WCN19 Journal Posters Part 1 V1

JNS-0000116541; No. of Pages 170 ARTICLE IN PRESS

Journal of the Neurological Sciences (2019) xxx–xxx

Contents lists available at ScienceDirect

Journal of the Neurological Sciences

journal homepage: www.elsevier.com/locate/jns

WCN19 Journal Posters Part 1_V1

WCN19-0018 doi:10.1016/j.jns.2019.10.412

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - WCN19-1690 Part I/stroke/training in neurology - Part I and traumatic brain injury Poster shift 01 - Channelopathies/neuroethics/neurooncology/ The paradoxical protective effect of hepatic steatosis on severity pain - Part I/sleep disorders - Part I/stem cells and gene therapy - and functional outcome in patients with ﬁrst-ever ischaemic Part I/stroke/training in neurology - Part I and traumatic brain stroke or transient ischaemic attack injury

M. Baika, S.U. Kimb, H.S. Nama, J.H. Heoa, Y.D. Kima Cerebral distribution of cerebral emboli in patients with patent aYonsei University College of Medicine, Department of Neurology, Seoul, foramen ovale using 99MTC-MAA brain SPECT Republic of Korea b Yonsei University College of Medicine, Department of Internal medi- R. Nematiac, M. Jalalibd, M. Assadibd cine- Yonsei Liver Centre, Seoul, Republic of Korea a2Nuclear Medicine Research Center, Department of Molecular Imaging and Radionuclide Therapy MIRT- Bushehr Medical University Hospital- Background Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran There is very limited information on the relationship between non- bNuclear Medicine Research Center, Department of Molecular Imaging alcoholic fatty liver disease (NAFLD) and the severity or functional and Radionuclide Therapy MIRT- Bushehr Medical University Hospital- outcomes of ischaemic stroke or transient ischaemic stroke (TIA). We Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran investigated the correlation between NAFLD and stroke outcomes. cDepartment of Neurology- Bushehr Medical University Hospital, Faculty of Medicine, Bushehr University of Medical Sciences- Bushehr - Iran, Bushehr, Iran Methods dDepartment of Neurology- Bushehr Medical University Hospital, Faculty of NAFLD was assessed in 321 patients with ﬁrst-ever acute Medicine, Bushehr University of Medical Sciences- Bushehr - Iran, Bushehr, ischaemic stroke or TIA, who underwent transient elastography from Iran January 2014 to December 2014. The association of liver steatosis with stroke severity, assessed using the National Institute of Health Background Stroke Scale (NIHSS), was investigated using robust regression One of the etiologies of stroke, especially in younger patients, is analysis. We also compared the functional outcome at 90 days patent foramen ovale (PFO). The aim of this study is distribution of according to the presence or burden of liver steatosis. brain emboli in patients with PFO.

Results Methods NAFLD was observed in 206 (64.2%) patients. Patients with We injected 99mTc-macroaggragated albumin (MAA) in 51 NAFLD had less severe stroke (median NIHSS score 2 vs. 3, P = patients, while accomplishing valsalva maneuver, then they under- 0.012) and more favourable functional outcome at 90 days (85.3 vs. went brain scintigraphy. 70.5, P = 0.004). Patients with NAFLD were likely to have a 23.3% lower (95% conﬁdence interval [CI], -39.2% to -3.2%, P = 0.026) Results NIHSS score and a 2.5-fold higher (95% CI, 1.08–5.67, P = The most intensity of MAA uptake was respectively in cerebellar, 0.033) possibility of favourable functional outcome in multivariate occipital, frontal and temporoparietal regions. analysis. Discussion Conclusions The study demonstrated that posterior circulation is dominant Our study shows that a higher burden of hepatic steatosis seems region of brain involve by cardiac emboli in subjects with PFO. to be associated with less severe stroke and better functional outcome after ischaemic stroke or TIA. doi:10.1016/j.jns.2019.10.413

0022-510X/$ – see front matter ARTICLE IN PRESS

2 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0057 Background Twenty until sixty percent of stroke patients experience sleep disorders, with different EEG patterns depending on stroke location. Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain Non-treated sleep disorders can aggravate brain damage. - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ stroke/training in neurology - Part I and traumatic brain injury Objective This study was conducted to investigate the correlation of Dyslipidemia in patients hospitalized for stroke at the Clinic of location of lesion and sleep disorders, and its impact on clinical Neuroscience Ibrahima Pierre Ndiaye, Fann National Teaching outcome in ischemic stroke. Hospital in Dakar – Senegal Methods M.L. Mansarea, T. Kamadoreb, F. Maoulyb, D. Amadou Gallob Sixtifive acute ischemic stroke patients were classified based on aDonka National Teaching Hospital, Neurology, Conakry, Guinea the location of stroke lesion and assessed for sleep disturbances by a bNeurosciences Clinic Ibrahima Pierre Ndiaye of Fann Hospital in Dakar, questionnaire. Clinical outcome was assessed by measuring NIHSS Neurology, Dakar, Senegal scores on the first day and the 10th day of treatment.

Introduction Results The objective of our study was to study the lipid profile of The number of patients with supratentorial lesion was 57 patients patients hospitalized for stroke (Ischemic or Hemorrhagic) by (87%) and infratentorial lesion was 8 patients (12,3%). The number of identifying among them, those who presented dyslipidemias. patients with sleep disorders was 55 patients (84,6%) and without sleep disorders was 10 patients (15,4%). There was no association between Materials and method location of the lesion and sleep disturbance (p=0,598). The mean NIHSS We conducted a study on the lipidogram results of 609 patients delta among the group with sleep disorders was 0.73 ± 2.670 and hospitalized for stroke. All the variables were included in the model a among normal group was -1.10 ± 2.025. There is a correlation between priori without any selection, with, first, the lipid variables, then sleep disorders and poor clinical outcome (p=0,044). secondarily the age, the sex. Conclusion Results This study supports the influence of sleep disturbances on the The stroke rate was 72% for the ischemic form and 28% for the deterioration of clinical outcome of stroke. hemorrhagic form. It had increased with age regardless of the ischemic or hemorrhagic type. The extreme ages were 17 and 95 years old with doi:10.1016/j.jns.2019.10.415 an average of 62.8 years. Men accounted for 53% of cases and women 47% of cases. The averages and standard deviations of the lipid fractions analyzed were respectively: TC (1.89, 0.55); HDL (0.49, 0.24); LDL (1.24, 0.50) and TG (0.90, 0.41). After controlling for confounders WCN19-0076 by bivariate analysis, the result for pure dyslipidemia showed that HDL was significantly associated with stroke in the foreground [OR 1.77; 95% CI 1.15-2.72; p = 0.002] followed by LDL [OR 2.00; 95% CI 1.04- Poster shift 01 - Channelopathies/neuroethics/neurooncology/ 4.87; p = 0.03]. No significant association could be found between TG, pain - Part I/sleep disorders - Part I/stem cells and gene therapy - TC and stroke. The overall mortality rate was 25% (154 cases). Part I/stroke/training in neurology - Part I and traumatic brain injury Conclusion In this study, the occurrence of fatal stroke was associated with Clinical features of low back pain in an outpatient clinic significant lowering of HDL cholesterol. From our point of view, it is fi important to study this type of lipid pro le well. K. Karbozova Kyrgyz State Medical Academy, Neurology and Clinical Genetics, Keywords: Dyslipidemia, Stroke, Senegal Bishkek, Kyrgyzstan doi:10.1016/j.jns.2019.10.414 Objective To determine the clinical features of low back pain and the conditions associated with this symptom in family medicine center WCN19-0075 in Bishkek, Kyrgyzstan.

Methods Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain The study was included medical reports of patients with LBP at - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ the age of 18-75 years attending in family medicine center №7in stroke/training in neurology - Part I and traumatic brain injury Bishkek from 2017 to 2018.The examination included a consultation of a neurologist, magnetic resonance imaging (MRI) of the spine, and Correlation of the location of stroke lesion and sleep disorders and blood tests. its effects on clinical outcome in acute ischemic stroke patients Results Z. Aﬁf, E. Arisetijono, S.F. Iswari During the study period 184 (85 men and 99 women) had LBP. ﬁ Universitas Brawijaya/Saiful Anwar General Hospital, Neurology, Ma- Among these patients 11 (5,98%) of them had a speci c cause of back lang, Indonesia pain: 3 - a traumatic spinal injury, 3 - a tumor lesion of the spine, 3 - ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 3 rheumatoid polyarthritis and tuberculosis were present in 2 patients. WCN19-0082 The remaining 173 (94,02%) patients had a nonspecific cause of back pain associated with degenerative spinal disease and included low back pain -94 (54,33%) , low back pain with nerve root pain Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain suggestive of disk herniation 73 (42,2%), and low back pain with - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ nerve root pain and lumbar spinal stenosis -6 (3,47%). When stroke/training in neurology - Part I and traumatic brain injury clarifying the anamnesis, it was revealed that the main initiating factor was inadequate physical activity and emotional stress. Differences in attitudes to ethic aspects of end of life care among patients with progressive neurological diseases and their family Summary members The obtained data once again emphasize the importance of careful collection of anamnesis and a physical examination to R. Bužgováa, R. Kozákováa, M. Barb,M.Škutováab, P. Ressnerb,P. identify “red flags” to excluding specific back pain. In connection Bártováb with the growing role of outpatient care in our country, there is a aUniversity of Ostrava, Department of Nursing and Midwifery, Ostrava, need to develop common approaches to correct evaluation of pain Czech Republic syndrome, determination the scope of the examination and choice bThe University Hospital Ostrava, Neurologic Clinic, Ostrava, Czech Republic the effective treatment tactics. doi:10.1016/j.jns.2019.10.416 The aim of the research was to determine differences in attitudes to ethics aspects of end of life care among patients with progressive neurological diseases (PND) and their family member. The attitudes were assessed with APND-EoLC questionnaire (The Attitudes of Patients with WCN19-0078 PND to End-of- Life Care). This cross-sectional study comprised 188 participants, patients with PND (multiple sclerosis, Parkinson disease, Huntington disease) from the Czech Republic and their family member. Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain There were significant differences (paired Wilcoxon test) in the domains - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ “control over end of life” (p=0.0002; patient’s score: mean=73.6; stroke/training in neurology - Part I and traumatic brain injury SD=15.0; families’ score: mean=67.1; SD=16.4) and “keeping patients alive” (p=0.0001; patient’s score: mean=61.9; SD=16.2; families’ Clinical features of elderly intracerebral hemorrhagic patients score: mean=68.5; SD=15.4). Patients more often agreed with statements focusing on attitudes related to the possibility of influencing H. Hoshinoa, T. Makotoa, F. Shodob, G. Saiseikai Stroke Investigatorsa their end of life (“Having medicine available to end one’slife.”, “Having pain aTokyo Saiseikai Central Hospital, Neurology, Tokyo, Japan killers under control.”). However, family members more often agreed with bSaiseikai Misumi Hospital, Neurosurgery, Misumi, Japan the attitudes related to keeping a patient’s(“When losing the ability to eat, to start tube/enteral feeding.”, “To have pain relief treatment at the cost of ” “ ” Background sedation/confusion. , When losing the ability to breathe, to introduce APV. , “ ” Recently the proportion of elderly stroke patients has been To be kept alive at any cost. ). Family members would more likely increasing explosively. So it is meaningful to clarify the clinical delegate decisions about life-saving treatment and hope for life- features of old (≥75 years-old) intracerebral hemorrhagic patients. prolonging treatment to doctors, unlike patients (p=0.0004). They preferred a chance of an early expressed wish or a decision of a family Method member who would be chosen in advance. Identifying opinions on Twenty-five Saiseikai hospitals in Japan prospectively registered ethical issues to end-of-life care can help physicians, patients, and family acute stroke patients within 7 days of onset in the Saiseikai Stroke members to develop individual care plans. Database from April 2014 to September 2018. The clinical back- doi:10.1016/j.jns.2019.10.418 grounds and outcomes of 1557 old intracerebral hemorrhagic patients were compared with those of 758 preold (65 to b75 years old) intracerebral hemorrhagic patients.

Results WCN19-0096 In the old group, the comorbidities of hypertension (77.9 vs 82.6%)， dyslipidemia (21.5 vs 26.0%), diabetes mellitus (16.8 vs 28.4%) and Poster shift 01 - Channelopathies/neuroethics/neurooncology/ chronic kidney disease (8.4 vs 11.9%) were significantly lower. Female pain - Part I/sleep disorders - Part I/stem cells and gene therapy - gender (59.3 vs 34.0%), current smoking (9.0 vs 2.9%), atrial fibrillation (15.1 vs 11.1%), congestive heart failure (8.1 vs 4.4%) and antithrom- Part I/stroke/training in neurology - Part I and traumatic brain botic prescription before hemorrhage (34.1 vs 23.1%) were significantly injury more prevalent. The history of intracerebal hemorrhage (8.5 vs 9.0%) did not differ between the groups. The proportion with the subcortical Impact of previous hemorrhagic stroke on short and long term hemorrhage (30.9 vs 23.9%) and the rate of mortality during admission outcomes in patients with STEMI (18.3 vs 11.9%) were significantly higher. S. Chimed Conclusion Second General Hospital, Emergency Department, Ulaanbaatar, Old intracerebral hemorrhagic patients had a higher prevalence of Mongolia subcortical hemorrhage with less atherosclerotic risk factors and higher mortality compared with preold patients. Background doi:10.1016/j.jns.2019.10.417 Hemorrhagic stroke is major cause of long term disability and associated with increased rate of mortality and morbidity. In this ARTICLE IN PRESS

4 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx study, we aimed to reveal association between previous hemorrhagic aNara Medical University, Department of Neurology, Kashihara, Japan stroke and patient’s outcome after STEMI. bNara Medical University, Department of Biochemistry, Kashihara, Japan cNara City Hospital, Department of Neurology, Nara, Japan Methods We prospectively selected patients who had STEMI. Cardiogenic Sleep apnea syndrome causes intermittent hypoxia (IH) during shock (CS) and all cause mortality were chosen for study endpoints. sleep. We previously demonstrated the IH-induced up-regulation of Cox proportional hazard regression and Kaplan-Meier curve estima- the mRNA levels of anorexigenic peptides POMC and CART via GATA tions were used to reveal association between previous hemorrhagic transcription factors in human neuronal cells. Appetite is regulated stroke and study endpoints. also by the peptides from gastrointestinal tract. Here, we investigated the effects of IH on the gene expression (s) of appetite- Results inhibiting gut hormones. Human enteroendocrine Caco-2 and mouse

A total of 542 patients were selected (mean age 60±14, 84% STC-1 cells were exposed to IH [64 cycles of 5 min hypoxia (1% O2) male). The 27 of patients were had previous experience of and 10 min normoxia (21% O2)] or normoxia for 24 hours. Real-time hemorrhagic stroke. Hemodynamic parameters at the admission RT-PCR revealed that IH significantly increased the mRNA levels of and LV functional parameters were comparable between patients peptide YY (PYY), glucagon-like peptide-1 (GLP-1), and neurotensin with and without hemorrhagic stroke. Frequency of CS (n=51, 9.4%) (NTS) in Caco-2 and STC-1 cells. ELISA showed that the concentra- was significantly higher in previous hemorrhagic stroke group (28% tions of PYY, GLP-1, and NTS in the culture medium were vs. 8.7%, pb0.001) and it was independent predictor of CS after significantly increased by IH. Luciferase reporter assays for PYY, adjustment HTN, DM, CKD, previous CAD, previous MI and previous glucagon (GCG), and NTS revealed that the promoter activities of PYY, CHF (OR=3.39, 95% CI 1.29-8.89, pb0.05). During follow-up, 58 GCG and NTS were not increased by IH. We then found that PYY, GLP- patients died and median follow-up was 27 months (IQR 13; 42). 1 and NTS mRNAs have potential target sequences for miR-96, -527, Previous hemorrhagic stroke was independently associated with all- and -2116, and revealed that the levels of the miRNAs were not cause mortality after adjustment of above mentioned previous decreased by IH. Furthermore, the mRNA levels of PYY, GLP-1, and diseases (HR=2.37, 95% CI 1.06-5.28, pb0.05). Also Kaplan-Meier NTS were significantly up-regulated even in normoxia by trichostatin curve estimation was revealed that survival rate was significantly A and were significantly decreased even in IH by 5-azacytidine, lower in patients who had previous hemorrhagic stroke (Fig. 1). suggesting that IH increases PYY, GLP-1, and NTS mRNAs via alterations in the chromatin structure in enteroendocrine cells. Conclusion IH might have an anorexigenic influence on the enteric nervous Previous hemorrhagic stroke is strong and independent predictor system. of short and long term outcome in patients with STEMI and associated with increased risk of death after STEMI. doi:10.1016/j.jns.2019.10.420

WCN19-0130

Development of theranostic targeting graphene quantum dots- antibody conjugates for effective treatment of glioblastoma

V. Patel, J. Shah Institute of Pharmacy-Nirma University, Department of Pharmaceutics, doi:10.1016/j.jns.2019.10.419 Ahmedabad, India

Aim Graphene Quantum Dots (GQDs) possess characteristic advan- WCN19-0121 tages like tunable ﬂuorescence, nano sizes, prominent, excellent and low enabling them as an ideal applicant for ﬂuorescence bio- imaging. possess excellent properties for gene delivery, drug delivery Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain and anticancer activity. has as anticancer drug carrier and DNA - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ cleavage activity enhancer, which remarkable application in cancer stroke/training in neurology - Part I and traumatic brain injury treatment.

Peptide YY (PYY), glucagon-like peptide-1 (GLP-1), and neuro- Objectives tensin (NTS) are up-regulated by intermittent hypoxia in enter- 1) Carbonization synthesis of GQDs nano-crystal from various oendocrine cells carbohydrate sources using different active surface agents. 2) Development of conjugation of GQDs with bio-recognized antibodies ﬁ R. Shobatakeabc, H. Otab, A. Itaya-Hironakab, A. Yamauchib,M. for active targeting to brain tumor. 3) Investigate ef ciency of ﬁ Makinob, S. Sakuramoto-Tsuchidab, T. Uchiyamab, N. Takahashic,S. synthesized GQDs and surface modi ed GQDs-conjugate in the Uenoa, K. Sugiea, S. Takasawab treatment of Glioblastoma. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 5

Methodology Early recognition of stroke mimics can reduce diagnostic costs and GQDs were prepared by various reactions like hydrothermal, and minimize the potential side effects of intravenous thrombolysis. microwave assisted chemical reactions. activated reaction were used for and conjugation of GQDs with Proteins/Antibodies. doi:10.1016/j.jns.2019.10.422

Result & discussion Fluorescence spectroscopy indicates GQDs have size dependent fluorescence emission. TEM and AFM conformed the size of GQDs WCN19-0147 around 20nm. NMR, Raman Spectroscopy, Gel electrophoresis and TLC data revealed the stable conjugation of GQDs-Protein/Antibody. Cell viability of SK-N-SH and N2a cell lines proved the cellular Poster shift 01 - Channelopathies /neuroethics /neurooncology / uptake, lower and targeting affinity of the GQD-conjugates to brain pain - Part I /sleep disorders - Part I /stem cells and gene therapy - tumor. Part I /stroke /training in neurology - Part I and traumatic brain injury Future direction In found that successive conjugation of GQDs-Protein. Which Anatomy research of the bifrontal decompressive craniectomy supports the hypothesis of targeted future cancer therapeutics of with coronal incision Glioblastoma. J.J. Huangabc, C.G. Mabc, J.Z. Yina, Y.W. Baia, G.Q. Zhanga, J.P. Wanga, J.Z. doi:10.1016/j.jns.2019.10.421 Yuc, Z. Caib aGeneral Hospital of Datong Coal Mining Group, Department of Neurosurgery, Datong, China bShanxi University of Chinese Medicine, The Key Research Laboratory of WCN19-0137A profile of stroke mimics in a tertiary hospital in Benefiting Qi for Acting Blood Circulation Method to Treat Multiple Quezon City, Philippines Sclerosis of State Administration of Traditional Chinese Medicine- and Scientific and Technological Innovation Team of Integrated Chinese and Poster shift 01 - Channelopathies /neuroethics /neurooncology /pain Western M, Jinzhong, China - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / cShanxi Datong University, Institute of Brain Science, Shanxi Key stroke /training in neurology - Part I and traumatic brain injury Laboratory of Inflammatory Neurodegenerative Diseases, Datong, China

F. Ocampo, J. Navarro, J. Cuanang Objective St. Luke's Medical Center, Section of Adult Neurology, Institute for To study the anatomy of the bifrontal decompressive craniectomy Neurosciences, Quezon City, Philippines with coronal incision and provide anatomical basis for the Chinese people. Background and aims Stroke mimics are conditions that simulate the signs and Material and methods symptoms of a stroke. In patients presenting with sudden-onset We simulated the bifrontal decompressive craniectomy with neurologic deficits, laboratory tests and imaging are requested in coronal incision in ten corpses skull speciments. And we identified order to distinguish an actual stroke from a stroke mimic. Our aim is anatomical landmarks and measured the anatomic data of frontal to determine the proportion of stroke mimics in patients who were sinus, superior sagittal sinus and inferior sagittal sinus. examined by the hospital’s Brain Attack Team from January 2014 to December 2017 and to determine the most common etiology of Results stroke mimics. The median distance between the anterior and posterior win- dows was 130.80 (126.40 ~ 139) mm. The left and right distance of Methods the bone window 238.32 (225.98 ~ 246.82)mm. The median of This is a retrospective review of all patients who were assessed by horizontal distance from the midpoint of brow to the farthest point the Brain Attack Team from January 1, 2014 to December 31, 2017. of the left frontal sinus was 23.29 (9.52 ~ 50.72) mm, to the farthest The diagnosis of stroke mimic was based on negative neuroimaging point of the right frontal sinus was 20.34 (9.62 ~ 45.36)mm. The findings as well as laboratory test results that showed an alternate median of the frontal sinus height above the eyebrow arch is 13.91 diagnosis. The proportion and most common etiologies of stroke (6.90 ~ 20.60) mm. The median distance from the inferior sagittal mimics were determined. sinus to the genu of the corpus callosum at the mid point of the decompression window was 7.28 (6.02 ~ 8.72) mm. Results Among 1485 patients examined by our hospital's Brain Attack Conclusion Team from 2014 to 2017, 448 (30.17%) were determined to be stroke The bone window of the double frontal coronal craniotomy is mimics. The incidence of stroke mimics was higher in hospitalized not less than 13 cm × 23 cm. If you have to keep the frontal sinus, patients compared to those who were examined in the emergency the frontal bone should preserve the island from the midpoint of department. The most common etiologies were encephalopathy (n the eyebrows to the left and right sides of each 2.5 cm and to = 83, 18.52%), seizures (n = 77, 17.19%), headache (n = 31, 6.92%), upward 1.5 cm in the Bifrontal Decompressive Craniectomy with and hypertensive emergency (n = 31, 6.92%). Coronal Incision. The sagittal sinus should be ligated at 2 cm before the decompression window, the sickle of the brain should be cut Conclusion off. Due to the high incidence of stroke mimics and substantial cost of diagnostics, physicians should be cognizant of the symptoms of doi:10.1016/j.jns.2019.10.423 stroke mimics to be able to distinguish them from actual stroke. ARTICLE IN PRESS

6 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0149 WCN19-0150

Poster shift 01 - Channelopathies/neuroethics /neurooncology / Poster shift 01 - Channelopathies /neuroethics /neurooncology /pain pain - Part I/sleep disorders - Part I /stem cells and gene therapy - - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / Part I/stroke /training in neurology - Part I and traumatic brain stroke /training in neurology - Part I and traumatic brain injury injury Early motor-behavioral outcome of ischemic stroke with keto- Microanatomy relation of carotid artery bifurcation with lateral genic diet preconditioning: Interventional animal study branch of the superior laryngeal nerve S. Shaafia, M. Shaifi Bonabb a J.J. Huangabc, C.G. Mabc, J.Z. Yina, Y.W. Baia, Y. Wanga, J.Z. Yuc, Z. Caib,J. Neurology Tabriz University of Medical Science, Neurology, Tabriz, Iran b P. Wanga, G.Q. Zhanga Tabriz University of Medical Science, Neurology, Tabriz, Iran aGeneral Hospital of Datong Coal Mining Group, Department of Neurosurgery, Datong, China Background bShanxi University of Chinese Medicine, The Key Research Laboratory of Cerebral stroke, with ischemic stroke being its most common Benefiting Qi for Acting Blood Circulation Method to Treat Multiple type, is the leading cause of chronic disability. The ketogenic diet has Sclerosis of State Administration of Traditional Chinese Medicine- and been used for treating seizures for centuries and has been considered Scientific and Technological Innovation Team of Integrated Chinese and to be a treatment for other neurologic diseases in recent years. The Western M, Jinzhong, China goal of this study is to evaluate the effects of ketogenic diet cShanxi Datong University, Institute of Brain Science, Shanxi Key preconditioning on the early motor-behavior outcome of rats with Laboratory of Inflammatory Neurodegenerative Diseases, Datong, China induced cerebral ischemic stroke.

Objective Methods To discuss the microsurgical anatomy of the carotid bifurcation Twenty-four rats were surveyed in 3 groups of Main, Control, and and the external branch of the superior laryngeal nerve (EBSLN), and Sham. The Main group received a ketogenic diet plus medium chain to explore the operative techniques in carotid endarterectomy. triglyceride oil starting 3 days prior to stroke induction, while the other 2 groups took a normal diet. Subsequently, Endothelin-1 was Methods injected stereo tactically near the middle cerebral artery to induce an The carotid bifurcation of 10 cadaveric heads were studied by ischemic stroke in the Main and Control group. Normal saline was using microanatomy. We measured the distance. injected to the members of the Sham group with the same technique. The motor-behavior functions of the rats were compared between 3 Results groups using adjusting step, beam, and cylinder tests. The vertical distance from carotid bifurcation to larynx point and mandibular angle was 24.32 (18.8 ~ 35.78)mm and 13.55 (9.26 ~ Results 19.60 ) mm. The straight distance from carotid bifurcation to mastoid After stroke induction, rats on ketogenic diet were able to adjust tip was 68.59 (49.48 ~ 76.94)mm respectively. According to the their steps more efficiently, moved faster on the beam, and used vertical distance of the larynx point to the carotid bifurcation, the their hands more symmetrically in the transparent cylinder in height of the bifurcation of the carotid artery was consistent with the relation to the rats in the Control group. results of the Wain measurement (K = 0.90), the difference was statistically significant (P b 0.05). The distance between the point of Conclusion EBSLN to medial margin of the carotid artery to the carotid artery It seems that ketogenic diet preconditioning improves the early bifurcation, the upper thyroid artery bifurcation, the mandibular motor-behavioral outcome of ischemic stroke. angle and the mastoid process 17.81 (15.24 ~ 25.58)mm, 19.42 (17.08 ~ 29.12)mm, 20.51 (17.98 ~ 22.20)mm, 71.00 (69.00 ~ 74.50) doi:10.1016/j.jns.2019.10.425 mm in normal bifurcations. The high bifurcation specimens were 6.40 (2.44 ~ 9.20)mm, 8.84 (4.74 ~ 10.88)mm, 12.15 (10.64 ~ 13.54) mm, 60.90 (59.80 ~ 66.50)mm, respectively. WCN19-0154 Conclusion The position of the laryngeal prominence is fixed, which can be used as a marker for surgical incision. In patients with normal carotid Poster shift 01 - Channelopathies /neuroethics /neurooncology / bifurcation, 1.5 cm of the carotid artery bifurcation can be used as a pain - Part I /sleep disorders - Part I /stem cells and gene therapy - safety mark limit during the operation. For patients with high carotid Part I /stroke /training in neurology - Part I and traumatic brain artery, the EBSLN is almost parallel to or down the superior thyroid injury artery and there is no safety margin. Stroke in evan syndrome Key words: Carotid endarterectomy, Cervical bifurcation, External branch of superior laryngeal nerve, Laryngeal prominence A. Dyah Kusumawati, I. Setyopranoto, A. Gofir Gadjah Mada University, Neurology, Yogyakarta, Indonesia doi:10.1016/j.jns.2019.10.424 Evans syndrome is a rare autoimmune disorder with unknown etiology, characterized as a combination of either concurrent or ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 7 sequential from Autoimmune Hemolitic Anemias (AIHA) and Idio- 0.001). The relationship between poor neurologic outcome with that pathic Trombocytopenias Purpura (ITP). Stroke is a complication that of a ≥30cc hemorrhage (p value = 0.000) or a bleed of b30 cc (p often occurs in evans syndrome. We report a 25-year-old woman, value = 0.000) were both statistically significant. There is also a pregnant 5 weeks, complained disartria and facial drop. The patient significant relationship between poor outcomes among those with has been diagnosed with evans syndrome 5 years ago and has a history central fever with (p value = 0.000) or without (p value = 0.000) of deep vein thrombosis (DVT) 2 years ago. On examination of the intraventricular involvement. patient's condition, compos mentis, blood pressure 128 / 70mmHg, pulse 103x / minute. Neurological examination found parese of VII and Conclusion XII cranial nerve, Barthel index is 70 and NIHSS is 3. Laboratory results Central fever negatively impacts outcome in pontine and basal of blood hemoglobin 7.8 gm / dl, 1.780 mg / dl leukocytes, 64.6% ganglia hemorrhages within the 24, 48 and 72 hours upon admission. neutrophils, 22.5% lymphocytes, and 6.7% eosinophils. 47,000 platelets Central fever also leads to poor neurologic outcome regardless of / cu.mm. The peripheral blood morphology examination is pancyto- intraventricular involvement and volume of the hemorrhage. penia with an overview of anemia et causa suspected hemolytic processes. Rheumatoid and specific protein immunological examina- doi:10.1016/j.jns.2019.10.427 tion. ACA IgG N 200 (elevated N 10), ACA IgM 2.2 (elevetedN 7), β2- GP1 IgM 2 (elevatedN 8), β2-GP1 IgG N 100 (elevated N 8). ANA test 0.651. Head CT scan examination is the cerebral infarction in the frontal frontal lobe. An ultrasound examination of the dopler on the WCN19-0173 left leg showed results deep vein thrombosis. The patient was treated with anticoagulant and immunosuppressive. This case report privides an overview of the association between Evan syndrome and stroke Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - doi:10.1016/j.jns.2019.10.426 Part I /stroke /training in neurology - Part I and traumatic brain injury

Immunomodulatory effects of interleukin-4 in neurological WCN19-0165 disorders induced by K+ channel blocker

fia a b Poster shift 01 - Channelopathies /neuroethics /neurooncology / N. Ahras-Si , A. Ladjel-Mendil , M.F. Martin-Eauclaire , F. Laraba- Djebaria pain - Part I /sleep disorders - Part I /stem cells and gene therapy - aUSTHB, Faculty of Biological Sciences: Laboratory of Cellular and Part I /stroke /training in neurology - Part I and traumatic brain Molecular Biology- BP32 EL-Alia- Bab-Ezzouar- Algiers- Algeria, Cellular injury and Molecular Biology, Algiers, Algeria bAix Marseille Universite, 13344 Marseille Cedex 15- France, Faculté de Central fever in patients with spontaneous intracerebral hemor- Médecine Nord, Marseille, France rhage at a tertiary hospital in Baguio city: Prevalence and outcomes Ion channel dysfunction is considered to be an important mechanism involved in various neurological diseases such as H.G. Barrozo, D. Liquete epilepsy. To better understand the mechanism by which these Baguio General Hospital and Medical Center, Neurology, Baguio, disorders occurs, a blocker of K+ channels, the Kaliotoxin (KTx), a Philippines neurotoxin isolated from scorpion venom is used to develop an experimental model of seizures. The effect of the cytokine interleu- Background kin-4 (IL-4), was used to modulate microglia homeostasis on the Central fever was considered a poor prognostic factor in patients neurotoxicity induced by KTx. with intracerebral hemorrhage and is associated with increased Results showed that injected KTx (25 ng/25g, i.c.v) is able to mortality rates and poor outcomes. induce myoclonic seizure with neuronal loss and neuro-inflammatory process. The administration of IL-4 (100 ng/25 g, i.p.) enhanced Objective the GFAP expression. IL-4 also promoted an increase of the anti- To determine the effect of fever on the neurologic outcomes of inflammatory cytokine IL-10 in the cerebral cortex. This treatment patients with intracerebral hemorrhage. using IL-4 seems to reverse the observed oxidative damage induced

in KTx model characterized by a decrease of NO, H2O2 levels and lipid Methods peroxidation (MDA) accompanied by an increase of anti-oxidant This is an observational cross-sectional study using probability markers (catalase and GSH) in brain and an improvement of sampling. A sample size of 323 yielded a 95% CI with a 5% margin of mitochondria swelling. IL-4 seems to enhance the expression of error. Data were analyzed using descriptive statistics. The relation- anti-apoptotic protein Bcl-2 which would be responsible for the ship between the location and volume of the hemorrhage with the decrease in the number of neuronal cells death induced by KTx. outcome of patients who developed central fever was determined The developed model using KTx could help the understanding of using ANOVA. P-value was set at ≤0.01. the cellular and molecular pathway involved in the neuropatholog- ical processes of epilepsy related to K+ channel dysfunctions. Results Interleukin-4 seems to blunt the toxic effects of the KTx. Exogenous Twenty eight percent had infectious fever while the remaining interleukin-4 can be neuroprotective, it could represent one of key 72% had a central cause. 99 patients had severe strokes involving the aspects for developing novel therapeutic strategy. basal ganglia (39%) followed by the thalamus (23%). Using ANOVA, a statistically signiﬁcant relationship existed between hemorrhage doi:10.1016/j.jns.2019.10.428 involving the pons (p value = 0.001) and basal ganglia (p value = ARTICLE IN PRESS

8 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0200 bTashkent Medical Academy 1st clinic, Neurology, Tashkent, Uzbekistan cTashkent Medical Academy 1st Clinic, Neurology, Tashkent, Uzbekistan

Poster shift 01 - Channelopathies /neuroethics /neurooncology / The purpose of the study was to analyze the severity of pain - Part I /sleep disorders - Part I /stem cells and gene therapy - hemorrhagic and ischemic strokes and their connection with the Part I /stroke /training in neurology - Part I and traumatic brain activity of von Willebrand’s factor (WF) in the blood plasma. injury Materials and methods Presence of PFO in patients with migraine and stroke We compared the severity of the clinical picture and evaluated the activity of WF as a molecular marker of endothelial dysfunction M. Pradeepa, A. Saleemb, P. Shreelakshmib, E. Deepakb in patients with hemorrhagic and ischemic strokes. aKG Hospital & Post Graduate Medical Institute, Neurology, Coimbatore, India Results of the study bKG Hospital& Post Graduate Medical Institute, Neurology, Coimbatore, India 84 patients were examined – first group - 20 patients with subarochnoidal hemorrhage; second group - 22 patients with Aim parenchymal-subarochnoidal hemorrhage; third group - 23 patients To establish the presence of Patent foramen ovale (PFO) & Right with lacunar ischemic stroke; fourth group - 19 patients with to Left shunt in patients with migraine & stroke ischemic stroke by type of thrombosis. In all patients in 1st day from the onset of the disease was performed a CT scan of the brain and the Back ground activity of WF in the blood plasma. fi The presence of a right to left shunt & PFO in patients with Activity of WF in rst group was 141%, in second group 132%, in migraine can be detected using Transcranial Doppler (TCD) & micro third group 153%, in fourth group 172%, respectively. bubbles. Conclusions Patients & methods In patients with acute ischemic stroke (IS), in locomical IS, unlike fi 106 patients with a history of migraine & stroke were studied patients with thrombosis, there is a signi cantly more pronounced from 2012 February to December 2018.The patients were in the age endothelium dysfunction, expressed in increased activity of von ’ group 28 to 54 years. All patients were subjected to TCD bubble Willebrand s factor, with a tendency to hyper coagulation. The study with valsalva meneuvre. TCD bubble study was done after severity of hemorrhagic stroke was inversely related to the activity of fixing a head frame & monitoring the Middle cerebral artery (MCA). the WF, and particular, as lower the WF activity was, as more 9 ml of saline & 1 ml of air was mixed & agitated and injected into pronounced the cerebral disorders. the right ante cubital vein. The procedure was done before & after A high degree of correlation between WF and the severity of the valsalva maneuvre. The timing of arrival of micro bubbles on TCD disease in patients with IS and hemorrhagic stroke in the acute after injection was noted. The number of high intensity transient period, which can be seen as a prognostic marker of stroke. signals (HITS) were quantified. doi:10.1016/j.jns.2019.10.430 Results In our study 46% of patients who had PFO. 62% of the PFOs were large causing spencer grade 3 & above shunting at the PFO. 38% of the PFOs were spencer grade 1 & 2. WCN19-0216

Conclusions Poster shift 01 - Channelopathies /neuroethics /neurooncology / TCD showed evidence of PFO in a high proportion of patients with pain - Part I /sleep disorders - Part I /stem cells and gene therapy - migraine & stroke. TCD is a very sensitive & reliable method of detecting right to left shunt at PFO level.TCD can help in predicting Part I /stroke /training in neurology - Part I and traumatic brain patients with migraine who are at a high risk of developing stroke injury doi:10.1016/j.jns.2019.10.429 Neuropsychological characteristics of patients with long-term effects traumatic brain injury

B. Amonova, N. Mirzaevaa, R. Matmurodova, I. Qilichevb WCN19-0210 aTashkent, Neurology, Tashkent, Uzbekistan bUrchench, Neurology, Urgench, Uzbekistan

Poster shift 01 - Channelopathies /neuroethics /neurooncology / One of the urgent problems of modern neurology and medical pain - Part I /sleep disorders - Part I /stem cells and gene therapy - psychology is the problem of neuropsychological disorders in Part I /stroke /training in neurology - Part I and traumatic brain traumatic brain injury (TBI). injury Aim Relationship of severity of ischemic and hemorrhagic strokes To study the neuropsychological disorders of patients with with the activity of von Willebrand's factor various forms of long-term effects of TBI.

M. Mavlanova, S. Dadajanovb, R. Sodiqovb, R. Ismoilovb,D. Material and methods Boykhonovab, N. Qodirovb, A. Sobirovc Were examined 38 patients with various forms of long-term aNeurology, Tashkent, Uzbekistan effects of TBI who received treatment in a multi-disciplinary regional ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 9 clinic in the Khorezm region. The age of patients was 21-45 years. Results Conducted clinical-neurological and neurophysiological studies, There was no difference of ischemic lesion size between WO, WP, neuropsychological tests. DA and DI (34.7 ml, 32.1 ml, 46.3 ml and 34.9 ml, respectively). Non- cardiogenic stroke subtype was numerically higher in WO compared Results with other groups (p = 0.34: 40%, WF 29%, DA 30% and DI 27%, In 31 (81%) patients there is asthenia, manifested in a decrease in respectively). Regarding sex difference, male rate of non-cardiogenic productivity by the end of work, in superficial judgments. Asthenic stroke in DA was significantly lower than other groups (p = 0.03: syndrome, in which the main syndrome for all periods of traumatic 46%, WO 83%, WP 83% and DI 100%, respectively). brain injury was observed in 30 (78.9%), local symptoms in 12 (31.5%), progressive dementia in 2 (5.2%). Almost all patients had Conclusion disturbances in the emotional-personal sphere of the personality, There was no difference of anticoagulation power between according to the type of anxiety and depression. Cognitive impair- patients with well controlled warfarin and DOACs. Although warfarin ment, since, impaired memory, attention, emotions and motivations, did not show any sex difference in the stroke preventive effect, regulation of the level of mental activity Motor disorders were DOACs might differently play a stroke prevention role in male and observed only in 1 (2.6%). In 18 (47.3%) patients, epileptic female. syndromes were observed and EEG studies were confirmed. There are no links between convulsive syndrome and localization of brain doi:10.1016/j.jns.2019.10.432 damage.

Conclusion In the long-term periods, the effects of TBI motor disorders such WCN19-0230 as paralysis are very rare. Characteristically, disorders of higher brain functions, which depend on the damage to the localization of TBI. Epileptic syndromes are very characteristic of long-term periods Poster shift 01 - Channelopathies/neuroethics/neurooncology/ with the effects of TBI. Each focal damage to the cerebral cortex is an pain - Part I/sleep disorders - Part I/stem cells and gene therapy - epileptic focus. Part I/stroke/training in neurology - Part I and traumatic brain injury doi:10.1016/j.jns.2019.10.431 Patterns of hand drift in parietal lobe lesion

S. Nagendraa, G.S. Sonib, K.A. Jagiasib WCN19-0222 aDepartment of Neurology, Department of Neurology, Grant Medical College, Sir JJ Group of Hospitals, Mumbai, India b Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Department of Neurology, Grant Government Medical College, Sir JJ Group of Hospitals, Department of Neurology, Grant Government pain - Part I /sleep disorders - Part I/stem cells and gene therapy - Medical College, Sir JJ Group of Hospitals, Mumbai, India Part I/stroke /training in nuerology - Part I and traumatic brain injury Introduction Clinical signs that help in detecting subtle weakness are Clinical differences of acute ischemic stroke during anti- invaluable in reaching early localisation of lesion and diagnosis. The coagulation therapy between warfarin and doacs parietal drift is a useful clinical sign that is helpful in localizing to parietal lobe. T. Nakasea, J. Moroib, T. Ishikawab, H. Shimizua a Akita University, Department of Neurosurgery, Akita, Japan Objective b Research Institute for Brain & Blood Vessels -Akita, Department of 1) To characterize the parietal drifts which are observed on the Surgical Neurology, Akita, Japan basis of extent, direction, and hand and finger movements. 2) To study association between direction of the drift and Background underlying causative lesion in brain parenchyma. The difference of clinical effects between warfarin and direct oral anticoagulants (DOACs) has not been unveiled, although the Materials and methods overwhelmed effect of DOACs was reported in various studies. This Study conducted at tertiary care centre over a duration of 12 study aimed to reveal the features of stroke subtype and outcome in months, where hand drift, fingers movement and any abnormal stroke patients under anticoagulation therapy with warfarin or posturing of fingers and wrist were noted by the two expert DOACs. assessors separately, for a period of 20-30 seconds each. The drift is described in each patient on the basis of following six parameters.1) Methods Curling of fingers 2) Outstretching of thumb 3) Outward drift of hand Between April 2015 and March 2018, acute ischemic stroke 4) Upward drift of hand 5) Downward drift of hand 6) Pronation of patients who had currently been treated with warfarin or DOACs hand were enrolled in this study (n = 94). Patients with warfarin were classified into the optimal control group (WO: n = 15) and poor Results & conclusions control group (WP: n = 21). Patients with DOACs were classified 1) Patients having lesions in parietal lobe demonstrated hand into the appropriately prescribed group (DA: n = 43) and inappro- drift which consisted of hand movement in outward, upward or priate group (DI: n = 15). rarely in downward direction. 2) Patients having lesion in the ARTICLE IN PRESS

10 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

Parieto-occipital regions demonstrated hand drift which consisted of WCN19-0235 hand movement in outward and upward direction 3) Patients having lesion in Parieto Temporal regions, demonstrated hand drift which consisted of hand movement in upward but NOT outward direction. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ 4) An attempt can be made to localize site of lesion whilst awaiting pain - Part I /sleep disorders - Part I/stem cells and gene therapy - radiological images by simple characterisation of this clinical sign Part I/stroke /training in neurology - Part I and traumatic brain injury doi:10.1016/j.jns.2019.10.433 Safinamide effects on skeletal muscle sodium channels and models of non-dystrophic myotonia (NDM) compared to mexiletine: Exploring potential for clinical utility WCN19-0231 J.F. Desaphya, M. De Bellisb, A. Farinatob, C. Altamuraa, P. Imbricib,C. Cacciac, E. Mellonic, G. Padoanic, S. Vailatic, C. Keywoodc, D. Conteb,S. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Piernob pain - Part I/sleep disorders - Part I/stem cells and gene therapy - aUniversity of Bari Aldo Moro, Biomedical Sciences and Human Part I/stroke /training in neurology - Part I and traumatic brain Oncology, Bari, Italy injury bUniversity of Bari Aldo Moro, Pharmacy & Drug Sciences, Bari, Italy cZambon SpA, Research & Development, Bresso, Italy Acute ischemic stroke in adolescents The antiarrhythmic sodium channel blocker mexiletine is used T. Rambauda, N. Legrisa, B. Celineb, M. Kossorotoffc, C. Deniera clinically to treat patients with myotonia. However, around 30% of aParis Sud University, Neurology, Le Kremlin Bicetre, France patients do not benefit from mexiletine due to poor tolerability or bBicetre Hospital University, Neurology, Le Kremlin Bicetre, France poor therapeutic response. Safinamide (Xadago®) is licensed for cParis Necker Hospital AP HP, Pediatry, Paris, France Parkinson’s disease treatment. Besides MAO-B inhibition, safinamide modulates glutamate release through blockade of neuronal sodium Objective channels. The in-vitro and in-vivo effects of safinamide compared to Adolescents have unique health issues, and only limited infor- mexiletine were investigated in skeletal muscle hNav1.4 sodium mation exists about stroke characteristics in this population. Our aim channels and in rat models of myotonia. was to describe the clinical and neuroradiological features, etiologies, Using patch-clamp, safinamide reversibly inhibited wild-type initial management, and outcome of ischemic stroke in adolescents. hNav1.4 sodium currents (INa) with an IC50 of 160 and 33 μMat stimulation frequencies of 0.1 and 10 Hz respectively, compared to 256 Methods and 46 μM for mexiletine (holding potential (hp) −120 mV). In a This retrospective cohort study evaluated all consecutive patients condition mimicking myotonia, i.e. hp of -90 mV and 50-Hz stimulation, aged 10–18 years with a first-ever ischemic stroke hospitalized both drugs exerted similar INa inhibition with IC50 of 5-6 μM. between 2007 and 2017 in 10 French academic centers representing When applied in vitro to isolated rat skeletal muscle fibers in a a population of approximately 10 million. Extracted data from the myotonia-like condition induced by 9-anthracene carboxylic acid (9- French national database served as validation. AC), safinamide inhibited action potential firing with an IC50 of 13 μM, compared to 55 μM for mexiletine. Results In vivo in rats, oral safinamide (ED50 1.2 mg/kg) was more potent A total of 60 patients were included (53% male, median age 15.2 than mexiletine (ED50 7.0 mg/kg) in counteracting 9-AC induced years). Diagnosis at first medical contact was misevaluated in 36%, myotonia. more frequently in posterior circulation strokes (55% vs 20%, OR 4.8 Safinamide inhibited myotonic skeletal muscle sodium channels IC95%[1.41;16.40],p = 0.01). Nevertheless, 19 patients (32%) re- in vitro and had more potent antimyotonic properties than ceived recanalization treatment: intravenous thrombolysis (17%), mexiletine in vivo. Further work is warranted to evaluate if endovascular therapy (11.7%), or both intravenous and intra-arterial safinamide may be clinically effective for NDM. thrombolysis (3.3%). Of these, only one presented with a hemorrhagic transformation, which was asymptomatic. The most common doi:10.1016/j.jns.2019.10.435 determined etiologies were cardioembolism (15%), vasculitis and autoimmune disorders (12%, occurring exclusively in females), and arterial dissections (10%, exclusively in males). Despite thorough etiological workup, 50% of strokes remained cryptogenic. Recurrent WCN19-0237 ischemic cerebrovascular events occurred in 12% (median follow-up 19 months). Recurrence rate was 50% in patients with identified vasculopathy but 0% after cryptogenic stroke. Functional outcome Poster shift 01 - channelopathies/neuroethics/neurooncology/ was favorable (Rankin Scale score 0–2 at day90) in 80% of cases. pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Conclusions injury This study confirms that ischemic stroke in adolescents has heterogeneous and specific causes, differing from those expected in The effect of oxidants/antioxidants balance on one-year progno- young adults or children. Recanalization treatments appear feasible sis of acute ischemic stroke patients and safe. S. Shaafia, F. Hadisib doi:10.1016/j.jns.2019.10.434 aNeurology, Tabriz University of Medical Science, Tabriz, Iran bTabriz University of Medical Science, Neurology, Tabriz, Iran ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 11

Objectives 1983-1987, vs. 1636 for 2013–2017). During the period 2013–2017, To evaluate and investigate the relationship between oxidant/ four journals: Pain with 443 NP-related papers, PLOS One (274), antioxidant balance at the time of acute ischemic stroke and the final Molecular Pain (243), and Neuroscience (175) concentrated 11.0% of National institute of Stroke Score (NIHSS) in a one year period. the literature on NP, while 1288 journals published 5 or less papers. The number of participating countries had continuously increased: Methods 25 countries in 1983-1987, 60 in 1998-2002, and 114 in 2013-2017. We selected 3 groups of randomized cases for our study which During the period surveyed, the USA was the most publishing each consisted of 47 patients. One main group of acute ischemic country, and if several European countries (UK, Germany, Italy, stroke patients and 2 control groups; one group with risk factors for France), Japan, and Canada, were continuously among the most ischemic stroke but without it and one group without any risk productive countries, some Asian countries and Brazil have factors for ischemic stroke. We measured the levels of "MDA", "TAC" emerged: in 2013-2017, China ranked 2nd, South Korea 8th, Brazil and "8-OH2dG" as the representatives of oxidants and antioxidants 10th, Turkey 14th and Taiwan 15th. To conclude, during the period in each group. Samples were taken in the first 48 hour of acute 1983–2017, the scientific literature on NP largely expanded in 3 ischemic event in our main group. Then we assessed the relationship directions: number of articles, publishing journals, and contributing between the levels of the above mentioned factors with the final countries. NIHSS of acute ischemic stroke patients at the end of first year after their ischemic event and also compared those measures with our doi:10.1016/j.jns.2019.10.437 control groups.

Results Compared with controls MDA", "TAC" and "8- WCN19-0256 OH2dG"antioxidants are lower in acute stroke patients and oxidants levels were higher. There were no significant differences between the three groups in non-enzymatic substances. There was positive Poster shift 01 - Channelopathies/neuroethics/neurooncology/ correlation between antioxidants levels and NIHSS. pain - Part I /sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Conclusion injury Above mentioned results suggests that imbalance in oxidant/ antioxidant hemostasis is a potent factor in ischemic stroke The alarm clock which travelled from migraine to MOH prognosis. A. Dubeya, S. Dubeyb, T. Dubeyc doi:10.1016/j.jns.2019.10.436 aNeurology, Bhopal, India bMeenakshi Medical College Hospital and Research Institute, Neurology, Kanchipuram, India cGandhi Medical College, Hamidia Hospital, Medicine, Bhopal, India WCN19-0252 We present a case of a 60 year old female who presented with Poster shift 01 - Channelopathies/neuroethics/neurooncology/ history of headache of duration of around 6–8 months. Interesting pain - Part I/sleep disorders - Part I/stem cells and gene therapy - part about this headache was that she was diagnosed as migraine and was put on NSAIDs and triptans but her headache gradually Part I/stroke/training in neurology - Part I and traumatic brain worsened with increase in intensity as well as frequency of injury headaches. Subsequently, she was labeled as medication overuse headache and was treated accordingly. After no response to fi Neuropathic pain: Expansion of its scienti c and medical litera- treatment, she was referred to us. ture from 1983 to 2017 Her meticulous history revealed that all her headache episodes were nocturnal, while sleeping and which woke her up everytime. a b c d C. Robert , W. Dieb , C. Wilson , C.D. Arreto These episodes occurred always around 2–4 AM and the frequency a Gliaxone, Université de Paris, Pharmacology, Paris, France was around 15–20 times per month with sometimes headache b U.F.R. d'Odontologie, Université Paris-Diderot, Laboratoire de Neuro- occurring even twice per night. Headaches were mostly bilateral and biologie Orofaciale, Paris, France dull aching with mild to moderate intensity and with no postural c University of New South Wales-UNSW, School of Information Systems- variation. There were no associated features like lacrimation/redness Technology and Management, Sydney, Australia of eyes. After waking up, she had to engage in some motor activity d Université de Paris/AP-HP, Pharmacology, Montrouge, France like reading/walking around or cooling the head but never any agitation. The duration of each episode of headache was between Neuropathic pain (NP) are pain cause by a lesion or disease of the half an hour to one hour. somatosensory system and its prevalence in the general population She was thus diagnosed as hypnic headache (also known as alarm is estimated at between 1.5% and 8%. This study provides a clock headache) and after normal brain scan, she was started on quantitative view of the evolution of the scientific literature lithium therapy. Her headache responded to this treatment in one published between 1983 and 2017 in this field. Bibliometric month and became almost symptom free in two months. indicators issued from article-type papers related to NP and Thus, meticulous history is must to diagnose hypnic headache published in journals indexed in the Web of Science SCI-Expanded and proper treatment can address the symptoms and suffering of database were computed. From 1983 to 2017, the number of patients in this type of primary headache disorder. publications on NP had increased more than 50 folds (198 papers for 1983–1987, vs. 10298 for 2013–2017), and the number of doi:10.1016/j.jns.2019.10.438 journals publishing NP articles increased 16 folds (102 journals for ARTICLE IN PRESS

12 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0285 We describe the case of patient who suffered from infarction of posterior inferior cerebellar artery after a cervical chiropractic manipulation. A 39-year-old man visited the emergency room with Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain the cerebellar dysfunction sign such as a repeated episode of vertigo - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ and loss of balance. Two weeks ago, he had history of a chiropractor stroke/training in neurology - Part I and traumatic brain injury for treatment of intermittent neck pain. At the time of admission, brain computed tomography, magnetic resonance image and angi- Hurdles in adherence to antiplatelet drugs in patients with ography revealed acute infarction in left posterior inferior cerebellar recurrent strokes artery (PICA) territory, and occlusion of extracranial vertebral artery (VA, V1/2 junction), which means the dissection of vertebral artery. D.T. Mathew, S.K. John, D.D. Souza, G. Sarma, R. Nadig, S. Badachi, A. Angiography of the vertebral artery revealed occlusion of the left Awati PICA and arterial dissection of VA at extracranial portion. He was St John's Medical College Hospital, Neurology, Begaluru, India treated with antiplatelet therapy. At 3 weeks later, he was discharged without any sequelae. The possibility of VA dissection Background should be considered in patients presenting with recent onset Anti-platelet therapy (APT) is an integral part of secondary stroke vertigo and loss of balance, and history of a cervical chiropractic prevention. Non-compliance to APT is an important factor in stroke manipulation. recurrence. In this study we have evaluated the reasons for non- doi:10.1016/j.jns.2019.10.440 compliance to APT.

Aim To identify the various causes of non-adherence to APT in recurrent stroke patients. WCN19-0308

Methods Poster shift 01 - Channelopathies/neuroethics/neurooncology/ The study was conducted in a tertiary care hospital in South India pain - Part I/sleep disorders - Part I/stem cells and gene therapy - with huge stroke burden.The study period was from October 2017 to September 2018. All recurrent stroke patients were evaluated for Part I/stroke/training in neurology - Part I and traumatic brain causes of recurrence and those with APT discontinuation was injury evaluated for various factors causing non-adherence. Clinical characteristics of patients with hemorrhagic transforma- Results tion in acute cerebellar infarction During the 12- month study period among 604 ischemic stroke patients, 128 (21%) had recurrent strokes. Of this 128, 60 (46.8%) were D.I. Shinab, H.S. Hanc, Y.B. Leed, H.Y. Jeona due to discontinuation of APT. The main factor for non-adherence to aChungbuk National University Hospital, Neurology, Cheongju, Republic APT was lack of awareness about the need for lifelong medication (41/ of Korea 60; 68.3%). 10 patients (16.7%) stopped treatment as they opted for bChungbuk National University, Neurology, Cheongju, Republic of Korea alternative therapy and 4 (6.7%) discontinued antiplatelets due to side cYuseong Sun General Hospital, Neurology, DaeJeon, Republic of Korea effects. A small proportion of the patients (3.3%) cited financial dGachon University, Gil Medical Center, Neurology, Incheon, Republic of constraints and forgetfulness as the issue while 1.7% had difficulty in Korea finding assistance to administer medicine. 27 (45%) patients had recurrent stroke within 2-15 days of stopping APT. Background and purpose Hemorrhagic transformation (HT) is a common cause of brain Conclusion parenchymal hemorrhage following ischemic stroke. However, little The main reason for non -adherence to antiplatelets is lack of is known about hemorrhagic transformation in cerebellar infarction. awareness about the need for life long antiplatelet therapy. Stroke This study evaluated the clinical characteristics of patients who have patients should be educated about the importance of lifelong HT after acute ischemic stroke in the cerebellum. antiplatelet therapy to prevent recurrent strokes. doi:10.1016/j.jns.2019.10.439 Methods We evaluated 61 patients with acute cerebellar infarction who presented to the emergency room within 48 hours of symptom onset. We divided the patients into those with (HT) and without WCN19-0294 (non-HT) hemorrhagic transformation and compared the baseline characteristics of the two groups. The functional outcome measure was the modified Rankin Scale score 90 days after stroke onset. Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ Results stroke/training IN neurology - Part I and traumatic brain injury Of the 61 patients with acute cerebellar infarction, 13 had HT and 48 did not. Old age and male sex were found to differ significantly A case of extracranial vertebral artery dissection with infarction between the two groups [odds ratio (units); 1.147 (year) and of posterior inferior cerebellar artery 12.171 (sex)] at baseline. In the univariate analysis, the plasma triglyceride level was lower in the HT group (mean±SD; 77.3 ± b S.K. Hwang 24.2 versus 127.6 ± 73.1; p 0.001), and HT was more frequent College of Medicine, Ewha Womans University, Neurosurgery, Seoul, when using antiplatelet drugs before the cerebellar infarction Republic of Korea [number (percentage); 5 (38.5) versus 6 (12.5); p = 0.046]. The ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 13 functional outcomes at 90 days did not differ signiﬁcantly between WCN19-0346 the two groups.

