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Childhood arterial ischemic stroke: a review of risk factors
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Abstracts / Journal of the Neurological Sciences 357 (2015) e363–e423
transient ischemic attacks until first ischemic stroke affecting the left frontal lobe. During hospitalization, he presented four ischemic strokes in multiple territories. Arteriography exhibited multiple distal irregularities in all arterial territories, suggesting cerebral vasculitis. Even with corticosteroids, cyclophosphamide and intravenous immunoglobulin no response was observe and he died 4 weeks latter. Conclusion: Isolated neurosarcoidosis is a big diagnostic challenge and, owing to its life-threatening consequences, the recognition of cerebral vasculitis in these patients is necessary for proper treatment and, therefore, to achieve better clinical outcomes.
doi:10.1016/j.jns.2015.08.1396
1354 WFN15-0210 Stroke Defining an international standard set of patient-centered outcome measures after stroke S. Martinsa, B. Norrvingb, J. Salinasc, S. Sprinkhuizend, L. Schwammc. a Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil; bNeurology, Lund University, Lund, Sweden; cNeurology, Massachusetts General Hospital Harvard Medical School, Boston, USA; d Neurology, International Consortium of Health Outcomes Measurement, Boston, USA Background: Value-based healthcare delivery is a strategy to align patients, providers, and payers toward improving outcomes while reducing costs. We sought to define an international standard set of patient-centered, stroke health outcomes. Methods: We assembled an international expert panel representing patients, advocates, and physician experts in stroke outcomes, stroke registries, global health, epidemiology, and rehabilitation. A modified Delphi process was used to reach consensus recommendations for a Standard Set of outcome measures, baseline risk adjustment variables, and included populations for use in both low and high income countries. Results: Patients presenting to a hospital with ischemic stroke or intracerebral hemorrhage evaluated with brain imaging were selected as the required included population, with optional inclusion of transient ischemic attacks. Because of differences in ascertainment and imaging modalities, duration of symptoms and type of imaging are collected to allow for comparisons of homogeneous groups across various countries and practice settings. Basic functional status is assessed at prestroke baseline, index admission, discharge, 90 days, and 1 year thereafter. Comorbidities and stroke severity are collected for risk adjustment. Symptomatic intracerebral hemorrhage after thrombolysis is the only complication captured, and many measures reflect patient-reported quality of life outcomes and priorities captured in the Patient Reported Outcomes Measurement Information System 10-question short form (PROMIS-10) and elements from existing registries. Conclusions: The stroke measure Standard Set is proposed for implementation to permit meaningful comparisons and increase value of stroke care worldwide using a simple, pragmatic strategy. doi:10.1016/j.jns.2015.08.1397
1355 WFN15-0405 Stroke Childhood arterial ischemic stroke: a review of risk factors H.H.S. Matozinhoa, L.C. Moraisa, V.C. Fariaa, L.S. Rimoldia, D.G. Costaa, J.E.S. Cavalcanteb, F.H.R. Slvaa, Y.L. Nogueiraa, R. Barbosaa, W.N. Navesb. aInternal Medicine Department, Federal University of Goias, Goiânia, Brazil; bNeurosurgery Department, Federal University of Goias, Goiânia, Brazil Background: Childhood Arterial Ischemic Stroke (CAIS) is a rare, but serious medical condition, associated with both acute and long-term neurologic impairment. There is still a limited comprehension of the risk factors (RF) and their influence in CAIS. Objective: Discuss the current understanding of RF in CAIS. Materials and methods: A search was performed in Pubmed using “stroke AND childhood”. Only free full texts published in the last 5 years were considered. There were 28 results, of which 8 approached the subject of interest. Results: The articles included in this analysis commented several conditions that may play an important role in CAIS. RF that have increased among children, adolescents and might be related to CAIS are the cardiovascular, obesity, hypertension, besides