$416 Thursday, November 10, 2005 Poster Abstracts

Objective: To determine whether serum triglyceride level in acute stage of stroke was independent factor associated with the outcome at 3 months after stroke. Method: 649 consecutive patients with acute stroke (ischemic and hemorrhagic) were prospectively registered within 24 hours of the onset o f stroke. Fasting samples of serum lipid estimation were drawl1 in the next morning of admission. The outcome measures included death, dependence and recurrence at the end of 3-month follow-up. Dependency at 3 months was assessed by Barthel Index. Logistic regression was used to estimate the correlation between serum lipid and outcomes. Results: The serum triglyceride level on admission ranged 0.65- 4.99 mmol/L, which of 27% of patients elevated (_>2.0 mmol/L). The serum cholesterol concentration on admission ranged 1.51-8.00 mmol/L, which of 12% of cases increased (>6.0 nmml/L). The serunl cholesterol and triglyceride level of patients with ischemic stroke were significantly higher on admission than that of patients with hemorrhagic stroke (14.90 ± 1.15 vs 4.30 ± 1.16 mmol/L, 1.82 ± 0.94 vs 1.37 ± 0.72 mmol/L, respectively). The independent predictor of death and dependence at 3 months was triglyceride concentration (RR: 0.53, 95°,5 CI: 0.32 to 0.88; RR: 0.42, 95%CI: 0.35 to 0.76, respectively), not cholesterol concentration. The patients with kigher sermn triglyceride level on admission had better outcome at 3 months. Conclusion: The type of stroke and the severity are independently related to the level of serum triglyceride and cholesterol on admission. Cholesterol concentration is not a independent predictor of death and death/disability at 3 months, while triglyceride concentration is.

1239 Relationship between Plasma Matrix Metalloproteinase-9 Levd and Hemorrhagic Translbnnalion in Acute Isdlelnic Stroke

Tan, S 1, Idu, NI l, Zhang, S 1, Zhou, y 2 Mao, y 3 Yang, Q1, Zhang, D 1, LI, W ~, Cao, X ~, Fang, y 1 Wu, B 1. 2Department of Neurology, West China Hospital, Siehuan University, Chengdu, China; 2Deparment. of Emergency, West China Hospital, Siehuan University, Chengdu, China; 3Department of Radiology, West China Hospital, Siehuan University, Cheng~u, China

Background: It was reported in western countries that high plasma MMP-9 concentration was an independent predictor of hemordmgic transformation (HT) in patients with acute ischemic stroke. But similar studies aren't still found in yellow people, so the study is to investigate the relationship between plasma MMP-9 concentrations and HT in Clfinese people. Methods: 1. Consecutive patients with ischemic stroke within first 24h of sy,nptom onset were prospectively registered in neurological wards of the West China Hospital. Healthy subjects without neurological disorders and inflammatory diseases etc. were also studied. Plasma MMP-9 levels were determined by ELISA. All clinical characteristics related to HT were collected. 2. Utfivariate and multivariate analysis was utilized to determine independent prediction of MMP-9 for spontaneous HT. Results: 80 patients and 40 healthy subjects were included. HT was observed in 17.57,'; (14/80) of patients. Median (quartiles) plasma MMP-9 concentrations were 249.8 [193.1,468.2], 73.9 [40.1, 169.6], 63.3 [38.0, 84.9] ng/ml in HT, non-HT, control group, respectively. Median MMP-9 value was significantly higher in HT group than in non-HT group (P < 0.001) and in healthy control group (P < 0.001). MMP-9 _<181.7ng/ml had a negative predictive value of HT of 96.3%. Multivariate analysis showed that MMP-9 > 181.7ng/ml independently associated with HT (OR 23.6; 95% CI 4-136; P < 0.001). Conclusions: High plasma MMP-9 concentration in the acute phase of cerebral infarcts independently associated with spontaneous HT; Plasma MMP-9 <181.7ng/ml has potential value as an indicator of low risk of HT; Further studies in larger sample are needed.

