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1378 Embolisation in intracranial aneurysms — our experience
$450
Thursday, November 10, 2005
Poster Abstracts
Vakifi, A ~, Dehghani, G a, Nekooeian, A 3. 1Semnan University
Background: CVT is encountered frequently in South India (1% of all
Of Medical Sciences, Semnan, Iran; ~Departments of Physiology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, !ran; 3Departments of Pharmacologyl, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, !ran
strokes). It has variable temporal profile, clinical presentation and excellent outcome. Methods: 30 cases of CVT were studied between June 2002 and August 2004. Detailed lfistory and clinical exanfinations were done. Underlying medical illnesses, joint pains, genital & oral ulcer, alcoholism, oral contraceptive usage, dehydration, fever, sepsis and anemia were taken into account. Routine Blood count, ESR, Electrolytes, Renal and Liver Function tests, Coagulation profile, Protein C, Protein S, antithrombin -l-l-I, ACL antibodies and Serum homocysteine were assayed. CSF was studied in selected cases (118/30). MRI Brain & M R Venogram were done in all cases. Two cases had digital subtraction angiography. Results: There were 16 males & 14 females. Predisposing factors in females were pregnancy (28.4%), oral contraceptives (121.4%) and dehydration (17.1%), and in males - chronic alcoholism (43.8%) and dehydration (6.2%). Headache with papilledema were observed in 86.7%, meuingeal signs in 23.3%, seizures in 30%, hemiplegia in 30% and altered sensorium in 13.3%. Superior sagital sinus was involved in 90%. CSF was normal in 12 and had features of tuberculous meningitis in 6.3 patients had elevated serum homocysteine and 2 had elevated anti phospholipid antibodies. Patients were treated with low molecular weight heparin, oral anti coagulants, anti epileptic drugs and supportive measures. Outcome: 29 patients improved and 1 died. Conclusion: CVT is not uncommon. Neurotuberculosis and alcoholism in men and pregnancy/oral contraceptives in women were major etiological causes. Treated appropriately, CVI" carries good prognosis.
Pentoxifylline (PTX) is used in human for intermittent claudication and cerebral vascular disorders including cerebrovascular dementia. It also inhibits the synthesis of tumor necrosis factor-7, which is believed to be neurotoxicin animal models of cerebral ischemia. As far as the literature is concerned, there is no published study investigating the role o f TNF
1378 Fznbolisation in lntracrmfial Aneurysms - out experience
1376
Vehnurugendxan C.U 1, Smfil M Kalhir 1, Vasudevan D 1,
Stroke unit in Seiniijold Central Hospital, Finland
Meenakslfi Sundaram U 1, ArulselvanV.L 1, Murali ~, Santhosh Joseph 1.
Viilimiild, M 1, Hiiuliiliiinen, M 1. ZSeindjoki Central Hospital, Finland
1Sri Ramaehandra Medical College & Research Institute ("Deemed University), Chomai, Tamilnadu, India
About 14 000 Finnish people have a stroke every year. It is our third cause of death and a leading cause of severe, long-term disability. The expense goes up to 900 milj. Euros/year. Seinfijoki Central hospital is a district hospital caring of 194 000 inhabitants in the rural area of Finland. In Seinfijoki Central Hospital we have a 4 bed semi intensive Stroke Unit near com~ection with Intensive Care Unit, wlfich gives us broad competence both in intensive and neurological treatment. Stroke Unit was started January 1997. It is a multidiscipline unit prepared with a wide range on patient monitoring (including ekg, invasive and non invasive blood pressure, saturation, respiration and temperature measurements) systems. PiNs Care Suite (Critical Care Manager) has taken place in collecting patient information. Continuous EEG monitoring is also available. We treat about 400 neurological patients annually. Most of these are stroke related problems (80%). The average care period for a stroke patient is 2,5 days. Our Stroke Uuit has attended numerous projects and studies to develop medical and nursing care. Thrombolysis (tPA) has taken its place as acute stroke treatment. We have been involved to ECASS II and SAINT I studies. Intensive Care Nursing Scoring System gives information of our nursing staff resources. Work analysis was done during 2000-2001 in our hospital. According to this study the proper dimension of our stroke unit was 6,25 registered nurses, 0,5 neurology and 0,5 physiotherapist. Our stroke uuits expenses were 500 000 Euros/year.