diabetes, dyslipidemia, alcohol, tobacco, drug abuse. Cardiac procedures, congenital heart disease, other cardiac abnormalities were also considered RF. CAIS happens in Sickle Cell Disease when the vaso-occlusive crisis affects the brain. It is also a common event in Moyamoya Syndrome, a disease characterized by progressive occlusion of cerebral vasculature. Hematologic conditions that cause CAIS include: inherited deficiency of proteins C, S, antithrombin, factor V, besides iron deficiency anemia, thrombocytosis, polycythemia. Metabolic disordes, preceding infections, migranea, and head and neck traumas (with stretching, tearing of the vertebral/carotid arteries) were considered too. However, 24% of cases are still idiopathic. Conclusion: Understand RF is the first step to improve prevention and enable the development of adequate intervention strategies and, therefore, minimize the physical, mental burden of CAIS. doi:10.1016/j.jns.2015.08.1398
1356 WFN15-1147 Stroke Relationship between strokes, later seizures and epilepsy L.S. Rimoldia, V.C. Fariaa, D.G. Costaa, L.C. Moraisa, H.H.S. Matozinhoa, R.M.G. Barbosaa, J.E.S. Cavalcanteb, S.T.S.L. Leãoc, J.B.A. Juncosc, G.L. Costa Juniorb. aInternal Medicine Department, Federal University of Goias, Goiânia, Brazil; bNeurosurgery Department, Clinics Hospital Federal University of Goias, Goiânia, Brazil; cNeurosurgery Department, Santa Monica Hospital, Goiânia, Brazil Background: Late-onset seizures, post stroke epilepsy are symptoms strongly linked to early-onset seizures in arterial ischemic stroke (AIS) in children, but it does not seem to occur in arterial hemorrhagic stroke (AHS). Epilepsy was also reported after neonatal cerebral sinovenous thrombosis. Objectives: Highlight the relationship between early-onset seizures, late-onset seizures and post stroke epilepsy in pediatrics, analysing risk factors. Materials and methods: A search was performed in Pubmed using “pediatric AND stroke AND epilepsy”. Only free full texts published in the last 5 years were considered. There were 18 results, of which only 5 approached the subject of interest. Results: Acute seizures had frequency of 22-25,6% in AIS, 15-30% in AHS, 69% in cerebral sinovenous thrombosis. Late-onset seizure in AIS was
Abstracts / Journal of the Neurological Sciences 357 (2015) e363–e423
transient ischemic attacks until first ischemic stroke affecting the left frontal lobe. During hospitalization, he presented four ischemic strokes in multiple territories. Arteriography exhibited multiple distal irregularities in all arterial territories, suggesting cerebral vasculitis. Even with corticosteroids, cyclophosphamide and intravenous immunoglobulin no response was observe and he died 4 weeks latter. Conclusion: Isolated neurosarcoidosis is a big diagnostic challenge and, owing to its life-threatening consequences, the recognition of cerebral vasculitis in these patients is necessary for proper treatment and, therefore, to achieve better clinical outcomes.
doi:10.1016/j.jns.2015.08.1396
1354 WFN15-0210 Stroke Defining an international standard set of patient-centered outcome measures after stroke S. Martinsa, B. Norrvingb, J. Salinasc, S. Sprinkhuizend, L. Schwammc. a Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil; bNeurology, Lund University, Lund, Sweden; cNeurology, Massachusetts General Hospital Harvard Medical School, Boston, USA; d Neurology, International Consortium of Health Outcomes Measurement, Boston, USA Background: Value-based healthcare delivery is a strategy to align patients, providers, and payers toward improving outcomes while reducing costs. We sought to define an international standard set of patient-centered, stroke health outcomes. Methods: We assembled an international expert panel representing patients, advocates, and physician experts in stroke outcomes, stroke registries, global health, epidemiology, and rehabilitation. A modified Delphi process was used to reach consensus recommendations for a Standard Set of outcome measures, baseline risk adjustment variables, and included populations for use in both low and high income countries. Results: Patients presenting to a hospital with ischemic stroke or intracerebral hemorrhage evaluated with brain imaging were selected as the required included population, with optional inclusion of transient ischemic attacks. Because