- Email: [email protected]
1204 Carotid duplex studies in patients young stroke with a prothrombotic state
$408
Thursday, November 10, 2005
Generalized outcomes are the following. Significant improvement occurred in 14 cases (29,8%), disability in 16 (134,1%), and 17 patients died (36,1%). Contusion: Surgical management of HHS with IH allowed to achieved good outcomes in patients with GCS scores 14-7. Operations on patients with GCS scores 6-3 nmst be considered only as a last chance to diminish for brain dislocation syndrome. 1204 Carotid Duplex studies in patients young stroke with a Prothrombotie state
D. Khuxana 1, S. Prabhakar 1, G Grewal 1, V Lal 1, PPS Kharbanda 1, CP Das ~, M Modi ~. 1Postgraduate Institute of Medical Education And
Research, India Baekgtoumh Prothronrbotic states like protein C deficiency, Protein S Deficiency, Antithrombin Deficiency, Anticardiolipin Antibodies (ACLA), lupus anticoagulant (LA) and factor V Leiden have been implicated in etiology o f young strokes ( < 45 years). The occurrence of carotid lesions in young strokes is o f low prevalence. Aims and Objectives: To prospectively determine the incidence of carotid/vertebral artery disease in young strokes with a prothrombotic state. Methods: Patients were recruited from the young strokes attending the Neurology outpatient who were found to be positive for one or more prothrombotic states -Protein C / S / Antithrombin deficiency, ACLA, LA or Factor V Leiden. Carotid duplex studies were done which included B-mode, colour and pulsed doppler. Results: 200 young strokes have been enrolled till April 2005. 63 (31.5%) patients have been found to be positive for a prothrombotic state. Out of these, 13 patients (20.63%) had an abnormal carotid duplex studies.6 patients (146.15%) were deficient in Protein S, 1 (17.69%) in Protein C, 2 (115.38%) in in both Protein C and S, 3 (23%) were positive for Lupus anticoagulant whereas 1 (7.69%) was positive for both Lupus anticoagulant and Anticardiolipin antibodies. Conclusions: Carotid atherosclerosis appears to be an important contributor to strokes o f prothrombotic origin. Protein S Deficiency is the commonest prothrombotic state associated with abnormal carotid duplex findings. These findings could help in formulating an effective screening strategy for prothrombotic states in young strokes with carotid atherosclerosis. 1205 Carotid Duplex studies and transesophageal echocardiography in acute ischemie stroke
Khuxana, D ~, Prashantha, D K 2, Prabhakar, S ~, Kunrar, R M ~.
2Department of Neurology, PGIMER, India; 2Department of Internal Medicine, PGIMER, India; 3Department of Cardiology, PGIMER, India Introduction: Duplex ultrasound is widely used as a screening tool for diagnosing atherosclerosis o f the extracranial carotid arteries. Transesophageal echocardiography (TEE) is used for detecting atherosclerosis of aortic arch and cardioembolic sources. Limited data is available for studies using these modalities to detemfine etiology in acute stroke. Aims and Objeclives: 1. To evaluate patients of acute ischemic stroke by duplex ultrasound for detection of atherosclerosis involving extracranial carotid arteries. 2. To perform TEE in these patients to detect aortic arch atherosclerosis and non-rheunratic cardioembolic sources. Methods 50 patients were prospectively evaluated from Neurology outpatient, wards and emergency medical services of P G I M E R , Chandigarh. Patients with anterior circulation strokes o f upto one week duration were included. Color duplex study of the carotids and TEE/transhoracic echocardiography was performed. Results: Mean age of presentation was 54yrs (Range 30-75yrs). Tire male-female ratio was 3.16:1.25 patients had a left M C A infarct,
Poster Abstracts 21 had a right MC.A infarct while two patients had right and left A C A infarcts respectively. Duplex study showed complete occlusion on the symptomatic side in 2 (4°,5) patients while 14 (28%) patients had increased IMT on the symptomatic side. 9 (18%) patients had plaques on the symptomatic side. Only 1 patient had a hypoechoic plaque, the rest had hyperechoic plaques. 3 (6%) patients had a stenosis > 50% while 6 (112%) patients had a stenosis of < 50%. TEE showed an Atrial septal defect in 1 (2%) patient and a Patent foramen ovale in 1 (2%) patient. However both patients had significant carotid atherosclerosis on the symptomatic side. Conclusions: Carotid duplex study is a practical tool to assess stroke etiology in the acute stage. Transesophageal echocardiography however should be employed in cases where etiology is not discernible. 1206 Retinal photography in patients with cerebral white inaller lesions
