$436 Thursday, November 10, 2005 Poster Abstracts

migraine, recurrent strokes and finally subcortical vascular dementia. Other than neurologic manifestations of the disease are less well known. Our aim was to assess the ophthalmologic characteristics in CADASIL, especially the nature of retinal vascular changes and their clirfical significance, in a cross-sectional study. Patients and Methods: 38 CADASIL patients, (aged 19 to 61 years; 20 in prestroke, 15 in stroke and 3 in dementia group), all with R133C Notch3 mutation underwent detailed ophthalmologic examination, including best corrected visual acuity, anterior and posterior segment biomicroscopy, measurenrent of intraocular pressure in all patients, and retinal fundus photographs in 33 patients and 16 healthy controls (aged 20-64 years). Diameters of arterioles and venules were measured and arteriole-to-venule (A/Y) ratios were calculated from digitized photographs. Results: Arterial narrowing and arterio-venous (AV) uickings occurred in almost all patients. Straighteuing of the retinal arterioles and marked wall reflex occurred in six patients. Tire mean A/V ratios in tire 33 CADASIL patients (0.528 ± 0.064) were significantly (13 < 0.001) lower than in the 16 controls (10.611 ± 0.057). Conclusions: The generalized arteriopathy of CADASIL causes a wide variety of changes in retinal arterioles but only minimal functional disturbances. Tiffs is in line with alterations in arterioles in cerebral grey matter with which retina is analogous, but contrasts with tire severe danrage of cerebral white matter arterioles.

Almost 2/3rds of all stroke patients developed hyperthermia (mxillary temperature >37.5'~C) within 72 hours of admission and such temperature elevations are nowadays considered to be a significant independent risk factor for worse outcome. However, as most stroke patients are not critically ill there is an important need for a non- invasive, conveuient, simple, cost-effective, and reliable cooling therapy to maintain euthennia during the initial brain injury phase. Our objective was to evaluate the feasibility of maintaining euthermia of brain-injured patients using solely peripheral intravenous (IV) infusion of various coolants (saline and ice slurry), infusion tem- peratures (0 and 5oC saline; 20 and 50% slurry) and rates (40 to 160 ml/hr). We simulated the cooling process of human blood by analyzing the thermal interaction between warm blood and cold intravenous (IV) solutions. It is demonstrated that the cooling rate of blood is at least 1.2°C/hour using 5°C saline infused at 160 ml/hour. Tiffs cooling process is siguificantly facilitated by adding ice slurry to tire IV solution. A cooling rate of 2.7°C/hour is obtained with 50"/o saline and 50% ice slurry as infusate. Based on these results, it will take less than 2.2 and 4.8 hours to lower the temperature of febrile patient from 43 to 37'~C using ice slurry and saline infusion, respectively. Siguificantly shorter time durations are needed to reduce less dranratic hyperthermJa. In these theoretically simulations we demonstrated that simple IV infusion can be utilized to maintain euthermJa or near euthemfic core temperatures in patients with acute brain injuries.

1318 Gender differences with regard to Atrial Fibrillation in the in-hospital mortality after suffering a first ever Ischemic Stroke

Roquer, j1, Rodriguez-Campello, A ~, GomJs, M ~, Ois, A ~, Montaner, j2, Alvarez Sabin, j2. ZServei de Neurologia. Hospital del Mar. Servei de Neurologia. Hospital de la Vall d'Hebrr, Barcelona, Spain; 2 Unitat Neurovascular. Hospital Vail d'Hebr6, Barcelona, Spain

Background: Atrial fibrillation is a well known poor predictor after acute ischemJc stroke, but it is unclear how interacts with other factors for modulating tire probability for early death. Objective: To determine whether the impact of atrial fibrillation on in- hospital mortality is different according the patient's age and gender. Methods: Analysis o f the impact of atrial fibrillation, gender, age (< 75 years or _>75 years) and stroke severity on in-hospital mortality. Sitting: Two uuiversity hospitals fi'om Barcelona, Spain. Patients: 1678 people adnfftted to hospital with first ever ischenric stroke. Results: In-hospital mortality was: 11.3%; for men, mortality was 10. 9%, and for women 11.6%. Analysed by age subgroups, mortality was lower in women in both groups (4.9% in <75 years; 16.1% in >75 years) compared with men (15.7°,5 in <75 years and 19.9°,5 in >75years, p - ns). Cox regression analysis showed that stroke severity by NIHSS >7 at adnffssion, HR: 8.08 (95"/0 CI: 4.80-13.60), age _>75 years, HR: 2.40 (195% CI: 1.69-3.40), male gender (HR 1.70 (95% CI: 1.27-2.29) and atrial fibrillation, HR: 1.67 (195% CI: 1.24-2.25), were independent predictors of ni-hospital death. After dividing the series into four groups (men/women; <75 years/ >75 years) atrial fibrillation was a poor predictor only in women. Conclusions: The impact of AF is different in both genders and appears as a specific ischemic stroke poor outcome predictor just for women.

