1226 Isolated cerebellar infarction in the territory of the medial branch of the superior cerebellar artery

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Poster Abstracts

Thursday, November 10, 2005

Symptoms subsided. Two weeks later she was readmitted with a worsening of the headache. Cerebral venography was attempted through a femoral access but only the left IJV could be entered Milch showed multiple collaterals drainilig into it with non visualizatioli of the sigmoid silius. She also developed Deep vein thrombosis of the right leg and Pulliloliary embolism during the course of stay. We will be discussing the management of the complications and successful management of raised ICP with regression of papilledema. 1222 Neuroproteetive etti~ct of Hyperbaric Oxygenation abet Embolie Stroke in rats Kueppers-Tiedt, L ~, Henninger, N 2'3, Guenther, A a, Sicard, K M 4, Kollmar, R a, Schwab, S a, Wagner, A 1, Schneider, D :. 1Department of

Neurology, University of Leipzig, Leipzig, Germany; 2Department of Neurology and E,~perimental Neurology, University of Heidelberg, Heidelberg, Germany; 3Department of Neurology, University of iVlassaehusetts Medical School, Worcester, MA, USA; 4Centerfor Comparative Neurolmaging, Department of Psychiatry, University of iVlassaehusetts Medical School Worcester, MA, USA Backgrouml: Hyperbaric oxygeli treatment (HBO) in acute stroke remains controversial. This study investigated potential IIeuroprotectire properties of HBO in a model of embolic middle cerebral artery occlusion (MCAO) in rats that simulates human stroke with its different degrees of inadvertent reperfusion. Methods: 3 h after MCAO, 30 male Wistar rats were randomly exposed to either 1 h of 100% oxygen at 2.5 atmospheres pressure (HBO group; II -- 15) or normobaric room air (colitrol group; n - 15). Cerebral blood flow (CBF), apparent diffusion coefficient (ADC) and T2-weighted images were acquired at 30 min, 5 h, 24 h (1"2 only), and 7 d (T2 only) post-MCAO. Lesion volumes were calculated by using viability thresholds or by visual inspection. After the last scan, animals were sacrificed and brains stained with hematoxylili & eosili (H&E) for infarct measurement. Results: In both groups, CBF withili the infarct core was reduced 95°,5 relative to the corresponding contralateral region immediately after MCAO and remained 55?,'; subnormal at 5 h. Within HBO group, the ADC-derived lesion volume was 73.4?,'; at 5 h, T2-derived lesion volumes were 82.2"/0 and 76.7°,5 at 1 d and 7 d respectively, and histologically-derived lesion volume was 62.4"/0 at 7 d (all values are with respect to control). Lastly, mortality tended to be lower in the HBO group (data not shown). Conclusion: HBO treatment is neuroprotective for up to 7 d after embolic MCAO when initiated within 3 h after ischemia.

1223 Cerebral hnbolism as a cause of Lacunar Stroke Kuznetsov, A l, Vinogradov, 01, Kucherenko, S2, Odinak, M ~.

1National Pirogov Centre of Therapy and Surgery, ivIoseow, Russia; 2Military Medical Academy, Saint-Petersburg, Russia Lacunar stroke is one of subtypes of ischemic stroke. The main cause of lacunar ilifarctioli is cerebral microaligiopathy due to arterial hypertension or diabetes mellitus. The purpose of this study was the estimation o f cerebral embolism as a possible cause of lacunar infarction. Material anti Methods: We studied 4g uliselected patients with various subtypes of acute ischemJc stroke, 26 patients with atrial fibrillation and ischemJc stroke, and 6 patients with infective elidocarditis and ischernic stroke. We used MRI ("Magnetom Impact", Germany) or CT ("Somatom+4"', Germany) of the brain, transthoracJc echocardiography, duplex sonography ("Acuson 128XP", USA) and M R A ("Magnetom Impact", Germany) for estimation of cerebral arteries, and microemboli detection ("Soliomed-300", Russia). Results: Pattern of lacunar infarction on MRI or CT was detected in 13 patients (127,1'%). Four of 13 patients had potential cardiac and

arterial sources o f cerebral embolism, and they had not other causes of stroke. In these patients lacunar infarction were larger, and it had more lateral localization, near froli1 ilisula. In the patients with atrial fibrillation lacunar infarction was very rare (7,7°,5). Most of the patients with infective elidocarditis had IImltiple small infarction with cortical and subcortical localization (83,3%). Microembolic signals were detected in all o f these patients. Conclusions: Cerebral embolism can cause lacunar infarction if the size of embolic material is small (about 200 mcTn). Possible sources are heart valve disease and unstable atherosclerotic plaques. In these patients the alitiplatelet agents should be used. Carotid elidarterectomy should be indicated if there is unstable carotid atherosclerotic plaque. 1224 A ease of infarction restricted to unilateral hypothalamus with symptoms of hyperphagia and hypersomnolence Kwon, YS ~, Seo, M JÀ, Yu, HJ ~, Roh, SY a. 1PundangJaesaeng General

