London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 703 674 Acute stroke: clinical patterns and practice Does process of care explain the apparent socioeconomic inequalities in stroke outcomes? T.J. Quinn1, M.R Walters2, S Wong3 University of Glagsow, Glasgow, UNITED KINGDOM1, University of Glasgow, Glasgow, UNIT-ED KINGDOM2, University of Glasgow, Glasgow, UNITED KINGDOM3 BACKGROUND Low socioeconomic status (SES) is associated with poor outcome from vascular disease including stroke, poor outcomes are independent of traditional vascular risk factors. Differing processes of care may explain this apparent inequality. Our aim was to determine whether stroke care (investiga-tion and prescribing) is influenced by SES and associations with stroke outcomes. METHODS We collected data from Glasgow Royal Infirmary and Western Infirmary, chosen to represent de-prived and affluent areas in one city. We identified consecutive ischaemic stroke admissions aged less than 75 years (August - November 2011 inclusive). We derived clinical and demographic data; outcomes; investigations and prescribing details from casenote review. SES was described as Scot-tish Index of Multiple Deprivation using postcode data. We analysed the proportion of patients who received comprehensive investigations (taking carotid ultrasound as exemplar) and prescribing (tak-ing antiplatelet and statins as exemplars) in relation to SES using univariate and multivariate analy-sis. RESULTS We assessed 200 ischaemic stroke patients (51% men, median age 65 years). Deprivation was over-represented in our study population n=95 (53%) in lowest SIMD quintile. Previous vascular events (p=0.04; smoking (0.03) were more common in lowest SIMD quintile. There was no associ-ation between SIMD and outcomes (modified Rankin p=0.85; mortality p=0.75). We found no asso-ciation between SES and investigation or prescribing patterns. All results remained non-significant after adjusted for age, sex and vascular risk factors in multivariate analysis. CONCLUSIONS We found no association between socioeconomic deprivation and process of care in stroke. How-ever, in contrast to other studies, we also found no association between deprivation and stroke out-comes. The high prevalence of deprivation in our population skewed the dataset and consequently our study may have had insufficient power to detect a true effect. 675 Acute stroke: clinical patterns and practice Acute headache at emergency department: reversible cerebral vasoconstriction syndrome complicated by subarachnoid haemorrhage and cerebral infarction, a case report. C. Zavanone1, M. Yger2, L. Abdennour3, A. Leger4, S. Deltour5, S. Crozier6, Y. Samson7 AP-HP Urgences Cérébro-Vasculaires, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie Paris VI, Paris Universitas, Paris, FRANCE1, AP-HP Urgences Cérébro-Vascu-laires, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie Paris VI, Paris Univer-sitas, Paris, FRANCE2, AP-HP Neuro-reanimation Chirurgical,Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie Paris VI, Paris Universitas, Paris, FRANCE3, AP-HP Urgences Cérébro-Vasculaires, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie Paris VI, Paris Universitas, Paris, FRANCE4, AP-HP Urgences Cérébro-Vasculaires, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie Paris VI, Paris Universitas, Paris, FRANCE5, AP-HP Urgences Cérébro-Vasculaires, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie Paris VI, Paris Universitas, Paris, FRANCE6, AP-HP Urgences Cérébro-Vasculaires, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie Paris VI, Paris Universitas, Paris, FRANCE7 Introduction Reversible cerebral vasoconstriction syndrome (RCVS) is becoming widely accepted as a rare cause of both ischemic and haemorrhagic stroke and should be evocated in case of recurrent thunderclap headaches with or without other symptoms. Here we present the case of a patient with ischemic stroke associated to cortical subarachnoid haemorrhage (cSAH) and reversible diffuse arteries nar-rowing, leading to the diagnosis of RCVS. Case report A 48-year-old woman with a history of adrenocortical insufficiency secondary to Sheehan syn-drome, was addressed to emergency department of a community hospital for an unusual thunderclap occipital headache occurring during an emotional stress. The computed tomography (CT) of brain completed by CT-angiography were unremarkable. Eleven days later, the patient was readmitted be-cause of a sudden left hemianopia followed by left hemiparesis. A brain magnetic resonance imaging (MRI) showed ischemic lesions in the right frontal and occipital lobe and diffuse cSAH. Magnetic resonance angiography (MRA) showed vasoconstriction in the anterior and posterior circulations bi-laterally. A bedside transcranial Doppler ultrasonography (TCD) showed bilateral and asymmetrical elevated mean middle cerebral arteries velocities (right MCA: 240 cm/s; left MCA: 150 cm/s) and anterior cerebral arteries velocities (right ACA: 102 cm/s; left ACA: 190 cm/s). An intravenous ni-modipine treatment was initiated and vasoconstriction completely regressed on day 16 after the first headache. The patient rapidly improved with no neurological impairment three months later. Conclusion Our case shows a severe RCVS where both haemorrhagic and ischemic complications were present at the same time. The history we reported shows that RCVS is still under recognized, particularly in the context of sudden-onset headache at emergency department.
Karger_ESC London_2013
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