London, United Kingdom 2013 14 Small vessel stroke and white matter disease Thrombolytic therapy in patients with lacunar stroke is effective and safe M. Griebe1, M. Kablau2, E. Fischer3, P. Eisele4, M.E. Wolf5, R. Kern6, A. Gass7, M.G. Hennerici8, K. Szabo9 Department of Neurology, UniversitätsMedizin Mannheim, Mannheim, GERMANY1, De-partment of Neurology, UniversitätsMedizin Mannheim, Mannheim, GERMANY2, Department of Neurology, UniversitätsMedizin Mannheim, Mannheim, GERMANY3, Department of Neurology, UniversitätsMedizin Mannheim, Mannheim, GERMANY4, Department of Neurology, Universi-tätsMedizin Mannheim, Mannheim, GERMANY5, Department of Neurology, UniversitätsMedizin Mannheim, Mannheim, GERMANY6, Department of Neurology, UniversitätsMedizin Mannheim, Mannheim, GERMANY7, Department of Neurology, UniversitätsMedizin Mannheim, Mannheim, GERMANY8, Department of Neurology, UniversitätsMedizin Mannheim, Mannheim, GERMANY9 Background: Lacunar stroke accounts for about one quarter of all ischemic strokes. While the clin-ical benefit of a thrombolytic therapy is assumed to be smaller in patients with a lacunar syndrome, haemorrhagic transformation after thrombolysis is infrequent in patients with lacunar stroke. How-ever, data about thrombolytic therapy in lacunar stroke is scarce. Methods: From our prospectively collected stroke database we analyzed the clinical course (NIHSS, clinical deterioration, mRS at discharge and after three months) and MRI findings (e.g. haemorrhag-ic transformation) in lacunar stroke patients between 2004 and 2011. We compared patients with to those without thrombolytic therapy. Main inclusion criterion was an MRI-confirmed lacunar stroke; patients with another possible stroke mechanism as defined by the ASCO score were excluded. Results: 537 patients (mean age 66.8 years, 60% male) were identified. Compared to patients re-ceiving standard medical care (n=467), patients with thrombolytic therapy (n=70) were more se-verely affected on admission (median NIHSS 5 vs. 3), presented with a non-lacunar syndrome more frequently (26% vs. 12%), and had more prevalent striatolenticular involvement (60% vs. 51%), but had fewer preceding cerebrovascular events (stroke 6% vs. 14%, TIA 0% vs. 3%). The clinical course was more favourable (median NIHSS improvement 3 vs. 1), functional deficit at discharge and after three months was similar (median mRS 2 vs. 2, resp.; see Fig. 1+2). While overall compli-cations were evenly distributed, MRI-confirmed haemorrhagic transformation was more frequent in treated patients (11% vs. 2%). No parenchymal haemorrhage was observed in either group. Discussion: In our collective, patients with lacunar stroke showed a benefit after thrombolysis with-out augmentation of clinical complications despite a higher rate of haemorrhagic transformation. Thus, patients with lacunar stroke or lacunar syndrome at presentation should not be treated any dif-ferently. E-Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 245 13 Small vessel stroke and white matter disease Progression of cerebral white matter hyperintensities increases the risk of multiple falls in old-er people - A prospective population-based study M.L. Callisaya1, R. Beare2, T.G. Phan3, A.G. Thrift4, J. Chen5, V.K. Srikanth6 Monash Medical Centre - Monash University, Melbourne, AUSTRALIA1, Monash Medical Centre - Monash University, Melbourne, AUSTRALIA2, Monash Medical Centre - Monash Univer-sity, Melbourne, AUSTRALIA3, Monash Medical Centre - Monash University, Melbourne, AUS-TRALIA4, Monash Medical Centre - Monash University, Melbourne, AUSTRALIA5, Monash Medi-cal Centre - Monash University, Melbourne, AUSTRALIA6 Background: Cerebral white matter hyperintensities (WMH) measured at one point in time are as-sociated with increased risk of falls. However, evidence is lacking as to whether WMH progression increases falls risk. We aimed to investigate the association between progression of WMH and risk of falls in a prospective population-based sample of older people. Methods: Participants aged 60-86 years were randomly selected from the electoral roll. At baseline and follow-up (mean 30.6 months), volumes of WMH were calculated using automated MRI seg-mentation. Falls were recorded prospectively over 12 months. Log multinomial regression was used to estimate the relative risk of single and multiple falls associated with WMH progression ad-justed for follow-up time, age, sex and total intracranial volume. Results: 184 people had baseline (mean age 70.4, SD 6.5) and follow-up MRI and falls data, with a mean follow-up of 2.5 years. Over 12 months, 33 participants (17.9%) reported a single fall and 35 (19.0%) reported multiple falls. A greater progression of WMH volume (WMH volume change as a proportion of baseline WMH volume) was associated with an increased risk of multiple falls (adjust-ed relative risk 1.31, CI 1.00-1.72, p=0.047), but a reduced risk of single falls (adjusted relative risk 0.70, CI 0.54-0.91, p=0.008). Conclusions: Greater progression of WMH’s increased the risk of multiple falls, suggesting that interventions to slow the progression of WMH may be successful in reducing multiple falls in older people. Further investigation into understanding inverse association between WMH progression and the risk of a single fall is required.
Karger_ESC London_2013
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