1. health and fitness
2. disease

Posters, Monday 10 September
Cerebrovascular diseases 2
P2074
P2073
Acute ischemic stroke caused by
infliximab infusion
Posterior reversible encephalopathy
syndrome in pregnancy and its MRI
characteristics
I.A. Khasanov, E.I. Bogdanov
Neurology and Rehabilitation Department, Kazan State
Medical University, Kazan, Russia
Introduction: Posterior reversible encephalopathy
syndrome (PRES) is often qualified as bilateral infarction in
posterior cerebral artery (PCA) circulation by mistake.
Methods: We observed 4 cases of PRES in patients with
preeclampsia and eclampsia during 2010-2011.
Results: All patients had impairment of consciousness (up
to coma), motor deficits and moderate meningeal signs.
There were seizures (tonico-clonic and myoclonic ones) in
the onset of the disease in 3 cases. The symptoms developed
against the background of raised blood pressure (BP). Initial
MR imaging demonstrated areas of vasogenic oedema of
occipital and parietal lobes in each case, in 2 cases frontal
lobes were involved and 1 patient had lesions of cerebral
peduncles, pons and basal ganglia. There were associated
acute ischemic lesions in 1 case and hemorrhagic imbibition
in the other one. If treatment was proper neuroimaging and
clinical signs regressed in 1-3 weeks. Authentic
differentiation of vasogenic oedema, represented in PRES
from cytotoxic oedema, reflecting PCA stroke is based on
MR DWI and ADC map images. Acutely infracted areas are
marked with hyperintensity on DWI and hypointensity on
ADC maps, but regions of vasogenic oedema are
characterized by hypo- or isointensed signals on DWI and
increased signals on ADC maps. In contrast to infarction in
PRES paramedian occipital cortex and calcarine fissure are
usually non-involved.
Conclusion: Prompt differentiation of these conditions
allows choosing correct tactics: infarction needs moderately
high BP and questions about thrombolysis should be
considered and PRES thrombolysis is contradicted and fast
BP decrease is needed.
481
P. Bernsen1, M.L. Bernsen2, P. van Vierzen3
1Neurology, St. Jansdal Hospital, Harderwijk, 2Faculty of
Medicine, Utrecht University, Utrecht, 3Radiology, St.
Jansdal Hospital, Harderwijk, The Netherlands
Infliximab is a chimeric monoclonal antibody specifically
directed against TNF-α which is effective in the treatment
of inflammatory auto-immune diseases such as rheumatic
arthritis, psoriasis, and Cohn’s disease. We report the case
of a 46-year-old female patient suffering from Crohn’s
disease who during the first infusion with infliximab
developed an ischemic stroke caused by an angiographic
confirmed occlusion of the middle cerebral artery. She was
not known for vascular risk factors. Because of recent
intestinal bleeding intravenous thrombolysis could not be
performed. An attempt was made to remove the blood clot
by intra-arterial thrombectomy. However, a remarkably
hardened blood clot was encountered and thrombectomy
proved to be impossible. The side effects of anti-TNF
therapy are diverse but relatively mild in the majority of
cases. They include an increased risk of peripheral venous
thrombosis but acute cerebral venous sinus thrombosis and
arterial thromboembolic events have also been reported.
TNF-α has a procoagulation activity that in-vitro is
antagonised by anti-TNF antibodies. Development of
significant levels of anti-cardiolipin antibodies has been
found after anti-TNF-α therapy, but this seems not to be
clinically relevant. This raises the question of a paradoxical
procoagulation potential of anti-TNF-α antibodies. In our
patient with no known vascular risk factors the first infusion
with infliximab promptly resulted in the development of an
ischemic stroke. We conclude that infliximab infusion,
besides being a risk factor for venous thrombosis, may be a
potential cause of ischemic stroke. The exact
pathophysiological mechanism remains to be elucidated.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
482
Posters, Monday 10 September
P2075
P2077
Hypoxia and hypothermia enhance
metallothionein transcription in mouse
brain endothelial cell line
Cardiac arrest induces widespread
astrocytic activation, myelin degeneration
and blood-brain barrier leakage in the
areas exhibiting neuronal damage:
Neuroprotection by methylene blue
K. Suk1, J. Park2, D.-I. Lee3, H.S. Han4
Pharmacology, 2Neurosurgery, Kyungpook National
University School of Medicine, Daegu, 3Kyungwon Medical,
Seoul, 4Physiology, Kyungpook National University School
of Medicine, Daegu, Republic of Korea
1
The protective role of hypothermia against stroke is well
known and hypothermia is supposed to mitigate bad genes
and promote good genes in ischemic brains. In this study,
the hypothermic regulation of metallothionein (MT) gene
expression was investigated especially in the brain
endothelial cells using in-vitro ischemic models, oxygen
glucose deprivation and reperfusion (OGD+R). When
bEnd.3 cells were exposed to OGD+R, MT-I/II gene
induction was observed. Hypothermia, which showed
protection of bEnd.3cells enhanced MT’ expression. To
elucidate the mechanism of the hypothermic effect on MT
expression, the related transcription factors and methylation
of the promoter are investigated. Hypothermia stimulated
the binding activity of metal response element (MRE) and
the signal transducers and activators of transcription3
(STAT3). A demethylating agent enhanced MT gene
expression and part of CpG sites in MT gene promoter
region was highly unmethylated in OGD+R condition. It is
suggested that hypothermia is a potent trigger of MT gene
transcription in the brain endothelial cells. Enhanced MT
gene expression may partially explain the hypothermic
protection. Hypothermia is supposed to enhance MT gene
expression through MRE/MTF-1 and STAT3. In addition,
the change of DNA methylation may contribute to MT gene
induction.
P2076
Abstract cancelled
H.S. Sharma, L. Wiklund
Surgical Sciences, Anaesthesiology & Intensive Care
Medicine, Uppsala University, Uppsala, Sweden
Cardiac arrest (CA) is a serious clinical problems leading to
long-term neurological dysfunction and disability to several
million people worldwide every year. The actual causes of
CA induced behavioural and functional disability are still
not well known. In a model of Porcine CA we observed
massive neuronal damages in the cerebral cortex,
hippocampus, thalamus, hypothalamus, cerebellum and
brain stem in a progressive manner following 30, 60 or
180min after earlier CA. In this investigation, we wanted to
see whether these neuronal changes are also associated with
alterations in non-neural cells, i.e., astrocytes and the
endothelial cells together with axonal distortion. Using
immunohistochemistry of glial fibrillary acidic protein
(GFAP) to detect astrocytes, myelin basic protein (MBP) to
identify axonal damage and albumin to detect endothelial
cell membrane permeability we examined selected tissue
pieces from the porcine brain after CA using standard
protocol. Our observations revealed a progressive activation
of astrocytes in different brain regions that correlated well
with neuronal damages. Likewise, albumin immuno­
reactivity also increased in the area showing GFAP
activation. Marked decrease in MBP indicating myelin
degradation was also present in the areas showing neuronal
damage and GFAP overexpression. Treatment with
methylene blue (MB) 5min or 30min after CA remarkably
attenuated these pathological reactions in the porcine brain.
These observations suggest that CA induces profound
neuronal and non-neuronal cell damages and antioxidant
MB has a good neuroprotective efficacy in the brain
pathology of CA, which has not been reported earlier.
P2078
Abstract cancelled
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
483
P2079
P2080
Fatigue and related phenomena soon
after stroke
Role of vertebral artery hypoplasia in
Wallenberg syndrome
M.A. Kutlubaev1, A.R. Saitgareeva2, L.R. Akhmadeeva2
H.G. Oh1, S.M. Yoon1, E.J. Rhee2, T.H. Park3, K.B. Lee1,
Y.I. Choi1, K.I. Yang1, D.S. Jeong1, H.K. Park1
1
2
Neurology, G.G. Kuvatov’s Republican Clinical Hospital,
Neurology, Bashkir State Medical University, Ufa, Russia
Introduction: Lack of energy, loss of motivation and low
mood are common after stroke and may be attributable to
fatigue, apathy, depression and daytime sleepiness which
seem to be similar phenomena, however the relationship
between them is not clear. We aimed to study the associations
between fatigue, depression, apathy and daytime sleepiness
in patients within the first month after stroke.
Methods: We recruited patients within the first month after
any stroke except for subarachnoid haemorrhage. We
assessed aforementioned phenomena by Fatigue Assessment
Scale (cut-off 22); Apathy Evaluation Scale (cut-off 14),
Hospital Anxiety and Depression Scale (cut-off 7) and
Epworth Sleepiness Scale (cut-off 8) correspondingly.
Cognitive function was evaluated by Montreal Cognitive
Assessment (MoCA).
Results: 60 patients took part in the study, M/F 39/21; mean
age 56.8 STD 11.6; 90% of patients had ischemic while the
rest had hemorrhagic strokes, median NIHSS score was 1.4
(I-Q range 2), mRS - 1 (I-Q range 2). Of 60 patients 77%
suffered from fatigue, 41% had day-time sleepiness, 28%
depression and 13% apathy. All of these phenomena
correlated with each other (moderate significant positive
correlation). Depression score correlated with NIHSS
(r=0.3, p=0.033) and mRS scores (0.3, p=0.015), apathy
score correlated with “Attention” task value (r=0.3, p=0.36)
in MoCA. The severity of fatigue was higher in patients
with posterior strokes, however this result has not reached
statistical significance.
Conclusion: Although there is an obvious overlap between
these phenomena, it seems that they have different
mechanisms of development as shown by different
associates.
Soonchunhyang University College of Medicine, Cheonan,
Kangbuk Samsung Hospital, Sungkyunkwan University
School of Medicine, 3Seoul Medical Center, Seoul, Republic
of Korea
1
2
Objectives: To investigate the frequency and clinical
relevance of vertebral artery hypoplasia (VAH) in
Wallenberg syndrome.
Methods: Among 1,568 patients who were admitted due to
acute ischemic stroke from September 2007 to December
2012, a total of 50 patients with lateral medullary infarction
were selected. The frequency of VAH, defined as a diameter
of ≤2.5mm by contrast-enhanced magnetic resonance
angiography, was measured in all patients with Wallenberg
syndrome. 50 patients were classified according to their age
(22 in 15-64 years, 28 in 65-99 years).
Results: A total of 21 patients had VAH (42%). VAH was
detected in 7 patients (31.8%) among the 22 patients in
15-64 years and 14 patients (50%) among the 28 patients in
65-99 years. In young patients (3 in 15-40 years), all
patients had VAH (100%) but no additional risk factors for
stroke. In very elderly patients (5 in 80-99 years), 3 patients
(60%) had VAH and atherosclerotic risk factors.
Conclusion: VAH is not considered a risk factor for stroke
as it is a common variant in the general population.
However, in young adults with lateral medullary infarction,
VAH may contribute to stroke if there are no additional risk
factors. Also older people with VAH may have a high
probability of Wallenberg syndrome, with atherosclerotic
susceptibility.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
484
Posters, Monday 10 September
P2081
P2082
Inclusion and retention of patients with
aphasia in acute stroke clinical trials
C-reactive protein and the morphology of
atherosclerotic plaques in carotid arteries
M. Ali1, P. Bath2, P. Lyden3, M. Brady1, on behalf of the
VISTA Collaboration
M. Danilova, T. Baidina
1
Background: Plaque disruption is the most common
mechanism of the pathogenesis of cerebral ischemia,
therefore the detection of unstable plaques is important for
the prevention of complications of carotid atherosclerosis.
Objective: A comparison of morphological characteristic of
atherosclerotic plaques in carotid arteries with the level of
C-reactive protein (CRP) in blood serum and clinical
manifestations of the disease.
Materials and methods: The level of CRP in blood serum
was determined in 61 patients with carotid artery disease by
immunosorbent assay before carotid endarterectomy. The
morphology of carotid plaques obtained during the
operation was studied.
Results: Histological features of vulnerable plaques, that
included a lot of macrophages, a large lipid core, a thin
fibrous cap, intraplaque haemorrhage and an increased
number of inflammatory cells, were detected in 26 patients.
In 35 patients the morphology of the plaque had the
characteristics of stable one.
In patients with unstable plaques in carotid arteries the CRP
level was significantly higher (6.6; 2.3-9.6mgl) than in
patients with stable plaques (2.1; 0.9-6.7mgl, p=0.010). In
patients with clinical manifestations (stroke or transient
ischemic attack in anamnesis) of carotid artery disease the
concentration of CRP was higher (6.8; 4.9-14.2mgl) than in
patients with asymptomatic atherosclerosis (2.1; 1.36.3mgl, p=0.002).
Conclusion: Increased concentration CRP in serum is
associated with complications of carotid atherosclerosis.
Unstable plaque is characterized by high concentration of
CRP, which indicates the activity of inflammatory reactions
in the artery wall.
Glasgow Caledonian University, Glasgow, 2University of
Nottingham, Nottingham, UK, 3Cedars-Sinai Medical Center,
Los Angeles, CA, USA
Introduction: Legislation permits inclusion of patients
with incapacity in some emergency research however stroke
may rob patients of their ability to consent to inclusion.
Enrolment of those with incapacity requires justification;
exclusion diminishes the generalisability of results. We
examined the inclusion of patients with aphasia, which can
mimic incapacity, in acute stroke clinical trials.
Methods: We analysed data from the Virtual International
Stroke Trials Archive (VISTA) on patient demography,
initial impairment assessed using the National Institutes of
Health Stroke Scale (NIHSS), country and year of
enrolment. We defined aphasia using the Best Language
domain of the NIHSS. We described the proportion of
patients with aphasia who were enrolled into trials, the
geographic and longitudinal variations in inclusion and
attrition, and formally tested associations using Proportional
Odds Modelling, adjusting for age, sex, stroke severity,
medical history and hemisphere affected by stroke.
Results: At baseline, 4,039/8,904 (45.4%) presented with
aphasia; complete follow-up data were available for 3,967
(98.2%) aphasic patients. There were no significant
geographic or longitudinal differences in attrition of
patients. Trial centres in Portugal enrolled fewer aphasic
patients (p=0.003, OR=0.5, 95% CI [0.32, 0.74]), centres in
the Philippines comprised more patients with aphasia
(p=0.0001, OR =2.5, 95% CI [1.4, 4.2]) & dysarthria
(p<0.0001, OR=2.6, 95% CI [1.4, 4.6]), after adjusting for
case-mix.
Conclusion: Acute stroke research includes patients with
aphasia; the methods employed across large, multicentre
trials of acute stroke interventions have demonstrated low
attrition. Similarly low levels of attrition should be feasible
in other stroke contexts.
Perm State Academy of Medicine, Perm, Russia
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
485
P2083
P2084
Molecular mechanism for cumulative
effects of repetitive transcranial magnetic
stimulation on neural plasticity in rats
Anti-coagulation in the daily routine in
Debrecen, Hungary
T.R. Han, J.Y. Kim, B.M. Oh
Department of Neurology, University of Debrecen Medical
and Health Science Center, Debrecen, Hungary
Rehabilitation Medicine, Seoul National University Hospital,
Seoul, Republic of Korea
Introduction: We aimed to evaluate the cumulative effect
of multi-session rTMS on gene expression and protein
synthesis which are correlated with neural plasticity.
Methods: Eight-week-old Sprague-Dawley rats (N=45)
were subjected to unilateral rTMS with low- (1Hz, n=15),
high- (20Hz, n=15) frequency, or sham (n=15) stimulation
groups. Each group was divided into 3 subgroups at the
number of stimulation sessions; 1-, 5-, and 10-day (n=5 for
each subgroup). Stimulation was applied to the left
hemisphere using a 25-mm, figure-of-8 coil for 20 minutes
with intensity set at 110% of motor threshold. Brain tissues
were obtained 15 minutes after rTMS, and RT-PCR was
conducted for c-fos, vegf, bdnf, mGluR1, and GABAa
receptor genes to investigate gene expression. Ratios of fold
changes to that of gapdh, a house-keeping gene, were
compared in each group. Western blot was done for Akt and
phospho-Akt .
Results: In RT-PCR, vegf-gene expression showed
significant difference between each group with 5-day
stimulation. High-frequency rTMS for 5 days increased
vegf expression. The vegf expressions tended to increase
with longer stimulation session, however, were not
significantly affected. The mGluR1 and GABAa receptors
were increased in low- and high-frequency groups
respectively. Levels of c-fos and bdnf did not differ between
subgroups. In Western blot, high-frequency rTMS for 10
days increased pAkt synthesis than 5-day rTMS did.
Conclusions: This study revealed evidence of increased
expression following high-frequency rTMS in the gene
concerning angiogenesis. It may play a key role in
excitation-neurogenesis coupling in rTMS-induced neural
changes.
G. Hofgárt, L. Csiba
Introduction: Atrial fibrillation is a risk factor of ischemic
stroke. To prevent stroke we can administer oral anticoagulants. Old and new type anti-coagulants are available.
In Hungary nowadays we prefer old type, acenocumarol
based anti-coagulants. The advantages and the disadvantages
of anti-coagulants are well-known. Despite these we find
often that anti-coagulants are underused in many cases.
Method: We investigated retrospectively acute stroke cases
in our Clinic in 2009, how often is atrial fibrillation and the
usage of anti-coagulants in the practice in contrast to
guidelines. We examined the INR levels on admission.
Results: 461 acute stroke cases were found, 96 had known,
22 had newly found atrial fibrillation in the anamnesis. Half
of the patients did not receive proper anti-coagulation. Only
8.4% of them had their INR levels in therapeutic range.
Discussion: Our data is similar to other investigators data.
Many factors have effect on our result, further investigation
is needed to determine these factors. With the development
of these factors the incidence of stroke could be decreased.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
486
Posters, Monday 10 September
P2085
P2086
Neuro-anatomical, clinical and cognitive
correlates of post-stroke dysphagia: the
role of leukoaraiosis
Effect of different anti-hypertensive drugs
on the morphological and functional
characteristics of the vascular wall
M. Toscano1, E. Cecconi1, L. Campiglio2, E. Capiluppi2,
A. Verzina1, T. Sasso D’Elia1, P.L. Bertora2, M. Fiorelli1,
G. Cislaghi2, G.L. Lenzi1, V. Di Piero1
K.R. Kovács1, Z. Bajkó2, C.C. Szekeres2, K. Csapó1,
S. Molnár1, L. Oláh1, M.T. Magyar1, L. Kardos3,
P. Soltész4, L. Csiba1
1Neurology and Psychiatry, Sapienza University of Rome,
Rome, 2L. Sacco Hospital, University of Milan, Milan, Italy
Introduction: Dysphagia affects half of stroke patients
with increased morbidity and mortality.
The aim of this study is to assess the neuroanatomical
correlates and the impact on clinical and cognitive outcome
of post-stroke dysphagia.
Methods: We prospectively examined consecutive patients
admitted for ischaemic or haemorrhagic stroke within 72
hours of symptoms onset. Dysphagia was assessed using
Water-Swallow-Test. A follow-up at 3 and 6 months was
performed.
Results: We recruited 211 patients (105M/106F; mean age
73.1 yrs ±11.8). At admission, dysphagia occurred in 46%
of the patients. Dysphagia increased by five times the risk
of death [OR 5.03 (95%CI 2.06-12.27)] and was associated
with a higher stroke severity (p<0.001). Dysphagia was
more frequent in patients with leukoaraiosis (p<0.01)
hemorrhagic stroke (p<0.001), lesion size >3 cm (p<0.001),
insular (p<0.01) and temporal lesion (p<0.01). Logistic
regression analysis showed that leukoaraiosis [OR 2.11
(95%CI 1.10-4.05)], stroke type [OR 2.64 (95%CI 1.345.21)], age [OR 1.03 (95%CI 1.01-1.06)], lesion size [OR
2.58 (95%CI 1.08-6.16)] and insular lesion [OR 2.45
(95%CI 1.08-5.59)] independently predict the occurrence of
dysphagia after stroke. Insular stroke was also associated
with persistent dysphagia at 6 months. At follow-up
dysphagic patients showed a poorer cognitive outcome
(p<0.01).
Conclusion: Our study confirms that dysphagia is a
negative factor for stroke outcome. It is intriguing that
dysphagia is correlated with leukoaraiosis severity and
decline in cognitive subcortical test. This suggests that the
disruption of cortical-subcortical white matter connections
plays a pivotal role in the pathogenesis of post-stroke
dysphagia.
