Poster Abstracts Thursday, November 10, 2005 $385

involved were the M C A in 8 pts, the vertebrobasilar system in 2 and multiple in 10. After first work-up, stroke was presumably attributed to atherosderosis in 9 pts (45%), to a coagulation disorder in 3 pts, to a cardiac cause in 4 pt. In 6 pts no cause was found . First treatnrent consisted with antiplatelet agents for 12 pts, and warfarin in 6. Within tire first mon t h 14 pts had a second stroke, 2 had epileptic seizures due to brain metastases, 1 had myocardial infarction, and 1 had bilateral deep vein thrombosis while being on optimal warfarin therapy. Second work-up allowed to find different malignancies: 2 lung cancers, 4 breast and 2 ovarian cancers. Other cancers were: B-cell lymphoma, sarcoma, acute myeloid leukemia, melanoma, prostate cancer, uterus epithelioma and intravascular lymphoma. 1 pt had brain metastase from adenocarcinoma of unknown origin. Definitive pathogenic mechanisms were: atherosclerosis in 6 pts, DIVC in 3, NBTE in 3, thrombophil ia in 2, tunror emboli in 2, paraneoplastic vasculitis in 1, mycotic aneurysnrs in 1, intravascular metastases inl , and intravascular lymphoma in 1 pt. The mortali ty rate was 75% (15/20) with a medial survival of 58.7 days (3-180) after index stroke. Mean follow-up of alive patients was 29.4 mon ths (range 3-60), none had a vascular recurrence. Conclusions: Systemic cancer work-up should be added in pts with stroke and who present an early vascular recurrence. Occurrence of a coagulation disorder as well as recurrent thrombotic events on optimal attticoagulation mus t be considered as strong warning signs for cancer.

1116 Outeoitte of Cryptogenic Strokes

Bleeie, S ~, Remiche, G ~, Jeangette, S t. 1Stroke Unit, Department of Neurology, Erasme Hospital, Brussels, Belgium

Objective: To determine tire outcome of patients (pts) with cryptogenic strokes (CS) compared to general pts (GP) with stroke. CS represent in different settles f r om4 to 29% ofpts . The discrepancy varies anrong tire series according to the CS definition, some limiting CS to the absence of both etiology and risk factors for stroke (RF), others accepting to have RF for stroke. In our s tudy we included pts who had no RF and no etiology (pure (2,5) that we compared in term of evolution to tire population of CS with R F and to the GP. F rom 1991 to 2003,4326 pts (12230 males) were adnfftted to the Stroke Unit. Mean age was 66.8 years. All had a stroke work-up. Trans-oesophageal echography, catheter angiography, extensive coagulation study, skin biopsy and lumbar puncture were performed in selected cases. All CS pts had an extensive stroke work-up and were followed twice a year for a max inmm of 5 years (average 3 years). 393/4326 (9.1%) pts were diagnosed has having CS. 69 pts (1.6"/o), had pure CS wlffle 324 pts (7.4%), had RF. Only 26 pts with 2 R F full-filled the criteria for CS. No pts with more than 2 R F were found to have CS. Mean age of the CS pts was 51 ± 4.1 years (p < 0.001 compared to GP), no differ- ence being observed between pts with pure CS and pts with CS. All patients with CS and R F were treated with aspirin, wlffle only 32 pts with pure CS were treated. Within tire follow-up period only 12 pts (3.0%) with CS had a vascular recurrence only one being found in the group of pure CS. 4 had a stroke and 8 had a cardiac, recurrence (p < 0.05 pts with pure CS versus pts with CS). No death was observed in both groups with CS. A statistical difference (p < 0.001) was observed for any vascular recurrences between pts with CS and GP, since a new vascular event was found in 1216/4326 pts of GP (28.1%) 554/having a new stroke (12.8%). This study demonstrated that pts with CS and GP differ widely in the follow-up, the former populat ion being at a particular low risk to have any vascular recurrence, pure CS being a particular protected entity.

