- Email: [email protected]
Does awareness about stroke and stroke severity affect stroke arrival time
e364
Abstracts / Journal of the Neurological Sciences 357 (2015) e363–e423
Objective: To report a case of prolonged FMSE due to reversible focal CNS hypoperfusion. Patients/Methods: a 90-year-old male presented with 1 week history of severe headache with episodic left-sided hemiparesis. Subsequently, left-sided focal motor seizures involving the face and arm developed that deteriorated into refractory FMSE. A brain CT revealed atrophy and subcortical white matter disease (SCWMD) but no cortical infarction. An EEG revealed delta waves over the right hemisphere compared to alpha waves over the left no epileptic discharges. MRI brain demonstrated an area of right parietal cortical restricted diffusion with an associated abnormality on ADC map. MRA showed a paucity of flow to the left middle cerebral artery branches with areas of mild irregularities intracranially but without severe stenosis. CSF analysis was within normal limits except for a protein of 578 mg/l. SPECT revealed significant decreased perfusion to left frontal, parietal and temporal to lesser extent the left occipital lobes. The patient was treated with multiple anticonvulsants with complete resolution of the seizures and weakness. A follow up brain CT showed SCWMD but no cortical infarction. The Institutional review board approved this case report. Conclusions: Focal motor status may result from a functional reversible abnormality in brain perfusion. Focal hypoperfusion may occur without focal vascular stenosis. DWI abnormalities may indicate severe hypoperfusion but not cortical infarction as follow up CT did not reveal evidence of a cortical stroke. doi:10.1016/j.jns.2015.08.1305
1236 WFN15-0576 Stroke Role of transcranial Doppler in a multimodal imaging stroke protocol for the evaluation of hyperacute stroke: a prospective observational study A. Brunser, P.M. Lavados, D. Cárcamo, A. Hoppe, V. Olavarría, E. Sujima, D. Herrero, J. López. Cerebrovascular Program Neurology service Department of Medicine, Clinica Alemana de Santiago, Santiago, Chile Background and Objective: Transcranial Doppler (TCD) can demonstrate dynamic information. We aimed to evaluate whether TCD generates useful additional information in the emergency room after a multimodal stroke imaging protocol and also whether this modified the management of patients with hyper acute strokes (b4.5 hours of evaluation). Methods: Consecutive patients admitted between December 2012 and January 2015 with ischemic stroke of less than 4.5 hours from symptom onset were studied with a protocol consisting of noncontrast brain CT, CTA of cervical and intra cerebral arteries, MRIDWI and then TCD as soon as possible. The study protocol was reviewed and approved by our institutional ethics and scientific committee. Results: 86 patients were included. The imaging protocol was performed 113.9 (±346) minutes after stroke symptoms and TCD after 152 (376) minutes. 66 patients were treated with revascularization therapies. TCD provided additional information in 49 cases (56%). More that one piece of additional information was obtained in 17 patients. The most frequent additional information was collateral pathways and active microembolization. Multivariate analysis demonstrated that age (p b 0.042), intracranial vessel occlusion (p b 0.001) and optimal sonographic windows (p b 0.004) were the variables associated with additional information. In 15 patients (17.4%), additional information changed management: In 8 patients endovascular rescue was aplied, in 5 patients angiography was suspended and in 2 aggressive neurocritical care was indicated.
