PO15.5 Effect of Antiplatelet Agent on the Progression of Leukoaraiosis

2009 Asian and Oceanian Congress of Clinical Neurophysiology PO15.5 Effect of Antiplatelet Agent on the Progression of Leukoaraiosis So-Hyun Kim *, Sung Rae 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: Leukoaraiosis is bilateral patchy or diffuse hyperintensity lesion in the cerebral white matter on T2-weighted or FLAIR imaging. It is thought to be caused by ischemia, but clinical relevance is uncertain. Asymptomatic elderly commonly show the incidental leukoaraiosis on MRI. However, there is no consensus on the treatment of these patients, including the usage of antiplatelet. We performed this study to assess the effects of antiplatelet treatment on the progression of asymptomatic leukoaraiosis. Methods: We recruited subjects who were more than 50 years-old and had two MRI scans separated by at least three years interval. The patients with brain lesion such as stroke, brain tumor, systemic malignancy, and infection were excluded. Subjects were categorized into antiplatelet and non-antiplatelet group, which were decided by the attending physician’s preference. White matter change was assessed in FLAIR image based on the Schelten’s scale without clinical information of the subjects, and the progression of scale was compared between the two groups. Wilcoxon signed rank sum test was used for the statistical comparison. Results: From 2002 to 2008 in Inha University Hospital, 34 patients were followed up and analyzed. Fifteen subjects were included in antiplatelet group and nineteen in non-antiplatelet group. Median Schelten scale of initial MRI were 6.9±2.5 in the antiplatelet group and 4.8±2.9 in the nonantiplatelet group (p = 0.04). The scale of follow-up MRI were 7.1±2.6 and 4.9±2.9 (p = 0.029), respectively. Worsening of scale more than 1 grade was evident in eight subjects (23.5%). There was no significant difference in the change of white matter grade between the antiplatelet group and the non-antiplatelet group (0.20±0.41, p = 0.082 vs. 0.05±0.02, p = 0.33). Conclusions: Subjects with higher white matter grade on MRI were more likely to take antiplatelet, but there was no effect on the progression of leukoaraiosis. PO15.6 Characteristics and Etiology of Ischemic Stroke in Young Adults Supharat Winitprichagul *, Disaya Ratanakorn Division of Neurology, Dept. of Medicine, Ramathibodi Hospital Mahidol University, Thailand E-mail address: [email protected] Background: Ischemic stroke is one of the major causes of disability in the young and may be caused by various etiologies. There is a limited study on stroke in the young in Thailand. The aim of this study is to determine the prevalence, characteristics and etiologies of ischemic stroke in young adults. Methods: The medical records of 118 consecutive patients aged 15to 45-years with a first-ever stroke admitted in Ramathibodi Hospital during January 2004 to December 2007 were retrospectively reviewed. Clinical characteristics, stroke risk factors, stroke subtype and medical investigations were analyzed in 82 patients with ischemic stroke and transient ischemic attack. Results: The prevalence of stroke in the young was 11.5% with cerebral infarction in 63.6%, transient ischemic attack in 5.9% and cerebral hemorrhage in 30.5%. 82 ischemic stroke patients included 46 male and 36 female with the mean age of 36.6±0.7 years. Regarding stroke subtypes, small-vessel occlusion (SVO) was diagnosed in 17.2% of cases, large-artery atherosclerosis (LAA) in 13.4%, cardioembolism (CE) in 25.6%, other determined etiology (ODE) in 20.7%, and undetermined etiology in 14.6%. Common risk factors were hyperlipidemia (85.37%), hypertension (70.37%), diabetes mellitus (48%) and family history of stroke (39%). Common causes of cardioembolism were atrial fibrillation (43.3%), rheumatic heart disease (23.3%), and infective endocarditis (10.0%). In the stroke of ODE, the two most common etiologies were antiphospholipid syndrome (23.5%), and systemic lupus erythematosus (17.6%). Conclusions: The prevalence of stroke in the young in our study is comparable to other study with the majority of ischemic stroke similar to that in adult. Atherosclerotic risk factors and family history of stroke are found in high proportion. Cardioembolic stroke is the major ischemic stroke subtype.

