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London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 685 640 Acute stroke: emergency management, stroke units and complications Fatal Contralateral Cardioembolic Stroke Promoted By Systemic Thrombolysis With rtPA In Ischemic Stroke B. von Sarnowski1, H. Zyber2, S. Brückmann3, S. Vogelgesang4, P.O. Behrndt5, M. Kirsch6, U. Schminke7, C. Kessler8 University Medicine Greifswald, Dpt. of Neurology, Greifswald, GERMANY1, University Med-icine Greifswald, Dpt. of Neurology, Greifswald, GERMANY2, University Medicine Greifswald, Dpt. of Pathology and Neuropathology, Greifswald, GERMANY3, University Medicine Greifswald, Dpt. of Pathology and Neuropathology, Greifswald, GERMANY4, University Medicine Greifswald, Dpt. of Radiology, Greifswald, GERMANY5, University Medicine Greifswald, Dpt. of Radiology, Greifswald, GERMANY6, University Medicine Greifswald, Dpt. of Neurology, Greifswald, GER-MANY7, University Medicine Greifswald, Dpt. of Neurology, Greifswald, GERMANY8 Background: Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) is both the most effective and the only approved causal treatment in acute ischemic stroke. Case: We report an 88-year-old woman who still attended to most of her daily needs including keeping house until she presented to our emergency room with acute right-sided hemiparesis. Ce-rebral CT confirmed the clinical diagnosis of acute left middle cerebral artery (MCA) infarction by time-to-peak prolongation in a small part of the MCA territory. There were no early ischemic signs or evidence of carotid artery or MCA occlusion. Tachyarrhythmic atrial fibrillation indicated car-dioembolic etiology. Intravenous thrombolysis with rtPA was started 210min after symptom onset. Directly after thrombolysis, the patient developed persistent tonic gaze deviation to the right and simultaneous tonic extention of all extremities. Immediate cerebral CT-scan did not reveal any new aspects. The epileptic status was terminated within 30min after administration of 6mg i.v. loraze-pam and 1.2g i.v. valproic acid. This left the patient in coma and made clinical judgment impossible. Fourteen hours later, CT scan did not show any infarction of the initially affected left hemisphere. However, a large space-occupying MCA and ACA infarction of the contralateral right hemisphere had occurred, which had caused the epileptic seizure. She finally died of transtentorial herniation 48h after thrombolysis. Autopsy revealed thrombi in the left and right atrium, large ischemia of the right MCA and ACA territory, occlusion of the superior mesenteric artery, and renal infarction. Conclusion: Due to the close temporal context of thrombolysis and fatal cardiac embolism, we hy-pothesize that thrombolysis therapy, though effective for the initial infarction, caused a rarely ob-served adverse event. It promoted further embolism by rtPA-induced detachment of fragments of cardiac thrombi and finally resulted in the patient’s death. 641 Acute stroke: emergency management, stroke units and complications The evAluation of patients with aCute hypertension and intraCerEbraL hEmorRhage with in-trAvenous clevidipine TreatmEnt (ACCELERATE) S.D. Bergese1, C. Graffagnino2, J. Love3, D. Schneider4, C. Lazardis5, M. LaPointe6, K. Lee7, G. Lynch8, M. Hu9, G.C. Williams10 The Ohio State University Wexner Medical Center, Columbus, USA1, Duke University Medical Center, Durham, USA2, Moses H. Cone Health System, Greensboro, USA3, University of Leipzig, Leipzig, GERMANY4, Medical University of South Carolina, Charleston, USA5, South Carolina College of Pharmacy, Charleston, USA6, Columbia University Medical Center, New York, USA7, Cleveland Clinic Hospitals, Cleveland, USA8, The Medicines Company, Parsippany, USA9,The Medicines Company, Parsippany, USA10 Background and Purpose - Intracerebral hemorrhage (ICH) causes 10-15% of all first-ever strokes with a 35-52% 30-day mortality. Blood pressure (BP) reduction may attenuate hematoma growth. The ACCELERATE trial evaluated the efficacy and safety of intravenous clevidipine infusion for the rapid treatment of acute hypertension in ICH patients. Methods - ICH patients presenting within 12 hours of symptoms and systolic blood pressure (SBP)>160 mm Hg were prospectively enrolled, and treated with open-label intravenous clevidip-ine, started at 2.0 mg/h and titrated every 90 seconds until BP ≤ 160 mm Hg was achieved then titrated to keep target SBP between 140 to 160 mm Hg. Results - Thirty-five patients (mean age 64 years; 27 males) with baseline median Glasgow Coma Scale score 12, median NIH Stroke Scale score 14, and mean SBP 186 mm Hg received clevidipine. Mean time from symptom onset to infusion start was 5.5 hours. Median time to achieve SBP target range was 5.5 minutes. All patients achieved target SBP within 30 minutes; 96.9% achieved target SBP without receiving additional or alternative intravenous antihypertensives. Mean average clevid-ipine infusion rate for the first 30 minutes of treatment was 7.9 mg/h. CT scans showed minimal he-matoma volume change for the overall population (median change -0.01mL; -2.9%). Mild/moderate hypotension was reported in 3 patients and resolved with dose reduction or drug discontinuation Conclusion – ICH patients overall showed minimal ICH volume change after SBP reduction with clevidipine. Clevidipine was effective and safe for rapid BP reduction in this cohort of critically ill patients. Clinical Trial Registry Information - http://clinicaltrials.gov/ct2/show/NCT00666328?term=clevid-ipine& rank=5 Unique Identifier:NCT00666328


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