- Email: [email protected]
0616 Antimony-induced cerebellar ataxia: Two case reports
Poster Abstracts
Tuesday, November 8, 2005
$255
patients received at least one course of pulse steroid therapy. Only two patients received beta interferon, 16(111%) patients received Methotraxate and 14 (10%) patients received Mitoxantrone. Seven (15"/o) patients did not receive any disease specific therapy. At most recent follow up 33(24%) were normal functioning, 63(145"/o) required some assistance for anthulation or activities o f daily living, 45(31%) were chair or bed bound. One patient died due to sepsis after pulse steroid treatment. Conclusion: MS is not uncommon in Pakistan. Cranial MS was more common than spinal or optico-spinal form. More than 80% patients with MS follow a relapsing-remitting course. Use of beta-interferon is extremely low in our patient population. More than 75% were moderately or severely disabled at the time of evaluation.
subsequently induced relapses. These findings could be confirmed by histopathology. Importantly, the protective effect was achieved by allogeneic, syngeneic and grafts fi'om diseased rats. BMT resulted in increased nunthers of CD4+CD25bright regulatory T cells, increased Foxp3 expression, a slfift in T cell epitope recognition and the reduction of autoantibody levels. Titus, our results indicate potential mechanisms of how BMT may contribute to the improvement of MS and provide a rationale for its application in patients suffering from various autoimmune diseases.
0613 Plasma exchange therapy for Nemotnyelifis Opfica with hypothalanic lesions
Background: In Japan, interferon betalb ([VNlb) therapy is the only way to prevent relapsing event o f nmltiple sclerosis (MS). However, there is no active marker which represents the degree of disease activity and effect of IFN 1b. The purpose o f this study is to identify the marker and predict the disease course after treatment with IFNlb. Method: We enrolled 31 MS patients according to Poser's criteria. CSF samples were centrifuged and stored at -80~'C immediately after withdrawal. The level of CSF IgG, albumin, 41 amino-acids, and nitric oxide (NO) metabolites were measured by HPLC and statistical analyses were performed The change of those measures in relation to clinical disease severity (expanded disability status score; EDSS) were also evaluated. Results: After treatment of IFN1 b, there is no statistical significance in the level of IgG index between groups. However, we could find some correlation in some individuals. The level of NO metabolites did not correlate well with therapy. After treatment o f I F N l b , the level of phosphoethanol amine at relapsing phase was decreased (P > 0.05). Individuals who have stopped IFN therapy due to side effect and relapsed thereafter, showed increased IgG index and EDSS. Contusion: The measurement of IgG indices were easily done world wide and would reflect the gross effect of IFNlb. With adding the information of the level of phosphoethanol amine, or other undetermined soluble factors we would predict the disease modifying effect of I F N I b at outpatient clinic.
Watanabe, S 1, Nakashima, I t, Fujthara, K 1, Miyazawa, I, Shiga, Y, Itoyama, Y. 1Department of Neurology, Tohoku University School of
Medicine, Sendal, Japan We report a patient of neuromyelitis optica (NMO) whose hypothalamic lesion was totally unresponsive to high-dose intravenous methylprednisolone (HIMP) but was successfully treated with plasma exchange (PE). Background: N M O is a unique inflammatory demyelinating disease of central nervous system (CNS) characterized by severe attacks of optic. neuritis and myelitis. In NMO, hypothalamic lesions occasionally develop and could involve the optic tract, and the cases with endocrinopathy due to hypothalamic dysfunction have been reported in the literature. N M O with hypothalarnic lesions generally carries a poor prognosis. Recently, therapeutic, efficacy o f PE in some corticosteroid-unresponsive cases of idiopathic, demyelinating diseases including N M O has been reported, but how hypothalamic lesions in N M O respond to PE remains unknown. Method: A 21-year-old woman developed right visual impairment and the brain MRI showed lesions in the hypothalamus, medulla oblongata, and spinal cord. Before admission, she had had total blindness in the left eye and upper-half visual field defect in the right eye as sequellae of previous attacks of NMO. Her visual acuity and the visual field were investigated before and after two courses of H I M P therapy (Day 1-3 and Day 9-11) and four times PE (Dayl6, 18, 22, and 26), which exchanged 2 liters of plasma with 5% albumin solution. Serum prolacfine level was also measured. Result: PE was effective in this case for the visual impairment and hyperprolactinenfia caused by the hypothalanfic lesions. Contusion: PE should be considered in treating N M O patients with hypothalantic lesions who are unresponsive to corticosteroid therapy. 0614 Bone marrow transplantation protects from experimental Autoimmune Encephalomyelitis by induction of CD4+CD25bright regulatory T cells anti reduction of autoanfibody levels Weissert, R t, Gaertner, S ~, Stadelmann, C 2, Herrmann, M 1.