Conclusion Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Our results showed that patients who were older, male, had low pain - Part I/sleep disorders - Part I/stem cells and gene therapy - triglyceride levels, and were using antiplatelet agents before their Part I/stroke/training in neurology - Part I and traumatic brain infarctions were more likely to have HT after acute cerebellar injury infarction. We recommend that acute cerebellar infarction patients with these factors be evaluated more carefully to check for HT. Comparison of increased intracranial pressure symptoms in brain doi:10.1016/j.jns.2019.10.441 tumor patients with imaging feature

G. Candrasaria, K. Dananjoyob, R.G. Maulekab, A. Asmedib aRsup dr. Sardjito, Neurology, Sleman, Indonesia bGadjah Mada Univeristy, Neurology, Yogyakarta, Indonesia WCN19-0326

An increased intracranial pressure (ICP) symptom is a medical Poster shift 01 - Channelopathies/neuroethics/neurooncology/ emergency. These often occur in patient with brain tumors pain - Part I/sleep disorders - Part I/stem cells and gene therapy - (headache, vomiting, blurred vision, decreased of consciousness Part I/stroke/training in neurology - Part I and traumatic brain and papilledema). MRI and head CT scan show midline shift, cerebral injury edema and hydrocephalus. However, not all centers in Indonesia have MRI and HCTS. Post stroke dysphagia and disability in minor strokes Purpose Comparing the symptoms of ICP in brain tumor patients with S. Erat Sreedharan, J. Vali Sayed, V.P. Vipina, M. Mohan, R. Paul, P. imaging features. Sylaja Sree Chitra Tirunal Institute for Medical Sciences and Technology, Method Neurology, Trivandrum, India This is a descriptive study of brain tumor patients at Sardjito Hospital, Indonesia in 2018 Introduction ﬁ ≤ Minor strokes, de ned as NIHSS 5 are considered non-disabling, Result associated with a favorable outcome. Our aim was to study patients Fifty patients with clinical symptoms of ICP. The most clinical presenting with minor stroke in the acute phase to see their medical symptoms were headaches (56 patients), followed by vomiting (36 complications and functional outcome on follow-up. patients) and blurred vision (24 patients). All patients with clinical symptoms of ICP show features of midline shifts, edema or Methods ventriculomegaly. The most frequent imaging features were cerebral Retrospective study design,where all minor strokes admitted to edema (53 patients) followed by midline shift (32 patients) and Stroke care centre,Sree Chitra Tirunal Institute for Medical Sciences ventriculomegaly (14 patients). Of the 44 patients with decreased of and Technology,Trivandrum between January 2016-June 2017,with 1 consciousness, 28 patients showed midline shifts, 9 patients only year completed followup were selected from medical records.Clinical showed edema, 3 patients showed edema and ventriculomegaly, and and imaging details and follow-up data were collected. 2 patients only showed ventriculomegaly.

Results Conclusion We had 147 patients with minor stroke during the study period All ICP clinical symptoms show typical imaging feature of ICP with median age 61 years .71% presented within 24 hours of with the most frequent feature are cerebral edema followed by symptom onset.Median NIHSS at admission was 3 (IQR 2). 85 midline shift. patients had anterior circulation strokes and 34 had chronic infarcts fi in imaging. At discharge, 19 had signi cant dysphagia ,with 10 doi:10.1016/j.jns.2019.10.443 requiring nasogastric feeding.Admission NIHSS and white mater changes in imaging were predictive of post stroke dysphagia. Excellant recovery of dysphagia was found within 1 month post stroke in all ,except one who required percutaneous gastrostomy. At 3 months,76% had excellent outcome. In multivariate logistic WCN19-0365 regression analysis,presence of dysphagia and DM were found to be statistically significant predictors of short term outcome,ie at 3 Poster shift 01 - Channelopathies/neuroethics/neurooncology/ months.At 12 months,post stroke dysphagia,females and those with pain - Part I/sleep disorders - Part I/stem cells and gene therapy - white mater changes had a less favourable stroke outcome. Part I/stroke/training in neurology - Part I and traumatic brain injury Conclusions Minor strokes are disabling in a small fraction of patients.Over 10% of them tend to have significant dysphagia necessitating Neurophobia among medical students and physicians in Brazil nasogastric feeding short term.This patient subgroup tend to have ab b b b b less favourable outcome on short and long term followup. V. Neri , C. Rosas , L. Figueiredo , A.M. Nunes , A.L. Menezes ,L. Chagasb, R. Muylaertb doi:10.1016/j.jns.2019.10.442 aUniversidade Federal do Estado do Rio de Janeiro, Neurology, Rio de Janeiro, Brazil ARTICLE IN PRESS

14 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

bFaculdade de Medicina de Campos, Neurology, Campos dos Goytacazes, WCN19-0366 Brazil

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Objectives To assess the attitude of Brazilian medical students and pain - Part I/sleep disorders - Part I/stem cells and gene therapy - physicians toward Neurology, identify whether Neurology is consid- Part I/stroke/training in neurology - Part I and traumatic brain ered a difficult subject from Rio de Janeiro/Brazil students and injury doctors, evaluate reasons for such perceived difficulties. Neurophobia in medical schools: A current issue Methods The study was conducted from February-December 2018. 111 V. Neria, C. Rosasb, L. Figueiredob, A.M. Nunesb, L. Chagasb, A.L. physicians and 155 medical students from Faculdade de Medicina de Menezesb, R. Brittob, A. Alvesc, J. Da Silvac Campos/Rio de Janeiro were invited for the study. Data were aUniversidade Federal do Estado do Rio de Janeiro, Neurology, Rio de collected by a pre-tested expert-validated self-administered ques- Janeiro, Brazil tionnaire (Likert scale), designed to assess the degree of perceived bFaculdade de Medicina de Campos, Neurology, Campos dos Goytacazes, difficulty, confidence, interest and knowledge of Neurology as Brazil compared to other subjects. Results: In all participants the current cUniversidade Estácio de Sá, Physical Therapy, Campos dos Goytacazes, level of interest was most for Clinical Medicine (35,4% among Brazil students and 11,7% doctors), while Neurology was the eighth least interesting specialty for medical students (4.5%) and doctors (15,3%). Objectives: To assess the attitude of Brazilian medical students fi Neurology was considered a dif cult discipline by 71.2% of doctors toward Neurology, identify whether Neurology is considered a difficult fi and 83,3% of medical students. 58,7% of students were not satis ed subject from Rio de Janeiro/Brazil students, evaluate reasons for such with their neurology teaching experience; 63,9% consider that basic perceived difficulties. Methods: The study was conducted from sciences, such as neuro-anatomy is essential for better neurological February-December 2018.155 medical students, 127 physical therapy understanding. 78,7% agreed that neurological diseases are compli- students and 126 psychology students from Rio de Janeiro Universities fi cated and dif cult. 86,5% of the students thought that their were invited for the study. Data were collected by a pre-tested expert- fi Neurology knowledge was insuf cient. 63% of physicians consider validated self-administered questionnaire (Likert scale). Results: the neurological examination complex, and 48.6% consider Neurol- Medical students: 4,5% selected Neurology as their first choice. ogy complex because there is no curative treatment (Table 1). Whereas 58,7% were not satisfied with their neurology teaching experience, 45,2% found Neurology difficult; 63,9% consider that basic Conclusion sciences, such as Neuroanatomy is essential for better neurological Most of the students and physicians had an unfavorable attitude understanding. 78,7% agreed that neurological diseases are compli- fi toward Neurology. The main reason for the perceived dif culty was cated and difficult. 82,6% of the students thought that their Neurology fi the de ciencies in clinical teaching. New strategies in Medical knowledge was insufficient. Physical therapy students: 23,6% were not Schools are needed to change students medical doctors attitude satisfied with their Neurology teaching experience, 74,8% found toward this demanding specialty. neurology difficult; 79,5% consider that basic sciences is essential. 70,9% agreed that neurological diseases are complicated. 40,2% thought that their Neurology knowledge was insufficient. Psychology doi:10.1016/j.jns.2019.10.444 students: 18,2% were not satisfied with their Neurology teaching ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 15

experience, 71,4% found neurology difficult; 68,2% consider that basic into 3 subtypes: cardioembolic (CE, n=15), atherothrombotic (ATBI, sciences is essential. 74,6% agreed that neurological diseases are n=52), lacunar infarction (LI, n=25). Carotid plaques were into 3 complicated. 37,3% thought that their neurology knowledge was types: low, intermediate, high intensity, and were into 2 types: insufficient (Table 1). Conclusion: There are differences of evaluation simple and mixed. Serum lipids (TC, LDL-C, HDL-C, TG), ApoA1, and about Neurology among the groups of students analyzed. The main ApoB were analyzed using commercially available kits. reason for the perceived difficulty was the deficiencies in clinical teaching. New strategies in Medical Schools are needed to change Results students attitude toward this demanding medical specialty. There was no difference in TC, LDL-C, HDL-C, and ApoB levels among 4 groups. Serum ApoA1 levels in the ATBI group were doi:10.1016/j.jns.2019.10.445 significantly lower compared with CONT groups. Among ATBI group, serum ApoA1 levels in the low intensity plaque type were significantly lower compared with intermediate or hard intensity type. Furthermore, serum ApoA1 levels in the mixed plaque type fi WCN19-0374 were signi cantly lower compared with simple type.

Conclusions Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain These ﬁndings suggest that serum ApoA1 levels might be - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ associated with the development of ATBI and plaque properties of stroke/training in neurology - Part I and traumatic brain injury carotid artery.

Association of serum apolipoprotein A1 levels with ath- doi:10.1016/j.jns.2019.10.446 erothrombotic infarction and plaque properties of carotid artery

R. Ohtania, S. Nirengib, J. Togawaa, M. Kinboshia, K. Takedaa,N. Mimuraa, R. Matsunaria, K. Kotanib, T. Tsukaharac, M. Nakamuraa,N. WCN19-0375 Sakaneb a National Hospital Organization Kyoto Medical Center, Neurology, Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Kyoto, Japan pain - Part I/sleep disorders - Part I/stem cells and gene therapy - bNational Hospital Organization Kyoto Medical Center, Division of Preventive Medicine, Kyoto, Japan Part I/stroke/training in neurology - Part I and traumatic brain cNational Hospital Organization Kyoto Medical Center, Neurosurgery, injury Kyoto, Japan Primary diffuse leptomeningeal gliomatosis with parenhycmal Background inﬁltration: A clinico- radio-pathological correlation The aim of this study is to investigate the association of serum apolipoprotein A1 (ApoA1) levels with ischemic stroke subtypes and P.E. Yambao plaque properties. Quirino Memorial Medical Center, Center of the neurological sciences, Quezon city, Philippines Methods We enrolled a total of 113 patients with ischemic stroke and age Primary Diffuse Leptomeningeal Gliomatosis (PDLG), as ﬁrst matched controls (CONT, n=21). The stroke patients were divided described by Moore (1954), is a very rare form of cancer resulting ARTICLE IN PRESS

16 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx from the meningeal heterotopic astrocytes that convert into after 24 h respectively. The Rankin mean was 3 in 7 days and 2.5 in 3 malignancies and possibly causing obstruction on the Virchow months for patients with thrombolysis by tenecteplase against a spaces leading to cystic parenchymal infiltration. This case, 4th Rankin average at 3.5 in 7 days and 2.5 in 3 months for patients documented case of atypical parenchymal infiltration, is a 45 -year thrombolysed by alteplase. Five patients thrombolysed by ten- old male with gradually progressive headache, difficulty sleeping and ecteplase underwent haemorrhagic transformation compared to profound anxiety, left-sided numbness and seizures. Cranial CT- Scan seven patients thrombolysed by alteplase. showed right thalamic lesion without hydrocephalus. A possible thalamic infarct or cavernoma was considered. Subsequent MRI Conclusion showed the same thalamic lesion but now with focal leptomeningeal This study shows that tenecteplase appears to be equally effective enhancement probably secondary to glioma versus tuberculosis. He in IVD Thrombolysis. was given anti-Koch’s medications and steroids. Leptomeningeal biopsy confirmed this malignancy. Post- mortem autopsy revealed doi:10.1016/j.jns.2019.10.448 thickened leptomeninges, right thalamic mass involving the centromedial and posterolateral portion and small cystic lesions all over the surface. Histopathology showed Virchow -robin space infiltration proving the parenchymal involvement through the pial WCN19-0382 vessels. This case highlighted the possibility of parenchymal involvement which challenged the traditional diagnostic criteria and may now serve as a basis for a revised diagnostic criteria . In this Poster shift 01 - Channelopathies/neuroethics/neurooncology/ case, imaging also showed an underestimation of the extent of pain - Part I/sleep disorders - Part I/stem cells and gene therapy - atypical brain parenchymal infiltration. Hence, headache coupled by Part I/stroke/training in neurology - Part I and traumatic brain leptomeningeal enhancement should always warrant close imaging injury surveillance and possibly repeated biopsies to rule out this exceptional condition. Cerebral infarction in a patient with hereditary spherocytosis: A case report and review of literature doi:10.1016/j.jns.2019.10.447 T.S. Khoo, N.C. Huan, Y.C. Lai Hospital Labuan, Department of Internal Medicine, Labuan, Malaysia

WCN19-0381 Introduction The relationship between primary red blood cell disorders and Poster shift 01 - Channelopathies/neuroethics/neurooncology/ cerebrovascular ischemia has long been demonstrated in literature in pain - Part I/sleep disorders - Part I/stem cells and gene therapy - terms of both alterations of hemoglobin concentration (polycythemia and anemia) and structural hemoglobin abnormalities. Whilst it Part I/stroke/training in neurology - Part I and traumatic brain is clearly established in cases such as sickle cell disease, a causal injury relationship is rarely reported in cases of hereditary spherocytosis.

Thrombolysis in ischemic stroke: tenecteplase or alteplase Case report We report a 51-year-old gentleman with no known prior medical H. Benjebara, I. Najmi, N. Chtaou, A. El Midaoui, Z. Souirti, M.F. illness who presented with a sudden onset left sided body weakness Belahsen involving the left facial muscles, upper limb and lower limb. Neurology, Fez, Morocco Examination revealed signs consistent with upper motor neuron lesion with left facial nerve weakness sparing the forehead, complete Background paralysis of left upper and lower limb with power of 0/5 with Intravenous thrombolysis remains the most accessible therapy for upgoing plantar reflex over the left. Cortical signs were absent. ischemic stroke with alteplase as standard therapy. Tenecteplase has Cardiovascular and respiratory examination were unremarkable. undergone several studies in ischemic stroke. The purpose of this Abdominal examination revealed splenomegaly with no hepatomeg- study is to compares Tenecteplase and alteplase for the recent aly. Computed tomography of the brain demonstrated acute right ischemic stroke. corona radiata and external capsule infarct with no intracranial bleed. Peripheral blood film sent for anaemia (haemoglobin level of Methods 10g/dL) revealed spherocytes which coincided with a positive family This is a quasi-experimental retrospective study involving a series history of spherocytosis. Patient had no other significant comorbid- of 30 patients over 18 years old, thrombolysed in the Department of ities as atherosclerotic risk factors for stroke. Neurology, CHU Hassan II Fez. The first group consists of patients thrombolyzed with Tenecteplase at a dose of 0.25 mg / kg. The Discussion and conclusion second group thrombolysed with Alteplase at 0.9 mg / kg (10% of the Due to rarity, the exact mechanism of cereborvascular ischaemia dose in 1 minute and 90% of the dose in 1 hour). NIHSS scores after 2 in patients with hereditary spherocytosis remains unknown al- hours and 24 hours of thrombolysis, product dosing delay, ASPECTS though both red cell deformability and rheological abnormalities of and Rankin scores were compared between the two groups. hereditary spherocytosis are possible contributing factors. We hope that our case report will foster more extensive studies into Results hereditary spherocytosis as a possible contributing risk factor leading The mean age was 67 years for group 1 and 69 years for group 2. to thrombosis and cerebral infarction. The mean NIH score increased from 14 on admission to 10 after 2 hours and 8 after 24 hours in patients who had tenecteplase doi:10.1016/j.jns.2019.10.449 compared to the other group: 14 on admission, 10 after 2h and 9 ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 17

WCN19-0383 J. Rajeswarana, C.N. Bennettb aNational Institute of Mental Health and Neurosciences NIMHANS, Clinical Neuropsychology and Cognitive Neuroscience Centre, Bangalore, India Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain bChrist University, Psychology, Bangalore, India - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ stroke/training in neurology - Part I and traumatic brain injury India is passing through a major socio-demographic and epidemiological transition with consequent changes in health scenario. TBI Stroke protocol in a hospital of the inland of Brazil: Five years of constitute significant burden on health care resources in India The experience impact on a person and family can be devastating. Patients with TBI experience persistent cognitive deficits, emotional changes, which P. Vasconcelosa, D. Menezes Terrab, D. Ferreira Manzoc, M.A. contribute to the disruption of life activities. The recovery of TBI Figueiredo Fidalgo Donadellic, L. Bezerra Estevesd would be maximized by appropriate rehabilitation. Neurofeedback is aSanta Casa de Misericórdia de Passos, Departamento de Neurologia, an emerging neuroscience-based clinical application. Passos, Brazil bSanta Casa de Misericórdia de Passos, Departamento de Cardiologia, Methodology Passos, Brazil TheaimofthestudywastoexploretheeffectivenessofEEG-NFTon cUniversidade de Alfenas, Departamento de Clínica Médica, Alfenas, Brazil Cognitive, Clinical, Biochemical and electroenceplograph correlates. Sixty dUniversidade do Estado de Minas Gerais, Departamento de Medicina patients were recruited for this study after obtaining informed consent. Geral do Adulto, Passos, Brazil Clinical assessment,Neuropsychological assessment. Pre-post serum cortisol was carried out. The Intervention group received neurofeedback Introduction training and the waitlist group did not receive any treatment during this Stroke has a major impact on health, as it is the leading cause of phase. Patients were allocated to intervention and waitlist group at disability and the second leading cause of death in Brazil. The random. There were 30 patients in each group. Patients were given 20 implementation of a stroke protocol improves the results of a health sessions of NFT Patients were given alpha theta training. Session lasted for institution. 40 minutes, with 5-6 sessions per week. The post-training assessment was carried out for the intervention group after 20 sessions of NFT. Objective To present the experience of implantation of the stroke protocol Results fi in a hospital of the inland of Brazil. showed EEG-NFT in ameliorating de cits in cognitive functions, reduction in symptoms and decrease in the cortisol and improving Method the quality of life in patients with TBI. Improvements were fi A retrospective study of the medical records of all patients treated corroborated by patients and signi cant others post NFT. with an initial stroke suspicion was carried out between January 2014 and December 2018. We will present data on the number of Conclusion strokes, number of thrombolysis performed , quality indicators: time The study illustrates the effectiveness of EEG NFT to perform skull CT, assessment of speech-language pathologist The details will be presented before diet and mortality doi:10.1016/j.jns.2019.10.451 Results During the five-year period, 1606 stroke patients were diagnosed, of which 1285 were ischemic stroke (80.0% of the total). A total of 61 thrombolysis were performed. The percentage of skull CT in 45 WCN19-0389 minutes in 2014 was 45.2%, and in the year 2017 it reached a percentage of 88.7%. The percentage of evaluation of speech- Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain language pathologist before the diet increased from 45.3% in 2014 - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ to 81.0% in 2018. The mortality rate in the year 2014 was 20.5%, reaching 24.3% in 2015, up to 18% in the year 2018. stroke/training in nuerology - Part I and traumatic brain injury

Conclusions Hypertension and outcomes in patients with different etiological Despite all the difﬁculties such as poor human resources and the subtypes of intracerebral hemorrhage: A multicenter cohort absence of a stroke unit, the use of the stroke care protocol allowed the study improvement in the indicators and the clinical outcome of these patients. S. Zhanga, M. Liub doi:10.1016/j.jns.2019.10.450 aWest China Hospital- Sichuan University, Department of neurology, Chengdu, China bSichuan university- West China Hospital, Neurology, Chengdu, China

WCN19-0387 Whether hypertension inﬂuences outcomes of patients with different etiological subtypes of intracerebral hemorrhage (ICH) is unknown. A total of 5394 patients with ICH were included in this Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain prospective cohort study, of whom 4052 (75.1%) had elevated SBP on - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ admission and 3015 (55.9%) had hypertension history. We found stroke/training in nuerology - Part I and traumatic brain injury that the association between elevated SBP and 3-month mortality was heterogeneous across ICH subtypes (P=0.02). Elevated SBP was Emerging hope: EEG neurofeedback training in TBI associated with higher risk of 3-month mortality only in the ARTICLE IN PRESS

18 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

hypertensive angiopathy (Ptrend=0.013) and undetermined Conclusion (Ptrend=0.005) subtypes. In the cerebral amyloid angiopathy (CAA) In the absence of objective neurology further MRI scanning does subtype, hypertension history showed a significant inverse associa- not add value. Objective neurological finding on assessment with an tion with 3-month mortality (Pb0.001). This study suggests that the initial negative CT brain is useful. Patients who have positive/new association between blood pressure and outcome of ICH depends on findings on outpatient MRI were managed well with positive out- ICH etiology and CAA might be pathogenetically distinctive from comes. A risk stratification tool can lead to reduction in MRI scanning, other subtypes of ICH. Our results support the importance of reduction in inpatient days which will lead to reduction in over- individualizing blood pressure-lowering strategy based on etiological stretched services in a safe clinical practice. subtype of ICH. doi:10.1016/j.jns.2019.10.452 doi:10.1016/j.jns.2019.10.453

WCN19-0391 WCN19-0392

Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ stroke/training in nuerology - Part I and traumatic brain injury stroke/training in nuerology - Part I and traumatic brain injury

The utility of imaging (computed tomography and magnetic Optimising management of anti-coagulation in acute stroke resonance imaging) in acute stroke patients presenting in atrial ﬁbrillation

E. Feldano, B. Ramasubbu, E. Barrie, S. Ghosh E. Feldano, B. Ramasubbu, E. Barrie, S. Ghosh University Hospital Crosshoue, Stroke Medicine, Kilmarnock, United Kingdom University Hospital Crosshouse, Stroke Medicine, Kilmarnock, United Kingdom

Introduction Introduction The superiority of MRI compared to CT in hyper-acute stroke is In spite of increasing awareness of atrial ﬁbrillation (AF) as a now widely recognised. In many centres due to practicalities CT major risk factor in stroke practice both in community and secondary remains the primary imaging modality. Our study was designed to care is not yet following the recommendations made in the NICE look at the usefulness of MRI for patient management. guidelines. Timing of commencing anticoagulation following TIA and stroke varies amongst clinicians as concern has been raised in case of Methods haemorrhagic transformation. Our aim was to study current practice Retrospective investigation of 100 consecutive cases involving and develop a guideline for commencing anticoagulation to remove patients who had both CT and MRI imaging following acute stroke. clinician variance and improve patient safety. Results Method 97 CT and MRI Brains were carried out. Three patients were We looked at 80 consecutive stroke and TIA admissions excluded due to MRI head not being completed. 60 patients had a presenting in AF and assessed the nature of their anti-coagulation negative CT Brain (62%). Table 1 shows the number of patients who treatment and its adherence to good practice guidelines. had inpatient vs outpatient MRI in the CT negative category. None of the patients from the negative CT brain category, who had Results normal MRI had any objective focal neurology, they were Thirty-four patients had previously diagnosed AF and 18 patients investigated due to their subjective symptoms. Findings from the were newly diagnosed on this admission. Of the 34 patients with known positive CT brain group are given in Table 2. For the patients who AF, 18 were on NOAC, 13 were on warfarin and three patients were not underwent MRI scanning for stroke with objective neurology had anticoagulated due to high risk of falls. Anticoagulation was considered no change in management as they were already on appropriate in all 44 patients with a new diagnosis of AF and either stroke or TIA. treatment. This was the case for both negative CT brain and positive Average initiation of anticoagulation was 3.5 days for TIA, 3.6 days for CT brain categories. mild CVA, 10.9 days for moderate CVA’s and 8.7 days for severe strokes. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 19

Conclusion research suggests careful prevention strategies in individuals with There is signiﬁcant variance in timing of introduction of RVO and RAO for future stroke. anticoagulation following TIA or stroke in our institution due to the lack of local protocol/guideline, hence the introduction of such doi:10.1016/j.jns.2019.10.455 following this work. doi:10.1016/j.jns.2019.10.454 WCN19-0460

Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain WCN19-0400 - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ stroke/training in nuerology - Part I and traumatic brain injury Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ Carotid endarterectomy (CEA) - Variants of neurological stroke/training in nuerology - Part I and traumatic brain injury complications

Associations of retinal vein and artery occlusions with mortality, N. Bozhenko, M. Bozhenko stroke and cerebral small vessel disease: A systematic review and Danylo Halytsky Lviv National Medical University, Neurology depart- meta-analysis ment, Lviv, Ukraine

J. Liu, M. Liu Actuality Department of Neurology, West China Hospital, Neurology, Chengdu, Population-based studies have estimated that ≈15% of ischemic China strokes are caused by large vessel cerebrovascular disease. For many years, CEA is considered as a "gold standard" for treating carotid Objective artery disease and standard of preventive therapy. However, the Retinal vein and artery occlusions (RVO and RAO)are perceived to be result of the operation is affected by its complications. related to vascular risk factors, but their associations with cerebrovascular diseases are unclear and inconsistent. We conducted a meta- Objective analysis to better understand the clinical significance of RVO and RAO on To analyze neurological complications in patients with CEA. mortality, stroke and cerebral small vessel disease (CSVD), and may optimize management strategies for patients with RVO and RAO. Materials and methods The neurological status of 183 patients with carotid pathology Methods was analyzed (98 men and 85 women), who underwent CEA during We searched for articles assessing the effects of RVO/RAO on the 2016 – 2018. All patients undergo a neurological examination before risk of mortality, stroke or CSVD in PubMed from inception to and after surgical intervention. All patients for confirmation of February, 2019. Studies that reported adjusted effect estimates and diagnosis had a comprehensive examination, ultrasonography, CT confidence intervals were included in meta-analysis.Data were with perfusion or MRI with angiography. extracted by predefined critia and then pooled by Stata version 12.0using inverse variance–weighted meta-analysis with random Results effects.Our study was complied with the meta-analysis of observa- The most frequent neurological complications after CEA were tional studies in epidemiology guidelines. cranial nerves injuries (CNI) in 14 (7,65%) patients. Mostly traumatized nerves where Vagus (X) in 9 patients (4,9%), Hypoglos- Results sal (XII) – 7 (3,8%), Facial (VII)- 3 (1,6%), Marginal mandibular Of 934 articles identified, 32 studies were eligible for qualitative branch of facial nerve – 3 (1,6%), Glossopharyngeal (IX)- 1 (0,55%), synthesis, and 13 studies for qantitative synthesis with up to 432454 Great auricular-9 (4,9%). Intraoperative stroke or stroke in the early paticipants for RVO, and 94383 participants for RAO. RVO was postoperative period due to embolism or prolonged compression of associated with higher risk of stroke (hazard ratio[HR],1.43,95% artery was observed in 4 patients (2.2%) , TIA in 9 (4.95%). Anxiety CI:1.33-1.55,Pb0.001), ischemic stroke (HR,1.36,95%CI:1.32-1.40, occured in 97 patients (53%) . Pb0.001),and hemorrhagic stroke (HR,1.54,95%CI:1.10-2.15,P=0.01), but not with mortality (HR,1.02 ,95%CI:0.99-1.04,P=0.20). RAO was Conclusions significantly associated with stroke (HR,1.88,95%CI:1.40-2.53,Pb0.001). The CNI rate has significantly decreased over the past years. The presence of both central RVO/RAO and branch RVO/RAO was Neurological examination is the basis of patients with CEA evalua- associated with increased risk of stroke (all Pb0.05). Data on the tion. Early diagnosis and correct treatment of complications and association of RAO with mortality, and the relationship between RVO/ determination of rehabilitation directions, in patients after CEA, is a RAO and CSVD were limited and insufficient to conduct meta-analysis.\ way to successful recovery and quality of life improvement of this category of patients. Conclusions We report evidence that RVO and RAO have major clinical doi:10.1016/j.jns.2019.10.456 significance in stroke, ischemic stroke and hemorrhagic stroke. This ARTICLE IN PRESS

20 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0920 care unit. Overall,100% patients received in-hospital rehabilitation; mean length of stay was10.37days. In hospital mortality rate was0.08%.The mean hospital cost per patient was85,469 INR Poster shift 01 - Channelopathies/neuroethics/neurooncology/ (8241.9INR/day). The mean ICU cost per patient was13,695 INR per pain - Part I/sleep disorders - Part I/stem cells and gene therapy - day. National institutes of health stroke scale score improved on Part I/stroke/training in nuerology - Part I and traumatic brain discharge and was4.07 points. injury Conclusion Despite the single Hospital- Based analysis, this study provided Short term health care costs associated with acute ischemic the current precise data on short-term inpatient care and costs of stroke in Mumbai, India acute ischemic stroke in a tertiary care hospital in Mumbai. We can conclude that early effective and proper management of stroke leads a a b K. Agrawal , N. Surya , H. Someshwar might lead to a better & cost-effective outcome. aBombay Hospital and Research Center, Neurology, Mumbai, India bKJ Somaiya College of Physiotherapy, Neurophysiotherapy, Mumbai, India doi:10.1016/j.jns.2019.10.457 Introduction There isn’t much knowledge on the cost of stroke in India, although it is an economic burden on the patients as well as care givers. WCN19-0917 Aim To evaluate the current status of care and cost of acute ischemic stroke in Mumbai. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Methods Part I/stroke/training in nuerology - Part I and traumatic brain During 12-month period of January 2018 to January 2019, injury consecutively hospitalized 120 patients with acute ischemic stroke data were included in the study. We examined the demographic Serum homocysteine- A predictor for acute stroke in a territary data, in- hospital care, length of stay, outcome at discharge and care hospital in Mumbai hospital costs. The medical cost data were collected from ofﬁcial hospital medical accounts department, which calculated direct N. Suryaa, H. Someshwarb, K. Agarwalc medical costs for beds, staff, radiological and blood examination, aBombay Hospital and Research Centre, Neurology, Mumbai, India medications and rehabilitation. bKJ Somaiya College of Physiotherapy, Neuro-Physiotherapy, Mumbai, India Results cBombay Hospital and Research Center, Neurology, Mumbai, India The mean age was 59.21 years, &76.15% were male. The mean National institutes of health stroke scale score was8.37 points on admission. All patients underwent MRI angiography of brain on Background admission. All Patients were treated with ischaemic protocol in Epidemiology studies have shown that increased serum homo- Stroke unit. 54.26% patients were admitted to neurological intensive cysteine levels are associated with an increased risk of ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 21 thromboembolic disease. Controversy exists over which subtype of WCN19-0467 stroke is allied to deranged homocysteine levels.

Aim Poster shift 01 - Channelopathies/neuroethics/neurooncology/ we aimed to investigate whether elevated homocysteine levels pain - Part I/sleep disorders - Part I/stem cells and gene therapy - are a risk factor to stroke, severity associated with stroke and which Part I/stroke/training in nuerology - Part I and traumatic brain subtype of stroke is associated with stroke. injury

Methodology Is the supramarginal gyrus a hub for orthographic processing? An observational study was conducted in a territory health care centre; patients admitted in stroke unit of territory health care V. Balasubramanian, S. Sabu, J. Terrezza, A. Stamey, M. Brower center were recruited in the study. Demographics, stroke severity Seton Hall University, Speech-Language Pathology, Nutley, NJ, USA through NIHSS and homocysteine, Vitam B12 and Vitamin D3 levels were assessed at time of admission. The subtype of stroke was The involvement of the supra marginal gyrus (SMG) in speech determined based on the classification of subtype of production is well attested in research (Gunther & Hickok, 2016). stroke‘TOAST’Trial. Normal homocysteine levels was taken at6.0- Recent research has added new information about the role of SMG 16.0 micromol/litre. and inferior parietal lobe in several different processes and networks (Bikofski et al, 2016). Contemporary studies strongly suggest that Results SMG plays a significant role in spelling/writing (Baldo etal, 2018), Out of the 120 patients screened,60.83% had an increase serum along with angular gyrus (AG). SMG underlies Spanish orthographic homocysteine levels on admission,39.2% had hypertension, and 17% competence (Gonzalez-Garrido et al, (2017), and visual word had h/o smoking. Out of 120, 29 had large vessel stroke,46 had processing (Stoeckel etal, 2009). In the present context, the current cardio-embolic stroke,22 had lacunar infarcts and 23 had undeter- study aims at answering the question ‘Does the SMG serve as a hub mined causes of stroke based on the TOAST criteria. Homocysteine for orthographic processing? was found to be higher in the patients with cardio-embolic subtype of stroke. There was significant difference in the vitaminb12 level in Method the large vessels stroke subtype. There was no significant correlation Subject. CBH, is a 59-year-old female chronic aphasic with between serum levels and stroke severity. bilateral inferior parietal lobe lesion (Figure 1.). Procedure: CBH was tested on Boston Diagnostic Aphasia Examination (BDAE) and Conclusion the Psycholinguistic Assessment of Language Performance in Aphasia Homocysteine can be a risk factor associated with stroke in (Figure 2.). Results: CBH’s spelling performance revealed impair- patients living in Mumbai. They have a significant risk of developing ments at the levels lexical-semantics, phoneme-grapheme conver- cardio-embolic strokes. Routine check of Homocysteine levels will sion, orthographic output lexicon, and graphemic buffer (Figure 3.). help in preventing stroke in these individuals. The current study offers support to the assertion that SMG plays a fi doi:10.1016/j.jns.2019.10.458 signi cant role in spelling/writing (Baldo et al, 2018). Other studies support the view that SMG also plays a significant role in ARTICLE IN PRESS

22 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 23 phonological short-term memory, visual word processing, phono- WCN19-0481 logical planning (Luria, 1970), and grammatical processing (Schonberger et al, 2014). Taken together, these studies and the results from the current study appear to suggest that SMG probably Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain serves as a hub (van den Heuvel & Sporns, 2013) pooling variety of - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ information and serving both spoken and written forms of stroke/training in nuerology - Part I and traumatic brain injury production. Comprehensive supportive care model for neurology cases doi:10.1016/j.jns.2019.10.459 S. Pramoda, B. Patidarb aIndian forum for Healthcare, Med, Indore, India bSFHCP, Med, Indore, India WCN19-0478 Background and aims Issues: People living with neurological-disorders needs price- Poster shift 01 - Channelopathies/neuroethics/neurooncology/ discounted-drugs & proper-nursing-care. Controversy is raging over pain - Part I/sleep disorders - Part I/stem cells and gene therapy - euthanasia for terminal-cases. Appropriate public-health-program Part I/stroke/training in nuerology - Part I and traumatic brain for supportive -care needed. injury Description: treatment-cost of neurological-disorders debatable. Over 82% patients in rural-asia cannot afford therapies, so life with Hospital-based stroke register studies and clinical features and neurology-disorder considered end-game. Since 2016 community- outcomes of stroke patients in China and other Asian countries: A initiatives implemented to reduce therapy-cost. we need to facilitate systematic review development of sound/sustainable nursing-care-programs in mar- ginalised communities. Establish Uniform public-health-policy to W. Tao develop of sound/sustainable care-programs. West China Hospital- Si Chuan University, Neurology, Cheng Du, China Methods Backgrounds and aims This is policy-paper by efforts of group of Asian nurses and Hospital-based stroke registration is an international research patient advocates hotspot in recent years. This study aims to compare the current status and quality of hospital-based stroke registers in China and Results other Asian countries, and to analyze the clinical features and Lessons learned: Community participation in administration of prognosis of stroke patients in these registries. nursing-care/therapeuticRX is very effective in terms of cost- management, better-compliance. Community mass intervention & Methods low-cost drug-supply-projects has proven useful in rural communi- Data were identified by electronic searches of electronic data- ties of resource poor-nations. participants must collaborate with bases from January 2000 to November 2016. References were hand health activists to address this issue. Uniform public health policy searched. We included the hospital-based stroke registry consecu- needed to implement supportive care services. tively conducted in China and other Asian countries and analyzed these data prospectively. Conclusions Promoting dialogue between health-services & nurses accelerates Results health-care-efforts. nurses participation increases more compliance. 80 articles from 32 stroke registries were included, sample size Nurses have direct-communication with patients. Hence nurses must ranging from 1070 to 46108. The 32 registries covered five Asian be involved in Public-health-policy issues. This would reduce fi countries, including China, Japan, South Korea, Thailand and dif culties faced by patients from resource poor southern countries. Vietnam. Stroke classification and subtype (according to TOAST Its essential that common guideline manual on this issue affecting classification) are shown below. Thrombolysis rates was reported in developing countries. This complex issue needs indepth discussion only 5 registries in China, ranging from 0.9% to 19.3%,which were for better outcome in management of neurological-disorders. from 1.9% to 63.9% in 8 registries from other Asian countries. Case fatality rates were reported in 10 Chinese registries, 1-year death doi:10.1016/j.jns.2019.10.461 ranging from 1.58% to 26.1%,which were ranging from 3% to 26.3% in 10 registries from other Asian countries.

Conclusions WCN19-0484 In terms of thrombolysis, Chinese patients are less active, but there is not much difference in mortality in one year. However, due Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain to the limitations of the research methods, data on the clinical characteristics of stroke patients is not reliable in making any - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ conclusive decisions. This study calls for a set of quality criteria to stroke/training in neurology - Part I and traumatic brain injury assess stroke registration studies and to conﬁrm their validity and feasibility. Statistical QOL assessment in stroke patients doi:10.1016/j.jns.2019.10.460 S. Pramoda, B. Patidarb aIndian forum for healthcare, med, Indore, India bSFHCP, med, Indore, India ARTICLE IN PRESS

24 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

Background and aims All questionnaires were returned and analyzed using simple Issues. Fatigue, Sleeplessness, depression, bed sores common in statistical method. We also designed framework for orientation/ stroke-sufferers. Supportive-care facility inaccessible in rural/tribal CME that would novices to experts in providing nursing care areas. for stroke patients. This presentation outlines role of nurses, impact on patient outcomes and education required for competent Objective. 174 persons die/year from stroke yearly. Statistically practice. N90% bed sores, 68% experience unbearable-pain; 70% social neglect/ humiliation, 54% sleeplessness, 37% complain fatigue and 64% Results depression. Importance of spirituality/religion in coping with N = 23 nurses aged between 20–35 years enrolled from District terminal-illness is increasingly recognized. we incorporated nurses hospital & rural catholic mission in rural/tribal population. 18 with traditional faith hears for palliative care. females, 5 males. knowledge, perception and attitudes of nurses towards stroke care is minimal with only 10 showing special skill, Methods perception and good attitudes towards caring for stroke patients as We surveyed stroke patients family through QOL-questionnaires. opposed to 9 with little knowledge and low perception to caring for After 14 weeks with psychosocial support, Counseling & palliative stroke patients and the remaining 4 with no speciﬁc knowledge and support with anti-depressants/pain-killers/nutrition QOL improved perception towards nursing care of stroke patients. to statistically. 5 Traditional faith-healers involved for more psychological impact on patients family. Conclusions Nursing is an important specialty but neglected in rural Asia. Results Resources are scarce for such initiatives. Trained nurses can improve opioids administered in 35%. Diazepam as adjuvant-drugs in 23% QOL of stroke patients. This presentation will highlights role of patients. Pethidine common analgesic, tramadol in 22%. N30% of cancer-nurses, impact on patient QOL, and education required for cases were in advanced-stage. 200 specialist palliative care beds competent clinical care of stroke patients. required for our Rural/tribal population of 6,00,000. signiﬁcant correlations between higher scores of spirituality with absence of doi:10.1016/j.jns.2019.10.463 depression, fatigue. Likewise higher scores of QOL (ANOVA p b 0.001) correlated with pain.

Conclusions WCN19-0487 Life-span/QOL of neurology disorder sufferers depends on social acceptance & appropriate-supportive-care. Caregivers should be trained in Palliative-care-services & rehabilitation. This study data Poster shift 01 - Channelopathies/neuroethics/neurooncology/ used for patient advocacy. Spiritual well-being increases end-of-life pain - Part I/sleep disorders - Part I/stem cells and gene therapy - despair in terminally-ill. Field of Spiritual/psycho-social/community Part I/stroke/training in neurology - Part I and traumatic brain support is fertile ground for further investigations for better injury management of neurology disorders in resource poor countries where specialized care is still inaccessible for majority population. Levadopa’s high effectiveness in neuropathies of the oculomotor nerves of diabetic genesis doi:10.1016/j.jns.2019.10.462 M. Mavlanova, S. Dadajonovb, R. Sodiqovb, R. Ismoilovb,D. Boykhonovab, N. Qodirovb, A. Sobirovb, B. Mikliyevb aNeurology, Tashkent, Uzbekistan WCN19-0485 bTashkent Medical Academy, Neurology, Tashkent, Uzbekistan

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Considering the high efﬁciency of levadopa in central paralysis, ’ ﬁ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - the purpose of the study was studying the levodopa sef ciency in neuropathies of the oculomotor nerves (ON) of diabetic etiology Part I/stroke/training in neurology - Part I and traumatic brain (DE). injury Materials and methods Nursing personal in care of stroke For the period between 2015 and 2018, under our supervision there were 53 patients with ON neuropathy of DE. a b S. Pramod , B. Patidar Patients were divided into 2 groups. First group (FG) consisted a Indian forum for healthcare, med, Indore, India of 26 patients (12 with neuropathy ON, abducens nerve 7, b SFHCP, med, Indore, India block nerve 7), who took levodopa at a dose of 125 mg per day with basic therapy. Second group (SG) consisted of 27 patients Background and aims (13, 9, 5 respectively), who received basic therapy. Statistical To assess knowledge, perception and attitudes of nurse in care of difference in age wasn’t observed in the examined groups. The stroke-patients. average age of patients in FG was 57 ± 0.7 years; in SG 55 ± 0.9 years. Methods All patients except the comprehensive diagnostic examinations From October 2014: Questionnaires based study consisted of two were carried out quantitative assessment of the angle of vertical and sections. 1] Information about neurological disorders. 2] Methods to horizontal strabismus according to the method of Girshberg. The elicit nurses' knowledge perception and attitudes in care of stroke average angle of deviation in FG was 25.4 ± 0.3 degrees, in SG was patients. 24.8 ± 0.2. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 25

Results Conclusions The average strabismus angle was 3.3 ± 0.1 degrees in FG`s GGRT can be an effective and safe way to rehabilitate patients patients, in SG 12.7 ± 0.5, by the end of 1 month, signiﬁcantly after IS. differed from SG (p b 0.001). In 19 patients of FG, diplopia (p b 0.001) was fully regressed, in SG regressed in 3 patients. doi:10.1016/j.jns.2019.10.465

Conclusions Early prescription of levodopa in the acute period of oculomotor neuropathy of diabetic genesis leads to faster restoration of WCN19-0517 strabismus, and also indicates the involvement of subcortical structures in that nosology. Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain doi:10.1016/j.jns.2019.10.464 - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ stroke/training in neurology - Part I and traumatic brain injury

Patient specific TBI patients’ treatment: single center study WCN19-0512 Y. Hamarata, A. Preiksaitisb, E. Kalvaitisa, V. Petkusa, P. Lucinskasa,V. Putnynaitea, S. Krakauskaitea, E. Zubaviciutec, S. Vosyliusc, S. Rockac, Poster shift 01 - Channelopathies/neuroethics/neurooncology/ D. Rastenyteb, J. Ariesd, J.O. Neumanne, A. Ragauskasa pain - Part I/sleep disorders - Part I/stem cells and gene therapy - aKaunas University of Technology, Health Telematics Science Institute, Part I/stroke/training in neurology - Part I and traumatic brain Kaunas, Lithuania injury bLithuanian University of Health Sciences, Department of Neurology, Kaunas, Lithuania Pilot study of the effect of hypercapnical-hypoxic respiratory cVilnius University, Clinic of Neurology and Neurosurgery, Vilnius, trainings on decrease of neurological deficiency after ischemic stroke Lithuania dUniversity of Maastricht Medical Center, Department of Intensive Care, P. Kovzeleva, M. Topuzovaa,A.Сhaykovskayaa, A. Krasilnikovaa,P. Maastricht, The Netherlands e Tregubb, N. Batuevaa, E. Paninaa, L. Kalinchenkoa, T. Alexeevaa University Hospital Heidelberg, Department of Neurosurgery, Heidel- aFederal State Budgetary Institution “Almazov National Medical Re- berg, Germany search Centre” of the Russian Federation, Department of Neurology and Psychiatry, St. Petersburg, Russia Patient-specific management methodology is crucial for out- bAltai Medical Institute of Postgraduate Education, Patologi, Barnau, comes of patients with traumatic brain injury (TBI). The clinical Russia outcomes depend on cerebrovascular autoregulation (CA) impairments which can also be affected by patients’ age, brain injury grade Objective or pharmacological influences. Here we compare the effectiveness of To evaluate the effectiveness of hypoxic-hypercapnic respiratory optimal cerebral perfusion pressure (CPPopt) targeted therapy in training (GGRT) in restoring neurological functions after IS. younger (b45 years-old) and elderly (≥45 years-old) TBI patients. Multimodal invasive ABP(t), ICP(t), CPP(t), and CPPopt(t) monitor- Materials and methods ing was performed on 81 severe TBI patients in Republic Vilnius We conducted a pilot blind, randomized, placebo-controlled University Hospital (Lithuania). ICM+ software was used for continu- study that was approved by the institutional review board. The ous CPPopt(t) assessment by identification of Pressure Reactivity Index study included 29 patients in the acute period of mild IS, which were (PRx(t)). The analysis of associations between the patients' outcome divided into two groups: exposure (GE, n = 14) and placebo (GP, n and complex of monitored physiological parameters was performed by = 15). Patients from GE underwent GGRT on a Carbonic ® simulator, creating multifactorial model of TBI patient’s outcome prediction. and GP patients breathed through a false loop. The average number The most significant prognostic factors were age, GCS, serum of workouts was 8. All patients were evaluated clinically before and glucose, Helsinki CT score and duration of Longest CA Impairment after the course of GGRT on the NIHSS, Barthel, Rankin, Rivermead event (LCAI) when PRx(t) N 0.5 within 24 h after admission. The and Stange test. modeled accuracies for mortality and unfavorable outcome prediction were 82% and 86%, respectively. Age N 45 years was associated Results with unfavorable outcome. CPP values close to CPPopt were When carrying out early rehabilitation with the help of GGRT, a associated with a better outcome in younger patients. Mean decrease in neurological deficit and degree of disability, an increase ΔCPPopt b −5.0 mmHg, mean PRx N 0.36, and LCAI N 100 min were in daily activity and an improvement in cognitive functions were significantly associated with mortality for the younger patients. The found in comparison with GP by days 11–14: NIHSS GE (1.1 ± 0.7) critical values of averaged PRx N 0.26 and LCAI N 61 min were vs GP (3.8 ± 0.7), p = 0.0035, the difference was 15%. Rankin GE 1.3 significantly associated with mortality for the elderly group. ± 0.5 vs GP 2.1 ± 0.7 (p = 0.02), the difference was 10.5%. Autoregulation guided treatment was more effective for individ- Rivermead GE 13.6 ± 1.1 vs GP 10.8 ± 2.3 (p = 0.01), the difference ual TBI management in younger patients. A phase III study is needed was 9.4%. to prove an effectiveness of CPPopt targeted therapy for elderly The time of the Stange test in the GE increased 28.7 ± 17.8 patient. → 40.7 ± 16.7 (p = 0.003), which did not occur in the GP (p = 0.8). doi:10.1016/j.jns.2019.10.466 ARTICLE IN PRESS

26 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0518 V. Trana, S. Walserb, J. Waylandb, A. Elwoodc, J. PosasIIIa aOchsner Medical Center, Neurology, New Orleans, USA bUniversity of Queensland-Ochsner Clinical School, School of Medicine, Poster shift 01 - Channelopathies/neuroethics/neurooncology/ New Orleans, USA pain - Part I/sleep disorders - Part I/stem cells and gene therapy - cDrexel University, College of Medicine, Philadelphia, USA Part I/stroke/training in neurology - Part I and traumatic brain injury With increasing popularity of novel sports, such as Quidditch inspired by the Harry Potter series, it is suspected that players are Carotid health in patients with cerebral venous thrombosis commonly misdiagnosed or not seeking treatment after suffering a concussion. N. Shaha, A.O. Sarojaa, K.R. Naika, P. Goudar Siddappab After obtaining IRB approval we conducted an anonymous cross- aJawaharlal Nehru Medical College, Neurology, Belagavi, India sectional survey amongst players in the Major League Quidditch for bJawaharlal Nehru Medical College, Radiodiagnosis, Belagavi, India the 2017 season. The survey included questions corresponding to demographics, previous medical history specific to concussions, and Introduction suspected concussions whilst engaging in Quidditch. Cerebral venous thrombosis (CVT) is an uncommon cause of 464 players were contacted via email with 34% response rate. stroke and shares common risk factors with arterial strokes like 96.2% previously engaged in sports either high school or collegiate hyperhomocysteinemia, tobacco, alcohol, drugs and hypercoagulable level. 26% of males and 29% of females reported having previously state. These risk factors could alter both arterial and venous health medically diagnosed concussions outside of Quidditch. 15% reported leading to occurrence of atherosclerosis in CVT patients. We aimed to never hitting their head during a Quidditch match while 19% evaluate carotid hemodynamics in CVT patients. indicated more than 10 total head injuries. 25% of players reported a medically confirmed concussion during play, with 20% indicating a Methods and material suspected concussion without medical evaluation. Of those with fi This prospective hospital-based case control study included 50 con rmed or suspected head injuries, 39% sought medical treatment consecutive CVT patients and 50 healthy controls.The demographic while 24% did not. data, vascular risk factors, clinical data, biochemical and radiological Majority of Quidditch players reported having suffered a concus- fi parameters were recorded. Carotid sonography was performed in sion prior to playing while half reported suffering a con rmed or CVT patients within first 24 h of admission. suspected concussion during a game. Players were divided on seeking treatment. It is well documented that history of migraines Results or other comorbidities combined with multiple concussions leads to Age of the patients was 35.04 ± 9.48 years and the controls longer recovery times as well as higher rates of post-concussive 38.88 ± 10.41 yearswith male preponderance in both groups. Risk syndrome (PCS). With the growing rate of traumatic brain injuries, it factors for atherosclerosis among patients included hyperhomocys- is imperative that players are diagnosed and treated to prevent teinemia (40 patients), diabetes mellitus (4 patients), hypertension future consequences. (9 patients), alcohol (17 patients) and tobacco (21 patients). Eight doi:10.1016/j.jns.2019.10.468 patients had abnormal carotid sonography. Six had nonflow-limiting plaques, one had carotid occlusion, two had increased intimal-medial thickness and one had increased peak systolic velocity. Among the controls, three subjects had nonflow-limiting plaques. The relative risk for developing carotid atherosclerosis in CVT patients was 1.54. WCN19-0554 There was no difference in carotid hemodynamic parameters between patients with normal and elevated homocysteine. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Conclusion This is the first study to the best of our knowledge looking at Part I/stroke/training in neurology - Part I and traumatic brain carotid health in venous strokes. The relative risk for carotid injury atherosclerosis in CVT patients is higher and requires long term follow up for initiation of preventive measures. The effect of granulocyte colony stimulating factor in the recovery of patients with ischemic stroke: A meta-analysis doi:10.1016/j.jns.2019.10.467 F. Ocampo, K.J. Luspian, A. Diaz St. Luke's Medical Center, Institute for Neurosciences, Quezon City, Philippines WCN19-0540 Background Stroke is a leading cause of morbidity and mortality worldwide. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Currently, few treatment exist for acute ischemic stroke, with pain - Part I/sleep disorders - Part I/stem cells and gene therapy - neuropotective agents generating interest as another approach to Part I/stroke/training in neurology - Part I and traumatic brain prevent the damaging pathological processes that persist in the injury brain after the acute stage. However, there is paucity of clinical studies and conflicting data regarding the efficacy of Catching the snitch or the consequences? Profiling incidence of these neuroprotectants, thereby limiting their use in the clinical concussions in quidditch players setting. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 27

Objective were excluded. A standard preformed questionnaire was designed To determine the efﬁcacy and safety of Granulocyte Colony and ﬁlled up for each patient. Data cleaning, validation and Stimulating Factor (G-CSF) in improving clinical outcome parameters analysis was performed using the SPSS/PC and graph and chart by among patients with acute ischemic stroke. MS excel.

Methods Results Eight randomized clinical trials were included after a compre- Shows socio-demographic information of the study patients, it hensive search of electronic databases and studies. The primary was observed that Male 82% and female 18%, majority of patients endpoint is efficacy, measured by the National Institute of Health (71%) are in 51–70 years age group. Most of the patients 94.0% were Stroke Scale (NIHSS) score, Barthel Index (BI), and modified Rankin married, 46 (46.0%) patients had completed primary education, 33 Scale (mRS) score. Secondary endpoints include incidence of death (33.0%) patients were self employed and 69 (69.0%) patients were and venous thromboembolism living in rural area. It was observed that 86 (86.0%) patients had ischemic stroke and 14 (14.0%) had hemorrhagic stroke. Results A total of eight studies and 541 patients were included in this Conclusion meta-analysis. Results indicated trend towards reduction in NIHSS Stroke cases in Bangladesh have significantly increased in number and mRS scores as well as improvement in BI. Among the three over the past decades; and demographic patterns are gradually parameters, only improvement in BI reached statistical significance. changing day by day. Demographic studies are helpful to plan and There is no significant difference in terms of incidence of death and develop better service for the stroke survivors. venous thromboembolism with G-SCF administration doi:10.1016/j.jns.2019.10.470 Conclusion This meta analysis suggests that granulocyte colony stimulating factor (G-CSF) is associated with a significant improvement in functional outcome, as measured by the Barthel Index and a trend WCN19-0558 towards reduction of both NIHSS and MRS scores. However, further studies are needed to determine the optimal dose, therapeutic time window and route of administration. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - doi:10.1016/j.jns.2019.10.469 Part I/stroke/training in neurology - Part I and traumatic brain injury

Diabetic patients with ischemic stroke have higher frequency of WCN19-0557 comorbid vascular risk factors and poor discharge outcomes

a a a a a Poster shift 01 - Channelopathies/neuroethics/neurooncology/ B. Homoud , A. Hakami , M. AlMalki , M. Shaheen , A. Althuabiti ,A. AlKhathaamib, I. Khatrib pain - Part I/sleep disorders - Part I/stem cells and gene therapy - aKing Saud bin Abdulaziz University for Health Sciences, College of Part I/stroke/training in neurology - Part I and traumatic brain Medicine, Riyadh, Saudi Arabia injury bKing Abdulaziz Medical City-MNGHA and King Saud bin Abdulaziz University for Health Sciences/KAIMRC, Division of Neurology, Depart- Demography and clinical types of acute stroke among 100 acute ment of Medicine, Riyadh, Saudi Arabia stroke patients with type 2 diabetics in Dhaka Medical College Hospital Background Diabetes mellitus increases stroke risk 1.5 – 3 fold, particularly a b b A. Shoab , M. Islam Torikul , M. Wadud Shaheen ischemic stroke. aSylhet MAG Osmani Medical College, Neurology, Sylhet, Bangladesh b Dhaka National Medical College, Neurology, Dhaka, Bangladesh Objective This study aimed to identify differences in the presentation and Background outcomes of ischemic stroke in diabetic and non-diabetic patients. Ischemic stroke is the major cause among stroke patients worldwide and in Bangladesh also this statistics is not different. Methodology A cross-sectional study of 802 ischemic stroke patients at King Aims Abdulaziz Medical City, MNGHA, KSA from January 2016 to To observe demography and clinical types of acute stroke among December 2017. 100 acute stroke patients with type 2 diabetes in DMCH. Results Methodology Among the 802 cases of ischemic stroke, 584 (72.8%) were Cross sectional observational study in DMCH. Total 100 patients diabetic; majority were males (63.5% in diabetics vs. 61.9% in non- of acute stroke with type 2 diabetes were enrolled in this study by diabetics). Non-diabetics were signiﬁcantly younger (54.6 ± 15.5 purposive sampling after written informed consent. The initial years vs. 63.3 ± 9.9, p b 0.001). Hypertension (83.6% vs 49.1%, p b clinical diagnosis of stroke was done from history obtained from 0.001), dyslipidemia (38.9% vs. 28.9%, p = 0.009), prior stroke (27.7% patient himself or his/her attendant and conﬁrmed by CT/MRI of vs. 19.3% p = 0.014), ischemic heart disease (20.4% vs. 7.8%, p b brain. Patients taking lipid lowering drugs, brain tumour, meningitis, 0.001) were more common in diabetics; smoking (19.3% vs. 11.1%, p viral encephalitis and/or metabolic encephalitis, hypothyroidism = 0.003) was more common in non-diabetics. More non-diabetics ARTICLE IN PRESS

28 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx presented within 3 hours of symptoms onset (p = 0.003). There was no difference in clinical presentation between the two groups. Large artery and small vessel disease were more common in diabetics than non-diabetics (55.8% vs. 44%, p = 0.003), and (16.6% vs. 11%, p = 0.05) respectively. Diabetics had more lacunar stroke (16.4% versus 9.2, p = 0.009). Transient ischemic attack (TIA) occurred more commonly in non-diabetics (26.1% vs. 13.7%, p b 0.001). Non-diabetics had good outcome (mRS 0–2) at discharge (62.4% vs. 45.9%, p = 0.002). In-hospital complications were more common among diabetic patients (41.8% vs. 36.2%).

Conclusions Almost 3 out of 4 patients were diabetic. Non-diabetics were younger, presented earlier and were more likely to have TIA before stroke. Diabetics had multiple vascular comorbid conditions and were likely to have more disability at the time of discharge. doi:10.1016/j.jns.2019.10.471

WCN19-0562

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain The C statistic was 0.77 (95% conﬁdence interval [CI], 0.66–0.88) injury for HE, 0.77 (95% CI, 0.67–0.87) for poor prognosis, and 0.80 (95% CI, 0.68–0.92) for in-hospital death. Multivariate logistic regression External validation of the nag scale for predicting hematoma analysis with known risk factors showed the NAG scale was the sole expansion in patients with acute intracerebral hemorrhage predictor for HE.

