Poster Abstracts Thursday, November 10, 2005 $421

was to examine the relationship meteorological elements and the occurrence of stroke in the hospitalized stroke patients in Tokyo. Methods: During 1997 to 2002, 1020 stroke patients were admitted to the wards of neurology in Juntendo hospital. The meteorological data offered from METOCEAN envirotmlent INC. were used. Results: Of the 1020 patients, 119 were intracerebral hemorrhage and 901 were cerebral infarction. For all strokes, there was marked seasonal variation in occurrence, with a higher peak in January and lower peak in July. Occurrence of all stroke and cerebral infarction showed a significant seasonal variation (p < 0.05), whereas intra- cerebral hemorrhage had no significant seasonal patter. Subjects 64 years of age showed a significant seasonal variation in occurrence of both all stroke and cerebral infarction (p < 0.05). The seasonal variation in occurrence of all strokes was obvious in first-event patients, but not in recurrent patients. A u-shaped relation was observed between mean temperature and occurrence of stroke, but was not statistically significant. In addition, occurrence of cerebral infarction was significantly related to daily temperature change (13<0.05). The relation was also noted among elderly patients, recurrent patients, patients with history of hypertension and patients with lacunar stroke. Conclusion: Our results suggested that daily temperature change is important for prevention of occurrence in stroke patients.

1258 Localization of the motor upper limb area

Y. Miyazawa ~, K. Ishihara ], Y. Suzuki ], J. Shiota ], M. Kawarnura ~. 2 Ushioda General Hospital, Japan; 2Department of Neurology, Showa University School of Medicine, )'apart

We invesitigated the lesions and symptoms of three patients presenting with monoparesis of the upper limb due to cortical infarction.

Patient 1. A 68-year-old, right-handed woman showed prominent weakness in the left proximal upper limb (especially shoulder extension). Her left upper limb was slightly hypotorfic, and sensation was intact. Tendon reflexes were normal. T2-weighted and FLAIR MRI performed 13 days after the onset showed a small high signal intensity at the inner point of the precentral knob.

Patient 2. An 85-year-old, right-handed woman had weakness gradually developing in the right upper limb (especially elbow flexion and extension). T2-weighted MRI showed a snlall high signal intensity at the inner point of the precentral knob, which was outer than tile lesion observed in patient 1.

Patient 3. An 81-year-old, right-handed woman showed prominent weakness in the right hand (especially finger flexion and finger exten- sion). These symptoms recovered temporally and appeared again after several hours. T2-weighted and FLAIR MRI performed 7 days after the onset showed a small high signal intensity at tile precentral knob.

Yoursry et al. (11997) described the localization of the motor hand area as 'precentral knob'. We described three patients (%houlder paresis', 'brachial paresis', and 'hand paresis') whose lesions revealed on MRI were located consistently witiffn and inmter area of tile precentral knob. We conclude that tiffs is a new map on tile localization of the upper limb area in the motor cortex and FLAIR MRI is useful for diagnosis.

1259 Comparison of Homocyslein, Vitandn B 12 and Folie acid level between those with and without Cerebrovaseular accident

Moghaddasi, M 1. 1Rasool Ak:ram Hospital, Iron University Of Medical Sciences, lran

Introduction: CVA is one of the most important health problems and it has different irreversible complications. Prevention is of the most important method for dealing with tiffs diseases. There are several controversies on the effects of Homocysteiff, Vitanffn B12 and Folic acid on tiffs disease. Tiffs study was conducted to compare

Homocystein, Vitamin B12 and Folio add level between those with and without Cerebrovascular accident. Methods: In tiffs case control study, 42 were selected as case and 20 as controls, using simple non-random sanlpling. All tile infomlation was obtained using their records and their plasnla sanlple. Homocystein, Vitanffn B 12 and Folio acid level were compared between cases and controls using t-test. Results: Mean Vitamin B12 in cases was 388.4 -c 390.3 and in controls was 369.8 -c 110.4 that did not show any significant difference. Mean Folio acid in cases was sigrfificantly lower than tile controls (16.8 ± 4.5 ng/nll Vs. 12.2 ± 3.0 ng/nll, P < 0.001). Mean Homocystein level in cases was significantly higher than the controls (121.1 ± 9.8 Mm/li, Vs. 13.5 ± 3.2 Mm/li, P < 0.001). Conclusion: Considering the results o f this study and comparing them with the other studies', it seenls that mean folio acid and Homocystein in those with CWA are lower than the other people. Considering tiffs fact, it is recommended to conduct further prospective studies to evaluate the cause and effect between these supplements and the disease and practical ways of prevention of CVA.

