XVII. European Stroke Conference
Nice, France

Poster Session: Longterm outcome of stroke
 

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 01
ADDITIONAL NON-STROKE-RELATED CARDIOVASCULAR HOSPITALIZATIONS IN MANAGED CARE PATIENTS FOLLOWING ISCHEMIC STROKE
P.B.Gorelick    C. Roberts    X. Ye     A. Rudolph     C. Harley                                    
 
University of Illinois at Chicago; Pfizer Inc; i3 Innovus

USA

Background: Patients with prior stroke are at increased risk of cardiovascular (CV) events; we investigated the risk of non-stroke-related CV hospitalizations following ischemic stroke in a US managed care population. Methods: Patients hospitalized with a diagnosis of ischemic stroke (ICD-9: 433.xx, 434.xx) from 2002-2005 were identified from a large US Managed Care Organization. Stroke cases were matched to control patients hospitalized for a non-CV acute event based on patient factors (age, gender, comorbidity, pre-index CV disease (CVD) history) and data similarity (hospitalization date, follow-up time). Additional stroke and non-stroke CV (myocardial infarction, angina, revascularization, congestive heart failure) hospitalizations in the stroke and control cohorts were identified using primary ICD-9 codes. Hospitalization rates were calculated using the Kaplan-Meier method at 6, 12, and 36 months after the index hospitalization. Hazard ratios (HR) and 95% confidence intervals (CI) were also calculated to assess the incremental risk of stroke and non-stroke CV hospitalizations in stroke cases versus controls. Results: 11,883 stroke cases and matched controls were identified (mean age ~58 years; 47.8% female). Compared with controls, the rate of non-stroke CV hospitalization was greater in stroke patients at 6 months (5.63% vs 2.37%), 12 months (8.49% vs 4.24%), and 36 months (22.05% vs 13.04%). Stroke patients had a significantly higher risk of non-stroke CV hospitalization (HR=1.95; 95% CI: 1.77, 2.14) than controls, in addition to an increased risk of repeat stroke hospitalization (HR=12.55; 95% CI: 10.50, 15.01). Results were consistent in patient subgroups with or without a history of stroke or other CVD. Discussion: Following ischemic stroke, patients have nearly twice the risk of non-stroke CV hospitalizations than matched controls. Attention to total CV risk reduction in these patients could potentially reduce downstream events and resource use.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 02
Symptoms associated with fatigue in patients with stroke and TIA
S.M.Walsh    M. Martin    N. Dooley     J.A.Harbison                                            
 
Department of Medical Gerontology, Trinity College Dublin

IRELAND

Introduction: Whilst a variety of symptoms are associated with fatigue in neurological diseases, those characteristic of post stroke fatigue have not been defined. Methods: A 25 item questionnaire of possible associations of post stroke fatigue was developed based on a literature review and patient interviews. A 5 point Likert scale of frequency of symptoms ranging from ‘never’ to ‘always’ was provided for each item. Correlations were determined between items and with the Fatigue Severity Score (FSS) for each subject. Subjects were recruited from a secondary prevention clinic. All were independent (modified Rankin Score <3) and had suffered a TIA or Stroke in the preceding 12 months. Results: 40 subjects were studied (35% Male, median 74years). Symptoms most frequently reported as occurring ‘often’ or ‘always’ in the population were early morning waking (55%), forgetting things (35%), mind working slowly (33%) problems falling asleep (33%), waking frequently at night (33%), lack of energy (30%) and muscle pain (26%). FSS correlated with muscle pain (r=0.425, p=0.09) and muscles feeling weak (r=0.470, p=0.003) reflecting the emphasis of the FSS on limitation of physical activity by fatigue. The frequency scale for ‘I feel physical fatigue’ correlated with 20 of the 24 other items, including anxiety (r=0.748, p<0.0001), shortness of breath (r=0.666, p<0.0001), lack of energy (r=0.644, p<0.0001), headache (r=0.505, p=0.001), problems falling asleep(r=0.547, p<0.0001), waking frequently at night (r=.540, p<0.0001), muscle pain (r = 0.477, p=002) and muscle weakness. (r=0.386, p=.014). Conclusion: Symptoms associated with fatigue are diverse, with myalgia and presence of sleep disorders being both highly prevalent and highly correlated with physical fatigue.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 03
A Postal Survey on Post-Stroke Pain
H. Klit    N.B.Finnerup    K. Overvad     G. Andersen     T.S.Jensen                                    
 
