and methods Long- Evans rats were subjected to middle cerebral artery occlusion (MCAO) for 5min (n=4), 30min (n=4), 1h (n=5), 3h (n=4), 24h (n=3), 72h (n=6), 7 days (n=3). Samples were obtained from the cortex at the infarct core, the boundary zone between the core and the normal tissue in the affected hemisphere (penumbra) and from symmetrical areas in the contralateral hemisphere. Calpain activation in terms of espectrin degradation and cleavage of its substrates eIF4G and p35 was determined by immunoblot. The ischemic lesion was measured in H&E stained brain sections in rats subjected to the same procedure (n=6 each group). Results Calpain activation was observed after 1h of ischemia. At 3h activated calpain is demonstrated at the infarct core but not at the penumbra and after 24 h calpain activation is maximal in all the ischemic area. Parallel degradation of eIF4G and p35 was observed. Conclusions Calpain activation depends on the duration, and probably the severity, of focal cerebral ischemia and is maximal at the infarct core. Lowest degree of calpain activation and degradation of eIF4G and p35 in some areas of ischemic tissue identifies the existence of ischemic penumbra, while maximal activation may indicate irreversible damage.

Kind of presentation: Oral 
Experimental studies  
 
Date: Thursday, 31 May 2007   Time: 12:00 - 12:10    Room: Room Alsh
Chair: C. Eschenfelder, Germany and L. Hirt, Switzerland
 

10
CALPAIN ACTIVATION PLAYS A ROLE IN THE PATHOPHYSIOLOGY OF FOCAL CEREBRAL ISCHEMIA AND DETERMINES LOST OF TISSUE VIABILITY AT THE ISCHEMIC PENUMBRA.
M. Gutiérrez    M. Alonso de Leciñana    M. Salinas    J. Masjuan    I. Ayuso    E. Díez Tejedor                            
 

La Paz University Hospital and Ramón y Cajal University Hospital. Madrid

SPAIN

Background and aims Calpains are calcium-dependent intracellular cysteine-proteases implicated in the pathophysiology of global cerebral ischemia causing proteolysis of different substrates: eIF4G cleavage by calpain induces down-regulation of translation and protein synthesis, and cleavege of p35, leads to abnormal activation of CdK5 that destroyes cytoskeletal proteins. We investigate calpain activation after focal cerebral ischemia Materials and methods Long- Evans rats were subjected to middle cerebral artery occlusion (MCAO) for 5min (n=4), 30min (n=4), 1h (n=5), 3h (n=4), 24h (n=3), 72h (n=6), 7 days (n=3). Samples were obtained from the cortex at the infarct core, the boundary zone between the core and the normal tissue in the affected hemisphere (penumbra) and from symmetrical areas in the contralateral hemisphere. Calpain activation in terms of espectrin degradation and cleavage of its substrates eIF4G and p35 was determined by immunoblot. The ischemic lesion was measured in H&E stained brain sections in rats subjected to the same procedure (n=6 each group). Results Calpain activation was observed after 1h of ischemia. At 3h activated calpain is demonstrated at the infarct core but not at the penumbra and after 24 h calpain activation is maximal in all the ischemic area. Parallel degradation of eIF4G and p35 was observed. Conclusions Calpain activation depends on the duration, and probably the severity, of focal cerebral ischemia and is maximal at the infarct core. Lowest degree of calpain activation and degradation of eIF4G and p35 in some areas of ischemic tissue identifies the existence of ischemic penumbra, while maximal activation may indicate irreversible damage.

Kind of presentation: Oral 
Experimental studies  
 
Date: Thursday, 31 May 2007   Time: 12:00 - 12:10    Room: Room Alsh
Chair: C. Eschenfelder, Germany and L. Hirt, Switzerland
 

10
CALPAIN ACTIVATION PLAYS A ROLE IN THE PATHOPHYSIOLOGY OF FOCAL CEREBRAL ISCHEMIA AND DETERMINES LOST OF TISSUE VIABILITY AT THE ISCHEMIC PENUMBRA.
M. Gutiérrez    M. Alonso de Leciñana    M. Salinas    J. Masjuan    I. Ayuso    E. Díez Tejedor                            
 

La Paz University Hospital and Ramón y Cajal University Hospital. Madrid

SPAIN

Background and aims Calpains are calcium-dependent intracellular cysteine-proteases implicated in the pathophysiology of global cerebral ischemia causing proteolysis of different substrates: eIF4G cleavage by calpain induces down-regulation of translation and protein synthesis, and cleavege of p35, leads to abnormal activation of CdK5 that destroyes cytoskeletal proteins. We investigate calpain activation after focal cerebral ischemia Materials and methods Long- Evans rats were subjected to middle cerebral artery occlusion (MCAO) for 5min (n=4), 30min (n=4), 1h (n=5), 3h (n=4), 24h (n=3), 72h (n=6), 7 days (n=3). Samples were obtained from the cortex at the infarct core, the boundary zone between the core and the normal tissue in the affected hemisphere (penumbra) and from symmetrical areas in the contralateral hemisphere. Calpain activation in terms of espectrin degradation and cleavage of its substrates eIF4G and p35 was determined by immunoblot. The ischemic lesion was measured in H&E stained brain sections in rats subjected to the same procedure (n=6 each group). Results Calpain activation was observed after 1h of ischemia. At 3h activated calpain is demonstrated at the infarct core but not at the penumbra and after 24 h calpain activation is maximal in all the ischemic area. Parallel degradation of eIF4G and p35 was observed. Conclusions Calpain activation depends on the duration, and probably the severity, of focal cerebral ischemia and is maximal at the infarct core. Lowest degree of calpain activation and degradation of eIF4G and p35 in some areas of ischemic tissue identifies the existence of ischemic penumbra, while maximal activation may indicate irreversible damage.

Kind of presentation: Oral 
Experimental studies  
 
Date: Thursday, 31 May 2007   Time: 12:00 - 12:10    Room: Room Alsh
Chair: C. Eschenfelder, Germany and L. Hirt, Switzerland
 

10
CALPAIN ACTIVATION PLAYS A ROLE IN THE PATHOPHYSIOLOGY OF FOCAL CEREBRAL ISCHEMIA AND DETERMINES LOST OF TISSUE VIABILITY AT THE ISCHEMIC PENUMBRA.
M. Gutiérrez    M. Alonso de Leciñana    M. Salinas    J. Masjuan    I. Ayuso    E. Díez Tejedor                            
 

La Paz University Hospital and Ramón y Cajal University Hospital. Madrid

SPAIN

Background and aims Calpains are calcium-dependent intracellular cysteine-proteases implicated in the pathophysiology of global cerebral ischemia causing proteolysis of different substrates: eIF4G cleavage by calpain induces down-regulation of translation and protein synthesis, and cleavege of p35, leads to abnormal activation of CdK5 that destroyes cytoskeletal proteins. We investigate calpain activation after focal cerebral ischemia Materials and methods Long- Evans rats were subjected to middle cerebral artery occlusion (MCAO) for 5min (n=4), 30min (n=4), 1h (n=5), 3h (n=4), 24h (n=3), 72h (n=6), 7 days (n=3). Samples were obtained from the cortex at the infarct core, the boundary zone between the core and the normal tissue in the affected hemisphere (penumbra) and from symmetrical areas in the contralateral hemisphere. Calpain activation in terms of espectrin degradation and cleavage of its substrates eIF4G and p35 was determined by immunoblot. The ischemic lesion was measured in H&E stained brain sections in rats subjected to the same procedure (n=6 each group). Results Calpain activation was observed after 1h of ischemia. At 3h activated calpain is demonstrated at the infarct core but not at the penumbra and after 24 h calpain activation is maximal in all the ischemic area. Parallel degradation of eIF4G and p35 was observed. Conclusions Calpain activation depends on the duration, and probably the severity, of focal cerebral ischemia and is maximal at the infarct core. Lowest degree of calpain activation and degradation of eIF4G and p35 in some areas of ischemic tissue identifies the existence of ischemic penumbra, while maximal activation may indicate irreversible damage.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

07
Transcranial sonographic delineation of intracerebral hemorrhage – A prospective multicenter study
K. Meyer-Wiethe     R. Kern    S. Meairs    G.  Seidel                                          
 

University Hospital Schleswig-Holstein, Campus Lübeck

GERMANY

Background: A prospective study was performed in patients suffering from acute intracerebral hemorrhage (ICH) in two German stroke centers to determine sensitivity, extent of midline shift (MLS) and lesion volume determined by transcranial ultrasound (US). Materials and Methods: US was performed with two systems (Philips SONOS 5500 and HDI 5000) via the temporal acoustic bone window. We used sector transducers at 2 MHz obtaining axial and coronary imaging planes. The sonographers were blinded to the results of computed tomography (CT) performed in each patient as a reference. Results. 33 consecutive patients suffering from acute ICH (mean age 65 years, range 37 -84, median NIHSS 8/34) were investigated within 48h of symptom onset. There was no difference in baseline characteristics between the patients from the different centres. The localisations of the lesions were as follows: 23 basal ganglia, 2 frontal, 5 parietal, 2 temporal, 1 occipital lobe. In 30 of 33 patients (91%), US identified the lesion correctly. In three patients ICH could not be detected due to inadequate insonation conditions. Both US and CT showed no case of significant midline shift of > 2 mm. CT depicted ventricular hemorrhage in 12 patients (US: 7 patients – sensitivity .58, specificity 1.0). There was a close correlation between blood clot volume measured in CT and US (r = .85, P <.001, n = 30). Conclusions: In this prospective multicenter study US correctly diagnosed, localized and measured intracerebral hemorrhage in patients with adequate bone windows. In contrast, US depiction of ventricular hemorrhage showed high specificity, but low sensitivity. This study is part of the UMEDS project (Ultrasonographic Monitoring and Early Diagnosis of Stroke) funded by the European Commission (QLG1-CT-2002-01518).

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

07
Transcranial sonographic delineation of intracerebral hemorrhage – A prospective multicenter study
K. Meyer-Wiethe     R. Kern    S. Meairs    G.  Seidel                                          
 

University Hospital Schleswig-Holstein, Campus Lübeck

GERMANY

Background: A prospective study was performed in patients suffering from acute intracerebral hemorrhage (ICH) in two German stroke centers to determine sensitivity, extent of midline shift (MLS) and lesion volume determined by transcranial ultrasound (US). Materials and Methods: US was performed with two systems (Philips SONOS 5500 and HDI 5000) via the temporal acoustic bone window. We used sector transducers at 2 MHz obtaining axial and coronary imaging planes. The sonographers were blinded to the results of computed tomography (CT) performed in each patient as a reference. Results. 33 consecutive patients suffering from acute ICH (mean age 65 years, range 37 -84, median NIHSS 8/34) were investigated within 48h of symptom onset. There was no difference in baseline characteristics between the patients from the different centres. The localisations of the lesions were as follows: 23 basal ganglia, 2 frontal, 5 parietal, 2 temporal, 1 occipital lobe. In 30 of 33 patients (91%), US identified the lesion correctly. In three patients ICH could not be detected due to inadequate insonation conditions. Both US and CT showed no case of significant midline shift of > 2 mm. CT depicted ventricular hemorrhage in 12 patients (US: 7 patients – sensitivity .58, specificity 1.0). There was a close correlation between blood clot volume measured in CT and US (r = .85, P <.001, n = 30). Conclusions: In this prospective multicenter study US correctly diagnosed, localized and measured intracerebral hemorrhage in patients with adequate bone windows. In contrast, US depiction of ventricular hemorrhage showed high specificity, but low sensitivity. This study is part of the UMEDS project (Ultrasonographic Monitoring and Early Diagnosis of Stroke) funded by the European Commission (QLG1-CT-2002-01518).

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

07
Transcranial sonographic delineation of intracerebral hemorrhage – A prospective multicenter study
K. Meyer-Wiethe     R. Kern    S. Meairs    G.  Seidel                                          
 

University Hospital Schleswig-Holstein, Campus Lübeck

GERMANY

Background: A prospective study was performed in patients suffering from acute intracerebral hemorrhage (ICH) in two German stroke centers to determine sensitivity, extent of midline shift (MLS) and lesion volume determined by transcranial ultrasound (US). Materials and Methods: US was performed with two systems (Philips SONOS 5500 and HDI 5000) via the temporal acoustic bone window. We used sector transducers at 2 MHz obtaining axial and coronary imaging planes. The sonographers were blinded to the results of computed tomography (CT) performed in each patient as a reference. Results. 33 consecutive patients suffering from acute ICH (mean age 65 years, range 37 -84, median NIHSS 8/34) were investigated within 48h of symptom onset. There was no difference in baseline characteristics between the patients from the different centres. The localisations of the lesions were as follows: 23 basal ganglia, 2 frontal, 5 parietal, 2 temporal, 1 occipital lobe. In 30 of 33 patients (91%), US identified the lesion correctly. In three patients ICH could not be detected due to inadequate insonation conditions. Both US and CT showed no case of significant midline shift of > 2 mm. CT depicted ventricular hemorrhage in 12 patients (US: 7 patients – sensitivity .58, specificity 1.0). There was a close correlation between blood clot volume measured in CT and US (r = .85, P <.001, n = 30). Conclusions: In this prospective multicenter study US correctly diagnosed, localized and measured intracerebral hemorrhage in patients with adequate bone windows. In contrast, US depiction of ventricular hemorrhage showed high specificity, but low sensitivity. This study is part of the UMEDS project (Ultrasonographic Monitoring and Early Diagnosis of Stroke) funded by the European Commission (QLG1-CT-2002-01518).

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

07
Transcranial sonographic delineation of intracerebral hemorrhage – A prospective multicenter study
K. Meyer-Wiethe     R. Kern    S. Meairs    G.  Seidel                                          
 

University Hospital Schleswig-Holstein, Campus Lübeck

GERMANY

Background: A prospective study was performed in patients suffering from acute intracerebral hemorrhage (ICH) in two German stroke centers to determine sensitivity, extent of midline shift (MLS) and lesion volume determined by transcranial ultrasound (US). Materials and Methods: US was performed with two systems (Philips SONOS 5500 and HDI 5000) via the temporal acoustic bone window. We used sector transducers at 2 MHz obtaining axial and coronary imaging planes. The sonographers were blinded to the results of computed tomography (CT) performed in each patient as a reference. Results. 33 consecutive patients suffering from acute ICH (mean age 65 years, range 37 -84, median NIHSS 8/34) were investigated within 48h of symptom onset. There was no difference in baseline characteristics between the patients from the different centres. The localisations of the lesions were as follows: 23 basal ganglia, 2 frontal, 5 parietal, 2 temporal, 1 occipital lobe. In 30 of 33 patients (91%), US identified the lesion correctly. In three patients ICH could not be detected due to inadequate insonation conditions. Both US and CT showed no case of significant midline shift of > 2 mm. CT depicted ventricular hemorrhage in 12 patients (US: 7 patients – sensitivity .58, specificity 1.0). There was a close correlation between blood clot volume measured in CT and US (r = .85, P <.001, n = 30). Conclusions: In this prospective multicenter study US correctly diagnosed, localized and measured intracerebral hemorrhage in patients with adequate bone windows. In contrast, US depiction of ventricular hemorrhage showed high specificity, but low sensitivity. This study is part of the UMEDS project (Ultrasonographic Monitoring and Early Diagnosis of Stroke) funded by the European Commission (QLG1-CT-2002-01518).

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

03
Biochemistry versus clinical severity of acute stroke: significance of NT proBNP to predict one year mortality.
J.C.Sharma    I.N.Ross                                                        
 

Kings Mill Hospital

UNITED KINGDOM

Background: We have investigated the value of biochemical measurements to predict stroke mortality. Methods: Logistic regression was used to investigate significant variables of the biochemical and clinical parameters in 125 previously independent (mRS <4) acute stroke patients for mortality at one year. Results: Age range 40 to 95, mean 73+/-12, Female:Male 63:62. 20 patients had died at one year. Results are given for means +/- SD between dead and alive patients using Student’s t test. There was no significant difference in mean creatinine 111+/-32 vs 101+/-41, p=0.32, eGFR 54 vs 62, p=0.08; oxygen saturation–97.0 vs 97.0, p=0.60; HbA1C 6.01+/-0.7 vs 6.3+/-1.3, p=0.38; glucose 6.6+/-1.4 vs 7.0+/-2.8, p=0.53; serum osmolality 306+/-11 vs 303+/-18, p=0.52; cholesterol 4.5+/-1.1 vs 4.9+/-1.2, p=0.16 and HDL 1.4+/-0.7 vs 1.5+/-0.7, p=0.42. There was a significant difference in urea 10.1+/-4.6 vs 7.5+/-4.4, p=0.01; ALT 133.3+/-459 vs 30+/-33, p=0.02; alk phosphatase 140+/-116 vs 91.6+/-45, p=0.002; NT proBNP 980+/-1249 vs 125+/-244, p<0.001; Barthel Index 2.2+/-2.5 vs 7.1+/-4.9, p<0.001; Scandinavian stroke scale (SSS) 22+/-14 vs 35+/-12, p<0.001 and NT proBNP log 6+/-1.7 vs 3.5+/-1.7, p<0.001. Logistic regression analysis using the significant variables from univariate analysis revealed that NT proBNP was the most significant variable to predict mortality – Wald 17.9, p<0.001 followed by SSS – wald 5.7, p=0.02. Other biochemical variables and Barthel Index were not significant to predict mortality. Conclusion: NT proBNP, a measure of cardiac impairment, is the only significant biochemical variable to predict one year mortality, more significant than the measures of clinical stroke severity. This provides an opportunity for intervention to reduce stroke mortality.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

03
Biochemistry versus clinical severity of acute stroke: significance of NT proBNP to predict one year mortality.
J.C.Sharma    I.N.Ross                                                        
 

Kings Mill Hospital

UNITED KINGDOM

Background: We have investigated the value of biochemical measurements to predict stroke mortality. Methods: Logistic regression was used to investigate significant variables of the biochemical and clinical parameters in 125 previously independent (mRS <4) acute stroke patients for mortality at one year. Results: Age range 40 to 95, mean 73+/-12, Female:Male 63:62. 20 patients had died at one year. Results are given for means +/- SD between dead and alive patients using Student’s t test. There was no significant difference in mean creatinine 111+/-32 vs 101+/-41, p=0.32, eGFR 54 vs 62, p=0.08; oxygen saturation–97.0 vs 97.0, p=0.60; HbA1C 6.01+/-0.7 vs 6.3+/-1.3, p=0.38; glucose 6.6+/-1.4 vs 7.0+/-2.8, p=0.53; serum osmolality 306+/-11 vs 303+/-18, p=0.52; cholesterol 4.5+/-1.1 vs 4.9+/-1.2, p=0.16 and HDL 1.4+/-0.7 vs 1.5+/-0.7, p=0.42. There was a significant difference in urea 10.1+/-4.6 vs 7.5+/-4.4, p=0.01; ALT 133.3+/-459 vs 30+/-33, p=0.02; alk phosphatase 140+/-116 vs 91.6+/-45, p=0.002; NT proBNP 980+/-1249 vs 125+/-244, p<0.001; Barthel Index 2.2+/-2.5 vs 7.1+/-4.9, p<0.001; Scandinavian stroke scale (SSS) 22+/-14 vs 35+/-12, p<0.001 and NT proBNP log 6+/-1.7 vs 3.5+/-1.7, p<0.001. Logistic regression analysis using the significant variables from univariate analysis revealed that NT proBNP was the most significant variable to predict mortality – Wald 17.9, p<0.001 followed by SSS – wald 5.7, p=0.02. Other biochemical variables and Barthel Index were not significant to predict mortality. Conclusion: NT proBNP, a measure of cardiac impairment, is the only significant biochemical variable to predict one year mortality, more significant than the measures of clinical stroke severity. This provides an opportunity for intervention to reduce stroke mortality.

