22. European Stroke Conference 130 Interesting and challenging cases “Spontaneous pneumoencephalocoele presenting as suspected stroke” M. Mandiratta1, B.S. Sidhu2, A Salam3, A.K. Banerjee4, M Rassappan5 ST3 Doctor, Russells Hall Hospital, Dudley, UNITED KINGDOM1, CT1 Doctor, Russells Hall Hospital, Dudley, UNITED KINGDOM2, Consultant Stroke Physician, Stroke Medicine, Russells Hall Hospital, Dudley, UNITED KINGDOM3, Consultant Stroke Physician and Clinical Lead, Stroke Medicine, Russells Hall Hospital, Dudley, UNITED KINGDOM4, SpR Stroke Medicine, Russells Hall Hospital, Dudley, UNITED KINGDOM5 Background: This is an abstract for a case of a 59 year old gentleman admitted under the Stroke team at Russell’s Hall Hospital with Stroke symptoms, and then transferred to the Neurosurgical team at Queen Elizabeth Hospital Birmingham with a Stroke mimic. He presented to A&E with acute onset right sided weakness/dysphasia which had been getting worse. He had been feeling gen-erally unwell prior to this and had been noted to have a sneezing episode 2 days previously. He had previously had a significant head injury in 1969 that was managed conservatively. He had 2 seizures in the past and following this was commenced on Carbamazepine. He had previously had a CT head and MRI brain which were reported as being normal. Based on his presentation he was given Aspirin 300mg and referred to the Stroke team. His power was graded at 2/5. He gradually improved over the next few days. A CT scan revealed a large vol-ume of intracranial air in the left frontal region. He was then transferred to Neurosurgery. His power at this point was noted to be Grade 4/5 on the right side. Repeat CT revealed a large amount of air in the left frontal lobe with associated mass effect leading to distortion of the left frontal horn of lateral ventricle. Defects were noted in the roof of the ethmoid and frontal sinus, presumed to be old frac-tures. In light of the above findings he underwent left frontal twist drill hole under GA. Aspiration of air was performed successfully using a Dandy cannula. He initially had an uneventful recovery and post-op imaging revealed a slight decrease in the volume of intracranial air. His GCS returned to 15/15. He was unfortunately found unresponsive and CPR was unsuccessful. Post-mortem revealed the gentleman had a pulmonary embolus. Conclusions: This case highlights the importance of rare Stroke mimics( Pneumoencephalocoele) presenting with acute Stroke-like symptoms. Early recogni-tion and Neurosurgical intervention is essential in cases such as this. 350 © 2013 S. Karger AG, Basel Scientific Programme 131 Interesting and challenging cases The challenges of treating patient with acute haemorrhagic stroke following primary coronary intervention. A.S. Bannaga1, A. Abdul’hamid2 Hull Royal Infirmary, Hull, UNITED KINGDOM1, Hull Royal Infirmary, Hull, UNITED KING-DOM2 We would like to present this 59 year old gentleman, who was initially admitted with an acute myo-cardial infarction and was treated with antiplatelets and low molecular weight heparin. He then un-derwent coronary stenting and was given unfractionated heparin during the procedure. 10 hours later he developed an acute hemorrhagic stroke. He had an elevated APTT of 168 seconds 6 hours before the stroke and an APTT of 43.8 seconds after the stroke. The need to weigh risks and benefits of ur-gently reversing the anticoagulant effect after intracranial haemorrhage in the presence of concurrent coronary artery stent and establishing an appropriate timing to restart antiplatelets necessitated mul-tidisciplinary team approach. There was a clinical dilemma of reversing the effect of low molecular weight heparin with protamine sulphate. The uncertainty of protamine effects on the recent coronary stent, the limited data on its clinical effectiveness and the modest elevation of APTT after the stroke led to joint clinical decision to not institute it in this case. He was further investigated with CT ce-rebral angiogram that ruled out an underlying vascular lesion. He was managed conservatively and had a good outcome with no expansion of haematoma. The case emphasises the need for further studies on protamine effects on reversal of heparins in in-tracranial haemorrhage as well as risks of thrombosis of coronary stents.
Karger_ESC London_2013
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