European Journal of Neurology 2007, 14 (Suppl. 1), 165–301 Poster Session 2, Monday 27 August Cerebrovascular diseases 2 atherothrombotic. The clinical affectation in scale NIH is worse in those of atherothrombotic etiology (p<0.05). Visual alterations P2001 were most frequent (82%), followed by motor (56%). In the vas- cular study, 22% of them show significant carotid stenosis and MATRIX METALLOPROTEINASE-2-1575 G/A 17% the fatal variant of ACP; these findings were associated with POLYMORPHISM AS A RISK FACTOR FOR severe clinical affectation (p<0.005). With regard to the prognosis, ANEURYSMAL SUBARACHNOID HEMORRHAGE the mortality was 3% and recurrence 5%. 1 1 1 1 A. Borratynska , A. Slowik , T. Dziedzic , J. Pera , Discussion: The descriptive analysis highlights the presence in 1 1 2 A. Klimkowicz-Mrowiec , D. Wloch , R. Czepko , half of cases of hemiparesis, hemihypoesthesia and hemianopsia, 1 A. Szczudlik characteristic of the affectation of the middle cerebral artery. In our 1 2 Neurology Department, Neurosurgery Department, Jagiellonian series 17% of PCA strokes showed the persistence of fetal circul- University, Krakow, Poland ation (P1 agenesia), and the great majority associated important haemodynamic affectation of the carotid that irrigated it, in re- Background and aim: Data suggest that extracellular matrix lation to severe carotid stenosis. remodelling plays a role in the pathogenesis of aneurysmal sub- Conclusions: The etiology of the PCA strokes in the majority of arachnoid haemorrhage (SAH) in humans. The aim of the study cases is indeterminate. The presence of anatomic variant of PCA was to assess the significance of matrix metalloproteinase-2 and its association with severe carotid stenosis is related, with (MMP-2) –1575 G/A polymorphism as risk factor for aneurysmal worse clinical affectation and prognosis. SAH. Material and methods: 239 patients with aneurysmal SAH (mean age: 50.0±12.6 years), and 241 healthy controls matched for age P2003 and sex, were genotyped for the MMP-2 G/A polymorphism. Aneurysmal SAH was diagnosed by cranial computed tomography, CLINICAL SIGNIFICANCE OF MICROEMBOLISM IN and/or lumbar puncture and digital subtraction angiography. Data ACUTE ISCHEMIC STROKE concerning demographics and possible risk factors for SAH were J. Lee, Y.K. Cho, S.J. Lee, H.J. Park, M.Y. Park, collected. MMP-2 genotypes were determined by PCR and RFLP J.S. Haa methods. Department of Neurology, Yeungnam University School of Medicine, Results: The MMP-2 genotype distribution in patients with aneu- Daegu, South Korea rysmal SAH (AA-3.0%, AG-39.3%, GG-57.7%) differed signifi- Background: Microembolic signals (MES) detected by transcrani- cantly from the controls (AA-7.9%, AG-39.0%, GG-53.1%) al Doppler (TCD) have been considered as an independent predic- (p<0.001). A logistic regression model showed that the AA geno- tor of recurrent ischemic stroke. However, the association between type (OR=0.69, 95%CI: 0.49–0.98), cigarette smoking, excessive the presence of MES and the risk of stroke has predominantly been alcohol consumption, and hypertension independently affected the risk for aneurysmal SAH. studied on a small and selected group of patients. To evaluate Conclusion: The study shows for the first time that AA genotype the clinical significance of MES in patients with acute ischemic of MMP-2 –1575 C/T polymorphism is associated with the redu- stroke, we investigated the prevalence of MES and analyzed the ced risk of aneurysmal SAH in a Polish population. relationship between MES and stroke subtype. Methods: We inten- ded to perform TCD monitoring to detect MES from the bilateral middle cerebral arteries in patients within 15 days of stroke onset. P2002 The strokes were subtyped using the TOAST classification criteria. Results: TCD study was performed on 590 consecutive ischemic STROKES AND FETAL VARIANTS IN stroke patients who were admitted to our stroke unit within 7 days VERTEBROBASILAR TERRITORY of stroke onset and 65 were excluded because there was a long P. Cardona1,L.Bau1,M.Cos2,A.Escrig1, F. Rubio1 interval between onset of symptoms and examination, an artificial 1Department of Neurology, Bellvitge Hospital, Barcelona, Spain, heart valve, and inadequate temporal bone window. MES were 2Department of Neuroradiology, IDI detected in 23 (4.2%) despite the fact that all patients were receiv- The incidence of clinic and etiology in strokes of posterior cerebral ing an antiplatelet or anticoagulant treatment. MES were detected artery (PCA) show a great heterogeneity. The contribution of the in 3.1% of patients with large-artery atherosclerosis stroke, 4.1% carotid territory to its affectation is unknown. of cardioembolic stroke, 2.1% of lacunar stroke, 9.1% of crypto- Patients and methods: We carry