XVII. European Stroke Conference
Nice, France

Poster Session: Risk factors of stroke
 

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

 01
Burden of atherosclerosis and risk of venous thromboembolism in migraine patients
S. Kiechl    J. Schwaiger    H.  Stockner     M. Knoflach     P.  Werner    G. Rungger     A. Gasperi     J. Willeit             
 
Innsbruck Medical University, Innsbruck

AUSTRIA

Background and Purpose: Previous studies have yielded evidence of an enhanced risk of cardiovascular disease especially stroke among migraine patients. Our understanding of the underlying mechanisms, however, is far from complete. Aims of the present study are to investigate the potential association between migraine and atherosclerosis and to assess the risk of venous thromboembolism a clinical surrogate for a procoagulant state in migraine patients. Methods: The examination was part of the population-based Bruneck Study. During the 2005 follow-up, 574 participants aged 55-94 years underwent extensive neurological and laboratory examinations involving a standardized headache interview and scanning of the carotid and femoral arteries to evaluate presence, severity and progression (2000-2005) of atherosclerosis. Results: A large number of well-founded and putative cardiovascular risk factors emerged as unrelated to migraine status. Prevalence, severity and 5-year progression of carotid and femoral atherosclerosis did not differ significantly between migraineurs with and without aura and non-migraineurs. Actually, there was even a tendency of atherosclerosis to be less pronounced among migraine patients, and of the common carotid artery IMT to be lower (P=0.029). As a novel finding migraineurs faced a significantly enhanced risk of venous thromboembolism (18.9% vs. 7.6% in non-migraineurs, age/sex-adjusted P=0.031). Conclusion: This study is the first to compare the burden of atherosclerosis as quantified by high-resolution duplex ultrasound between migraineurs and non-migraineurs in the general community, and provides solid evidence against the view that migraine predisposes to atherosclerosis. The higher risk of venous thromboembolism among migraineurs awaits confirmation and elaboration in future research.

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

 02
Hyperhomocysteinemia is Related to Small Vessel Occlusive Disease but Not to Microbleeds and Atherosclerosis in Ischemic Stroke Patients
S.B.Jeon    S.M.Park    D.W.Kang     H.S.Song     K.H.Cho    J.S.Kim     S.U.Kwon                     
 
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine

SOUTH KOREA

Background- There have been disagreements about the mechanism of stroke caused by homocysteine. The relationship between genetic causes of hyperhomocysteinemia (HHcy) and subtypes of stroke is also uncertain. We performed this study to evaluate the attribution of plasma homocysteine and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism to the development of certain subtypes of stroke. Methods and Results- Total 956 were recruited after exclusion of hemorrhagic or cardioembolic stroke among 1898 stroke patients. Plasma levels of homocysteine and the polymorphism of MTHFR C677T were measured. The extent of small vessel occlusive disease (SVOD) including lacunar infarctions and leukoaraiosis on T2-weighted or fluid attenuated inversion recovery imaging was assessed using the Scheltens grading. Microbleeds on T2*-weighted gradient-echo imaging were counted. The number of atherosclerotic vessels on MR angiogram was evaluated in each patient. The levels of homocysteine were significantly higher in TT genotype than in CT or CC (17.0+/-11.0 μmol/L vs. 13.6+/-4.6 μmol/L vs. 12.7+/-4.3 μmol/L, respectively; p<0.0001). Homocysteine was weakly related to SVOD (rs=0.123, p<0.0001), but not to microbleeds and atherosclerosis. The SVOD scores of the quartile 4 (>15.8 μmol/L) of homocysteine were significantly higher than those of the quartile 1 (≤10.6 μmol/L) (13.9+/-10.1 vs. 10.3+/-9.6, respectively; p<0.0001). MTHFR C677T polymorphism was not related to SVOD. After adjustment for age, sex, hypertension, diabetes, hypercholesterolemia, smoking status and alcohol consumption, SVOD was significantly associated with homocysteine (regression coefficient=0.137, p=0.007). Conclusions- This study shows that HHcy is associated with SVOD (lacunar infarctions and leukoaraiosis), but not with microbleeds and atherosclerosis. MTHFR C677T polymorphism is not related to SVOD per se, although it is an important determinant of plasma homocysteine level.

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

 03
Stroke knowledge, stroke risk perception and effects of an educational multimedia campaign vary in different stroke risk groups
J.J.Marx    C. Gube    M. Nedelmann     H. Kuntze     B.  Haertle    M. Dieterich     M.  Eicke                     
 
Johannes Gutenberg-University Mainz

GERMANY

Background: Aim of the study was to evaluate the impact of individual stroke risk factors on stroke knowledge, stroke risk perception and the corresponding educational effects of a multimodal educational campaign. Methods: Computer-assisted telephone surveys were conducted among 500 members of the general public, before and immediately after an intense three months educational campaign in a western German area of 400.000 inhabitants. The multimodal educational program comprised of poster advertisements, print media like flyers, and mail circular to all households. Slogans, stroke interest stories and interviews appeared regularly in local newspapers, on television and radio, and public events focused on the subject. Results: 32.7% of respondents considered themselves as being at risk of stroke before, and 41.9% (p<0.01) after the intervention. Especially in diabetics (+21.4%) and hypertensive individuals (+17.2%) stroke risk perception significantly increased after the campaign, while there was no effect in patients with heart disease at all. Evaluation of stroke risk increased with number of individual stroke risk factors (no risk factor: 8%, 5 risk factors: 75%). Correct identification of the individual disease as a risk factor was especially high in obese individuals (100%) and smokers (97.9%) and particularly low in patients with heart disease (80.6%). General knowledge of stroke and risk factors was best in hypertensive and obese individuals and worst in respondents with heart disease. Discussion: Our data indicate that educational programs do increase stroke risk perception in the public. The presence of established risk factors is associated with self perception of an increased risk. Individual stroke risk is remarkably underrated in some high risk populations like those with coronary heart disease, who did not benefit from the broad educational intervention either. In other risk groups like smokers or obese a ceiling effect following intense public debates has to be assumed. Accordingly, future campaigns should focus on specific target groups at risk of stroke.

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

 04
Genetic Variation in the Lymphotoxin-Alpha Pathway and the Risk of Ischaemic Stroke in European Populations
T. Freilinger    S. Bevan    S. Ripke     A. Gschwendtner     P. Lichtner    B. Müller-Myhsok     H.E.Wichmann     H.S.Markus    T. Meitinger   M. Dichgans
 
Ludwig-Maximilians-Universität München, Klinikum Grosshadern

GERMANY

Background Several genes involved in the inflammatory lymphotoxin-alpha cascade (LTA, LGALS2 and PSMA6) have been reported to modify the risk of myocardial infarction. Here, we present a comprehensive analysis of all three genes in two large European samples with ischaemic stroke (IS) using single marker and haplotype association tests. Methods 601 German IS patients were recruited from a single Stroke Unit. Patients were subjected to a detailed phenotyping protocol, and IS was subtyped according to the TOAST classification system. Controls comprised 736 unrelated age- and sex-matched individuals from the community-based KORA study. Blood samples were obtained from all participants, and DNA was extracted with standard techniques. Selection of tagging SNPs was based on data of the International HapMap Project (CEU population). 23 SNPs were genotyped using the iPlex-method on a MassArray System (Sequenom). SNPs and haplotypes were tested for association with overall IS, large vessel stroke and cardioembolic stroke, with correction for multiple tests according to Westfall and Young. Nominally significant associations were replicated in an independent sample of 843 IS cases and 933 controls from the UK. Results Only one SNP (rs1048990 in PSMA6) showed association with overall IS, but this was not replicated in the UK sample. Three SNPs showed significant associations with stroke subtypes, but only one also showed association in the UK population (rs2844484 in LTA with large vessel stroke), and this association did not survive correction for multiple testing. Discussion Genetic variation in the lymphotoxin-alpha cascade (LTA, LGALS2 and PSMA6) is not a major risk factor for IS.

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

 05
Relationship between 677C>T polymorphism of methylenetetrahydrofolate reductase gene and childhood ischemic stroke
I. Zak    B. Sarecka-Hujar    I. Kopyta     E. Emich-Widera     E. Marszal                                    
 
Medical University of Silesia

POLAND

Background: Ischemic stroke (IS) is rare, multifactorial disease. In many cases more than one risk factor is diagnosed in IS patients. The genetic susceptibility to IS may be determined by specific polymorphic variants encoding markers of e.g. endothelium dysfunction or prothrombotic disordes. The methylenetetrahydrofolate reductase (MTHFR) is an enzyme involved in homocysteine (Hcys) metabolism. Common 677C>T polymorphism of MTHFR was related to hyperhomocysteinemia and elevated level of Hcys is established risk factor of cerebrovascular diseases. The aim of this study was to find a relationship between 677C>T polymorphism of MTHFR and IS in children. Methods: We studied: 41 patients–children with IS, their parents (n=79) and 27 healthy children. Diagnosis of IS was established according to WHO definition. The 677C>T polymorphism of MTHFR was genotyped using PCR-RFLP. Statistical analyses were performed with Statistica 6.0 and EpiInfo softwares. Results: The IS was more prevalent in boys than girls (63% vs 37%). The frequency of MTHFR T allele in IS children was higher compared to controls (43% vs 22%, p=0.014 OR=2.61). Carriers of T allele (subjects with genotypes CT+TT) were more frequent in patients (68%) than in controls (37%) (p=0.011 OR=3.66). The T allele was more prevalent in male patients than in male controls (50% vs 20%, p=0.003 OR=4.00). The number of T allele carriers among boys with IS was also higher compared to healthy boys (81% vs 30%, p=0.005 OR=9.80). Transmission disequilibrium test (TDT) analysis showed that T allele transmission from heterozygous parents to their children did not differ from the expected values (1:1). Discussion: Obtained results indicate that MTHFR 677C>T polymorphism might be risk factor of IS in children, especially in boys.