1Department of Neurology, University of Debrecen Medical
and Health Science Center, Debrecen, Hungary, 2Department
of Neurology, Mures County Emergency Hospital, TârguMures, Romania, 3Contract Medical Statistician, Kenézy
Gyula Hospital, 43rd Department of Internal Medicine,
University of Debrecen Medical and Health Science Center,
Debrecen, Hungary
Introduction: While blood pressure reducing effect of the
anti-hypertensive drugs is well known, their effects on other
cardiovascular parameters are less documented. Our aim
was to assess the effect of different anti-hypertensive drugs
on several cardiovascular parameters.
Methods: 49 recently diagnosed hypertensive patients were
included in the study (mean age:45.1±10 years, male/
female:1.4). Laboratory tests, ambulatory blood pressure
monitoring (ABPM), measurement of the carotid intimamedia thickness (IMT), detection of arterial stiffness
parameters (pulse wave velocity-PWV), and monitoring of
various hemodynamic parameters during head-up tilt table
testing (HUTT) were performed in all patients. After the
baseline evaluation, anti-hypertensive therapy was started.
Angiotensin-converting-enzyme inhibitors (ACEi) were
given to 31 patients, while 9 patients received angiotensinreceptor blockers (ARB) and 9 patients beta-blockers (BB).
The tests were repeated after 6 months.
Results: At the 6-month follow-up, a significant reduction
in systolic and diastolic blood pressure values measured by
ABPM was found in the ACEi and ARB groups. IMT
(ACEi: 0.65→0.62mm, p: 0.0124; ARB: 0.67→0.63mm,
BB: 0.58→0.56mm) and PWV (ACEi: 10.0→9.7m/s; ARB:
10.1→8.1m/s; BB: 8.4→7.6m/s) were reduced in all
groups. After 6 months the tilting provoked elevation in
total peripheral resistance during HUTT measurements was
significantly lower in the ACEi and ARB groups (p: 0.04,
and p:0.05), while tilting provoked tachycardia was less
pronounced in the BB group.
Conclusion: Positive effects on the morphological and
functional characteristics of the arterial wall (IMT, PWV)
are independent, while changes in some hemodynamic
parameters during HUTT are dependent upon the applied
anti-hypertensive therapy.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
P2087
P2088
VEGF and SDF-1 synergistically restore
endothelial proliferation, migration and
tube formation following native LDL
exposure
Late mortality of hemorrhagic
transformation of ischemic stroke
487
F. Valentino, V. Terruso, G. Famoso, S. Realmuto,
P. Aridon, P. Ragonese, M. D’Amelio, G. Savettieri
F. Jin
Dept of Experimental Biomedicine and Clinical
Neuroscience, University of Palermo, Italy
Introduction: Considerable efforts have been made to
amplify angiogenesis therapeutically under conditions of
ischemia by vascular endothelial growth factor (VEGF)
delivery, yet with limited success. Resulting mostly from
peripheral embolisms related to atherosclerosis, vascular
diseases are often associated with hypercholesterolemia.
Whether and how the exposure to lipids influences the
responses of blood vessels to angiogenic growth factors,
was unknown.
Methods: We herein investigated effects of native low
density lipoprotein (LDL) exposure on the proliferation,
migration and tube formation of human umbilical vein
endothelial cells.
Results: We observed that native LDL attenuated
endothelial proliferation, migration and tube formation in a
dose-dependent way without influencing endothelial
survival. Reduced abundance of VEGFR1, VEGFR2 and
chemokine receptor CXCR4 were noticed in LDL-exposed
endothelial cells that were associated with decreased
responses to VEGF and CXCR4 ligands, stromal cellderived factor (SDF)-1. As such, the attenuation of
angiogenesis was reversed only when both growth factors
were simultaneously administered. VEGF and SDF-1
delivery mutually elevated CXCR4 and VEGFR2 levels.
Conclusions: Our observations throw new light on the
disappointing results of studies on therapeutic angiogenesis.
Based on our data, responses to VEGF may be compromised
in hypercholesterolemia. Combined treatment with VEGF
and SDF-1, on the other hand, might allow restoring
angiogenesis.
Introduction: Hemorrhagic transformation (HT), a
complication of ischemic stroke (IS) is supposed to
influence patient’s prognosis. Aim of our study was to
evaluate, in a hospital-based series of patients not treated
with thrombolysis, the relationship between HT and late
mortality.
Methods: Mortality of individuals with spontaneous HT
was compared to that of individuals without. Medical
records of patients diagnosed with anterior IS during the
period 2004-2006 were reviewed. Living status was
obtained from the public record office of the municipality
of Palermo or indirectly by telephone interview. Outcome
measure was 90 days survival after IS onset. Kaplan-Meier
estimates were used to construct survival curves. Cox
proportional hazards model was used in a univariate
analysis to estimate RR for the main outcome measure
(death) in the different strata. We evaluated the relationship
between HT and the main mortality risk factors. HT was
stratified in hemorrhagic infarction (HI) and parenchymal
hematoma (PH).
Results: Living status was determined for 96.7%. At
3-month follow-up, mortality rate was 12.1% (28/232). At
multivariate analysis, large infarct size (OR 2.7, 95% CI
1.2, 6.0, p=0.02) and HT (OR 2.3, 95% CI 1.0, 5.4, p=0.05)
were significantly associated with increased mortality.
Parenchymal hematoma was the strongest independent risk
factor for late mortality (OR 7.9, 95% CI 2.9, 21.4,
p<0.0001).
Conclusions: Infarct size and HT play a significant role in
late mortality after IS. Parenchymal hematoma is the
strongest predictor of late mortality.
Neurology, University Hospital Essen, Germany
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
488
Posters, Monday 10 September
P2089
P2090
The anti-thrombotic and antiinflammatory actions of C1-inhibitor
protect from focal cerebral ischemia in
rodents
Prognostic value of capillary glucose
levels in hemorrhagic stroke
N. Heydenreich1, M.W. Nolte2, F. Langhauser1, E. Göb1,
G. Stoll1, C. Kleinschnitz1
University Hospitals, Würzburg, CSL Behring GmbH,
Marburg, Germany
1
2
Background: Although inflammation and thrombosis are
key events during focal cerebral ischemia current
therapeutic options are limited. The contact-kinin system is
critically involved in stroke development and represents an
interface between inflammatory and thrombotic circuits.
The serine protease inhibitor C1-inhibitor (C1-INH)
counteracts activation of the contact-kinin system at
multiple levels for instance by blocking of activated
coagulation factor FXII (FXIIa) and plasma kallikrein.
Objectives: To assess the therapeutic potential of C1-INH
in different models of focal cerebral ischemia.
Methods: 369 C57Bl/6 mice (349 males, 20 females) and
33 male CD rats were subjected to middle cerebral artery
occlusion (MCAO) and treated with C1-INH after 1h or 6h.
Infarct volumes, additionally validated by magnetic
resonance imaging (MRI), and functional outcomes were
evaluated between day 1 and day 7. Blood-brain-barrier
damage and oedema formation were determined using
vascular tracers. Invasion of immune cells was visualized
by immunohistochemistry. The extent of thrombus
formation was quantified by Western blot.
Results: Treatment with 15.0 U C1-INH, but not 7.5 U 1h
after ischemic stroke reduced infarct volumes by ~50% and
improved clinical scores in mice of either sex at day 1. This
protective effect was preserved at later stages of infarction
just as in elderly mice or in another species, i.e. rats.
Delayed treatment still improved clinical outcome. Bloodbrain-barrier damage, oedema formation and inflammation
were significantly lower compared with controls. Moreover,
C1-INH showed strong anti-thrombotic effects.
Conclusion: C1-INH is a multifaceted anti-inflammatory
and anti-thrombotic compound that protects from ischemic
neurodegeneration in clinically meaningful scenarios.
G. Ruiz-Ares1, B. Fuentes1, R. Hipola2,
P. Martínez-Sánchez1, M. Martínez-Martínez1,
E. Díez-Tejedor1
Stroke Unit, Neurology, University Hospital La Paz,
Madrid, 2Neurology, University Hospital of Salamanca,
Salamanca, Spain
1
Background and purpose: The development of
hyperglycaemia has been associated with poor outcome in
acute ischemic stroke. However, it is unknown whether
hyperglycaemia also affects outcome in hemorrhagic
strokes. Our objectives were to identify the capillary
glucose threshold with the highest predictive accuracy of
poor outcome and to evaluate its hypothetical value in
influencing functional outcome by adjusting for other wellknown prognostic factors in acute hemorrhagic stroke.
Methods: Prospective and observational study including
consecutive patients with hemorrhagic stroke within the
first 24 hours from stroke onset. Capillary finger-prick
glucose and stroke severity were determined on admission
and 3 times a day during 48 hours. Blood pressure
monitoring and hemorrhage volume were recorded. Poor
outcome (modified Rankin Scale >2) was evaluated at 3
months.
Results: 106 patients were included. The receiver operating
characteristic curves showed the predictive value of
maximum capillary glucose at any time within the first 48
hours pointed to 153mg/dl as the optimal cut-off level for
poor outcome (57% sensitivity; 72% specificity;
AUC=0.687; 95% CI, 0.584-0.790; P<0.01) and mortality
(69% sensitivity; 64% specificity; AUC=0.720; 95% CI,
0.572-0.869; p=0.01) at 3 months. This point was associated
with 36.761-fold increase (95% CI, 1.632 to 828.042) in the
odds of death after adjustment for age, sex, maximum
systolic and diastolic pressure levels, haemorrhage volume,
baseline stroke severity, smoking and treatment with statins
and hipotensor drugs.
Conclusions: Hyperglycaemia >153mg/dL at any time
within the first 48 hours from hemorrhagic stroke onset is
associated with higher mortality at 3 months.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
489
P2091
P2092
Apolipoprotein-E controls ATP-binding
cassette transporters ABCB1 and ABCC1
on cerebral microvessels after
methamphetamine intoxication
The relationship between low anklebrachial index and intra- and extra-cranial
atherosclerosis
A. ElAli1, A. Urrutia2, A. Rubio-Araiz2, M. HernandezJimenez2, M.I. Colado2, T.R. Doeppner3, D.M. Hermann3
The 3rd Hospital of Hebei Medical University, Shijiazhuang,
China
Neurology, University Hospital Essen, Essen, Germany,
Departamento de Farmacologia, Facultad de Medicina,
Universidad Complutense de Madrid, Madrid, Spain,
3Department of Neurology, University Hospital Essen, Essen,
Germany
1
2
Background: Methamphetamine is a powerful addictive,
which has been associated with ischemic stroke and brain
haemorrhage in humans. Whether and how
methamphetamine influences the expression of tight
junctions and ATP-binding cassette transporters was
unknown.
Methods: C57BL/6J mice received intraperitoneal
injections of methamphetamine (three times 4mg/kg,
separated by 3 hours), either alone or in combination with
the ApoER2 inhibitor receptor-associated protein (40µg/kg)
or the inducible NO synthase inhibitor 1400W (5mg/kg).
Animals were killed 3 or 24 hours after methamphetamine
exposure. Tissue responses were evaluated with Western
blots, immunoprecipitation, and immunohistochemistry
using total brain and cerebral microvessel extracts.
Results: Methamphetamine induced a transient activation
of stress kinases JNK1/2 and p38 in the brain parenchyma
and increased ICAM-1 and VCAM-1 expression on cerebral
microvessels without inducing loss of tight junction proteins
and without inducing IgG extravasation. Methamphetamine
transiently increased the expression of the luminal ATPbinding cassette transporter ABCB1 on cerebral
microvessels and reduced the expression of the abluminal
transporter ABCC1. Elevated expression of ApoE was
noted in the brain parenchyma by methamphetamine,
activating ApoER2 on brain capillaries, deactivating
JNK1/2 and c-Jun, and regulating ABCB1 and ABCC1
expression. Indeed, ApoER2 and inducible NO synthase
inhibition prevented the ABCB1 and ABCC1 expression
changes.
Conclusions: Acute exposure to methamphetamine at doses
comparable to those consumed in drug addiction does not
induce tight junction breakdown, but differentially regulates
ATP-binding cassette transporters via the ApoE/ ApoER2/
JNK1/2 pathway.
Z. Li, J. Liu
Background and purpose: Disputation about the
relationship between low ankle-brachial index (ABI) and
intra- and extra-cranial atherosclerosis still exist. So the
relationship was validated and the pathogenesis of intraand extra-cranial atherosclerosis will be approached further.
Methods: Patients with large artery atherosclerosis (LAA)
and small artery disease (SAD) were enrolled in this study
according to classic TOAST subtype. All subjects were
divided into 3 groups: intra-cranial atherosclerosis (ICA),
extra-cranial atherosclerosis (ECA) and small artery
disease. The prevalence of abnormal ankle-brachial index
and the risk factors between intra- and extra-cranial
atherosclerosis were investigated.
Results: 31.51% of LAA patients were associated with
peripheral artery disease, which is much higher than the
SAD patients (31.51% vs. 19.75%, χ2=4.023, p=0.045).
There was a remarkable difference about the prevalence of
abnormal ABI between ECA stenosis and ICA stenosis
patients. (47.17% vs. 22.31%, χ2=10.867, p=0.001).
Multivariable logistic regression identified peripheral artery
disease (OR=2.759, 95%CI:1.485-5.124), smoking
(OR=2.032, 95%CI:1.093-3.779) as the independent risk
factors for ECA stenosis, and hypertension (OR=1.957,
95%CI:1.119-3.421), male sex (OR=2.024, 95%CI:1.2513.274) for ICA stenosis. Peripheral artery disease was not
related to ICA stenosis.
Conclusions: Both the risk factors and mechanism were not
consistent between intra-cranial and extra-cranial
atherosclerosis. Abnormal ABI often suggested carotid
artery stenosis.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
490
Posters, Monday 10 September
P2093
P2094
Generalized atherosclerotic disease
among young ischemic stroke patients.
Assessment by the NOR-SYS research
protocol. The NORwegian Stroke in the
Young study
Correlation of depression and functional
ability of patients during acute stroke
A. Fromm1,2, L. Thomassen1,2, H. Naess1,
U. Waje-Andreassen1
Dept. of Neurology, Haukeland University Hospital,
Department of Clinical Medicine, University of Bergen,
Bergen, Norway
1
2
Introduction: Atherosclerosis is the underlying condition
in a majority of patients with ischemic cerebrovascular
events. However, risk factor profile and etiology differ in
young patients. They also show a higher vascular morbidity,
such as recurrent ischemic stroke, coronary and peripheral
arterial disease, and mortality is increased compared to
controls. Ultrasound imaging is a sensitive method for
detection of arterial stenoses, and the relationship between
intima-media thickness (IMT), cardiovascular risk factors
and ischemic events has consequently been shown.
However, results are conflicting as methodologies vary and
data collection and analysis are inhomogenous.
Methods: NOR-SYS is a national multicenter study with
prospective, longitudinal long-term follow-up design and
established standardized methods for anamnestic, clinical
and ultrasound data collection in ischemic stroke patients
aged ≤60 years, their partners and the couples’ adult
children. The ultrasound protocol includes duplex­
sonography of carotids, femoral arteries and abdominal
aorta, and ultrasonographic estimation of epicardial,
intraabdominal and subcutaneous fat distribution is
additionally applied to determine the severity of
atherosclerotic disease in the individual. Detailed lifestyles
questionnaires are used and the families’ histories of
vascular disease are collected.
Conclusions: The major target of NOR-SYS is to diagnose
atherosclerotic disease in young ischemic stroke patients
and their families, and to provide optimal secondary and
primary prophylaxis by combining standardized casehistory ascertainment, comprehensive state-of-the-art stroke
and ultrasound protocols, and a stringent long-term followup schedule. NOR-SYS intends to reduce disability,
cognitive impairment and death due to vascular disease.
Inclusion of the patients' relatives is an excellent platform
for primary prophylaxis.
T. Vujanic1, M. Semnic2,3
1
3
Dpt. for Cerebrovascular Diseases, 2Clinic for Neurology,
University of Novi Sad, Novi Sad, Serbia
Introduction: During acute stroke, patients usually
experience neurological symptoms, but it may also appear
depression and lower functional ability. The aim of this
study was to determine the correlations between depression
and functional ability of patients during acute stroke.
Methods: 30 patients during acute phase of stroke were
tested in this research study. Control group consisted of 30
healthy volunteers. For both groups, we used: Beck
Depression Inventory (BDI) for assessment of depression
and to assess functional ability of patients during acute
stroke, we used Barthel Index (BI). Additionally, stroke was
classified using National Institute of Stroke Scale (NIHSS).
Results: Between the tested groups there was statistically
significant difference in the score of Beck Depression
Inventory (t=0.00106, p<0.05). The correlation between
scores was established: BDI and Barthel Index (r=-0.474,
p=0.008); Barthel Index and NIHSS (r=-0.396, p=0.0314)
of patients during acute stroke. Still, there was no correlation
between BDI and NIHSS (r=0.046, p=0.809).
Conclusion: Patients during acute stroke experience
depression and functional disability. Correlations were
established between depression and functional ability of
patients during acute stroke.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
P2095
P2096
Quality of life after acute ischemic stroke
Aasfara1,
491
Benomar1,2,
Regragui1,
J.
A.
W.
E.H. Ait Ben Haddou1, M. Yahyaoui1
Department of Neurology and Neurogenetics, Faculty of
Medicine and Pharmacy of Rabat, University Mohammed V
Souissi, 2Centre de Recherche en Epidémiologie Clinique et
Essais Thérapeutiques (CRECET), University Mohammed V
Souissi, Rabat, Morocco
1
Introduction: Stroke victims have a poorer quality of life
than the general population. The cultural and social nature
of the concept of ’’quality of life’’ (QoL) means that it is
difficult to extrapolate results from other countries to
Moroccan patients. Consequently, there is a need for
targeted data in a Moroccan population.
Objective: Assess the impact of neurological sequel of
ischemic stroke on QoL using the translated and validated
Arabic version of the EuroQol questionnaire.
Methods: 21 patients followed in our department during a
period of 18 months after first ischemic stroke. Neurological
examination was performed and the QoL was measured by
EuroQol, administered by the same interviewer. The scores
were correlated with specific international stroke score:
Rankin, NIH and IADL. The statistical analysis was
performed using SPSS 13.0.
Results: We examined 21 patients, with mean age (66.7±5.3
years) and male predominance (12H/9F). The importance of
initial neurological deficit and age intervened significantly
in the alteration of the QoL. 19% patients required regular
assistance of another person. The NIH and Rankin scores
were inversely correlated with EuroQol (P < 0.003). Severe
pain was reported in 18% cases and depression in 14.3%
cases.
Conclusion: Regardless of age, our results showed
deterioration of QoL after stroke. Dependence in self-care
and mobility are a significant burden for stroke survivors.
Post-stroke depression and pain, yet underestimated,
diminish the effectiveness of rehabilitation and reintegration
of patients.
Cerebral venous thrombosis in Behçet’s
disease: a retrospective study
J. Aasfara1, F. Imounan1, E.H. Ait Ben Haddou1,
W. Regragui1, A. Benomar1,2, M. Yahyaoui1
1Department of Neurology and Neurogenetics, Faculty of
Medicine and Pharmacy of Rabat, University Mohammed V
Souissi, 2Centre de Recherche en Epidémiologie Clinique et
Essais Thérapeutiques (CRECET), University Mohammed V
Souissi, Rabat, Morocco
Introduction: Behçet’s disease is a chronic relapsing
multisystem vasculitis of unknown etiology. Cerebral
venous thrombosis (CVT) is one of its major neurological
manifestations and characterized by a large clinical
variability.
Objective: To evaluate the epidemiological, clinical,
paraclinical, therapeutic and evolutionary aspects of CVT in
Behçet’s disease.
Methods: We report a retrospective study of 22 cases of
cerebral venous thrombosis secondary to Behçet’s disease,
collected between 2004 and 2011 in the neurology
department of Rabat.
Results: The mean age at onset was 34±12 years and the
sex ratio was 1.75. The predominant manifestation in our
series was hemiparesis (63.6%) and intracranial
hypertension (31%). Our series is individualized by the
predominance of deeply located CVT with 14 cases. The
treatment consists of association of anticoagulants and
corticosteroids. Only patients having a deep CVT were
treated with Cyclophosphamide. All except two of the
patients had good results.
