XVII. European Stroke Conference
Nice, France

Poster Session: Epidemiology of stroke

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Sex differences in stroke treatment and outcome
M. Eriksson    E-L. Glader    B. Norrving     A. Terént     B. Stegmayr                                    
 
Department of Public Health and Clinical Medicine, Umeå University

SWEDEN

Background - Results from previous studies concerning sex-related differences in stroke treatment and outcome are inconsistent and not always easily interpreted. We used data from a national stroke register to investigate and further explore possible sex differences in baseline characteristics, stroke treatment and outcome. Methods - This study included 24 633 stroke events registered in Riks-Stroke, the Swedish national quality register for stroke care, during the year 2006. Information concerning risk factors, functional status, living conditions prior to stroke as well as information about consciousness on admission, stroke subtype, medical treatment, secondary complications and stroke unit care were collected during the hospital stay. After three months, the patients living conditions and outcome were followed up. Results - Women were older than men when they had their stroke (mean age 78.4 vs. 73.6 years). They were also more often living alone or in institution and were more often dependent in ADL prior to stroke. On admission to hospital, women were more often unconscious than men. Among conscious patients, there was no sex-related difference in the utilisation of stroke unit care. Men and women had equal probability to receive trombolysis and oral anticoagulants. Women were more likely to have deep venous thromboses and fractures, whilst men were more likely to have pneumonia during their hospital stay. Women had worse 3 months survival, a difference that was associated with higher age and impaired level of consciousness on admission. Women were less often living at home at the follow-up. However, the difference in residency was not present among patients living at home without community support with a spouse prior to stroke. Conclusions - Observed sex differences in stroke care and outcome are mainly explained by women’s higher age and lower level of consciousness on admission.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Outcome and characteristics of transient monocular blindness in SOS-TIA clinic.
L. Cabrejo    J. Labreuche    P.C.Lavallee     E. Meseguer     M. Mazighi    T. Slaoui     H. Abboud     I.F.Klein    P.J.Touboul   P. Amarenco
 
INSERM-U698 and Denis Diderot University-Paris VII

FRANCE

Background To describe characteristics of transient monocular blindness (TMB) in a TIA clinic and to evaluate the 90-day stroke risk. Methods 1,085 consecutive patients with a suspicion of TIA were admitted to the SOS-TIA clinic with round-the-clock access, immediate evaluation lasting <4 hours, and immediate multifactorial therapeutic interventions. In 643 patients with definite TIA, we compared clinical features, carotid duplex ultrasonography and 90-day stroke rate between patients with TMB and those with cerebral TIA. Results 110 patients (17%) had TMB. Compared to patients with cerebral TIA, TMB patients were younger (mean age 62 vs. 67, p<0.01), and had less cardiovascular risk factors, especially diabetes mellitus (5% vs. 71%, p<0.05), shorter duration of symptoms. (≤ 5 minutes, 69% vs. 32%, p<0.001), and more often had an unknwon underlying cause (67% vs. 51%, p<0.01). Internal carotid artery (ICA) atherosclerosis (plaques with and without lumen stenosis or occlusion) was less frequent in TMB group (49% vs 68%, p=0.01), except for severe ICA atherosclerosis (stenosis ≥70% or occlusion) detected in 11% (n=12) of TMB patients and in 7% (n=36) of patients with cerebral TIA (p=0.08). As part of multifactorial treament intervention, 8% (n=9) of TMB patients had a carotid endartectomy. Within 90-days from examination, there were no stroke in TMB patients and 12 (2.2%) in patients with cerebral TIA. The mean 90-day stroke rate expected from ABCD² score was 2.5% in TMB patients and 7.2% in patients with cerebral TIA. Discussion Among patients with definite TIA, 17% had TMB. One patient in 12 with TMB were elligible for carotid endarterectomy. Patients with TMB had better prognosis than patients with cerebral TIA.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Asymptomatic Cerebral Microbleeds Seen in Healthy Subjects Have a Strong Association with Asymptomatic Lacunar Infarction.
M. Igase    Y. Tabara    N. Ochi     T. Nagai     T. Kido    K. Sadamoto     K. Igase     K. Kohara    T. Miki      
 
Department of Geriatric Medicine,Ehime University Graduate School of Medicine

JAPAN

Purpose:Gradient-echo (GE) T2*-weighted Magnetic Resonance (MR) imaging is highly sensitive in the detection of cerebral micro bleed (CMB). CMB is considered to be a risk factor of occurrence of intra cerebral hemorrhage in the patients. Even neurologically healthy persons are pointed out asymptomatic CMB. To confirm both the frequency of the CMB and the backgrounds seen in the brain dock participants could be contributory to prevent future cerebrovascular disease. Methods:The subjects were comprised of 377 neurologically healthy peoples (149 men, mean age 67.6years) who visited the Anti-Aging Center at Ehime University Hospital for medical check-ups. CMBs were defined as a small hypointense signal (<5mm in diameter) with a well-defined margin on the T2*-weighted GE images. Silent lacunar infarction (SLI) was defined as small lesions of hyperintensity on T2-weighted MRI and corresponding distinctive low-intensity areas on T1-weighted MRI. Results:The overall incidence of CMB was 5.6% (21/377). In these 21 individuals (8 men, age 72years), CMB is associated with a high incidence of hypertension. Gender, BMI, high LDL-cholesterol level, low HDL-cholesterol level, insulin resistance, visceral fat, and micro albuminuria did not influence the presence of CMBs. 10.1% subjects had silent launar infarction (SLI). Eight of 38 (21.1%) subject with SLI had CMBs compare with 13 of 339 (3.8%) without SLI (p<0.001, Fisher’s exact test). In a simple correlation analysis, CMB showed a positive association with age (p=0.006), and Systolic blood pressure (SBP) (p=0.091). Logistic regression analysis revealed that SLI was the factor most strongly associated with occurrence of CMB (Odds ratio=5.813, p=0.001). No other conventional risk factors were identified in this analysis. Conclusions:The risk factors of CMBs are completely different from conventional risk factors for ischemic infarction. CMB may be one of the target organs damages of high blood pressure and significance of CMB in the physically healthy person should be clear by future examination.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Lipids and carotid plaque in the Northern Manhattan Study (NOMAS)
H. Gardener    D. Cabral    F. Denaro     M.S.Elkind     R.L.Sacco    T. Rundek                             
 
University of Miami Miller School of Medicine

USA

Background: Lipids, in particular elevated low-density lipoprotein (LDL) and decreased high-density lipoprotein (HDL), are associated with an increased risk of stroke and cardiovascular disease, possibly due to atherosclerotic plaque formation. The objective of this cross-sectional analysis was to investigate the relation between blood lipid profiles and carotid plaque. Methods: As part of NOMAS, a prospective population-based study to determine the incidence and risk factors of stroke in a multiethnic stroke-free population, we evaluated 2338 participants with blood lipid measurements and B-mode ultrasound of carotid arteries (mean age 68 +/- 10 years; 39% men; 55% Hispanic, 24% black, 21% white). The association between lipid parameters and carotid plaque (yes/no) was analyzed by multiple logistic regression. Results: Plaque was present in 59% of participants. The mean total cholesterol was 203.8 +/- 40.0 mg/dl. After controlling for other pertinent lipid parameters, demographic factors and risk factors for plaque, the only total cholesterol subfraction associated with carotid plaque was LDL (OR for a 10-unit change= 1.04, 95% CI 1.02-1.07). Neither HDL nor triglycerides, nor the ratio triglycerides:HDL, independently predicted carotid plaque. Lipoprotein A was also independently associated with an increased risk of plaque (OR for a 10-unit change= 1.05, 95% CI 1.00-1.10). An analysis of precursor proteins supports the strength of the LDL association, as ApoB was associated with an increased risk of plaque (OR for a 10-unit change= 1.12, 95% CI 1.04-1.21), whereas ApoA-I was not. Among the common lipid ratios examined, ApoB:HDL had the strongest relation with carotid plaque (OR=1.39, 95% CI 1.17-1.65; total cholesterol:HDL OR=1.10; LDL:HDL OR=1.14). Discussion: These results indicate that among the common lipid parameters, LDL has the strongest relation with carotid plaque, and the association with non-HDL cholesterol is likely driven by LDL. While elevation of HDL may be beneficial, therapies that lower LDL and ApoB may be most effective to reduce plaque formation.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Stroke severity, its correlates and impact on thrombolysis in a population-based study
F. Fluri    P.A.Lyrer    M. Gostynski     L.  Bonati     S.  Papa    V. Ajdacic-Gross     S.T.Engelter                     
 
University Hospital Basel

SWITZERLAND

Objective: Data about the distribution of stroke severity and its correlates are sparse. In a population-based approach, we determined the NIH-Stroke-scale score (NIHSSS) and studied associations with demographic variables, type of stroke care provider, etiology, the onset-assessment-interval (OAI), and the rate of thrombolysis. Methods: We performed a databank-based post hoc analysis of data ascertained during the prospective, population-based stroke study among the 188’015 permanent residents of the canton Basle-City, Switzerland (2002/3). Results: In 246 of 269 (91.4%) patients, NIHSSS were available. The mean NIHSSS was 7.2+/-7.3. NIHSSS 0-6, 7-15, and >15 was present in 156 (63%), 56 (23%), and 34 (14%) patients, respectively. Higher NIHSSS were associated with advancing age (p=0.038), female gender (p=0.04), stroke unit treatment (p=0.003), cardioembolic etiology (p<0.001), shorter OAI (p=0.009), and thrombolytic therapy (p<0.001). Multivariate regression analyses revealed that advancing age, shorter OAI and thrombolytic treatment were independent correlates of higher NIHSSS. Stroke unit patients differed from non-stroke-unit patients in shorter OAI, younger age, and higher NIHSSS. The epidemiological thrombolysis rate amounts to 7.5 (95%CI 4.1–12.2) per 100’000 population/year. Conclusion: In a geographically defined stroke population, one of three patients had moderate to severe strokes. Patients with less severe strokes were younger, sought medical attention later and were less likely to receive thrombolysis. Thus, public stroke awareness programs should target also younger individuals and stress that also mild-moderate strokes benefit from emergent medical care, including thrombolysis. For western countries, planning of stroke care should assume the need of 75 thrombolyses per million inhabitants per year.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Clinical severity predicts time to hospital admission in patients with spontaneous intracerebral hemorrhage
H.B.Huttner    M. Köhrmann    D. Staykov     E. Jüttler     J. Bardutzky    P.D.Schellinger     S. Schwab                     
 