Kind of presentation: Oral 
Large clinical trials (RCTs)  
 
Date: Friday, 1 June 2007   Time: 11:40 - 11:50    Room: Clyde Auditorium
Chair: P. Bath, United Kingdom and G.-L. Lenzi, Itlay
 

05
Patients with symptomatic carotid stenosis have changed over the last 10 years: A comparison between CAVATAS and ICSS.
R.L Featherstone    J Ederle    J Dobson    MMBrown                                          
For the ICSS Investigators

UCL Institute of Neurology

UNITED KINGDOM

BACKGROUND Assessment of the risks and benefits of endarterectomy and endovascular treatment for carotid stenosis will require a meta-analysis of the trials. Heterogeneity between studies may complicate such analyses. We therefore investigated heterogeneity in baseline vascular risk factors. METHODS We compared the baseline characteristics of patients in two randomised controlled trials comparing surgical with endovascular interventions for symptomatic carotid stenosis: the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS) and the International Carotid Stenting Study (ICSS). CAVATAS recruited patients between 1992 and 1997 at 28 centres. ICSS began recruiting in 2001 and continues at 49 centres. 14 centres participated in both trials. RESULTS The incidence of treated hypertension was 55% in CAVATAS and 67% in ICSS (p<0.001), 11% of patients had non-insulin dependent diabetes in CAVATAS and 16% in ICSS (p<0.05). Mean systolic blood pressure was higher in CAVATAS; 152 vs 147 mmHg (p<0.005). Patients with cholesterol >6.5mmol/l fell from 25% to 14% in ICSS (p<0.001). There was no difference in mean age, gender, current smoking or history of MI. A calculation using the Framingham model suggests that on average ICSS patients, if they went untreated, would have a cumulative stroke risk after ten years 0.4% greater than the CAVATAS group. In contrast, CAVATAS patients have a 5% absolute greater risk of myocardial infarction and coronary death than patients randomised in ICSS. DISCUSSION The data demonstrate substantial changes in baseline risk factors of patients with carotid stenosis randomised over a 10 year period. The effect on coronary risk was more striking than the effect on stroke risk.

Kind of presentation: Oral 
Large clinical trials (RCTs)  
 
Date: Friday, 1 June 2007   Time: 11:40 - 11:50    Room: Clyde Auditorium
Chair: P. Bath, United Kingdom and G.-L. Lenzi, Itlay
 

05
Patients with symptomatic carotid stenosis have changed over the last 10 years: A comparison between CAVATAS and ICSS.
R.L Featherstone    J Ederle    J Dobson    MMBrown                                          
For the ICSS Investigators

UCL Institute of Neurology

UNITED KINGDOM

BACKGROUND Assessment of the risks and benefits of endarterectomy and endovascular treatment for carotid stenosis will require a meta-analysis of the trials. Heterogeneity between studies may complicate such analyses. We therefore investigated heterogeneity in baseline vascular risk factors. METHODS We compared the baseline characteristics of patients in two randomised controlled trials comparing surgical with endovascular interventions for symptomatic carotid stenosis: the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS) and the International Carotid Stenting Study (ICSS). CAVATAS recruited patients between 1992 and 1997 at 28 centres. ICSS began recruiting in 2001 and continues at 49 centres. 14 centres participated in both trials. RESULTS The incidence of treated hypertension was 55% in CAVATAS and 67% in ICSS (p<0.001), 11% of patients had non-insulin dependent diabetes in CAVATAS and 16% in ICSS (p<0.05). Mean systolic blood pressure was higher in CAVATAS; 152 vs 147 mmHg (p<0.005). Patients with cholesterol >6.5mmol/l fell from 25% to 14% in ICSS (p<0.001). There was no difference in mean age, gender, current smoking or history of MI. A calculation using the Framingham model suggests that on average ICSS patients, if they went untreated, would have a cumulative stroke risk after ten years 0.4% greater than the CAVATAS group. In contrast, CAVATAS patients have a 5% absolute greater risk of myocardial infarction and coronary death than patients randomised in ICSS. DISCUSSION The data demonstrate substantial changes in baseline risk factors of patients with carotid stenosis randomised over a 10 year period. The effect on coronary risk was more striking than the effect on stroke risk.

Kind of presentation: Oral 
Large clinical trials (RCTs)  
 
Date: Friday, 1 June 2007   Time: 11:40 - 11:50    Room: Clyde Auditorium
Chair: P. Bath, United Kingdom and G.-L. Lenzi, Itlay
 

05
Patients with symptomatic carotid stenosis have changed over the last 10 years: A comparison between CAVATAS and ICSS.
R.L Featherstone    J Ederle    J Dobson    MMBrown                                          
For the ICSS Investigators

UCL Institute of Neurology

UNITED KINGDOM

BACKGROUND Assessment of the risks and benefits of endarterectomy and endovascular treatment for carotid stenosis will require a meta-analysis of the trials. Heterogeneity between studies may complicate such analyses. We therefore investigated heterogeneity in baseline vascular risk factors. METHODS We compared the baseline characteristics of patients in two randomised controlled trials comparing surgical with endovascular interventions for symptomatic carotid stenosis: the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS) and the International Carotid Stenting Study (ICSS). CAVATAS recruited patients between 1992 and 1997 at 28 centres. ICSS began recruiting in 2001 and continues at 49 centres. 14 centres participated in both trials. RESULTS The incidence of treated hypertension was 55% in CAVATAS and 67% in ICSS (p<0.001), 11% of patients had non-insulin dependent diabetes in CAVATAS and 16% in ICSS (p<0.05). Mean systolic blood pressure was higher in CAVATAS; 152 vs 147 mmHg (p<0.005). Patients with cholesterol >6.5mmol/l fell from 25% to 14% in ICSS (p<0.001). There was no difference in mean age, gender, current smoking or history of MI. A calculation using the Framingham model suggests that on average ICSS patients, if they went untreated, would have a cumulative stroke risk after ten years 0.4% greater than the CAVATAS group. In contrast, CAVATAS patients have a 5% absolute greater risk of myocardial infarction and coronary death than patients randomised in ICSS. DISCUSSION The data demonstrate substantial changes in baseline risk factors of patients with carotid stenosis randomised over a 10 year period. The effect on coronary risk was more striking than the effect on stroke risk.

Kind of presentation: Oral 
Large clinical trials (RCTs)  
 
Date: Friday, 1 June 2007   Time: 11:40 - 11:50    Room: Clyde Auditorium
Chair: P. Bath, United Kingdom and G.-L. Lenzi, Itlay
 

05
Patients with symptomatic carotid stenosis have changed over the last 10 years: A comparison between CAVATAS and ICSS.
R.L Featherstone    J Ederle    J Dobson    MMBrown                                          
For the ICSS Investigators

UCL Institute of Neurology

UNITED KINGDOM

BACKGROUND Assessment of the risks and benefits of endarterectomy and endovascular treatment for carotid stenosis will require a meta-analysis of the trials. Heterogeneity between studies may complicate such analyses. We therefore investigated heterogeneity in baseline vascular risk factors. METHODS We compared the baseline characteristics of patients in two randomised controlled trials comparing surgical with endovascular interventions for symptomatic carotid stenosis: the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS) and the International Carotid Stenting Study (ICSS). CAVATAS recruited patients between 1992 and 1997 at 28 centres. ICSS began recruiting in 2001 and continues at 49 centres. 14 centres participated in both trials. RESULTS The incidence of treated hypertension was 55% in CAVATAS and 67% in ICSS (p<0.001), 11% of patients had non-insulin dependent diabetes in CAVATAS and 16% in ICSS (p<0.05). Mean systolic blood pressure was higher in CAVATAS; 152 vs 147 mmHg (p<0.005). Patients with cholesterol >6.5mmol/l fell from 25% to 14% in ICSS (p<0.001). There was no difference in mean age, gender, current smoking or history of MI. A calculation using the Framingham model suggests that on average ICSS patients, if they went untreated, would have a cumulative stroke risk after ten years 0.4% greater than the CAVATAS group. In contrast, CAVATAS patients have a 5% absolute greater risk of myocardial infarction and coronary death than patients randomised in ICSS. DISCUSSION The data demonstrate substantial changes in baseline risk factors of patients with carotid stenosis randomised over a 10 year period. The effect on coronary risk was more striking than the effect on stroke risk.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

01
Delays in treatment for symptomatic carotid stenosis at research active centres
R.LFeatherstone    J. Ederle    M.M.Brown                                                 
 

UCL Institute of Neurology

UNITED KINGDOM

BACKGROUND: Treatment of symptomatic carotid artery stenosis is an effective secondary prevention measure for stroke. The earlier endarterectomy is performed after symptoms, the better the long-term outcome. We have used baseline data from the International Carotid Stenting Study (ICSS), an ongoing multicentre study of symptomatic patients randomized between carotid endarterectomy and stenting, to assess delays in treatment. METHODS: The interval between the most recent TIA or non-disabling stroke, recorded at randomization, and the date of procedure (carotid endarterectomy or stenting) was calculated for all ICSS patients where data on the procedure was returned by December 2006. Data came from 36 centres in the UK, Europe, North America and Australia. RESULTS: The median delay between event and treatment was 55 days (n=854). Most of the delay occurred before randomization, median delay between randomization and treatment was 14 days. The three centres with the shortest average delay between event and treatment were compared with the three that had the longest. The median delay at the fastest centres was 14 days (N=42 patients) compared to 123 days in the three slowest centres (N=72 patients), a significant difference (p<0.001). DISCUSSION: Significant differences exist in treatment delays between centres. Even the most efficient research active centres are failing to treat many patients with symptomatic carotid stenosis within 2 weeks of the presenting symptoms, when the benefit is greatest. Such treatment delays result in a substantial proportion of patients being left at high risk of a recurrent event while awaiting investigation and treatment. The results emphasise the need to reorganize stroke services to investigate and treat carotid stenosis urgently.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

01
Delays in treatment for symptomatic carotid stenosis at research active centres
R.LFeatherstone    J. Ederle    M.M.Brown                                                 
 

UCL Institute of Neurology

UNITED KINGDOM

BACKGROUND: Treatment of symptomatic carotid artery stenosis is an effective secondary prevention measure for stroke. The earlier endarterectomy is performed after symptoms, the better the long-term outcome. We have used baseline data from the International Carotid Stenting Study (ICSS), an ongoing multicentre study of symptomatic patients randomized between carotid endarterectomy and stenting, to assess delays in treatment. METHODS: The interval between the most recent TIA or non-disabling stroke, recorded at randomization, and the date of procedure (carotid endarterectomy or stenting) was calculated for all ICSS patients where data on the procedure was returned by December 2006. Data came from 36 centres in the UK, Europe, North America and Australia. RESULTS: The median delay between event and treatment was 55 days (n=854). Most of the delay occurred before randomization, median delay between randomization and treatment was 14 days. The three centres with the shortest average delay between event and treatment were compared with the three that had the longest. The median delay at the fastest centres was 14 days (N=42 patients) compared to 123 days in the three slowest centres (N=72 patients), a significant difference (p<0.001). DISCUSSION: Significant differences exist in treatment delays between centres. Even the most efficient research active centres are failing to treat many patients with symptomatic carotid stenosis within 2 weeks of the presenting symptoms, when the benefit is greatest. Such treatment delays result in a substantial proportion of patients being left at high risk of a recurrent event while awaiting investigation and treatment. The results emphasise the need to reorganize stroke services to investigate and treat carotid stenosis urgently.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

01
Delays in treatment for symptomatic carotid stenosis at research active centres
R.LFeatherstone    J. Ederle    M.M.Brown                                                 
 

UCL Institute of Neurology

UNITED KINGDOM

BACKGROUND: Treatment of symptomatic carotid artery stenosis is an effective secondary prevention measure for stroke. The earlier endarterectomy is performed after symptoms, the better the long-term outcome. We have used baseline data from the International Carotid Stenting Study (ICSS), an ongoing multicentre study of symptomatic patients randomized between carotid endarterectomy and stenting, to assess delays in treatment. METHODS: The interval between the most recent TIA or non-disabling stroke, recorded at randomization, and the date of procedure (carotid endarterectomy or stenting) was calculated for all ICSS patients where data on the procedure was returned by December 2006. Data came from 36 centres in the UK, Europe, North America and Australia. RESULTS: The median delay between event and treatment was 55 days (n=854). Most of the delay occurred before randomization, median delay between randomization and treatment was 14 days. The three centres with the shortest average delay between event and treatment were compared with the three that had the longest. The median delay at the fastest centres was 14 days (N=42 patients) compared to 123 days in the three slowest centres (N=72 patients), a significant difference (p<0.001). DISCUSSION: Significant differences exist in treatment delays between centres. Even the most efficient research active centres are failing to treat many patients with symptomatic carotid stenosis within 2 weeks of the presenting symptoms, when the benefit is greatest. Such treatment delays result in a substantial proportion of patients being left at high risk of a recurrent event while awaiting investigation and treatment. The results emphasise the need to reorganize stroke services to investigate and treat carotid stenosis urgently.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

24
S100B as a biomarker: its optimal role in stroke
P. Dassan    G. Keir    R. Jager    M.M.Brown                                          
 

UCL, Institute of Neurology

UNITED KINGDOM

BACKGROUND Blood biomarkers may be important in three areas of acute stroke: diagnosis; as a surrogate marker for severity of brain damage; and predicting prognosis. The S100B protein has been studied in each area individually in selected patients but there are no studies directly comparing its utility in these areas. We correlated all three measures with serial measurements of S100B in an unselected series to determine its optimal role. METHOD Blood samples and National Institute of Health Stroke Scale (NIHSS) scores were taken on arrival to hospital and daily, where possible, for up to 6 days after onset of symptoms in 40 consecutive patients with suspected ischaemic stroke (26 acute infarcts and 14 stroke mimics). Serum S100B was measured by enzyme-linked immunosorbent assay. Infarct volumes were measured on diffusion-weighted images. RESULTS In patients venesected within 24 hours of symptom onset there was no significant difference in S100B levels between acute infarction and stroke mimics (mean 0.19 ng/ml vs 0.12 ng/ml). Peak S100B levels after 24 hours however, correlated well with both infarct volume and maximum NIHSS scores (r = 0.89, P<0.001 and r = 0.81, P<0.001 respectively). The highest level was seen in a patient with malignant middle cerebral artery infarction. Peak S100B level was a good predictor of dichotomised outcome after discharge (independent mean 0.14ng/ml vs dependent mean 0.36ng/ml, P<0.05). CONCLUSION Serum S100B measurements are not helpful in distinguishing infarction from stroke mimics in the emergency room. Measurement of blood S100B levels after cerebral infarction is a useful measure of the severity of brain damage and predicts prognosis. It may also be a useful predictor of malignant infarction.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

24
S100B as a biomarker: its optimal role in stroke
P. Dassan    G. Keir    R. Jager    M.M.Brown                                          
 

UCL, Institute of Neurology

UNITED KINGDOM

BACKGROUND Blood biomarkers may be important in three areas of acute stroke: diagnosis; as a surrogate marker for severity of brain damage; and predicting prognosis. The S100B protein has been studied in each area individually in selected patients but there are no studies directly comparing its utility in these areas. We correlated all three measures with serial measurements of S100B in an unselected series to determine its optimal role. METHOD Blood samples and National Institute of Health Stroke Scale (NIHSS) scores were taken on arrival to hospital and daily, where possible, for up to 6 days after onset of symptoms in 40 consecutive patients with suspected ischaemic stroke (26 acute infarcts and 14 stroke mimics). Serum S100B was measured by enzyme-linked immunosorbent assay. Infarct volumes were measured on diffusion-weighted images. RESULTS In patients venesected within 24 hours of symptom onset there was no significant difference in S100B levels between acute infarction and stroke mimics (mean 0.19 ng/ml vs 0.12 ng/ml). Peak S100B levels after 24 hours however, correlated well with both infarct volume and maximum NIHSS scores (r = 0.89, P<0.001 and r = 0.81, P<0.001 respectively). The highest level was seen in a patient with malignant middle cerebral artery infarction. Peak S100B level was a good predictor of dichotomised outcome after discharge (independent mean 0.14ng/ml vs dependent mean 0.36ng/ml, P<0.05). CONCLUSION Serum S100B measurements are not helpful in distinguishing infarction from stroke mimics in the emergency room. Measurement of blood S100B levels after cerebral infarction is a useful measure of the severity of brain damage and predicts prognosis. It may also be a useful predictor of malignant infarction.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

24
S100B as a biomarker: its optimal role in stroke
P. Dassan    G. Keir    R. Jager    M.M.Brown                                          
 

UCL, Institute of Neurology

UNITED KINGDOM

BACKGROUND Blood biomarkers may be important in three areas of acute stroke: diagnosis; as a surrogate marker for severity of brain damage; and predicting prognosis. The S100B protein has been studied in each area individually in selected patients but there are no studies directly comparing its utility in these areas. We correlated all three measures with serial measurements of S100B in an unselected series to determine its optimal role. METHOD Blood samples and National Institute of Health Stroke Scale (NIHSS) scores were taken on arrival to hospital and daily, where possible, for up to 6 days after onset of symptoms in 40 consecutive patients with suspected ischaemic stroke (26 acute infarcts and 14 stroke mimics). Serum S100B was measured by enzyme-linked immunosorbent assay. Infarct volumes were measured on diffusion-weighted images. RESULTS In patients venesected within 24 hours of symptom onset there was no significant difference in S100B levels between acute infarction and stroke mimics (mean 0.19 ng/ml vs 0.12 ng/ml). Peak S100B levels after 24 hours however, correlated well with both infarct volume and maximum NIHSS scores (r = 0.89, P<0.001 and r = 0.81, P<0.001 respectively). The highest level was seen in a patient with malignant middle cerebral artery infarction. Peak S100B level was a good predictor of dichotomised outcome after discharge (independent mean 0.14ng/ml vs dependent mean 0.36ng/ml, P<0.05). CONCLUSION Serum S100B measurements are not helpful in distinguishing infarction from stroke mimics in the emergency room. Measurement of blood S100B levels after cerebral infarction is a useful measure of the severity of brain damage and predicts prognosis. It may also be a useful predictor of malignant infarction.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

24
S100B as a biomarker: its optimal role in stroke
P. Dassan    G. Keir    R. Jager    M.M.Brown                                          
 

UCL, Institute of Neurology

UNITED KINGDOM

BACKGROUND Blood biomarkers may be important in three areas of acute stroke: diagnosis; as a surrogate marker for severity of brain damage; and predicting prognosis. The S100B protein has been studied in each area individually in selected patients but there are no studies directly comparing its utility in these areas. We correlated all three measures with serial measurements of S100B in an unselected series to determine its optimal role. METHOD Blood samples and National Institute of Health Stroke Scale (NIHSS) scores were taken on arrival to hospital and daily, where possible, for up to 6 days after onset of symptoms in 40 consecutive patients with suspected ischaemic stroke (26 acute infarcts and 14 stroke mimics). Serum S100B was measured by enzyme-linked immunosorbent assay. Infarct volumes were measured on diffusion-weighted images. RESULTS In patients venesected within 24 hours of symptom onset there was no significant difference in S100B levels between acute infarction and stroke mimics (mean 0.19 ng/ml vs 0.12 ng/ml). Peak S100B levels after 24 hours however, correlated well with both infarct volume and maximum NIHSS scores (r = 0.89, P<0.001 and r = 0.81, P<0.001 respectively). The highest level was seen in a patient with malignant middle cerebral artery infarction. Peak S100B level was a good predictor of dichotomised outcome after discharge (independent mean 0.14ng/ml vs dependent mean 0.36ng/ml, P<0.05). CONCLUSION Serum S100B measurements are not helpful in distinguishing infarction from stroke mimics in the emergency room. Measurement of blood S100B levels after cerebral infarction is a useful measure of the severity of brain damage and predicts prognosis. It may also be a useful predictor of malignant infarction.

