London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 533 462 Small vessel stroke and white matter disease Does urinary sodium creatinine ratio predict white matter lesions in patients with mild stroke? S.D.J. Makin1, M.S. Dennis2, J.M. Wardlaw3 University of Edinburgh, Edinburgh, UNITED KINGDOM1, University of Edinburgh, Edin-burgh, UNITED KINGDOM2, University of Edinburgh, Edinburgh, UNITED KINGDOM3 Background Dietary salt is linked to stroke risk on a population level but is difficult to measure. Because the gold standard of a 24 hour urine is impractical, researchers have used urinary sodium creatinine ratio (Na/ Cr) as an alternative indicator of dietary salt. We aim to investigate associations between reported added salt, Na/Cr, clinical factors and white matter hyperintensities(WMH) in patients with non dis-abling stroke. Methods We recruited patients with a non-disabling ischaemic stroke and recorded clinical features and WMH on MRI (Fazekas scale). We measured Na/Cr in early morning urine one month post-stroke. Patients rated how often they added salt to food during cooking and at the table on a scale of 1-5. We carried out multivariate analysis using ordinal logistic regression Results We recruited 264 patients, 196(75%) patients provided a urine specimen; median age 67.5(IQR60- 75), median NIHSS 2 (IQR 2-3). Patients with a specimen were more likely to be male, have milder stroke, and normal cholesterol. There were no differences in age, clinical features, or WMH. Higher urinary Na/Cr ratio was associated with female sex, diuretic use, hypertension, age and renal impairment (eGFR<60), but not with other clinical factors including admission blood pressure, no associations were seen in under 65s. On multivariable analysis there was no significant association between urinary Na/Cr and WMH 0.99(0.97-1.00), (corrected for age, diuretic use, previous stroke, hypertension, smoking, family history and IHD). There was no significant correlation between reported added dietary salt and mea-sured urinary Na/Cr, (Spearman’s correlation coefficient -0.01, p0.94). Conclusion We did not find a significant association between urinary Na/Cr and WMH, nor a correlation be-tween urinary Na/Cr and reported added salt, (not total dietary salt).Future studies using Na/Cr in older people should be mindful of confounding with age, sex, diuretic use hypertension and renal function. 463 Small vessel stroke and white matter disease A fatal microangiopathic bleed in a young woman after recurrent mild ischaemic stroke within a space of six weeks seen at Medway Hospital, Kent, UK A. Mahmood1, M. Mamun2 Medway NHS Foundation trust, Gillingham, UNITED KINGDOM1, Medway NHS foundation trust, Gillingham, UNITED KINGDOM2 Background Cerebral microangiopathy manifests as leukoariasis or lacunar infarcts and responsible for 25-30% of strokes due to infarction or haemorrhage. Aetiologically these changes are associated with older age, hypertension and diabetes mellitus. Case report A 42 year old single mother came in as an emergency in July 2012. She was found confused and unable to speak clearly. She suffered a non-disabling stroke six weeks earlier and was admitted to a nearby hospital with left sided symptoms. A diagnosis of right thalamic infarct was confirmed on MRI brain. She was a smoker, non-alcoholic, and used heroin, but claimed to be clean for two years. On arrival she was awake but mildly confused with reduced speech output (mild aphasia) and mild right facial asymmetry. She was able to stand and walk indoors. NIHSS score was 4. A CT-head and a carotid Doppler were NAD, and toxicology screen was satisfactory. She improved over the next few days, and an MRI (DWI) four days later confirmed a small, acute left parietal infarction. Four hours later a tonic clonic seizure was witnessed, and she collapsed with a dilated left pupil. An emergency CTH revealed a large left intralesional bleed with midline shift. She was intubated and transferred to ITU. She was not for neurosurgical intervention, and in due course brain death was confirmed, and organ harvested (liver only used because of Hep C +ve). Discussion A post-mortem was performed and neuro-pathology revealed that in several sections abnormal 1-2 mm conglomerates of thin walled ectatic blood vessels (vascular malformations) were seen within the white matter. Rupture of such a malformation was judged to be the most likely aetiology of the fatal bleed. There was no evidence for vasculitis or medium / large vessel AVM. This patient had none of the usual aetiological factors for microangiopathy. This case highlights that microangiopathic changes can occur in younger patients in the absence of the usual risk factors and can prove fatal.
Karger_ESC London_2013
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