Hospital, Korea Background: It is well known that brain infarction restricted to unilateral hypothalamus is very rare because of abundant blood supply from circle of Willis. Results: We report a case of right hypothalamic infarction. A 63-yearold woman developed hyperphagia, hypersomnolence and hemihypertfidrosis limited to the left face. Conclusion: Brain M R imaging revealed the high signal intensities in right aliteromedial hypothalamus. 1225 Hiccups in Pure Lateral Medullary Infarction

Kwon, SB a, Hwang, SH ~, Yun, SH ~, Jung, S a, Lee, BC a. 1Department

of Neurology, Hallym University College of Medicine, SeouL Korea Background: Hiccups are not a frequent but disabling condition of lateral medullary infarction (LMI). Unlike other sSaliptoms and signs of LMI, the attatomJcal lesions of hiccups are not well known. Although there were studies about clinical-radiological correlation studies using MRI, few studies have evaluated the relation between the lesional location of LMI and hiccups. Therefore, we performed this study to clarify the lesiolial correlation with hiccups in LML Method: Between 1997 and 2004, we identified 12 patients with pure LMI (LMI without concomitant politilie or cerebellar infarction) who presented with hiccups in addition to typical lateral medullary syndrome. Eighteen patients without hiccups were included as a control. Clinical and radiologic findings were compared between two groups. Results: The patients with hiccups significalitly IIlore ofteli had dorsolateral rather than ventral lesions at horizontal levels (P < 0.05, likelihood ratio test for trend). But, there were no rosto-caudal differences at vertical levels. Conclusion: We suggest that LMI associated with hiccups often locates in the dorsolateral medulla at horizontal correlation. This comparative study using MRI helps us to expand the uliderstalidilig of the neural substrate for hiccups in LMI. 1226 Isolated CerebeUar Infarction in tile territory of tile medial branch of the Superior Cerebellar Artery Hyung Lee ~, Hyon-Ah Kim 1, Sung-II Sohn ~, Robert W Baloh 2.

1Defiartment of Neurology, Keimyung University School of Medicine, Daegu, South Korea; 2Department of Neurology UCLA School of Medicine, Los Angeles, CA, USA Background: The clinical syndrolire associated with dorsomedial infarction of the rostral cerebellulir in the territory of the medial

Poster Abstracts branch of the superior cerebellar artery (MSCA) has not yet been fully characterized, although single cases have been reported. Methods: We studied the cliuical features o f 14 patients with all isolated cerebellar infarction in the territory of the MSCA diagnosed by brain MRI. Results: Isolated MSCA territory cerebellar infarction represented 30?,'; (114/47) of the all SCA infarction in our stroke registry from January 2000 to February 2005. All but 1 had acute infarction in the rostral vermis on brain MRI. The most common and striking clinical finding at onset was severe gait ataxia with sudden fall (n -- 9) or severe veering (in - 2). Eleven (85%) of 13 patients with vermal involvement could not walk without assistance. Cerebellar dysarthria was found in 8 patients, all o f whom had infarction in the rostral paravermal region of the anterior lobe. Eight patients had hemispheric dysfunction with a mfilateral limb ataxia (mild compared to the truncal ataxia). Ten patients showed no occlusion in the vertebrobasilar system on brain MRA. Eight had a cardiac source of emboli. All patients improved spontaneously. Conclusions: Infarction in the territory of the MSCA typically produces a distinct clinical syndrome characterized by the severe truncal ataxia, cerebellar dysarthria, and mild ipsilateral extremity ataxia. It usually results from cardiac emboli. 1227 Prolonged Hypotension after Carotid Artery Stenting Lee BC ~, Yu KH a, Kim JH ~, Kim KH a. 1Department of Neurology,

Hallym University College of Medicine, Seou~ Korea Background: Acute hemodynanfic instability after carotid artery stenting (CAS) is relatively well recognized. We experienced several cases with prolonged hypotension after CAS and proposed a possible predictor of post-stenting prolonged hypotension. Methods: Blood pressure (BP) was measured every 1 hour from predilatation period to post-stenting 1 day in 7 cases with CAS performed with self expandable stent. Prolonged hypotension was defined as greater than 30 mmHg decrease in systolic arterial BP compared with baseline lasting at least 1 hour or requiring vasopressor agents. Results: Four patients had prolonged hypotension of 7 patients. In all patients with prolonged hypotension, CAS was performed in left side. The patients with prolonged hypotension were older (median of age 67 vs. 58) and inserted with longer stent than patients without prolonged hypotension. Tire vascular risk factors (hypertension, use of anti-hypertensive agent before procedure, diabetes mellitus, and smoking), degree of pre and post-stent dilatation, and ultrasonographic characteristics of carotid plaques were not different. Conclusion: Our case series support that old age and laterality of procedure (left side of carotid artery) might be related with development of prolonged hypotension after CAS. These findings should be clarified by large prospective clinical study. 1228 Associated Vascular risk factor for extra- and intracranial Atherosclerosis in Korean Patients Soo-Joo Lee, M D 1, Boram Lee, M D 1, Jung-Eun Kim, M D 1, Gun-Sei Oh, M D ~, Tae-Hyung Kim, M D ~, Yong-Seok Lee, M D a.