Kind of presentation: Oral 
Vascular imaging  
 
Date: Wednesday, 30 May 2007   Time: 11:20 - 11:30    Room: Room Dochart
Chair: N. Bornstein, Israel and S. Meairs, Germany
 

03
New combined Power M-mode and spectrogram TCD microemboli signal criteria Improve emboli detection and limit artifact misinterpretation
Y. Choi    M. Saqqur    F. Khan    A. Jin    C. Stephenson    E. Stewart    J.M.Boulanger    S. Coutts    A.M.Demchuk       
 

University of Calgary

CANADA

Background: Single gate TCD spectrogram alone has limitations in detecting microembolic signal (MES). Adding Power M-mode Doppler information may improve MES detection and separate artifacts from emboli. Methods: TIA/stroke patients prospectively enrolled within 24 h of symptom onset underwent bilateral MCA 1 hour TCD emboli monitoring within 48 h. Two stroke neurologists who were blinded to clinical data reviewed the TCD results together by consensus for MES using standard single gate consensus conference recommendations (SPECT); and novel power M-mode criteria (PMD). Based on review of disparity between two methods we derived new combined diagnostic criteria of MES (PMD/SPECT) defined as: 1. High signal intensity that can meet the SPECT or PMD. 2. No evidence of artifact on SPECT or PMD. We defined the artifact on PMD as increase in power occurring in multidepth simultaneously or increase in power occurring at not random pattern within the cardiac cycle. We then reported on the frequency of artifact and MES counts when comparing the two methods (SPECT vs. PMD/SPECT) and compared the predictability of two methods of baseline DWI lesion on MR scan. Results: Of 231 patients, 46 patients (male 71.5% and mean age 63.4 +/- 17.3 years) had evidence of MES on either SPECT or PMD. Total MES count on SPECT was 364 MESs (mean 7.8 +/- 16.7, median 2.0), and using PMD/SPECT revealed 427 MESs (9.3 +/- 19.1, median 3.0). 42 MESs (11.5%) on SPECT were subsequently determined to represent artifacts, 101 MESs (23.7%) were missed by SPECT and 4 MES (0.9%) were missed by PMD. PMD/SPECT predicted baseline DWI ischemic lesions (p=0.026) better than SPECT did (P= 0.291). Discussion: The PMD/SPECT appeared to improve MES yield and separate artifacts from real emboli. The PMD/SPECT predicted the baseline DWI lesion more accurately than SPECT.

Kind of presentation: Oral 
Vascular imaging  
 
Date: Wednesday, 30 May 2007   Time: 11:20 - 11:30    Room: Room Dochart
Chair: N. Bornstein, Israel and S. Meairs, Germany
 

03
New combined Power M-mode and spectrogram TCD microemboli signal criteria Improve emboli detection and limit artifact misinterpretation
Y. Choi    M. Saqqur    F. Khan    A. Jin    C. Stephenson    E. Stewart    J.M.Boulanger    S. Coutts    A.M.Demchuk       
 

University of Calgary

CANADA

Background: Single gate TCD spectrogram alone has limitations in detecting microembolic signal (MES). Adding Power M-mode Doppler information may improve MES detection and separate artifacts from emboli. Methods: TIA/stroke patients prospectively enrolled within 24 h of symptom onset underwent bilateral MCA 1 hour TCD emboli monitoring within 48 h. Two stroke neurologists who were blinded to clinical data reviewed the TCD results together by consensus for MES using standard single gate consensus conference recommendations (SPECT); and novel power M-mode criteria (PMD). Based on review of disparity between two methods we derived new combined diagnostic criteria of MES (PMD/SPECT) defined as: 1. High signal intensity that can meet the SPECT or PMD. 2. No evidence of artifact on SPECT or PMD. We defined the artifact on PMD as increase in power occurring in multidepth simultaneously or increase in power occurring at not random pattern within the cardiac cycle. We then reported on the frequency of artifact and MES counts when comparing the two methods (SPECT vs. PMD/SPECT) and compared the predictability of two methods of baseline DWI lesion on MR scan. Results: Of 231 patients, 46 patients (male 71.5% and mean age 63.4 +/- 17.3 years) had evidence of MES on either SPECT or PMD. Total MES count on SPECT was 364 MESs (mean 7.8 +/- 16.7, median 2.0), and using PMD/SPECT revealed 427 MESs (9.3 +/- 19.1, median 3.0). 42 MESs (11.5%) on SPECT were subsequently determined to represent artifacts, 101 MESs (23.7%) were missed by SPECT and 4 MES (0.9%) were missed by PMD. PMD/SPECT predicted baseline DWI ischemic lesions (p=0.026) better than SPECT did (P= 0.291). Discussion: The PMD/SPECT appeared to improve MES yield and separate artifacts from real emboli. The PMD/SPECT predicted the baseline DWI lesion more accurately than SPECT.

Kind of presentation: Oral 
Vascular imaging  
 
Date: Wednesday, 30 May 2007   Time: 11:20 - 11:30    Room: Room Dochart
Chair: N. Bornstein, Israel and S. Meairs, Germany
 

03
New combined Power M-mode and spectrogram TCD microemboli signal criteria Improve emboli detection and limit artifact misinterpretation
Y. Choi    M. Saqqur    F. Khan    A. Jin    C. Stephenson    E. Stewart    J.M.Boulanger    S. Coutts    A.M.Demchuk       
 

University of Calgary

CANADA

Background: Single gate TCD spectrogram alone has limitations in detecting microembolic signal (MES). Adding Power M-mode Doppler information may improve MES detection and separate artifacts from emboli. Methods: TIA/stroke patients prospectively enrolled within 24 h of symptom onset underwent bilateral MCA 1 hour TCD emboli monitoring within 48 h. Two stroke neurologists who were blinded to clinical data reviewed the TCD results together by consensus for MES using standard single gate consensus conference recommendations (SPECT); and novel power M-mode criteria (PMD). Based on review of disparity between two methods we derived new combined diagnostic criteria of MES (PMD/SPECT) defined as: 1. High signal intensity that can meet the SPECT or PMD. 2. No evidence of artifact on SPECT or PMD. We defined the artifact on PMD as increase in power occurring in multidepth simultaneously or increase in power occurring at not random pattern within the cardiac cycle. We then reported on the frequency of artifact and MES counts when comparing the two methods (SPECT vs. PMD/SPECT) and compared the predictability of two methods of baseline DWI lesion on MR scan. Results: Of 231 patients, 46 patients (male 71.5% and mean age 63.4 +/- 17.3 years) had evidence of MES on either SPECT or PMD. Total MES count on SPECT was 364 MESs (mean 7.8 +/- 16.7, median 2.0), and using PMD/SPECT revealed 427 MESs (9.3 +/- 19.1, median 3.0). 42 MESs (11.5%) on SPECT were subsequently determined to represent artifacts, 101 MESs (23.7%) were missed by SPECT and 4 MES (0.9%) were missed by PMD. PMD/SPECT predicted baseline DWI ischemic lesions (p=0.026) better than SPECT did (P= 0.291). Discussion: The PMD/SPECT appeared to improve MES yield and separate artifacts from real emboli. The PMD/SPECT predicted the baseline DWI lesion more accurately than SPECT.

Kind of presentation: Oral 
Vascular imaging  
 
Date: Wednesday, 30 May 2007   Time: 11:20 - 11:30    Room: Room Dochart
Chair: N. Bornstein, Israel and S. Meairs, Germany
 

03
New combined Power M-mode and spectrogram TCD microemboli signal criteria Improve emboli detection and limit artifact misinterpretation
Y. Choi    M. Saqqur    F. Khan    A. Jin    C. Stephenson    E. Stewart    J.M.Boulanger    S. Coutts    A.M.Demchuk       
 

University of Calgary

CANADA

Background: Single gate TCD spectrogram alone has limitations in detecting microembolic signal (MES). Adding Power M-mode Doppler information may improve MES detection and separate artifacts from emboli. Methods: TIA/stroke patients prospectively enrolled within 24 h of symptom onset underwent bilateral MCA 1 hour TCD emboli monitoring within 48 h. Two stroke neurologists who were blinded to clinical data reviewed the TCD results together by consensus for MES using standard single gate consensus conference recommendations (SPECT); and novel power M-mode criteria (PMD). Based on review of disparity between two methods we derived new combined diagnostic criteria of MES (PMD/SPECT) defined as: 1. High signal intensity that can meet the SPECT or PMD. 2. No evidence of artifact on SPECT or PMD. We defined the artifact on PMD as increase in power occurring in multidepth simultaneously or increase in power occurring at not random pattern within the cardiac cycle. We then reported on the frequency of artifact and MES counts when comparing the two methods (SPECT vs. PMD/SPECT) and compared the predictability of two methods of baseline DWI lesion on MR scan. Results: Of 231 patients, 46 patients (male 71.5% and mean age 63.4 +/- 17.3 years) had evidence of MES on either SPECT or PMD. Total MES count on SPECT was 364 MESs (mean 7.8 +/- 16.7, median 2.0), and using PMD/SPECT revealed 427 MESs (9.3 +/- 19.1, median 3.0). 42 MESs (11.5%) on SPECT were subsequently determined to represent artifacts, 101 MESs (23.7%) were missed by SPECT and 4 MES (0.9%) were missed by PMD. PMD/SPECT predicted baseline DWI ischemic lesions (p=0.026) better than SPECT did (P= 0.291). Discussion: The PMD/SPECT appeared to improve MES yield and separate artifacts from real emboli. The PMD/SPECT predicted the baseline DWI lesion more accurately than SPECT.

Kind of presentation: Oral 
Vascular imaging  
 
Date: Wednesday, 30 May 2007   Time: 11:20 - 11:30    Room: Room Dochart
Chair: N. Bornstein, Israel and S. Meairs, Germany
 

03
New combined Power M-mode and spectrogram TCD microemboli signal criteria Improve emboli detection and limit artifact misinterpretation
Y. Choi    M. Saqqur    F. Khan    A. Jin    C. Stephenson    E. Stewart    J.M.Boulanger    S. Coutts    A.M.Demchuk       
 

University of Calgary

CANADA

Background: Single gate TCD spectrogram alone has limitations in detecting microembolic signal (MES). Adding Power M-mode Doppler information may improve MES detection and separate artifacts from emboli. Methods: TIA/stroke patients prospectively enrolled within 24 h of symptom onset underwent bilateral MCA 1 hour TCD emboli monitoring within 48 h. Two stroke neurologists who were blinded to clinical data reviewed the TCD results together by consensus for MES using standard single gate consensus conference recommendations (SPECT); and novel power M-mode criteria (PMD). Based on review of disparity between two methods we derived new combined diagnostic criteria of MES (PMD/SPECT) defined as: 1. High signal intensity that can meet the SPECT or PMD. 2. No evidence of artifact on SPECT or PMD. We defined the artifact on PMD as increase in power occurring in multidepth simultaneously or increase in power occurring at not random pattern within the cardiac cycle. We then reported on the frequency of artifact and MES counts when comparing the two methods (SPECT vs. PMD/SPECT) and compared the predictability of two methods of baseline DWI lesion on MR scan. Results: Of 231 patients, 46 patients (male 71.5% and mean age 63.4 +/- 17.3 years) had evidence of MES on either SPECT or PMD. Total MES count on SPECT was 364 MESs (mean 7.8 +/- 16.7, median 2.0), and using PMD/SPECT revealed 427 MESs (9.3 +/- 19.1, median 3.0). 42 MESs (11.5%) on SPECT were subsequently determined to represent artifacts, 101 MESs (23.7%) were missed by SPECT and 4 MES (0.9%) were missed by PMD. PMD/SPECT predicted baseline DWI ischemic lesions (p=0.026) better than SPECT did (P= 0.291). Discussion: The PMD/SPECT appeared to improve MES yield and separate artifacts from real emboli. The PMD/SPECT predicted the baseline DWI lesion more accurately than SPECT.

Kind of presentation: Oral 
Vascular imaging  
 
Date: Wednesday, 30 May 2007   Time: 11:20 - 11:30    Room: Room Dochart
Chair: N. Bornstein, Israel and S. Meairs, Germany
 

03
New combined Power M-mode and spectrogram TCD microemboli signal criteria Improve emboli detection and limit artifact misinterpretation
Y. Choi    M. Saqqur    F. Khan    A. Jin    C. Stephenson    E. Stewart    J.M.Boulanger    S. Coutts    A.M.Demchuk       
 

University of Calgary

CANADA

Background: Single gate TCD spectrogram alone has limitations in detecting microembolic signal (MES). Adding Power M-mode Doppler information may improve MES detection and separate artifacts from emboli. Methods: TIA/stroke patients prospectively enrolled within 24 h of symptom onset underwent bilateral MCA 1 hour TCD emboli monitoring within 48 h. Two stroke neurologists who were blinded to clinical data reviewed the TCD results together by consensus for MES using standard single gate consensus conference recommendations (SPECT); and novel power M-mode criteria (PMD). Based on review of disparity between two methods we derived new combined diagnostic criteria of MES (PMD/SPECT) defined as: 1. High signal intensity that can meet the SPECT or PMD. 2. No evidence of artifact on SPECT or PMD. We defined the artifact on PMD as increase in power occurring in multidepth simultaneously or increase in power occurring at not random pattern within the cardiac cycle. We then reported on the frequency of artifact and MES counts when comparing the two methods (SPECT vs. PMD/SPECT) and compared the predictability of two methods of baseline DWI lesion on MR scan. Results: Of 231 patients, 46 patients (male 71.5% and mean age 63.4 +/- 17.3 years) had evidence of MES on either SPECT or PMD. Total MES count on SPECT was 364 MESs (mean 7.8 +/- 16.7, median 2.0), and using PMD/SPECT revealed 427 MESs (9.3 +/- 19.1, median 3.0). 42 MESs (11.5%) on SPECT were subsequently determined to represent artifacts, 101 MESs (23.7%) were missed by SPECT and 4 MES (0.9%) were missed by PMD. PMD/SPECT predicted baseline DWI ischemic lesions (p=0.026) better than SPECT did (P= 0.291). Discussion: The PMD/SPECT appeared to improve MES yield and separate artifacts from real emboli. The PMD/SPECT predicted the baseline DWI lesion more accurately than SPECT.

Kind of presentation: Oral 
Vascular imaging  
 
Date: Wednesday, 30 May 2007   Time: 11:20 - 11:30    Room: Room Dochart
Chair: N. Bornstein, Israel and S. Meairs, Germany
 

03
New combined Power M-mode and spectrogram TCD microemboli signal criteria Improve emboli detection and limit artifact misinterpretation
Y. Choi    M. Saqqur    F. Khan    A. Jin    C. Stephenson    E. Stewart    J.M.Boulanger    S. Coutts    A.M.Demchuk       
 

University of Calgary

CANADA

Background: Single gate TCD spectrogram alone has limitations in detecting microembolic signal (MES). Adding Power M-mode Doppler information may improve MES detection and separate artifacts from emboli. Methods: TIA/stroke patients prospectively enrolled within 24 h of symptom onset underwent bilateral MCA 1 hour TCD emboli monitoring within 48 h. Two stroke neurologists who were blinded to clinical data reviewed the TCD results together by consensus for MES using standard single gate consensus conference recommendations (SPECT); and novel power M-mode criteria (PMD). Based on review of disparity between two methods we derived new combined diagnostic criteria of MES (PMD/SPECT) defined as: 1. High signal intensity that can meet the SPECT or PMD. 2. No evidence of artifact on SPECT or PMD. We defined the artifact on PMD as increase in power occurring in multidepth simultaneously or increase in power occurring at not random pattern within the cardiac cycle. We then reported on the frequency of artifact and MES counts when comparing the two methods (SPECT vs. PMD/SPECT) and compared the predictability of two methods of baseline DWI lesion on MR scan. Results: Of 231 patients, 46 patients (male 71.5% and mean age 63.4 +/- 17.3 years) had evidence of MES on either SPECT or PMD. Total MES count on SPECT was 364 MESs (mean 7.8 +/- 16.7, median 2.0), and using PMD/SPECT revealed 427 MESs (9.3 +/- 19.1, median 3.0). 42 MESs (11.5%) on SPECT were subsequently determined to represent artifacts, 101 MESs (23.7%) were missed by SPECT and 4 MES (0.9%) were missed by PMD. PMD/SPECT predicted baseline DWI ischemic lesions (p=0.026) better than SPECT did (P= 0.291). Discussion: The PMD/SPECT appeared to improve MES yield and separate artifacts from real emboli. The PMD/SPECT predicted the baseline DWI lesion more accurately than SPECT.

