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1140 Failure to maintain attention to spatial locations in visual neglect following stroke
Poster Abstracts Lopes Lhna J, Correia M 1, Silva M R z, Matos 13, Magalhges R 4, Silva M C ~. 1Servij:o de Neurologia, Hospital Germ de Santo Antrnio,
Porto, Portugal; 2Servi,co de Neurologia, Hospital de S. Pedro, Vila Real, Portugal; 3Servi,co de Neurologia, Hospital Distrital de Mirandela, Mirandela, Portugal; 4Departamento de Estudos de Populac&s, Instituto de Cidncias Biornddicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal Background: A new definition of Transient Ischemic Attacks (TIA), based on symptoms duration and on the evidence of no cerebral (or retinal) ischaemic lesion is under discussion, as well as the concept of Acute Ischemic Cerebrovascalar Syndrome. The objective of tiffs study is to report the incidence of a first-ever-in-a-lifetime Acute Ischemic Cerebrovascular Event (AICVE) in rural and urban populations in Northern Portugal. Methods: All suspected firs~ever strokes and TIAs occurring between October 1998 and September 2000 in 18677 residents in a rural municipality and 59527 living in the city of Porto were entered a population-based registry. Standard defirfitions and comprehensive sources of information were used. All patients reporting a past history of TIA or stroke were excluded. Results: During the 24-month period, 122 patients in rural and 237 in urban areas were registered with a first-ever AICVE. The crude annual incidence was 3.00 (95% CI, 1.54~4.87) and 1.99 per 1000 (95%CI, 1.43-2.79) for rural and urban populations, respectively; corresponding rates adjusted to the European standard population were 1.92 (IC 95%, 1.49-2.46) and 1.29 (195% IC, 0.94-1.80). Age-specific incidence followed different patterns in rural and urban populations, reaching major discrepancy for those 75 84 years old, 20.2 (95% CI, 14.6 26.7) and 9.4 (95% CI, 7.4 11.2), respectively. Conclusions: This first report on the incidence of AIC.VE in Northern Portugal strengthens the difference found between rural and urban communities already reported for stroke. Risk factors underlying this finding should be investigated. 1140 Failure to maintain attention to spatial locations in visual neglect following Stroke Coulthard E Lz, Malhotra p~;Z, Parton A La, Husain M 1.a. 1Imperial
College London, Charing Cross Hospital, London, United Kingdom; 2Institute of Cognitive Neuroscience, University College London, London, United Kingdom Background: Left visual neglect is a common disorder following righthemisphere stroke. Recent studies show that several different types of cognitive deficit contribute to the neglect syndrome, including impaired memory for spatial location and reduced ability to sustain attention. Here we investigate how these component deficits might combine to exacerbate neglect. Method: The performance of 10 right-hemisphere neglect patients was compared to two control groups: right-hemisphere patients without neglect and healthy subjects. Participants performed a basic sustained attention task, testing their ability to respond to a central stimulus presented irregularly over 8 minutes. In addition, they performed two variants of a task that required them either to maintain attention to spatial locations (displayed in a vertical array), or to the verbal identity of stimuli. Results: Neglect patients were significantly worse than both control groups in maintaining attention. Importantly, they were disproportionately impaired when asked to maintain attention to spatial locations compared to the verbal task. Furthermore, their error rate increased over time on the spatial, but not the verbal, task. By contrast, controls maintained their attention over time in both tasks. Performance on the spatial task correlated with neglect severity. A follow-up study using spatial and non-verbal texture stimuli confirmed that neglect patients are severely impaired at maintaining attention to spatial locations, even when these are in a vertical array.