Dept Neurology, University of Erlangen, Germany

GERMANY

Background: In this study we analyzed whether demographic, clinical and neuroradiological parameters are associated with time to hospital admission in patients with spontaneous intracerebral hemorrhage (ICH). Methods: Clinical and neuroradiological parameters of consecutive patients with spontaneous ICH directly admitted to two neurological University departments were subjected to correlation and logistic regression analyses for prediction of (i) early hospital admission, and (ii) favorable clinical presentation at admission (dichotomized Glasgow Coma Scale >/=9). Results: One hundred fifty-seven (157) patients with a median age of 66 (39-93) were analyzed. Patient trichotomization according to the GCS revealed a significant difference (p<0.001) between all groups with regard to the time from symptom onset to hospital admission: patients with a GCS 3-5 were admitted after 105 (40-300) min, those with a GCS 6-9 after 180 (45-420) min, and those with a GCS 10-15 after 300 (60-1560) min. There were significant correlations between (i) hematoma volume and GCS, (ii) time to admission and GCS, and (iii) Graeb scores for intraventricular hemorrhage (IVH) and hematoma volume. In the multivariate regression model for prediction of time until hospital admission, presence of IVH and the GCS on admission were significant. In the multivariate regression model for prediction of a GCS on admission of >/=9, hematoma volume and time until hospital admission were significant parameters. Discussion: Clinically more severely affected patients were admitted to hospital earlier. This highlights the importance of most rapid diagnosis of ICH. Efforts should be made to get less severely affected patients admitted earlier as they might be ideal candidates for emerging innovative treatments.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Systematic declaration of Serious Adverse Events (SAE) in a critical care stroke unit: results over a one year period.
S. Deltour    C. Pires    I. Meresse     C. Rosso     S. Crozier    A. Leger     F. Bourdillon     Y. Samson             
 
Stroke Unit, Pitié Salpêtrière Hospital , Paris

FRANCE

OBJECTIVE: To determine the incidence and nature of SAE in acute stroke unit. BACKGROUND: Systematic recording of SAE is a major element of medical and economic evaluation in acute stroke units and could contribute to improve the quality of the care. We report here our experience between October 2006 and October 2007. METHODS: SAE were collected in a prospective way on a computer form whose methodology is detailed in another abstract (Pires et al. ESC 2008). RESULTS: Fifty one patients of 294 (17%) experienced 71 SAE during the studied period. Thirty height patients presented a neurological SAE (contributed to death for 15 patients) with mainly: 13 malignant brain infarcts, 12 extensions of infarct size, 5 increases of size and/or oedema of haematoma, 4 hemorrhagic symptomatic transformations after t-PA therapy, and a hypoglycemia under insulin. Height patients presented a non neurological SAE (contributed to death for 2 patients) including mainly 5 respiratory distresses with one occurring after bronchoscopy, one aortic dissection extended after t-PA therapy and one peritoneal hemorrhage under anticoagulant treatment. Lastly, 5 patients suffered at the same time neurological and non neurological SAE (contributed to death for 1 patient).SAE group was older (70 vs 59, p=0,0001) and more serious (initial NIHSS with 20 vs 9, p<0,0001) that group without SAE. The average duration of days in hospital in a critical care stroke unit was also longer (11 vs 4 days, p<0,0001) with a less frequent return at home (2% vs 40%, p<0,0001). CONCLUSION: This study shows that SAE occur among old and serious patients. The sources of SAE are often neurological and generally dominated by the malignant brain infarct. They have a major impact over the duration of days in hospital. One SAE on 9 is of iatrogenic origin and 1 on 14 is caused by the t-PA therapy in this series.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Incidence rates of intracerebral and subarachnoid hemorrhage: first results from the EVROS-INTRA registry.
K. Vadikoias    I. Heliopoulos    G. Tsivgoulis     M. Papaioakim     C. Aggelopoulou    T. Birbilis     K. Kontoyiannidis     C. Piperidou             
 
Department of Neurology, Democritus University of Thrace, Alexandroupolis, Greece

GREECE

Background: Epidiomological data on subarachnoid (SAH) and intracerebral (ICH) hemorrhage rates from South-Earstern Mediterranean area are scarce. We organized a prospective population-based registry in Evros province, located in north eastern Greece, to determine SAH and ICH incidence in Greece over a 5-year period. Methods: The EVROS-INTRA (EVros Registry Of Spontaneous Intracranial Non-TRaumatic hAemorrhage) was a prospective computerized registry that included all the records of patients, who were permanent residents of Evros region, with a diagnosis of intracranial haemorrhage, either intracerebral or subarachoid, excluding traumatic causes. Standard definitions and overlapping case-finding methods were used to identify all cases of first-ever in a lifetime intracerebral and subarachnoid hemorrhages (FELHSHs) in all age-groups, occurring in the 5 years of registration (Jun 1, 2001, to Jan 1, 2006). The diagnosis and stroke type were confirmed by CT scan in all cases. Sudden deaths because of FELHSHs which were been recorded from the Forensic Department were also included Results: During the 5- year period, 118 FELHSHs were registered. The mean age of cases was 59.4 years (range, 22 to 92 years), and 37.29% were female. From the 118 events registered over whole years, the crude annual incidence for the total population was 18.3 per 100 000 (10.9 for men and 7.2 for women). After age-adjustment to the European population, the incidence rate was 17.1 per 100000 (11.3 for men and 5.9 for women). The annual crude incidence rate of intracerebral hemorrhage was 10.4/100000 and of subarachnoid hemorrhage 7.9/100000. Discussion: Our findings revealed incidence rates of SAH similar to those reported from other population-based European studies but incidence of ICH was lower than previously reported.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Systematic declaration of Serious Adverse Events (SAE) in a critical care stroke unit: methodology and exhaustivity over a one year period
C. Pires    S. Deltour    I. Meresse     C. Rosso     S. Crozier    A. Leger     F. Bourdillon     Y. Samson             
 
Stroke unit Pitié Salpêtrière Hospital, Paris

FRANCE

OBJECTIVE: To develop a SAE recording system in clinical routine in a stroke center. BACKGROUND: Systematic recording of SAE may contribute to the improvement of quality of care, and we are not aware of a dedicated process for acute stroke units. We develop such a process and report our initial experience over a one year period. METHODS: We have developed a specific computerized form listing the most frequent neurological and non neurological SAE occurring in a stroke center as well as emergency transfer in other intensive care units, intubations, and death. The form is filled as soon as possible by the on duty stroke neurologist, and immediately sends by e-mail to all senior neurologists of the stroke unit and to a MD of the public health department. The process is controlled by the senior stroke fellow of the unit. The reliability of the process has been tested by cross-checking the declarations of death, transfer, and intubation reported in the SAE database with the same data recorded in other database systems of the hospital. RESULTS: One or multiple SAE were reported in 51 of 294 patients (17%) admitted in the unit between October 2006 and October 2007, including 11 emergency transfers, 17 intubations and 18 deaths. The exhaustivity of the SAE database was 100 % for death and intubations but only 69% for transfers. CONCLUSION: This process of SAE declaration was highly reliable in clinical routine for death and intubation, but remains to be improved for emergency transfers in other structures. The study also suggests that efficient and low-cost data quality management may beneficiate from automatic cross-checking of different sources of information.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Decreasing stroke mortality in Hungary – the consequence of more efficient treatment of hypertension in primary care? Observation on 8088 stroke patients over 12 years
D. Bereczki    K. Fekete    Z. Bajkó     C. Szekeres     L. Mihálka    B. Fülesdi     I. Fekete     L. Csiba             
 
Semmelweis Universit University of Debrecen

HUNGARY

Background: according to WHO data, the standardized death rate of stroke in Hungary decreased from over 240/100.000 inhabitants in 1980 to below 120/100.000 in 2005. To check if better treatment of blood pressure could be a cause of this decrease we evaluated the changes in admission blood pressure over 12 years in a stroke center. Methods: the single center Debrecen Stroke Database was established in 1995 and contains data of 8088 consecutively admitted stroke patients up till the end of 2006. Descriptive statistical methods and ANOVA were applied in the current analysis. Results: there was a clear trend for decreasing annual hospital case fatality ranging between 16.8 – 20.7% for men and 16.2 – 20.1% for women in the 1995-2000 period to 9.7 – 14.5% and 10.2 – 16.2 values for men and women respectively in the 2001-2006 period. Mean systolic blood pressure measured on admission decreased from 158 +/- 27 in 1995 to 154 +/- 28 mm Hg in 2006 in men and from 163 +/- 30 to 150 +/- 27 mm Hg in women. A decrease in admission diastolic pressure was also observed: from 90 +/-13 and 91 +/- 13 in men and women in 1995 to 89 +/- 14 and 86 +/- 14 in 2006. Blood pressure values significantly differed between genders and among years (p<0.001). Conclusions: Hospital case fatality trends in a single center reflected the decreasing stroke mortality data of the population. Changing admission blood pressures values over 12 years might reflect improving blood pressure control in the population. A similar drop in case fatality is associated with a much larger drop in admission blood pressure values among women then among men. Better blood pressure control may contribute to, but probably is not the only factor responsible for decreasing stroke mortality in this Central European population.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Comparison between risk factor profile of lacunar and non-lacunar stroke in Dijon, France, from 1989 to 2006. A population-based study
Y. Bejot    G.V.Osseby    O. Rouaud     M. Caillier     G. Couvreur    J. Durier     A. Gentil     I. Benatru    T. Moreau   M. Giroud
 