Kim HY 1, Koo DL 1, Lee K Y 1, Lee yj1, Kim HT 1, Kim SH 1, Kim j 1 Kim M H 1. 2Hanyang University Hospital, Seou4 Korea Background: Retinal photographic abnormalities reflect cumulative vascular change from hypertension, aging, and other various processes. Cerebral wlfite matter lesions (WML) detected on magnetic resonance imaging have been hypothesized to have a microvascular etiology and are associated with retinal vascular changes. However, few clinical data are available about the relationship between these microvascular changes and cerebral arterial stenosis. Method: We investigated demographic features, vascular risk factors, and subtypes in 355 stroke patients with wlfite matter lesions over 2 years between January 2003 and February 2005 and we performed retinal photographs, brain M R image (MRI) and Angiography (MRA). Retinal photographs were evaluated for specific retinal vascular abnormalities (eg, microaneurysm, retinal hemorrhage, soft exudates, arteriolar narrowing, and arteriovenous nicking) by graders using standardized protocols. White matter lesions were coded from 0 for normal to 9 for most severe WML. Cerebral arterial stenosis was defined by MRA. Results: Age and hypertension correlated with prevalence of retinopathy in patients with white matter lesions. In retinal photography, arteriovenous nicking, focal arteriolar narrowing, and generalized arteriolar narrowing were associated with the presence of cerebral artery stenosis (p - 0.005, -- 0.014, and 0.043, respectively). But, in stroke subtypes, there was no relationship between tire presence of retinopathy and stroke subtypes. Conclusion: These findings suggest that retinal vascular abnormalities on retinal photographs are associated with the presence of cerebral arterial stenosis. 1207 Cervical Brown-Sequard Symtroine wilh Facial Hypesthesia after oriental acupuncture procedure and massage Tae-Hyung Khn, M D ~, Jong-Un Chun, MD ~, Gun-Sei Oh, M D 1, Hye-Eun Shin, M D 1, Jae-Gook Kim, M D 1. 2Department of Neurology,
Eulji University School of Medicine, Daejeon, South Korea A 36-year-old man got art acupuncture and manual massage on Iris right posterior neck areas due to dull aching headache. He noted rightsided tingling sense after 10 hours. On neurologic examination, he had right facial hypesthesia, severe right hentiparesis, a right extensor plantar response, diminished vibratory, proprioceptive sensation on right upper and lower limbs, and diminished pinprick, temperature sensation on left upper and lower limbs. He had no risk factor for stroke. M R T2-weighted and F L A I R images showed small hyperintensity at right cervicomedullary junction. Diffusion-weighted images also showed the lesion compatible with infarction. Conventional angiography revealed dissecting aneurysm on right distal vertebral artery. He was given intravenous heparin and subsequently oral anticoagulant, and showing the progressive recovery of tire motor
Thursday, November 10, 2005
Generalized outcomes are the following. Significant improvement occurred in 14 cases (29,8%), disability in 16 (134,1%), and 17 patients died (36,1%). Contusion: Surgical management of HHS with IH allowed to achieved good outcomes in patients with GCS scores 14-7. Operations on patients with GCS scores 6-3 nmst be considered only as a last chance to diminish for brain dislocation syndrome. 1204 Carotid Duplex studies in patients young stroke with a Prothrombotie state
D. Khuxana 1, S. Prabhakar 1, G Grewal 1, V Lal 1, PPS Kharbanda 1, CP Das ~, M Modi ~. 1Postgraduate Institute of Medical Education And
Research, India Baekgtoumh Prothronrbotic states like protein C deficiency, Protein S Deficiency, Antithrombin Deficiency, Anticardiolipin Antibodies (ACLA), lupus anticoagulant (LA) and factor V Leiden have been implicated in etiology o f young strokes ( < 45 years). The occurrence of carotid lesions in young strokes is o f low prevalence. Aims and Objectives: To prospectively determine the incidence of carotid/vertebral artery disease in young strokes with a prothrombotic state. Methods: Patients were recruited from the young strokes attending the Neurology outpatient who were found to be positive for one or more prothrombotic states -Protein C / S / Antithrombin deficiency, ACLA, LA or Factor V Leiden. Carotid duplex studies were done which included B-mode, colour and pulsed doppler. Results: 200 young strokes have been enrolled till April 2005. 63 (31.5%) patients have been found to be positive for a prothrombotic state. Out of these, 13 patients (20.63%) had an abnormal carotid duplex studies.6 patients (146.15%) were deficient in Protein S, 1 (17.69%) in Protein C, 2 (115.38%) in in both Protein C and S, 3 (23%) were positive for Lupus anticoagulant whereas 1 (7.69%) was positive for both Lupus anticoagulant and Anticardiolipin antibodies. Conclusions: Carotid atherosclerosis appears to be an important contributor to strokes o f prothrombotic origin. Protein S Deficiency is the commonest prothrombotic state associated with abnormal carotid duplex findings. These findings could help in formulating an effective screening strategy for prothrombotic states in young strokes with carotid atherosclerosis. 1205 Carotid Duplex studies and transesophageal echocardiography in acute ischemie stroke
Khuxana, D ~, Prashantha, D K 2, Prabhakar, S ~, Kunrar, R M ~.
