- Email: [email protected]
FP06-MO-04 Hyperhomocysteinemia in non-puerperal cerebral venous thrombosis
S66
19th World Congress of Neurology, Free Paper Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S57–S154
FP06-MO-03 Increment of hemoglobin above normal values at 3,600 meters above sea level, as a risk factor in the stroke J.C. Duran, J.C. Fernandez, M.I. Cusicanqui, F. Fortun, C.P. Laforcada, O. Quilo. Neurology, Hospital General, La Paz, Bolivia Purpose: To determine whether the increment of the hemoglobin value above the normal value, at 3,600 meters above sea level constitutes a risk factor for the STROKE. Method: Design of cases-controls, a study performed in patients interned in the Neurology Unit of the city of La Paz, Bolivia, at 3,600 masl, from January 2005 to December 2008. Eightyseven patients with stroke (cases), and eighty-seven patients with other pathology (control) were included. The patients with stroke had clinical diagnosis and CT scan. The criteria for inclusion were patients with egress of stroke without hematological, renal or respiratory pathology, and the criteria of exclusion were hematological disorders, medication that has influence over erythropoyesis. Hematimetric values were collected from clinical records, and listed in three groups: (1) patients with high hemoglobin (males with more than 18.5 g/dL, females with more than 16.5 g/dL), (2) patients with normal Hb (males: 15.5– 18.5 g/dL, females: 14.5–16.5 g/dL), and (3) patients with low hemoglobin (males: less than 15.5 g/dL, females less than 14.5 g/dL, in accordance with values established by the Bolivian Biology Institute for an altitude of 3,600 masl. Results: Patients with ICVA with incremented hemoglobin reached 17% with dominance in males, the out ratio obtained was 2.87 (95% CI 1.007277–8.207825) using the program EPIDAT 3.0. Conclusions: We consider that the increment of the value of hemoglobin above normal ranges for an altitude of 3,600 masl (erithrocitosis by miss-adaptation to altitude) is associated as a risk factor to develop stroke, above all in males. FP06-MO-04 Hyperhomocysteinemia in non-puerperal cerebral venous thrombosis R. Christopher1 , V.P. BharathKumar1 , D. Nagaraja2 . 1 Neurochemistry, National Inst of Mental Health and Neuro Sciences, Bangalore, India; 2 Neurology, National Inst of Mental Health and Neuro Sciences, Bangalore, India Purpose: Cerebral venous thrombosis (CVT), generally considered an uncommon entity in the developed world, is not so rare in India. Numerous causes of CVT have been reported. Recently, hyperhomocysteinemia has been identified as a risk factor for venous thrombosis. There is paucity of data from India on the role of hyperhomocysteinemia as a risk factor for non-puerperal CVT. Method: We investigated 105 patients diagnosed with aseptic non-puerperal CVT and 181 age and gender-matched healthy subjects. Plasma total homocysteine was measured by HPLC using electrochemical detection. Genotyping for MTHFR C677T gene mutation was performed by PCR-RFLP. Vitamin B12 and folate were estimated in plasma by radioimmunoassay. Results: A significant number of CVT patients had hyperhomocysteinemia compared to controls (41.9% vs. 13.3%, p ≤ 0.001), the adjusted odd’s ratio being 3.82 (95% CI, 2.09 to 6.09). Plasma homocysteine was positively modulated by age, gender, oral contraceptive usage, and hypertension. Low plasma folate was more prevalent in CVT patients (21.9% vs 9.3%, p = 0.003). Plasma folate correlated with hyperhomocysteinemia. Low vitamin B12 was found in 2.9% of CVT cases and 1.1% of controls (p = 0.275). The distribution of MTHFR 677CT and TT genotypes were not significantly altered in the study groups (p = 0.49, p = 0.29 respectively). Frequency of the MTHFR 677T allele was 23.2% in cases vs 17.3% in controls. Mean plasma homocysteine was significantly higher in 677TT than in 677CT and 677CC genotypes (34.44±2.41vs 25.81±2.45 vs 18.50±1.74 mmol/l, respectively, p < 0.001).