1Department of General Neurology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany; 2Department of Neuropathology, University of Goettingen, Goettingen, Germany Experimental autoinmmne encephalomyelitis (EAE) in rats is a lfighly valuable model o f multiple sclerosis (MS) since it mimics major hallmarks of the human disease. Recently, bone marrow transplantation (BMT) was introduced as a novel strategy to treat MS but its efficiency and the underlying mechanism are debatable. Readdressing this issue in an animal model, we found that BMT at the peak of EAE but not in the chronic phase lead to disease attenuation. In both settings bone marrow transplanted rats were protected from
0615 Activity marker in Ulultiple sclerosis Yokoyama, K, Mizuno, Y. Juntendo University School Of Medicine
0615B Can mulfifocal visual evoked potential latency analysis predict progression to Multiple Sclerosis? Fraser, C t, Klistorner, A 1 Graham, S 1 Garrick, R 2 Billson, F 1 Grigg, J~. 1Save Sight Institute, Sydney, Australia," 2 St Iqncent's
Hospital, Sydney, Australia Background: In our pilot study of 68 subjects, nmltifocal visual evoked potential (mVEP) latency analysis of patients with optic neuritis (ON) it was found that latency values are significantly different between groups of patients classified according to the McDonald criteria for Multiple sclerosis (MS). The "possible-MS'" patients were shown to have a bimodal distribution of latency z-score results: some patients had no latency delay (mirroring results from the "not-MS" patients) whereas other patients had long latency delays similar to those already diagnosed as "MS". It was hypothesized that delayed mVEP latency in a "possible-MS'" patient could be used to predict future progression to "MS". Method: 29 ON patients categorized as "possible-MS" by a consultant neurologist were followed for one year. Multifocal VEP was performed using the Accumap T M (ObjectiVision, Sydney, Australia) at the start of the study. The latency z-scores were determined, and group was divided into those with delayed mVEP latency results, and those with normal results. Results: 24.2% (17) had no latency delay on z-score analysis. The remaining 75.9% (122) had significantly delayed latency results. Over one year 7 of these patients progressed clinically to a diagnosis "MS". All of these patients had shomt a latency delay on initial mVEP
$256
Poster Abstracts
Tuesday, November 8, 2005
testing. Thus the conversion to "MS" was 31.8% in the high latency group, and 0% in the normal latency group. Conclusion: Tiffs provides further evidence to suggest that mVEP latency results may have a role in identifying a patient's risk for future MS. 0616 Anfimony4ndueed eerebellar ataxia: Two ease reports Almled Ammar, E1VI2, Khalil, E A G a~, Musa, A M a, Muna Hussein Abboud 4 Leislnnaniasis Research Group/Sudan. 2Institute of Endemic
Diseases, University of Khartourn; 2Department of Physiology, Faculty of Medicine, University of fOlartoum; 3Department of Medicine, Faculty of Medicine, University of Khartoum; 4Tropical Diseases Hospital, Om Durman, Sudan Sodimn stibogluconate (Pentostam®), the mainstay o f treatment of visceral leishinaniasis (VL) is cardiotoxic and neurotoxic. Recently, neurological matfffestations in VL have been documented. Cerebellar atmxia has been reported with infections and as a toxic effect of some drugs. We report two cases of cerebellar atmxia that followed administration of Pentostam ®. Two adult patients, one suspected and the other was a confirmed case of kala-azar were treated by Pentostam ® at a dose of 20 mg/Kg body weight/day. On day 17 of treatment the suspected case developed marked