1240 Feasibility of Thrombolytic therapy at tertiary care centers in Sri Lanka

IAyanage PLGC 1, Patlfirana K D 1, Senavitratne M 2, Abeywardene L 3, Basnayake LS 1. 1Facuhy of Medicine, University of Ruhuna Sri Lanka; 2Base Hospital Moneragala Sri Lanka; 3Base Hospital D@atahalawa Sri Lanka

Background: In Nor th Colombo and in India 51% and 29 % of patients with stroke are admitted within 3 hours respectively. We studied the feasibility of thrombolytic therapy in peripheral tertiary hospitals in Sri Lanka. Methods: We recruited patients from Teaching Hospital Galle (THG), Base Hospitals Moneragala (BHM) and Diyatalawa (BHD) with acute stroke. Following data were collected; Bio data, time of onset, distance to the nearest hospital, and the tertiary care centre, time for adnfission and imaging and awareness on therapy. Results: Out of 76 stroke patients in 3 hospitals, with 40 (52.6%) males and 36(147.4% ) females. Thirty-three (143.4%) are from THG, 23 (130.3%) from BHM and 20 (26.3%) from BHD. The age range was 33 to 89 years. The number of patients below 60 years was 19 (25%). Mean duration to admit at 3 hospitals were 27.07hrs, 42.40 hrs and 30.27hrs respectively for THG, BHM and BHD. Eight (11.3°,5) were admitted witkin lhr, 13 (18.3%) witkin 2 hrs and only 18 (25.3%) in 3 hours. Six of them had contra indications Mean distances from home to THG BHM and BHD were 41.7 kin, 24.94 km 16.8 km respectively. Mean duration to get a CT was 45.9 hrs. Only two had CT scans within 2 hours. Delays were due to poor transport facilities, going through a local hospital and poor knowledge on treatment. Conclusion: Only 18°,5 of stroke sufferers were admitted to a tertiary care centre within 2 hours. Transport, imaging facilities and aware- ness about thrombolytic therapy should be improved if widespread thrombolytic therapy is to be started in Sri Lanka.

1241 Unusual p~esentation of Cerebellar Haeino~rhage

N.Lobjatfitlze 1, Janelidze 1. 2Tbilisi State Medical Academy, Georgia

Background: Physiological and functional neuroimaging studies suggest that the cerebellum participate in organization of higher order function, but debate concerning the clinical evidence for non- motor functions of cerebellmn has been hampered by the lack of sufficient clinical data. Case report: A 69-year old right-handed teacher-female developed rapid onset of acute confusional state with impaired attention/ concentration, disorientation, global disturbance of cognition. Neuro- logical exanfination did not reveal cranial nerves dysfunction, motor deficit, dysarthria, in-coordination of arms or legs, sensory distur- bances or meningeal signs. CT scan demonstrated haemordmge in the right cerebellar hemisphere, without hydrocephalus. During two weeks after stroke she had disturbances of psychomotor behaviour with hyperactivity, extreme agitation, irritability, vivid hallucinations. Disturbances of perception include derealization, depersonalization. Her speech was fluent, granmmtically correct but with altered thinking ability. Tiffs agitated delirimn was accompanied by impairment of both short and long term memory, decrease of digit span. Subsequently periods of alert consciousness appeared, with gradual lengthening. 5 month post-stroke parient's cognition and personality returned to her "old self". Conclusion: Presented cerebellar haemorrhage with long lasting reversible agitated delirium, without motor signs of cerebellar dysfunction, significantly differs from clinical entity "cerebellar cognitive affective syndrome". The latter include impairment of executive function, personality changes and definite language deficit. Agitated delirious state caused by stroke is usually due to unit/bilateral posterior cerebral artery infarcts, involving occipital/temporal lobe cortex, it can be supposed that cerebellmn is an essential node in the distributed neural circuitry subserving cogtfitive/affective disorders.