Background: To study the usefulness of early endovascular manage-
ment of intracranial aneurysms in patients presenting with acute subarachnoid hemorrhage (SAH) at our center. Methods: 25 patients (113 men and 12 women) in the age group o f 2565 years presenting with aneurysmal SAH were studied. The presenting SAH Grade was: Grade 1-14, Grade I1-6, Grade II1-1, Grade IV-1. Digital Subtraction Angiography was done with GE Biplane DSA System with 3D rotational angiography. The distribution of aneurysms were ACA-7, Carotid ophthalmic -6, M C A -3, P C O M -2, Posterior Fossa -4, Peripheral aneurysms -3. Under GA, following femoral catheterization and guiding catheter placement in appropriate vessel, using micro catheter/micro wire combination, embolisation was done with either Gugleilmi detachable coils or N-butyl cyano acrylate (NBCA) glue. Patients were followed up for 2-14 months. Results: 22 patients were embolised with coil and 3 patients with peripheral aneurysms with NBCA. Anticoagulants and antiepileptic were used post procedure. Cheek angiogram showed successful embolisation of all aneurysms. 22 patients had no complications and were discharged home. Hemiplegia, Vitreous hemorrhage and fatal retroperitoneal hemorrhage occurred in one patient each. No patient had recurrence of SAH during follow up. Conclusion: Endovaseular coiling o f aneurysms is a relatively safe and effective procedure and early results are encouraging.
Cerebral Venous Thrombosis (CVT): a cli~fical profile seen in South India
1379 Coordinated care across healthcare sTstems, a Disease Management Concept: the Singapore Model for Stroke Care
Vehnurugendxan CU 1, Nagesh T ~, Vasudevan D 1, Meenakstfi
Veld~etasubraulanian, N 1, Yin, A 2, Heng, B2, Cheah, j2. ZNational
Sundaram U 1, Arulselvan VL 1. ZSri Ramachandra Medical College &
Neuroscience Institute, Singapore; 2National Healthcare Group, Singapore
1377
Research Institute (Deemed University), Chennai, amilnadu, India
Thursday, November 10, 2005
Poster Abstracts
Vakifi, A ~, Dehghani, G a, Nekooeian, A 3. 1Semnan University
Background: CVT is encountered frequently in South India (1% of all
Of Medical Sciences, Semnan, Iran; ~Departments of Physiology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, !ran; 3Departments of Pharmacologyl, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, !ran
strokes). It has variable temporal profile, clinical presentation and excellent outcome. Methods: 30 cases of CVT were studied between June 2002 and August 2004. Detailed lfistory and clinical exanfinations were done. Underlying medical illnesses, joint pains, genital & oral ulcer, alcoholism, oral contraceptive usage, dehydration, fever, sepsis and anemia were taken into account. Routine Blood count, ESR, Electrolytes, Renal and Liver Function tests, Coagulation profile, Protein C, Protein S, antithrombin -l-l-I, ACL antibodies and Serum homocysteine were assayed. CSF was studied in selected cases (118/30). MRI Brain & M R Venogram were done in all cases. Two cases had digital subtraction angiography. Results: There were 16 males & 14 females. Predisposing factors in females were pregnancy (28.4%), oral contraceptives (121.4%) and dehydration (17.1%), and in males - chronic alcoholism (43.8%) and dehydration (6.2%). Headache with papilledema were observed in 86.7%, meuingeal signs in 23.3%, seizures in 30%, hemiplegia in 30% and altered sensorium in 13.3%. Superior sagital sinus was involved in 90%. CSF was normal in 12 and had features of tuberculous meningitis in 6.3 patients had elevated serum homocysteine and 2 had elevated anti phospholipid antibodies. Patients were treated with low molecular weight heparin, oral anti coagulants, anti epileptic drugs and supportive measures. Outcome: 29 patients improved and 1 died. Conclusion: CVT is not uncommon. Neurotuberculosis and alcoholism in men and pregnancy/oral contraceptives in women were major etiological causes. Treated appropriately, CVI" carries good prognosis.