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

 06
The evaluation of the ischemic stroke consequences in children with or without the cardiological problems, and the others stroke risk factors- the pilot study
I. Kopyta    E. Emich-Widera    B. Sarecka     I. Zak     E. Marszal                                    
 
Department of Neuropediatrics, Silesian School of Medicine, Katowice

POLAND

Background and purpose: In most of pediatric stroke patients the traditional and the other risk factors, like coaguopathies, dyslipidemias or antiphospholipid syndrome may be found. The aim of the study was the evaluation of the ischemic stroke consequences in children according to the risk factors: traditional, cardiac problems, and others, eg. dyslipidemias, hyperfibrinogenemia. The study population consisted of 117 children, aged 9 months to 17 years, including: 59 ischemic stroke children and 58 healthy children as control group (Group III). The stroke children group was divided into two groups: group I – stroke children with a cardiac problem (n=10), and group II – children with only stroke (n = 49; within 2 with foramen ovale apertum). All patients were examined physically and neurologically and underwent neuroimaging procedures and cardiological examination. Laboratory testing for the biochemical ischemic stroke risk factors mentioned above were done. The results were statistically analyzed using Statistica 6.0 software. Results: Children in group II had significantly higher mean triacylglycerols serum concentrations and plasma fibrinogen level compared to controls (p=0.0034 and p=0.044 respectively). The mean triacylglycerols serum level also differentiated group I from healthy children (p=0.0022). We also found that mean level of LDL-cholesterol was higher in control compared to children from group I (p<0.0001). When we analyzed group I and II together, we observed higher mean triacylglycerols and plasma fibrinogen levels than in control group (p=0.0003 and p=0.048 respectively). Logistic regression analysis revealed that triacylglycerols serum level might be the risk factor for stroke (p=0.0006, OR=1.02 95%CI 1.01-1.04 in univariate analysis). Stroke consequences (motor deficits, speech problems, epilepsy, recurrences or death) were found in 7 children in group I (subgroup IA) and 31 children in group II (subgroup IIA) ( not significant). The larger groups of patients are required to make the obvious conclusions.

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

 07
Stroke Risk Factors in Active Policemen
C.N.Gandolfo    G.P.Povedano    G. Grazioli     J. Tartaglione     J.A.Saggese                                    
 
Churruca Hospital

ARGENTINA

Risk factors of cardiovascular disease have been widely studied in diffferent populations. We studied a population of policemen on duty with a follow-up of 10 years looking for any relationship between their medical history and cardio and/or cerebrovascular events Material and methods: In 1997, while annual ranking routine evaluation, a systematic search for cardiovascular risk factors was performed looking for arterial hypertension, diabetes, cardiac disease, dyslipidemia, smoking, body mass index (BMI) and fibrinogen levels. None of them had stroke history. Results: 2537 policemen were evaluated, 159 (6,3 %) women and 2378 men (93,7 %). Mean age was of 37.7 years (range from 18 to 65 years). Risk factors frequency was: Overweight / obesity: 70 %, smoking: 42,9 %, alcohol: 37,1 %, family history for cardiovascular disease 16,6 %, referred hypertension 3,15 %, (actual hypertension 17 % for women and 29,5 % for men), diabetes history: 2,16 %, (actual hyperglucemia 3.13% ) previously known dyslipidemia 0,9 % (24.10% in laboratory findings),fibrinogen levels over 400 mg% 12,7 %. The rate of cardiovascular events was of 2,60 /year and for stroke was of 0,67/year. The mortality rate was of 3,11/year. Conclusions: These findings show a major prevalence of vascular risk factors and cardio and cerebrovascular events when compared with the general population (according to VIGI+A and INDEC information). Similar findings in other countries were related to the police activity profile.

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

 08
Hyperglycemia and stroke incidence Comparison between fasting and two-hour glucose criteria
M. Hyvarinen     J. Tuomilehto    Q. Qiao                                                    
for the DECODE study group
University of Helsinki

FINLAND

Background We investigated hemorrhagic and ischemic stroke incidence in individuals with different degrees of hyperglycemia and compared the differences in risk associated with fasting plasma glucose (FPG) and 2-hour post-challenge plasma glucose (2-h PG) criteria. Methods Data from 8 European cohorts comprised 6226 women and 7969 men. The maximum length of follow-up varied between 3.9 to 36.8 years. Multivariate adjusted Cox proportional hazards model was used to estimate hazards ratios (95% confidence intervals (CIs)) for stroke incidence. Results The hazards ratios (95% CIs) in individuals without a history of diabetes corresponding to a 1SD increase in FPG for overall and ischemic stroke incidence were 1.04 (0.96-1.13) and 1.07 (0.98-1.18) in men and 1.29 (1.15-1.46) and 1.28 (1.09-1.49) in women, and in 2-h PG 1.15 (1.07-1.24) and 1.15 (1.05-1.26) in men and 1.20 (1.04-1.39) and 1.10 (0.92-1.33) in women, respectively. Neither FPG nor 2-h PG predicted the incidence of hemorrhagic stroke. Adding FPG to the Cox model based on 2-h PG improved the prediction of stroke incidence in women (Chi square = 7.01, p=0.01) for all stroke subtypes and for ischemic stroke (Chi square = 6.25, p=0.01), but not in men (Chi square =1.73, p=0.19) and (Chi square = 0.20, p=0.66), respectively. Adding 2-h PG to the model based on FPG improved the prediction of overall (Chi square = 12.99, p=0.00) and ischemic stroke (Chi square =6.42, p=0.01) in men, but not in women (Chi square = 0.23, p=0.64) and (Chi square =0.22, p=0.64), respectively. Discussion In men, 2-h PG better predicts the risk of first overall and ischemic stroke events compared with FPG, whereas in women the latter is better than the former. Neither of the two glucose criteria predict the risk of hemorrhagic stroke.

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

 09
Cerebral Microbleeds Is a Risk Factor for Warfarin-Related Intracerebral Hemorrhage
S.-H.Seung-Hoon    W.-S.Ryu    J.-K.Roh                                                    
 
Clinical Research Center for Stroke, Seoul National University Hospital

SOUTH KOREA

Background: Cerebral microbleeds are known to be indicative of bleeding-prone microangiopathy and may predict incident intracerebral hemorrhage. In this study, we investigated whether the microbleeds are associated with incidence of warfarin-related intracerebral hemorrhage (ICH). Methods: Patients with ICH while on out-patient treatment with warfarin were selected from a consecutive cohort. From the database, 24 patients were included as ICH cases. Control subjects as warfarin users with no history of ICH were randomly selected during the same time period, and 48 patients were finally included. We compared demographic factors, vascular risk factors, laboratory findings, and radiological findings including microbleeds between the groups. Result: There were more patients with microbleeds in the ICH cases than in the control subjects (79.2% vs. 22.9%: p<0.001), and the number of microbleeds was much higher in the ICH cases (9.0±26.8 vs. 0.5±1.03: p<0.001). Moreover, the number of microbleeds was significantly correlated with the presence of warfarin-related ICH (r=0.299; p<0.001). Multivariate analysis showed that increased prothrombin time and the presence of microbleeds were independently related to incidence of warfarin-related ICH (microbleeds: adjusted odds ratio, 11.99). Conclusion: This study suggests that underlying microbleeds are independently associated with an incidence of warfarin-related ICH. Future researches should focus on the risk vs. benefit of warfarin medication in the patients with microbleeds.

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

 10
The prevalence of Aspirin Resistance and Association with Recurrent Ischemic Stroke
Y.B.Lee    S.H.kim    H.Y.Kim                                                    
 
Gachon University of Medicine and Science, Gil Medical Center

SOUTH KOREA

Aspirin is an effective antiplatelet agent with proven benefits in the prevention of ischemic stroke. However, ischemic stroke may recur in some patients of previous cerebrovascular events despite therapy with aspirin. Recent observation raise the possibility that aspirin resistance may contribute to the failure of aspirin treatment in a significant proportion of patients. We sought to investigate the prevalence of aspirin resistance and the association with clinical events. To evaluation the clinical relevance of aspirin non-responder status, we analyzed platelet functions in recurrent and no-recurrent patients treated with aspirin for secondary prevention of cerebrovascular events using VerifyNow test. Demographic data, vascular risk factors, laboratory data (CRP, homocysteine, HbA1C) and drug history were recorded. The stroke subtypes were categorized as large artery disease (LAD) and small vessel occlusion (SVO) by TOAST classification. Statistical analysis was performed to determine association factors of aspirin resistance and the interaction of aspirin resistance with clinical ischemic events. A total of 78 patients on aspirin for secondary prevention (mean treatment duration 16 months) were included. Results of the patients studied, the mean ARU was 468+/-67, and by this study, 12(15.4%)patients were aspirin resistant. There were no significant differences between ASA-responders and ASA-non-responders concerning age, gender. risk factors and aspirin dose. However, multivariate analysis revealed a duration of aspirin treatment to be independent predictor of aspirin resistance (P=0.009) and large artery disease group of stroke subtype was more related with aspirin resistance. In addition, increased ARU was associated with clinical recurrent ischemic events. (p<0.05). The prevalence of aspirin resistance in patients with ischemic cerebrovascular events was approximately 15% and aspirin treatment duration and large artery disease is associated with higher incidence of aspirin resistance.

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

 11
The Relationship Between Carotid IMT and Osteoporosis in Elderly Patients with Ischemic Stroke
Y.B.Lee    E.K.Yim    H.Y.Kim                                                    
 
Gachon University of Medicine and Science, Gil Medical Center

SOUTH KOREA

Recent studies found a relationship between osteoporosis and atherosclerosis. Low bone mass is associated with an increased risk of calcified atherosclerotic plaques. In addition, vitamin D(VitD) potently stimulates bone matrix mineralization and VitD deficiency is well documented in long-term stroke survivors. An increase in carotid Intima-Medial Thickness(IMT) is used as a marker of atherosclerosis. This study was proposed to analyze the relationship between carotid IMT and osteoporosis in elderly patients with ischemic stroke. We prospectively evaluated 63 elderly patients hospitalized due to ischemic stroke. Vascular risk factors were checked. Laboratory data(total cholesterol, triglyceride, HDL, LDL, 25-OH VitD3, and osteocalcin) were checked. The stroke subtypes were categorized by TOAST classification. We investigated Bone Mineral Density(BMD) and the 25-OH VitD3 level which are indicators of osteoporosis. BMD was divided into 3 categories(normal, osteopenia, osteoporosis) by femur T-score and carotid IMT was categorized as two groups(normal vs thickening) by their thickness. Statistical analysis was performed to determine association factors ; carotid IMT and BMD, carotid IMT and serum VitD level . Total 63 patients were included, 50 patients have normal carotid IMT, 13 patients have thickening of carotid IMT. Among 63 patients, only 17 patients were low serum VitD level. In addition, 19 patients were osteoporosis, 21 patients were osteopenia and others were normal BMD. Three factors were associated with carotid IMT, which were the history of previous stroke(p=0.034), BMD(p=0.026) and low serum VitD level(p=0.014). Partial correlation analysis revealed that thickened carotid IMT group showed a positive relation to osteoporosis group(p=0.036) and low serum VitD level patients(p=0.028). But there were no statistically significant differences among other vascular risk factors, laboratory abnormalities and TOAST stroke subtypes. This study indicates that low bone marrow density as well low serum VitD level are associated with an increased carotid IMT.