Danish Pain Research Center, Aarhus University Hospital

DENMARK

Background Chronic pain after stroke, such as hemiplegic shoulder pain and central post-stroke pain, is common. The objective of the study is to assess pain prevalence in post-stroke patients and in a reference group. Method All surviving stroke patients (N=964, F=457, M=507), registered in the National Indicator Project (NIP) stroke database in Aarhus County, Denmark, between March 2004 and February 2005, were mailed a questionnaire about the development of chronic pain after stroke onset. A sex- and age-matched reference group (N=957, F=456, M=501) served as control. Results Mean age of stroke subjects and controls was 70.9 and 69.6 years (p=0.89) and male ratio was 55.3% and 58.3% (p=0.3), respectively. Response rates were 66.5% (643) and 59.5% (570) (p<0.05), respectively. Development of chronic pain (38.7% vs 28.9%), chronic headache (10.9% vs 2.3%), shoulder pain (15.2% vs 9.8%), pain from spasticity (17.2% vs 5.3%), other pain (20.4% vs 12.9%) and high LANSS score, suggesting neuropathic pain (10.1% vs 3.9%), were significantly more common in the stroke group. Conclusion Chronic headache, shoulder pain, neuropathic pain, and pain from spasticity is more common in stroke patients than in an age- and sex-matched control group.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 04
Initial stroke unit treatment did not reduce mortality over 12 years compared with general medical wards
O.M.Rønning    K. Stavem                                                           
 
Akershus Universityhospital

NORWAY

Background: It has previously been shown that treatment of acute stroke patients in comprehensive stroke unit for two weeks has beneficial effect on survival 10 years after stroke. The objective of this study was to determine whether initial stroke unit treatment influence long term survival among patients admitted to an acute stroke unit (SU) with a short length of stay compared with general medical wards (GMW). Methods: 550 consecutive patients admitted to hospital for stroke between March 1994 and December 1995 were randomised to acute treatment in a SU or GMW. Subjects were followed prospectively to determine survival. Effects of risk factors on death were assessed using the Cox proportional hazards regression model. Results: Twelve years after stroke the proportion of deaths in the SU group was 244/271 (90%) and in the GMW 232/279 (83%). The number of observational years was 2664. The best regression model contained nine baseline variables that were independent predictors of death within 12 years: age (relative risk [RR], 1.08; 95% confidence interval [CI], 1.07 to 1.10), male gender (RR, 1.69; 95% CI, 1.23 to 1.85), ADL-score (RR, 0.99; 95% CI, 0.98 to 0.99), previous stroke (RR, 1.32; 95% CI, 1.05 to 1.64), coronary artery disease (RR, 1.32; 95% CI, 1.03 to 1.67), atrial fibrillation (RR, 1.39; 95% CI, 1.09 to 1.79), diabetes (RR, 1.64; 95% CI, 1.25 to 2.13), current smoking (RR, 1.56; 95% CI, 1.23 to 2.00) and hemorrhagic stroke (RR, 1.50; 95% CI, 1.10 to 2.00). Conclusion: Our study is the first to show that initial treatment in a stroke unit with short length of stay do not reduce long term mortality. We confirmed the importance of age, gender, type of stroke and comorbidities to long term survival.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 05
Long-term prognosis in ischemic stroke subtypes – results from the Sahlgrenska Academy Study on Ischemic Stroke
P. Redfors    K. Jood    L. Holmegaard     C. Blomstrand     C. Jern                                    
 
Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Göteborg University

SWEDEN

Background: About 20% of all strokes occur in people of working age. However, there is still limited information on prognosis after stroke in this age group. Here we report predictors of outcome 2 years after ischemic stroke in patients younger than 70 years. Methods: Six hundred consecutive patients with ischemic stroke (18-69 years) from the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS) were included. Stroke subtype was defined using TOAST criteria. Patients were investigated after two years with telephone interviews and by review of medical records. Results: Data were obtained from 591 patients (1.5 % lost to follow-up). Twenty four patients (4%) had died, 42 (7%) had suffered recurrent stroke or transient ischemic attack (TIA) and 7 (1%) had suffered myocardial infarction (MI). The combined outcome death, recurrent stroke/TIA or MI differed between subtypes (p<0.01) with highest recurrence/mortality rate in large vessel disease (LVD) (24%) and lowest in cryptogenic stroke (7%). Multivariate analysis showed that stroke subtype (odds ratio (OR) 3.1; 95% CI 1.4-6.8¸ p<0.01, for LVD vs cryptogenic stroke), a previous history of stroke (2.3; 1.3-4.2, p<0.01) were independent determinants of this combined outcome measure. The proportion of patients with unfavourable functional outcome (modified Rankin Scale 3-6) differed between subtypes (p<0.001), and was highest in LVD (35%) and lowest in small vessel disease (SVD) (12%). In multivariate analysis age (OR, 1.04, 95% CI 1.01-1.06, p<0.01), stroke subtype (3.1; 1.5-6.6, p<0.01 for LVD and 2.4; 1.2-5.1, p<0.05 for CE stroke, compared to SVD) and a previous history of stroke (1.8; 1.1-2.9, p<0.05) showed association to unfavourable outcome, whereas family history of stroke showed a protective effect (OR, 0.6; 0.4-0.9, p<0.05). Conclusion: Ischemic stroke subtype shows an independent association to both prognosis with regard to recurrent vascular events or death and to functional outcome two years after the event in patients younger than 70 years. For both measures LVD shows the poorest outcome.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 06
Post-stroke phobias: frequency, subtypes, relation to depression and neurological deficit
M.A.Savina    I.A.Serpukhovitina    E.A.Petrova     N.V.Alexandrova     V.A.Kontzevoy    V.I.Skvortsova                             
 
Stroke Institute, Moscow

RUSSIAN FEDERATION

Background. There are only single case reports about manifestation of phobias after stroke (Nagaratnam, 2000). We aimed to study incidence of post-stroke phobias, their clinical features and their relation to depressive disorder and neurological deficit. Methods. 135 patients hospitalized with first-ever ischemic or hemorrhagic stroke without severe aphasia (54% of males, mean age 66+- 11 years) were observed in fixed time-points during 6 month. Depression and phobias were diagnosed using criteria DSM-IV. Results. 16 patients (11,9%) had post-stroke phobias, in 6 cases phobias were multiple. 5 patients (20% of males, mean age 71) had agoraphobia. 2 patients (females, mean age 72) had social phobia. 9 patients (56% of males, mean age 63) had space phobia. 2 patients (males, mean age 62) had fear of situation in which their stroke occurred. 1 patient (male, 66 years) had fear of driving. 1 patient (female, 59 years) had nosophobia. Most of the phobias manifested after discharge though nosophobia and 4 (44%) space phobias appeared in acute period of stroke. The majority of phobias persisted longer than 5 month excepting 5 (56%) space phobias that lasted only up to 3 month. The degree of negative impact on patient activities varied from severe (agoraphobia, social phobia, some space phobia) to insignificant (phobia of situation in which stroke occurred). 12 of 16 (75%) detected phobias were associated with depression. In 3 cases phobias preceded the manifestation of poststroke depression. Most of the patients (12 of 16 – 75%) had no neurological deficit that could be reason of phobia. 4 patients with space phobia had some substantial deficit: 3 patients had mild lower limb paresis, 1 patient had subtle static ataxia. Conclusion. Phobias are not rare post-stroke abnormalities often comorbid with depression. Some of them have severe negative impact of patient life. Further researches are needed to study risk factors of this disorders, clinical course, and treatment opportunities.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 07
Predictive value of clinical and CT signs prior to decompressive surgery in malignant MCA infarction on death and functional outcome
S. Schwarzlose    T. Beni    C.W.Wallesch     R. Firsching     M. Goertler                                    
 