Dijon Stroke Registry, EA 4184

FRANCE

Background: Certain studies suggest there is a correlation between the prevalence of certain cerebrovacular risk factors, such as hypertension and diabetes mellitus, and lacunar stroke. However, there is still controversy about the existence of a particular of risk factor profile associated with this ischemic stroke subtype. Methods: We compared the prevalence of classical cerebrovascular risk factor in patients with symptomatic lacunar stroke with those in patients with non-lacunar infarct in a prospective well-defined population-based study, in Dijon, France (150,000 inhabitants), from 1989 to 2006. Results: We recorded 2536 ischemic strokes. Among these, 715 (28%) were classified as lacunar stroke (354 men and 361 women) and 1821 were identified as non-lacunar stroke (831 men and 990 women). Concerning the distribution of risk factors, a history of atrial fibrillation was significantly more frequent in patients with non-lacunar ischemic stroke (31%, 95% CI 0.29-0.33), than in patients with lacunar infarcts (15%, 95% CI 0.13-0.18) (p<0.001). We did not find any significant difference in the distribution of the other cerebrovascular risk factors, especially hypertension and diabetes mellitus. Conclusion: Our results suggest that there is no particular risk factor profile associated with lacunar stroke. The apparent excess of hypertension and diabetes in lacunar versus non-lacunar stroke reported in some studies could be due to classification bias or the fact that these studies were hospital-based.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Factors associated with delayed admission of Nigerian stroke patients to hospital: a prospective multicentre study
F. Salawu    A. Danburam    S. Bwala     D. Balami     J. Agbo    Y. Jubrin     A. Olokoba     B. Grema             
 
Federal Medical Centre Yola

NIGERIA

Background: Early admission to hospital followed by correct diagnosis with minimum delay is a prerequisite for successful intervention in acute stroke. Objective: We aimed at clarifying in detail the factors related to delay in the time to admission of Nigerians with acute stroke. Method: This prospective, multicentre, consecutive study explored factors influencing the time from stroke onset until patient arrival at the emergency department. Within three days of hospital admission, the patients, and/or their relatives were interviewed by use of a standardized structured protocol, and the patients’ neurological deficits were assessed. Early arrival was defined as within 3 hours of awareness of symptoms, all other patients were classified as late arrivals. Results: Patients (n=395) with first-ever-stroke were studied at six community-based hospitals: 293 subjects with brain infarct and 102 with intracerebral haemorrhage. Admission was markedly delayed in most patients, with less than one-tenth of our patients sought medical attention within 3 hours of becoming aware of stroke symptoms, and over 80% arriving after 24 hours. Factors significantly associated with early arrival were higher educational attainment, large strokes and no primary health care consultation. The most important reason associated with a delay in reaching the hospital was poor early stroke recognition. Other factors associated with delay were mild neurological symptoms, ischaemic stroke and stroke onset in the evening or night and prior admission in outlying hospitals. Discussion: Increased public awareness of the need to seek medical or other attention promptly after stroke onset will be required for effective treatment options for the majority of our patients who are probable candidates for thrombolytic therapy arrived after prolonged delays for multiple reasons.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Ethnic variations in acute ischemic stroke: Findings from the National Acute Stroke Israeli Survey (NASIS)
B. Gross    N.M.Bornestein     R. Schwartz      U. Goldbourt      O. Azrilin     D. Tanne                              
for the National Acute Stroke Israeli Survey Study Group
Western Galile Hospital

ISRAEL

Background: The burden and management of acute stroke may vary among ethnically and culturally diverse groups. We assessed the baseline characteristics, management and outcome of acute ischemic stroke among the Israeli Arab and Jewish population in a comprehensive national stroke survey. Methods: The NASIS was a prospective national survey conducted over a period of two consecutive months (Feb-March 2004), throughout all 28 hospitals operating in Israel, including all patients hospitalized during this period. Patients were systematically evaluated for demographics, risk factors, clinical presentation, stroke severity, type and subtype, management and clinical outcome. Results: Among the 1541 patients admitted with acute ischemic stroke,169 (11%) were Israeli Arabs and 1372 (89%) Jewish. The mean age of the Israeli-Arab patients was significantly lower (62 ±11 vs 71 ±12 years). Age-adjusted rates of diabetes and obesity were significantly higher among Arabs, while those of dyslipidemia were lower. Israeli Arabs tended to arrive less often by ambulance to the hospital (28% vs 51%), and less often arrived at the emergency room within 3 hours from onset of symptoms (27% vs 42%). No differences were observed between the groups in clinical presentation and severity of stroke according to NIH stroke scale, in management or in discharge medication, except for hypoglycemic drugs and insulin that were used more often prescribed among Israeli Arab patients. Israeli Arab patients were discharged more often to their home (75% vs 63%) and less often to nursing facilities (1% vs 5.5%). No differences were observed in functional disability at discharge, and in-hospital, 30 days and 3 months death rates adjusting for potential confounders. Conclusions: This study demonstrate the unique characteristics of the Israeli Arab population afflicted with ischemic stroke. This information should be considered when planning stroke-care services and culturally oriented public education programs, particularly modifying stroke risk factors and encouraging early arrival to hospital

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Stroke and Nursing Home Care: Quantifying the prevalence through a national study
S. Cowman    M. Royston    F. Horgan     A. Hickey     K. Galligan    H. McGee     D. ONeill                     
 
Royal College of Surgeons in Ireland and Trinity College

IRELAND

In recognition of a lack of reliable information the Irish Heart Foundation commissioned a National Audit of Stroke Care (NASC) The aim of the study was to conduct a national stroke audit of hospital and community stroke care for the Republic of Ireland. This element of national study included a random selection of 60 private and public nursing homes (3239 residents) in the Republic of Ireland. A cross-sectional survey research design was used to investigate the experiences of nursing home proprietors, staff and patients One in 6 nursing home residents in Ireland have a history of stroke (22% of public homes and 12% of private) and 96% reported a condition that substantially limited one or more basic physical activities. The overall nursing home age profile included 80% of residents aged 75 years or more with few (4%) aged less than 65 years. The age category 65-74 years represented the largest proportion of stroke patients (23%). Managers reported that 41 % of stroke residents had one of the following conditions: blindness, deafness or a severe vision or hearing impairment. Almost all 96% reported a condition that substantially limited one or more basic physical activities such as walking, climbing the stairs, reaching, lifting or carrying. Again, a majority 83% (vs 58% Census) were reported to have difficulties in learning, memory and concentration. A majority 97% had difficulties in dressing, bathing or mobilising outside the nursing home. Levels of cardiovascular medication prescribing for this post-stroke group appeared low with only (42%) prescribed anti-platelet or antihypertensive medication. Use of cholesterol lowering medication and anticoagulants was lower (36%). One in two residents was prescribed antidepressant (53%) or sedatives (56%) The study concluded that there is currently little or no structured care (beyond generic care) for stroke survivors who reside in nursing homes with gaps in service and limited resources

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Comparison of different Criteria for Atherosclerotic Plaques derived from the Mannheim Carotid Intima-Media Thickness Consensus Proposal and from the Study of Health in Pomerania
Y.M.Huang                                                                  
 
Uppsala University

SWEDEN

Background: Although the presence of atherosclerotic carotid plaques is a frequently used endpoint in epidemiological studies investigating for subclincal atherosclerosis, the definition of plaques varies considerably between different study protocols. Recently, the Mannheim Carotid Intima-Media Thickness (IMT) Consensus proposed a plaque definition based on quantitative measures. The aim of the study was to compare the plaque definition used in the Study of Health in Pomerania (SHIP) with a definition based on the Mannheim Consensus criteria. Methods: The protocol adopted from SHIP defined a plaque as any focal thickening of IMT encroaching into the vessel lumen, while the Mannheim Consensus criteria required either (1.) thickness from the media-adventitia interface to the intima-lumen interface of more than 1.5mm; or (2.) protrusion into the lumen of at least 0.5mm; or (3.) 50% of the surrounding IMT. Plaque thickness and IMT measurement of the plaque free arterial segments caudally and cranially to the plaque were performed using the cross-hair electronic calliper of the ultrasonography instrument. Results: From a total of 179 plaques, plaque thickness was less than 1.5mm in 53 plaques (29.6%). Twelve plaques (6.7%) did not encroach more than 0.5mm of the surrounding IMT into the vessel lumen. All these 12 plaques were less than 1.5mm in thickness. Half of them also did not show a protrusion of more than 50% of the surrounding IMT, meaning that a total of 6 out of 179 plaques (3.4%), which did not fulfil any of the three criteria of the Mannheim Consensus. Discussion: We found concordance between the two protocols in more than 96% of investigated plaques. However, smaller plaques may be missed by the definition proposed by the Mannheim IMT Consensus.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
By how much do hospital separation data underestimate the true frequency of acute cerebrovascular disease?
S. Phillips    c. Corning    N. Gill     G. Gubitz     W. Simpkin    J. Fang     L. Graham     J. Mathers    M. Kapral      
 
Dalhousie University

CANADA

Background Stroke surveillance remains a compromise between accuracy and completeness on one hand and feasibility and sustainability on the other. We used published event rates and data from an audit of in-patient stroke care in an entire Canadian province to estimate the gap between the true frequency of acute cerebrovascular disease and that detected by routinely collected hospital separation statistics. Methods We identified all cases of acute (within 2 weeks of onset) stroke and TIA that were hospitalized in acute care hospitals (n=33; excluding children’s and mental health care hospitals) in Nova Scotia (population 937,900) during fiscal 2004/5 from the Discharge Abstract Database maintained by the Canadian Institute for Health Information using the International Classification of Diseases, Tenth Revision codes I60, I61, I63, I64 and G45 (excluding G45.4). Trained abstractors captured information from health records using the Registry of the Canadian Stroke Network. The expected numbers of cases were estimated by applying age-specific event rates from the Oxford Vascular Study to the 2005 Nova Scotia population (based on the Statistics Canada 2001 Census). Results On review of the health records, there were 253 transient ischemic attacks (TIA), 790 ischemic strokes (IS), 92 intracerebral hemorrhages (ICH), 49 subarachnoid hemorrhages (SAH), and 203 strokes of uncertain type, for a total of 1387 cases; hospitalization rate 1.4/1000/year. The expected numbers were 1032 TIA, 1885 IS, 141 ICH, and 94 SAH (total 3152). Discussion Restricting stroke surveillance in Nova Scotia to hospitalized cases would likely seriously underestimate the frequency of acute cerebrovascular disease. More precise epidemiological data are needed for resource planning purposes.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Inter-ethnic differencs in trends in cerebrovascular disease mortality in Singapore: a 20-year study
N. Venketasubramanian                                                                  
 