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

 12
Uric Acid as an independent Risk Factor of Silent Brain Infarction in Healthy Adults
S.H.Heo    S.H.Lee    H.M.Kwon     S.H.Choi     B.W.Yoon                                    
 
Seoul National University Hospital, Seoul, Korea

SOUTH KOREA

Background: Uric acid has apparently contradictory properties in relation to brain function. It has some beneficial effects as antioxidant, but elevations of serum uric acid also accompany vascular disease including ischemic stroke. A silent brain infarction (SBI) can predict clinical overt stroke or dementia. In this study, we examined whether uric acid is independently associated with SBI in healthy adults. Methods: A consecutive series of 1577 neurologically healthy adults were included for this analysis. They underwent brain MRI at Seoul National University Hospital Healthcare System Gangnam Center, and we examined associations between uric acid and SBI by controlling possible confounders. Results: Eighty-eight (5.6%) were found to have ≥1 SBI on MRI. Age, hypertension, and diabetes were found to be significantly related to SBI prevalence. Moreover, participants with highest quartile serum uric acid (≥7.1mg/dL for men and ≥5.3mg/dL for women), compared with those with low to moderate serum uric acid levels, were significantly more likely to have SBI. After controlling for age, hypertension, diabetes, hypercholesterolemia, and smoking, the multivariate-adjusted odds ratio (OR) of SBI were elevated in the entire study population [OR 1.84(1.14-2.96)]. The association was significant in women [OR 2.64(1.27-5.46)], but not in men [OR 1.27(0.65-2.49)]. Conclusions: Our results indicate that serum uric acid is independent risk factor of SBI only in women, but not in men, with adjustment of confounding risk factors.

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

 13
Comparing risk factors, subtypes, and outcomes between first and recurrent ischemic strokes
I.M.Jang     K.B.Lee     H.G.Oh      H.J.Roh      M.Y.Ahn                                    
 
College of Medicine, SOONCHUNHYANG University

SOUTH KOREA

Background & Objective : Some studies of recurrence after stroke have been reported worldwide, but there is scant information on Korean population. Comparison of risk factors, stroke mechanisms, and outcomes for recurrent stroke could allow clinicians to prevent stroke recurrence. Methods : From January 2005 to October 2007, all first-in-a-lifetime and recurrent acute ischemic stroke were identified in SOONCHUNHYANG university hospital. We analyzed baseline demographics, risk factors, ischemic stroke subtypes, severities and functional outcome profiles between two groups. Stroke subtypes were classified by TOAST classification. Neurologic deficit and functional outcome were determined by NIHSS and mRS. Result : A total of 1001 first stroke patients (mean age 66.13+/_12.63) and 156 recurrent stroke patients (mean age 68.25+/_11.34; P=.034) were recruited. The frequencies of hyperlipidemia (22.9 VS 19.9%), and smoking (27.1% VS 20.5%) were not different between the two groups, but hypertension (67.1% VS 80.1%, P=.001), diabetes (35.6% VS 48.1%, P=.003) were more prevalent in recurrent stroke group than in first stroke group. Among initial laboratory findings, Total cholesterol (185.67mg/dL VS 177.14mg/dL, P=.037) and HDL cholesterol (45.58mg/dL VS 43.30mg/dL, P=.036) were significantly lower in recurrent stroke group. There were 370 LAA (47.8%), 103 CE (13.3%), 301 SVO (38.9%) in first stroke group, but a different distribution of stroke subtype was noticed in recurrent stroke group (P=.028); 69 LAA (59.0%), 17 CE (14.5%), 31 SVO (26.5%). NIHSS and mRS on admission as well discharge were higher in recurrent group. Although delta NIHSS was not different between the two groups (P=.548), delta mRS was significantly lower in recurrent stroke group (0.44 VS 0.23; P=.029) Conclusions: Patients with recurrent stroke have more diabetes, hypertension and lower HDL cholesterol level. They may also have different stroke subtypes and poor functional recovery. This study could provide a better understanding in the clinical characteristics of recurrent ischemic stroke.

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

 14
PFO closure in stroke prevention: following the strict protocol criteria.
M. Reif    R. Mikulík    D. Goldemund     O. Hlinomaz     M. Orban    M. Rezek                             
 
The Saint Anne´s Hospital, Brno, Czech Republic

CZECH REPUBLIC

Background:Patent foramen ovale(PFO) might be the cause of stroke through paradoxical embolization. Precise indication criteria for PFO-closure in stroke prevention are still undetermined. The goal of our study is to investigate the safety and effectiveness of PFO closure indicated by following our institutional protocol. Method:All ischemic stroke patients treated in our department between July 2004 and March 2007 were indicated for PFO-closure if they met such criteria: age≤55, cryptogenic stroke, recent large-vessel stroke and either previous large vessel stroke within different territory or venous trombembolic source of recent stroke, presence of PFO on TEE and at least “shower” on TCD-bubble test. By braking the protocol, the PFO closure was also performed as “rescue” therapy in patients of age>55 with vascular risk factors and several recurrent strokes when all secondary prevention accesses failed. Patients were monitored in terms of peri-, post-procedural complications, stroke recurrence in the next 1 year, RLS (right-to-left shunt) closure quality. Results: Of 734 patients, 114 (16%) were ≤55 years, 36 of them(32%) suffered from cryptogenic stroke. Out of those, 36 patient 18(54 %) had PFO diagnosed by both TCCD- bubble test and TEE. 11 were excluded: hypermobile or aneurysmatic interatrial septum not present(5), at least “shower” on TCD was not present(6), lacunar stroke(3), refused the procedure (1). Of 7 patients (mean age 41, female 3) after the procedure: none had stroke and 1 had positive TCD-bubble test without any signs of RLS on TEE. In 3 patients (68, 56, 65 years old) PFO closure was indicated as rescue therapy. Stroke occurred in 2of them after procedure. Peri-or post-procedural complications were not observed in any patient. Conclusion: PFO closure was safe and preventing the majority of RLS. Our protocol appears to be strict enough to select the group of patients possibly profiting of this procedure. Breaking the protocol should be considered carefully and rather avoided due to probable lack of benefit.

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

 15
Smoking Cessation Support Post Stroke: An Ageist Referral Policy?
A. Craig    K. Brennan    A. Rabone     A. Hendry     M. Barber                                    
 
Monklands District General Hospital Airdrie Lanarkshire Scotland

UNITED KINGDOM

Introduction: Smoking cessation is an important component of secondary prevention post stroke. Older patients can be engaged successfully in smoking cessation programmes. Our aim was to assess if age influences whether post stroke patients have access to, and utilise, smoking cessation services. Methods: The Stroke Audit in Lanarkshire (SAIL) database records details of inpatient stay and outpatient follow up. We retrospectively analysed clinical and demographic data along with details on whether the patient had been offered smoking cessation. We also analysed if they had attended classes or received input from specialist nurses, and if they had stopped smoking over their period of follow up. Results: Between January 2006 and August 2007, 620 patients were admitted with a diagnosis of stroke, of whom 174 (28%) were smokers. Sixteen of these smokers died during hospital stay. Of the remaining 158 patients (mean age 65 years), 69% of those aged under 65 were offered smoking cessation treatment (SCT) compared to 43% of those aged 65 or over (p=0.004). For those offered SCT 66% of the younger group accepted, compared with 62% in the older group (p=0.4). When followed up in the community 22% of the younger group and 20% of the older group had given up smoking post event (p=0.9). Conclusions: Our study shows a clear deficiency in access to smoking cessation services in older patients post stroke. However, the proportion of patients accepting smoking cessation and giving up smoking were comparable in both groups. Further education of health professionals, patients and their carers is required to promote smoking cessation for older people.

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

 16
Increased levels of fibrinogen elastase degradation products in patients with ischemic stroke
L.M.de Lau    E. Cheung    C.  Kluft     F.W.Leebeek     P. Meijer    R. Laterveer     D.W.Dippel     M.P.de Maat             
 
Erasmus Medical Center, Rotterdam, the Netherlands

THE NETHERLANDS

Background Ischemic stroke is associated with accumulation and activation of leukocytes, which release several proteolytic enzymes, including elastase. One of the proteins that can be degraded by elastase is fibrinogen, resulting in fibrinogen elastase degradation products (FgEDP). FgEDP levels may serve as a specific biochemical marker of elastase proteolytic activity. The aim of the current study was to evaluate the association between levels of FgEDP and ischemic stroke. Methods We studied FgEDP levels in a case-control study of 111 patients with a recent first-ever ischemic stroke and 119 age- and sex-matched controls. In a random subgroup of 48 patients, FgEDP was also measured 3 months after the event. Data were analyzed by means of multivariable logistic regression. Results FgEDP levels were significantly higher in patients with ischemic stroke than in controls. Participants in the highest quartile of FgEDP had a significantly higher risk of ischemic stroke compared with those in the lowest quartile (OR, 7.5; 95%CI, 2.2 to 25.0). The association remained unchanged after adjustment for several cardiovascular risk factors and the acute phase proteins CRP and fibrinogen. FgEDP levels assessed 3 months after the stroke were lower than in the acute phase, but still significantly higher than in the control group Discussion FgEDP levels are strongly elevated in ischemic stroke, both in the acute phase and three months after the event. It needs to be clarified whether increased FgEDP levels reflect only leucocyte activation, or are indeed causally related to the occurrence of ischemic stroke.