generalized tremors and unstable gait. An EEG examination showed generalized spikes. A diagnosis of pentostam-induced cerebellar atmxia was made, possibly due to a wide spread brain insult. Pentostam was stopped and he continued to improve and by four weeks the tremors disappeared and his coordination was back to normal but the reflexes remained exaggerated. The second patient was resistant to Pentostam. She received 126 injections o f pentostam without clinical or parasitological response. While on pentostam, she developed abnormal movements. A n EEG examination showed generalized spikes and a diagnosis of pentostam-unresponsive VL with pentostam-induced cerebellar ataxia was made. She responded clinically and parasitologically to AmBisome. Her neurological symptoms and signs improved dramatically with the treatment. 0617 Barkhof and Tintorr's MRI criteria: Comparison between Relapse-reinitting Multiple Sclerosis and Recurrent Neuroulyelitis optica Vasconcelos, CCF 1"2, Silveira, R 2, Alvarenga, M L3, Papais-Alvarenga, R L2. :Federal University of Rio de Janeiro State, Rio
de Janeiro, Brazil," 2Hospital da Lagoa, Rio de Janeiro, Brazil 3Severino Sombra University, Vassouras, Brazil Background: MS and N M O are demyelinating inflannnatory (DI) multiphasic and polysymptomatic diseases of the CNS. Recurrent N M O differ from MS by 'the selective involvement of the optic nerve and spinal cord, extensive spinal cord lesion, normal MRI at onset and pleocytosis at acute phase of the bouts (Wingerchuk et al., 1999). MS is still recognized by "dissemination in time and space" and Barkhof and Tintor~ MRI criteria was indicated to support the MS diaguostic (McDonald, 2001). Method: We applied the Barkhof and Tintor~ MRI criteria in fourty patients with DI disease with recurrent course: twenty with MS by MacDonald criteria and twenty with N M O R by Wingerchuk criteria assisted in Hospital da Lagoa (Rio de Janeiro). We analyzed and compared gender, race, age at onset of disease and the duration of the disease when MRI study was done in the two groups. Results: We found a female predominance in both groups (80% RRMS and 85% N M O R ) with no difference concerning ethnic background. The mean of age at onset o f disease was 30 years to N M O R and 29,5 years to RRMS, the mean of time disease until the Brain MRI was 4.5 years to N M O R and 6 years respectively to RRMS; with no statistic difference in the two groups Only 5"/0 of the R N M O fulfilled the MRI criteria; 75% of the RRMS patients
meet the criteria, with significant statistic difference between groups (iJ - 0.019 in the Qui-square test). Contusion: Barkoft and Tintore MS MRI criteria is useful to distinguish RRMS from RNMO. 0618 Magnetic resonance imaging findings of a thalassemic patient with extramedullary hemopoiesis and paraplegia. A case report Anfinzadeh, P. Sari Medical School, Sari, .[ran. A 33 year-old Irarfian man presented with abrupt onset of lower extremities weakness. He mentioned thoracolumbar bone pain since 1 month ago. Past medical history was positive for Beta-Thalassemia Intermedia. He had never received any blood transfusions. Physical examination was positive for paraplegia. MRI of thoracolumbar spine revealed multiple well defined lobulated mass lesions with same signal of bone marrow within central canal along thoracic and sacral regions which had led to sigtffficant cord compression. A diagnosis of extramedullary hemopoiesis with neurologic sequellae was made; and the patient was referred for hydroxyurea therapy that resulted to marked neurologic improvement. Conclusion: Extramedullary hemopoiesis should be considered as a cause of neurologic syl~dromes in patients with chronic hemolytic anemias especially patients with thalassenffa. Correct diagnosis may prevent unnecessary surgery and lead to effective therapy with good results. 0619 Color duplex sonography in patients with Lacunar Stroke Arsovska, A 1, Popovski, A 1. 2Clinic of Neurology, Clinical Center,