1260 Patient-and-lesion tailored Nemoprotected Carotid Artery stenting in Stroke prevention: results from a 4 year follow up

Motyl, R l, Pierfiazek, P~, Musialek, p 2 Kablak-Ziembicka, A 2, Przewlocki, T 2, Kadzielski, A 2, Moczulski, Z ], Pasowicz M 1, Tracz, W 2. 1The John Paul H Hospital Center for the Diagnosis and Rehabilitation of Heart and Lung Diseases, Krakow, Poland," 2The Jagiellonian University Department of Cardiac and Vascular Diseases, RYa]cow, Poland

Background: Percutaneous carotid artery stenting (CAS) is a viable alternative to surgical endarterectonly but still little is known about long-term results o f CAS. Methods: From 2000 we have performed CAS in 218 patients with _>60% carotid artery stenosis. Prior to CAS CT-angiography and extra- and intracrarfial duplex Doppler were performed to assess plaque hemodytlanffc siglffficance/morphology and tile anatonly/ function of intracratffal circulation. All patients were evaluated by a neurologist. CAS procedures were performed with neuroprotection systems (proximal 32%, distal 68%). In each case the system was tailored to the patient and lesion. Histopathologic evaluation of the captured debris revealed embolic particles in 69%.

Tile first 100 patients (82 symptomatic) have now been followed up for 2-4 years. Logistic regression analysis of neurovascalar event risk was performed. Findings: At 2-4 years, 89% patients were defined as responders to CAS, irrespective of being symptomatic or asymptomatic prior to CAS. There were no fatal or disabling strokes. Within 30 days of CAS, the risk of a TLA_/small stroke was 4.8"/0 in symptomatic patients and 0% in asymptomatic patients. At >30days to 2-4 years, neurovascular event risk was respectively 6% (only TIAs) versus 11% (only small lacunar strokes). The likelihood of asymptomafic post CAS course was higher in patients with a patent contralateral carotid artery (OR 3.3, 95%Cf [1,1 -11,0]). Contusions: Our intermediate-temt follow up of a large series of consecutive CAS patients indicates that patient-and-lesion tailo- red neuroprotected carotid artery stenting offers optimal primary and secondary stroke prevention in patients with carotid artery stenosis.

1261 Teleneurology in the implementation of a Stroke programme: the RUN-Stroke experiment

Moulin, T l, Decavel, P], Belahsen, F 2, Medeiros-De Bustos ], E, Vuillier, F ], Bonnans, V 1, Retel, 01. 2Neurology Department, University Hospital Besanfon, Besank'on, France; 2Neurology Department, Fez University Hospital, Morocco

$422 Thursday, November 10, 2005 Poster Abstracts

Background: The emeRgency neUrology Network in the Franche- Comt~ (RUN-FC) seeks to develop a more effective stroke manage- ment strategy in both the acute phase and secondary prevention using an organised teleneurology network based on information technology (liT) supports. Operational objectives are orgatfised along two lines; the first dedicated to better identifying stroke from other neurological emergencies and improving overall patient management. The second specifically organises inhospital and follow-up stroke patient care as well as secondary prevention (RUN- Stroke). Methods: Teleneurology has made it possible to establish close working links between healthcare providers by using IT supports. The organi- sation of neuroimaging networks facilitates diagnostic and consulta- tion procedures, distant clinical examinations and image transfers. The RUN-Stroke progrannne, set up in 2001, involves a muttidisci- plinary stroke team centred around the Besan~on Stroke Utfit (Sir). Patient data has been recorded and is updated using an internet- based computerised medical file from the acute phase and long term follow-up. Results: We have organised a regional collaborative working group, produced patient care procedures (almost 100 to date) and implemen- ted telemedicine technology in 11 hospitals (approximately 2,500 videoconference and image transfers). The electronic medical file (inpatient and follow-up) has been designed according to diagnostic approaches. Moreover, an information sheet comprising 3 sections (general, exchange, specialised working tools) has been designed to facilitate interactions, e.g. between SU and rehabilitation units. The 2003 prospective cohort now includes 1,015 patients and RUN-Stroke has trained 300 professionals. Conclusion: Our experience has shown the utility of IT in order to better organise stroke patient management.

I262 L-Lysine Monohydxoelfloride therapy in Acute Isdlaeinie Stroke

Mukherjee, S 1, Banerjee, A 2, Biswas, A 2, Hashmi, M 3, Alam, M 1, Pulai, S ~, Datta, D ~, C.hatterjee, G 1, Mukherjee, A ~. 1Department of Neurology, Medical College, Kolkata, India; ~Department of Medicine, Medical College, Kolkata, India; 3EKO MRI Centre, Medical College, Kolkata, India

