22. European Stroke Conference 625 Acute stroke: emergency management, stroke units and complications Decompressive Surgery in Acute Stroke R. Kunt1, E. Yaka2, V. Ozturk3, E. Ozer4, K. Kutluk5 University of Dokuz Eylul, Faculty of Medicine, Department of Neurology, Izmir, TURKEY1, University of Dokuz Eylul, Faculty of Medicine, Department of Neurology, Izmir, TURKEY2, Uni-versity of Dokuz Eylul, Faculty of Medicine, Department of Neurology, Izmir, TURKEY3, Universi-ty of Dokuz Eylul, Faculty of Medicine, Department of Neurosurgery, Izmir, TURKEY4, University of Dokuz Eylul, Faculty of Medicine, Department of Neurology, Izmir, TURKEY5 Background: Patients with large space occupying cerebral and cerebellar infarcts have poor prog-nosis and are at high risk for malignant brain edema. Decompressive surgery has been recommend-ed for cerebellar infarcts as a potentially lifesaving measure. Recent trials have also demonstrated that hemicraniectomy reduces mortality without increasing the risk of severe disability. However, these trials tested surgery within two days and in patients up to 60 years of age. We documented the results of decompressive surgery in our patients with different types of acute stroke. Methods: Be-tween August 2010 and January 2013, twelve patients with acute stroke with the signs of neurologi-cal worsening despite medical treatment at our stroke unit, have undergone surgery. Large hemicra-niectomy plus duraplasty or suboccipital craniectomy has been performed according to the location of the lesion. The main criterion for surgery was the obvious worsening of the clinical and radiologi-cal status, regardless of time and the age of patients. Results: The diagnosis was malignant middle cerebral artery infarction in 5 patients, cerebellar in-farction in 3 patients, lobar hemorrhages in 3 patients, and venous infarction in 1 patient. Ages of the cases varied between 31 and 85. Surgery has been performed within 48 hours in 8 patients, 4 days in 2 patients, 10 days in 1 patient and 11 days in one patient. Four patients (2 with lobar hemorrhages, 1 with malignant MCA infarct, 1 with cerebellar infarct) died because of stroke and other compli-cations. The preoperative/postoperative mRS scores were 5/3, 5/4, 5/2, 5/5, 5/2, 5/4, 4/1 and 5/2 in 8 patients who had survived. Follow up period ranged between 5 and 99 days. Conclusion: Since evidence is increasing that decompressive surgery decreases mortality and improves functional outcome, we think that this therapy will be performed wider in everyday clinical practice for acute stroke patients and in centers with neurosurgical expertise. 678 © 2013 S. Karger AG, Basel Scientific Programme 626 Acute stroke: emergency management, stroke units and complications Urinary Norepinephrine levels, physiological parameters and outcome in acute ischemic stroke: a pilot study. A. De Vos1, R.J. Van Hooff2, A. De Smedt3, R. Brouns4, S. De Raedt5, J. De Keyser6 UZ Brussel, Brussels, BELGIUM1, UZ Brussel, Brusssels, BELGIUM2, UZ Brussel, Brussels, BELGIUM3, UZ Brussel, Brussels, BELGIUM4, UZ Brussel, Brussels, BELGIUM5, UZ Brussel, Brussels, BELGIUM6 BBackground Acute ischemic stroke is often associated with sympathetic overactivity. The aim of this study was to investigate whether stroke severity, hypertension, hyperglycemia, elevated body temperature and outcome are associated with sympathetic overactivity. Methods We prospective-ly studied 58 patients with acute ischemic stroke. Sympathetic activity was assessed by measuring 24-hour urinary norepinephrine (NE) levels. Blood pressure, body temperature and glycemia were recorded after stroke. Stroke severity was quantified using the National Institute of Health Stroke Scale. Outcome after 3 months was assessed using the modified Rankin Scale. Results In univari-ate analyses, we found no association between urinary NE levels and systolic blood pressure (p = 0.617), diastolic blood pressure (p = 0.581) and body temperature (p = 0.540). Urinary NE levels were associated with hyperglycemia in univariate analysis (p = 0.031), but were no longer an inde-pendent variable after logistic regression analysis (OR = 1.026, 95% CI = 0.998 – 1.054, p = 0.069). Poor outcome was associated with urinary NE levels in univariate analyses (p = 0.015), but was no longer significant after logistic regression analysis (OR = 1.131, 95% CI = 0.998 – 1.281, p = 0.054). Stroke severity was associated with urinary NE levels (p = 0.011), and this remained so after logistic regression analysis (OR = 1.047, 95% CI = 1.012 – 1.083, p = 0.007). Conclusions In this preliminary study we found an association between sympathetic overacivity measured by urinary NE levels and stroke severity, possibly reflecting that more severe strokes lead to an higher gener-alized stress reaction. However, we cannot exclude the reverse that sympathetic activity influences stroke severity. We found no associations between sympathetic overactivity and hypertension, hy-perglycemia or elevated body temperature. A limitation of our study is that numbers were small. Further studies are required to confirm these findings.
Karger_ESC London_2013
To see the actual publication please follow the link above