out a retrospective study of the genic stroke, and 4.1% of undetermined stroke (p=0.241). In 6 of patients with stroke in territory of PCA, who entered our centre the 8 patients (75%) with the anterior circulation infarct, MES between 2001–2005. We made a clinical analysis of risk factors, were observed ipsilateral to the affected territories. ultrasonography study, determination of vascular territory affected Discussion: During antithrombotic treatment, the prevalence of by magnetic resonance and prognosis. MES is low and MES detection dose not improve ischemic stroke Results: They represent 9% of the strokes (113 patients). The eti- subtype classification. The MES are frequent in the territories of ology was in 40% indeterminate, 33% cardioembolic and 27% symptomatic arteries in the anterior circulation stroke. © 2007 EFNS 165 166 Posters, Monday 27 August P2004 CADASIL and the involvement of stress-oxidative induced apopt- THE EFFECTS OF A RECOMBINANT HUMAN osis in lymphocytes and fibroblasts from 15 Italian CADASIL COAGULATION FACTOR VII, NOVOSEVEN 50 UG/KG patients IN PATIENTS WITH INTRACEREBRAL HEMORRHAGE: Methods: Apoptosis was evaluated by in situ end labelling assays A CASE SERIES for DNA fragmentation (TUNEL) in the brain from a CADASIL A. Ehtisham1,2, S. Taylor3, M.W. Klein4 patient. Peripheral blood lymphocytes (PBLs) and fibroblasts 1Neurocritical Care Unit, Via Christi Regional Medical Centre, obtained from 15 patients were exposed to 2-deoxy-D-ribose (dRib) 2Departments of Neurology and Neurosciences, University of Kansas and apoptosis was analysed by flow cytometry, agarose gel electro- School of Medicine at Wichita, 3Department of Pharmacy, phoresis, and fluorescence microscopy for caspase-3 activation 4Department of Research, Via Christi Regional Medical Centre, (FLICA), phosphatydilserine exposure (Annexin V) and mito- Wichita, KS, USA chondrial membrane depolarization (JC-1). Results: The number of apoptotic cells was increased in brain tissue, Introduction: Intracerebral haemorrhage is associated with high both in the cortex and particularly in the white matter. The response incidence of morbidity and mortality, and resultant cerebral to dRib-induced apoptosis was significantly more elevated in PBLs oedema is of particular concern. An ideal treatment would halt and fibroblasts from CADASIL patients than in control cells. haematoma expansion without thromboembolic events. Early Conclusion: Our results show a very remarkable involvement studies in intracerebral haemorrhage have shown promise in of the white matter according to the NMR findings of CADASIL. NovoSeven, a recombinant factorVII. However, the ideal dose and Moreover, the increased response to dRib induced apoptosis timeframe of NovoSeven is unidentified. We report our results in PBLs and fibroblasts of CADASIL patients suggests that with NovoSeven in the management of 10 patients with intracere- NOTCH3 mutations are an important apoptotic trigger, not limited bral haemorrhage. to the brain but involved also in other tissues. Methods: Patients with low risk for thromboembolic events were eligible for NovoSeven therapy. A NovoSeven dosing of 50 ug/kg P2007 was used at various timeframes post symptom-onset. Results: 8 of 10 patients (80%) survived their hospital stay. Aver- LOCALIZATION OF PURE SENSORY STROKE age length of hospital stay was 8.3 days (S.D. +4.3 days). 4 of C.K. Ha, K.H. Ji, S.R. Kim, J.H. Rha 10 patients (40.0%) received NovoSeven less than 4 hours after Department of Neurology, Inha University Hospital, Inchon, symptom onset, 3 patients (30.0%) between 4 and 8 hours after South Korea symptom onset, and the remaining 3 patients (30.0%) over 8 hours Background and aims: Anatomical substrate of pure sensory after symptom onset. Average baseline haemorrhage volume was stroke (PSS) is widely known as thalamic lesion. However non- 26.92 cm3 (S.D. +18.57 cm3) and 26.80 cm3 (S.D. +17.02 cm3) thalamic, especially pontine lesion, also may produce PSS. We post-NovoSeven. Average percent change in haemorrhage volume evaluate the frequency of PSS caused by extrathalamic lesion. was an increase of 6.3% (S.D. +33.1%). Treatment failure (≥30% Methods: We studied 2142 consecutive patients with acute is- increase in haemorrhage volume) occurred in 2 of 10 patients chemic stroke, hospitalized within seven days after onset, from (20.0%). No thromboembolic events occurred in any patients. Inha Stroke Registry between January 2002 and September 2006. Conclusions: These results suggest NovoSeven at 50 ug/kg may be Brain MRI was performed in all cases. As PSS was determined by safe and effective for haemostasis at various timeframes in selected presenting symptoms and signs, evolving cases from sensory patients with intracerebral haemorrhage.