Background: Acute stroke management remains an area of great need for advancement where novel approaches may be considered. Method: 10 patients (16 males, 4 females) out o f 15 study patients of acute ischaernic stroke, aged 44-69 years, presenting 25-98 hours after onset of stroke were adnfinistered L-Lysine monohydrochloride (LMH) I.V. as 60 mg/kg.body weight/day in 4 divided doses for 7 days immediately after baseline imaging. Matched controls of 5 cases (3 males, 2 females) were assessed using the same protocol. Clinical outcome in both groups were assessed by National Institutes of Health Stroke Scale (NIHSS) at baseline, 7 th day and 6 weeks, Modified Rankin Scale (MRS) on 90 th day and MRI using T2, T1, FLAIR, DWI and MRA sequences. Results: Out of 15 cases, 13 had M R A evidence of arterial occlusion, of both anterior and posterior circulation, that remained persistent upto 6 weeks. Mean NIHSS score in LMH group ranged 13.00 ± 2.11, changing to 7.40 ± 2.46 at 7 th day and 3.80 ± 1.03 at 6 weeks.The corresponding values in controls were 12.60 d_ 3.05, 10.20 ± 2.77 and 8.40 ± 2.30 respectively. MRS value on 90 th day was 1.3 d_ 1.06 in LMH group vis-a-vis 3.2 ± in control group. Mean infarct area reduction, as evident in MRI on 7 a~ day, was also significantly more in LMH group. Follow-up MRI revealed TI hyperintensity of infarct area, consistent with methaemoglobin, in LMH group only. ConcluSion: Preliminary data of the present study using LMH with wider window approach of >24 hours is suggestive of favourable clirdcal and imaging outcome both in anterior and posterior circulation infarction, presumably due to angiogenesis.

1264 Homocys~teine, a risk factor for stroke in the young- A study from South India

Naga~aja D 1, Christopher R 1. 1National Institute of Mental Health and Neuro Sciences, Bangalore, India

Background: Stroke in the young accounts for 20-30% of all strokes reported from India. The cause remains unknown in a majority. During recent years, hyperhomocysteinernia has been implicated as a risk factor for atherothrombosis. Oxidative stress has been suggested to contribute to homocysteine's deleterious effects on the vasculature. The aim of our study was to evaluate the role of homo cysteine as a risk factor for stroke in the young and elucidate the role of oxidative stress in homocysteine-mediated toxicity. Methods: We evaluated 99 patients, aged <40 years, with completed ischemic stroke and 100 age-and gender matched clinically normal subjects. Fasting plasma total homocysteine (tHey) was measured by HPLC analysis. Serum malondialdehyde, an indicator of lipid peroxidation, was assayed by fluorimetic method and the antioxidant status of plasma estimated by ferric reducing antioxidant power (FRAP) assay. Results anti Conclusion: The basal total homocysteine was significantly elevated in stroke patients compared to controls (117.6 ± 19.8 vs 13.2 d_ 8.1 /~mol/L p - 0.041). Mean plasma tHey was higher in men, smokers, alcoholics and in patients with previous TIA or stroke. Serum malondialdehyde was significantly elevated (1.0 ± 0.65 vs 0.75 ± 0.37 mmol/L, p -- 0.026) and FRAP reduced (743.2 ± 231.4 vs 1068.9 d_ 326.2 ~mo l / L p - 0.000) in stroke patients compared to controls. Serum malondialdehyde showed a significant positive correlation with tHey in both patients and controls. Our study suggests that elevated plasma tHey is an independent risk factor for stroke in the young and oxidative stress and lipid peroxidation play a role in the patho-physiology of hyperhomocysteinemia.

1265 Reduction of Cerebral Infarction in SHR-SP by s~tatins associated with Amelioration of Oxidative Stress

Nagotatfi, S l, Hayaslfi, T l, Hamakawa, K a, Degnchi, K a, Sehara, Y~, Zhang, H 1, Shoji, M 1, Abe, K 1 . lOkayama University, Okayama,/apan

Backg~ouud: 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (starins) have pleiotropic effects on ischemic brain. This study aimed to clarify the effect of starins against spontaneous stroke occurrence and oxidative brain damage caused by transient middle cerebral artery occlusion (tMCAO). Method: Stroke-prone spontaneously hypertensive rats (SHR-SP) were treated with pitavastatin (10 mg/kg), atorvastatin (120 mg/kg), simvastatin (120 mg/kg), or vehicle (n - 5 each group) for 28 days. Physiological parameters and serum lipids were measured, and spontaneous infarct volumes were evaluated by immunohistochernical examination for MAP2. Using the simvastatin- (in - 12) and the vehicle-treated (in - 10) SHR-SP, we inmmnohistochenfically detected the oxidative stress markers for lipids (HEL and 4-HNE) and DNA (8-OHdG) in their brains following 90 min of tMCAO. Results: In the spontaneous stroke model, body weight and blood pressure were not different among 4 groups. Statnis did not affect the serum cholesterol levels. The infarct volume was significantly smaller in the atorvastatin (3.5 d_ 3.2 nmt 3, P < 0.05)- and the simvastatin (3.3 ± 1.1 nun 3, P < 0.01)-treated groups than in the vehicle-treated group (8.7 ± 3.6 mm3). In the tMCAO model, irnmunoreactivities for HEL, 4-HNE, and 8-OHdG in neurons were increased at 4 and 24 hr after tMCAO in the vehicle-treated animals, while simvastarin significantly reduced such inductions. Conclusion: Treatment with statins reduced infarct volume in the spontaneous stroke model, and ameliorated the oxidative stress in the tMC.AO model. Our results suggest that the antioxidarive properties