University of Magdeburg

GERMANY

Background: Decompressive surgery in malignant infarction of the middle cerebral artery within 48 hours of stroke onset reduces mortality and increases favourable functional outcome. However, timing of surgery and variables indicating its necessity, e.g. level of consciousness, clinical signs of herniation, and midline shift on brain CT scans, are controversially discussed. We aimed to assess the predictive value of these variables in patients who underwent surgery before and after 48 hours. Methods: 60 consecutive patients (pts) (38 male, mean age 58 (30-80) years) underwent decompressive surgery. Median time from infarction to surgery was 37.7 hours (range 11.8 to 165). Median NIH Stroke Scale score was 21 (range 3 to 36) at admission and 35 (range 16 to 38) at surgery. 6 Pts with secondary parenchymal haemorrhage had been excluded from analyses. Results: 30 patients were comatose before surgery and 17 showed clinical signs of herniation. Midline shift on the level of the 3rd ventricle was 8.3 mm, on the level of the septum pellucidum 11.4 mm. Clinical signs of herniation (non-reactive pupil) were associated with an increased mortality (59% vs. 30%) (p = 0.04) and an unfavourable outcome (modified Rankin Scale 5) or mortality (82% vs. 54%) (p = 0.04). No association was found for the level of consciousness and the midline shift as measured on CT scans. Conclusion: Clinical signs of cerebral herniation but not the level of consciousness and the midline shift as measured on CT scan prior to decompressive surgery for malignant MCA infarction may be predictive for an unfavourable outcome or death at 6 months after stroke onset.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 08
An Analysis of Readmissions following Stroke
D. CHAN    O DSOUZA    M GARGET     L WHITEHEAD     SKMUNSHI                                    
 
Nottingham University Hospitals, Nottingham

UNITED KINGDOM

Background: Hospital readmissions following stokes are expensive in terms of costs and poor clinical outcome. Very little data are available on the burden of readmission after stroke. We analysed the reasons and rates of readmission in our stroke patients. Methodology: Readmission rates for patients discharged from five stroke wards between 1st Jan 2006 and 31st Dec 2006 were calculated at 28 days and at one year of discharge. Reasons for readmission were analysed, with special emphasis on whether these could have been prevented prior to the initial discharge. We used descriptive statistics to summarise the baseline characteristics of the cohort and proportions to describe the rates and causes of hospital readmission at 28 days and 1 year after the index stroke. Results: Out of 1449 patients discharged from the stroke units (mean age 78.1 years) 117 (8.1%) were readmitted within 1 year, with 30 (25.6%) of those getting readmitted in the first month after discharge. Chest infections accounted for a large proportion of readmissions, 24 % at 28 days and 18 % at one year. Urinary tract infections, C. difficile diarrhoea and cellulitis accounted for about 10 % of readmissions in the year after discharge, stroke related complications (seizures, dementia and pressure sores) accounted for 14 %, mobility problems, carer stress and breakdown of care package in 7 %, restroke in 9 % , myocardial infarction in 4.1 %, falls and fractures in 4% and drug related complications in 5%. Mortality rates among patients who were readmitted were 18.8 % at 6 months and 32 % at one year. Conclusion: The most common reasons for readmission could have been prevented by the establishment of good post-discharge care. Readmissions are expensive and associated with high mortality. Community based multidisciplinary input could prevent readmissions. Recurrent stroke prevention alone is not enough if we are to reduce our public health burden of stroke readmissions.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 09
Long-Term Health-Related Quality of Life after Decompressive Hemicraniectomy in Stroke Patients with Life-Threatening Space-Occupying Brain Edema
B. von Sarnowski    W. Kleist-Welch Guerra    U. Schminke     T. Kohlmann     J. Moock    A.V.Khaw     C. Kessler     H.W.S.Schroeder             
 
University of Greifswald, Departments of Neurology, Neurosurgery and Community Medicine