Conclusions: TCD can provide additional information to a multimodal acute ischemic stroke imaging protocol, and can result in changes in the management of an important number of these patients. doi:10.1016/j.jns.2015.08.1306
1237 WFN15-1130 Stroke Does awareness about stroke and stroke severity affect stroke arrival time A. Alhazzania, O. Abuhawib, A. Aboelyazeedb, M. Asserib, A. Alshehrib. a Neurology College of Medicine, King Khalid University, abha, Kingdom of Saudi Arabia; bCollege of Medicine, King Khalid University, abha, Kingdom of Saudi Arabia Stroke is the second leading cause of death worldwide and the leading cause of adult disability. The time window for effective intervention is very short and often underutilized. One of the reason is delay in presentation. In this prospective study conducted by direct assessment and interview of acute stroke patients we aim to assess the relationship between awareness about stroke, stroke severity and arrival time to tertiary hospital in Aseer region, Saudi Arabia Results: A total of 100 stroke patients were interviewed and completed the survey. The mean age was 67 ± 18 years with 55% males from different educational and social level. Only 29% thought they were having stroke and 15% knowing what stroke is. None of the participants know all risk factors of stroke, and only 1% mentioned all warning signals correctly, 34 of participants did not know what to do when having stroke. Forty three think it is untreatable disease and as expected there was a significant correlation between good knowledge about stroke and early arrival. Thirty seven patients presented within 3 hours and 44 presented after 12 hours from onset of symptoms. When assessing severity it was found that 29% had minor stroke, 46% had moderate stroke and 25% had severe stroke. Surprisingly, there was a correlation between stroke severity and time taken to presentation. Conclusion: In spite of lack of recognition of stroke as a treatable emergency and the lack of awareness of stroke symptoms, one third of stroke patients seek medical attention within 3 hours of onset regardless of stroke severity. There is urgent need to increase public awareness about stroke and ensure availability of tPA and acute stroke programs at tertiary care hospitals. doi:10.1016/j.jns.2015.08.1307
1238 WFN15-0825 Stroke NAVIGATE ESUS: Phase-III RCT assessing prevention of stroke and systemic embolism in patients with embolic stroke of undetermined source S. Amerisoa, P. Lavadosb, A. Arauzc, R.J. Gagliardid, A. Shoamaneshe, C. Paterf, H. Mundlg, S.D. Berkowitzh, S.J. Connollyi, R.G. Harte. aNeurology, Institute for Neurological Research-FLENI, Buenos Aires, Argentina; b Neurology, The German Hospital of Santiago, Santiago, Chile; cNeurology, National Institute of Neurology, Mexico City, Mexico; dNeurology, Santa Casa of Sao Paulo, Sao Paulo, Brazil; eMedicine (Neurology), McMaster University/Population Health Research Institute, Hamilton, Canada; f Cardiovascular and Coagulation, Bayer Healthcare, Leverkusen, Germany; g Cardiovascular and Coagulation, Bayer Healthcare, Wuppertal, Germany; h Thrombosis and Cardiovascular, Bayer Healthcare, Whippany, USA;
Abstracts / Journal of the Neurological Sciences 357 (2015) e363–e423
Objective: To report a case of prolonged FMSE due to reversible focal CNS hypoperfusion. Patients/Methods: a 90-year-old male presented with 1 week history of severe headache with episodic left-sided hemiparesis. Subsequently, left-sided focal motor seizures involving the face and arm developed that deteriorated into refractory FMSE. A brain CT revealed atrophy and subcortical white matter disease (SCWMD) but no cortical infarction. An EEG revealed delta waves over the right hemisphere compared to alpha waves over the left no epileptic discharges. MRI brain demonstrated an area of right parietal cortical restricted diffusion with an associated abnormality on ADC map. MRA showed a paucity of flow to the left middle cerebral artery branches with areas of mild irregularities intracranially but without severe stenosis. CSF analysis was within normal limits except for a protein of 578 mg/l. SPECT revealed significant decreased perfusion to left frontal, parietal and temporal to lesser extent the left occipital lobes. The patient was treated with multiple anticonvulsants with complete resolution of the seizures and weakness. A follow up brain CT showed SCWMD but no cortical infarction. The Institutional review board approved this case report. Conclusions: Focal motor status may result from a functional reversible abnormality in brain perfusion. Focal hypoperfusion may occur without focal vascular stenosis. DWI abnormalities may indicate severe hypoperfusion but not cortical infarction as follow up CT did not reveal evidence of a cortical stroke. doi:10.1016/j.jns.2015.08.1305
1236 WFN15-0576 Stroke Role of transcranial Doppler in a multimodal imaging stroke protocol for the evaluation of hyperacute stroke: a prospective observational study A. Brunser, P.M. Lavados, D. Cárcamo, A. Hoppe, V. Olavarría, E. Sujima, D. Herrero, J. López. Cerebrovascular Program Neurology service Department of Medicine, Clinica Alemana de Santiago, Santiago, Chile Background and Objective: Transcranial Doppler (TCD) can demonstrate dynamic information. We aimed to evaluate whether TCD generates useful additional information in the emergency room after a multimodal stroke imaging protocol and also whether this modified the management of patients with hyper acute strokes (b4.5 hours of evaluation). Methods: Consecutive patients admitted between December 2012 and January 2015 with ischemic stroke of less than 4.5 hours from symptom onset were studied with a protocol consisting of noncontrast brain CT, CTA of cervical and intra cerebral arteries, MRIDWI and then TCD as soon as possible. The study protocol was reviewed and approved by our institutional ethics and scientific committee. Results: 86 patients were included. The imaging protocol was performed 113.9 (±346) minutes after stroke symptoms and TCD after 152 (376) minutes. 66 patients were treated with revascularization therapies. TCD provided additional information in 49 cases (56%). More that one piece of additional information was obtained in 17 patients. The most frequent additional information was collateral pathways and active microembolization. Multivariate analysis demonstrated that age (p b 0.042), intracranial vessel occlusion (p b 0.001) and optimal sonographic windows (p b 0.004) were the variables associated with additional information. In 15 patients (17.4%), additional information changed management: In 8 patients endovascular rescue was aplied, in 5 patients angiography was suspended and in 2 aggressive neurocritical care was indicated.