Conclusion: CVT in patients with Behçet’s disease may
result in serious neurologic outcomes. A therapy combining
anticoagulation, corticosteroids and immunosuppressive
drugs, has improved the prognosis.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
492
Posters, Monday 10 September
P2097
P2098
The superior value of ABCD3-V in
predicting risks for developing ischemic
stroke in patients with transient ischemic
attacks
The clinical characteristics of patients
with medullary strokes and outcome at 30
days
L. Wu1, H. Zhang2, J. Wu2
Neurological, National O.O.Bogomolets University, Kiev,
Ukraine
Department of Neurology, The First Hospital of Jilin
University, Jilin University, ChangChun, 2Jilin University,
Changchun, China
1
Introduction: Atherosclerosis is a cardinal reason for
transient ischemic attack (TIA) and ischemic stroke. In our
previous retrospective analysis of 1003 subjects, a cerebral
artery stenosis was found in 41% of patients with TIA,
while an atherosclerotic plaque in 56.2%. The ABCD2
score was correlated with the occurrence of atherosclerotic
plaques rather than vascular stenoses. These results point to
a necessity of employing vessel examination in the
evaluation of TIA.
Method: To address the values of the ABCD3-V score
(ABCD3-V plus neuroimaging tests) in predicting the
prognosis of TIA, we enrolled 77 in-patients with TIA and
recorded their clinical manifestations, risk factors,
neuroimaging findings and progression of disease.
Results:
(1) A middle cerebral artery (MCA) stenosis was found in
34 subjects (44.2%), among which 50% were high-grade
stenoses (>70%).
(3) For those who progressed to stroke within one week,
75% had a high-grade MCA stenosis.
(4) Diabetes was an independent risk factor for developing
ischemic stroke.
(5) An atherosclerotic plaque was found in 59 subjects
(76.6%), among which 16.9% were unstable plaques.
(6) Microemboli were found in 4 of 31 patients (16.1%)
who received microembolus signal monitoring.
(7) ABCD3-V had a higher sensitivity and specificity in
categorizing stroke risks as compared with ABCD3 or
ABCD2, and patients with a score >7 had a higher risk for
stroke.
Conclusions:
(1) High-grade MCA stenoses and occurrence of
microemboli indicate a high risk for stroke;
(2) The ABCD3-V score is superior to ABCD3 and ABCD2
in predicting stroke.
K. Antonenko, L. Sokolova
Objectives: To correlate clinical and radiological findings
in patients with medullary strokes and indicate the outcome
at 30-days.
Materials and methods: 34 consecutive patients aged 50
to 85 years with acute medullary infarcts were evaluated
during 2007-2011 in the neurological center of the
Alexander Clinical Hospital, Kiev. Comprehensive
examination included an attentive clinical study; assessment
of neurological status with the use of scales NIHSS,
Hoffenberth B. et al., modified Rankin scale, Barthel index.
Localization and size of the ischemic lesion were verified
with the MRI.
Results: Lateral medullary infarcts correlated with vertigo,
nausea and vomiting (p=0.033, CI [0, 56-0,86]), nystagmus
(p=0.005, CI [0, 56-0,86]), ipsilateral - segmental
disturbances of pain and temperature sensitivity on the face
(p=0.04, CI [0,38-0,8]), Horner syndrome (p=0.009, CI
[0,58-0,9]), cerebellar ataxia (p=0.005, CI [0,56-0,86]),
contralateral - conductive hypaesthesia of pain and
temperature sensitivity (p=0.04, CI [0,38-0,8]). Medial
medullary infarction correlated with the contralateral tactile
anaesthesia and bathyanaesthesia (p=0.002, CI [0,38-0,98]),
tetraparesis (p=0.009, CI [0,25-0,89]). Quite often
dysarthria, dysphonia (71%), dysphagia (53%), rarer
hiccups, respiratory dysfunction (26%) were determined.
Classical full Wallenberg’s lateral medullar syndrome was
revealed in 64% cases of lateral lesion. At 30 days overall
mortality was low - 3 deaths (9%) of patients with medial
medullary syndrome. Favourable outcome was observed in
86% patients with lateral medullary stroke, 13 patients with
Wallenberg’s syndrome had no functional disability.
Conclusions: Knowledge of specific neurological signs of
the proximal vascular territory lesion can improve the
clinical diagnostics of medullary infarcts. In the whole, the
prognosis of medullary strokes is good, especially in
Wallenberg’s lateral medullary syndrome.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
P2099
P2100
Neuro- and renoprotective effects of
pioglitazone versus glimepiride in normoalbuminuric patients with type-2 diabetes
mellitus: a randomized controlled trial
Intraventricular haemorrhage in
haemorrhagic transformation brain
infarction
M. Petrica1, L. Petrica2, A. Vlad3, D.C. Jianu4,
G. Gluhovschi2, C. Ianculescu5, C. Firescu6,
V. Dumitrascu7, F. Gadalean2, S. Giju5, C. Gluhovschi8,
S. Ursoniu9, S. Velciov2, O. Milas2, C. Balgradean2,
A. Gaina4
Neurology, ’Victor Babes’ University of Medicine, County
Emergency Hospital, 2Nephrology, 3Diabetes and Metabolic
Disorders, 4Neurology, 5Clinical Laboratory, Urinary
Biochemistry, 6Clinical Laboratory, Immunology, 7Clinical
Laboratory, Blood Biochemistry, ’Victor Babes’ University of
Medicine and Pharmacy, County Emergency Hospital,
8Nephrology, 9Public Health Medicine, ’Victor Babes’
University of Medicine and Pharmacy, Timisoara, Romania
1
Introduction: In the course of diabetes mellitus (DM)
endothelial behaviour is different in various vascular
territories, such as the kidney and the brain. Consequently,
pioglitazone may exert both nephro- and neuroprotective
effects by different mechanisms.
Methods: A total of 68 normoalbuminuric type-2 DM
patients (p) were enrolled in a one-year open-label
randomized controlled trial (A:34p-pioglitazone plus
metformin vs. B:34p-glimepiride plus metformin). All p
were assessed concerning urinary albumin/ creatinine ratio
(UACR), urinary alpha1-microglobulin, urinary beta2microglobulin, plasma asymmetric dymethyl-arginine
(ADMA), serum creatinine, GFR,; pulsatility index,
resistance index in the internal carotid artery and middle
cerebral artery, intima-media thickness in the common
carotid artery; cerebrovascular reactivity was evaluated
through the breath-holding test.
Results: At 1 year there were differences between groups A
and B regarding plasma ADMA (p<0.04), urinary beta2microglobulin (p<0.004), urinary alpha1- microglobulin
(p<0.0001), serum creatinine (p<0.0024), GFR (p<0.0010),
UACR (p<0.0001), the cerebral haemodynamic indices.
The increase in alpha1-microglobulin and beta2microglobulin in group B preceded the occurrence of
microalbuminuria. The proximal tubule (PT) biomarkers
correlated with UACR (r=0.4854; p<0.0001) and GFR
(r=0.4867; p<0.0001), while plasma ADMA correlated with
GFR (r=0.3702; p<0.0004) and the cerebral haemodynamic
indices. There were no correlations between ADMA and
UACR, urinary alpha1-microglobulin, urinary beta2microglobulin. The cerebrovascular parameters improved in
group A vs. group B and correlated with plasma ADMA,
duration of DM, HbA1c, and GFR.
Conclusion: PT dysfunction does not parallel endothelial
dysfunction. Pioglitazone delays PT dysfunction and
improves cerebral vessels endothelial dysfunction in
normoalbuminuric p with type 2 DM.
493
A. Sharifi Razavi1, M. Kazemian2, A. Moghaddam
Ahmadi3, S.M. Sadati Kiadehi4
1Neurology, 2General Physician, Mashhad University of
Medical Sciences, Mashhad, 3Neurology, Rafsanjan
University of Medical Science, Rafsanjan, 4Academic Center
for Education, Culture & Research, Mashhad, Iran
Introduction: Hemorrhagic transformation of brain infarct
(HTBI) is an undesirable complication that occurs in 2.2%44.0% of clinical cases. The pathogenesis of HTBI appears
to relate to reperfusion of bleeding from recanalized but
ischemically injured vessels. Distinguishing HTBI and
parenchymatous haemorrhage on CT may be difficult. On
CT, HTBI appears as a discontinuous heterogeneous
mixture of high and low densities occurring within the
vascular territory of the infarct. In contrast, parenchymatous
haemorrhage appears as a discrete, homogeneous collection
of blood that often exerts mass effect and may extend
beyond the original infarct boundaries or even into the
ventricles.
Methods: Consecutive patients with HTBI admitted in
Ghaem hospital, Mashad during 2010 enrolled in an
observational study. All patients underwent brain CT within
24 hours post event. Presence of intraventricular
haemorrhage, heterogeneous patchy or punctuate
haemorrhage within infarct zone was evaluated by serial
brain CT.
Results: Among 37 patients (16 male, 21 female) with
HTBI that confirmed with serial brain CT-Scan, 7 patients
(18.91%) had intraventricular haemorrhage.
Conclusion: Intraventricular haemorrhage can occur during
HTBI.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
494
Posters, Monday 10 September
P2101
P2102
Risk factors of resistance to
acetylsalicylic acid used in secondary
stroke prevention
A case of cerebral infarction associated
with pseudoaneurysm at the bifurcation
of the left common carotid artery
B. Labuz-Roszak1, K. Pierzchala1, E. Niewiadomska2,
A. Machowska-Majchrzak1, M. Skrzypek2
C.-S. Shin1, G.J. Yoon2
1
2
Dept of Neurology, Medical University of Silesia, Zabrze,
Medical University of Silesia, Katowice, Poland
Introduction: The aim of this study was to evaluate the
prevalence of laboratory resistance to acetylsalicylic acid
(ASA), used for secondary prevention of stroke, including
assessment of risk factors associated with lack of aspirin
antiaggregative action.
Material and methods: The study involved 198 patients
after TIA or ischemic stroke. Assessment of platelet
functions was performed by impedance aggregometry in the
whole blood using a multi-channel platelet function
analyzer (Multiplate). Results of platelet aggregation were
shown as AUC (area under curve).
Results: Reduced sensitivity to ASA was found in 59
patients (29.8%), resistance to ASA in 18 patients (9.1%),
more frequently in chronic phase (p<0.04) and younger age
(p<0.05). In patients with reduced sensitivity and resistant
to ASA mean heart rate (p<0.05) and hematocrit (p<0.05)
were higher. Mean LDL concentration was lower in patients
"sensitive" to ASA (p<0.001). Angiotensin II receptor
antagonists were more often used by people with reduced
sensitivity and resistant to ASA (p<0.05), while diuretics in
this group - more rarely (p<0.05). Mean AUC was lower in
patients treated with fibrates (p<0.01).
Conclusions: The method allowed detecting the
phenomenon of aspirin resistance in some patients after TIA
and ischemic stroke. The association between the prevalence
of ASA resistance and age, duration of therapy, LDL
concentration, heart rate and hematocrit value was observed.
The relationship between the effect of ASA and other
medications (angiotensin II receptor blockers, fibrates,
diuretics) requires confirmation in a larger group of patients.
Neurology, Seogwang General Hospital, 2Neurology,
Gwangju General Hospital, Gwangju, Republic of Korea
1
Background and significance: Occurrence of a tuberculous
pseudoaneurysm extracranially is a rare disease. The
pseudoaneurysm appeared to have resulted from direct
extension of tuberculous lymphadenitis to artery. Because
adventitial infection of the artery weakens the arterial wall,
and gives rise to formation of aneurysm.
Case: A 33-year-old man was admitted to the hospital with
right hemiparesis and dysarthria. Neurological examination
revealed right hemiparesis (MRC grade I/I), conduction
aphasia and right central type facial palsy. For 3 months
prior to onset of neurological symptoms, he was treated
with a combination of anti-TB medication and surgical
therapy (aneurysm wrapping) in tuberculous pseudo­
aneurysm of the left common carotid artery (CCA).
Intravenous recombinant tissue plasminogen activator (IV
rt-PA) was given within 2 hours of stroke onset. Diffusion
weighted MRI demonstrated high signal intensity lesions in
left basal ganglia and temporal lobe. Cerebral angiogram
showed occlusion in the proximal portion of M1 segment of
left middle cerebral artery (MCA). And neck colour Doppler
and digital subtraction angiography (DSA) revealed
thrombosed aneurysm on left common carotid bifurcation
and proximal internal carotid artery. 1 day after IV rt-PA
thrombolysis, right hemiparesis (MRC grade IV+/V) was
improved.
Conclusion: We report our experience with a case of left
basal ganglia infarction due to embolism from a tuberculous
pseudoaneurysm sac that occurred accompanying
tuberculous lymphadenitis in the region of the carotid artery
bifurcation.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
P2103
P2105
Usefulness of MRA-DWI mismatch in
neuro-endovascular therapy for acute
cerebral infarction
Myocardial hypoperfusion in cerebral
autosomal dominant arteriopathy with
subcortical infarcts and leukoencephalopathy (CADASIL)
I. Deguchi, T. Fukuoka, H. Maruyama, H. Nagoya,
Y. Kato, O. Yasuko, Y. Horiuchi, N. Tanahashi
Saitama International Medical Center, Saitama Medical
University, Hidaka, Japan
Background: This study evaluated the usefulness of MRADWI mismatch (MDM) in neuroendovascular therapy over
3 hours after onset of acute cerebral infarction.
Methods: The subjects were 14 cases who had an anterior
circulation deficit on DWI/MRA on arrival and underwent
neuroendovascular therapy over 3 hours after onset.
MDM(+) was defined as “major artery lesion(+) and DWIASPECTS≥6”; MDM(-) was defined as “major artery
lesion(+) and DWI-ASPECTS< 6”
Results: Reperfusion was achieved in 9 of 14 cases with
neuroendovascular therapy. Within the reperfusion group,
in the 5 MDM(+) patients and the 4 MDM(-) patients, the
outcome was a favourable clinical response in the MDM(+)
group. The mRS scores after 90 days were 0-2 in 3 (60%)
and 3-6 in 2 (40%) of the MDM(+) group patients and 0-2
in 0 (0%) and 3-6 in 4 (100%) of the and MDM(-) group
patients. In the MDM(+) group, a good outcome was
achieved. However, the number of cases was small, so this
was not a significant difference. Within the non-reperfusion
group, in the 3 MDM(+) patients and the 2 MDM(-)
patients, the mRS scores after 90 days were 0-2 in 1 (33%)
and 3-6 in 2 (67%) of the MDM(+) group patients and 0-2
in 0 (0%) and 3-6 in 2 (100%) of the MDM(-) group
patients. In both groups, the outcome was poor.
Conclusions: With neuroendovascular therapy, a good
outcome with reperfusion was achieved in the MDM(+)
group compared to the MDM(-) group. This suggests that
the presence or absence of MDM may be useful in
determining prognosis after reperfusion.
495
H. Chang
Neurology, Wonkwang Medical Center, Iksan, Republic of
Korea
Cerebral autosomal dominant arteriopathy with subcortical
infarcts and leukoencephalopathy (CADASIL) is a rare
hereditary small vessel disease characterized by mutations
in the Notch3 gene. Although the symptoms are almost
exclusively neurological, the arteriopathy is generalized.
We hypothesized that vascular and functional abnormalities
may exist in the cardiovascular system, and perform cardiac
evaluation in patients with CADASIL. We studied 3 patients
from two families (2 male/1 female; mean age 41 years).
They were confirmed by the identification of a mutation in
the Notch3 gene. All subjects were examined with
myocardial perfusion imaging using Tc-99m tetrofosmin
SPECT (MPI), echocardiography, electrocardiogram (ECG)
and dual source 128-channel multi-detector CT (MDCT)
angiography. All patients had no history of cardiovascular
diseases. Neither luminal narrowing on MDCT angiography,
nor abnormalities of regional wall motion, chamber and
valvular function on echocardiography was found in all
patients. Left ventricular systolic function and ECG findings
were within normal limit. However, MPI demonstrated
myocardial perfusion abnormalities including reversible
myocardial perfusion defects in 2 patients and reversed
reversible perfusion defects in 1 patient. MPI using SPECT
noninvasively assessed myocardial perfusion abnormalities,
as defined by normal findings on MDCT angiography,
echocardiography and ECG, in CADASIL patients with no
history of cardiovascular disease, and thus MPI may be
deliver important information for identifying myocardial
ischemia and clinical decision making in CADASIL.
P2104
Abstract cancelled
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
496
Posters, Monday 10 September
P2106
P2107
Comparative analysis of fatigue and
fatigability in stroke survivors: a pilot
study
Post-partum reversible cerebral
vasoconstriction syndrome
M.A. Kutlubaev1, L.R. Shafikova2, I.M. Zaitov1,
L.R. Akhmadeeva2
Centre Hospitalier d’Alencon, Alencon, France
Neurology, G.G. Kuvatov’s Republican Clinical Hospital,
2Neurology, Bashkir State Medical University, Ufa, Russia
1
Introduction: Fatigue is a common and debilitating sequel
of stroke. Its’ mechanisms are unknown. Fatigability (or
exertional fatigue) seems to be different from fatigue.
However the relationship between fatigue and fatigability
after stroke needs to be elucidated. The aim of this study
was to explore the relationship between fatigue and
fatigability in stroke survivors.
Methods: We prospectively recruited patients 4-24 months
after any stroke, except for subarachnoid haemorrhage.
Fatigue and fatigability were assessed by Fatigue
Assessment Scale (FAS) and Dutch Exertional Fatigue
Scale (DEFS) correspondingly. We also used Montréal
Cognitive Assessment (MoCA), Hospital Anxiety and
Depression Scale (HADS), modified Rankin Scale (mRS)
to assess cognitive function, the level of anxiety (A) and
depression (D) and functional state of the patients.
Results: We recruited 29 patients, F/M 22/7, ischemic/
hemorrhagic strokes 24/5, median of NIHSS score was 3.
Median FAS score was 22 (max 50); median DEFS score
was 13 (max 45). Patients with clinically significant fatigue
defined as FAS≥22 suffered from more prominent
fatigability then those with no fatigue (p=0.001). There was
a correlation between fatigability and mRS (r=0.6;p=0.000);
NIHSS (r=0.6;p=0.001); MoCA (r=0.6;p=0.001); HADS-D
(r=0.4;p=0.004); HADS-A (r=0.6;p=0.000) scores while
fatigue correlated with HADS-D (r=0.4;p=0.035) and
HADS-A (r=0.3;p=0.017) scores only. We found no
correlation between FAS and DEFS scores.
Conclusion: Our preliminary results support the concept
that fatigue and fatigability in stroke survivors are different
phenomena. Fatigability was related to the severity of
cognitive and physical deficit, and state of mood, while
fatigue was associated with anxiety and depression scores
only.
M. Boulanger, A. Guilbert, J.P. Thenint
Introduction: Reversible cerebral vasoconstriction
syndrome (RCVS) is more frequent than previously thought
and is characterized by severe headaches, generalized
seizures and neurological deficits due to reversible cerebral
vasoconstriction. It can occur either spontaneously or in
association with factors such as vasoconstrictive drugs and
post-partum period. It can be complicated by ischaemic or
hemorrhagic strokes.
Methods: We report the case of a primipara 25-year-old
woman with no medical history, who was 4 days postpartum after an uncomplicated pregnancy when she
developed acute severe headaches and generalized seizures.
She had received no specific treatment during pregnancy or
delivery.
Results: A brain computed tomography (CT) excluded a
subarachnoid haemorrhage and a cerebral venous sinus
thrombosis. Cerebral magnetic resonance imaging (MRI)
showed oedema in posterior and frontal areas with
hyperintensities on diffusion-weighted signal, T2-weighted
signal and fluid-attenuated inversion recovery signal. A
cerebral magnetic resonance angiography (MRA) showed
irregularities of intracerebral arteries. The bilateral middle
cerebral arteries velocities were accelerated on transcranial
Doppler ultrasonography. There were no biological
abnormalities. The outcome was favourable in the following
days with Levetiracetam and Nicardipine. The radiological
abnormalities were normalized within 12 weeks.
Conclusion: RCVS is probably underdiagnosed but should
be kept in mind in severe acute headaches because of the
potential fatal consequences. The exact pathophysiology
and the risk of recurrences are not well-known.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
497
P2108
P2109
Motor unit number estimate and
electromyographic changes after a stroke
Knowledge of stroke, in stroke patients’
caregivers one month after stroke in
Tehran City
I. Kouzi, E. Trachani, J. Ellul, E. Chroni
Department of Neurology, University of Patras, Patras,
Greece
Introduction: The consequences of suppressed central
drive upon lower motor neurons muscles complex after a
stroke have not been clearly defined. The purpose of this
study was to identify possible neuromuscular re-organization
in stroke patients.