GERMANY

Background: Although randomized clinical trials have reported significant improvement in mortality and functional outcome as measured with modified Ranking Scale (mRS) or Barthel index (BI) in stroke patients with space-occupying anterior circulation infarctions treated with hemicraniectomy, many clinicians are still concerned about the postsurgical long-term health-related quality of life (HRQoL). Methods: Ten patients (6 m, 4 w; mean age 48 (SD 5.8) years) were examined at 9 to 51 months after hemicraniectomy. Our test battery comprised physical tests (NIH stroke scale, BI, mRS), neuropsychological tests like the Visual Object and Space Perception Battery (VOSP) and the clock test, and HRQoL-scales including Short Form 36 Health Survey (SF-36), Nottingham Health Profile (NHP), Questions on Life Satisfaction (FLZ), the Hospital Anxiety and Depression Scale (HADS) and EuroQoL (EQ-5D). Results: Median values for NIHSS, BI and mRS were 11.5, 55 and 3.5 (mRS scores were 3 in 50%, 4 in 30%, 5 in 20% of our patients.). The HRQoL-scales showed consistently a very severe impairment in subscales related to physical mobility and functioning, while subscales related to psychological well-being were impaired to a much lesser extent, e.g. in SF-36, mean scores for physical functioning and physical role were 10.5 and 12.5, those for emotional role and mental health were 63.3 and 66.4; in NHP, mean scores for physical mobility and energy were 61.3 and 43.3, those for emotional reaction and social isolation were 18.9 and 16.0. Discussion: As physical components of HRQoL are extremely impaired in these patients, we hypothesize coping mechanisms enabling them to achieve a level of psychological well-being, which is within the range known from patients with other severe chronic diseases.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 10
Admission Glucose over 8 mmol/L is associated with increased 10-year mortality in acute ischemic stroke.
I. Markaki    V. Kostulas    T, Masterman     N. Kostulas                                            
 
Neuro-Angiological Research Center, Karolinska Institutet, Karolinska University Hospital, Huddinge

SWEDEN

Background: Admission hyperglycemia is associated with worse prognosis and higher short-term mortality within three months post stroke. Reports on long-term mortality are not equally consistent. The effect of admission hyperglycemia on mortality of patients with transient ischemic attack (TIA) has not been widely investigated. Here the influence of admission hyperglycemia (blood glucose levels > 8 mmol/L) was evaluated as predictor of long-term mortality in acute ischemic stroke (IS) and TIA. Methods: Consecutive patients with diagnosis of IS and TIA, admitted from January 1997 until December 2002 were retrospectively studied. Blood glucose (BG) was measured within three days from stroke onset. Information on the date of death was obtained within 10 years. Results: 509 patients were included (mean age 70 years; 44% women; 78% IS; 22% TIA). Admission hyperglycemia was present in 28% and 18% of the IS and TIA patients respectively. Mean admission BG was 7.6+/-3.2 mmol/L in IS and 6.7+/-2.3 mmol/L in TIA. During a mean observation of 66+/-35 months, 42% of the IS compared to 31% of the TIA died (P<0.05). In IS, normoglycemia at admission correlated with a 27-month longer median survival compared with hyperglycemia (110 vs. 83 months, P<0.05). The 1-year mortality risk was 18% for the hyperglycemics and 12% for the normoglycemics, while the 5-year and 10-year risk were 42% vs. 29% and 55% vs. 52%, respectively. Increasing age and admission hyperglycemia were associated with an increased probability of death after IS (HR 2.6 and 1.5; 95% CIs 1.76-3.69 and 1.05-2.07 respectively). Admission hyperglycemia did not affect the survival of TIA patients, while increasing age and Diabetes mellitus were predictors of higher mortality in this group (HR 4.5 and 2.3; 95% CIs 1.98-10.29 and 1.03-5.04 respectively). Discussion: Admission hyperglycemia at stroke onset is associated with increased 10-year mortality, which is greater during the first 5 years.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 11
Quality of life in patients with poststroke epilepsy - a prospective study using the SF -36 Health Survey
C. Muhl    B. Böger    K. Klausa     R. v. Zijderfeld     J. Jörg    S. Isenmann                             
C. Muhl
HELIOS KLINIKUM WUPPERTAL