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

 17
24-hour Blood Pressure and Risk for Cerebrovascular Incidences
G. Simonyi    R.J.Bedros    M. Medvegy                                                    
 
Ferenc Flor Hospital/Cardiometabolic Centre

HUNGARY

Introduction Hypertension is one of the most frequent disease of the world. It is risk factor for several vascular disease including cerebrovasular lesions. The beneficial effects of antihypertensive treatment in preventing cardiac disease and stroke are well known. It is known relationship between nocturnal blood pressure (BP) decline and more type of cerebrovascular damage. Patients with extreme dipping pattern may have severe cerebrovascular damage than dippers. Thus the discovering this pattern important to assess as risk factor for cerebrovascular incidence. Patients and methods We investigated 1253 patients with ambulatory blood pressure monitor (ABPM). The criteria of extreme dipping were nocturnal blood pressure fall ≥20%. We assessed the circadian pattern of BP, bady mass index (BMI), heart rate (HR). Results From this population we found 63 patients (5.55%) with extreme dipping pattern. Age 46.8±13.01 years, BMI was 29.7±5.95 kg/m2. The 24-hour systolic BP was 126.08±14.76 mm Hg the diastolic was 74.13± 10.72 mm Hg, the HR was 70.02±8.16 beat/min. The systolic diurnal index (DI) was 23.42±2.76% and diastolic DI was 27.41±5.15%. We found significant difference between dipper and extreme dipper group between 24-hour systolic and diastolic blood pressure variability (p<0.0001), daytime systolic blood pressure. The prevalence of hypertension was 34,13% of this patients. Conclusions ABPM is important non-invasive method to investigate the circadian rhythm of blood pressure. The extreme dipper pattern is frequent in the investigated population. If we found extreme dipping pattern, despite of normotension, we have look for other risk factors for cardiovascular events.

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

 18
Prevalence of hypertension increases during follow-ip of ischemic stroke
M. Dakermandji    S. Lanthier                                                           
 
Université de Montréal, and Centre hospitalier de l'Université de Montréal

CANADA

Background: Hypertension is the most important modifiable risk factor for ischemic stroke (IS), being present in two-thirds of cases. It accounts for an attributable risk of 50%. The proportion of normotensives who develop hypertension following IS is unknown. Goal: To determine the prevalence of hypertension at different time intervals following IS. Methods: Consecutive individuals admitted for acute IS at our stroke unit are enrolled in a database, which is approved by our local ethics board and includes data prospectively collected on medication and systematic blood pressure measurements during hospitalization and at clinical follow-up visits. We reviewed data of individuals hospitalized between Jan. 2003 and Jun. 2007. Hypertension diagnostic criteria were: (a) treatment with antihypertensive agents, (b) blood pressure >140/90 mmHg on 2 or more occasions, or (c) mean blood pressure >135/85 on self-measurements or ambulatory monitoring. We excluded 47 individuals with follow-up <20 days because blood pressure often increases transiently during acute IS. Results: We analyzed 629 individuals (333 men, 296 women) with a mean of 3.2 follow-up visits over a mean of 29.8 months. At admission, 233/629 (37%) individuals were on antihypertensive drugs. Prevalence of hypertension increased from 415/629 (66%) at >/=4 months following IS, to 342/475 (72%) at >4-15 months (p=0.036), 260/353 (74%) at >15-27 months (p=0.015), 168/226 (74%) at >27-39 months (p=0.024), and 81/104 (78%) at >39-51 months (p=0.017). Conclusion: One-third of those who are normotensives at IS develop hypertension in the next 4 years. Careful monitoring of blood pressure is mandatory in the follow-up of IS.

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

 19
Sex differences in the prevalence of undetected vascular risk factors after an acute ischemic stroke
P. Martinez-Sanchez    B. Fuentes    M.A.Ortega-Casarrubios     E. Diez-Tejedor                                            
 
Stroke Unit. Deparment of Neurology. Hospital Universitario La Paz.

SPAIN

BACKGROUND: The prevalence of vascular risk factors are different in men an women however, the knowledge of vascular risk factors that are diagnosed in the days following an AIS is scarce. Our aim is to analyze possible sex differences in vascular risk factors diagnosed after an acute ischemic stroke. METHODS: Observational study using data from the Stroke Unit Data Bank from consecutive patients with first-ever cerebral infarction (2000-2006). We analyzed: demographic data, previous diagnosed vascular risk factors, stroke severity (Canadian Stroke Scale), stroke subtype, in-hospital complications, functional status at discharge (modified Rankin Scale [mRS]) and vascular risk factors diagnosed after the AIS (atrial fibrillation, arterial hypertension, diabetes mellitus and hyperlipidemia). RESULTS: 1,673 patients, 941 men. Mean age: 66.96 years (SD 12.25) in men and 70.42 years (SD 13.03) in women (P<0.0001). Previous vascular risk factors more frequent in men than in women: peripheral arterial disease, coronary arterial disease, current smoking and alcohol abuse (P<0.0001). Women had a higher frequency of previous arterial hypertension and atrial fibrillation (P<0.0001). Men showed a higher frequency of post-stroke diagnosed arterial hypertension than women (9.6% vs. 4.5%, P<0.0001) as well as diabetes mellitus (4.4% vs. 1.5%, P=0.001). The logistic regression analysis showed that male (OR, 1.665; 95% CI, 1.001 to 2.748) and previous hyperlipidemia (OR, 1.786; 95% CI, 1.026 to 3.111) were the factors associated with post-stroke diagnosis of arterial hypertension, and male (OR, 3.168; 95% CI, 1.419 to 7.070) the only factor associated to post-stroke diagnosis of diabetes mellitus; after adjustment for age, sex, previous vascular risk factors, stroke subtype and severity and in-hospital complications. DISCUSSION: male is associated with a higher post-stroke diagnosis of diabetes mellitus and arterial hypertension than female. These results suggest the existence of sex-differences in undetected vascular risk factors and wide scope for stroke prevention.

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

 20
Are thrombophilic disorders the link between migraine, atrial septal abnormalities and stroke?
P. Martinez-Sanchez    B. Fuentes    M.V.Cuesta     M.A.Ortega-Casarrubios     J. Fernandez    E. Diez-Tejedor                             
 
Hospital Universitario La Paz. Madrid

SPAIN

BACKGROUND: Migraine has been associated with patent foramen ovale (PFO) and more recently, with inherited thrombophilic disorders. Our goal was to assess the relationship between migraine, PFO +/- atrial septal aneurism (ASA) and thrombophilic disorders in young patients with cryptogenic stroke. METHODS: Observational study with inclusion of consecutive patients from the Stroke Unit Data Bank (January 1996-January 2007). We investigated patients under 55 years of age with a cryptogenic acute ischemic stroke. Variables analyzed: gender, vascular risk factors, previous migraine and the presence of hypercoagulable states (HS) by an extensive battery of hematological tests. The presence of PFO +/- ASA was assessed by transesophageal echocardiography +/- transcranial Doppler sonography. RESULTS: 188 patients were included. Median age [intercualtile range]: 43.5 years [12], 38.2% women. Previous migraine was present in 9% (17 cases) of patients. Patients with migraine were more commonly females (76.5% vs. 35.1% P = 0.001) and tended to have fewer classic vascular risk factors. Migraine was associated with a higher frequency of HS (crude OR, 3.33; 95% CI, 1.06 to 10.50) and the presence of PFO+ASA (crude OR, 7.50; 95% CI, 2.17 to 25.93). Patients with migraine and PFO had the highest frequency of HS (crude OR, 16.2; 95% CI, 2.78 to 94.14). DISCUSSION: in acute stroke patients under 55 years of age, thrombophilic disorders are diagnosed more frequently in patients with migraine, especially if they have atrial septal abnormalities. Some types of migraine might be an expression of an underlying HS and could predispose patients to ischemic stroke if they are associated with atrial septal abnormalities.

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

 21
Plasma homocysteine in ischemic stroke subtypes
K. Jood    L. Ögge Englund    C. Ladenvall     C. Blomstrand     C. Jern                                    
 
Institute of Neuroscience and Physiology, the Sahlgrenska Academy at Göteborg University

SWEDEN

Background: Elevated plasma levels of homocysteine (hcy) are associated with ischemic stroke. However, data on ischemic stroke subtypes are limited. Therefore, we investigated hcy in ischemic stroke subtypes. Methods: The material comprises the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS), in which 600 consecutive patients with acute ischemic stroke (18-69 years) and 600 matched controls have been included. Ischemic stroke subtype was determined according to TOAST criteria. In this analysis, subjects on treatment with vitamin B12 and/or folate were excluded (n=107). Plasma hcy during the acute stage and at 3-month follow-up was determined using high performance liquid chromatography. Results: Among cases, there was a significant increase in plasma hcy at follow-up compared to the acute stage (p<0.001). At both time points, levels were significantly higher in cases compared to controls (p<0.001). Among subtypes, small vessel disease (SVD) displayed the highest, and cryptogenic stroke the lowest hcy level. However, plasma hcy did not differ significantly between subtypes (p>0.09). This is in contrast to other biomarkers in this sample, i.e. high-sensitivity CRP (hsCRP) and tissue-type plasminogen (t-PA) antigen, that differ significantly between subtypes with highest levels of both measures in large vessel disease (LVD). After adjustment for traditional vascular risk factors the association for hcy at 3-month follow-up remained significant only for SVD and cardioembolic stroke (OR per 1 µmol/L increase in plasma hcy 1.06 95% CI 1.01-1.11, p<0.05 and 1.08 95% CI 1.03-1.14, p<0.01, respectively). Analysis of two common variants in the gene encoding metyltetrahydrofolat reductase (MTHFR), i.e. MTHFR C677T and A1298C, confirmed an association to plasma hcy level for both polymorphisms. However, no significant association between genetic variants and ischemic stroke was detected. Conclusion: Plasma hcy levels are elevated in all ischemic stroke subtypes. In contrast to hsCRP and t-PA antigen, there is no significant subtype-specific difference in hcy.

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

 22
Smoking and functional outcome after rtPA treatment
M.J.Ariës    M. Uyttenboogaart    P.C.Vroomen     J. de Keyser     G.J.Luijckx                                    
 
University Medical Centre Groningen

THE NETHERLANDS

Introduction: Smokers thrombolysed for myocardial infarction have better outcome than nonsmokers. A posthoc analysis of the NINDS cohort suggested in 2005 that smokers treated with rtPA had a significantly drop in NIHSS score 24 hours after treatment compared with nonsmokers and lower mortality over 1 year. It is unclear whether smoking influences functional outcome of rtPA treatment in patients with acute ischemic stroke. Methods: In a consecutive patient registry comprising 345 ischemic stroke patients treated with rtPA, we investigated the relation between smoking status and functional outcome. Favourable outcome was defined as a modified Rankin Scale (mRS) score of 0-2 at 3 months. We also assessed the risk of Symptomatic Intracerebral Haemorrhage (SICH) after rtPA treatment in smokers and nonsmokers. The independent effect of smoking status on outcome and SICH was evaluated by logistic regression analyses. Results: Fifty-two percent of the smokers (n= 101) treated with rtPA had a favourable outcome compared to forty-two percent of nonsmokers (n= 244) (p = 0.10). After adjustments for demographic variables, stroke severity and other vascular risk factors, smoking was not independently associated with favourable outcome (OR 0.96 95% CI 0.48-1.92, p = 0.91). The incidence of SICH was comparable between smokers and nonsmokers (5.9% versus 6.6%, p =0.83). Conclusion: Our analysis suggests that smokers with acute ischemic stroke who receive IV thrombolysis experience no different functional outcome compared to nonsmokers. The risk of SICH was not increased in smokers.