Methods: 37 patients (27 males; mean age ±SD,
61.00±13.16 years), with unilateral paresis after cerebral
infarction participated in this study and their abductor digiti
minimi muscle was examined bilaterally: (i.) Motor unit
number estimate (MUNE) by applying the adapted multiple
point stimulation method and calculating summated and
mean single-MUAP (S-MUAP) area, (ii.) multi-motor unit
potentials (MUP) analysis, which included measurements
of amplitude, mean duration and size index (SI) of mean
simple, mean polyphasic and total MUPs.
Results: Significantly different findings in the paretic side
compared to the healthy side were: MUNEs: mean±SD,
211.87±86.70 vs. 352.51±156.71 (p<0.001) and S-MUAP
area: 80.06±32.12 vs. 57.224±17.824 (p<0.001). 7 patients
showed spontaneous electromyographic activity in the
paretic hand. In the Multi-MUP analysis the only statistical
significant differences between the paretic and healthy side
were the percent of polyphasic MUPS (mean 18.19% vs.
12% respectively, p=0.004) and the SI of simple MUP
(mean 1.27 vs. 1.96, p=0.001).
Conclusion: The smaller-than-normal MUNE implying
functional loss of motor units which, however in
electromyography showed no specific changes indicative of
reinnervation. These findings advocated against a
preferential effect of pyramidal syndrome on particular
groups of anterior horn cells.
N. Beladimoghadam1, R. Rezai2
1Neurology, 2Shahid Beheshti University of Medical
Sciences, Tehran, Iran
Background: Secondary prevention of stroke has been
shown to dramatically reduce stroke recurrence. knowledge
about stroke has not been studied among patients’ care
givers in Iran.
Objective: This study has been carried out to determine the
knowledge level of stroke patients’ caregivers about stroke
1 month after cerebrovascular accident (CVA).We define
caregiver as a close family member whose role is caregiver
in the first month of event (an amateur caregiver).
Method: We chose 6 hospitals from 6 parts of Tehran
metropolitan with different socio economic conditions and
contacted patients’ caregivers by phone from hospital admit
note. We called 256 patients’ caregivers 1 month after CVA
and asked 9 questions about stroke definition, risk factors,
symptoms, related drugs, rehabilitation role, and prognosis.
Statistical methods: To describe data we used
Mean±Standard deviation, median (range), frequency (%).
To evaluate the relation of parameters with the level of
knowledge we employed, Mann-Whitney and KruskalWallis test as well as Spearman correlation. All statistical
analysis was performed using SPSS Software (Version 17.0,
SPSS Chicago, IL).
Results: Deficiency in care givers stroke knowledge was
found. 32.4% of responders had poor knowledge about
stroke and 57.8% had moderate knowlege. Only 9.8% of
responders had good stroke knowledge. No one had
excellent knowledge. In risk factors most persons pointed to
hypertension (50%). Most responders mentioned
hemiparesis as a stroke symptom (57%).
Conclusions: Most responders had a weak level of
knowledge and awareness thereby putting patients at high
risk for recurrent stroke.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
498
Posters, Monday 10 September
P2110
P2111
The relationship between serum protein
s100B levels and lesion type and size in
acute cerebrovascular diseases
The relationship between hemorrhagic
transformation and use of acetylsalicylic
acid alone or combined with enoxaparin
in patients with acute ischemic stroke
M. Alpua1, N. Oztekin1, F. Ak1, F. Bakır2
1Neurology, 2Biochemistry, MOH Ankara Numune Education
and Research Hospital, Ankara, Turkey
Objective: The aim of the study is to access whether there
is a relationship between lesion type and size and serum
protein s100B levels in patients with acute ischemic stroke.
Method: 62 patients with acute cerebrovascular accident
were enrolled to the study. 26 healthy age matched people
are used as controls. Serum samples of the patients were
obtained within 24 hours after admission. All the patients
were divided into ischemic and hemorrhagic groups
according to the type of lesion confirmed by CT and/ or
MRI. The group with ischemic lesions are analysed by
dividing into 3 groups according to lesion localisation and
size as TACI, PACI and POCI with Bamford classification.
Results: In our study we found no statistically significant
differences between levels of protein S100 B levels both in
hemorrhagic and ischemic stroke groups. When analysed in
terms of localisation and volume we found a statistically
significant difference both in ischemic and hemorrhagic
groups in terms of S100B levels when compared to normal
controls.
Conclusion: The results of our study revealed that serum
S100 B levels can be used as an indicator of brain injury
after ischemic and hemorrhagic stroke and can be useful to
a certain extent about the lesion type, volume and
localization. But more studies are required about this
relationship to make an accurate deduction.
S. Mungan, N. Oztekin, M.İ. Yön, S. Balcı, F. Ak
Neurology, MOH Ankara Numune Education and Research
Hospital, Ankara, Turkey
Objective: Hemorrhagic transformation is one of the most
frequently encountered complications during acute ischemic
stroke treatment. The aim of the study is to evaluate if there
is a positive correlation between risk of hemorrhagic
transformation and treatment with acetylsalicylic acid
(ASA) 300mg/d alone or ASA and enoxaparin in patients
with acute ischemic stroke and to analyse if there is an
additive effect of combined therapy in hemorrhagic
transformation.
Method: Medical records of patients with acute ischemic
stroke in our hospital were reviewed and 1765 patients who
received ASA alone or combined with enoxaparin were
enrolled. Demographic characteristics of the patients, risk
factors, treatments they received, hemorrhagic
transformation and gross haemorrhage are all evaluated.
Results: Among the evaluated 1765 patients there was 65
(3.6%) hemorrhagic transformation and gross haemorrhage.
When this group is realanalysed 88% of the 65 patients had
hemorrhagic transformation, 12 % had gross haemorrhage.
53 % of the patents who had hemorrhagic transformation
gross haemorrhage received enoxaparin only, and the event
occurred within 10 days of the accident in 78% of the
patients , whereas after 10 days in 22%. 10% of the patients
received ASA only, 20% received ASA enoxaparin
combination and 3% received both ASA and clopidogrel.
Conclusion: The results of our study revealed that
enoxaparin alone or combined with ASA was not associated
with a high frequency of hemorrhagic events. Further
studies with larger series will be helpful to enlighten the
safety of enoxaparin ASA combination after acute ischemic
stroke.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
P2112
P2113
Survival and length of stay in neurology
intensive care unit (NICU) in patients with
acute stroke in basilar (BA) and medial
cerebral arteries (MCA) areas
Determinants of quality of life in stroke
survivors
I. Berisavac, P. Stanarcevic, O. Savic, D. Jovanovic,
V. Padjen, M. Budimkic, L. Beslac Bumbasirevic
Emergency Neurology Department, Clinical Center of
Serbia, School of Medicine, University of Belgrade,
Belgrade, Serbia
Background: Stroke is one of the leading causes of death.
Neurologic deficit severity impacts prognosis and survival.
Aim: Comparison of survival, complications and length of
stay in NICU between patients with an acute stroke in either
BA or MCA area.
Methods: Prospective, observational, single-center study
was done on consecutive 69 acute stroke patients allocated
in groups depending on area of irrigation, group 1: BA (30
patients, 23 males); group 2: MCA (39 patients, 24 males).
Age, Glasgow coma scale (GCS), The National Institute of
Health Stroke Scale (NIHSS), complications as mechanical
ventilation (MV), infections, acute kidney injury (AKI),
acute myocardial infarction (AMI), length of stay in NICU
and survival were compared among groups.
Results: Age was similar in both groups. Women were
older than men only in group 1 (71.1 vs. 57.2, p=0.0046).
At the admission into NICU, GCS was lower in group 1
than 2 (8.16±3.92 vs. 10.85±5.37, p=0.025) and NIHSS was
greater (28.79±11.38 vs. 19.17±9.88, p=0.0006). In each
group 16 patients were on MV (p=0.44). Complications
occurred similarly in both groups: infections, AKI, AMI (all
p>0.05). Group 1 had a longer length of stay in NICU
(12.6±20.4 vs. 6.9±5.8,p=0.17), hospitalization duration
(18.9±24.4 vs. 12.8±9.2, p=0.13) and greater NIHSS at
dismissal from hospital (14.12±13.55 vs. 10.46±7.07,
p=0.38). Survival was similar in both groups (53% vs. 46%,
p =0.73)
Conclusion: Acute stroke in region of BA was more severe.
No significant difference in complication rate, NICU length
of stay and survival was found in comparison to stroke in
MCA.
499
J.M. Ramirez-Moreno1, A. Ollero-Ortiz1,
F. López Espuela2, J.C. Portilla Cuenca2,
T. Gavilán Iglesias2, M.J. Gómez Baquero1,
J.D. Pedrera Zamorano3, P.E. Jimenez Caballero2,
I. Casado Naranjo2
1Neurology, Stroke Unit, Hospital Universitario Infanta
Cristina, Badajoz, 2Neurology, Stroke Unit, Hospital San
Pedro de Alcántara, 3Nursing, Universidad de Extremadura,
Cáceres, Spain
Introduction: In the social model of stroke, health-related
quality of life (HRQoL) is a complex interplay between
stroke severity, social support and health-promoting
behaviours. Assessment of HRQoL in stroke survivors
should be multidimensional.
Objective: To identify the main determinants of HRQoL in
stroke survivors.
Methods: Ischemic stroke patients treated in a stroke unit
in the acute phase were evaluated at 6 months with the
SF-12 Health Survey. SF-12 included 8 domains. Physical
(PCS) and Mental Health (MCS) Summary Scores were
computed. Multivariate stepwise regression analyses were
conducted to determine independent predictors of these
scores. Age, gender, socioeconomic class, education,
residence area, social support (Gijón score), previous
comorbidity (Charlson index), previous stroke, side of
stroke, NIHss at admission, Barthel index (BI) and
modified-Rankin scale (mRS) at discharge, and length of
stay were included in the models.
Results: 131 patients were assessed (mean age: 70.1(12.5);
62.6% males). At 6 months approximately one third (33.6%)
had a BI score <90 and mRS>2 (poor outcome). PCS mean
(SD) score was 39.46 (9.3) and MCS mean (SD) was
34.86(10.1). PCS decreased in female, poor social support,
Charlson index and BI (β=0.204, p=0.009; β=-0.225,
p=0.003; β=-0.162, p=0.032; and β=0.384, p<0.0001,
respectively). MCS decreased in female, NIHss, and BI
(β=0.162, p=0.062; β=-0.265, p=0.019; and β=0.203,
p<0.071, respectively).
Conclusions: The stroke severity, disability, gender, social
support and previous-stroke comorbidity have a significant
negative impact in physical and mental domains of generic
HRQoL.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
500
Posters, Monday 10 September
P2114
P2115
Carpal tunnel syndrome and intima-media
thickness
Analysis of the medical literacy of a
Moscow regional population and
stratification of the stroke risk
J.Y. Kim1, J.H. Park1, J.H. Lee2
1Neurology, Sanggye Paik Hospital, Inje University College
of Medicine, Seoul, 2Neurology, National Health Insurance
Corporation Ilsan Hospital, Ilsan, Republic of Korea
Introduction: Carpal tunnel syndrome (CTS) is the most
common nerve entrapment. Some evidence exists on the
role of atherosclerosis risk factors such as obesity, smoking,
hypercholesterolemia and metabolic syndrome in CTS. In
this study, we measured the values of the carotid intimamedia thickness (IMT), a surrogate marker of early
atherosclerosis, in patients with CTS and compared them
with the control group in order to evaluate the risk of
atherosclerotic disease.
Methods: Between January 2011 and December 2011,
patients presenting CTS were screened for study enrolment.
For the study, the maximum IMT was measured by
intimascope. Demographic factors and the prevalence of
conventional atherosclerosis risk factors, and potential
confounders were also evaluated.
Results: During the study period, 74 patients were enrolled
for the CTS group and 64 patients for the control group.
There were no significant differences in the demographic
and laboratory findings between the CTS patients and
controls (p>0.05). However, the mean value of the
maximum IMT in the CTS patients was significantly higher
than that in controls (0.995 mm±0.174 in CTS patients,
0.904 mm±0.151 in controls, p=0.001).
Conclusion: The current study may support the role of
atherosclerosis and its risk factors in the etiology of CTS.
Our findings suggest that CTS may be a manifestation of
atherosclerosis, or that both conditions may have common
risk factors. Further studies focusing on clinical outcomes
are required to assess the relationship between
atherosclerosis and CTS.
E. Vereshchagina, E. Isakova, S. Kotov
Department of Neurology, M.F.Vladimirsky Moscow
Regional Clinical and Research Institute, Moscow, Russia
Introduction: Stratification of the stroke risk based on
the expression of the risk factors (RF) is an important
step of the prophylactic strategy. Not the least of the
factors is the medical literacy of the population including
knowledge about the risk factors.
Materials and methods: A total of 108 (mean age 70.5±5.1
years) was examined.
Results: An automated program “Assessment of the stroke
risk” which was validated during the mass screening of a
Moscow regional population was used for risk stratification.
A high risk of stroke was determined in 69.5%, mean risk
- in 23.1% and low one -in 7.4%. Patients were asked about
the factors of stroke risk and their measures to control them.
60.2% answered that they regularly controlled and regulated
arterial blood pressure (ABP), but in 27 cases elevated AP
>140/90 mm Hg was noted. Only 60.2% annually underwent
ECG measurement and were aware of their cardiac
pathology. Control of glucose level in blood and taking
antidiabetes mellitus drugs if necessary were done in 71.3%.
Only 34.3% were aware of their cholesterol blood level and
controlled it. Only 4.6% were aware of body mass index
(BMI), but investigation gave BMI >25 kg/m2 for 83.3%
women and 53.4% men.
Conclusion: More than a half of patients have a high risk
of stroke. The awareness of patients of their role in
development of stroke and of the ways of its correction was
extremely low. It is indicative of the necessity to elevate
medical literacy of the people.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
501
P2116
P2117
Analysis of intravenous recombinant
tissue plasminogen activator therapy
combined with edaravone treatment
Unilateral cerebral deep vein thrombosis
mimicking thalamic mass lesion
Y. Takahashi, D. Fujii, H. Narai, N. Omori, Y. Manabe
1Neurology, MOH Ankara Yildirim Beyazit Education and
Research Hospital, 2Neurology, MOH Ankara Numune
Education and Research Hospital, Ankara, Turkey
Purpose: This study aimed to evaluate the availability of
edaravone (radical scavenger) treatment in patients with
acute ischemic stroke treated with intravenous recombinant
tissue plasminogen activator (rt-PA).
Methods: We classified 73 consecutive patients (43 male
and 30 female patients, mean age 71 years) treated with
intravenous rt-PA between October 2005 and September
2011. They were seperated into 2 groups (Group 1 was
combined with edaravone treatment, Group 2 was not
combined with edaravone treatment), and we retrospectively
compared the risk factors, NIH Stroke Scale (NIHSS) on
admission, upper or lower extremities NIHSS on admission,
upper or lower extremities NIHSS seven days after onset,
frequency of intracranial haemorrhage, and modified
Rankin Scale (mRS) 3 months after onset between the both
groups. A total of 66 patients belonged to Group 1 (40 male
and 26 female patients, mean age 71 years old), 7 patients
belonged to Group 2 (3 male and 4 female patients, mean
age: 74 years old).
Results: On admission, upper extremities NIHSS 7 days
after onset, frequency of intracranial haemorrhage, and
mRS 3 months after onset were significantly less severe in
Group 1 versus Group 2 (1.5±1.6, 3.0% and 2.0±2.0 vs.
2.6±0.8, 28.6 % and 4.5±0.6; p<0.05, p<0.05 and p<0.01,
respectively).
Conclusion: Intravenous rt-PA treatment combined with
edaravone improves the severity of stroke to a greater extent
than not combined with edaravone. This suggests that the
management of stroke may be improved with rt-PA therapy
combined with edaravone treatment by protecting
neurovascular unit.
Introduction: Unilateral deep vein thrombosis (DVT) is a
very rare but serious syndrome and the diagnosis is often
challenging due to variable clinical signs especially in
patients younger than 50 years. Thalamic tumour or abscess
is included in differential diagnosis. Interpretation of
clinical and radiological signs is the hallmarks correct
diagnosis .
Method: A 45-year-old female was admitted with numbness
in the left side of her face and mild left sided weakness with
persisted for a week. The patient was diabetic, with a
10-year history of hypertension. Her physical examination
was normal and her blood pressure was 200/100mm Hg. On
her neurological examination she had left sided central type
facial paralysis, left-sided mild hemiparesis with brisk
tendon reflexes and left Babinski sign. CT showed left
thalamic hypodense lesion. She was admitted to hospital for
further evaluation.
Results: The patient was evaluated including vasculitic
tests, hormone screening, and D-Dimer which revealed
mild elevation. Radiological tests including cranial MRI
with thalamic hyperintense T2 lesion, MR spectroscopy,
MR angiography, and echocardiography were done. DVT
was diagnosed following these tests. She completely
recovered after antiedemateous and antithrombothic
treatment. Her cranial MRI after the second month showed
minimal hyperintensities on left thalamus.
Conclusion: Unilateral deep thalamic venous infarcts are
difficult to diagnose in the absence of haemorrhage and they
must be kept in mind in the differential diagnosis of tumours
to avoid unnecessary surgical intervention.
National Hospital Organization Okayama Medical Center,
Okayama, Japan
M.F. Oztekin1, N. Oztekin2
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
502
Posters, Monday 10 September
P2118
P2119
Thrombolysis of acute ischaemic stroke
in the presence of sphenoid sinus tumour
"Scrape basilar syndrome": report of 3
cases
L. Al-Dhahir, G. Abdulla
L. Mohanna, C. Homedes, A. Paipa, L.M. Cano,
H. Quesada, P. Cardona, F. Rubio
Medicine, BHR University Hospitals, Queen’s Hospital,
London, UK
We report the case of a 75-year-old gentleman who
presented with right ischemic stroke and had successful
thrombolysis treatment without secondary haemorrhage
which was confirmed by repeated head CT postthrombolysis. The head CT showed moderately enlarged
pituitary fossa with polypoid mucosal thickening in the
sphenoid sinus. Further evaluation with MRI pituitary and
head revealed widening of the Sella tucica, with soft tissue
thickening along the floor and a large lobulated neoplastic
mass in the region of sphenoid sinus. Although thrombolysis
was an absolute contraindication in this patient in view of
possible malignant tumour in the base of skull, the patient
had full recovery from the stroke with no bleed in the
tumour, he declined biopsy from the tumour and he was
independent at 6 months follow-up.
Neurology, Hospital Universitari de Bellvitge, Barcelona,
Spain
Introduction: "Scrape basilar syndrome" is considered a
prolegomenon of a top of the basilar stroke. Defined by
acute infarct with progressive symptoms of brainstem,
cerebellum and occipital lobes as basilar thrombosis
sequentially occludes PICA, AICA, SCA, perforators of
brainstem, PCA; often bilateral or alternating sides. They
usually end with complete occlusion of the basilar artery,
top of the basilar syndrome and infarct.
Methods: Report of 3 cases of “scrape of the basilar
syndrome”.
Results: 1st case: a 65-year-old male HTN, hospitalized for
blurred vision, facial palsy and instability. Angio-CT scan:
thrombus left vertebral artery. Neurologic exam: bilateral
III, right VII palsies. Angio-MRI: dolichoectasia of basilar,
thrombus in the basilar and left vertebral artery, acute
infarct both PICA, left mesencephalic, bilateral thalamus.
NIHSS 0, mRS 1 at discharge. Two months later he passed
away from a top of the basilar stroke.
2nd case: a 75-year-old male HTN, APKD, hospitalized for
dysarthria, diplopia, and left-sided lateralization. CT scan:
basilar dolichoectasia with aneurysm of the basilar and right
PCoA. Angio-MRI: bilateral anterior mesencephalic and
thalamic infarcts. NIHSS 1, mRS1 at discharge.
3rd case: a 62-year-old male HTN, DMNID, DLP
hospitalized for one-and-half syndrome. CT scan: right P1
thrombus; thrombectomy was performed with vessel
permeabilization. Control CT scan: infarcts of both PICA,
left mesencephalic, thalamic and PCA arteries. Days later
top of the basilar syndrome ensued; MRI: previous infarcts
documented plus bilateral SCA.
