Poster Abstracts Thursday, November 10, 2005 $411

Saitama, Japan; 2juntendo University School of Ivledici~ze, Tokyo, Japan

Background: Seasonal variation in incidence of stroke was investigated in Japanese stroke patients. Method: 4040 hospitalized stroke patients between January 1, 1994 and December 31, 2004 were enrolled in this study. Most patients were transferred to our rehabilitation unit from many acute care hospitals in Saitama and Tokyo, Japan. The mean age of all patients was 64 years old and the male: fenlale ratio was 2505:1535. The x 2 test was used to analyze the seasonal variation in incidence of stroke. Results: The nmnber of onset o f cerebral infarction was as follows, 580 (March-May), 554 (Jun-August), 590 (September-November), and 591 (December-February). There was no significant seasonal variation (x a -- 1.539, df -- 3, p < 0.673). The number of onset of intracerebral hemorrhage was 337, 297, 358, and 466. The peak incidence for intracerebral henlorrhage was December-February (x 2 _ 42.955, df - 3, p < 0.001). The number of onset of subarachnoid hemorrhage was 78, 69, 62, and 58. There was no significant seasonal variation (x 2 - 3.457, d r - - 3, p < 0.326). Conclusion: A significant seasonal variation in incidence of intracer- ebral hemorrhage was showed in tiffs study. These findings indicate that winter is the risk factor of intracerebral hemorrhage in Japan.

1217 Red Cell and Leukocyte Defommbflity in Stroke patients suffered t~oii1 a certain Vascular Pathology

Kowal, p1. 1Rheologieal Laboratory, Department of Neurology, Po~'wah, Poland

Background: Hemorheological factors play all important role in blood flow regulation in cerebral ischaemia. The aim of tiffs study was to answer the question if hemorheological disturbances have been related to a certain vascular pathology. Material and Method: The study was carried out in 24 patients after ischaemic stroke divided into two clinical groups: 10 subjects with snlall vessel d i sease /SVD/ and 14 subjects with large vessel disease/ LVD/. The reference group /10 subjects/ included tile healthy age- matched people. Red cell and leukocyte deformability were examined by means of St. George's Fi l t rometer /Carr i Met . Darking, England/. Red cell transit t i me / R C T T / i nd i ca t ed erythrocyte elasticity, whereas clogging particles /CP/ exemplified leukocyte deformability. All patients were evaluated with CT exanlination, U S G Doppler and in some cases angiography. Results: We found R C T T and CP increased/p < 0.001 and p < 0.01 respectively/ in SVD group and only CP in LVD group /p < 0.05/ compared them with the reference group. In comparison between patients" groups we found an elevated R C T T va lue /p < 0 .05/ in SVD subjects. Conclusion: The result of the study indicated a role of some hemorheological changes/connected with blood cells physical proper- t ies / in a certain cerebral vascular pathology.

1218 An Influence of the alternating ulagneting tield on tile Heulorheologieal parameters in patients with Cerebrovascular Disease

Kowal, p1, Gapiflska-Marcinkowska, A ~. 1Mwologieal Laboratory, Department of Neurology, Poznar~, Poland

Background: Hemorheological disturbances play all important role in cerebral blood flow impairment, particularly in cerebral microdrcula- tion. The aim of this study was to estimate an influence of the alternating magnetic field on the rheological properties of blood in patients suffered from cerebrovascular disease. Material and Method: The study was carried out in the group of 10 patients with TIA. The magnetostinlulation was applied by means of VIOFOR JPS using progranmie M~Pa and I-2 intensity. It was done

twice a day for 13 days. Hemorheological examination was performed four times: before application, after 4, 8 and 13 days. The Contraves LS40 rheometer was used for these estimations. The blood flow curve analysis was done by means of Quemada model, which allowed to estimate red cells aggregation and their deformability. The following other paranleters were also studied: haematocrit , p lasma viscosity and blood viscosity. Result: We indicated a beneficial effect of the alternating magnetic fe ld application on plasma viscosity and red cells aggregation. The study will be continued with a greater number o f patients.

1219 Heparin Tkofiban combination in Acute Ischaemic Stroke

Krishnan, V 1. 1Kovai Medical Center & Hospitals, Coimbatore, India

Backgrouud: Anticoagulat ion for acute ischemic stroke beyond the time window for thrombolysis is still a matter o f debate. A combination of heparin and tirofiball (a gpIIaIIIb inhibitor) for treating acute ischemic stroke sounds logical. Method: Series of eight cases of acute ischaemic stroke that presented to the emergency department of Kovai medical center and hospital beyond the time window for thrombolysis were considered for acute anticoagulation with heparin and tirofiban. Results: Tile mean time of administration of Heparin and Tirofiban in this series was 7.5 hours. Heparin was administered as a continuous infusion at a rate of 1000 units/hour, titrating to maintain a l i f T of 50-70 seconds. Tirofiban was administered as an infusion bolus of 0.4 micrograni /Kg/mt for 30 nits followed by 0.1 mcg/kg/nlt for 24 hours. All cases in this series made remarkable recovery. There were no bleeding episodes. Conclusion: Heparin Tirofiban combination is found to be safe and effective in managing acute ischemic strokes and needs larger randomized studies to identify its place in acute stroke management .