Thursday, November 10, 2005
$391
Conclusion: There is an important functional interaction between memory for spatial locations and sustaining attention in the neglect syndrome. Treating inlpaitailents of sustained attention might improve the spatial deficit in neglect. lI4I Effect of piracetam on cognitive performance of patients undergoing Coronary Bypass Surgery Csiba, L l, Szalma, Ia, Kiss, A 2, Nyitrai, E 3, Tordai, Z 3, Horvath, G 4, Settakis, j1.1University of Debrecen, Dept. of Neurol. Debrecen,
Hungary; 2University of Targu Mures, Dept. of Neurol. Targu Ivfures, Rumania; 3University of Debrecen, Dept. of Psychol. Debreeen, Hungary; 4University of Debreeen, Dept. of Cardiac Surg. Debreeen, Hungary; SUniversity of Debreeen, Public Health School. Debrecen, Hungary Background: Neuropsychological impairment may follow coronary artery bypass surgery as a complex result of perioperative cerebral microembolism/hypoxiafischemia. The hypothesis that piracetam (given during and after CABG) would provide protection has been tested in this double blind, prospective, randomized trial. Method: 93 patients undergoing coronary bypass surgery were randomized to receive piracetam (150 mg/kg/day) or placebo before, during and 6 weeks after the operation. Neurological scales, CT (before and after CABG), cardiac, and carotid ultrasound and a battery of neuropsychological tests (Word Fluency, Digit Symbol, Digit Span, Trail Making, Spielberger State-Trait Anxiety Inventory, Beck Depression Inventory, Latent Learning, Pieron, Psychomotor speed-A-B-C) were adnffnistered before and 6 weeks after surgery. All patients (mean age 55.6 years) had coronariasclerosis, 95,4% angina pectoris and 63,6% myocardial infarction. Mean cardiopulmonary bypass-, hypothermia- and hypotension duration was 97,2 ± 26,5 ruin, 59,7 ± 20,8 ruin, 104,59 ± 62,9 ruin. respectively. No clinical neurological deficit developed after CABG. Primary variable: the Cognitive Battery Composite Score derived from the cognitive psychometric, scales. Results: Intention to treat population: O'Brian multiple endpoint procedure result: t - 1.828 (p - 0.071). Per protocol population: O'Brien multiple endpoint procedure. Result: t -- 1.943 (P -- 0.056). Intention to treat population (Cognitive battery composite score) placebo (in -- 46) 0.32, active (in -- 47) 2.01 ANOVA: p -- 0.043, while in per protocol population (Cognitive battery composite score) placebo (in - 45) 0.27, active (in -- 45) 2.16 ANOVA: p -- 0.027. Conclusion: The piracetam might be efficient in prevention of subclinical cognitive deficits associated with CABG. 1 I42 Tile intluence of admitting National Institute Of Health Stroke Scale INIHSS] on prognosis of Ischaemic Stroke in Lagos Danesi, M ~, Dawodu,C z. 1University of Lagos, Lagos, Nigeria; 2Lagos
State University, Lagos, Nigeria Background: The prognostic value of the NHSS score has not been evaluated in Afiicans. The present study set out to evaluate it in Nigerians. Methods: We studied 87 patients with ischaemic stroke. Their presenting NIHSS score, the clinical features including complications were recorded on admission. Mortality and outcome within 90 days were evaluated using Glasgow outcome scale. Results: Patients with NIHSS score of 20 and above had mortality of 56.5% and all the survivors had severe disability; with NIHSS score between 15-19, mortality was 30% and of survivors, 42.8% had severe disability, 33.7%, moderate disability and 14.2% recovered completely. With NIHSS score between 6 14 mortality was 11.76% and of survivors, 13.3% had severe disability, 36.6%, moderate disability and 50"/0 had good recovery. With NIHSS score of 5 or less, there
Porto, Portugal; 2Servi,co de Neurologia, Hospital de S. Pedro, Vila Real, Portugal; 3Servi,co de Neurologia, Hospital Distrital de Mirandela, Mirandela, Portugal; 4Departamento de Estudos de Populac&s, Instituto de Cidncias Biornddicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal Background: A new definition of Transient Ischemic Attacks (TIA), based on symptoms duration and on the evidence of no cerebral (or retinal) ischaemic lesion is under discussion, as well as the concept of Acute Ischemic Cerebrovascalar Syndrome. The objective of tiffs study is to report the incidence of a first-ever-in-a-lifetime Acute Ischemic Cerebrovascular Event (AICVE) in rural and urban populations in Northern Portugal. Methods: All suspected firs~ever strokes and TIAs occurring between October 1998 and September 2000 in 18677 residents in a rural municipality and 59527 living in the city of Porto were entered a population-based registry. Standard defirfitions and comprehensive sources of information were used. All patients reporting a past history of TIA or stroke were excluded. Results: During the 24-month period, 122 patients in rural and 237 in urban areas were registered with a first-ever AICVE. The crude annual incidence was 3.00 (95% CI, 1.54~4.87) and 1.99 per 1000 (95%CI, 1.43-2.79) for rural and urban populations, respectively; corresponding rates adjusted to the European standard population were 1.92 (IC 95%, 1.49-2.46) and 1.29 (195% IC, 0.94-1.80). Age-specific incidence followed different patterns in rural and urban populations, reaching major discrepancy for those 75 84 years old, 20.2 (95% CI, 14.6 26.7) and 9.4 (95% CI, 7.4 11.2), respectively. Conclusions: This first report on the incidence of AIC.VE in Northern Portugal strengthens the difference found between rural and urban communities already reported for stroke. Risk factors underlying this finding should be investigated. 1140 Failure to maintain attention to spatial locations in visual neglect following Stroke Coulthard E Lz, Malhotra p~;Z, Parton A La, Husain M 1.a. 1Imperial
College London, Charing Cross Hospital, London, United Kingdom; 2Institute of Cognitive Neuroscience, University College London, London, United Kingdom Background: Left visual neglect is a common disorder following righthemisphere stroke. Recent studies show that several different types of cognitive deficit contribute to the neglect syndrome, including impaired memory for spatial location and reduced ability to sustain attention. Here we investigate how these component deficits might combine to exacerbate neglect. Method: The performance of 10 right-hemisphere neglect patients was compared to two control groups: right-hemisphere patients without neglect and healthy subjects. Participants performed a basic sustained attention task, testing their ability to respond to a central stimulus presented irregularly over 8 minutes. In addition, they performed two variants of a task that required them either to maintain attention to spatial locations (displayed in a vertical array), or to the verbal identity of stimuli. Results: Neglect patients were significantly worse than both control groups in maintaining attention. Importantly, they were disproportionately impaired when asked to maintain attention to spatial locations compared to the verbal task. Furthermore, their error rate increased over time on the spatial, but not the verbal, task. By contrast, controls maintained their attention over time in both tasks. Performance on the spatial task correlated with neglect severity. A follow-up study using spatial and non-verbal texture stimuli confirmed that neglect patients are severely impaired at maintaining attention to spatial locations, even when these are in a vertical array.
