22. European Stroke Conference 9 Acute stroke: clinical patterns and practice 17:50 - 18:00 Focal neurology occurs with syncope and presyncope D.J. Ryan1, O. Mahon2, R.A. Kenny3, J.A. Harbison4 Stroke department, St. James Hospital, Dublin, IRELAND1,Stroke Department, St. James Hospital, Dublin, IRELAND2, Falls and Blackouts unit, St. James Hospital, Dublin, IRE-LAND3, Stroke Department, St. James Hospital, Dublin, IRELAND4 Syncope frequently presents to stroke services as a mimic, a typically applied distinction being the absence of focal neurology in syncope. Misdiagnosis of syncope as Stroke /TIA may lead to inappropriate antihypertensive therapy and further events. We prospectively sought for the presence of focal neurological events at syncope onset among syncope unit attendees. Over a 9 month period, all syncope-unit attendees completed a questionnaire that screened for migraine (ID-migraine), somatoform disorders (PHQ-15), cardiovascular risk and syncope bur-den (childhood syncope and events in the preceding year). Suspected cases were interviewed by a stroke physician and, if confirmed, underwent neuroimaging and Fazekas white matter scoring. Cases were compared to three controls, matched for age, gender and underlying hypo-tensive disorder. All underwent active stand assessment using phasic beat-to-beat blood pres-sure monitors. Thirty-one of 540 attendees described definite focal neurological symptoms during syncope or presyncope (5.7%). Mean age was 49yrs and 71% (22) were female. 17 described a monopa-resis/ dysasthesia and the remainder, a hemiparesis/dysasthesia. Median symptom duration was 10 minutes (2mins to 19 hrs). 10 reported symptoms to a physician and in 6 a stroke was di-agnosed yet neuroimaging and vascular workup were normal. 14 patients described more than one event, median 10 over 2 years. Neuroimaging was normal in 28 (90.3%), 3 exhibited old infarcts. Mean Fazekas score was not higher in the hemisphere that corresponded to the focal neurology (p=0.82). Cases reported more childhood syncope (p=0.005) and frequent recent epi-sodes (p=0.008). Somatoform scores, migraine prevalence and cardiovascular risk were similar for both groups. On active stand, cases exhibited impaired diastolic BP recovery at 30 seconds (p=0.02). Contrary to accepted teaching, focal neurological events can occur in syncope. No evidence of related cerebral ischaemia could be found in any case. Table 1: Predictors of the anterior vs. posterior localization of large vessel occlusions in acute ischemic stroke. OR (95% CI) p-value Circumstantial features Onset-to-door time (per min) 0.9 (0.9-1.0) 0.02 Neurological examina-tion Hemiparesis 4.8 (1.3- 17.4) 0,02 Sensory deficits 6.3 (2.6- 15.3) <0,01 Hemineglect 32.2 (10.4- 99.8) <0,01 Visual field defects 0.1 (0.0-0.2) <0,01 0.05 (0.0- Cerebellar defects 0.1) <0,01 Aphasia 53.1 (16.1- 175.9) <0,01 Physiological findings Diastolic BP (mmHg) 1,1 (1,0-1,1) <0,01 Imaging findings Normal ASPECTS (adapted to circulation) 0.7 (0.5-0.9) 0.02 Figure 1: Presence of neurological deficits according to the localization of the large vessel oc-clusion. 172 © 2013 S. Karger AG, Basel Scientific Programme
Karger_ESC London_2013
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