K. Sakutaa, T. Mukaia, I. Hasegawab, K. Okunob, T. Tanakac, H. Yaguchia Conclusion aThe Jikei University Kashiwa Hospital, Neurology, Kashiwa-shi, Japan External validation of the NAG scale showed good discrimination. bThe Jikei University Kashiwa Hospital, Emergency Medicine, Kashiwa- shi, Japan doi:10.1016/j.jns.2019.10.472 cThe Jikei University Kashiwa Hospital, Neurosurgery, Kashiwa-shi, Japan

Background and purpose WCN19-0576 Early hematoma expansion (HE) is seen in about 30% of intracerebral hemorrhage (ICH) patients, but detecting high risk Poster shift 01 - Channelopathies/neuroethics/neurooncology/ factors for HE is challenging. The NAG scale was one of the proposing pain - Part I/sleep disorders - Part I/stem cells and gene therapy - factors for HE in patients with acute ICH. The aim of this study is to validate the scale. Part I/stroke/training in neurology - Part I and traumatic brain injury Methods Between January 2016 and December 2018, we retrospectively WAKE-up stroke is associated with sleep-disordered breathing in reviewed consecutive series of patients with primary ICH, who were men diagnosed by an initial non-contrast computed tomography (CT) scan within 24 h after onset. Patients underwent follow-up CT scans J. Park, S. Kim, S.Y. Lee at 6 h, 24 h, and 7 days after admission, and the HE was defined as an Kangwon National University Hospital, Neurology, Gangwondo, Repub- increasing rate in hematoma volume N33% or an absolute volume of lic of Korea increment N6 mL on follow-up CT scans, compared with initial CT fi fi – scans. Poor prognosis was de ned as modi ed Rankin Scale 4 6at Introduction discharge. Logistic regression analysis and receiver operating char- Previous studies on the relationship between waking up stroke acteristic curves were used to determine discrimination ability of the (WUS) and sleep have been performed using post stroke poly- score. somnography (PSG). However, post stroke PSG cannot be used to diagnose preexisting obstuctive sleep apnea (OSA) due to the high Results prevalence of new-onset OSA following acute stroke. And they didn’t A total of 82 patients (51 men; median age 67 years) were analyze according to subtype of stroke. Therefore, in this study, we analysed in our study, and HE was included in 25 patients (30%). examined whether preexisting symptoms of OSA affects the onset of Higher NAG sores were related to HE, poor prognosis, and in-hospital WUS and association between WUS and OSA depending stroke death. etiology. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 29

Patients and methods WCN19-0579 We consecutively evaluated adult patients who were admitted with acute ischemic stroke between December 1, 2013 and April 30, 2015. We investigated consecutive patients who were admitted with Poster shift 01 - Channelopathies/neuroethics/neurooncology/ acute ischemic stroke, using a standardized protocol including the pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Berlin Questionnaire on symptoms of OSA prior to stroke. The Part I/stroke/training in neurology - Part I and traumatic brain collected stroke data included the time of the stroke onset, risk injury factors, and etiologic subtypes. The association between preceding OSA symptoms and WUS was assessed using multivariate logistic A comparative analysis of the severity using voxel-based spect regression analysis. CVR map in acute stroke

Results Y. Leea, C.A. Parkb, J.M. Shimc, J. Yangd, C.K. Kange fi We identi ed 557 subjects with WUS. Neither snoring nor apnea aGil Medical Center- Gachon University College of Medicine, Neurology, frequency differed between WUS and non-WUS groups. In gender Incheon, Republic of Korea fi strati ed analyses, men with WUS compared to men with non-WUS bGachon University, Biomedical Engineering Research Center, Incheon, fi had signi cantly higher rates of snoring and apnea (p = 0.010). Republic of Korea These differences were not seen in women. There was no difference cGachon University, Neuroscience Research Institute, Incheon, Republic in WUS according to stroke subtype. of Korea dGil Medical Center, Gachon University College of Medicine, Neurology, Conclusion Incheon, Republic of Korea In this population-based study, WUS was associated with OSA in eCollege of Health Science, Gachon University, Radiological Science, men but not in women. WUS was not associated with stroke Incheon, Republic of Korea etiology. Treating OSA might therefore be beneficial in preventing stroke, particularly in men. The study aimed to develop the quantitative and voxel-based cerebrovascular reactivity (CVR) assessment tool using acetazol- doi:10.1016/j.jns.2019.10.473 amide (ACZ) single photon emission computed tomography (SPECT) ARTICLE IN PRESS

30 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx and provide clinical evaluation with better statistical power to 3. Comparison of brain stem lesions:The basilar artery “embedding” differentiate small lesions. sign is a glioma. TDLs had small lesions but signiﬁcant symptoms, Automated preprocessing steps were performed for creating but tumors do the opposite. CVR map using ‘Base-SPECT’ and ‘ACZ-SPECT’ images. The quanti- 4. Contrast enhanced MRI: TDLs in different course showed different tative CVR values were calculated on a voxel basis (voxel-based enhanced dynamic imaging. Ring, Broken rings, open-ring, C or CVR), which was compared with region of interest (ROI) basis inverse C shaped enhancement,“comb”sign were features of TDLs. (ROI-based CVR). A nuclear physicist also assessed the regional Most of the PCNSL exhibited round enhancement. Multiple severity of patients. The calculated voxel-based CVR values were nodules and complete annular enhancement are common in averaged in each ROI, which was then ranked for further statistical astrocytoma. analysis. 5. Comparison of ASL or PWI in MRI: blood supply of astroglioma can In the results, the only voxel-based CVR showed a distribution in be presented as hyperperfusion; TDLs showed no hyper perfusion. the selected ROIs rather than only a mean value by ROI-based (Fig. Most of the PCNSL were of equal or slightly higher perfusion. 1). The distribution in the selected regions of each representative 6. SWI comparison: no bleeding on SWI in TDLs; High grade subject in the Severity 3 and 2 showed that Severity 3 clear astrocytoma often see hemorrhagic signals in SWI; Less PCNSL discriminated between the legions and normal compared to in bleeding Severity 2. On the other hand, in the histogram of Severity 2, the distribution was more overlapped with the normal, when compared with Severity 3. doi:10.1016/j.jns.2019.10.475 In conclusion, the developed CVR mapping program could provide quantitative assessment and improve user's convenience by conﬁguring software with GUI. If the distribution of voxel-based CVR values is further analyzed, the range of normal subjects would be statistically determined and it would be utilized as a quantitative WCN19-0583 analysis to predict the risk related with the reduced range of CVR values in patients, helping in the treatment and/or prevention of Poster shift 01 - Channelopathies/neuroethics/neurooncology/ cerebrovascular diseases. pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain doi:10.1016/j.jns.2019.10.474 injury

Anemia, oral contraceptive pills and cerebral venous thrombosis

WCN19-0581 M. Khan, S. Farooq, S.H. Kamran, S. Al Rukn Rashid Hospital, Neurology, Dubai, United Arab Emirates

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Background pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Cerebral venous thrombosis is a serious neurological condition Part I/stroke/training in neurology - Part I and traumatic brain requiring timely recognition and management to prevent morbidity injury and mortality. Both iron deficiency anemia and use of oral contraceptive pills are recognized risk factors leading to the Rapid differential diagnosis of tumefactive demyelinating lesions condition. The purpose of our study is to describe how these two and brain tumors by neuroimaging factors may be brought together in a single patient to increase the risk of CVT X. Qi The Sixth Medical Center of Chinese PLA General Hospital, Neurology, Cases Beijing, China We report seven cases of women in reproductive age group who presented with CVT. All seven had iron deficiency anemia on Tumefactive demyelinating lesions (TDLs) is a special inflamma- presentation and had been started on oral contraceptive pills (OCPs), tory demyelinating disease with space-occupying lesions. The a median of 4 months before the presentation. Indications for OCPs problem of bilateral misdiagnosis between TDLs and brain tumor were menorrhagia in 4 cases, to defer menstruation for religious mainly lies in that neurologists, neurosurgeons and radiologists do reasons in 2 cases, and for birth control in one case. All seven not fully grasp the imaging characteristics of TDLs. Differential patients tested negative for other hypercoagulable states including fi diagnosis from TDLs and brain tumor can be made according to the protein C, S de ciency, Anti-thrombin 3, factor V Leiden mutation, imaging characteristics as following: and antiphospholipid antibodies. We describe the clinical presentation and imaging features of these patients, in addition to potential 1. Comparison of T1 and T2 signals: TDLs had clear image edges of mechanisms for hypercoagulability. lesions on T1 and T2, while astroglioma had unclear boundaries presenting as "foggy-like". Discussion 2. Comparison of CT scan: PCNSL and astrocytoma lesions on plain CT OCPs and iron deficiency anemia are both independent risk often show hyper density, some slightly higher or equal density. factors leading to CVT and are well described in literature. When TDLs lesions were low density. enhanced CT showed that TDLs combined in a single patient they may have an additive effect on the fi lesions were non-enhanced, while PCNSL lesions signi cantly risk. This relationship is not well recognized and a number of fi enhanced. Grade 3 or above can be slightly or signi cantly patients with menorrhagia in particular are started on OCPs. The enhanced. purpose of this report is to highlight that without addressing ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 31 underlying anemia, addition of OCPs may increase the risk of CVT for Aims these women. Few studies have investigated the incidence and predictors of doi:10.1016/j.jns.2019.10.476 recurrent stroke and cardiovascular events in patients with watershed infarction.

Methods Between January 2013 and November 2015, patients who WCN19-0586 fulfilled the following criteria were prospectively recruited from National University Hospital, Singapore: (1) acute watershed Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain infarction, (2) presence of steno-occlusion in the affected vascular - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ territory and (3) willingness to be followed-up for three years. Neuroimaging information, including pattern of watershed infarc- stroke/training in neurology - Part I and traumatic brain injury tion (cortical, internal or both), collateral supply and burden of deep white matter lesions (using the Fazekas score), were Cerebral venous thrombosis: Common presentation across a collected. Relationships between study variables and cardiovascular spectrum of quantitative hemoglobin abnormalities outcomes were examined using Cox proportional hazards regression model. M. Khan, S. Al Rukn, A. Al Madani Rashid Hospital, Neurology, Dubai, United Arab Emirates Results Eighty-four patients (mean age 63.9 years; 71% men) were Cerebral venous thrombosis, is becoming a more frequent recruited and followed for a mean duration of 2.2 years. 31 patients diagnosis. A number of hypercoagulable states have been implicated. had an internal watershed infarct, 14 with a cortical watershed However, common conditions like anemia and polycythemia are infarct and 39 with both internal and cortical watershed infarcts. 17 often overlooked. We describe two cases with extremes of hemo- (20%) patients developed recurrent vascular events (10 with globin levels and discuss how each is implicated in the pathophys- recurrent ischemic stroke and 7 with coronary artery disease). 5 iology of this potentially disabling condition. (6%) patients developed an extension of the initial vascular territory Our first case is a 32 year old gentleman who presented with a at a median of 1.5 years following their initial stroke; 4 patients were short history of headache, vomiting and drowsiness. Computed on single antiplatelet agent at the time of stroke recurrence. After Tomography-CT Cerebral Venography demonstrated venous throm- adjusting for confounders, persistent cigarette smoking emerged as a bosis involving internal cerebral veins, inferior sagittal and straight significant predictor of recurrent vascular events (HR 5.18, 95% CI sinuses. Etiological workup was positive only for iron deficiency 1.25-21.5; p=0.024). anemia, Hemoglobin of 5.8 mg/dL. Second case is a 30 year old gentleman, heavy smoker who Conclusions presented with new onset seizures and headache. CT showed small Patients with watershed stroke are prone to developing recurrent subarachnoid hemorrhage and CT Venography confirmed filling vascular events. Cigarette smoking is a modifiable risk factor that can defect in the superior sagittal and left transverse sinus. His workup be targeted to reduce the burden of recurrent vascular events. for possible etiologies was positive only for a hemoglobin of 19 mg/ dL. No genetic cause was identified for this polycythemia, and it was doi:10.1016/j.jns.2019.10.478 likely secondary to chronic smoking. Several mechanisms are proposed for increased risk of thrombosis with iron deficiency anemia. Among them are reactive thrombocytosis, and elevated levels of certain cytokines. Polycythemia, whether primary WCN19-0593 or secondary has been implicated also in CVT due to increase in blood viscosity and associated thrombocytosis seen with primary. There is a need for further studies to better understand the mechanism of Poster shift 01 - Channelopathies /neuroethics /neurooncology /pain thrombosis associated with these two common conditions. - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / stroke /training in neurology - Part I and traumatic brain injury doi:10.1016/j.jns.2019.10.477 Monocyte to HDL cholesterol ratio is associated with hemorrhagic transformation in patients with acute ischemic stroke

WCN19-0589 Y. Wanga, K. Qiub, Q. Songa, Y. Chenga, J. Liua, M. Liua aWest China hospital of Sichuan University, Department of neurology, Poster shift 01 - Channelopathies /neuroethics /neurooncology /pain Chengdu, China bSichuan University, West China School of Medicine, Chengdu, China - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / stroke /training in neurology - Part I and traumatic brain injury Background and Objective Monocyte to high-density lipoprotein ratio (MHR) has been Predictors and outcomes of patients with watershed infarction: a recognized as a perfect biomarker of cardiovascular diseases. The aim longitudinal cohort analysis of this study is to explore the association of MHR with hemorrhagic transformation (HT) after acute ischemic stroke (AIS). E.Z. Thea, M.Y. Ngb,G.Ngb,B.Erb, A. Queka, R. Seetb a National University Hospital, Medicine- Division of Neurology, Singa- Methods pore, Singapore We consecutively enrolled ischemic stroke patients within 24 b National University of Singapore, Medicine, Singapore, Singapore hours of stroke onset form January 2016 to September 2018. Baseline ARTICLE IN PRESS

32 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

characteristics, including monocyte and high-density lipoprotein, WCN19-0598 were collected. Patients were divided into three categories based on MHR tertiles: T1 (b0.22), T2 (0.22-0.37), T3 (N0.37). HT was defined Poster shift 01 - Channelopathies /neuroethics /neurooncology / based on the magnetic resonance imaging or computed tomography. pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Results Part I /stroke /training in neuerology - Part I and traumatic brain We enrolled 974 patients (573 males; mean age, 67 ± 14 years), injury of whom 149 patients (15.3%) presented with HT. The lowest MHR was associated with 1.85-fold increase the risk of HT to T3 (hazard Cases presented with diagnosis of stroke in period 2016-2017 in ratio [HR], 1.85; 95%CI 1.21-2.82; P =0.004). After adjusting for age, emergency of regional hospital Durres, Albania sex, baseline National Institutes of Health Stroke Scale score, history fi of atrial brillation, SBP, white blood cell, LDL-C, other potential E. Shemsia, F. Domib, K. Shemsic covariates, HR for T1 was 1.70 (95%CI, 1.05, 2.78; P=0.033). aRegional Hospital Durres, Neurology, Durres, Albania bRegional Hospital Durres, Emergency, Durres, Albania Conclusion cFaculty of Medicine, University of Medicine Tirana, Tirana, Albania Decreased MHR at admission was independently associated with increased risks of HT in AIS patients. Further large sample size Background and aims studies are needed to confirm these findings. In Albania, a complete epidemiological study has not yet been conducted across the country, but the number of stroke patients is considered relatively high, comparable to the countries of eastern doi:10.1016/j.jns.2019.10.479 Europe due to the high risk factors such as hypertension, hyperlipidemia diabetes mellitus, fibrillation. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 33

Methods the CDU study from which 56 cases were determined total EICA In 2016-2017, in Emergency of Durres Hospital, 870 cases were occlusions. RESULTS: Of these 56 (11.38%) patients with complete diagnosed with Stroke. Of all cases, 802 were diagnosed by occlusion of EICA, men were predominant (81.6%) with mean age of emergency physicians and 69 by family physicians. In the total 58.0±14.8 years and sex ratio 2.5:1. Symptomatic EICA was detected in number with Stroke 228 patients (26%) were recurrent and 642 49 (87.5%) cases with mean age of 57.5±17.6 while asymptomatic EICA (74%) were new cases. Are classified as Ischemic Stroke 574 cases was determined in 7 cases (12.5%) with mean age of 48.3±15.3 years. (66%) and 296 cases (34%) classified as haemorrhagic Stroke. The most frequent identified risk factors were hypertension (87.5%), smoking (63.6%) and coronary artery disease (69.2%)(pb0.05). By Results grading atherosclerotic plaques, low echo-density was 16 (28.5%), In hemorrhagic cases 29 patients (9.8%) were diagnosed with echodensity with substantial areas of echo lucent were 19 (33.9%), and HSA, of which 18 cases were subjected to neurosurgical interven- highechodensity were 21 (37.5%). CONCLUSIONS: Our study showed tion. Were presented within the first 3 hours of starting ischemic that frequency of EICA is higher among men, similar to other countries. Stroke only 54% (309), of these 115 patients (37.2%) are sent for The EICA is frequently occurred among younger population which thrombolysis and 12 cases (6.1%) for thrombectomia in Universitary requires more consideration. Another important finding of the study is Hospital of Tirana. By gender 53% of cases (457) were female and that asymptomatic EICA is more common than symptomatic EICA 47% of cases (413) were males. The average age of patients was among youth. 64.7 years for ischemic Stroke and 56.4 years for haemorrhagic Stroke. The main risk factor in all cases was HTA 61% (530), the Keywords: Extracranial internal carotid artery, Symptomatic, second most frequent factor being smoking (55%) (482), with Asymptomatic occlusion, Duplex sonography hyperlipidemia 54% (477), 17% (173) atrial fibrillation, 18% (187) diabetes mellitus,(92) 10.5% alcohol consuming, post myocardial infarction 9% (89). doi:10.1016/j.jns.2019.10.481

Conclusions First risk factor in our study was Hypertension and by gender females had higher prevalence in front of males WCN19-0619 doi:10.1016/j.jns.2019.10.480 Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain WCN19-0609 injury

Poster shift 01 - Channelopathies /neuroethics /neurooncology / PGE2/EP4 receptor and TRPV1 channel are involved in repeated pain - Part I /sleep disorders - Part I /stem cells and gene therapy - restraint stress-induced prolongation of sensitization pain evoked by subsequent PGE2 challenge Part I /stroke /training in neurology - Part I and traumatic brain injury W. Maa,L.Lib, S. Xingb aMcGill University, Douglas Mental Health University Institute, Dept. of Extracranial internal carotid artery occlusion-a prospective study Psychiatry, Montreal, Canada bMcGill University, Douglas Mental Health University Institute, Mon- a b b B. Gongor , D. Tsagaankhuu , T. Guntev treal, Canada aMongolian Neurological Society, Stroke Unit, Neurology Center, The Third State Central Hospital, Ulaanbaatar, Mongolia Prevalence of prior stressful experience is linked to high incidence b Mongolian Neurological Society, Department of Neurology, Mongolian of chronic pain. Stress, particularly repeated stress, is known to induce National University of Medical Sciences, Ulaanbaatar, Mongolia maladaptive neuroplasticity along peripheral and central pain transmission pathways. These maladaptive neuroplastic events facilitate Backround sensitization of nociceptive neurons and transition from acute to Symptomatic and asymptomatic occlusions of the extracranial chronic pain. Pro-inﬂammatory and pain mediators are involved in internal carotid artery (EICA) is linked with high risk of stroke event. inducing neuroplasticity. Pain mediators such as prostaglandin E2 (PGE2), EP4 receptor and transient receptor potential vanilloid-1 Objective (TRPV1) contributes to the genesis of chronic pain. In this study, we This study aimed to compare symptomatic and asymptomatic examined role of PGE2/EP4 signaling and TRPV1 signaling in repeated occlusion of EICA by carotid duplex ultrasonography (CDU) and restraint stress-induced prolongation of sensitization pain, a model for determine the risk factors of atherosclerotic plaques and identify the transition from acute to chronic pain, in both in vivo and in vitro clinical features. models. We found that pre-exposure to single restraint stress induced analgesia that masked sensitization pain evoked by subsequent PGE2 Methods challenge. However, pre-exposure to 3d consecutive restraint stress This was a hospital based prospective study, conducted at the Third not only prolonged sensitization pain, but also increased stress General Central Hospital , between 2015- 2017. Totally, 492 ischemic hormone corticosterone (CORT) in serum, COX2 levels in paw skin, stroke and complained before symptoms of transient ischemic attack EP4 and TRPV1 levels in dorsal root ganglion (DRG) and paw skin. Pre- patients aged below and above 50 years of both sexes were included in exposure to CORT for 3d, not 1d, also prolonged sensitization pain ARTICLE IN PRESS

34 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx evoked by PGE2. Co-injection of glucocorticoid receptor (GR) antag- important to evaluate and modify the method and program's onist RU486, COX2 inhibitor NS-398, EP4 receptor antagonist L161,982 participants to improve community concern and response about or TRPV1 antagonist capsazepine prevented 3d restraint stress acute stroke. prolonged sensitization pain evoked by PGE2. In DRG cultures, CORT increased EP4 and TRPV1 protein levels through GR activation. These doi:10.1016/j.jns.2019.10.483 data suggest that PGE2/EP4 signaling and TRPV1 signaling in peripheral pain pathway contributes to repeated stress-predisposed transition from acute to chronic pain. WCN19-0628 doi:10.1016/j.jns.2019.10.482

Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - WCN19-0621 Part I /stroke /training in neurology - Part I and traumatic brain injury

Poster shift 01 - Channelopathies /neuroethics /neurooncology / Admission neutrophil to lymphocyte ratio (NLR) as a predictive pain - Part I /sleep disorders - Part I /stem cells and gene therapy - factor in the outcome of acute spontaneous intracerebral Part I /stroke /training in neurology - Part I and traumatic brain hemorrhage (ICH) injury E. Hernandez, M.E. Collantes, C.J. Go Comparison of time to hospital admission of ischemic acute Manila Doctors Hospital, Internal Medicine, Manila, Philippines stroke before and after promotive and preventive program at emergency room national stroke hospital Bukittinggi 2018 Background and purpose A growing body of evidence supports that inflammatory mech- a b a R. Fitrina , A.H. Rahim , P.A. Sundari anisms are involved in secondary brain injury after intracerebral a National Stroke Hospital, Neurology, Bukittinggi, Indonesia hemorrhage (ICH) which has implications on the morbidity and b Jakarta, Indonesia mortality of stroke patients. Neutrophil to lymphocyte ratio (NLR) is a comprehensive index marker of inflammation and immune status Introduction of a patient. The prognostic value of NLR in predicting in-hospital We have been organized promotive and preventive program to mortality and functional outcome of patients with spontaneous increase community concern about stroke. Acute stroke management intracerebral hemorrhage will be assessed in this study. must be carried out quickly in order to improve outcome. Definitive therapy for stroke must be done quickly with an emphasis on "time Methods is brain" principle. We retrospectively selected 151 hemorrhagic stroke patients and demographic and clinical characteristics were collected and com- Aims puted for NLR. The association of NLR with the in-hospital mortality To compare time to hospital admission of acute stroke before and and functional outcome was assessed using Logistic regression after promotive and preventive program. analysis. Pearson Product Model Correlation was utilized to evaluate the correlation of NLR with ICH volume. Methods This is a retrospective cross sectional study including 200 patients Results medical record data at Emergency Room National Stroke Hospital Admission NLR showed a significant association (p=b0.001 OR Bukittinggi from January to December 2018. Time to hospital 7.99) with in-hospital mortality. Receiver operating characteristics admission is defined as time from symptom onset to hospital arrival. yielded a NLR threshold of 7 with a sensitivity of 70.83% and This study compared stroke onset of 100 patients before and 100 specificity of 72.82%. An NLR of more than 7 showed a greater patients after promotive and preventive program been organized. superiority in predicting in-hospital mortality than poor functional outcome (sensitivity=31%, specificity=86.67%). In addition, com- Results puted NLR of more than 6.4 showed significant association There were more male patients (59%) than female (41%) before (p=0.040 OR 2.92) with poor outcome. However, admission NLR the program and number of female patients increased to 52% after showed a low level of correlation (r=0.2968, p=0.002) with the program. Most samples in both group (37% before and 39% after volume of ICH. program) are 65 years old or more, with current hypertension (69,5%) and history of hypertension (70,5%) as the most risk factor. Conclusion Time to hospital before the program wad 24.0 (0.33-432) and after This study demonstrated that ICH patients with an elevated NLR the program was 24.5 (0.50-360). No significant defference between is associated with increased in-hospital mortality and poor functional before and after the program. outcome and that NLR could be used to predict clinical outcome of patients with ICH. Conclusion There was no significant difference in time to hospital admission at Emergency Room Stroke National Hospital Bukittinggi before and doi:10.1016/j.jns.2019.10.484 after promotive and preventive program in 2018. Further more, it is ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 35

WCN19-0631 cDr Ram Manohar Lohia Hospital, Medicine, New Delhi, India dAll India Institute of Medical Sciences, Neurology, New Delhi, India

Poster shift 01 - Channelopathies /neuroethics /neurooncology / Background pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Several patients are receiving stem cell therapy for stroke even Part I /stroke /training in neurology - Part I and traumatic brain though it is not proven through RCT. Summarizing this evidence injury using systematic review is worthwhile for establishing evidence.

Cardiac papillary fibroelastoma, a cause of acute embolic stroke: Method Report of two cases Two independent investigators searched electronic databases PubMed, Google Scholar for retrieving studies published from Jan J. Akhtar, A. Ceccarelli 2000 to Feb 2019. Combination of MeSH search terms “stem cell Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United therapy” OR “regenerative medicine” AND “stroke” OR “ischemic Arab Emirates stroke” used. Cochrane Mantel Haenszel test was used to compute the pooled standardized mean difference and risk ratio with 95% CI. Background Random effect model was used if heterogeneity was more than 50% fi Cardiac Papillary Fibroelastoma (PFE) is a rare benign cardiac otherwise xed effect model used. Revman version 5.3 was used for tumor mainly clinically asymptomatic that unexpectedly can cause a statistical analyses. wide variety of embolic manifestations in heart and brain. Results Cases presentation Five studies involving 161 participants in the intervention group Our first case was a 27 years old Indian man, with no previous and 197 in the control group.were included The meta-analysis did fi cardiac or cerebral diseases history, presented in emergency not suggest signi cant improvement in the stem cell group for stroke department (ED) with sudden onset of acute nausea, vomiting, scale barthel index (standarized mean difference 1.01, 95% CI -0.29 fi vertigo and imbalance. The neurological exam (NE) showed to 2.31, P =0.13). Signi cant reduction in NIHSS score in the cerebellar ataxia. Brain imaging showed acute right cerebellar infarct. intervention group compared to control (standardized mean differ- fi The transesophageal echocardiogram (TEE) showed a cardiac mass of ence -2.16, 95% CI -3.34 to -0.97, P= 0.0004). No signi cant the mitral valve that was subsequently defined as PFE by the cardiac difference in event of deaths between intervention and control MRI. The second case was a 50 years old Arabic male with no group (Risk ratio 0.66, 95% CI 0.31 to 1.31, P= 0.27). previous cardiac or cerebral diseases history, presented at our ED with acute onset of aphasia and right sided weakness. NE confirmed Conclusion the aphasia and right hemiparesis. Brain imaging showed patchy left This therapy does not lead to serious adverse event in patients middle cerebral artery infarction. TEE showed mobile echo density with ischemic stroke compared to control. Preliminary evidence of noted attached to the aortic valve which was consistent with the PFE. improvement in neurological outcome observed in stem cell group Evidence of large vessels occlusion and post infective vegetation based on small sample size studies. Well designed RCTs are were excluded in both cases. needed for conclusive evidence of stem cell therapy in such patients. Conclusion doi:10.1016/j.jns.2019.10.486 We have presented two cases of PFEs associated with cerebral embolic stroke. These clinical cases strengthen the notion that cardiac tumors carried a high risk of cerebral embolic presentation and emphasize the need to suspect their presence at every age in the event of an embolic stroke. Advanced imaging use is important for a WCN19-0634 correct diagnosis and management. Poster shift 01 - Channelopathies /neuroethics /neurooncology / doi:10.1016/j.jns.2019.10.485 pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain injury WCN19-0633 Stroke service in Thailand

Poster shift 01 - Channelopathies /neuroethics /neurooncology / S. Tiamkao pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Faculty of medicine, Khon Kaen University, Medicine, Khon Kaen, Part I /stroke /training in neurology - Part I and traumatic brain Thailand injury Background A meta-analysis of randomized controlled trials conducted using The incidence of acute stroke in 2009 was 172: 100,000 people stem cell therapy for patients with ischemic stroke aged 15 years and over, and increase to 286: 100,000 in 2018. Developing a stroke fast track service system started in 2009. A. Gulatia, S. Gulatib, S. Gulatic, R. Sagard, A. Kumara aAll India Institute of Medical Sciences, Clinical epidemiology unit, Delhi, Objective India To study the outcome of the development of stroke fast track bSir Ganga Ram Hospital, Medicine, New Delhi, India service system ARTICLE IN PRESS

36 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

Method The incidence of stroke and cerebrovascular involvement of FD in Study from reimbursement database, universal health care single center in Korea was similar in studies of western countries. coverage treatment rights in 2009-2018. The stroke mechanism of our cases were various as transient ischemic attack due to large artery disease and typical small vessel Results disease. However, the common radiological findings in FD such as The incidence of acute stroke in 2009-2018 was 172.25, 179.78, chronic white matter hyperintensities or pulvinar sign were lack in 199.15, 210.07, 220.61, 239.32, 253.85, 269.9, 289.6, and 286.58: our cases. Nationwide large cohort study is warranted to elucidate 100,000, respectively. The incidence of acute cerebral infarction the pattern of stroke and cerebrovascular involvement in Korean FD. (ACI) in 2009-2018 was 90.37, 100.79, 112.58, 122.78, 134.03, 146.61, 160.36, 170.85, 184.11, and 183.63: 100,000, respectively. doi:10.1016/j.jns.2019.10.488 The number of hospitals providing thrombolytic therapy in the 2009- 2018 was 24, 38, 53, 70, 99, 124, 138,150, 168, and 168, respectively. The rate of receiving thrombolytic therapy in 2009-2018 was 0.53, 1.24, 1.62, 2.19, 3.02, 3.85, 4.26, 4.82, 5.77, and 6.45%, respectively. WCN19-0639 The hospital mortality rate of ACI in 2009-2018 was 8.05, 8.33, 7.37, 7.19, 6.44, 6.09, 5.78, 5.06, and 4.76%, respectively. Most of provincial hospital service by neurologist, internist and emergency physician. Poster shift 01 - Channelopathies /neuroethics /neurooncology / All of district hospital service by internist and emergency physician. pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain Conclusion injury The incidence of acute stroke patients, especially ACI, has increased considerably. Increasing the rate of receiving thrombolytic Statin effects in atrial fibrillation-related stroke: A systematic therapy and reducing the mortality rate of hospital ACI patients. review and meta-analysis doi:10.1016/j.jns.2019.10.487 M.Y. Euna, J.M. Jungb, W.K. Seoc aSchool of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Neurology, Daegu, Republic of Korea WCN19-0638 bKorea University Ansan Hospital, Korea University College of Medicine, Neurology, Ansan, Republic of Korea c Poster shift 01 - Channelopathies /neuroethics /neurooncology / Samsung Medical Center, Sungkyunkwan University School of Medi- cine, Neurology, Seoul, Republic of Korea pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain Background injury Effects of statins on atrial fibrillation (AF)-related stroke are not well established. We aimed to evaluate whether statin therapy is ’ Cerebrovascuar involvement and stroke in Fabry s disease: Single associated with mortality and recurrent cardiovascular events after center experience in Korea AF-related stroke by conducting a systematic review and meta- analysis of recent observational studies. K.P. Parka, S.H. Ahna, M.G. Parka, I.S. Moonb, S.H. Kimc a Pusan National University Yangsan Hospital, Pusan National University Methods School of Medicine, Department of Neurology, Yangsan, Republic of Electronic databases (PubMed, EMBASE, and Cochrane library) Korea were searched to identify literature investigating the effect of pre- b Daedong Hospital, Department of Neurology, Busan, Republic of Korea and post-stroke statins on clinical outcomes in AF–related stroke c Dong-A University College of Medicine, Department of Neurology, patients. The primary outcome was all-cause mortality. Secondary Busan, Republic of Korea outcomes were recurrent ischemic stroke, recurrent all-type stroke, myocardial infarction, major adverse cardiovascular events (MACE), Fabry’s disease (FD) is an X-linked lysosomal storage disorder and poor functional outcome (mRS 4-6) at discharge. We extracted caused by α-galactosidase A deficiency due to GLA gene mutation. adjusted hazard ratios (HRs) and 95% confidence interval (95% CI) Cerebrovascular complication occurs in about a third of the patients. from multivariable analysis of each study to diminish limitations of FD is one of the important cause of young stroke. We studied observational studies. The pooled estimates on each outcome were cerebrovascular involvement in FD and report two cases of acute acquired. stroke associated with FD in single center of Korea. From May 2008 to May 2019, we identified 26 FD patients with Results genetically confirmed diagnosis in our tertiary university hospital. A total of 6 studies were divided into post-stroke statin group Among them, nine were studied by MRI or MRA due to various (n=5) and pre-stroke statin group (n=2). Post-stroke statin therapy reasons. Only two showed symptomatic and radiological cerebro- was associated with reduced risk of all-cause mortality (HR, 0.64; vascular involvement (7.7%). Otherwise 7 were normal neurologi- 95% CI, 0.55–0.74, I2=13%). Regarding to recurrent ischemic stroke, cally and radiologically. One case was 33 year-old man, who showed post-stroke statin was not effective to prevent event (HR, 0.99; 95% as transient ischemic attack of transient dysarthria and right limb CI, 0.80-1.21, I2=21%). There were no significant association weakness. Diffusion-weighted image (DWI) showed no abnormali- between post-stroke statin therapy and risk reduction of recurrent ties. Multifocal stenosis in cerebral arteries were seen in MRA. The stroke, myocardial infarction, or MACE. Pre-stroke statin use was other was 53 year-old woman, who showed diplopia and left ocular associated with a low risk of poor functional outcome at discharge tilt reaction. DWI showed focal diffusion restriction in right (HR, 0.76; 95% CI, 0.60-0.96, I2=9%). paramedian thalamus. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 37

Conclusions Conclusions In these meta-anal Surgery in MMCAI is associated with 60% survival and, survivors yses, statin therapy was associated with risk reduction of all- are left with signiﬁcant disability which changes little over time. cause mortality and poor functional outcome in patients with AF- related stroke. doi:10.1016/j.jns.2019.10.490 doi:10.1016/j.jns.2019.10.489

WCN19-0645

WCN19-0644 Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Poster shift 01 - Channelopathies /neuroethics /neurooncology / Part I /stroke /training in neurology - Part I and traumatic brain pain - Part I /sleep disorders - Part I /stem cells and gene therapy - injury Part I /stroke /training in neurology - Part I and traumatic brain injury Correlation of different sleep apnea scores with polysomnographic study in patients with acute stroke and transient Prospective longitudinal study of outcomes of decompressive ischemic attack craniectomy for malignant middle cerebral artery infarct- Results from Bangalore South India S. Patela, N. Daveb, S. Pandac, C. Agrawalb aKD Hospital, Neurology, Ahmedabad, India G. Kulkarnia, C. Reddyb, S. Somannac, A. Hanumanthpura Ram- bSir Ganga Ram Hospital, Neurology, Delhi, India alinghiahd cAIIMS, Neurology, Jodhpur, India aNational Institute of Mental Health And Neurosciences NIMHANS, Neurology, Bangalore, India Objective b Yashodha Hospital, Neurology, Hyderabad, India To study correlation between different sleep apnea scores and c National Institute of Mental Health And Neurosciences NIMHANS, polysomnographic study in patients with acute stroke and transient Neurosurgery, Bangalore, India ischemic attack (TIA). dNational Institute of Mental Health And Neurosciences NIMHANS, Neuroradiology, Bangalore, India Background Obstructive sleep apnea hypopnea syndrome (OSAHS) is a Introduction common disorder affecting general population. There is increase in Decompressive surgery (DC) for Malignant MCA infarct (MMCAI) cardiovascular and stroke risk in patients with untreated OSAHS. is lifesaving. The study objective was to explore the immediate and Frequency of OSAHS in acute stroke patients appears much higher, long-term outcomes in patients seen in stroke unit of a developing reaching almost 70%. Screening of OSAHS requires careful sleep country over 2 years (November2015 to October2017). history which may include preformed questionnaire. The objective of the study was to study correlation between different sleep apnea Methods scores and polysomnographic study in patients with acute stroke/ Prospective, longitudinal study of MMCAI patients confirmed by TIA. CT with features of herniation and undergoing DC. Outcome measured by mortality and mRS over 3,6,12 months. Informed Design/method consent and ethical approval obtained. 50 patients of acute ischemic stroke/TIA presenting to Sir Ganga Ram Hospital were enrolled in the study. Patients were subjected to Results clinical data collection, neurological examination, laboratory assess- Thirty patients (M:F::26:4,mean age:42.3±11.9 (range 27-70, ment, brain imaging, sleep apnea scoring using STOP questionnaire, 70%b45yrs), (22-MCA, 8-MCA with ACA/PCA)) with median duration STOP Bang questionnaire and SOS score (Sleep apnea score of symptoms1 day (range:1-4) were seen. At presentation weakness- optimized for stroke) and polysomnography (class I sleep study). 30 (100%), altered sensorium 27 (90%), pupillary asymmetry 11 (36.7%) were seen. Among them17 (56.7%) underwent DC within 48 Results hrs and 13 (43.3%) after48 hrs. Preoperative GCS was 8.0±2 (range Prevalence of OSAHS (defined as AHI = 5) was 30%. Out of 50 3-13),infarct volume-249.1±66.5 ml.Post op 24hours GCS- 9.0±3.1 patients 4% had mild OSAHS, 8% had moderate OSAHS and 18% had (range 4-15). Duration of hospital stay-22.4±20.1 days.Nineteen severe OSAHS. Hypertension was most frequent comorbidity in our (63.3%) patients required ventilatory support.Complications seen: study. There was significant association between positive STOP pulmonary infection-4, DVT 2, sepsis-1, epiduralcollection-1 patients. questionnaire, SOS score and AHI index (=5). p value was b0.001 Mortality was 12 (40%)(10-during admission, 2 later) with younger for both. For STOP Bang questionnaire and AHI index (=5) p value age associated with survival. Timing of surgery, side, size of infarct, was 0.067 suggesting no association. midline shift and GCS were not significant. Median mRS at 3, 6 and 12 months were 5, 5, 4 respectively.At the end of 12 months 5 Conclusion (16.6%)patients had good outcome (mRS≤3) and 25 (83.3%) patients Prevalence of OSAHS is quite high (30%) among stroke patients. had poor outcome, again age of the patients was significant and STOP questionnaire and SOS score should be used for sleep apnea unrelated to timing of surgery and preop GCS and midline shift. prediction in stroke patients.

doi:10.1016/j.jns.2019.10.491 ARTICLE IN PRESS

38 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0649 Introduction Patients need an effective treatment to combat the harm painful peripheral neuropathy (PPN) inﬂicts on them. Experts describe our Poster shift 01 - Channelopathies/neuroethics/neurooncology/ current treatments as “inadequate,”“frustrating and maybe even pain - Part I/sleep disorders - Part I/stem cells and gene therapy - appalling” while claiming that “nerves in patients with neuropathy Part I/stroke/training in neurology - Part I and traumatic brain are irreversibly damaged.” Thus, Regenerating nerves, Reducing pain, injury and Restoring function without side effects deﬁnes a truly effective treatment. Intravenous thrombolysis by tenecteplase: Experience of the Odell and Sorgnard brilliantly developed CET (Combined Electro- neurology department of Chu Hassan II Fez, Morocco chemical Treatment) to effectively treat neuropathy.

H. Benjebara, I. Najmi, N. Chtaou, A. El Midaoui, Z. Souirti, M.F. Method Belahcen A retrospective outpatient study using CET on six patients with Neurology, Neurology, Fez, Morocco PPN did not require Institutional Review Board approval, but did receive consent from each of the treated patients. Epidermal Nerve Fiber Density (ENFD) biopsies were done before and after treatment. Background The highest pain scores and functioning indexes were recorded Intravenous infusion of alteplase was the thrombolytic agent used during the treatment, at the end of treatment and when last seen. for thrombolysis of ischemic stroke since 2010 in our neurology Changes in medication use and side effects were recorded. department.Tenecteplase was used as a thrombolytic agent for 127 patients in 2 years.The objective of our study is to determine the Results prevalence of Thrombolysis patients by Tenecteplase, to evaluate the Five of six patients were followed for an average of 26 months length of care, the NIHSS scale before and after thrombolysis, the after ending treatment and one lost to follow-up. On average, five of modified Rankin scale at 3 months, in order to assess the autonomy six (83%) had a 91% increase in their nerve fibers. The average and the mortality rate. patient reduced their pain 75% at the end of treatment and 81% when last seen, while improving their function by 60% at the end of Methods treatment and 65% when last seen. Four of five patients on It’s a retrospective study involving a group of 127 patients over 2 medication for PPN stopped one or more of these. None had side years old, who have undergone intravenous Thrombolysis by effects. tenecteplase in our department. Conclusion Results These results prove that CET, which can easily be used in any The mean age was 67 years with a slight male predominance office that treats neuropathy, meets the definition of an effective (69%). High blood pressure was the main cardiovascular risk factor. treatment for PPN. 38% of patients had a NIHSS between 8 and 14, 47% greater than 14. The average time to admit patients (from onset of symptoms to doi:10.1016/j.jns.2019.10.493 arrival in the emergency room) was 130 minutes. The average imaging time (from admission to the imaging room) was 22 minutes. The mean time to Thrombolysis (from admission to emergency at the start of treatment with rt-PA) was 69 minutes. The average time from onset of symptoms to treatment was 200 minutes.The main WCN19-0652 etiology for our patients was the cardio-embolic origin.The mean of fi the Rankin scale is not yet de ned (our study is in progress). Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/Sleep disorders - Part I/stem cells and gene therapy - Conclusion Part I/stroke/training in neurology - Part I and traumatic brain This study shows that tenecteplase before thrombectomy was associated with a high incidence of reperfusion and appears to be injury effective in thrombolysis among patients with ischemic stroke. Isolated perimesencephalic subarachnoid hemorrhage as pre- doi:10.1016/j.jns.2019.10.492 senting feature of basilar artery dissection: A case report

H. Ashayeriahmadabad, Z. Mirzaasgari, M. Mehrpoor, B. Zamani Iran University Of Medical Sciences, Neurology, Tehran, Iran WCN19-0651 Subarachnoid hemorrhage (SAH) is a life threatening condition with high mortality and morbidity. Perimesencephalic SAH accounts Poster shift 01 - Channelopathies/neuroethics/neurooncology/ for 10 percent of spontaneous SAH cases and is presumed to be pain - Part I/sleep disorders - Part I/stem cells and gene therapy - idiopathic but the most common hypothesis is venous rupture. Part I/stroke/training in neurology - Part I and traumatic brain However, we present a case of 40 year-old female with thunderclap injury headache during running, nausea and recurrent vomiting. On examination she was awake and aware with Glasgow Coma Scale Effectively treating painful peripheral neuropathy: A study of six (GCS) of 15. All other neurological examinations were normal except cases for mild meningismus. Brain computed tomography (CT) revealed SAH conﬁned to perimesencephalic cisterns with mild dilated lateral P. Carney ventricles (Fig. 1A). Three dimensional CT angiography (CTA) Pain Medicine, Elkhart, USA showed mild stenosis of basilar artery (Fig. 1B). However cerebral ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 39 angiography disclosed smooth narrowing and intimal ﬂap in other CIS patients (p=0.248). Conclusion: The risk of RIS was very midpontine part of basilar artery without any aneurysmal dilation low and did not differ between young ESUS and other CIS patients. (Fig. 1C-D). Diagnosis of ruptured basilar artery dissection (BAD) was made and she was treated conservatively for headache and blood Acknowledgment pressure monitoring. Nevertheless when SAH was cleared after one Supported by the grant of Ministry of Health of Czech Republic n. week on repeat CT scan she was put on single anti-platelet therapy 17-30101A and IGA LF UP_008_2019. with clopidogrel due to steno-occlusive pattern of BAD. She was discharged home after 10 days of admission with good recovery. Non doi:10.1016/j.jns.2019.10.495 aneurysmal BAD is a rare but important cause of isolated perimesencephalic SAH and conservative therapy including blood pressure control and anti-platelet might be a reasonable option for steno-occlusive type of BAD. Although this entity is rare, but it is a WCN19-0662 devastating condition and requires prompt attention and comprehensive management. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ doi:10.1016/j.jns.2019.10.494 pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain injury

WCN19-0659 Tricky factors

a b b b b c Poster shift 01 - Channelopathies/neuroethics/neurooncology/ P. Fiori , A. Corbo , G. Corbo , L. Iorillo , G. Capaldo , F. Botticella ,C. c c c c d pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Dragonetti , A. Morella , V. Pellecchia , G. Bellizzi , C. Pelosi ,P. Savinod, M. Albericoe, G. Benignie, M. De Caroe, B. Guerrieroe, E. Pacee, Part I/stroke/training in neurology - Part I and traumatic brain E. Mazzaf, C. Tammarog, L.M. Giannettih, A. Monacob injury aOspedale S.Ottone Frangipane - ASLAV - II University of Naples, Neurology, Ariano Irpino, AV, Italy Risk of recurrent ischemic stroke in young cryptogenic patients bS. Ottone Frangipane Hospital- ASLAV- II University of Naples, with embolic stroke of undetermined source Neurology, Ariano irpino, AV, Italy cS. Ottone Frangipane Hospital- ASLAV- II University of Naples, a a b a a b D. Sanak , P. Divisova , M. Hutyra , M. Kral , A. Bartkova , J. Latal ,J. Cardiology, Ariano irpino, AV, Italy c a b a a Zapletalova , T. Veverka , S. Hudec , D. Franc , T. Dornak ,P. dS. Ottone Frangipane Hospital- ASLAV- II University of Naples, Internal a Kanovsky Medicine, Ariano irpino, AV, Italy a Palacký University Hospital, Comprehensive Stroke Center, Department eS. Ottone Frangipane Hospital- ASLAV- II University of Naples, Intensive of Neurology, Olomouc, Czech Republic Care, Ariano irpino, AV, Italy b Palacký University Hospital, Department of Cardiology, Olomouc, Czech fS. Ottone Frangipane Hospital- ASLAV- II University of Naples, Republic Radiology, Ariano irpino, AV, Italy c Palacký University Medical School, Department of Biophysics and gS. Ottone Frangipane Hospital- ASLAV- II University of Naples, statistics, Olomouc, Czech Republic Laboratory, Ariano irpino, AV, Italy hS. Ottone Frangipane Hospital- ASLAV- II University of Naples, Infantile Introduction Neuropsychiatry, Ariano irpino, AV, Italy In young patients, cause of ischemic stroke (IS) remains very often cryptogenic and thus effectiveness of secondary prevention The activation of clotting cascade occurs in several conditions, may be uncertain. Elderly cryptogenic IS patients (CIS) with ESUS from inflammatory to oncologic ones. The detection of early (Embolic Stroke of Undetermined Source) have a higher risk of biomarkers may prevent thrombosis and reduce mortality. recurrent IS (RIS). The aim was to compare risk of RIS between ESUS The aim of our study was to assess fibrinogen and d-dimer for and other young CIS patients. better prediction of thrombophilic risk and for improving reliability of prognosis. Methods We recruited 1720 Acute Strokes (AS), 738 Chronic Cerebro- The study set consisted of young acute IS patients b 50 years Vascular Diseases (CCVD) and 285 Other Neuropsychiatric Diseases enrolled in the prospective HISTORY (Heart and Ischemic STrOke (OND). We classified them according to cardiological dysfunctions Relationship studY) study registered on ClinicalTrials.gov and ongoing therapies. Blood withdrawal was performed within 24 (NCT01541163). In all patients, brain ischemia was confirmed on hours. CT/MRI. Admission ECG, serum specific cardiac and thrombophilia Our preliminary results showed significant differences in fibrin- markers, neurosonology, TEE, 24-hour and 3-week ECG-Holter were ogen and d-dimer levels in all AS compared to OND. Surprisingly, a performed to assess cause of IS according to the ASCOD classification. higher percentage of patients in class I/II New York Heart Association (NYHA), A/B American Cardiology Association (ACA) scales had Results values over a cut off value of 350 mg/dl of fibrinogen compared to Of 279 enrolled patients b 50 years (153 males, mean age 41.1 ± those in class III/IV NYHA, C/D ACA. The difference in fibrinogen 7.8 years), 199 (71%) were identified as cryptogenic and 106 (59 levels were statistically more significant in the former, compared to males, mean age 40.7 ± 7.5 years) fulfilled ESUS criteria. During the the latter, because of lower standard deviation. follow-up with a median of 17 months, two (2%) ESUS and 4 (4%) Early autonomic dysregulation may lead to a thrombophilic other CIS patients suffered from RIS (p=0.421). The mean time to milieu, triggering and or worsening haemodinamic dysfunctions RIS did not differ between both groups (14 vs. 27 months, p=0.248). and microemboli formation also in class I/II NYHA, A/B ACA. High One-year risk of RIS was 0 for ESUS and 0.025 (95% CI: 0-0.059) for fibrinogen level represents an early marker of increased ARTICLE IN PRESS

40 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx thrombophilic risk, being converted by thrombin into fibrin. It is a outcomes. Low CR in CCVD may reflect arteriosclerosis and pharmaco- red flag in class III/IV NYHA, C/D ACA. D-dimer is a degradation logical effects. Our observations may be useful for planning rehabilita- product of fibrin. High d-dimer/fibrinogen ratio may prelude an tion in AS, health-enhancing-physical-activity in aging. Moreover, they increased risk of haemorrhagic complications in cerebrovascular may reduce the risk of injuries for training overload in athletes. diseases as well as in late stage of other severe conditions, as pulmonary thromboembolism and cancers. doi:10.1016/j.jns.2019.10.497 doi:10.1016/j.jns.2019.10.496

WCN19-0667

WCN19-0665 Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Part I/stroke/training in neurology - Part I and traumatic brain pain - Part I/sleep disorders - Part I/stem cells and gene therapy - injury Part I/stroke/training in neurology - Part I and traumatic brain injury Even late may still be brain, but be careful

Let’s develop our Olympic brain P. Fioria, A. Corboa, G. Corboa, L. Iorilloa, G. Capaldoa, F. Botticellab,C. Dragonettib, A. Morellab, A. Pellecchiab, G. Bellizzib, C. Pelosic,P. P. Fioria, A. Corboa, G. Corboa, L. Iorilloa, G. Capaldoa, F. Botticellab,C. Savinoc, M. Albericod, G. Benignid, M. De Carod, B. Guerrierod,E. Dragonettib, A. Morellab, V. Pellecchiab, G. Bellizzib, C. Pelosic,P. Paced, E. Mazzae, C. Tammarof, L.M. Giannettig, A. Monacoa Savinoc, G. Romanod, M. Albericoe, G. Benignie, M. De Caroe,B. aOspedale S.Ottone Frangipane - ASLAV - II University of Naples, Guerrieroe, E. Pacee, E. Mazzaf, C. Tammarog, L.M. Giannettih,A. Neurology, Ariano Irpino, AV, Italy Monacoa bOspedale S.Ottone Frangipane - ASLAV - II University of Naples, aOspedale S.Ottone Frangipane - ASLAV - II University of Naples, Cardiology, Ariano Irpino, AV, Italy Neurology, Ariano Irpino, AV, Italy cOspedale S.Ottone Frangipane - ASLAV - II University of Naples, Internal bOspedale S.Ottone Frangipane - ASLAV - II University of Naples, Medicine, Ariano Irpino, AV, Italy Cardiology, Ariano Irpino, AV, Italy dOspedale S.Ottone Frangipane - ASLAV - II University of Naples, cOspedale S.Ottone Frangipane - ASLAV - II University of Naples, Internal Intensive Care, Ariano Irpino, AV, Italy Medicine, Ariano Irpino, AV, Italy eOspedale S.Ottone Frangipane - ASLAV - II University of Naples, dOspedale S.Ottone Frangipane - ASLAV - II University of Naples, Radiology, Ariano Irpino, AV, Italy Nephrology, Ariano Irpino, AV, Italy fOspedale S.Ottone Frangipane - ASLAV - II University of Naples, eOspedale S.Ottone Frangipane - ASLAV - II University of Naples, Laboratory, Ariano Irpino, AV, Italy Intensive Care, Ariano Irpino, AV, Italy gOspedale S.Ottone Frangipane - ASLAV - II University of Naples, fOspedale S.Ottone Frangipane - ASLAV - II University of Naples, Infantile Neuropsychiatry, Ariano Irpino, AV, Italy Radiology, Ariano Irpino, AV, Italy g Ospedale S.Ottone Frangipane - ASLAV - II University of Naples, High levels of troponin T (hsTroT) and NT-Pro-Brain Natriuretic Laboratory, Ariano Irpino, AV, Italy Peptide (NT-Pro-BNP) were detected in elderly patients affected h Ospedale S.Ottone Frangipane - ASLAV - II University of Naples, with cerebrovascular diseases, especially in those in class III/IV, C/D Infantile Neuropsychiatry, Ariano Irpino, AV, Italy New York Heart Association (NYHA) and American Cardiology Association (ACA) scales (Fiori P. et al., 2018). Pulse rate (PR) may be considered a reflex of heart rate (HR). In Our study evaluated whether their increase may account for worst sporting, there is no significant mismatch. In hypovolemia PR is ASPECTS scores in early, acute stroke at Computerized Tomography. higher, in hypervolemia with heart failure, it progressively weans. The highest levels of hsTroT were detected in class III/IV, C/D We defined beat indices the difference (D) and the ratio (R) between patients with at least 50% relative increase (rI) compared to those maximal (MaxHR) or minimal (MinHR) HR on maximal (MaxPR) or with at least 50% relative decrease (rD) of NT-Pro-BNP at day VII. minimal (MinPR) PR, as expression of cardiovascular reactivity (CR). These patients had the lowest GCS at admission, as well as the lowest Biomarkers and Holter Arterial Pressure Measurements were GCS and highest MRS at day VII. ASPECTS scores were tendentially assessed in Acute Stroke (AS), Chronic Cerebro-Vascular Diseases lower in class III/IV AS patients with stable or increased levels of NT- (CCVD), Other Neuropsychiatric Diseases (OND). pro-BNP compared to those with at least 100% rD of NT-pro-BNP at MaxHR, MaxPR and PR Standard Deviation were significantly day VII. In the former, significant correlations were found between higher in AS. Max R increased in Atrial Fibrillation-AS (AF-AS), Min R ASPECTS, GCS, hsTroT at admission, GCS and MRS at day VII. in Normal Rate (NR-AS), Tachycardia (TAC-AS) and AF-AS. Higher Our results highlight that even late may still be brain in all AS, the HR, cardiac and renal biomarkers, lower the Glasgow Come Scale class III/IV, C/D NYHA, ACA included. However, poor collaterals, and higher the Modified Rankin Scale were in all patients, especially decreased perfusion, increased diffusion, retrograde venous leakage in those in class III-IV New-York-Heart-Association, C/D American- may account for futile recanalization and increase the risk of Cardiology-Association scales. MaxCR correlated with cardiac bio- haemorrhagic complications. Further studies are needed for better markers in TAC-AS, renal dysfunctions in AF-AS. A reduced MaxCR defining the therapeutical window in AS patients suffering from was observed in CCVD. heart failure, decision making concerning the strategy of “scoop and The central autonomic network is the generator of the dynamic run” to mechanical thrombectomy or “stay and play” with plasmin- balance between cholinergic and adrenergic activity. Its dysfunction ogen activators and/or other pharmacological agents. triggers a pathological cascade, leading to allostatic overload. Its persistence is responsible of multiorgan impairments. A similar pattern doi:10.1016/j.jns.2019.10.498 of CR was observed in TAC and AF-AS and it may relate to worst ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 41

WCN19-0675 S.W. Jeonga, W.S. Ryub aDongguk University Ilsan Hospital, Department of Neurology, 27- Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea Poster shift 01 - Channelopathies/neuroethics/neurooncology/ bDongguk University Ilsan Hospital, Department of Neurology, Goyang- pain - Part I/sleep disorders - Part I/stem cells and gene therapy - si, Gyeonggi-do, Republic of Korea Part I/stroke/training in neurology - Part I and traumatic brain injury Background Using a large sample-sized patients and quantitative measure- Risk of epilepsy in stroke patients ment of WMH, we investigated the impact of WMH on stroke recurrence, type of recurrence (ischemic vs. hemorrhagic). J.H. Leea, S.H. Hwangb, J.H. Parkc aNational Health Insurance Service Ilsan Hospital, Neurology, Goyang-si, Method Republic of Korea A total of 7101 ischemic stroke patients were enrolled. Type of bHallym University Hospital, Neurology, Seoul, Republic of Korea stroke recurrence were prospectively captured. WMH were stratified cInje University Hospital, Neurology, Seoul, Republic of Korea into quartiles. To examine the independent impact of WMH on the type of stroke recurrence, we used cox regression and competing risk Background and objectives analysis as appropriate. The incidence of epilepsy in elderly stroke patients has been significant attention because planning future needs for health Results services and improved primary and secondary prevention of stroke Mean age was 67.8 (standard deviation 12.7) and 4170 (58.7%) – are important. We evaluated the relationship between stroke and the were men. During 1-year, 345 (4.9%) patients had recurrent stroke fi subsequent development of epilepsy within 10 years follow-up. 286 ischemic strokes, 28 hemorrhagic strokes, 25 unclassi ed strokes, and 6 transient ischemic attacks. Cox regression analysis Methods showed that WMH quartiles were independently associated with fi This study included a cohort of 42,925 patients who were first recurrent all strokes. Compared with the rst quartile, adjusted fi diagnoses as stroke between 2004 and 2006. To match each stroke hazard ratio (HR) for fourth quartile was 1.84 (95% con dence – patient, 218,478 control subjects were selected from the data-base. interval 1.27 2.68, Table). Competing risk analysis demonstrated that only the fourth quartile of WMH was associated with recurrent Result ischemic stroke after adjusting for covariates (adjusted HR 1.54, 95% fi – In this cohort, the prevalence of stroke was higher in female con dence interval 1.07 2.29). With respect to hemorrhagic (62%) than in male (38%). A higher prevalence of stoke was observed stroke, WMH quartiles strongly associated with recurrent hemor- fi in the 60-70 years age and more than 80 years age group in urban rhagic stroke (p for trend = 0.003). Compared to the rst quartile, area. The incidence of stroke was increased from 2002 to 2009, but adjusted subdistribuion HR for third and fourth quartiles were 12.1 fi – – decreased from 2010 to 2013. The diagnosis of epilepsy was done at (95% con dence interval 1.5 99.0) and 29.5 (3.6 242.1). averagely 20 months after the diagnosis of stroke. Cox regression respectively. analysis showed that the HR of epilepsy was 7.658 times greater for patients with stroke (95% CI: 7.402-7.923) than for control group Conclusion after adjusting for other risk factors. The HR of epilepsy was 1.08 WMHs are more strongly associated with recurrent hemorrhagic (95% CI: 1.045-1.116) in female patients, 1.66 (95% CI: 1.607-1.715) stroke than ischemic stroke. Our data implicate that WMHs might be in diabetic patients, 1.679 (95% CI: 1.625-1.734) in hypertensive used as a risk marker of recurrent hemorrhagic stroke in patients patients, 1.831 (95% CI: 1.626-2.062) in chronic kidney disease and with ischemic stroke. 1.647 (95% CI: 1.593-1.703) in hypercholesterol patients. doi:10.1016/j.jns.2019.10.500 Conclusion Our findings suggest that stoke may be independent risk factor for epilepsy in elderly patients (HR 7.658, 95% CI: 7.402-7.923). So we need to control and pay attention to epilepsy in elderly stroke WCN19-0679 patients. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ doi:10.1016/j.jns.2019.10.499 pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in nuerology - Part I and traumatic brain injury WCN19-0678 Risk scores for predicting stroke associated pneumonia: Validity of A2DS2 and ISAN scores Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - H. Elhasina, M. Szolicsa, A. Hassana, N. Solimanb, A. Kaaschc Part I/stroke/training in neurology - part I and traumatic brain aTawam hospital, Neurology, Al ain, United Arab Emirates injury bTawam hospital, Neurology, Al Ain, United Arab Emirates cHeinrich-Heine-University Düsseldorf, Institute for Medical Microbiol- White matter hyperintensities are more strongly associated with ogy and Hospital Hygiene, Düsseldorf, GermanyKeywords: Stroke recurrent hemorrhagic stroke than ischemic stroke associated pneumonia, A2DS2 score, ISAN score ARTICLE IN PRESS

42 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

Background Conclusion Strokeassociated pneumonia (SAP) is a major cause of in-hospital Clinical risk scores are simple and reliable tools for predicting morbidity and mortality inacute stroke patientswith a strong inhospital SAP and the prevention of SAP needs to be strengthened association with a poor functional outcome.Clinical risk scoring in acute ischemic stroke patients with high scores. systems as A2DS2 (Age, Atrial Fibrillation-Dysphagia, Stroke severity, doi:10.1016/j.jns.2019.10.501 Sex) and ISAN (Independence pre-stroke, Sex, Age, NIHSS) scores may be a useful tool to identify patients at an increased risk of pneumonia. WCN19-0681 Objectives We aimed to assess the incidence of in hospital SAP and mortality Poster shift 01 - Channelopathies/neuroethics/neurooncology/ and asses the validity of A2DS2and ISAN scores to predict SAP in pain - Part I/sleep disorders - Part I/stem cells and gene therapy - acute ischemic stroke patients. Part I/stroke/training in neurology - Part I and traumatic brain injury Method and materials This study was a prospective observational study of consecutive ischemic stroke patients admitted over a period of one year in Al Ain Screening for stroke in emergency room with the Los Angeles hospital stroke unite. Sensitivity and speciﬁcity of each score were prehospital stroke screen (Lapss) in two central hospitals in Laos assessed for in-hospital SAP. S. Keovilayhonga, M. Mayxayb, K. Phetsirisenga a Results Mittaphab hospital, Neurology department, Vientiane capital, Laos b The overall incidence rate of SAP and mortality in this study were University of Health Sciences- Laos, President of University, Vientiane 21% (n=42) and 4.5% (n=9), respectively. The incidence of SAP and capital, Laos mortality were increased in patients with a higher A2DS2 score (5- 10), and a higher ISAN score (11-22). The A2DS2 score was superior Background and propose toISAN score for predicting in-hospital pneumonia. The AUC of the In Laos, there is no screening test for patients suspected of stroke. A2DS2 and ISAN scores were (0.955 (95% [CI] 0.929-0.981) and 0.845 The Los Angeles Stroke Screen (LAPSS) has been proved more ([CI] 0.771-0.909), respectively. Both scores were nearly the same performant than the FAST test as a screening tool for stroke in senstivity (0.881 for A2DS2 and 0.889 for ISAN score). developed countries. We applied LAPSS in emergency departments ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 43 to improve stroke awareness and reduce duration of door to needle admission eleven months later, patient was given hypertonic saline time in Laos. infusion for sodium correction. Instead of increasing sodium level, this infusion decreased sodium level. Oral lithium was started and Methods serum sodium level raised to 135 mg/dL. Lithium was continued for Medical staffs in Emergency departments were trained by a 1 months. Serum sodium kept normal between 135-139 mg/dL. neurology resident to screen patients suspected of stroke with LAPSS. Results were compared with the emergency department and final Conclusions discharges diagnoses. Sensitivity and specificity scores were The administration of sodium increases sodium delivery to the calculated. loop of Henle and an increased renal tubular reabsorption of water, which leads to worsening of hyponatremia. Lithium carbonate Results decrease reabsorption of water in renal tubular. So, it can recover From April to October 2016, the LAPSS data sheet was completed hyponatremia. for 214 patients. A LAPSS positive result was produced for 64.48% of cases. Sensitivity and specificity was 93.93% and 96.77% respectively. doi:10.1016/j.jns.2019.10.503 Sensitivity differed slightly between two groups: 91.42% for non- MD-diagnosed cases and 92.03% for MD-diagnosed cases, but the specificity was very high: 100% for MD and 96.96% for non-MD. Excluding N45 years old patients, decreased sensitivity to 91.89% WCN19-0702 while letting specificity unchanged. Seventy-five per cent of examiners completed the form in 5 minutes. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Conclusion pain - Part I/sleep disorders - Part I/stem cells and gene therapy - LAPSS can be considered as a relevant tool to screen for stroke Part I/stroke/training in nuerology - Part I and traumatic brain patients in peripheral hospital who should be referred to a Stroke injury Unit. Affective disorders in patients with the cerebral stroke doi:10.1016/j.jns.2019.10.502

P. Kovzelev, A. Krasilnikova, N. Batueva, M. Topuzova, T. Alekseeva Federal State Budgetary Institution “V.A. Almazov National Medical Research Center” of the Ministry of Health of the Russian Federation, WCN19-0701 Neurology and Psychiatry, Saint-Petersburg, Russia

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Purpose pain - Part I/sleep disorders - Part I/stem cells and gene therapy - To determine the effect of anxiety, depression, fatigue and drowsiness on the dynamics of neurological disorders in the acute Part I/stroke/training in neurology - Part I and traumatic brain period of stroke. injury Materials and methods Prolonged hyponatremia following mild head injury - A case The study involved 56 patients (28 women and 28 men), the report average age was 62.3 ± 9.7 years. The severity of neurological deﬁcit and affective disorders was assessed according to the scales: NIHSS, L. Lifea Barthel, Rankin, Rivermead, HADS, ESS, FSS, and FIS. The assessment Kasih Ibu Hospital, Neurology, Badung, Indonesia was carried out at the admission and at the discharge.

