London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 467 344 Vascular surgery and neurosurgery Vasospasm of proximal internal carotid artery causing acute ischemic stroke after transcranial removal of a pituitary adenoma W. Joo1 The Catholic University of Korea, ST. Mary’s Hospital, Seoul, SOUTH KOREA1 Introduction Cerebral vasospasm is well known to occur after various events that cause subarachnoid hemor-rhage, such as aneurysmal hemorrhage and neurotrauma. Vasospasm after resection of skull base tu-mors is rare. We present a patient with vasospasm of cervical, petrous and cavernous ICA proximal to pituitary tumor. Case presentation A 45-year-old man presented with right visual disturbance and ocular pain for 3 months. MRI demonstrated suprasellar and right cavernous mass impinging on the right optic nerve with encase-ment of right ICA. MRA showed no abnormality. We performed optic nerve decompression by re-moving the suprasellar mass. No vasospasm was evident at the time of closure. On third postopera-tive day, he suddenly developed left arm weakness. MRA and diffusion MRI showed spasm of right proximal ICA and high signal intensity in right frontal area respectively. Active hypertensive hyper-volemic hemodilution therapy was initiated immediately. On the postoperative 14th day, follow up MRA revealed complete resolution of arterial spasm. Discussion Several hypotheses may be suggested explaining the occurrence of vasospasm after pituitary sur-gery: blood spillage into the basal cistern, direct damage to blood vessels, hypothalamic dysfunction and vasoactive material released from the tumor. Among the hypotheses, imbalance of vascular tone is attractive to us. Increased cerebral vasoreactivity to vasoactive substance liberated from tumor may be reliable in causing the vasospasm suffered by this patient. Conclusion Although vasospasm associated with tumor resection is infrequent complication, one must take it into consideration if there is any delayed deterioration in a patient who has undergone cranial base tumor surgery. If vasospasm was confirmed by angiography or MRA, aggressive and prompt man-agement is a key element for improving patient’s outcome. Management and economics (PO 345 - 376) 345 Management and economics The association between 7 day consultant ward rounds and mortality risk in stroke patients admitted at the weekend B.D. Bray1, S. Ayis2, J. Campbell3, A. Hoffman4, P. Tyrrell5, C.D.A. Wolfe6, A.G. Rudd7 on behalf of the Intercollegiate Stroke Working Party Group King’s College London, London, UNITED KINGDOM1, King’s College London, London, UNITED KINGDOM2, Royal College of Physician’s London, London, UNITED KINGDOM3, Roy-al College of Physician’s London, London, UNITED KINGDOM4, Salford Royal Foundation Trust, Manchester, UNITED KINGDOM5, King’s College London, London, UNITED KINGDOM6, Guy’s and St Thomas’ Foundation Trust, London, UNITED KINGDOM7 Background Observational studies have demonstrated higher post stroke mortality following weekend admission. 7 days a week consultant ward rounds have been proposed as a solution to this, although evidence is lacking that this can reduce the “weekend effect”. We aimed to estimate the relationship between 7 day consultant ward rounds, weekend admission and 30 day mortality in stroke patients. Methods Patient level data were extracted from the Stroke Improvement National Audit Programme (SINAP) of patients admitted with stroke to a participating hospital in England from June 2011-Sep 2012. These were linked with data from the 2012 Sentinel Audit of the characteristics of stroke services. Mortality data were obtained from national mortality records. Multivariable Cox regression was used to estimate hazard ratios for 30 day mortality, adjusting for patient level prognostic variables (stroke type, age, pre stroke independence, reduced consciousness, hypoxia, dysphasia, hemiano-pia, arm weakness, leg weakness), stroke service variables (stroke unit type, nurse: patient ratio and thrombolysis provision)and clustering effects. Results Of 46 757 patients with stroke admitted to 106 participating hospitals in England, 11 890 (25.6%) were admitted on a weekend. 26 270 patients were admitted to a hospital (n=44) reporting 7 day consultant ward rounds. Crude 30 day mortality was 12.6% for weekday and 14.5% for weekend ad-missions. After adjustment for patient and stroke service variables, patients admitted at the weekend were observed to have higher mortality if they were admitted to a hospital without 7 day consultant ward rounds (HR 1.13, 95% CI 1.01-1.26, p=0.028) but not following admission to a hospital with 7 day consultant rounds (HR 1.04, 95% CI 0.94-1.14, p=0.47). Conclusion Observational data suggest that 7 day per week ward rounds by a consultant may mitigate the effect of weekend admission on post stroke mortality.
Karger_ESC London_2013
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