London, United Kingdom 2013 16 Interesting and challenging cases Pregnancy and intracerebral haemorrhage. A description of 5 cases. M. Terceño1, Y. Silva2, C. van Eendenburg3, J. Serna4, M. Castellanos5 Josep Trueta Hospital. Girona, Neurology Service, Girona, SPAIN1, Josep Trueta Hospital. Giro-na, Neurology Service, Girona, SPAIN2, Josep Trueta Hospital. Girona, Neurology Service, Girona, SPAIN3, Josep Trueta Hospital. Girona, Neurology Service, Girona, SPAIN4, Josep Trueta Hospital. Girona, Neurology Service, Girona, SPAIN5 INTRODUCTION Our study aimed to review all patients admitted for intracerebral haemorrhage (ICH) related to preg-nancy, and to study their aetiology and clinical outcome. METHODS Retrospective study of patients admitted between 2004 and 2011 to the Stroke Unit of our hospital with the diagnosis of ICH during pregnancy or the postpartum period (PP). Data relating to vascular risk factors, clinical, neuroimaging, and laboratory analysis variables, and clinical evolution were gathered. RESULTS Five patients were indentified with a mean age of 34.4 years. No personal antecedents were detect-ed, nor cardiovascular or toxic risk factors other than one case of gestational diabetes. Three patients presented ICH during gestation, one during delivery and another in the inmediate PP. The mean haematoma volume was 24 cc and the most frequent localisation was deep (4/5). One pa-tient required surgical evacuation of the haematoma. Mean basal NIHSS was 12, and 7 at hospital release. At 3 months, 60% presented mRS<2. During the follow-up period (1-7 years), no recurrenc-es of haematoma were detected. The aetiological diagnosis after a completed study was: 1 posterior reversible encephalopathy (PRES) due to eclampsia, 1 hypertensive following the administration of ephedrine, 1 idiopathic, 1 postpartum cerebral angiopathy (PCA), and 1 associated to a partial deficiency of the enzyme a-ga-lactosidase E-Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 601 A. CONCLUSIONS ICH in pregnancy and the PP is an infrequent condition with several aetiologies, such as PCA, ec-lampsia and PRES. The most widespread hypothesis is that these entities could share a common de-nominator that is an endothelial dysfunction due to placental protein release with associated intimal hyperplasia and fibrinoid necrosis that can develop vasoespasm or microaneurysms. For this reason, patients with ICH during delivery or the PP need an extensive eaetiological study that would include a transcranial duplex to role out the presence of vasoespasm even though angiog-raphy is normal. 35 Intracerebral/subarachnoid haemorrhage and venous diseases Spontaneous Intracerebral Haemorrhages in the Posterior Fossa: characteristics, prognostic factors and outcome H. El Jarkass1, C. Rossi2, N. Dequatre-Ponchelle3, H. Hénon4, C. Cordonnier5 University Lille Nord de France, Department of Neurology and Stroke Unit, Lille, FRANCE1, University Lille Nord de France, Department of Neurology and Stroke Unit, Lille, FRANCE2, Uni-versity Lille Nord de France, Department of Neurology and Stroke Unit, Lille, FRANCE3, Univer-sity Lille Nord de France, Department of Neurology and Stroke Unit, Lille, FRANCE4, University Lille Nord de France, Department of Neurology and Stroke Unit, Lille, FRANCE5 Background: Posterior fossa (PF) haemorrhages account for 11-25% of all intracerebral haemor-rhages (ICH), but our knowledge concerning their risk factors, pathophysiology, and long-term outcome is still limited. Our aim was to evaluate the baseline characteristics, prognostic factors and long-term outcome of patients with PF-ICH and to discuss hypothesis on their pathogenesis. Methods: The PITCH (Prognosis of Intracerebral Haemorrhage) cohort is a prospective, hospi-tal- based cohort of 562 consecutive adults with a spontaneous ICH. The patients were recruited be-tween 11/04 and 03/09 and those who presented a PF-ICH were eligible for the study. We performed multivariate analyses (logistic regression and survival models). Results: 64 ICH, i.e. 11.4% of the PITCH cohort, were located in the PF: 48% were in the brainstem and 52% in the cerebellum. The in-hospital mortality was 52% and was highly influenced by the NIHSS at presentation (p<0.0001). Associated factors with in-hospital mortality were: brainstem lo-cation (vs cerebellum) (OR=16.0; 95%CI 1.7 to 149.7) and ICH volume (OR=1.1 per 1 ml increase; 95%CI 1.01 to 1.2). Mortality was not affected by the baseline characteristics or pre-ICH treatments. Compared with cerebellar ICH, patients with brainstem ICH were more likely to have an excessive alcohol consumption (OR=4.2; 95%CI 1.1 to 16.3) and less likely to be treated with antihyperten-sive drugs (OR=4.9; 95%CI 1.5 to 15.7). Three years after ICH onset, 36% of patients were still alive. Half of those who survived at discharge had a good functional outcome. None suffered ICH recurrence. Conclusion: The high prevalence of in-hospital mortality within patients with PF-ICH is mainly influenced by the acute clinical presentation, but the functional long-term outcome may be better than expected. The pathogenesis of PF-ICH remains unexplored, but indirect markers suggest the in-volvement of deep perforating vasculopathy in the pathogenesis of brainstem ICH.
Karger_ESC London_2013
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