Conclusions: Although an underreported syndrome in
vascular neurology, "scrape basilar syndrome" is of
paramount to recognize for its devastating outcomes;
complete vascular study is indispensable.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
503
P2120
P2121
Influence of the arterial pressure control
before stroke upon the peculiarities of its
course and outcome
Computed stabilometry in complex
rehabilitation of patients with the
consequences of cerebral stroke
M. Romanova, I. Kolchu
M. Romanova, E.V. Isakova, S.V. Kotov
Introduction: Arterial hypertension (AH) is one of leading
risk factors of stroke. Preventive efficiency of antihypertensive therapy is well known.
Methods: The total of 188 AH patients (mean age 69±0.84
years) were examined in the acute period of stroke: 81
(43.09%) men and 107 (56.91%) women. According to their
predilection for anti-hypertensive therapy administered
before stroke, all patients were divided into 3 groups (those
who received therapy regularly, who never received or who
received it irregularly).
Results: The majority of patients before stroke received
anti-hypertensive therapy irregularly (46.3%) or never
received it (25%). Among patients who regularly took
preparations to treat AH before stroke, only 24.1% reached
the target levels of systolic AP and 55.5% - the target levels
of diastolic AP. Predilection for anti-hypertensive therapy
before the stroke didn’t demonstrate its reliable influence on
the outcome. In all 3 groups, patients with a mean disease
severity prevailed. Lethality of the 60-74-year-old patients
was higher (р<0.001) in those who did not receive antihypertensive therapy before stroke or received it irregularly
(р<0.05).
Conclusion: So, regular anti-hypertensive therapy
decreased the lethality of the 60-74-year-old patients in the
acute disease period when compared to those who did not
take anti-hypertensive drugs or took them irregularly, the
initial disease severity being comparable but associated
with less complications and concomitant diseases
One of the methods to improve rehabilitation of patients
with stroke consequences is including balance simulators
based on principle of biological feedback into complex
rehabilitation program.
Objective: Assessing the efficiency of balance training on
the stabilometric platform in complex rehabilitation of
patients with stroke consequences.
Materials: The study involved 30 patients (19 women and
11 men aged 55.3±6.7 years) with cerebral stroke: 80% of
patients were admitted to the hospital in the late restoration
period and 20% in the residual one. In addition to physical
training, physiotherapy, and axial loading using special
training suit, the patients underwent training on stabilometric
platform "Stabilotrainer-ST-150".
Results: Initial stabilometric investigation showed
asymmetry of the basic stand, deviation from the pressure
center (PC) to the healthy extremity in the frontal plane.
With closed eyes, PC deviations in Romberg’s pose
increased along both axes. The square of statokinesiogram
increased 1.5-2.0-fold as compared to the norm (initial
values ranged from 278.3mm2 to 748.5mm2). In the end of
the course, according to stabilometric data, decrease of
initially elevated PC deviations was noted along X-axis by
15.5% (-41.8; 31.8)% (р>0.05). PC deviations along Y-axis
changed insignificantly (from 12.8mm to 12.1mm)
(р>0.05). Statokinesiogram square decreased 1.8 fold.
Conclusion: Training on stabilometric platform in complex
rehabilitation of patients with stroke consequences increases
vertical pose stability and improves supporting capacity of
injured extremity.
Department of Neurology, M.F.Vladimirsky Moscow
Regional Clinical and Research Institute, Moscow, Russia
Department of Neurology, M.F.Vladimirsky Moscow
Regional Clinical and Research Institute, Moscow, Russia
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
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P2122
P2123
Inhabitual cause of stroke: Rendu-WeberOsler’s disease with extracardiac shunt
Platelet haemostasis parameters in
patients with different variants of
ischemic stroke
M. Boix1, C. Gonzalez1, F. Purroy1, M. Vilà2
1Neurology, 2Pneumology, Hospital Universitari Arnau de
Vilanova, Lleida, Spain
Introduction: Right-to-left shunt is a not uncommon source
of stroke, usually associated with major stroke in young
people due to obstruction of large intracranial arteries by
paradoxical embolism of venous origin, usually a lower
limb DVT. Patent foramen ovale is the major cause of R-L
shunt, with extracardiac communication being a very rare
embolism source. Rendu-Weber-Osler’s disease (RWO) is
associated to the existence of extracardiac shunt. We
describe one of such cases
Methods: A woman of 43 years affected with RWO disease
and ferropenic anaemia secondary to digestive telangiectasic
bleeding was admitted to our service after suffering a stroke
in left MCA territory. MRI angiography confirmed MCA
proximal occlusion and the Doppler vascular study showed
normal vessels with R-L shunt. Transoesophagic
ECOcardiography was normal. Contrast enhanced thoracic
CT scan confirmed a venous-arterial fistula and submassive
bilateral pulmonary thromboembolism.
Results: Heparin treatment was started before endovascular
embolisation of the fistula, which was successfully closed.
Doppler study ruled out DVP. The search of other sources
of embolism revealed an underlying renal neoplasm (clear
cell renal carcinoma) causing an hypercoagulative state.
Conclusion: The existence of a pulmonary fistula should be
considered in patients with Doppler demonstrated R-L
shunt without cardiac sept anomalies, especially if a familial
or personal history of RWO symptoms is present.
V. Goldobin, E. Klocheva, T. Vavilova, O. Sirotkina,
A. Laskovets, B. Bibulatov, P. Asadullaeva, M. Topuzova
North-West State Medical University n.a. I.I.Mechnikov,
Saint Petersburg, Russia
Introduction: Antiplatelet therapy is an obligatory part of
secondary prevention of atherothrombotic and lacunar
strokes. The platelet haemostasis study is essential for such
patients.
Patients and methods: 41 patients with atherothrombotic
stroke (26 men, 15 women, mean age - 66.0±9.4 years), 42
patients with lacunar stroke (22 men, 20 women, mean age
- 63.0±11.6 years) were examined during the acute stage.
The control group included 18 healthy persons. The
neurological examination, brain CT or MRI, duplex
scanning of brachiocephalic arteries, routine laboratory
investigation, flow cytometry for detection of GPIIb/IIIa,
P-selectin and GP1bα upon the platelet surface, molecular
genetic investigation of point mutation of GP1bα gene
(с.3550С>T) were performed.
Results: Significant decreasing of mean platelet volume on
day 10 of the disease comparing with the data at admission
was revealed in patients with lacunar stroke (11.0±4.4 fl vs.
8.7±1.0 fl, p<0.05). There was platelet activation
according to P-selectin expression in patients with both
atherothrombotic and lacunar infarction, compared with the
control group (p<0,05). The hyperexpression of GPIIb/IIIa
in patients with lacunar stroke was associated with
concurrent leucoareosis. The density of GP1bα in patients
with atherothrombotic, lacunar infarction did not differ
significantly from the control group (4.0±1.3, 4.1±1.2 and
3.8±1.6, respectively; p>0.05) There was significantly
increased frequency of GP1bα gene с.3550С>T mutation in
patients with atherothrombotic stroke (p<0.05).
Conclusions: The difference of platelet characteristics was
revealed in patients with atherothrombotic and lacunar
strokes. The specific antiplatelet therapy may be indicated
for such groups of patients.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
P2124
The impact of baroreceptor reflex
sensitivity (BRS) in cerebral ischemic
stroke (iCI), arterial hypertension (AH) and
coronary artery disease (CAD)
D. Bartko1, P. Blazicek2, Z. Gombosova1, L. Bubelkova3,
L. Danihel4, F. Rusnak5, J. Fabcin6, I. Combor1,
K. Kubovicova4, J. Kubala7, E. Kurca8, V. Nosal8,
K. Zelenak9
1Institute of Medical Sciences, Neurosciences, Military
Health, Central Military University Hospital, Ruzomberok,
2Division of Clinical Biochemistry, Alpha Medical Company,
Bratislava, 3Dept. of Neurology, 4Dept. of Radiology, 5Dept.
of Vascular Surgery, 6MRI Center, 7Institute of Clinical
Biochemistry, Immunology and Alergology, Central Military
University Hospital, Ruzomberok, 8Dept. of Neurology,
9Dept. of Radiology, Comenius University, University
Hospital, Martin, Slovak Republic
Introduction: There does not exist sufficient explanation,
regarding changes in BRS (POST HOC or PROPTER
HOC), and impact of contributing factors. Is impaired BRS
associated with bilateral carotid atherosclerosis (CA) or
not? This study wants to contribute to these controversies.
Aim:
1. To evaluate significance of BRS in pts with AH, iCI, and
CAD.
2. To correlate BRS changes with HRV, stiffness, IMT, and
plaque morphology.
Material and methods: 614 subjects divided into four
groups: 1. healthy controls (CI,n=157 ), mean age 50.72±11.3,
men 43.07%, BMI=23.9±4.4,without history of stroke,
2. arterial hypertension (AH, n=228), mean age 65.07±11.2,
men 42.3%, BMI=29.2±4.8,
3. coronary artery disease (CAD, n=70), mean age 67.3±7.5,
men 42.5%), BMI=28.8 ±3.8,
4. ischemic cerebral infarction (iCI, n=159), mean age
66.8±10.7, men 52.7%, BMI=27.6±4.5, NIHS, mRS,CT/MRI
(volume), USG, lipid spectrum, inflammation markers, other
biochemical/haematological parameters, ECG/BP monitoring.
BRS measured by Finometer (FInapress,Amsterdam), HRV
(VarCor F7-CR), LP-PLA2 activity (dia Dexuss CA,USA),
Carotid-femoral PWV, aortic augmentation index
(SphygmoCor, AtCor, Sydney), Statistics: PearsonSpearman-Kandell, Student, Whitney U tests. Prospective
multicenter, multidisciplinary study.
Results: The changes in median BRS are age related, the
lowest values in oldest group (p<0.0001). Median BRS
significantly lower in all three groups (AH, CAD, iCI) with
lowest values in CI, comparing to controls (4.41±2.5 vs.
7.01±2.26, p=0.0001). LP-PLA2 significantly higher in all
groups with lower activity in AH, comparing to controls
(p=0.0002), PWV (m/sec), Aix (%), IMT (mm), plaque
morphology showed significant higher values in all patient
groups comparing to controls (IMT:0.802±0.237mm vs.
0.651±0.106mm, p=0.0001). Statistically significant
inverse relationship between changes of arterial wall and
BRS was observed in all patient groups (-0.52, p<0.001).
505
Conclusions:
1.The largest prospective multidisciplinary, multicenter
study regarding BRS comparing to HRT, BPV and changes
of carotid arteries. The study showed:
2. Statistically significant decrease in BRS, HRV, and
increase in aortic PWV, augmentation index, IMT in all
groups was observed comparing to controls.
3. Study documented inverse relationship between decrease
values in BRS and increase of pathological changes of
carotid arteries.
P2125
Simultaneous TCD changes and
“suppression burst” EEG during carotid
endarterectomy
L.Z. Katona1, A. Verma2
1University of Debrecen Medical and Health Science Center,
Debrecen, Hungary, 2Clinical Neurophysiology Program
Department of Neurology, The Methodist Neurological
Institute, Houston, TX, USA
Carotid endarterectomy (CEA) is a treatment for
symptomatic carotid stenosis. During CEA, monitoring
cerebral blood flow by Transcranial Doppler (TCD) and
brain activity by electroencephalography (EEG) can
identify intraoperative ischemia development. A 67-yearold female was diagnosed with severe symptomatic stenosis
(90%) in her right carotid artery and 50% stenosis in her left
carotid artery. The patient underwent right CEA with
general anaesthesia and intraoperative TCD and EEG
monitoring. Medial Cerebral Artery (MCA) flow signals
were identified bilaterally using TCD system (Spencer
Technologies, Seattle, WA) for continuous monitoring. A
16-channel EEG (Nicolet, CareFusion, Madison, WI)
recording was started before induction and terminated after
extubation. Induction was achieved with iv. propofol and
fentanyl. Baseline EEG showed continuous background
while TCD confirmed a blunted waveform on the right
MCA. [Mean Flow Velocity (MFV): 36, Pulsatility Index
(P.I.): 1.5]. Additional fentanyl injection resulted in short
burst suppression episodes on EEG and continued to appear
for 2-4 seconds throughout CEA. Simultaneously, velocity
fluctuation in the MCA (MFV range: 40-50 cm/s, P.I. range:
0.6-0.8) was recorded contralateral to the operated side.
Velocity on the CEA side was constant and improved after
the clamp was released (MFV increased from 36 to 80 cm/s,
and, P.I. decreased from 1.5 to 0.9). The patient made an
uncomplicated recovery after CEA. Since these waveforms
were noted from initiation until termination we concluded
that the applied anaesthetics were responsible for the EEG
changes. Unexpected TCD changes could result from intact
autoregulation on the contralateral side but not on the CEA
side.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
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P2126
P2127
Ethiopathogenetic subtypes of transient
ischemic attacks: features of neurological
clinics, haemodynamics and treatment
The thrombin-induced proliferation of
astrocytes is regulated by activated
protein C
O.Y. Fartushna
L. Gorbacheva1, A. Ivanova1, G. Reiser2, V. Pinelis3,
S. Strukova1
Neurology, Bogomolets National Medical University, Kiev,
Ukraine
Nearly half of all strokes occur within the first 2 days after
a TIA. This is a critical issue because treatment depends
upon accurately identifying the cause of symptoms.
Aim is to increase the efficiency of stroke secondary
prevention by study pathogenetic approach to the
management of TIA patients and improving patient
supervision schemes.
Methods: The complicated clinical-neurological, Doppler
ultrasound and neuroimaging examination of 178 patients
with a confirmed diagnosis of TIA. Development of stroke
was considered the primary endpoint. Observation period
was 2 years.
Results: The following ethiopathogenetic TIA subtypes are
distinguished and described (copyright # 38268, 2011):
atherothrombotic (ATR), cardioembolic (CE), lacunar
(LAC) and one which cannot be exactly determined for the
lack of prevailing mechanisms or presence of some equal
causes (UD). The duration and reversibility of neurological
deficits in different subtypes of TIA was different: at ATR
- 137.34±17.39min, CE - 235.22±19.01min, LAC 48.26±7.99min, UD-86.15±9.92min (р<0.05). We have
described the haemodynamics disorders in patients with
TIA the severity of which depends on TIA subtype (р<
0.05). The 2-year analysis of a re-TIA/stroke risk has shown
that the risk, dynamics and correlation of their frequency
differ and depend on subtypes of a primary TIA as well as
presence of an acute ischemia on neuroimaging results.
Stroke occurred most in patients after ATR (56.0%) and CE
(54.5%) TIA.
Conclusions: The duration and volume of the neurological
deficit as the haemodynamics disorders and stroke risk
depended on TIA subtype and were much higher in patients
with CE and ATR TIA.
Lomonosov Moscow State University, Moscow, Russia,
Institut für Neurobiochemie Medizinische Fakultät der Ottovon-Guericke Universität, Magdeburg, Germany, 3Scientific
Centre for Children’s Health RAMS, Moscow, Russia
1
2
Recently neuroprotective effects of activated protein C
(APC) on stressed neurons, hypoxic brain endothelium has
been found and APC may be useful in therapy of stroke
(Gorbacheva et al 2009, Zlokovic et al, 2005). However, the
participation of APC in regulation of astrocyte function is
not clear. Thrombin (Th) promotes cell proliferation, which
correlates with astrogliosis (Nicole et al., 2005). S100B
protein express in high abundance and release by astrocytes
(Sen and Belli, 2007), and abnormally elevated levels of
S100B contribute to prominent reactive gliosis. The
influences of APC on the thrombin-induced proliferation of
astrocytes are in a focus of our research.
Methods: Confocal microscopy, Western blot methods and
MTT-assay of the cultured astrocytes at Th-induced toxicity
and pre-treatment with APC were used.
Results: Fluorescence immunostaining revealed that
expression of S100B was higher in cells that received the
continuous application of 50nM thrombin (20h) than in
untreated control astrocytes. Pre-treatment and
co-incubation of astrocytes with 1nM APC led to decrease
of S100B level. In agreement with the previous studies, an
MTT assay indicated that cells treated with 50nM Th (20h)
proliferate 25% as much as cells grown in 10% foetal
bovine serum (the positive control). Pre-treatment with
1nM APC prevented Th-induced astrocytic proliferation.
Thus APC has not only neuroprotective effects but also can
prevent the activation of astrocytes and astrogliosis during
pathological condition. Our results demonstrate new aspects
of APC as a protective agent for brain at trauma and
neuropathology.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
507
P2128
P2129
Subarachnoid haemorrhage caused by
cerebral venous thrombosis
Ultrastructural characteristics of bloodbrain barrier breakdown at acute
endotoxemia
C.K. Ha, H.-K. Park
Department of Neurology, Inha University Hospital, Incheon,
Republic of Korea
Background and aims: Cerebral venous thrombosis can be
difficult to diagnose if a patient initially presents with acute
subarachnoid haemorrhage (SAH). We report a case of
54-year-old woman with thrombus in the superior sagittal
sinus, who initially presented with acute SAH over the right
parietal sulci.
Case report: A 54-year-old female was admitted with
abrupt onset of severe thunderclap headache. She denied the
past-medical history of any medication, hypertension and
trauma. T2-weighted images showed high signal intensities
in the right parietal sulcal area, which were not enhanced
with gadolinium. The venous phase of digital subtraction
angiography demonstrated the thrombus in superior sagittal
sinus and delayed perfusion of the right parietal cortex.
After 3 days of anticoagulation therapy, the symptoms
disappeared. Two weeks later, follow-up brain CT showed
no high density in this area.
Conclusion: This case suggests that the anticoagulation
should be considered for therapy of cerebral venous
thrombosis in case of SAH.
E. Gasimov1, G. Eyyubova1, R. Ghaffarzadagan2
1Hystology, Azerbaijan Medical University, Baku,
Azerbaijan, 2City of Zürich Medical Services, Zurich,
Switzerland
Introduction: Both clinical and experimental data indicate
that increased permeability of the blood-brain barrier (BBB)
plays an important role in the initiation of brain damage. We
have determined the electron microscopic characteristics of
routes of macromolecule transport across the BBB during
acute inflammation.
Methods: Acute experimental endotoxemia was induced by
intravenous injection of purified LPS from E. coli. Adult
male white rats were treated intravenously with either LPS
(1.0mg/kg) or 0.9% sterile saline alone. 2h after the injection
under deep anaesthesia, the brains were removed and
harvested into Karnowsky’s fixative at least 4 hours and
then processed using standard EM.
Results: The electron microscopic investigation of brain
capillaries at acute endotoxemia revealed the presence of
three types of endotheliocytes in their wall: intact,
oedematous and with dark cytoplasm. The tight junctions
between the endothelial cells of cerebral vessels which
represent the morphological base of BBB functioning were
disrupted between the oedematous endothelial cells. In dark
endotheliocytes, near their contact sites fenestrations with
diameter of 30-40nm were seen. Moreover, the disturbances
in structural integrity of luminal plasma membrane of
endotheliocytes, which designate the beginning of their
necrotic changes was evident.
Conclusions: We found that the BBB breakdown at acute
endotoxemia is mediated by: 1) the formation of
fenestrations; 2) disruption of tight junctions; 3) disturbances
in structural integrity of endothelial cell plasma membrane.
Our findings indicate that detail investigation of structural
parameters of BBB breakdown at systemic inflammation
could help find targets for therapeutic treatments.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
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P2130
P2131
Transverse myelitis in a primary antiphospholipid syndrome
Gender differences in patients with total
anterior circulation infarct
E. Pakosova1, G. Timarova2, M. Papayova1
Y. Inanc, Y. Kaplan, O. Kamisli, S. Kamisli, C. Ozcan
Neurological Department, Comenius University, University
Hospital, 2Neurological Department, University Hospital,
Bratislava, Slovak Republic
1
Introduction: The anti-phospholipid syndrome is a
systemic auto-immune disorder characterized by vascular
thrombosis and/or pregnancy morbidity occurring with
persistently positive anti-phospholipid antibodies.
Neurological involvement is a common feature of the antiphospholipid syndrome. Strokes and transient ischemic
attacks are the most common arterial thrombotic
manifestation. Transverse myelitis is an uncommon, but
well-known neurological complication of secondary antiphospholipid syndrome, but the reported cases of primary
anti-phospholipid syndrome are rare.