1319 Intravenous Saline as simple coolant to avoid Hyperthermia in patients with Acute Strokes

Rosengart, AJ ~, Zhu L ~. 1Neurocritieal Care andAcute Stroke Section, Departments of Neurology and Surgery (Neurosurgery), The University of Chicago, IL, USA; ZDepartment of Mechanical Engineering, University of Maryland Baltimore County Baltimore, MD, USA

1320 Investigating the perception of Stroke-specific quality of life: a preliminary study

Rude, N ~, Decavel, P~, Puyraveau, M a, Kehoe, P~, Retel, O ~, Moulin, T 2. ZFranche-ComtO University, Besanfon, France; 2 Besan, con University Hospital, Besanfon, France

Background: Perception of quality of life (QoL) is important to determine the long-term outcome of stroke patients. Our objective was to study the feasibility of administering a French version of the Stroke hnpact Scale (SIS) and compare it to a generic QoL scale (SF-12) and a specific semi-structured interview (SSSI). Method: Stroke patients were selected from tire Besan~on Stroke Unit, examined at 6 months (outpatients living at home -- "group H ' ; nisritutionalised patients -- "group I") and given a neurological assessment (NIHSS, Barthel Index, Rankin, MMS, MADRS). QoL was evaluated by SIS, SF-12 and SSSI (42 questions). Each patient assessment was associated with an interview (face-to-face or telephone) with the referent care giver (GP or hospital doctor) and the patient's relatives. Results: Thirty patients were included, mean age: 60 (119-86), 30% were working and 50% were married. All scales were successfully adnffrfistered for 84"/o of patients. The failure rate ( > 2 questions not answered) was higher in group I (40%) compared to group H (5"/o). SSSI highlighted the QoL issues important to patients and included in the SIS, such as communication with relatives, autonomy and fears, as well as those not taken into account, i.e. future perspectives, sleep and pain. Care givers and entourage were successfully interviewed, except for GPs ( > 80"/o failure rate). Conclusion: Our study showed that the different QoL dimensions must be adapted to the patient's health status in order to better analyse their perception of QoL and to improve the correlation between stroke type and QoL.

1321 Cerebrovascular Disease in childhood: a twelve year hospital based study

Ruiz Miyares, F 1, Parr6n Cardero, 11, Nfifiez Lahera, 11. 2Hospital lnfantil Sur, Santiago De Cuba, Cuba; ZHospital S. Lora, Santiago De Cuba, Cuba

Poster Abstracts Thursday, November 10, 2005 $437

We have performed a cross-sectional, retrospective, hospital based study of all admitted cases in Hospital Infantil Sur, Santiago de Cuba from January, 2001 through December 2003 to assess clinical evolution and outcome in tiffs group of patients. Ischemic infarctions slightly predominated over hemorrhages and the non-favorable outcome was related with the latter where all fatalities resulted from arteriovenous malformations. Territories involving surface branches of middle cerebral arteries were the majority both in ischemic and hemorraghic cases, meanwhile their depth territories were more frequently affected in hemorrhages. If we consider that there were 25 cases in a 12 year period, we can affirm that it was a very low incidence, however, the 6 cases that died makes high the mortality rate. Cerebrovascular diseases in childhood, although rare, represent a life-threatening condition with potential disabling sequelae, thus, early diagnosis and intervention must be the standard. In our serie, the fatal cases showed no symptoms, nor signs, heralding the potential threat before the onset. The clinical profile and etiologies are discussed.

1322 Expression of S-100 protein and protective effect of arundie acid on the rat brain of chronic cerebral hypoperfusion

Ohlani, R 1, Tomimoto, H 1, Wakita, H 2, Kitaguchi, H 1 , Nakaji, K 1, Akiguchi, 13, Takahashi, 11 . ~Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan; 2Nationa[ Nstitute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA; 3Department of Neurology, Koseikai Takeda Hospital, Kyoto, Japan

Background: S-100 protein is primarily expressed by astrocytes in the brain, and accumulated in and around the lesion of ischemic brain damage. A novel astrocyte-modulating agent (arundic acid) has a neuroprotective effect toward acute cerebral infarction. However, the protective effect of arundic acid remains uncertain in chronic cerebral hypoperfusion. Methods: The rats under chronic cerebral hypoperfusion were subjected to bilateral ligation of the common carotid arteries, and allowed to survive for 1, 3, 7 and 14 days. The 24 animals received a daily intraperitoneal injection either of 5.0, 10.0 and 20.0 mg/kg of arundic acid or vehicle for 14 days. The 30 animals received a delayed intraperitoneal injection of 20.0 mg/kg of arundic acid or vehicle, which started either from 1, 3 and 7 days and continued to 14 days. The pathological changes were quantified in terms of white matter (WM) lesions and numerical increase of S- 100 protein immunoreac.tive astroglia. Results: S-100 im_munoreactive astroglia increased significantly in vehicle compared to sham in the WM. A dose of 10.0 and 20.0 mg/kg of arundic acid suppressed the WM lesions and astroglial activation. In the arundic acid-treated rats, number of astroglia positively inmmno- labeled for S-100 antigens in the WM showed a tendency towards a decrease, and the WM rarefaction was less severe as compared to the vehicle, after a delayed treatment up to 3 days. Conclusions: Protective effect of arundic acid in a dose-dependent manner and in postischemic treatment were indicated, and these results suggest a potential usefulness in cerebrovascular disease.