Pentoxifylline (PTX) is used in human for intermittent claudication and cerebral vascular disorders including cerebrovascular dementia. It also inhibits the synthesis of tumor necrosis factor-7, which is believed to be neurotoxicin animal models of cerebral ischemia. As far as the literature is concerned, there is no published study investigating the role o f TNF
1378 Fznbolisation in lntracrmfial Aneurysms - out experience
1376
Vehnurugendxan C.U 1, Smfil M Kalhir 1, Vasudevan D 1,
Stroke unit in Seiniijold Central Hospital, Finland
Meenakslfi Sundaram U 1, ArulselvanV.L 1, Murali ~, Santhosh Joseph 1.
Viilimiild, M 1, Hiiuliiliiinen, M 1. ZSeindjoki Central Hospital, Finland
1Sri Ramaehandra Medical College & Research Institute ("Deemed University), Chomai, Tamilnadu, India
About 14 000 Finnish people have a stroke every year. It is our third cause of death and a leading cause of severe, long-term disability. The expense goes up to 900 milj. Euros/year. Seinfijoki Central hospital is a district hospital caring of 194 000 inhabitants in the rural area of Finland. In Seinfijoki Central Hospital we have a 4 bed semi intensive Stroke Unit near com~ection with Intensive Care Unit, wlfich gives us broad competence both in intensive and neurological treatment. Stroke Unit was started January 1997. It is a multidiscipline unit prepared with a wide range on patient monitoring (including ekg, invasive and non invasive blood pressure, saturation, respiration and temperature measurements) systems. PiNs Care Suite (Critical Care Manager) has taken place in collecting patient information. Continuous EEG monitoring is also available. We treat about 400 neurological patients annually. Most of these are stroke related problems (80%). The average care period for a stroke patient is 2,5 days. Our Stroke Uuit has attended numerous projects and studies to develop medical and nursing care. Thrombolysis (tPA) has taken its place as acute stroke treatment. We have been involved to ECASS II and SAINT I studies. Intensive Care Nursing Scoring System gives information of our nursing staff resources. Work analysis was done during 2000-2001 in our hospital. According to this study the proper dimension of our stroke unit was 6,25 registered nurses, 0,5 neurology and 0,5 physiotherapist. Our stroke uuits expenses were 500 000 Euros/year.
Background: To study the usefulness of early endovascular manage-
ment of intracranial aneurysms in patients presenting with acute subarachnoid hemorrhage (SAH) at our center. Methods: 25 patients (113 men and 12 women) in the age group o f 2565 years presenting with aneurysmal SAH were studied. The presenting SAH Grade was: Grade 1-14, Grade I1-6, Grade II1-1, Grade IV-1. Digital Subtraction Angiography was done with GE Biplane DSA System with 3D rotational angiography. The distribution of aneurysms were ACA-7, Carotid ophthalmic -6, M C A -3, P C O M -2, Posterior Fossa -4, Peripheral aneurysms -3. Under GA, following femoral catheterization and guiding catheter placement in appropriate vessel, using micro catheter/micro wire combination, embolisation was done with either Gugleilmi detachable coils or N-butyl cyano acrylate (NBCA) glue. Patients were followed up for 2-14 months. Results: 22 patients were embolised with coil and 3 patients with peripheral aneurysms with NBCA. Anticoagulants and antiepileptic were used post procedure. Cheek angiogram showed successful embolisation of all aneurysms. 22 patients had no complications and were discharged home. Hemiplegia, Vitreous hemorrhage and fatal retroperitoneal hemorrhage occurred in one patient each. No patient had recurrence of SAH during follow up. Conclusion: Endovaseular coiling o f aneurysms is a relatively safe and effective procedure and early results are encouraging.
Cerebral Venous Thrombosis (CVT): a cli~fical profile seen in South India
1379 Coordinated care across healthcare sTstems, a Disease Management Concept: the Singapore Model for Stroke Care
Vehnurugendxan CU 1, Nagesh T ~, Vasudevan D 1, Meenakstfi
Veld~etasubraulanian, N 1, Yin, A 2, Heng, B2, Cheah, j2. ZNational
Sundaram U 1, Arulselvan VL 1. ZSri Ramachandra Medical College &
Neuroscience Institute, Singapore; 2National Healthcare Group, Singapore
1377
Research Institute (Deemed University), Chennai, amilnadu, India