1Department of Neurology, EuD'i University Hospital, Ezdfi University School of Medicine, Daejeon, South Korea; 2Department of Neurology, Seoul Municipal Borarnae Hospital, Collegeof Medicine, Seoul National University, Seoul, Korea Background: Besides race-ethnicity, the role of other risk factors that can be related to the distribution of cerebral atherosclerosis has been controversial. Objective: We determined if there were vascular risk factors related to the extra- and intracranJal atherosclerosis in Korean stroke patients. Methods: We studied 856 consecutive patients with ischemJc stroke adnfitted to our two hospitals over a 5-year period. We excluded

Thursday, November 10, 2005

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patients who had potential cardiogenic source o f embolism. We determined the location and severity of atherosclerotic lesions on M R angiography (MRA). The presence of atherosclerotic lesion in intracranial cerebral arteries and extracrauial carotid artery was defined as 50% or more narrowing of lunfinal diameter or occlusion on MRA. The information about potential vascular risk factors such as age, sex, arterial hypertension, diabetes mellitus, hyperlipidemia, cigarette smoking, and alcohol consumption, was obtained from medical records. Results: Three hundred fifty-five patients (41.5%) had intracranial atherosclerotic lesion on MRA. Sixty-one patients (7.1%) had stenoocclusive extracranial carotid artery disease, and 78 (9.1%) had combined extracranial carotid and intracranial atherosclerotic lesions. Multivariate logistic regression analyses showed that hyperlipidemia were significantly associated with the extracrauial carotid atherosclerosis (OR, 4.12; 95% CI, 1.21 9.11, p < 0.01), but that diabetes mellitus was only associated with intracrauial atherosclerosis (OR, 3.26; 95°'; CI, 1.45-6.52, p < 0.01). Contusions: Our data suggest that the risk factors for extra- and intracranial artery lesion are different. Diabetes mellitus may be associated with the development of intracrarfial atherosclerosis, which disease is predominant in Korean patients.

1229 Territorial distribution of Infarctions in patients with Poslerior Cerebral Artery Occlusion

Lee, JY~, Nam, HS 1, Heo, JH 1. 1Department of Neurology, Yonsei

University College of Medicine, Seoul, Korea Background: The posterior cerebral artery (PCA) branches several perforators during its course to the cortex. Although there many patients presented with PCA occlusion, little is known regarding the territorial distribution of infarctions in association with P C A occlusion. Methods: Among 2202 ischemic stroke patients, who were registered in Yonsei Stroke Registry and underwent both angiograptfic studies and brain MRI, those with P C A occlusion were identified. Occlusion sites, territorial distribution of infarctions, and etiologic mechanisms were investigated in them. Results: PCA occlusion was found in 60 patients. (12.77,'8; 46 men and 14 women; aged 28 to 82 years; mean 64.2). Of these, 3 patients were excluded from analyses due to unavailable image scans. The occlusion was clinically relevant in 47 patients (MRA 20, conventional angiography 27). The site of occlusion was at P1 in 19 and at P2 or the distal sequent in 28 patients. In P1 occlusion, cortical artery territories were the most frequent sites of infarctions (68.4%), which was followed by thalamogeniculate arteries (152.6%). In P2 or distal artery occlusion, cortical artery infarctions were also most common (82.1%), followed by tire splenial artery (67.9%). No patient showed infarctions involving tire entire vascular territories, while 42.1% of P1 occlusion and 21.4% of P2 occlusion had an infarction involving only one branch arterial territory. Large-artery atherosclerosis was the most frequent subtype in both groups (P1 52.6?,'8, P2 57.17,'8). Contusions: Occlusion of the PCA caused infarctions involving only a part of the vascular territories, which suggests tire presence of local collateral flows.

1230 Length of Middle Cerebral Artery susceptibility sign on T2*- weighted Gradient Echo M R I correlates with initial Stroke severity Kwang Ho Lee ~, Gyung Moon Kim ~, Chin-Sang Chung ~, Tat Hwan Park 2, Oh-Sang Kwon ~. 1Department of Neurology,

Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea," 2Department of Neurology, Chungang University Medical Center, Seoul, Korea