- Email: [email protected]
Non-lateralised defects in stroke patients with visuospatial neglect
ABSTRACTS Dynamic Imaging of Cerebral Ischemia Treated With EC-IL Bypass
Starreveld, Y., Lee, T.-Y., Lownie, S.P., Lee, D.H. Fox, A.H., Baxter, B. (London, Ontario)
Background Regional cerebral'ischemia is measured by analyzing 120 images from a two minute contrast enhanced CT head scan. The radial artery in the wrist is also imaged and deconvoluted to yield a brain impulse residue function which is used to calculate cerebral blood volume (CBV) and mean transit time (MTT). Cerebral blood flow (CBF) is calculated as CSV/HTT. Methods A 46 year old right handed woman presented with a giant left internal carotid (ICA) aneurysm causing progressive visual loss. ICA balloon test occlusion was tolerated clinically for 30 minutes. After surgical trapping of the aneurysm, delayed progressive left hemisphere ischemia developed over 48 hours. Angiography demonstrated no vasospasm and good collaterals. Dynamic C'I-imaging was done before and after external carotid-saphenous vein to internal carotid bypass grafting. Results Marked elevation of CBV and MTT with reduction in CBF was observed in clinically ischemic zones of the left hemisphere pre-operatively. Following bypass, hemiparesis and global aphasia resolved. Hemodynamic values improved to levels symmetric with the opposite hemisphere. .Conclusions This method measures cerebral perfusion using a widely available CT contrast scan, Applications in vasospasm and ischemic stroke diagnosis are discussed.
Stroke Home Health Care: The Transition to Independence
D. Thrutoldey, D. DeLong, M. Rymer (Kansas City, Missouri)
Background Stroke patients and caregivers feel abandoned, frightened, and confused during the difficult transition phase of discharge from the hospital or rehabilitation unit to home. Health care providers have difficulty during this transition tracking outcomes and assuring patients and caregivers successful re-integration into the community. Issues of secondary prevention, medical management, follow-up anticnagulation, home safety, depression, and cognition not addressed in the inpatient setting may threaten overall outcome and lead to unnecessary readmissions.
Methods A Stroke Home Health Program was developed to address these issues. The nurses were trained to use the NIH Stroke Scale, Barthei Index, Geriatric Depression Scale, CoaguChesk system for home monitoring of INR/PTI', and learned the principles of teaching home safety and secendary stroke prevention. Every patient discharged from the Stroke Center is referred for Strokr Home Health services.
Results Outcome data are collected regarding stroke severity, functional independence, depression and quality of life and compared to acute therapies received. Anticeagulation is monitored in a reliable manner and secondary prevention is stressed. The methods for these assessmentswill be demonstrated in the poster.
.Conclusions A Stroke Home Health Program can ease tbe transition from hospital to home, decrease length of stay and costs while improving outcome and patient satisfaction.
465 EXTRINSIC CONGENITAL
COMPRESSION OF VERTEBRAL FORAMEN TRANSVERSARIUH
D.K.Nguyen,MD;
P.Laplante,MD
ARTERF BY STEMOSIS
(Montreal,
Canada)
Background. The authors report a case of posterior circulation s t r o k e r e l a t e d to a v e r y r a r e maybe unique cause of vertebro-basilar ischemia. Methods. A detailed r e p o r t o f the c l i n i c a l presen r a t i o n is g i v e n . We t h e n r e v i e w the r e s u l t s o f the c o m p l e t e radiological investifation.We discuss the e t i o l o g y of this clinical picture and review the r e p o r t e d c a s e s o f e x t r i n s i c compressive lesion o f the c e r v i c a l p o r t i o n o f t h e v e r t e b r a l artery. Results. A 43-gears-old male presented for what was a p a r t i a l W a l l e n b e r g syndrome which appeared in a t w o - s t e p w a y d u r i n g a 24 h o u r s p e r i o d . T h e clinical picture was quite suggestive of a vertebraldissection which followed a neck injury relat e d to a f r i e n d l y struggle between the patient and his son.This resulted in a d e l a u e d t r a n s i e n t deficit f o l l o w e d the n e x t d a y by a p e r s i s t e n t lesion o f the m e d u l l a . A r t e r i o g r a p h i c and CTScan studies o f the n e c k a r e s h o w n . T h e y d e m o n s t r a t e an e x t r i n sic compression o f the v e r t e b r a l a r t e r y at the site os a congenital foramen transversarium stenosis. Conclusions. We t h i n k t h a t t h i s is the first report of a vertebro-basilar ischemic accident related to an e x t r i n s i c compression o f the vertebral a r t e r y by a c o n g e n i t a l stenosis of the foramen transversarium o f the f i f t h v e r t e b r a .