Case report: A case of acute transverse myelitis following
primary anti-phospholipid syndrome is presented. A
34-year-old woman was admitted to our hospital with
paraesthesia and weakness of both lower extremities and
acute psychosis. Neurological examinations revealed
paraparesis of lower extremities, hypaesthesia below T6
and urinary retention. Magnetic resonance images of the
spine revealed longitudinal intramedullary signal in the
spinal cord (T2-T6). MR brain images, spinal angiography,
visual evoked potential were normal. A routine cerebrospinal
fluid examination for biochemical changes and cytology
was normal and no oligoclonal bands were detected by
electrophoresis. Laboratory examinations for bacterial, viral
and parasitic infections, antinuclear and anti-aquaporin-4
antibodies, antibody screen were also negative. Antiphospholipid antibodies were repeatedly positive. There
was no apparent history or features of systemic lupus
erythematosus; renal biopsy was negative. The patient had
previous a history of miscarriage. A diagnosis of primary
anti-phospholipid syndrome was performed. After steroid
and anticoagulant therapy, both clinical symptoms and
abnormal findings on MR improved.
Conclusion: We report on a rare case of transverse myelitis
that was associated with primary anti-phospholipid
syndrome. Early recognition and treatment improve the
prognosis.
Neurology, Inonu University, Turgut Ozal Medicine Center,
Malatya, Turkey
Objectives: We evaluated risk factors, demographical,
clinical and etiological characteristics of patients with Total
Anterior Circulation Infarct (TACI). In this study we aimed
to elucidate the impact of gender-based differences on these
parameters.
Methods: 74 patients with TACI were enrolled. 38 (51.3%)
patients were females, 36 (48.6%) patients males. We
compared age, previous stroke, pre-stroke modified Rankin
Scale (mRS), NHIS score according to The National
Institute of Health Stroke scale, Glasgow coma score and
mRS at the time of admission, risk factors, etiological
subtypes of stroke, topography of infarcts, the rate of
neurologic and systemic complications, length of hospital
stay, the rate of death, and mortality causes between gender.
Results: 25.6% of all patients, 36.8% of women and 13.8%
of men were hospitalized because of recurrent stroke. There
was statistically significant difference for frequency of
recurrent stroke between the genders (p<0.05). The
frequency of diabetes mellitus was much higher in women
than men (24% and 11% respectively, p=0.01). Although
there was no statistically significant difference for stroke
etiology, location of radiological lesion, clinical and
radiological data for adverse prognostic sign, mortality rate
and mortality cause, women have statistically significantly
higher median length of hospital stay (24+21.6 days for
women vs. 15.8+8.7 days for men; p<0.05) and have more
systemic complications than men (76% for women vs. 50%
for men; p<0.05).
Conclusion: The result of the present study indicated that
female gender has a negative effect on clinical outcome of
TACI.
P2132
Abstract cancelled
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
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P2133
P2134
Cerebellar infarction due to acute
occlusion of the superior cerebellar artery
The relation between knowledge about
risk factors in patients with ischemic
stroke and myocardial infarction in the
Ukraine
S.T. Trajkovic-Bezmarevic, A. Bezmarevic
Neurology, Special Hospital for Cerebrovascular Diseases
’St. Sava’, Belgrade, Serbia
Introduction: The vascular supply of cerebellum is derived
from the posterior circulation and is unequally divided by
tree arteries: cerebelli inferior posterior artery (PICA),
cerebelli inferior anterior artery (AICA) and superior
cerebellar artery (SCA). Each SCA emerges from the distal
segment of the basilar artery and supplies the superior and
lateral aspect of ipsilateral cerebellar hemisphere.
Objective: The aim of the study is to define vascular risk
factors, clinical characteristics, and outcome in patients
with acute ischemic cerebellar infarcts due to occlusion of
SCA.
Methodology: All patients with the signs and symptoms of
acute stroke admitted to our hospital underwent the CT/
NMR of brain in the first 24h. The patients with proven
isolated ischemic lesions in the territory of SCA were
included in the study.
Results: 26 consecutive patients (mean age 68; range 37-81
years) were included in the study. The most frequent
vascular risk factors were: hypertension (76.9%), heart
failure (53.8%); smoking (34.6%) hyperlipidemia (32.1%),
and diabetes mellitus (30.7%). Three patients (11.5 %) had
no documented vascular risk factors. None of the patients
with cerebellar stroke had depressed level of consciousness.
The most prevalent prodromal symptoms were instability,
dizziness, nausea, and vomiting. Majority of the patients
(84.6%) showed improvement in the functional status in the
first weeks.
Conclusion: The patients with acute ischemic lesions of the
cerebellum, due to isolated occlusion SCA, have the similar
vascular risk profile as other patients with an ischemic
stroke. Despite the prodromal neurological injury the
outcome and overall prognosis is good.
509
O. Shulga1, N. Sydor1, O. Kal’bus2
Volyn Region Hospital, 2Dnepropetrovsk State Medical
Academy, Lutsk, Ukraine
1
Background: The value of risk factors as predictors of
ischemic stroke (IS) and myocardial infarction (MI) has
been understood. We aimed to stratify the knowledge about
risk factors in the population of Ukrainian patients after IS
and MI.
Methods: A total of 312 patients after myocardial infarction
(median age 62.2±9.8 years) and 235 patients after ischemic
stroke (median age 62.5±10.3 years) were observed.
Results: It was found that only 11.80% of patients
considered high arterial pressure as a risk factor for stroke
and MI (13.12% − in MI and 9.95% in IS group; р=0.28).
Physical activity as a risk factor was considered by 10.74%
of patients (13.12% in MI and 9.95% − in IS patients;
р=0.28). Only 9.91% of patients considered smoking as risk
factor (10.25% − in MI та 9.45% − in IS group; р=0.77) and
8.88% of patients considered that decrease of alcohol
consumption influences on secondary prevention (10.95%
− in MI and 5.97% − in IS group patients; р=0.06). 52.7%
of patients used only one method of prevention (52.65% −
in MI and 52.79% − in IS patients, р=0.97). 2 to 3 methods
of prevention were used by 44.07% of patients (44.52% −
MI and 43.43% − IS group, р=0.81). Only 12.86% of
patients used three methods of prevention.
Conclusion: Knowledge of risk factors in the population is
low in both groups of patients. Patients with MI were more
aware about risk factors.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
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P2135
P2136
Prediction of early clinical outcome in
patients with acute ischemic hemispheric
stroke using evaluation of melatonin
serum level
Intravenous thrombolysis in young
patients with severe stroke - Serbian
experience with thrombolysis in ischemic
stroke (SETIS)
A. Kuznietsov, O. Kozyolkin
P. Stanarcevic, M. Stefanovic Budimkic, V. Padjen,
I. Berisavac, M. Ercegovac, O. Savic, L. Beslac
Bumbasirevic, D.R. Jovanovic
Zapororozhzhye State Medical University, Zaporozhzhye,
Ukraine
Introduction: The highest neuroprotective properties of
melatonin have been established. Melatonin’s serum level
is the sign of oxidative stress intensity, it indicates activity
of compensatory anti-oxidant mechanisms. The aim of this
study was to estimate the predictive value of dynamic of
melatonin’s serum level in patients with acute ischemic
hemispheric stroke.
Methods: Prospective observational cohort study was done.
We recruited patients aged 50 years or older, who were
hospitalized during less than 12 hours from appearing the
symptoms of stroke. Methods of investigation include brain
computer tomography (CT), evaluation of melatonin level
(nmol/l) in serum on the 1st and 7th day of stroke onset. The
primary outcome was estimated by mRS and NIHSS on
21th day. Mortality was assessed with Kaplan-Meier
survival analysis.
Results: We enrolled 66 patients with CT-confirmed acute
ischemic hemispheric stroke. Dynamic of melatonin’s
serum level (Δ%) on 7th day correlated with symptoms
dynamic by NIHSS (R=-0.56, p<0.05). Median 21-days
NIHSS score was 14 in increase-melatonin-level patients
versus 10 in non-increase-melatonin-level patients (p<0.01).
Median 21-days mRS score was 5 in increase-melatoninlevel patients and 3 in non-increase-melatonin-level patients
(p<0,01). Mortality at 21-day was 9.3% (3 of 32) in
increase-melatonin-level patients versus 2.9% (1 of 34) in
non-increase-melatonin-level patients (HR 2.8, 95%; CI
1.4-4.2, p=0.005).
Conclusion: Increase of melatonin’s serum level is a
predictor of poor early clinical outcome in patients with
acute ischemic hemispheric stroke. Intensification of
neuroprotective therapy in those patients seems to be crucial
to improve outcomes.
Department of Emergency Neurology, Clinic for Neurology,
Clinical Center of Serbia, Belgrade, Serbia
Objective: Young stroke patients have a better outcome
than the older. The aim was to determine the safety and
efficacy of intravenous thrombolysis in young patients with
severe stroke compared to patients older than 45 years.
Methods: Among 651 enrolled patients in the Serbian
Experience with Thrombolysis in Ischemic Stroke (SETIS)
register, 252 patients were with severe stroke (NIHSS ≥ 15),
26 of them younger than 45 years of age. Primary outcome
measures were functional outcome at 3 months after stroke
onset, and occurrence of symptomatic intracerebral
haemorrhage (sICH) defined according to SITS criteria.
Results: Average overall NIHSS rate at admission was 19,
rising to 21 in group of young patients. Good functional
outcome (mRS 0-2) at 3 months was significantly higher in
younger patients (57.7% vs. 39.8%). There was no
significant difference in incidence of sICH - 3.8% in
younger patients comparing to 4.0% in older group.
Interestingly, majority of sICH (90%) was registered in
patients treated within 180 minutes, and only 10% in
extended time window, in elderly group. Multivariable
logistic regression showed significant influence of selected
baseline characteristics on functional outcome and
occurrence of sICH.
Conclusion: Intravenous thrombolysis is equally safe in
both group of patients, but younger patients with severe
stroke show significantly better outcome comparing to
older patients.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
P2137
P2138
Stroke outcomes in elderly patients
(>70 years old) treated with and without
intravenous thrombolysis
Ferulic acid attenuates the middle
cerebral artery occlusion-induced
reduction of hippocalcin expression
P.A. Dharmasaroja1, S. Muengtaweepongsa2,
P. Dharmasaroja3
P.-O. Koh1, J.-H. Sung2, F.-A. Shah2, E.-H. Cho1,
M.-O. Kim2
511
1Department of Internal Medicine, 2Division of Neurology,
Department of Internal Medicine, Thammasat University,
Klong Luang, 3Department of Anatomy, Mahidol University,
Phayathai, Thailand
1Department of Anatomy, College of Veterinary Medicine,
Institute of Agriculture and Life Science, 2Division of Life
Science and Applied Life Science, Gyeongsang National
University, Jinju, Republic of Korea
Background: Higher mortality was found in very old
patients with acute ischemic stroke treated with intravenous
recombinant tissue-plasminogen activator (rtPA) as
compared to younger patients. The benefit of thrombolytic
treatment in this particular subgroup is still debated. The
purpose of this study was to compare stroke outcomes in
patients aged >70 years treated with and without intravenous
rtPA.
Patients and methods: 105 patients with acute ischemic
stroke, aged >70 years who were treated with intravenous
rtPA and 105 patients without rtPA treatment (as a control
group) were included. The baseline characteristics of the
patients and outcomes of interest were compared.
Results: Higher rate of early improvement was found in
patients with rtPA treatment (4% vs. 23%, p=0.001). There
was no significant difference in the rates of favourable
outcomes (41% vs. 37%, p=0.56) or mortality (25% vs.
22%, p=0.69) with a marginally higher rate of symptomatic
intracerebral haemorrhage in the rtPA treatment group (4%
vs. 14%, p=0.09). However, there were significant
differences in some baseline characteristics. In subgroups of
patients aged >80 years, higher rates of favourable outcomes
(16% vs. 40%, p=0.14) and lower mortality rates (44% vs.
22%, p=0.13) were found in patients with rtPA treatment,
although these differences were not significant.
Conclusions: Because of significant differences in some
baseline characteristics between case and control groups in
our pilot study, no significant improvement was found in
patients treated with rtPA. Further randomized controlled
studies are still needed to confirm the suspected benefit of
thrombolysis in aging patients.
Ferulic acid, a phenolic compound from nature, protects
neuronal cells against focal cerebral ischemic injury through
its anti-oxidative and anti-inflammatory effects. Ferulic
acid has antioxidant effects against reactive oxygen species.
Hippocalcin is a calcium sensor protein that regulates
intracellular calcium concentrations and apoptotic cell
death. This study investigated whether ferulic acid regulates
hippocalcin expression in focal cerebral ischemia and
glutamate toxicity-induced neuronal cell death. Male
Sprague-Dawley rats were immediately treated with vehicle
or ferulic acid (100mg/kg, i.v.) after middle cerebral artery
occlusion (MCAO), and cerebral cortex tissues were
collected 24h after MCAO. A proteomics approach
elucidated the reduction of hippocalcin in MCAO-operated
animals, and ferulic acid treatment attenuated the injuryinduced reduction in hippocalcin expression. Moreover,
RT-PCR and Western blot analyses clearly confirmed that
ferulic acid treatment attenuates the injury-induced
reduction in hippocalcin levels. In cultured hippocampal
cells, glutamate toxicity significantly increased the
intracellular Ca2+ concentration, whereas this increase in
Ca2+ levels was inhibited by ferulic acid treatment.
Moreover, ferulic acid treatment prevented the glutamate
exposure-induced decrease in hippocalcin levels. These
results suggest that ferulic acid plays a neuroprotective role
by preventing the injury-induced reduction of hippocalcin
and modulating intracellular Ca2+ levels. This work was
partially supported by the National Research Foundation of
Korea (NRF) grant funded by the Korea government (MEST)
(No.2010-0007881) and partially supported by a grant from
the Next-Generation BioGreen 21 Program (No.PJ008075),
RDA, Republic of Korea.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
512
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P2139
P2140
Clinical management and outcome of
pregnancies complicated by cerebral
venous thrombosis: a review of 19 cases
Splenectomy contributes to experimental
stroke in rats by anti-inflammation, but
not brain-derived neurotrophic factor
C.F. Demir1, M. Yıldız2, H.H. Özdemir1, F. İnci3,
E. Erdoğan4
B. Zhang, Z. Lu, X. Men, H. Li, X. Hu
Department of Neurology, 2Department of Emergency, Fırat
(Euphrates) University, 3Department of Radiology,
4Department of Neurology, State Hospital, Elazig, Turkey
1
Purpose: To determine the risk factors and clinical outcome
in pregnant women with cerebral venous thrombosis (CVT).
Methods: 19 pregnant women with a diagnosis of CVT
followed-up in the Neurology unit between 2008 and 2011
were included. Patients with CNS infection and with CVT
secondary to invasive procedures were excluded. MRIs and
MRVs were performed for all patients.
Results: There were 19 pregnant women with age ranging
from 18 to 38 years (mean 27.5 years). The follow-up
period ranged between 11 and 24 months (mean 19 months).
Symptoms and signs that suggest rising in intracranial
pressure (ICP) including headache, vomiting with or
without nausea, disturbances of consciousness, and
papilledema were present nearly in all cases. Seizures and
even status epilepticus (with or without preeclampsia) were
present in 8 cases. The rate of CVT was higher in the third
trimester. Superior sagittal sinus thrombosis (TSSS) is the
most common in CVT. There was no maternal mortality and
20 children were still alive and healthy.
Conclusion: If MR imaging is available, it should be used
for detection of CVT in all pregnant patients instead of CT.
Patients with parenchymal lesions, thrombophilia and antiphospholipid syndrome had greater risk to be left with
neurological sequelae. For pregnant women with CVT, lowweight molecular heparin (LWMH) in full anticoagulant
doses should be continued throughout pregnancy.
Anticoagulant therapy did not predispose to further
intracranial haemorrhage.
Department of Neurology, The Third Affiliated Hospital of
Sun Yat-sen University, Guangzhou, China
Objectives: Recent works in the area of stroke have
demonstrated the significance of the inflammatory response
accompanying necrotic brain injury and the increase of
brain-derived neurotrophic factor (BDNF). Inhibition of the
inflammatory response to stroke limits the expansion of
infarction. As a major peripheral immune organ, spleen
plays roles in the stroke-induced immune response.
Methods and results: Here we show that the infarction
volume in the brain of rats which were splenectomized 2
weeks before permanent middle cerebral artery occlusion
was decreased over 50% compared to that of rats subjected
to the stroke surgery alone. Splenectomy also resulted in
decreased population of T-cells, neutrophils, and
macrophages presented in the brain tissue. Removal of
spleen also decreased the level of pro-inflammatory
cytokines like IL-1β, TNF-α, and elevated the level of antiinflammatory factor IL-10 in the brain and peripheral blood.
However, our data from splenectomy did not affect the
increase of BDNF.
Conclusion: These findings indicate that possible
mechanisms of protective effect from splenectomy may be
related to the decrease of inflammatory cells in the ischemic
zone of brain and the change of inflammatory cytokines in
the central nervous system and blood. Removal of the
spleen has no influence on the level of BDNF in the brain
and blood, which may have no bad effect on recovery after
stroke.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
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P2141
P2142
PRE-syndrome mimics vasospasms after
elective aneurysm clipping
The role of patent foramen ovale in
cryptogenic ischemic stroke
M. Holling1, M. Richters1, B.R. Fischer1, T. Niederstadt2,
W. Stummer1
A. Bartkova1, D. Sanak1, M. Hutyra2, R. Herzig1,
J. Zapletalova3, M. Kral1, T. Veverka1, P. Hlustik4,
P. Kanovsky4
Department of Neurosurgery, 2Department of Clinical
Radiology, University Hospital Münster, Münster, Germany
1
Objective: PRE-Syndrome (posterior reversible
encephalopathy syndrome) is a very rare cerebral
complication in patient’s post-operative course. It is
characterized by headaches, seizures, visual abnormalities
and typical neuroradiological signs. Only rare cases have
been described after aneurysmal subarachnoid haemorrhage.
We report the first case of PRE-Syndrome after elective
aneurysm clipping.
Methods: A 67-year-old women suffered from intermittent
dizziness and headaches. Imaging revealed three aneurysms
located at the left A. cerebri media, right A. cerebri media
and right A. carotis interna. Due to size and configuration
the left ACM-aneurysm has been clipped without
complications. The post-operative course was fine without
any deficits until day 5 after surgery. The patient suffered
from focal seizures, slight right-sided hemiparesis and
intense headache. A cranial computer tomography revealed
no acute haemorrhage while vasospasm was detected via
transcranial Doppler sonography and conventional
angiography. Vasospasmolytic treatment was initiated but
symptoms did not improve. Finally, MRI was performed.
Hyperdensities in the FLAIR-sequence were detected at the
left occipital lobe. These results, in conjunction with the
clinical symptoms favoured the diagnosis of PREsyndrome.
Results: After diagnosis we reduced vasospasmolytic
treatment immediately as recommended. 3 months after
surgery, the patient had improved and, did not display
neurological deficits with the exception of intermittent
dizziness. MRI revealed left occipital infarction. The two
remaining aneurysms were without progression.
Conclusions: PRE-syndrome is very rare and can imitate
true vasospasms. In case of clinical and radiological
findings indicating vasospasms resistant to vasospasmolytic
therapy, MR angiography should be performed in order to
exclude PRES-syndrome.
513
Comprehensive Stroke Center, Department of Neurology,
Faculty of Medicine and Dentistry, Palacký University and
University Hospital, 2Department of Internal Medicine I Cardiology, Faculty of Medicine and Dentistry, Palacky
University, 3Department of Medical Biophysics, Faculty of
Medicine and Dentistry, Institute of Molecular and
Translational Medicine, Palacky University, 4Department of
Neurology, Faculty of Medicine and Dentistry, Palacký
University and University Hospital, Olomouc, Czech
Republic
1
Background: The aim was to assess the occurrence and
long-term risk of PFO for recurrent ischemic stroke (IS) in
cryptogenic IS patients aged up to 50 years.
Methods: 91 consecutive CIS patients (47 males, mean age
42.0±7.5 years) were enrolled in prospective study. All
patients underwent transoesophageal echocardiography.
Initial neurological deficit was assessed using NIHSS and
90-day clinical outcome using modified Rankin Scale.
Patients were divided into 2 groups according to the PFO
presence (Group 1) or absence (Group 2).