of differences in ascertainment and imaging modalities, duration of symptoms and type of imaging are collected to allow for comparisons of homogeneous groups across various countries and practice settings. Basic functional status is assessed at prestroke baseline, index admission, discharge, 90 days, and 1 year thereafter. Comorbidities and stroke severity are collected for risk adjustment. Symptomatic intracerebral hemorrhage after thrombolysis is the only complication captured, and many measures reflect patient-reported quality of life outcomes and priorities captured in the Patient Reported Outcomes Measurement Information System 10-question short form (PROMIS-10) and elements from existing registries. Conclusions: The stroke measure Standard Set is proposed for implementation to permit meaningful comparisons and increase value of stroke care worldwide using a simple, pragmatic strategy. doi:10.1016/j.jns.2015.08.1397
1355 WFN15-0405 Stroke Childhood arterial ischemic stroke: a review of risk factors H.H.S. Matozinhoa, L.C. Moraisa, V.C. Fariaa, L.S. Rimoldia, D.G. Costaa, J.E.S. Cavalcanteb, F.H.R. Slvaa, Y.L. Nogueiraa, R. Barbosaa, W.N. Navesb. aInternal Medicine Department, Federal University of Goias, Goiânia, Brazil; bNeurosurgery Department, Federal University of Goias, Goiânia, Brazil Background: Childhood Arterial Ischemic Stroke (CAIS) is a rare, but serious medical condition, associated with both acute and long-term neurologic impairment. There is still a limited comprehension of the risk factors (RF) and their influence in CAIS. Objective: Discuss the current understanding of RF in CAIS. Materials and methods: A search was performed in Pubmed using “stroke AND childhood”. Only free full texts published in the last 5 years were considered. There were 28 results, of which 8 approached the subject of interest. Results: The articles included in this analysis commented several conditions that may play an important role in CAIS. RF that have increased among children, adolescents and might be related to CAIS are the cardiovascular, obesity, hypertension, besides diabetes, dyslipidemia, alcohol, tobacco, drug abuse. Cardiac procedures, congenital heart disease, other cardiac abnormalities were also considered RF. CAIS happens in Sickle Cell Disease when the vaso-occlusive crisis affects the brain. It is also a common event in Moyamoya Syndrome, a disease characterized by progressive occlusion of cerebral vasculature. Hematologic conditions that cause CAIS include: inherited deficiency of proteins C, S, antithrombin, factor V, besides iron deficiency anemia, thrombocytosis, polycythemia. Metabolic disordes, preceding infections, migranea, and head and neck traumas (with stretching, tearing of the vertebral/carotid arteries) were considered too. However, 24% of cases are still idiopathic. Conclusion: Understand RF is the first step to improve prevention and enable the development of adequate intervention strategies and, therefore, minimize the physical, mental burden of CAIS. doi:10.1016/j.jns.2015.08.1398
1356 WFN15-1147 Stroke Relationship between strokes, later seizures and epilepsy L.S. Rimoldia, V.C. Fariaa, D.G. Costaa, L.C. Moraisa, H.H.S. Matozinhoa, R.M.G. Barbosaa, J.E.S. Cavalcanteb, S.T.S.L. Leãoc, J.B.A. Juncosc, G.L. Costa Juniorb. aInternal Medicine Department, Federal University of Goias, Goiânia, Brazil; bNeurosurgery Department, Clinics Hospital Federal University of Goias, Goiânia, Brazil; cNeurosurgery Department, Santa Monica Hospital, Goiânia, Brazil Background: Late-onset seizures, post stroke epilepsy are symptoms strongly linked to early-onset seizures in arterial ischemic stroke (AIS) in children, but it does not seem to occur in arterial hemorrhagic stroke (AHS). Epilepsy was also reported after neonatal cerebral sinovenous thrombosis. Objectives: Highlight the relationship between early-onset seizures, late-onset seizures and post stroke epilepsy in pediatrics, analysing risk factors. Materials and methods: A search was performed in Pubmed using “pediatric AND stroke AND epilepsy”. Only free full texts published in the last 5 years were considered. There were 18 results, of which only 5 approached the subject of interest. Results: Acute seizures had frequency of 22-25,6% in AIS, 15-30% in AHS, 69% in cerebral sinovenous thrombosis. Late-onset seizure in AIS was