Kind of presentation: Oral 
Vascular imaging  
 
Date: Wednesday, 30 May 2007   Time: 11:20 - 11:30    Room: Room Dochart
Chair: N. Bornstein, Israel and S. Meairs, Germany
 

03
New combined Power M-mode and spectrogram TCD microemboli signal criteria Improve emboli detection and limit artifact misinterpretation
Y. Choi    M. Saqqur    F. Khan    A. Jin    C. Stephenson    E. Stewart    J.M.Boulanger    S. Coutts    A.M.Demchuk       
 

University of Calgary

CANADA

Background: Single gate TCD spectrogram alone has limitations in detecting microembolic signal (MES). Adding Power M-mode Doppler information may improve MES detection and separate artifacts from emboli. Methods: TIA/stroke patients prospectively enrolled within 24 h of symptom onset underwent bilateral MCA 1 hour TCD emboli monitoring within 48 h. Two stroke neurologists who were blinded to clinical data reviewed the TCD results together by consensus for MES using standard single gate consensus conference recommendations (SPECT); and novel power M-mode criteria (PMD). Based on review of disparity between two methods we derived new combined diagnostic criteria of MES (PMD/SPECT) defined as: 1. High signal intensity that can meet the SPECT or PMD. 2. No evidence of artifact on SPECT or PMD. We defined the artifact on PMD as increase in power occurring in multidepth simultaneously or increase in power occurring at not random pattern within the cardiac cycle. We then reported on the frequency of artifact and MES counts when comparing the two methods (SPECT vs. PMD/SPECT) and compared the predictability of two methods of baseline DWI lesion on MR scan. Results: Of 231 patients, 46 patients (male 71.5% and mean age 63.4 +/- 17.3 years) had evidence of MES on either SPECT or PMD. Total MES count on SPECT was 364 MESs (mean 7.8 +/- 16.7, median 2.0), and using PMD/SPECT revealed 427 MESs (9.3 +/- 19.1, median 3.0). 42 MESs (11.5%) on SPECT were subsequently determined to represent artifacts, 101 MESs (23.7%) were missed by SPECT and 4 MES (0.9%) were missed by PMD. PMD/SPECT predicted baseline DWI ischemic lesions (p=0.026) better than SPECT did (P= 0.291). Discussion: The PMD/SPECT appeared to improve MES yield and separate artifacts from real emboli. The PMD/SPECT predicted the baseline DWI lesion more accurately than SPECT.

Kind of presentation: Oral 
Vascular imaging  
 
Date: Wednesday, 30 May 2007   Time: 11:20 - 11:30    Room: Room Dochart
Chair: N. Bornstein, Israel and S. Meairs, Germany
 

03
New combined Power M-mode and spectrogram TCD microemboli signal criteria Improve emboli detection and limit artifact misinterpretation
Y. Choi    M. Saqqur    F. Khan    A. Jin    C. Stephenson    E. Stewart    J.M.Boulanger    S. Coutts    A.M.Demchuk       
 

University of Calgary

CANADA

Background: Single gate TCD spectrogram alone has limitations in detecting microembolic signal (MES). Adding Power M-mode Doppler information may improve MES detection and separate artifacts from emboli. Methods: TIA/stroke patients prospectively enrolled within 24 h of symptom onset underwent bilateral MCA 1 hour TCD emboli monitoring within 48 h. Two stroke neurologists who were blinded to clinical data reviewed the TCD results together by consensus for MES using standard single gate consensus conference recommendations (SPECT); and novel power M-mode criteria (PMD). Based on review of disparity between two methods we derived new combined diagnostic criteria of MES (PMD/SPECT) defined as: 1. High signal intensity that can meet the SPECT or PMD. 2. No evidence of artifact on SPECT or PMD. We defined the artifact on PMD as increase in power occurring in multidepth simultaneously or increase in power occurring at not random pattern within the cardiac cycle. We then reported on the frequency of artifact and MES counts when comparing the two methods (SPECT vs. PMD/SPECT) and compared the predictability of two methods of baseline DWI lesion on MR scan. Results: Of 231 patients, 46 patients (male 71.5% and mean age 63.4 +/- 17.3 years) had evidence of MES on either SPECT or PMD. Total MES count on SPECT was 364 MESs (mean 7.8 +/- 16.7, median 2.0), and using PMD/SPECT revealed 427 MESs (9.3 +/- 19.1, median 3.0). 42 MESs (11.5%) on SPECT were subsequently determined to represent artifacts, 101 MESs (23.7%) were missed by SPECT and 4 MES (0.9%) were missed by PMD. PMD/SPECT predicted baseline DWI ischemic lesions (p=0.026) better than SPECT did (P= 0.291). Discussion: The PMD/SPECT appeared to improve MES yield and separate artifacts from real emboli. The PMD/SPECT predicted the baseline DWI lesion more accurately than SPECT.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

04
Interest of perfusion and diffusion MR Imaging to follow patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
E. Le Bars    H. Brunel    M. Moynier    G. Boubotte    A. Bonafé                                   
 

CHU Hôpital Gui de Chauliac, Montpellier

FRANCE

Objective: study the potentiality of Diffusion and Perfusion MRI to improve the vasospasm diagnosis sensitivity in case of aneurysmal subarachnoid bleeding. Methods: Thirty cases of aneurysmal SAH were evaluated with TCD, DWI and PWI within the first three days and the following sixth and tenth day after the bleeding. The fourth MRI examination is done at 6 months to evaluate brain damages. For each patient, the apparent diffusion coefficient, the cerebral blood volume, the cerebral blood flow, the tissue mean transit time, the Time to Peak (TTP), the time inflow of contrast agent were evaluated for each exam. Two methods for the evaluation of DWI and PWI analysis were carried out: a qualitative analysis for the thirty cases; a longitudinal quantitative analysis of PWI based on two groups of patients. The control group showed no modification of PWI during the study. In the other group variations of PWI time data outside the ischemic area were found. Results: We found in two patients a complete reversibility in DWI anomalies. Three patients showed PWI anomalies without DWI modification. The amplitude of relative perfusion time data at the acute stage of vasospasm is statistically significant between the two groups. The evolution of relative perfusion time data for the group with altered perfusion is statistically significant compared to the control group. The relative TTP evolution is correlated with the clinical symptoms during the acute stage of vasospasm, MRI lesion and with the neurological deficits at 6 months. The longitudinal analysis of the rTTP value was the most sensitive parameters witch was correlated with the deficit and with a risk of a lesion at six month. Conclusion: The DWI and PWI appear to be sensitive imaging techniques for cerebral vasospasm evaluation. According to these preliminary results, perfusion appears to be an important tool for the evaluation of symptomatic or asymptomatic vasospasm and for the follow up of those patients.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

04
Interest of perfusion and diffusion MR Imaging to follow patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
E. Le Bars    H. Brunel    M. Moynier    G. Boubotte    A. Bonafé                                   
 

CHU Hôpital Gui de Chauliac, Montpellier

FRANCE

Objective: study the potentiality of Diffusion and Perfusion MRI to improve the vasospasm diagnosis sensitivity in case of aneurysmal subarachnoid bleeding. Methods: Thirty cases of aneurysmal SAH were evaluated with TCD, DWI and PWI within the first three days and the following sixth and tenth day after the bleeding. The fourth MRI examination is done at 6 months to evaluate brain damages. For each patient, the apparent diffusion coefficient, the cerebral blood volume, the cerebral blood flow, the tissue mean transit time, the Time to Peak (TTP), the time inflow of contrast agent were evaluated for each exam. Two methods for the evaluation of DWI and PWI analysis were carried out: a qualitative analysis for the thirty cases; a longitudinal quantitative analysis of PWI based on two groups of patients. The control group showed no modification of PWI during the study. In the other group variations of PWI time data outside the ischemic area were found. Results: We found in two patients a complete reversibility in DWI anomalies. Three patients showed PWI anomalies without DWI modification. The amplitude of relative perfusion time data at the acute stage of vasospasm is statistically significant between the two groups. The evolution of relative perfusion time data for the group with altered perfusion is statistically significant compared to the control group. The relative TTP evolution is correlated with the clinical symptoms during the acute stage of vasospasm, MRI lesion and with the neurological deficits at 6 months. The longitudinal analysis of the rTTP value was the most sensitive parameters witch was correlated with the deficit and with a risk of a lesion at six month. Conclusion: The DWI and PWI appear to be sensitive imaging techniques for cerebral vasospasm evaluation. According to these preliminary results, perfusion appears to be an important tool for the evaluation of symptomatic or asymptomatic vasospasm and for the follow up of those patients.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

04
Interest of perfusion and diffusion MR Imaging to follow patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
E. Le Bars    H. Brunel    M. Moynier    G. Boubotte    A. Bonafé                                   
 

CHU Hôpital Gui de Chauliac, Montpellier

FRANCE

Objective: study the potentiality of Diffusion and Perfusion MRI to improve the vasospasm diagnosis sensitivity in case of aneurysmal subarachnoid bleeding. Methods: Thirty cases of aneurysmal SAH were evaluated with TCD, DWI and PWI within the first three days and the following sixth and tenth day after the bleeding. The fourth MRI examination is done at 6 months to evaluate brain damages. For each patient, the apparent diffusion coefficient, the cerebral blood volume, the cerebral blood flow, the tissue mean transit time, the Time to Peak (TTP), the time inflow of contrast agent were evaluated for each exam. Two methods for the evaluation of DWI and PWI analysis were carried out: a qualitative analysis for the thirty cases; a longitudinal quantitative analysis of PWI based on two groups of patients. The control group showed no modification of PWI during the study. In the other group variations of PWI time data outside the ischemic area were found. Results: We found in two patients a complete reversibility in DWI anomalies. Three patients showed PWI anomalies without DWI modification. The amplitude of relative perfusion time data at the acute stage of vasospasm is statistically significant between the two groups. The evolution of relative perfusion time data for the group with altered perfusion is statistically significant compared to the control group. The relative TTP evolution is correlated with the clinical symptoms during the acute stage of vasospasm, MRI lesion and with the neurological deficits at 6 months. The longitudinal analysis of the rTTP value was the most sensitive parameters witch was correlated with the deficit and with a risk of a lesion at six month. Conclusion: The DWI and PWI appear to be sensitive imaging techniques for cerebral vasospasm evaluation. According to these preliminary results, perfusion appears to be an important tool for the evaluation of symptomatic or asymptomatic vasospasm and for the follow up of those patients.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

04
Interest of perfusion and diffusion MR Imaging to follow patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
E. Le Bars    H. Brunel    M. Moynier    G. Boubotte    A. Bonafé                                   
 

CHU Hôpital Gui de Chauliac, Montpellier

FRANCE

Objective: study the potentiality of Diffusion and Perfusion MRI to improve the vasospasm diagnosis sensitivity in case of aneurysmal subarachnoid bleeding. Methods: Thirty cases of aneurysmal SAH were evaluated with TCD, DWI and PWI within the first three days and the following sixth and tenth day after the bleeding. The fourth MRI examination is done at 6 months to evaluate brain damages. For each patient, the apparent diffusion coefficient, the cerebral blood volume, the cerebral blood flow, the tissue mean transit time, the Time to Peak (TTP), the time inflow of contrast agent were evaluated for each exam. Two methods for the evaluation of DWI and PWI analysis were carried out: a qualitative analysis for the thirty cases; a longitudinal quantitative analysis of PWI based on two groups of patients. The control group showed no modification of PWI during the study. In the other group variations of PWI time data outside the ischemic area were found. Results: We found in two patients a complete reversibility in DWI anomalies. Three patients showed PWI anomalies without DWI modification. The amplitude of relative perfusion time data at the acute stage of vasospasm is statistically significant between the two groups. The evolution of relative perfusion time data for the group with altered perfusion is statistically significant compared to the control group. The relative TTP evolution is correlated with the clinical symptoms during the acute stage of vasospasm, MRI lesion and with the neurological deficits at 6 months. The longitudinal analysis of the rTTP value was the most sensitive parameters witch was correlated with the deficit and with a risk of a lesion at six month. Conclusion: The DWI and PWI appear to be sensitive imaging techniques for cerebral vasospasm evaluation. According to these preliminary results, perfusion appears to be an important tool for the evaluation of symptomatic or asymptomatic vasospasm and for the follow up of those patients.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

04
Interest of perfusion and diffusion MR Imaging to follow patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
E. Le Bars    H. Brunel    M. Moynier    G. Boubotte    A. Bonafé                                   
 

CHU Hôpital Gui de Chauliac, Montpellier

FRANCE

Objective: study the potentiality of Diffusion and Perfusion MRI to improve the vasospasm diagnosis sensitivity in case of aneurysmal subarachnoid bleeding. Methods: Thirty cases of aneurysmal SAH were evaluated with TCD, DWI and PWI within the first three days and the following sixth and tenth day after the bleeding. The fourth MRI examination is done at 6 months to evaluate brain damages. For each patient, the apparent diffusion coefficient, the cerebral blood volume, the cerebral blood flow, the tissue mean transit time, the Time to Peak (TTP), the time inflow of contrast agent were evaluated for each exam. Two methods for the evaluation of DWI and PWI analysis were carried out: a qualitative analysis for the thirty cases; a longitudinal quantitative analysis of PWI based on two groups of patients. The control group showed no modification of PWI during the study. In the other group variations of PWI time data outside the ischemic area were found. Results: We found in two patients a complete reversibility in DWI anomalies. Three patients showed PWI anomalies without DWI modification. The amplitude of relative perfusion time data at the acute stage of vasospasm is statistically significant between the two groups. The evolution of relative perfusion time data for the group with altered perfusion is statistically significant compared to the control group. The relative TTP evolution is correlated with the clinical symptoms during the acute stage of vasospasm, MRI lesion and with the neurological deficits at 6 months. The longitudinal analysis of the rTTP value was the most sensitive parameters witch was correlated with the deficit and with a risk of a lesion at six month. Conclusion: The DWI and PWI appear to be sensitive imaging techniques for cerebral vasospasm evaluation. According to these preliminary results, perfusion appears to be an important tool for the evaluation of symptomatic or asymptomatic vasospasm and for the follow up of those patients.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31tMay 2007   Time:      Room: Poster Area
Chair:  
 

24
Cardio-protection in acute stroke: hypothesis for intervention for mortality reduction.
J.C.Sharma    I.N.Ross    M. Vassallo                                                 
 

Kings Mill Hospital

UNITED KINGDOM

Background: Measures of damage limitation for acute stroke have not produced substantial benefit to reduce stroke mortality. Search continues for measures to reduce stroke mortality. Methods: Literature review for influence of cardiovascular factors, specifically the value of NT proBNP (a sensitive index of cardiac impairment) for stroke mortality, Results: Cardiovascular factors, in particular cardiac failure, adversely influence acute stroke mortality. Recent studies reveal that Troponin and NT-proBNP are elevated in acute stroke patients, in response to the activated Renin-Angiotensin-Aldosterone-System and other neurohumoral changes, as a protective mechanism for sympatho-inhibitory activity. Elevated NT-proBNP has been reported to be associated with higher short and long term mortality. In one study all patients who died at 4 months had NT-proBNP levels above the median, no patient with NT-proBNP below the median value died. Two studies revealed that NT-proBNP is more significant than clinical stroke severity for stroke mortality. Raised Troponin indicates myocardial injury, raised NT-proBNP indicates occult cardiac impairment in acute stroke patients. Protection of myocardium in stroke patients may be possible by the use of drugs such as beta-blockers and the drugs acting on RAAS. Reduction of mortality in studies of candesartan (ACCESS) and prior betablockers is one such example. Conclusion: Some stroke patients die due to occult cardiac impairment in acute phase due to common risk factors. This relationship between brain and heart needs evaluation. Protection of heart with currently available or new drugs in acute strokes is worth investigating since this intervention could be applied to a large proportion of acute stroke patients over a wide time window.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31tMay 2007   Time:      Room: Poster Area
Chair:  
 

24
Cardio-protection in acute stroke: hypothesis for intervention for mortality reduction.
J.C.Sharma    I.N.Ross    M. Vassallo                                                 
 

Kings Mill Hospital

UNITED KINGDOM

Background: Measures of damage limitation for acute stroke have not produced substantial benefit to reduce stroke mortality. Search continues for measures to reduce stroke mortality. Methods: Literature review for influence of cardiovascular factors, specifically the value of NT proBNP (a sensitive index of cardiac impairment) for stroke mortality, Results: Cardiovascular factors, in particular cardiac failure, adversely influence acute stroke mortality. Recent studies reveal that Troponin and NT-proBNP are elevated in acute stroke patients, in response to the activated Renin-Angiotensin-Aldosterone-System and other neurohumoral changes, as a protective mechanism for sympatho-inhibitory activity. Elevated NT-proBNP has been reported to be associated with higher short and long term mortality. In one study all patients who died at 4 months had NT-proBNP levels above the median, no patient with NT-proBNP below the median value died. Two studies revealed that NT-proBNP is more significant than clinical stroke severity for stroke mortality. Raised Troponin indicates myocardial injury, raised NT-proBNP indicates occult cardiac impairment in acute stroke patients. Protection of myocardium in stroke patients may be possible by the use of drugs such as beta-blockers and the drugs acting on RAAS. Reduction of mortality in studies of candesartan (ACCESS) and prior betablockers is one such example. Conclusion: Some stroke patients die due to occult cardiac impairment in acute phase due to common risk factors. This relationship between brain and heart needs evaluation. Protection of heart with currently available or new drugs in acute strokes is worth investigating since this intervention could be applied to a large proportion of acute stroke patients over a wide time window.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31tMay 2007   Time:      Room: Poster Area
Chair:  
 

24
Cardio-protection in acute stroke: hypothesis for intervention for mortality reduction.
J.C.Sharma    I.N.Ross    M. Vassallo                                                 
 

