22. European Stroke Conference 664 Acute stroke: clinical patterns and practice Fantastic perceptive distortion due to a paramedian thalamic stroke M.G. Delgado1, J. Bogousslavsky2 Hospital Universitario Central de Asturias, Oviedo, SPAIN1, Clinique Valmont, Montreaux, SWITZERLAND2 Background: The role of the thalamus in the pathogenesis of the visual and auditory hallucinations has been reported under the name of peduncular hallucinosis, usually with coexisting midbrain in-volvement. However, hallucinations taking the form of a complex distortion of perception is a dif-ferent phenomenon, which to our knowledge has not been reported. Patients: We studied two patients with complex, “fantastic”, perceptive distortion involving the visu-al and auditory systems after thalamic stroke limited to the region of the dorsomedial nucleus, spar-ing the intralaminar nuclei and the midbrain. Our patients reported the modification of usual stimuli (face, body, voices) into unreal, fantastically distorted perceptions (monstrous change of shapes or sounds without appearance of new items). Discussion: The thalamus includes nuclei acting as modulators of brainstem inputs towards auditory and visual cortex. For that reason, lesions outside the primary visual (or auditory) system may trig-ger a release phenomenon provoking visual and auditory hallucinations. However, there has been no report of fantastic perceptive distortion (visual or auditory), such as shown by our patients, either after thalamic stroke, or with lesions in another location. Conclusion: While the exact mechanism leading to such fantastic perceptive distorsions remains un-known, a release phenomenon due to damage to the paramedian thalamus (probably affecting cho-linergic system) responsible for a disinhibition of cortical function involved in familiarity of percep-tion seems likely. 698 © 2013 S. Karger AG, Basel Scientific Programme 665 Acute stroke: clinical patterns and practice NEUROLOGICAL IMPROVEMENT IN THE FIRST 24 HOURS AFTER INTRAVENOUS FIBRINOLYSIS AND LONG-TERM FUNCTIONAL RECOVERY L. Isidoro1, J. Sargento-Freitas2, F. Silva3, R. Cardoso4, N. Mendonça5, C. Machado6, C. Macário7, A. Geraldo8, B. Rodrigues9, G. Cordeiro10, L. Cunha11 Stroke Unit, Coimbra Hospital and University Centre (CHUC), Coimbra, PORTUGAL1, Stroke Unit, Coimbra Hospital and University Centre (CHUC), Coimbra, PORTUGAL2, Stroke Unit, Coimbra Hospital and University Centre (CHUC), Coimbra, PORTUGAL3, Stroke Unit, Co-imbra Hospital and University Centre (CHUC), Coimbra, PORTUGAL4, Stroke Unit, Coimbra Hos-pital and University Centre (CHUC), Coimbra, PORTUGAL5, Stroke Unit, Coimbra Hospital and University Centre (CHUC), Coimbra, PORTUGAL6, Stroke Unit, Coimbra Hospital and University Centre (CHUC), Coimbra, PORTUGAL7, Stroke Unit, Coimbra Hospital and University Centre (CHUC), Coimbra, PORTUGAL8, Stroke Unit, Coimbra Hospital and University Centre (CHUC), Coimbra, PORTUGAL9,Stroke Unit, Coimbra Hospital and University Centre (CHUC), Coimbra, PORTUGAL10, Stroke Unit, Coimbra Hospital and University Centre (CHUC), Coimbra, PORTU-GAL11 BACKGROUND: Early neurological improvement after intravenous thrombolysis has been suggested predictor of late functional independence. However, no consensual definition exists and after thrombolysis the physi-cian is often unaware of long-term functional impact of a slight clinical improvement. This issue is of major importance when informing relatives about stroke prognosis in the first few hours after the event. We aim to identify cut-off points for improvement in National Institute of Health Stroke Scale (NI-HSS) at 2 and 24 hours and their predictive value regarding late outcome. METHODS: We included patients consecutively admitted in our Stroke Unit from January 2010 to April 2012 with ischemic cerebrovascular disease undergoing intravenous thrombolysis. Patients with premor-bid Rankin scale (mRS) of at least 3 and those submitted to intra-arterial recanalization therapies were excluded. NIHSS variation at two and 24 hours after thrombolysis was defined as the difference to base-line NIHSS. Good functional outcome at 3 months was considered when a mRS of 2 or under was achieved. Cut-off points for good outcome were identified using receiver-operator characteristic (ROC) curves including NIHSS variation from baseline to 2 and 24 hours. RESULTS: In total, from 215 intravenous fibrinolysis, 194 patients were included. Mean age 72.03 ± 11.77 years, 55.7% male. 63 patients (32.5%) had good outcome at 3 months. NIHSS variation at 2 hours was not predictive of good outcome, area under curve (AUC): 0.655, 95% confidence interval (95% CI): 0.569-0.740, (p=0.001). A 4 points improvement at 24 hours NIHSS predicted good functional recovery (AUC 0.790, 95% CI 0.721; 0.859, p<0.001), with a sensitivity of 69% and specificity of 79%. CONCLUSION: Our study suggest that, in contrast with 2 hours evaluation, NIHSS at 24, when at least a 4 points improvement is achieved, seems to predict good outcome. Thus, physicians should be cautious when interpreting early signs of neurological recovery.
Karger_ESC London_2013
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