Skopje, Macedonia Background: Lacunar infarcts (iLl) represent a subgroup of ischemJc strokes that result mostly from an occlusion of a penetrating artery. So far, the association between LI and stenosis of the extracratffal and intracranial carotid arteries has been variable. Aim: To investigate the prevalence of extracranial and intracranial carotid artery stenosis in patients with LI. Method: We studied 92 patients with clinical-radiological criteria o f LI. All patients mlderwent color duplex sonography o f the extracrarfial and intracratffal carotid arteries. We then compared the severity between ipsilateral and contralateral stenotic diseases. Results: We found normal results in 52 patients (156, 5%); increased intima-media thickness was found in 16 patients (17, 4%). Moderate stenosis was measured in 18 patients (17, 4%) and severe stenosis was seen in 6 patients (6, 5<'/0). There was no sigrfificalrt difference between tire severity of stenotic changes of ipsilateral and contralateral side (p < 0, 01). Contusion: Stenotic diseases of the carotid arteries do not represent a significant risk factor for patients with LL 0620 Evaluation of Olfactory Function by single photon emission COulputed tomography (SPECT). Eftekhari, M l, Saghari, M ~, Assadi, M ~, Kazemi, M ~, Fard-Esfahani, A ~, Mehdizadeh, j2, Sadeghi-Hasanabadi, M 2.
1Shariati Hospital, Tehran, Iron; 2Amiralam Hospital, Tehran, Iron Background: olfactory perception is considerably limited in tmnlan being compared to that of other arfimals. The inadequate knowledge about this sense is probably due to its very subjective; as well as it's less development in human. We studied the role of single photon emission computed tomography (SPECT) in olfactory function using vanilla powder. Methods: SPECT was perfomled with 99m Tc-ECD as imaging agent on 36 patient with posttraumatic anosmia and 22 healthy controls. Senti quantitative analysis was performed by computing count of
Tuesday, November 8, 2005
$255
patients received at least one course of pulse steroid therapy. Only two patients received beta interferon, 16(111%) patients received Methotraxate and 14 (10%) patients received Mitoxantrone. Seven (15"/o) patients did not receive any disease specific therapy. At most recent follow up 33(24%) were normal functioning, 63(145"/o) required some assistance for anthulation or activities o f daily living, 45(31%) were chair or bed bound. One patient died due to sepsis after pulse steroid treatment. Conclusion: MS is not uncommon in Pakistan. Cranial MS was more common than spinal or optico-spinal form. More than 80% patients with MS follow a relapsing-remitting course. Use of beta-interferon is extremely low in our patient population. More than 75% were moderately or severely disabled at the time of evaluation.
subsequently induced relapses. These findings could be confirmed by histopathology. Importantly, the protective effect was achieved by allogeneic, syngeneic and grafts fi'om diseased rats. BMT resulted in increased nunthers of CD4+CD25bright regulatory T cells, increased Foxp3 expression, a slfift in T cell epitope recognition and the reduction of autoantibody levels. Titus, our results indicate potential mechanisms of how BMT may contribute to the improvement of MS and provide a rationale for its application in patients suffering from various autoimmune diseases.
