22. European Stroke Conference 543 Epidemiology of stroke Subtypes of stroke in the very elderly: Similar to or different from younger patients with a first-ever ischemic stroke? A.Y. Gur1, D. Tanne2, N.M. Bornstein3, R. Milo4, E. Auriel5, L. Shopin6, S. Koton7 Department of Neurology, Barzilai Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva., Ashkelon, ISRAEL1, Department of Neurology, Sheba Medical Center, The Sackler Faculty of Medicine, Tel Aviv University., Ramat Gan, ISRAEL2, De-partment of Neurology,Tel-Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel Aviv University., Tel Aviv, ISRAEL3, Department of Neurology, Barzilai Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva., Ashkelon, ISRAEL4, Depart-ment of Neurology,Tel-Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel Aviv University., Tel Aviv, ISRAEL5, Department of Neurology,Tel-Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel Aviv University., Tel Aviv, ISRAEL6, Stanley Steyer School of Health Professions, The Sackler Faculty of Medicine, Tel Aviv University,, Tel Aviv, ISRAEL7 Background: Very old subjects repesent a fastly growing proportion of stroke patients. However, age-related aspects of stroke are still uncertain. Recent data on subtypes of stroke in the very elderly are limited. Our aim was to study subtypes of stroke in the very elderly patients (aged ≥ 85 years) in comparison with patients aged 65-84 years with a first-ever ischemic stroke in the National Acute Stroke Israeli Surveys (NASIS) registry. Methods: NASIS is a prospective hospital-based regis-try performed triennially (2004, 2007, 2010). Patients with ischemic stroke aged ≥85 years were compared with those 65-84 years old regarding etiology of stroke using the chi-square test. Stroke subtypes were determined based on the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Results: A first-ever ischemic stroke was diagnosed in 2056 patients ≥65 years old, 426 of them were very elderly (≥85 years) patients. The very elderly presented with more cardi-oembolic strokes: 34.4% of the ≥85 years-old patients compared with 20.8% in the younger age group (p<0.0001). In contrast, significantly fewer very elderly patients were diagnosed with large artery atherosclerosis and small vessel infarctions: 4.9% vs 9.1%; 15.1% vs 28.5% respectively (p<0.0001). Analysis by registry period of stroke etiology among ≥85 years-old patients showed that the proportion of small vessel infarctions decreased significantly from 20.1% in 2004 to 17.7% in 2007 and 8.9% in 2010 (p for trend=0.0007). Conclusions: We found significantly more cardioem-bolic stroke type and less large vessel atherosclerosis and small vessel occlusive types in the very elderly compared with younger patients. Active treatment of atrial fibrillation in the very elderly is warranted to improve the stroke prevention strategy. 632 © 2013 S. Karger AG, Basel Scientific Programme 545 Epidemiology of stroke Differences in characteristics and outcome between wake-up, awake-onset, and unknown-on-set stroke in a stroke registry population J.M. Reid1, O. Varsou2, B. Cheripelli3, C. Christian4, Y. Reidy5, G.J. Gubitz6, S.J. Phillips7 Department of Neurology, Aberdeen Royal Infirmary, Aberdeen, UNITED KINGDOM1, Di-vision of Applied Health Sciences, University of Aberdeen,, Aberdeen, UNITED KINGDOM2, University of Glasgow, Glasgow, UNITED KINGDOM3, Division of Neurology, Queen Elizabeth II Health Sciences Centre, Halifax Infirmary, Halifax, CANADA4, Division of Neurology, Queen Elizabeth II Health Sciences Centre, Halifax Infirmary, Halifax, CANADA5, Division of Neurolo-gy, Queen Elizabeth II Health Sciences Centre, Halifax Infirmary, Halifax, CANADA6, Division of Neurology, Queen Elizabeth II Health Sciences Centre, Halifax Infirmary, Halifax, CANADA75 Introduction Debate exists as to whether wake-up stroke (WUS i.e. symptoms first noted on waking) differs in subtype and prognosis from awake-onset stroke (AOS). Some studies do not describe a third catego-ry of unknown-onset stroke (UOS) where symptom onset time is unclear. This study aimed to exam-ine stroke characteristics and in-patient and six month outcomes in these three groups. Methods The stroke registry database from the Halifax Infirmary (Nova Scotia, Canada) was interrogated for patients admitted to hospital with stroke diagnosis (1999-2011). Information was available on demo-graphics, stroke subtype and severity, in-patient mortality, and discharge functional status (modified Rankin score mRS). Six month mRS outcomes were available in 2001-2 from the Stroke Outcome Study. WUS and UOS were compared to AOS independently. Results 3890 patients were included. 65% had AOS, 21% WUS and 14% UOS. There was no difference in demographics between AOS and WUS, except a lower rate of pre-stroke independence in WUS pa-tients (81 vs. 85%, p=0.01). UOS patients were significantly older, more commonly female and liv-ing alone than AOS patients. Rates of UOS increased from 10 to 16% of patients in the second half of the period (p<0.0001). UOS had higher a stroke severity, with no difference in severity between AOS and WUS. Intracerebral haemorrhage (ICH) was less common (9 vs. 13%, p=0.0007) and lacu-nar stroke more common (23 vs. 19%, p=0.004) in WUS compared to AOS. In UOS left hemisphere localisation was more likely, and lacunar stroke less common. No differences in outcomes between AOS and WUS were seen; by contrast, UOS had higher rates of in-hospital mortality (23 vs. 16%, p<0.0001) and poorer functional status six months after stroke (mRS<3 in 26% of UOS and 46% of AOS, p=0.02). Conclusion WUS has lower rates of ICH but similar stroke severity and outcomes to AOS. In contrast, UOS prevalence appears to be increasing, has higher stroke severity and worse prognosis.
Karger_ESC London_2013
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