Objective Results A case of patient with prolonged hyponatremia following mild A decrease in neurological deficit and in the level of anxiety and head injury is presented. Cerebral salt wasting is potential cause of depression was observed (NIHSS 5.1 ± 3.9 → 2.2 ± 1.8, p b0.001, hyponatremia in those with CNS disease, particularly subarachnoid Barthel 61.9 ± 20.7 → 89.9 ± 11.2, p b0.001, Rankin 3,05 ± 0.94 → hemorrhage. It usually subsides in several weeks as the cause is 1.73 ± 0.82, p b0.001, Rivermead 5.8 ± 3.5 → 11.6 ± 3.1, p b0.001, resolved. HADS anxiety : 6.1 ± 4.2 → 5.3 ± 3.9, p = 0.024; HADS depression: 5.6 ± 3.2 → 4.9 ± 3.1, p = 0.009). A decrease in the level of anxiety, Case depression and drowsiness in the men group reached statistical A 40 years old woman was admitted to hospital consciously due significance (p = 0.048, p = 0.014, p = 0.027). The combined effect to head injury. Head CT scan showed subarachnoid hemorrhage at of anxiety and depression on the severity of neurological deficit was frontal region with brain swelling. On day 3, she had generalized revealed (p = 0.014) during analysis of variance. seizure and became drowsy. Serum sodium and serum osmolality were low (108 mg/dL and 276 mosmol/kg). Urine sodium was high Conclusions (235 mmol/24 hours) and urine osmolality was within normal limit Patients in the acute period of stroke showed an improvement in (530 mosmol/kgH2O). Diagnosis of cerebral salt wasting was made. neurological functions, a decrease in the severity of affective Hypertonic saline (NaCl 3%) was administered to raise sodium level. disorders (especially in men). The degree of regression of neurolog- Seizure stopped, sodium level raised around 120-125 mg/dL and ical disorders depends on the level of depression and anxiety. patient’s condition was getting better. She was discharged 1 month later. There were several readmissions due to persistent hyp- doi:10.1016/j.jns.2019.10.504 onatremia despite enough oral sodium supplementation. On the last ARTICLE IN PRESS

44 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0706 cPalacký University Medical School and Hospital, Department of Radiology, Olomouc, Czech Republic dMasaryk Hospital Ústí nad Labem KZ a.s., Faculty of Health Studies, J.E. Poster shift 01 - Channelopathies /neuroethics /neurooncology / Purkinje University, Department of Radiology, Ústí nad Labem, Czech pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Republic Part I /stroke /training in neurology - Part I and traumatic brain ePalacký University Medical School and Hospital, Department of Medical injury Biophysics and Statistics, Olomouc, Czech Republic fKZ a.s.- Masaryk Hospital, Comprehensive Stroke Center, Department of Trigeminal neuralgia as a presenting symptom of brain metasta- Emergency, Ústí nad Labem, Czech Republic sis in advanced stage of breast cancer Introduction J.W. Shina,E.Oha, D.H. Kimb Many different factors may have an impact on clinical outcome aChungnam national university hospital, Neurology, Daejeon, Republic after mechanical thrombectomy (MT) for acute ischemic stroke of Korea (AIS). We aimed to investigate levels of serum glycemia (GLY) bDong-A University Hospital, Neurology, Busan, Republic of Korea within the ﬁrst 48 hours after MT.

Trigeminal neuralgia is defined as sudden, usually unilateral, Subjects and methods severe, brief, stabbing, recurrent episodes of pain in the distribution Consecutive AIS patients were enrolled in the retrospective bi- fi of one or more branches of the trigeminal nerve. We report a case of center study. Neurological de cit was assessed with National trigeminal neuralgia which was a presenting symptom for the Institutes of Health Stroke Scale (NIHSS) and functional outcome fi diagnosis of brain metatstasis in a patient with advanced stage of after 3 months with modi ed Rankin scale (mRS) with a score 0-2 breast cancer. A 51 old female complained of right facial pain. She for good outcome. Presence of symptomatic intracerebral hemor- had been diagnosed invasive ductal carcinoma one year ago. Since rhage (SICH) was assessed according to the SITS- MOST criteria. the detection of cancer, she had multiple metastasis in bone, both lung and chest wall. Brief recurrent lanscinating right facial pain was Results persisted during 7 days without relief. On admission, pain was In total, 868 patients (442 males, mean age 69.7±12.2 years) distributed in maxillary and mandibular division of trigeminal nerve. with a median of admission NIHSS 17 points were enrolled and 253 Neurologic examination revealed no contraction of masseter and (29.1%) of them had DM. Recanalization (TICI 2b-3) was reached in temporalis on the same side. Hypestheia was accompanied in right 758 (87.3%) patients and SICH occurred in 55 (6.4%) patients. maxillary and mandibular branch of trigeminal nerve. Brain MRI Patients with good outcome (412, 47.5%) had lower median of GLY b fi depicted multiple metastasis in right cavernous sinus, Meckel’s cave (6.5 vs. 7.4 mmol/l, p 0.0001) within the rst 48 hours after MT. b and bilateral cerebellum. Neurophysiologic study showed normal Similar results were found in diabetics (8.1 vs. 9.6 mmol/l, p 0.0001) blink reflex response, but no potential for masseter reflex test. She and in patients with achieved recanalization (6.5 vs. 7.5 mmol/l, b was diagnosed with secondary trigeminal neuralgia and we pre- p 0.0001). Patients with SICH had higher median of GLY (8.5 vs. 6.8 b scribed oxcarbazepine with palliative chemotherapy. Malignant mmol/l, p 0.0001). Multivariate regression analysis with adjustment metastasis involving the path of trigeminal nerve could elicit for potential confounders showed median of GLY (p=0.0001, OR: neuralgic pain as a secondary cause of trigeminal neuralgia. In our 0.830, 95% CI: 0.755-0.913) as a predictor of good outcome after MT patient, the neuralgic pain in the area of trigeminal nerve was the only presenting symptom of brain metastasis. Secondary cause of Conclusion fi trigeminal neuralgia should be evaluated with extensive brain Lower levels of GLY within the rst 48 hours after MT may be imaging especially in patient with cancer. associated with better functional outcome after 3 months doi:10.1016/j.jns.2019.10.505 doi:10.1016/j.jns.2019.10.506

WCN19-0707 WCN19-0708

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Part I/stroke/training in nuerology - Part I and traumatic brain injury injury

Levels of glycemia within the ﬁrst 48 hours after mechanical Hemodynamic hemichorea associated with severe stenosis of thrombectomy for acute ischemic stroke may affect clinical internal carotid artery outcome J.W. Shina, D.H. Kimb,E.Oha a D. Cerníka, D. Sanakb, P. Divisovab, M. Köcherc, F. Cihlard,J. Chungnam national university hospital, Neurology, Daejeon, Republic Zapletalovae, T. Veverkab, D. Ospalika, M. Cernac, P. Janousovaf,K. of Korea b Belinovaf, M. Kralb, T. Dornakb, D. Francb, V. Prasilc, P. Kanovskyb Dong-A University Hospital, Neurology, Busan, Republic of Korea aKZ a.s.- Masaryk Hospital, Comprehensive Stroke Center, Department of Neurology, Ústí nad Labem, Czech Republic Hemichorea refers to forcible, ﬂowing, involuntary arrhythmic bPalacký University Medical School and Hospital, Comprehensive Stroke movements on one side of the body. Impaired cerebral perfusion due Center- Department of Neurology-, Olomouc, Czech Republic to internal carotid artery (ICA) stenosis would be a rare cause of ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 45 hemichorea. We report a patient with hemichorea which was depressive illness and vagueness of symptoms delayed his reporting associated with severe stenosis of contralateral ICA. A 61 year old to emergency department. Acute onset of neurological symptoms in man with multiple myeloma admitted to hematologic department a patient of such age with vascular risks should lead to imaging early. because of febrile sense. At admission, he reported involuntary movement of right hemibody which begun one day ago. Moreover, doi:10.1016/j.jns.2019.10.508 he had experienced several times of recurrent right side transient motor weakness within last month. As the presence of neck bruit in the left carotid bifurcation, brain MRI with angiography was performed. The MR angiography showed severe stenosis of left WCN19-0717 proximal ICA. Carotid duplex sonography showed 93% stenosis of left proximal ICA with elevated velocity (782 cm/sec). We prescribed massive hydration with administration of aspirin 300mg and Poster shift 01 - Channelopathies/neuroethics/neurooncology/ clopidogrel 300mg. Hemichorea was subsided with the treatment. pain - Part I/sleep disorders - Part I/stem cells and gene therapy - With the finding of decreased vasomotor reactivity in TCD breath Part I/stroke/training in neurology - Part I and traumatic brain holding test, we planned revascularization of the severe carotid injury stenosis. Carotid artery stenting was successful for the symptomatic carotid stenosis and there was no recurrent hemichorea. Hemichorea Stroke patients with atrial fibrillation detected by implantable is an unusual presentation of extracranial ICA stenosis. In our patient, loop recorder - Clinical profile, treatment and follow-up massive hydration and administration of antiplatelet agent resolved hemichorea, implicating cerebral hypoperfuison was the cause of the S. Lourencoa, V. Nevesb, S. Baratac, T. Emerencianod, C. Corzoa,P. hemichorea. Dionisiod, C. Baratab, L. Rebochoc, J. Aguiard aÉvora´s Hospital, Internal Medicine 2- Stroke Unit, Évora, Portugal doi:10.1016/j.jns.2019.10.507 bÉvora´s Hospital, Internal Medicine 2, Évora, Portugal cÉvora´s Hospital, Stroke Unit, Évora, Portugal dÉvora´s Hospital, Cardiology, Évora, Portugal

WCN19-0716 Background and aims The majority of non-lacunar cryptogenic stroke are embolic and Poster shift 01 - Channelopathies/neuroethics/neurooncology/ had been reclassified as embolic strokes of undetermined source fi pain - Part I/sleep disorders - Part I/stem cells and gene therapy - (ESUS). We aimed to characterize the clinical pro le and follow-up of patients (pts) with ESUS and atrial fibrillation (AF) detected with Part I/stroke/training in neurology - Part I and traumatic brain implantable loop recorder (ILR) from our stroke database. injury Methods Complex partial seizures as sole presentation of acute stroke - From June 2014 to December 2018, 17 consecutive pts admitted Rare learning case with ESUS received ILR. These pts had all previous cardiac work-up negative for embolic source (continuous telemetry, ECG, 24 hours O. Seidi Holter, transthoracic and transoesophageal echocardiography) and Faculty of Medicine, Soba University Hospital- University of Khartoum, no prothrombotic conditions. We analysed the pts with AF detection Neurosciences, Khartoum, Sudan by ILR.

68 years old gentleman presented to ER with three days history of Results sudden onset of frequent spells of confusion and memory distur- AF detection occurred in 5 pts (29.4%; mean age79.6±3.4; 60% bance. These last for thirty to forty seconds at a time leaving him male) with ILR. All pts had hypertension and 2 pts dyslipidemia. The feeling very tired. His wife noted that he becomes unresponsive and stroke localization was medium cerebral artery in all pts. Two pts stares in vague without jerks. He also described feeling as if he goes had left atrial enlargement. The mean time from ILR placement to AF in a short dream repeatedly. He is diabetic, hypertensive and had diagnostic was 165.5 days [range 29 - 268]. Mean follow-up was CABG previously. Also suffered with long standing depression using 736.7 days. The treatment was anticoagulation in all 5 pts. There was SSRI’s on and off. No past history of similar symptoms, TIA or stroke. one recurrence. NIHSS in admission 5±1.6; last evaluation 3.2±0.82 He admitted to have low mood. Clinically was fully alert, orientated (p=0.051). but was unable to read or write nor to perform simple calculation without other focal signs. Conclusions HisECG and basic blood tests were within normal limits. Old age, hypertension and dyslipidemia were the most conditions An MRI scan of the brain revealed a subacute infarction in the left associated with AF detection in patients with ESUS. Left atrial medial temporal lobe with spots of minor bleeds. An EEG showed enlargement occurred in less pts than we expected. The functional active seizure discharges from the same area. outcome was good. This small study analysed the patients who He was managed as inpatient with Aspirin and clopidogrel, beneﬁt more ILR for AF detection, but further investigational trials atorvastatin and levetiracetam. should be done. He did well and all his symptoms resolved. He remained stable on I have obtained patient and/or Institutional Review Board (IRB) follow up in the out patient three weeks later. approval, as necessary. Although it is well known, but very rare for a stroke to present with complex partial seizures without classical focal neurological doi:10.1016/j.jns.2019.10.509 signs, presenting with only seizures is even rarer. The back ground of ARTICLE IN PRESS

46 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0723 Y. Wanga, Y. Chenga, Q. Songa, W. Guob, J. Liua, M. Liua aWest China Hospital of Sichuan University, Department of Neurology, Chengdu, China Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain bSichuan University, West China School of Medicine, Chengdu, China - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ stroke/training in neurology - Part I and traumatic brain injury Objective To evaluate the associations of the aspartate transaminase/ Prior antithrombotic therapy is associated with cerebral alanine transaminase (De Ritis ratio, AAR) with hemorrhagic microbleeds but not leukoaraiosis in ischemic stroke patients transformation (HT) in patients with acute ischemic stroke (AIS). with atrial fibrillation and/or rheumatic heart disease Methods Y. Chenga, J. Liua, S. Zhanga,J.Lib,C.Weia, Y. Wanga, M. Liua This study enrolled ischemic stroke patients within 7 days of aCenter of Cerebrovascular Diseases, Department of Neurology, West stroke onset between January 2016 and September 2018. Baseline China Hospital, Sichuan University, Chengdu, China characteristics, including liver function tests were collected. Partic- bPeople’s Hospital of Deyang City, Department of Neurology, Deyang, ipants were divided into four categories based on AAR quartiles: Q1 China (b0.86), Q2 (0.86-1.15), Q3 (1.16-0.1.50), Q4 (N1.50). The outcome was defined as HT. The relationship between AAR quartiles and HT Background among patients with AIS was assessed by multivariate logistic Antithrombotic agents are the mainstay for prevention of stroke in regression analysis. patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD). However, the impact of antithrombotic agents on cerebral Results microbleeds (CMBs) and leukoaraiosis remains controversial. A total of 2042 patients (1290 males; mean age, 65 ± 14 years) were included, among whom 232 (11.4%) occurred HT. Compared fi Objective with the rst quartile, the fourth quartile of AAR was associated with fi We aimed to explore this association in Chinese ischemic stroke increased risk of HT (adjusted hazard ratio 1.59 [95% con dence – patients with AF and/or RHD. interval (CI) 1.05 2.41], P for trend =0.004) after adjusting possible covariates. Patients and methods/material and methods Ischemic stroke patients with AF and/or RHD within 7 days of Conclusion fi onset from two hospitals were enrolled. Clinical information, prior An increased AAR at admission was signi cantly associated with use of antiplatelets or anticoagulation, presence and location of CMBs an increased risk of HT in patients with AIS. and leukoaraiosis were recorded. doi:10.1016/j.jns.2019.10.511 Results Totally, 160 patients (median age, 71 years) were included. CMBs were observed in 90 (56.3%) patients, of whom 37 were with strictly lobar CMBs and 53 were with deep/infratentorial CMBs. leukoaraiosis WCN19-0734 was observed in 107 (66.9%) patients. There was a significant difference in antiplatelet use between patients with and without Poster shift 01 - Channelopathies/neuroethics/neurooncology/ CMBs (33.3 vs. 11.4%, P = 0.001), but not found for anticoagulants. pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Prior use of antiplatelets was independently associated with the presence of CMBs (OR 3.075, 95% CI 1.175–8.045, P = 0.022) and Part I/stroke/training in neurology - Part I and traumatic brain especially strictly lobar CMBs (OR 2.635, 95% CI 1.050–6.612, P = injury 0.039) in multivariate analysis. However, no significant association was found between any antithrombotic agent and leukoaraiosis. Outcome of mechanical thrombectomy by ADAPT technique in acute ischemic stroke: A prospective study from a rural tertiary Conclusions care center in India CMBs and leukoaraiosis are common cerebral small vessel disease markers in ischemic stroke patients with AF and/or RHD. Prior A. Subir, F. Ghafoor, M. Rafeeque, N. Krishnadas antiplatelet use is independently associated with the presence of M.E.S Medical College, Neurology, Perinthalmanna, India CMBs predominantly in the strictly lobar region. Background and aims doi:10.1016/j.jns.2019.10.510 Mechanical thrombectomy with ADAPT-technique for acute ischemic stroke has been reported as fast and effective method and aim of this study is to evaluate imaging criteria as possible predictors of stroke severity, therapeutic success, and stroke WCN19-0724 outcome.

Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain Methods Out of the 106 participants with acute stroke 10 were eligible for - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ thrombectomy within 6 h of symptom onset and were enrolled in stroke/training in neurology - Part I and traumatic brain injury our prospective observational study. NIHSS and mRS and data was analysed. ANOVA,Chi square and Kruskal wallis test were used as Association between De Ritis ratio (AST/ALT) and hemorrhagic tests of signiﬁcance and a p b 0.05 was considered statistically transformation in patients with acute ischemic stroke signiﬁcant. ARTICLE IN PRESS

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Results the contralesional sensorimotor and bilateral parietal cortex (W0- 10 out of 106 (9.4%) acute stroke patients underwent ADAPT W11) and in the default mode network (W4-W11). technique. 8/10had Dense MCA sign in CT imaging. Mean NIHSS was 16 with signiﬁcant difference in scores at 1 hour (p b 0.001), 24 h (p Conclusion = 0.01) and at 1 week (p = 0.05) and mRS score showed signiﬁcant The absence of BoNT-A-related effects in our pilot study improvement mRS at 1month was 3.5 which improved to 2 at 3 might be attributed to the relatively small sample size, which months (p = 0.008).2/10 had undergone bridging therapy with reduced the overall statistical power to detect smaller treatment alteplase before undergoing thrombaspiration. 9 out 10 patients effects. showed major improvement with only onepatient showing symp- This study was supported by the Ministry of Health of the Czech tomatic intracranial hemorrhage (10%). Republic—by the grant NV17-29452A.

Conclusions doi:10.1016/j.jns.2019.10.513 ADAPT is an effective endovascular method of stroke treatment especially in large vessel occlusion stroke Few interesting cases with patient videos (if oral ppt) ,graph,DSA pictures/videos can be presented WCN19-0742 doi:10.1016/j.jns.2019.10.512 Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain WCN19-0735 injury

Notch3 family expression between human intracranial and Poster shift 01 - Channelopathies/neuroethics/neurooncology/ extracranial vasculature smooth muscle cells and pericytes pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain L. Jung-Aeab, K. Hyung-Seoka, P. Man Seokc, C. Kang Hoc injury aChonnam National University Medical School, Department of Forensic Medicine, Gwangju, Republic of Korea Changes of the brain functional connectivity in post-stroke bChonnam National University Medical School, Center for Creative spasticity: A pilot study Biomedical Scientists, Gwangju, Republic of Korea cChonnam National University Medical School, Department of Neurol- T. Veverka, P. Hok, P. Kaňovský, P. Hluštík ogy, Gwangju, Republic of Korea Palacky University and University Hospital Olomouc, Department of Neurology, Olomouc, Czech Republic Cerebral Autosomal Dominant Arteriopathy with Subcortical infarcts and Leukoencephalopathy (CADASIL) is the most prominent Introduction known cause of inherited presenile dementia due to intracranial Resting-state functional magnetic resonance imaging (rs-MRI) vascular smooth muscle degeneration. The disease gene, NOTCH3, has been used to examine cerebral correlates of post-stroke has point mutation and make odd number variation in a transmem- spasticity (PSS). The purpose of the study was to describe resting- brane receptor primarily expressed in vascular smooth muscle cells state networks of chronic stroke patients with PSS and to explore the (vSMC). However, the exact expression pattern of Notch3 and acting relationship between functional connectivity (FC) and spasticity, downstream genes in human intracranial and extracranial arterial with particular emphasis on botulinum toxin type A (BoNT-A)- system remains elusive. qRT-PCR screening for Notch1, 3, and Hes1, related changes. 5 was performed for vascular smooth muscle of the middle cerebral artery and left anterior descending coronary artery from 27 dead Methods body (autopsy). And Notch3 expression was also confirmed by Ten chronic stroke patients (2 females, mean age 61 years, SD Western blot and immunohistochemistry. In contrast to previous 9.7) with clinically relevant PSS of the upper limbs were investi- Notch3 expression in, intracranial vSMC are showed high Notch3 gated. fMRI examinations and clinical (spasticity) evaluation were mRNA and protein expression than extracranial vSMC (25/27, performed just before BoNT-A injection (W0), then 4 weeks (W4) 92.6%), but not in Notch1, Hes1, and Hes5. This results provide and 11 weeks (W11) thereafter. The change of PSS was assessed insight into different Notch3 expression in human intracranial and with the modified Ashworth scale (MAS). The rs-MRI scans were extracranial system, and might give an important clue to understand obtained using a 1.5-Tesla Siemens MRI scanner. Following standard of CADASIL pathobiology. (This study was supported by a grant from preprocessing, changes in FC were evaluated using an independent the Brain Korea 21 Plus Program through the National Research component analysis in MELODIC and DualRegression tools (FSL v. Foundation of Korea (NRF) funded by the Ministry of Education, 5.0.9). Results were thresholded at the corrected p b 0.05. Science and Technology (LJA) and Cooperative Research Program for Agriculture Science & Technology Development, PJ012551042019 Results (KHS)). Rs-MRI did not reveal any significant changes of FC attributable to the specific BoNT-A effect (W0-W4 or W4-W0), despite alleviation of doi:10.1016/j.jns.2019.10.514 PSS after BoNT-A treatment. Significant changes of FC were shown in ARTICLE IN PRESS

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WCN19-0751 Conclusion According to the results of the study, women aged above 35 years Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain old, are commonly affected by stroke due to complication of - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ pregnancy. The main risk factors are high blood pressure, cerebrovas- stroke/training in neurology - Part I and traumatic brain injury cular disorder, and coagulopathy such as venous stasis.

The results of the study on brain stroke during pregnancy and Key words: Stroke, Pregnancy, Postpartum, Preeclampsia, Risk factors postpartum period

N. Gendendagva, B. Gongor, T. Galaa, B. Purevjav, B. Tumenbayar, A. doi:10.1016/j.jns.2019.10.515 Jambaldorj Mongolian Neurological Society, Department of Stroke, The Third State Central Hospital, Ulaanbaatar, Mongolia

Background WCN19-0757 In recent years, as a one of the major obstetric complications, many stroke cases are occurred among women of the reproductive Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain age groups associated with pregnancy and birth rates. - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ stroke/training in neurology - Part I and traumatic brain injury Method Total of 5272 stroke patients were admitted in the Stroke Department of the Third State Central Hospital from 1 November Ultra-early recanalisation after rtpA for acute ischemic stroke: 2013 to 01 December 2018. From them, 35 women, who were Report of 4 cases admitted due to pregnancy and postpartum period, were selected. S.M. Al Alawia, R. Renganathanb Results aShamma Masoud AL Alawi, Neurology, Abu Dhabi, United Arab During the ﬁve years of the study, a total of 35 maternal stroke cases Emirates were analyzed. In all cases, women aged 16–49 are dominated and bMedical, Neurology, Abu Dhabi, United Arab Emirates average age was 31.4 ± 6.8. Early pregnancy (16–19 age) were 3 (8.6%), late pregnancy (above 35 age) were 9 (25.7%). Types of stroke Background were determined in all cases, hemorrhagic 12 (34.3%) ischemic 12 While waiting for endovascular intervention post-rtpA, patients (34.3%), subarachnoid hemorrhage 7 (19.9%). Two cases of them may show ultra-early recanalisation. located in spinal cord and four cases (11.4%) were cerebral venous sinus thrombosis. Evaluation of risk factors revealed that 12 cases were Case descriptions caused by high blood pressure associated with pregnancy, 15 cases 4 cases who showed early recanalisation after rtpA were were associated with preeclampsia, 10 cases were associated cerebro- identiﬁed from the Stroke Registry from Jan 2016 to Dec 2018. vascular anomaly. Our this study was no maternal mortality. ARTICLE IN PRESS

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Discussion and conclusion WCN19-0764 Ultra-early recanalisaton post-rtpA predicts good or moderate outcome. There were no complications or mortality. In 3 out of the 4 patients, mRS at discharge was 1. Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ stroke/training in neurology - Part I and traumatic brain injury doi:10.1016/j.jns.2019.10.516 Clinical characteristics, medical treatments and functional outcomes of cerebral amyloid angiopathy-related intracerebral hemorrhage in Mainland China: A prospective multicenter WCN19-0759 hospital-based study

Q. Wu, S. Zhang, Y. Cheng, M. Liu Poster shift 01 - Channelopathies/neuroethics/neurooncology/ West China Hospital- Sichuan University, Department of Neurology, pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Chengdu, China Part I/stroke/training in neurology - Part I and traumatic brain injury Objective We aimed to investigate clinical features, medical treatments of Coexistent ipsilateral venous sinus thrombosis and arterial stroke cerebral amyloid angiopathy (CAA)-related intracerebral hemor- in iron deficiency anemia rhage (ICH) and their association with the functional outcomes in hospitalized population. S. Siddiqi, A.A. AlShaffi Rashid Hospital, Department of Neurology, Dubai, United Arab Emirates Methods Patients diagnosed with probable or possible CAA-related ICH Concomitant ipsilateral cerebral venous sinus thrombosis and according to Boston Criteria were consecutively and prospectively arterial infarction are exceedingly rare clinical entity. We suggest enrolled from 21 tertiary and secondary hospitals across mainland that iron deficiency anemia caused the simultaneous affection of the China from April 2012 to October 2015. Demographics, clinical two arterial beds. information, and medical treatments were collected and analyzed. We report a 34-year-old right-handed male who presented with Univariable and multivariable logistic regression were used to headache, vomiting, left hemiplegia and drowsiness. On arrival to ER, identify potential independent predictors of 3-month poor he had hypotension and sinus bradycardia necessitating inotropic outcomes. support. He was drowsy and had signs of right middle cerebral artery involvement confirmed by unenhanced CT brain showing acute right Results fi temporo-parietal ischemic infarction. A total of 490 patients with CAA-related ICH were nally The investigations revealed anemia (Hb 8.8 g/dL, MCV 57.7fL), included, of which 329 (67.1%) were male and mean age was hypoferritinemia (b5 ng/mL) and hypochromic microcytic anemia 69.47 years. The rate of mortality and disability at three months suggesting iron deficiency anemia. was 21.6% and 49.0%, respectively. Compared with patients who Other investigations including inflammatory markers, bacterial had good outcomes, those with poor outcomes were older, and cultures, anticoagulation profile, lipids, glycemic indices, Hb had lower Glasgow Coma Score (GCS), higher National Institutes of Electrophoresis, autoimmune markers including antiphospholipid Health Stroke Scale (NIHSS), larger ICH volume, and higher blood syndrome, cryoglobulins, thrombophilia screen, viral markers for urea nitrogen (BUN) and glycemia on admission. Patients with hepatitis B and C as well as HIV were negative. The echocardio- poor outcomes also presented with lower proportion of hyperten- gram and a pan CT abdomen and chest were unremarkable. sion, higher frequency of midline shift, subarachnoid hemorrhage, A repeat CT brain on the same day revealed right middle cerebral intraventricular hemorrhage, frontal and parietal lobe hemorrhage artery territory infarction with hyperdense right transverse and and complications, and received fewer treatments of anti-hyper- b sigmoid sinuses. tensive and neuroprotectants (all P 0.05). Multivariable logistic fi CT cerebral angio- and venogram showed dural sinus thrombosis regression identi ed that age, hypertension, GCS, ICH volume, involving the right transverse and sigmoid sinuses, jugular bulb and parietal lobe hemorrhage and BUN were independent predictors of proximal jugular vein along with linear filling defect at the origin of 3-month poor outcomes. the right internal carotid artery. Later, he underwent decompressive hemicraniectomy. He re- Conclusion fi ceived blood transfusions, iron supplementations and therapeutic This study identi ed some clinical factors and treatments that fl anticoagulation. Inotropic support was weaned off gradually. Neuro- may in uence prognosis of CAA-related ICH, which needs to be fi logically, residual hemiplegia prevailed. veri ed by larger sample studies with long-term outcomes. doi:10.1016/j.jns.2019.10.517 doi:10.1016/j.jns.2019.10.518 ARTICLE IN PRESS

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WCN19-0768 its prevention and ensure prompt response in emergency. Study objectives were to assess the extent of knowledge on risk factors and warning signs and the attitude to stroke. Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ Methods stroke/training in neurology - Part I and traumatic brain injury A cross-sectional observational study was performed through a structured self-reported, validated stroke awareness questionnaire A cross-sectional study on awareness of risk factors, warning (SAQ). Participants included family members and care-givers of signs and management of stroke patients attending the Out-Patient department at a tertiary care centre. S.S. Nallani Chakravarthia, S. Jalab, S. Vooturib, S. Kaulb aAmrita Institute of Medical Sciences, Cochin, India Results bKrishna Institute of Medical Sciences, Neurology, Secunderabad, The average age of the 1750 participants was 39.53 ± 15.58 (17– India 95), with 562 (32.1%) women; 713 (40.7%) participants thought Stroke as heart attack, 207. While 94.8% participants recalled at least Background one risk factor for stroke (stress 1002 (57.3%), hypertension 1015 Stroke is a leading cause of death and disability worldwide. (58.0%). Importantly, 1494 (85.4%) participants named at least one Knowledge of stroke, its risk factors and warning signs may improve warning sign, most frequently weakness of one side of body 723 ARTICLE IN PRESS

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(41.3%), speech impairment 573 (32.7%) and 655 (37.4%) knew a Differences in costs were related to ICU stay, repeat imaging need person who had stroke. Stroke was considered as worst imaginable and the tPA cost. by 280 (16.0%) and extremely serious by 687 (39.3%); 146 (8.3%) participants did not know how to respond in-case a person had Conclusion stroke. Only one-third patients knew importance of medical Thrombolysis in mild AIS increased costs by 4 times with no treatment within hours of stroke; one third still believed in therapies major change in outcome at discharge. Evidence-based guideline other than medications. Although 71.5% participants knew that statement focusing on thrombolysis in mild AIS in resource limited recurrence is more likely after ﬁrst stroke, 679 (38.5%) participants settings when patients pay out of own pockets are needed. did-not know role of services like physiotherapy, occupational therapy post stroke. doi:10.1016/j.jns.2019.10.520

Conclusion Despite reasonable stroke-related knowledge, the study participants had insufﬁcient awareness about medical management of WCN19-0781 stroke and role of supportive services in stroke recovery.

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ doi:10.1016/j.jns.2019.10.519 pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain injury

WCN19-0774 Sympathomimetic drug (xylometazoline) abuse and acute ischemic stroke. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - S. Desaia, D. Desaib, A. Banerjeeb a Part I/stroke/training in neurology - Part I and traumatic brain Shree Krishna Hospital and Pramuhswami Medical College, Neurology, injury Anand, India bs, Medicine, Anand, India Thrombolysis in mild ischemic stroke in resource limited settings: Comparing outcomes and costs in patients who receive Background thrombolysis versus those who refuse Xylometazoline is a nasal decongestant which stimulates the alpha adrenergic receptors in arterioles of nasal mucosa and produces vasoconstriction. It has a potential to cause stroke due to S. Desaia, D. Desaib, S. Pathanc its sympathomimetic activity. aShree Krishna Hospital, and Pramukhswami Medical College, Neurol- ogy, Anand, India Case bShree Krishna Hospital and Pramukhswami Medical College, Medicine, A 54 year male, with history of chronic xylometazoline use Anand, India presented with acute onset tingling and numbness in left upper limb cShree Krishna Hospital and Pramukhswami Medical College, Research, and lower limb, giddiness in form of imbalance while walking and Anand, India swaying towards the left side, vertigo and dysphagia, dysarthria, dysphonia. On examination he had absence of pain sensation on left Introduction side of the face, decreased power on left upper limb and lower limb Nearly half of acute ischemic strokes [AIS] have mild deﬁcits with left sided cerebellar signs and truncal ataxia, nystagmus and [National Institute of Health Stroke Scale, NIHSS b 5]. The safety / Horner’ syndrome. beneﬁts of alteplase [tPA] is still not clear in this group. We aimed to compare outcomes and costs between mild AIS in thrombolytic Results window with regards to whether they received thrombolysis or not. MRI brain suggestive of acute left lateral medullary infarct with left vertebral artery stenosis. Hemogram, liver, renal function, 2D ECHO, Method ECG and Neck vessel angiography were all normal. On revisiting the Between Jan 2014 and Dec 2018, 74 AIS patients presented in history, he had a habit of using xylometazoline nasal spray daily for thrombolytic window period. Amongst these, 29 had NIHSS b 5. Of three-four times since last 5-6years which he started to use after he these, 11 declined consent for thrombolysis while 18 received was prescribed it once for an upper respiratory tract infection. So thrombolysis with consent. We collected the baseline demographics, possibility of Xylometazoline associated cerebral vasoconstriction risk factors, NIHSS and mRS at admission and discharge, days of leading to stroke was considered. Dual antiplatelets and statins were hospital stay, and cost of inpatient care. prescribed and he was advised to stop xylometazoline. A review of literature shows 5 cases of ischemic stroke reported in association with Result xylometazoline use out of which 2 were in the posterior circulation Risk factors were similar in both the groups. All patients had territory and 3 were in the middle cerebral artery territory. small vessel disease. The mean NIHSS in both groups was 4. All had mRS b/= 1 at admission as well as discharge, irrespective of whether Conclusions they received thrombolysis or not. All the patients were discharged Xylometazoline abuse can lead to stroke and its over-the-counter in 5 days. The reasons for refusal of thrombolysis were [non- availability should be curtailed. affordability [8], not understanding the disease severity [2] and fear of bleeding [1]. The mean inpatient costs of patients were Rs 84573 doi:10.1016/j.jns.2019.10.521 [thrombolysis group] versus Rs 19234 [non-thrombolysed]. ARTICLE IN PRESS

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WCN19-0799 Abstract

Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain Introduction - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ Neurology is a branch of medicine concerned with the study and stroke/training in neurology - Part I and traumatic brain injury treatment of disorders of the nervous system.

Simultaneous onset of hemorrhagic and ischemic stroke in a Objective patient: Case report To see the perception of Sudanese medical students towards neurology. R.J. Ketarena, J. Simcab aSiloam Hospitals Lippo Village, Department of Neurology, Tangerang, Methods Indonesia About 300 medical students from 24 Sudanese medical colleges bSiloam Hospitals Lippo Village, Inpatient Department, Tangerang, were involved in the study. A questionnaire including 17 questions Indonesia Results Male to female ratio 1:2, 33% are interested in neurology; most of Introduction the students (78%) have good knowledge about neurology. 80% think Stroke is a disorder seen in fifteen million of the world that neurology is difficult. 20% considers neurology as a future career population, however simultaneous onset of hemorrhagic and option. 86% think that neurological signs difficult to detect. 33% think ischemic stroke is considered a very rare enigma. Precise risk factors that neurological disease can be treated in spite of being compli- and etiology contributing to the enigma is yet to be concealed. cated. 90% think that neurological cases are challenging and interesting. 60% think that neurological patients are uncooperative Result and difficult to examine. Almost 70% think that the majority of We hereby report a case of a 48-year-old female patient neurological disease have poor prognosis. Regarding neurological presented with headache and multiple unknown onset generalized teaching 90% prefer rounds, 70% lectures, 60% videos, 50% tutorials . tonic clonic seizure since 2 hours before admission and patient was Almost 80% prefer to examine patient in private room and 20% in unconscious since. History of uncontrolled hypertension was identi- general ward. About 80% thinks that the difficult part of neurology is fied. Physical examination showed high blood pressure of 180/90 movement disorders. mmHg, GCS 6, downward gaze on both eyes, cranial nerve VII and XII Recommendations: Revolution of the style of teaching of palsy, with bilateral extremity weakness. ECG was normal and neurology should be considered by neurologist. routine lab examination showed low potassium level, high LDL and high white blood cell count. Brain CT Scan revealed simultaneous acute intracerebral hemorrhage on the left thalamus with perifocal edema, and acute infarct on the left parieto-temporo-occipital lobe. Anticonvulsants together with antibiotics, osmotic diuretic and doi:10.1016/j.jns.2019.10.523 tranexamic acid was introduced during hospitalization, despite no intensive care facility was available. Patient passed away the day after regardless of the given treatment. WCN19-0826 Conclusion Simultaneous onset of hemorrhagic and ischemic stroke undeni- ably has a poor prognosis. Studies with abundant samples are Poster shift 01 - Channelopathies/neuroethics/neurooncology/ needed to investigate the risk factors contributing to this condition, pain - Part I/sleep disorders - Part I/stem cells and gene therapy - which can evidently lead to increase prevention of this scanty Part I/stroke/training in neurology - Part I and traumatic brain phenomena. injury doi:10.1016/j.jns.2019.10.522 Oral antiplatelet and anticoagulant drugs in secondary stroke prevention in Polish patients – Results of lipidogram and lipidogen study

WCN19-0816 B. Labuz-Roszaka, M. Banachb, M. Skrzypekc, M. Tomaszewskid,D. Mikhailidise, P. Tothf, A. Catapanog, K. Rayh, G. Howardi,G.Lipj,F. k l m n o Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Charchar , N. Sattar , B. Williams , T. Macdonald , J. Jozwiak aFaculty of Public Health in Bytom- Medical University of Silesia in pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Katowice, Department of Basic Medical Sciences, Bytom, Poland Part I/stroke/training in neurology - Part I and traumatic brain bMedical University of Lodz, Department of Hypertension- Chair of injury Nephrology and Hypertension, Lodz, Poland cFaculty of Public Health in Bytom- Medical University of Silesia in Perception of medical students toward neurology Katowice, Department of Biostatistics, Bytom, Poland dUniversity of Manchester, Division of Cardiovascular Studies, Manches- A. Hussein, H. Abbashar, A. Siddig, K. Mohamed Ahmed Abbasher, M. ter, United Kingdom Abbashar, M.M. Aldar, Y. Alsedig, R. Tofaha AlHusseini, A. Ahmed, M. eUniversity College London, Department of Clinical Biochemistry, A. Fadelalla, R.A.S. Salih, E. Ibrahim, M.A. Alwalid, M.I. Ibrahim, S. London, United Kingdom Hamza, S.A. Yahya, R.M. Hassan fCGH Medical Center, Sterling, USA Daoud Research Group, Neurology, Khartoum, Sudan gIRCCS Multimedica of Milan, Milan, Italy ARTICLE IN PRESS

54 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx hImperial College London, School of Public Health, London, United Kingdom Background and aims iUniversity of Alabama, Birmingham School of Public Health, Birmingham, Infection with herpesviruses is an independent risk factor for USA stroke. Aim was to study the importance of using antiviral drugs jBirmingham City Hospital, Institute of Cardiovascular Sciences, Birming- for the treatment of stroke patients with diabetes mellitus ham, United Kingdom (DM) and high titer of herpes simplex (HS) and cytomegalovirus kUniversity of Melbourne, L. E. W. Carty Cardiovascular Genomics (CMV). Laboratory, Melbourne, Australia lUniversity of Glasgow, Institute of Cardiovascular and Medical Sciences, Methods Glasgow, Poland 62 stroke patients with DM were under our observation in the mUniversity College London, Institute of Cardiovascular Science, London, Department of Neurology of Tashkent city Municipal Hospital №7, United Kingdom during March to December, 2018. All of the patients were out of nUniversity of Dundee, Medicines Monitoring Unit, Dundee, United Kingdom therapeutic window for thrombolysis and rechecked by NIHSS after 2 oUniversity of Opole, Institute of Medicine, Opole, Poland weeks. The patients had been investigated for HS and CMV by ELISA. 5 seronegative patients were excluded from investigation. 57 Background patients were divided into 2 groups: (1) 25 patients took only The purpose of the study was to evaluate the frequency of use of standard and symptomatic treatment , (2) 32 patients took oral antiplatelet and anticoagulant drugs as secondary stroke additionally Gancyclovir 1000 mg/day. Both groups divided into A, prevention among people in Poland and its association with B, C subgroups respectively to severity of stroke – NIHSS 5-15, 16-20, sociodemographic factors, place of residence, and concomitant 21-42. cardiovascular risk factors. Results Material and methods The decrease of neurological deficit (decrease ≥ 1 point by NIHSS The study group consisted of 268 subjects with a history of a after 2 weeks ) amounted to 44%(11), 62,6%(20), respectively to first previous ischaemic stroke, participants of multicentre, population- and second monitoring groups. See file ``tableherpes_page-0001``. based study (Lipidogram & Lipidogen Study). We have obtained patient and Institutional Review Board (IRB) approval, as necessary. Conclusions The improvement of neurostatus dynamics under the treatment Results with gancyclovir is significantly higher than under standard Among all the examined patients, 165 subjects (61.6%) used at treatment in patients with DM and high titer of herpes infection (p least one drug as the secondary prevention. Oral antiplatelets were b0.01). Determining the herpes virus as a debilitating factor in stroke used by 116 patients (43.3%); oral anticoagulants - by 70 subjects could be important in ensuing management of stroke patients, but (26.1%). Antiplatelet and anticoagulant therapy was simultaneously further research is needed. applied in 21 patients (7.8%). 157 subjects (58.6%) used hypolipid- aemic drugs, and 205 (76.5%) – antihypertensive drugs. Among all doi:10.1016/j.jns.2019.10.525 the concomitant cardiovascular risk factors, coronary heart disease was significantly associated with antiplatelet treatment, and a history of atrial fibrillation, coronary heart disease, and previous myocardial infarction - with anticoagulant treatment. Use of drugs WCN19-0832 did not depend on age, gender, time from stroke, place of residence (rural or urban), and level of education. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Conclusions pain - Part I/sleep disorders - Part I/stem cells and gene therapy - It seems that in Poland secondary cardiovascular preventive Part I/stroke/training in neurology - Part I and traumatic brain therapy is used too rarely. Structured educational programs should injury be developed in Poland to improve usage of secondary preventive therapy. Door to needle time 25 minutes thrombolysis therapy in acute ischemic stroke at the Zainoel Abidin Public Hospital Banda Aceh, doi:10.1016/j.jns.2019.10.524 Indonesia

S. Gazali Abdul Rahman, N. Nurul Huda, A. Ade Silvana Danial, D. Deri Rivano, D. Dessy R. Emril, E. Endang Mutiawati R, F. Farida, I. Imran, I. WCN19-0829 Indriazel Syaputri, N. Nasrul Musadir, R. Rike Fitrianita, S. Suheman, Z. Zefri Suhendar Medical Faculty of Syiah Kuala University- Zainoel Abidin Public Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Hospital- Indonesia Neurology Association, Neurology, Banda Aceh, pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Indonesia Part I/stroke/training in neurology - Part I and traumatic brain injury Acute ischemic stroke is one of the leading causes of death and disability worldwide. The main beneﬁt of thrombolysis therapy with The better outcome by using antiviral drugs in stroke patients intravenous tissue plasminogen activator in acute ischemic stroke with diabetes mellitus and herpes infection appears before 4.5 hours. However, patient who suffered from stroke usually comes to the ER within the last minutes of this therapeutic A. Azimov, I. Kim window. As a consequence, the time taken to administer thrombol- Tashkent City Hospital №7, Neurology, Tashkent, Uzbekistan ysis therapy is reduced. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 55

The aim of this study was to reduce the door-to-needle Methods (treatment) time to less than 25 minutes. To achieve this aim, we In this retrospective analysis, we analyzed the data of 54 optimised our door-to-needle protocol at our Hospital. patients with large vessel occlusion, treated from Sep 2014 to Dec Firstly, we prepared the Kit Code Stroke alert for patient who 2018. The treatment techniques were divided into two groups: would enrol in the thrombolysis (alteplase) treatment. Secondly, we first-pass use of a large-bore aspiration-catheter or a stent-retriever make a standardisation of thrombolysis therapy, such as the door-to- and primary combined approach of an aspiration catheter and needle time standard, Code Stroke alert and standardize protocol for stent-retriever. neurologists, neurology residents and nurses in the ER. Lastly, we also eliminate unnecessary movement of patients using stroke bag. Results Patients were also given stroke stamp to identify their medical There was no difference in successful reperfusion rates with 75% records as a priority which can be identified as such by the personnel in the single device group and 86.7% in the combined approach in CT room and laboratories. group (p value=0.16). However, nearly or complete reperfusion was Target to achieve a door-to-needle time less than 25 minutes more frequently achieved in the combined approach group (63.3% vs. must be achieved for at least 50% of acute ischemic stroke patients. 29.2%, p value=0.016). Procedure time was significantly different We collected data from patients admitted in ER from January 2019 to with 52.8 min in the combined approach group and 72.7 min in the April 2019. We collected five cases of acute ischemic stroke. Of the single device group (p value=0.02). five patients we reported, the time of door to needle time required is 22–25 minutes. All of these patients have achieved an outstanding Conclusions clinical outcome. Our data showed that combined approach of an aspiration catheter and stent-retriever could be more effective for nearly or complete reperfusion of large vessel occlusion in acute ischemic doi:10.1016/j.jns.2019.10.526 stroke with shorter procedure time. The results should be confirmed in larger prospective randomized trial.