0613 Plasma exchange therapy for Nemotnyelifis Opfica with hypothalanic lesions
Background: In Japan, interferon betalb ([VNlb) therapy is the only way to prevent relapsing event o f nmltiple sclerosis (MS). However, there is no active marker which represents the degree of disease activity and effect of IFN 1b. The purpose o f this study is to identify the marker and predict the disease course after treatment with IFNlb. Method: We enrolled 31 MS patients according to Poser's criteria. CSF samples were centrifuged and stored at -80~'C immediately after withdrawal. The level of CSF IgG, albumin, 41 amino-acids, and nitric oxide (NO) metabolites were measured by HPLC and statistical analyses were performed The change of those measures in relation to clinical disease severity (expanded disability status score; EDSS) were also evaluated. Results: After treatment of IFN1 b, there is no statistical significance in the level of IgG index between groups. However, we could find some correlation in some individuals. The level of NO metabolites did not correlate well with therapy. After treatment o f I F N l b , the level of phosphoethanol amine at relapsing phase was decreased (P > 0.05). Individuals who have stopped IFN therapy due to side effect and relapsed thereafter, showed increased IgG index and EDSS. Contusion: The measurement of IgG indices were easily done world wide and would reflect the gross effect of IFNlb. With adding the information of the level of phosphoethanol amine, or other undetermined soluble factors we would predict the disease modifying effect of I F N I b at outpatient clinic.
Watanabe, S 1, Nakashima, I t, Fujthara, K 1, Miyazawa, I, Shiga, Y, Itoyama, Y. 1Department of Neurology, Tohoku University School of
Medicine, Sendal, Japan We report a patient of neuromyelitis optica (NMO) whose hypothalamic lesion was totally unresponsive to high-dose intravenous methylprednisolone (HIMP) but was successfully treated with plasma exchange (PE). Background: N M O is a unique inflammatory demyelinating disease of central nervous system (CNS) characterized by severe attacks of optic. neuritis and myelitis. In NMO, hypothalamic lesions occasionally develop and could involve the optic tract, and the cases with endocrinopathy due to hypothalamic dysfunction have been reported in the literature. N M O with hypothalarnic lesions generally carries a poor prognosis. Recently, therapeutic, efficacy o f PE in some corticosteroid-unresponsive cases of idiopathic, demyelinating diseases including N M O has been reported, but how hypothalamic lesions in N M O respond to PE remains unknown. Method: A 21-year-old woman developed right visual impairment and the brain MRI showed lesions in the hypothalamus, medulla oblongata, and spinal cord. Before admission, she had had total blindness in the left eye and upper-half visual field defect in the right eye as sequellae of previous attacks of NMO. Her visual acuity and the visual field were investigated before and after two courses of H I M P therapy (Day 1-3 and Day 9-11) and four times PE (Dayl6, 18, 22, and 26), which exchanged 2 liters of plasma with 5% albumin solution. Serum prolacfine level was also measured. Result: PE was effective in this case for the visual impairment and hyperprolactinenfia caused by the hypothalanfic lesions. Contusion: PE should be considered in treating N M O patients with hypothalantic lesions who are unresponsive to corticosteroid therapy. 0614 Bone marrow transplantation protects from experimental Autoimmune Encephalomyelitis by induction of CD4+CD25bright regulatory T cells anti reduction of autoanfibody levels Weissert, R t, Gaertner, S ~, Stadelmann, C 2, Herrmann, M 1.
1Department of General Neurology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany; 2Department of Neuropathology, University of Goettingen, Goettingen, Germany Experimental autoinmmne encephalomyelitis (EAE) in rats is a lfighly valuable model o f multiple sclerosis (MS) since it mimics major hallmarks of the human disease. Recently, bone marrow transplantation (BMT) was introduced as a novel strategy to treat MS but its efficiency and the underlying mechanism are debatable. Readdressing this issue in an animal model, we found that BMT at the peak of EAE but not in the chronic phase lead to disease attenuation. In both settings bone marrow transplanted rats were protected from
