- Email: [email protected]
1220 Our tryst with acute ischemic stroke
Poster Abstracts Saitama, Japan; 2juntendo University School of Ivledici~ze, Tokyo, Japan Background: Seasonal variation in incidence of stroke was investigated in Japanese stroke patients. Method: 4040 hospitalized stroke patients between January 1, 1994 and December 31, 2004 were enrolled in this study. M o s t patients were transferred to our rehabilitation unit from m a n y acute care hospitals in Saitama and Tokyo, Japan. The m e a n age of all patients was 64 years old and the male: fenlale ratio was 2505:1535. The x 2 test was used to analyze the seasonal variation in incidence of stroke. Results: The nmnber of onset o f cerebral infarction was as follows, 580 (March-May), 554 (Jun-August), 590 (September-November), and 591 (December-February). There was no significant seasonal variation (xa -- 1.539, df -- 3, p < 0.673). The n u m b e r of onset of intracerebral hemorrhage was 337, 297, 358, and 466. The peak incidence for intracerebral henlorrhage was December-February (x 2 _ 42.955, df 3, p < 0.001). The n u m b e r of onset of subarachnoid hemorrhage was 78, 69, 62, a n d 58. There was no significant seasonal variation (x2 3.457, d r - - 3, p < 0.326). Conclusion: A significant seasonal variation in incidence of intracerebral hemorrhage was showed in tiffs study. These findings indicate that winter is the risk factor of intracerebral hemorrhage in Japan. 1217 Red Cell and Leukocyte Defommbflity in Stroke patients suffered t~oii1 a certain Vascular Pathology Kowal, p1. 1Rheologieal Laboratory, Department of Neurology,
Po~'wah, Poland Background: Hemorheological factors play all important role in blood flow regulation in cerebral ischaemia. The aim of tiffs study was to answer the question if hemorheological disturbances have been related to a certain vascular pathology. Material and Method: The study was carried out in 24 patients after ischaemic stroke divided into two clinical groups: 10 subjects with snlall vessel d i s e a s e / S V D / and 14 subjects with large vessel disease/ LVD/. The reference group /10 subjects/ included tile healthy agematched people. Red cell and leukocyte deformability were examined by means of St. George's Filtrometer/Carri M e t . Darking, England/. Red cell transit t i m e / R C T T / i n d i c a t e d erythrocyte elasticity, whereas clogging particles /CP/ exemplified leukocyte deformability. All patients were evaluated with CT exanlination, U S G Doppler and in some cases angiography. Results: We found R C T T and CP increased/p < 0.001 and p < 0.01 respectively/ in SVD group and only CP in LVD group /p < 0.05/ compared them with the reference group. In comparison between patients" groups we found an elevated R C T T v a l u e / p < 0.05/in SVD subjects. Conclusion: The result of the study indicated a role of some hemorheological changes/connected with blood cells physical propert i e s / i n a certain cerebral vascular pathology. 1218 An Influence of the alternating ulagneting tield on tile Heulorheologieal parameters in patients with Cerebrovascular Disease Kowal, p1, Gapiflska-Marcinkowska, A ~. 1Mwologieal Laboratory,
Department of Neurology, Poznar~,Poland Background: Hemorheological disturbances play all important role in cerebral blood flow impairment, particularly in cerebral microdrculation. The aim of this study was to estimate an influence of the alternating magnetic field on the rheological properties of blood in patients suffered from cerebrovascular disease. Material and Method: The study was carried out in the group of 10 patients with TIA. The magnetostinlulation was applied by m e a n s of V I O F O R JPS using progranmie M~Pa and I-2 intensity. It was done
Thursday, November 10, 2005
$411
