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22. European Stroke Conference 822 Rehabilitation and reorganisation after stroke Holmes Tremor after Brainstem Hemorrhage, Treated with Levodopa: A Case Report S.H. Lim1, J.S. Kim2, B.Y. Hong3, J.H. Woo4 Department of Rehabilitation Medicine, Suwon St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Su-won-si, SOUTH KOREA1, Department of Rehabilitation Med-icine, Suwon St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Su-won-si, SOUTH KOREA2, Department of Rehabilitation Medicine, Suwon St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Su-won-si, SOUTH KOREA3, Department of Re-habilitation Medicine, Suwon St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Su-won-si, SOUTH KOREA4 Holmes tremor is a rare movement phenomenon,with atypical low-frequency tremor at rest and when changing postures,often related to brainstem pathology. We report a 70-year-old female patient who presented with dystonic head and upper limb tremor after a brainstem hemorrhage. The patient had experienced sudden onset left hemiparesis and right facial paralysis. Brain magnetic resonance imaging showed an acute hemorrhage, from the brachi-um pontis through the dorsal midbrain on the right side. Several months later, the patient developed resting tremor of the head and left arm, which was exacerbated by a sitting postureand intentional movement. The tremor showed a regular low frequency(1–2 Hz) for the bilateral sternocleidomas-toid and cervical paraspinal muscles at rest. The patient’s symptoms did not respond to propranolol or clonazepam, but gradually improved withlevodopa administration.Although various remedie-swere tried, overall,results were poor. We suggest that levodopa might be a useful remedy for Holmes tremor. The curative or relieving ef-fect of the dopaminergic agent in Holmes tremor needs more research. 780 © 2013 S. Karger AG, Basel Scientific Programme 823 Rehabilitation and reorganisation after stroke Venous thrombo-embolism prophylaxis following acute stroke on a rehabilitation unit: an au-dit cycle after introducing a 2-week checklist M. KRISHNAN1, M. TARRANT2, H. NAHAS3, J. PEARSON4, R. BOSNELL5 SOUTHMEAD HOSPITAL, NORTH BRISTOL NHS TRUST, BRISTOL, UNITED KING-DOM1, SOUTHMEAD HOSPITAL, NORTH BRISTOL NHS TRUST, BRISTOL, UNITED KINGDOM2, SOUTHMEAD HOSPITAL, NORTH BRISTOL NHS TRUST, BRISTOL, UNITED KINGDOM3, SOUTHMEAD HOSPITAL, NORTH BRISTOL NHS TRUST, BRISTOL, UNITED KINGDOM4, SOUTHMEAD HOSPITAL, NORTH BRISTOL NHS TRUST, BRISTOL, UNITED KINGDOM5 Background: Venous thrombo-embolism (VTE) is a well-recognised risk in immobile hospital inpa-tients. Pharmacological prophylaxis is contraindicated in acute stroke and ideally should be avoid-ed for 2 weeks. Our 28- bedded stroke rehabilitation ward had 4 VTE in the last 4 months, making us review our current practice. Methodology: A cross sectional case note audit of VTE prophylaxis undertaken. Results reviewed and a 2-week checklist introduced with stroke type, VTE risk review, anticoagulation in atrial fibrillation (AF) and patient discussion. Audit cycle completed 8 weeks af-ter the intervention. Results: Of our 21 ischaemic strokes, only 9 (41%) had VTE decision reviewed at 2 weeks. Of the 6 haemorrhagic strokes, none had their risks reviewed; two developed VTE and were anticoagulated without any complications. 9 ischaemic strokes were in AF, 6 started on rivar-oxaban, 3 on dabigatran; Only 5 (18.5%) of our non-AF patients were on pharmacological prophy-laxis and documentation of patient discussion was poor. Re-auditing in 8 weeks showed adherence to the checklist in 82% with documented VTE management plan at day 14 (range 13-15). 18% had a delayed assessment completed at 30 days (range 26 to 35 days). 12 out of 17 of ischaemic strokes were started on anticoagulation for AF (10 on rivaroxaban, 2 on dabigatran) and 4 non-AF com-menced on prophylactic heparin, all had clear documentation of patient discussion as set out in the new checklist. Conclusion: We recognised the need for change of practice and introduced a struc-tured method for VTE risk review. Now appropriate patients are given pharmacological prophylaxis at the right time and it acts as a reminder for anticoagulation in AF. This has also improved our doc-umentation of patient involvement in anticoagulation decisions especially in the light of newer oral anticoagulants.


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