0615 Activity marker in Ulultiple sclerosis Yokoyama, K, Mizuno, Y. Juntendo University School Of Medicine
0615B Can mulfifocal visual evoked potential latency analysis predict progression to Multiple Sclerosis? Fraser, C t, Klistorner, A 1 Graham, S 1 Garrick, R 2 Billson, F 1 Grigg, J~. 1Save Sight Institute, Sydney, Australia," 2 St Iqncent's
Hospital, Sydney, Australia Background: In our pilot study of 68 subjects, nmltifocal visual evoked potential (mVEP) latency analysis of patients with optic neuritis (ON) it was found that latency values are significantly different between groups of patients classified according to the McDonald criteria for Multiple sclerosis (MS). The "possible-MS'" patients were shown to have a bimodal distribution of latency z-score results: some patients had no latency delay (mirroring results from the "not-MS" patients) whereas other patients had long latency delays similar to those already diagnosed as "MS". It was hypothesized that delayed mVEP latency in a "possible-MS'" patient could be used to predict future progression to "MS". Method: 29 ON patients categorized as "possible-MS" by a consultant neurologist were followed for one year. Multifocal VEP was performed using the Accumap T M (ObjectiVision, Sydney, Australia) at the start of the study. The latency z-scores were determined, and group was divided into those with delayed mVEP latency results, and those with normal results. Results: 24.2% (17) had no latency delay on z-score analysis. The remaining 75.9% (122) had significantly delayed latency results. Over one year 7 of these patients progressed clinically to a diagnosis "MS". All of these patients had shomt a latency delay on initial mVEP
$256
Poster Abstracts
Tuesday, November 8, 2005
testing. Thus the conversion to "MS" was 31.8% in the high latency group, and 0% in the normal latency group. Conclusion: Tiffs provides further evidence to suggest that mVEP latency results may have a role in identifying a patient's risk for future MS. 0616 Anfimony4ndueed eerebellar ataxia: Two ease reports Almled Ammar, E1VI2, Khalil, E A G a~, Musa, A M a, Muna Hussein Abboud 4 Leislnnaniasis Research Group/Sudan. 2Institute of Endemic
Diseases, University of Khartourn; 2Department of Physiology, Faculty of Medicine, University of fOlartoum; 3Department of Medicine, Faculty of Medicine, University of Khartoum; 4Tropical Diseases Hospital, Om Durman, Sudan Sodimn stibogluconate (Pentostam®), the mainstay o f treatment of visceral leishinaniasis (VL) is cardiotoxic and neurotoxic. Recently, neurological matfffestations in VL have been documented. Cerebellar atmxia has been reported with infections and as a toxic effect of some drugs. We report two cases of cerebellar atmxia that followed administration of Pentostam ®. Two adult patients, one suspected and the other was a confirmed case of kala-azar were treated by Pentostam ® at a dose of 20 mg/Kg body weight/day. On day 17 of treatment the suspected case developed marked generalized tremors and unstable gait. An EEG examination showed generalized spikes. A diagnosis of pentostam-induced cerebellar atmxia was made, possibly due to a wide spread brain insult. Pentostam was stopped and he continued to improve and by four weeks the tremors disappeared and his coordination was back to normal but the reflexes remained exaggerated. The second patient was resistant to Pentostam. She received 126 injections o f pentostam without clinical or parasitological response. While on pentostam, she developed abnormal movements. A n EEG examination showed generalized spikes and a diagnosis of pentostam-unresponsive VL with pentostam-induced cerebellar ataxia was made. She responded clinically and parasitologically to AmBisome. Her neurological symptoms and signs improved dramatically with the treatment. 0617 Barkhof and Tintorr's MRI criteria: Comparison between Relapse-reinitting Multiple Sclerosis and Recurrent Neuroulyelitis optica Vasconcelos, CCF 1"2, Silveira, R 2, Alvarenga, M L3, Papais-Alvarenga, R L2. :Federal University of Rio de Janeiro State, Rio