Kings Mill Hospital

UNITED KINGDOM

Background: Measures of damage limitation for acute stroke have not produced substantial benefit to reduce stroke mortality. Search continues for measures to reduce stroke mortality. Methods: Literature review for influence of cardiovascular factors, specifically the value of NT proBNP (a sensitive index of cardiac impairment) for stroke mortality, Results: Cardiovascular factors, in particular cardiac failure, adversely influence acute stroke mortality. Recent studies reveal that Troponin and NT-proBNP are elevated in acute stroke patients, in response to the activated Renin-Angiotensin-Aldosterone-System and other neurohumoral changes, as a protective mechanism for sympatho-inhibitory activity. Elevated NT-proBNP has been reported to be associated with higher short and long term mortality. In one study all patients who died at 4 months had NT-proBNP levels above the median, no patient with NT-proBNP below the median value died. Two studies revealed that NT-proBNP is more significant than clinical stroke severity for stroke mortality. Raised Troponin indicates myocardial injury, raised NT-proBNP indicates occult cardiac impairment in acute stroke patients. Protection of myocardium in stroke patients may be possible by the use of drugs such as beta-blockers and the drugs acting on RAAS. Reduction of mortality in studies of candesartan (ACCESS) and prior betablockers is one such example. Conclusion: Some stroke patients die due to occult cardiac impairment in acute phase due to common risk factors. This relationship between brain and heart needs evaluation. Protection of heart with currently available or new drugs in acute strokes is worth investigating since this intervention could be applied to a large proportion of acute stroke patients over a wide time window.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

05
Acute Vertigo of Undetermined Origin: Diagnostic Value of Magnetic Resonance Imaging
L. Huang    A. Villringer    A. Hartmann                                                 
 

Charité Campus Benjamin Franklin

GERMANY

Background: The origin of acute vertigo often remains undetermined after neurological, otological, and CT examination in the emergency room. We investigated the diagnostic yield of magnetic resonance imaging (MRI) in these patients. Methods: Patients were included in the study if they had presented with sudden onset of vertigo to our Department between 01/2002 and 06/2005, and complete neurological, otological and cranial CT investigation allowed no definite allocation to peripheral or central origin of the vertigo. Results of cranial MRI including diffusion-weighted imaging (DWI), clincal, and epidemiological information were taken to compare the patients with (group 1) and those without (group 2) acute lesions on MRI using univariate statistics. Results: In the 108 patients with acute vertigo (mean age 61 years, 62% women), acute ischemic lesions were detected in 12% on DWI. Affected regions were medulla oblongata, cerebellum, pons, thalamus, corpus callosum, temporo-occipital lobe, parietal lobe, both periventricular areas, and frontal lobe. Higher prevalence of vertigo-unrelated ischemic CT changes (p=0.01) and non-significant trends towards elevated serum cholesterol (p=0.06), older age (0.07) and higher blood glucose levels (0.09) were observed in group 1 compared with group 2. All other clinical and epidemiolgical variables were similar in both groups. Conclusion: In patients with acute vertigo and inconclusive clinical and CT examinations, the diagnostic yield of cranial MRI is low. Patients with old ischemic lesions on CT are more likely to have a central vertigo origin. Clinical and epidemiological characteristics are not associated with higher detection rates of acute brain lesions.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

05
Acute Vertigo of Undetermined Origin: Diagnostic Value of Magnetic Resonance Imaging
L. Huang    A. Villringer    A. Hartmann                                                 
 

Charité Campus Benjamin Franklin

GERMANY

Background: The origin of acute vertigo often remains undetermined after neurological, otological, and CT examination in the emergency room. We investigated the diagnostic yield of magnetic resonance imaging (MRI) in these patients. Methods: Patients were included in the study if they had presented with sudden onset of vertigo to our Department between 01/2002 and 06/2005, and complete neurological, otological and cranial CT investigation allowed no definite allocation to peripheral or central origin of the vertigo. Results of cranial MRI including diffusion-weighted imaging (DWI), clincal, and epidemiological information were taken to compare the patients with (group 1) and those without (group 2) acute lesions on MRI using univariate statistics. Results: In the 108 patients with acute vertigo (mean age 61 years, 62% women), acute ischemic lesions were detected in 12% on DWI. Affected regions were medulla oblongata, cerebellum, pons, thalamus, corpus callosum, temporo-occipital lobe, parietal lobe, both periventricular areas, and frontal lobe. Higher prevalence of vertigo-unrelated ischemic CT changes (p=0.01) and non-significant trends towards elevated serum cholesterol (p=0.06), older age (0.07) and higher blood glucose levels (0.09) were observed in group 1 compared with group 2. All other clinical and epidemiolgical variables were similar in both groups. Conclusion: In patients with acute vertigo and inconclusive clinical and CT examinations, the diagnostic yield of cranial MRI is low. Patients with old ischemic lesions on CT are more likely to have a central vertigo origin. Clinical and epidemiological characteristics are not associated with higher detection rates of acute brain lesions.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

05
Acute Vertigo of Undetermined Origin: Diagnostic Value of Magnetic Resonance Imaging
L. Huang    A. Villringer    A. Hartmann                                                 
 

Charité Campus Benjamin Franklin

GERMANY

Background: The origin of acute vertigo often remains undetermined after neurological, otological, and CT examination in the emergency room. We investigated the diagnostic yield of magnetic resonance imaging (MRI) in these patients. Methods: Patients were included in the study if they had presented with sudden onset of vertigo to our Department between 01/2002 and 06/2005, and complete neurological, otological and cranial CT investigation allowed no definite allocation to peripheral or central origin of the vertigo. Results of cranial MRI including diffusion-weighted imaging (DWI), clincal, and epidemiological information were taken to compare the patients with (group 1) and those without (group 2) acute lesions on MRI using univariate statistics. Results: In the 108 patients with acute vertigo (mean age 61 years, 62% women), acute ischemic lesions were detected in 12% on DWI. Affected regions were medulla oblongata, cerebellum, pons, thalamus, corpus callosum, temporo-occipital lobe, parietal lobe, both periventricular areas, and frontal lobe. Higher prevalence of vertigo-unrelated ischemic CT changes (p=0.01) and non-significant trends towards elevated serum cholesterol (p=0.06), older age (0.07) and higher blood glucose levels (0.09) were observed in group 1 compared with group 2. All other clinical and epidemiolgical variables were similar in both groups. Conclusion: In patients with acute vertigo and inconclusive clinical and CT examinations, the diagnostic yield of cranial MRI is low. Patients with old ischemic lesions on CT are more likely to have a central vertigo origin. Clinical and epidemiological characteristics are not associated with higher detection rates of acute brain lesions.

Kind of presentation: Oral 
Venous diseases  
 
Date: Thursday, 31 May 2007   Time: 17:10 - 17:20    Room: Room Dochart
Chair: C. Stam, The Netherlands and H. Chabriat, France
 

05
Isolated lateral sinus thrombosis: 62 cases
M. Damak    I. Crassard    V. Wolff    M.G.Bousser                                          
 

Lariboisiere Hospital

FRANCE

Background: Isolated lateral sinus thrombosis (ILST), i.e. without thrombosis of other sinus, was considered for a long time as a complication of middle ear disease. Little attention has been recently paid to this variety of thrombosis. We therefore reviewed all cases of ILST prospectively collected in our center (1997-2006). Methods: Among 195 patients with cerebral venous thrombosis (CVT), we identified 157 patients with LST, including 62 patients with ILST. Clinical, etiologic and prognostic features were compared with those of other 133 CVT cases. Results: 62 patients (32%) had ILST. The most frequent mode of onset was subacute in 81% of cases. Headaches were present in 95% of patients. The main clinical presentation was isolated headache in 28 patients (45%) while 15 (24%) had isolated intracranial hypertension. Nineteen patients (31%) had at least one focal sign (deficit and/or focal seizure). Aphasia was the most common one (8 patients). Compared with the other 133 CVT cases, presentation with isolated headaches was the most frequent one (p<0.001). Parenchymal lesions were found in 19 cases and were less frequent than in other CVT cases (p=0.007). Numerous causes or predisposing factors were identified without difference of repartition with other CVT patients, particularly for local or infectious causes. Treatment consisted of anticoagulation in all patients. Clinical evolution was good with a complete recovery in 57 patients (92%). One patient died after the occurrence of massive pulmonary emboli, despite adequate anticoagulation. Four patients had moderate sequelea (no difference with the other CVT). Discussion: The ILST is a frequent variety of CVT, presenting in a majority of cases with isolated headache in our series. Etiologic check up must be complete because of the frequency of multiple risk factors. The therapeutic management is not different from that of other locations of CVT and allows most often a complete recovery.

Kind of presentation: Oral 
Venous diseases  
 
Date: Thursday, 31 May 2007   Time: 17:10 - 17:20    Room: Room Dochart
Chair: C. Stam, The Netherlands and H. Chabriat, France
 

05
Isolated lateral sinus thrombosis: 62 cases
M. Damak    I. Crassard    V. Wolff    M.G.Bousser                                          
 

Lariboisiere Hospital

FRANCE

Background: Isolated lateral sinus thrombosis (ILST), i.e. without thrombosis of other sinus, was considered for a long time as a complication of middle ear disease. Little attention has been recently paid to this variety of thrombosis. We therefore reviewed all cases of ILST prospectively collected in our center (1997-2006). Methods: Among 195 patients with cerebral venous thrombosis (CVT), we identified 157 patients with LST, including 62 patients with ILST. Clinical, etiologic and prognostic features were compared with those of other 133 CVT cases. Results: 62 patients (32%) had ILST. The most frequent mode of onset was subacute in 81% of cases. Headaches were present in 95% of patients. The main clinical presentation was isolated headache in 28 patients (45%) while 15 (24%) had isolated intracranial hypertension. Nineteen patients (31%) had at least one focal sign (deficit and/or focal seizure). Aphasia was the most common one (8 patients). Compared with the other 133 CVT cases, presentation with isolated headaches was the most frequent one (p<0.001). Parenchymal lesions were found in 19 cases and were less frequent than in other CVT cases (p=0.007). Numerous causes or predisposing factors were identified without difference of repartition with other CVT patients, particularly for local or infectious causes. Treatment consisted of anticoagulation in all patients. Clinical evolution was good with a complete recovery in 57 patients (92%). One patient died after the occurrence of massive pulmonary emboli, despite adequate anticoagulation. Four patients had moderate sequelea (no difference with the other CVT). Discussion: The ILST is a frequent variety of CVT, presenting in a majority of cases with isolated headache in our series. Etiologic check up must be complete because of the frequency of multiple risk factors. The therapeutic management is not different from that of other locations of CVT and allows most often a complete recovery.

Kind of presentation: Oral 
Venous diseases  
 
Date: Thursday, 31 May 2007   Time: 17:10 - 17:20    Room: Room Dochart
Chair: C. Stam, The Netherlands and H. Chabriat, France
 

05
Isolated lateral sinus thrombosis: 62 cases
M. Damak    I. Crassard    V. Wolff    M.G.Bousser                                          
 

Lariboisiere Hospital

FRANCE

Background: Isolated lateral sinus thrombosis (ILST), i.e. without thrombosis of other sinus, was considered for a long time as a complication of middle ear disease. Little attention has been recently paid to this variety of thrombosis. We therefore reviewed all cases of ILST prospectively collected in our center (1997-2006). Methods: Among 195 patients with cerebral venous thrombosis (CVT), we identified 157 patients with LST, including 62 patients with ILST. Clinical, etiologic and prognostic features were compared with those of other 133 CVT cases. Results: 62 patients (32%) had ILST. The most frequent mode of onset was subacute in 81% of cases. Headaches were present in 95% of patients. The main clinical presentation was isolated headache in 28 patients (45%) while 15 (24%) had isolated intracranial hypertension. Nineteen patients (31%) had at least one focal sign (deficit and/or focal seizure). Aphasia was the most common one (8 patients). Compared with the other 133 CVT cases, presentation with isolated headaches was the most frequent one (p<0.001). Parenchymal lesions were found in 19 cases and were less frequent than in other CVT cases (p=0.007). Numerous causes or predisposing factors were identified without difference of repartition with other CVT patients, particularly for local or infectious causes. Treatment consisted of anticoagulation in all patients. Clinical evolution was good with a complete recovery in 57 patients (92%). One patient died after the occurrence of massive pulmonary emboli, despite adequate anticoagulation. Four patients had moderate sequelea (no difference with the other CVT). Discussion: The ILST is a frequent variety of CVT, presenting in a majority of cases with isolated headache in our series. Etiologic check up must be complete because of the frequency of multiple risk factors. The therapeutic management is not different from that of other locations of CVT and allows most often a complete recovery.

Kind of presentation: Oral 
Venous diseases  
 
Date: Thursday, 31 May 2007   Time: 17:10 - 17:20    Room: Room Dochart
Chair: C. Stam, The Netherlands and H. Chabriat, France
 

05
Isolated lateral sinus thrombosis: 62 cases
M. Damak    I. Crassard    V. Wolff    M.G.Bousser                                          
 

Lariboisiere Hospital

FRANCE

Background: Isolated lateral sinus thrombosis (ILST), i.e. without thrombosis of other sinus, was considered for a long time as a complication of middle ear disease. Little attention has been recently paid to this variety of thrombosis. We therefore reviewed all cases of ILST prospectively collected in our center (1997-2006). Methods: Among 195 patients with cerebral venous thrombosis (CVT), we identified 157 patients with LST, including 62 patients with ILST. Clinical, etiologic and prognostic features were compared with those of other 133 CVT cases. Results: 62 patients (32%) had ILST. The most frequent mode of onset was subacute in 81% of cases. Headaches were present in 95% of patients. The main clinical presentation was isolated headache in 28 patients (45%) while 15 (24%) had isolated intracranial hypertension. Nineteen patients (31%) had at least one focal sign (deficit and/or focal seizure). Aphasia was the most common one (8 patients). Compared with the other 133 CVT cases, presentation with isolated headaches was the most frequent one (p<0.001). Parenchymal lesions were found in 19 cases and were less frequent than in other CVT cases (p=0.007). Numerous causes or predisposing factors were identified without difference of repartition with other CVT patients, particularly for local or infectious causes. Treatment consisted of anticoagulation in all patients. Clinical evolution was good with a complete recovery in 57 patients (92%). One patient died after the occurrence of massive pulmonary emboli, despite adequate anticoagulation. Four patients had moderate sequelea (no difference with the other CVT). Discussion: The ILST is a frequent variety of CVT, presenting in a majority of cases with isolated headache in our series. Etiologic check up must be complete because of the frequency of multiple risk factors. The therapeutic management is not different from that of other locations of CVT and allows most often a complete recovery.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

14
Longer Term Stroke Care: How should services be developed in the post-acute phase?
A.M.Cox    L. Kalra    A.G.Rudd    C.D.A.Wolfe    C. McKevitt                                   
 

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

UNITED KINGDOM

Background: Organised stroke care, such as inpatient stroke units and early supported discharge, improves outcomes for patients. There is less evidence for the optimal organisation and delivery of stroke care in the longer term. Following the MRC Framework for developing complex interventions, we undertook Phase 1 work to identify the potential components of an intervention to improve longer term stroke care. Methods: In-depth interviews with a purposive sample of health professionals (n=25) working in stroke. Participants were asked to describe existing services for patients in the post-acute phase, identify successes and shortcomings and propose ways to improve service provision. Interviews were recorded, transcribed and analysed using framework analysis. Results: Participants highlighted gaps in the available evidence base regarding the optimal setting, timing, intensity and focus of therapy delivery. There are theoretical questions that need to be resolved to improve post-acute services. These include whether specialist care is necessary and what specialism means in this context, the nature of multi-disciplinary working, and how to overcome the structural and professional divisions that currently influence service provision. Problems relating to the delivery of services include transfer of care between services, lack of psychology support, capacity to provide intensive therapy, inadequate service provision for the cognitively and perceptually impaired. Conclusion: This interview study identified gaps in the evidence base, theoretical questions that underpin the organisation of services as well as practical problems in care delivery. These will need to be addressed in formulating an improved model of post-acute stroke care.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

14
Longer Term Stroke Care: How should services be developed in the post-acute phase?
A.M.Cox    L. Kalra    A.G.Rudd    C.D.A.Wolfe    C. McKevitt                                   
 

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

UNITED KINGDOM

Background: Organised stroke care, such as inpatient stroke units and early supported discharge, improves outcomes for patients. There is less evidence for the optimal organisation and delivery of stroke care in the longer term. Following the MRC Framework for developing complex interventions, we undertook Phase 1 work to identify the potential components of an intervention to improve longer term stroke care. Methods: In-depth interviews with a purposive sample of health professionals (n=25) working in stroke. Participants were asked to describe existing services for patients in the post-acute phase, identify successes and shortcomings and propose ways to improve service provision. Interviews were recorded, transcribed and analysed using framework analysis. Results: Participants highlighted gaps in the available evidence base regarding the optimal setting, timing, intensity and focus of therapy delivery. There are theoretical questions that need to be resolved to improve post-acute services. These include whether specialist care is necessary and what specialism means in this context, the nature of multi-disciplinary working, and how to overcome the structural and professional divisions that currently influence service provision. Problems relating to the delivery of services include transfer of care between services, lack of psychology support, capacity to provide intensive therapy, inadequate service provision for the cognitively and perceptually impaired. Conclusion: This interview study identified gaps in the evidence base, theoretical questions that underpin the organisation of services as well as practical problems in care delivery. These will need to be addressed in formulating an improved model of post-acute stroke care.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

14
Longer Term Stroke Care: How should services be developed in the post-acute phase?
A.M.Cox    L. Kalra    A.G.Rudd    C.D.A.Wolfe    C. McKevitt                                   
 

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

UNITED KINGDOM

Background: Organised stroke care, such as inpatient stroke units and early supported discharge, improves outcomes for patients. There is less evidence for the optimal organisation and delivery of stroke care in the longer term. Following the MRC Framework for developing complex interventions, we undertook Phase 1 work to identify the potential components of an intervention to improve longer term stroke care. Methods: In-depth interviews with a purposive sample of health professionals (n=25) working in stroke. Participants were asked to describe existing services for patients in the post-acute phase, identify successes and shortcomings and propose ways to improve service provision. Interviews were recorded, transcribed and analysed using framework analysis. Results: Participants highlighted gaps in the available evidence base regarding the optimal setting, timing, intensity and focus of therapy delivery. There are theoretical questions that need to be resolved to improve post-acute services. These include whether specialist care is necessary and what specialism means in this context, the nature of multi-disciplinary working, and how to overcome the structural and professional divisions that currently influence service provision. Problems relating to the delivery of services include transfer of care between services, lack of psychology support, capacity to provide intensive therapy, inadequate service provision for the cognitively and perceptually impaired. Conclusion: This interview study identified gaps in the evidence base, theoretical questions that underpin the organisation of services as well as practical problems in care delivery. These will need to be addressed in formulating an improved model of post-acute stroke care.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

14
Longer Term Stroke Care: How should services be developed in the post-acute phase?
A.M.Cox    L. Kalra    A.G.Rudd    C.D.A.Wolfe    C. McKevitt                                   
 