National Neuroscience Institute

SINGAPORE

Background: Singapore is a small island city state in the heart of South East Asia, population 4.4 million, comprising 76% Chinese, 15% Malays, 8% Indians. Heavily-subsidised government-funded healthcare is widely available. Stroke is presently our 4th leading cause of death, with an overall falling mortality trend over the last 25 years. Aim: This study was performed to investigate inter-ethnic difference in trends in stroke mortality in Singapore. Methods: All deaths in Singapore have to be certified and notified using the International Death Certificate(IDC) to the Registry of Births and Deaths(RBD) before burial or cremation is allowed. Most deaths are certified by medical practitioners; the police are involved in certifying deaths due to unnatural causes. Data on stroke mortality was obtained from the annual reports of the RBD. The ethnicity was as recorded in the IDC. Data from 1981 to 2003 was obtained. The rates were age and sex-standardised to the World Standard Population. Data was analysed using SPSS 12.0. Results: There is a falling trend in stroke mortality for all races, from 90/100000 in 1981 to 40/100000 in 2003. The trend was seen in all 3 ethnic groups; however, there were brief, inexplicable rises from 1987 to 1991 and again from 1993 to 1994 among the Malays. Mortality was consistently higher among Malays compared to the other ethnicities for all years studied; rates were similar and Chinese and Indians. Conclusions: Stroke mortality is falling among all 3 major ethnic groups in Singapore. Malays have the highest mortality. More research is needed identify the reason for these differences. Possible reasons include differences in the presence and control of stroke risk factors as identified in the National Health Surveys, socioeconomic status, health seeking behaviour.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Allele 677T MTHFR: prothrombotic risk factor for cerebral venous thrombosis? A meta-analysis.
L.O.Gouveia    P. Canhão                                                           
 
Hospital Santa Maria, Lisboa, Portugal

PORTUGAL

Background and purpose- Methylenotetrahydrofolate reductase 677TT genotype has been associated with a higher risk of venous thrombosis. Studies of this polymorphism in cerebral venous thrombosis (CVT) are inconclusive. The aim of this systematic review was to collect studies properly conducted to compare the frequency of C677T polymorphism in CVT patients (cases) and healthy controls. Methods- We identified all published case-control studies that evaluated the presence of MTHFR mutation in CVT using the MEDLINE electronic database and reference lists of retrieved articles. Two reviewers independently selected studies. Frequency of C677T MTHFR polymorphism was compared between cases and controls using the Mantel-Haenszel method and a fixed-effects model in the pooled data. Results- Eight case-control studies were included. The pooled analysis for homozygosis included 344 patients with CVT and 1279 controls. The frequency of homozygoty for MTHFR mutation among CVT patients was not higher compared with controls (13.4% versus 13.8 %); odds ratio 0.94 (95% confidence interval (95% CI) 0.65 to 1.36; P<.001). Heterogeneity between studies was not significant (chi2=9.94, p=0.19). The pooled analysis for homo/or heterozigoty included 160 patients with CVT and 461 controls. There was increased frequency of homo/or heterozygoty MTHFR mutation in controls compared with CVT patients (49.9% versus 31.9%); odds ratio 0.60 (95%CI 0.38 to 0.96; P<.001). Considerable heterogeneity was found between studies (chi2=6.17, p=0.10) Conclusions- This meta-analysis shows that there is insufficient data to support that MTHFR mutation is a risk factor for CVT.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Configuration of the circle of Willis, direction of flow, and shape of the aneurysm as risk factors for rupture of intracranial aneurysms
N.K.de Rooij    B.K.Velthuis    A. Algra     G.J.Rinkel                                            
 
University Medical Centre Utrecht, Utrecht

THE NETHERLANDS

Background— Improved knowledge on risk factors for rupture of intracranial aneurysms may lead to more tailored aneurysm management. We studied whether configuration of the circle of Willis, direction of flow towards the aneurysm, and shape of the aneurysm are risk factors for rupture. Methods— We reviewed CT-angiograms of 126 patients with 75 ruptured and 75 unruptured aneurysms, matched for site of the aneurysm, gender and age of the patient, and year of CT-angiogram. For the characteristics studied, we calculated odd ratios (OR’s) with corresponding 95% confidence intervals (CI’s) for risk of rupture. Configuration of the circle of Willis (incompleteness, asymmetry or dominance) was analyzed on per site basis. Non-spherical shape was subdivided into elliptical (oval and oblong) and multilobed. In additional analyses we adjusted for size by means of multivariable logistic regression. Results— Flow straight into the aneurysm (OR 2.0; 95%CI 1.0-4.1) and non-spherical shape (OR 2.8; 95%CI 1.5-5.5) were associated with rupture. Both elliptical shape, with increasing OR’s for oval (OR 1.8; 95%CI 0.8-4.0) to oblong shape (OR 6.2; 95%CI 1.9-21), and multilobed shape (OR 4.1; 95%CI 1.2-14) were associated with rupture. These OR’s decreased after adjustment for size. Configuration of the circle of Willis was not associated with a strong risk of rupture; moderate risk could not be excluded. Conclusion— Direction of flow into the aneurysm and non-spherical (both elliptical and multilobed) shape may contribute to the risk of rupture, but are related to aneurysm size and may warrant more frequent follow-up.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Risk Factors for stroke among diabetic and nondiabetic women with coronary heart disease.
U. Goldbourt    N. Koren-Morag    D. Tanne                                                    
 
Tel Aviv University Medical Faculty

ISRAEL

Diabetes exposes men and women to increase risk of coronary heart disease (CHD) and stroke. The risk of women with CHD and the factors disposing them to stroke have not been fully investigated. We used data from a screening of 15,700 CHD patients for a secondary prevention trial Bezafibrate Infarction prevention (BIP). Vascular co-morbidity was recorded and functional limitation according to NYHA classification was assessed. Follow-up lasted from 1990/2 to 1999, over a mean period of 8 yrs. Mortality was obtained by matching with the National Population registry and incident stroke was assessed from hospital records. There were 714 female and 2,139 male diabetic CHD patients, and 2,181 female and 10,044 nondiabetic counterparts. Multivariate analysis using a yielded hazard ratio (HR) estimates for age, NYHA class, peripheral vascular disease (PVD), hypertension and serum lipid levels. Results. The age-adjusted rates stroke for diabetic and nondiabetic women with CHD were 6.5% and 11.7%, respectively. The corresponding rates for men were 6.3% and 13.1%, respectively. Hazard ratios for factors predicting the risk among women are depicted in the table. Hypertension, smoking, serum cholesterol, and PVD increased the risk of stroke materially among non-diabetic women but were weakened or erased in diabetic women, among whom only deteriorated NYHA class appeared to play an important predictive role. In contrast, diabetic and nondiabetic men with CHD exhibited a nearly identical risk profile for stroke. Comment. We showed similar risk of stroke in diabetic men and women with CHD. A biologically plausible explanation for neither the attenuation of risk factors in diabetic women with CHD, nor the inefficiency of predicting stroke risk among them, remains to be elucidated.

 
http://www.eurostroke.org/ni_graphics/t_aid3058.htm

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Sex differences in ischemic stroke in Korea
B.C.Lee    K.H.Yu    M.S.Oh     J.K.Roh                                            
Korean Stroke Registry Study Group
Hallym University Sacred Heart Hospital

SOUTH KOREA

Background and Objective: Acute stroke is the leading cause of death and disability in not only men but also women. However, there are a few of limited data analyzing acute stroke in women, taking into account the vascular risk factor, stroke subtype, and outcome, especially in Korean population. The aim of this study was to assess whether sex differences exist in patients with acute stroke who have registered in the Korean Stroke Registry (KSR). Methods: Among 26,152 patients in the KSR between November 2001 and March 2007, we excluded the cases with missing data including sex, the TOAST classification, brain imaging, and so on. Finally, a total of 21,350 patients (43.4% women) were analyzed for demographics, risk factors, stroke subtypes, and outcome data. Results; Women were older than men (68.4±11.7 vs 63.4±11.9, P<0.001). Women had higher rates of hypertension (P<0.001), hyperlipidemia (P<0.001), and atrial fibrillation (p<0.001), whereas smoking (P<0.001) was related to men. Women suffered more cardioembolic (p<0.001) stroke; men suffered more large artery atherothrombotic strokes (p=0.018). There are no sex differences in stroke severity at admission. However, women were more likely than male to have the durations of hospitalization (P<0.001), mortality in hospital (P=0.02) and women stroke survivors had more disable than men (p<0.001). Conclusions; Women differ from men in the distribution of vascular risk factors, stroke subtypes, and outcome. The amelioration of hypertension and hyperlipidemia control and anticoagulant treatment in patients with atrial fibrillation would be the best options for preventing stroke, especially in women.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Tea consumption is inversely associated with carotid plaques in women
S. Debette    N. Leone    D. Courbon     J. Gariépy     C. Tzourio    J.F.Dartigues     P. Barberger-Gateau     K. Ritchie    A. Alpérovitch   P. Amouyel
P. Ducimetière and M. Zureik.
(EA2691), University Hospital of Lille; Inserm, U744, Lille,