twice a day for 13 days. Hemorheological examination was performed four times: before application, after 4, 8 and 13 days. The Contraves LS40 rheometer was used for these estimations. The blood flow curve analysis was done by m e a n s of Q u e m a d a model, which allowed to estimate red cells aggregation and their deformability. The following other paranleters were also studied: haematocrit, plasma viscosity and blood viscosity. Result: We indicated a beneficial effect of the alternating magnetic feld application on plasma viscosity and red cells aggregation. The study will be continued with a greater n u m b e r o f patients. 1219 Heparin Tkofiban combination in Acute Ischaemic Stroke Krishnan, V 1. 1Kovai Medical Center & Hospitals, Coimbatore, India Backgrouud: Anticoagulation for acute ischemic stroke beyond the time window for thrombolysis is still a matter o f debate. A combination of heparin and tirofiball (a gpIIaIIIb inhibitor) for treating acute ischemic stroke sounds logical. Method: Series of eight cases of acute ischaemic stroke that presented to the emergency department of Kovai medical center and hospital beyond the time window for thrombolysis were considered for acute anticoagulation with heparin and tirofiban. Results: Tile mean time of administration of Heparin and Tirofiban in this series was 7.5 hours. Heparin was administered as a continuous infusion at a rate of 1000 units/hour, titrating to maintain a l i f T of 50-70 seconds. Tirofiban was administered as an infusion bolus of 0.4 micrograni/Kg/mt for 30 nits followed by 0.1 mcg/kg/nlt for 24 hours. All cases in this series made remarkable recovery. There were no bleeding episodes. Conclusion: Heparin Tirofiban combination is found to be safe and effective in managing acute ischemic strokes and needs larger randomized studies to identify its place in acute stroke management. 1220 Our tryst with Acute Ischemie Stroke Krishnan, S ~, Mathew, C 1, Pankaj, M 1, Baskar, P~, Dinesh ~. 1Kovai
Medical Center & Hospitals, Coimbatore, India Background: Acute ischemic stroke is best managed in a center with a well equipped stroke unit. Method: Series of Acute ischaemic stroke presenting to tile E M R , K M C H at varying timeframes from the onset managed with Intravenous, Intra arterial thrombolysis and Acute anticoagulation. Results: 31 cases of acute ischaemic stroke were seen during the year 2003 to 2004. Cases presenting to tile E M R between 30 nits to 12hours were included for aggressive management. 2 cases were m a n a g e d with IV rTPA, 21 cases with hltra arterial Urokinase and 8 cases with Heparin Tirofiban combination. There were 2 deaths in the intra arterial group due to fatal haemorrhage. The average NIHSS was 18 .22 cases improved significantly with modified R a n k i n Scale of 2. The outcome in the remaining 7 was a scale o f 4 in two cases and 3 in five cases. Conclusion: Acute ischaemic stroke Call be m a n a g e d effectively using a multi pronged approach in a well equipped stroke unit. 1221 IntereSting course of events in a case of Cortical Venous Sinus Tkrombosis Vijayan, K 1, Mathew, C 1, Pankaj, M 1, Pattabhiranian, V R 1. 2Kovai
Medical Center & Hospitals, Coimbatore, India Case report: 45yr old M r s . R presented with headache, bilateral papilloedema and no lateralising signs. CT brain was normal. M R Venograni showed n o n visualization o f tile Straight, both transverse and Sigmoid sinuses. She was anticoagulated with Heparin followed by warfarin and given Mannitol and steroid with adequate hydration.
Po~'wah, Poland Background: Hemorheological factors play all important role in blood flow regulation in cerebral ischaemia. The aim of tiffs study was to answer the question if hemorheological disturbances have been related to a certain vascular pathology. Material and Method: The study was carried out in 24 patients after ischaemic stroke divided into two clinical groups: 10 subjects with snlall vessel d i s e a s e / S V D / and 14 subjects with large vessel disease/ LVD/. The reference group /10 subjects/ included tile healthy agematched people. Red cell and leukocyte deformability were examined by means of St. George's Filtrometer/Carri M e t . Darking, England/. Red cell transit t i m e / R C T T / i n d i c a t e d erythrocyte elasticity, whereas clogging particles /CP/ exemplified leukocyte deformability. All patients were evaluated with CT exanlination, U S G Doppler and in some cases angiography. Results: We found R C T T and CP increased/p < 0.001 and p < 0.01 respectively/ in SVD group and only CP in LVD group /p < 0.05/ compared them with the reference group. In comparison between patients" groups we found an elevated R C T T v a l u e / p < 0.05/in SVD subjects. Conclusion: The result of the study indicated a role of some hemorheological changes/connected with blood cells physical propert i e s / i n a certain cerebral vascular pathology. 1218 An Influence of the alternating ulagneting tield on tile Heulorheologieal parameters in patients with Cerebrovascular Disease Kowal, p1, Gapiflska-Marcinkowska, A ~. 1Mwologieal Laboratory,
