London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 523 446 Small vessel stroke and white matter disease Cerebral white matter disease is associated with elevated levels of glycated hemoglobin in acute ischemic stroke patients M. Rozanski1, T.B. Richter2, U. Grittner3, M. Endres4, J.B. Fiebach5, G.J. Jungehulsing6 Center for Stroke research Berlin (CSB), Department of Neurology Charité, Berlin, GERMA-NY1, Center for Stroke research Berlin (CSB), Berlin, GERMANY2, Center for Stroke research Ber-lin (CSB), Berlin, GERMANY3, Center for Stroke research Berlin (CSB), Department of Neurology Charité, Berlin, GERMANY4, Center for Stroke research Berlin (CSB), Berlin, GERMANY5, Cen-ter for Stroke research Berlin (CSB), Department of Neurology Charité, Berlin, GERMANY6 Background: To investigate the association of cerebral white matter disease (WMD) with cerebral microbleeds (CMB) on MRI, laboratory findings and vascular risk factors in consecutive first acute ischemic stroke (AIS) patients. Methods: AIS patients underwent MRI ≤24 hours after stroke onset and follow-up on day 2. WMD was scored on FLAIR according to the Wahlund score (WS). Number of CMB on T2* MRI, vascular risk factors and laboratory parameters were assessed. Univariate and multivariate logistical regression analyses were used. Results: We included 512 patients with first AIS; mean age 68.5 (SD 13.2), 192 female, median NIHSS on admission 3 (IQR: 1-6), median WS 4 (IQR: 2-9). WMD was present in 460 (89.8%) pa-tients. CMB’s on T2* MRI were found in 134 (26.2%) patients. In univariate analysis, age, arterial hypertension (HTN), reduced estimated glomerular filtration rate (eGFR), elevated glycated hemo-globin (HbA1c) levels, and presence of CMB were significantly associated with WMD (p<0.05). In multivariate analyses, age, hypertension, CMB, and higher levels of HbA1c (p<0.05) remained inde-pendently associated with WMD. Conclusion: Among the known risk factors higher levels of HbA1c were associated with cerebral WMD in stroke patients and may suggest that hyperglycemia plays an important role in the patho-physiology of WMD. 447 Small vessel stroke and white matter disease An impaired baroreflex may mediate hypotension-induced borderzone lacunar stroke D.J. Ryan1, C. Finucane2, O. Mahon3, R.A. Kenny4, J.A. Harbison5 Stroke Department, St. James Hospital, Dublin, IRELAND1, Medical Gerontology, Trinity Col-lege Dublin, Dublin, IRELAND2, Stroke Department, St. James Hospital, Dublin, IRELAND3, Falls and Blackouts unit, St. James Hospital, Dublin, IRELAND4, Stroke Department, St. James Hospital, Dublin, IRELAND5 White matter infarction is caused by small vessel disease, however, blood pressure variability may also contribute. The white matter is perfused by narrow blood vessels and is vulnerable to sudden flow changes, particularly in the border-zone regions (corona radiata). We investigated whether pa-tients with border-zone infarcts (BZI) demonstrated more blood pressure (BP) variability than those with basal ganglia infarcts (BGI). All patients between October 2011 and May 2012, in sinus rhythm, that exhibited an acute DWI positive lacunar infarct on MRI, were prospectively recruited. All underwent phasic beat-to-beat BP assessment during 5 minutes resting, 6 weeks after their stroke. Spontaneous measures of baroreflex sensitivity were derived according to the sequence method allow up-events and down-events was and total baroreflex sensitivity to be estimated. Spectral analysis was applied to derive low-frequen-cy (LF) and high-frequency (HF) components of BP variability. In total, 23 acute lacunar infarcts were recruited, 10 border-zone and 13 basal ganglia. The mean age in the BZI group was 71.6 years and in the BGI group was 66.4 years (p=0.3). The baseline BP was equal in both groups 151/76 and 147/76 mmHg (p=0.6). BRS was impaired in the BZI group, com-pared with the BGI group (4.27 and 7.6, p=0.04). In addition the down the BRS_down component, was impaired in the BZI group (3.88 and 8.6, p=0.01), which indicates hypotension uncompensated by heart rate. BP low-frequency variability was higher in the BZI group (2335 and 1446, p=0.05). BP high-frequency variability was equal in both groups. Baroreflex sensitivity is blunted in patients with borderzone lacunar infarcts, particular the BRS_ down component, which suggests impaired heart rate response to hypotension. As the borderzones are flow-vulnerable regions, infarction may have arisen from hypotension even though these patients they do not have severe carotid disease.
Karger_ESC London_2013
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