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PO15.1 Optimization of Diagnosis and Treatment of Haemodynamic and Water-Electrolytic Disturbances in Arterial Hypertension in Pregnant Women with Preeclampsia
S90
Posters: PO15. Neuroopthalmology and Neurotology, Cerebrovascular Disease, Neurosonology
PO15. Neuroopthalmology and Neurotology, Cerebrovascular Disease, Neurosonology PO15.1 Optimization of Diagnosis and Treatment of Haemodynamic and Water-Electrolytic Disturbances in Arterial Hypertension in Pregnant Women with Preeclampsia Ludmila Kyryllova *, Alexandr Shevchenko Dept.of Children’s Psychoneurology, Institute of Paediatrics, Obstetrics and Gynecology Academy of Medical Sciences of Ukraine, Ukraine E-mail address: [email protected] Background: Increasing efficiency of intensive care of preeclampsia. Methods: We examined 100 pregnant women with preeclampsia. In the main group, we assessed preeclampsia severity, taking into account changes in hemodynamics system and in vegetative tonus following the method of aminazine test, developed by the author. We also determined plasma osmolality, considering growth in fluid volume during application of infusion solutions. The control group received conventional complex preeclampsia therapy. Aminazine test consisted of intravenous titrated administration of up to 12.5 mg of aminazine with control of arterial blood pressure, hands skin temperature, and blood-filling of nail beds. Results: We diagnosed compensated preeclampsia stage in case of positive aminazine test (decrease in systolic blood pressure by 20 25 mm Hg, in diastolic blood pressure by 10 15 mm Hg, temperature increase by 1ºC comparing with the primary improvement in blood-filling of nail beds. In the absence of the described reaction, we diagnosed decompensated stage. After aminazine test we introduced 5 mg of aminazine every 4 hours for both stages, which produced decrease in the amount of prescribed medications. The effect of developed method induced the shortening of treatment period, decrease in the number of surgical operations during delivery. It also pushed up the number of independent deliveries. Conclusions: For differentiated diagnostics of preeclampsia’s stage severity, and for creation of the background for correction of pathophysiological disturbances, it is necessary to include into complex intensive care aminazine test. PO15.2 Comparison of Lacunar Infarct with Branch Atheromatous Occlusion Sung Rae Kim *, So-Hyun Kim, Il-Gon Kim, Changseok Song, Yoonjae Choi, Ki-Hwan Ji, Eun-Cheol Song, Joung-Ho Rha Dept. of Neurology, Inha University Hospital, Korea E-mail address: [email protected] Background: It is difficult to differentiate between lacunar infarct and branch atheromatous occlusion (BAO) is difficult to differentiate. The former is caused by small vessel occlusion, whereas the latter is the consequence of larger artery atherosclerosis, and would have more atherosclerotic feature, regardless of the size of the infarct. We studied to compare the clinical, angiographic, and risk factor profile between lacunar infarct and BAO. Methods: We consecutively recruited patients who had acute (<7 days) lacunar syndrome with infarct in the penetrating artery territory of middle cerebral or basilar artery. Brain MRI including DWI and MR angiography was performed in all the patients. Patients with cardioembolic source were excluded. Using the coronal and axial T2 and DWI, we divided these patients into 2 groups: branch occlusion (comma/wedge shape infarct) and lacune (round shape infarct). The clinical, MR angiographic and cardiovascular risk factors were compared in these two groups. Results: From 2001 to 2008, 270 patients were registered from Inha university hospital, with 225 patients (83.3%) of BAO and 44 (16.3%) of lacunar infarct. Among the 225 BAO, 50 (22.3%) had a middle cerebral or basilar artery atherosclerotic change compared to 12 of 44 (27.3%) in lacunar infarct (p = 0.56). Mean infarct size of BAO (17.1±6.7 mm2) was larger than that of lacune (11.9±4.6 mm2) (p < 0.01). Neurologic deficit by NIHSS at admission and 7 days after were more severe in the BAO than lacune (p = 0.03, 0.01, respectively). Systolic blood pressure at admission was higher in BAO (161.1±29.6 mmHg) than those with lacune (152.9±24.3 mmHg) (p = 0.05). Conclusions: Compared to lacunar infarct, BAO had larger infarct size, more severe neurologic deficit, and higher blood pressure. But our
