22. European Stroke Conference 560 © 2013 S. Karger AG, Basel Scientific Programme 21 Epidemiology of stroke BRAIN MICROBLEEDS IN A MEDITERRANIAN HYPERTENSIVE COHORT OF THE ISSYS PROJECT (Investigating Silent Strokes in hYpertensives a magnetic resonance imag-ing Study) I. Riba-Llena1, A. López-Rueda2, J.M. Gómez-Andrés3, J.L. Fernández López-Lara4, X. Mun-det- Tudurí5, J.L. Tovar-Méndez6, F. Orfila-Pernas7, C.I. Jarca8, M. Domingo9, C. Nafria-Pérez10, X. Castañé-Tenas11, I. Fernández-Cortiñas12, J. Álvarez-Sabin13, J. Montaner-Villalonga14, P. Delga-do- Martínez15 ISSYS PROJECT Neurovascular Research Laboratory. Vall Hebron Research Institute (VHIR), Barcelona, SPAIN1, Neurovascular Research Laboratory. Vall Hebron Research Institute. Interventional Neu-roradiology. Clinic Hospital of Barcelona., Barcelona, SPAIN2, Neurovascular Research Laboratory. Vall Hebron Research Institute., Barcelona, SPAIN3, Neuroradiology. Dr. Manchón Clinics, Barcelo-na, SPAIN4, Research Support unit of Barcelona- IDIAP Jordi Gol i Gurina, Barcelona, SPAIN5, Ne-phrology Service. Vall Hebron University Hospital, Barcelona, SPAIN6, Research Support unit of Barcelona- IDIAP Jordi Gol i Gurina, Barcelona, SPAIN7, Primary Care. CAP Cotxeres, Barcelona, SPAIN8, Primary Care. CAP Sant Roc, Barcelona, SPAIN9, Neurovascular Research Laboratory. Vall Hebron Research Institute., Barcelona, SPAIN10, Neuro-vascular Research Laboratory. Vall Hebron Research Institute., Barcelona, SPAIN11, Neurovascular Research Laboratory. Vall Hebron Research Institute., Barcelona, SPAIN12, Neurology Service. Neu-rovascular Section. Vall Hebron University Hospital., Barcelona, SPAIN13, Neurovascular Research Laboratory. Vall Hebron Research Institute. Neurology Service. Neurovascular Section. Vall Hebron University Hospital., Barcelona, SPAIN14, Neurovascular Research Laboratory. Vall Hebron Re-search Institute., Barcelona, SPAIN15 BACKGROUND: Hypertension and the presence of silent cerebrovascular lesions (SCL) are associated with an in-creased risk of brain infarction and dementia. Our present objectives are to determine the prevalence of brain microbleeds (BMBs) in hypertensives and study their associated factors. METHODS: Prospective observational study in participants aged 50-70 with essential hypertension and no his-tory of stroke or dementia. Patients were randomly selected from 14 primary healthcare centres. Demographical and clinical data were recorded and the presence of cognitive impairment was eval-uated. Global cardiovascular risk was assessed by means of the REGICOR-calibrated Framingham function and hypertensive target organ damage (heart, kidney) was evaluated. A brain MRI was per-formed to assess for the presence of SCL, including among others silent ischemic infarcts (SII) and BMBs which were rated by two independent readers by means of the BOMBS scale. The cohort will be followed up annually to assess the incidence of dementia and new SCL. RESULTS: 1,035 subjects have been included, mean age 62.8±8.26 years, 50.2% male and long-lasting hyper-tension (years since diagnosis 11.8±7.1, mean BP levels 143±16/78±10 mmHg). BMBs prevalence reached 5.6%, mostly unique and located in subcortical and deep brain regions (4.6%). BMBs were associated with male gender, older age, hypertension duration and lower HDL (all p<0.01). Also with increasing REGICOR score (p=0.014), and clinical (presence of ischemic heart disease, p<0.05) and subclinical hypertensive brain (SII, p<0.001) and kidney damage (in-creasing albumin/creatinine ratio, p<0.001). After adjustment by gender and other vascular risk fac-tors, SII and increasing REGICOR were the most powerful predictors for BMBs presence (OR 3.8; 1.9-7.7 and OR 1.06; 1.001-1.14) CONCLUSIONS: BMBs are highly prevalent in long-term treated hypertensives and are associated with clinical and subclinical damage of other target organs. The identification of this high risk population could im-prove the prevention of new vascular events. 20 Epidemiology of stroke Prognostic value of headache on early mortality in acute stroke: the Dijon Stroke Registry V. Abadie1, A.L. Vialatte2, B. Daubail3, J. Durier4, M. Giroud5, Y. Béjot6 Dijon Stroke Registry, EA4184, Medical School and Univeristy Hospital of Dijon, University of Burgundy, Dijon, FRANCE1, Dijon Stroke Registry, EA4184, Medical School and Univeristy Hospital of Dijon, University of Burgundy, Dijon, FRANCE2, Dijon Stroke Registry, EA4184, Med-ical School and Univeristy Hospital of Dijon, University of Burgundy, Dijon, FRANCE3, Dijon Stroke Registry, EA4184, Medical School and Univeristy Hospital of Dijon, University of Burgun-dy, Dijon, FRANCE4, Dijon Stroke Registry, EA4184, Medical School and Univeristy Hospital of Dijon, University of Burgundy, Dijon, FRANCE5, Dijon Stroke Registry, EA4184, Medical School and Univeristy Hospital of Dijon, University of Burgundy, Dijon, FRANCE6 Introduction: Headache is common in acute stroke but there is still uncertainty about its prognostic value. We evaluated the prevalence of headache and the association of this symptom with one-month mortality in patients with acute stroke. Methods: All cases of stroke (ischemic stroke and spontaneous intracerebral hemorrhage ICH) occurring in Dijon, France (152,000 inhabitants) were ascertained from 2006 to 2011 using a population-based registry. Demographic and clinical data, including headache at onset, were recorded. The initial clin-ical severity was quantified by the NIHSS score. All-cause mortality was evaluated at one month. Multivariable-adjusted hazard ratios (HRs) were estimated using Cox models. Results: 1411 stroke patients were collected. Data about headache were obtained in 1391 (98.6%) of them. Among these patients, 1185 (85.2%) had an ischemic stroke, 201 (15.4%) had an ICH, and 5 (0.4%) had a stroke of unknown etiology. Headache was found in 253 (18.2%) patients. Patients with head-ache had a higher one-mortality than those without headache (17.0% versus 10.5%, p<0.01). In multivariable analyses, headache was associated with a higher risk of one-month mortality (adjusted HR 2.00, 95% CI 1.40-2.86, p<0.001). In stratified analyses, no association was found for ischemic stroke (adjusted HR 0.97, 95% CI 0.51-1.84, p=0.93), whereas in patients with ICH, a higher risk of one-month mortality was noted in those with headache (adjusted HR 2.10, 95% CI 1.19-3.66, p=0.93). This positive association was found in patients with deep ICH (adjusted HR 2.54, 95% CI 1.17-5.50, p=0.018) but not in those with lobar ICH (adjusted HR 1.68, 95% CI 0.55-5.16, p=0.36). Conclusion: This study demonstrates that headache is associated with a poorer early prognosis in patients with acute ICH, especially deep ICH, independently of the clinical severity. This result suggests that headache may reflect an active bleeding responsible for rapid deterioration in ICH patients.
Karger_ESC London_2013
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