$432 Thursday, November 10, 2005 Poster Abstracts

Conclusion: The examination of fraction C.PK represents new non- invasive laboratory method of choice in detection development cardiac complications in patients with IS.

1302 Tile Intraeranial Hemorrhage: role of risk factors

Raicevic, R l, Mandic-Radic, S a, Markovic, L ~, Obradovic, D a, Dincic, E *, Tavcioski, D 4. 1Department of Neurology, Military Medical Academy, Belgrade, Serbia and Montenegro; 2Department of Biochem- istry, Military Medical Academy, Belgrade, Serbia arid Montenegro; 3Department of Radiology, Military Medical Academy, Belgrade, Serbia arid Montenegro; 4Department of Cardiology, Military Medical Academy, Belgrade, Serbia and Montenegro

Introduction: Several clinical entity are included in intracranial hemorrhage syndrome. The aim of tiffs study was to confirmed and to detetaxfined role, significance and place of risk factors and associated disorders due to results and prognosis of intracranial hemorrhage. Methods: We observed 150 patients with ICH that have been treated conservatively in our hospital. To all patients were determined grade of neurological and functional deficit as well as a level of consciousness. Canadian neurologic scale, Bartel functional ability index, and Glasgow soma score were used for tiffs purpose. As a conferment of hypertension existence an ophtalmological exanffnation were perfor- med, and for conferment of glycoregulation glycemic day profile were done.

Consumed amount of alcohol per day we multiplicand with years of abuse to gain a grade of alcohol dependence. Confirmed of SAH and ICH were done by using CI" inside first 48 hours since the first clinical manifestations have shown out. Results: Hypertension is the most readily recognized factors in the genesis oh ICH (90 patients-60%). On the other hand alcohol abuse (15 patients/10%) represent unfavorable predictive indicates of un expectable results of this syndrome. Association of the several risk factors represent nmltiple and non-linear increasing liability to the most difficult results of ICH. Conclusion: On the basis of such observations it was clearly determined pathogenic connection between risk factors and ICH on one side and knowledge of the key pathopsychology process that are taking place in this syndrome on the other side can implicate new facts for the multidisciplinary preventive therapeutic program of tiffs seriously clirfical entity.

1303 The value of simultaneous Holter-Electrocardiography (ECG) and Holler Electrocueephalography in patients with Epilepsy

Raieevic, R ~, Tavciovski, D 2, Perisic, O ~, Rajsic, N ~. ~Department of Neurology', Military Medical Academy, Belgrade, Serbia arid iVlontenegro; 2Department of Cardiology, ivlilitary Medical Academy, Belgrade, Serbia and iVlontenegro

Background: Electrocardiographic (ECG) changes are well known accompalffng malfffestations of numerous neurological disease (ischemic brain disease, intracralffal haemorrhage, expansive processes and epilepsy). In patients with epilepsy ECG changes can be responsible for sudden death. The aim of the study was to exclude or prove influence of epileptogenic discharge on ECG abnormalities by simultaneous continous Holter ECG (HECG) and Holter EEG (HEEG). Methods and Results: We included 24 patients in our study with clmicaly observed epileptic, seizures and previous epileptic, anamnesis. All patients underwent simultaneous 24h Holter ECG/Holter EEG. In 9 patients with speciphic grapho elements in HEEG without changes in HECG. In 4 patients HEEG and HECG findings were normal. In 8 patients in HECG we observed episodes of heart rhythm disorders wlffch were time related with specific epileptogerfic discharges in HEEG. In 3 patient we observed simultaneous speciplffc grapho

elements in HEEG and VT (ventricular tachiarrhytmJas) episodes in HECG. Conclusions: Observed findings indicate possible origin of sudden death in patients with epilepsy wlffch are to consecvence of cardiac complications of epileptogelffC discharge and results of our study support the idea of neural structural involvement in pathogenesis of the cardiac complications and their electrophysiologic correlates.