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

 23
Stroke Patient knowledge of Hypertension after discharge from hospital
L. O'Connor    M.T.Lonergan    N. Cogan     D. O'Neill     D.R.Collins                                    
 
Adelaide & Meath Hospital, Dublin

IRELAND

Introduction: Hypertension is the most prevalent and modifiable of cardiovascular risk factors but patient awareness of its importance may be poor even after a stroke [1]. It is a principle target for patient education and intervention in our stroke service. We assessed knowledge among our community patient population after discharge from hospital. Methods: Stroke patients returning to our clinic 1-2 years after stroke were invited to complete a questionnaire anonymously. Results: 100 patients participated. Only 56% were aware that the term “hypertension” meant blood pressure. 14% were unaware that hypertension can be asymptomatic and 11% were unaware of any symptoms of hypertension. 90% were aware that lowering blood pressure could improve health. 65% patients realised blood pressure was a risk factor for heart attack and stroke. 8% stroke only, 9% heart attack only and 9% were unaware of the risks of high blood pressure. 27% were aware of current BP targets. 36 % were aware of targets but couldn't identify the correct range. 37% patients were unaware of BP targets. Only 30% of those surveyed knew their recent blood pressure reading. 85% patients were aware that blood pressure could be controlled but 38% patients were unaware of lifestyle measures to lower blood pressure. 37% patients aware that exercise/diet could be effective in reducing blood pressure. Only 5% aware smoking cessation could help control BP. 27% of those studied were still smoking. Discussion:Survey highlights that despite having suffered a stroke and being given secondary preventative advice while in hospital, that knowledge of blood pressure and lifestyle measures is poor after discharge and smoking levels are high. Continued patient education is required after hospital discharge. 1. A Croquelois, JBogousslavsky Risk awareness and knowledge of patients with stroke: results of a questionnaire survey 3 months after stroke., Journal of Neurology, Neurosurgery, and Psychiatry 2006;77:726-728)

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

 24
The Effect of Serum Apolipoprotein B/A-1 Ratio on Baseline Carotid Intima-Media Thickness (CIMT) and CIMT Progression in a Population Free of Cardiovascular Disease
N. Sanossian    N, Kono    W.J.Mack     P. Alaupovic     H.N.Hodis                                    
 
University of Southern California

USA

Background: Serum lipoprotein and apolipoprotein levels may reflect the balance of pro-atherogenic and anti-atherogenic activity and correlate with baseline carotid intima-medial thickness (CIMT) and progression of CIMT over time. Objective: To study the association of baseline apolipoprotien (apo) B to apo A1 ratio with baseline CIMT and CIMT progression on ultrasound evaluation. Methods: Subjects aged >=40 years with fasting homocysteine >=8.5 µmol/L and no evidence of coronary disease were participating in a clinical trial of vitamin B supplementation, or placebo and received carotid ultrasonography at baseline and every 6 months for 2.5 to 4.5 years. Fasting apolipoprotien analysis was performed during the initial visit. The effect of baseline apoB/A1 ratio on baseline CIMT and CIMT progression analyzed while controlling for factors known to affect CIMT progression such as lipid-lowering therapy (LLT). Results: There were 506 subjects with a mean age of 61.6 +/- 9.9 years, 39% were women, the mean CIMT at baseline was 0.752 mm and the rate of CIMT progression was 0.0026 mm/year. Baseline mean (SD) concentrations of lipoproteins were apoA1 149 +/- 23 mg/dL, apoB 105 +/- 18 mg/dL, and mean ratio of apoB/A1 was 0.72. Apo B/A1 ratio was not associated with CIMT progression in either continuous (-0.001 /year IMT rate per unit of ApoB/A1 ratio, p=0.57) or categorical (0.0007mm/year IMT rate comparing highest vs. lowest quartile, p=0.56) analysis. Baseline CIMT was similar across apoB/A1quartiles (Q1: 0.74mm, Q4: 0.75mm). In multivariate analysis, ApoB/A ratio was positively associated with baseline CIMT in those not on LLT (N=316, beta=.09, p=.05), after controlling for age, sex and SBP. Conclusions: Ratio of apoB/A1 was positively associated with baseline CIMT in asymptomatic individuals not on LLT but was not associated with CIMT progression. The apoB/A1 ratio may reflect longstanding subclinical atherosclerosis in those not on LLT but may not have a measurable effect on CIMT progression over a few years or in the face of LLT.

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

 25
Sleep apnea and risk of more severe white matter abnormalities on magnetic resonance imaging in hypertensive subjects
T.J.Kiernan    M.G.Hickey    L.A.Pearce     M.I.Aguilar                                            
 
Mayo Clinic Arizona

USA

Background: Obstructive sleep apnea (OSA) is linked with hypertension (HTN) and cardiovascular disease. While each sleep arousal parallels a surge in blood pressure the exact mechanism relating OSA to cerebrovascular disease (CVD) has not been elucidated. White matter disease (WMD) seen on magnetic resonance imaging (MRI) is a manifestation of CVD. Most common risk factors for WMD are age and HTN. We hypothesize that OSA is an independent risk factor for WMD. Methods: A sleep lab database was searched for subjects with HTN, without CVD who had polysomnography and brain MRI during 2006-2007. OSA was defined as an apnea/hypopnea index (AHI) above 5. MRIs were read by 2 of the coauthors (inter-rater reliability was 85%). WMD was scored by the ARWMC scale (0-24 possible). A total score above 4 was considered significant WMD. Demographics were compared using Chi-square test for categorical and Mann-Whitney U test for continuous variables. Multivariate logistic regression was used to determine if severity of OSA was independently associated with WMD. Results: 68 patients met inclusion criteria. Mean age of 67. Mild OSA was observed in 31% of subjects and moderate-severe OSA (including patients on CPAP) in 69%. WMD was diagnosed in 31 subjects (50%); older age was associated with more severe WMD (ARWMC 0-4: 45% of subjects age > 65 vs. ARWMC 5-8: 75% vs. ARWMC 9+: 92%, p = 0.008). Severity of OSA was associated (p = 0.06) with WMD but not linearly (p = 0.87). After adjustment for age, moderate-severe vs. mild OSA was not linked with ARWMC. Discussion: Our results suggest that the severity of OSA is associated with WMD, although the analysis in this small sample size did not reach statistical power after adjusting for age. Subjects with HTN and OSA commonly have both OSA and WMD. We suspect a relationship between OSA and WMD regardless of age and HTN and will assess with a larger sample size in our ongoing research. The brain is targeted by HTN and presumably more so in the presence of OSA. Recognition and treatment of OSA may promote brain health in subjects with HTN.

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

 26
Usefulness of Arterial Stiffness Assessment in Stroke Prevention
C. Alecu    C. Labat    A. Kearney-Schwartz     R. Fay     P. Salvi    L. Joly     P. Lacolley     H. Vespignani    A. Benetos      
 
University of Nancy, INSERM U684

FRANCE

Background: Increased arterial stiffness predicts stroke through several mechanisms: arterial remodelling, atheroma and plaque rupture, and microangiopathy. Carotid-femoral pulse wave velocity (AoPWV), gold standard for arterial stiffness, represents the speed of travel of the pulse along an arterial segment (L/Dt in m/s). ESH-ESC guidelines introduced increased AoPWV as target organ damage and as a determinant to be taken into account for the evaluation of cardiovascular risk. There are, however, no generally accepted limits for defining the normal or reference values. The aim of the present study was to define reference values for AoPWV. Patients and methods: AoPWV was assessed using the PulsePen device in an ambulatory population of 455 subjects 60-75 years old. The 95th percentile of a sample of 206 subjects without hypertension or diabetes, outlet of this population, was used to determine the upper limit of AoPWV reference values. Results: Mean AoPWV was 8.7±2.3 m/s. The 95% confidence intervals of the median values of AoPWV were <10 m/s in all 3 age-subgroups; median values (95% CI) were 8.0 m/s (7.6-8.5) in the 60-64, 8.0 m/s (7.5-9.0) in the 65-69 and 9.0 m/s (7.9- 9.5) in the 70-75 years old group. The sample's 95% percentiles were in all 3 age subgroups <13 m/s. Conclusion: Measured with the PulsePen, an AoPWV value <10 m/s can be used as a reference in subjects 60 years age or more. A value of 13 m/s must be considered as high. Values between 10 and 13 m/s can be considered as high normal or moderately elevated values.

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

 27
Increased ischemic stroke risk among Greek apoE4 allele carriers
K. Spengos    C. Konialis    B. Hagnefelt     G. Paraskevas     E.  Manios    E. Koroboki     E. Gialafos     K.N.Vemmos    N. Zakopoulos   C. Pangalos
 
University of Athens- Diagnostic Genetic Center Athens

GREECE

Background: Although several studies in various countries have indicated that the presence of the Apolipoprotein (ApoE)-epsilon4 allele is a risk factor for ischemic cerebrovascular disease, the existence of this association still remains a matter of debate. This study aimed to evaluate the association between the ApoE-4 allele frequency and the risk of ischemic stroke in a sample of hospitalized Greek patients. Methods: ApoE alleles were determined using the semi-nested polymerase chain reaction in 130 hospitalized ischemic stroke (IS) patients, 178 patients with ischemic coronary heart disease (CHD) and 230 controls with no cerebro- or cardiovascular disease. Statistical analysis was performed using univariate and multivariate logistic regression models. Results: ApoE4 allele frequency was significantly higher (p=0.01) among patients with IS (23.7%) and CHD (18.8%) when compared to controls (11%). The odds ratio (OR) for IS associated with the presence of the ApoE4 allele was 2.55 (95%CI:1.43-4.56, p=0.0012), whereas the OR for CHD associated with the presence of the ApoE4 allele was 1.88 (95%CI:1.07-3.3, p=0.0257). Multivariate regression analysis revealed the ApoE4 allele as an independent predictor of IS (p=0.003), together with male gender (p<0.0001) and advanced age (p=0.029). Conclusions: In contrast to previous studies from Greece our results support the role of the ApoE4 allele as risk factor for both ischemic coronary disease and ischemic stroke among Greek patients.