Conclusion: Hyperhomocysteinemia is an independent risk factor for non-puerperal CVT. The MTHFR C677T polymorphism has a significant impact on plasma homocysteine levels. Folate, rather than vitamin B12 deficiency is more important in causing hyperhomocysteinemia. Reduction of plasma homocysteine by vitamin B supplementation offers a possibility for prevention of CVT in India. FP06-MO-05 Stroke admission and air pollution in Tehran: a cross sectional study B. Jafari1 , M. Jalali1 , S.M. Nabavi1 , S.N. Nedjat2 , K.H. Ashrafi3 . Neurology, Shahed University, Faculty of Medicine, Tehran, Islamic Republic of Iran; 2 Epidemiology and Biostatistcs, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; 3 Biology, Center for Control of Pollution and Air Quality, Tehran, Islamic Republic of Iran
1
Objective: Tehran, capital of Iran, with more than 11 million population, is one of the most air polluted cities in the world, mainly because of more than 2.5 million cars and too many factories on it. It is obvious the pollutions on the air may cause or aggravate a lot of respiratory and cardiac disorders. To assess the association between stroke and air pollution we have done a cross sectional study for first time in Tehran. Methods: The number of stroke admissions in 6 major hospitals of Tehran were located in different parts of the city – were extracted in one year (2005–2006). The air pollutant level (including CO, O3, SO2, PM10, NOX (NO+NO2)) in the same date were registered and matched. Also some influencing factors such as: Temperature, humidity and the day of the week were considered. We assessed associations through Bivariate and regression analysis. Results: One thousand one hundred fourteen admissions were registered in 365 days of the year, (maximum admission per day 9 and the minimum 0). In bivariate analysis there were significant association between the levels of O3 and SO2 in 48H before admission day and the admission numbers (p = 0.032, p = 0.030, consequently). In regression analysis after considering potential confounders such as type of day of the week (holidays or not), humidity, Temperature, and the mentioned pollutants, only the NOX in the day and 48 before the admission had significant association with hospital admission: (p = 0.032, p = 0.0110, consequently). The number of admissions in the holidays were significantly lower than other days (p = 0.009). Conclusion: Although this is a preliminary result the significant association between O3 and SO2 levels in the Tehran 48 h before admission and also NOX level in the day and 48 h before admission are alarming subjects and emphasis the urgent practical protocol for managing of the air pollution in Tehran. FP06-MO-06 Prevalence and risk factors of extracranial internal carotid and intracranial artery stenosis in asymptomatic Thai subjects N. Chaisinanunkul, A. Chutinet, N.C. Suwanwela. Medicine, Chulalongkorn Hospital, Bangkok, Thailand Purpose: Prevalence of extracranial ICA and intracranial atherosclerosis in asymptomatic Asian population has been rarely reported. The purpose of this study was to search for prevalence and risk factors of significant extracranial and intracranial carotid stenoses in Thai healthy people who did not have history of ischemic stroke. Methods: From January to February 2009, healthy volunteers and members of elderly club at King Chulalongkorn Memorial hospital aged over 45 years old without history of stroke were studied. Carotid duplex ultrasound and Transcranial Doppler Ultrasound were performed to identify extracranial internal carotid and intracranial artery stenoses. Significant stenosis of the tested arteries was defined by standard criteria. In patients with evidence of significant stenosis, MRA of the brain and neck were performed to confirm diagnosis.
19th World Congress of Neurology, Free Paper Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S57–S154
FP06-MO-03 Increment of hemoglobin above normal values at 3,600 meters above sea level, as a risk factor in the stroke J.C. Duran, J.C. Fernandez, M.I. Cusicanqui, F. Fortun, C.P. Laforcada, O. Quilo. Neurology, Hospital General, La Paz, Bolivia Purpose: To determine whether the increment of the hemoglobin value above the normal value, at 3,600 meters above sea level constitutes a risk factor for the STROKE. Method: Design of cases-controls, a study performed in patients interned in the Neurology Unit of the city of La Paz, Bolivia, at 3,600 masl, from January 2005 to December 2008. Eightyseven patients with stroke (cases), and eighty-seven patients with other pathology (control) were included. The patients with stroke had clinical diagnosis and CT scan. The criteria for inclusion were patients with egress of stroke without hematological, renal or respiratory pathology, and the criteria of exclusion were hematological disorders, medication that has influence over erythropoyesis. Hematimetric values were collected from clinical records, and listed in three groups: (1) patients with high hemoglobin (males with more than 18.5 g/dL, females with more than 16.5 g/dL), (2) patients with normal Hb (males: 15.5– 18.5 g/dL, females: 14.5–16.5 g/dL), and (3) patients with low hemoglobin (males: less than 15.5 g/dL, females less than 14.5 g/dL, in accordance with values established by the Bolivian Biology Institute for an altitude of 3,600 masl. Results: Patients with ICVA with incremented hemoglobin reached 17% with dominance in males, the out ratio obtained was 2.87 (95% CI 1.007277–8.207825) using the program EPIDAT 3.0. Conclusions: We consider that the increment of the value of hemoglobin above normal ranges for an altitude of 3,600 masl (erithrocitosis by miss-adaptation to altitude) is associated as a risk factor to develop stroke, above all in males. FP06-MO-04 Hyperhomocysteinemia in non-puerperal cerebral venous thrombosis R. Christopher1 , V.P. BharathKumar1 , D. Nagaraja2 . 