WCN19-0833 doi:10.1016/j.jns.2019.10.527

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - WCN19-0838 Part I/stroke/training in neurology - Part I and traumatic brain injury Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - The effect of primary combined approach of an aspiration catheter and stent-retriever compared with single device use Part I/stroke/training in neurology - Part I and traumatic brain injury Y. Kawabataa, N. Norioa, F. Shunichib, M. Hidenoria, T. Tetsuyab aKyoto Katsura Hospital, Neurosurgery, Kyoto, Japan Illness perception in patients with lymphoproliferative diseases bNational Hospital Organization Kyoto Medical Center, Neurosurgery, Kyoto, Japan L. Akhmadeevaa, D. Teregulovaa, B. Bakirovb aBashkir State Medical University, Neurology, Ufa, Russia b Background and purpose Bashkir State Medical University, Internal Medicine, Ufa, Russia Neurothrombectomy has become the standard treatment of acute ischemic stroke due to large vessel occlusion. ASTER trial recently Introduction showed that there were no signiﬁcant differences between contact Survival of patients with lymphoproliferative diseases increases. aspiration and stent-retriever groups for the clinical efﬁcacy For effective treatment we should pay attention to a subjective outcomes. The purpose of this study is to compare radiological understanding of the patients’ perception of the disease, which outcomes and time metrics between single device group and depends on the personality characteristics, emotional experiences combined approach group. and expectations of treatment. ARTICLE IN PRESS

56 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

Methods Results We used The Brief Illness Perception Questionnaire (BIPQ) for The VKORC1 genotype AA and AG were found in 81% and 19% assess the illness perception in patients with chronic lymphocytic respectively. None of patients had GG. All patients with AG took daily leukemia (CLL) and multiple myeloma (MM). VK less than 250μg and daily VK intake among AA patients distributed in wide range (50-600μg).Both VK concentration and Results warfarin dosage in patients with AG were significantly higher than We included 94 patients with a diagnosis of lymphoproliferative those with AA. Whereas there existed a significant correlation disease (chronic lymphocytic leukemia - 42 people, multiple between VK concentration and total VK intake in patients with AG, myeloma - 52) into this study: 55 (58.51%) men and 39 (41/49%) there was no correlation in patients with AA. Also, we found a women. The average age of patients was 63,37 ± 9,96 years. The significant correlation between VK intake and warfarin dosage in mean scores of the points of the BIPQ were as follows: Consequences patients with AG, no correlation was found in patients with AA. In – 7,28 ± 2, 88 ; Timeline – 7,52 ± 2,99; Personal control – 6,79 ± spite of these results, the difference of average TTR in both genotypes 3,12; Treatment control – 7,64 ± 2,40; Identity – 7,54 ± 2,87; was not significant. Concern – 7,45 ± 2, 82 ; Understanding – 7,29 ± 2,81; Emotional response – 6,1 ± 3, 26. The results of all components of the Conclusion questionnaire in patients with lymphoproliferative diseases were The influence of daily VK intake for warfarin treatment was higher compared with breast cancer, diabetes, asthma patients. recognized only among patients with VKORC1 AG genotype. For Illness perception according to the BIPQ was similar to those of patients with AG, the daily intake of VK up to 250μg is acceptable, patients with non-psychotic depressions. Overall threat level of the furthermore, a strict restriction of VK may not need among those disease was high (57, 5 ± 11, 99). The most frequent causes of the with AA. disease according to the patients perception were: stress, work with harmful production, ecology, genetics. doi:10.1016/j.jns.2019.10.529

Conclusion Patients with lymphoproliferative diseases showed high scores on BIPQ, this is probably due to the presence of depression in patients WCN19-0846 and requires further study. doi:10.1016/j.jns.2019.10.528 Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain injury WCN19-0839 Risk factors of post stroke pain Poster shift 01 - Channelopathies/neuroethics/neurooncology/ I. Suharjanti, V. Kusuma pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Faculty of Medicine- Airlangga University, Neurology, Surabaya, Part I/stroke/training in neurology - Part I and traumatic brain Indonesia injury Background and objective Correlation between warfarin control and daily vitamin K intake: Post stroke pain (PSP) had developed as the main consequency The difference among VKORC1 genotype after stroke. Early identification in high risks patients made easier to predict PSP based on prognostic profile. The aim of this study to T. Nagaoa, K. Yasunishib, H. Kumagaib, E. Kodanic, K. Kimurad analyse the risk factors of PSP. aNippon Medical School Tama Nagayma Hospital, Neurology, Tokyo, Japan Method bUniversity of Shizuoka, Clinical Nutrition, Shizuoka, Japan Case control study was performed in 110 post stroke patients, cNippon Medical School Tama Nagayma Hospital, Cardiology, Tokyo, who were fulfilling inclusion and exclusion criterias, that came to Japan neurology outpatient clinic of Dr. Soetomo General Hospital, from dNippon Medical School, Neurology, Tokyo, Japan January-February 2019. Nine variables of risk factors (age, gender, stroke duration, stroke type, stroke location, motoric strength, Background and purpose functional disability, depression, and smoking) were analyzed fi The restriction of vitamin K (VK) intake is essential for patients bivariate followed by multivariate. It were determined the signi cant with warfarin anticoagulation. However, the ideal daily intake of VK variables in PSP. for each patients were not established. In this study we evaluated the correlation between warfarin control and VK intake from the Result b perspective of the VKORC1 genotype. Three of nine variables in bivariate analysis showed p 0.25, and were followed by multivariate analysis; they were gender, stroke Subjects and methods duration, and depression. Regresion logistic analysis was performed We enrolled 84 patients taking warfarin more than one year. The by backward stepwise method. A woman compared to a man had an serum VK concentration and VKORC1 genotype were evaluated with adjusted Odds ratio (OR) 5.6 in a risk of post stroke pain (p=0.03; – informed consent, and the original questionnaire about daily food 95%CI 1.12 5.81). Patients with post stroke duration were three menu was contrived to estimate the VK intake. months or more had higher risk to get PSP than whom the duration ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 57 were earlier (adjusted OR 2.2, p=0.05; 95%CI 0.99–5.02). And the Conclusion depression, which was scored by Hamilton Depression Rating Scale APS can present with neurological and cardiac manifestations and (HDRS) more than 7, when compared to normal HDRS, had higher therefore high index of suspicion is necessary for diagnosis. risk in PSP (adjusted OR 4.5, p=0.04; 95%CI 1.07–18.61). doi:10.1016/j.jns.2019.10.531 Conclusion There were three signiﬁcant variables as risk factors of PSP; they were gender of woman, post stroke duration three months or more, and depression. WCN19-0850

Keywords: Depression, Gender, Post stroke pain, Risk factors, Stroke duration Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain injury doi:10.1016/j.jns.2019.10.530

Therapeutic dilemma: When to start anticoagulation for cardiac thrombi in acute ischemic stroke? Lessons from a case

WCN19-0848 R. Shila, R. Mansoorb, G.A. Anosac, J.M. Olidanc, R. Renganathand aAl Ain Hospital, Academic Affairs, Al Ain, United Arab Emirates Poster shift 01 - Channelopathies/neuroethics/neurooncology/ bAl Ain Hospital, Specialist Neurology, Al Ain, United Arab Emirates c pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Al Ain Hospital, Stroke Nurse, Al Ain, United Arab Emirates d Part I/stroke/training in neurology - Part I and traumatic brain Al Ain Hospital, Consultant Neurology, Al Ain, United Arab Emirates injury Background There are no guidelines to address the issue of when to start Anti-phospholipid antibody syndrome presenting with seizure, anticoagulation for cardiac thrombi in acute ischemic stroke. stroke and atrial mass: A case report

a a b c d Case description R. Shil , A.A. AlDhuhoori , V.M. Thomachan , J. Teir , R. Renganathan 53 year old man presented with acute onset weakness of left aAl Ain Hospital, Academic Affairs, Al Ain, United Arab Emirates b side. He had acute inferior STEMI 9 days prior and had PCI to RCA. Al Ain Hospital, Cardiology, Al Ain, United Arab Emirates He had a background history of dilated cardiomyopathy, and cAl Ain Hospital, Rheumatology, Al Ain, United Arab Emirates d hypertension. Examination on admission showed left hemiparesis Al Ain Hospital, Neurology, Al Ain, United Arab Emirates with NIHSS 9. CT brain was normal. As he presented within window period for intravenous thrombolysis, he was given rtpA. Background NIHSS post-rtpA was 2. CT angiogram of head and neck was Antiphospholipid antibody syndrome (APS) has a broad spectrum unremarkable. MRI brain showed infarct in right middle cerebral of thrombotic and non-thrombotic clinical manifestations. We artery territory involving the frontal, temporal and parietal present a case of APS presenting with seizure, stroke and atrial mass. regions. Transthoracic ECHO done 2 days after admission showed multiple Case description thrombi in right ventricle measuring 5 × 6 mm and 4 × 6 mm in A 38 year-old male presented with headache of 10 days duration diameter respectively; akinetic apex, anteroseptal and inferoseptal and tonic-clonic seizure. Neurological examination was normal. MRI walls; ejection fraction 20%. Cardiology consultation suggested brain showed small acute right cerebellar infarct. MRA brain and warfarin. Newer anticoagulants are not approved. After discussion, neck showed focal narrowing in origin of internal carotid artery he was started on therapeutic enoxaparin 3 days after admission. bilaterally. EEG was normal. He was started on aspirin, atorvastatin Dual anti-platelet therapy was continued. Warfarin was started 7 and carbamazepine. Transthoracic and transesophageal Echo showed days after admission. mRS at discharge was 1. atrial mass pedunculated and lobular measuring 1 * 1.5 cm freely mobile across mitral valve opening across the left ventricular inflow. Discussion and conclusion N Antiphospholipid (aPL) antibodies were positive in higher titer (IgG In view of the recent ischemic stroke, early initiation of warfarin 120). B2 glycoprotein was 90. ANA was negative. ESR and CRP were would likely have increased the likelihood of hemorrhagic normal. Platelet count was low. APS was diagnosed. He underwent transformation; hence it was decided to defer warfarin therapy successful surgical removal of the mass, which looked like a initially. thrombotic clot, Histopathological analysis confirmed fibrinous clot, The risk of thromobembolic event (pulmonary) without with no evidence of tumor cells. He was started on full anti- anticoagulation was weighed against the risk of hemorrhagic coagulation treatment and was followed up regularly in the clinic, transformation of acute cerebral infarction following early initiation where he did not have any further complications from the disease. of anticoagulation. Our treatment approach resulted in good outcome. Discussion Our patient was diagnosed to have APS based on the features of high positive anticardiolipin antibody IgG and B2 glycoprotein IgG, doi:10.1016/j.jns.2019.10.532 Stroke, thrombocytopenia and abnormal ECHO findings. Thrombotic vegetation can mimic an atrial myxoma on ECHO. ARTICLE IN PRESS

58 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0853 WCN19-0856

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I /stem cells and gene therapy - pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Part I/stroke/training in neurology - Part I and traumatic brain injury injury

Albumin-corrected calcium as a prognostic factors in ischemic Transcranial dopplerosonography in subarachnoid hemorrhage stroke A. Purvee J. Jesiscaa, D.S. Roryb, Y.B. Hartantoc Third State Center Hospital, Neurocenter, Ulaanbaatar, Mongolia aH. Ishak Umarella Hospital, Family Medicine, Central Maluku, Indone- sia Background bAbdul Aziz Hospital, Family Medicine, Singkawang, Indonesia Aneurysmal subarachnoid hemorrhage (aSAH) affects young cBethesda Hospital, Neurology, Yogyakarta, Indonesia people more. There has been duly arisen a need to take appropriate measures for making diagnosis, treatment and pre- Background vention from severity. From 2014 to 2018 in The Third State Given the enormous burden that ischemic stroke exerts, it is Central Hospital of Mongolia, 5272 patients who had stroke were important to develop a more precise estimation of a stroke prognosis hospitalized amongst which 20.4% were subarachnoid hemorrhage to lead new strategies for their therapy. Calcium induced cytotoxicity (aSAH). may responsible for the severity of injury in stroke ischemic, as it is initiating and activating cell death pathway which can results in poor Objective clinical outcomes. Albumin-corrected calcium is a better parameter To compare clinical condition severity of aSAH and cerebral to evaluate the effect of calcium when direct ionized calcium level vasospasm degree. measurement is not available. Study materials and methods Objective This cross sectional study enrolled 60 patients with aSAH, who This study aimed to determine albumin-corrected calcium as a hospitalized from 2017 to 2018 year. Informed consent form were predictor of poor outcomes and prognosis in ischemic stroke patient. obtained from each participants. Clinical condition of participants were classified by Hunt-Hess scale (HHS). Cerebral vasospasm Methods degree was graded by Lindegaard index. This is a prospective cohort study of 133 ischemic stroke patients admitted to Bethesda Hospital from October 2018 until January 2019. Study results Albumin-corrected calcium level was obtained ≤72 hours from onset. Of the participants, 52.5% were men and 47.5% were women. The stroke severity and prognosis was assesed on admission using Average age was 49.9±12. Comparing clinical condition degree to The Scandinavian Stroke Scale (SSS) and the functional outcome at vasospasm grade, in the first degree of HHS group, 11.1% was the time of discharge using modified Rankin scale (mRS). normal or no spasm, mild and moderate spasm were either in 44.4%. In the second degree of HHS group, normal was in 6.9%, Results mild in 3.4%, moderate in 86.2%, and severe spasm was in 3.4%. In A total of 133 subjects, 79 patients (59,4%) were male and 54 the third degree of HHS group, 11.1% were no spasm, moderate (40,6%) were female. The average (SD) age was 63,91 (11,2) years. It spasm was in 77.8%, and severe spasm was in 11.1%. In fourth was found that albumin-corrected calcium had no significant degree of HHS group, 71.4% were with moderate spasm, 28.6% correlation with the prognostic value of SSS, both on prognostic were with severe spasm (p = 0.001). and long term score, respectively p = 0,835 and p = 0,360 and with the functional outcome by mRS (p = 0.487). Conclusion Based on the results of the transcranial dopplerosonography we Conclusion have come to conclude that the clinical complication degree and Albumin-corrected calcium levels are not associated with a cerebral vasospasm severity are correlated. poorer outcome and prognosis after ischemic stroke in these patients. Key words: aSAH, HHS, Lindegaard index

Keywords: Ischemic stroke, Albumin-corrected calcium, Scandina- vian Stroke scale, Modiﬁed Rankin scale, Prognosis

doi:10.1016/j.jns.2019.10.534 doi:10.1016/j.jns.2019.10.533 ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 59

WCN19-0862 R. Nematiab, H. Shoolycd, M. Assadicd a2Nuclear Medicine Research Center, Department of Molecular Imaging and Radionuclide Therapy MIRT, Bushehr Medical University Hospital, Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Iran Part I/stroke/training in neurology - Part I and traumatic brain bDepartment of Neurology, Bushehr Medical University Hospital, Faculty injury of Medicine, Bushehr University of Medical Sciences- Bushehr - Iran, Bushehr, Iran c Intracerebral hemorhage in immune thrombocytopenic purpura Nuclear Medicine Research Center, Department of Molecular Imaging and Radionuclide Therapy MIRT, Bushehr Medical University Hospital, E.P. Labana, L.A. Kadarjonob, R.T. Pinzonb Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran d aBethesda Hospital, General Practitioner, Yogyakarta, Indonesia Department of Neurology, Bushehr Medical University Hospital, Faculty bBethesda Hospital, Neurology Department, Yogyakarta, Indonesia of Medicine, Bushehr University of Medical Sciences- Bushehr - Iran, Bushehr, Iran Introduction Intracerebral hemorhage is one of the stroke types that has an Background insidence around 24.6 out of 100.000 people per year. Intracerebral This study aims to report our initial experience with an ongoing hemorhage has high mortality and morbidity. Some of the etiologies pilot study on the treatment of the brain tumors using peptide of intracerebral hemorhage are hypertension, coagulation and receptor radionuclide therapy (PRRT) in 5 patients. haemostasis abnormalities. Methods Objective In this pilot study, five patients with high-grade glioma tumors To report a case of intracerebral hemorhage in patient with were included to investigate the treatment efficacy with i.v. 177-Lu- Immune Trombocytopenic Purpura (ITP). DOTATAE on high grade glioma tumors in these patients. The had radiological characteristics or histopathological confirmation of high- Result and discussion grade glioma tumors, blood brain barrier (BBB) disruption as well as A male, 22 years old, came from Pacitan Hospital complaining adequate SSTRs expression on the surface of tumor cells. that he has disorientation, left hemiplegia, redish rash found in chest, both arms and legs, gingival bleeding. Previously, he has a history of Results immune trombocytopenic purpura without routine therapy. Throm- A total of 5 patients received the i.v. 177Lu-DOTATATE in the bocyte count 5.000/ mm3, bleeding time 1,3; protombin time (PT) treatment of high grade glioma tumors. The intensity of tracer 1,30 ; activated parsial thromboplastin time (APTT) 21.3. Head CT uptake on PET or SPECT images was well correlated with the areas scan reveals the intracerebral hemorhage in right parietoocipital lobe with GAD-enhancement. The participants’ response were seen with edema and mid line shift. Patient was given gamaglobulin, complete remission (n=1), partial remission (n=2), and progressive manitol, dan methylprednisolone therapy. disease (n=2) in one- year follow up by brain imaging.

Conclusion Conclusion Intracerebral hemorhage is one of complications from ITP which The therapy was well tolerated without systemic toxicity has a low insidence but high mortality and morbidity if diagnose and (hematologic or renal toxicity) although our participants were therapy are not done immidiately. Administration of gamaglobulin critically ill and disabled. In addition, it showed that PRRT seems as with methylprednisolone as therapy for ITP and manitol as therapy an alternative treatment in patients with high-grade glioma tumors; for intracerebral hemorhage serve a good result for this patient. In however further well-designed studies are required. intracerebral hemorhage patient, it is suggested to check trombocyte count and coagulation factor to differentiate the etiology of doi:10.1016/j.jns.2019.10.536 intracerebral hemorhage caused by ITP or another coagulation and haemostasis abnormalities.

Keywords: Intracerebral hemorhage, ITP WCN19-0888

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ doi:10.1016/j.jns.2019.10.535 pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain injury

WCN19-0863 20 Years of sudden falls presenting as narcolepsy type 1 (NT 1)

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ M. Kaarlõp pain - Part I/sleep disorders - part I/stem cells and gene therapy - East Tallinn Central Hospital, Department of Neurology, Tallinn, Estonia Part I/stroke/training in neurology - Part I and traumatic brain 58-year-old woman was referred to a neurologist by a cardiolo- injury gist due to unspeciﬁed falls with no underlying cardiovascular disease with a hypothesis of potential epilepsy. Her Tilt-table test, Radionuclide therapy for high-grade astrocytoma: A pilot study 24- hour ECG monitoring and cardiac ultrasound revealed no abnormalities. ARTICLE IN PRESS

60 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

For 20 years she had been suffering from sudden falls without normal upper extremities strength, generalized areflexia and stock- loss of conciousness 3–4 times a month after which she could not ing sensory loss to all modalities in lower limbs. move her body for approximately 30 seconds following a a complete Lab investigations were unremarkable, including serum and urine recovery in 10 minutes. Sometimes these episodes were triggered by protein electrophoresis. CSF protein was 146 mg/dl (normal: 15–60 emotions. She experienced excessive daytime sleepiness, but had mg/dl). Nerve conduction studies demonstrated length-dependent, trouble sleeping at night and was subjected to sleep paralysis with symmetric mixed axonal and demyelinating sensorimotor poly- hypnagogic and hypnopompic hallucinations especially when wak- neuropathy. MRI pelvis revealed a left sacral destructive lesion. PET ing up in the morning or during the night. CT confirmed it was a solitary area of abnormality with no other A hypothesis of narcolepsy with cataplexy (NT1) was presented. areas of increased activity elsewhere. The lesion was proven to be a The following investigations were performed: electroencephalo- plasmacytoma on biopsy. Lesion irradiation and weekly dexameth- gram and magnetic resonance imaging of the brain revealed no asone injections led to a gradual steady recovery. abnormalities. Lumbar puncture showed no signs of infection. Levels of CSF hypocretin on the other hand were decreased (82 pg/ml). NT1 Conclusion is characterized by a low hypocretin level (b110 pg/ml). She tested Patients presenting with progressive cryptogenic polyneuropathy positive for both narcolepsy related HLA allels DQB1*06:02 and need to be thoroughly investigated for plasma cell neoplasms, as DQA1*01:02. She was diagnosed with narcolepsy type 1. She was treatment of these disorders leads to clinical recovery of the prescribed 200 mg modafinil and 150 mg venlafaxine daily. That has neuropathy. been reducing her daytime sleepiness, cataplexy and sleep paralysis. doi:10.1016/j.jns.2019.10.538 doi:10.1016/j.jns.2019.10.537

WCN19-0893 WCN19-0889 Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Part I/stroke/training in neurology - Part I and traumatic brain injury injury Differences in etiology and functional outcomes in anterior and Solitary plasmacytoma presenting as sensorimotor poly- posterior circulation ischemic strokes neuropathy: A case report J.V. Sayyeda, S.N. Sruthia, P.N. Sylajaa, P. Jeyarajb, S.M.V. Padmac,K. M. Binfalaha, S. Alsadadib, M. Mattarc Dheerajd, K. Subhashe, S. Aneesh Bf, A. Deepthib, P.S. Sankarag aUniversity Medical Center- King Abdullah Medical City, Neurology, aSree Chitra Tirunal Institute for Medical Sciences and Technology, Manama, Bahrain Neuromedicine, Trivandrum, India bUniversity Medical Center- King Abdullah Medical City, Hematology bChristian Medical College, Neurology, Ludhiana, India and Oncology, Manama, Bahrain cAll India Institutes of Medical Sciences AIIMS, Neurology, New Delhi, cUniversity Medical Center- King Abdullah Medical City, Radiology, India Manama, Bahrain dPostgraduate Institute of Medical Education and Research, Neurology, Chandigarh, India e Objective Nizam's Institute of Medical Sciences NIMS, Neurology, Hyderabad, We present a patient with progressive sensorimotor poly- India f neuropathy, who was found to have a solitary plasmacytoma. Massachusetts General Hospital, Neurology, Boston, USA gSree Chitra Tirunal Institute for Medical Sciences and Technology, Background Biostatistics, Trivandrum, India Solitary plasmacytoma is a plasma cell neoplasm characterized by a single mass of clonal plasma cells, with no or minimal bone Introduction marrow plasmacytosis. It may present as a solitary bone or Posterior circulation stroke (PCS) accounts for 20% of all ischemic extraosseous plasmacytoma. Solitary plasmacytoma with peripheral strokes. There are very few studies comparing anterior circulation neuropathy is uncommon, and the neuropathy is often the ischemic strokes (ACS) and PCS. presenting symptom. Objective Case. A 66 years old male with type 2 Diabetes presented with We analysed the differences in PCS and ACS in terms of risk slowly progressive symmetric weakness of both lower extremities. factors, stroke etiological subtype and outcome from the large There was no upper extremity, bladder or bowel involvement, prospective multicentre Indo–US collaborative stroke project. cranial neuropathies, or autonomic symptoms. He became unable to walk without using a cane. Neurological examination showed Methods profound bilateral foot weakness (MRC grade 0 dorsiflexion, 2 Patients with acute ischemic stroke within 2 weeks of onset were palmer flexion), 4+ weakness of proximal lower limb muscles, classified into anterior and posterior circulation strokes based on the ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 61 infarct location in the neuroimaging. Patients with uncertain of atypical parenchymal inﬁltration thru the Virchow’s space may be localization and both ACS and PCS strokes were excluded. included as part of the diagnostic criteria.

Results doi:10.1016/j.jns.2019.10.540 Of the 1583 patients (1026 male) with a mean age 59.1 (±14) years, 73.9% had ACS and 26.1% had PCS. The onset stroke severity was more in ACS compared to PCS (median NIHSS 11 vs 7; p b 0.001). There was no signiﬁcant difference in the risk factor proﬁle WCN19-0897 between ACS and PCS except rheumatic valvular disease which was more in the ACS (7.3% vs 3.1%; p = 0.003). Large vessel atherosclerosis (31.7% vs 21.3% ; p = 0.00) and cardioembolic strokes (27.4% vs Poster shift 01 - Channelopathies/neuroethics/neurooncology/ 20.1%; p = 0.03) were more often seen in ACS and small vessel pain - Part I/sleep disorders - Part I/stem cells and gene therapy - occlusions were more common in PCS (23.7% vs 13.5% p = 0.00). Part I/stroke/training in neurology - Part I and traumatic brain More patients with ACS received IV thrombolysis (15.6%) and injury endovascular treatment (3.6%) compared to PCS. At 90 days, ≤ excellent outcome (mRS 2) was more in PCS than ACS (58.4% vs Cerebral embolism in the surgical treatment of stenotic lesions of 49%; p = 0.001). the brachiocephalic arteries

Conclusion A. Dudinovaa, N. Rybalkob, O. Vinogradova, A. Kuznetsova Signiﬁcant differences were noticed in stroke severity, stroke aThe National Pirogov Medical Surgical Center- National Center of subtype and functional outcome between ACS and PCS. Cerebrovascular, Neurology, Moscow, Russia bScientiﬁc Research Institute of Emergency Care Named N.V. doi:10.1016/j.jns.2019.10.539 Ckliphosovskyy, Neurology, Moscow, Russia

Background Surgery and manipulations performed with stenotic lesions of the WCN19-0896 cerebral arteries, along with antithrombotic and lipid-lowering therapy, are the basis of primary and secondary prevention of Poster shift 01 - Channelopathies/neuroethics/neurooncology/ ischemic stroke, but can be the source of perioperative embolism in pain - Part I/sleep disorders - Part I/stem cells and gene therapy - the cerebral arteries. Part I/stroke/training in neurology - Part I and traumatic brain Objective injury Determine the composition of the embolic material and the clinical significance of microembolus identified in the cerebral Primary diffuse leptomeningeal gliomatosis with parenhycmal vascular bed during carotid endarterectomy and carotid stenting. infiltration: A clinico- radio-pathological correlation Materials and methods P.E. Yambao A total of 41 patients with hemodynamically significant stenosis Quirino Memorial Medical Center, Center of the Neurological Sciences, of the left/right ICA, who were treated at the hospital from 2013 to Quezon City, Philippines 2015 (26 patients were operated by the method of endarterectomy, 15 patients - by the carotid stenting method). MES registration was Primary Diffuse Leptomeningeal Gliomatosis (PDLG), as first performed intraoperatively for each patient by the method of described by Moore (1954), is a very rare form of cancer resulting bilateral Doppler monitoring of MCA on the SOMOMED-300M from the meningeal heterotopic astrocytes that convert into malig- device. nancies and possibly causing obstruction on the Virchow spaces leading to cystic parenchymal infiltration. This case of atypical Results parenchymal infiltration, 4th in literature, is a 45 -year old male with It was established that the total number of registered cerebral gradually progressive headache, difficulty sleeping and profound MES significantly predominates during endovascular interventions anxiety, left-sided numbness and seizures. Cranial CT- Scan showed due to massive gas embolism. The number of material microparticles right thalamic lesion without hydrocephalus. A possible thalamic prevails in patients undergoing endarterectomy compared with infarct or cavernoma was considered. Subsequent MRI showed the carotid stenting. Most of the material microparticles (up to 80%) same thalamic lesion but now with focal leptomeningeal enhance- when performing carotid stenting are recorded at the stage of stent ment probably secondary to glioma versus tuberculosis. He was given implantation and subsequent deflation. The majority of material anti-Koch’s medications and steroids. Leptomeningeal biopsy con- emboli (up to 62%) during endarterectomy were recorded before the firmed this malignancy. Post- mortem autopsy revealed thickened internal carotid artery was clamped, at the stage of atherosclerotic leptomeninges, right thalamic mass involving the centromedial and plaque isolation. posterolateral portion and small cystic lesions all over the surface. Histopathology showed Virchow -robin space infiltration proving the Conclusion parenchymal involvement through the pial vessels. This case The critical stages of registration of MES of material origin are: for highlighted the possibility of parenchymal involvement which carotid stenting, the stage of stent implantation with subsequent challenged the traditional diagnostic criteria. In this case, imaging also deflation; for endarterectomy, the stage of atherosclerotic plaque showed an underestimation of the extent of atypical brain parenchy- isolation to the clamping of the internal carotid artery. mal infiltration. Hence, headache coupled by leptomeningeal enhancement should always warrant close imaging surveillance and doi:10.1016/j.jns.2019.10.541 biopsy to rule out this exceptional condition. Moreover, the presence ARTICLE IN PRESS

62 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0899 Case 2: A 55 year man is admitted in an unarousable state for 10 hours. He recovered spontaneously after 24 hours but with hyper somnolence and memory impairment. Neurological exam revealed Poster shift 01 - Channelopathies/neuroethics/neurooncology/ vertical gaze palsy and right sided 6th and 7th nerve palsy. pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Case 3: A 40-year-old previously healthy female presented with Part I/stroke/training in neurology - Part I and traumatic brain sudden onset unresponsiveness. Examination revealed vertical gaze injury and right lateral rectus palsy. Basic haematology, non-contrast CT brain and toxicology screen Paramedian thalamic syndrome due to artery of Percheron was normal in all. MRI brain revealed bilateral thalamic infarctions infarction, effectively treated with early anticoagulation: A series (Figure 1,2 and 3). MRA, MRV were negative. Anticoagulation was of 3 cases started in addition to routine stroke care.

I. Rajapakshe, B. Senanayake Institute of Neurology, National Hospital of Sri Lanka, Colombo, Sri Discussion Lanka AOP infarction is characterized by a triad of altered mental status, vertical gaze palsy and memory impairment. Diagnosis need high suspicion and is confirmed on MRI. Management is similar to any Introduction/background ischemic stroke but the diagnostic delay usually prevents thrombol- Artery of Percheron infarction (AOP) is a rare cause of ischemic ysis or thrombectomy. Efficacy of long-term anticoagulation is not stroke characterized by bilateral thalamic infarcts with or without established. Our patients recovered significantly after starting rostral midbrain involvement.It represents 0.1% of total ischemic anticoagulation without disability. It suggests that anticoagulation strokes and 4% of thalamic strokes. We report 3 cases with AOP is an effective treatment option. infarction that responded well to early anticoagulation. Conclusions Case series The diagnosis of AOP infarction is difficult and is delayed due to Case 1: A 58 year female is admitted with sudden onset loss of its unusual presentation and lack of awareness. Early diagnosis and consciousness.Neurological exam revealed vertical gaze palsy with treatment with anticoagulation improves prognosis. no limb weakness. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 63

doi:10.1016/j.jns.2019.10.542 Results 520 stroke patients were admitted during study period. 383 (73.65%) had ischemic stroke, 34 (8.87%) were thrombolysed with intravenous recombinant tissue plasminogen activator (rtPA). 25 – WCN19-0901 (73.5%) were men; mean age was 52.6 years (21 83 years). Median NIHSS was 15.5 (11–22), median door to needle time was 102.2 minutes (30–180). 11 (32.35%) had good clinical outcome, for one Poster shift 01 - Channelopathies/neuroethics/neurooncology/ patient outcome is at 50 days. One patient (2.94%) had SICH and he pain - Part I/sleep disorders - Part I/stem cells and gene therapy - died. Part I/stroke/training in neurology - Part I and traumatic brain injury Conclusion Physicians in consultation with neurologist, using WhatsApp for Finding solutions: Whatsapp consult with neurologist can guide assessment of CT images can safely thrombolyse ischemic stroke patients. physicians to thrombolyse acute ischemic stroke patients

doi:10.1016/j.jns.2019.10.543 A. Jaiswala, D. Kabrab, N. Bahetib, N. Chandak Nitinb aShri KMJ Memorial Hospital & Research Centre- Gondia, Medicine, Gondia, India bDr. G. M. Taori Central India Institute of Medical Sciences, Department of Neurology, Nagpur, India WCN19-0902

Introduction Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Around 2000 Neurologist serve 1300 million Indians. 70 percent pain - Part I/sleep disorders - Part I/stem cells and gene therapy - live in rural areas and majority of neurologist work in urban regions. Part I/stroke/training in neurology - Part I and traumatic brain Stroke patients, especially in rural India do not have access to injury thrombolysis either due to lack of infrastructure, affordability or inadequate physician training. AHA/ASA target: Stroke phase 2 goals achieved in UAE: “Acute ” fi ‘ ’ Methods stroke clinical pathway signi cantly reduced door-to-needle This is a prospective study of all subsequent acute ischemic stroke time in acute ischemic stroke patients thrombolysed at Shri Kishanlal Mohanlal Jaiswal Memorial a b a a Hospital at Gondia, Maharashtra, India from March 2014 to March R. Renganathan , A. Al Aryani , A. Sabbah , A. Abdelhady ,H. a c 2019. Homaidan , N. Moussa a Physician would make a telephone call to neurologist and provide Al Ain Hospital, Neurology, Al Ain, United Arab Emirates b relevant clinical information. Neurologist would evaluate Com- Al Ain Hospital, Internal Medicine, Al Ain, United Arab Emirates c puterised tomography (CT) scan images received on Whatsapp and Retd Al Ain Hospital, Neurology, Al Ain, United Arab Emirates provide opinion on suitability for thrombolysis. Primary outcome was good clinical improvement at three months ,defined as score of Background 0-1 on modified Rankin score (m RS). Safety outcome was Target: Stroke was launched by the American Heart Association/ symptomatic intracranial bleed (SICH), defined as any intracranial American Stroke Association (AHA/ASA). Phase 1: To achieve Door- bleed within thirty six hours associated with clinical worsening by to-needle (DTN) within 60 minutes in ≥50%. of acute ischemic Stroke four or more points on National Institute of Health Stroke scale patients treated with IV rtPA. Phase 2: In acute ischemic stroke (NIHSS) or death. patients treated with IV rtPA, the Primary goal to achieve DTN times ARTICLE IN PRESS

64 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx within 60 minutes in ≥75%; Secondary Goal to achieve DTN times Case report within 45 minutes in ≥50%. We implemented “Acute Stroke Clinical A 32-years-old female known to have HbSS genotype sickle cell Pathway” in 2015 to improve DTN time and Stroke care. disease (SCD), who had a good clinical recovery from the SCD crises with multiple blood transfusions, presented with thunderclap head- Methods ache and rapid clinical neurological deterioration. Nonaneurysmal We prospectively analysed 48 month (Jan 2015 – Dec 2018) data SAH and convexital ICH had been diagnosed associated with reversible from Stroke Registry in AAH. We included patients who arrived cerebral vasoconstriction syndrome (RCVS) in combination with a within window period and received intravenous rtpA for acute patchy vasogenic cerebral edema, resembling atypical posterior ischemic stroke. reversible encephalopathy syndrome (PRES). The patient recovered well neurologically after four weeks of hospital course and neuroim- Results aging sign of CRVS and PRES like changes regressed completely. The Number of patients who met inclusion criteria was 21 in 2015, 20 patient was discharged with a mild residual pyramidal sign and a in 2016, 10 in 2017 and 22 in 2018. In 2015, 86% were treated within residual sign of convexital ICH on brain MRI. 60 minutes and 38% within 45 minutes. In 2016, 100% were treated within 60 minutes and 45% within 45 minutes. In 2017, 80% were Conclusion treated within 60 minutes and 40% within 45 minutes. In 2018, 100% To the best of our knowledge this is a second case description of were treated within 60 minutes and 73% within 45 minutes. nonaneurysmal SAH and ICH associated with RCVS and radiological features reminding PRES developed after blood transfusions in a Conclusion patient with SCD. We signiﬁcantly improved DTN times since the implementation of “Acute Stroke Clinical Pathway”. In acute ischemic stroke patients doi:10.1016/j.jns.2019.10.545 treated with IV rtPA, we have achieved the Primary goal of AHA/ASA Target: Phase 2 to achieve DTN times within 60 minutes in ≥75% and the Secondary Goal of achieving DTN times within 45 minutes in ≥50%. WCN19-0908 doi:10.1016/j.jns.2019.10.544 Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain WCN19-0906 injury

Al Ain Hospital in UAE maintains excellent standard of quality of Poster shift 01 - Channelopathies/neuroethics/neurooncology/ care for acute ischemic stroke pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain R. Renganathana, M. Sunilb, A. Joseb, L. Josephb, A. Sabbaha,A. injury Abdelhadya, H. Homaidana, N. Moussac aAl Ain Hospital, Neurology, Al Ain, United Arab Emirates Unusual intracranial hemorrhagic complications of sickle cell bAl Ain Hospital, Quality and Safety, Al Ain, United Arab Emirates disease after multiple blood transfusions: One or multiple clinical cRetd. Al Ain Hospital, Neurology, Al Ain, United Arab Emirates - Radiological entity? Background a a a a a M. Szolics , H. El Hasin , N. Soliman , A. Hassan , M. Al Kuwaiti ,Y. We have a 7-bedded unit Stroke Unit in Al Ain Hospital (AAH), Al b b b c Statsenko , T.M. Al Mansoori , K.N. Von Gorkom , M. Ljubisavljevic Ain, UAE. The Stroke Measure Set (STK) is a standardised perfor- a Tawam Hospital in afﬁliation with Johns Hopkins Medicine, Medicine- mance measure developed by Joint Commission in collaboration with Division of Neurology, Al Ain, United Arab Emirates American Heart Association/ American Stroke Association (AHA/ b College of Medicine and Health Science- UAEU, Radiology, Al Ain, ASA). Our aim was to assess the quality of Stroke care based on STK. United Arab Emirates c College of Medicine and Health Science- UAEU, Physiology, Al Ain, Methods United Arab Emirates We prospectively analysed data from Stroke registry for a 36- month period starting 01.01.2016. We measured 8 quality indicators Background STKs 1,2,3,4,5,6,8 and STK-10 from STK . Cerebrovascular complications in sickle cell disease (SCD) are STK set No. Stroke Measure usually attributed to vasculopathy, endothelial dysfunction, patho- STK-1 DVT Prophylaxis logical angiogenesis, and aneurysm formation. The nonaneurysmal STK-2 Discharged on Antithrombotic therapy subarachnoid haemorrhage (SAH) and intracerebral haemorrhage STK-3 Patients with Atrial Fibrillation Receiving Anticoagulation (ICH) as complications in SCD are less well understood and less Therapy frequent. STK-4 Thrombolytic Therapy Administered STK-5 Antithrombotic Therapy by End of Hospital Day Two Objectives STK-6 Discharged on Statin To present a type of an unusual hemorrhagic intracranial STK-8 Stroke Education (SAH/ICH) complications associated with additional clinical-radio- STK-10 Assessed for Rehabilitation logical phenomena in the patient with SCD developed after multiple blood transfusions in the recovery period from sickle cell Results crises. 858 Stroke patients were admitted of which 86% were ischemic. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 65

severity (NIHSS) at the admission was signiﬁcantly lower in young stroke patients than in older ones (8.5 vs. 11.3, p = 0.01), as well as mortality at one month (8% vs. 20%, p = 0.004). Favorable outcome (modiﬁed Rankin Scale b3) had 70% of young adults compared with only 50% of patients in the older group (p = 0.0005).

Conclusion Stroke in young adults in Tuzla Canton is rare, and men are overrepresented. Leading risk factors in young stroke patients are hypertension and tobacco use. Severity and outcome at one month in young adults are different from those in older patients.

doi:10.1016/j.jns.2019.10.547

We aimed for a target range of N 95% for each of the STK measures. Expected target ranges were achieved in all 8 STK measures. WCN19-0911 The Average Achieved Target Range for study period: 99.8% (STK- 1), 100% (STK-2), 100% (STK-3), 100% (STK-4), 100% (STK-5), 99.2% Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain (STK-6), 98.9% (STK-8), 99.8% (STK-10). - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ Conclusion stroke/training in neurology - Part I and traumatic brain injury • We conclude that the quality of stroke care in AAH is high. • We plan to include other quality indicators such as dysphagia Short door-to-needle times in acute ischemic stroke: Report of 2 screening and door-to-needle time to further improve quality of cases from UAE care for Stroke patients. R. Renganathana, A. Alduhooria, R. Mansoora, Z. Jummanib doi:10.1016/j.jns.2019.10.546 aAl Ain Hospital, Neurology, Al Ain, United Arab Emirates bAl Ain Hospital, Accident and Emergency, Al Ain, United Arab Emirates

Background WCN19-0910 Median Door-to-Needle (DTN) time ≤ 60 minutes in acute ischemic stroke is recommended by AHA/ASA. We present 2 patients ≤ Poster shift 01 - Channelopathies/neuroethics/neurooncology/ with DTN time 23 minutes. pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Case description Part I/stroke/training in neurology - Part I and traumatic brain Case 1. 54 year old man with a background history of hyperten- injury sion, ischemic heart disease, chronic kidney disease presented with acute onset speech difficulty and numbness right hand. NIHSS on Stroke in young adults in Tuzla Canton, Bosnia and Herzegovina admission was 6. CT brain showed dense left MCA sign. Patient came within window period for thrombolysis. rtpA was given. DTN time D. Smajlovic, A. Burgic, A. Brkic, O.Ć. Ibrahimagić was 23 minutes. Post rtpA he developed hypertension which University Clinical Center, Department of Neurology, Tuzla, Bosnia and controlled with medicaiton. NIHSS post-rtpA was 2. MRI showed Herzegovina acute left MCA infarct. At discharge he was on dual antiplatelet, statin and antihypertensives. mRS at discharge was 0. Objective Stroke in young adults accounts up to 10% of all strokes. There are Case 2. 52 year old man with background history of CABG with a very few data about stroke in young adults in Bosnia and poor compliance to Aspirin presented with acute onset dizziness and Herzegovina. inability to walk. Exam showed significant ataxia. CT brain was normal. Patients and methods Patient came within window period for thrombolysis. rtpA was From January 2013 to December 2015, 1836 patients with first-ever given. DTN time was 21 minutes. Post rtpA, there were no stroke were admitted at the Department of Neurology Tuzla, Bosnia complications. NIHSS post-rtpA was 2. MRI showed acute right and Herzegovina. We studied risk factors, stroke subtypes, severity pontine infarct. At discharge he was on dual anti platelet and statin. and outcome at 1 month in all young adults (18–49 years of age). mRS at discharge was 0

Results Discussion Out of total, there were 96 (5%) young adults with stroke. Mean “Acute Stroke Clinical Pathway” in Al Ain hospital was designed in age was 42.7 +/- 5.7 years and 40% were women. The leading risk 2015 and is updated periodically. Successful implementation of this factors in young stroke patients were hypertension (61%), followed pathway is key in achieving short DTN times. by tobacco use (52%), hyperlipidemia (41%) and alcohol overuse We present the first reports of short DTN times in UAE thus (33%). Ischemic stroke was more common than hemorrhagic (55% vs. reflecting the efficiency of our Stroke Code team. 45%), and predominantly was large artery atherosclerosis stroke type (40%). The subarachnoid hemorrhage (SAH) was more frequent than doi:10.1016/j.jns.2019.10.548 intracerebral hemorrhage (ICH) 26% vs. 19% (p = 0.01)). Stroke ARTICLE IN PRESS

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WCN19-0915 J. Bednarik, I. Srotova, E. Vlckova University Hospital Brno, Department of Neurology, Brno, Czech Republic Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Background Part I/stroke/training in neurology - Part I and traumatic brain Prevalence of pain in multiple sclerosis (MS) patients ranges from injury 29% to 86%, and central ongoing neuropathic extremity pain (CNEP) is most frequently described. Challenges in managing vascular hemiballismus-hemichorea: A multidisciplinary team approach Aim A prospective cohort study was aimed at evaluation of sensory R. Renganathan, G. Anosa, J. Olidan, S. Al Jarrah, A. Jessy Mol and pain modulation proﬁles in a well-deﬁned group of MS patients Al Ain Hospital, Neurology, Al Ain, United Arab Emirates suffering from CNEP.

Background Methods Hemiballismus due to ischemic stroke is very rare and is A group of 56 MS patients suffering from CNEP that complied with fi challenging to treat. the criteria of de nite neuropathic pain were compared with two control groups: a painless MS group (n = 63) and a group of 73 healthy Case description volunteers, age- and sex-matched with the pooled MS group (mean age 65 year old man with background history of hypertension 36.3 vs. 37.7 years, 66.7% vs. 68.9% women in controls vs. pooled MS presented with sudden collapse, restlessness and abnormal move- patients). Pain questionnaires and standardized quantitative sensory ments of left leg. Examination showed agitated behaviour with testing (QST) protocol and its dynamic variant (dQST) assessing both continuous hemiballismus-hemichorea of left leg. MRI brain showed the facilitatory (temporal summation) and inhibitory (conditioned pain acute infarct right thalamus and sub thalamus. ECHO was normal. He modulation) pain mechanisms were used to characterize pain and to fi was started on dual antiplatelet, statin, amlodipine and prophylactic compare sensory pro les of evaluated subgroups. enoxaparin. During his stay, he was increasingly agitated with outbursts of physical aggression directed toward the nursing staff Results fi and resulting in self-harm. Various medications including clonaze- In the CNEP group, QST disclosed signi cantly more severe and pam, risperidone, haloperidol, quetiapine, topiramate and amanta- frequent sensory loss (predominantly in thermal modalities) as com- dine were tried to manage his hemiballismus and agitation. pared to both painless MS and control groups. In addition, thermal and Psychiatry consult obtained. One-to-One nursing care was provided pressure pain hypersensitivity in both CNEP and painless MS subgroups to manage his behavioural issues. 4-point restraint was used in comparison with healthy controls were found. dQST showed no periodically to prevent him from self-harm. As he failed swallow difference between CNEP and painless MS patients or controls. screen, nasogastric tube was inserted, but he repeatedly pulled it. Due to constant movement of his leg, his basal metabolic rate Conclusion increased and he was losing weight significantly. He lost 2.5 kg in the To conclude, in CNEP MS patients we found signs of sensory loss first week of admission. Protein and calorie requirements were (as an indicator of deafferentation secondary to lesion in the spino- adjusted in his diet. thalamocortical pathways) in combination with thermal and mechanical hypersensitivity due to supposed central pain mechanisms. Discussion doi:10.1016/j.jns.2019.10.550 This patient had a prolonged stay in Stroke Unit. Hemiballismus, Behavioural problems, issues with loss of weight were challenging to manage. However, with excellent nursing care and multidisciplinary team input, he recovered and was stable at discharge. WCN19-0932 Conclusion Although challenging to treat, vascular hemiballismus-hemi- Poster shift 01 - Channelopathies/neuroethics/neurooncology/ chorea can be successfully managed with appropriate nursing and pain - Part I/sleep disorders - Part I/stem cells and gene therapy - supportive care in addition to medical management. Part I/stroke/training in neurology - Part I and traumatic brain doi:10.1016/j.jns.2019.10.549 injury

Neural substrate in subcortical hemispatial neglect: Voxel-based lesion-symptom mapping study WCN19-0922 S.H. Leea, S. Kwona, W.S. Kima, J. Parka, N.J. Paika, C.E. Hanb, M. Choib aSeoul National University Bundang Hospital, 1Department of Rehabil- Poster shift 01 - Channelopathies/neuroethics/neurooncology/ itation Medicine, Seoul, Republic of Korea pain - Part I/sleep disorders - Part I/stem cells and gene therapy - bKorea University- Sejong, Department of Electronics and Information Part I/stroke/training in neurology - Part I and traumatic brain Engineering, Sejong, Republic of Korea injury Background Sensory and pain modulation proﬁles of central neuropathic The neural correlates for visuospatial hemispatial neglect in ongoing extremity pain in multiple sclerosis patient with subcortical stroke are varying according the ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 67 methodologies of previous studies and subjects analyzed. The aim of Aim this study was to investigate neural substrates associated with To investigate the association of aspirin resistance with mortality subcortical neglect by comparing the stroke lesion in patients with in a cohort of Indian patients with acute ischemic stroke. neglect with that in control patients, using voxel-based lesion- symptom mapping (VLSM). Methodology This is an interim analysis from an ongoing study. Patients with Methods ischemic stroke receiving aspirin therapy alone for at least 7 days Twenty three patients with right subcortical stroke, who were and within 30 days of the stroke event were enrolled in the study. admitted to Department of Rehabilitation Medicine, Seoul National Aspirin responsiveness was determined by light transmission University Bundang Hospital were retrospectively enrolled. Subjects aggregometry. Patients were divided in to aspirin resistant, aspirin were allocated to the hemispatial neglect group (n = 9), if they semi-resistant and aspirin sensitive group using standard definitions. showed positive results for neglect in two or more tests, out of three Clinical outcome was measured using modified Ranking Score at 3 tests (line bisection test, Albert’s test, house drawing test). Subjects months and 12 months. who showed negative results in all three tests were allocated to the control group (n = 14). Stroke lesions in diffusion, T2-weighted or Results T1- weighted MRI were manually drawn, using MRIcron software Data of 205 patients is presented. There were 140 (68.2%) males (http://www.mccauslandcenter.sc.edu/mricro/mricron/). At every and 65 (31.8%) females. The mean age of patients is 54 ± 14.8 years. voxel, a statistical test (t-test) was performed to compare the 21 patients were resistant to aspirin (10.2%, 95% CI: 6.5%–15.2%); 61 behavioral scores of patients with and without a lesion in that voxel. patients were semi- resistant to aspirin (29.8%, 95% CI: 23.6%–36.5%); A permutation testing is applied to correct errors from multiple 123 patients were sensitive to aspirin (60%, 95% CI: 52.9%–66.7%). 3 comparisons. months follow up was completed for 181 patients, mortality rate was higher in resistant group (26.3%) in comparison to semi resistant Results (7.7%) and sensitive group (7.3). Statistically, there was significant The VLSM analysis demonstrated that the brain regions signifi- difference in the mortality between the three groups (p value- 0.02). cantly associated with subcortical hemispastial neglect (minimum 12 months follow up was completed for 133 patients. The mortality significant t-value of 2.41, p b 0.01) were the right fronto-parietal rate was higher in resistant group (53.3%) than semi-resistant subcortical whiter matter including corpus callosum, corona radiata (28.21%) and sensitive group (16.4%). Statistically significant differ- (Fig. 1.). These subcortical brain regions are along the course of ences were observed between the three groups (p = 0.007). superior longitudinal fasciculus (SLF). Conclusion Conclusions Interim analysis suggests that biochemical aspirin resistance is In this study, the dorsal visual pathway including SLF appears to not uncommon in acute ischemic and is associated with higher be a neural substrate associated with subcortical neglect in patients mortality. with stroke. doi:10.1016/j.jns.2019.10.552 doi:10.1016/j.jns.2019.10.551

WCN19-0948 WCN19-0938 Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Part I/stroke/training in neurology - Part I and traumatic brain injury injury Aspirin resistance and stroke recurrence: A prospective cohort Aspirin resistance with mortality in patients with ischemic stroke study

P. Sisodiaa, R. Bhatiaa, P. Balia, N. Singha, A. Chauhana, R. Hoodaa,R. P. Sisodiaa, R. Bhatiaa, R. Saxenab, M.V.P. Srivastavaa, K. Prasada,S. Saxenab, M.V.P. Srivastavaa, K. Prasada, S. Vishnubhatlac, G. Sharmad, Vishnubhatlac, G. Sharmad, M.B. Singha M.B. Singha aAll India Institute of Medical Sciences- New Delhi, Neurology, Delhi, aAll India Institute of Medical Sciences- New Delhi, Neurology, Delhi, India India bAll India Institute of Medical Sciences- New Delhi, Hematology, Delhi, bAll India Institute of Medical Sciences- New Delhi, Hematology, Delhi, India India cAll India Institute of Medical Sciences- New Delhi, Biostatistics, Delhi, cAll India Institute of Medical Sciences- New Delhi, Biostatistics, Delhi, India India dAll India Institute of Medical Sciences- New Delhi, Cardiology, Delhi, dAll India Institute of Medical Sciences- New Delhi, Cardiology, Delhi, India India Background Background A proportion of patients may have stroke recurrence while on Aspirin is used in ischemic stroke therapy. However some treatment with aspirin. Some studies have suggested that such patients are not responsive to the anti-thrombotic action of aspirin. recurrence could be partly attributed to biochemical aspirin resistance. ARTICLE IN PRESS

68 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

Aim the Health Insurance Review Agency which includes population- To determine the prevalence of aspirin resistance and is based health insurance electronic records of all medical and association with recurrent stroke events after ischemic stroke. prescription drug claims. Adherence to AHT was calculated as the proportion of days covered (PDC), based on the total number of days Methodology supplied for filled prescriptions during the observation interval. This is an interim analysis from an ongoing study. Patients with Patients were classified as poor adherence group based on the PDC b ischemic stroke receiving aspirin therapy alone for at least 7 days 80%. The primary outcome included overall mortality and readmis- and within 30 days of the stroke event were enrolled in the study. sion for vascular disease. Aspirin responsiveness was determined by light transmission aggregometry. Patients were divided in to aspirin-resistant, aspirin Results semi-resistant and aspirin sensitive groups using standard defini- We included 17,168 patients who were admitted between January tions. A follow-up period of 1 year was performed to record stroke 2008 and December after excluding patients who were not taking AHT recurrence events. (n = 13,474) and had received AHT for less than 6 months (n = 4,442). The overall survival rate was significantly lower in the poor Results adherence group. Adjusted HRs for mortality of poor adherence to AHT 205 patients have been enrolled in this study. There were 140 was 1.454 [95% CI 1.269–1.666]. The rate of vascular readmission was (68.2%) males and 65 (31.8%) females. The mean age of patients is 54 significantly higher in the poor adherence group. The adjusted OR for ±14.8 years. 21 patients were resistant to aspirin (10.2%, 95% CI: vascular readmission was 1.854 (95% CI 1.686–2.038). 6.5%–15.2%); 61 patients were semi-resistant to aspirin (29.8%, 95% CI: 23.6%-36.5%); 123 patients were sensitive to aspirin (60%, 95% CI: Conclusion 52.9%-66.7%). Follow-up was complete in 181 patients.16/181 (8.8%) Poor adherence to AHT increased the risk of overall mortality and patients had recurrence of stroke. 6/13 (31.6%) patients were in readmission for vascular disease. More attention needs to be given to aspirin resistant group, 5/52 (9.6) patients were in aspirin semi- patient compliance to their AHT. resistant group and 5/110 (4.6%) patients were in aspirin sensitive group. The stroke recurrence was higher in the aspirin resistant doi:10.1016/j.jns.2019.10.554 patients compared to the patients in aspirin semi-resistant and sensitive group, which was statistically significant (p value-0.001).

Conclusion WCN19-0956 Complete aspirin resistance was seen in 10% of study population and 40% had both complete and semi-resistance. Patients with aspirin resistance may have a greater risk of stroke recurrence. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - doi:10.1016/j.jns.2019.10.553 Part I/stroke/training in neurology - Part I and traumatic brain injury

The relationship between carotid artery plaque and cerebral WCN19-0951 infarction of middle cerebral artery and its branches

a a a a a b a Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Y.J. Li , Y.Q. Dong , W.H. Lliu , R.Q. Cheng , C.Y. Liu , Z. Chai , L. Feng , J.J. Huangc, Z.Q. Yuand, J.Z. Yua, B.G. Xiaoe, C.G. Mab pain - Part I/sleep disorders - Part I/stem cells and gene therapy - aThe NO.1 Affiliated hospital of Shanxi Datong University, Institute of Part I/stroke/training in neurology - Part I and traumatic brain Brain Science- Shanxi Key Laboratory of Inflammatory Neurodegener- injury ative Diseases, Datong, China bShanxi University of Chinese Medicine, The Key Research Laboratory of Impact of adherence to anti-hypertensive drugs after acute Benefiting Qi for Acting Blood Circulation Method to Treat Multiple ischemic stroke Sclerosis of State Administration of Traditional Chinese Medicine- and Scientific and Technological Innovation Team of Integrated Chinese and S. Jungab, P. Ki-Jongab, Y. Changhyob Western M, Jingzhong, China aGyeongsang National University College of Medicine- Institute of cGeneral Hospital of Datong Coalmine Group, Neurosurgery, Datong, China Health Science, Neurology, Jinju, Republic of Korea dAcademy of Military Medical Sciences, Military Cognition and Brain bGyeongsang National University Changwon Hospital, Neurology, Science Center, Beijing, China Changwon, Republic of Korea eFudan University, Institute of Neurology- Huashan Hospital- Institutes of Brain Science and State Key Laboratory of Medical Neurobiology, Shanghai, Introduction China Hypertension is an important, modifiable risk factor for cerebrovascular disease. However, little is known that the impact of non- Background adherence to antihypertensive therapy (AHT) on the clinical The occlusion of middle cerebral artery was mainly caused by outcomes in patients with acute ischemic stroke (AIS) or transient carotid artery plaque. The study of carotid atherosclerosis and carotid ischemia attack (TIA). artery and its branches is important.

Methods Objective We conducted a record-linkage study that was based on the Through the study of infarction risk factors, pathogenesis, clinical prospective, multicenter registry of consecutive patients with AIS or symptoms, imaging examination, to the re understanding of carotid TIA. The prescription data of all enrolled patients were obtained from atherosclerosis and carotid plaque provided to a new level. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 69

Methods of the face, unequal palatal elevation, weak gag reflex with no A retrospective selection of 85 patients, with comprehensive sensorimotor deficit. However, progression of symptoms was noted analysis of relevant inspection criteria for determining the anterior during hospitalization. Patient became quadriplegic with inability to cerebral circulation ischemia (MCA, ACA two infarction rate). To protrude tongue and impaired deep sensations. MRI and CTA were summarize the risk factors, etiology, pathogenesis, clinical symptoms done. and imaging examination, per the degree of thickening of the carotid artery of the patients were divided into carotid plaque group and Results carotid artery plaque group, compared the infarction patients’ Cranial MRI result revealed acute bilateral medial medullary distribution. infarcts corresponding to the pyramidal tracts, along the vascular territories of the medullary perforating branches of the vertebral Results arteries. Incidence rate of Cerebral anterior circulation infarction can be as Angiographic results revealed “short segment narrowing at the high as 76.17%; carotid atherosclerotic plaque formation in the M1-M2 junction of the right middle cerebral artery territory (R MCA) middle cerebral artery and its incidence rate is 64.6%. Logistic and in the territories of right vertebral artery (R VA)”. regression analysis showed that age and hypertension were independent risk factors of carotid artery plaque. Carotid plaque in Conclusion cerebral infarction patients were more likely to involve the parts of Bilateral medial medullary infarction is a rare stroke which has a MCA, three (P b 0.05) there are significant differences between the poor clinical outcome. Though it occurs due to an atheromatous two groups. occlusion of a distal Vertebral Artery, it can also be preceded or occurred simultaneously with Wallenberg Syndrome. Diagnosis of Conclusions such combination warrants vigilance, thorough neurologic examina- Anterior cerebral artery ischemic infarction and carotid plaque tion and a high suspicion together with the aid of MRI to arrive with has little relationship. Age, high blood pressure and MCA is a possible the accurate neurologic diagnosis. related factor in the formation of carotid plaque in anterior circulation infarction. (NNSF of China 81471412, 81473577, Shanxi Science and Technology Key R&D Program 2016ZD0505, Shanxi Provincial Platform Base Special Project201805D111009,201805D131005). doi:10.1016/j.jns.2019.10.556 doi:10.1016/j.jns.2019.10.555

WCN19-0964

WCN19-0959 Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Part I/stroke/training in neurology - Part I and traumatic brain pain - Part I/sleep disorders - Part I/stem cells and gene therapy - injury Part I/stroke/training in neurology - Part I and traumatic brain injury Effect of intravenous thrombolysis of Alteplase in treatment of acute ischemic stroke “A storm in the middle” evolution of a lateral medullary a a a a b a a syndrome to a bilateral medial medullary infarct: A case report L.B. Zhang , R.S. Cheng , D.H. Wang , J. Yuan , Z. Chai , T. Meng ,L.Li, L. Fenga, J.J. Huangc, Z.Q. Yuand, J.Z. Yua, B.G. Xiaoe, C.G. Mab a fi P.J. De Leon, J.H. Hiyadan The NO.1 Af liated hospital of Shanxi Datong University, Institute of fl Baguio General Hospital and Medical Center, Neurology, Baguio City, Brain Science- Shanxi Key Laboratory of In ammatory Neurodegener- Philippines ative Diseases, Datong, China bShanxi University of Chinese Medicine, The Key Research Laboratory of fi Abstract Bene ting Qi for Acting Blood Circulation Method to Treat Multiple Sclerosis of State Administration of Traditional Chinese Medicine- and Introduction Scientific and Technological Innovation Team of Integrated Chinese and Posterior circulation infarction accounts for about 20–25% of all Western M, Jingzhong, China c ischemic strokes in the general adult population. Medial medullary General Hospital of Datong Coalmine Group, Neurosurgery, Datong, infarction (MMI) is reported to be less than 1% of vertebrobasilar China d artery strokes, with only 18% of such cases occurring bilaterally to Academy of Military Medical Sciences, Military Cognition and Brain involve both medial side of the medulla. Science Center, Beijing, China eFudan University, Institute of Neurology- Huashan Hospital- Institutes Objective of Brain Science and State Key Laboratory of Medical Neurobiology, To present a rare case of Wallenberg syndrome evolving to a Shanghai, China bilateral medial medullary infarct. Case: Background A 55-year old, hypertensive, male complaining of sudden onset Thrombolysis therapy is the most effective treatment for Acute vertiginous dizziness and non-projectile vomiting with initial ischemic stroke (AIS) at present. The study that the blood vessel was manifestation of right pseudoptosis, sensory deficit on the right side not passed after the therapy is less. ARTICLE IN PRESS

70 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

Objective To investigate the effect of intravenous thrombolysis of Alteplase Method in the treatment of AIS， especially the effect on the patients with This is a cross-sectional, descriptive analytic study of the medical failure of intravenous thrombolysis. records belonging to spontaneous SAH patients admitted to Pasar Minggu Hospital from January 2016 – November 2018. Data is Methods analyzed with the Chi-square test (CI=95%, α=0.05). 60 patients with AIS were divided into the thrombolysis group and non-thrombolysis group. All the patients underwent head CTA at Results 24h after the hospitalization， and the cerebral vascular perfusion Twenty-four subjects were obtained. Mortality rate is 20.8%. Most grading (m-TICI) was evaluated. The baseline data， scores at each subjects are female (70.8%) aged b60 years old (75%), with a median stage (NIHSS， BI index and mRS), clinical data after hospitalization, age of 49 (34–78) years old, suffering from hypertension (62.5%), and post-treatment complications were compared. with eunatremia (91.7%) and normoglycemia (91.7%). GCS at onset is 9-14 in 50% of subjects. Hunt and Hess score is mostly 3 (54.2%). Results Modified Fisher score is mostly 3 and 4 (29.2% each). Pneumonia is There were 10 cases of responsible vascular recanalization in the found in 54.2% of subjects. There is significant correlation between thrombolysis group， and the recanalization rate was 33%， whereas GCS score and SAH mortality (p = 0.014). There is no significant there was no case of responsible vascular recanalization in the non- correlation between age, blood pressure, Hunt and Hess score, thrombolysis group. The NIHSS scores in the thrombolysis group modified Fisher score, hypernatremia, hyperglycemia, or pneumonia were significantly lower than those in the non-thrombolysis group. with mortality. The scores in the recanalization after thrombolysis group were significantly lower than those in the non-thrombolysis group. The BI Conclusion scores at each stage in the thrombolysis group, recanalization after Mortality rate of spontaneous SAH in Pasar Minggu Regional thrombolysis group and failed recanalization after thrombolysis General Hospital is still high. The significantly correlated risk factor is group were significantly higher than those in the non-thrombolysis GCS score at onset. group. (p b 0.05). Keywords: Mortality rate, SAH, Risk factors Conclusion This study suggests that the safety of intravenous thrombolysis with Alteplase in patients with AIS is very good. (NNSF of China 81471412, 81473577, Shanxi Science and Technology Key R&D doi:10.1016/j.jns.2019.10.558 Program 2016ZD0505, Shanxi Provincial Platform Base Special Project201805D111009,201805D131005). doi:10.1016/j.jns.2019.10.557 WCN19-0971

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - WCN19-0967 Part I/stroke/training in neurology - Part I and traumatic brain injury Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Research of Clinical Features about first-ever ischemic stroke in Part I/stroke/training in neurology - Part I and traumatic brain small-artery occlusion patients injury X. Li, H. Yu, J. Ma, X. Zhen, Y. Zhang Mortality rate of spontaneous subarachnoid hemorrhage and Yueyang Hospital of Integrated Traditional Chinese and Western related factors in Pasar Minggu Regional General Hospital Medicine affiliated to Shanghai University of Traditional Chinese Medicine, Neurology, Hongkou- Shanghai, China W. Chahyania, M.I. Rinaldya, M.S. Hastutia, T. Wahyunib aThe Faculty of Medicine and Health University of Muhammadiyah Objective Jakarta, Neurology, South Tangerang, Indonesia Small-Vessel Occlusion is a common etiology of ischemic stroke. fi bThe Faculty of Medicine and Health University of Muhammadiyah In this study, we investigate the Clinical Features of rst-ever Jakarta, Clinical Pathology, South Tangerang, Indonesia ischemic stroke in small-artery occlusion patients.

Background Methods The prevalence of spontaneous subarachnoid hemorrhage (SAH) All the information were provided by the database of patients in Indonesia is 4.2%, with a high mortality rate (up to 80%). Studies with acute ischemic stroke admitted to the Department of show that risk factors that can cause an increase in mortality rate are Neurology, Shanghai Yueyang Hospital, Shanghai, China, from blood pressure, Glasgow Coma Scale (GCS), clinical presentation, January 2011 to January 2016. According to the TOAST criteria, ﬁ characteristics of the brain CT-scan, pneumonia, electrolyte imbal- 172 rst-ever acute ischemic stroke patients were divided into SAO ance, and hyperglycemia. The author aims to ﬁnd out the mortality group (small-artery occlusion) and Non-SAO group. We compared rate of spontaneous SAH among patients of Pasar Minggu Hospital the differences of two groups in risk factors, clinical manifestations and associated risk factors. and laboratory data. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 71

Results Results Cerebral perfusion according to SPECT in groups 1 and 2 were In SAO group, family history of stroke (14.2% vs 4.5%， P= 76.2% and 79.2%, respectively; differences were not statistically 0.045) and diabetes (33.0% vs 18.2%， P = 0.034) were more significant (p N 0.05). MMSE and MoCa in groups 1 and 2 appeared to common， and the proportion of patients with atrial fibrillation be 25.7 ± 0.5 and 26.8 ± 0.5 (p N 0.05); 26.5 ± 0.4 and 27.5 ± 0.4 (7.6% vs 16.7%, P = 0.009) was less common when compared to (p N 0.05), respectively. According to cognitive evoked potentials, those in Non-SAO group. Paralysis (49.4% vs 77.8%，P = 0.002), latencyP-300 in groups were 406 ± 0.6 ms and 371 ± 0.6 ms, speech disorder (55.4% vs 80%， P = 0.006)and pulmonary respectively (p N 0.05). No correlation between severity of stenosis infection (13.2% vs 33.3%, P = 0.002)were less common， and and cognitive functions in groups 1 and 2 were seen (r b 0.3). the severity of the disease is mild according to MIHSS, BI and MRS in the SAO group (P = 0.000； P = 0.000； P = 0.009). And Conclusion the contents of WBC、GOT、LDL、CRP、D-Di was significantly Macroangiopathy of cerebral arteries (carotid stenosis) is not lower in SAO group than those in Non-SAO group.Con- associated with cognitive deterioration. clusion There was significantly difference in risk factors, clinical manifestations and laboratory data between SAO group and Non- doi:10.1016/j.jns.2019.10.560 SAO group.