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

 28
Vascular Risk Factors and Morphometric Data in Cervical Artery Dissection: A matched case control-study
M. Arnold    B. Pannier    H. Chabriat     K. Nedeltchev     C. Stapf    F. Buffon     I. Crassard     L. Guize    R.W.Baumgartner   M.G.Bousser
 
University Hospitals Bern, Lariboisière Paris; Clinical and Preventive Investigations Center Paris

SWITZERLAND

ABSTRACT Background: Limited knowledge exists on vascular risk factors, body height and weight in patients with spontaneous cervical artery dissection (sCAD). A previous case-control study suggested that hypertension might be a risk factor for sCAD. Patients and methods: In this case-control study, major vascular risk factors, body weight, body height and body mass index (BMI) of 239 patients obtained from a prospective university hospital-based sCAD registry were compared with 516 age- and sex-matched healthy controls undergoing systematic health examinations in the Clinical and Preventive Investigations Center (ICP), Paris. Gender-specific analyses were performed. Results: Mean body height was increased in sCAD patients compared with controls (171.3 cm (SD 8.6) versus 167.7 cm (SD 8.9); p < 0.0001) and sCAD patients had a significantly lower mean BMI than healthy controls (22.9 (SD 3.3) Kg/m² versus 24.5 (SD 4.2) Kg/m²; p < 0.0001). Mean body weight (67.5 (SD 12.2) kg versus 69.3 (SD 14.6) kg; p=0.312) and the overall frequency of hypertension (17% versus 19%, p=0.565), diabetes (1% versus 1%, p=0.918), current smoking (27% versus 31%, p=0.22), past smoking (17% versus 19%, p=0.648), and hypercholesterolemia (61% versus 57%, p=0.35) did not differ significantly between sCAD patients and controls. Mean total plasma cholesterol level was identical in patients and controls (5.5 mmol/l, SD 1.1). Gender specific subgroup analyses showed similar results for men and women. Conclusion: Our results indicate that patients with sCAD have higher body height and lower BMI than controls while major vascular risk factors were similar in sCAD patients and controls.

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

 29
Smoking cessation after stroke – influencing factors
A.H.Sienkiewicz-Jarosz    B.P.Zatorski    C.A.Baranowska     D.A.Scinska     E.P.Bienkowski    F.P.Ryglewicz                             
 
Instit of Psychiatry & Neurology/Dept of Neurol; Medical Academy/Dept of Otolaryngol, Warsaw

POLAND

Introduction: Cigarette smoking is an independent risk factor for stroke. Consideration of factors predicting difficulty with smoking cessation is important for preparing more effective programs. Aim: Purpose of this prospective study was to determine clinical factors influencing smoking cessation in the group of patients with the first-ever in a lifetime ischemic stroke (FES). Methods: Participants were patients with FES, who are smokers on admission. Informations regarding medical history, history of smoking and current smoking status (Fagerström Test of Nicotine Dependence (FTND), readiness to quit up smoking and nicotine craving – visual analoque scales (VAS), readiness to change (RTCQ)), neurological status (NIHSS, Barthel scale) and breath CO levels were collected. Patients were assessed at 5-10 days after stroke and at 3 months. Results: 65 patients, mean age 58.3 y were included. Comparison of patients, who quit up smoking within 3 months (NS) and still smoking (CS) showed significant differences in: functional status after 3 months (Barthel scale: 19.1±2.2 vs 16.3±5.8; p=0.01, for CS and NS patients, respectively), initial FTND (CS vs NS: 5.1±2.3 vs 3.5±2.4; p<0.01) and breath CO (CS vs NS: 10.5±11.6 vs 3.2±3.0; p<0.01). CS patients declared lower readiness to quit up smoking during hospitalization (CS vs NS: VAS: 58.2±36.9 vs 90.4±18.4; p<0.01), and most of them during initial examination was at precontemplation phase. Multiple regression analysis showed that predictors of smoking cessation within 3 months after stroke were: readiness to quit up smoking during initial examination, smoking status (breath CO and initial FTND) and functional status (Barthel scale) [F(5.59)=13.19, p<0.001, R²=0.52 for: RTCQ beta =-0.22; CO beta=0.34; Barthel beta=0.24; FTND beta=0.22]. Conclusion: Our preliminary data showed, that smoking cessation after stroke could be dependent on initial smoking status and readiness to change (RTCQ) during subacute phase of stroke, and on functional status after stroke. *Study is supported by grant KBN 2 P05D 058 29

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

 30
Hypertension-induced vessel wall, cerebral hemodynamical and neuropsychological alterations
L. Csiba    Cs. Szekeres    Z. Bajkó     E. Nyitrai     P. Soltész    K. Csapó                             
 
Debrecen University

HUNGARY

The early diagnosis of subclinical alterations of vessel wall (IMT), cerebral hemodynamics, cognition (attention, memory deficits) is important for the prevention of stroke and cognitive decline in hypertensives. Our aim was to perform a complex assessment of morphological, hemodynamical and neuropsychological alterations in essential hypertensives before and after therapy. Material and methods: 70 non-treated (recently diagnosed) pts. (44+/-11yrs) were investigated with carotid US (IMT), transcranial Doppler and beat-to-beat blood pressure monitoring during head up tilt-table testing. Cognitive performance was also evaluated by neuropsychological testing (trail making, digit span backward, reaction time, WAIS block design, digit symbol) including depression (Beck) test. The results were compared with those of age matched controls.. Results:the prevalence of subclinical depression was higher in HT group and did not decrease after anti-HT treatment. Neither the supine nor the tilt MCA blood velocities showed any significant differences compared with controls. The untreated hypertensives produced significantly worse performance in reaction time (p=0.02), trail making, WAIS block design test ( p=0.01) and digit span test (0.04). The results were even worse in untreated hypertensives with Beck depression score>10. Conclusion: untreated hypertension significantly worsens the attention, concentration and slightly the motor and mental speed, but these tests improved after 6 month anti-HT therapy. Subclinical depression significantly influences the cognitive functions both in untreated and treated hypertensives and the depression scores did not improve after anti-HT treatment. The co-existence of hypertension and subclinical depression might need special therapeutic consideration.

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

 31
BLOOD PRESSURE PATTERN IN ACUTE PERIOD OF ISCHEMIC STROKE
D.A.Uluduz    B. Ince    M. Sohtaoglu     G. Benbir                                            
 
risk factors of stroke

TURKEY

INTRODUCTION: Hypertension (HT) is an important risk factor for recurrence and mortality in patients with acute ischemic stroke, and it is being diagnosed for the first time after stroke in a portion of patients. There are still controversies about the treatment of HT in patients with acute ischemic stroke. METHODS AND FINDINGS: 255 patients diagnosed with ischemic stroke between Jan. 2005 and Jan.2006 enrolled to this study. Blood pressure values of each patient were recorded at first admission, in the first, second and seventh days, 4-6 times a day, after hospitalization. Previous history of hypertension, cardiac findings, anti-hypertensive medication and other risk factors were noted. RESULTS: The mean age was 67.9±13.2. There were 125 male and 130 female. Previous HT history was encountered in 162 patients. %78.3 (127/162) of previously diagnosed hypertensive patients were found to be using anti-hypertensive medication, whereas the rest were drug free. Systolic and diastolic mean blood pressure values of the patients were calculated in a 7-day period. At the first admission, blood pressure values of hypertensive patients were significantly higher than patients without previous hypertension history (149/87.5 mmHg versus 131/79mmHg, p<0.05). Blood pressure values of hypertensive patients were found to be higher in the first and second day. But the blood pressure results obtained on the seventh day were similar in patients regardless of previous hypertension history. In the follow-up period, fifty four patients started a new anti-hypertensive drug. 35% (19/54) of these patients were recently diagnosed as having hypertension. 20.3% (33/162) of the patients needed a change in their previous antihypertensive therapy. CONCLUSION: Blood pressure values in ischemic stroke patients proceed higher levels in the acute period, but decreases to normal ranges within the following few days. On this stage, it will be adequacy to continue previous medication in stable patients, while drug adjustment might be needed in patients with uncontrolled severe hypertension.

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

 32
Profile Of Circadian Variation Of Blood Pressure In Patients With TIA And Stroke
A. Mateer    K. Khan    N. Dean     A. Salam     A. Shuaib                                    
 
Univ of Alberta, Edmonton, AB

CANADA

BACKGROUND: Circadian variation of blood pressure has been associated with increased risk of cardiac and other vascular events. We sought to explore blood pressure variability in apparently well treated hypertensive with a diagnosis of TIA or stroke. METHOD: In an ongoing prospective, observational 24 hours (hrs) ambulatory blood pressure monitoring trial (ABPM), patients were recruited from stroke clinic. Inclusion criteria included age above 18 years, diagnosis of TIA or stroke and clinic manual BP reading < 140/90. Normal (ABPM) was taken as 120/80.RESULTS: Thirty seven patients (mean age 66.4 ± SD 12.7 years; 51.3% women) with clinical, CT or MRI proven diagnosis of Stroke or TIA (stroke 17/37(45.9%), TIA 19/37 (51.3%) and 1/37 (2.7%) with intracererbral hemorrhage were analyzed. Among these with established diagnosis of hypertension (eHTN) alone were 16/37 (43.2%), Diabetes (DM) plus HTN 9/37 (24.3%), non-DM plus non-HTN 11/37 (29.7%), and 1(2.7%) had just diabetes. Average 24hrs Systolic/Diastolic ABPM was 124.7 ± SD 13.1 / 70.1 ± SD 9.01 mmHg. Twenty four hrs Systolic/Diastolic blood pressures above normal were 55.2% / 21.2% mmHg. Systolic Non-dipping (SND) was seen in 24/37 (64.8%), among these (eHTN11/24, DM plus HTN 5/24 and non-DM plus non-HTN 7/24). Diastolic Non-dipping (DND) was seen in 17/37 (45.9%) among these (eHTN 9/17, DM plus HTN 3/17and non DM plus non HTN 5/17). Morning surges (MS) of BP were seen in 32/37 (86.4%), (e HTN 14/32, DM plus HTN 9/32 and non-DM plus non HTN 8/32). Morning Rise in BP was seen in 29/37 (78.3%) of patients (e HTN12/29, DM plus HTN 9/29 and non-DM plus non HTN 8/29). Reversed Dipping (RD) was observed in 7/37, (e HTN6/7, DM plus HTN 1/7). CONCLUSION: Our data shows high risk ABPM profile after the diagnosis of TIA or stroke in patients with established and treated hypertension. The clinical significance of these variables on the incidence of future TIA or stroke remains to be established.