data failed to show the difference in the underlying parent artery atherosclerotic change. More precise assessment of penetrating artery like 7T MR is required for further study. PO15.3 Intima-Media Thickness According to TOAST Classificaton and Risk Factors in Ischemic Stroke Sung Rae Kim *, So-Hyun Kim, Il-Gon Kim, Changseok Song, Yoonjae Choi, Ki-Hwan Ji, Eun-Cheol Song, Joung-Ho Rha Dept. of Neurology, Inha University Hospital, Korea E-mail address: [email protected] Background: Carotid intima-media thickness (cIMT) is considered as a marker of the generalized atherosclerosis, but studies in stroke population are scanty. We studied to identify cIMT difference in different stroke subtypes and to find association between cIMT, vascular risk factors, presence of intracranial stenosis, and previous antiplatelet therapy. Methods: We prospectively recruited 523 consecutive admitted patients with acute ischemic stroke from February 2007 to December 2008. All patients underwent carotid duplex ultrasonography and average and maximum cIMT (cIMT-ave, cIMT-max) were measured by automated software. Stroke subtype according to TOAST classification, vascular risk factors, and prior treatment (antiplatelet or anticoagulation) were investigated and analyzed. Results: By TOAST classification, 290 patients had large artery disease (LAD), 76 small vessel disease (SVD), 60 cardioembolism (CE), and 97 undetermined (U). cIMT-ave of each subtypes were not significantly different (LAD 0.66±0.16; SVD 0.64±0.15; CE 0.61±0.14; U 0.63±0.17, p = 0.16). cIMT-ave of LAD were higher than those with CE (p = 0.02). Patients with hypertension had higher cIMT-ave value than those without (0.65±0.17 vs. 0.63±0.15, p = 0.08), and patients with diabetes had higher cIMT-ave value than those without (0.66±0.16 vs. 0.63±0.16, p = 0.06) but this differences failed to reach statistical significance. Smoking, dyslipidemia, and previous therapy showed no differences in cIMT. Conclusions: Patients with LAD had higher cIMT value than those with CE. Patients with hypertension and diabetes showed tendency to have higher cIMT value than those without. Smoking, dyslipidemia, and previous antiplatelet treatment had little effect on cIMT in stroke population. PO15.4 Hypertensive Encephalopathy with Infarcts Status-Post Hysterectomy William S. Baek * Dept. of Neurology, Southern California Permanente Medical Group, USA E-mail address: [email protected] Background: This is a case report of hypertension status-post hysterectomy, leading to reversible posterior leukoencephalopathy. Case report: A 46-year-old female presented with headaches, nausea and vomiting after receiving total abdominal hysterectomy two and a half months ago. Four days prior to admission she developed numbness, tingling and weakness in arms, left perioral numbness and difficulty reading. She denied having headaches or hypertension prior to her hysterectomy. On admission her blood pressure was high at 198/110. She had simultagnosia with oculomotor apraxia, and bilateral weakness. Results: Initial labs, head CT, CSF analysis, initial MRI with gadolinium, and CT angiogram were normal. Her EEG showed frontal intermittent rhythmic delta activity. She was treated with aspirin, antihypertensives, and dexamethasone. A repeat brain MRI with gadolinium demonstrated patchy enhancing infarcts in bilateral parieto-occipital cortical and subcortical regions with mild edema (poster figure). Five weeks later her headaches resolved and blood pressure, vision and sensation normalized. Conclusions: Hypertensive encephalopathy, otherwise known as reversible posterior leukoencephalopathy, is a clinical syndrome based on symptoms and neuroimaging. Her initial workup did not reveal any vasculopathies or secondary causes of hypertension. Hysterectomy with ovarian preservation increases the risk of hypertension. Either hysterectomy or the development of myomas may increase the risk of hypertension. In one article the prevalence of salt sensitivity doubled as early as 4 months in normotensive women post-hysterectomy with oophorectomy. Such loss of ovarian hormones may unmask salt sensitivity which, with aging, would be a risk factor for hypertension.