Keywords: First-ever stroke, Small-artery occlusion, Clinical Features WCN19-0979

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ doi:10.1016/j.jns.2019.10.559 pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain injury

WCN19-0972 Baseline characteristics of embolic strokes patients in the Dr. Zainoel Abidin Hospital Banda Aceh, Indonesia Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - S. Gazali Abdul Rahman, N. Nurul Fajri, I. Imran, N. Nova Dian Lestari, fi Part I/stroke/training in neurology - Part I and traumatic brain S. Sri Hastuti, L. Laila Fajri, E. Ellya Nur da, K. Khatab Medical Faculty of Syiah Kuala University- Zainoel Abidin Public injury Hospital- Indonesia Neurology Association, Neurology, Banda Aceh, Indonesia Cerebral hemodynamics and cognitive function in patients with atherosclerotic lesions of brachiocephalic arteries Embolic strokes are most commonly thrombotic in nature. Age, a history of stroke or TIA's, hypertension, diabetes and heart failure in A. Mushba, O. Vinogradov, A. Kuznetsov, M. Vachromeeva, E. Kankia- stroke with atrial fibrillation as additional risk factors for future Denisenko, V. Batrashov embolisms diagnosis. National Center of Cerebrovascular Disorders, The National Pirogov We use a retrospective cross-sectional study design. We collect Medical Surgical Center, Moscow, Russia data from patients admitted from February 2019 to April 2019 diagnosed and treated for embolic strokes. The clinical information, Introduction treatment, and prognosis were also analysed. Steno-occlusive atherosclerotic lesions of extra- and intracranial We collected 35 cases of embolic strokes, which consist of 15 males fi cerebral arteries is regarded as the most signi cant factor for (43%) and 20 females (57%) with an average age of N66 years. Patients ischemic stroke risk. The greater the percentage of stenosis, the characteristics were as follows; for the main complaints, Limb weakness higher the risk of stroke. However it is unclear the impact of and cranial nerve paralysis, 60% (21 patients) with headache, and 43% macroangiopathy (stenos in the carotid arteries) in the inhibition of (15 patients) with vomiting. The major risk factors are hypertension cognitive functions. (63%) and concomitant with diabetes mellitus, smoking history, and recurrent stroke. GCS scores found during the examination were scores Materials and methods ≥9 (29 patients) and score ≤8 (6 patients). Radiology findings were; 22 In study were included 2 groups of patients: group 1 - patients patients with MCA, 6 patients MCA, PCA and 4 patients ACA, MCA, PCA. N with asymptomatic carotid stenosis 50% (30 patients); group 2 - Therapeutical regiments implemented for patients were 72% with patients with carotid stenosis b50% (30 patients). In the group with enoxafarin sodium and 28% with Clopidogrel. asymptomatic carotid stenosis N50% were 22 (73.3%) male and 8 Approximately 40% of embolic strokes is of unknown caused. Age, (26.7%) women; mean age of patients was 62.5 ± 1.3 years. In the a history of stroke or TIA's, hypertension, diabetes and heart failure group with carotid stenosis b50% - 19 (63.3%) male and 11 (36.6%) play a role in stroke with atrial fibrillation as additional risk factors women; mean age of patients was 64.5±1.4 years. All patients for future embolisms. Successful treatment programs for both underwent assessment of scale of cognitive impairment (MMSE, conditions are highly dependent upon specialised treatment units, МоСа ), cognitive evoked potentials (P-300), duplex scanning of provision of care by teams of health care providers and the chain of brachiocephalic arteries, transcranial duplex scan, brain MRI and survival from symptom onset to reperfusion. Single-photon emission computed tomography (SPECT) with 99mТс- HMPAO. doi:10.1016/j.jns.2019.10.561 ARTICLE IN PRESS

72 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-0986

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in nuerology - Part I and traumatic brain injury

Sleep disturbances among medical students

S. Enkhtuyaa, S. Jambala, N. Davaadavgab, A. Jamsranjavb aReﬂex Clinic, Neurology, Ulaanbaatar, Mongolia bMongolian National University of Medical Sciences, School of Medicine, Ulaanbaatar, MongoliaKey words: Medical students, Sleep quality, Epworth sleepiness scale, Pittsburg sleep quality index

Purpose This study was aimed to investigate the quality of sleep and related factors in medical students.

Methods This cross-sectionalquestionnaire survey comprised samples from Mongolian medical university. We used the Pittsburgh Sleep Quality Index and Epworth sleepiness scale. Statistical analysis was performed by using the SPSS, version 21. Student’s T-test, chi-square test and analysis of variance were used for comparisons when appropriate. The level of statistical signiﬁcance was set at pb0.05.

Results We surveyed totally 440 participants; of them, 350 (79.5%) were females and 90 (20.5%) were males. Overall mean age was 20.45 ±1.92 years. Poor sleep quality was present in 278 (63.2%) of students that was associated with marital status (p=0.042), academic performance (p=0.001), course (p=0.007), total hours slept (p=0.0001), sleep latency (p=0.0001) and excessive daytime sleepiness (p=0.0001). In our study, the overall prevalence of excessive daytime sleepiness was 11.3%. Increased risk of excessive ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 73 daytime sleepiness was marital status (p=0.005), academic perfor- WCN19-1003 mance (p=0.009) and body mass index (p=0.028).

Conclusion Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Our study ﬁndings reveal that poor sleep quality and excessive pain - Part I/sleep disorders - Part I/stem cells and gene therapy - daytime sleepiness are highly prevalent in medical students and is Part I/stroke/training in neurology - Part I and traumatic brain associated with predisposing and several modiﬁable factors. injury doi:10.1016/j.jns.2019.10.562 Serial case report: Primary central nervous system lymphoma in immunocompetent patients

D. Rahmawati, R. Rachmasari WCN19-0997 Faculty of Medicine, Universitas Brawijaya- Saiful Anwar Hospital, Neurology, Malang, Indonesia Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Primary Central Nervous System Lymphomas (PCNSL) are rare pain - Part I/sleep disorders - Part I/stem cells and gene therapy - tumors of the Central Nervous System (CNS), comprising 0.8% to 6.6% Part I/stroke/training in nuerology - Part I and traumatic brain of all primary CNS tumors. PCNSL can develop in immunosuppressed injury (ex:HIV/ AIDS) or immunocompetent patients. Unlike other brain tumors, it often has a favorable response to both chemotherapy and Correlation of ischemic lesion volume change whith stroke long radiation therapy, but compared with lymphomas outside the CNS, term clinical outcome survival is usually inferior. We Report 3 immunocompetent patients, 2 females and 1 male, Z. Akbarkhodjaeva diagnosed with Primary central nervous system Lymphoma. The Tashkent Medical Academy, Neurology, Tashkent, Uzbekistan median age of the cases with PCSNL was 50 years. All patients presented initially with features of intracranial mass lesion. Pre- Purpose of the study is to determine relationship of ischemic operative clinico-radiological diagnosis of gliomas or metastasis was lesion volume dynamics with clinical outcome of stroke. suspected. However, after surgical resection, non-Hodgkin’s lymphoma was conﬁrmed by histopathology and subsequent immuno- Materials and methods histochemistry. All patient was treated with chemotherapy meth- 120 stroke patients were examined. All patients underwent brain othrexate via intratecal. 2 patient completed chemotherapy regi- MRI in acute period of stroke and from 28 days to 6 months from ment, but 1 patient did not survive. tstroke onset re-performed brain MRI. doi:10.1016/j.jns.2019.10.564 Results In most cases, left MCA was affected (50%), then vertebrobasilar basin (27%) and right MCA (23%). The volume of large lesion was more than 50 cm3, the middle-from 10 to 50 cm3, small ones were WCN19-1006 with a volume of up to 50 cm3. The best recovery of impaired functions was observed with medium sizes of lesion, the smallest - Poster shift 01 - Channelopathies/neuroethics/neurooncology/ with small lesions of ischemia. Comparison of rates of recovery of neurological disorders in dynamics showed that in acute period of pain - Part I/sleep disorders - Part I/stem cells and gene therapy - stroke, the regression of neurological deﬁcit occurred at least two Part I/stroke/training in neurology - Part I and traumatic brain times more actively. The initiation of treatment during the “thera- injury peutic window” was also of great importance in restoring lost functions and shaping the size of ischemic lesion. Comparison of the Sickle cell disease related cerebral fat embolism: Characterizing clinical picture in acute phase of stroke with localization and size of the clinical syndrome the lesion does not reveal a direct correlative connection, in particular, central hemiplegia and hemianesthesia occur with N. Ramachandirana, S. Ranigab, S. Al Kindic, F. Al Azrib, A. Al Asmid extensive foci of ischemia, and with limited lacunar infarctions in aCollege of Medicine and Health Sciences, Neurology unit- Department the deep. of Medicine, Al Khoud, Oman bSultan Qaboos University Hospital, Radiology and Molecular Imaging, Conclusion Muscat, Oman The size of lesion during stroke plays an important, but not the cCollege of Medicine and Health Sciences, Sultan Qaboos University, only role in taking into account restoration of impaired functions. Hematology, Muscat, Oman In 46% of patients a direct correlation was found between dCollege of Medicine and Health Sciences, Neurology unit- Department the magnitude of stroke lesion and its clinical,functional of Medicine, Muscat, Oman manifestations. Objective doi:10.1016/j.jns.2019.10.563 To characterize the clinical syndrome of sickle cell disease (SCD) related cerebral fat embolism syndrome (CFES) ARTICLE IN PRESS

74 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

Background Materials and methods SCD-related CFES results from bonemarrow embolism in the From January 2010 to December 2016, 453 operations were absence of trauma and except for a few single case reports, its performed for patients with aneurysmal SAH. clinico-imaging spectrum has not been fully characterized. The severity of the disease was assessed at admission and in dynamics using commonly accepted scales: Hunt-Hess, Graeb, the Design/methods Rivermid Mobility Index and others. Statistical processing was Twelve SCD patients (6 women and 6 men, aged 28.4±9.9 years), performed using the program BioStat 5.0 (AnalystSoft). were evaluated for neurological complications such as altered The severity of the condition with subarachnoid hemorrhage on sensorium (n=12) and seizures (n=2) in the setting of acute chest the scale of Hant-Hess: with 1 degree of severity - 12 patients (2.6%), syndrome, fever and no preceding trauma (n=12). with 2 degree of severity - 45 (9.9%), with 3 degree of severity - 179 (39.5%), with 4 degree of severity - 165 (36.4%), with 5 degree of Results severity - 52 patients (11.5%). Laboratory findings included high CRP (11 out of 11 tested) and In the clinic in 2011, an active search for the most optimal thrombocytopenia (n=12), normal CSF findings (n=2 out of 2 method of treatment of cerebral angiospasm was conducted. As a tested). EEG showed non-specific diffuse slowing in 9 out of 10 cases result of the search, it was decided to resort to the method of and occasional left temporal spike discharges (n=1). Cerebral PET chemical angioplasty of the cerebral arteries. From May 2011 to 2016 scan obtained in a single case showed globally reduced glucose inclusive, 225 patients underwent 662 chemoangioplasty. uptake. Lipid laden macrophages were demonstrated in the broncho- alveolar lavage in two cases. CFES was diagnosed based on the Results and discussion characteristic finding of multiple cerebral microbleeds in the The study found that the use of chemoangioplasty in cerebral splenium and subcortical location on susceptibility weighted imaging vasospasm, developed as a result of an aneurysmal SAH, significantly (SWI). Our patients received exchange transfusion, antibiotics, reduces mortality and disability. ventilatory assistance (n=12) and anticonvulsant (n=2). One patient died, while the others survived with variable functional doi:10.1016/j.jns.2019.10.566 disability.

Conclusions In SCD patients presenting with acute chest syndrome, altered WCN19-1014 mental status and fever, the presence of thrombocytopenia and high CRP provides important clue to the possibility of CFES. The diagnosis is conﬁrmed with SWI MRI that usually demonstrates multiple Poster shift 01 - Channelopathies/neuroethics/neurooncology/ microbleeds in the splenium and subcortical areas. SCD-related CFES pain - Part I/sleep disorders - Part I/stem cells and gene therapy - carries considerable short-term morbidity and occasional mortality. Part I/stroke/training in neurology - Part I and traumatic brain injury doi:10.1016/j.jns.2019.10.565 Factors inﬂuencing aphasia outcome in patients with occlusive stroke

WCN19-1009 E. Shawky Mohamed, A. el Shamy, O.A. Ragab, A.M. Al Malt, E. ElshazlyD. Mogazy mohamed Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Tanta university Hospital, Neuropsychiatry, Tanta, Egypt pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Background Part I/stroke/training in neurology - Part I and traumatic brain About 21–38% of acute stroke patients had aphasia with its negative injuryY consequences on mood and behaviour, occupational activities and quality of life. The aim of this work: is to predict factors influencing Possibilities of using the method of chemical angioplasty of aphasia outcome in patients with ischemic stroke. Patients and cerebral vasospasm as complications of subarachnoid hemor- methods: Sixty eight patients with acute first ever ischaemic stroke rhage of aneurysmatic etiology to reduce poor outcomes associated with aphasia were subjected to clinical neurological examination, baseline assessment of severity of ischemic stroke by S. Karpov, O. Belokon, S. Ermakov, I. Vyshlova NIHSS, assessment language deficits by aphasia rapid test (ART) and Stavropol state medical university, Neurology- Neurosurgery- Medical outcome of aphasia by aphasia handicap scale (AHS), neuro-radiolog- genetics, Stavropol, Russia ical assessment using Non-Contrast CT (NCCT), functional magnetic resonance image (fMRI) and diffusion tensor image (DTI). Actuality mortality and persistent disability with aneurysmal subarachnoid Results hemorrhage (SAH) are topical problems despite the introduction of The study showed that, 20.5% of the patients had a perisylvian neuroimaging methods of diagnosis and modern, including mini- lesion, 23.5% had extra sylvian lesion while 14% had Wernicke's area mally invasive surgical interventions for an aneurysmal disease of infarction.The mean scores of ART at day 8 and the mean scores of the brain. NIHSS were significantly correlated with AHS (Pb0.05). fMRI The aim of research was to study the possibility of applying the revealed that,26.4% of patients had activity in perilesional area, method of chemical angioplasty to reduce mortality and disability 8.8% had activity in contralateral homotopic brain areas, while 29% from cerebral vasospasm as complications of SAH of aneurysmatic had bilateral brain activity.Fourty one pecent of the studied patients etiology. had reconstruction of the arcuate fasciculus while 58.8% had not, as ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 75 proved by the DTI of arcuate fasiculus. Fifty five percent of patients WCN19-1029 with perilesional fMRI activation showed favourable outcome on AHS compared to 80% of patients with bilateral activation. Patients whom developed reconstruction arcuate fasiculus achieve signifi- Poster shift 01 - Channelopathies/neuroethics/neurooncology/ cantly lower score on AHS (Pb0.05). pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Conclusion injury Aphasia outcome influenced by lesion-related factors. Low back pain and associated collagen tissue pathology doi:10.1016/j.jns.2019.10.567 D. Khaibullina, F. Devlikamova, Y. Maximov, A. Khaibullina, B. Gubeev, R. Esin Neurology, Kazan state medical akademy, Kazan, Russia WCN19-1016 Introduction Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Low back pain and pelvic pain with no apparent clinical cause is known to be a common problem, but considerably less is understood pain - Part I/sleep disorders - Part I/stem cells and gene therapy - regarding the aetiology of such pain. Part I/stroke/training in neurology - Part I and traumatic brain injury Materials and methods 250 patients aged between 18 and 45 with low back pain and pelvic Possible application neurospecific proteins in predicting outcome pain were examined. Clinical investigation included neurologic aneurysmal subarachnoid hemorrhage inspection, ultrasonic inspection of joints, an internal and vessels, a biochemical blood test with level definition Beta-Cross laps and P1NP S. Karpov, S. Ermakov, O. Belokon, I. Vyshlova (N-terminal propeptide of procollagen of 1 type) has been taken. Stavropol state medical university, Neurology- neurosurgery- medical genetics, Stavropol, Russia Results Two hundreds and fifty patients with low back pain and pelvic Actuality pain were examined. There were 55 examined patients had hernia of subarachnoid hemorrhage (SAH) of aneurysmal etiology is one of intervertebral disk, 98 – intervertebral disks prolaps, 64 - sacroiliac the most serious diseases in the structure of acute cerebrovascular joint block, 33 – myofascial pain in lumbar spine. Different disorders, despite the introduction of neuroimaging and minimally symptoms of collagen tissue pathology were found in 160 cases. invasive methods of diagnosis and treatment of cerebral aneurysms. There were 95 men and 65 women with following syndromes: The aim of research was study the possibility of using neurospecific MASS-phenotype - 45 (18,0%) of the 160 cases, Hypermobility proteins for predicting outcomes and determining the role of Syndrom - 32 (12,8%), Marfan phenotype - 15 (6,0%), Ehlers-Danlos neurospecific proteins in predicting the rehabilitation potential of phenotype - 9 (3,6%), Marfan Syndrome - 3 (0,12%) and Ehlers- patients with aneurysmal subarachnoid hemorrhage. Danlos Syndrom Type II - 1 men (0,04%). The others 55 (22,0%) patients have separate symptoms: tensility of the skin; hypermobil- Materials and methods ity of joints, mitral valve prolaps, etc related to above pathology. A determination of the level of autoantibodies to neurospecific Clinical examination shows that more than the half of patients with proteins was performed in 55 patients. Patients underwent general low back pain and pelvic pain (in fact, 62,6% of the total amount), clinical and laboratory examination, neuroimaging and ultrasound reveals the symptoms of collagen tissue pathology and they are examinations. The severity of the disease was assessed at admission amenable to genetic advice at the time of presentation. and in dynamics using commonly accepted scales: Hunt-Hess, Graeb, the Rivermid Mobility Index and others. Statistical processing was doi:10.1016/j.jns.2019.10.569 performed using the program BioStat 5.0 (AnalystSoft).

Results and discussion Determination of the titer of autoantibodies to neurospecific WCN19-1031 proteins in the acute period of aneurysmal SAH allows predicting the risk of development of life-threatening complications and, consequently, to predict its course. The study established a statistically Poster shift 01 - Channelopathies/neuroethics/neurooncology/ significant relationship between the titer of autoantibodies to pain - Part I/sleep disorders - Part I/stem cells and gene therapy - neurospecific proteins and the values of the Rivermid mobility index Part I/stroke/training in neurology - Part I and traumatic brain and the Rankin score. injury

Conclusions Metformin dillema; Neuroprotection: Yes or no? Determination of autoantibodies titer to neurospeciﬁc proteins in acute period of aneurysmal SAH allows predicting the risk of Z. Mirzaasgari, S. Esmaeili, F. Abbasi, M. Farhangnia, A. Eshraghi development of life-threatening complications and predicting its Iran University of Medical Sciences, Neurology, Tehran, Iran course and rehabilitation potential in patients when discharging from the hospital. Objective Experimental evidence suggests that metformin as an AMPK doi:10.1016/j.jns.2019.10.568 activator can reduce stroke severity. However, data is scarce and ARTICLE IN PRESS

76 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx controversial and are mainly in animal models not in human Results models. The aim of this study is to evaluate stroke outcome in Five patients were included (3 men and 2 women). The average diabetic patients taking metformin in comparison with other age was 37.25 years old. A history of diabetes was noted in 2 cases, agents. hypertension and coronaropathy in one case. IS in the middle cerebral artery was noted in 4 cases and in the posterior cerebral Materials and methods artery in one case. A transesophageal echocardiography was In a case-control study, medical records of 60 patients with acute performed and showed an isolated PFO in 4 cases and an associated stroke were collected. Drug history was collected and diabetic atrial septal aneurysm in one case. Rhythmic Holter record was patients were divided into two groups: metformin users and other normal. The supra-aortic trunk echo-Doppler showed an atheroma- diabetic agents’ users. Some of these stroke patients had been treated tous infiltration without significant stenosis in one patient. A with Intravenous thrombolysis (rTPA). The Severity of Stroke was heterozygote MTHFR mutation was noted in 3 cases. The immuno- evaluated via Modified Ranking Scale (MRS) at the time of stroke and logic workup was negative. Anticoagulant therapy was indicated in 2 the outcome of the stroke was assessed via 3-month Modified patients and antiplatelet therapy in the 3 others. The evolution was Ranking Scale (MRS) after stroke. These factors were compared favorable in all our patients without recurrence. between 2 groups. Subgroup analysis were performed for patients who were treated with rTPA. Conclusion Many studies discussed the responsibility of PFO in the occur- Results rence of IS. However, the results were contradictory and the causal Two groups were match regarding baseline blood glucose, HBA1c, link between these two entities remains uncertain. age and gender. χ2 Test showed that there is no significant difference between two groups regarding severity of Stroke at the time of onset doi:10.1016/j.jns.2019.10.571 (P-Values=0.8) or outcome of stroke in the form of 3-month MRS(P- Value=0.2). Exact fisher test confirms the results. In subgroup analysis in patients who were treated with rTPA, there was also no significant difference between the outcome of the stroke (P- WCN19-1034 Value=0.01)

Conclusions Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Despite previous experimental models, this study did not prove pain - Part I/sleep disorders - Part I/stem cells and gene therapy - the neuroprotective effect of metformin. Further studies with more Part I/stroke/training in neurology - Part I and traumatic brain subjects and evaluating post-stroke administration of metformin injury should be considered Comparison of the number of circulating CD144+ stem cells in doi:10.1016/j.jns.2019.10.570 proportion to leukocytes in patients with the acute phase of ischemic stroke and control group

L. Kotułaa, K. Grabowska-Aleksandrowiczb,K.Kądziołkab,P. WCN19-1033 Aleksandrowiczc, K. Ziora-Jakutowicza, K. Rejdakb, M. Bednarska- Makaruka, J. Kockid a ł Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Instytut Psychiatrii i Neurologii, Zak ad Genetyki, Warszawa, Poland bUniwersytet Medyczny w Lublinie, Klinika Neurologii, Lublin, Poland pain - Part I/sleep disorders - Part I/stem cells and gene therapy - cUniwersytet Medyczny w Lublinie, Zakład Peidontologii, Lublin, Poland Part I/stroke/training in neurology - Part I and traumatic brain dUniwersytet Medyczny w Lublinie, Zakład Genetyki, Lublin, Poland injury Introduction Patent foramen ovale: Causal link with ischemic stroke Epithelial cadherin (cadherin E, CD144) helps to maintain the polarity of endothelial cells and controlof vascular permeability. VE- A. Ouerdiene, M. Messelmani, M. Mansour, J. Zaouali, R. Mrissa cadherin mediates the adhesion between endothelial cells, affects Military hospital, Neurology, Tunis, Tunisia vascular morphogenesis, participates in the maintenance of connec- tions between endothelial cells and the structural continuity of the Background and aims vascular endothelium. Patent foramen ovale (PFO) has a prevalence of 20 to 34% in the general population. Its role in the genesis of ischemic stroke (IS) is Material and methods still uncertain. The study included 32 patients with ischemic stroke who were The aim of this study is to determine the mechanism of IS evaluated in terms of factors predisposing to vascular diseases and associated with PFO, to discuss the causal link between the two, and the neurological condition in subsequent control stages.The control to assess the risk of recurrence of IS. group consisted of 14 patients. The number of CD144+ stem cells and lymphocytes in venous Materials and methods blood was evaluated in the 1st, 3rd and 8th days of stroke using ﬂow A retrospective study of 10 years (2008 – 2018) was performed, cytometry. including patients who presented an IS associated with a PFO. The study protocol has been positively evaluated by the Bioethics Clinical, paraclinical, therapeutic and evolutive data was collected Committee. and analyzed. Received results were analyzed statistically. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 77

Results hyperlipidemia and 81 (43%) were obese. Intravenous thrombolysis The number of CD144+ cells in the study group on the first day was administered to 25 (13.3%) of CS cases. Length of hospital stay was: 472.10, on the third: 472.10, on the eighth: 330.29, and in the were longer in CS cases (median 7, IQR 3-15) compared to non-CS control group: 3860.00. cases (median 4, IQR 2-9) (p=0.001). CS was significantly associated The number of CD45+ cells (leukocytes) in the study group on with poor functional outcome (mRs 3-6) and severe NIHSS at the first day was: 1310452.58, on the third: 241417.81, on the discharge (pb0.001). eighth: 270477.83, and in the control group: 351670.83. The ratio of CD144+ cells to CD45+ cells on the first day of Conclusion ischemic stroke was 0.001350, on the third: 0.002518 and on the The prevalence of CS within ischemic stroke patients admitted to eighth: 0.001597. In the control group: 0.002972. National Guard Hospital was 20.7%. CS was associated with poor functional outcomes and severe NIHSS at discharge. Physicians Conclusions should keep specific attention for CS in terms of diagnosis and The highest number of CD144+ cells in relation to all leukocytes management. was found in the study group on the third day. On the remaining days of the evaluation, the number of CD144+ / WBC cells was doi:10.1016/j.jns.2019.10.573 almost two times smaller. doi:10.1016/j.jns.2019.10.572 WCN19-1045

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ WCN19-1044 pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Poster shift 01 - Channelopathies/neuroethics/neurooncology/ injury pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Characterization the low back pain in patients with connective injury tissue pathology

Cardioembolic stroke: Prevalence, patients characteristics and D. Khaibullina, Y. Maximov, F. Devlikamova, A. Khaibullina, D. outcome in Saudis Mansurov Neurology, Kazan State Medical Academy, Kazan, Russia Q. Alboqamia, M. Alskainib, M. Badria, A. El-Metwallya,A.Al b Khathaami Acute and chronic pain syndromes are the most frequent reasons a King Saud bin Abdulaziz University for Health Sciences, College of for patients to seek medical care. In the study included 80 patients Public Health and Health Informatics, Riyadh, Saudi Arabia with lower back pain aged 18 to 45 years. Group 1 included 49 b King Abdulaziz Medical City- MNGHA, Division of Neurology- Depart- (61.2%) people with phenotypic signs of connective tissue pathology. ment of Medicine, Riyadh, Saudi ArabiaKeywords: Cardioembolic, Group 2 included 31 people without signs of connective tissue Ischemic, Stroke, Saudi, Prevalence pathology. Among patients of group 1 -73,5% patients were diagnosed hernia, in group 2 - 32,3% patients had a similar pathology Introduction (pb0,05). According to MRI, more than one intervertebral disc hernia Cardioembolic stroke (CS) has significant mortality and morbid- was found to be significantly more common in group 1 (pb0.05) – in ity. About 14–30% of all ischemic strokes are cardioembolic. Little is 29 (59.2%) people, compared with group 2, where only one disc known about CS in Saudi Arabia. We aimed to describe the hernia was detected – in 10 (32.3%) patients. Assessment of prevalence, characteristics and outcomes of CS patients in Saudi subjective perception of pain by Visual analog scale showed the Arabia. following results: in group 1 indicators ranged from 7.1+/-1.8, in group 2 5.2+/-1.3. Chronic pain syndrome, was revealed in group 1 Methods in 38 (77.6%) people, in the second group only in 9 (29.0%) patients In this retrospective cohort study, we reviewed all records of (pb0.05). Against the background of the standard treatment (anti- patients admitted to acute stroke unite in National Guard Hospital, inflammatory drugs, chondroprotectors, massage, reflexotherapy), Riyadh, Saudi Arabia from February 2016 to July 2018. Only patients positive dynamics was observed in both groups. The intensity of pain with ischemic stroke and transient ischemic attack (TIA) were syndrome in Visual analog scale decreased in group 1 in 40 (81.1%) included. We used TOAST classification for accurate identification of patients to 5.5+/-1.2, in 9 (18.9%) patients the intensity of pain ischemic stroke causes. Institutional Review Board (IRB) approval syndrome has not changed, in group 2 in all patients Visual analog has been obtained. scale decreased to 3.5+/-1.2; (pb0.05). In group of patients with low back pain, connective tissue dysplasia syndrome (pb0.05) is Result significantly more common. Of 907 patients admitted with ischemic stroke and TIA, 188 (20.7%) were identified as CS with mean age of 61 (SD±13) years. Among CS patients, 114 (60.6%) were male, 142 (75.5%) had doi:10.1016/j.jns.2019.10.574 hypertension, 120 (63.8%) were diabetic, 61 (32.4%) had ARTICLE IN PRESS

78 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-1055 WCN19-1057

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Electrocardiographic changes during the acute phase of stroke at pain - Part I/sleep disorders - Part I/stem cells and gene therapy - the neurology Unit of Befelatanana Hospital, Antananarivo, Mad- Part I/stroke/training in neurology - Part I and traumatic brain agascar injury Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain Study of the sleep in Egyptian children with systemic lupus - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ erythematosus and it's effect on their scholastic achievement stroke/training in neurology - Part I and traumatic brain injury

a b b J. Mekkya, H. Fathyb, H. Mostafac, S. Adeld, A. Thabete F. Ravelosaona , M.D. Rakotoniaina , O. Andriamihary ,J. a a aAlexandria University-Faculty of Medicine-AAN-AASM-ESRS Member, Razaﬁmahefa , A.D. Tehindrazanarivelo a Neuropsychiatry, Alexandria, Egypt HU Befelatanana, Neurology, Antananarivo, Madagascar b bAlexandria University, Pediatrics, Alexandria, Egypt HU Befelatanana, Cardiology, Antananarivo, Madagascar cAlexandria University, Rehabilitation Dep., Alexandria, Egypt dAlexandria University, Pediatrics, Alexandria, Egypt Introduction eAlexandria University-Faculty of Medicine, Pediatrics, Alexandria, Egypt Electrocardiographic changes are common during the acute phase of stroke. The interpretation of these results is still difﬁcult in Systemic lupus erythematosus (SLE) is a chronic multisystem practice because this has an impact on the treatment of patients who disease that affects among others the sleep of the patients. Sleep often remains discordant affects the quality of life of these patients and is affected by the disease. Objective To determine the incidence of electrical changes and to describe Aim the electrocardiographic aspects of patients during the acute phase The aim of the study is the evaluation of the sleep in children of stroke. with SLE , and it's effect on their school grades. Methods Subjects A retrospective descriptive, cross-sectional, single-centric study 38 children diagnosed with SLE attending the hospital over a was conducted between July 2016 and July 2018. Only records of period of 1 year from May 2017 till April 2018 and 30 matched patients with stroke with evidence electrocardiogram (ECG) and CT control subjects. scan were included in the study.

Methods Results After taking a written concent, complete history and examination We selected 226 files. The mean age was 58.66 years with a sex ratio were taken and the sleep disturbance scale for children was used to of 1. Arterial hypertension was the main risk factor for cardiovascular evaluate the sleep of the children and comparing it with their school disease (83.63%), followed by smoking (24.78%). Our patients had grades. ischemic stroke in 74, 85% of cases. Patient ECGs were abnormal in 67.7% of cases. The main ECG abnormalities that we found were dominated by Results ST segment alteration in 23.00% of cases, incomplete left bundle block in Both the total score and the 6 subscores were compared between 14, 16% of cases, and left ventricular hypertrophy in 9.73% of cases. We both groups. could not find a significant relationship between stroke type and 52.6% of the patients had sleep problems as follows: electrocardiographic abnormalities. 13.2% had disorders of initiating and maintaining sleep which was highly significant compared to the control group. Conclusion 2.6% had sleep disordered breathing, Repolarization disorders are not negligible during the acute phase 10,5% with arousal disorders also significantly different from the of cerebrovascular accidents. These changes may mask underlying control subjects as well as myocardial ischemia that will require further investigation to 7.9%with sleep hyperhiderosis statistically significant result. confirm. 2,6% with disorders of excessive somnolene also significantly different , doi:10.1016/j.jns.2019.10.576 5.3%with sleep wake transition also statistically significant result and 7.9%with total sleep disturbance total score The total sleep disturbance score was highly significant different WCN19-1059 between both patients and control group (pb0.001) The scolastic achievement was also significantly lower in the SLE Poster shift 01 - Channelopathies/neuroethics/neurooncology/ group .The sleep parameters significantly related to this result were mainly the sleep disordered breathing subscore and the total score pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Recommendation injury Sleep disorders should be screened in SLE patients. Ischemic stroke treated with mechanical thrombectomy: 3 year doi:10.1016/j.jns.2019.10.575 data from stroke registry in Al Ain Hospital, UAE ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 79

S.W. Khana, A. Abdelhadyb, H. Homaidanb, R. Renganathanb,J. Background Akoteeshc Stroke is one of the leading causes of permanent disabilities. In aAl Ain Hospital, Internal Medicine, Al Ain, United Arab Emirates addition to motor deﬁcits, cognitive impairments are a signiﬁcant bAl Ain Hospital, Neurology, Al Ain, United Arab Emirates burden to stroke survivors. Yet, there are few effective therapeutic cAl Ain Hospital, Interventional Radiology, Al Ain, United Arab Emirates approaches readily available to chronic stroke survivors. Clinical evidence suggests that computer-based approaches could be effec- Background tive in improving cognitive function of stroke survivors. Mechanical thrombectomy with or without iv thrombolysis is indicated for treatment of acute ischemic stroke due to large vessel Objective occlusion. The Stroke Unit in Al Ain Hospital in Al Ain, UAE is CCPC- To validate the therapeutic effectiveness of serious mobile games accredited in ischemic strokes. We present the results of mechanical that were developed for cognitive rehabilitation, among chronic thrombectomy for acute ischemic stroke from our unit. stage stroke survivors with moderate cognitive impairment.

Methods Methods We analysed data from our comprehensive Stroke Registry. A randomized controlled, single-center clinical trial was con- Baseline demographics including age, gender, baseline NIHSS, stroke ducted in a long-term care rehabilitation center in South Korea. Fifty subtype, imaging results, type of intervention, type of endovascular stroke survivors in the chronic stage (at least 1-year post-stroke) device used, symptom onset to groin puncture time, complications, with moderate cognitive impairment were recruited. Subjects were mortality and mRS at discharge were analysed. randomized to standard medical care (n=25) or standard medical care plus serious games (n=25). The intervention, which was Results performed independently in their rehabilitation setting by stroke A total of 17 patients were treated during the 36 month period survivors, lasted 3 months. Standard cognitive tests were performed starting January 2016 with mechanical thrombectomy. Age range at baseline and post-intervention. was from 36 year to 82 years. 13 males and 4 females. Baseline NIHSS varied from 11 to 30. Results 3 patients had additional stenting done. 90% showed occlusion in A two-way mixed model ANOVA and Tukey’s post hoc tests anterior circulation. Intravenous rtpA was given in 44% of patients. identified significant differences in the Korean Mini-Mental State Average Symptom to Groin puncture Time (STG) was 224 minutes. Examination, digit backward span, and geriatric depression scale 88% of patients showed complete recanalisation (TICI 2b/3) between the experimental and the control groups after the immediately after the procedure. No immediate complications were intervention but not at baseline. Within the experimental group, seen in any of the patients. Mortality rate was 24%. At discharge, 24% there were statistically significant improvements in all the outcomes achieved mRS score of ≤ 2; 29% achieved mRS score of 3-4. except for the language category of Korean Mini-Mental State Examination. Within the control group, there were no improvements Conclusion in any of the outcomes. We conclude that mechanical thrombectomy was successful radiologically and good or moderate clinical outcome was achieved Conclusion in 53% of patients. The use of specifically designed serious games by chronic stroke survivors can lead to improvements in several aspects of cognitive doi:10.1016/j.jns.2019.10.577 function.

doi:10.1016/j.jns.2019.10.578

WCN19-1074 WCN19-1080 Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Part I/stroke/training in neurology - Part I and traumatic brain pain - Part I/sleep disorders - Part I/stem cells and gene therapy - injury Part I/stroke/training in neurology - Part I and traumatic brain Preliminary results from a randomized controlled trial of serious injury games for the improvement of cognitive function in chronic stroke survivors Outcome description of intraventricular hemorrhage patients which are operated and provided by nimodipine in Zainoel Abidin H.T. Junga, J.F. Daneaultb, T. Nangloa, H. Leec, K. Kimc, B. Kimc, S. Parkd, Public Hospital Banda Aceh, Indonesia T. Ryud, Y. Kimd, S. Leea aUniversity of Massachusetts Amherst, Computer Science, Amherst, USA S. Gazali Abdul Rahman, N. Nurul Fajri, N. Nasrul Musadir, N. Nur bRutgers University, Rehabilitation and Movement Sciences, Newark, Astini, I. Ika Marlia, E. Elsa Susanti, R. Rita Mulyana, N. Nona Suci USA Rahayu cWoorisoft, Woorisoft, Daegu, Republic of Korea Medical Faculty of Syiah Kuala University, Zainoel Abidin Public dHeeyeon Rehabilitation Hospital, Rehabilitation, Changwon, Republic of Hospital, Indonesia Neurology Association, Neurology, Banda Aceh, Korea Indonesia ARTICLE IN PRESS

80 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

Intraventricular hemorrhage (IVH) has a particularly poor D. Aldosaria, S. Khairyb, A. Elmetwallya, M. Badria prognosis with the expected mortality between 50% and 80%. aKing Saud Bin Abdulaziz University for Health Sciences, Epidemiology We use a retrospective cross-sectional study design from July and Biostatistics, Riyadh, Saudi Arabia 2018 to September 2018 that was diagnosed and treated for IVH. The bKing Fahad National Guard Hospital, Neurosurgery, Riyadh, Saudi clinical information, treatment, and prognosis at follow-up were also ArabiaKeywords: Obesity, Paradox, Subarachnoid, Saudi, Retrospec- analyzed. tive cohort We collected 20 cases of IVH, that consist of 12 male (60%) and 8 females (40%) with an average age of 50 years, 13 patients (65%) Background presented with GCS scores ≥ 9 and 7 patients (35%) with score ≤ 8. Subarachnoid hemorrhage (SAH) is a sever type of stroke and the Eight patients undergo surgical treatment for VP shunt and their risk increased for persons with current smoking, positive family postoperative management were followed-up, and 12 patients who history and hypertension. However, an elevated body mass index refused surgery were given a continuous treatment of nimodipine. 6 (BMI) does not consider an independent risk factor, but it's related to patients that went for VP shunt died following the surgery, and 2 poor neurological outcome or death. Few studies have been were discharged for home care. conducted to confirm the validity of obesity paradox on subarach- 12 patients (60%) that were treated with continuous nimodipine noid, but still the evidence is not conclusive. on a drip for 10 days. Six of these patients were discharged with GCS score ≥ 12, and an improving clinical and brain imaging. The Method remaining 6 patients died, 2 patients died within 2 days of A retrospective cohort study that depends on the retrieval and treatment, they were presented with GCS score ≤ 8, hypertension data extracting from the medical records for all the patient with encephalopathy, head CT scan ICH, SAH, IVH, and sepsis. 4 patients SAH, in King Abdul-Aziz Medical City, Riyadh, Saudi Arabia. For th died after the 10 day of treatment with GCS score ≤ 11. total cases of subarachnoid who admitted over the past 11 years, We reported 20 cases of IVH, and we compared patients who only 80 patients confirmed aneurysmal by (digital subtracted underwent surgery and non-surgical therapy with nimodipine. angiography). All data analyses were conducted using the SPSS Patients outcome depend on the clinical condition when the patient program. The institutional review board approval (IRB) has been arrived in the hospital, GCS score, brain imaging and complications obtained. during treatment. Result doi:10.1016/j.jns.2019.10.579 A total of 80 patients included in our analysis. The mean age at onset was 47.3, 47 (58.8%) were male, 32 (40%) were obese, and 33 (41.3%) was a smoker. Majority of them didn’t suffer from diabetes 59 (73.8%), hypertension 43 (53.8%) or previous stroke 71 (88.8%). In WCN19-1081 our population, we observed that there is no significant influence of obesity paradox on functional outcome and mortality after SAH (p=0.430; p=0.235, respectively). Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Conclusion Part I/stroke/training in neurology - Part I and traumatic brain Obesity paradox appeared to affect neither functional outcome injury nor mortality after SAH.

Does “obesity paradox” exist in the functional outcome of patients with subarachnoid hemorrhage? A retrospective cohort doi:10.1016/j.jns.2019.10.580 study in Saudi Arabia ARTICLE IN PRESS

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82 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-1099 Background Local studies on the neuropsychological impairments that focus on the cognitive and emotional deficits after aSAH has been limited. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Objectives Part I/stroke/training in neurology - Part I and traumatic brain To determine the neuropsychological dysfunction after aSAH and injury to correlate the domain-specificdeficits with aneurysm location.

The possibility of using antioxidants to reduce reperfusion injury Methods in acute ischemic stroke, a narrative review This is a prospective, observational study over a 17-month period using simple random sampling. Assessment measures included S.A.A. Musa MoCA and HADS at least 3 months after discharge. Data were University of Gezira, Medicine, Hassahisa, Sudan analyzed using descriptive statistics. The relationship between the neuropsychological dysfunction with the aneurysm location was determined using Cramer’s V test. P-value was set at ≤ 0.05. Introduction Thrombolysis is the only approved intervention in the manage- Results ment of acute ischemic stroke, despite its effectiveness; the Seventy one percent of the subjects had MoCA-defined cognitive consequences of blood flow restoration are not completely benign, impairments. Executive function (63%), language (65%) and delayed presenting the serious issue of reperfusion injury, of which oxidative recall (69%) were the top 3 cognitive domains with the lowest MoCA stress and production of free radicals is a characteristic feature scores. Mild anxiety was seen in 25% of the patients while moderate leading to disruption of BBB with consequent cerebral edema and/or levels were found in the remaining 21% using HADS. Twenty five hemorrhage. percent were mildly depressed while only 8% were in the moderate to severe depression range. There was no significant relationship Objectives between the location of the aneurysm and the MoCA-assessed While the role of oxidative stress in the pathogenesis of stroke (in cognitive domains and depression. However, there was a statistically both ischemic cascade and reperfusion injury) is well established, it significant relationship between aneurysm location and anxiety. is not the same regarding the therapeutic role of antioxidants in Mild cases of anxiety were associated with ACOM and MCA reducing the reperfusion-ischemic injury. This review aimed to aneurysms while moderate levels were associated with ACA and consolidate understanding and bring together previous work of the ICA aneurysms. past decade; highlighting possible gaps along with areas of promising future. Conclusion A review committee of three bachelor degree holders from In patients with aSAH, cognitive and emotional domain impair- University of Gezira, Faculty of medicine was formed to insure an ments persist even after discharge. Measures to come up with unbiased process. The committee reviewed 87 preclinical models, standardized assessment tests unique to aSAH patients would be review papers, clinical studies in total, 49 of which were included, beneficial to improve functional outcomes. and 38 were excluded according to date and relevance to original review questions. doi:10.1016/j.jns.2019.10.582

Conclusions It is fair to says that antioxidant are a good choice for adjuvant therapy to thrombolysis; however, it will take some time before we see any in pharmaceutical forefronts, Clinical trials regarding their WCN19-1130 use to attenuate reperfusion injury are scares although many candidates have shown potentials in experimental animal models. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - doi:10.1016/j.jns.2019.10.581 Part I/stroke/training in neurology - Part I and traumatic brain injury

WCN19-1122 Investigation on health status in patients with non-acute ischemic stroke based on community

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Y. Yaoa, Y. Wanga, J. Zhoub, L. Gongc,R.Qid,H.Yue,L.Kua, Y.Y. Zhanga pain - Part I/sleep disorders - Part I/stem cells and gene therapy - aYueyang Hospital of Integrated Traditional Chinese and Western Part I/stroke/training in neurology - Part I and traumatic brain Medicine Afﬁliated to Shanghai University of Traditional Chinese injury Medicine, Department of Neurology, Shanghai, China bFengcheng Hospital of Fengxian District, Department of Traditional Neuropsychological dysfunction after aneurysmal subarachnoid Chinese Medicine, Shanghai, China c hemorrhage in a tertiary hospital in Baguio City: A prospective Shanghai Baoshan Integrated Traditional Chinese and Western Medi- study cine Hospital, Department of Neurology, Shanghai, China dYueyang Hospital of Integrated Traditional Chinese and Western Medicine Afﬁliated to Shanghai University of Traditional Chinese H.G. Barrozo, D. Liquete Medicine, Department of Physiatry, Shanghai, China Baguio General Hospital and Medical Center, Neurology, Baguio, eShanghai Meilong Community Healthcare Service Centre, Department Philippines of Traditional Chinese Medicine, Shanghai, China ARTICLE IN PRESS

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Objective Methods Ischemic stroke is a disease with high disability and high All ischemic stroke patients with course for 2 weeks to 2 years in recurrence, the purpose of this study is to investigate the health 11 communities of Jiading District and Minhang District in Shanghai, status of non-acute IS patients for further making to promote China from October 2016 to January 2017 were investigated. MRS rehabilitation and prevention of re-stroke. (Modiﬁed Rankin Scale) and disability performance, MMSE (Mini- ARTICLE IN PRESS

84 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

Mental State Examination),SDS (Self-rating Depression Scale) and tailored surgical approach as compared to other brain tumors due to SAS (Self-Rating Anxiety Scale) were observed to know their physical its epileptogenic nature. disability, cognition and emotion. doi:10.1016/j.jns.2019.10.584 Results 305 non-acute ischemic stroke patients were recruited in this study, including 189 males and 116 females, with an average age of 67±7.9. The most common vascular risk factors were hypertension WCN19-1142 [78.0% (238/305)], Diabetes [28.2% (86/305)] and past stroke history [26.9% (82/305)]. 66.6% (203/305) patients had different degrees of sequelae (MRS1~5). Somatosensory disorder was the most common Poster shift 01 - Channelopathies/neuroethics/neurooncology/ symptom [18.0% (55/305)], followed by limb paralysis [15.1% (46/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - 305)] and speech disorder [12.5% (38/305)]. 38.7% (118/305) Part I/stroke/training in neurology - Part I and traumatic brain patients had different degrees of cognitive impairment. 20.3% (62/ injury 305) patients had mild to severe depression and 12.5% (38/305) had varying degrees of anxiety. Clinical outcome of primary subarachnoid hemorrhage and their determinants three week after admission, in Omdurman Teach- Conclusions ing Hospital- Sudan from May 2013 - September 2013 Most of non-acute ischemic stroke have sequelae of varying degrees, and some of them have cognitive impairment, depression M. Elsayeda, R. Ibrahimb, M. Ahmedc, S. Badid and anxiety, they need further help to get back to normal state. aUniversity Hospital Sharjah, Neurology, Sharjah, United Arab Emirates doi:10.1016/j.jns.2019.10.583 bOmdurman Teaching Hospital, Neurology, Omdurman, Sudan cMilton Keynes University Hospital NHS Foundation Trust, Department of Medicine and HIV Metabolic Clinic, Melton Keynes, United Kingdom dOmdurman Islamic University, Department of Pharmacy, Omdurman, WCN19-1134 Sudan

Abstract Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ Introduction stroke/training in neurology - Part I and traumatic brain injury SAH is a serious emergency leading to high case fatality and neurological disability. Methodology: a total number of 40 patients Polymorphous low-grade neuroepithelial tumor of the young with spontaneous SAH were enrolled in the study, over 5 months (PLNTY): Case report and literature review and followed up for 3 weeks in regard to the symptomatology, signs, GCS, weakness, CT findings and clinical outcome. Poor outcome H. Kamalboora, A. Dababob, M. Alkhateeba group was used for patients who died at the end of the 3 weeks aKing Faisal Specialist Hospital & Research Center, Neurosciences, while good outcome for survivors. Riyadh, Saudi Arabia bKing Faisal Specialist Hospital & Research Center, Pathology, Riyadh, Results Saudi Arabia Mean age for SAH was 53 years, females were 62%. The commonest presenting symptoms in the 2 groups were headache (95%, 81%) and neck pain (75%,68%). One third had H/T and smoking. Polymorphous low-grade neuroepithelial tumor of the young Seizures occurred in 8%, hemiparesis 7.5%, unilateral ptosis in 2.5%, (PLNTY) is a recently described variant of low-grade neuroepithelial subhyaloid hemorrhage in 15%, 22% had large CT hemorrhage, 40% tumor (LGNT) associated with epilepsy among children and young moderate hemorrhage. In 50% of patients GCS was 15/15 on adults. Thus, it can be considered as one of the long-term epilepsy- admission, 66.7% of which had good outcome. associated brain tumors (LEATs), which consist of a broad histopathological spectrum of low-grade glial & glio-neuronal pheno- Discussion types. However, with the ongoing attempts & recommendations on The headache and neck pain proved to be the commonest classifying LEATs subtypes, there are characteristic features that help presentation. GCS and hemiparesis were the strongest negative in identifying PLNTY as recently reported. predictors of outcome. The authors describe the case of a 23-year-old Saudi lady with drug-resistant epilepsy who was found to have a left anterior Conclusion temporal lesion, which radiologically had a similar appearance to The mean age, clinical presentation and mortality rates of the other LGNTs. She underwent tailored resection of the lesion. study population were related to the international literature. 40% of Characteristic histopathological features of PLNTY were demon- patients died at the end of the first 3 weeks and 87.5% of them died strated, with the presence of oligodendroglioma-like cellular com- in the first week. All patients had evidence of SAH on non-contrast ponents, infiltrative growth patterns, & intense CD34 CT. The most important bad prognostic factors included delayed immunopositivity. This case illustrates the possibility of classifying diagnosis, low GCS and hemiparesis. Others were age above 80 years, a LGNT variant or what can also be considered as a LEAT subtype Hypertension, smoking, and large bleed on the CT brain. using a routine set of immunohistochemical stains. Although infrequently reported, PLNTYs appear to behave like other LEATs, doi:10.1016/j.jns.2019.10.585 which are mostly WHO Grade I, but would probably require a ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 85

WCN19-1145 Introduction Atrial fibrillation (AF) is the leading cause of cardio-embolic stroke (CES) but data in Subsaharan African were scarce. The aim of Poster shift 01 - Channelopathies/neuroethics/neurooncology/ this study was to describe the clinical pattern and to evaluate the pain - Part I/sleep disorders - Part I/stem cells and gene therapy - outcome of CES due to AF. Part I/stroke/training in neurology - Part I and traumatic brain injury Patients and methods A 8-year retrospective cohort study was carried out in the Cleveland clinic Abu Dhabi stroke registry (CCADSR) young Neurological Unit and the Intensive Care Unit of the Douala General ischemic strokes - Initial results Hospital. Were included all the files of patient admitted with established diagnosis of CES due to AF confirmed respectively by CT N ≥ B. Piechowski Jozwiaka, V. Kumarb, S. Hussaina, S. Johna, R. Navarroa, scan and ECG. Standard scores (CHA2DS2-VASc 2, HAS-BLED 3 and fi N K. Zahraa, A. O'Sullivana, S. Samplesa, V. Mifsuda modi ed Rankin Score 2) were used respectively to evaluate aCleveland Clinic Abu Dhabi, Neurological Institute, Abu Dhabi, United embolic risk, risk of bleeding and poor functional outcome. Survival Arab Emirates was determined using Kaplan Meier curve. bCleveland Clinic Abu Dhabi, Medical Subspecialties Institute, Abu Dhabi, United Arab Emirates Results 85 files CES due to AF were included (52% women) with a mean age of 69±11,96 years. 34.9% of patients have pre-existing AF. United Arab Emirates (UAE) population is growing and it is to Embolic and hemorrhagic risks were classified high in 91.3% and reach 13,163,548 by 2050 and it is mainly composed of expatriates - 94.1% respectively. Antithrombotic treatment was introduced in only 11% are UAE Nationals (UAEN). The epidemiological stroke data 95.5% during hospitalisation. In-hospital mortality rate was 24.7% for UAE is limited especially in young patients. and the survival rate at 2 years was 19.1%. Stroke recurrency was We studied all young ischemic stroke patients (YISP; 50 years cut found in 7 (11%) in a mean delay of 3.4 months post-stroke and was off) admitted to Cleveland Clinic Abu Dhabi (CCAD) from May 2015 associated with preexisting AF, the absence of antithrombotic till May 2018. We studied demographics, risk factors, TOAST medication for AF (P b 0.001). Functional outcome was poor in classification and outcomes. We used descriptive statistics and 55.2% at hospital release. student t test for continuous variables; statistical significance was at 0.05. Conclusion There were 146 YISP: (mean age 40.3 y; min 22, max 50), there CES due to AF affects mostly old-patients in Subsaharan Africa were 42 women (28.8%) and 104 men (71.2%); there was no age and are associated with high mortality and recurrency rates. Short difference between the two (40.5 vs. 40.2; p=ns); there were 48 term functional outcome is poor on 1 patient over 2. UAEN (32.9%) and 98 expats (67.1%) and there was no age difference between the two (40.7 vs. 40; p=ns). The most common risk factor doi:10.1016/j.jns.2019.10.587 was dyslipidemia (73.3%) followed by hypertension (63%), diabetes (39.7%), obesity (34.2%), smoking (23.3%), ischemic heart disease (9.6%). There were 25.3% large artery strokes, 22.6% cardioembolic, 19.9% undetermined, 17.8% small vessel and 14.4% other etiologies. Initial mean NIHSS score was 9.49 (range 0-39); 16.4% of patients WCN19-1159 had mRS 0-1at discharge, case fatality was 3.4%. Our data show high prevalence of dyslipidemia and hypertension Poster shift 01 - Channelopathies/neuroethics/neurooncology/ in YISP. There was high frequency of large artery and cardioembolic pain - Part I/sleep disorders - Part I/stem cells and gene therapy - strokes. Minority of YISP had favorable outcome at discharge. Part I/stroke/training in neurology - Part I and traumatic brain Prospective studies are needed to further elucidate stroke epidemiology and prognosis in UAE especially in young patients. injury doi:10.1016/j.jns.2019.10.586 Electrophysiological findings of acroparesthesia: A single center experience

I.S. Joo, S. Ko, M. Lee, S.Y. Park WCN19-1149 Ajou University Hospital, Neurology, Suwon, Republic of Korea

Background Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Acroparesthesia is abnormal sensory experiences in the ex- pain - Part I/sleep disorders - Part I/stem cells and gene therapy - tremities, especially in hands and feet, and is one of the most Part I/stroke/training in neurology - Part I and traumatic brain common symptoms encountered in the neurology outpatient clinic. injury It is caused by diverse medical conditions and even in a normal situation. Because exact diagnosis is very important to manage it Outcome of cardio-embolic stroke by atrial ﬁbrillation: Lesson properly, a variety of tests including nerve conduction study from Subsaharan Africa setting (NCS) should be considered. The purpose of this study is to know the electrophysiological ﬁndings in patients with Y. Mapourea, H.F. Oumaroub,H.Bac, A. Dzudiea, H.N. Lumaa acroparesthesia. aDouala General Hospital, Internal Medicine, Douala, Cameroon bUniversity of Douala, Clinical Sciences, Douala, Cameroon Methods cUniversity of Yaoundé I, Internal Medicine, Yaoundé, Cameroon 159 patients with acroparesthesia were recruited from January 2018 to December 2018 at the neurology outpatient clinic of a ARTICLE IN PRESS

86 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx tertiary hospital. Demographics, clinical manifestations, associated WCN19-1163 medical conditions and laboratory findings including NCS were analyzed. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Results pain - Part I/sleep disorders - Part I/stem cells and gene therapy - NCS was normal in 98 patients (61.6%). Predictive factors of Part I/stroke/training in neurology - Part I and traumatic brain normal NCS findings were younger age, female gender, partial injury involvement of symptom, symptom onset after cold exposure, intermittent symptom episodes and emotional anxiety (pb0.05). In Fibroelastoma- A rare cause of stroke and importance of contrast, fine motor symptoms, a history of diabetes or renal disease transesophageal echocardiogram in diagnosis were significantly associated with abnormal NCS in the patients with acroparesthesia. J. Perkash, S. Siddiqi, S. AlRukn Rashid Hospital, Neurology, Dubai, United Arab Emirates Conclusion A thorough understanding of clinical history and symptom We present a case of a 60-years-old male having diabetes, patterns in the patients with acroparesthesia would be able to afford hypertension, ischemic heart disease with previous angioplasty and a valuable information regarding to the necessity of NCS to find a recent admission for non-ST elevation myocardial infarction (NSTEMI) cause who presented to ED with acute NSTEMI. He developed transient right sided numbness and heaviness in the speech the next day while doi:10.1016/j.jns.2019.10.588 receiving dual antiplatelet therapy. A CT brain showed lacunar infarcts and cerebral atrophy. Transthoracic echocardiogram showed mild aortic regurgitation. He experienced recurrent neurological symptoms in the following days while on dual antiplatelet therapy and developed WCN19-1162 homonymous hemianopia and facial weakness. The MRI brain revealed multiple diffusion-restricted areas in corpus callosum, left Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pre central gyrus and right superior frontal gyrus along with small vessel disease. A transesophageal echocardiogram was done to look for pain - Part I/sleep disorders - Part I/stem cells and gene therapy - the source of embolism which revealed mobile structure attached to Part I/stroke/training in neurology - Part I and traumatic brain the ventricular side of non- coronary cusp of aortic valve suggesting injury fibroelastoma. Ultrasound Doppler study for carotids and vertebral arteries showed atheromatous disease. Correlation of motor function level and social participation with In view of recurring events, multiple acute strokes on imaging chronic stroke and mobile valvular fibroelastoma, anticoagulation and dual antiplatelet therapy (aspirin and clopidogrel) was started. E.J. Kim He underwent complete surgical excision and histopathology Sehan University, Department of Occupational Therapy, Yeongam-gun- revealed fragment of fibro collagenous tissue with marked calcifica- Jeollanam-do, Republic of Korea tion. He was maintained on dual platelets afterwards with no recurrence of any neurological symptoms till 6 months follow up. The aim of this study was conducted to investigate a correlation between motor function level and social participation with chronic Conclusion stroke. In this study, Korean version of the Fugl-Meyer Assessment Fibroelastoma is a rare cause of stroke. Transthoracic echocardio- (K-FMA) and Korean version of the Reintegration to Normal Living gram may not be able to pick these lesions. Transesophageal Index (K-RNLI) were administered to 74 chronic stroke patients echocardiogram should be done if suspicion of cardioembolism is who were diagnosed with stroke and were living in a community high. for more than 12 months. The SPSS 21.0 was used for the analysis, and the correlation coefficient between the motor function level doi:10.1016/j.jns.2019.10.590 and the social participation was used. According to the patients’ general characteristics, motor function was related to affected side, and social participation showed a significant difference with respect to the type of lesion (p b .05)(table 1). The results of the analysis of WCN19-1164 the motor function level and the social participation correlations showed that motor function level moderate and marked were a significant correlation with the social participation (pb.05)(table). Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Based on the results of this study, it is possible to consider the pain - Part I/sleep disorders - Part I/stem cells and gene therapy - intervention direction according to the level of motor function of Part I/stroke/training in neurology - Part I and traumatic brain the chronic stroke patients, to promote their social participation injury and to carry out their role with a sense of existence as a member of the community, It should be possible to maintain a Prediction of stroke (infarction) post tuberculous meningitis balanced life. using biomarkers (CSF cytokines and interleukins) doi:10.1016/j.jns.2019.10.589 N. Kuthiala, P. Srivastava MV, S. Sharma All India Institute of Medical Sciences, Neurology, New Delhi, India ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 87

Background WCN19-1165 Tuberculous meningitis (TBM) is a devastating form of Mycobac- terium Tuberculosis infection. According to the World Health Organization (WHO, 2012),the annual incidence of tuberculosis is Poster shift 01 - Channelopathies/neuroethics/neurooncology/ 8.7 million worldwide, of which the major brunt being borne by the pain - Part I/sleep disorders - Part I/stem cells and gene therapy - developing countries. In India, the estimated mortality due to TBM is Part I/stroke/training in neurology - Part I and traumatic brain 1.5/100,000 population.8% of strokes in the young in India have been injury attributed to TB vasculopathy. Reversible middle cerebral artery stenosis and stroke symptoms Methodology and results after correcting severe iron deficiency anemia Based on Modified British Research Council clinical criteria patients were categorized into 3 stages. J.M. Park, W.W. Lee, K. Kang, J.J. Lee, O. Kwon, B.K. Kim fi Stage I: prodromal phase with no de nite neurological symptoms, Nowon Eulji Medical Center- Eulji University, Neurology, Seoul, Republic GCS 15/15. (12 patients) of Korea Stage II: slight or no clouding of sensorium and minor or no neurological deficits, GCS between11-14. (35 patients) Introduction Stage III: severe clouding of sensorium, focal neurological deficits, Little has been known about the relationship between iron GCS ≤ 10.(33 patients) deficiency anemia (IDA) and acute ischemic stroke. We present a case of patient with acute ischemic infarction with bilateral MCA Data analysis stenosis complicated by severe IDA, which resolved rapidly after Interim analysis was done calculating the mean and SD. Total 80 correcting IDA. samples were analyzed out of 96 (N=96; of which 16 expired). ELISA-Assay was run for all the samples. Case presentation A 67-year-old woman was referred to emergency department with right hemiparesis on wake-up. On examination she had MRC grade 3 Observation weakness of the right upper and lower extremities with a NIH Stroke Development of infarction persists to be dreadful complication of Scale score (NIHSS) of 4. DWI showed multifocal diffusion restriction tuberculosis meningitis. Patients with TBM having low Glasgow foci involving Lt. temporal, both parietal and occipital lobes. MRA coma scale score on presentation and presence of exudates have a revealed segmental severe stenosis at both proximal MCA. Her significantly high risk for development of infarction. Development of haemoglobin level of 1.9 g/dL, which rose to 4.0 g/dL after RBC infarction was found to have significant disability as well as high transfusion. In 2 hours, her neurologic symptoms improved to NIHSS 1. mortality as compared to those without infarction. Gastrofiberscopy, colonoscopy, and CT scan of the chest and abdomen revealed no signs of malignancy or acute internal bleeding. The results doi:10.1016/j.jns.2019.10.591 of hematological and biochemical studies were compatible with the diagnosis of IDA. Follow-up MRA on 5th days showed remarkably ARTICLE IN PRESS

88 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx improved bilateral MCA stenosis compared with baseline MRA. Results and treatment of CVRF in the general population to reduce stroke of the baseline and follow-up TCD also suggested improved MCA impact. stenosis. She was discharged with a haemoglobin level of 7.8 g/dL and without signiﬁcant neurologic deﬁcit. doi:10.1016/j.jns.2019.10.593

Discussion We report an acute ischemic stroke patient with bilateral MCA stenosis and severe IDA. Stroke severity and the degree MCA stenosis WCN19-1170 improved promptly by correcting anemia with RBC transfusion. Severe anemia may be a trigger factor for aggravating stenosis of intracranial arteries and stroke symptoms. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain doi:10.1016/j.jns.2019.10.592 injury

Does formal stroke education to inpatients in stroke unit improve their knowledge of stroke? Prospective data from UAE WCN19-1166 J. Kuruvila, H. Deria, S. Mathew, E. Maysoun, U. Isip, S. Al Shamisi, A. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Aquino, S. Mathew, A. Altarshi, J. Canoza, J. Olidan, G. Anosa, R. Renganathan pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Al Ain Hospital, Stroke Care Unit, Al Ain, United Arab Emirates Part I/stroke/training in neurology - Part I and traumatic brain injury Background Newly-diagnosed Stroke patients lack awareness about Stroke. Hospital epidemiology of stroke in Sub-Saharan Africa: Analysis Inpatients in the Stroke unit were educated by a dedicated stroke of 1210 consecutive cases in Cameroon educator about recognition of Stroke symptoms, risk factors, follow- up care, medication and lifestyle modiﬁcations. These were done by a b b a Y. Mapoure , M.O. Ngoule , D.C. Ateba Ndongo , C. Kenmegne ,D. one-to-one sessions and written material. Information was further a a Gams Massi , H.N. Luma emphasised by nurses in the Stroke unit. We wished to evaluate a Douala General Hospital, Internal Medicine, Douala, Cameroon the impact of Stroke education given to inpatients in our Stroke b University of Douala, Clinical Sciences, Douala, Cameroon unit.

