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1249 Hyperhomocysteinaemia in cerebral venous thrombosis
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Poster Abstracts
Thursday, November 10, 2005
Conclusion: TCD is considered a valuable tool in clinical and research domains. The reproducibility of the measurements obtained between and within observers is vital to the reliability o f tiffs tech~ffque. This study will not only assess the reliability of TCD witlffn our present study but may set a precedent for assessment of operators of tiffs tool in future research/clinical practice.
1246 Stroke in pregnancy and post-pextum: clinical characteris~cs and foetalmaternal prognosis Medeixos-De Bustos, E ~, Decavel, pZ Vuillier, F 1, Moulin, T 1, Leys, D 2. 2Besanfon University Hospital, Besan,con, France; 2Lille
University Hospital, Lille, France Background: To characterise stroke subtypes and prognosis during pregnancy and in puerperium. Method: We studied pregnant women or women in puerperium consecutively adnfftted between 1988 and 2003 for stroke and evaluated in 2 university hospital stroke programmes (Besan~on and Lille5. Three subtypes were analysed: cerebral infarction (CI), cerebral venous thrombosis (CVT) and intracerebral haemorrhage (ICH). Results: Among 474 women admitted for stroke, 38 (8% 5 were pregnant (123) or in puerperium (15), mean age was 31. Stroke subtypes were: 39"/0 (115) CI, 31% (12) CVT, 10% (4) ICH. CI was the main subtype occurring in pregnancy (56%); 20% of CVT, 63% of CI and 25% o f ICH cases occurred post-partum. CVT was more common post-partum (80%). Conventional vascular risk factors played a minor role (hypertension 2/38 cases; 1/38 was diabetic); smoking was the most common (7/38). Etiologic origin of CI was identified in 5/15 patients (coagulopathy _ 3, carotid artery dissection -- 1, hormone induced pregnancy - 1). HELLP syndrome occurred in 2/4 (50%) of ICH patients. Two (5%) patients died while 17 (147%) recovered fully. Four foetal deaths occurred; (12 maternal deaths and 2 therapeutic abortions). No miscarriages or premature deliveries occurred. Outcome was better when stroke occurred in the puerperium compared to during pregnancy. Patients with CVT stroke had a better prognosis; 31% had sequelae compared to CI (73%) and ICH (175%). At discharge 39% o f pregnant women had fully recovered, 60% had a neurological deficit. Conclusion: Stroke is not uncommon during in and puerperium and may have serious consequences in terms of foetal-maternal outcome. 1247 Cerebral Isehemia related to Dolichoarteriopathies of the Internal Carotid Artery
NletUe, S l, Radak, D 2, Sternic, N ~, Sumrak, D ~. ZDr Dragisa Misovic
Hospital, Center of Neurology', Belgrade, Serbia arid Montenegro; 2Institute of Cardiovascular DL~eases Ded#lje, Belgrade, Serbia arid Montenegro; 3Institute of Neurology, Clinical Center of Serbia, Belgrade, Serbia and Montenegro Background: Dolichoarteriopathies (kinking, coiling, and tortuosity) of the internal carotid artery in 15-20% cases may result in symptomatic cerebrovascular disease through a thromboembolic or hemodynamic mechanism. The objective was to establish if there is a significant correlation between different types of dolichoarteriopathies, their hemodynamic and morphological characteristics and symptoms of cerebral ischemia. Method: We analyzed two groups 150 symptomatic and 50 asymptomatic patients with unilateral or bilateral carotid dolychoarteriopathies. Diagnostic. procedures included: neurological examination, duplex Doppler sonography, arteriography in symptomatic cases, brain CT and/or MRI. Patients with other anomalies o f the carotid and vertebral arteries were excluded, as well as the patients with atherosclerotic stenosis greater than 60%. Symptomatic group included patients with ischemic stroke (255, transitory ischemic attack (TIA) (144) and nonhemispheric symptoms of cerebral ischemia (81).