de Janeiro, Brazil," 2Hospital da Lagoa, Rio de Janeiro, Brazil 3Severino Sombra University, Vassouras, Brazil Background: MS and N M O are demyelinating inflannnatory (DI) multiphasic and polysymptomatic diseases of the CNS. Recurrent N M O differ from MS by 'the selective involvement of the optic nerve and spinal cord, extensive spinal cord lesion, normal MRI at onset and pleocytosis at acute phase of the bouts (Wingerchuk et al., 1999). MS is still recognized by "dissemination in time and space" and Barkhof and Tintor~ MRI criteria was indicated to support the MS diaguostic (McDonald, 2001). Method: We applied the Barkhof and Tintor~ MRI criteria in fourty patients with DI disease with recurrent course: twenty with MS by MacDonald criteria and twenty with N M O R by Wingerchuk criteria assisted in Hospital da Lagoa (Rio de Janeiro). We analyzed and compared gender, race, age at onset of disease and the duration of the disease when MRI study was done in the two groups. Results: We found a female predominance in both groups (80% RRMS and 85% N M O R ) with no difference concerning ethnic background. The mean of age at onset o f disease was 30 years to N M O R and 29,5 years to RRMS, the mean of time disease until the Brain MRI was 4.5 years to N M O R and 6 years respectively to RRMS; with no statistic difference in the two groups Only 5"/0 of the R N M O fulfilled the MRI criteria; 75% of the RRMS patients
meet the criteria, with significant statistic difference between groups (iJ - 0.019 in the Qui-square test). Contusion: Barkoft and Tintore MS MRI criteria is useful to distinguish RRMS from RNMO. 0618 Magnetic resonance imaging findings of a thalassemic patient with extramedullary hemopoiesis and paraplegia. A case report Anfinzadeh, P. Sari Medical School, Sari, .[ran. A 33 year-old Irarfian man presented with abrupt onset of lower extremities weakness. He mentioned thoracolumbar bone pain since 1 month ago. Past medical history was positive for Beta-Thalassemia Intermedia. He had never received any blood transfusions. Physical examination was positive for paraplegia. MRI of thoracolumbar spine revealed multiple well defined lobulated mass lesions with same signal of bone marrow within central canal along thoracic and sacral regions which had led to sigtffficant cord compression. A diagnosis of extramedullary hemopoiesis with neurologic sequellae was made; and the patient was referred for hydroxyurea therapy that resulted to marked neurologic improvement. Conclusion: Extramedullary hemopoiesis should be considered as a cause of neurologic syl~dromes in patients with chronic hemolytic anemias especially patients with thalassenffa. Correct diagnosis may prevent unnecessary surgery and lead to effective therapy with good results. 0619 Color duplex sonography in patients with Lacunar Stroke Arsovska, A 1, Popovski, A 1. 2Clinic of Neurology, Clinical Center,
Skopje, Macedonia Background: Lacunar infarcts (iLl) represent a subgroup of ischemJc strokes that result mostly from an occlusion of a penetrating artery. So far, the association between LI and stenosis of the extracratffal and intracranial carotid arteries has been variable. Aim: To investigate the prevalence of extracranial and intracranial carotid artery stenosis in patients with LI. Method: We studied 92 patients with clinical-radiological criteria o f LI. All patients mlderwent color duplex sonography o f the extracrarfial and intracratffal carotid arteries. We then compared the severity between ipsilateral and contralateral stenotic diseases. Results: We found normal results in 52 patients (156, 5%); increased intima-media thickness was found in 16 patients (17, 4%). Moderate stenosis was measured in 18 patients (17, 4%) and severe stenosis was seen in 6 patients (6, 5<'/0). There was no sigrfificalrt difference between tire severity of stenotic changes of ipsilateral and contralateral side (p < 0, 01). Contusion: Stenotic diseases of the carotid arteries do not represent a significant risk factor for patients with LL 0620 Evaluation of Olfactory Function by single photon emission COulputed tomography (SPECT). Eftekhari, M l, Saghari, M ~, Assadi, M ~, Kazemi, M ~, Fard-Esfahani, A ~, Mehdizadeh, j2, Sadeghi-Hasanabadi, M 2.
1Shariati Hospital, Tehran, Iron; 2Amiralam Hospital, Tehran, Iron Background: olfactory perception is considerably limited in tmnlan being compared to that of other arfimals. The inadequate knowledge about this sense is probably due to its very subjective; as well as it's less development in human. We studied the role of single photon emission computed tomography (SPECT) in olfactory function using vanilla powder. Methods: SPECT was perfomled with 99m Tc-ECD as imaging agent on 36 patient with posttraumatic anosmia and 22 healthy controls. Senti quantitative analysis was performed by computing count of