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Cerebral venous thromboembolism complication of isotretinoin use: a case report
Abstracts / Journal of the Neurological Sciences 357 (2015) e363–e423
indications. An example for acute stimulation, is the case of acute ischemic stroke, where blood circulation has been compromised. SPG stimulation can increase perfusion to the areas suffering from reduced or lack of blood supply, and help save brain tissue. The device is implanted by neurologists in a minimal invasive bed-side procedure under local anaesthesia. The device was tested to date in ~ 1000 acute ischemic stroke patients. In 2 previous clinical studies SPG stimulation demonstrated good safety profile and a promising clinical effect, and currently is being tested in a confirmatory pivotal trial, ImpACT-24B. doi:10.1016/j.jns.2015.08.1417
1375 WFN15-0038 Stroke Cerebral venous thromboembolism complication of isotretinoin use: a case report E. Okuyucu, I.M. Melek, S. Colakoglu, O. Demetgul, M. Guntel, T. Duman. Neurology, Mustafa Kemal Unversitiy, Antakya, Turkey Background: We report a 27-year-old woman with any risk factor for thromboses who presented with right hemiparesis due to left transverse venous sinus occlusion associated with isotretinoin use for acne. Case presentation: A healthy 27-year-old woman ,with no significant past medical history, presented with sudden onset of headache, vomiting , right hemiparesis and unconsciousness associated with convulsions. She had a history of taking isotretinoin for acne for the last 2 months. A magnetic resonance scan of her brain showed the presence of cerebral infarction of left thalamic area , magnetic resonance venography ultimately revealed left transverse sinus thrombosis. Treatment with anticoagulation recovered her from headache but not from hemiparesis. Conclusion: Isotretinoin is one of the most used treatment modality in many patients with acne.However, isotretinoin use can be associated with life-threating thrombotic side effects especially in young patients. Physicians must be more alert to be aware of this side effect. doi:10.1016/j.jns.2015.08.1418
1376 WFN15-0787 Stroke Head position in stroke trial (Headpost) pilot phase V. Olavarriaa, A. Brunsera, F. Gonzálezb, P. Muñozc, S. Martinsd, J. Gaetee, H. Arimaf, C.S. Andersonf, P.M. Lavadosg. aInternal Medicine, Clinica Alemana Universidad del Desarrollo Instituto de Neurociencias, Santiago, Chile; bInternal Medicine, Clinica Alemana de Santiago, Santiago, Chile; cInternal Medicine, Clinica Alemana de Santiago Universidad del Desarrollo Insituto de Neurociencias, Santiago, Chile; d Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; e Internal Medicine, Hospital Clínico de Magallanes, Punta Arenas, Chile; f Neurology, The George Institute for Global Health Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; gInternal Medicine, Clínica Alemana de Santiago Universidad del Desarrollo Instituto de Neurociencias and Universidad de Chile, Santiago, Chile Background: Controversy exists over the optimal head position in acute ischemic stroke (AIS) patients in the first 24-48 hours. Interventions that augment cerebral blood flow (CBF) could be beneficial. The simplest way to do this could be to place the head in 'lying flat” rather than 'sitting up” position. Potential benefits may be offset by an increased risk of pneumonia or cardiac failure.