GERMANY

Background: Cerebrovascular diseases are the main cause of symptomatic epilepsy in elderly patients. One aim of the following study was to determine whether seizure occurrence correlates with stroke type, pathogenesis, or clinical outcome. Methods: To examine quality of life in long-term stroke survivors with and without epileptic seizures we evaluated prospectively the incidence of late epileptic seizures (“LES”; occurring > 14 days after stroke onset) in consecutive patients with first-time ischemic stroke (IS) or intracerebral haemorrhage (ICH). During a recruiting period of 1 year we included 173 patients (98 male, 75 female; mean age 65,5 years). Cerebral computed tomography (CCT) and National Institute of Health Stroke Scale (NIHSS) were performed at day 1, cerebral magnetic resonance imaging (cMRI) at day 8-10. One year after stroke onset NIHSS was repeated and the SF-36 Health Survey was raised with patients ( “self-assessment”) as well as with their closely attached persons (“external assessment”). Results: 20 patients were lost to follow-up ( 4 died, 16 cold not be contacted). 12 of the remaining 153 patients developed LES (= 7,8%); all of those had IS, none ICB. If infarction was of macroangiopathic origin, LES were more frequent (p= 0,016). Patients with LES showed significant higher NIHSS (p= 0,009), higher care levels (p= 0,019) and less often lived independent in their dwellings than the stroke patients without LES . According to the SF-36 external and self assessment physical and mental components were worse in LES patients than in LES-free patients. Conclusion: the occurrence of LES lead to higher dependence of stroke patients and worsen their quality of live. A significant risk factor of developing LES is macroangiopathic origin of stroke.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 12
Is tPA neurotoxic in human stroke? A neuropsychological case-control study.
G. Ortega    R. Delgado-Mederos    O. Maisterra     E. Santamarina     M. Quintana    M. Rubiera     M. Ribó     L. Dinia    J. Álvarez-Sabín   C.A.Molina
 
Stroke Unit, Hospital Vall d'Hebron

SPAIN

Background: Although systemic thrombolysis has demonstrated to be effective in improving long-term outcome in stroke patients, tPA has also been shown to be neurotoxic in cultures and animal models. We aim to determine cognitive differences between tPA stroke patients and non-tPA who achieve an excellent outcome (mRS≤1) at 3 months after stroke onset. Methods: We prospectively evaluated 112 stroke patients with a MCA occlusion treated with iv tPA. Of these, 41 (36%) achieved a mRS score ≤1 at 3 months. These patients were compared with 41 non-tPA MCA strokes with 3-month mRS≤1 matched by age, sex and educational level. All patients underwent a neuropsychological testing including attention, executive functions, language, visuospaciality and memory. All scores were adjusted by age, education and were standardized (0 to 100). Global cognitive status (GCS) was defined as the mean score of all individual functions. Scores<40 determined impaired functions. Clinical and demographic data were collected. Results: 82 patients were studied. Mean age was 64 and 33% female. Mean time of education was 11 years. On admission median NIHSS score was 6 (3-12), at discharge 1 (0-3) and 31.7% had a mRS of 1 at 3 months. No differences were found between both groups in risk factors, etiology and laterality. tPA patients did not show a worse GCS (34.1% vs 46.3%, p= 0.260). The neuropsychological evaluation results were similar in both groups, although tPA patients tended to show a worse efficacy in language (82.9% vs 68.3%, p=0.123) and information processing speed (43.9% vs 26.8%, p = 0.106).Conclusions: Neuropsychological evaluation does not show significant differences and no improvement in long-term cognitive outcomes within non tPA patients even being functional independent.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 13
AN INITIAL EVALUATION OF THE PSYCHOMETRIC PROPERTIES OF A NEW CLINICAL MONITORING TOOL TO ASSESS LONGER-TERM UNMET NEEDS AFTER STROKE (LUNS)
J. Murray    J.B.Young    A. Forster     S. Bogle                                            
 
Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust

UNITED KINGDOM

Background and purpose: Stroke patients may experience a range of longer-term problems encompassing physical, social and mental well-being. There is currently no available measure that provides a ‘good fit’ across all of these outcome domains in the special context of longer-term stroke care. Through literature reviews, preliminary psychometric testing, expert peer review and consumer feedback we have developed a patient-centred, short but comprehensive clinical monitoring tool to measure longer-term unmet needs after stroke (LUNS). The postal reliability and validity of the 21-item LUNS has been tested in an initial study. Methods: The LUNS was presented in a pack with two other validated outcome measures (hospital anxiety and depression scale (HADS) and the Nottingham extended activities of daily living scale (NEADL)). Stroke patients were recruited retrospectively (living at home up to two years post-stroke) and prospectively (due to return home from hospital). The pack was posted to patient’s homes on two separate occasions approximately one week apart. Results: Packs were posted to the homes of 65 patients of whom, 48 (74%) completed the questionnaire twice. Percentage agreement between timepoints 1 and 2 was 85%. Reliability testing revealed Kappa scores of >0.5 for 18 of the 21 items. Cronbach’s Alpha scores were 0.8 and 0.76 at timepoints 1 and 2 indicating adequate internal consistency of the LUNS. Principle component analysis of the LUNS revealed low coefficients for four items. Moderate discriminant and concurrent validity was observed between the LUNS and the HADS and NEADL respectively. Discussion: The initial study revealed that the LUNS has adequate reliability and validity. Further research to refine the LUNS by way of qualitative semi-structured interviews with stroke patients is underway. The psychometric properties of the next version of the LUNS will be evaluated in a larger multi-centre study. Currently the LUNS show promise as a comprehensive clinical monitoring tool and an outcome measure for use in rehabilitation trials.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 14
Community-based stroke care in Ireland: the Irish National Audit of Stroke Care (INASC)
A. Hickey    F.  Horgan    H. McGee     D. O'Neill                                            
on behalf of the INASC team
Royal College of Surgeons in Ireland

IRELAND

The extent of stroke-related disability typically becomes most apparent after patient discharge to the community. Maximising rehabilitation input at this point can minimise the impact of disability. As part of the Irish National Audit of Stroke Care (INASC), a national survey was conducted of community-based allied health professionals (AHPs) and public health nurses (PHNs). The aim was to document availability of services for patients with stroke and to profile the views, experiences and needs of these community health professionals. The survey was conducted in three phases, involving interviews with representative regional managers for services incorporating stroke (N=7), disciplinary AHP and PHN managers (N=25), and a postal survey of frontline staff (N=97). Participation across the three surveys was 85%. Results indicated a lack of formal, structured community-based services for stroke, with no designated posts for stroke care across disciplines nationally. There was significant regional variation in availability of AHPs, some disciplines focusing almost exclusively on services for children. Considerable inequity was identified in access to services for patients with stroke, with greater access, where available, for older patients (>65 years). The absence of stroke prevalence statistics was identified as a significant impediment to service planning, alongside organisational barriers to employment of additional staff. While services for stroke in the community were very limited, overall, there were encouraging initiatives likely to impact positively on community management of stroke. These included, in particular, the development of Primary Care Teams to facilitate GP, AHP and PHN co-ordination in team-based approaches to stroke patient care in the community.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 15
Etiology and clinical outcome in young adults (19-45 years old) with ischemic stroke in an outpatient stroke clinic in a greek general hospital
M.K.Gryllia    P. Philippakopoulou    I. Chatzi     C. Doulia     C. Carageorgiou                                    
 
Neurology Department of the General Hospital of Athens

GREECE

Objective: To determine the etiology and the 3 year outcome in 107 young adults (19-45 years old) admitted consecutively in our department between 2000 and 2002 for an ischemic stroke Material and methods:We included all young patients (19-45 years old) admitted in our department for an ischemic stroke during a two years period.We defined the etiology of stroke according to the TOAST criteria:large vessel atherosclerosis,cardioembolism.small vessel disease,other definite causes and undetermined causes.Follow-up was obtained with clinical examination every 6 months.Functional outcomes were classified with the modified Rankin scale (mRS). Results: 107 patients were included.Stroke was attributed to a large vessel atherosclerosis in 11 patients (10,28%),a cardioembolism in 17 patients (15,8%),small vessel disease in 14 patients (13%),cervical artery dissection in 18 patients (16,8%),angiitis in 4 patients (3,07%).No cause could be defined in 43 patients (40%).After a mean follow-up of 3 years no patient was lost to follow-up.An annual stroke reccurence rate of 3,7% was found during the first year and then of 1,8%.Annual mortality rate for the first year was 1,8%.Annual mortality rate for the next 2 years was very low (below 1%).Independence (mRS=0 to 2) was found in 92 patients (80,6%).A 0,6% annual rate of myocardial infarct was found. Conclusion: In young patients who experience ischemic strokes no etiology can be established in 40% of cases.Although there is a low risk of stroke recurrence 205 of patients do not regain independence