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

UNITED KINGDOM

Background: Organised stroke care, such as inpatient stroke units and early supported discharge, improves outcomes for patients. There is less evidence for the optimal organisation and delivery of stroke care in the longer term. Following the MRC Framework for developing complex interventions, we undertook Phase 1 work to identify the potential components of an intervention to improve longer term stroke care. Methods: In-depth interviews with a purposive sample of health professionals (n=25) working in stroke. Participants were asked to describe existing services for patients in the post-acute phase, identify successes and shortcomings and propose ways to improve service provision. Interviews were recorded, transcribed and analysed using framework analysis. Results: Participants highlighted gaps in the available evidence base regarding the optimal setting, timing, intensity and focus of therapy delivery. There are theoretical questions that need to be resolved to improve post-acute services. These include whether specialist care is necessary and what specialism means in this context, the nature of multi-disciplinary working, and how to overcome the structural and professional divisions that currently influence service provision. Problems relating to the delivery of services include transfer of care between services, lack of psychology support, capacity to provide intensive therapy, inadequate service provision for the cognitively and perceptually impaired. Conclusion: This interview study identified gaps in the evidence base, theoretical questions that underpin the organisation of services as well as practical problems in care delivery. These will need to be addressed in formulating an improved model of post-acute stroke care.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

14
Longer Term Stroke Care: How should services be developed in the post-acute phase?
A.M.Cox    L. Kalra    A.G.Rudd    C.D.A.Wolfe    C. McKevitt                                   
 

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

UNITED KINGDOM

Background: Organised stroke care, such as inpatient stroke units and early supported discharge, improves outcomes for patients. There is less evidence for the optimal organisation and delivery of stroke care in the longer term. Following the MRC Framework for developing complex interventions, we undertook Phase 1 work to identify the potential components of an intervention to improve longer term stroke care. Methods: In-depth interviews with a purposive sample of health professionals (n=25) working in stroke. Participants were asked to describe existing services for patients in the post-acute phase, identify successes and shortcomings and propose ways to improve service provision. Interviews were recorded, transcribed and analysed using framework analysis. Results: Participants highlighted gaps in the available evidence base regarding the optimal setting, timing, intensity and focus of therapy delivery. There are theoretical questions that need to be resolved to improve post-acute services. These include whether specialist care is necessary and what specialism means in this context, the nature of multi-disciplinary working, and how to overcome the structural and professional divisions that currently influence service provision. Problems relating to the delivery of services include transfer of care between services, lack of psychology support, capacity to provide intensive therapy, inadequate service provision for the cognitively and perceptually impaired. Conclusion: This interview study identified gaps in the evidence base, theoretical questions that underpin the organisation of services as well as practical problems in care delivery. These will need to be addressed in formulating an improved model of post-acute stroke care.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31tMay 2007   Time:      Room: Poster Area
Chair:  
 

03
Prognostic factors of thrombolytic therapy in hyperacute ischemic stroke
J.H.Rha    B.N.Yoon    K.H.Ji    J. Lee                                          
 

Inha University Hospital

SOUTH KOREA

Background: To investigate the prognostic factors of intravenous thrombolysis, we evaluated 121 consecutive patients treated with IV tPA. Methods: Demographic and clinical profiles, laboratory results, transcranial Doppler, and brain imaging were evaluated. Clinical assessment was done by National Institutes of Health Stroke Scale (NIHSS) for one week, and by modified Rankin Scale (mRS) at baseline and three months. Early improvement was defined as the complete resolution of the neurological deficit or an improvement of 4 or more points by NIHSS within 24 hours of the stroke onset, and good outcome as mRS score of 2 or less at three months. We assessed the possible relationship of the factors with early improvement and good outcome, and also analyzed the correlation of TCD grade with NIHSS score. Comparisons of variables were performed using Fisher’s exact test, t-test and Mann-Whitney test. The predictors of early improvement and good outcome were analyzed by logistic regression, and the correlation of TCD grade and NIHSS score were analyzed by Spearman correlation. Results: On univariate analysis, younger age, absence of abnormal CT findings (hyperdense middle cerebral artery sign [HMCAS], focal hypodensity in the total MCA territory > 33 %) were significantly associated with early improvement. Good outcome was associated with younger age, lower levels of baseline NIHSS score, mean blood pressure, fasting glucose, lipoprotein (a) [Lp(a)], and absence of abnormal CT findings. Multivariate analysis revealed age < 63 years and no HMCAS as independent predictors of early improvement. Thrombolysis in brain ischemia grade by TCD monitoring significantly correlated with NIHSS score for 24 hours. Conclusions: These results suggest that younger age, normal CT findings are important prognostic factors of acute thrombolytic therapy, whereas age, CT findings, baseline NIHSS, blood pressure, blood sugar and Lp (a) level might be associated factors of long term outcome. TCD can be a useful indicator of clinical improvement.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31tMay 2007   Time:      Room: Poster Area
Chair:  
 

03
Prognostic factors of thrombolytic therapy in hyperacute ischemic stroke
J.H.Rha    B.N.Yoon    K.H.Ji    J. Lee                                          
 

Inha University Hospital

SOUTH KOREA

Background: To investigate the prognostic factors of intravenous thrombolysis, we evaluated 121 consecutive patients treated with IV tPA. Methods: Demographic and clinical profiles, laboratory results, transcranial Doppler, and brain imaging were evaluated. Clinical assessment was done by National Institutes of Health Stroke Scale (NIHSS) for one week, and by modified Rankin Scale (mRS) at baseline and three months. Early improvement was defined as the complete resolution of the neurological deficit or an improvement of 4 or more points by NIHSS within 24 hours of the stroke onset, and good outcome as mRS score of 2 or less at three months. We assessed the possible relationship of the factors with early improvement and good outcome, and also analyzed the correlation of TCD grade with NIHSS score. Comparisons of variables were performed using Fisher’s exact test, t-test and Mann-Whitney test. The predictors of early improvement and good outcome were analyzed by logistic regression, and the correlation of TCD grade and NIHSS score were analyzed by Spearman correlation. Results: On univariate analysis, younger age, absence of abnormal CT findings (hyperdense middle cerebral artery sign [HMCAS], focal hypodensity in the total MCA territory > 33 %) were significantly associated with early improvement. Good outcome was associated with younger age, lower levels of baseline NIHSS score, mean blood pressure, fasting glucose, lipoprotein (a) [Lp(a)], and absence of abnormal CT findings. Multivariate analysis revealed age < 63 years and no HMCAS as independent predictors of early improvement. Thrombolysis in brain ischemia grade by TCD monitoring significantly correlated with NIHSS score for 24 hours. Conclusions: These results suggest that younger age, normal CT findings are important prognostic factors of acute thrombolytic therapy, whereas age, CT findings, baseline NIHSS, blood pressure, blood sugar and Lp (a) level might be associated factors of long term outcome. TCD can be a useful indicator of clinical improvement.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31tMay 2007   Time:      Room: Poster Area
Chair:  
 

03
Prognostic factors of thrombolytic therapy in hyperacute ischemic stroke
J.H.Rha    B.N.Yoon    K.H.Ji    J. Lee                                          
 

Inha University Hospital

SOUTH KOREA

Background: To investigate the prognostic factors of intravenous thrombolysis, we evaluated 121 consecutive patients treated with IV tPA. Methods: Demographic and clinical profiles, laboratory results, transcranial Doppler, and brain imaging were evaluated. Clinical assessment was done by National Institutes of Health Stroke Scale (NIHSS) for one week, and by modified Rankin Scale (mRS) at baseline and three months. Early improvement was defined as the complete resolution of the neurological deficit or an improvement of 4 or more points by NIHSS within 24 hours of the stroke onset, and good outcome as mRS score of 2 or less at three months. We assessed the possible relationship of the factors with early improvement and good outcome, and also analyzed the correlation of TCD grade with NIHSS score. Comparisons of variables were performed using Fisher’s exact test, t-test and Mann-Whitney test. The predictors of early improvement and good outcome were analyzed by logistic regression, and the correlation of TCD grade and NIHSS score were analyzed by Spearman correlation. Results: On univariate analysis, younger age, absence of abnormal CT findings (hyperdense middle cerebral artery sign [HMCAS], focal hypodensity in the total MCA territory > 33 %) were significantly associated with early improvement. Good outcome was associated with younger age, lower levels of baseline NIHSS score, mean blood pressure, fasting glucose, lipoprotein (a) [Lp(a)], and absence of abnormal CT findings. Multivariate analysis revealed age < 63 years and no HMCAS as independent predictors of early improvement. Thrombolysis in brain ischemia grade by TCD monitoring significantly correlated with NIHSS score for 24 hours. Conclusions: These results suggest that younger age, normal CT findings are important prognostic factors of acute thrombolytic therapy, whereas age, CT findings, baseline NIHSS, blood pressure, blood sugar and Lp (a) level might be associated factors of long term outcome. TCD can be a useful indicator of clinical improvement.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31tMay 2007   Time:      Room: Poster Area
Chair:  
 

03
Prognostic factors of thrombolytic therapy in hyperacute ischemic stroke
J.H.Rha    B.N.Yoon    K.H.Ji    J. Lee                                          
 

Inha University Hospital

SOUTH KOREA

Background: To investigate the prognostic factors of intravenous thrombolysis, we evaluated 121 consecutive patients treated with IV tPA. Methods: Demographic and clinical profiles, laboratory results, transcranial Doppler, and brain imaging were evaluated. Clinical assessment was done by National Institutes of Health Stroke Scale (NIHSS) for one week, and by modified Rankin Scale (mRS) at baseline and three months. Early improvement was defined as the complete resolution of the neurological deficit or an improvement of 4 or more points by NIHSS within 24 hours of the stroke onset, and good outcome as mRS score of 2 or less at three months. We assessed the possible relationship of the factors with early improvement and good outcome, and also analyzed the correlation of TCD grade with NIHSS score. Comparisons of variables were performed using Fisher’s exact test, t-test and Mann-Whitney test. The predictors of early improvement and good outcome were analyzed by logistic regression, and the correlation of TCD grade and NIHSS score were analyzed by Spearman correlation. Results: On univariate analysis, younger age, absence of abnormal CT findings (hyperdense middle cerebral artery sign [HMCAS], focal hypodensity in the total MCA territory > 33 %) were significantly associated with early improvement. Good outcome was associated with younger age, lower levels of baseline NIHSS score, mean blood pressure, fasting glucose, lipoprotein (a) [Lp(a)], and absence of abnormal CT findings. Multivariate analysis revealed age < 63 years and no HMCAS as independent predictors of early improvement. Thrombolysis in brain ischemia grade by TCD monitoring significantly correlated with NIHSS score for 24 hours. Conclusions: These results suggest that younger age, normal CT findings are important prognostic factors of acute thrombolytic therapy, whereas age, CT findings, baseline NIHSS, blood pressure, blood sugar and Lp (a) level might be associated factors of long term outcome. TCD can be a useful indicator of clinical improvement.

Kind of presentation: Oral 
Risk factors of stroke  
 
Date: Thursday, 31 May 2007   Time: 17:50 - 18:00    Room: Room Boisdale
Chair: G. Ford, United Kingdom and D. Toni, Itlay
 

18
CHRONIC KIDNEY DISEASE AND CLINICAL OUTCOME IN PATIENTS WITH ACUTE STROKE
G. Yahalom    R. Schwartz    Y. Schwammenthal    O. Merzeliak    M. Toashi    D. Orion    D. Tanne                     
 

Sheba Academic Center

ISRAEL

Background: Chronic kidney disease (CKD) is increasingly recognized as an independent risk factor for cardiovascular disease and stroke. However, few data exist regarding its relation to long-term outcome after acute stroke. Methods: We examined the association between baseline CKD and one-year functional outcome and mortality in 802 consecutive patients with acute stroke (ischemic or hemorrhagic). Glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease (MDRD) equation and a rate ≤60 ml/min/1.73m2 defined CKD. Patients with kidney failure (estimated GFR<15 ml/min/1.73m2) were excluded. Results: Thirty-six percent of patients (n=291) had CKD. After adjustment for differences in stroke type, NIHSS score, prior disability and baseline characteristics, patients with CKD had after 1-year an adjusted odds ratio (OR) for death of 1.67 (95% CI, 1.04-2.68), for death or disability (Barthel Index<75) 1.82 (1.16-2.85) and for death or long-term nursing care 1.78 (1.12-2.84). Estimating the OR for poor 1-year outcome by GFR categories of 15-44 and 45-60, as compared to those >60 ml/min/1.73m2, reveals a particularly poor outcome among those with markedly low estimated GFR of 15-44: adjusted OR for death of 4.60 (2.39-8.99) and 0.88 (0.49-1.56), for death or disability 3.57 (1.74-7.54) and 1.39 (0.84-2.31) and for death or long-term nursing care 4.06 (2.04-8.22) and 1.18 (0.68-2.02), respectively. Discussion: CKD and in particular estimated GFR <45 ml/min/1.73m2 is a strong predictor of poor outcome in patients with acute stroke. These findings underscore the importance of estimating GFR in routine clinical practice among patients with acute stroke, and considering those with CKD as a high-risk group.

Kind of presentation: Oral 
Risk factors of stroke  
 
Date: Thursday, 31 May 2007   Time: 17:50 - 18:00    Room: Room Boisdale
Chair: G. Ford, United Kingdom and D. Toni, Itlay
 

18
CHRONIC KIDNEY DISEASE AND CLINICAL OUTCOME IN PATIENTS WITH ACUTE STROKE
G. Yahalom    R. Schwartz    Y. Schwammenthal    O. Merzeliak    M. Toashi    D. Orion    D. Tanne                     
 

Sheba Academic Center

ISRAEL

Background: Chronic kidney disease (CKD) is increasingly recognized as an independent risk factor for cardiovascular disease and stroke. However, few data exist regarding its relation to long-term outcome after acute stroke. Methods: We examined the association between baseline CKD and one-year functional outcome and mortality in 802 consecutive patients with acute stroke (ischemic or hemorrhagic). Glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease (MDRD) equation and a rate ≤60 ml/min/1.73m2 defined CKD. Patients with kidney failure (estimated GFR<15 ml/min/1.73m2) were excluded. Results: Thirty-six percent of patients (n=291) had CKD. After adjustment for differences in stroke type, NIHSS score, prior disability and baseline characteristics, patients with CKD had after 1-year an adjusted odds ratio (OR) for death of 1.67 (95% CI, 1.04-2.68), for death or disability (Barthel Index<75) 1.82 (1.16-2.85) and for death or long-term nursing care 1.78 (1.12-2.84). Estimating the OR for poor 1-year outcome by GFR categories of 15-44 and 45-60, as compared to those >60 ml/min/1.73m2, reveals a particularly poor outcome among those with markedly low estimated GFR of 15-44: adjusted OR for death of 4.60 (2.39-8.99) and 0.88 (0.49-1.56), for death or disability 3.57 (1.74-7.54) and 1.39 (0.84-2.31) and for death or long-term nursing care 4.06 (2.04-8.22) and 1.18 (0.68-2.02), respectively. Discussion: CKD and in particular estimated GFR <45 ml/min/1.73m2 is a strong predictor of poor outcome in patients with acute stroke. These findings underscore the importance of estimating GFR in routine clinical practice among patients with acute stroke, and considering those with CKD as a high-risk group.

Kind of presentation: Oral 
Risk factors of stroke  
 
Date: Thursday, 31 May 2007   Time: 17:50 - 18:00    Room: Room Boisdale
Chair: G. Ford, United Kingdom and D. Toni, Itlay
 

18
CHRONIC KIDNEY DISEASE AND CLINICAL OUTCOME IN PATIENTS WITH ACUTE STROKE
G. Yahalom    R. Schwartz    Y. Schwammenthal    O. Merzeliak    M. Toashi    D. Orion    D. Tanne                     
 

Sheba Academic Center

ISRAEL

Background: Chronic kidney disease (CKD) is increasingly recognized as an independent risk factor for cardiovascular disease and stroke. However, few data exist regarding its relation to long-term outcome after acute stroke. Methods: We examined the association between baseline CKD and one-year functional outcome and mortality in 802 consecutive patients with acute stroke (ischemic or hemorrhagic). Glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease (MDRD) equation and a rate ≤60 ml/min/1.73m2 defined CKD. Patients with kidney failure (estimated GFR<15 ml/min/1.73m2) were excluded. Results: Thirty-six percent of patients (n=291) had CKD. After adjustment for differences in stroke type, NIHSS score, prior disability and baseline characteristics, patients with CKD had after 1-year an adjusted odds ratio (OR) for death of 1.67 (95% CI, 1.04-2.68), for death or disability (Barthel Index<75) 1.82 (1.16-2.85) and for death or long-term nursing care 1.78 (1.12-2.84). Estimating the OR for poor 1-year outcome by GFR categories of 15-44 and 45-60, as compared to those >60 ml/min/1.73m2, reveals a particularly poor outcome among those with markedly low estimated GFR of 15-44: adjusted OR for death of 4.60 (2.39-8.99) and 0.88 (0.49-1.56), for death or disability 3.57 (1.74-7.54) and 1.39 (0.84-2.31) and for death or long-term nursing care 4.06 (2.04-8.22) and 1.18 (0.68-2.02), respectively. Discussion: CKD and in particular estimated GFR <45 ml/min/1.73m2 is a strong predictor of poor outcome in patients with acute stroke. These findings underscore the importance of estimating GFR in routine clinical practice among patients with acute stroke, and considering those with CKD as a high-risk group.

Kind of presentation: Oral 
Risk factors of stroke  
 
Date: Thursday, 31 May 2007   Time: 17:50 - 18:00    Room: Room Boisdale
Chair: G. Ford, United Kingdom and D. Toni, Itlay
 

18
CHRONIC KIDNEY DISEASE AND CLINICAL OUTCOME IN PATIENTS WITH ACUTE STROKE
G. Yahalom    R. Schwartz    Y. Schwammenthal    O. Merzeliak    M. Toashi    D. Orion    D. Tanne                     
 

Sheba Academic Center

ISRAEL

Background: Chronic kidney disease (CKD) is increasingly recognized as an independent risk factor for cardiovascular disease and stroke. However, few data exist regarding its relation to long-term outcome after acute stroke. Methods: We examined the association between baseline CKD and one-year functional outcome and mortality in 802 consecutive patients with acute stroke (ischemic or hemorrhagic). Glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease (MDRD) equation and a rate ≤60 ml/min/1.73m2 defined CKD. Patients with kidney failure (estimated GFR<15 ml/min/1.73m2) were excluded. Results: Thirty-six percent of patients (n=291) had CKD. After adjustment for differences in stroke type, NIHSS score, prior disability and baseline characteristics, patients with CKD had after 1-year an adjusted odds ratio (OR) for death of 1.67 (95% CI, 1.04-2.68), for death or disability (Barthel Index<75) 1.82 (1.16-2.85) and for death or long-term nursing care 1.78 (1.12-2.84). Estimating the OR for poor 1-year outcome by GFR categories of 15-44 and 45-60, as compared to those >60 ml/min/1.73m2, reveals a particularly poor outcome among those with markedly low estimated GFR of 15-44: adjusted OR for death of 4.60 (2.39-8.99) and 0.88 (0.49-1.56), for death or disability 3.57 (1.74-7.54) and 1.39 (0.84-2.31) and for death or long-term nursing care 4.06 (2.04-8.22) and 1.18 (0.68-2.02), respectively. Discussion: CKD and in particular estimated GFR <45 ml/min/1.73m2 is a strong predictor of poor outcome in patients with acute stroke. These findings underscore the importance of estimating GFR in routine clinical practice among patients with acute stroke, and considering those with CKD as a high-risk group.