Results: PFO was found in 27 (28.1%) of patients (12
males, mean age 44.0±7.6 years). No difference was found
between groups in age and sex distribution, occurrence of
arterial hypertension and diabetes mellitus, contraceptives
use and clinical outcome. PFO patients had higher initial
NIHSS value (median 5.0 vs. 3.5, p=0.033) and lower
occurrence of hyperlipidemia (25.9 vs. 51.6%, p=0.0036).
Recurrent IS occurred in 1.5% of PFO patients and in 3.5%
of patients without PFO (p>0.05) with similar mean time to
the occurrence of recurrent IS (80 vs. 88 months, p>0.05).
No statistically significant difference was found in the
number of patients with good 90-day clinical outcome
between the respective groups (96.0 vs. 76.6%, p=0.085).
Conclusion: According to the results of the presented study,
the risk of recurrent IS is low in CIS patients and the PFO
presence does not increase this risk. Thus, the indication for
endovascular PFO closure should be carefully considered.
Acknowledgement: Supported by the IGA MH CR grants
NT/11386-5/2010, NT/11046-6/2010 and by the grant
CZ.1.05/2.1.00/01.0030.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
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P2143
P2145
Coiling of ruptured tiny cerebral
aneurysms (2-3mm, with at least one
dimension <2mm), feasibility, safety and
durability at midterm follow-up
Retrospective study of 864 cases of
neuro-ultrasound examinations for
primary and secondary prevention of
ischemic stroke
O. Mansour1,2, M. Schumacher2
G. Struga, J. Kruja
Neurology, Alexandria University, Alexandria, Egypt,
2Neuroradiology Department, Freiburg University,
Neurocenter, Freiburg im Breisgau, Germany
1
Background: The tiny size of cerebral aneurysms is
representing one of the challenging facets for endovascular
treatment. We report on coiling of tiny saccular ruptured
cerebral aneurysms. All the cases were of ≤2-3mm
aneurysms with at least 1 of the dimensions being less than
2mm.
Materials: Between the period of April 2008 and December
2010, we performed retrospective analysis of 9 consecutive
cases of tiny aneurysms treated by coil embolisation in our
institution .
Results: Coil embolisation was successfully performed in
9 cases, while in 1 case, intra-operative rupture of the
fundus (IOR) was encountered before complete obliteration
of the aneurysm expected to be achieved with 2 coils.
Complete (n = 7) or near complete (n = 2) immediate
occlusion was seen. A total of 18 coils were used for coiling
of the 9 aneurysms, where 5 aneurysms were coiled with 2
coils for each, two aneurysms coiled with 3 coils each and
only one coil was satisfactory to achieve accepted results in
two aneurysms. Although minimal coil projection in the
parent vessel was seen in 3 cases, no untoward clinical
complications were seen. At mean follow-up (6.7 m, IQR
3-12m) DSA and MR angiography in 9 patients
demonstrated persistent occlusion (n = 6) of the aneurysms,
one aneurysm showed marked filling of fundus, and 2
aneurysms showed neck remnant but did not need
retreatment. All of the patients with available follow-up
were scored on modified Rankin Score (mRS) of 0 or 1.
University Service of Neurology, Tirana, Albania
Background: Neuro-ultrasound is useful for prevention of
ischemic stroke.
Method: Data was retrieved and statistically analyzed from
864 patients.
Results: There is a significant statistical connection
between age and carotid artery stenosis (CAS) (p=0.001)
with 6% increase each year the risk for stroke. A sharp rise
in CAS between 50 and 60 years, our patients have ischemic
stroke at age 64.29±10.25. Male compared to female and
CAS (t=3.825,df=510, p=0.001) CAS and IMI (intima
media index) (t=3.574, df=350, p<0.001). CAS and
smoking (p=0.001), CAS and HTA (p=0.001), CAS and
diabetes (p=0.001), CAS and high cholesterol (p=0.001).
CAS and alcohol abuse (N 512, p=0.03). Hipoechogen
plaque 66% risk to cause stroke (OD=1.66, CI95%: (1.012.66) with male 49% more risk than female to have stroke
from hipoechogenic plaque (OD=0.49, CI95%: (0.26-0.97).
CAS in non-lacunar (55%, SD 17.83) versus lacunar
infarction has significant statistical difference (35%, SD
14.57) (p<0.001).
Conclusions: Screening of high risk patients in their fourtis
is recommended for CAS or IMI. Male gender, age,
smoking, hypertension, cholesterol and diabetes but not
alcohol are significant risk factors for CAS. CAS is
relatively spare in lacunar stroke. Stroke risk is high
particularly in males with hipoechogen plaque and should
be treated more aggressively. Our patients having ischemic
stroke at the age 64.29±10.25 indicate future strategy for
primary prevention in our population.
P2144
Abstract cancelled
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
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515
P2146
P2147
Increase of platelet monoamine oxidase
activity (MAO) in acute ischaemic stroke
is associated with good outcome
Impact of heart failure on ischemic stroke
severity and short-term prognosis: an
Egyptian study
V.V. Alferova1, A.B. Guekht1, M.G. Uzbekov2,
E.Y. Missionzhnik2
L.M. Elnabil
The Russian State Medical University, 2Research Institute of
Psychiatry, Moscow, Russia
1
Pronounced activation of serotonin and dopamine oxidative
deamination by MAO was revealed in different brain
structures during experimental acute ischemic stroke (AIS).
Association of changes in MAO activity with brain
restoration was presumed. Human blood platelets are
known to be used as model of peripheral dopaminergic and
serotonergic synapses in CNS; accordingly, evaluation of
MAO activity in platelets was performed.
Methods: 30 consecutive patients (mean age 70.9±6.24
years) with hemispheric AIS (MRI confirmed) were studied.
Platelet MAO and NIH stroke scale (NIHSS) were measured
on the 5th days after admission. Stroke outcomes were
assessed by NIHSS and Bartel ADL index (BI) on 30 days
after stroke onset. Platelet MAO activity of 17 healthy agematched people were considered as “control”.
Results: It was revealed significant increase MAO activity
in 67% of patients compared with matched controls
(p=0.0001). Change in MAO activity on the 5th day of AIS
correlated with the degree of neurological recovery on 30
days after stroke-onset (МАО/NIHSS: rs= - 0.72, р=0.04).
High MAO activity was associated with favourite outcome
BI 78.5 in stroke patients and had a prognostic value (OR
5.79, p= 0.005; 95% CI 3.59-7.81).
Conclusions: The prognostic significance of these changes
should be further analysed with the special attention to
increase MAO activity as possible regulatory mechanism in
acute ischemic stroke.
Neurology, Ain Shams University, Faculty of Medicine,
Cairo, Egypt
Background: Heart failure with impaired systolic function
was documented to be associated with severer stroke
presentations and increased incidence of long-term
mortality and morbidity after ischemic stroke. Heart failure
patients are more prone to develop ischemic stroke and
there is a steady association between ischemic stroke and
heart failure of variable severity.
Aim: To assess the impact of heart failure on ischemic
stroke severity and short-term prognosis for early prevention
and better management.
Methods: The study included 200 patients diagnosed with
acute ischemic stroke within 3 days recruited from stroke
unit, Ain Shams University Specialized Hospital. They
underwent clinical and radiological examination including
echocardiography and routine laboratory investigations and
they were reassessed after one month using National
Institute of Health Stroke Scale (NIHSS).
Results: 11% of patients had heart failure. They tended to
have partial anterior circulation infarcts (62.5%) according
to modified Oxfordshire classification and 87.5% of them
had leucoaraiosis which is higher than that for the entire
group. They tended to have more severe strokes and to have
higher morbidity and mortality rates.
Conclusion: Heart failure tends to have a negative impact
on the severity and prognosis of ischemic stroke patients.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
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P2148
P2149
Deformations of brachycephalic vessels
in children
Embolisation followed by spontaneous
thrombosis as resolution for a trilobed
aneurysm of the basilar artery in a child
M. Abramova, I. Stepanova, N. Shurupova,
S. Shayunova, S. Novoselova
The Russian National Research Medical University named
after N.I. Pirogov, Moscow, Russia
Purpose: It is necessary for children with brachycephalic
vessels (BCV) deformations to carry out complex
investigation for working out an algorithm of diagnostics,
treatment and further recommendations.
Methods: Duplex examination of BCV of 6000 patients
aged from 3 to 18. 68% has been done. Some abnormalities
have been found: deformations of internal carotid arteries
(ICA)-47.6%; vertebral arteries (VA)-81.53%. The
deformations were the following:1.C-shaped tortuosity of
ICA-35.87%,VA-22.7%; 2. S-shaped tortuosity of ICA19.24%, VA-3.8%; coiling of ICA-6.89%, VA-2.53%. A
connection between hemodynamic disturbance of
deformations and localizations (25% of ICA and 5.7% of
VA) and types (S-tortuosity and coiling) have been found.
These children complained about headaches with nausea
and vomiting, dizziness, nasal bleedings, lassitude
intolerance of weather jumps. Clinical appearance of
deformations depended also on presence and intensity of
venous dysfunction. We have been surveying children with
deformations of ICA for 12 years and noted the next
modification: C-tortuosity turned into rectilinear one at 3%
of children; S-shaped deformation with acute angles turned
into S-shaped one with obtuse angles at 7% of children; into
C-shaped one or rectilinear one-1.5% of children; coiling never changed its configuration.
Conclusion: The frequency of examination of
brachycephalic vessels abnormalities depends on the type
of deformation, its hemodynamic infringements and clinical
appearances: S-shaped tortuosity and coiling - one time in
3-6 months, C-shaped tortuosity-one time in 6-9 months. It
is necessary to conduct a proper research (should not be
hard, tiring for the children or causing negative emotional
reactions), analysis of received data, considering the
experience of managing the cases of elderly patients.
P.A. Rizzi1, R. Messina2, F. Dicuonzo3, L. Chiumarulo3,
A. De Tommasi2
University of Bari, 2Department of Neurosurgery,
Department of Neuroradiology, University of Bari, Bari,
Italy
1
3
Introduction: Paediatric intracranial aneurysms are rare
diseases, accounting for less than 5% of all intracranial
aneurysms. Morphology, clinical and radiological
presentation of these aneurysms differ slightly from those
found in adults. Aneurysm location in the posterior
circulation is more common in children than in adults. Such
aneurysms are giant, fusiform and dissecting.
Methods: A 15-month-old girl came to our attention
following a generalized seizure. A CT brain scan showed
subarachnoid haemorrhage in the basal cisterns with
ventricular involvement. Neurological clinical findings
were: Children’s Coma Scale of 11/15, rigor nucalis,
anisocoria right>left. Angio CT scan showed a trilobed and
dissecting aneurysm of the basilar artery with ectasia at the
origin of the right posterior communicating artery and
peripheric haematoma close to the brainstem. The trilobed
aneurysm was treated through endovascular procedure for
two lobes and conservative management for the third
dissecting lobe.
Results: The post-operative angiography showed the
complete exclusion of the aneurysm with coiling of the two
lobes and thrombosis of the third dissecting lobe, normal
cerebral blood flow and a small ischemic lesion in the right
calcarine area. Hydrocephalus was treated through V.P.
shunt. At discharge the patient showed normal neurological
status with the exception of a slight right III cranial nerve
palsy.
Conclusions: Dissecting aneurysms are dynamic lesions
with variable and unpredictable behaviour and close followup and/or early treatment is warranted. Our case
demonstrates that the thrombosis of a dissecting aneurysm
may be a mechanism for spontaneous repair in paediatric
aneurysms which therefore requires further elucidation.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
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517
P2150
P2151
Magnetic resonance angiography findings
in ischemic cerebrovascular disease
Is it valid to use S100B levels in ischemic
stroke patients?
V. Guzel1, V. Yayla1, A. Culha1, O. Selcuk1, M. Cabalar1,
B. Guveli1, H. Selcuk2
O. Selcuk1, V. Yayla1, M. Cabalar1, V. Guzel1, S. Uysal1,
A. Gedikbasi2
1Department of Neurology, 2Neuroradiology, Department of
Neurology, Bakirkoy Training and Research Hospital,
Istanbul, Turkey
1Bakirkoy Training and Research Hospital, Department of
Neurology, 2Biochemistry, Bakirkoy Training and Research
Hospital, Istanbul, Turkey
Introduction: Demonstration of atherosclerotic lesions in
MRA has recently become an important diagnostic tool in
ischemic strokes. All of the cervical and cranial arteries can
be visualized by MRA, including the lumen irregularity,
plaque formation, atherosclerotic occlusion, and even
embolic obstruction signs of distal vessels. In this study,
localizations of atherosclerotic lesions, stenosis rates
detected by cervical and cranial MRA, and the relationship
of risk factors were evaluated in ischemic stroke patients.
Methods: This study consisted of 250 patients admitted
consecutively between 1st September 2010 - 31st August
2011. The patients were diagnosed as stroke by cranial CT
and diffusion or brain MRI, cervical and cranial MRA’s
were performed. OCSP classification was used. Vascular
abnormalities were classified as extracranial (EC),
intracranial (IC) or combined and also symptomatic and
asymptomatic based on alignment with the MRA findings.
Results: The age range was 25-90 years (64±13 years) and
56% were male, 44% female. HT (76%), hyperlipidemia
(53%), DM (31%), recurrent stroke (23%) were risk factors.
Symptomatic and/or asymptomatic lesions were detected in
70.4% of the entire group but it was higher (78.9%) in the
patients with recurrent ischemic stroke. Vascular lesions
were 52.4% EC (36% carotid, 35% vertebrobaziler, 29%
both systems) and 48.4% IC (21% carotid, 60%
vertebrobaziler, 19% both).
Conclusion: In this study, symptomatic/asymptomatic
lesions (stenosis, occlusion, hypoplasia) of EC and/or IC
vascular network were found to be at high percentage in
ischemic stroke patients, monitorizing EC and IC arteries
by MRA will contribute to treatment strategies and
prognosis.
Introduction: Gender, age, and frequently accompanying
systemic diseases (diabetes mellitus, hypertension or
hyperlipidemia) do not affect S100B levels, thus it could be
used specifically to show brain damage in ischemic stroke
patients. We aimed to evaluate S100B protein as a marker
of brain cell damage in ischemic stroke.
Methods: In this prospective study, 50 ischemic stroke
patients and control group (n:27) were included. In the
patient group, serum S100B protein levels were measured
on the 1st, 3rd and 5th day and NIHS and modified Rankin
Scales were used. The correlation between protein S100B
levels, cerebral lesion size and localization were analyzed
and protein S100B levels were compared by the control
group.
Results: Age range of 24 male, 26 female patients were
40-98 years (68±13 years). S100B levels were at their
highest level (395.3±614.3) on the 3rd day and reduced
(362.4±553.5) on the 5th day and the results were
significantly higher than controls(p<0,001). Although a
correlation was observed between the infarct size and
increased levels of S100B (r: 0.73, p<0.001), there was no
significant relationship between the severity of the stroke
and the levels of S100B (p>0.05). There was a slight
correlation between disability at the first month and S100B
levels on the 3rd day (p<0.05).
Conclusion: Protein S100B was detected at high levels in
the peripheral circulation after ischemic stroke. Although it
may not be sufficient to detect the prognosis in ischemic
stroke, it can be used as a peripheral marker of brain damage
depending on infarct volume.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
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P2152
P2153
Seronegative Sneddon’s syndrome:
a case report
Evaluation of high sensitive C-reactive
protein (hsCRP) measurement for
assessing the outcome and prognosis in
ischemic stroke
G. Cirillo, A. Tessitore, M. Cirillo, M.R. Monsurrò,
G. Tedeschi
Neurological Sciences, Second University of Naples, Italy
Introduction: Sneddon’s syndrome (SS) is characterized
by ischemic cerebrovascular episodes and livedo reticularis.
Methods: We report the case of a 56-years-old man who
had repeated ischemic cerebral episodes and livedo
reticularis but also headache, seizures, progressive
behavioural changes and cognitive deficits. We performed
MRI imaging and thrombophilic screening including
vascular genetic polymorphisms, antinuclear (ANA, ENA),
ANCA and anti-phospholipid antibodies and lupus
anticoagulans.
Results: Neurological examination is consistent with a
plurifocal vascular disease; general examination revealed
diffused livedo racemosa. MR brain scanning showed
multiple and diffused ischemic lesions. Thrombophilic
screening including genetic polymorphisms, ANCA, antiphospholipid antibodies and lupus anticoagulans is normal.
Conclusion: The clinical combination of livedo racemosa
and recurrent ischemic strokes is referred to as Sneddon’s
syndrome. It is generally associated with seizures, headache,
valvulopathy, renal involvement and vascular dementia.
Studies of patients with Sneddon’s syndrome revealed
elevated anti-phospholipid-antibody levels in 57% of
patients matched with normal controls. However, in some
patients these antibodies are repeatedly not found, indicating
that Sneddon’s syndrome may be a distinct entity or perhaps
a group of different disorders.
References:
1 - Clinical, neurovascular and neuropathological features
in Sneddon’s syndrome. Marinho JL, Piovesan EJ, Leite
Neto MP, Kotze LR, Noronha L, Twardowschy CA, Lange
MC, Scola RH, Zétola VH, Nóvak EM, Werneck LC. Arq
Neuropsiquiatr. 2007; 65(2B): 390-395.
2 - Livedo racemosa: a striking dermatological sign for the
anti-phospholipid syndrome. Uthman IW, Khamashta MA.
J Rheumatol. 2006; 33(12): 2379-2382.
P. Petramfar, A. Shariat, S. Mosallaei, M. Sharifian
Dorche
Shiraz University of Medical Sciences, Shiraz, Iran
Background and aims: Several studies have shown that
modest elevation of plasma high sensitive C-reactive
protein (hsCRP) in the range seen in patients with ischemic
stroke is a strong predictor of future outcome and prognosis.
The aim of this study is to evaluate the value of hsCRP in
predicting the 1 year prognosis and outcome of the patients
with ischemic stroke in Iran.
Materials and methods: 105 patients were included in this
study. Serum hsCRP was measured, 24-72 hours after
stroke. We examined the association between the level of
hsCRP after stroke and outcome.
Results: The mean±SD age was 66.6±12.7 years. Greater
prevalence of diabetes mellitus (35.7% versus 67.6%;
p=0.007), mitral/aortic valve disease (50.7% versus 67.6%;
p=0.023), age higher than 70 (21.4% versus 48.4%;
p=0.042) and death (7.2% versus 23.1%; p=0.005) were
noted in patients with elevated hsCRP, together with more
severe neurological deficit and relevant disability as judged
by the NIHSS score (p=0.003) and BI on admission
(p=0.012), BI on six months later (p=0.018) and BI on one
year later (p=0.032), respectively.
Conclusion: Elevation of hsCRP is common in ischemic
stroke. hsCRP levels may provide a mechanism to stratify
poststroke patients into relatively high-risk and low-risk
groups: patients with CRP levels ≥1.5mg/dL have a worse
prognosis.
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
P2154
P2156
Relationship between matrix
metalloproteinase-9, tissue
metalloproteinase-9 inhibitor, Interleukin-6
and carotid atheromatous plaque stability
Plasma homocysteine level in Egyptian
cerebrovascular stroke patients
C.R.S. Revnic1, F.G. Revnic2, G.I. Prada3, B. Paltineanu4
Cardiology, UMF ’Carol Davila’, Cell and Molecular
Biology of Aging, NIGG Ana Aslan, 3Geriatrics, UMF ’Carol
Davila’, 4Geriatrics, NIGG Ana Aslan, Bucharest, Romania
1
2
Introduction: Matrix metalloproteinases (MMPs), tissue
metalloproteinase-inhibitors (TIMPs) and interleukin-6
(IL-6 ), regulate extacellular matrix (ECM ) remodelling, a
key feature of atherosclerosis, and their circulating
concentrations can be assayed.
Aim: To relate circulating biomarkers of extracellular
matrix (ECM) turnover such as MMP-9 tissue
metalloproteinase inhibitor-1 (TIMP-1), MMP-9/TIMP-1
ratio, IL-6 to site-specific measures of carotid artery
atherosclerosis on Echo Doppler ultrasound.
Material and methods: 110 patients admitted in
Cerebrovascular Clinic, divided into three groups: (I.) 44
patients with ischaemic stroke related to carotid stenosis,
(II.) 36 patients with asymptomatic carotid stenosis and
(III.) 30 controls. All patients underwent carotid EchoDoppler examination and serum levels of total MMP- 9 ,
TIMP-1 and IL-6 were evaluated using Quantikine Human
MMP-9 (total), TIMP-1 and IL-6 ELISA R&D Systems
Kits with a ChemWell 2019, Awarness,Inc. USA
Autoanalyser.
