22. European Stroke Conference 445 Small vessel stroke and white matter disease Atypical ischaemia in CADASIL patients. F.C. Moreton1, K.W. Muir2 University of Glasgow, Glasgow, UNITED KINGDOM1, University of Glasgow, Glasgow, UNIT-ED 522 © 2013 S. Karger AG, Basel Scientific Programme KINGDOM2 Background: Stroke and TIA are characteristic of the inherited small vessel disease CADASIL, occurring in up to 85% of patients. Strokes are typically subcortical and present most frequently as lacunar syndromes. Territorial infarcts have been described very rarely. We aimed to establish their frequency in a CA-DASIL population. Methods: We reviewed clinical records of confirmed CADASIL patients attending a specialist clinic. The most recent MRI brain scans were reviewed where available, as were older scan reports. Scheltens score and the presence of microbleeds, lacunar infarcts and brainstem abnormalities were recorded where possible. Results: Of 105 subjects from 49 pedigrees, 64 (61%) had a history of stroke or TIA, with 130 events report-ed (median 1; range 1-8) of which 31 were diagnosed as lacunar stroke, 25 TIAs, 2 haemorrhages, and 63 not stated. 86/105 had a subsequent MRI scan or report available. In subjects with a history of stroke, MRI demonstrated lacunes in 41/42 compared to 15/35 without stroke (p <0.01). Scheltens score was higher in those with a history of stroke (mean 38 +/- SD9.6 v 30 +/- 12.8; p <0.01). 7 unrelated patients (aged 18-63 years) had non-lacunar infarcts, affecting cerebellar watershed (2), single (2) or multiple acute (1) cortical sites, PICA territory (1) and complete basal ganglia (1). Compared to the 33 patients with subcortical stroke, Scheltens score was lower (mean 31+/- SD12 v 39 +/- 9) but there were no differences in age, presence of other radiological features or vascular risk factors. Conclusions: Subcortical ischaemic events were most common clinically and radiologically, but 7% of patients had cortex, large artery territorial or watershed infarcts on MRI. These patients had lower Scheltens scores but otherwise no difference in risk factor profile. Whether these represent coincidental, unre-lated events or are related to the vasculopathy causing CADASIL is unknown.
Karger_ESC London_2013
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