Kind of presentation: Oral 
Risk factors of stroke  
 
Date: Thursday, 31 May 2007   Time: 17:50 - 18:00    Room: Room Boisdale
Chair: G. Ford, United Kingdom and D. Toni, Itlay
 

18
CHRONIC KIDNEY DISEASE AND CLINICAL OUTCOME IN PATIENTS WITH ACUTE STROKE
G. Yahalom    R. Schwartz    Y. Schwammenthal    O. Merzeliak    M. Toashi    D. Orion    D. Tanne                     
 

Sheba Academic Center

ISRAEL

Background: Chronic kidney disease (CKD) is increasingly recognized as an independent risk factor for cardiovascular disease and stroke. However, few data exist regarding its relation to long-term outcome after acute stroke. Methods: We examined the association between baseline CKD and one-year functional outcome and mortality in 802 consecutive patients with acute stroke (ischemic or hemorrhagic). Glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease (MDRD) equation and a rate ≤60 ml/min/1.73m2 defined CKD. Patients with kidney failure (estimated GFR<15 ml/min/1.73m2) were excluded. Results: Thirty-six percent of patients (n=291) had CKD. After adjustment for differences in stroke type, NIHSS score, prior disability and baseline characteristics, patients with CKD had after 1-year an adjusted odds ratio (OR) for death of 1.67 (95% CI, 1.04-2.68), for death or disability (Barthel Index<75) 1.82 (1.16-2.85) and for death or long-term nursing care 1.78 (1.12-2.84). Estimating the OR for poor 1-year outcome by GFR categories of 15-44 and 45-60, as compared to those >60 ml/min/1.73m2, reveals a particularly poor outcome among those with markedly low estimated GFR of 15-44: adjusted OR for death of 4.60 (2.39-8.99) and 0.88 (0.49-1.56), for death or disability 3.57 (1.74-7.54) and 1.39 (0.84-2.31) and for death or long-term nursing care 4.06 (2.04-8.22) and 1.18 (0.68-2.02), respectively. Discussion: CKD and in particular estimated GFR <45 ml/min/1.73m2 is a strong predictor of poor outcome in patients with acute stroke. These findings underscore the importance of estimating GFR in routine clinical practice among patients with acute stroke, and considering those with CKD as a high-risk group.

Kind of presentation: Oral 
Risk factors of stroke  
 
Date: Thursday, 31 May 2007   Time: 17:50 - 18:00    Room: Room Boisdale
Chair: G. Ford, United Kingdom and D. Toni, Itlay
 

18
CHRONIC KIDNEY DISEASE AND CLINICAL OUTCOME IN PATIENTS WITH ACUTE STROKE
G. Yahalom    R. Schwartz    Y. Schwammenthal    O. Merzeliak    M. Toashi    D. Orion    D. Tanne                     
 

Sheba Academic Center

ISRAEL

Background: Chronic kidney disease (CKD) is increasingly recognized as an independent risk factor for cardiovascular disease and stroke. However, few data exist regarding its relation to long-term outcome after acute stroke. Methods: We examined the association between baseline CKD and one-year functional outcome and mortality in 802 consecutive patients with acute stroke (ischemic or hemorrhagic). Glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease (MDRD) equation and a rate ≤60 ml/min/1.73m2 defined CKD. Patients with kidney failure (estimated GFR<15 ml/min/1.73m2) were excluded. Results: Thirty-six percent of patients (n=291) had CKD. After adjustment for differences in stroke type, NIHSS score, prior disability and baseline characteristics, patients with CKD had after 1-year an adjusted odds ratio (OR) for death of 1.67 (95% CI, 1.04-2.68), for death or disability (Barthel Index<75) 1.82 (1.16-2.85) and for death or long-term nursing care 1.78 (1.12-2.84). Estimating the OR for poor 1-year outcome by GFR categories of 15-44 and 45-60, as compared to those >60 ml/min/1.73m2, reveals a particularly poor outcome among those with markedly low estimated GFR of 15-44: adjusted OR for death of 4.60 (2.39-8.99) and 0.88 (0.49-1.56), for death or disability 3.57 (1.74-7.54) and 1.39 (0.84-2.31) and for death or long-term nursing care 4.06 (2.04-8.22) and 1.18 (0.68-2.02), respectively. Discussion: CKD and in particular estimated GFR <45 ml/min/1.73m2 is a strong predictor of poor outcome in patients with acute stroke. These findings underscore the importance of estimating GFR in routine clinical practice among patients with acute stroke, and considering those with CKD as a high-risk group.

Kind of presentation: Oral 
Risk factors of stroke  
 
Date: Thursday, 31 May 2007   Time: 17:50 - 18:00    Room: Room Boisdale
Chair: G. Ford, United Kingdom and D. Toni, Itlay
 

18
CHRONIC KIDNEY DISEASE AND CLINICAL OUTCOME IN PATIENTS WITH ACUTE STROKE
G. Yahalom    R. Schwartz    Y. Schwammenthal    O. Merzeliak    M. Toashi    D. Orion    D. Tanne                     
 

Sheba Academic Center

ISRAEL

Background: Chronic kidney disease (CKD) is increasingly recognized as an independent risk factor for cardiovascular disease and stroke. However, few data exist regarding its relation to long-term outcome after acute stroke. Methods: We examined the association between baseline CKD and one-year functional outcome and mortality in 802 consecutive patients with acute stroke (ischemic or hemorrhagic). Glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease (MDRD) equation and a rate ≤60 ml/min/1.73m2 defined CKD. Patients with kidney failure (estimated GFR<15 ml/min/1.73m2) were excluded. Results: Thirty-six percent of patients (n=291) had CKD. After adjustment for differences in stroke type, NIHSS score, prior disability and baseline characteristics, patients with CKD had after 1-year an adjusted odds ratio (OR) for death of 1.67 (95% CI, 1.04-2.68), for death or disability (Barthel Index<75) 1.82 (1.16-2.85) and for death or long-term nursing care 1.78 (1.12-2.84). Estimating the OR for poor 1-year outcome by GFR categories of 15-44 and 45-60, as compared to those >60 ml/min/1.73m2, reveals a particularly poor outcome among those with markedly low estimated GFR of 15-44: adjusted OR for death of 4.60 (2.39-8.99) and 0.88 (0.49-1.56), for death or disability 3.57 (1.74-7.54) and 1.39 (0.84-2.31) and for death or long-term nursing care 4.06 (2.04-8.22) and 1.18 (0.68-2.02), respectively. Discussion: CKD and in particular estimated GFR <45 ml/min/1.73m2 is a strong predictor of poor outcome in patients with acute stroke. These findings underscore the importance of estimating GFR in routine clinical practice among patients with acute stroke, and considering those with CKD as a high-risk group.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

06
Acute mortality prediction in stroke patients
M. Delobel    A. Viguier    M.C.Turnin    V. Larrue                                          
 

CHU de Toulouse France

FRANCE

We examined the use of the Simplified Acute Physiology Score II (SAPS II) for the prediction of in-hospital mortality in a large number of stroke patients managed in a neurological intensive care unit. Data on SAPS II were prospectively collected in patients with ischemic stroke, cerebral hemorrhage, transient ischemic attack, or subarachnoid hemorrhage, consecutively admitted to a tertiary neurological intensive care unit. We constructed receiver operating characteristic curves (ROC) to determine the ability of SAPS II to predict in-hospital mortality. 2214 patients were included in this analysis. 321 (14.5 %) patients died in hospital. The area under ROC curve [95 % confidence interval] was 0.83 [0.81-0.86]. With a cut-off point of 30 the positive predictive value of SAPS II was 38.3 %, and the negative predictive value 94.8 %. Findings were similar in an analysis restricted to patients older than 40 years. The findings indicate that SAPS II is a reliable tool to predict acute mortality in patients managed for stroke in a neuroligical intensive care unit.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

06
Acute mortality prediction in stroke patients
M. Delobel    A. Viguier    M.C.Turnin    V. Larrue                                          
 

CHU de Toulouse France

FRANCE

We examined the use of the Simplified Acute Physiology Score II (SAPS II) for the prediction of in-hospital mortality in a large number of stroke patients managed in a neurological intensive care unit. Data on SAPS II were prospectively collected in patients with ischemic stroke, cerebral hemorrhage, transient ischemic attack, or subarachnoid hemorrhage, consecutively admitted to a tertiary neurological intensive care unit. We constructed receiver operating characteristic curves (ROC) to determine the ability of SAPS II to predict in-hospital mortality. 2214 patients were included in this analysis. 321 (14.5 %) patients died in hospital. The area under ROC curve [95 % confidence interval] was 0.83 [0.81-0.86]. With a cut-off point of 30 the positive predictive value of SAPS II was 38.3 %, and the negative predictive value 94.8 %. Findings were similar in an analysis restricted to patients older than 40 years. The findings indicate that SAPS II is a reliable tool to predict acute mortality in patients managed for stroke in a neuroligical intensive care unit.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

06
Acute mortality prediction in stroke patients
M. Delobel    A. Viguier    M.C.Turnin    V. Larrue                                          
 

CHU de Toulouse France

FRANCE

We examined the use of the Simplified Acute Physiology Score II (SAPS II) for the prediction of in-hospital mortality in a large number of stroke patients managed in a neurological intensive care unit. Data on SAPS II were prospectively collected in patients with ischemic stroke, cerebral hemorrhage, transient ischemic attack, or subarachnoid hemorrhage, consecutively admitted to a tertiary neurological intensive care unit. We constructed receiver operating characteristic curves (ROC) to determine the ability of SAPS II to predict in-hospital mortality. 2214 patients were included in this analysis. 321 (14.5 %) patients died in hospital. The area under ROC curve [95 % confidence interval] was 0.83 [0.81-0.86]. With a cut-off point of 30 the positive predictive value of SAPS II was 38.3 %, and the negative predictive value 94.8 %. Findings were similar in an analysis restricted to patients older than 40 years. The findings indicate that SAPS II is a reliable tool to predict acute mortality in patients managed for stroke in a neuroligical intensive care unit.

Kind of presentation: Poster 
   
Poster Session II
Date: Thursday, 31 May 2007   Time: 13:00 - 14:30    Room: Poster Area
Chair:  
 

06
Acute mortality prediction in stroke patients
M. Delobel    A. Viguier    M.C.Turnin    V. Larrue                                          
 

CHU de Toulouse France

FRANCE

We examined the use of the Simplified Acute Physiology Score II (SAPS II) for the prediction of in-hospital mortality in a large number of stroke patients managed in a neurological intensive care unit. Data on SAPS II were prospectively collected in patients with ischemic stroke, cerebral hemorrhage, transient ischemic attack, or subarachnoid hemorrhage, consecutively admitted to a tertiary neurological intensive care unit. We constructed receiver operating characteristic curves (ROC) to determine the ability of SAPS II to predict in-hospital mortality. 2214 patients were included in this analysis. 321 (14.5 %) patients died in hospital. The area under ROC curve [95 % confidence interval] was 0.83 [0.81-0.86]. With a cut-off point of 30 the positive predictive value of SAPS II was 38.3 %, and the negative predictive value 94.8 %. Findings were similar in an analysis restricted to patients older than 40 years. The findings indicate that SAPS II is a reliable tool to predict acute mortality in patients managed for stroke in a neuroligical intensive care unit.

Kind of presentation: Oral 
Acute stroke: complications and early outcome  
 
Date: Thursday, 31 May 2007   Time: 12:00 - 12:10    Room: Room Boisdale
Chair: D. Tanne, Israel and A.Tsiskaridze, Georgia
 

10
HEMOGLOBIN LEVEL AND CLINICAL OUTCOME IN PATIENTS WITH ACUTE STROKE
R. Schwartz    Y. Schwammenthal    O. Merzeliak    T. Philips    D. Orion    D. Tanne                            
 

Sheba Medical Center

ISRAEL

Background: In the setting of an acute stroke, anemia has the potential to worsen brain ischemia, however, data relating hemoglobin levels to long-term clinical outcomes in acute stroke remain limited. Methods: We examined the association between baseline hemoglobin values and one-year mortality and outcome in 863 consecutive patients with acute stroke (ischemic or hemorrhagic). Results: After adjustment for differences in baseline characteristics, patients with anemia at baseline (hemoglobin<13 in males, <12g/dL in women) had after 1-year an odds ratio (OR) for death of 1.85 (95%CI, 1.13-3.03), for death or disability (Barthel Index<75) 1.65 (0.96-2.84) and for death or long-term nursing care 1.67 (0.96-2.88). A reverse J-shaped relationship between hemoglobin levels and clinical outcomes was observed by examining hemoglobin levels in categories of <11 (n=47), 11-12 (n=74), 12-13 (n=127), 13-14 (n=193), 14-15 (n=224), 15-16 (n=125), and >16g/dL (n=73). Using hemoglobin levels 14-15g/dL as the reference, the OR for 1-year mortality adjusted for potential confounders rose as hemoglobin levels fell below 12g/dL, with an OR of 2.00 (0.87-4.58) for 11-12g/dL and 3.99 (1.60-10.01) for <11g/dL, while at the other end of the range, patients with levels >16g/dL had an OR of 1.82 (0.72-4.56). The adjusted OR for death or long-term nursing care after 1-year were 2.47 (1.18-5.22) for hemoglobin level of 12-13g/dL, 2.18 (0.87-5.41) for 11-12g/dL and 4.42 (1.60-12.6) for <11g/dL, while at the other end of the range, patients with levels >16 g/dL had an OR of 1.79 (0.68-4.65). Discussion: Anemia is a strong predictor of poor outcome in patients with acute stroke. Findings suggest a reverse J-shaped association between hemoglobin level and long-term outcome after acute stroke.

Kind of presentation: Oral 
Acute stroke: complications and early outcome  
 
Date: Thursday, 31 May 2007   Time: 12:00 - 12:10    Room: Room Boisdale
Chair: D. Tanne, Israel and A.Tsiskaridze, Georgia
 

10
HEMOGLOBIN LEVEL AND CLINICAL OUTCOME IN PATIENTS WITH ACUTE STROKE
R. Schwartz    Y. Schwammenthal    O. Merzeliak    T. Philips    D. Orion    D. Tanne                            
 

Sheba Medical Center

ISRAEL

Background: In the setting of an acute stroke, anemia has the potential to worsen brain ischemia, however, data relating hemoglobin levels to long-term clinical outcomes in acute stroke remain limited. Methods: We examined the association between baseline hemoglobin values and one-year mortality and outcome in 863 consecutive patients with acute stroke (ischemic or hemorrhagic). Results: After adjustment for differences in baseline characteristics, patients with anemia at baseline (hemoglobin<13 in males, <12g/dL in women) had after 1-year an odds ratio (OR) for death of 1.85 (95%CI, 1.13-3.03), for death or disability (Barthel Index<75) 1.65 (0.96-2.84) and for death or long-term nursing care 1.67 (0.96-2.88). A reverse J-shaped relationship between hemoglobin levels and clinical outcomes was observed by examining hemoglobin levels in categories of <11 (n=47), 11-12 (n=74), 12-13 (n=127), 13-14 (n=193), 14-15 (n=224), 15-16 (n=125), and >16g/dL (n=73). Using hemoglobin levels 14-15g/dL as the reference, the OR for 1-year mortality adjusted for potential confounders rose as hemoglobin levels fell below 12g/dL, with an OR of 2.00 (0.87-4.58) for 11-12g/dL and 3.99 (1.60-10.01) for <11g/dL, while at the other end of the range, patients with levels >16g/dL had an OR of 1.82 (0.72-4.56). The adjusted OR for death or long-term nursing care after 1-year were 2.47 (1.18-5.22) for hemoglobin level of 12-13g/dL, 2.18 (0.87-5.41) for 11-12g/dL and 4.42 (1.60-12.6) for <11g/dL, while at the other end of the range, patients with levels >16 g/dL had an OR of 1.79 (0.68-4.65). Discussion: Anemia is a strong predictor of poor outcome in patients with acute stroke. Findings suggest a reverse J-shaped association between hemoglobin level and long-term outcome after acute stroke.

Kind of presentation: Oral 
Acute stroke: complications and early outcome  
 
Date: Thursday, 31 May 2007   Time: 12:00 - 12:10    Room: Room Boisdale
Chair: D. Tanne, Israel and A.Tsiskaridze, Georgia
 

10
HEMOGLOBIN LEVEL AND CLINICAL OUTCOME IN PATIENTS WITH ACUTE STROKE
R. Schwartz    Y. Schwammenthal    O. Merzeliak    T. Philips    D. Orion    D. Tanne                            
 

Sheba Medical Center

ISRAEL

Background: In the setting of an acute stroke, anemia has the potential to worsen brain ischemia, however, data relating hemoglobin levels to long-term clinical outcomes in acute stroke remain limited. Methods: We examined the association between baseline hemoglobin values and one-year mortality and outcome in 863 consecutive patients with acute stroke (ischemic or hemorrhagic). Results: After adjustment for differences in baseline characteristics, patients with anemia at baseline (hemoglobin<13 in males, <12g/dL in women) had after 1-year an odds ratio (OR) for death of 1.85 (95%CI, 1.13-3.03), for death or disability (Barthel Index<75) 1.65 (0.96-2.84) and for death or long-term nursing care 1.67 (0.96-2.88). A reverse J-shaped relationship between hemoglobin levels and clinical outcomes was observed by examining hemoglobin levels in categories of <11 (n=47), 11-12 (n=74), 12-13 (n=127), 13-14 (n=193), 14-15 (n=224), 15-16 (n=125), and >16g/dL (n=73). Using hemoglobin levels 14-15g/dL as the reference, the OR for 1-year mortality adjusted for potential confounders rose as hemoglobin levels fell below 12g/dL, with an OR of 2.00 (0.87-4.58) for 11-12g/dL and 3.99 (1.60-10.01) for <11g/dL, while at the other end of the range, patients with levels >16g/dL had an OR of 1.82 (0.72-4.56). The adjusted OR for death or long-term nursing care after 1-year were 2.47 (1.18-5.22) for hemoglobin level of 12-13g/dL, 2.18 (0.87-5.41) for 11-12g/dL and 4.42 (1.60-12.6) for <11g/dL, while at the other end of the range, patients with levels >16 g/dL had an OR of 1.79 (0.68-4.65). Discussion: Anemia is a strong predictor of poor outcome in patients with acute stroke. Findings suggest a reverse J-shaped association between hemoglobin level and long-term outcome after acute stroke.