Non-lateralised Defects in Stroke Patients with Visuospatial Neglect
T.P. Cassidy (South Tyneside), S. Lewis (Edinburgh), C.S. Gray (Sunderland)
Background: Visuospatial neglect Cv'SN) is a syndrome in which the patient fails to report or respond to novel or meaningful stimuli presented to the side opposite the brain lesion (Heilman. Clinical Neuropsychology 1993). Our aims were to examine the relationship of errors made in star, line and letter cancellation tests in stroke patients with VSN and their relationship to recovery. Method: Acute fight hemisphere stroke patients (<7days) were assessed. Those patients with evidence of VSN were followed up for a period of three months. Reault~: 27 (40.9%) of 66 stroke patients had evidence of VSN. Median age 73 years (Range 57 - 85), median Rankin 5 (range 2 - 6), median Barthel ? (range 2 - 20). An incremental improvement in VSN occurred from leit to right hemispace (Mean correct 10 to 86%). Recovery occurred across both hemispaces (Mean correct 64.6 to 100% at three months). There was a significant correlation between improvement in function (Barthei score) and recovery from VSN with time, 1 month Rs 0.642, p0.001; 2 months Rs0.623, p0.003; 3months Rs 0.636, p0.003. High scores on the line cancellation test was significantly associated with discharge home (1~ 0.4217, p--0.028). Conclusions: Errors in the ipsilesional hemispace suggest a generalised attention problem. Secondly, use of the line cancellation test on admission may help predict recovery.
Starreveld, Y., Lee, T.-Y., Lownie, S.P., Lee, D.H. Fox, A.H., Baxter, B. (London, Ontario)
Background Regional cerebral'ischemia is measured by analyzing 120 images from a two minute contrast enhanced CT head scan. The radial artery in the wrist is also imaged and deconvoluted to yield a brain impulse residue function which is used to calculate cerebral blood volume (CBV) and mean transit time (MTT). Cerebral blood flow (CBF) is calculated as CSV/HTT. Methods A 46 year old right handed woman presented with a giant left internal carotid (ICA) aneurysm causing progressive visual loss. ICA balloon test occlusion was tolerated clinically for 30 minutes. After surgical trapping of the aneurysm, delayed progressive left hemisphere ischemia developed over 48 hours. Angiography demonstrated no vasospasm and good collaterals. Dynamic C'I-imaging was done before and after external carotid-saphenous vein to internal carotid bypass grafting. Results Marked elevation of CBV and MTT with reduction in CBF was observed in clinically ischemic zones of the left hemisphere pre-operatively. Following bypass, hemiparesis and global aphasia resolved. Hemodynamic values improved to levels symmetric with the opposite hemisphere. .Conclusions This method measures cerebral perfusion using a widely available CT contrast scan, Applications in vasospasm and ischemic stroke diagnosis are discussed.
Stroke Home Health Care: The Transition to Independence
D. Thrutoldey, D. DeLong, M. Rymer (Kansas City, Missouri)
Background Stroke patients and caregivers feel abandoned, frightened, and confused during the difficult transition phase of discharge from the hospital or rehabilitation unit to home. Health care providers have difficulty during this transition tracking outcomes and assuring patients and caregivers successful re-integration into the community. Issues of secondary prevention, medical management, follow-up anticnagulation, home safety, depression, and cognition not addressed in the inpatient setting may threaten overall outcome and lead to unnecessary readmissions.