2Department of Neurology, PGIMER, India; 2Department of Internal Medicine, PGIMER, India; 3Department of Cardiology, PGIMER, India Introduction: Duplex ultrasound is widely used as a screening tool for diagnosing atherosclerosis o f the extracranial carotid arteries. Transesophageal echocardiography (TEE) is used for detecting atherosclerosis of aortic arch and cardioembolic sources. Limited data is available for studies using these modalities to detemfine etiology in acute stroke. Aims and Objeclives: 1. To evaluate patients of acute ischemic stroke by duplex ultrasound for detection of atherosclerosis involving extracranial carotid arteries. 2. To perform TEE in these patients to detect aortic arch atherosclerosis and non-rheunratic cardioembolic sources. Methods 50 patients were prospectively evaluated from Neurology outpatient, wards and emergency medical services of P G I M E R , Chandigarh. Patients with anterior circulation strokes o f upto one week duration were included. Color duplex study of the carotids and TEE/transhoracic echocardiography was performed. Results: Mean age of presentation was 54yrs (Range 30-75yrs). Tire male-female ratio was 3.16:1.25 patients had a left M C A infarct,
Poster Abstracts 21 had a right MC.A infarct while two patients had right and left A C A infarcts respectively. Duplex study showed complete occlusion on the symptomatic side in 2 (4°,5) patients while 14 (28%) patients had increased IMT on the symptomatic side. 9 (18%) patients had plaques on the symptomatic side. Only 1 patient had a hypoechoic plaque, the rest had hyperechoic plaques. 3 (6%) patients had a stenosis > 50% while 6 (112%) patients had a stenosis of < 50%. TEE showed an Atrial septal defect in 1 (2%) patient and a Patent foramen ovale in 1 (2%) patient. However both patients had significant carotid atherosclerosis on the symptomatic side. Conclusions: Carotid duplex study is a practical tool to assess stroke etiology in the acute stage. Transesophageal echocardiography however should be employed in cases where etiology is not discernible. 1206 Retinal photography in patients with cerebral white inaller lesions
Kim HY 1, Koo DL 1, Lee K Y 1, Lee yj1, Kim HT 1, Kim SH 1, Kim j 1 Kim M H 1. 2Hanyang University Hospital, Seou4 Korea Background: Retinal photographic abnormalities reflect cumulative vascular change from hypertension, aging, and other various processes. Cerebral wlfite matter lesions (WML) detected on magnetic resonance imaging have been hypothesized to have a microvascular etiology and are associated with retinal vascular changes. However, few clinical data are available about the relationship between these microvascular changes and cerebral arterial stenosis. Method: We investigated demographic features, vascular risk factors, and subtypes in 355 stroke patients with wlfite matter lesions over 2 years between January 2003 and February 2005 and we performed retinal photographs, brain M R image (MRI) and Angiography (MRA). Retinal photographs were evaluated for specific retinal vascular abnormalities (eg, microaneurysm, retinal hemorrhage, soft exudates, arteriolar narrowing, and arteriovenous nicking) by graders using standardized protocols. White matter lesions were coded from 0 for normal to 9 for most severe WML. Cerebral arterial stenosis was defined by MRA. Results: Age and hypertension correlated with prevalence of retinopathy in patients with white matter lesions. In retinal photography, arteriovenous nicking, focal arteriolar narrowing, and generalized arteriolar narrowing were associated with the presence of cerebral artery stenosis (p - 0.005, -- 0.014, and 0.043, respectively). But, in stroke subtypes, there was no relationship between tire presence of retinopathy and stroke subtypes. Conclusion: These findings suggest that retinal vascular abnormalities on retinal photographs are associated with the presence of cerebral arterial stenosis. 1207 Cervical Brown-Sequard Symtroine wilh Facial Hypesthesia after oriental acupuncture procedure and massage Tae-Hyung Khn, M D ~, Jong-Un Chun, MD ~, Gun-Sei Oh, M D 1, Hye-Eun Shin, M D 1, Jae-Gook Kim, M D 1. 2Department of Neurology,
Eulji University School of Medicine, Daejeon, South Korea A 36-year-old man got art acupuncture and manual massage on Iris right posterior neck areas due to dull aching headache. He noted rightsided tingling sense after 10 hours. On neurologic examination, he had right facial hypesthesia, severe right hentiparesis, a right extensor plantar response, diminished vibratory, proprioceptive sensation on right upper and lower limbs, and diminished pinprick, temperature sensation on left upper and lower limbs. He had no risk factor for stroke. M R T2-weighted and F L A I R images showed small hyperintensity at right cervicomedullary junction. Diffusion-weighted images also showed the lesion compatible with infarction. Conventional angiography revealed dissecting aneurysm on right distal vertebral artery. He was given intravenous heparin and subsequently oral anticoagulant, and showing the progressive recovery of tire motor