S91 PO15.7 Frontal Cortical Infarction Presenting as Anterior Interosseous Neuropathy Shin-Hye Baek *, Mi-Young Ahn, Sang-su Lee, Sung-Hyun Lee, Dong-Ick Shin Dept. of Neurology, Chungbuk National Universty College of Medicine, Korea E-mail address: [email protected] Background: Lesions of the anterior interosseous nerve result in weakness of the flexor pollicis longus, flexor digitorum profundus (to digit 2, 3, or both), and the pronator quadrantus. Patients characteristically are unable to make “OK” sign (form a circle with thumb and index finger). The thumb and index finger are unable to flex at the interphalangeal joint and the distal interphalangeal joint, repectively. But, same feature can be seen when infarction involves at hand knob. Case report: 62-years old man with hypertension, presented to our emergency room right after sudden onset weakness of right 1st, 2nd finger flexion. He reported that he was unable to write or to dial a phone number because of clumsiness of his fingers. There was no sensory disturbance. Electrophysiologic study showed no abnormality and a DWI showed HSI of left frontal cortex. Conclusions: Stroke also may lead to finger weakness only. This possibility should be considered when clinicians encounter patients with sudden finger weakness only. PO15.8 Clinical Characteristics and Prognostic Factors for Recurrence of Benign Paroxysmal Positional Vertigo Jae-Jun Song1 *, Sang-Wuk Jeong2 1 Dept. of Otorhinolaryngology Head and Neck Surgery, Dongguk University International Hospital, Korea, 2 Neurology, Dongguk University International Hospital, Korea E-mail address: [email protected] Background: Benign paroxysmal positional vertigo (BPPV) is characterized by episodic vertigo and nystagmus which was provoked by change of the head position. However, little is known about the prognostic factors for recurrence. In this study, we tried to identify the clinical characteristics and the prognostic factors of BPPV. Methods: We analyzed clinical features of 89 patients (mean age = 57.1±11.5) with BPPV that was diagnosed by nystagmus induced by positioning maneuver. The induced nystagmus was recorded using videooculography. According to the semicircular canal involved, BPPV patients were classified into horizontal canal type (HC-BPPV) and posterior canal type (PC-BPPV). Univariate analysis for age, sex, and history of vertigo, and Kaplan-Meier analysis for recurrence were performed. Results: HC-BPPV (n = 52, 58.4%) was more common than the PCBPPV (n = 37, 41.6%). The history of vertigo was more frequent in the canalithiasis type HC-BPPV (n = 13, 50%) than the cupulolithiasis type HCBPPV (n = 5, 19.2%) (p = 0.04). Ten patients (19.2%) with HC-BPPV had recurrence and 2 patients with PC-BPPV (5.4%) had recurrence (p = 0.11). Overall recurrence rate of BPPV by Kaplan-Meier analysis was 17.4% at 1 year and recurrence of HC-BPPV (25.2%) was higher than PC-BPPV (6.1%) (p = 0.061). Conclusions: HC-BPPV is more common than previous report from the tertiary referral center, and the HC-BPPV has a tendency to recur more frequently than the PC-BPPV. We need community-based multicenter study for the evaluation of recurrence of BPPV. PO15.9 Perverted Head-Shaking and Positional Downbeat Nystagmus in Patients with Multiple System Atrophy Jee-Young Lee1 *, Woong-Woo Lee1 , Ji Soo Kim2 , Hee Jin Kim3 , Jin-Kyung Kim3 , Beom S. Jeon4 1 Dept. of Neurology, Seoul National University Hospital, Korea, 2 Dept. of Neurology, Seoul National University Bundang Hospital, Korea, 3 Neuroscience Research Institute, Seoul National University College of Medicine, Korea, 4 Clinical Research Institute and Movement Disorder Center, Seoul National University Hospital, Korea E-mail address: [email protected] Background: The diagnosis of multiple system atrophy (MSA) is mainly based on the clinical criteria, which are often of little assistance in the early stages of the disease. Positional downbeat (pDBN) and