The anticardiolipin antibodies (ACA) in acute ischemic strokes—A prospective case control study

ABSTRACTS

452 THE ANTICARDIOLIPIN STROKES

-

A

K.B. DAL~Lt P.M.

ANTIBODIES (ACA) IN ACUTE I S C H ~ I C

PROSPECTIVE

CASE

CONTROL STUDY.

DALAL and O~IERS. SIR N. N- MEDICAL

IIt~EAIICII CF-.NTItE, R.R. ROY HAIIG, I]OHDAY 400 OO~, INDIA. Many studies anttcardlollpln neurological

have shown

nnnoclnLton between

antibodies ( ACA )

disorders

(ICVD). Hlgh ACA t l t r e s

wlth

acute

and

the

the various

lschemlc strokes

ranging from O to 21 pep cent

have been reported In subjects with 1CVD, pELPtlcularly In "Strokes In the Young". In thls study,

we have a n a l y s e d

the association

os

ACA i n 51 consecutive and unselected ICVD p a t l e n t s

the conventional r i s k f a c t o r s ;

and compared the

to

same

wlth 51 abe and sex mntched "non-strokeehoopltal cases and wlth 50 "healthy community controls".

In such hospital-based study,we dld not s

stror~

a s s o c i a t i o n o f the presence os hlgh ACA t l t r ~ s In ICVD cases

when co~pared to

non-stroke h o s p l t a l cases

or"

"healthy community c o n t r o l s n. These trends, however,do not censure r l s k o f stroke as they perta/n to ACA, and well deslgned epldemlologlcal studles In c ~ u n l t y

be needed to a s c e r t a i n the v a l l d l t y

wlll

o f our f i n d i n g s .

CLASSIFICATION OF THE VASCULAR DEMENTIAS VALIDATED. J S Meyer, H Akivama, Y Terns'area, S Konno, KF MorteL GM Manzishvili. Baylor College of Medicinc and Veterans Affairs Medical Center, Houston, Texas. USA. Objective To identify specific regional vasomotor reactivitins, we investigated ccrchral vasodilator responses among vascular dementia (VAD) patients by 26% xenon enhanced cerebral blood flow measurements (CT-CBF) before and after oral administration of I gram acetazolamide (Diamox| Local CBF changes (ALCBF) at~cr acctazolamidc ~crc calculated within cortical and subcortical gray or white matter. Methods 35 patients with probablc VAD (mean age 70.7 _+ 7.9. range 47-84 .years) wcm classified into 8 sub~'pes according to thc following classification. T)13c h multi-in~.ret dcmcntia duc to muhiplc large cerebral cmboli of cardiogenic or aorto-ccphalic athcrosclemtic plaque origin (N=7. mean age 6~.3 4- 5.7). T)10c 2: strategically placed infarcts involving frontal white matter, basal ganglia, or angular ~'ms (N=5, 67.4 • 9.4), Typc 3: multiple subcortical lacunar infarcts (N=I I. 72.0 • 6.7), Type 4: Binswanger's ~l~e of subcortical artcrinsdcrolic leukoenccphalopathy (N=I. 74). Type 5: mixtures of I. 2 and 3 (N=4. 72.8 • 6.6). Type 6: hemorrtmgic Icsinns (N=I. 72). Type 7: ccrcbral autosomally dominant arteriopathy with subcortical infarcts and Icuko:ncephalopathy (CADASIL), angiitidcs, familial amyloid angiopathics and coagulopathies (N=2, 58.5 • 16.3). T,,pc 8: mixed VAD + ,Mzhcimer's dementia (N=4. 78.0 • 4.5). Results were compared with 42 age-matched normal volunteers (mcan age 68.3 -+ 9.4 .years)and 14 stroke patients without cognitive impairments. Results Bnsclinc LCBFs wcrc reduced in VAD patients compared to agc-matchcd normals and stroke paUeats without dementia. After administration of acctazolamidc ACBFs wcrc greater in Type 3 and 4 compared to Type I. 2 and 5 (p<0.05). LCBF incrcascs in cortical gray matter wcre greater in ~pc 3 compared with type I. in white rnatlcr were greater in type 3 compared with ~'pe 2 or 5 (p<0,05). T}~e 4 had largu cortical increases (+45.4%). In P/pc 6. extensive cortical hemorrhagic lesions limited CBF increases to subeortical gray matter (+81.4%). Conclusions Vasodilator responses among VAD subtypes reveal specific regional vasomotor patterns which arc dctcmfined by infarct volumes and diffcrcnt b='pcsof discormcction syndromes which arc important causes for thc cognitive impairments. Results confiml thc importance of disconnection syndromes particularly in VAD caused by subcortical lacunar infarcts (T~0r 3) and xshitc matter lesions of Binswangcr's (T}1~c4) which were not seen in stroke patients without coguitivc impairrncnLs. Rcsults also validatc thc classification of VAD patients.