1220 Our tryst with Acute Ischemie Stroke

Krishnan, S ~, Mathew, C 1, Pankaj, M 1, Baskar, P~, Dinesh ~ . 1Kovai Medical Center & Hospitals, Coimbatore, India

Background: Acute ischemic stroke is best managed in a center with a well equipped stroke unit. Method: Series of Acute ischaemic stroke presenting to tile EMR, K M C H at varying timeframes from the onset managed with Intravenous, Intra arterial thrombolysis and Acute anticoagulation. Results: 31 cases of acute ischaemic stroke were seen during the year 2003 to 2004. Cases presenting to tile E M R between 30 nits to 12hours were included for aggressive management . 2 cases were managed with IV rTPA, 21 cases with hltra arterial Urokinase and 8 cases with Heparin Tirofiban combination. There were 2 deaths in the intra arterial group due to fatal haemorrhage. The average NIHSS was 18 .22 cases improved significantly with modified Rankin Scale of 2. The outcome in the remaining 7 was a scale o f 4 in two cases and 3 in five cases. Conclusion: Acute ischaemic stroke Call be managed effectively using a multi pronged approach in a well equipped stroke unit.

1221 IntereSting course of events in a case of Cortical Venous Sinus Tkrombosis

Vijayan, K 1, Mathew, C 1, Pankaj, M 1, Pattabhiranian, VR 1 . 2Kovai Medical Center & Hospitals, Coimbatore, India

Case report: 45yr old Mrs .R presented with headache, bilateral papilloedema and no lateralising signs. CT brain was normal. M R Venograni showed non visualization o f tile Straight, both transverse and Sigmoid sinuses. She was anticoagulated with Heparin followed by warfarin and given Mannitol and steroid with adequate hydration.

$412 Thursday, November 10, 2005 Poster Abstracts

Symptoms subsided. Two weeks later she was readmitted with a worsening of the headache. Cerebral venography was attempted through a femoral access but only the left IJV could be entered Milch showed multiple collaterals drainilig into it with non visualizatioli of the sigmoid silius. She also developed Deep vein thrombosis of the right leg and Pulliloliary embolism during the course of stay. We will be discussing the management of the complications and successful management of raised ICP with regression of papilledema.

1222 Neuroproteetive etti~ct of Hyperbaric Oxygenation abet Embolie Stroke in rats

Kueppers-Tiedt, L ~, Henninger, N 2'3, Guenther, A a, Sicard, K M 4, Kollmar, R a, Schwab, S a, Wagner, A 1, Schneider, D :. 1Department of Neurology, University of Leipzig, Leipzig, Germany; 2Department of Neurology and E,~perimental Neurology, University of Heidelberg, Heidelberg, Germany; 3Department of Neurology, University of iVlassaehusetts Medical School, Worcester, MA, USA; 4Center for Comparative Neurolmaging, Department of Psychiatry, University of iVlassaehusetts Medical School Worcester, MA, USA

Backgrouml: Hyperbaric oxygeli treatment (HBO) in acute stroke remains controversial. This study investigated potential IIeuroprotec- tire properties of HBO in a model of embolic middle cerebral artery occlusion (MCAO) in rats that simulates human stroke with its different degrees of inadvertent reperfusion. Methods: 3 h after MCAO, 30 male Wistar rats were randomly exposed to either 1 h of 100% oxygen at 2.5 atmospheres pressure (HBO group; II -- 15) or normobaric room air (colitrol group; n - 15). Cerebral blood flow (CBF), apparent diffusion coefficient (ADC) and T2-weighted images were acquired at 30 min, 5 h, 24 h (1"2 only), and 7 d (T2 only) post-MCAO. Lesion volumes were calculated by using viability thresholds or by visual inspection. After the last scan, animals were sacrificed and brains stained with hematoxylili & eosili (H&E) for infarct measurement. Results: In both groups, CBF withili the infarct core was reduced 95°,5 relative to the corresponding contralateral region immediately after MCAO and remained 55?,'; subnormal at 5 h. Within HBO group, the ADC-derived lesion volume was 73.4?,'; at 5 h, T2-derived lesion volumes were 82.2"/0 and 76.7°,5 at 1 d and 7 d respectively, and histologically-derived lesion volume was 62.4"/0 at 7 d (all values are with respect to control). Lastly, mortality tended to be lower in the HBO group (data not shown). Conclusion: HBO treatment is neuroprotective for up to 7 d after embolic MCAO when initiated within 3 h after ischemia.