FRANCE

Background: Several studies have suggested an inverse association of tea consumption with coronary artery disease and stroke, although some conflicting data exist. The relationship of tea consumption with carotid plaques has not been evaluated before. Aim: The aim of the present study was to assess the relationship between tea consumption and both common carotid artery intima-media thickness (CCA-IMT) and carotid plaques in a large population-based study. Method: The study was performed on 6597 subjects aged >65 years, recruited in the French population for the Three-City-Study. Carotid ultrasound examination included an assessment of atherosclerotic plaques in the extracranial carotid arteries and a measurement of IMT in the common carotid arteries (CCA) at a site free of plaques. We also tested whether the results found in the Three-City-Study could be replicated in an independent and younger French population sample (EVA-Study). Results: In the Three-City-Study, increasing daily tea consumption was associated with a lower prevalence of carotid plaques in women: 44.0%, 42.5% and 33.7% in women drinking no tea, 1-2 cups per day and >3 cups per day respectively (p=0.0001). This association was independent of age, centre, major vascular risk factors, educational level, and dietary habits: multivariable OR=0.68[95%CI:0.54-0.86] for women drinking >3 cups of tea daily compared to women drinking none. Results were unchanged after excluding women with a history of vascular disease (OR=0.70[95%CI:0.56-0.89]). In the EVA-Study, carotid plaque frequency was 18.8%, 18.5% and 8.9% in women drinking no tea, 1-2 cups per day and >3 cups per day respectively (p=0.08). In both studies there was no significant association of tea consumption with carotid plaques in men and with CCA-IMT. Discussion: These results may suggest a protective effect of tea consumption on carotid atherosclerosis in elderly women. Further studies are warranted to confirm this and improve our understanding of the underlying mechanisms.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
State of Current lipid and hypertension TReatment Of stroke patients in KorEa: The STROKE Study
G. Lee    H.S.Bae    J. Kim     Y. Kim     E. Kim    J. Kim     Y.S.Lee     S. Suk    G. Cho   J. Cha
J Lee, JS Koo, J Lee, and for the STROKE study investigators
Samsung Medical Center

SOUTH KOREA

Background & Objectives: We tried to investigate the prevalence of hypertension and dyslipidemia and the proportion to reach BP/lipid goals in Korean stroke patients. Methods: This is a nationwide, multi-center, retrospective observational study, planning to recruit patients from 12 hospitals scattered over the nation. Eligibility criteria were as follows; 1) hospitalized within 7 days from the onset of acute cerebral infarction or transient cerebral ischemia, 2) available medical records, 3) discharged within 3 months, and 4) followed up at out-patient-clinic after 3 months but not later than 9 months. All clinical and laboratory parameters were predefined and extracted by trained research nurses from admission and out-patient clinic records until 9 months after the onset. Results: During 2005, 5523 patients were hospitalized, 1808 were randomly selected, and 1050 met all the criteria. Among 1672 who met the eligibility criteria 1) & 2), 61.8% had a history of hypertension, 38.2% took antihypertensive during hospitalization, and 47.7% had BP > 140/90 mm Hg at discharge. If we define hypertension as having any of these, 81.5% were hypertensive. For dyslipidemia, only 5.4% had a history, 34.4% took medications during hospitalization, and 28.5% had LDL cholesterol 130 mg/dL or more. If we define dyslipidemia as a history or high LDL cholesterol, 32.7% were dyslipidemic. Among 1050 who met all the criteria, 17.3% had no BP data, and 75.5% had no lipid measurement after discharge. During follow-up period, BP was controlled in 53.6% of all subjects and 52.6% of hypertensives, and LDL cholesterol was controlled in 20.5% of all subjects and 24.5% of dyslipidemics. BP and lipid measurement and control rates varied markedly by hospital. Conclusion: This study showed that in Korean stroke patients, 1) the prevalence of hypertension and dyslipidemia are relatively high, 2) about a half of hypertensives are under-treated, and 3) with respect to lipid management, the poor measurement seems more problematic than treatment.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
NOS3 Glu/Asp in codon 298 of exon 7 in stroke patients
S. Markoula    G Demin    S Giannopoulos     A Tatsioni     APKyritsis    I Georgiou                             
 
University Hospital of Ioannina

GREECE

Background and Purpose: Variants at the NOS3 gene have been related to type 2 diabetes mellitus, insulin resistance, metabolic syndrome and coronary artery disease. Our purpose is to investigate a possible relationship of the NOS3Glu/Asp in codon 298 of exon 7 in the NOS3 gene with stroke. Methods: We prospectively recruited patients hospitalized with ischemic stroke, between 2005 and 2007. All patients were classified as cardio embolism, large-artery atherosclerotic, lacunare, of other demonstrated etiology and of undetermined etiology according to TOAST criteria. Only patients with large-artery atherosclerotic stroke and lacunars were included and were stratified in two groups. We used univariate logistic regressions to examine the association between each one of the following characteristics in the groups of large-artery atherosclerotic stroke and lacunars with controls: genotype, female gender, age, age at first event, and pathological triplex. Results: The group of large-artery atherosclerotic stroke was consisted of 76 patients and the group of lacunars was consisted of 70 patients and the control group was consisted of 150 healthy individuals. There was no significant association between genotype and large artery stroke group or lacunar group (Kruskal-Wallis 2.44; P=0.12), or genotype and pathological Triplex results (Kruskal-Wallis 1.72; P=0.20). Only female gender was correlated with large-artery atherosclerotic stroke (odds ratio 0.49; 95% confidence interval 0.26-0.92, P=0.03). None of the other variables was found to be an independent predictor for large-artery atherosclerotic stroke, lacunars or pathological Triplex results. Discussion: Although this particular variant of NOS3 gene was negative for association with stroke and also equally distributed among large artery stroke and lacunars, the significance of NOS3 for endothelial function can not be ruled out in stroke. More variants of this gene and of the other members of NOS gene family are needed to explore, in depth, the influence of these genes in stroke predisposition.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
CIRCADIAN VARIATION OF THE STROKE INCIDENCE IN A FRENCH HYPERTENSIVE COHORT: THE CICLADES STUDY
R. Asmar    M. Rejdych    D. Miljkovic                                                    
 
Cardiovascular Institute

FRANCE

OBJECTIVE: To assess the circadian variation in the occurrence of stroke, and to describe the patient’s characteristics. METHODS: This was a national, multicentre, cross-sectional study conducted retrospectively by cardiologists using their patients’ records. All patients were hypertensive with uncontrolled blood pressure, treated or not, and who experienced stroke within one year prior to inclusion. RESULTS: 585 cardiologists participated to this study. They reviewed 1159 patients records. Most of patients were men (74%) with a mean age of 67 ± 11 years.. 28% of them had a stroke. According to their files, the first symptoms of stroke occurred during the morning period (6h-12h) in 60% patients: 61.9% in male and 56.7% in female; in the afternoon period (12h-18h) for 17.3% of patients: 19.7% in male and 13.3% in female; in the evening period (18h-24h) for 12.2%: 9.5 % in male and 16.7% in female; and during the night period (24h-6h) for 10.5 %: 8.8% in male and 13.3% in female. All patients had other associated risk factor (3 for women, 4 for men). The frequency of risk factors was hypercholesterolemia (66,5%), smoking (44,0%), diabetes (23,5%), obesity (26,5%), left ventricular hypertrophy (26%) and myocardial infarction (25%) for men. Women showed associated risk factors in hypercholesterolemia (55,1%), diabetes (32,3%), left ventricular hypertrophy (29,1%), obesity (22,8%) and smoking (15,7%), CONCLUSION : This study showed that there was a circadian distribution of stroke occurrence with the highest prevalence during the morning period. No difference was observed between men and women except higher rate of smokers in men.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Seasonality and Weekly Variation of Transient Ischemic Attack and Acute Myocardial Infarction in Hungary
I. Kriszbacher    I. Csoboth    J. Betlehem     I. Boncz     A. Olah    E. Zsigmond     J. Bodis                     
 
University of Pecs Faculty of Health Sciences Institiute of Nursing and Patient Care

HUNGARY

OBJECTIVES: The purpose of our study was to find out whether a weekly variation or seasonal change can be shown in the incidence of a transient ischemic attack (TIA) and an acute myocardial infarction (AMI) during a three-year study period in Hungary, and whether the occurrence of a TIA or an AMI is influenced by age and sex. METHODS: We have analyzed TIA (N=3723) and AMI (N=44497) patients received at clinics and hospitals between 2002 and 2004 in Hungary. Data were obtained from the data-base of the National Social Security Fund (OEP) based on the International Classification of Diseases (ICD codes). Statistical analysis as one-way analysis of variance (ANOVA) was carried out with SPSS 14.0. RESULTS: The onset of a transient ischemic attack and an acute myocardial infarction shows a weekly and a seasonal variation. With consideration to seasonal variation, the peek period of TIA and AMI was found during the months of Spring, with lowest number of events during the Summer. There was a significant difference between number of events for each season (p<0.01). The weekly peek period of cerebral circulatory disturbance and infarction was found on the first day of the week, on Monday, with a gradually decreasing tendency towards the end of the week, until Sunday. When examining variation according to age groups we have only found a significant difference with consideration to weekly variation and only in case of TIA: decrease in the number of events during the weekend is significantly greater in the age group below the age of 60 (p<0.01). Differences between the sexes was similarly only found in the weekly variation of number of events of TIA, with a marked difference between the first five days of the week and the weekend (p<0.01). CONCLUSIONS: The incidence of a transient ischemic attack and an acute myocardial infarction shows characteristic variation with consideration to seasons and the days of the week.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
CHADS2 scores in patients admitted for stroke with and without atrial fibrillation - insights from The Swedish National Quality Register for Stroke Care
B. Farahmand    K.M.Henriksson    S. Johansson     S. Åsberg     N. Edvardsson    A Terént                             
 