1117 Vertebrobasilar insuffideney only revealed with 99M-HMPAO. SPECT

Blecic, S, Jeangette, S, Dumarey, R, RemJche, G. Stroke Unit, Department of Neurology, Erasme Hospital, Brussels, Belgium

Two patients were seen to the neurovascular outpatient clinic for a transient sudden blurred of vision, for the latter accompanied by a transient severe hyperventilation. Both patients were in theirs seventies. Both suffered from important cervical arthrosis. The first was used to flying ultra light aviation and had several short episodes of blurred of vision while flying. The second was used to practicing sporting activities and had neurological symptoms when doing a smash while playing squash.

Both had a normal neurological examination. Stroke work-up, which included trails esophageal echocardiography and catheter angiography, was normal for the first patient. In the second M R A disclosed V2 vertebral dissection without any brainstem or cerebellar infarction. Cervical spine X-Ray confirmed severe arthrosisin both patients. Both underwent r-CBF-SPECT. They were set in a quiet room and were instructed to keep their eyes open. A tracer bolus of 740 Mbq was injected intravenously. The tracer used for r-CBF scans were Tc-99M-HMPAO. SPECT acquisitions were all performed 45 minutes post injections. In both patients SPECT were performed first in a rest condition. Thereafter a second examination was performed when the patients were set in cervical hyperextension. SPECT images were reconstructed by filtered back projection with Butterworth filter on a vision station and analyzed by two nuclear medicine physicians.

In both patients the rest exanffnation was normal while cervical hyperextension induced hypoperfusion defects in both occipital, temporal and parietal lobes. Theses two cases confirmed that a vertebro-basilar hypo-perfnsion could occur when vertebral arteries are stressed by cervical arthrosis and could be tire cause of transient neurological symptoms. It illustrates that SPECT could be a useful tool when other usual investigations renrained un-conclusive to explain neurological symptoms.

1118 Cortical Venous Thrombosis (CVT) associated with migraine - an insight

Prasad, B t , Radhesh, S 1 , Anand , H 2, Ranganath , K 1 , Taly, A 1 . 1The Bangalore Hospital, Bangalore.." :Elbit Diagntostics, Bangalore," 3Ragav's Diagnostics and Research Center, Bangalore," 4National Institute of Mental Health and Neuroseienees, Bangalore

Background: Gestational CVT is common. Nongestat ional CVT is rare and is either due to primary or secondary hypercoagulable conditions. CVT in rnigraineurs hasn ' t been described. We report 10 such cases. Methods: Retrospective analysis of cases of migraine presenting with intractable headache and diagnosis confirmed on Neuroimaging were included. Results: Ten cases (F:M 4:1) o f age group (20 to 60 years) all migraineurs of variable duration (13 to 25 years) with aura (30%) and without aura (70%) presenting with acute to subacute, severe headache with or without vomiting. Clinical evaluation revealed no papilledema in any, focal motor deficit in one. Neuroimaging revealed CVT with infarcts (40%) and without (160%), anemia (Hb _< 10gin% - 50%). Increased acute phase reactants (80%), hyperhomocyst inemia (13/9). Deficiency of one of tire anticoagulant factors (+ re 3/6). 8/10 was treated with anticoagulants for variable periods and followed up. Conclusion: Migraine though thought to be a benign condition, is a complex neurobiologic disorder. The pathophysiology is incompletely understood, more so of its complications viz., status mJgrainosus and transformed migraine. This condition could be associated with abnormal and complex pro-coagulant cascade triggered by neuroge- nic inflammation leading to CVT. The hyperviscosity due to such a state could alter the blood flow velocities and be the possible mechanism of such complications. Their association with CVT is evident here. The abnormal haemorreological mechanisms should be looked into for a better understanding of tiffs condition. This could be a subgroup of patients with nongestational CVT. Tiffs series is an eye opener in unraveling tire association between the two.