Introduction Methods Stroke is a leading public health concern in Sub-saharan Africa. Prospective data from Al Ain Hospital (AAH) Stroke registry was Epidemiological data should help to implement prevention measures analysed for the period Jan 2017 to Dec 2018. Patients were asked and to reduce the fatality case. The aim of this study was to describe the following questions by telephonic interview at 1,2 and 3 months cerebro-vascular risk factors (CVRF), clinical presentation and to following discharge. evaluate the outcome in Cameroon. Questions asked were: 1. Compliance with medication Patients and methods 2. Compliance with diet A cohort study was carried out from the stroke registry of the 3. Compliance with follow-up Douala General Hospital between January 2010 and march 2019. 4. Any symptoms or signs of new Stroke Stroke was conﬁrmed by brain imaging while patient with sub- 5. Any re-admissions arachnoid hemorrhage and cerebral thrombosis were excluded. For 6. Compliance with regular blood pressure monitoring each patient, socio-demographic, clinical and paraclinical data were 7. Compliance with regular blood glucose monitoring recorded as the mortality. 8. Smoking cessation Results Results Of 1210 patients included (55.5% male), the mean age was 60 ± 293 Stroke patients were followed up during the study period. 13.64 years with ischemic stroke (IS) in 754 (62.3%). Major CVRF 100% were compliant with medication, with diet and with regular were hypertension (70%), alcohol intake (23.7%), diabetes (20.7), follow-up. 2.5% of the patients reported new symptoms or signs of previous stroke (14.4%) and tobacco consumption (11.6%). The mean Stroke or of re-admission. 93% reported regular monitoring of blood delay from stroke onset to hospitalization was 46,64 ±1,75 hours pressure. 86% reported regular home monitoring of blood glucose. with 240 (19.9%) patients admitted less than 4.5 hours. Etiologies of 86% patients who were smokers reported quitting smoking. IS were cardio-embolic (28.2%), atherosclerosis (23.8%), small artery disease (7.8%) and unknown in 40.1% of cases. Hypertension was the Conclusion leading cause of hemorrhagic stroke (66.9%). The length of We conclude that formal “Stroke education” given to inpatients in hospitalization was 8,45±0,23 days with an in-hospital mortality the Stroke unit has a signiﬁcant impact on improving the knowledge rate of 24.5% (292) with septic condition as the main cause. The 3- of Stroke patients. Patient can therefore learn to monitor their co- month cumulative mortality rate was 49.6%. morbbidties and to maintain a healthy lifestyle to prevent recurrent strokes. Conclusion Results from this study suggests a big challenge based on the doi:10.1016/j.jns.2019.10.594 need of population awareness on stroke and systematic screening ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 89

WCN19-1172 WCN19-1186

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Part I/stroke/training in neurology - Part I and traumatic brain injury injury

Does nursing care in stroke unit significantly reduce the Primary pauci - Melanotic leptomeningeal melanomatosis complications of fall, urinary tract infection, venous thromboembolism and pressure ulcers? Data from UAE E. Koziorowska-Gawrona, J. Bladowskab, M. Kaczorowskic,S. Budrewicza, K. Slotwinskia, M. Koszewicza, A. Halonc J. Kuruvila, H. Deria, D. Manlangit, M. Elatta, S. Yusuf, L. Parampil, J. aWroclaw Medical University, Neurology, Wroclaw, Poland Olidan, G. Anosa, R. Renganathan bWroclaw Medical University, General Radiology- Interventional Radi- Al Ain Hospital, Stroke Care Unit, Al Ain, United Arab Emirates ology and Neuroradiology, Wroclaw, Poland cWroclaw Medical University, Pathomorphology and Oncologic Cytol- Background ogy, Wroclaw, Poland Post-stroke complications can prolong length of stay and increase morbidity and mortality. Our objective was to evaluate if nursing Introduction care in our Stroke unit reduced post-stroke complications of falls, Primary melanotic changes of the central nervous system (CNS) urinary tract infection (UTI), venous thromboembolism (VTE) and are rare and appear as benign forms like melanocytoma and pressure ulcers. melanocytosis or as malignant disorders like melanoma and melanomatosis. The diagnosis of leptomeningeal melanomatosis is Methods based on cytological and immunohistochemical tests of cerebro- Retrospective data from Al Ain Hospital (AAH) Stroke registry spinal fluid (CSF) or bioptic sample, together with exclusion of was analysed for the period 2015 - 2018. Age, Gender, Stroke melanoma outside the CNS. The prognosis is serious, most of patients subtype, complications including falls, UTI, VTE and pressure ulcers die within 12 months. were analysed. Case report Results The authors present a 68-year-old male patient with a history of 81% had ischemic strokes and 19% hemorrhagic strokes. 12/9456 neuroborreliosis, progressive aphasia, and an epileptic attack. In the (1.3/1000 patient-days) had falls. 10/9456 (1/1000 patient-days) neurological examination were found: consciousness disturbances, had pressure ulcers. There was no patient with UTI or VTE during the meningeal signs, paresis of four limbs with pyramidal signs and lack study period. of deep reflexes. A CSF study showed increased protein and decreased glucose levels, high cellularity with atypia. In neuroimages Discussion non - specific lesions were observed (diffuse areas of high signal We infer that assessment (initial and periodic) and interventions intensity within white matter in the T2-weighted image and used by nurses are effective in preventing post-stroke complications. leptomeningeal enhancement in the T1-weighted image after All patients admitted to the Stroke Unit undergo baseline fall contrast administration, decreased N-acetylaspartate level, increased assessment using Morse Falls Risk Assessment Score. All patients choline and myo-inositol levels, very high lactate peak in MR are classified as high risk. Indwelling foley catheter is usually spectroscopy). The condition of patient worsened and he died. removed after first 24 hours. Appropriate VTE prophylaxis is Postmortem examination revealed a diffuse neoplastic process prescribed on admission depending on the type of stroke. Skin involving leptomeninges and brain parenchyma. The ancillary integrity is assessed using Braden score, which has 6 categories studies led to the diagnosis of primary pauci - melanotic including sensory perception, moisture, activity, mobility, nutrition leptomeningeal melanomatosis. No other foci of melanoma were and friction. Nurses identify the sub-scale that drives the highest risk found during the autopsy. and apply appropriate interventions. Conclusion Conclusion The authors present a very rare case of the primary Our results show negligible number of patients with post-stroke leptomeningeal melanomatosis and underline the difficulties during complications of falls and pressure ulcers and no patients with UTI or diagnostic procedures. The diagnostic process was complicated by VTE. These findings reflect the high quality nursing care provided in the positive tests for neuroborreliosis, and pauci-melanotic form of our Stroke Unit melanomatosis. doi:10.1016/j.jns.2019.10.595 doi:10.1016/j.jns.2019.10.596 ARTICLE IN PRESS

90 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-1195 Case A 62 year-old male patient with chief complaint of focal seizure of his right hand with subsequent severe headache and right sided Poster shift 01 - Channelopathies/neuroethics/neurooncology/ weakness of his body. Brain MRI revealed hemorrhagic lesions in left pain - Part I/sleep disorders - Part I/stem cells and gene therapy - frontal and parietal lobes (Fig. 1) as well as thromboses in superior Part I/stroke/training in neurology - Part I and traumatic brain sagital sinus and right transversal sinus (Figs. 2 and 3). While injury treatment plan for the patient was being discussed, his condition worsen. He eventually became hemiplegic with a new onset of left Cerebral venous sinus thrombosis: An experience of choosing sided weakness. Another brain MRI done depicted a new hemor- between local intrasinus thrombolysis and anticoagulant in rhagic lesion in right parietal lobe (Fig. 4). patient with bleeding problem Result ’ V. Hartoyoa, E.E. Suryawijayab, Y.M.T. Siahaanb, H. Harsanc, P. Tiffania Anticoagulant was put on hold due to the patient s condition and aFaculty of Medicine- Universitas Pelita Harapan, Neurology, Tangerang, his bleeding problem. Local intrasinus thrombolysis was chosen ’ Indonesia however, his symptoms didn t improve and radiologic investigation fl bSiloam Hospitals Lippo Village, Neurology, Tangerang, Indonesia showed only minuscule restoration of blood ow. He was then given fi cSiloam Hospitals Lippo Village, Neurosurgery, Tangerang, Indonesia intravenous unfraction heparin which nally resulted in remarkable outcome of both cerebral sinuses blood flow and left motoric function. Introduction Cerebral Venous Sinus Thrombosis (CVST) is a rare neurological disorder which can often leads to catastrophic results if not treated Conclusion carefully. Local intrasinus thrombolysis has been considered as Anticoagulant therapy in CVST patient with bleeding problem treatment option with favourable results in patients whose result is may still be viable with close monitoring. insignificant or deteriorate despite optimal anticoagulant therapy as mainstay therapy. doi:10.1016/j.jns.2019.10.597

Objective To report treatment options in a case of CVST with bleeding problem. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 91

WCN19-1206 S. Sharma, P. Srivastava MV, N. Kuthiala, A. Bhasin, R. Sharma AIIMS-New Delhi, Neurology, Delhi, India

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Background pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Stroke remains the second most common cause of death Part I/stroke/training in neurology - Part I and traumatic brain worldwide and the leading cause of disability. Climate change and injury stroke, with varying conclusions. The highest levels of air pollution and bear a disproportionate burden of global stroke mortality and Features of the cytotoxic effect of lymphocytes with cardiolipin in morbidity. patients with ischemic stroke in low mountain area Objectives N. Chekeeva To examine the associations of gaseous air pollutants and climate National Hospital under Ministry of Health of Kyrgyz Republic, change Neurology Department for Patriotic War disabled, Bishkek, Kyrgyzstan Methodology and results Objective NO2, SO2, CO, and PM 2.5 &PM10 in diameter were measured in Sensitization to phospholipids can act not only as an immediate Delhi designated areas using the help of Delhi Pollution Control cause of development of the ischemic stroke (IS) itself, but as its Board at onset of stroke, 15 days of enrollment & 3 months. 90 complications also, which, in combination with other factors may patients were recruited so far. We found that PM 2.5 & PM 10 levels aggravate the course of the disease. One of the rarely used methods were statistically related to stroke onset and 3months (p=0.002; fi that reflect the state of lymphocyte sensitization and tendency to p=0.03) where as it was non-signi cantly related to stroke onset thrombus formation is the study of the reaction of the cytotoxic and on 15 days of enrollment (p=0.45; p=0.67). The mean PM10 effect of lymphocytes to cardiolipin (CESL) level was high as compared to PM 2.5 at all time points indicating that higher particulate or coarse particles are better measured than fi fi Background the ne particles.It was observed that NO2 levels were signi cantly b Recognition of the concept of pathogenetic heterogeneity of high as compared to SO2 & CO (p 0.0.5). Multivariate regression ischemic cerebral blood circulation is of great practical importance, analysis keeping age, type of stroke as constant with covariables like 2= since only upon revealing the cause and pathogenetic mechanism of type of fuel, CO, PM2.5 showed R 0.119, F =3.92, p=0.057. the development of an acute cerebrovascular episode, it becomes possible to conduct adequate therapy and secondary prevention Conclusion Incidence of stroke was high in cold season followed by mild cold. Design/methods Hemorrhagic stroke was more in cold season. Multi-variate regres- We examined 36 patients with diagnosis of IS on 1st and 10th day sion analysis showed that unclean fuel, carbon monoxide levels, since onset of the disease. The average age 64.50±10.88.The pm2.5 were strongly associated with occurrence of stroke. No diagnosis was verified by clinical examinations, including hem- association between age, sex, gaseous pollutants was observed. ostasiological screening studies. CESL was determined by the doi:10.1016/j.jns.2019.10.599 standard method.

Results/conclusions The higher rates of CESL in the examined patients were observed on the background of hypercoagulable changes in the blood. Since WCN19-1211 sensitization to cardiolipin contributes to an increased tendency to thrombus formation, our data can reﬂect this process in severe acute Poster shift 01 - Channelopathies/neuroethics/neurooncology/ and acute stage of ischemic stroke. In patients with ischemic stroke, pain - Part I/sleep disorders - Part I/stem cells and gene therapy - autoimmune reactions of lymphocytes to cardiolipin are detected. The apparency of cytotoxic reactions of lymphocytes to cardiolipin Part I/stroke/training in neurology - Part I and traumatic brain depends on the severity of the process. The CESL for cardiolipin may injury serve as an additional criterion for the presence of hemostasiological disorders in patients with cerebral infarctions. Cleveland clinic Abu Dhabi stroke registry (CCADSR) young hemorrhagic strokes - Initial results doi:10.1016/j.jns.2019.10.598 B. Piechowski Jozwiaka, V. Kumarb, S. Hussaina, S. Johna, R. Navarroa, K. Zahraa, A. O'Sullivana, S. Samplesa, V. Mifsuda aCleveland Clinic Abu Dhabi, Neurological Institute, Abu Dhabi, United WCN19-1210 Arab Emirates bCleveland Clinic Abu Dhabi, Medical Subspecialties Insitute, Abu Dhabi, United Arab Emirates Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - United Arab Emirates (UAE) population is growing and it is to Part I/stroke/training in neurology - Part I and traumatic brain reach 13,163,548 by 2050 and it is mainly composed of expatriates injury - only 11% are UAE Nationals (UAEN). The epidemiological hemorrhagic stroke data for UAE is limited especially in young Is air pollution and climate change a stroke risk factor? patients. ARTICLE IN PRESS

92 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

We studied young hemorrhagic stroke patients (YHSP; 50 years Only 11% of patients reported depression on the DISC which cut off) admitted to Cleveland Clinic Abu Dhabi (CCAD). We studied maybe an underestimation of post-stroke depression. Fifteen percent demographics, risk factors, stroke subtype and outcomes. We used of the patients did not receive DISC screening due to sensory descriptive statistics and student t test for continuous variables problems, receptive aphasia, visual field deficit and medical instabil- (Pb0.05). ity. Fifty percent of depressed patients had brief psychological There were 45 YHSP: (mean age 39.2 y; min 20, max 50), there intervention and 20% had a combination of psychological and were 13 women (28.9%) and 32 men (71.1%); there was no age pharmacological intervention. difference between the two (40.0 vs. 39.3; p=ns); there were 8 Repeat DISC screening data, 1-month post-discharge, was avail- UAEN (17.8%) and 37 expats (82.2%) and there was no age difference able for 20% percent of patients who showed significant improve- between the two (43.6 vs. 38.6; p=0.057). There were 21 (46.7%) ment in symptoms following a psychological intervention. intracerebral hemorrhage patients [ICH; 14 primary (31.1%); 7 secondary (15.6%)], and 24 (53.3%) subarachnoidal hemorrhage Discussion and conclusion (SAH) patients; there was no age difference between the two (40.6 Post-stroke depression has been reported in one third of stroke vs. 38.5y). The risk factors included hypertension (52%), dyslipid- patients and maybe under-represented in the current study as a emia (27.1%), smoking 12 (25%), obesity 13 (27.1%) in the whole subset of patients could not be assessed. Alternative interview group. Initial mean NIHSS score was 13.6 (range 0-35); 37.8% of measures and screening based on observational behaviours associ- patients had mRS 0-1at discharge, case fatality was 20%. ated with depression may be useful. Our data show high prevalence of hypertension and dyslipidemia Depression was unrelated to site location. in YHSP. More than 1/3 of YHSP had favorable outcome at discharge. Larger scale studies are needed to further elucidate hemorrhagic doi:10.1016/j.jns.2019.10.601 stroke epidemiology and prognosis in UAE especially in young patients. doi:10.1016/j.jns.2019.10.600 WCN19-1214

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ WCN19-1212 pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain injury Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Assessment of neuromodulation and behavioral effects by 5 days Part I/stroke/training in neurology - Part I and traumatic brain of navigated CTBS of non-lesional hemisphere in stroke: A case injury report

Post-stroke depression screening using the depression intensity N. Asima, A.H. Fawazb, S. Bashirc scales circles in the UAE aKing Fahad Specialist Hospital, Neuroscience, Dammam, Saudi Arabia bKing Saud University, Neurology, Riyadh, Saudi Arabia S. Al Jarraha, S. AlQaydib, F.T. Thajudeenc, R. Radhakrishnana cKing Fahad Specialist Hospital Dammam- Dammam- Saudi Arabia.,, aMedical Institute, Neurology, Al Ain, United Arab Emirates Neurophysiology, Dammam, Saudi Arabia bBehavioural Sciences Institute, Academic Affairs, Al Ain, United Arab Emirates The purpose of this case study was to test the hypothesis that c UAEU, Department of Psychology and Counselling, Al Ain, United Arab with of M1 for five days (contra lateral to stroke) navigated Emirates continuous theta-burst stimulation (cTBS) will result in a lasting increase in excitability and improved in behavioral assessments in Background the lesioned M1. The Depression Intensity Scales Circles (DISCs) was developed to The patient received five days of navigated cTBS and following achieve an accessible scale for patients with more severe cognitive evaluations were carried out: change in cortical excitability, finger and communicative problems. tapping, 9 hole peg, pinch force, and simple reaction time tests were assessed in both hands. Methods The results show showed decreased intracortical inhibition and Ninety-five acute patients presenting with stroke symptoms in increased intracortical facilitation following intervention during 2018 were screened prospectively for depression using the DISCs. paired-pulse TMS testing of ipsilesional M1 and improved in reaction This was administered by a neuropsychologist or stroke nurse during time and pinch force tests, while also showing improvement in the acute admission and in the patient's native language. fugal-Mayer (FM) score. These results highlighted the potential for inducing lasting Results modulation of excitability in M1 by navigated cTBS of the healthy The majority (76%) of patients had Ischemic Stroke (IS), 8% M1, possibly reflecting modulation of interhemispheric interactions Transient Ischemic Attack (TIA) and 16% Intracerebral Hemorrhage and demonstrating the potential therapeutic use of such a paradigm. (ICH). The median age of patients was 56 years. 78% were male and 47% were South Asian. doi:10.1016/j.jns.2019.10.602 ARTICLE IN PRESS

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WCN19-1217 WCN19-1236

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Part I/stroke/training in neurology - Part I and traumatic brain injury injury

Patients with dual stroke mechanisms: Outcomes in a university Cleveland clinic Abu Dhabi stroke registry (CCADSR) methodology hospital stroke registry B. Piechowski Jozwiak, A. O'Sullivan, S. Hussain, S. John, R. Navarro, K. A. Gujjara, D. Lalb, S. Kumarb, R. Nandhagopala, S.S. Gangulyc, A.R. Al- Zahra, V. Kumar, S. Samples, V. Mifsud Asmia Cleveland Clinic Abu Dhabi, Neurological Institute, Abu Dhabi, United aCollege of Medicine and Health Sciences- Sultan Qaboos University, Arab Emirates Department of Medicine Neurology Unit, Muscat, Oman b Sultan Qaboos University Hospital, Medicine, Muscat, Oman Stroke is the leading cause of death and disability. Its burden is c College of Medicine and Health Sciences- Sultan Qaboos University, increasing and significant ethnical differences can be noted. United Department of Family Medicine and Public Health, Muscat, Oman Arab Emirates (UAE) population consists of 89% expatriates of mixed ethnicities and 11% are UAE Nationals. The epidemiological stroke Background data for UAE is scarce. Common stroke mechanisms – large artery athrosclerosis (LAA), Cleveland Clinic Abu Dhabi is a regional quaternary hospital with cardioembolism (CES) and small-vessel disease (SVD) – have regional comprehensive hyperacute and rehab stroke services. CCAD overlapping risk factors but differing outcomes. Co-existence of dual provides thrombectomy, thrombolysis and acute neurological care stroke mechanisms in a patient is sometimes recognized. 24/7. CCADSR was approved by CCAD Ethical Committee (A-2018- 020). CCADSR collects hospital level data. All patients’ entries are Aim anonymised. All patients with acute stroke as main diagnosis This study explores the influence of dual stroke mechanisms in admitted to CCAD are included (ischemic stroke, hemorrhagic stroke, patients with ischemic stroke (IS) on clinical outcomes. subarachnoidal haemorrhage). Registry set up is based on international scientific and Joint Commission International quality require- Methods ments. The following data domains are collected: demographics, Adult patients with IS treated at a university hospital were premorbid functional status, vital parameters, cardiovascular risk entered into a stroke registry using TOAST classification. Case- factors, time of onset of symptoms, stroke type/subtype, diagnostic records were reviewed for reasonable evidence of an additional/ results, initial clinical presentation, etiological stroke subtyping, coexisting stroke mechanism. Examples are SVD in the context of treatment received, vital status at discharge and follow-up. CES, or symptomatic extra/intracranial atherosclerotic stenosis with Until May 2018 we included 1013 stroke patients (mean age 55.9 SVD or CES. Outcomes were classified as good (modified Rankin y; min 17, max 98y; 68.4% men; 36.7% UAE Nationals). There were Score 0-2) or poor (3-6). Univariate and multivariate analyses were 590 ischemic strokes (58.73y; 17-98y; 68.5% men; 40% UAEN), 176 used to determine factors influencing outcome. ICH (52.8y; 20-97y; 71.6% men; 46.8% UAEN) and 117 SAH (46.74y; 18-77y; 61.53% men; 21.36% UAEN). Results Collection of stroke epidemiological data is critical for primary Of a total of 678 patients with IS (mean age: 63+13 yrs; M: and secondary stroke preventative strategies. Further prospective F::428:250), 87 (12.8%) had an additional mechanism of stroke. SVD studies are needed to explore stroke epidemiology in UAE and to (46%) and CES(40%) were the most frequent additional stroke understand the differences in stroke epidemiology between UAE diagnoses. On univariate analysis, patients with dual stroke diagno- Nationals and Expats. ses were older, had lower GCS scores and higher systolic BP (pb0.05) but did not differ in stroke severity (NIHSS). On logistic regression doi:10.1016/j.jns.2019.10.604 analysis, age, gender and GCS were independent predictors of outcome but not an additional stroke mechanism. Coexisting CES showed a trend towards poor outcome. WCN19-1240 Conclusions A significant number of patients with ischemic stroke have an additional mechanism of stroke. Such patients are likely older, have Poster shift 01 - Channelopathies/neuroethics/neurooncology/ poorly controlled risk factors and worse sensorium. Cardioembolic pain - Part I/sleep disorders - Part I/stem cells and gene therapy - stroke occurring in the context of another mechanism of stroke may Part I/stroke/training in neurology - Part I and traumatic brain be associated with worse outcomes. injury doi:10.1016/j.jns.2019.10.603 Study of histopathological pattern of CNS tumors from a tertiary hospital in Nepal – A retrospective study ARTICLE IN PRESS

94 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

S. Banstolaa, R. Paudelb, A. Thapac, B. Bijukachhed, G. Sayamia measured with the modified Rankin Scale (mRS) and Scandinavian aGrande International Hospital, Pathology, Kathmandu, Nepal Stroke Scale (SSS). bGrande International Hospital, Neurology, Kathmandu, Nepal cGrande International Hospital, Neurosurgery, Kathmandu, Nepal Results dGrande International Hospital, Spine Surgery, Kathmandu, Nepal Data was obtained from 135 patients, eighty-one were male (60%), and fifty-four were female (40%). Subject had a mean age of Introduction 64.05 ± 11.57 years (mean ± SD). Spearman correlation analysis Primary Central Nervous system (CNS ) tumours refer to a showed there was a significant correlation between neutrophil - to- heterogeneous group of tumours arising from cells within the CNS, lymphocyte ratio and long term score according to Scandinavian and can be benign or malignant. There are paucity of the reports Stroke Scale (SSS) (r: -0.234; p= 0.006) and functional outcome from Nepal about different histologic types of tumors in CNS . according to modified Rankin Scale (mRS) (r=0.235; p= 0.006).

Materials and methods Conclusion In the period between 2005-2009 April, we retrospectively High neutrophil - to- lymphocyte ratio is correlated with poor analyzed data on 91 patients (51 male and 40 female) diagnosed long term score according to Scandinavian Stroke Scale (SSS) and with CNS tumors according to the World Health Organization’s poor functional outcome according to modiﬁed Rankin Scale (mRS). diagnostic criteria. Patient data were retrieved from the archives of the department of Pathology, Grande International Hospital. doi:10.1016/j.jns.2019.10.606

Results A total of 91 CNS tumors were diagnosed during a four year period. Of these, 95 (86.45%) were primary, and 5 (4.55%) were WCN19-1253 metastatic. The most frequent type of CNS tumors was Meningioma (22 cases, 20%), followed by Schwannoma (14 cases, 12.7%) and Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Glioblastoma Multiformi (12 cases, 10.92%). Among the 5 metastatic tumors, the most common histologic type was adenocarcinoma . pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Conclusion injury The most frequent type of CNS tumors in this study was Meningioma, followed by schwannoma and Glioblastoma multi- ALNUGE stroke: An innovative approach for improving stroke forme. The ratio of male to female for all CNS tumors was 1.2:1. recognition in schools Female outnumbered male in meningioma (2.1:1). J. Mallaiah doi:10.1016/j.jns.2019.10.605 Columbia University Irving Medical Center, Neurology, New York, USA

Background ALNUGE (ALphabets NUmbers Geometrics) Stroke is an innova- WCN19-1246 tive approach to improving stroke preparedness of children through its use of alphabets, numbers, and geometric shapes, which represent Poster shift 01 - Channelopathies/neuroethics/neurooncology/ a visual language coding system. The program is designed to engage children in activities that involve encoding and decoding actionable pain - Part I/sleep disorders - Part I/stem cells and gene therapy - stroke information. Part I/stroke/training in neurology - Part I and traumatic brain injury Methods ALNUGE Stroke was administered by trained facilitators in two 1- Neutrophil - To - Lympocyte ratio as a prognostic factor in acute hour classroom sessions delivered over two consecutive days. We ischemic stroke patients pilot tested ALNUGE Stroke among twenty-five 5th grade students of a low-income ethnic minority elementary school, and assessed D.S. Rorya, J. Jesiscab, Y.B. Hartantoc stroke preparedness. A validated stroke preparedness instrument adr. Abdul Aziz Hospital, Family Medicine, Singkawang, Indonesia was used (Cronbach’s α = 0.78 and 0.74 for stroke recognition and bdr. H. Ishak Umarella Hospital, Family Medicine, Central Maluku, intent to call 911 respectively) at baseline, immediate posttest and at Indonesia 3-months posttest. We also assessed the students’ self-efficacy for cBethesda Hospital, Neurology, Yogyakarta, IndonesiaKeywords: Neu- stroke recognition and action. trophil - to- lymphocyte ratio, Ischemic, Stroke, Outcome Results Purpose Mean stroke recognition scores (max score = 13) increased from This study aims to investigate the correlation between neutrophil a baseline of 5.92 (SD 2.53) to 10.40 (SD 1.47) immediately following - to- lymphocyte ratio and ischemic stroke clinical outcomes. the program, and 10.52 (SD 2.22) 3-months following the program (p b0.001). Mean intent to call 911 scores (max score = 13) Methods increased from 3.04 (SD 2.23) to 6.80 (SD 2.65) to 5.12 (SD=2.24) This is a prospective cohort study of 135 patients over 35 years respectively (pb0.001). However, self-efficacy for recognizing a old. The subjects were first time acute ischemic stroke patients, onset stroke, communicating stroke recognition to a 911 operator and to b72 hours, who were inpatients in Bethesda Hospital Yogyakarta parents, did not significantly change across the test sequences (p = from October until December 2018. Clinical outcomes were 0.598). ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 95

Conclusion WCN19-1262 ALNUGE Stroke demonstrated substantial improvement in stroke recognition, and signiﬁcant improvement in intent to call 911 for stroke, among low-income ethnic minority students. However, more Poster shift 01 - Channelopathies/neuroethics/neurooncology/ work is needed to assess the impact of this approach on self-efﬁcacy. pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain doi:10.1016/j.jns.2019.10.607 injury

Arrival times of patient with ischemic stroke at emergency room: Comparison of two time periods a study in South India WCN19-1261 M.A. Mohda, D. Kurhadeb, A.K. Gattub, M.K.M. Jagarlapudib, M.R. Yerasub, S.K. Jaiswalb, O. Syedb Poster shift 01 - Channelopathies/neuroethics/neurooncology/ aSenior Resident, Neurology, Hyderabad, India pain - Part I/sleep disorders - Part I/stem cells and gene therapy - bCare Institute of Neuro sciences, Neurology, Hyderabad, India Part I/stroke/training in neurology - Part I and traumatic brain injury Background Intravenous thrombolysis and endovascular thrombectomy are Is there a change in the ischemic stroke subtypes and causes in the proven treatments for ischemic stroke. These treatments are young in India? A comparative study between two time periods time-based. This study aims at finding changes in the arrival times of patients with ischemic stroke between two time periods A.K. Gattua, D. Kurhadeb, M.A. Mohdb, M.K.M. Jagrlapudib, M.R. Yerasub, S.K. Jaiswalb, O. Syedb Methods aSenior Resident, Neurology, Hyderabad, India This is a retrospective analysis of prospectively collected stroke bCare Institute of Neurosciences, Neurology, Hyderabad, India registry data. The study compared arrival times of patients with ischemic stroke at Emergency Room between two time periods: Background 2008-2010 (T-I) vs. 2016-2018 (T-II). Patients with first ever new In India there has been an epidemiological transition of stroke were included. TOAST criteria were applied to determine the cardiovascular risk factors for ischemic stroke and also there has stroke sub type. been decline in the prevalence of chronic rheumatic heart disease (CRHD). The aim of this study is to find whether there is any change Results in the risk factors for ischemic stroke in young. There were 549 and 451 patients in T-I and T-II periods respectively. Clinical differences between T-II vs. T-I were elderly Methods age 60.76+14.35 vs. 58.30+13.64 pb005); and less severe stroke This is a retrospective analysis of prospectively collected stroke (NIHSS: 6.53+5.82 vs. 10.7+3.0 pb0001). During T-II period more registry data. The study compared ischemic stroke subtypes and patients arrived in the window period for iv thrombolysis (100 vs. 56 causes in young (b49 years) between two time periods: 2008-2010 pb0.0001) and more patients received iv thrombolysis (91 vs. 40 (T-I) vs. 2016-2018 (T-II). Patients with first ever ischemic stroke pb0.0001). Number of patients with proximal occlusive disease who were included. TOAST criteria were applied to determine stroke arrived in the window period (b6 h) for possible endovascular subtype. treatment were (T-II vs. TI) 20 vs. 15 (pb0.14) and 4 patients received the therapy in T-II. Patients who could be possible Results candidates for thrombectomy in 7-24 h were (T-II vs. T-I) 29 vs. 29 Total number of first ever ischemic stroke in the two time periods (pb0.43). were: T-I 121 [range 19-49 years; M:F 2.36:1] and T-II 81 [range 19- 49; M:F 2.85:1]. The distribution of stroke subtypes between the two Conclusion time period was (T-I vs. T-II): large artery atherosclerosis (LAA) 40 This study suggests that there is increased awareness of stroke (33.05%) vs. 31 (38.27%); cardioembolic (CE) 32 (26.45%) vs. 16 and stroke treatment in this part of India. More patients utilized (19.75%); small vessel occlusion 9 (7.43%) vs. 11 (13.58%); other thrombolysis treatment. demonstrated causes 11 (9.1%) vs. 14 (17.28%); undetermined 29 (23.9%) vs. 9 (11.1%) (p=0.02). Of the other causes of stroke, doi:10.1016/j.jns.2019.10.609 hyperhomocysteinemia was the most common cause in both the time periods: 81.8% vs. 57.14%. Of the cardiac lesions, there was no significant difference in the frequency of CRHD between the two time periods. WCN19-1263

Conclusion In spite of epidemiological transition of risk factors for ischemic Poster shift 01 - Channelopathies/neuroethics/neurooncology/ stroke, this study does not show any changing trends in the stroke pain - Part I/sleep disorders - Part I/stem cells and gene therapy - mechanisms and causes in the young. Part I/stroke/training in neurology - Part I and traumatic brain injury doi:10.1016/j.jns.2019.10.608 Patterns and outcomes of stroke thrombolysis in a large tertiary care hospital in Riyadh, Saudi Arabia - Single center experience ARTICLE IN PRESS

96 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

M. AlSkainia, A. AlDayelb, Q. AlBoqamic, E. Masuadid, M. AlShammaria, WCN19-1268 A. AlKhalafa, D. AlRasheeda, A. AlKhathaamib, N. AlOtaibib,M. Tarawnehe, K. AlHizane, I. Khatrib aKing Abdulaziz Medical City- MNGHA- Riyadh- KSA, Division of Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain Neurology- Department of Medicine, Riyadh, Saudi Arabia - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ bKing Abdulaziz Medical City- MNGHA- Riyadh- KSA- King Saud bin stroke/training in neurology - Part I and traumatic brain injury Abdulaziz University for Health Sciences- Riyadh- KSA- King Abdullah International Medical Research Center KAIMRC- Riyadh- KSA, Division Genetic study, histochemical analysis and neuroimaging profile in of Neurology- Department of Medicine, Riyadh, Saudi Arabia Brazilian patients with cadasil cKing Saud bin Abdulaziz University for Health Sciences- Riyadh- KSA, College of Public Health, Riyadh, Saudi Arabia V. Neriabc, T. Louvainde, E. Medina-Acostae, L. Vandesteenf, A. Pessoag, d King Saud bin Abdulaziz University for Health Sciences- Riyadh- KSA- A.L. Nascimentoh, A. Siquarai, D. Viannab, J. Fazoli de Carvalhoc,J. King Abdullah International Medical Research Center KAIMRC- Riyadh- Damasceno de Sác, B. Pereirac, V. Moreira dos Santosc, A. Costac,T. KSA, College of Medicine, Riyadh, Saudi Arabia Renonc, S. Maiac, A.C. Souza Lopesc, M. Mottéc, M. Santanac, A.L. e King Abdulaziz Medical City- MNGHA- Riyadh- KSA, Department of Limac, P. Gloria Netoc Nursing, Riyadh, Saudi Arabia aUniversidade Federal do Estado do Rio de Janeiro, Neurology, Rio de Janeiro, Brazil Background bCentro de Doença de Alzheimer e Parkinson, Neurology, Campos dos Thrombolysis in acute ischemic stroke although being standard of Goytacazes, Brazil care is still significantly underutilized. There is no published data cFaculdade de Medicina de Campos, Neurology, Campos dos Goytacazes, from Saudi Arabia about the use and outcomes of thrombolysis in Brazil stroke. dFaculdade de Medicina de Campos, Genetics, Campos dos Goytacazes, Brazil eUniversidade Estadual do Norte Fluminense, Genetics, Campos dos Objective Goytacazes, Brazil To present single center experience of stroke thrombolysis from a fFaculdade de Medicina de Campos, Neuroradiology, Campos dos Goy- tertiary care center in Riyadh, KSA. tacazes, Brazil gUniversidade do Estado do Rio de Janeiro, Dermatology, Rio de Janeiro, Brazil Methods hUniversidade do Estado do Rio de Janeiro, Histology, Rio de Janeiro, Brazil An IRB approved cross-sectional, observational study of patients iUniversidade Federal Fluminense, Pathology, Rio de Janeiro, Brazil receiving thrombolysis between January 2012 and December 2018. Objectives Results Analyze the histochemical aspect of granular osmiophilic material A total of 148 patients received thrombolysis, 94 (63%) were in cutaneous biopsy, evaluate morphometrically white matter in men; mean age 58.2 + 14.5years. Mean time from stroke onset to cerebral MRI and study of variants of the NOTCH3 gene in patients hospital arrival was 89 + 48 minutes; 25% arrived within one hour. with suspected CADASIL (cerebral autosomal dominant arteriopathy Mean NIHSS score on admission was 13.4. Hypertension (68.9%), with subcortical infarcts and leukoencephalopathy). diabetes (56.1%), and dyslipidemia (40.5%) were commonest risk factors. Cardioembolism was the commonest mechanism of stroke Methods (43.2%) and was associated with more severe presentation Human gDNA from freshly drawn peripheral blood samples was (p=0.031). Intravenous thrombolysis alone was given to 98 extracted using a commercial illustra bloodgenomic Prep Mini Spin (66.2%); the rest had IV tPA and endovascular therapy or endo- Kit. Variants in exons 3 and 4 of the NOTCH3gene were screened by vascular therapy alone. Mean door-to-needle time was 79.7 minutes, Sanger Sequencing method. Brain morphological evaluation by 3- showing significant improvement between 2012 (111.6 minutes) Tesla MRI. For ultrastructural analysis, skin samples were fixed in and 2018 (69.9 minutes); p-value b0.001. Good outcome (mRS of 0- 2.5% glutaraldehyde, postfixed in 1% osmium tetroxide, dehydrated 2) was seen in 35.8%, whereas 14 (9.5%) patients died. Symptomatic in acetone and embedded in Epon. Analysis of vessel wall structure ICH was seen in 11.5%. All vascular risk factors were more common was performed by transmission electron microscopy on skin. in age N 60 years except smoking which was more common in younger (p = 0.007). Results 20 suspected cases were evaluated. We found fifteen patients to Conclusions be heterozygous for the pathogenic allele variant c.457CNT In our cohort, high frequency of vascular risk factors was seen. (Arg153Cys; rs797045014*T) from the ten probably unrelated One-third of patients received endovascular treatment. The mean kindreds. One patient is heterozygous for the pathogenic allele door-to-needle time improved significantly over years. Cardioem- c.328CNT (Arg110Cys; rs775836288*T), Figure1. All patients with bolic strokes were the most frequent and more severe. pathogenic allele had MRI lesions; MRI morphometric analyses revealed higher lesion load in frontal and temporal lobes and in doi:10.1016/j.jns.2019.10.610 deep areas (internal and external capsule, basal ganglia, thalamus), brainstem and cerebellum; in one case we observed spinal cord ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 97 ARTICLE IN PRESS

98 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx involvement. We searched for granular Electron-dense Extracellular WCN19-1280 Material (GOM) located in the internal part of the media, reaching the basal lamina, in four patients (Figure2). Poster shift 01 - Channelopathies /neuroethics /neurooncology / Conclusion pain - Part I /sleep disorders - Part I /stem cells and gene therapy - For assessment of CADASIL, association between skin biopsy and Part I /stroke /training in neurology - Part I and traumatic brain electron microscopy, study of pathogenic variants in exons 3 and 4 of injury the NOTCH3gene and MRI morphometric study, increase the sensitivity for a correct diagnosis. Pre and in-hospital delay in the use of thrombolytic therapy for acute ischemic stroke patients in Egypt doi:10.1016/j.jns.2019.10.611 A. Nasreldeina, F. Abd -Allahb, A.A. Ghalic, K. Faßbenderd, G.A. Shehataa, K.O. Mohameda aAssiut University Hospitals, Assiut University, Department of Neurol- ogy, Assiut, Egypt WCN19-1277 bCairo University, Department of Neurology, Cairo, Egypt cTanta University, Department of Neurology, Tanta, Egypt dSaarland University Hospitals, Saarland University, Department of Poster shift 01 - Channelopathies /neuroethics /neurooncology /pain Neurology, Homburg, Saarland, Germany - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / stroke /training in neurology - Part I and traumatic brain injury Background Stroke patients in Egypt don’t receive enough i.v thrombolytic Non-peptide orexin 2 receptor modulators as promising way to therapy because they presented outside the therapeutic time treatment of narcolepsy/insomnia window. It's important to understand the factors behind pre- and in-hospital delays of those patients. J. Janockova, T. Kobrlova, E. Mezeiova, R. Dolezal, J. Korabecny, O. Soukup Methods University Hospital Hradec Kralove- Biomedical Research Center, This prospective observational study included 296 patient Biomedical Research Center, Hradec Kralove, Czech Republic presented with acute ischemic stroke and did not receive thrombolytic therapy from January, 2018, to June, 2018. from 3 large tertiary Narcolepsy is a chronical neurological disorder of alertness charac- university hospitals (Assiut, Cairo and Tanta). A detailed history terized by a decrease of ability to manage a sleep-wake cycles which is including the demographic data, which alarm patients notified, time demonstrated as abnormal daytime sleeping periods, hypersomnia, of emergency medical service arrival, onset-to-door time , door-to- interrupted nocturnal sleep, cataplexy and rapid eye movement(1). examination time, door-to-imaging time , door-to-laboratory time, Contrastly, insomnia is sleep disorder characterized by difficulty the time interval between obtaining the test result and the needle initiating or maintaining sleep(2). Currently, patients with narcolepsy time. NIHSS and mRS were carried out for each patient at admission are treated symptomatically with amphetamine-like stimulants and and discharge. antidepressants, but it was shown a higher risk of potential addiction (3). Treatment of insomnia involves benzodiazepine-receptor agonist Results drugs which safety and efficacy is also limited(4). An alternative to 156 patients were male and 140 were female, 200 patients came treatment of narcolepsy and insomnia would be a direct orexigenic from rural area, 96 from urban area. The mean age was 62.5. A system-targeted therapy(5,6,7). Orexin A and orexinB are neuropep- prehospital delay was reported for all patients and it had multiple tides produced by hypothalamic neurons and belong to ligands for reasons like Stroke misdiagnosis, delay in alarming emergency orphan G-protein coupled receptors, OX1-R and OX2-R(8,9). Generally, services, time wasting in referral from hospital to another. Intra- the primary role of orexines is to act as excitatory neurotransmitters and hospital time wasting was calculated for patients who came only in regulators of the sleep process(10,11). Accordingly, the discovery of therapeutic time window (117 patient ). It has multiple factors in orexin receptors, modulators and their casual implication in narcolepsy/ which time delay till obtaining laboratory results and making insomnia is the most important advance in sleep-research. decision contributed the most. The presented work is focused on the evaluation of intrinsic activity of compounds (1-7) to modulate OX2-R in comparison to Conclusion standard agonist orexin A. Initially, our attempts sought to identify a Pre and In-hospital delays reduced the number of patients eligible novel receptor agonist. However, none of ligands showed any for IV thrombolysis in Egypt. Efforts should focus on increasing significant agonistic effect. In addition, ligands 1, 5 and 6 were able awareness about stroke and its symptoms between general popula- significantly and dose-dependently reduce the signal of orexin A– tion and Health care professionals, and improvement of the pathway evoked response, which still offers some promise mainly for the organization inside the Hospitals. treatment of insomnia. As the most potent antagonist can be highlighted 6. We have also predicted their blood-brain barrier permeability and cytotoxicity. doi:10.1016/j.jns.2019.10.613 doi:10.1016/j.jns.2019.10.612 ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 99

WCN19-1287 Introduction Recurrent stroke, is defined as a stroke, in which there was clinical evidence of the sudden onset of a new focal neurological Poster shift 01 - Channelopathies /neuroethics /neurooncology / deficit with no apparent cause other than that of vascular origin. pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain Methodology injury Prospective observational, hospital based study. First stroke, evolving stroke and venous stroke were excluded. History clinical Effects of exposure to air pollution on ischemic stroke incidence Profile, functional outcome were analyzed. and mortality Results Y. Jung 104 recurrent CVA, (Ischemic 90/hemorrhage 14). The mean age Changwon Fatima Hospital, Neurology, Changwon, Republic of Korea in ischemic 60.28 yrs , while hemorrhagic 60.64 yrs. Males 72 (59 ischemic / 13 hemorrhagic) Females 32 (31 Ischaemic/1 Hemorrragic). Urban 11 (10 Ischemic / 1 hemorrhagic), rural 93 Background (80 Ischemic / 13 Hemorrhagic). Predominant risk factor is Air pollutants, such as the particulate matter of fewer than 10 μm hypertension, 66.3% followed by dyslipidaemia 63.5%, Smoking 49%, (PM10), sulfur dioxide (SO2), carbon monoxide (CO), nitrogen DM 39.4%, Alcohol 36.5%, CAD 17.3%, and AF 11.5%. 92.9% of the dioxide (NO2), ozone have the association with all-cause mortality hemorrhagic group has hypertension, compared to 62.6% of the in ischemic stroke patients. We aimed to investigate the association ischemic group, which is significantly higher. between exposure (monthly) to air pollution and ischemic stroke MCA is most involved territory, followed by vertebrobasilar incidence and all-cause mortality in Korea. territory , posterior cerebral artery , anterior cerebral artery. Capsuloganglionic bleed is the predominant of hemorrhagic stroke Method followed by thalamic bleed , cerebellum and pons. 67.31% of cases The data source for this study were obtained from the nationwide have duration (from first stroke) of greater then 12 months, sample cohort comprising 1,025,340 individuals (2% of the entire Predominant complaint is left hemiparesis followed by right population in Korea) which were established by Nationwide Health hemiparesis , bulbar symptoms , seizures. 5 patients died in-hospital Insurance System from 2004 to 2013. For meteorological and air stay, (3 ischemic / 2 belongs hemorrhagic). mRS scores of majority of pollution data, we collected monthly measures of average levels of patients have improved by the time of discharge and during 3 PM10, NO2, SO2, O3, CO from the Climate and Air Quality monthly follow up. Management Division of South Korea. We also obtained the mean temperature, diurnal temperature range, humidity, and pressure. Conclusion Knowledge of risk factors outcome of recurrent CVA guides Results management. During a 10 year follow-up period, a total of 9688 had ischemic stroke events. There was no significant association between monthly doi:10.1016/j.jns.2019.10.615 exposure to air pollution and ischemic stroke incidence. However, all cause of mortality in patients with ischemic stroke during sample cohort period was significantly associated with increased level of PM10 (hazard ratio (HR), 1.01; 95% confidential interval[CI], 1.01 to 1.02), SO2 (HR 1.47; 95% CI, 1.12 to 1.85), and CO (HR 3.06; 95% CI, WCN19-1301 2.2 to 4.2). Poster shift 01 - Channelopathies /neuroethics /neurooncology / Conclusion pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Air pollutants, such as SO2, PM10, O3, CO, have an association Part I /stroke /training in neurology - Part I and traumatic brain with all-cause mortality in ischemic stroke patients. injury doi:10.1016/j.jns.2019.10.614 Differential approach to the diagnosis of sleep disorders at Prakinson’s disease

a b b WCN19-1298 S. Djalilova , Z. Ibodullayev , D. Abdullayeva aNeurological diseases, Tashkent, Uzbekistan bTashkent medical academy, Neurological diseases, Tashkent, Poster shift 01 - Channelopathies /neuroethics /neurooncology / Uzbekistan pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain Objective injury To study the differential approach to the diagnosis of sleep disorders in at Prakinson’s disease Risk factors and outcome of recurrent CVA: A prospective hospital based study from Sea Coast population of South India Material and method 30 patients with Parkinson's disease (PD) at the 1st and 2nd stage S.K. N S, S.T. Pinnamaneni were studied. The average age of patients were 57 ± 3.5 years, from Narayana Medical college, Neurology, Nellore, India them 12 women and 18 men. All patients were divided into two ARTICLE IN PRESS

100 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx comparison groups according to psycho-emotional disorders. For the no statistical significance (p = 0.34). The R allele was also found to analysis of sleep disorders conducted polysomnography. The hospital pose 1.077 fold (CI = 0.50-2.29) increased risk for Ischemic stroke, anxiety and depression scale (HADS) was used to identify psycho- albeit with no statistical significance (p = 0.847). After adjustment emotional disorders. for conventional vascular and prothrombotic risk factors, odds ratio analysis revealed that both RR genotype [OR-0.153 (0.012 - 1.898), p Results = 0.144] and R allele [OR-0.932 (0.349 - 2.492), p = 0.888] posed According to the results of HADS, the patients were divided into reduced risk for Ischemic stroke, albeit with no statistical two comparison groups: the first group included 17 patients with significance. clinically severe depression (average score 15 ± 6.5); the second - 13 patients with clinically severe anxiety (average score 14 ± 4.5) [ρ Conclusion ≥ 0.05]. The results of polysomnography in both groups showed that Our study suggests the possible role of R allele of PON1 Q192R in the first group there was a high incidence of increased motor polymorphism as genetic risk factor when presented simultaneously activity during the fast sleep phase (67%), in 5% of cases, sleep apnea with other known traditional risk factors of Ischemic stroke. Further was observed. In the second group, a high level of sleep fragmen- studies are necessary before PON1 Q192R gene polymorphism can be tation was noted (74%), the parasomnia was significantly lower considered as genetic risk factor for Ischemic Stroke. (15%) [ρ ≥ 0.05]. doi:10.1016/j.jns.2019.10.617 Conclusion According to the results of the study, it is clear that parasomnia is often accompanied by clinically severe depression, in turn, sleep fragmentation with prolonged daytime sleepiness is observed in WCN19-1308 severe anxiety, which may be one of the diagnostic criteria for choosing a method for correcting of sleep disorders in Parkinson's disease. Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - doi:10.1016/j.jns.2019.10.616 Part I /stroke /training in neurology - Part I and traumatic brain injury

Sensitivity and responsiveness of the HIV-associated neuropathic WCN19-1305 pain questionnaire

a b b Poster shift 01 - Channelopathies /neuroethics /neurooncology / A. Iyagba , M. Owolabi , A. Ogunniyi aUniversity of Port Harcourt Teaching Hospital, Medicine, Port Harcourt, pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Nigeria Part I /stroke /training in neurology - Part I and traumatic brain bUniversity College Hospital, Medicine, Ibadan, Nigeria injury Back ground Pon1 (Paraoxonase 1) Q192R gene polymorphism in ischemic The HIV-associated neuropathic pain questionnaire (HANP-Q) is a stroke among North Indian population newly derived tool for measuring neuropathic pain (NP) among HIV- AIDS persons. Sensitivity and responsiveness are key psychometric a a b R.K. Dhamija , A. Gupta , K. Saraswathy properties of scale development. Responsiveness is the ability of a a Lady Hardinge Medical College and Associated Hospitals, Neurology, test to detect clinically significant change between two measure- New Delhi, India ments in a patient’s health status over time. Sensitivity is the b University of Delhi, Anthropology, New Delhi, India smallest absolute amount of change that can be detected by a measuring scale or instrument. Background PON1 is an HDL-associated esterase, two common polymor- Aim phisms in the PON1 gene, the Q192R and L55M substitutions, To determine the sensitivity and responsiveness of the HANP-Q. determine inter-individual variation in PON1 activity. The association of these polymorphisms with the risk of Ischemic stroke remains Method controversial. Hence, the role of PON1 Q192R gene polymorphism in Ethical approval was obtained. Forty-eight patients with HIV Ischemic stroke was studied in North Indian Population. were assessed for NP using the HANP-Q. Sensitivity to change was determined by assessing changes in the HANP-Q scores from Design and methods baseline (T0) and four (T1) and eight weeks (T2) with the In the present study, the PON1 Q192R gene polymorphism was Wilcoxon-sign rank test. Responsiveness was determined from the analyzed in Ischemic stroke patients (n-63) and age, sex and standardized response means (criterion: ≥0.7). Data were analyzed geography matched healthy controls (n-63) through PCR-RFLP using Statistical Package for Social Sciences-21 software. method. Ethical clearance was obtained from Ethics committee for Human Research, Lady Hardinge Medical College, New Delhi. Results The Wilcoxon Signed Rank Test for T0/T1 revealed a statistically Results significant reduction in the HANP-Q scores between the two test In the present study, distribution of PON1 Q192R gene polymor- administration, z = −2.414, p = 0.016, with a medium effect size (r phism was not seen to differ between cases and controls. Unadjusted = 0.3). Correlation coefficient between the two test scores was odds ratio analysis showed that RR genotype was found to pose 3.07 0.818. For T0/T2, z = −2.414, p = 0.016, with a medium effect size fold (CI = 0.30-30.67) increased risk for Ischemic stroke, albeit with (r = 0.3). Correlation coefficient between the two test scores was ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 101

0.587. SRM for T1 and T2 were 0.8 (marked responsiveness) and 0.6 B.G. Yoo, J.H. Lee (moderate responsiveness) respectively. Kosin University Gospel Hospital, Department of Neurology, Busan, Republic of Korea Conclusion The HANP-Q is a sensitive and responsive scale that should be Background used to measure neuropathic pain in HIV positive individuals. Recently, a relationship between the thickness of epicardial adipose tissue and the incidence and severity of atrial ﬁbrillation doi:10.1016/j.jns.2019.10.618 (AF) has been reported. However, the potential association between epicardial fat thickness (EFT) and plasma free fatty acid (FFA) level in ischemic stroke with or without AF has not been previously investigated. The objective of this study was to assess the WCN19-1310 performance of EFT and plasma FFA level in identifying patients with ischemic stroke and AF.

Poster shift 01 - Channelopathies /neuroethics /neurooncology / Methods pain - Part I /sleep disorders - Part I /stem cells and gene therapy - We retrospectively included 214 patients (mean age, 66.8 ± 12.3 Part I /stroke /training in Neurology - part I and traumatic brain years; 39.7% women) with acute ischemic stroke who were admitted injury within 3 days of symptom onset to a single university hospital. EFT was measured perpendicular from the free wall of the right ventricle A case of remote intracerebral hemorrhage after thrombolysis at end-systole in three cardiac cycles.