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 16
Prevalence of fatigue, sleepiness and hypersomnia after ischemic stroke
P.O.Valko    C.R.Baumann    C.L. Bassetti                                                    
 
University Hospital Zurich

SWITZERLAND

Background: The prevalence of poststroke fatigue is high (30-74%). The simultaneous prevalence of other vigilance disturbances following stroke - including excessive daytime sleepiness (EDS) and hypersomnia - as well as their association with fatigue and other stroke-related factors have not yet been studied. Objective: To assess the prevalence of fatigue, excessive daytime sleepiness, and hypersomnia after ischemic stroke, and to elucidate their relationship to demographic and clinical variables. Methods: The Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale (ESS) and mean bedtimes (as a measure of sleep need per 24 hours) are assessed in 285 consecutive patients with a history of definite ischemic stroke. Results: Fatigue (FSS score >/=4.0) was found in 135 (47%), EDS (ESS >/=10) in 79 (28%), and hypersomnia in 77 (27%) patients. Fatigue was frequently associated with EDS (44%) and hypersomnia (36%) (p<0.001 and p=0.003, resp.). Multivariate analysis showed that mRS at discharge (p<0.001) and (younger) age (p=0.031) are independent predictors of poststroke fatigue severity; NIHSS at discharge (p<0.001), (older) age (p<0.001), female sex (p=0.001), and (longer) duration of hospital stay (p=0.032) are independent predictors of poststroke hypersomnia. Conclusions: Poststroke fatigue is often associated with EDS and hypersomnia. Severity and frequency of poststroke fatigue is higher in younger age categories, and is related to stroke outcome. Conversely, poststroke hypersomnia is more frequent in females and in older age categories, and may be predicted by stroke severity and duration of hospital stay.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

 17
Quality of Life in Survivors after Cervical Artery Dissection
U. Fischer    I. Ledermann    K. Nedeltchev     N. Meier     J. Gralla    M. Sturzenegger     H.P.Mattle     M. Arnold             
 
Inselspital, University Hospital Bern and University of Bern

SWITZERLAND

Background and purpose: Few data exist about long-term clinical outcome, quality of life (QOL) and its predictors after spontaneous cervical artery dissections (sCAD). Methods: Clinical and radiological data of 114 patients with sCAD were collected prospectively. Six patients died within the first 3 months. The remaining 108 were contacted after a mean of 1498 days (range: 379-3455), 99 survivors (92%) responded. QOL, assessed with the stroke specific quality of life scale (SS-QOL), and functional abilities, measured with modified Rankin Scale (mRS) were compared, and predictors of QOL were analyzed. Subgroup analyses were performed for patients with ischemic stroke, those with isolated local symptoms or transient ischemic symptoms and those without significant disabilities (mRS 0-1) at follow-up. Results: Seventy-one of 99 patients (72%) had no significant disability, but only 53 patients (54%) reported a good QOL (SS-QOL >/=4). Compared to the premorbid condition of all patients, SS-QOL was significantly impaired after sCAD (p<0.001); impairment of QOL was observed in patients with ischemic stroke (p<0.001), in patients with isolated local or transient ischemic symptoms (p<0.038) and patients without significant disabilities at follow-up (p=0.013). Nevertheless, low mRS was associated with better overall QOL (Kendall’s tau >0.5). High National Institute of Health Stroke Scale score on admission and higher age were independent predictors of impaired QOL (p<0.05). Conclusion: QOL is impaired in almost half of long-term survivors after sCAD, even in patients with local or transient symptoms and in patients without functional disability. Impairment of QOL is surprisingly frequent long-term sequelae after sCAD and deserves attention as an outcome measure in these patients.