$396 Thursday, November 10, 2005 Poster Abstracts

1159 Risk factors of large versus small Artery Disease in Cerebrovascular Is ctleanic Stroke

E1-Tamawy, M 1, Hashem, S 1 , Sanffr, H 1, Kamal, y1.1Cair o University, Cairo, Egypt

Background: Despite recurrent progress on the deleterious effects of risk factors on cerebral vessels in stroke patients, yet it is still uncertain whether specific risk factors could differently affect various levels of cerebral arteries. Tiffs study aimed at identifying if there are certain risk factors leading to large artery disease (LAD) versus small artery disease (SAD) in ischemic stroke patients. Methods: Forty Egyptian patients (34 males and 6 females) with ischemic strokes underwent the following: History taking, clinical exanffnation, neuroinmging and laboratory investigations to detect specifically the risk factor for every patient, in a trial to correlate between these factors and the level of vascular insult. Results: Out of 40 patients included in the study, 45% (ll - 18) had LAD and 55% had SAD (n -- 22). Eighty one percent of patients with SAD had a highly significant lack of regular daily-based physical exercise (p < 0.001) and 55% of SAD patients had an elevation of hematocrite (p - 0.04). Moreover, elevated serum triglycerides was significant in 61% of SAD patients specifically affecting the basal ganglia (p -- 0.02). On the other view, 39% of LAD patients suffered from migraine with aura (p - 0.04), 38% of LAD patients had urinary tract infection (p - 0.04) and 56% of LAD patients had cardiac diseases (p -- 0.005). Conclusions: Lack of regular daily-based physical exercise and elevated hematocrite value were identified as risk factors for SAD. Elevated sermn triglycerides was more detected in patients with SAD specific- ally affecting the basal ganglia. On the other hand migraine with aura, urinary tract infection and cardiac diseases were the risk factors commonly associated with LAD. The predilection for affection of cerebral arteries varies at different levels, depending upon the presence of certain risk factors.

1160 As~mptomatic Intracranial Atheroselerosis independently predicts Total and Vascular Disease mortality in Type 2 Diabetic patients in Chinese

FAN, YH 1, Thomas, N 1, Tomlinson, B a, Wong, KS 1. eDivision of Neurology, Department of Medicine & Therapeutics, Chinese University of Hong Kong SAR

Background: In Chinese populations, intracranial atherosclerosis espedally middle cerebral artery (MCA) stenosis is the most commonly identified intracranial vascular lesion but the prognostic value among asymptomatic patients remain uncertain. Method: We screened 1863 type II diabetics without lffstory of stroke and found 380 of them (151.8"/0 had bilateral involvemen 0 had MCA stenosis. Cox Proportional Hazards regression was used to detenrfne if the presence of aymptomatic MCA stenosis was an predictor for all-cause or vascular disease mortality, including after adjustment for conventional vascular risk factors. Anthropometric and fasting biochemical parameters were compared between Type 2 diabetic patients with MCA stenosis and 1492 without evidence of stenosis. Results: The subjects were followed-up for 11,547 patient years, with a mean duration of 6.2 years. A total of 152 deaths were identified (35.5% of vascular disease origin). After adjustment for age, gender, and diabetes duration, the Hazard ratios for all-cause mortality for 1 and 2 vessel disease were 1.54 (95% CI 0.92 2.56), p - 0.102, and 2.43 (95% CI 1.56-3.77), p < 0.001 and p < 0.001 for trend to increasing all-cause mortality with increasing severity of cerebrovas- cular involvement, and 1.66 (195% CI 0.68-4.08), p -- 0.26, and 3.56 (95% CI 1.81-7.03), p < 0.001 and p < 0.01 for trend, for vascular disease mortality. There was no attenuation of risk following further adjustments for anthropometric, and fasting biochemical parameters, or existing disease and treatment history.

Conclusion: The presence of asymptomatic MCA stenoses was an independent predictor of all-cause and vascular disease mortality in diabetics, and suggests more aggressive treatment of risk factors merits further evaluation.

1161 Southern Egypt Stroke study

Fawi, GH ~, A. El Rahman, A.H 2, Abdul Nasser, A 3, A. El Rout', 0 4, Abd E1-Baset, E 5, A- EI-Sayed 6. 1Department of Neurology, Sohag Facility of Medicine, South Valley University, Egypt," 2Department of Neurology, Zagazig Facility of Medicine, Egypt," 3Department of Neurology, Ain Shams Facility of Medicine, Egypt," 4Department of Neurology, Facility of Medicine, Egypt.." SDepartrnent of Public Health, Sohag Facility of Medicine, South Valley University, Eygpt; 6Department of Internal Medicine, Sohag Facility" of Medicine, South I/alley University, Eygpt

Background: Stroke now ranks as the second cause of death and the most common life threatening neurological disease. The best approach to reducing the burden of stroke remains prevention. Objectives: To determine: The distribution of stroke in Upper Egypt by type, risk factors, and to compare our results with other national & international studies. Methods: Prospective hospital-based study carried out in Neurology department of Sohag University hospital, involved 467 stroke patients. Patients were subjected to history taking, examination and investiga- tion. Demographic data, stroke-subtypes, stroke-prone individual, risk factors, and stroke outcome, were analyzed and compared with other multi-center, national and international studies. Results: Hemorrhagic strokes reported in 37.5%. 56.3% were above 60 years and 8.6% were below 40 years. 62% of stroke occurred in autumn-winter. Hemorrhagic. stroke was higher in spring-summer. (153 %). Stroke reported more in rural areas 57 %. Non educated stroke patients were the commonest 67.5%, hypertension reported in 42% of patients, more in males 59%, more in >40 years (97.4%), smoking in 37.7%, ischemic heart diseases in 32.8%, dyslipidaemia in 29.5%, history of TIA in 23.1%, Diabetes in 21.6% of, Past history of similar stroke in 10.5%, obesity in 10.1%, Positive family history of stroke in 9.6%, atrial fibrillation in 6%, 60%. RHD in 5.6% of patients. Alcohol abuse in only 1.3%. Conclusion: In Upper Egypt, we reported higher incidences of Hemorrhagic stroke and RHD wlffle lower incidences of, hyperten- sion, D.M., hyperlipidemia, previous attacks and alcohol consumption were reported compared with other studies.

1162 The Vestibular control of balance after Slroke

1 2 Fedotov, V . KJlar]cov Medical Universi(v, Ukraine

To examine vestibular control of balance in those who recovered the ability to stand after middle cerebral artery (MCA) stroke. 24 patients with MCA stroke were compared with 10 age matched controls. Two additional patients were studied with isolated corticospinal tract lesions, one each at the level of the pons and medulla. Vestibular evoked postural responses were obtained using galvanic vestibular stimulation (GVS) while patients stood with their eyes closed and head facing forwards, equally loading both legs. The GVS response was characterised by measuring the amplitude of the stimulus evoked lateral forces acting through each leg and the lateral displacement of the axial skeleton. Lateral displacement and net lateral force following GVS were significantly larger after stroke. Unlike controls, the lateral forces in the stroke group were asymmetrical, being enhanced on the side of the non-paretic limb and small on the side of the paretic limb. The degree of GVS evoked asymmetry correlated with corticospinal damage assessed using transcranial magnetic stimulation. A similar asy~mnetrical response was seen in the patient with the pontine lesion but not the patient with the medullary lesion. MCA stroke may disrupt