e401
Aims: HeadPoST Pilot will determine the safety, feasibility and potential efficacy of the 'lying flat” compared to the standard 'sitting up” head position in AIS patients. Methods: Cluster randomized, open, blinded endpoint assessment, active-comparative, international clinical trial. Patient are included if within 12 hours from symptom onset, anterior circulation infarction, NIHSS ≥ 1 and adequate sonographic window. Main efficacy outcome is mean CBF velocity in the 'lying flat” compared to the 'sitting up” head position assessed by Transcranial Doppler (TCD) to the middle cerebral arteries. Secondary objectives are safety and neurological status at 7 days and disability at 90 days. A sample size of 32 clusters (mean 3 patients) was calculated to detect an 8.3 cm/s increase in CBF velocity (IC 95% 4.82 a 12.03) with 90% power, 5% significance. Results: The study has included 81 patients (32 clusters) as of April 2015 in 3 centres. No safety concerns have been raised by the DSMB. Conclusions: This pilot phase will finish recruitment soon. The lying flat head position is a potential low cost, widely applicable, nursing intervention to increase CBF in AIS and may improve clinical outcomes. doi:10.1016/j.jns.2015.08.1419
1377 WFN15-0792 Stroke Clínica Alemana de Santiago cerebrovascular disease registry (Recca): a single center seventeen-year prospective project V. Olavarriaa, A. Brunsera, D. Herreroa, D. Cárcamoa, J. Lópeza, M. Valenzuelaa, A. Hoppea, E. Sujimaa, E. Mansillaa, S. Illanesa, A. Recciusa, V. Díazb, P.M. Lavadosc. aInternal Medicine, Clinica Alemana Universidad del Desarrollo Instituto de Neurociencias, Santiago, Chile; b Internal Medicine, Clinica Alemana Universidad del Desarrollo Instituto de Neurociencias and Hospital Clínico Universidad del Chile, Santiago, Chile; cInternal Medicine, Clinica Alemana Universidad del Desarrollo Instituto de Neurociencias and Universidad del Chile, Santiago, Chile Background: Stroke is the leading cause of death and disability in lowand middle-income countries. In Chile it is the first cause of death. Hospital registries are useful to describe risk factors, distribution of stroke subtypes and patterns of care. They are a source of hypothesis generating analytical studies and they help to evaluate changes in care process and the uptake of interventions suggested by clinical evidence in real health conditions as well as quality control of care. Objective: To describe a large prospective single center stroke registry and its main outputs. Patients and methods: Clínica Alemana is a 500-bed tertiary care nonfor-profit private academic medical center, serving a population of approximately 400,000 inhabitants. All consecutive patients with acute stroke admitted to our institution are prospectively included in the registry. We use standardized definitions for stroke diagnosis and classification. All data is stored using Epi-Info. The registry has undergone several modifications. The project has ethics committee approval. Results: Between December 1997 and December 2014, 2703 cases were included in the registry. The pathological distribution was 2239 ischemic strokes, 334 intracerebral hemorrhages and 130 subarachnoid hemorrhages. Mean ages and (SD) are 69 (16), 66 (17) and 54 (13), respectively. Eight papers in peer-reviewed journal have been published and more than 30 abstracts presented in national and international meetings with data from the registry. Many of the analysis have resulted in protocol changes to improve care. Conclusion: RECCA is an ongoing very productive single center stroke registry, both scientifically and in clinical practice. doi:10.1016/j.jns.2015.08.1420
indications. An example for acute stimulation, is the case of acute ischemic stroke, where blood circulation has been compromised. SPG stimulation can increase perfusion to the areas suffering from reduced or lack of blood supply, and help save brain tissue. The device is implanted by neurologists in a minimal invasive bed-side procedure under local anaesthesia. The device was tested to date in ~ 1000 acute ischemic stroke patients. In 2 previous clinical studies SPG stimulation demonstrated good safety profile and a promising clinical effect, and currently is being tested in a confirmatory pivotal trial, ImpACT-24B. doi:10.1016/j.jns.2015.08.1417
1375 WFN15-0038 Stroke Cerebral venous thromboembolism complication of isotretinoin use: a case report E. Okuyucu, I.M. Melek, S. Colakoglu, O. Demetgul, M. Guntel, T. Duman. Neurology, Mustafa Kemal Unversitiy, Antakya, Turkey Background: We report a 27-year-old woman with any risk factor for thromboses who presented with right hemiparesis due to left transverse venous sinus occlusion associated with isotretinoin use for acne. Case presentation: A healthy 27-year-old woman ,with no significant past medical history, presented with sudden onset of headache, vomiting , right hemiparesis and unconsciousness associated with convulsions. She had a history of taking isotretinoin for acne for the last 2 months. A magnetic resonance scan of her brain showed the presence of cerebral infarction of left thalamic area , magnetic resonance venography ultimately revealed left transverse sinus thrombosis. Treatment with anticoagulation recovered her from headache but not from hemiparesis. Conclusion: Isotretinoin is one of the most used treatment modality in many patients with acne.However, isotretinoin use can be associated with life-threating thrombotic side effects especially in young patients. Physicians must be more alert to be aware of this side effect. doi:10.1016/j.jns.2015.08.1418
1376 WFN15-0787 Stroke Head position in stroke trial (Headpost) pilot phase V. Olavarriaa, A. Brunsera, F. Gonzálezb, P. Muñozc, S. Martinsd, J. Gaetee, H. Arimaf, C.S. Andersonf, P.M. Lavadosg. aInternal Medicine, Clinica Alemana Universidad del Desarrollo Instituto de Neurociencias, Santiago, Chile; bInternal Medicine, Clinica Alemana de Santiago, Santiago, Chile; cInternal Medicine, Clinica Alemana de Santiago Universidad del Desarrollo Insituto de Neurociencias, Santiago, Chile; d Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; e Internal Medicine, Hospital Clínico de Magallanes, Punta Arenas, Chile; f Neurology, The George Institute for Global Health Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; gInternal Medicine, Clínica Alemana de Santiago Universidad del Desarrollo Instituto de Neurociencias and Universidad de Chile, Santiago, Chile Background: Controversy exists over the optimal head position in acute ischemic stroke (AIS) patients in the first 24-48 hours. Interventions that augment cerebral blood flow (CBF) could be beneficial. The simplest way to do this could be to place the head in 'lying flat” rather than 'sitting up” position. Potential benefits may be offset by an increased risk of pneumonia or cardiac failure.