Kind of presentation: Oral 
Acute stroke: complications and early outcome  
 
Date: Thursday, 31 May 2007   Time: 12:00 - 12:10    Room: Room Boisdale
Chair: D. Tanne, Israel and A.Tsiskaridze, Georgia
 

10
HEMOGLOBIN LEVEL AND CLINICAL OUTCOME IN PATIENTS WITH ACUTE STROKE
R. Schwartz    Y. Schwammenthal    O. Merzeliak    T. Philips    D. Orion    D. Tanne                            
 

Sheba Medical Center

ISRAEL

Background: In the setting of an acute stroke, anemia has the potential to worsen brain ischemia, however, data relating hemoglobin levels to long-term clinical outcomes in acute stroke remain limited. Methods: We examined the association between baseline hemoglobin values and one-year mortality and outcome in 863 consecutive patients with acute stroke (ischemic or hemorrhagic). Results: After adjustment for differences in baseline characteristics, patients with anemia at baseline (hemoglobin<13 in males, <12g/dL in women) had after 1-year an odds ratio (OR) for death of 1.85 (95%CI, 1.13-3.03), for death or disability (Barthel Index<75) 1.65 (0.96-2.84) and for death or long-term nursing care 1.67 (0.96-2.88). A reverse J-shaped relationship between hemoglobin levels and clinical outcomes was observed by examining hemoglobin levels in categories of <11 (n=47), 11-12 (n=74), 12-13 (n=127), 13-14 (n=193), 14-15 (n=224), 15-16 (n=125), and >16g/dL (n=73). Using hemoglobin levels 14-15g/dL as the reference, the OR for 1-year mortality adjusted for potential confounders rose as hemoglobin levels fell below 12g/dL, with an OR of 2.00 (0.87-4.58) for 11-12g/dL and 3.99 (1.60-10.01) for <11g/dL, while at the other end of the range, patients with levels >16g/dL had an OR of 1.82 (0.72-4.56). The adjusted OR for death or long-term nursing care after 1-year were 2.47 (1.18-5.22) for hemoglobin level of 12-13g/dL, 2.18 (0.87-5.41) for 11-12g/dL and 4.42 (1.60-12.6) for <11g/dL, while at the other end of the range, patients with levels >16 g/dL had an OR of 1.79 (0.68-4.65). Discussion: Anemia is a strong predictor of poor outcome in patients with acute stroke. Findings suggest a reverse J-shaped association between hemoglobin level and long-term outcome after acute stroke.

Kind of presentation: Oral 
Acute stroke: complications and early outcome  
 
Date: Thursday, 31 May 2007   Time: 12:00 - 12:10    Room: Room Boisdale
Chair: D. Tanne, Israel and A.Tsiskaridze, Georgia
 

10
HEMOGLOBIN LEVEL AND CLINICAL OUTCOME IN PATIENTS WITH ACUTE STROKE
R. Schwartz    Y. Schwammenthal    O. Merzeliak    T. Philips    D. Orion    D. Tanne                            
 

Sheba Medical Center

ISRAEL

Background: In the setting of an acute stroke, anemia has the potential to worsen brain ischemia, however, data relating hemoglobin levels to long-term clinical outcomes in acute stroke remain limited. Methods: We examined the association between baseline hemoglobin values and one-year mortality and outcome in 863 consecutive patients with acute stroke (ischemic or hemorrhagic). Results: After adjustment for differences in baseline characteristics, patients with anemia at baseline (hemoglobin<13 in males, <12g/dL in women) had after 1-year an odds ratio (OR) for death of 1.85 (95%CI, 1.13-3.03), for death or disability (Barthel Index<75) 1.65 (0.96-2.84) and for death or long-term nursing care 1.67 (0.96-2.88). A reverse J-shaped relationship between hemoglobin levels and clinical outcomes was observed by examining hemoglobin levels in categories of <11 (n=47), 11-12 (n=74), 12-13 (n=127), 13-14 (n=193), 14-15 (n=224), 15-16 (n=125), and >16g/dL (n=73). Using hemoglobin levels 14-15g/dL as the reference, the OR for 1-year mortality adjusted for potential confounders rose as hemoglobin levels fell below 12g/dL, with an OR of 2.00 (0.87-4.58) for 11-12g/dL and 3.99 (1.60-10.01) for <11g/dL, while at the other end of the range, patients with levels >16g/dL had an OR of 1.82 (0.72-4.56). The adjusted OR for death or long-term nursing care after 1-year were 2.47 (1.18-5.22) for hemoglobin level of 12-13g/dL, 2.18 (0.87-5.41) for 11-12g/dL and 4.42 (1.60-12.6) for <11g/dL, while at the other end of the range, patients with levels >16 g/dL had an OR of 1.79 (0.68-4.65). Discussion: Anemia is a strong predictor of poor outcome in patients with acute stroke. Findings suggest a reverse J-shaped association between hemoglobin level and long-term outcome after acute stroke.

Kind of presentation: Oral 
Acute stroke: complications and early outcome  
 
Date: Thursday, 31 May 2007   Time: 12:00 - 12:10    Room: Room Boisdale
Chair: D. Tanne, Israel and A.Tsiskaridze, Georgia
 

10
HEMOGLOBIN LEVEL AND CLINICAL OUTCOME IN PATIENTS WITH ACUTE STROKE
R. Schwartz    Y. Schwammenthal    O. Merzeliak    T. Philips    D. Orion    D. Tanne                            
 

Sheba Medical Center

ISRAEL

Background: In the setting of an acute stroke, anemia has the potential to worsen brain ischemia, however, data relating hemoglobin levels to long-term clinical outcomes in acute stroke remain limited. Methods: We examined the association between baseline hemoglobin values and one-year mortality and outcome in 863 consecutive patients with acute stroke (ischemic or hemorrhagic). Results: After adjustment for differences in baseline characteristics, patients with anemia at baseline (hemoglobin<13 in males, <12g/dL in women) had after 1-year an odds ratio (OR) for death of 1.85 (95%CI, 1.13-3.03), for death or disability (Barthel Index<75) 1.65 (0.96-2.84) and for death or long-term nursing care 1.67 (0.96-2.88). A reverse J-shaped relationship between hemoglobin levels and clinical outcomes was observed by examining hemoglobin levels in categories of <11 (n=47), 11-12 (n=74), 12-13 (n=127), 13-14 (n=193), 14-15 (n=224), 15-16 (n=125), and >16g/dL (n=73). Using hemoglobin levels 14-15g/dL as the reference, the OR for 1-year mortality adjusted for potential confounders rose as hemoglobin levels fell below 12g/dL, with an OR of 2.00 (0.87-4.58) for 11-12g/dL and 3.99 (1.60-10.01) for <11g/dL, while at the other end of the range, patients with levels >16g/dL had an OR of 1.82 (0.72-4.56). The adjusted OR for death or long-term nursing care after 1-year were 2.47 (1.18-5.22) for hemoglobin level of 12-13g/dL, 2.18 (0.87-5.41) for 11-12g/dL and 4.42 (1.60-12.6) for <11g/dL, while at the other end of the range, patients with levels >16 g/dL had an OR of 1.79 (0.68-4.65). Discussion: Anemia is a strong predictor of poor outcome in patients with acute stroke. Findings suggest a reverse J-shaped association between hemoglobin level and long-term outcome after acute stroke.

Kind of presentation: Oral 
Vascular Surgery and Neurosurgery/Interventinal Neuroradiology  
 
Date: Friday, 1 June 2007   Time: 9:20 - 9:30    Room: Room Alsh
Chair: A. Halliday, United Kingdom and D. Schneider, Germany
 

06
Carotid artery stenting in ischaemic stroke prevention: initial results from the National Programme of Prevention and Treatment of Cardiovascular Diseases POLKARD
A. Kobayashi    J. Bembenek    A. Dowzenko    M. Skowronska    I. Sarzynska-Dlugosz    A. Czlonkowska                            
POLKARD Collaborators

Institute of Psychiatry and Neurology, Medical University of Warsaw

POLAND

Carotid artery stenosis is responsible for 15–20% of all ischaemic strokes. The only approved treatment for primary and secondary prevention of ischaemic stroke due to carotid stenosis is currently endarterectomy. Percutaneous carotid angioplasty and stenting is a novel method requiring further evaluation of efficacy of treatment compared to endarterectomy. The aim of the National Programme for Prevention and Treatment of Cardiovascular Diseases POLKARD is introduction and monitoring of new treatments and controlling of healthcare quality. Carotid artery stenting procedures were funded by the programme between 2003 and 2005 in 18 selected centres. In the years 2004–2005 a register was conducted in order to monitor safety and efficacy. The procedures were performed only in patients with a 50 to 99% stenosis of carotid artery. 420 procedures were performed and 411 reported. 71.8% of patients in the study group were male and the mean age was 65 years. 42.8% had an ischaemic stroke and 31.9% had a TIA (transient ischaemic attack) preceding the procedure. 28.7% of patients were asymptomatic. Complications in the first 30 days following the procedure included ischaemic stroke in 6.8% of patients, intracerebral haemorrhage in 0.7%, TIA in 3.6% and myocardial infarction in 3.2%. The total risk of severe complications was 10.0%. Carotid angioplasty with stenting in Poland has a relatively high periprocedural complication rate. It is comparable to the Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S). Long-term observation and further studies comparing it with endarterectomy are needed to fully establish its utility in stroke prevention.

Kind of presentation: Oral 
Vascular Surgery and Neurosurgery/Interventinal Neuroradiology  
 
Date: Friday, 1 June 2007   Time: 9:20 - 9:30    Room: Room Alsh
Chair: A. Halliday, United Kingdom and D. Schneider, Germany
 

06
Carotid artery stenting in ischaemic stroke prevention: initial results from the National Programme of Prevention and Treatment of Cardiovascular Diseases POLKARD
A. Kobayashi    J. Bembenek    A. Dowzenko    M. Skowronska    I. Sarzynska-Dlugosz    A. Czlonkowska                            
POLKARD Collaborators

Institute of Psychiatry and Neurology, Medical University of Warsaw

POLAND

Carotid artery stenosis is responsible for 15–20% of all ischaemic strokes. The only approved treatment for primary and secondary prevention of ischaemic stroke due to carotid stenosis is currently endarterectomy. Percutaneous carotid angioplasty and stenting is a novel method requiring further evaluation of efficacy of treatment compared to endarterectomy. The aim of the National Programme for Prevention and Treatment of Cardiovascular Diseases POLKARD is introduction and monitoring of new treatments and controlling of healthcare quality. Carotid artery stenting procedures were funded by the programme between 2003 and 2005 in 18 selected centres. In the years 2004–2005 a register was conducted in order to monitor safety and efficacy. The procedures were performed only in patients with a 50 to 99% stenosis of carotid artery. 420 procedures were performed and 411 reported. 71.8% of patients in the study group were male and the mean age was 65 years. 42.8% had an ischaemic stroke and 31.9% had a TIA (transient ischaemic attack) preceding the procedure. 28.7% of patients were asymptomatic. Complications in the first 30 days following the procedure included ischaemic stroke in 6.8% of patients, intracerebral haemorrhage in 0.7%, TIA in 3.6% and myocardial infarction in 3.2%. The total risk of severe complications was 10.0%. Carotid angioplasty with stenting in Poland has a relatively high periprocedural complication rate. It is comparable to the Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S). Long-term observation and further studies comparing it with endarterectomy are needed to fully establish its utility in stroke prevention.

Kind of presentation: Oral 
Vascular Surgery and Neurosurgery/Interventinal Neuroradiology  
 
Date: Friday, 1 June 2007   Time: 9:20 - 9:30    Room: Room Alsh
Chair: A. Halliday, United Kingdom and D. Schneider, Germany
 

06
Carotid artery stenting in ischaemic stroke prevention: initial results from the National Programme of Prevention and Treatment of Cardiovascular Diseases POLKARD
A. Kobayashi    J. Bembenek    A. Dowzenko    M. Skowronska    I. Sarzynska-Dlugosz    A. Czlonkowska                            
POLKARD Collaborators

Institute of Psychiatry and Neurology, Medical University of Warsaw

POLAND

Carotid artery stenosis is responsible for 15–20% of all ischaemic strokes. The only approved treatment for primary and secondary prevention of ischaemic stroke due to carotid stenosis is currently endarterectomy. Percutaneous carotid angioplasty and stenting is a novel method requiring further evaluation of efficacy of treatment compared to endarterectomy. The aim of the National Programme for Prevention and Treatment of Cardiovascular Diseases POLKARD is introduction and monitoring of new treatments and controlling of healthcare quality. Carotid artery stenting procedures were funded by the programme between 2003 and 2005 in 18 selected centres. In the years 2004–2005 a register was conducted in order to monitor safety and efficacy. The procedures were performed only in patients with a 50 to 99% stenosis of carotid artery. 420 procedures were performed and 411 reported. 71.8% of patients in the study group were male and the mean age was 65 years. 42.8% had an ischaemic stroke and 31.9% had a TIA (transient ischaemic attack) preceding the procedure. 28.7% of patients were asymptomatic. Complications in the first 30 days following the procedure included ischaemic stroke in 6.8% of patients, intracerebral haemorrhage in 0.7%, TIA in 3.6% and myocardial infarction in 3.2%. The total risk of severe complications was 10.0%. Carotid angioplasty with stenting in Poland has a relatively high periprocedural complication rate. It is comparable to the Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S). Long-term observation and further studies comparing it with endarterectomy are needed to fully establish its utility in stroke prevention.

Kind of presentation: Oral 
Vascular Surgery and Neurosurgery/Interventinal Neuroradiology  
 
Date: Friday, 1 June 2007   Time: 9:20 - 9:30    Room: Room Alsh
Chair: A. Halliday, United Kingdom and D. Schneider, Germany
 

06
Carotid artery stenting in ischaemic stroke prevention: initial results from the National Programme of Prevention and Treatment of Cardiovascular Diseases POLKARD
A. Kobayashi    J. Bembenek    A. Dowzenko    M. Skowronska    I. Sarzynska-Dlugosz    A. Czlonkowska                            
POLKARD Collaborators

Institute of Psychiatry and Neurology, Medical University of Warsaw

POLAND

Carotid artery stenosis is responsible for 15–20% of all ischaemic strokes. The only approved treatment for primary and secondary prevention of ischaemic stroke due to carotid stenosis is currently endarterectomy. Percutaneous carotid angioplasty and stenting is a novel method requiring further evaluation of efficacy of treatment compared to endarterectomy. The aim of the National Programme for Prevention and Treatment of Cardiovascular Diseases POLKARD is introduction and monitoring of new treatments and controlling of healthcare quality. Carotid artery stenting procedures were funded by the programme between 2003 and 2005 in 18 selected centres. In the years 2004–2005 a register was conducted in order to monitor safety and efficacy. The procedures were performed only in patients with a 50 to 99% stenosis of carotid artery. 420 procedures were performed and 411 reported. 71.8% of patients in the study group were male and the mean age was 65 years. 42.8% had an ischaemic stroke and 31.9% had a TIA (transient ischaemic attack) preceding the procedure. 28.7% of patients were asymptomatic. Complications in the first 30 days following the procedure included ischaemic stroke in 6.8% of patients, intracerebral haemorrhage in 0.7%, TIA in 3.6% and myocardial infarction in 3.2%. The total risk of severe complications was 10.0%. Carotid angioplasty with stenting in Poland has a relatively high periprocedural complication rate. It is comparable to the Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S). Long-term observation and further studies comparing it with endarterectomy are needed to fully establish its utility in stroke prevention.

Kind of presentation: Oral 
Vascular Surgery and Neurosurgery/Interventinal Neuroradiology  
 
Date: Friday, 1 June 2007   Time: 9:20 - 9:30    Room: Room Alsh
Chair: A. Halliday, United Kingdom and D. Schneider, Germany
 

06
Carotid artery stenting in ischaemic stroke prevention: initial results from the National Programme of Prevention and Treatment of Cardiovascular Diseases POLKARD
A. Kobayashi    J. Bembenek    A. Dowzenko    M. Skowronska    I. Sarzynska-Dlugosz    A. Czlonkowska                            
POLKARD Collaborators

Institute of Psychiatry and Neurology, Medical University of Warsaw

POLAND

Carotid artery stenosis is responsible for 15–20% of all ischaemic strokes. The only approved treatment for primary and secondary prevention of ischaemic stroke due to carotid stenosis is currently endarterectomy. Percutaneous carotid angioplasty and stenting is a novel method requiring further evaluation of efficacy of treatment compared to endarterectomy. The aim of the National Programme for Prevention and Treatment of Cardiovascular Diseases POLKARD is introduction and monitoring of new treatments and controlling of healthcare quality. Carotid artery stenting procedures were funded by the programme between 2003 and 2005 in 18 selected centres. In the years 2004–2005 a register was conducted in order to monitor safety and efficacy. The procedures were performed only in patients with a 50 to 99% stenosis of carotid artery. 420 procedures were performed and 411 reported. 71.8% of patients in the study group were male and the mean age was 65 years. 42.8% had an ischaemic stroke and 31.9% had a TIA (transient ischaemic attack) preceding the procedure. 28.7% of patients were asymptomatic. Complications in the first 30 days following the procedure included ischaemic stroke in 6.8% of patients, intracerebral haemorrhage in 0.7%, TIA in 3.6% and myocardial infarction in 3.2%. The total risk of severe complications was 10.0%. Carotid angioplasty with stenting in Poland has a relatively high periprocedural complication rate. It is comparable to the Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S). Long-term observation and further studies comparing it with endarterectomy are needed to fully establish its utility in stroke prevention.

Kind of presentation: Oral 
Vascular Surgery and Neurosurgery/Interventinal Neuroradiology  
 
Date: Friday, 1 June 2007   Time: 9:20 - 9:30    Room: Room Alsh
Chair: A. Halliday, United Kingdom and D. Schneider, Germany
 

06
Carotid artery stenting in ischaemic stroke prevention: initial results from the National Programme of Prevention and Treatment of Cardiovascular Diseases POLKARD
A. Kobayashi    J. Bembenek    A. Dowzenko    M. Skowronska    I. Sarzynska-Dlugosz    A. Czlonkowska                            
POLKARD Collaborators

Institute of Psychiatry and Neurology, Medical University of Warsaw