Thursday, November 10, 2005
$391
Conclusion: There is an important functional interaction between memory for spatial locations and sustaining attention in the neglect syndrome. Treating inlpaitailents of sustained attention might improve the spatial deficit in neglect. lI4I Effect of piracetam on cognitive performance of patients undergoing Coronary Bypass Surgery Csiba, L l, Szalma, Ia, Kiss, A 2, Nyitrai, E 3, Tordai, Z 3, Horvath, G 4, Settakis, j1.1University of Debrecen, Dept. of Neurol. Debrecen,
Hungary; 2University of Targu Mures, Dept. of Neurol. Targu Ivfures, Rumania; 3University of Debrecen, Dept. of Psychol. Debreeen, Hungary; 4University of Debreeen, Dept. of Cardiac Surg. Debreeen, Hungary; SUniversity of Debreeen, Public Health School. Debrecen, Hungary Background: Neuropsychological impairment may follow coronary artery bypass surgery as a complex result of perioperative cerebral microembolism/hypoxiafischemia. The hypothesis that piracetam (given during and after CABG) would provide protection has been tested in this double blind, prospective, randomized trial. Method: 93 patients undergoing coronary bypass surgery were randomized to receive piracetam (150 mg/kg/day) or placebo before, during and 6 weeks after the operation. Neurological scales, CT (before and after CABG), cardiac, and carotid ultrasound and a battery of neuropsychological tests (Word Fluency, Digit Symbol, Digit Span, Trail Making, Spielberger State-Trait Anxiety Inventory, Beck Depression Inventory, Latent Learning, Pieron, Psychomotor speed-A-B-C) were adnffnistered before and 6 weeks after surgery. All patients (mean age 55.6 years) had coronariasclerosis, 95,4% angina pectoris and 63,6% myocardial infarction. Mean cardiopulmonary bypass-, hypothermia- and hypotension duration was 97,2 ± 26,5 ruin, 59,7 ± 20,8 ruin, 104,59 ± 62,9 ruin. respectively. No clinical neurological deficit developed after CABG. Primary variable: the Cognitive Battery Composite Score derived from the cognitive psychometric, scales. Results: Intention to treat population: O'Brian multiple endpoint procedure result: t - 1.828 (p - 0.071). Per protocol population: O'Brien multiple endpoint procedure. Result: t -- 1.943 (P -- 0.056). Intention to treat population (Cognitive battery composite score) placebo (in -- 46) 0.32, active (in -- 47) 2.01 ANOVA: p -- 0.043, while in per protocol population (Cognitive battery composite score) placebo (in - 45) 0.27, active (in -- 45) 2.16 ANOVA: p -- 0.027. Conclusion: The piracetam might be efficient in prevention of subclinical cognitive deficits associated with CABG. 1 I42 Tile intluence of admitting National Institute Of Health Stroke Scale INIHSS] on prognosis of Ischaemic Stroke in Lagos Danesi, M ~, Dawodu,C z. 1University of Lagos, Lagos, Nigeria; 2Lagos
State University, Lagos, Nigeria Background: The prognostic value of the NHSS score has not been evaluated in Afiicans. The present study set out to evaluate it in Nigerians. Methods: We studied 87 patients with ischaemic stroke. Their presenting NIHSS score, the clinical features including complications were recorded on admission. Mortality and outcome within 90 days were evaluated using Glasgow outcome scale. Results: Patients with NIHSS score of 20 and above had mortality of 56.5% and all the survivors had severe disability; with NIHSS score between 15-19, mortality was 30% and of survivors, 42.8% had severe disability, 33.7%, moderate disability and 14.2% recovered completely. With NIHSS score between 6 14 mortality was 11.76% and of survivors, 13.3% had severe disability, 36.6%, moderate disability and 50"/0 had good recovery. With NIHSS score of 5 or less, there