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

 33
Polymorphisms of genes involved in lipid metabolism in children after ischemic stroke
I. Zak    A. Balcerzyk    B. Sarecka-Hujar     I. Kopyta     E. Marszal                                    
 
Medical University of Silesia

POLAND

Background. The ischemic stroke in children is not as common as in adults, however, it is an important social problem as 50% of the survivors are left with significant neurological disabilities. Carotid atherosclerosis is a major cause of stroke in adults but the etiology of the disease in children is poorly understood. In search of genetic risk factors of the disease we analyzed polymorphisms of two genes encoding proteins involved in lipid metabolism since previous data show that hypercholesterolemia is common in children after stroke. The ATP Binding Cassette Transporter (ABCA1) gene encodes the protein that mediates the transfer of cellular cholesterol to acceptor apolipoproteins. Paraoxonase 1 gene (PON1) encodes an enzyme that prevents lipid oxidation and thus could protect against vascular diseases in brain. The aim was to evaluate a possible association between polymorphic variants of PON1 and ABCA1 genes and ischemic stroke in children. Methods. The study included 120 Caucasian subjects: 40 children after ischemic stroke and 80 biological parents of them. The polymorphisms R219K ABCA1 and R192Q PON1 were analyzed using Restriction Fragments Length Polymorphism (RFLP) method. The Transmission Disequilibrium Test (TDT) was used to detect the presence of genetic linkage between genetic markers and the disease. Results. In the TDT analysis we did not observed a preferential transmission of the studied polymorphisms to the affected children. Discussion. Previous studies suggested an association of analyzed polymorphisms with stroke in adults or coronary artery disease. The results of our study do not support the hypothesis that the analyzed polymorphisms are risk factors of ischemic stroke in children but we plan to confirm these results on a larger group.

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

 34
Trigger factors among different stroke subtypes: A case-crossover study
S.H.Yoo    S.C.Yun    D.W.Kang     S.U.Kwon     J.Y.Koh    J.S.Kim                             
 
Asan Medical Center

SOUTH KOREA

Introduction Little is known about the triggering factors of stroke, especially the differences among different stroke subtypes. Methods From June 2003 to May 2004, consecutive patients admitted to the Asan Medical Center, diagnosed has having primary intracerebral hemorrhage (ICH) and ischemic stroke (IS) were interviewed using a structured questionnaire. IS subtypes were divided as large artery atherosclerosis (LAA) and small vessel occlusion (SVO) based on MRI and MR angiographic results. Patients with cardiogenic embolism or other uncommon etiologies were excluded. In a case-crossover design, we assessed exposures to potential triggers (increase in alcohol drinking, physical exertion, psychological distress, and infection) during 3-day hazard period compared to one month before the index stroke. We compared the triggers between ICH and IS, and LAA and SVO by independent t-test and chi-square test, and calculated relative risk of each stroke subtype in a hazard period compared to a control period by conditional logistic regression. Results 429 patients (327 IS and 102 ICH) were included. Among IS, there were 170 LAA and 157 SVO. Recent increase in alcohol drinking was reported in 14%, psychological distress in 33.1%, physical exertion in 32.6% and infection in 9.6% of all stroke patients in hazard period. Thus, 55.1% of the patients were exposed to at least one of four triggers. Among the triggers, only psychological distress was different between ICH and IS patients (p=0.047), but not between LAA and SVO. The odds of ICH in exposure to psychological distress during hazard period were 13.0(95% CI 4.0 to 42.1), and the odds of IS were 3.9(95% CI 1.8 to 8.4). The odds of ICH compared to IS were 1.6 (95% CI 1.0 to 2.5, p=0.048). Conclusions More than half of stroke patients are exposed to at least one of potential triggers during 3-day prior to the index stroke. Psychological distress may be a potential trigger more closely related to ICH than IS.

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

 35
Stressful life events and ischaemic stroke: a case-crossover study
V. Guiraud    E. Touzé    F. Rouillon     J.L.Mas                                            
 
Hôpital Sainte-Anne

FRANCE

Background Psychological stress has been shown to be a risk factor for many medical conditions but the association with ischaemic stroke (IS) is still a matter of debate. We investigated the association between exposure to stressful life events (SLE) and IS. Methods Consecutive patients admitted to our stroke unit, from March to November 2007, were interviewed about SLE exposure (e.g. bereavement, health problem) during the preceding six months using Paykel’s interview. Each patient served as his/her own control. Exposure within one week and one month of IS onset (risk periods) was compared to exposure during a control period preceding the risk period (three weeks and five months respectively). In this case-crossover design, odds ratios (OR) and their 95% confidence intervals (CI) were calculated using conditional logistic regressions. Results A total of 161 patients (mean age 62.6 years, 58% males) were interviewed within a median time of 4.6 days (IQR 3.2-7.4) after IS. 34.2% (n=55) of patients were exposed to SLE at least once during the first month (week1, 17.4%; week2, 6.8%; week3, 4.3%; week4, 9.3%). 72.7% (n=117) of patients were exposed at least once during the preceding six months (month1, 33.5%; month2, 19.9%; month3, 22.4%; month4, 15.5%, month5, 16.1%, month6, 15.5%). The OR was 2.78 (95% CI 1.63-4.76) for exposure within the preceding week and 2.37 (1.61-3.48) for exposure within the preceding month. Discussion This study shows that exposure to SLE is significantly more common within the first week preceding IS, suggesting that SLE could be a triggering factor for IS.

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

 36
Alcohol consumption and smoking are associated with higher 30-day case fatality after stroke in the Mures-Uzhgorod-Debrecen (MUD) database
K.E.Fekete    S. Szatmári    I. Szőcs     C. Szekeres     J. Szász    L. Mihálka     V. Smolanka     L. Csiba    D. Bereczki      
 
University of Debrecen, Faculty of Medicine

HUNGARY

Introduction: Excessive alcohol consumption and smoking are important risk factors for stroke, a disease frequently resulting in death or disability of various severity. Methods: We analyzed the association of alcohol consumption and smoking with disability and case fatality in 1047 patients of the MUD database (554 patients in Debrecen, 260 in Targu Mures, 233 in Uzhgorod). Results: Of the patients 57.5% were male. Before discharge 222 patients (22.1%) died. The rate of hemorrhagic stroke was 17.42% with 43% case fatality. Among the surviving 825 patients 18.5% needed permanent care, 22% patients needed some help in every-day activities, 27.5% patients were independent with residual signs, and 31.5% had no neurological sign at discharge. Stroke occurred in younger age in males: over two thirds in the 30-60 years age group were males in the ischemic and the hemorrhagic subgroups as well. Of the patients 249 (23.8%) admitted alcohol consumption, 52.6% did not, and no data were available for 23.6%. In patients with ischemic stroke the 30 day case fatality rate was 25.3% among those admitting alcohol consumption, but only 9.3% in abstainers (p<0.001). In hemorrhagic strokes case fatality was high and did not differ regarding alcohol consuming status. In the total population 25.1% were smokers. The 30 day case fatality rate was 29% among smokers, and 18% among non-smokers (p<0.001). Conclusion: Heavy alcohol consumption and smoking are not only risk factors for stroke but are also significantly associated with worse outcome after stroke. This should also be emphasized in health education programs.

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

 37
Assessment of hemostatic genetic polymorphisms accumulation in stroke patients
E. Pongracz    H. Andrikovics    Z. Nagy                                                    
 
National Health Center

HUNGARY

Background and purpose: In 20 to 40% of ischemic stroke patients no obvious cause can be established. Genetic polymorphisms responsible for thrombophilia were recently demonstrated. Our aim was to study the frequency and clustering of selected hemostatic genetic polymorphisms in young (<50 years) and in elderly ischemic stroke patients compared to controls. Methods: A total of 433 ischemic stroke patients and 173 healthy controls were enrolled. In this prospective, case-control study the frequency and clustering of polymorphisms of platelet receptor GP IIb/IIIa (PLA2), prothrombin gene G20210A, factor V Leiden mutation, ACE I/D, methylenetetrahydrofolate reductase (MTHFR) and fibrinogen gene G455A were studied. Family history, patients’ risk factor profile and their correlation with the polymorphisms were analysed in young (n=189) and elderly (n=244) cohorts. Results Among genetic variants, only the factor II 20210A (OR: 4.87 p=0.03) and D allele of ACE gene (OR: 3.28 p=0.001) were found to be more common in the young cohort, as compared to controls. Assessed the prevalence of two polymorphisms as „gen-dose” in controls and patients it could be detected that factor II G20210A variant represented a high incidence in linkage with Leiden mutation (p=0.001), with ACE gene polymorphism (p=0.025), with fibrinogen gene (p=0.049) and MTHFR (p=0.001), respectively. Furthermore D allele of ACE gene coupled with fibrinogen (p=0.044) and fibrinogen -455G/A with MTHFR (p=0.001) together increased the genetic risk of patients in contrast to controls. Leiden mutation was associated with hyperlipidemia (p=0.02) and with plasma hyperviscosity (p=0.01) in young patients. Conclusion: The prothrombotic stage due to high occurence and the clustering tendency of genetic polymorphisms of hemostatic factors could be partially responsible to the increased stroke morbidity even in the young population.

