London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 645 568 Acute stroke: emergency management, stroke units and complications BARRIERS TO ESTABLISH A TELESTROKE NETWORK IN LOW AND MIDDLE IN-COME COUNTRIES G.W. KUSTER1, T BRONER2, F.F. TOSO3, P.V.T. PIZA4, C. VOLCOV5, M.A.G. BARONI6, M.C. ARRUDA7, L.A. DUTRA8, G.W. KUSTER9 HOSPITAL PAULISTANO/ AMIL STROKE NETWORK, SAO PAULO, BRAZIL1, HOS-PITAL PAULISTANO/ AMIL STROKE NETWORK, SAO PAULO, BRAZIL2, HOSPITAL PAULISTANO/ AMIL STROKE NETWORK, SAO PAULO, BRAZIL3, HOSPITAL PAULISTA-NO/ AMIL STROKE NETWORK, SAO PAULO, BRAZIL4, HOSPITAL PAULISTANO/ AMIL STROKE NETWORK, SAO PAULO, BRAZIL5, HOSPITAL PAULISTANO/ AMIL STROKE NETWORK, SAO PAULO, BRAZIL6, HOSPITAL PAULISTANO/ AMIL STROKE NETWORK, SAO PAULO, BRAZIL7, HOSPITAL PAULISTANO/ AMIL STROKE NETWORK, SAO PAULO, BRAZIL8, HOSPITAL PAULISTANO/ AMIL STROKE NETWORK, SAO PAULO, BRAZIL9 Background: The new global strategies (WHO) reflect the growing burden of stroke particularly in the low and middle income countries. There are enormous disparities in the access to the health care network that directly affect the acute stroke care in these countries. Our aim was to review the appli-cability of telestroke care to low and middle income countries. Methods: We developed a pilot study in a metropolitan area among hospitals that participate in one of the largest health care provider’s organization in the country. The Amil Stroke Network provides neurological expertise in acute stroke care (24 hs) from a major comprehensive stroke center (CSC-hub) to 12 primary care hospitals (PCH - spokes) in the city of São Paulo. Results: We evaluated 156 consecutive patients; The majority were young (mean age: 56 y) and male (61.5%). Of 156 patients, only 50% (79) were acute stroke (70% ischemic and 20% ICH) and 6,5% (10) TIA. In addition, 20 patients were diagnosed as SAH, 14 with Subdural Hema-toma and 7 with Cerebral Venous Thrombosis. Others cerebrovascular disorders were found in 16.7% of patients. Of 56 patients with acute ischemic stroke, 44% arrived within 8 hours at the PCH. Few patients that arrived at the therapeutical window (4.5 hs) did not receive rtPA. Only 6 patients were removed to the CSC and 4 of them submitted to mechanical revascularization. Conclusion: Few acute ischemic stroke patients were treated and are receiving more expensive treatment due to late therapeutical window. In addition, elderly patients may have limit access to the acute stroke care system. Educational programs should start among the healthcare professionals to improve the local hospitals participation in the system and decrease the disparities in acute stroke care between the CSC and PCH. 569 Acute stroke: emergency management, stroke units and complications Subarachnoid haemorrhage in Cerebral Hyperperfusion Syndrome: a serious complication af-ter carotid endarterectomy. A case report. N. Badat1, S. Deltour2, F. Baronnet3, M. Amor4, Y. Samson5 Stroke Unit, HOSPITAL PITIE SALPETRIERE, PARIS, FRANCE1, Stroke Unit, HOSPITAL PITIE SALPETRIERE, PARIS, FRANCE2, Stroke Unit, HOSPITAL PITIE SALPETRIERE, PAR-IS, FRANCE3, NeuroRadiology Center, HOSPITAL PITIE SALPETRIERE, PARIS, FRANCE4, Stroke Unit, HOSPITAL PITIE SALPETRIERE, PARIS, FRANCE5 Cerebral hyperperfusion syndrome (CHS) is a rare, serious complication after carotid revasculariza-tion. CHS is characterised by headache, seizures, and focal neurological deficits, due to raised brain oedema, intracerebral haemorrhage (ICH), or more rarely to subarachnoid haemorrhage. Impaired cerebral autoregulation and post-revascularization changes in cerebral hemodynamics are the main mechanisms involved in the development of the CHS. We report a particulary case of CHS. Mr. M., aged 53, with a history of diabetes and smoking, underwent left carotid endarterectomy for a severe stenosis revealed by a left transient monocular blindness. Two days after surgery, the patient com-plained of headaches. Three days later, aphasia, right central facial palsy, right hemianopia, and se-vere headache appeared. Finally, he presented a partial motor seizure secondarily generalized. Brain CT showed left subarachnoid haemorrhage (SH). MRI reported white-matter oedema, predominant-ly involving the posterior parietal-occipital regions and local SH at left. No vascular malformations were found. Blood pressure was controlled by nicardipine and the treatment consisted of the cessa-tion of antiplatelets and prevention of seizure through levetiracetam. The evolution of the neurologi-cal deficits was favourable, with disappearance of MRI abnormalities. The main risk factor for CHS is per and post-operative hypertension. Therefore, a scrupulous blood pressure management and control of hypertension are paramount and could help prevent CHS. Patients must also be advised to contact vascular unit if they develop headaches or any neurological symptoms in the days following surgery. CHS following carotid revascularisation is a serious complication that remains underdiag-nosed. Early identification and treatment of patients at risk is essential.
Karger_ESC London_2013
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