Results: There were significantly more patients with kinking, coiling and combined anomalies in symptomatic group than in asymptomatic group in which were more patients with tortuosity (p < 0,05); there were higher prevalence of hemodynamic alterations in the symptomatic group (p < 0,01); kinking showed the lffghest frequency of hemodynamic alterations, followed by coiling and tortuosity (p < 0,01); patients with high-grade kinking (angle <60 '7) were more frequent symptomatic, than the patients with low-grade kinking (angle >60 ~') (p < 0,01); the most frequent symptoms are nonhemisferic, followed by TIA and ischemic stroke (with ratio 1,7:15; clinical picture is more serious in patients with more pronounced angulation. Contusion: High-grade hamodynamically significant carotid kinking carries the highest risk of cerebral ischemia and these patients should be carefully evaluated by neurologist and vascular surgeon. 1248 Non Puerperal Cerebral Venous Thrombosis
Meshram, C 1. ZBrain Centre, Nagpur, India Background: Cerebral Venous Thrombosis (CVT) is thought to be a disease of post partem women. With the advent of newer imaging modalities, more and more non puerperal cases are being diagnosed. However the condition is highly underreported. Method: 32 patients of CVT seen between 1998 to 2005 were prospectively included in the study. CVT patients related to pregnancy and puerperium were excluded. Diagnosis was established by MRI/ MRV in 116 (80%) patients and by CT Scan in 16 (112%) patients. Results: There were 77 men and 55 women, with M :F ratio of 1.4:1 .Eighty eight (166 %5 patients were between age group of 21 40 yrs and only 3 patients were above 60 yrs. Headache was the commonest (86%) manifestation. Seizures were reported in 36 % and focal deficit was observed in 20% patients. CT Scan was normal in 26% patients.Plasma homocysteine was estimated in 49 patients and was found to be elevated in 39 (79.6%) patients. Outcome was good and only 2 patients died. Contusion: Non puerperal CVT is not as uncommon as considered. As it presents with varying manifestations, high index of suspicion is the key to early diagnosis. MRI with M R V is the investigation of choice for establishing the diagnosis. Acquired Hyperhomocysteinaemia is most common predisposing condition in central India. 1249 Hyperhomocysteinaemia in Cerebral Venous Thrombosis
Meshram, C 1. ZBrain Centre, Nagpur India Background: Elevated plasnra levels of homocystiene are associated with the increased risk of arterial stroke and deep venous thrombosis. We assessed the prevalence of raised homocystiene in cerebral venous thrombosis (CVT). Method: Fifty three patients of CVT were prospectively studied. Diagnosis of CVT was confirmed by CT scan in 8 patients M R I / M R V in 45 patients. Fasting plasma homocystein level was estimated. Homocystein was considered lffgh if level was more than 15/,mtol/l. Results: Of the 53 patients studied homocystein was elevated in 42 patients (79%). Homocystein was high in 27 (90%) out of 30 men and 15 (65%) out of 23 women. The range of rise in 6 patients was 15.1 to 20, in 19 patients 20.1 to 40/-~mol/u in 17 it was mo re titan 40/,mtol/l. In patients with lffgh homocystein levels other risk factors were Lupus anticoagulants in 2, Pueperium in 2, oral contraceptives in 2, Protein C and Protein S deficiency in 1 each, Methylenetetrahydrofolate reductase mutation in 1, inceased haematocrit in 6, Sickle cell trait in 2. In 26 patients hyperhomocysteniaemia was the only risk factor. Contusion: This study suggests that hyperhomocysteinaemia is commonest risk factor for CVT in this part of world. Most probably it is related to deficient nutritional status. It should be estimated in all patients of CVT as it is a risk factor easiest to modify.
Poster Abstracts
Thursday, November 10, 2005
Conclusion: TCD is considered a valuable tool in clinical and research domains. The reproducibility of the measurements obtained between and within observers is vital to the reliability o f tiffs tech~ffque. This study will not only assess the reliability of TCD witlffn our present study but may set a precedent for assessment of operators of tiffs tool in future research/clinical practice.
1246 Stroke in pregnancy and post-pextum: clinical characteris~cs and foetalmaternal prognosis Medeixos-De Bustos, E ~, Decavel, pZ Vuillier, F 1, Moulin, T 1, Leys, D 2. 2Besanfon University Hospital, Besan,con, France; 2Lille
University Hospital, Lille, France Background: To characterise stroke subtypes and prognosis during pregnancy and in puerperium. Method: We studied pregnant women or women in puerperium consecutively adnfftted between 1988 and 2003 for stroke and evaluated in 2 university hospital stroke programmes (Besan~on and Lille5. Three subtypes were analysed: cerebral infarction (CI), cerebral venous thrombosis (CVT) and intracerebral haemorrhage (ICH). Results: Among 474 women admitted for stroke, 38 (8% 5 were pregnant (123) or in puerperium (15), mean age was 31. Stroke subtypes were: 39"/0 (115) CI, 31% (12) CVT, 10% (4) ICH. CI was the main subtype occurring in pregnancy (56%); 20% of CVT, 63% of CI and 25% o f ICH cases occurred post-partum. CVT was more common post-partum (80%). Conventional vascular risk factors played a minor role (hypertension 2/38 cases; 1/38 was diabetic); smoking was the most common (7/38). Etiologic origin of CI was identified in 5/15 patients (coagulopathy _ 3, carotid artery dissection -- 1, hormone induced pregnancy - 1). HELLP syndrome occurred in 2/4 (50%) of ICH patients. Two (5%) patients died while 17 (147%) recovered fully. Four foetal deaths occurred; (12 maternal deaths and 2 therapeutic abortions). No miscarriages or premature deliveries occurred. Outcome was better when stroke occurred in the puerperium compared to during pregnancy. Patients with CVT stroke had a better prognosis; 31% had sequelae compared to CI (73%) and ICH (175%). At discharge 39% o f pregnant women had fully recovered, 60% had a neurological deficit. Conclusion: Stroke is not uncommon during in and puerperium and may have serious consequences in terms of foetal-maternal outcome. 1247 Cerebral Isehemia related to Dolichoarteriopathies of the Internal Carotid Artery
NletUe, S l, Radak, D 2, Sternic, N ~, Sumrak, D ~. ZDr Dragisa Misovic
Hospital, Center of Neurology', Belgrade, Serbia arid Montenegro; 2Institute of Cardiovascular DL~eases Ded#lje, Belgrade, Serbia arid Montenegro; 3Institute of Neurology, Clinical Center of Serbia, Belgrade, Serbia and Montenegro Background: Dolichoarteriopathies (kinking, coiling, and tortuosity) of the internal carotid artery in 15-20% cases may result in symptomatic cerebrovascular disease through a thromboembolic or hemodynamic mechanism. The objective was to establish if there is a significant correlation between different types of dolichoarteriopathies, their hemodynamic and morphological characteristics and symptoms of cerebral ischemia. Method: We analyzed two groups 150 symptomatic and 50 asymptomatic patients with unilateral or bilateral carotid dolychoarteriopathies. Diagnostic. procedures included: neurological examination, duplex Doppler sonography, arteriography in symptomatic cases, brain CT and/or MRI. Patients with other anomalies o f the carotid and vertebral arteries were excluded, as well as the patients with atherosclerotic stenosis greater than 60%. Symptomatic group included patients with ischemic stroke (255, transitory ischemic attack (TIA) (144) and nonhemispheric symptoms of cerebral ischemia (81).