1323 Dual Antiplatelet Therapy in Secondary Stroke prevention: a community hospital experience

Sachdev, HS 1, Berardi, V 1, Sachdev, N 1, Catalli, L 1, Fitzgerald, T 1, Douville, A 1, Zrelak, p1. ZGood Samaritan Hospital, San Jose, California, USA

Background: Dual therapy of clopidogrel, a thienopyridine, and aspirin, thromboxane inhibitor is often used in stroke patients for potential additive effect. We performed a retrospective study evaluat- ing the efficacy and safety of combined Clopidogrel 75 mg and Aspirin 81 mg.

Methods: Of 2806 ischemic stroke patients, 330 with documented infarcts on CT or MRI were followed for 3-5 years for recurrent stroke and bleeding complication. We excluded patients with GI pathology or bleeding diatheses. Our results were compared to CURE and MATCH trials. Results Eflicaey: 11% (137) had recurrent stroke, compared to 8.7% MATCH over 18 months Bleeding Complications: Major- 2.1% (7 patients) (RR 0.59, 95%CI 0.28-1.24) compared to 3.7% (RR 1.38, CI 1.13- 1.67) in CURE, 1.94% (RR 1.36, C.I 0.86-1.86) in MATCH. Life threatening-l . l% (4 patients) (RR 0.58, CI 0.22-1.28) compared to 2.2% (RR 1.21,C1 0.95-1.56) in CURE and 2.55% (RR 1.26, CI 0.64- 1.88) in MATCH. Minor- 5.4% (118 patients) (RR 0.36, CI 0.23-0.56) compared to 5.1% (RR 2.12, CI 1.75-2.56) in CURE. Conclusions: A) The combination therapy of 75 mg Clopidogrel and 81 mg Aspirin is effective in secondary stroke prevention. B) Risk of major bleeding is lower in our study and in MATCH as compared to CURE. This appears to be related to aspirin dosage: our study (81 mg), MATCH (175 mg), CURE (325 mg?) C) Life threatening bleeding is almost half (1.1%) compared to CURE (2.2%) and MATCH (12.5 %). D) Dual antiplatelet therapy with low dose aspirin is relatively safe in a carefully selected patient population without preexisting gastrointestinal disorders or bleeding diathesis.

1324 Characteristics of Stroke in Malduguri, North Eastern Nigeria

Salawu, F ~, Wakil, MA ~, Bwala, S 3, Bukbuk, D 4, Waru, BG 4, Musa, B 4, Kida, [4, Minoza, K 4, Aquil, R 4, Ahmed Bello, L 5. 1Federal Medical Centre, Nguru Yobe State, Nigeria; 2Federal Neuropsychiatric Hospital, Maiduguri, Nigeria; 3University of Mai~uguri, Maiduguri, Nigeria; 4University of Mai~uguri Teaching Hospital, Maidugiri, Nigeria; S State Specialist Hospital Maiduguri, Nigeria

Background: Stroke is a common neurological disorder that is encountered worldwide. This one year study was designed to show the characteristics of the problem at the University of Maiduguri Teaching Hospital, Maidugnri, Nigeria. Method: This was a prospective hospital-based study of all first-ever Nigerian stroke patients admitted to the medical wards during the study period. They were matched for age and sex with neurologic controls with stroke. All stroke patients had plain axial computerized tomo graphy scan o f the brain. All patients had haematological and full biochenrical investigations including haematocrit, erythrocyte sedi- mentation rate. Electocardiography was done on all patients and echocardiography was done when indicated. Results: The 124 Nigerian patients studied fulfilled the criteria for stroke. The female: male ratio of the stroke patients was 1:2.1 and their ages ranged between 35 and 76 years (mean 52.7 ± 10.2) and between 41 and 80 years (mean 60.6 ± 10.3) for females. The relative frequencies of stroke subtypes were ischaemic infarcts (75%), of which 13% were lacunar infarcts, intracerebral haemorrhage (121%) and subarachnoid haemorrhage (14%). The most common risk factor was hypertension alone (40.3%), diabetes alone (14.5%), concomitant hypertension with diabetes mellitus (23.4%), atrial fibrillation (5.6%), other cardiac factors (5.6%) and smoking (8.1"/o). No risk factor was detected in 3.2"/o of the patients. The influence of weather on different types of stroke was not statistically significant. The overall in-hospital mortality was 13.7% with a significant male preponderance. Results: This study demonstrated that stroke is a common neurologic condition in the north eastern part o f Nigeria. It also showed that hypertension alone was the most important risk factor in stroke with a male preponderance. However, there are other independent risk factors which can lead to stroke or compound and accelerate cerebrovascular disease. The evidence for prevention is therefore compelling. There is a need to establish a stoke register at the University of Maiduguri Teaching Hospital so that the actual incidence and prevalence rates of the disease in the north eastern Nigeria can be more accurately measured.