London, United Kingdom 2013 19 Acute stroke: emergency management, stroke units and complications SPINAL REFLEXES IN BRAIN DEATH PATIENTS DUE TO STROKE Y. Beckmann1, Y. Çiftçi2, T. Kurt3, G. Akhan4 Department of Neurology, Katip Çelebi University Atatürk Training and Research Hospi-tal, Izmir, TURKEY1, Department of Neurology, Katip Çelebi University Atatürk Training and Research Hospital, Izmir, TURKEY2, Department of Neurology, Katip Çelebi University Atatürk Training and Research Hospital, Izmir, TURKEY3, Department of Neurology, Katip Çelebi Univer-sity Atatürk Training and Research Hospital, Izmir, TURKEY4 Background: Brain death is a term denoting both medical and legal human health determined by tests on irreversible cessation of the clinical functions of the brain. Brain death has consequences be-yond the particular affected individual as the diagnosis of a brain death is often the departure point for organ translation decisions that impact vast segments of the populations that are currently await-ing for suitable human donors. The comprehensive analysis of brain death diagnostics informs this exceedingly important but currently underappreciated subfield of in clinical neurology, and global health more broadly. The aim of this report is to describe a brain-dead patient with unusual motor movements. Methods: We report the presence of spontaneous and reflex movements in patients who fulfilled the criteria for brain death. Results: This prospective study consisted of 144 patients with the clinical diagnosis of brain death due to cerebrovascular diseases followed by the authors in the intensive care units between 2010 and 2012. Out of the 144 patients were 57% were males and 43% were females. The mean age was 52.1. A detailed evaluation was performed and all responses were recorded in a database. The evaluation included a thorough history of brain death, demographic factors, and a detailed neurological exam-ination administered by the authors, and a detailed physical and neurological examinations. All ex-aminations were conducted by at least two neurologists. We observed spinal cord reflexes in 15.3% of 144 brain death patients due to ischemic or hemorrhagic stroke in our intensive care unit between 2010-2012. Those movements were Babinski sign (5), Lazarus sign (4), finger jerks (1), fascicula-tions (1), facial myokymia (1), deep tendon reflexes (6), ondulating toes (10), periodic limb move-ments (4). Conclusion: We suggest that spontaneous and reflex movements outlined in this study has to be ac-cepted as motor symptoms in brain death patients. Spinal reflexes should be well recognized by the physicians and it should be born in mind that the brain death can be determined in the presence of spinal reflexes. E-Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 565 18 Acute stroke: emergency management, stroke units and complications Thrombolysis of basilar artery occlusion: impact of baseline ischemia and time D. Strbian1, T. Sairanen2, H. Silvennoinen3, O. Salonen4, M. Kaste5, P.J. Lindsberg6 Helsinki University Central Hospital, Neurology, Helsinki, FINLAND1, Helsinki University Central Hospital, Neurology, Helsinki, FINLAND2, Helsinki University Central Hospital, Radiolo-gy, Helsinki, FINLAND3, Helsinki University Central Hospital, Radiology, Helsinki, FINLAND4, Helsinki University Central Hospital, Neurology, Helsinki, FINLAND5, Helsinki University Central Hospital, Neurology, Helsinki, FINLAND6 Background Treatment strategies of basilar artery occlusion (BAO) remain empirical and differ from RCT-guided protocols in hemispheric stroke. We evaluated the impact of extensive baseline isch-emic changes on functional outcome after BAO thrombolysis, and analyzed effect of time to treat-ment in absence of such findings. Methods We prospectively analyzed 184 consecutive patients with angiography-proven BAO. The ma-jority of patients received iv thrombolysis and concomitant full-dose heparin. Extensive base-line ischemia was defined as posterior circulation Acute Stroke Prognosis Early CT score (pc-AS-PECTS)< 8. Onset-to-treatment time (OTT) was analyzed both as continuous and categorical vari-able (0-6h, 6-12h, 12-24h, and 24-48h). Successful recanalization was designated as thrombolysis in myocardial infarction (TIMI) score of 2-3. Poor 3-month outcome was defined as modified Rankin Scale (mRS) 3-6. Results Majority (96%) of patients with baseline pc-ASPECTS<8 had poor 3-month outcome, and this was not different (94%) in those with confirmed recanalization (51.5%). In contrast, half of the patients with pc-ASPECTS≥8 and recanalization (confirmed in 73.2%) achieved good outcome. In these patients, OTT was neither associated with poor outcome as continuous nor as categorical variable. Symptomatic intracranial hemorrhage (sICH; ECASS-2 criteria) occurred in 25% of patients with pc-ASPECTS<8, com-pared with 11.5% in those with pc-ASPECTS≥8 (p=0.03). In the latter group, higher age, baseline NIHSS, lack of recanalization, history of atrial fibrillation, and sICH were independently associated with poor outcome. In the model including pa-tients with any pc-ASPECTS, pc-ASPECTS<8 was independently as-sociated with poor outcome (OR 5.83; 1.09-31.07). Conclusion In absence of extensive baseline ischemia, recanalization of BAO up to 48 hours was sel-dom futile and produced good outcomes in 50% of patients; independently of OTT.
Karger_ESC London_2013
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