1223 Cerebral hnbolism as a cause of Lacunar Stroke

Kuznetsov, A l, Vinogradov, 01, Kucherenko, S 2, Odinak, M ~. 1National Pirogov Centre of Therapy and Surgery, ivIoseow, Russia; 2Military Medical Academy, Saint-Petersburg, Russia

Lacunar stroke is one of subtypes of ischemic stroke. The main cause of lacunar ilifarctioli is cerebral microaligiopathy due to arterial hypertension or diabetes mellitus. The purpose of this study was the estimation of cerebral embolism as a possible cause of lacunar infarction. Material anti Methods: We studied 4g uliselected patients with various subtypes of acute ischemJc stroke, 26 patients with atrial fibrillation and ischemJc stroke, and 6 patients with infective elidocarditis and ischernic stroke. We used MRI ("Magnetom Impact", Germany) or CT ("Somatom+4"', Germany) of the brain, transthoracJc echocardio- graphy, duplex sonography ("Acuson 128XP", USA) and M R A ("Magnetom Impact", Germany) for estimation of cerebral arteries, and microemboli detection ("Soliomed-300", Russia). Results: Pattern of lacunar infarction on MRI or CT was detected in 13 patients (127,1'%). Four of 13 patients had potential cardiac and

arterial sources of cerebral embolism, and they had not other causes of stroke. In these patients lacunar infarction were larger, and it had more lateral localization, near froli1 ilisula. In the patients with atrial fibrillation lacunar infarction was very rare (7,7°,5). Most of the patients with infective elidocarditis had IImltiple small infarction with cortical and subcortical localization (83,3%). Microembolic signals were detected in all o f these patients. Conclusions: Cerebral embolism can cause lacunar infarction if the size of embolic material is small (about 200 mcTn). Possible sources are heart valve disease and unstable atherosclerotic plaques. In these patients the alitiplatelet agents should be used. Carotid elidarterect- omy should be indicated if there is unstable carotid atherosclerotic plaque.

1224 A ease of infarction restricted to unilateral hypothalamus with symptoms of hyperphagia and hypersomnolence

Kwon, YS ~, Seo, M JÀ, Yu, HJ ~, Roh, SY a. 1Pundang Jaesaeng General Hospital, Korea

Background: It is well known that brain infarction restricted to unilateral hypothalamus is very rare because of abundant blood supply from circle of Willis. Results: We report a case of right hypothalamic infarction. A 63-year- old woman developed hyperphagia, hypersomnolence and hemihyper- tfidrosis limited to the left face. Conclusion: Brain M R imaging revealed the high signal intensities in right aliteromedial hypothalamus.

1225 Hiccups in Pure Lateral Medullary Infarction

Kwon, SB a, Hwang, SH ~, Yun, SH ~, Jung, S a, Lee, BC a . 1Department of Neurology, Hallym University College of Medicine, SeouL Korea

Background: Hiccups are not a frequent but disabling condition of lateral medullary infarction (LMI). Unlike other sSaliptoms and signs of LMI, the attatomJcal lesions of hiccups are not well known. Although there were studies about clinical-radiological correlation studies using MRI, few studies have evaluated the relation between the lesional location of LMI and hiccups. Therefore, we performed this study to clarify the lesiolial correlation with hiccups in LML Method: Between 1997 and 2004, we identified 12 patients with pure LMI (LMI without concomitant politilie or cerebellar infarction) who presented with hiccups in addition to typical lateral medullary syndrome. Eighteen patients without hiccups were included as a control. Clinical and radiologic findings were compared between two groups. Results: The patients with hiccups significalitly IIlore ofteli had dorsolateral rather than ventral lesions at horizontal levels (P < 0.05, likelihood ratio test for trend). But, there were no rosto-caudal differences at vertical levels. Conclusion: We suggest that LMI associated with hiccups often locates in the dorsolateral medulla at horizontal correlation. This comparative study using MRI helps us to expand the uliderstalidilig of the neural substrate for hiccups in LMI.

1226 Isolated CerebeUar Infarction in tile territory of tile medial branch of the Superior Cerebellar Artery

Hyung Lee ~, Hyon-Ah Kim 1, Sung-II Sohn ~, Robert W Baloh 2. 1Defiartment of Neurology, Keimyung University School of Medicine, Daegu, South Korea; 2Department of Neurology UCLA School of Medicine, Los Angeles, CA, USA

Background: The clinical syndrolire associated with dorsomedial infarction of the rostral cerebellulir in the territory of the medial