Page 602

Karger_ESC London_2013

22. European Stroke Conference 602 © 2013 S. Karger AG, Basel Scientific Programme 18 Interesting and challenging cases Intracranial occlusive vasculopathies as a cause of recurrent stroke in adults A. Pérez Hernández1, A. Medina2, D. Alonso3, A. González4, V. Díaz5, I. Tejera6 Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, SPAIN1, Hospi-tal Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, SPAIN2, Hospital Universi-tario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, SPAIN3, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, SPAIN4, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, SPAIN5, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, SPAIN6 Background: Intracranial occlusive vasculopathies are a heterogeneous group of conditions that af-fect young adults and result in an appreciable percentage of ischemic stroke in this population. They are characterized by progressive stenosis of intracranial circulation varying its degree and location, secondary to processes of inflammatory damage/thickening vascular wall not completely under-stood. Its intermediate forms, in which the diagnosis of vasculitis/vasculopathy is not possible to es-tablish clearly, constitute a challenge in clinical practice. Methods: We retrospectively analyzed the patients evaluated in the Stroke Unit of our hospital from 2004 to 2012 with neuroimaging features compatible with progressive stenosis of the intracranial circulation, their characteristics, their clini-cal and radiological evolution and we reviewed the literature. Results: We found five adult patients (three female and two male) aged between 44 and 70 years old. The ischemic stroke, transitory or established, was the way of starting in every case. Two of them were diagnosed of moyamoya, with intravenous fibrinolysis before the diagnosis was done to one patient without any complication. In two others, the changes of caliber intracranial circulation were considered secondary to CNS vas-culitis and high-dose steroid therapy was given with good outcomes. In the fifth case, the pattern of stenosis, as well as their characteristics and evolution did not allow a definitive diagnosis, although it was considered due to CNS angiitis. Conclusion: Intracranial occlusive vasculopathies are a het-erogeneous group of entities presenting in young adults causing recurrent strokes. Their differentia-tion is not always obvious, especially in the intermediate forms, constituting a clinical challenge that is unresolved yet. 17 Interesting and challenging cases Cortical Vein Thrombosis presenting as transient Neurological Symptoms A.H. Lavan1, L. Brewer2, S. Looby3, A. O’Hare4, D.J.P. Williams5 Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin 2, IRELAND1, Royal College of Surgeons Ireland, Dublin, IRELAND2, Department of Radiology, Beaumont Hos-pital, Dublin, IRELAND3, Department of Radiology, Beaumont Hospital, Dublin, IRELAND4, De-partment of Geriatric and Stroke Medicine, Beaumont Hospital and Royal College of Surgeons, Ire-land, Dublin, IRELAND5 Background Cerebral Venous thrombosis causes approximately 0.5 to 1% of strokes worldwide with differing in-cidences in specific patient cohorts. 8% occur in those >65 years. In this group the incidence is equal in men and women. 62% occur in the superior sagital sinus whereas 17% present as isolated cortical vein thrombosis(ICVT). Methods We present the case of a 70 year old right handed female smoker, with a history of ischaemic heart disease, dyslipidaemia and a positive family history of cardiac disease who presented to the emer-gency department following a 2 week history of episodic right arm and leg weakness. There were no other focal neurological symptoms. Results At presentation her GCS was 15, BP 153/92, NIHSS 0. ECG was normal sinus rhythm. No carotid bruit was heard. Her ABCD2 score was 4. A CT brain showed no stroke disease. Her subsequent stroke work up was negative for a causative factor. A presumptive diagnosis of a transient ischaemic attack was made. She subsequently complained of a headache and had a multiple sequence MRI and MRV brain which confirmed the presence of an ICVT(image 1). Extensive investigations were done to search for an underlying malignancy or haematological disorder. None was found. She was com-menced on anticoagulation (target INR of 2.5). Follow up imaging at three months showed recanali-sation of the cortical vein. Conclusion We present an unusual cause of transient neurological symptoms. Headache is the most common presentation of cerebral venous thrombosis, however 28.5% of people present with stroke like symptoms. At presentation 30% of CT brain scans are normal, 30-40% show haemorrhage and 30% will have specific signs of venous thombosis. MRV and gradient ECHO are the most sensitive im-aging techniques. Malignancy is a frequent cause in those > 65 years however in 37% no cause is found. When diagnosed and treated promptly prognosis is good with complete recovery in 79%. There is a paucity of information on the management of IVCT with the majority of information be-ing derived from evidence from case reports and case series. With improvements in imaging tech-niques it is likely that their incidence will increase.


Karger_ESC London_2013
To see the actual publication please follow the link above