1304 Cerebral Sinus TIrrombosis: a study of 19 cases I~om the United Arab Fznirates

Rajan, M 1. 2Al Jazeira & Central Hospitals, Abu Dhabi, United Arab Ernir ates

Background: Cerebral sinus thrombosis, described by Rabies in 1825, has lffgh mortality and morbidity (10-15%), but with underestimated incidence. The advent of MRI and M R venography has eased diagnosis, natural history and treatment. Method: This prospective follow-up study of 19 cases was conducted in a tertiary care referral hospital in Abu Dhabi over 8 years. The clinical features, predisposing factors and investigations including those for vasculitis, thrombophilia and homocystinuria were docmnented. CT and MRI brain were conducted. Follow-up was for one to 48 months. Results: For the 15 females and 4 males, the ages ranged from 19 to 42 years. Headache was present in all. Nine had alterations in sensorium, seizures and weakness. Eight showed pappilloedemia. Others had varying combinations of vomiting, diplopia, and focal defecit. One patient had bilateral weakness of the limbs. The symptoms varied from 3 to 17 days. Eight patients were on oral contraceptives. Two had SLE, two were in post partmn period. Of the two with hyperlipidaemia, one had elevated lipoprotein a. One had severe bilateral otitis media and one had antithrombin III deficiency. Causes were undetermined in three. The CT Brain was diagnostic in seven and the rest by MRI and M R venography. All received IV heparin followed by warfarin. One patient died. The rest recovered fully. Conclusion: One should consider the possibility of cerebral sinus thrombosis in a patient with headache in association with any neurological abnormality. MRI with M R venogram is the choice of investigation and the prognosis is excellent if treated promptly.

1305 Transcranial monitoring in Acute Slroke expericuee t~om Chennai, India

Rajappa, S ~, Arjundas, D 2, Sivakumar, S 1. 1Cerebrovaseular and Vaseulitis Research Foundation, Chennai, Tarnilnadu, India; 2'The Stroke Unit' - I/~jaya Heath Centre, Chennai, TamilnaKu, India

Aim: To exanffne the role of transcranial Doppler ultrasound (TCD), in Acute Stroke. Background: Transcranial Doppler (TCD) has been documented to be useful in acute ischemic stroke, monitoring vasospasm after subar- achnoid hemorrhage, detecting intracranial stenosis and has a role in carotid endarterectomy (CEA) and angioplasty. TCD also can monitor spontaneous or intravenous tissue plasnffnogen activator ( iv TPA) induced arterial recanalization. Methods: The records of 1000 consecutive patients undergoing serial TCD monitoring following acute ischemic strokes and subarachnoid hemorrhage (SAH) were reviewed. Dates and results of TCDs and cerebral angiograms when performed and the development of new neurological deficits were recorded. TCD was performed immediately after the stroke and serially whenever indicated. 42 patients underwent Sonothrmbolysis (Continuous 2 MZ Ultrasound was administered along with iv TPA in the dose of 0.9 mg./Kg, body weight). The results of TCD examination were correlated with M R Angiograms and invasive 4 vessel Digital Substraction Angiograms. Results: The Mean age was 58.4 years. The Men : Women ratio was 6.5: 3.5. Right middle cerebral stenosis/occlusions were seen in 16"/o,

Poster Abstracts Thursday, November 10, 2005 $433

left middle cerebral narrowing in 22% and Basilar stenosis in 4%. Poor temporal windows were seen in 17%. Mild or moderate TCD-defined vasospasm developed in 30% and 20% developed severe TCD-defined vasospasm after 7-8 days. TCD abnormalities preceding tire focal neurological deficits by 3 days in 30%. Conclusions: A high incidence of intracranial stenosis were present. Sonothrombolysis enhances the benefits of iv TPA. TCD may be helpful in selecting patients for intra-arterial thrombolysis. Since TCD- defined vasospasm preceded the neurological deficit in patients with SAH, early intervention might reduce the incidence of vasospasm- related stroke.

1306 Circulating Levels of Nitric oxide in Stroke

Nandhagopal, R ~, Krishnanroorthy, SG a, Venganmm B :, Shyam Singh 1, Latheef SAA a, Subramanyanr G 1. 1Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Background: Physiologically, nitric oxide is a key signaling molecule in cerebral vasoregulation. Its role in the evolution of stroke is multifaceted. The purpose of this study is to evaluate the serum levels of nitric oxide in different subtypes of acute stroke. Method: Forty consecutive patients diagnosed as having ischemic or hemorrhagic stroke were evaluated with NIH stroke scale and Oxfordshire Community Stroke Project classification. Nitric oxide was measured in the serum, collected within twenty four hours of admission, as total nitrites. Result: Twenty eight patients had ischemic stroke either involving tire anterior or posterior circulation and eight had intracerebral hemor- rhage. Cerebral sino-venous thrombosis was diagnosed in four patients. Serum nitric oxide was found to be decreased (iJ < 0.026) when compared with the healthy controls (140.9 ± 3.9 vs. 59.9 ± 7.3/~mol/L). Conclusion: Circulating levels of nitric oxide fall in the different types of acute stroke syndromes. It could serve as a potential marker in tire therapeutic stroke trials.

