22. European Stroke Conference 234 Brain imaging IMPACT OF MIDDLE CEREBRAL ARTERY HYPERDENSITY ON PROGNOSIS AFTER THROMBOLYSIS IN ACUTE ISCHEMIC STROKE. ANALYSES OF A COHORT OF PA-TIENTS FROM THE SYNTHESIS EXPANSION TRIAL S. Lanfranconi1, C. Motto2, P. Doneda3, M. Piano4, F. Casoni5, F. Muscia6, A. Saletti7, L. Tancre-di8, E. Agostoni9, A. Ciccone10 for Synthesis Expansion Investigators Neurology - Ospedale Policlinco, Milano, ITALY1, Stroke Unit AO Niguarda Ca’ Granda, Milano, ITALY2, Neuroradiology AO Niguarda Ca’ Granda, Milano, ITALY3, Neuroradiology AO Niguarda Ca’ Granda, Milano, ITALY4, Ospedale di Baggiovara, Modena, ITALY5, Ospedale Valduce, Como, ITALY6, Ospedale S. Anna, Ferrara, ITALY7, Ospedale S. Anna, Como, ITALY8, Neurologia-Stroke Unit AO Niguarda Ca’ Granda, Milano, ITALY9,Ospedale Poma, Mantova, ITALY10 Background: Middle cerebral artery (MCA) hyperdensity is an early marker of stroke whose prog-nostic value is still unclear. The aim of our study was to evaluate the prognostic value of early CT signs of acute ischemia in a cohort of patients with acute ischemic stroke patients treated with intra-venous (IV) t-PA or endovascular treatment. Methods: We analyzed the baseline CT of 147 patients prospectively included in the Synthesis Expansion study, a randomised multicenter controlled trial on fast-track endovascular treatment compared to IV t-PA for acute ischemic stroke. Early CT signs of acute ischemia, including MCA and carotid artery hyperdensity, lentiform nucleus obscuration, loss of white/gray matter differentiation, sulcal effacement, and clinical outcome (7-day NIHSS, 90-day mRS) were evaluated. Favorable outcome was defined as 90-day mRS score </=1. All pa-tients had basal and control CT scans on 2 to 7 days. The presence of early CT signs of ischemia was agreed by two different observers blinded to treatment allocation and clinical outcome. Results: The presence of at least one early change of cerebral ischemia was observed in 21 patients (45%) with favorable outcome and in 57 (62%) with unfavorable outcome (p=0.070). Lentiform nucleus obscuration was observed in 7 (15%) vs 26 (28%) patients, respectively (p=0.095); loss of white/ gray matter differentiation in 16 (34%) vs 35 (38%, p=0.708), and sulcal effacement in 11 (23%) vs 28 (30%, p=0.424). MCA hyperdensity was observed in 11 (23%) vs 41 (45%) patients, and was the only early radiological sign associated with unfavorable outcome (p=0.02). MCA hyperdensity was also associated to hemorrhagic transformation of infarct (OR 2.4; 95%CI 1.1-5.2; p=0.021). Conclu-sion: Among early radiological signs of ischemia MCA hyperdensity was the only predictor of poor outcome in patients with acute stroke treated with thrombolysis. 410 © 2013 S. Karger AG, Basel Scientific Programme 235 Brain imaging Brain MRI findings in patients with uncomplicated arterial hypertension grade 1-2 E.V. Gnedovskaya1, A.G. Amintayeva2, Y.Y. Varakin3, M.V. Krotenkova4, R.N. Konovalov5, G.V. Gornostaeva6, M.E. Procopovich7, M.A. Kravchenko8, O.S. Andreeva9, A.V. Kadykov10, E.V. Osh-chepkova11, N.V. Lazareva12, M.M. Tanashyan13, Z.A. Suslina14 Research Center of Neurology, Moscow, RUSSIAN FEDERATION1, Research Center of Neu-rology, Moscow, RUSSIAN FEDERATION2, Research Center of Neurology, Moscow, RUSSIAN FEDERATION3, Research Center of Neurology, Moscow, RUSSIAN FEDERATION4, Research Center of Neurology, Moscow, RUSSIAN FEDERATION5, Research Center of Neurology, Moscow, RUSSIAN FEDERATION6, Research Center of Neurology, Moscow, RUSSIAN FEDERATION7, Research Center of Neurology, Moscow, RUSSIAN FEDERATION8, Research Center of Neurolo-gy, Moscow, RUSSIAN FEDERATION9, Research Center of Neurology, Moscow, RUSSIAN FEDERATION10, Russian Cardiology Com-plex, Moscow, RUSSIAN FEDERATION11, Russian Cardiology Complex, Moscow, RUSSIAN FEDERATION12, Research Center of Neurology, Moscow, RUSSIAN FEDERATION13, Research Center of Neurology, Moscow, RUSSIAN FEDERATION14 Background: Studying correlations between brain MRI findings and arterial hypertension (HTN) at-tributes is necessary for clarifying mechanisms of vascular encephalopathy. Methods: 89 patients (50-65 years old, mean 57) with uncomplicated HTN grade 1-2 were exam-ined. Persons with cerebrovascular events, severe carotid atherosclerosis, heart diseases, and trau-matic brain injury, were excluded. MRI imaging was done on Magnetom Symphony 1.5 Tesla (Siemens). 24 hours blood pressure (BP) monitoring was done by MDP NS 02 system. Results: Mean duration of diagnosed HTN was 12+/-9 years. No brain MRI findings was in 25 pa-tients (30%). Multifocal scattered hyperintense signal changes in subcortical and periventricular white matter on T2 and T2-FLAIR were found in 60 (69%). Number of focal changes <=5 observed in 35 of 60 cases. Virchow-Robin spaces were identified in 54 (61%). Silent lacunar infarcts – 6 cas-es (7%), leukoaraiosis – 6 cases (7%). Widening of subarachnoid spaces - 17 cases (19%), ventric-ular dilatation - 20 (22%). Following correlations (Kendall) were found: identified Virchow-Robin spaces and increased variability of systolic BP (r=0.25; p=0.0009), age (r=0.16; p=0.025), duration of HTN (r=0.17; p=0.01), pulse pressure (r=0.16; p=0.03); Widening of subarachnoid spaces and systolic/ pulse BP (r=0.2; p=0.005), (r=0.26; p=0.0004), duration of HTN (r=0.19; p=0.01), grade of HTN (r=0.17; p=0.02); silent lacunar infarcts and HTN grade (r=0.22; p=0.002); T2 and T2-FLAIR white matter hyperintensities and duration of HTN (r=0.13; p=0.06); Silent lacunar infarcts and history of hypertensive emergencies (r=0.17; p=0.018), grade of HTN (r=0.22, p=0.002), degree of nighttime lowering of BP (r=-0.2; p=0.006), increased daytime variability of systolic BP (r=0.17, p=0.01). Conclusions: most of the hypertensives have brain MRI findings correlated with different HTN at-tributes. Studying of these correlations can be used for more précised prediction of cerebrovascular disease.
Karger_ESC London_2013
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