London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 707 682 Acute stroke: clinical patterns and practice No differences in outcome between acute extracranial and intracranial carotid occlusion fol-lowing endovascular reperfusion therapy. R.R. Leker1, R. Eichel2, G. Keigler3, J.M. Gmori4, J.E. Cohen5 Hadassah-Hebrew University Medical Center, Jerusalem, ISRAEL1, Hadassah-Hebrew Univer-sity Medical Center, Jerusalem, ISRAEL2, Hadassah-Hebrew University Medical Center, Jerusalem, ISRAEL3, Hadassah-Hebrew University Medical Center, , ISRAEL4, Hadassah-Hebrew University Medical Center, Jerusalem5 Background: Acute carotid artery occlusions cause large hemispheric stroke leading to poor out-come. However, it remains unclear whether occlusion site impacts outcome. Methods: All patients with acute carotid artery occlusion undergoing endovascular reperfusion were prospectively en-rolled. Patients with occlusion at the carotid bifurcation were compared with those that had carotid T occlusions. Accrued data included demographics, risk factor profile and procedure related vari-ables. Neurological deficits were studied with the NIHSS scale and outcome was studied with the modified Rankin Score (mRS) at day 90 after stroke and dichotomized into favorable (≤2) or unfa-vorable (>3). Vessel recanalization status was studied with the thrombolysis in cerebral infarction (TICI) scale. Results: We included 51 patients (33 with extracranial carotid bifurcation and 18 with intracranial carotid-T occlusions). Patients with T lesions were significantly older (median 74 vs. 56 years, p=0.02), more frequently had atrial fibrillation (61% vs. 18%; p=0.005) and cardioembolic strokes (78% vs. 21% p=0.001) and less often smoked (6% vs. 42%; p=0.01). Patients with T le-sions were less often received stents (11% vs. 48%; p=0.015). Neurological severity at presentation, day 1 or at discharge did not differ between the groups (median NIHSS scores 23.5, 19 and 10 vs. 22, 17.5 and 11 respectively). Good or excellent recanalization rates were similar (TICI 2b-3; 50% vs. 52%). Mortality rates (24% vs. 23%), and the chances of obtaining favorable outcome at 90 days (33% vs. 24%) also did not differ between the groups. On multivariate logistic regression analysis, occlusion location was not a significant modifier of outcome. Conclusions: Despite differences in stroke etiology, age and gender between patients with extracranial bifurcation and intracranial T ca-rotid occlusions, lesion location in itself does not influence outcome in patients with carotid occlu-sion undergoing endovascular treatment. 683 Acute stroke: clinical patterns and practice A Case of Persistent Anterograde Amnesia in Papez Circuit Stroke S.M. Buzori1, P. Tourniaire2, B. Bonnefoi3, N. Moreau4 Centre Hospitalier d’Avignon, Avignon, FRANCE1, Centre Hospitalier d’Avignon, Avignon, FRANCE2, Centre Hospitalier du Pays d’Aix, Aix-en-Provence, FRANCE3, Centre Hospitalier du Pays d’Aix, Aix-en-Provence, FRANCE4 Background: Papez circuit processes anterograde memory and learning. Stroke in Papez circuit gives precise memory deficits, due to selective localization and sudden function attempt. Methods: A 62-year-old man presented to the emergency with sudden onset disorientation, repetitive discourse, ongoing forgetfulness of daily facts, these being a brutal change in his behaviour. The patient was under anti-vitamin K treatment for aortic valve prosthesis. International Normalized Ra-tio (INR) on entry was below recommended therapeutic limits. On exam he had severe temporal dis-orientation, repetitive discourse, anterograde amnesia with complete inability to recall new informa-tion, preserved retrograde memory anterior to the ictus, no sensitivo-motor or cranial nerve deficit. Results: Cranial CT on presentation revealed two occipital hypodensities suggesting acute infarcts in posterior cerebral arteries territory. Doppler echocardiography showed suspect contrast image in left ventricular outflow tract, not confirmed on echocardiographic control and intact valvular prosthesis function. Cerebral MRI was performed 18 days after presentation (because of initial mis-understanding of aortic prosthesis MR compatibility) showing negative diffusion, while the FLAIR sequence found infarcts in each occipital lobe and also in each crus of fornix at their junction with the fimbria of hippocampus. We diagnosed multiple strokes in vertebro-basilar territory, probably cardioembolic. Neuropsychological evaluation confirmed a severe anterograde amnesia, consequent to bilateral fornix lesions. Neuropsychological re-evaluation at one year, when the patient was hos-pitalized for cerebellar subdural hemorrhage, found anterograde memory recovery almost null. Conclusions: This is a case of stroke involving Papez circuit, interesting by its fornix localization, the consequent severe anterograde amnesia with poor recovery.
Karger_ESC London_2013
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