Methods A Stroke Home Health Program was developed to address these issues. The nurses were trained to use the NIH Stroke Scale, Barthei Index, Geriatric Depression Scale, CoaguChesk system for home monitoring of INR/PTI', and learned the principles of teaching home safety and secendary stroke prevention. Every patient discharged from the Stroke Center is referred for Strokr Home Health services.
Results Outcome data are collected regarding stroke severity, functional independence, depression and quality of life and compared to acute therapies received. Anticeagulation is monitored in a reliable manner and secondary prevention is stressed. The methods for these assessmentswill be demonstrated in the poster.
.Conclusions A Stroke Home Health Program can ease tbe transition from hospital to home, decrease length of stay and costs while improving outcome and patient satisfaction.
465 EXTRINSIC CONGENITAL
COMPRESSION OF VERTEBRAL FORAMEN TRANSVERSARIUH
D.K.Nguyen,MD;
P.Laplante,MD
ARTERF BY STEMOSIS
(Montreal,
Canada)
Background. The authors report a case of posterior circulation s t r o k e r e l a t e d to a v e r y r a r e maybe unique cause of vertebro-basilar ischemia. Methods. A detailed r e p o r t o f the c l i n i c a l presen r a t i o n is g i v e n . We t h e n r e v i e w the r e s u l t s o f the c o m p l e t e radiological investifation.We discuss the e t i o l o g y of this clinical picture and review the r e p o r t e d c a s e s o f e x t r i n s i c compressive lesion o f the c e r v i c a l p o r t i o n o f t h e v e r t e b r a l artery. Results. A 43-gears-old male presented for what was a p a r t i a l W a l l e n b e r g syndrome which appeared in a t w o - s t e p w a y d u r i n g a 24 h o u r s p e r i o d . T h e clinical picture was quite suggestive of a vertebraldissection which followed a neck injury relat e d to a f r i e n d l y struggle between the patient and his son.This resulted in a d e l a u e d t r a n s i e n t deficit f o l l o w e d the n e x t d a y by a p e r s i s t e n t lesion o f the m e d u l l a . A r t e r i o g r a p h i c and CTScan studies o f the n e c k a r e s h o w n . T h e y d e m o n s t r a t e an e x t r i n sic compression o f the v e r t e b r a l a r t e r y at the site os a congenital foramen transversarium stenosis. Conclusions. We t h i n k t h a t t h i s is the first report of a vertebro-basilar ischemic accident related to an e x t r i n s i c compression o f the vertebral a r t e r y by a c o n g e n i t a l stenosis of the foramen transversarium o f the f i f t h v e r t e b r a .
Non-lateralised Defects in Stroke Patients with Visuospatial Neglect
T.P. Cassidy (South Tyneside), S. Lewis (Edinburgh), C.S. Gray (Sunderland)
Background: Visuospatial neglect Cv'SN) is a syndrome in which the patient fails to report or respond to novel or meaningful stimuli presented to the side opposite the brain lesion (Heilman. Clinical Neuropsychology 1993). Our aims were to examine the relationship of errors made in star, line and letter cancellation tests in stroke patients with VSN and their relationship to recovery. Method: Acute fight hemisphere stroke patients (<7days) were assessed. Those patients with evidence of VSN were followed up for a period of three months. Reault~: 27 (40.9%) of 66 stroke patients had evidence of VSN. Median age 73 years (Range 57 - 85), median Rankin 5 (range 2 - 6), median Barthel ? (range 2 - 20). An incremental improvement in VSN occurred from leit to right hemispace (Mean correct 10 to 86%). Recovery occurred across both hemispaces (Mean correct 64.6 to 100% at three months). There was a significant correlation between improvement in function (Barthei score) and recovery from VSN with time, 1 month Rs 0.642, p0.001; 2 months Rs0.623, p0.003; 3months Rs 0.636, p0.003. High scores on the line cancellation test was significantly associated with discharge home (1~ 0.4217, p--0.028). Conclusions: Errors in the ipsilesional hemispace suggest a generalised attention problem. Secondly, use of the line cancellation test on admission may help predict recovery.