Department of Neurology, Poznar~,Poland Background: Hemorheological disturbances play all important role in cerebral blood flow impairment, particularly in cerebral microdrculation. The aim of this study was to estimate an influence of the alternating magnetic field on the rheological properties of blood in patients suffered from cerebrovascular disease. Material and Method: The study was carried out in the group of 10 patients with TIA. The magnetostinlulation was applied by m e a n s of V I O F O R JPS using progranmie M~Pa and I-2 intensity. It was done
Thursday, November 10, 2005
$411
twice a day for 13 days. Hemorheological examination was performed four times: before application, after 4, 8 and 13 days. The Contraves LS40 rheometer was used for these estimations. The blood flow curve analysis was done by m e a n s of Q u e m a d a model, which allowed to estimate red cells aggregation and their deformability. The following other paranleters were also studied: haematocrit, plasma viscosity and blood viscosity. Result: We indicated a beneficial effect of the alternating magnetic feld application on plasma viscosity and red cells aggregation. The study will be continued with a greater n u m b e r o f patients. 1219 Heparin Tkofiban combination in Acute Ischaemic Stroke Krishnan, V 1. 1Kovai Medical Center & Hospitals, Coimbatore, India Backgrouud: Anticoagulation for acute ischemic stroke beyond the time window for thrombolysis is still a matter o f debate. A combination of heparin and tirofiball (a gpIIaIIIb inhibitor) for treating acute ischemic stroke sounds logical. Method: Series of eight cases of acute ischaemic stroke that presented to the emergency department of Kovai medical center and hospital beyond the time window for thrombolysis were considered for acute anticoagulation with heparin and tirofiban. Results: Tile mean time of administration of Heparin and Tirofiban in this series was 7.5 hours. Heparin was administered as a continuous infusion at a rate of 1000 units/hour, titrating to maintain a l i f T of 50-70 seconds. Tirofiban was administered as an infusion bolus of 0.4 micrograni/Kg/mt for 30 nits followed by 0.1 mcg/kg/nlt for 24 hours. All cases in this series made remarkable recovery. There were no bleeding episodes. Conclusion: Heparin Tirofiban combination is found to be safe and effective in managing acute ischemic strokes and needs larger randomized studies to identify its place in acute stroke management. 1220 Our tryst with Acute Ischemie Stroke Krishnan, S ~, Mathew, C 1, Pankaj, M 1, Baskar, P~, Dinesh ~. 1Kovai
Medical Center & Hospitals, Coimbatore, India Background: Acute ischemic stroke is best managed in a center with a well equipped stroke unit. Method: Series of Acute ischaemic stroke presenting to tile E M R , K M C H at varying timeframes from the onset managed with Intravenous, Intra arterial thrombolysis and Acute anticoagulation. Results: 31 cases of acute ischaemic stroke were seen during the year 2003 to 2004. Cases presenting to tile E M R between 30 nits to 12hours were included for aggressive management. 2 cases were m a n a g e d with IV rTPA, 21 cases with hltra arterial Urokinase and 8 cases with Heparin Tirofiban combination. There were 2 deaths in the intra arterial group due to fatal haemorrhage. The average NIHSS was 18 .22 cases improved significantly with modified R a n k i n Scale of 2. The outcome in the remaining 7 was a scale o f 4 in two cases and 3 in five cases. Conclusion: Acute ischaemic stroke Call be m a n a g e d effectively using a multi pronged approach in a well equipped stroke unit. 1221 IntereSting course of events in a case of Cortical Venous Sinus Tkrombosis Vijayan, K 1, Mathew, C 1, Pankaj, M 1, Pattabhiranian, V R 1. 2Kovai
Medical Center & Hospitals, Coimbatore, India Case report: 45yr old M r s . R presented with headache, bilateral papilloedema and no lateralising signs. CT brain was normal. M R Venograni showed n o n visualization o f tile Straight, both transverse and Sigmoid sinuses. She was anticoagulated with Heparin followed by warfarin and given Mannitol and steroid with adequate hydration.