Results: The levels of MMP-9, TIMP-1 and IL-6 were
significantly higher in ischaemic stroke than those in control
group. Plasma MMP-9 was positively correlated with
TIMP-1. The ratio of MMP-9/TIMP-1 increased only in
microemboli positive patients. Carotid Echo-Doppler study
showed that in stroke group most of plaques found were
echolucent with irregular surface compared with
symptomatic group where echogenic plaques with smooth
surface are found frequently (p=0.04).
Conclusions: Plasma MMP-9 and IL-6 are involved in
cerebral infarction; MMP-9/TIMP-1 ratio accounts for a
close relationship with atheromatous plaque instability. The
TIMP-1 can reduce the vasogenic brain oedema and
infarction volume, being also effective in preventing
atherosclerosis and ischaemic brain damage. Thus, MMPs
may become a new potential target for stroke therapy and
TIMPs can be used for the treatment of cerebrovascular
diseases.
P2155
Abstract cancelled
519
M. Khalaf1, N. Kitchener1, R.S.A. Sidhom2, I. Kamel3,
F. Farouk4
Neurology, 2Internal Medicine, 3Clinical Pathology,
Immunology, Mataria Teaching Hospital, General
Organization for Teaching Hospitals and Institutes, Cairo,
Egypt
1
4
P2157
Cerebral venous and sinus thrombosis in
young patients
A. Gogu1, D. Scutelnicu2
Neurology, Emergency County Hospital, 2University of
Medicine and Pharmacy, Timisoara, Romania
1
P2158
Carotid artery dissection caused by
typhoon ride
H.L. Gül1, O. Karadas2, H. Tutkan3, A. Arslan1, U. Turk
Boru1
1Neurology, Kartal Research and Education Hospital,
Istanbul, 2Neurology, Erzincan Military Hospital, Erzincan,
3Neurology, Occupational Diseases Hospital, Istanbul,
Turkey
P2159
Diagnostic values of serum CRP in
prediction of stroke
D.-G. Kim, T.-I. Chung
Neurology, Gangneung Dong-in Hospital, Gangneung,
Republic of Korea
P2160
Early markers in acute stroke
P.F. Fiori1, G. Esposito2, A. Morella3, L. Iurato1,
G. Bellizzi3, L.M. Giannetti4, C. Tammaro2,
V.M.N. Ferrante5, M. Raffa6, A. Monaco1
1Neurology, 2Laboratory, 3Cardiology, ASL AV, Civil Hospital
of Ariano Irpino, II University of Naples, Ariano Irpino,
4Infantile Neuropsychiatry - Social Service, ASL AV, Hospital
of Avellino, II University of Naples, Avellino, 5Didactic Pole,
6Intensive Care - Anaesthesiology, ASL AV, Civil Hospital of
Ariano Irpino, II University of Naples, Ariano Irpino, Italy
P2161
Abstract cancelled
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
520
Posters, Monday 10 September
P2162
P2168
Causes of early case-fatality in the acute
period of ischemic and hemorrhagic
strokes
Complex assessment of emotional state
and cognitive functions of patients with
cerebrovascular diseases
M.N. Azhermacheva1, T.A. Valikova1, V.M. Alifirova1,
L.N. Alekseeva2, D.M. Plotnikov1,2
S.A. Igumnov
Department of Neurology and Neurosurgery, Siberian State
Medical University, 2Regional Vascular Center, Tomsk,
Russia
1
P2163
Endovascular treatment – a safe and
efficient alternative approach for
ophthalmic segment aneurysms
A.C. Mergeani1, C. Laza1, D. Popescu1, B. Dorobat2,
O.A. Bajenaru1, F. Antochi1
Neurology, 2Interventional Radiology, University Emergency
Hospital Bucharest, Bucharest, Romania
1
P2164
Localization of hemorrhagic
transformation of ischemic stroke
associated with aspirin and enoxaparin
and aspirin concomitant therapy
M.İ. Yön, S. Mungan, N. Oztekin, S. Balcı, F. Ak
Neurology, MOH Ankara Numune Education and Research
Hospital, Ankara, Turkey
Republican Research and Practical Centre of Mental Health,
Minsk, Belarus
P2169
Intracerebral/subarachnoid haemorrhage
and venous diseases, late recurrence of
cerebral venous thrombosis: is life-long
anticoagulant therapy warranted in male
patients without risk factors?
H. Delgado1, R. Miguel1, S. Calado1,2, L. Val-Flores1,
M. Viana-Baptista1,2
Department of Neurology, Egas Moniz Hospital, 2CEDOC,
Medical Sciences Faculty, New Univeristy of Lisbon, Lisboa,
Portugal
1
P2170
Hypertrophic olivar degeneration after
pontine haemorrhage: a rare cause of
delayed neurological deterioration after
stroke
I. Menezes-Cordeiro1, J. Tavares2, S. Reimão2,
R. Geraldes3, J. Ferro3
Neurology Service, Hospital de Faro, Faro,
Neurorradiology Service, 3Neurology Service, Hospital de
Santa Maria, CHLN, Lisbon, Portugal
1
P2165
2
Prognosis comparison of intra-arterial
thrombolysis 6 hours before and after
onset time
O.J. Kim, H. Lee
Neurology, CHA University, Sungnam, Republic of Korea
P2171
Atypical cerebral haemorrhage
R. Tojal, J. Campillo
Professor Fernando Fonseca Hospital, Amadora, Portugal
P2166
Influence of the metabolic syndrome on
occurrence of ischemic stroke
P2172
Abstract cancelled
M. Vujnić
Department of Pathophysiology, Medical Faculty, University
in Banja Luka, Banja Luka, Bosnia-Herzegovina
P2173
Three different cases of CADASIL
P2167
J. Buczek, B. Blazejewska-Hyzorek, G. Gromadzka
2nd Department of Neurology, Institute of Psychiatry and
Susac’s syndrome
S. Mrabet, N. Kessentini, S. Fray, N. Ben Ali,
H. Khiari Mrabet, A. Mrabet
Neurology, Warsaw, Poland
Neurology, Charles Nicolle Hospital, Tunis, Tunisia
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
521
P2174
P2180
The effect of Yokukansan (TJ-54) on
delirium following acute ischemic stroke
and hospitalization
Cannabis use and multifocal intracranial
vasoconstriction: a case report of a young
patient
M. Nakazaki, T. Mori, H. Tajiri, T. Iwata, Y. Miyazaki,
K. Mizogami
P. Santos, C. Semedo, J.F. Pinto Marques
Department of Stroke Treatment, Shonan Kamakura General
Hospital, Stroke Center, Kamakura, Japan
P2175
Significance of early warning score in
patients with acute stroke
S. Jevdjic1, S. Kostic2
1General Hospital Pancevo, Pancevo, 2KBC Zvezdara,
Beograd, Serbia
Setubal Hospital, Lisbon, Portugal
P2181
The use of an individual index of health in
primary prevention of stroke
N. Michailovna1, Y. Madjidova1, U. Shaykhova2
Tashkent Medical Academy, 2Central Policlinic2, Tashkent,
Uzbekistan
1
P2182
Cerebral venous and sinus thrombosis
presenting with epileptic seizures: a case
report
P2176
Abstract cancelled
T. Dogan, M.T. Kendirli, M.G. Senol
P2177
GATA Haydarpasa Training Hospital, Istanbul, Turkey
Cerebral infarction and carotid artery
dissection secondary to blunt trauma:
case and review of the literature
P2183
B. Gökçe, A.K. Erdemoğlu
M. Baig1, T. Gaunt2, L. Al-Dhahir3
Neurology, Kirikkale University School of Medicine,
Kirikkale, Turkey
P2178
Successful aggressive antiplatelet
treatment in a case with crescendo TIAs
due to basilar artery stenosis
P. Sykioti1, A. Simitsi1, G. Tsivgoulis2, L. Stefanis1,
C. Liantinioti1, K. Voumvourakis1, N. Oikonomopoulos1,
M. Papathanasiou1
Neurology, Attikon University Hospital, 2Neurology,
Democritus University of Thrace, Athens, Greece
Moya-moya vasculitis
1
3
Queen’s Hospital Romford, 2General Surgery,
Neurosciences, Queen’s Hospital Romford, London, UK
P2184
Vertebral spasm after head and neck
injury
B. Adamkiewicz1, K. Kierkus-Dłużyńska1, P. Kolasa2,
P. Grygielski3
1Stroke Unit, 2Neurosurgery Dept., 3Radiology Dept.,
Kopernik Hospital, Lodz, Poland
1
P2179
Stroke in patients with chronic alcohol
consumption
I. Macavei1, I. Huza2, A. Macavei3, A. Treaba4
1Neurology, University of Medicine and Pharmacy, Tirgu
Mures, 2Neurology, Emergency Clinical County Hospital
Mures, 3General Medicine, Clinical County Hospital Mures,
4Radiology, Emergency Clinical County Hospital TirguMures, Târgu-Mures, Romania
P2185
Multiple cervical arteries dissection:
clinical and radiological correlations
B. Dumitriu
National Institute of Neurology and Neuro-Vascular
Diseases, Bucharest, Romania
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
522
Posters, Monday 10 September
P2186
P2192
Anterior choroidal artery infarct presented
by Horner syndrome and hypoglossal
nerve palsy
Internal carotid artery occlusion caused
by an acute-on-chronic pansinusitis:
a case report
E. Coban, N. Kale, E. Acar, D. Kırbas
R. Halmer, L. Davies, S. Walter, K. Fassbender
Bakirköy Mental Health Hospital, Istanbul, Turkey
P2187
The correlations between stroke risks and
classifications in a young population:
a retrospective analysis of stroke in
patients younger than 50 years
Babtain1,2,
F.
H. Bhatia2, E. Al Shehri1, B. Al Ghamdi1,
E. Al Amer1, M. Al Jabri1, M. Al Hamrany1, N. Ali1,
A. Al Hazzani1,2, M. Velmurugan2
King Khalid University, 2Aseer Central Hospital, Abha,
Saudi Arabia
1
P2188
Auditory and visual hallucinations as the
presentation of stroke: a case report
C.K. Wee
National Neuroscience Institute, Singapore, Singapore
P2189
Vascular anatomical settings and
neurovascular conflict in the central
nervous system
A.I. Bulboaca1, I.I. Opincaru2, A.E. Bulboaca3
Neurology, University of Medicine and Pharmacy,
Anatomy, 3Neurology, University of Medicine and Pharmacy
Cluj-Napoca, Romania
1
2
P2190
Gender differences in depression and
arterial hypertension combination
K. Larissa, L. Zakaryanova
Medical University of Astana, Kazakhstan
P2191
The changes in heart rate variability in
young patients with vertebrogenic
vertebrobasilar insufficiency
N. Nekrasova
Neurology, Kharkiv National Medical University, Kharkiv,
Ukraine
Neurology, University Hospital Saarland, Homburg,
Germany
P2193
Proteinuria in ischemic stroke: is it an
independent risk factor?
M.F. Oztekin1, N. Oztekin2, H. Okkan1
Neurology, MOH Ankara Yildirim Beyazit Education and
Research Hospital, 2Neurology, SB Ankara Numune
Education and Research Hospital, Ankara, Turkey
1
P2194
Therapeutic decision making in acute
carotid dissection - a potential role for
percutaneous vascular intervention
J. Lewis1, Á. Merwick2, L. Williams1, D. Mullane1,
R. O’Laoide1, A. O’Hare3, C. McGuigan1
1St. Vincent’s University Hospital, 2Department of Neurology,
Mater Misericordiae University Hospital, 3Department of
Neuroradiology, Beaumont Hospital, Dublin, Ireland
P2195
Psychotherapy in treatment of patients
with cerebral ischemic stroke
Y. Neryanova, O. Kozyolkin
Zaporozhye State Medical University, Zaporozhye, Ukraine
P2196
Predicting survival in haemorrhagic
stroke: the prognostic value of glucose
A.M.H. Young1, C.K. Weerasuriya1, A.J. Procter1,
S. Singh1, N. Wang1, A. Rinnert1, U. Rai2
1School of Clinical Medicine, University of Cambridge,
Cambridge, 2Department of Stroke Medicine, Queen
Elizabeth Hospital, King’s Lynn, UK
P2197
Superior sagittal sinus thrombosis:
sources of errors in image interpretation.
Report of two clinical cases
B. Blazejewska-Hyzorek1, R. Poniatowska2,
W. Łojkowska3
12nd Department of Neurology, 2Department of
Neuroradiology, 31st Department of Neurology, Institute of
Psychiatry and Neurology, Warsaw, Poland
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
523
P2198
P2203
Recurrent stroke in a healthy individual
with heterozygous factor V Leiden
Neuropsychological disorders after deep
cerebral venous thrombosis: a case
report
N. Anand
Neurology, NFMMC, Niagara Falls, NY, USA
P2199
Percheron artery occlusion in a patient
with previous atypical posterior reversible
encephalopathy syndrome: a case report
A. Morotti1, M. Gamba2, N. Gilberti2, V. Vergani2,
G. De Maria3, M. Magoni2, A. Padovani1
Department of Neurology, University of Brescia, Spedali
Civili, 2Stroke Unit, 3Department of Neurophysiology,
Spedali Civili, Brescia, Italy
1
P2200
Our first 100 patients treated with
intravenous thrombolysis during the last
3 years
V. Vuletic, M. Majdak
Neurology, University Hospital Dubrava, Zagreb, Croatia
P2201
Spontaneous internal carotid artery
dissection presenting with hemiballism:
a case report
N. Gilberti, M. Gamba, E. Del Zotto, A. Costa,
M. Magoni
I. Bouchhima, F. Jardak, M. Damak, E. Turki,
A. Boukhris, M.I. Miladi, I. Feki, C. Mhiri
Department of Neurology, Habib Bourguiba Hospital, Sfax,
Tunisia
P2204
Spontaneous psoas muscle haematoma
as a complication of anticoagulation in
acute cerebral venous thrombosis
C. Fernandes, P. Pereira, M. Rodrigues
Neurology Department, Hospital Garcia de Orta, Almada,
Portugal
P2205
Effect of citoflavin on the venous
component of cerebral haemodynamics in
patients with chronic cerebral ischemia
(CCI) with constitutional phlebopathy
(CCP)
O.Y. Kolotik-Kameneva, L.A. Belova, V.V. Mashin,
A.V. Byrina, N.V. Belova
Ulyanovsk State University, Ulyanovsk, Russia
P2206
Spedali Civili di Brescia, Italy
Is cerebellopontine angle syndrome
caused by dilated Virchow-Robin spaces?
P2202
P. Pereira1, L. Neves2, M. Grunho1, C. Fernandes1,
S. Matias2, J. Coimbra1
Spontaneous intracranial hypotension
preceding a primary angiitis of the central
nervous system: co-incidence or
co-existence?
M. Erwan1, F. Grays2, J. Cabane3, R. Meckenstock4, C.
Hubert5, M.-L. Chadenat1, F. Pico1
Neurology Department, Versailles Hospital, Versailles,
Pathology Department, Lariboisère Hospital, 3Internal
Médicine Department, St Antoine Hospital, Paris, 4Internal
Médicine Department, Versailles Hospital, 5Radiologie
Department, Versailles Hospital, Versailles, France
1
2
1Neurology, 2Neuroradiology, Hospital Garcia de Orta,
Almada, Portugal
P2207
Causes of intracranial arterial
hyperdensity
A. Sen1, A. Sever2, B. Arpaci1
1Neurology, 2Psychiatry, Bakirkoy Research and Training
Hospital for Neurology, Neurosurgery and Psychiatry,
Istanbul, Turkey
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
524
Posters, Monday 10 September
P2208
P2214
Iron deficiency anaemia as a risk factor
for stroke
Neurorehabilitation of patients with
post-stroke asthenic syndrome
H.Z. Batur Çağlayan1, B. Nazliel1, C. Irkec1, A. Dumlu2,
A. Filiz1
S. Medvedkova
Neurology, Gazi University Faculty of Medicine, Ankara,
2Neurology, Tokat Public Hospital, Tokat, Turkey
1
Zapororozhzhye State Medical University, Zaporozhzhye,
Ukraine
P2215
P2209
Dural sinus thrombosis following head
injury
F. Dany, I. Lahlou, H. Otmani, M.A. Rafai,
B. Elmoutawakil, I. Slassi
Pontis and extra-pontis myelinosis as a
result of Schwartz-Batter syndrome:
a case report
A. Zecevic, I. Grkic, V. Miletic
CHU IBN Rochd, Casablanca, Morocco
The Special Hospital for the Prevention and Treatment of
CVD ’Sveti Sava’, Belgrade, Serbia
P2210
P2216
Prognostic importance of morphodensitometry parameters of erythrocytes
for evaluation of progression of
cerebrovascular insufficiency
Cerebral vasoreactivity measured by
transcranial Doppler sonography to
differentiate ischemic and demyelinating
lesions
A.V. Anisimova, K.V. Anisimov, E.I. Gusev,
T.I. Kolesnikova
P. Petramfar, A. Zoghi
Neurology, Russian State Medical University, Moscow,
Russia
Neurology Department, Shiraz University of Medical
Sciences, Shiraz, Iran
P2217
P2211
Sleep apnoea and stroke
H. Derbali, L. Rais, M. Mansour, J. Zaouali, R. Mrissa
Neurology, Military Hospital, Tunis, Tunisia
Anti-epileptic drugs as therapeutic
approach in agitated/aggressive patients
with acute stroke
K. Flabouriari1, K. Vlachos2
1Neurology, 2Neurological, General Hospital of Attica,
Sismanogleion, Athens, Greece
P2212
Comparing the expression of VEGF-A
between acute ischemic stroke patients
and non-stroke patients
I. Setyopranoto, S. Wibowo
Stroke Unit Department Neurology, Faculty of Medicine
Gadjah Mada University, Yogyakarta, Indonesia
P2218
Fatal posterior reversible encephalopathy
syndrome in a young adult with secondary
hypertension: a case report
J. Stochmal1, J. Staszewski1, E. Skrobowska2, A. Stępień1
P2213
1Department of Neurology, 2Department of Radiology,
Military Institute of Medicine, Warsaw, Poland
Gender differences of risk factors of
ischemic stroke
P2219
A.G. Fazliakhmetova
Vertebral artery dissection: 10 cases
Kazan State Medical University, Kazan, Russia
M. Cabalar1, S. Uysal1, A. Demirtas-Tatlidede1,
H. Selcuk2, B. Kara2, V. Yayla1
1Bakirkoy Training and Research Hospital, Department of
Neurology, 2Neuroradiology, Bakirkoy Training and
Research Hospital, Istanbul, Turkey
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807
Posters, Monday 10 September
P2220
P2222
Variation of circle of Willis with A1aplasia
correlated with bilateral cerebral
infarction
Subclavian steal syndrome clinics:
a report of two cases and review of
the literature on epidemiology,
symptomatology and outcome
E. Shemsi1, S. Gabrani2, A. Rroi3
Neurology, Regional Hospital of Durres, Durres,
Morfology, UT, 3Neuroradiology, University Hospital ’Nene
Tereza’, Tirana, Albania
1
2
P2221
A. Jesic1, J. Maric2, A. Konjovic2, M. Poznic- Jesic3,
Z. Zivanovic1, I. Divjak1
525
1Neurology Clinic, Clinical Centre of Vojvodina, 2University
of Novi Sad, 3Psychiatry Clinic, Clinical Centre of
Vojvodina, Novi Sad, Serbia
Role of trigeminal ganglion neuron
density on posterior communicating
artery remodelling after bilateral common
carotid artery ligation: an experimental
study
R. Aygul1, M.D. Aydın2, D. Kotan3, R. Demir1, H. Ulvi1,
M. Karalar4, N. Nalbantoglu5, M. Eseoglu6
Department of Neurology, 2Department of Neurosurgery,
Ataturk University, Erzurum, 3Department of Neurology,
Sakarya University, Sakarya, 4Department of Neurosurgery,
Silivri State Hospital, Istanbul, 5Department of Pathology,
Ataturk University, Erzurum, 6Department of Neurosurgery,
Yuzuncu Yıl University, Van, Turkey
1
© 2012 EFNS European Journal of Neurology 19 (Suppl. 1), 458–807