The Stroke Unit at Uppsala University Hospital

SWEDEN

The CHADS2 score (congestive heart failure (CHF), hypertension, age ≥75 years, diabetes, previous stroke (S2)) is accepted to guide antithrombotic treatment in patients with atrial fibrillation (AF). However, most embolic strokes occur in patients without AF. This study explored the prevalence of CHADS2 criteria in stroke patients with and without AF to see how well the CHADS2 scoring system could apply to stroke risk in a non AF population. Patients registered in The Swedish National Quality Register for Stroke Care (RS) in Sweden during 2001-5 were linked to the Inpatient Registry. Prevalence criterias of the CHADS2 score were identified in all patients with and without AF reported in these registers. For each CHADS2 score (subgroups 0-6) the relative prevalence of each criterion was investigated in order to disclose if particular combinations would indicate especially high risk. Strokes occurred in 73,253 (70%) of the patients without, and in 31,821 (30%) with AF. For patients with AF the distributions of CHADS2 score were 15.7; 30.0; 25.4; 15.1; 9.9; 3.4 and 0.5% by each of the score groups.Corresponding figures for patients without AF were 4.3; 20.1; 27.4; 21.6; 16.4; 7.9 and 2.2% and these groups had a prevalence of the individual variables of the CHADS2 score of 8.1; 54.8; 54.0; 20.9 and 24.0% for CHF, hypertension, >/=75 years, diabetes and previous stroke, respectively. The corresponding prevalence in patients with AF was much higher: 30.0; 63.0; 78.6; 23.0 and 31.7%. Conclusions: Fewer stroke patients had AF than not, however, the stroke patients with AF had a higher prevalence of CHADS2 criteria: 86% had a CHADS2 score of 0-3 as compared with 73% for patients without AF. Age and hypertension were the most frequent CHADS2 criteria in either group.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
No evidence of under treatment of vascular risk in a socially deprived cerebrovascular clinic population.
T.J.Quinn    M. Rafferty    J. Dawson     M.R.Walters     K.R.Lees                                    
 
Gardiner Institute of Cardiovascular and Medical Sciences University of Glasgow

UNITED KINGDOM

Introduction: Morbidity and mortality from cerebrovascular disease is over represented in socially deprived communities. Traditional risk factors do not account for all the variation. Under-treatment of cardiovascular risk in the community may contribute. We analysed treatment data for a cohort of unselected referrals to a typical cerebrovascular clinic, seeking effects of socioeconomic status. Methods: We serve an urban population including the most affluent and deprived areas of the city. We prospectively recorded structured details of patients seen at clinic from August 1992 to January 2005 inclusive. Socio-economic deprivation was calculated from postcode using 2001 census data. Deprivation was described using the Depcat scale, ranging from 1=least deprived to 7=most deprived. We analysed proportions of patients with risk factors and proportions on treatment using chi-square and Kruskal-Wallis testing as appropriate. Results: We assessed 3478 patients (median age 67, range 16-95). Deprived areas were over represented. Prior use of antihypertensive and antiplatelet was associated with Depcat grade but with no pattern of under-treatment of the most deprived.Discussion: There is no evidence of under-treatment of vascular risk factors in this socially deprived population. Other mechanisms must be sought to explain the poor outcomes in this group.

 
http://www.eurostroke.org/ni_graphics/t_aid3002.htm

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Differences in prevalence and management of prior-to stroke risk factors between Black Caribbean’s in the UK and in Barbados
P.U.Heuschmann    N.C.Smeeton     A. Hennis      D.O.C.Corbin      I. Hambleton     C.D.A.Wolfe                             
 
King's College London

UNITED KINGDOM

Background-Risk of stroke is about 25% higher in immigrant Black Caribbeans (BC) in the UK compared to BC in their country of origin. This finding might be caused by differences in prevalence and management of prior-to-stroke risk factors. Methods-Data were collected from the South London Stroke Register (SLSR), a population-based register covering a multiethnic source population of 271,817 inhabitants (2001) in South London and the Barbados Register of Stroke (BROS) with a source population of 268,762 inhabitants (2000) in Barbados. Data collection and definitions are standardized between the registers. Differences in prevalence and management of stroke risk factors were adjusted for age, sex, living conditions pre-stroke and socioeconomic status by multivariable logistic regression. Results-Between Jan 1995 and Dec 2004 336 BC with first stroke were registered in SLSR, between Oct 2001 and Mar 2005 989 BC in BROS. Mean age was 66.4y in SLSR and 70.8y in BROS; 54.8% were male in SLSR and 43.9% in BROS. In multivariable analysis patients in BROS were less likely to have a pre-stroke diagnosis of myocardial infarction (OR 0.42; 95% CI 0.21-0.84) or diabetes (OR 0.71; 95% CI 0.51-1.00) and were less likely to report smoking (OR 0.31; 95% CI 0.19-0.49) or drinking alcohol excessively (OR 0.41; 95% CI 0.18-0.96). Patients in Barbados were more likely to receive appropriate pre-stroke antihypertensive (OR 1.97; 95% CI 1.28-3.05) or antidiabetic drug treatment (OR 3.14; 95% CI 1.37-7.18) and less likely to receive cholesterol-lowering drugs (OR 0.17; 95% CI 0.05-0.64). Conclusions-The higher risk of stroke in immigrant BC in the UK might be caused by a higher prevalence of major prior-to-stroke risk factors and a less healthy lifestyle compared to indigenous BC populations.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Acetylcholinesterase and Cholinergic Status: New Biomarkers for Diagnosis of Acute Ischemic Stroke
S. Shenhar-Tsarfaty    E. Ben-Assayag    L.T.Soreq     K. Ofek     I. Bova    L. Shopin     S. Berliner     I.  Shapira    N.M.Bornstein   H. Soreq
 
Tel-Aviv Medical Center

ISRAEL

Background Measurement of circulating biomarkers has enabled early diagnosis and risk assessment of acute myocardial infarction. Unfortunately, to date there is no such diagnostic measurement in acute ischemic stroke. Previous studies have implicated acetylcholinesterase (AChE) involvement in cerebral infarction. Our study sought diagnostic values of circulating AChE and Cholinergic Status (the total circulating capacity for acetylcholine hydrolysis) in patients presenting with suspected acute ischemic stroke at the hospital. Methods AChE activities, Cholinergic Status and inflammatory biomarkers were determined in serum samples from 264 ischemic stroke patients during the acute phase. Principal Components Analysis (PCA) and Linear Discriminative Analysis (LDA) were used to distinguish patients from carefully matched controls. Correlations between inflammatory biomarkers and cholinergic parameters were determined by the two tailed-Spearman rank test using SPSS/WIN software. Results Individual PCA evaluations based on AChE activity and Cholinergic Status measurements discriminated stroke patients from matched controls. Furthermore, using LDA, we could assign each subject to a specific group with specificity of 97% and sensitivity of 80%. Additionally, when normalized to sampling time from stroke occurrence, both Cholinergic parameters were directly and prominently correlated with multiple inflammatory biomarkers, including fibrinogen, interleukin-6, C-reactive protein and white blood cell counts (r=0.713, r=0.607; r=0.421, r=0.341; r=0.276, r=0.255; r=0.641, r=0.566, respectively; all p-values <0.001). Conclusions Our findings present the power of AChE and Cholinergic Status measurements as useful early diagnostic tools for acute stroke patients. Importantly, these were considerably more distinctive than the inflammatory biomarkers, albeit closely associated with them.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
A 20 YEARS DYNAMICS OF STROKE MORTALITY IN ARMENIA
L.G.Gimoyan    A.V.Kazaryan                                                           
 
Yerevan Medical University after M. Heratsi

ARMENIA

Background: The carried out epidemiological researches showed various level of stroke mortality and morbidity as well as different tendency in their dynamics among different countries Many publications have recently emerged devoted to the burden of stroke in low-income and middle-income countries. The objective of this study is to estimate dynamics of stroke mortality in the general population during the last 20 years in Armenia. Methods: Retrospective analysis of Ministry of Health Care data, which provides for the entire Armenian population morbidity and mortality rates, including data from all polyclinics (outpatient clinics) serving the urban and rural regions, hospital registrations and death certificates for 1985-2005 . Considering that during the research period demographic changes of population have occurred, in addition to mortality rates on 100 000 population European age-standardized rates and mortality rates in the age of 35-74 were calculated, as well as average age of died from stroke. Results: Approximately 4000 stroke deaths occur (an annual mortality rate 118 per 100 000 population in 2005 versus to 2561cases, with an annual mortality rate 76 per 100 000 population in 1985(56% increase during the reporting period). Age standardized stroke mortality rates decreased from 132,4 in 1985 to 126,4 in 2005, and stroke mortality rates in the age of 35-74changed from 104,3 in 1985 to 110,6 in 2005. Average age of died changed from 74,2 in 1985 to 74,1 in 2005. Discussions: Those changes are not statistically significant. So we can state, that level of stroke mortality in Armenian population during 20 years practically remained the same. Increase of stroke deaths can be explained by increase portion of people above 65 years in general population from 5,6% in 1985 to 10,9% in 2005

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Epidemiology of stroke in Sousse, Tunisia : time for action.
L. Ben Slamia    H. Ben Jemaa    T. Lamouchi     M. Grira     S. Harzallah    S. Benamou                             
 
Sahloul Hospital

TUNISIA

BACKGROUND Stroke is a major cause of disability and death. It can have devastating consequences for families and enormous costs to society particulary in developing Countries. Tunisia, country in demographic transition, is particularly affected by this problem. OBJECTIVE: discusse epidemiologic caracteristics of ischaemic and haemorrhagic stroke in the center of tunisia. MATERIAL AND METHODS Prospective data were collected on consecutive patients admitted to Sahloul Hospital with a diagnosis of stroke (december 2004-november 2005). Risk factors and clinical characteristics were assessed by neurological examination and computed tomography scan. RESULTS A total of 203 patients were enrolled in the study (26% of the activity of the departement of neurology in the same period), of whom 111 (54.7%) were men. The age (mean+/-standard deviation) of the patients was 67+/-11.6 years. 75.4% and 24.6% patients had ischaemic and haemorrhagic stroke, respectively. 92.1 % had at least one risk factor ; 62.5% of patients had hypertension. The other risk factors were diabetes mellitus(28.6%), heart disease (36.9%), smoking (40.0%) and hypercholesterolaemia (13.3%). transient ischaemic attack was present in 13.7% of patients. Mortality rate were 11.8%. CONCLUSION This prospective study have demonstrated particularities of stroke in our tunisian population and the main risk factors. These findings can improve the management of acute stroke and define high-risk cohorts for research in to stroke prevention.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Prehospital identification, prioritizing and care of acute stroke-patient: A retrospective study of the stroke chain-of-care in Stockholm.
H. Borovszky    L. Svensson    A. Berglund     L. Jonsson     N. Wahlgren                                    
 
