London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 815 886 Intracerebral/subarachnoid haemorrhage and venous diseases MANAGEMENT, OUTCOME AND RISK FACTORS OF SPONTANEOUS INTRACERE-BRAL HEMORRHAGE (SICH) IN A SERIES OF 282 CONSECUTIVES CASES M.L. DELODOVICI1, L. PRINCIOTTA CARIDDI2, F. CARIMATI3, E.P. VERRENGIA4, A. SQUIZZATO5, F. DENTALI6, W. AGENO7 DPT OF NEUROLOGY AND STROKE, OSPEDALE DI CIRCOLO - UNIVERSITY OF IN-SUBRIA, VARESE, ITALY1, DPT OF NEUROLOGY AND STROKE, OSPEDALE DI CIRCO-LO - UNIVERSITY OF INSUBRIA, VARESE, ITALY2, DPT OF NEUROLOGY AND STROKE, OSPEDALE DI CIRCOLO - UNIVERSITY OF INSUBRIA, VARESE, ITALY3, DPT OF NEU-ROLOGY AND STROKE, OSPEDALE DI CIRCOLO - UNIVERSITY OF INSUBRIA, VARESE, ITALY4, DPT OF CLINICAL MEDICINE, OSPEDALE DI CIRCOLO - UNIVERSITY OF IN-SUBRIA, VARESE, ITALY5, DPT OF CLINICAL MEDICINE, OSPEDALE DI CIRCOLO - UNI-VERSITY OF INSUBRIA, VARESE, ITALY6, DPT OF CLINICAL MEDICINE, OSPEDALE DI CIRCOLO - UNIVERSITY OF INSUBRIA, VARESE, ITALY7 BACKGROUND Spontaneous Intracerebral Hemorrhage is a critical condition with almost stable mortality/disability rates. Large population studies confirm the primary role of hypertension, older age, ethnicity and other genetic and environmental risk factors (RFs) for this condition. We describe retrospective analysis aimed to better define SICH phenotype and potential risk factors for poor prognosis. METHODS In our series (n.282, M153/F129, mean-age 72yrs) type, location, volume of hematoma, the global vascular burden at neuroimaging scoring leukoaraiosis (LA), lacunar infarction and cortical atrophy (ARWMC-Visual rating), treatment and clinical/laboratory variables have been considered RESULTS SICH represents 13.5% of incident major stroke of our Hospital and shows a 3month mortality rate of 28% and severe disability at discharge in over 17%. At presentation 46% of cases were on OAT/antiplatelets treatment and 28% had previous history of CVD: 30%TIA - 70%stroke. LA was observed in 54% of cases, of severe degree in 26% (ARW-MCscore= 3). hypertension confirms as being the most important RF (70%), followed by overweight (58%) and smoking (20%). Volume of Haematoma was>60cm³ in 35% of cases. Low values of cho-lesterol were found in 60%, with HDL>40mg/dl in 88%. Larger volume of hematoma and high inflammatory markers at presentation were related to poor outcome (death-disability). Renal failure was a main RF in patients on secondary OAT/antiplatelets treatment. CONCLUSION Besides hypertension also an history of ischemic events (heart/brain) together with global subcorti-cal damage and ongoing treatment represented a relevant RF for SICH; the high percentage of neu-roradiological vascular lesions are consistent with the incidence of hypertension and its association with diabetes and heart disease (p<0.05). Focus on a wide range of RFs and an accurate “phenotyp-ic“ definition of SICH with delineation of conditions associated with bleeding risk can help a better prevention of the disease. 887 Intracerebral/subarachnoid haemorrhage and venous diseases Imminent Subarachnoid Hemorrhage in Basilar Dolichoectasia Heralded by Thrombosis and Ponto-Cerebellar Ischemia A.A. Sokolov1, S. Husain2, R. Sztajzel3, A. Croquelois4, J.A. Lobrinus5, D. Thaler6, C. Städler7, H. Hungerbühler8, V. Caso9, G. Rinkel10, P. Michel11 Département des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SWITZERLAND1, Department of Interventional Neurology, MAX Institute of Neu-rosciences, MAX Superspeciality Hospital, New Delhi, INDIA2, Département des Neurosciences Cliniques, Hôpitaux Universitaires de Genève (HUG), Geneva, SWITZERLAND3, Département des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SWIT-ZERLAND4, Service de Pathologie Clinique, Hôpitaux Universitaires de Genève (HUG), Geneva, SWITZERLAND5, The Comprehensive Stroke Center, Tufts Medical Center, Boston, USA6, Neuro-centro della Svizzera Italiana, Ospedale Regionale de Lugano, Lugano, SWITZERLAND7, Neurolo-gische Klinik, Kantonsspital Aarau, Aarau, SWITZERLAND8, Stroke Unit and Division of Internal and Cardiovascular Medicine, Ospedale Santa Maria della Misericordia, Perugia, ITALY9,Depart-ment of Neurology, University Medical Center Utrecht, Utrecht, THE NETHERLANDS10, Dépar-tement des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SWITZERLAND11 BACKGROUND Vertebrobasilar dolichoectasia (VBD) is a chronic progressive disease that may be life-threatening through local compressive symptoms, basilar thrombosis and perforator ischemia. Subarachnoid hemorrhage (SAH) is a rare complication of VBD, but its pathogenesis, precursor signs and clinical course are little known. METHODS In a retrospective multi-center study, 20 patients (seven females, median age 70 years, interquartile range (IQR) 18.3 years, range 47-93) with VBD and SAH were analyzed with regards to clinical symptoms, concomitant thrombosis within the VBD, associated ponto-cerebellar isch-emia, clinical outcome and effects of treatment on survival. RESULTS 70% of all patients presented new or acutely deteriorating posterior fossa clinical signs at a median of 3 days (IQR 5 days, range 0.5-12) prior to SAH. 78.6 % of patients with clinical deteri-oration had a thrombus within the VBD, and 71.4 % suffered ponto-cerebellar ischemia. Thrombosis occurred irrespective of antithrombotic therapy before symptom onset. 65 % of VBD patients died, at a median of 24 hours (IQR 30, range 5-264) after SAH. All of the six patients undergoing com-plex endovascular treatment survived, only one patient without endovascular intervention survived. CONCLUSION SAH in patients with VBD is often preceded by acute posterior fossa symptoms, which is frequently related to endoluminal clot formation and ischemia. Timely recognition of this association appears vital, as instantaneous endovascular treatment seems to prevent an otherwise rapidly fatal outcome.
Karger_ESC London_2013
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