London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 697 662 Acute stroke: clinical patterns and practice Isolated Nodular Ischemic Infarction: a central lesion that may present as peripheral vertigo V.K. Sharma1, H.L. Teoh2, B.P.L. Chan3, B.R. Wakerley4, P.R. Paliwal5, G.H.T. Lim6, L.L. Yeo7 National University of Singapore, Singapore, SINGAPORE1, National University Health System, Singapore, SINGAPORE2, National University Health System, Singapore, SINGAPORE3, National University Health System, Singapore, SINGAPORE4, , , 5, Tan Tock Seng Hospital, Singapore, SIN-GAPORE6, National University Health System, Singapore, SINGAPORE7 Background and aim- Giddiness is a common neurological conditions and differentiation between ‘peripheral’ and ‘central etiologies’ remains the first aim of a treating physician to avoid unnecessary investigations as well as ‘not missing’ a potentially serious diagnosis such as ischemic stroke. Nod-ulus is a small area of cerebellum, just adjacent and posterior to the 4th ventricle and plays an im-portant role in maintaining balance. Isolated Nodular infarction can present with clinical signs that mimic a peripheral vestibular cause. Methods- We present a case series to reflects the clinical spectrum of isolated Nodular infarction. Results- Of the 286 patients admitted to our tertiary center with acute vertigo, 6 (2.1%) suffered from acute Nodular infarction. Similar to other ischemic strokes, nodular infarcts occurred in all age-groups (mean age 66.5 years; range 37-88) and most cases suffered from various cardiovascu-lar risk factors. All cases presented with severe giddiness of sudden-onset and walking was severely impaired due to imbalance. Most of the cases demonstrated nystagmus at rest that became worse on head-shaking. None of the patients suffered from hearing difficulties, tinnitus, pain or ear discharge. Absence of dysarthria, cranial nerve palsy, long tract signs and truncal ataxia were the striking fea-tures. Importantly, dysmetria or other cerebellar signs were not seen in any case. Magnetic reso-nance angiography did not reveal any signficant arterial stenosis in the vertebro-basilar circulation. All cases in our series recovered completely at 3 months from symptom-onset. Conclusions- Sudden onset of giddiness is the commonest presentation of isolated ischemic infarc-tion of the Nodulus. In presence of multiple cardiovascular risk factors, a high index of suspicion for the diagnosis of nodular infarct is needed in patients presenting with severe vertigo if the head impulse test is negative. 663 Acute stroke: clinical patterns and practice Changing Patterns of TIA and its impact: Queens Hospital Experience S. Andole1, A. MUBASHIR2, M. Mukhtar3, M. Rasool4, L. AL DHAHIR5, M. BAIG6 Barking Havering and Redbridge Hospitals NHS Trust, Romford, UNITED KINGDOM1, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UNITED KINGDOM2, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UNITED KINGDOM3, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UNITED KINGDOM4, Barking Havering and Red-bridge Hospitals NHS Trust, ROMFORD, UNITED KINGDOM5, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UNITED KINGDOM6 Introduction:Speed of investigations with urgent treatment in Transient ischaemic attacks have been the corner stone of stroke units across the world. There is a plethora of evidence for such manage-ment of TIA patients. To see that similar results are replicated in one of the busiest London HASU units in UK, we devised this survey. The purpose of this study was also to make effective use of the limited resources without endangering stroke outcomes and patients expectations.Materials and Methods:We analyzed tia data for 4 consecutive months at out unit. All patients were assessed for risk factors including age, sex, clinical features including medical conditions and results of urgent investigations such as carotid artery duplex and CT scan of head.Results:1)High risk patients were likely to have significant abnormality on Duplex imaging of carotid arteries and CT scanning2)The risk of significant stenosis of carotids in high risk patients was similar higher. Odds Ratio 5.37(95% CI 1.0053- 28.7) with P value of 0.0493.3)The overall rate of abnormality for a patient needing in-tervention for high risk group was also high. OR 4.6(95% CI 1.4-15.224) with P value of 0.011.4) It is very unlikely that CT scan of head in patients with TIAs is going to change the management. In our patient groups we did not encounter even a single patient where it has changed the immediate outcome.5)Whilst significant number of patients referred to TIAs did not symptoms of TIAs, several of them had abnormal scans of head with ‘silent’ infarcts. Conclusions: 1)Rapid treatment does not necessarily mean immediate complicated investigations. Such investiga-tions apart from being expensive and time consuming can significantly delay the very treatment the patient has been referred.2)More targeted imaging such as MRI scan with DWI may be more useful in risk stratification and accurate diagnosis. To make this practical referral process should be more efficient in evaluation of TIA patients.3)Improved training to medical staff involved in patient refer-ral pathway may improve the eventual outcomes of at risk patients.
Karger_ESC London_2013
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