Posters: PO15. Neuroopthalmology and Neurotology, Cerebrovascular Disease, Neurosonology
PO15. Neuroopthalmology and Neurotology, Cerebrovascular Disease, Neurosonology PO15.1 Optimization of Diagnosis and Treatment of Haemodynamic and Water-Electrolytic Disturbances in Arterial Hypertension in Pregnant Women with Preeclampsia Ludmila Kyryllova *, Alexandr Shevchenko Dept.of Children’s Psychoneurology, Institute of Paediatrics, Obstetrics and Gynecology Academy of Medical Sciences of Ukraine, Ukraine E-mail address: [email protected] Background: Increasing efficiency of intensive care of preeclampsia. Methods: We examined 100 pregnant women with preeclampsia. In the main group, we assessed preeclampsia severity, taking into account changes in hemodynamics system and in vegetative tonus following the method of aminazine test, developed by the author. We also determined plasma osmolality, considering growth in fluid volume during application of infusion solutions. The control group received conventional complex preeclampsia therapy. Aminazine test consisted of intravenous titrated administration of up to 12.5 mg of aminazine with control of arterial blood pressure, hands skin temperature, and blood-filling of nail beds. Results: We diagnosed compensated preeclampsia stage in case of positive aminazine test (decrease in systolic blood pressure by 20 25 mm Hg, in diastolic blood pressure by 10 15 mm Hg, temperature increase by 1ºC comparing with the primary improvement in blood-filling of nail beds. In the absence of the described reaction, we diagnosed decompensated stage. After aminazine test we introduced 5 mg of aminazine every 4 hours for both stages, which produced decrease in the amount of prescribed medications. The effect of developed method induced the shortening of treatment period, decrease in the number of surgical operations during delivery. It also pushed up the number of independent deliveries. Conclusions: For differentiated diagnostics of preeclampsia’s stage severity, and for creation of the background for correction of pathophysiological disturbances, it is necessary to include into complex intensive care aminazine test. PO15.2 Comparison of Lacunar Infarct with Branch Atheromatous Occlusion Sung Rae Kim *, So-Hyun Kim, Il-Gon Kim, Changseok Song, Yoonjae Choi, Ki-Hwan Ji, Eun-Cheol Song, Joung-Ho Rha Dept. of Neurology, Inha University Hospital, Korea E-mail address: [email protected] Background: It is difficult to differentiate between lacunar infarct and branch atheromatous occlusion (BAO) is difficult to differentiate. The former is caused by small vessel occlusion, whereas the latter is the consequence of larger artery atherosclerosis, and would have more atherosclerotic feature, regardless of the size of the infarct. We studied to compare the clinical, angiographic, and risk factor profile between lacunar infarct and BAO. Methods: We consecutively recruited patients who had acute (<7 days) lacunar syndrome with infarct in the penetrating artery territory of middle cerebral or basilar artery. Brain MRI including DWI and MR angiography was performed in all the patients. Patients with cardioembolic source were excluded. Using the coronal and axial T2 and DWI, we divided these patients into 2 groups: branch occlusion (comma/wedge shape infarct) and lacune (round shape infarct). The clinical, MR angiographic and cardiovascular risk factors were compared in these two groups. Results: From 2001 to 2008, 270 patients were registered from Inha university hospital, with 225 patients (83.3%) of BAO and 44 (16.3%) of lacunar infarct. Among the 225 BAO, 50 (22.3%) had a middle cerebral or basilar artery atherosclerotic change compared to 12 of 44 (27.3%) in lacunar infarct (p = 0.56). Mean infarct size of BAO (17.1±6.7 mm2) was larger than that of lacune (11.9±4.6 mm2) (p < 0.01). Neurologic deficit by NIHSS at admission and 7 days after were more severe in the BAO than lacune (p = 0.03, 0.01, respectively). Systolic blood pressure at admission was higher in BAO (161.1±29.6 mmHg) than those with lacune (152.9±24.3 mmHg) (p = 0.05). Conclusions: Compared to lacunar infarct, BAO had larger infarct size, more severe neurologic deficit, and higher blood pressure. But our