e401
Aims: HeadPoST Pilot will determine the safety, feasibility and potential efficacy of the 'lying flat” compared to the standard 'sitting up” head position in AIS patients. Methods: Cluster randomized, open, blinded endpoint assessment, active-comparative, international clinical trial. Patient are included if within 12 hours from symptom onset, anterior circulation infarction, NIHSS ≥ 1 and adequate sonographic window. Main efficacy outcome is mean CBF velocity in the 'lying flat” compared to the 'sitting up” head position assessed by Transcranial Doppler (TCD) to the middle cerebral arteries. Secondary objectives are safety and neurological status at 7 days and disability at 90 days. A sample size of 32 clusters (mean 3 patients) was calculated to detect an 8.3 cm/s increase in CBF velocity (IC 95% 4.82 a 12.03) with 90% power, 5% significance. Results: The study has included 81 patients (32 clusters) as of April 2015 in 3 centres. No safety concerns have been raised by the DSMB. Conclusions: This pilot phase will finish recruitment soon. The lying flat head position is a potential low cost, widely applicable, nursing intervention to increase CBF in AIS and may improve clinical outcomes. doi:10.1016/j.jns.2015.08.1419
1377 WFN15-0792 Stroke Clínica Alemana de Santiago cerebrovascular disease registry (Recca): a single center seventeen-year prospective project V. Olavarriaa, A. Brunsera, D. Herreroa, D. Cárcamoa, J. Lópeza, M. Valenzuelaa, A. Hoppea, E. Sujimaa, E. Mansillaa, S. Illanesa, A. Recciusa, V. Díazb, P.M. Lavadosc. aInternal Medicine, Clinica Alemana Universidad del Desarrollo Instituto de Neurociencias, Santiago, Chile; b Internal Medicine, Clinica Alemana Universidad del Desarrollo Instituto de Neurociencias and Hospital Clínico Universidad del Chile, Santiago, Chile; cInternal Medicine, Clinica Alemana Universidad del Desarrollo Instituto de Neurociencias and Universidad del Chile, Santiago, Chile Background: Stroke is the leading cause of death and disability in lowand middle-income countries. In Chile it is the first cause of death. Hospital registries are useful to describe risk factors, distribution of stroke subtypes and patterns of care. They are a source of hypothesis generating analytical studies and they help to evaluate changes in care process and the uptake of interventions suggested by clinical evidence in real health conditions as well as quality control of care. Objective: To describe a large prospective single center stroke registry and its main outputs. Patients and methods: Clínica Alemana is a 500-bed tertiary care nonfor-profit private academic medical center, serving a population of approximately 400,000 inhabitants. All consecutive patients with acute stroke admitted to our institution are prospectively included in the registry. We use standardized definitions for stroke diagnosis and classification. All data is stored using Epi-Info. The registry has undergone several modifications. The project has ethics committee approval. Results: Between December 1997 and December 2014, 2703 cases were included in the registry. The pathological distribution was 2239 ischemic strokes, 334 intracerebral hemorrhages and 130 subarachnoid hemorrhages. Mean ages and (SD) are 69 (16), 66 (17) and 54 (13), respectively. Eight papers in peer-reviewed journal have been published and more than 30 abstracts presented in national and international meetings with data from the registry. Many of the analysis have resulted in protocol changes to improve care. Conclusion: RECCA is an ongoing very productive single center stroke registry, both scientifically and in clinical practice. doi:10.1016/j.jns.2015.08.1420