COGNITIVE, EMOTIONAL, SOCIAL AND PHYSICAL CORRELATES OF DEPENDENT LIVING THREE MONTHS AFTER ISCHEMIC STROKE Tarja Poh[asvaara. Time Erkinjuntti, Risto Vataja, Ma.rkku Kaste. Department of Neurology, Helsinld, Finland. Objectives. The objective was to examine the correlates of dependent living three months after ischemic stroke. Measures of post-stroke dependence have mainly included items related to physical disability and impairments in activities of daffy living (ADL). Cognitive impairment has also been suggested to be an independent correlate of pOStoSa'oke dependence. Methods. A consecutive cohort included 486 ischemic stroke patients, aged from 55 to 85 years, they were examined three months after the index stroke. We evaluated in detail medical neurological and radiological strokes. The parameters included structured measures of cognition, emotion and behaviour, ADL, physical disability, and ~ s m e n t of dependent living. Results. Independent correlates of dependent living three months post-stroke were presence of major bemispheral stroke syndrome (OR 11.8, 95% CL 7.2 - 19.9 ), and combination of physical (Rankin Scale. OR 3.9, 95 % CL 2.6-6.1), cognitive (DSM-III-R dementia. OR 3.9, CL 1.5-10.7; any cognitive decline, OR 4.5, CL 2.0-11.2).and social impairments (Functional Activities Questionnaire (FAQ), OR 1.2, 95 % CL 1.1-1.2). Rankin Scale explained 51.5 %, FAQ 5.9 % and presence of DSM-III-R dementia 2.3% of the total varience between dependent and idependent patients post-stroke. DLscussion and conclusions. Independent of the effects of physical disability, presence of cognitive impairment has important functional consequences in stroke patients. Our findings emphasizes evaluation of cognitive functions in both observational and interventional clinical trials, as well as in planning treatment, rehabilitation and guidance of patients with ischemic stroke.

TWO YEARS FOLLOW-UP OF NON DEMENTED ELDERLY HYPERTENSIVE PATIENTS WITH LEUKOARAIOSIS A B6s. PA Delnla N Bertholom. R Calvez. G Rancurcl Neurologie, CHU Ranguoil, Toulouse; RPR Laboratory Montrougo, France Whether or not leukoaraiosis is associated with cognitive decline remains questionable. We selected 31 individuals aged 60-82 with hypertension whose CT scan showed a significant leukoaraiosis. We excluded patients with history of stroke (except for TIA) and clinical evidence ofdemential according to DSMIII-R criteria; other exclusion criteria were major depression, as neurological examination. Futhermoere, at baseline MMS should be over 24 and scores on both the Revised Weschler Adult Intelligence Scale (IQ) and tile Weschler Memory Scale (MQ) had to be of 90 or more; CT scan was performed at baseline and two years after; during tbis fullow-up period, subjects underwent every six months a neuropsychological evaluation of memory, attention and concentration, verbal, psycho-motor functions After two years, scores on the tests exploring memory deteriorated as well as did psychomotor performances. However, no global cognitive deterioration can be evidenced from MMS, IQ, or MQ scores will no significance increase of leukoaraiosis can be deducted from CT scan. In conclusion, leukoaraiosis in elderly hyperlensive patients without over neurological or cognitive abnormality is associated wifll mild but rater specific neuropsycliological disturbances which seem to increase with time.