Conclusions: TCD can provide additional information to a multimodal acute ischemic stroke imaging protocol, and can result in changes in the management of an important number of these patients. doi:10.1016/j.jns.2015.08.1306
1237 WFN15-1130 Stroke Does awareness about stroke and stroke severity affect stroke arrival time A. Alhazzania, O. Abuhawib, A. Aboelyazeedb, M. Asserib, A. Alshehrib. a Neurology College of Medicine, King Khalid University, abha, Kingdom of Saudi Arabia; bCollege of Medicine, King Khalid University, abha, Kingdom of Saudi Arabia Stroke is the second leading cause of death worldwide and the leading cause of adult disability. The time window for effective intervention is very short and often underutilized. One of the reason is delay in presentation. In this prospective study conducted by direct assessment and interview of acute stroke patients we aim to assess the relationship between awareness about stroke, stroke severity and arrival time to tertiary hospital in Aseer region, Saudi Arabia Results: A total of 100 stroke patients were interviewed and completed the survey. The mean age was 67 ± 18 years with 55% males from different educational and social level. Only 29% thought they were having stroke and 15% knowing what stroke is. None of the participants know all risk factors of stroke, and only 1% mentioned all warning signals correctly, 34 of participants did not know what to do when having stroke. Forty three think it is untreatable disease and as expected there was a significant correlation between good knowledge about stroke and early arrival. Thirty seven patients presented within 3 hours and 44 presented after 12 hours from onset of symptoms. When assessing severity it was found that 29% had minor stroke, 46% had moderate stroke and 25% had severe stroke. Surprisingly, there was a correlation between stroke severity and time taken to presentation. Conclusion: In spite of lack of recognition of stroke as a treatable emergency and the lack of awareness of stroke symptoms, one third of stroke patients seek medical attention within 3 hours of onset regardless of stroke severity. There is urgent need to increase public awareness about stroke and ensure availability of tPA and acute stroke programs at tertiary care hospitals. doi:10.1016/j.jns.2015.08.1307
1238 WFN15-0825 Stroke NAVIGATE ESUS: Phase-III RCT assessing prevention of stroke and systemic embolism in patients with embolic stroke of undetermined source S. Amerisoa, P. Lavadosb, A. Arauzc, R.J. Gagliardid, A. Shoamaneshe, C. Paterf, H. Mundlg, S.D. Berkowitzh, S.J. Connollyi, R.G. Harte. aNeurology, Institute for Neurological Research-FLENI, Buenos Aires, Argentina; b Neurology, The German Hospital of Santiago, Santiago, Chile; cNeurology, National Institute of Neurology, Mexico City, Mexico; dNeurology, Santa Casa of Sao Paulo, Sao Paulo, Brazil; eMedicine (Neurology), McMaster University/Population Health Research Institute, Hamilton, Canada; f Cardiovascular and Coagulation, Bayer Healthcare, Leverkusen, Germany; g Cardiovascular and Coagulation, Bayer Healthcare, Wuppertal, Germany; h Thrombosis and Cardiovascular, Bayer Healthcare, Whippany, USA;