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

 38
VERTEBROBASILAR DOLICHOECTASIA AND ISCHEMIC STROKE
M. Jerkovic    S. Gvozdenovic    M. Zarkov     K. Bozic                                            
 
Cilinica centre of Vojvodina ,Clinic of Neurology

YUGOSLAVIA

Introduction:Vertebrobasilar dolichoectasia(VBD) may be asymptomatic or lead to a temporary or permanent neurological deficit by compressing the posterior fossa structures or through development of ischemia.Objective:To estimate the incidence of VBD in patients with first-ever ischemic stroke(IS); evaluate the relationship between VBD and IS risk factors and subtypes; and define the imaging characteristics of a dol ichoectatic blood vessel predisposing to development of ischemia.Methods: Eight patients with first IS and VBD and 3 patients with VBD and no IS who were hospitalized at the Institute of Neurology in Novi Sad during 2006 were evaluated. Patients with VBD and no IS were hospitalized due to a clinically manifest syndrome of cranial nerve compression.The diagnosis of VBD was established according to the accepted CT/MRI/MRA criteria (Smoker et al and Giang et al.Results:Among the 246 patients with first IS, VBD was found in 8 patients (3.2%).The mean age of VBD patients was 53.6 yrs (range 42-70 yrs). All of these patients had one or more risk factors for IS, and hypertension was the most frequent (87.5%). Five patients had multiple lacunar infarcts, including supratentorial localization. The etiology of IS in the other 3 patients was probably artery-to-artery embolism. One of these 3 patients had two ischemic lesions(mesencephalon and cerebellum). Overall, the most frequent localization of ischemic lesions was the midpons, followed by cerebellum and mesencephalon. Patients with VBD and IS had more pronounced vertical elongation of basilar artery (BA),(tortuosity), while patients with VBD and no IS had more pronounced ectasia of BA.Conclusions: VBD may represent an independent risk factor for IS. Existing atherosclerotic changes in the posterior circulation may precipitate ischemia, although the exact mechanism of the development of ischemia remains unclear. The observed clinically relevant association between the vertical elongation of BA and IS has no statistical significance due to the small sample size.

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

 39
Low prevalence of IgG auto-antibodies to ADAMTS-13 (von Willebrand factor-cleaving protease) in ischaemic cerebrovascular disease patients with reduced ADAMTS-13 activity
D.J. McCabe    R. Starke    P. Harrison     P.S.Sidhu     M.M.Brown    S.J.Machin     I.J.Mackie                     
 
AMNCH, Trinity College Dublin

IRELAND

Background: Reduced ADAMTS-13 activity may lead to accumulation of very large von Willebrand factor multimers, thus potentially increasing the risk of recurrent vascular events. ADAMTS-13 activity has been shown to be significantly reduced in the early (N = 56, P = 0.002), but not late phase (N = 44, P = 0.07) after ‘non-TTP’-related TIA or ischaemic stroke [Cerebrovasc Dis 2007,23(Suppl 2):146]. We investigated whether these findings were influenced by circulating auto-antibodies to ADAMTS-13, or by reduced ADAMTS-13 antigen levels. Methods: Plasma concentrations of IgG auto-antibodies to ADAMTS-13, and ADAMTS-13 antigen levels were measured with Imubind® kits (American Diagnostica, USA) in patients who had reduced ADAMTS-13 activity in our initial observational analytical study. Subjects were studied in the early (≤ 4 weeks; N = 24) and convalescent phases (≥ 3 months; N = 14) after TIA or stroke onset. Normal ranges were established by analysis of pooled normal plasma. Results: 4/24 patients in the early phase (16.7%) and 4/14 patients (28.6%) in the convalescent phase had elevated ADAMTS-13 IgG auto-antibody titres (> 9.6 ug/ml). One woman with a large artery atherosclerotic TIA had reduced ADAMTS-13 activity and elevated IgG auto-antibody titres in both the early and late phases after symptom onset. However, there was no definite association between IgG auto-antibody levels and ADAMTS-13 activity. One man had normal ADAMTS-13 antigen levels in the early phase (355 ng/ml; normal range: 350-730), with slightly reduced antigen levels in the convalescent phase after symptom onset (279.5 ng/ml); auto-antibody titres were normal at each time point. Discussion: IgG auto-antibodies to ADAMTS-13 are found in a minority of ‘non-TTP’ ischaemic cerebrovascular disease patients with reduced ADAMTS-13 activity. These assays do not differentiate between neutralising and non-neutralising IgG auto-antibodies to ADAMTS-13. These data suggest that other factors contribute to the inhibition of ADAMTS-13 enzyme activity in most ‘non-TTP’ cerebrovascular disease patients.

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

 40
Neuropsychological testing on vascular patients with and without cerebral infarct.
L. Csiba    V. Kemény    S. Molnár     E. Nyitray     G. Horváth                                    
 
Debrecen University

HUNGARY

Arteriosclerosis is a generalized disease affecting coronaries, peripheral, extra-and intracranial arteries resulting in subclinical and clinical deficits. Our aim was to give an overview about the frequency and risk factors of silent brain infarcts and summarize own observations on vascular pts. with and without brain infarcts. Results: every fifth septuagenarian has silent brain infarcts.. Hypertension, presence of cardiovascular disease increase the frequency. Previous studies detected worse cognitive ability and more frequent depression in silent brain infarct pts.. Our observations were performed on 25 multifocal cerebral infarct (CV) pts. (Rankin-scale <3, MMSE 26.8+/-1.5 mean). The data of CV pts. were compared with control persons and with 25 coronary pts. before coronary bypass intervention, but without neurological symptoms and without silent brain infarct. Trail making score was significantly different (0.597 p=0001) compared to controls and worse Digit Symbol Test results (-21.229 p<0.001) were detected in the CV group. Digit span forwards (-0135, p= 0.019) and backwards (-0.144 p=0.031), digit symbol test (-20.33, p <0.001) were significantly worse in coronary pts. than those in controls. Conclusion:not only the cerebral infarct pts. but also the patients with manifest coronary disease without brain infarct might have cognitive deficits.

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

 41
Comparative study of atherosclerosis of carotid arteries and grade of arterial stiffness
A. Folyovich    I. Antalics    Cs. Földesi     A. Kovács     K. Vadasdi    I. Vastagh                             
 
Szent János Hospital, Department of Neurology and Stroke Center

HUNGARY

Background: The measurement of arterial stiffness (AS) allows the evaluation of atherosclerosis in large arteries. The carotid arteries are affected by atherosclerotic lesions as part of a general atherosclerotic process. The lesion of carotid arteries does not necessarily reflect the status of coronaries and peripheral vessels and vice versa. Our aim was to compare the grade of atherosclerosis in different parts of the arterial system, based on findings of carotid ultrasonography (US) and measurements of AS. We wanted to test a cheap and fast procedure for screening a large number of high-risk patients with vascular disease. No similar study using our method has been published. Methods: 233 measurements were evaluated. Our patients were unselected, including stroke patients as well as others with different neurological diseases. A high resolution ultrasonograph was used to examine large cervical vessels. Findings were evaluated by an experienced neurosonologist. Severity of carotid atherosclerosis was classified according to a 5-grade scale. AS was measured with MS 2000 CardioVision equipment. The degree of AS was evaluated by a 3-grade scale. Results: Comparing results in both groups, the progression of carotid atherosclerosis correlated with general atherosclerosis, however, we observed remarkable differences between the two parameters in some patients. Carotid lesions were observed in a number of cases with a normal value of AS. Conclusions: Our results suggest that US of carotid arteries is a more sensitive method for evaluating atherosclerosis than the measurement of AS. These two methods do not replace, but supplement each other, and their combination provides a more valuable tool for screening high-risk patients with cardiovascular disease.

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

 42
Relationship between PDE4D gene polymorphism and ischemic cerebrovascular diseases in Chinese peopole
Y.D.Zhang    S.L.Xu    X.J.Lin                                                    
 
Nanjing Brain Hospital, Nanjing Medical University

CHINA

Objectives: To study the relationship between the polymorphism of phosphodiesterase 4D (PDE4D) gene and the ischemic cerebrovascular diseases (ICVD) in Chinese people. Methods: The base-variations in SNP45, SNP83 and rs918592 of PDE4D gene were determined by means of PCR-RFLP in 116 cases of ICVD patients, including 87 cases of large-artery atherosclerosis infarction (LA) and 29 cases of small-artery occlusion lacunar infarction (SA) by TOAST classification, and 110 healthy controls. Results: The A allele frequency in rs918592 of PDE4D gene was significantly higher in the ICVD patients (58.6%) than in the controls (48.6%), particularly in the patients of SA subtype (63.8%). The frequencies of SNP83 genotypes and alleles were not of significant difference between ICVD patients and the controls. There was no polymorphism in SNP45 loci of PDE4D gene detected in the studied subjects. And there was no correlation of PDE4D gene polymorphism with plasma glucose, insulin levels and quantitative insulin sensitivity check index (QUICKI). Conclusions: There may be the relationship of A allele in rs918592 loci of PDE4D gene with ICVD, and A allele may be a risk factor for lacunar infarction in the Chinese, which are independent of the glucose metabolism.

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

 43
Risk factors of stroke in men and women with acute ischaemic stroke.
H. Christensen    G. Boysen                                                           
 
Bispebjerg Hospital, University of Copenhagen

DENMARK

Background: The aim of this study was to estimate the frequency of established risk factors in men and women with acute ischaemic stroke and estimate the frequency of patients admitted with acute ischaemic stroke without easily identifiable risk factors of stroke. Patients and methods: This analysis was based on 895 consecutive patients: 460 males and 435 females with acute stroke, who were admitted to an acute stroke unit and diagnosed with an ischaemic stroke based on CT-scan and clinical findings. We recorded the following risk factors: prior stroke/TIA, a history of hypertension, blood pressure >140/90 mm Hg 24 hours after admission, ischaemic heart disease, atrial fibrillation, diabetes, hormone replacement therapy, alcohol abuse, smoking, hyperhomocysteinemia, hypercholesterolemia, and obstructive lung disease. Results: In 14 of 895 patients, mean age 73.9 years, none of pre-specified risk-factors were observed; in four of these patients other risk-factors were found. Risk factors of stroke were absent in 10/895 patients or 1.1 % of patients. The median number of risk factors was 3. The majority of patients had 1 – 4 risk factors of stroke; and no patients had more than 8 risk factors of stroke. The three most frequently observed were hypertension, smoking and previous stroke or TIA. No gender differences were found in the number of risk factors; however smoking and diabetes were more frequent in men. Atrial fibrillation, blood pressure >140/90, and hormone replacement therapy were more frequent findings in women. Conclusions: Acknowledged risk factors of stroke may be identified in the vast majority of stroke patients. Substantial gender differences are observed in the distribution of risk factors.