Karolinska Institute, Department of prehospital care

SWEDEN

Background and purpose: Stroke is the most common cause of disability and the third leading cause of death. Thrombolysis within 3 h of symptom onset is the drug of choice in ischaemic stroke. Studies have shown that this treatment is under-used and the main reason for this is delayed presentation. Early and rapid identification of symptoms is necessary to minimize the time between onset of symptoms and treatment. The aim of this study was to determine the prehospital factors that cause delay for the stroke patients that arrived to the hospital with ambulance. Methods: This is a retrospective observation study of all the stroke-patients, admitted to the emergency department (ED) of Södersjukhuset in Stockholm during 2006. Data were collected from medical records and the SOS Alarm data base. Results: Overall 1144 patients were included in the survey and 74% were admitted to the ED by ambulance. Three percent of the patients received thrombolysis and all, except one, were transported to hospital with ambulance. Altogether the patients were in the prehospital chain-of-care in a median time for 101 minutes. The time of symptoms onset was missing in 59%. The patient itself represented the greatest delay, 55 minutes. The dispatcher could identify the symptoms as stroke in only 48%. Only 6% of these patients were dispatched with the highest priority. The ambulance staff identified the condition of the patient as stroke in only 51%. In the ambulance pulse, systolic blood pressure and oxygen saturation was measured in 93-95%, blood glucose in only 51% and body temperature in 3% of the cases. Conclusions: The major findings are that 74% of the patients were admitted to hospital with ambulance. All patients who were treated with thrombolysis, but one, were transported with ambulance. There were difficulties in identifying the symptoms in all links in the chain-of-care. The ambulance staff followed the medical guidelines, but there were failures in monitoring diastolic blood pressure, body temperature and blood glucose.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Cervical artery dissection: a ten-year experience.
P. Cardona    L. Cano    A.  Alentorn     A. Albertí     M. Mora    F. Rubio                             
 
Bellvitge University Hospital. Stroke Unit. Barcelona

SPAIN

Background: The underlying causes of cervicocerebral artery dissections are not well known. Prognosis, degree of arterial recanalization, and outcome are unknowned. Methods: We reviewed retrospectively our database of 2656 patients who were admitted between 1998 and 2007. We analyze the clinical and radiological presentation of cervical dissections, etiology and subsequent outcome. Results: Cervical dissection was present in 37 patients (0,7%). Carotid dissection was affected in 70%, vertebral dissection 20%, and multivessel 10%. The most frequently encountered symptoms was headache 90% (10% aphasia), associated to neck pain 40%, Horner syndrome 40% and 56% stroke. Extra-intracranial dissection accounts for approximately 65% of all dissection, followed by extracranial 30 %. Pseudoaneurysms appeared in about 10%. Patognomonic signs of dissection with intramural hematoma in MR was found in less than 25%. Antiagregants were used in 64% and anticoagulation 33%. Recanalization of dissecated vessel occurred in 65% cases. Patients who present persistent Horner at day 90 had partial o none degree of vascular recanalization. Clinical prognosis was quite good; functional independence (Rankin 0-1 at day 90) was 45%, and good outcome (mRankin of 0 to 2) was seen in 81% of patients. Three patients received intravenous rt-PA. Two of them had complete recovery at day 7, and all three patients had final good outcome at day 90 (Rankin 0-1). Global risk of dissection recurrence was less than 3%. Conclusions: Cerebrovascular disections are very infrequent, embolism is a common cause of stroke associated a dissection. Persistent Horner is a good sign to detect some degree of persistent dissection in follow-up. The good prognosis and low recurrence no support routine use of anticoagulation.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
FREQUENCY AND DETERMINANTS OF HEMORRHAGIC TRANSFORMATION OF CEREBRAL INFARCTION
V. Terruso    N. Di Benedetto    G. Famoso     M.A.Mazzola     V. Saia    P. Aridon     P. Ragonese     C. Sarno    M. D'Amelio   G. Savettieri
 
Department of Clinical Neurosciences (DiNeC), University of Palermo

ITALY

Background. Hemorrhagic transformation (HT) is a worrying and not rare complication of ischemic stroke (IS). However, frequency and risk factors of HT are uncertain. Our aim was to estimate the overall frequency and risk factors for HT in a hospital-based series of patients. Methods. 3 year study period (2004-2006). Retrospective review of medical records of patients discharged with a diagnosis of IS from our Department. Frequency of HT was estimated only among those patients with anterior IS who underwent two or more CT scans. Univariate and multivariate logistic regression analysis were used to estimate risk factors for spontaneous HT. Results. We included 265 patients with anterior IS and at least two neuroimaging exams (135 females and 130 males). Mean age at admission was 72.7 years. HT was observed in 30/265 patients (11.3%). At univariate analysis, large infarct size (OR 4.5, 95% CI 1.9–20.5), cardioembolic stroke (OR 2.1, 95% CI 1–4.5), low level of consciousness at admission (OR 6.4, 95% CI 1.4–30.2), early CT signs (OR 5, 95% CI 1.2–5.4) and neurological worsening (OR 4.2, 95% CI 1.6–11.2) were significantly associated to HT. At multivariate analysis only large infarcts (OR 2.6, 95% CI 1.1–6.2) and neurological worsening (OR 3.6, 95% CI 1.3–10.6) remained significantly associated with HT. Discussion. The frequency of HT in our study is 11.3%. Consistent with previous results HT was associated to the size of ischemic area and worsening of neurological condition. Patients included in our study are not from a stroke unit for thrombolysis, but from a sample of patients admitted in a Neurologic Clinic. As a consequence, our results are applicable to those patients that clinicians usually deal with.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
CLINICAL CHARACTERISTICS AND THERAPEUTIC MANAGEMENT OF HYPERTENSIVE PATIENTS WHO EXPERIENCED STROKE: THE CICLADES STUDY
R. Asmar    M. Rejdych    D. Miljkovic                                                    
 
Cardiovascular Institute, Paris

FRANCE

OBJECTIVE: The study aimed to describe the clinical characteristics and the therapeutical management of hypertensive patients who experienced cardiovascular events. METHOD: This was a national, multicentre, cross-sectional study conducted by cardiologists in France. All patients were hypertensive with high blood pressure, treated or not, and with cardiovascular events that occurred within one year prior to inclusion. RESULTS: 585 cardiologists participated to the study; they included 1159 patients, 72% (N=832) of them had myocardial infarction, and 28% (N=327) stroke. Patients were men (74%) with a mean age of 67 +/- 10 for men and 73 +/- 10 for women; mean Body Mass Index of 27,4 +/- 11 kg/m² for men and 25,11 +/- 10,5 kg/m² for women. Systolic blood pressure (BP) was 145 +/- 16 mmHg and 149 +/- 21 mmHg, and diastolic BP was 83 +/- 10 mmHg and 85 +/- 12 mmHg respectively for men and women. 22.8 % of patients had lifestyle changes and over 92% were receiving antihypertensive treatments with a mean of 2 drugs. Men received more beta blockers (54,1% vs 38,0%), Calcium antagonists (37,3% vs 31,0%), angiotensin converting enzyme inhibitors (43,3% vs 33,8%), but less diuretics (47,6% vs 60,6%) than women. No gender difference was noticed for angiotensin receptor blockers (22,1%). 87% of patients received additional treatment with a mean of 2 drugs. Among those patients, 53% were receiving statines and 49% antiplatelet therapy and 24% were receiving an oral antidiabetic drug. There was no gender difference for the additional treatment. CONCLUSION: Most hypertensive patients who experienced cardiovascular events were receiving an antihypertensive treatment that does not warrant optimal protection. Moreover, results of this study showed gender difference in antihypertensive therapy with a higher use of beta blockers in men (irrespective of ischemic heart disease history) and diuretic in women.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Intracranial arteries calcifications are associated with carotid atherosclerosis, age and renal failure: a retrospective study in 340 patients with ischemic stroke
J.M.Bugnicourt    J.M.Chillon    S. Canaple     C. Lamy     Z.A.Massy    O. Godefroy                             
 
Amiens University Hospital

FRANCE

Background The increased risk of stroke in patients with chronic kidney disease (CKD) is partly explained by more advanced atherosclerotic disease. Arterial calcifications, frequently observed on brain CT scans but understudied, are an easily identifiable marker of atherosclerosis. The aim of this study was to determine the relationship between intracranial arteries calcifications (IAC) and CKD in stroke patients. Methods All eligible patients admitted to Amiens University Hospital for acute ischemic stroke or transient ischemic attacks between January and December 2006 who had CT examinations by 16-slice multi-detector-row computed tomography were included (n=340). The presence of IAC was investigated in 7 intracranial arteries: the internal carotid arteries, middle cerebral arteries, vertebral arteries and basilar artery. Patients were divided into those with and without IAC. Glomerular filtration rate (GFR) was estimated by MDRD formula. CKD was defined by a GFR of <60 ml/min/m2. Results 259 patients (76.2%) had IAC. The highest prevalence of calcifications was seen in the intracranial internal carotid artery (72.9%). In multivariate analysis, carotid atherosclerosis (OR: 4.8; 95%CI: 2.5−9.3; p<0.001), age (OR: 1.1; 95%CI: 1.06−1.1; p<0.001) and GFR (OR: 0.98; 95%CI: 0.96−0.99; p=0.026) were found to be independently associated with IAC. Discussion In addition to well defined risk factors for vascular calcifications, our results show that CKD is also an independent risk factor for IAC in ischemic stroke patients.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
CLINICAL CHARACTERISTICS OF HYPERTENSIVE PATIENTS WHO EXPERIENCED CARDIOVASCULAR EVENTS : THE CICLADES STUDY.
R. Asmar    M. Rejdych    D. Miljkovic                                                    
 