data failed to show the difference in the underlying parent artery atherosclerotic change. More precise assessment of penetrating artery like 7T MR is required for further study. PO15.3 Intima-Media Thickness According to TOAST Classificaton and Risk Factors in Ischemic Stroke Sung Rae Kim *, So-Hyun Kim, Il-Gon Kim, Changseok Song, Yoonjae Choi, Ki-Hwan Ji, Eun-Cheol Song, Joung-Ho Rha Dept. of Neurology, Inha University Hospital, Korea E-mail address: [email protected] Background: Carotid intima-media thickness (cIMT) is considered as a marker of the generalized atherosclerosis, but studies in stroke population are scanty. We studied to identify cIMT difference in different stroke subtypes and to find association between cIMT, vascular risk factors, presence of intracranial stenosis, and previous antiplatelet therapy. Methods: We prospectively recruited 523 consecutive admitted patients with acute ischemic stroke from February 2007 to December 2008. All patients underwent carotid duplex ultrasonography and average and maximum cIMT (cIMT-ave, cIMT-max) were measured by automated software. Stroke subtype according to TOAST classification, vascular risk factors, and prior treatment (antiplatelet or anticoagulation) were investigated and analyzed. Results: By TOAST classification, 290 patients had large artery disease (LAD), 76 small vessel disease (SVD), 60 cardioembolism (CE), and 97 undetermined (U). cIMT-ave of each subtypes were not significantly different (LAD 0.66±0.16; SVD 0.64±0.15; CE 0.61±0.14; U 0.63±0.17, p = 0.16). cIMT-ave of LAD were higher than those with CE (p = 0.02). Patients with hypertension had higher cIMT-ave value than those without (0.65±0.17 vs. 0.63±0.15, p = 0.08), and patients with diabetes had higher cIMT-ave value than those without (0.66±0.16 vs. 0.63±0.16, p = 0.06) but this differences failed to reach statistical significance. Smoking, dyslipidemia, and previous therapy showed no differences in cIMT. Conclusions: Patients with LAD had higher cIMT value than those with CE. Patients with hypertension and diabetes showed tendency to have higher cIMT value than those without. Smoking, dyslipidemia, and previous antiplatelet treatment had little effect on cIMT in stroke population. PO15.4 Hypertensive Encephalopathy with Infarcts Status-Post Hysterectomy William S. Baek * Dept. of Neurology, Southern California Permanente Medical Group, USA E-mail address: [email protected] Background: This is a case report of hypertension status-post hysterectomy, leading to reversible posterior leukoencephalopathy. Case report: A 46-year-old female presented with headaches, nausea and vomiting after receiving total abdominal hysterectomy two and a half months ago. Four days prior to admission she developed numbness, tingling and weakness in arms, left perioral numbness and difficulty reading. She denied having headaches or hypertension prior to her hysterectomy. On admission her blood pressure was high at 198/110. She had simultagnosia with oculomotor apraxia, and bilateral weakness. Results: Initial labs, head CT, CSF analysis, initial MRI with gadolinium, and CT angiogram were normal. Her EEG showed frontal intermittent rhythmic delta activity. She was treated with aspirin, antihypertensives, and dexamethasone. A repeat brain MRI with gadolinium demonstrated patchy enhancing infarcts in bilateral parieto-occipital cortical and subcortical regions with mild edema (poster figure). Five weeks later her headaches resolved and blood pressure, vision and sensation normalized. Conclusions: Hypertensive encephalopathy, otherwise known as reversible posterior leukoencephalopathy, is a clinical syndrome based on symptoms and neuroimaging. Her initial workup did not reveal any vasculopathies or secondary causes of hypertension. Hysterectomy with ovarian preservation increases the risk of hypertension. Either hysterectomy or the development of myomas may increase the risk of hypertension. In one article the prevalence of salt sensitivity doubled as early as 4 months in normotensive women post-hysterectomy with oophorectomy. Such loss of ovarian hormones may unmask salt sensitivity which, with aging, would be a risk factor for hypertension.