London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 713 693 Acute stroke: clinical patterns and practice Lemierre`s syndrome as rare cause of extra and intracranial venous thrombosis followed by ischemic and hemorrhagic infarction a long and complicated story B. Matosevic1, M. Knoflach2, A. Zangerle3, G. Wille4, J. Willeit5, S. Kiechl6 Department of Neurology, Medical University of Innsbruck, Innsbruck, AUSTRIA1, Depart-ment of Neurology, Medical University of Innsbruck, Innsbruck, AUSTRIA2, Department of Neu-rology, Medical University of Innsbruck, Innsbruck, AUSTRIA3, Department of Neurology, Medi-cal University of Innsbruck, Innsbruck, AUSTRIA4, Department of Neurology, Medical University of Innsbruck, Innsbruck, AUSTRIA5, Department of Neurology, Medical University of Innsbruck, Innsbruck, AUSTRIA6 Background: Lemierre`s syndrome a thrombophlebitis of the internal jugular vein usually develops after a tonsillitis and affects young male healthy adults. The penetrating infection is caused by fuso-bacterium necrophorum or streptocci and often leads to pneumonia. Central nervous system can be affected in different manners especially in pretreated, abortive forms. Case: In august 2011 a 19 year young male presented with fever, sore throat and headache. A ton-sillitis was diagnosed and patient was given amoxicillin and clavulanic acid for treatment as well as antiphlogistic drugs. Headache persisted, and two weaks later, he suffered a generalized epi-leptic seizure. Cerebral imaging revealed a sinus venous thrombosis of the left saggital superior, transversal and sigmoid sinus, the bulb of the left internal jugular vein. The extensive jugular vein thrombosis thogether with the tonsillitis lead to the diagnosis of Lemierre`s syndrome. Patient was immediately set on leveteriacetam and intravenous heparin and intravenous antibiotics were started. The disease course was complicated by a levetiracetam induced thromobcytopenia, and intracranial bleeding with right sided hemiparesis. After a hospital stay of four weeks patient symptoms com-pletely resolved and MR examination showed a partial recanalization of the sinus. Conclusion: Sinus venous thrombosis is a rare but serious disease among many headache provoking conditions and difficult to diagnose. In case of penetrating infecetions sinusitis and mastoiditis are well known risk factors . In case of patients presenting with tonsillitis and headache, one should be aware of Lemierre`s syndrome to enable early diagnosis and prevent serious sequelae. Referring to our case, the clinical variability of Lemierre`s syndrome will be discussed and diagnostic key issue elucidated. 694 Acute stroke: clinical patterns and practice Clinical outcome following DWI/MRA-based intravenous rt-PA in acute ischemic stroke pa-tients M. Tokura1, T. Mori2, T. Iwata3, Y. Miyazaki4, M. Nakazaki5, Y. Takahashi6 Shonan Kamakura General Hospital Stroke Center, Department of Stroke Treatment, Ka-makura, JAPAN1, Shonan Kamakura General Hospital Stroke Center, Department of Stroke Treatment, Kamakura, JAPAN2, Shonan Kamakura General Hospital Stroke Center, Department of Stroke Treatment, Kamakura, JAPAN3, Shonan Kamakura General Hospital Stroke Center, Depart-ment of Stroke Treatment, Kamakura, JAPAN4, Shonan Kamakura General Hospital Stroke Center, Department of Stroke Treatment, Kamakura, JAPAN5, Shonan Kamakura General Hospital Stroke Center, Department of Stroke Treatment, Kamakura, JAPAN6 Purpose: The purpose of our retrospective study was to investigate whether or not our intravenous rt-PA protocol based on DWI/MRA can yield good clinical outcome in acute ischemic stroke pa-tients. Methods: Included were acute stroke patients who were admitted from 2006 to 2012, who under-went emergency DWI/MRA, and who underwent intravenous rt-PA treatment. When DWI showed extensive intensity area or MRA suggested complete occlusion of the internal carotid artery (ICA) or vertebro-basilar artery (VA-BA), patients were less likely to undergo intravenous rt-PA. NIHSS on admission (NIHSS-A) and on the 7th day (NHISS-7), dramatic recovery and in-hospital death were investigated in not only overall but also patients stratified by occlusion site of the middle cerebral artery (MCA). Dramatic recovery was defined as a ≥10-point reduction or a total NIHSS score of 0 to 1 at 24 hours and 7 days. Results: Consecutive seventy-one patients who underwent MR and intravenous rt-PA were included in analysis. Among them, 58 patients (81.7%) suffered from the MCA occlusion. Among the 58, 24 had proximal M1 occlusion, 16 had distal M1 occlusion and 18 had M2 occlusion. Among overall 71 patients, 8 patients suffered from the IC occlusion, 2 patients from the mid BA occlusion and oth-ers. Overall median NIHSS-A and NIHSS-7 were 15 and 8, respectively (p<0.01). Dramatic recov-ery was obtained in 24/71 (33.8%) patients. The median NIHSS-A and –7 was 13.5 and 8.5 in the MCA occlusion, 19.5 and 14 in the IC occlu-sion, and 14 and 4.5 in the mid BA occlusion. The median NIHSS-A and NIHSS-7 were 13.5 and 8.5, 16 and 9, and 12 and 7.5 in proximal M1, distal M1 and M2 occlusion, respectively. Five patients (7.0%) only died within 7 days. In 3 out of the 5 patients (4%: 3/71), fatal hemorrhagic infarctions had occurred. Conclusion: Our intravenous rt-PA protocol based on DWI/MRA seemed to yield good clinical re-sults and few complications.
Karger_ESC London_2013
To see the actual publication please follow the link above