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22. European Stroke Conference 676 Acute stroke: clinical patterns and practice Outcome of Japanese minor stroke within 6 hours after the symptom onset ~Fukuoka Stroke Registry~ S. Fujimoto1, S. Mezuki2, T. Matsuki3, J. Jinnouchi4, T. Ishitsuka5, T. Kitazono6 Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, JAPAN1, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, JAPAN2, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, JAPAN3, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, JAPAN4, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, JAPAN5, Department of Medicine and Clini-cal Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JAPAN6 Background & Purpose: Patients with minor stroke with the initial NIH stroke scale score of 4 or less were often treated without recombinant tissue plasminogen activator (rt-PA) even when they are admitted within 4.5 hours after the symptom onset. We investigated the outcome of minor stroke within 6 hours after the symptom onset. Methods: Among the consecutive 4455 stroke patients who were admitted to the 7 stroke centers within 24 hours after the symptom onset, 963 patients with ischemic lesions on diffusion-weight-ed image, NIH stroke scale of 4 or less, and prior modified Rankin scale (mRS) of 0 or 1 were in-cluded in the present study. Thirty-four (3.5%) of the 963 patients were treated with intravenous rt-PA. In other 926 patients, we observed a neurological deterioration (a NIHSS score worsening of >/=1-point) and stroke recurrence during the first 21 hospital days. A good outcome was defined as mRS of 0 or 1. Results: A good outcome 3 weeks and 3 months after admission was observed in 82.2% and 82.3%. Stroke recurrence and neurological deterioration occurred in 3.7% and 9.2% of 926 patients during the first 3 weeks. Patients with a good outcome were younger than those without a good outcome 3 weeks after admission. Atrial fibrillation and diabetes mellitus were less frequent in patients with than without a good outcome. The initial NIH stroke scale score, BUN, creatinine, LDL-choles-terol, glucose, HbA1c, d-dimer, and CRP values were lower, and the initial HDL-cholesterol and estimated GFR (eGFR) values were higher in patients with than without a good outcome. On mul-tivariate analysis, age (OR 0.94, 95%CI 0.92~0.97), the initial NIH stroke scale score (OR 0.60, 95%CI 0.48~0.74), LDL-cholesterol (OR 0.99, 95%CI 0.98~1.00), and D-dimer (OR 0.92, 95%CI 0.85~0.99) were negatively associated with a good outcome 3 weeks after admission. Conclusions: In minor stroke treated without rt-PA, 18% was not able to show a good outcome. Age, the initial NIH stroke scale score, LDL-cholesterol and D-dimer were associated with the outcome. Indication criteria for intravenous rt-PA in minor stroke should be considered. 704 © 2013 S. Karger AG, Basel Scientific Programme 677 Acute stroke: clinical patterns and practice Stroke mimics in pre-hospital medicine : patient outcome compared to ischemic and hemor-rhagic stroke F. Boutot1, K. Milojevic2, S. Parisse3, M. Pessoa4, A. Sar5, M. Ebrard6, J.M. Caussanel7, Y. Lam-bert8 SAMU78, Versailles Hospital, Le Chesnay, FRANCE1, SAMU78, Versailles Hospital, Le Chesnay, FRANCE2, SAMU78, Versailles Hospital, Le Chesnay, FRANCE3, SAMU78, Versailles Hospital, , 4, Emergency Department, Versailles Hospital, Le Chesnay, FRANCE5, Emergency De-partment, Versailles Hospital, Le Chesnay, FRANCE6, SAMU78, Versailles Hospital, Le Chesnay, FRANCE7, SAMU78, Versailles Hospital, Le Chesnay, FRANCE8 Background : Among suspected acute stroke (SAS), differential diagnosis rate is estimated 19 to 31% in emergency departments (ED) and stroke units (SU). The goal of this study was to evaluate prevalence and causes of differential diagnosis among patients examined by Mobile Intensive Care Units (MICU) for SAS, and to compare the outcome of stroke mimics (SM) to that of ischemic and hemorrhagic stroke (IS and HS). Methods : 860 SAS with NIHSS notified during MICU management (year 2004 to 2012) were in-cluded. Hospital discharge reports were reviewed to assess final diagnosis and outcome. 3 groups were considered: stroke mimics (SM), ischemic stroke (IS) and hemorrhagic stroke (HS). Groups endured matching selection for age and NIHSS. 4-class outcome categorization based on modified Ranking Scale (mRS) was used: mRS < 2, mRS 2 to 4, mRS > 4, Death. Results : SAS distribution was: SM 220 (26%), IS 431 (50%), HS 209 (24%). Causes of SM were: seizures 24%, transient ischemic attack 21%, space occupying lesion 10% (head trauma 5%), meta-bolic 8% (hypoglycemia 7%), migraine 7%, toxic 6% (alcohol 4%), psychiatry 7%, sepsis 6%, he-modynamic 5%, peripheral neurologic impairment 4%, other 2%. Among SM, main diagnosis was established by MICU in 30% of cases, suspected in 35% of cases, ignored in 35% of cases. After matching procedure, subgroups responded to the same profile for age (64+/- 16 years) and initial NI-HSS (10 +/-7) but subgroup size decreased: SM 200, IS 240, HS 60. The outcome of the 3 matched subgroups is shown in Table I. Despite adjusted analysis, outcome distribution was significantly linked to subgroup type (p < 0.01). Conclusion : In this pre-hospital medicine study, SM rate is 26 +/- 5%. This estimation and the eti-ology dispersion is in accordance with ED and SU previous studies. Stroke presentations involve 3 subgroups with different outcome and treatment requirements : ischemic, hemorrhagic and, let us not forget… stroke mimics! Table I: Outcome of 3 subgroups with similar age and NIHSS profile mRS < 2 mRS 2 to 4 mRS > 4 Death Stroke Mimics 66% 20% 10% 4% Ischemic Stroke 26% 50% 19% 5% Hemorrhagic Stroke 10% 40% 25% 25%


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