Results: There were significantly more patients with kinking, coiling and combined anomalies in symptomatic group than in asymptomatic group in which were more patients with tortuosity (p < 0,05); there were higher prevalence of hemodynamic alterations in the symptomatic group (p < 0,01); kinking showed the lffghest frequency of hemodynamic alterations, followed by coiling and tortuosity (p < 0,01); patients with high-grade kinking (angle <60 '7) were more frequent symptomatic, than the patients with low-grade kinking (angle >60 ~') (p < 0,01); the most frequent symptoms are nonhemisferic, followed by TIA and ischemic stroke (with ratio 1,7:15; clinical picture is more serious in patients with more pronounced angulation. Contusion: High-grade hamodynamically significant carotid kinking carries the highest risk of cerebral ischemia and these patients should be carefully evaluated by neurologist and vascular surgeon. 1248 Non Puerperal Cerebral Venous Thrombosis
Meshram, C 1. ZBrain Centre, Nagpur, India Background: Cerebral Venous Thrombosis (CVT) is thought to be a disease of post partem women. With the advent of newer imaging modalities, more and more non puerperal cases are being diagnosed. However the condition is highly underreported. Method: 32 patients of CVT seen between 1998 to 2005 were prospectively included in the study. CVT patients related to pregnancy and puerperium were excluded. Diagnosis was established by MRI/ MRV in 116 (80%) patients and by CT Scan in 16 (112%) patients. Results: There were 77 men and 55 women, with M :F ratio of 1.4:1 .Eighty eight (166 %5 patients were between age group of 21 40 yrs and only 3 patients were above 60 yrs. Headache was the commonest (86%) manifestation. Seizures were reported in 36 % and focal deficit was observed in 20% patients. CT Scan was normal in 26% patients.Plasma homocysteine was estimated in 49 patients and was found to be elevated in 39 (79.6%) patients. Outcome was good and only 2 patients died. Contusion: Non puerperal CVT is not as uncommon as considered. As it presents with varying manifestations, high index of suspicion is the key to early diagnosis. MRI with M R V is the investigation of choice for establishing the diagnosis. Acquired Hyperhomocysteinaemia is most common predisposing condition in central India. 1249 Hyperhomocysteinaemia in Cerebral Venous Thrombosis
Meshram, C 1. ZBrain Centre, Nagpur India Background: Elevated plasnra levels of homocystiene are associated with the increased risk of arterial stroke and deep venous thrombosis. We assessed the prevalence of raised homocystiene in cerebral venous thrombosis (CVT). Method: Fifty three patients of CVT were prospectively studied. Diagnosis of CVT was confirmed by CT scan in 8 patients M R I / M R V in 45 patients. Fasting plasma homocystein level was estimated. Homocystein was considered lffgh if level was more than 15/,mtol/l. Results: Of the 53 patients studied homocystein was elevated in 42 patients (79%). Homocystein was high in 27 (90%) out of 30 men and 15 (65%) out of 23 women. The range of rise in 6 patients was 15.1 to 20, in 19 patients 20.1 to 40/-~mol/u in 17 it was mo re titan 40/,mtol/l. In patients with lffgh homocystein levels other risk factors were Lupus anticoagulants in 2, Pueperium in 2, oral contraceptives in 2, Protein C and Protein S deficiency in 1 each, Methylenetetrahydrofolate reductase mutation in 1, inceased haematocrit in 6, Sickle cell trait in 2. In 26 patients hyperhomocysteniaemia was the only risk factor. Contusion: This study suggests that hyperhomocysteinaemia is commonest risk factor for CVT in this part of world. Most probably it is related to deficient nutritional status. It should be estimated in all patients of CVT as it is a risk factor easiest to modify.