1 Neurochemistry, National Inst of Mental Health and Neuro Sciences, Bangalore, India; 2 Neurology, National Inst of Mental Health and Neuro Sciences, Bangalore, India Purpose: Cerebral venous thrombosis (CVT), generally considered an uncommon entity in the developed world, is not so rare in India. Numerous causes of CVT have been reported. Recently, hyperhomocysteinemia has been identified as a risk factor for venous thrombosis. There is paucity of data from India on the role of hyperhomocysteinemia as a risk factor for non-puerperal CVT. Method: We investigated 105 patients diagnosed with aseptic non-puerperal CVT and 181 age and gender-matched healthy subjects. Plasma total homocysteine was measured by HPLC using electrochemical detection. Genotyping for MTHFR C677T gene mutation was performed by PCR-RFLP. Vitamin B12 and folate were estimated in plasma by radioimmunoassay. Results: A significant number of CVT patients had hyperhomocysteinemia compared to controls (41.9% vs. 13.3%, p ≤ 0.001), the adjusted odd’s ratio being 3.82 (95% CI, 2.09 to 6.09). Plasma homocysteine was positively modulated by age, gender, oral contraceptive usage, and hypertension. Low plasma folate was more prevalent in CVT patients (21.9% vs 9.3%, p = 0.003). Plasma folate correlated with hyperhomocysteinemia. Low vitamin B12 was found in 2.9% of CVT cases and 1.1% of controls (p = 0.275). The distribution of MTHFR 677CT and TT genotypes were not significantly altered in the study groups (p = 0.49, p = 0.29 respectively). Frequency of the MTHFR 677T allele was 23.2% in cases vs 17.3% in controls. Mean plasma homocysteine was significantly higher in 677TT than in 677CT and 677CC genotypes (34.44±2.41vs 25.81±2.45 vs 18.50±1.74 mmol/l, respectively, p < 0.001).
Conclusion: Hyperhomocysteinemia is an independent risk factor for non-puerperal CVT. The MTHFR C677T polymorphism has a significant impact on plasma homocysteine levels. Folate, rather than vitamin B12 deficiency is more important in causing hyperhomocysteinemia. Reduction of plasma homocysteine by vitamin B supplementation offers a possibility for prevention of CVT in India. FP06-MO-05 Stroke admission and air pollution in Tehran: a cross sectional study B. Jafari1 , M. Jalali1 , S.M. Nabavi1 , S.N. Nedjat2 , K.H. Ashrafi3 . Neurology, Shahed University, Faculty of Medicine, Tehran, Islamic Republic of Iran; 2 Epidemiology and Biostatistcs, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; 3 Biology, Center for Control of Pollution and Air Quality, Tehran, Islamic Republic of Iran
1
Objective: Tehran, capital of Iran, with more than 11 million population, is one of the most air polluted cities in the world, mainly because of more than 2.5 million cars and too many factories on it. It is obvious the pollutions on the air may cause or aggravate a lot of respiratory and cardiac disorders. To assess the association between stroke and air pollution we have done a cross sectional study for first time in Tehran. Methods: The number of stroke admissions in 6 major hospitals of Tehran were located in different parts of the city – were extracted in one year (2005–2006). The air pollutant level (including CO, O3, SO2, PM10, NOX (NO+NO2)) in the same date were registered and matched. Also some influencing factors such as: Temperature, humidity and the day of the week were considered. We assessed associations through Bivariate and regression analysis. Results: One thousand one hundred fourteen admissions were registered in 365 days of the year, (maximum admission per day 9 and the minimum 0). In bivariate analysis there were significant association between the levels of O3 and SO2 in 48H before admission day and the admission numbers (p = 0.032, p = 0.030, consequently). In regression analysis after considering potential confounders such as type of day of the week (holidays or not), humidity, Temperature, and the mentioned pollutants, only the NOX in the day and 48 before the admission had significant association with hospital admission: (p = 0.032, p = 0.0110, consequently). The number of admissions in the holidays were significantly lower than other days (p = 0.009). Conclusion: Although this is a preliminary result the significant association between O3 and SO2 levels in the Tehran 48 h before admission and also NOX level in the day and 48 h before admission are alarming subjects and emphasis the urgent practical protocol for managing of the air pollution in Tehran. FP06-MO-06 Prevalence and risk factors of extracranial internal carotid and intracranial artery stenosis in asymptomatic Thai subjects N. Chaisinanunkul, A. Chutinet, N.C. Suwanwela. Medicine, Chulalongkorn Hospital, Bangkok, Thailand Purpose: Prevalence of extracranial ICA and intracranial atherosclerosis in asymptomatic Asian population has been rarely reported. The purpose of this study was to search for prevalence and risk factors of significant extracranial and intracranial carotid stenoses in Thai healthy people who did not have history of ischemic stroke. Methods: From January to February 2009, healthy volunteers and members of elderly club at King Chulalongkorn Memorial hospital aged over 45 years old without history of stroke were studied. Carotid duplex ultrasound and Transcranial Doppler Ultrasound were performed to identify extracranial internal carotid and intracranial artery stenoses. Significant stenosis of the tested arteries was defined by standard criteria. In patients with evidence of significant stenosis, MRA of the brain and neck were performed to confirm diagnosis.