Cardiovascular Institute

FRANCE

OBJECTIVE: To assess the clinical characteristics of hypertensive patients with uncontrolled blood pressure who experienced stroke or myocardial infarction (MI). METHODS: This was a national, multicentre, cross-sectional study conducted by cardiologists using their patients’ records. All patients were hypertensive with uncontrolled blood pressure, treated or not, and with cardiovascular events that occurred within one year prior to inclusion. RESULTS: 585 cardiologists participated to this study. 1159 patients records were reviewed. Patients were aged 67 ± 11 years, and were men for 74%. 72% of them had a myocardial infarction and 28% stroke. Among patients with myocardial infarction and with stroke, respectively 79% and 61% were men. Whether for myocardial infarction or stroke women were older, respectively 71 +/- 11 versus 64 +/- 11 for men and 73 +/- 10 versus 67 +/- 10. All patients had associated risk factors , around 3 in women and 4 in men. The most frequent other risk factor for men was dyslipidaemia (72.8% N=479 in patients with MI and 66.5% N=133 in patients with stroke); whereas in women, the most frequent risk factor was dyslipidaemia for MI, and obesity for stroke. In patients with MI, the second main risk factor was smoking for men (57.6% N=379) and obesity for women (33.3% N=58). In patients with stroke, the second main risk factor was dyslipidaemia (55.1%) for women and smoking (44%) for men. In patients with MI, 23.7% men and 31.6% women had diabetes. Among patients with stroke, 23.5% of men, 32.3% of women had diabetes. CONCLUSION: Results of this cross-sectional study showed that hypertensive patients who experienced cardiovascular events present 3 (in women) and 4 (in men) other associated risk factors. Gender may influence the determinants of stroke and MI.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Stroke in the young: access to care and outcome: A Western versus Eastern European Perspective
A. Bhalla    R. Grieve    A.G.Rudd     C.D.A.Wolfe                                            
 
King's College, London, UK

UNITED KINGDOM

Background: In order to develop effective strategies to address the needs of young stroke patients, it is important to recognise what components of stroke care they receive. The aims of this study are to describe the provision of stroke care and the factors independently associated with 3 month mortality and poor outcome (death and disability) in patients below the age of 55 years across Western and Eastern Europe. Methods: Data from hospital based stroke registers in Western Europe (7 centres, 6 countries) and Eastern Europe (4 centres, 3 countries) were analysed between 1997-98. Results: Of 1735 patients admitted to hospital, 221 (12.7%) patients were below 55 years of age (Western European centres: 51% and Eastern European centres 49%). Brain imaging rates were higher in Western centres (100%) than in Eastern centres (83%) (P<0.001). Stroke unit care was higher in Western centres (67%) than in Eastern centres (26%) (P<0.001). Doctor (P<0.001), therapy (P=0.01) and nursing time (P<0.001) were also higher in Western centres. At 3 months, the case fatality rates between Western and Eastern centres were 8% vs. 20% (P=0.01). Lack of stroke unit care was significantly associated with poor outcome (P<0.05). Patients in Eastern European centres were more likely to suffer poor outcome at three months (OR=21.5, CI=2.5 to 187, P<0.001). Conclusion: Younger stroke patients in Western Europe are more likely to gain access to a number of important components of stroke care compared to in Eastern Europe. The future challenge is to ensure that recommendations and guidelines are adopted to ensure all young patients receive evidence based stroke care across Europe.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Improving survival after a first hospitalisation for stroke in Scotland, 1986-2005
J.D.Lewsey    P.S.Jhund    M. Gillies     A. Redpath     L. Kelso    A. Finlayson     M. Walters     P. Langhorne    J. McMurray   K. MacIntyre
 
University of Glasgow

UNITED KINGDOM

Introduction Previous reports describing trends in case fatality after a first stroke have reported trends until the early 2000s. It is unclear whether reductions in case fatality are continuing for a whole country population and whether trends are similar across all age groups and both sexes. Methods Using the Scottish Linked Morbidity Record Database we identified all patients with a first episode of stroke hospitalized between 1986 and 2005 in Scotland and any subsequent death recorded by the General Registrar Office. Case fatality was calculated at 30 days, 1 year and 5 years (excluding deaths in the first 30 days for 1 year and 5 years). Logistic regression was used to determine the odds of all cause mortality at 30 days, 1 year and 5 years after adjustment for comorbidity. Results 73676 men and 88808 women were discharged from hospitals in Scotland between 1986 and 2005. In men (women) 30 day case fatality fell from 32% (35%) in 1986 to 17% (22%) in 2005. In men (women) 1 year case fatality fell from 23% (26%) in 1986 to 15% (20%) in 2005. In men (women) 5 years case fatality fell from 54% (59%) in 1986 to 41% (49%) in 2001. The adjusted odds ratios (OR) of death at 30 days for 2005 vs. 1986 was 0.49 (95% CI 0.40, 0.59) in men aged less than 55 years. For those aged 55-64 years, 65-74 years and 75-84 years and over 85 years the corresponding ORs were 0.37 (0.31, 0.43), 0.33 (0.30, 0.37), 0.36 (0.32, 0.40) and 0.43 (0.36, 0.51) respectively. In women the corresponding ORs were 0.41 (0.34, 0.50), 0.35 (0.29, 0.41), 0.34 (0.30, 0.38), 0.39 (0.36, 0.43) and 0.58 (0.52, 0.64). This observation of less reduction in those under 55 years and those above 85 years was also seen for 1 year and 5 years case fatality. Conclusions Crude case fatality at 30 days, 1 year and 5 years fell in both men and women from 1986 to 2005. Furthermore, the adjusted odds of death fell significantly in both men and women over the period in all age groups. However, those under 55 years and those above 85 years old achieved the least gains. This finding merits further investigation, particularly in the young, where the potential loss of life years is greatest.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Stroke and newspapers: inattention or neglect?
M. Bartley    W.O.Tobin    R. Collins     D. O'Neill                                            
 
The Adelaide & Meath Hospital, Incorporating the National Children's Hospital.

IRELAND

<b>Background and Purpose</b) — Services for stroke are poorly developed in Europe, and research into stroke is under-funded compared with heart disease or cancer. This may arise from the low profile of stroke within the public domain. Our aim was to assess the coverage of stroke compared with heart disease in a popular form of mass media, newspapers in the UK and Ireland. Methods—We searched the online databases of four major newspapers in UK and Ireland using the terms “stroke” and “heart” over a one-year period from 1st May 2006 to 1st May 2007. The resulting articles were then classified by two clinicians and those relating to the clinical conditions of stroke and heart disease were selected. Results—The searches were refined by hand and those articles relating to ‘stroke’ were 105 articles in the Irish Times, 223 in the Daily Telegraph, 22 in The Observer and 149 in The Guardian. The number of articles relating to ‘heart’ were 443 articles in the Irish Times, 653 in the Daily Telegraph, 81 in The Observer and 688 in The Guardian. Conclusions—Newspaper coverage of stroke is underreported when compared with heart disease, despite the clinical and financial burden of this condition. Professional and advocacy organizations for those with stroke need to develop strategies to increase the profile of stroke in the public domain.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Effect of Novoseven on hospitalization duration of Iranian ICH* patients
N.N.Madjdinasab    N. Sharafaddinzadeh    E. Mohamadianinejad     R. Bavarsad      A. Khakzadeh                                    
 
Joundishapour University of medical science , Ahwaz

IRAN

Background: Intracerebral hemorrhage is recently designated as one of the most important death causes. Due to its high morbidity and mortality rate great efforts have been carried out to find a useful solution. Among those patients with intracerebral hemorrhage more than 33% die within the first month after onset and only 20% back to a favorable level of functional status and no help of others. Long periods of hospitalization predispose the patients to other serious problems (infection, bed sore, cost increment….); so presenting an acceptable and effective treatment can result great benefits like cost reduction and preventing the medical complications trough decreasing the admission period. Materials and Methods : Methods : between the years of 2006 and 2007 in Golestan hospital of Ahvaz , about 54 patients who suffered to ICH, in early 5 hours of stroke presentation ,were randomly assigned in order to create control & case groups and case group were assigned by NOVOSEVEN (µ40g /kg ) treatment ,after all the average of admission period of both compared with each other . Results : Regarding significant difference novoseven treated group with 7.7 days of hospitalization period comparing with those which not treated by Novoseven (8.7 days) ; pvalue<0.05 ; Sequentially the effect of drug assessed for its interactions by other covariates (gender , age , MAP ), no interaction detected with other factors . Conclusions: According to available results the effect of “NOVOSEVEN " on the duration of admission period of ICH Iranian patients is favorable . Key words: ICH – Novoseven – Iranian – Hospitalization period * Intracerebral hemorrhage

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
The Effects of Seasonal Variations and Weather Conditions on the Occurrence of Transient Ischemic Attack in Hungary between 2002-2004
I. Csoboth    J. Bodis    J. Betlehem     I.  Boncz     B. Vas    G. Vas     I. Kriszbacher                     
 
Univeristy of Pecs Faculty of Health Sciences Institute of Nursing Patient Care

HUNGARY

OBJECTIVES: The onset of transient ischemic attack shows circadian and seasonal variations that are influenced by sex, age and the changes of weather conditions as well. The purpose of our present study is to investigate whether a seasonal variation can be found in the onset of transient ischemic attack during the period under investigation, and whether certain meteorological factors (air temperature, front movements) influence the incidence of transient ischemic attack. METHODS: Retrospective analysis has been carried out on patients admitted because of transient ischemic attack in Hungary between 2002 and 2004 (n = 3723). Data has been taken from the database of the National Health Insurance Fund Administration based on the International Classification of Diseases (ICD). Weather related data were provided by the National Meteorology Service. Statistical analysis as one-way analysis of variance (ANOVA) was carried out with SPSS 14.0. RESULTS: Regarding seasonal distribution the peak incidence period of transient ischemic attack was spring, whereas the lowest number of events was observed during the summer months. There was a marked difference in the number of events per season (p<0.001). A low level positive correlation was found in spring between the difference of average temperatures of the actual day and the day before and the occurrence of transient ischemic attack (r=0,127, p<0,05) during the examined period. Correlation couldn’t be shown between front movements and the number of events. CONCLUSIONS: Our findings show that certain meteorological factors may be related to the onset of transient ischemic attack, however a number of other factors may also play an important role.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Blood Pressure One Year After Stroke