1307 Surgical versus conservative trealrnent in the management of spontaneous Intraeerebral Hemorrhage in adults: a retrospective study

Ranlos, R a, Matila, R a, Diaz, A 1. 1Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila, Philippines

Background: To evaluate patients who suffered from supratentorial spontaneous intracerebral hemorrhage (SICH), treated either surgi- cally or Conservatively, and to detemfine outcome in terms of tire Glasgow Coma Scale (GCS) score and blood pressure on admission, age, sex, volume of the hematoma, and the presence of intraventricular extension (lIVE) and hydrocephalus on cralfial CI" scan. Methods: We evaluated the hospital case records and cranial CT scans of adult patients diagnosed with SICH admitted in a tertiary hospital between January 2003 and August 2004. Results: Among 133 adult patients, twenty (15%) were surgically treated Mille 113 (85"/0) were managed conservatively. Age, volume of hematoma and area of henlatoma were found to be significantly different between the surgically and medically-treated groups with p-values less than the level of significance of 0.05 (0.008, 0.009 and 0.014, respectively). In tire medical group, the variables that were found to be significantly different between discharged and expired subjects were the GCS, volunre of hematoma, area of hematoma, and the presence of IVE and hydrocephalus with computed p-values less than the level of significance (0.000, 0.000, 0.001 and 0.000, res- pectively). In the surgical group, no variables were found to be significantly different between discharged and expired subjects. Conclusion: Neither medical nor surgical managenlent is superior over the other in the treatnrent of SICH. The GCS score, volume and area of henratoma, and the presence of IVE and hydrocephalus are

predictors of outcome for patients treated conservatively. Surgery may not be helpful in improving the outcome of these patients.

1308 A single centre experience of Endovascular Carotid intervention since 1993: long-term event free survival rates

Randall, M ~, McKevitt, F ~, Cleveland, T ~, Gaines, P~, Venables, G ~. 1Royal Hallarnshire Hospital, Sheffield, England; 2Northern General Hospital, Sheffi'eld, England

Background: Endovascular intervention for symptomatic carotid stenosis (NASCET/ECST criteria) has been performed at tire Sheffield Vascular Institute for 12 years. Two radiologists TJC and PAG have over 590 cases experience between them. This study reviews the long- term follow up of these cases. Method: A nrultidisciplinary teanl of neurologists, surgeons, and radiologists selected patients for carotid stenting. Procedures were performed using recommended stentnig techniques and medications at the time ozf the procedure. Data was prospectively collected for the database. Some of the procedures were performed as part of ongoing randomised trials. Yearly outcomes for index events and stent res- tenosis were recorded. All index events were classified by a neurologist. Results: 420 carotid stenting procedures have been perforated in symptomatic individuals. Follow data of up to 5 years was available for review. Mean follow up 2.54 yrs median 2 yrs. Mean event free survival for stroke or death of all causes was 3.98 yrs (CI 3.8 - 4.17) and 4.1 yrs (CI 3.92 - 4.27) if only ipsilateral stroke is considered (Kaplan Meier). The use of a Statin (Log Rank 6.61 p - 0.01) at the time of stenting appears to have a beneficial effect on long term survival. Conehision: Our registry provides strong data to support the continued use of carotid stenting in symptomatic patients as part o f randomized trials. Our non randomized patient group has similar long term outcomes when compared to tile data from previous carotid endar- terectonly and stenting trials. The database has also highlighted the importance of medical therapy in addition to the stenting procedure.

1309 COillpa~son of TranseXanial Doppler and Magnetic Resonance Angiography in tile assessment of IntraCranial Vasculature in Acute Isdlemie Stroke

Raihakrishnan, R z, Sharma, V 1, Sect, R 1 , Chart, B 1, Ong, B 1 . 2Divisian of Neurology, National University Hospital, Singapore

Background: Transcratfial Doppler (TCD) and magnetic resonance angiography (MRA) are widely used non-invasive methods of assessing intracratfial vasculature in stroke. We aimed to investigate tile Correlation between TCD and M R A in assessing intracranial stenosis in acute stroke patients in this study. Methods: Patients with acute ischaernic stroke presented to the Neurology Division, National University Hospital, Singapore, from November 2004 to March 2005 who underwent both TCD and MRA were included. Previously published peak velocity criteria were used for diagnosis in TCD, and visual inspection of M R A was performed. Stenoses _>50% or occlusion of a major intracranial artery were considered significant. The results of both studies on each major intracranial artery were cross-tabulated and Ctfi square test was used for statistical analysis. Results: 60 patients of equal gender proportions were included. 26 (43%) had suboptimal or absent temporal windows on TCD, 18 (69%) were females and 17 (58%) were older than 60 years. There was significant correlation between TCD and MRA when examining internal carotid artery siphons (p < 0.001), M1 segments of middle cerebral arteries (right p - 0.03, left p < 0.001), A1 segments of anterior cerebral arteries (p - 0.03) and intracralfial vertebrobasilar arteries (p < 0.001).