22. European Stroke Conference 730 Acute cerebrovascular events (ACE): TIA and minor strokes Case report: intracerebral haematoma secondary to probable cerebral amyloid angiopathy presenting with transient neurological symptoms N.J. Ahmad1, M. Srinivasan2, R.R. Campbell3 Princess Royal Hospital, Telford, UNITED KINGDOM1, Princess Royal Hospital, Telford, UNITED KINGDOM2, Princess Royal Hospital, Telford, UNITED KINGDOM3 Background: Cerebral amyloid angiopathy (CAA) is a recognised cause of intracerebral haemor-rhage. Transient neurological symptoms related to haemorrhage are a known mode of presentation which is under appreciated. Without imaging, the clinician may be mislead into a clinical diagnosis of a transient ischaemic attack (TIA) resulting in adverse therapeutic decision making. Stroke guide-lines in England do not recommend routine brain imaging in TIA. The case presented here demon-strates where brain imaging had significant treatment implications for a patient originally diagnosed clinically as a TIA. Methods (Case): A 73 year old man with a past history of mild chronic obstructive airways disease and melanoma of the left cheek excised curatively in October 2011 was seen in the TIA clinic at Princess Royal Hospital Telford in November 2012. There was no significant history of hyperten-sion. He had three episodes of transient left facial and left hand paraesthesia lasting a few minutes only. Neurological examination was normal. There were no signs of cognitive impairment. He was in sinus rhythm. Carotid ultrasound was normal. Antiplatelets were commenced for a suspected TIA. An MRI brain scan was requested in view of his recurrent neurological episodes and history of ma-lignancy. 730 © 2013 S. Karger AG, Basel Scientific Programme Results (Outcomes): MRI brain demonstrated a resolving 1.8cm right parietal haematoma. Gradient recalled echo images showed multiple old large vessel, small vessel and subarachnoid haemorrhag-es. A diagnosis of probable CAA according to the Boston criteria was made, antiplatelets stopped and counselling given. Conclusion: Intracerebral haemorrhage particularly in association with CAA is a potential TIA mim-ic. Clinicians need to have a greater awareness of this and a lower threshold for appropriate imaging which is instrumental in diagnosis. 731 Acute cerebrovascular events (ACE): TIA and minor strokes Decreasing variation in diagnosis of transient ischemic attack and ischemic stroke between hospitals D. Bhupali1, DL Labovitz, MD2 Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, USA1, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, USA2 Background: The short duration of symptoms and multitude of non-vascular mimics make diagnosis of transient ischemic attack (TIA) subjective and challenging. Pathophysiology is the same for TIA and ischemic stroke (IS); therefore, the TIA-IS ratio, defined as the ratio of TIA to IS cases, should be the same across demographic and clinical strata and theoretically should not vary between hospi-tals. Our objective was to assess whether re-evaluation of the diagnosis of TIA and IS through appli-cation of formal diagnostic criteria reduces differences between hospitals in the TIA-IS ratio. Methods: Cases were identified using primary ICD9 discharge codes at three US (Bronx, NY) hos-pitals, including a community hospital without neurology residents, from January 2009-June 2011. Each TIA diagnosis was confirmed by chart review, excluding the diagnosis of TIA in cases with acute IS on brain imaging, duration >24 hours or a non-vascular syndrome by NINDS criteria. IS diagnosis required an acute infarct on imaging or an explicit statement that the diagnosis was IS de-spite negative imaging. Chi-square was used for univariate statistical comparison. Results: There were 798 TIA and 2125 IS cases by primary ICD9 code, for an overall TIA-IS ratio of 27.3%. The ratio was highest for the hospital lacking neurology residents (39.2%) versus the two hospitals with neurology residents (26% and 25.2%, p<0.0001). Confirmation of diagnosis by chart review dropped the number of TIA cases by 45%, IS cases by 10%, and decreased the overall TIA-IS ratio to 18.7%. Differences in the ratio between hospitals became non-significant: 19.6% at the hospital lacking neurology residents and 17.4% and 20.4% at the hospitals with neurology residents, p=0.33. Conclusion: The TIA-IS ratio differs between hospitals; however, retrospective application of sim-ple clinical criteria reduces the differences. Applying commonly accepted criteria can harmonize the way US hospitals diagnose and bill for IS and TIA.
Karger_ESC London_2013
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