J.G. Kim, S.J. Lee Results fi Eulji University Hospital, Neurology, Daejeon, Republic of Korea The ischemic stroke with AF group showed signi cantly higher plasma FFA level (1,379.7 ± 717.5 vs. 757.8 ± 520.5 uEq/L, pb0.001) and EFT (6.5 ± 1.2 vs. 5.3 ± 1.2 mm, p b 0.001) and poorer prognosis Intracerebral hemorrhage (ICH) is the most serious complication than the group without AF. In addition, plasma FFA level was of thrombolysis in patient with acute ischemic stroke. Remote ICH significantly correlated with EFT and plasma FFA level and EFT were was defined as single or multiple hemorrhages that appear in brain independently associated with stroke with AF. According to the final regions without visible ischemic damage detected by brain com- model, which was selected in stepwise fashion, both EFT (adjusted puted tomography, remote from the area causing the initial stroke odds ratio [OR], 2.031; 95% confidence interval [CI], 1.454-2.938; p b symptoms in the European Cooperative Acute Stroke Study. The 0.001) and FFA (adjusted OR, 1.002; 95% CI, 1.001-1.002; p b 0.001) incidence of remote ICH after thrombolysis was reported 1.3 to 3.7%. were independent predictor factors associated with ischemic stroke Previous study showed that lobar cerebral microbleeds (CMBs) with AF after adjusting for age. increased the risk of remote ICH. I will present a case of remote intracerebral hemorrhage after thrombolysis in patient with thalamic Conclusions microbleed. A 79-year-old female visited emergency room due to Echocardiographic EFT and plasma FFA levels could facilitate the sudden onset of left hemiplegia. She had previous stroke, atrial identification of patients with ischemic stroke with AF. fibrillation, and dementia. Neurological examination revealed severe dysarthria, left central type facial palsy, left hemiplegia, and neglect. doi:10.1016/j.jns.2019.10.620 Initial NIH stroke scale score was 17. Brain computed tomography (CT) scan with angiography showed no hemorrhage and right middle cerebral artery (MCA) occlusion. Intravenous thrombolysis was started 180 minutes after symptom onset. Additional mechanical thrombectomy was performed, and right MCA was recanalized. WCN19-1313 CT scan just after thrombolysis displayed ICH at the right thalamus, midbrain, and pons. Multiple etiologies contribute to the pathogen- Poster shift 01 - Channelopathies /neuroethics /neurooncology / esis of post-thrombolysis remote ICH. CMBs, as markers of hemor- pain - Part I /sleep disorders - Part I /stem cells and gene therapy - rhage-prone small vessel injury, might contribute particularly to Part I /stroke /training in neurology - Part I and traumatic brain remote ICH regardless of location. injury doi:10.1016/j.jns.2019.10.619 A 44 year old male Filipino with spontaneous acute subdural hematoma and subarachnoid hemorrhage caused by a dural arteriovenous fistula of the occipital lobe WCN19-1312 G. Vista, N. Belonguel Perpetual Succour Hospital, Internal Medicine, Cebu, Philippines Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Background Part I /stroke /training in neurology - Part I and traumatic brain Spontaneous acute subdural hematoma (ASDH) comprises only injury 2.6% of all ASDH. In one study, only 178 cases of spontaneous ASDH were documented, however, only 1 case among them was attributed Elevated epicardial fat thickness and plasma free fatty acid are to the presence of dural arteriovenous fistula (dAVF).Only less than associated with ischemic stroke with atrial fibrillation 10% of all subarachnoid hemorrhage (SAH) are caused by vascular ARTICLE IN PRESS

102 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx malformations. Spontaneous ASDH and SAH occurring together is Results extremely rare. There is a scarcity of literature on cases with dAVF of There was a significant increase in SS-QOL in comprehensive the occipital lobe as a cause of simultaneous spontaneous ASDH and treatment (CT) group after a treatment session (P b 0.05). The HAMD SAH. score in CT group was significant lower than control group at the post-intervention and follow-up assessments, especially in the Case Anxiety Factors (Pb0.05). Improvement of ADL assessed with Barthel A 44 year old Filipino male with no history of trauma, Index was similar after intervention (P = 0.96) and at 1 month presented with severe headache, vomiting, and decreasing senso- follow-up (P = 0.83), there were no between-group differences for rium. CT scan revealed acute parenchymal bleed in the left ADL in this study. occipital lobe with subarachnoid extension and subdural hematoma in the left frontoparietotemporal convexity and posterior Conclusions interhemispheric falx. Due to the location of the lesion seen on CT Acupuncture combined with rehabilitation is more effective in scan and the gender distribution, Arteriovenous malformation alleviating depression, especially in mental and somatic anxiety. In (AVM) was initially considered, thus proceeded to CTA to establish addition, this comprehensive treatment also had a better short-term the diagnosis of vascular anomaly, however, revealed dAVF effect in improving the quality of life in PSD patients. instead. Four-vessel angiogram was done to assess the tributaries of the dAVF and confirmed the diagnosis. Complete obliteration of doi:10.1016/j.jns.2019.10.622 dAVF of the occipital lobe was done with Onyx Embolization in one session.

Conclusion WCN19-1317 This is the ﬁrst case of Borden type II, Cognard type IIa+IIb dAVF, as reported in this institution. Although extremely rare as a cause of SAH and ASDH, dAVF should be considered as a differential in Poster shift 01 - Channelopathies /neuroethics /neurooncology / patients with the absence of identiﬁable common cause of new onset pain - Part I /sleep disorders - Part I /stem cells and gene therapy - of severe headache and poor neurologic status. Part I /stroke /training in neurology - Part I and traumatic brain injury doi:10.1016/j.jns.2019.10.621 Risk factors for ischemic stroke among mongolian population

G. Oidovdorja, O. Bosookhuua, C. Banzraia, P. Boldbayara, K. Baatara, WCN19-1316 S. Turbata,B.Dambasurena, E. Yadamsurena,A.Jambaldorjb, B. Damchaaa,M.Batmunkhc a Poster shift 01 - Channelopathies /neuroethics /neurooncology / Institute of Medical Sciences, Department of Neurology, Ulaanbaatar, Mongolia pain - Part I /sleep disorders - Part I /stem cells and gene therapy - bThird State Central Hospital, Stroke unit, Ulaanbaatar, Mongolia Part I /stroke /training in neurology - Part I and traumatic brain cMongolian National University of Medical Sciences, Central Scientiﬁc injury Research Laboratory, Ulaanbaatar, Mongolia

Effects of acupuncture combined with rehabilitation on mental Background and quality of life of patients with mild depression after stroke Stroke is a leading cause of death and disability, especially in low- income and middle-income countries. Approximately 80% of stroke a a b a a a Y. Liu ,R.Qi, J. Liu , G. Zhang , H. Zhang , C. Shan events could be prevented by making simple lifestyle modifications. a Yueyang Hospital of Integrated Traditional Chinese and Western Therefore, it is crucial to determine characterization of risk factors for Medicine, Shanghai University of Traditional Chinese Medicine, Reha- ischemic stroke in Mongolia. bilitation Medicine, Shanghai, China b Shanghai University of Traditional Chinese Medicine, Yueyang Clinical Objective Medical College, Shanghai, China To determine risk factors for ischemic stroke among Mongolian population Objective To compare the effectiveness of Integrated traditional Chinese Methods and Western Medicine treatment to conventional rehabilitation in Our study was conducted by case-control study design. Cases mental and quality of life in patients with depression after stroke were patients with acute first stroke; controls were matched with (PSD). cases for age and sex. The study was conducted in Stroke center of Third State Central hospital from January to December, 2017. Methods Structured questionnaires were administered and physical examina- In this randomized, controlled, single-blind trail, 66 patients with tions were done in the same manner in cases and controls. Odds mild depression after stroke were randomized to two groups and all ratios (OR) and logistic regression were calculated. received conventional motor and psychological rehabilitation, half of them received extra scalp-body acupuncture, treatment 3–5 times Results per week for 10 times. Patients were assessed by stroke-specific In total, 173 patients with ischemic stroke and 171 controls were quality of life (SS-QOL), Hamilton Depression Scale score (HAMD-24) included. The patients’ age ranged from 17 to 92, the mean age was and Activity of Daily Living (ADL) at baseline, after intervention, and 61.2 ± 14.4. Events were more frequent in man than women by at the 1-month follow-up. 27.4%. History of diabetes mellitus (OR 3.13,95% CI 1.18-8.25), atrial ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 103

ﬁbrillation (OR 4.83%, 1.55–14.9), alcohol consumption (OR 4.82,95% WCN19-1326 CI 2.40–9.69) were all signiﬁcantly associated with ischemic stroke. The mean age was lower in patients with stroke of other determined etiology. The frequency of hypertension was higher in patients with Poster shift 01 - Channelopathies /neuroethics /neurooncology /pain lacunar infarct than other subtypes. Smoking was high frequent in - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / patients with large artery atherosclerosis. stroke /training in neurology - Part I and traumatic brain injury

Conclusion Safety and efﬁcacy of repeated thrombolysis with recombinant 6 potentially modiﬁable risk factors were collectively associated tissue- type plasminogen activator in early recurrent ischemic with ischemic stroke and were different among ischemic stroke stroke: A systematic review subtypes in Mongolian population. The odds ratios of these risks are higher than other countries’ study. R.J. Sarmiento, J.D. Diestro, A. Espiritu, M.C. San Jose Philippine General Hospital, Department of Neurosciences, Manila, doi:10.1016/j.jns.2019.10.623 Philippines

Background Thrombolysis with intravenous tissue- type plasminogen activa- WCN19-1321 tor (IVtPA) is the only approved treatment for patients with acute ischemic stroke. History of stroke for the past three months is an exclusion criteria set by the National Institute of Neurological Poster shift 01 - Channelopathies /neuroethics /neurooncology / Disorders and Stroke study. It is unknown whether repeat IVtPA in pain - Part I /sleep disorders - Part I /stem cells and gene therapy - early ischemic stroke is associated with higher complication rates. Part I /stroke /training in neurology - Part I and traumatic brain injury Objectives The main objective of this review was to determine the safety and Seasonal variations and meteoral factors inﬂuence in stroke on efﬁcacy of repeated thrombolysis in patients who had early recurrent Nouakchott ischemic strokes.

D. Samy Mohamed Leminea, M.G. Ahmed jedoub, M. Abderrahmaneb, Search method D. Mouhamadouc MEDLINE by PubMed, CENTRAL by The Cochrane Library, HERDIN, aCentrehospitalier des specialités, Service de neurologie, Nouakchott- SCOPUS and ClinicalTrials.gov websites were searched in August Ouest, Mauritania 2018. bService de neurologie, Neurology, Nouakchott, Mauritania cService de neurology, Neurology, Nouakchott, Mauritania Selection criteria All studies reporting the use of repeated IVtPA in patients with The role of meteorological conditions in stroke occurrence has early recurrent ischemic strokes were included. been the subject of several studies in the last ten years. Most of the work was carried out in temperate climates, few studies concerned Data collection and analysis the tropical climate. We carried out a retrospective study at the Nktt Data collected include study design, population characteristics, CHS neurology department, going from 01/01/2012 to 31/12/2016. treatment outcomes (symptomatic hemorrhage, functional status in Our inclusion criteria were an age greater than 15 years, all medical three months, systemic hemorrhage, anaphylaxis). imaging confirmed stroke from the Nouakchott region. Daily meteorological information was obtained from the national meteo- Results rological service by calculating the monthly and seasonal average of The review included ten articles with a total of 33 patients. One each parameter (mean wind speed, temperature and humidity). The developed hemorrhagic conversion leading to neurologic deteriora- seasons were distributed in the rainy dry season, cold dry season and tion and death. Half of the patients with reported functional status in the hot season. We collected 1280 patient records, with a sex ratio three months after the repeated thrombolysis had no or minimal fi of 1.24. The average age of patients was 61.59 years, with extremes signi cant disability. One died from spontaneous rupture of previ- fi of 16 to 95 years. The most representative age group was between 70 ously unidenti ed infrarenal aortic aneurysm. No anaphylactic and 80 years old at 28.3%. The average number of strokes per year reactions were noted. was 256 and the average number per month was 21.3. There is a decrease in global incidenc in the rainy season with a minimum in Conclusion fi July and a maximum in December and January. The incidence of Repeated IVtPA can be safe and ef cacious in patients who had fi AVCH decreases during the hot, rainy season. That of DALYs, shows a early recurrent ischemic stroke. Larger studies are needed to con rm fi slight decrease in cold dry season, with a maximum during the bene cial effects and risks of repeated IVtPA in patients with september. The number of strokes is significantly negatively early recurrent ischemic strokes. correlated with humidity. At the end of this work, we observe the seasonal variation in the incidence of stroke as a whole. Keywords: Early recurrent ischemic stroke, Repeat thrombolysis, IVtPA doi:10.1016/j.jns.2019.10.624 doi:10.1016/j.jns.2019.10.625 ARTICLE IN PRESS

104 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-1334 WCN19-1336

Poster shift 01 - Channelopathies /neuroethics /neurooncology /pain Poster shift 01 - Channelopathies /neuroethics /neurooncology / - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - stroke /training in neurology - Part I and traumatic brain injury Part I /stroke /training in neurology - Part I and traumatic brain injury Progressive myelopathy due to spinal epidural arteriovenous fistula with retrograde venous drainage Bright vessel sign seen on arterial spin labeling (ASL) and its utility for therapeutic management of hyperacute ischemic H.J. Kima, H.J. Kangb, H. Leea, J.J. Parka, H.G. Rohc stroke aKonkuk University School of Medicine, Department of Neurology, Seoul, Republic of Korea P. Oak, Y. Sawant, M. Verma, D. Patkar b Samsung Changwon Hospital, Sungkyunkwan University School of Nanavati Superspeciality Hospital-Mumbai, Neurology, Mumbai, India Medicine, Department of Neurology, Changwon, Republic of Korea c Konkuk University School of Medicine, Department of Radiology, Seoul, Background and aim Republic of Korea To evaluate, whether bright vessel sign seen on arterial spin labeling (ASL) can assist in localizing the site of arterial occlusion in Objectives Management of hyperacute ischemic stroke. Spinal epidural arteriovenous fistula (AVF) is rare vascular malformation. Its usual symptom is radicular pain. We report a Methods patient presented with progressive myelopathy who finally diag- Images of all patients diagnosed with hyperacute ischemic stroke nosed with spinal epidural AVF. on MRI were retrospectively assessed visually for 1) Occluded artery on 3D TOF – MRA (3D Time of flight – MR Angiography), 2) Case report Susceptibility vessel sign on SWAN (susceptibility weighted angiog- A 80-year-old man presented with 1 month history of progressive raphy sequence) and 3) Bright vessel sign on ASL (arterial spin weakness and tingling sense of both legs. He fell down riding a labeling) sequences. bicycle 6 months ago. There was diffuse weakness of lower extremities (MRC grade 4~4+) with sensory level at L1 on Results examination. Knee jerk was symmetric and brisk, and the function Of total 79 patients who showed hyperacute infarcts as detected of anal sphincter was intact. by restricted diffusion and isointensity on FLAIR images, MRA Magnetic resonance image (MRI) of spine showed cord swelling showed intracranial arterial occlusion in 32 patients. In these 32 with high signal and central enhancement from T10 to L1. Also, there patients only susceptibility vessel sign was seen in 14 patients. In were crowding of cauda equina and intradural tortuous venous the remainder 18 patients, bright vessel sign with susceptibility engorgement from T12 to L3. Angiogram demonstrated arteriove- sign was seen in 13 patients, and only bright vessel sign was seen nous shunting from lumbar artery to the left anterior epidural vein at in 5 patients. Only 1 patient without significant occlusion on MRA the level of L2 lumbar vertebral body. Finally, it was drained to the showed bright vessel sign positive on ASL map. right L2 perimedullary vein. After embolization with N-butyl cyanoacrylate (NBCA) glue at the proximal epidural draining vein, Conclusion there was no residual shunt in post embolization angiography. In hyperacute ischemic stroke, bright vessel sign correlates well The patient recovered gradually and was left with slight gait with the site of thrombotic occlusion in conjunction with suscepti- instability. The extent of edema, enhancement of the cord and bility vessel sign seen on SWAN and arterial occlusion on MRA perimedullary venous engorgement decreased on follow-up MRI images. Only bright vessel sign without susceptibility vessel sign is after 1 month. important key in identification of thrombus location and its fibrin rich composition. In addition ‘bright vessel’ sign provides crucial Conclusions & Comments information concerning distant thrombi, delayed filling/ slow flow Spinal epidural AVF can present with symptoms secondary to proximal and distal to the site of occlusion and presence of congestive myelopathy and can be treated successfully by endo- collaterals. vascular treatment in case of our patient. Thus, it is important to consider spinal epidural AVF as one of curable vascular etiology of myelopathy. doi:10.1016/j.jns.2019.10.626 doi:10.1016/j.jns.2019.10.627 ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 105

WCN19-1355 WCN19-1359

Poster shift 01 - Channelopathies /neuroethics /neurooncology / Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain Part I /stroke /training in neurology - Part I and traumatic brain injury injury

Use of anticoagulant therapy and cerebral microbleeds: A Use of ceftriaxone in stroke patients, a predictor of good outcome systematic review and meta-analysis in stroke patients: experience from a tertiary care center in North India Y. Chenga, Y. Wanga, K. Qiub, Q. Songa, M. Liua aCenter of Cerebrovascular Diseases, Department of Neurology, West A. Pathak China Hospital, Sichuan University, Chengdu, China Neurology, IMS, BHU, Varanasi, India bSichuan University, West China School of Medicine, Chengdu, China Background Background Post stroke pneumonia is a common cause of mortality in stroke Cerebral microbleeds (CMBs) has been recognised as a prognostic patients and role of prophylactic antibiotics is controversial. Whether marker of future risk of intracerebral haemorrhage in patients on use of ceftriaxone as a prophylactic measure has any added anticoagulation. Whether CMBs itself are affected by anticoagulants advantage over other antibiotics is not known. remains unclear. Methods Objective A cross-sectional prospective study was conducted in the S S Lal We performed a systematic review and meta-analysis to inves- Hospital, Institute of Medical Sciences, Banaras Hindu University, tigate the association between anticoagulant use and prevalent India, throughout June, 2017 to December, 2018 on the efﬁcacy of CMBs. short-term antibacterial therapy to develop post-stroke infection. We assessed the outcome of therapy by mRS at discharge which was Patients and methods/Material and methods grouped in to two categories: mRS with good outcome (0–3) and We searched PubMed, Ovid EMBASE, and Cochrane Library up to mRS with poor outcome (4–6). Similarly patients were grouped into March 2019 for relevant studies. We calculated the pooled odds ratio four categories: Group 1 (no antibiotic group), Group 2 (Pipracillin (OR) for CMB prevalence and distribution (strictly lobar, deep/ plus tazobactum group), Group 3 (Ceftazidine group) and Group 4 infratentorial) in anticoagulant users versus nonusers, using the (Ceftriaxone group). Further data was analyzed using SPSS software random-effects model. version 25.

Results Results We included 18 825 participants from 36 studies. Pooled results 366 stroke patients were analyzed for outcome with age ranging showed that CMBs were more frequent in anticoagulant users than from 20 to 95 years and out of which 151 were females. Efficacy of those in nonusers (pooled OR, 1.54; 95% confidence interval, 1.26– antibiotic was analyzed between two groups: poor outcome (mRS 1.88, P b 0.001). The association remained in the subgroups 4–6) and good outcome (mRS 0-3) using Pearson’s Chi-square and stratified by type of participants (stroke-free population: OR 1.86, Binary Logistic Regression. It was found that severity was signifi- 95%CI 1.25 to 2.77; ischaemic stroke/transient ischaemic attack: OR cantly lower in those patients who were given ceftriaxone antibiotic 1.33, 95%CI 1.06 to 1.67; intracerebral haemorrhage: OR 2.26, 95% with p = 0.010; odd’s ratio = 0.327; 95% CI, 1.270–8.758 CI 1.06 to 4.83; all P b 0.05). There was a significant association of respectively. anticoagulant therapy with strictly lobar CMBs (OR, 1.60; 95% confidence interval, 1.19–2.17, P = 0.002) rather than deep/ Conclusion infratentorial MBs (OR, 1.50; 95% confidence interval, 0.89–2.55, Prophylactic use of ceftriaxone in stroke patients have better P = 0.03). outcome in comparison to Pipracillin-tazobactum and Ceftrazidine.

Conclusions doi:10.1016/j.jns.2019.10.629 Anticoagulant therapy is associated with presence of CMBs among stroke patients and stroke-free individuals. In addition, the relationship between anticoagulant therapy and CMBs may be inﬂuenced by distribution of CMBs. Due to the indication bias and WCN19-1362 lack of adjusted estimates, our results should be considered hypothesis-generating. Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain injury doi:10.1016/j.jns.2019.10.628 To study the predictive value of serum bilirubin in outcome of stroke patients: A prospective analytical study ARTICLE IN PRESS

106 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

A. Pathak Echocardiography revealed anterior mitral valve leaﬂet vegetation Neurology, IMS-BHU, Varanasi, India indicative of Infective Endocarditis. Blood culture was positive for growth of Streptococcus bovis. Ceftriaxone was started and work up Background and purpose for colonic pathology was done. Abdominal CT scan showed an Bilirubin has been implicated to have protective role in many enhancing intraluminal mass arising from the posterior wall of the studies, but its relationship to stroke is not clearly understood. rectum approximately 5.9 cm from the anal verge. The patient had no previous gastrointestinal symptoms or complaints. Colonoscopy Methods revealed a friable nodular mass about 8 cm from the anal verge. Biopsy This study is a cross-sectional prospective descriptive study revealed Villous Adenoma. Patient underwent Laparoscopic Low conducted in the S S Lal Hospital, Institute of Medical Sciences, Banaras Anterior resection, Proctosigmoidoscopy and ileostomy. Final biopsy Hindu University, India, throughout June, 2017 to December, 2018. The of the mass showed well-differentiated Rectal Adenocarcinoma. subjects with potential hepatobiliary diseases or Gilbert syndrome Patient was discharged with plans of chemotherapy as an outpatient. were excluded from analysis. 447 stroke patients were evaluated based on their brain CT and MRI scan, mRS, and serum levels of doi:10.1016/j.jns.2019.10.631 bilirubin. Data were analyzed using SPSS software, version 25.

Results To assess the outcome at discharge serum total bilirubin WCN19-1379 measurements were divided into 2 levels: 0.1 to 1.3 and N1.3 mg/dl and mRS were also divided into two categories: mRS good outcome Poster shift 01 - channelopathies /neuroethics /neurooncology / (0 to 3) and mRS poor outcome (4 to 6) respectively. Pearson’s Chi- square and Binary Logistic Regression were performed to analyze the pain - Part I /sleep disorders - Part I /stem cells and gene therapy - data. Total bilirubin levels were signiﬁcantly lower in mRS with poor Part I /stroke /training in neurology - Part I and traumatic brain outcome group with p = 0.002; odd’s ratio = 0.247; 95%CI, 0.104– injury 0.588 compared to mRS with good outcome group. Complications as poor prognostic factors in patients with Conclusions hemorrhagic stroke: A hospital-based stroke registry in Indonesia This ﬁnding suggest that serum total bilirubin might have some protective function against stroke severity/mortality. V.O. Wijaya, R. Pinzon Duta Wacana Christian University, Faculty of Medicine, Yogyakarta, doi:10.1016/j.jns.2019.10.630 Indonesia

Introduction Stroke patients commonly experience various medical complica- WCN19-1366 tions during their rehabilitation stay. Understanding complications in hemorrhagic stroke patients can determine the patients prognosis. Poster shift 01 - Channelopathies /neuroethics /neurooncology / Aim pain - Part I /sleep disorders - Part I /stem cells and gene therapy - This study aimed to explore complications as prognostic factors Part I /stroke /training in neurology - Part I and traumatic brain among patients with hemorrhagic stroke injury Methods An acute ischemic stroke presenting as rectal adenocarcinoma This was an observational analytic study with cross sectional and streptococcus bovis endocarditis: A case report design in 480 subjects. All subjects were recruited from acute stroke care unit in Bethesda Hospital. All data recorded and obtained from J. Torrevillasa, J.A. Vatanagulb electronic stroke registry. Disability, mortality, and length of stay aPerpetual Succour Hospital, Internal Medicine, Cebu, Philippines (LoS) were assessed as clinical outcomes for this study. Multivariate bPerpetual Succour Hospital, Internal Medicine, Neurology, Cebu, Philippines logistic regression was used to analyze the data

Background Results Infective endocarditis is a rare disease with various known The majority of subjects were males (58.5%), with £60 years old bacterial etiology. Patients with prosthetic valves or co existent (52.3%), stroke onset N 3 hours (87.5%), and had stroke for the first time valvular disease are predisposed. Streptococcus gallolyticus (formerly (82.9%). The most common complications was GI tract bleeding (19.8%), S. bovis) has long been identified as a cause of infective endocarditis whereas the least was decubitus ulcer (1.5%). 25.8% patients died during and also is well documented to be associated with colonic tumors. hospitalization period. Among 356 survivors, there were no significant prognosis factors of disability in subjects. Logistic regression found Case stroke onset N3 h (OR: 2.68; 95%CI: 1.29–5.59; p = 0.009) and GI tract A 55-year-old male, diabetic presented with a two-week history of bleeding (OR: 0.06; 95%CI:0.03–0.13; p = 0.000) to be an independent left-sided weakness, facial asymmetry and dizziness. Cranial MRI predictors of mortality in hemorrhagic stroke, whereas GI tract bleeding showed late Subacute to chronic infarcts in both frontal cortex and (OR: 3.48; 95%CI: 1.77–6.85; p = 0.000) was also an independent acute lacunar infarct in the left occipital lobe. He was managed as predictors of prolonged length of stay in hemorrhagic stroke. Ischemic stroke and eventually discharged from a local hospital. Persistence of dizziness and weakness prompted readmission in Conclusion another hospital. Significant physical examination showed left facial This study identify the prognostic factors in hemorrhagic stoke asymmetry, left hemiparesis and a Grade 3 pansystolic murmur. patients. Statistically, stroke onset N3 h and GI tract bleeding were ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 107 independent predictors of poor prognosis in hemorrhagic stroke. S.P. Adisti, S. Subagya, S. Wibowo, R.G. Mauleka There were no prognosis factor that affects the disability in subjects. University of Gadjah Mada, Neurology, Yogyakarta, Indonesia doi:10.1016/j.jns.2019.10.632 Stem cells therapy is the one of exciting potential for Parkinson's disease (PD) treatment because of the superiority for reducing progression of dopamine (DA) neurons degeneration in substantia nigra of middle brain, which causes the motor symptoms and WCN19-1399 nonmotor symptoms of PD. The development of stem cells therapy for PD is quite slow because it has problems related to patient selection, safety, and Poster shift 01 - channelopathies /neuroethics /neurooncology / ethical problems. So far, there have been no stem cell research for PD pain - Part I /sleep disorders - Part I /stem cells and gene therapy - publications until phase IV according to FDA clinical trials. Current Part I /stroke /training in neurology - Part I and traumatic brain researches have only reached phase I-III, which some studies are still injury in the research process and not yet published. At present, stem cell researchers are still looking for the best The levels of cholesterol and triglycerides and the risk for stroke method for transplanting stem cells in PD patients. Optimization of in first degree relatives of stroke patients stem cell therapy for PD can be done by: (1) choosing the right donor stem cells, (2) inducing and selecting DA neurons appropri- C. Grosua, M.M. Leon-Constantinb, A. Mastalerub ately, (3) conducting valid preclinical research, (4) optimizing the aNeurology, University of Medicine and Pharmacy "Grigore T. Popa" Iasi- host brain environment. Clinical Rehabilitation Hospital Iasi, Iasi, Romania Further studies are needed to answer some crucial questions bInternal Medicine, University of Medicine and Pharmacy "Grigore T. about the different issues in stem cell therapy. Accordingly, stem cell Popa" Iasi-Clinical Rehabilitation Hospital Iasi, Iasi, Romania based therapy for PD also needed more complementary evaluation in both basic and clinical study areas. Stroke is a leading cause of major invalidity and mortality doi:10.1016/j.jns.2019.10.634 worldwide in the last years. One of the major modifiable risk factors is the lipid profile, causing clinical and subclinical atherosclerosis. The intima media thickness (IMT) has proved to be a very good diagnostic marker for subclinical atherosclerosis and also a prognostic marker for predicting future cardio- and cerebrovascular events. The purpose of WCN19-1413 this paper was to determine if there are any correlations between the cholesterol and triglycerides value and the intima-media thickness as a Poster shift 01 - channelopathies /neuroethics /neurooncology / risk factor for stroke in first degree relatives of stroke patients. We pain - Part I /sleep disorders - Part I /stem cells and gene therapy - included a total of 176 subjects, selected by well-defined criteria, Part I /stroke /training in neurology - Part I and traumatic brain divided into three groups: stroke patients, first degree relatives of stroke patients and a healthy control group. We evaluated the injury parameters weight, height and body mass index, the levels of cholesterol and triglycerides and IMT by cervical ultrasound mode B, A comparison between phantom breast syndrome and phantom at the common carotid artery (CCA) and internal carotid artery (ICA) limb: A systematic review bilaterally. The results showed mean values of lipids in the normal range, but in the stroke group, both cholesterol and triglyceride levels J. Coates, A. Jha were increased compared to the other groups. The correlations found Texila American University, College of Medicine, East Bank Demerara, were the triglycerides levels with IMT in the CCA in both control and Guyana stroke patients and an increased IMT in stroke patients with an increase in IMT of their relatives. Further research is needed in order to Phantom Breast Syndrome (PBS) is a post mastectomy condition elaborate a screening algorithm for primary prevention of stroke in in which patients experience both non painful sensations as well as first degree relatives of stroke patients. phantom breast pain in the area of the amputated breast. Studies into phantom breast arose decades after the term “phantom limb” Keywords: Stroke, First degree relatives, Intima-media thickness was introduced. However, the aetiology of the phantom phenomenon is yet to be fully understood. Furthermore, there are fewer doi:10.1016/j.jns.2019.10.633 documented cases and researches done into PBS in comparison with phantom limb. PBS and phantom limb are believed to develop under the same neurological basis; however, differences exist. For instance, the WCN19-1404 concept of proprioception is proposed as a possible contribution to phantom pain, incorporated into the mirror box therapy used to treat phantom limb, was proven effective, based on various studies. Poster shift 01 - channelopathies /neuroethics /neurooncology / This review, draws comparison between Phantom Limb and PBS pain - Part I /sleep disorders - Part I /stem cells and gene therapy - and also aims at highlighting the proposed causes to phantom Part I /stroke /training in neurology - Part I and traumatic brain phenomenon, the risk factors and possible treatment of PBS in breast injury cancer patients. The PRISMA methodology was implemented; random articles were evaluated, drawn from electronic databases such as PUBMED, Scopus, MEDLINE, HINARI, EBSCO, Science Direct Stem cells therapy for Parkinson's disease: An update review and Google Scholar. ARTICLE IN PRESS

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In conclusion, there is limited studies into PBS in relation to WCN19-1429 phantom limb and thus questions arise which evoke curiosity. Is it possible that PBS is the key to unlocking the mystery to the phantom phenomenon? Does PBS have an effect on post-mastectomy recovery Poster shift 01 - channelopathies /neuroethics /neurooncology / and breast cancer prognosis? If so, PBS deems worthy of further pain - Part I /sleep disorders - Part I /stem cells and gene therapy - research as there is a rising global cancer epidemic. Part I /stroke /training in neurology - Part I and traumatic brain injury doi:10.1016/j.jns.2019.10.635 [99MTC]-MDM SPECT as a prognostic marker for pre-operative and post-operative serial evaluation of glioma compared with DSCE-MRI and 1H-MRS WCN19-1415 N. Rania, B. Singha, P.P. Hazarib, P. Singhc, N. Kumard, S. Gupta Kumare, A.K. Mishrab Poster shift 01 - channelopathies /neuroethics /neurooncology / aPostgraduate Institute of Medical education and Research, Department pain - Part I /sleep disorders - Part I /stem cells and gene therapy - of Nuclear Medicine, Chandigarh, India Part I /stroke /training in neurology - Part I and traumatic brain bINMAS, Division of Cyclotron and Radiopharmaceutical Sciences, Delhi, injury India cPostgraduate Institute of Medical education and Research, Department Paraneoplastic neuropathies and ion channels antibodies spec- of Radiology, Chandigarh, India trum: Comparison and analysis dPostgraduate Institute of Medical education and Research, Department of Radiotherapy, Chandigarh, India D. Labunskiy, S. Kiryukhina, V. Podsevatkin ePostgraduate Institute of Medical education and Research, Department N.P. Ogarev Mordovia State University N.P., Neurology and Psychiatry, of Neurosugery, Chandigarh, India Saransk, Russia Background Small-cell lung cancer (SCLC) sometimes is associated with The currently available PET tracers have proven high diagnostic paraneoplastic neurological autoimmunity. Different àntibodies efficacy in gliomas. However, SPECT based tracers is always viewed have been used for diagnosis of this condition and for diagnosis as a cost-effective alternate to PET imaging. and signs of therapy results. Therefore various types of antibodies play a pathogenic role in mechanisms of autoimmune processes in Objective paraneoplastic neuropathies (PN). To determine the diagnostic efficacy of 99mTc-labelled MDM Under our observation were 59 patients with different type of PN, (bis-methionine) SPECT in the diagnostic work-up in glioma in 37 from them suffered from SCLC with paraneoplastic neuropathies, comparison to DSCE-MRI and MRS. and 11 from Gullian-Barre syndrome. Control group consist of^246 neurologicall healthy donors. Cerebrospinal fluid (CSF) was obtained Methods from urological patients during spinal anesthesia and consequent 143 gliomas (101M: 42F) were enrolled. Amongst these, 29/143 surgeries. were freshly diagnosed patients of glioma and the remaining 114/ We used ELISA and Western Blot analysis for detection of anti- 143 patients were on post-surgery follow-up with chemotherapy/ myelin-associated glycoprotein antibodies (MAG), anti-ganglioside radiotherapy. The patients were subjected to a Ki-67 analysis, antibodies. which are principally associated with autoimmune 99mTc-MDM-SPECT, DSCE-MRI and MRS for the disease evaluation peripheral neuropathies and anti-glutamic acid decarboxylase anti- at presentation and during the course of follow-up after surgery/ bodies in serum and CSF of all patients and control group. Besides chemo/radiotherapy. this AB against urinergic receptor channel P2X purinoceptor 7

(P2X7), the voltage-gated potassium channel KV1.3 and the volt- Results age-gated sodium channel NaV1.7 as examples of targeting ion On histological analysis, 26/29 patients (pre-surgery group) were channels were studied. diagnosed to have glioma (G IV-13; G III-04; G II-09) and 3/29 It was revealed that in 78 per cent of PN all AB were increased patients were found to be meningioma. The mean T/NT ratios of two and three-fold. Ion channels AB were especially raised. 99mTc-MDM in glioma G-II, G-III, G-IV and meningioma patients In conclusion, we can state that antibody response plays a a key were estimated to be 2.46 ± 2.3, 7.13 ± 2.2, 5.16 ± 1.2 and 15.9 ± role in pathogenesis of all autoimmune neuropathies. Paraneoplastic 6.8 respectively. In the post-surgery group, the ﬁnal diagnosis could pathology in this regard is essential. Future research has to be done be made in 72/114 (47-recurrent/residual vs. 25-necrosis) patients. consider ion channel involvement and autoimmune reactivity Quantitative data analysis estimates the ROC derived cut-off value of toward them. T/NT N 1.90 (97.9%, 92.0%), nCBV N 3.32 (84.6%, 93.0%), Cho/NAA, Cho/Cr, Cr/NAA, Cr/Cho and Cho/LL to be N1.57, 81.0%/73.0%; N1.64, doi:10.1016/j.jns.2019.10.636 85.3%/73.7%; N1.06. 57.1%/ 63.6%; ≤0.60, 72.3%/81.0% and N0.90, 71.4%, /50% respectively. T/NT ratio showed a strongest linear ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 109 correlation with nCBV(r = 0.775, P b 0.00001) followed by Cho/NAA side effects of the medication and mortality. The trial has recruited (r = 0.467, P = 0.007). 25 patients till now.

Conclusion Conclusion 99mTc-MDM can be useful for tumor characterization in newly The trial tests an important clinically relevant research question. diagnosed gliomas as well as for response assessment in treated The results could have a major inﬂuence in the clinical practice gliomas. regarding prophylactic antiepileptic therapy to stroke patients. (CTRI/2018/02/011926) doi:10.1016/j.jns.2019.10.637 doi:10.1016/j.jns.2019.10.638

WCN19-1430 WCN19-1438 Poster shift 01 - channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Poster shift 01 - channelopathies /neuroethics /neurooncology /pain Part I /stroke /training in neurology - Part I and traumatic brain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / injury stroke /training in neurology - Part I and traumatic brain injury

Prophylactic levetiracetam for the prevention of post stroke Stroke awareness and knowledge in patients with stroke and seizures (PROLEVIS): A randomized, double blind, placebo- other cerebrovascular diseases: Kyrgyzstan based study controlled trial protocol N. Moloshovaa, I. Lutsenkob, A. Sultanovac, D. Nazhmudinovac,A. c V. Vishnua, P. Srivastavaa, J. Sharmaa, Y. Guptaa, M. Singha, S.N. Orunbaeva a Dwivedib, V. Goyala, R. Bhatiaa, A. Gargc Vascular Neurology Bishkek Clinic 1, Bishkek, Kyrgyzstan b aAll India Institute of Medical Sciences- New Delhi, Neurology, New Kyrgyz State Medical Academy, Online and Distance Learning, Bishkek, Delhi, India Kyrgyzstan c bAll India Institute of Medical Sciences- New Delhi, Biostatistics, New Bishkek Clinic 1, Vascular Neurology, Bishkek, Kyrgyzstan Delhi, India cAll India Institute of Medical Sciences- New Delhi, Neuroradiology, New Backgrounds and aims Delhi, India Stroke is one of the major death causes that stipulate low life expectancy in the Kyrgyz Republic. The aim of our study was to learn Background and hypothesis the level of stroke awareness among patients with stroke and other Stroke is the most common cause of acquired epilepsy. Currently, cerebrovascular diseases. there is insufficient evidence to recommend for or against prophylactic antiepileptic therapy for the primary prevention of post-stroke Materials and methods seizures. The study of stroke awareness was conducted for the first time in Kyrgyzstan. We used a unique questionnaire for interviewing Aim patients with cerebrovascular diseases about their stroke prevention To determine whether 3 months of prophylactic beliefs, stroke warning symptoms, stroke risk factors and treatment, levetiracetam can prevent seizures in patients with supra-tentorial commitment to healthy lifestyle and hypotensive therapy. cortical stroke Results Study design In our study participated 142 patients aged mean 57.08 土 11.401 PROLEVIS is an investigator-initiated, single centre, prospective, years, 63.4% were women. In our study high systolic blood pressure stratified, randomized, double blind, placebo controlled superiority (N130 mmHg) increases stroke development for 9 times (OR 9.94; trial which will enroll 800 patients (400 ischemic stroke and 95% CI 2.264 - 43.641). The most common risk factor for stroke, intracranial haemorrhage each, 1:1 allocation using permuted block according to the interviewed patients, is stress (80.99%). Stroke randomisation, 200 in active arm and 200 in placebo arm). Eligibility patients admitted that they could have prevented stroke if they will require a diagnosis of ischemic stroke, or parenchymal avoided carbohydrates and animal fat intake and lead healthy intracerebral haemorrhage (spontaneous non-aneurysmal, non- lifestyle. Among patients with higher education, there was a higher traumatic intracerebral haemorrhage) with a cortical syndrome percentage of stroke recognition compared to those without higher (either parenchymal involvement documented by imaging or education: p=0.016 . In the total sample of patients, only 29.6% presence of aphasia, apraxia, agnosia or cortical visual disorders). would recognize stroke on their own. Recruitment should happen within 1 week of onset in arterial stroke or intracranial haemorrhage. Patients will be randomized to either Conclusion oral levetiracetam or placebo twice a day for 3 months Our study shows the low level of stroke awareness among interviewed patients. Patients’ level of education influenced on the Study outcomes recognition of stroke. Patients believe that stress is the main factor of The primary outcome measure will be occurrence of first post stroke. More educational campaigns are needed for increasing stroke stroke seizure. Secondary outcomes include time from stroke to awareness in population. occurrence of seizure, occurrence of early or late epileptic seizure after stroke, seizure severity, functional outcome at 3 months doi:10.1016/j.jns.2019.10.639 (Glasgow outcome scale, and modified Rankin Scale), occurrence of ARTICLE IN PRESS

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WCN19-1442 Conclusion In our study we found that more than half the patients diagnosed as CVT were women. Among men Alcohol consumption was the Poster shift 01 - channelopathies /neuroethics /neurooncology / most signiﬁcant factor for developing thrombosis and Superior pain - Part I /sleep disorders - Part I /stem cells and gene therapy - sagittal sinus was the most commonly involved site of thrombus. Part I /stroke /training in neurology - Part I and traumatic brain doi:10.1016/j.jns.2019.10.640 injury

Study on profile of cerebral venous sinus thrombosis in a tertiary care hospital in southern Tamil Nadu WCN19-1452 J. Cornelius, M. Ramaraj Madurai Medical College, Neurology, Madurai, India Poster shift 01 - channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Introduction Part I /stroke /training in neurology - Part I and traumatic brain CVT is a rare neurovascular syndrome in contrast to the more injury common arterial disease. A study on clinical prevalence of stroke in a tertiary care hospital Materials & methods in southern India Ours is a cross sectional study of all CVT patients done over a period of 6 months from October 2018 to March 2019 in a tertiary J. Cornelius, M. Ramaraj, S. Balakrishnan care hospital in southern Tamil Nadu. Patients diagnosed as Madurai Medical College, Neurology, Madurai, India puerperal CVT, old CVT, recurrent CVT, radiological CVT and radiological artefacts were excluded from the study. Introduction The prevalence of stroke in India continues to rise due to multiple Analysis factors. There is insufficient data regarding the prevalence of stroke A total of 31 patients were included in the study, of which 14 in India, although preceding medical literature denotes a gradual rise were males (45.2%) and 17 were females (54.8%). The most common sinus involved was superior sagittal sinus over the years. (45.2%) followed by sigmoid sinus (19.4%), Left transverse sinus (16.1%), Right transverse sinus (9.7%), Deep cerebral veins (6.5%) Objective and Great vein of Galen (3.2%). To review the prevalence of stroke in a tertiary care center in The age of the patients showed a wider spectrum comprising of 2 Southern Tamil Nadu. (6.5%) patients less than 20 yrs, 17 (54.8%) within 21–40 years, 9 (29.0%) within 41–60 yrs and 3 (9.7%) over 60 yrs. Methods There was no significant correlation between the age and the site A cross sectional study done over a period of one year from of thrombus (P N 0.05) and There is a significant Correlation between January to December 2018. The study included all the Acute Stroke aetiology of CVT and sex of the patient (P b 0.05). patients admitted in our Institution.

Discussion Analysis CVT is a rare stroke in Non Pregnant women, in our study, female A total of 1168 patients diagnosed with Acute CVA were included patients were affected more than males. In males, alcoholism is a in the study, of which 779 were males (66.69%) and 389 were signiﬁcant predisposing factor. Diagnosis of CVT may be easily females (33.30%). There were a total of 848 Ischaemic Stroke patients missed in alcoholic patients. (72.60%) and 320 Haemorrhagic stroke patients (27.39%).

Discussion Stroke incidence doubles with each decade after 45 years [1]. According to the Indian stroke fact sheet (2012), the estimated age- adjusted prevalence rate for stroke ranges between 84–262/lakh population in rural and 334–424/lakh population in urban areas [2]. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 111

Following ischemic stroke (75%), haemorrhagic stroke (27.39%) was lymphocytic pleocytosis in 2 patients. Flow cytometry couldn’tbe observed to be the second most common subtype. The prevalence of performed (small number of lymphocytes). In one patient, immu- anterior circulation stroke (88%) higher, when compared to the nophenotyping report indicated the presence of monoclonal prolif- posterior circulation in our study. eration of B cells in an axillary adenopathy and in CSF. These B cells express the same surface markers, thus confirming CNS infiltration. Conclusion Intrathecal chemotherapy was indicated in 2 patients with favorable The present study is an attempt to review the current prevalence outcome in one of them. of stroke in a tertiary care centre in southern Tami Nadu. Conclusion References Involvement of the CNS during CLL although rare, should be considered as a differential diagnosis of inflammatory disease of the [1] M. Kelly-Hayes, Influence of age and health behaviors on stroke CNS. Inaugural neurological symptoms make the diagnosis risk: lessons from longitudinal studies, J Am Geriatr Soc. 58 challenging. (Suppl. 2) (2010) S325–S328, https://doi.org/10.1111/j.1532- 5415.2010.02915.x. doi:10.1016/j.jns.2019.10.642 [2] J.D. Pandian, P. Sudhan, Stroke epidemiology and stroke care services in India, J Stroke. 15 (3) (2013) 128–134, https://doi. org/10.5853/jos.2013.15.3.128. WCN19-1471 doi:10.1016/j.jns.2019.10.641 Poster shift 01 - channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain injury WCN19-1457 Atrial fibrillation, cardioembolism and heart-brain interactions Poster shift 01 - channelopathies /neuroethics /neurooncology / P. Lebedynetsa, D. Lebedynetsb, V. Lebedynetsb pain - Part I /sleep disorders - Part I /stem cells and gene therapy - aKharkiv National Medical University, Neurology#1, Kharkiv, Ukraine Part I /stroke /training in neurology - Part I and traumatic brain bV.N. Karazin National University, Clinical Neurology- Psychiatry and injury Nacrology, Kharkiv, Ukraine

Chronic lymphocytic leukemia with central nervous system Background and aims involvement: Report of three cases 5 patients - NIHSS 14±3, GCS 13±1 with history of hypertension, atrial fibrillation. 3 of them had prosthetic aortic valve and 2 of them T. Mguidich, N. Farhat, O. Hdiji, S. Sakka, K. Moalla, S. Daoud, M. had prosthetic mitral valve and were on warfarin (INR was from 2.2 Damak, M. Chokri to 2.6) Habib Bourguiba Hospital, Neurology, Sfax, Tunisia Methods Introduction NCCT scan was done to all patients. Reperfusion was not done Central nervous system (CNS) involvement is a rare complication because of high INR. of chronic lymphocytic leukemia (CLL). Optic neuritis (ON) as well as myelitis are rarer. We report 3 cases of CNS involvement during CLL Results revealed by ON. From 4 to 7 days after all patients developed fever (38±0.5) and worsened neurologically with NIHSS 17±2, GCS 12 ± 2. TTE was Patients and methods done - vegetations on valves. All patients were prescribed with We included patients with CLL who had revealing or subsequent antibiotics. Follow-up blood culture test were positive and CT in 5 neurological symptoms with monoclonal population of lymphocytes day after deterioration showed brainstem stroke in 1 case and MCA demonstrated on cerebrospinal fluid (CSF) study or imaging findings stroke in 4 cases. Treatment was continued with antibiotics and suggestive of CNS process. Clinical course, diagnostic work-up and warfarin (under INR control). In 10–14 days patients were discharge treatment were determined. from the hospital with NIHSS 10 ± 3, mRS 3 ± 1).

Results Conclusions Three patients were included (sex ratio: 0.5). They had 56, 48 and Infective endocarditis with emboli from vegetations is one of the 64 years old. Neurological symptoms were inaugural in one patient. causes of embolic stroke (and very often with multifocal lesions). So all They were concomitant to a relapse of CLL in one patient. All patients patient with prosthetic heart valves and stroke even if they are on developed optic neuritis as a ﬁrst neurological symptom. One patient anticoagulants should be investigated with TEE or TTE for vegetations developed later a paraparesis with evidence of myelitis in MRI of the development and treated properly with antibiotics if those are found. spine. Brain MRI showed multiple T2 and Flair hypersignals in the doi:10.1016/j.jns.2019.10.643 periventricular and subcortical regions in one patient. It was normal in the 2 other patients. CSF study showed predominantly ARTICLE IN PRESS

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WCN19-1487 bUniversity of Nairobi, Undergraduate Medical School, Nairobi, Kenya cAga Khan University Medical College of East Africa, Department of Emergency Medicine, Nairobi, Kenya Poster shift 01 - channelopathies /neuroethics /neurooncology /pain dAga Khan University Medical College of East Africa, Department of - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / Surgery, Nairobi, Kenya stroke /training in neurology - Part I and traumatic brain injury Intravenous thrombolysis (IVT) and endovascular mechanical Cervical-artery dissections in a Tunisian population thrombectomy (EMT) services for hyper-acute ischaemic stroke (HIS) are suboptimally delivered in lower-middle-income countries, T.Mguidich,O.Hdiji,S.Sakka,N.Farhat,H.HajKacem,M.Damak, especially in sub-Saharan Africa (SSA). Our hospital is the only M. Chokri regional tertiary neurology referral centre that has routinely Habib Bourguiba Hospital, Neurology, Sfax, Tunisia provided both treatments since 2015. We audited HIS cases and outcomes (modified Rankin Scale, Introduction mRS) for the period January 2016 to December 2018. Our Cervical-artery dissection (CAD) is an underestimated disorder, Institutional Review Board (IRB) waived formal approval. yet it is a major cause of cerebral ischemia in young adults. Of 186 cases (mean age 63.9 years), 40 (21.5%) had onset-to-door (OTD) time b3.5 h, of which 24/40 (60.0%) underwent IVT [rate 26/ Patients and methods 186 (14.0%), mean OTD 102.8 min, door-to-needle time (DTN) 91.5 We conducted a retrospective study at the department of min]. Reasons IVT was not administered: NIHSS ≤ 2 (n = 5); anti- Neurology at Habib Bourguiba hospital. The aim was to determine coagulation (n = 4); age N90 years (n = 2); and n = 5 for atypical the epidemiological, radiological and etiological particularities of presentation, misdiagnosis by non-neurologist, and unaffordability. CAD in our population. We include all patients with confirmed CAD. Of 89 EMT-eligible cases (b24 h OTD), eight underwent EMT (9.0%; We exclude patients who had an iatrogenic CAD. mean DTN 104.4min). Untreated but treatment-eligible cases had mean OTD of 440.7 min (range 140.8–740.7 min; p b 0.001 when Results compared to IVT). There was no significant difference in mRS or Twenty-five patients were included. The sex ratio was 1.2. Mean length-of-stay (LOS; mean 10.42 days) between treated and non- age was 36.5 ± 16.2. Five patients report a recent trauma while one treated groups. There were no deaths in the EMT-treated group (4 patient had migraine. CAD occurred in the postpartum in one patient. and 13 in IVT and non-intervention groups respectively). All the dissections resulted in cerebral ischemia. Vertebral artery We present the largest cohort of IVT/EVT cases from the region. dissection was found in 60% of cases. No patient had intracranial The majority of cases arrived N3.5 h; our IVT rates are similar to internal carotid artery dissection. Ultrasound was performed in 10 global averages, although our DTNs are longer. Modifiable in-hospital patients and was positive in 70% of cases (arterial occlusion: 7 barriers included non-specialist decision-making and unaffordability. patients, intimal flap: 4 patients). Two patients had CT Angiography There was insignificant treatment effect on mRS or LOS. Our data that showed arterial occlusion and stenosis. Eighty-four percent of highlight pre-hospital barriers, in-hospital treatment stand- our patients had Brain MRI that was normal in only one patient. The ardisation, and accessiblity to IVT/EMT as important considerations most common feature was vessel wall hematoma noticed in 85.7% of to improve HIS care. cases. MR angiography of the supra-aortic arteries was performed in 10 cases, 9 of whom had an arterial occlusion. No patient had signs of doi:10.1016/j.jns.2019.10.645 underlying vascular disease. Only one patient had arterial angiography which showed only internal carotid dissection.

Conclusion WCN19-1506 Despite the progress that has been made in the diagnosis of CAD, this diagnosis is still challenging especially for intracranial dissec- Poster shift 01 - channelopathies /neuroethics /neurooncology /pain tions that have not been detected in our population. - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / doi:10.1016/j.jns.2019.10.644 stroke /training in neurology - Part I and traumatic brain injury

Differences in age and comorbidities of stroke patients from the galilee according to sex and ethnicity Shahien Radi, Ryder Chen WCN19-1505 and Zarka Salman

R. Shahien Poster shift 01 - channelopathies /neuroethics /neurooncology / Ziv Medical Center, Neurology, Safed, Israel pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain Background injury Studies done on stroke demonstrated great variance in the rate of hospitalization, age of onset, mortality, and comorbidity between Clinical audit and outcomes of hyper-acute ischaemic stroke different ethnicities and sexes. The patient’s population at the treatment in the largest regional cohort at a tertiary neurology Northern part of Israel includes distinct groups of different referral centre in Nairobi, Kenya ethnicities, including Jews and Arabs. There is currently scarcity of studies that characterize these groups in relation to risk factors, age C. Mithia, A. Vakilb, J. Shaha, B. Wachirac, E. Mogered, D. Sokhia of onset and mortality. The purpose of the current study was to aAga Khan University Medical College of East Africa, Department of characterize differences in comorbidities and age of onset of stroke Medicine, Nairobi, Kenya between different ethnicities. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 113

Methods Results Data was collected from discharge letters of stroke patients A total of 2680 participants were evaluated (mean age: 55.8 admitted to Department of Neurology at Ziv hospital between 2010- years, male sex: 48.0%). There are 1160 of normal glucose level 2015. (43.3%) and 1520 of prediabetes (56.7%). The group with prediabetes had high ratio of male sex (43.0% vs 51.8%; p b 0.001), hypertension Results (17.8% vs 25.1%; p b 0.001), larger BMI (23.64 vs 24.34; p b 0.001) 964 patients were included, 64.2% Jews, 7.7% Moslems, 1.7% and tended to be older (54.0 vs 57.2; p b 0.001). Christians, 22.5% Druze and 3.9% Bedouins. 61% male and 39% female. In the prediabetes groups had more small vessel diseases, The study groups were divided according to ethnicities and sexes. especially, lacunes (59 vs 112; p = 0.017) and WMH (1.0377 vs The average age of onset for stroke was 63 for Arabs versus 67 for 1.1767; p = 0.001). Jews and 67 for men versus 71 for women. The Jewish population had a higher prevalence of ischemic heart disease, vascular diseases Conclusion and malignancy, where in the Arab population metabolic diseases, Prediabetes is closely associated with cerebral small vessel including diabetes, obesity and dyslipidemia were more common. disease, especially in lacunes and WMH. This suggests that Women were found to have a higher prevalence of atrial ﬁbrillation, prediabetes is possible predictor of cerebral small vessel disease. endocrine disorders and hematologic diseases, while men were more likely to smoke and consume alcohol. doi:10.1016/j.jns.2019.10.647

Conclusion This study showed differences in age of onset and comorbidity type between different ethnicities and sexes regarding to stroke. The WCN19-1521 results may be a corner stone in constructing a tailored prevention programs. Poster shift 01 - channelopathies /neuroethics /neurooncology /pain doi:10.1016/j.jns.2019.10.646 - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / stroke /training in neurology - Part I and traumatic brain injury

Stroke knowledge in underserved Spanish speakers in central WCN19-1509 California

C. Lemona, S. Jamallb, R. Coloradoc Poster shift 01 - channelopathies /neuroethics /neurooncology / aSalinas Valley Memorial Healthcare System, Clinical Research, Salinas, pain - Part I /sleep disorders - Part I /stem cells and gene therapy - USA Part I /stroke /training in neurology - Part I and traumatic brain bTouro University, Internal Medicine, Vallejo, USA injury cSalinas Valley Memorial Healthcare System, Neurology, Salinas, USA

Prediabetes and cerebral small vessel disease Race-ethnic disparities in acute stroke care are a major public health problem in the U.S.A. Latinos/Hispanics have higher incidence of stroke, H. Moa, H.M. Kwonb, H.Y. Jeongc, K.W. Namc, J.H. Parkd worse outcomes after stroke, and receive less stroke treatment than aThe Catholic University of Korea- Eunpyeong St. Mary's Hospital, non-Latino/Hispanic whites. A major barrier to receiving acute stroke Department of Neurology, Seoul, Republic of Korea treatments is poor stroke knowledge. This study aimed to determine bSeoul National University College of Medicine and Seoul Metropolitan baseline stroke knowledge in Spanish speakers within Central Califor- Government-Seoul National University Boramae Medical Center, nia. 167 Spanish speakers attending health education sessions aimed at Department of Neurology, Seoul, Republic of Korea underserved Latino/Hispanic Communities completed an 11-question cSeoul National University College of Medicine and Seoul National stroke knowledge survey. Approximately 45% reported having middle University Hospital, Department of Neurology, Seoul, Republic of Korea school education or lower. Most participants (84%) did not recognize dSeoul National University College of Medicine and Seoul National the English stroke recognition acronym F.A.S.T. (Face, Arm, Speech, University Hospital, Department of Family Medicine, Seoul, Republic of Time). There was a significant relationship between level of education Korea and likelihood of choosing the correct meaning of F.A.S.T. (r = −0.6, p = 0.001). The preferred names for stroke were derrame cerebral (46%) Purpose and ataque cerebral (23%). Only 7% chose all five correct stroke signs and The risk of prediabetes on cerebrovascular diseases is not symptoms out of eight signs and symptoms of illness. In conclusion, clear. In this study, we evaluated the relationship between knowledge of common stroke signs and symptoms and of the F.A.S.T. prediabetes and cerebral small vessel disease (cSVD) in a healthy acronym was very low in this population. Future stroke education tools population. for this population should be simple to understand and should use names for stroke including derrame or ataque cerebral, as the prevailing Methods practice in stroke campaigns of simply using English-Spanish transla- We assessed consecutive health check-up volunteers between tion of the acronym F.A.S.T. may not be an effective strategy. Culturally- 2006 and 2013. White matter hyperintensity volumes (WMH) were targeted educational tools for increasing stroke knowledge among rated using a semi-automated quantitative methods. Presence of Spanish-speaking Latinos/Hispanics are urgently needed and will likely lacunes, cerebral microbleeds (CMBs), and enlarged perivascular improve acute stroke care for this population in the U.S.A. and other spaces (EPVSs) were also measured as cSVD lesions. We classified Spanish-speaking countries. all patients' glucose levels according to the diagnosis and classification of diabetes mellitus of American Diabetes Association (ADA) doi:10.1016/j.jns.2019.10.648 2014. ARTICLE IN PRESS

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WCN19-1524 Tashkent Pediatric Medical Institute, Neurology- Pediatric Neurology and Medical Genetics, Tashkent, Uzbekistan

Poster shift 01 - channelopathies /neuroethics /neurooncology / Relevance pain - Part I /sleep disorders - Part I /stem cells and gene therapy - There is no ofﬁcial epidemiological statistics of stroke in the Part I /stroke /training in neurology - Part I and traumatic brain register throughout the Republic of Uzbekistan (RUz) because of injury which there is no assessment of the epidemiological situation in a particular region. According to the literature the incidence of Incidence and predictors of post‐stroke epilepsy cerebral stroke 2.5 per 1000 population.

K.S. Moallaa, M. Damaka, O. Chakrounb, N. Farhata, S. Daouda,O. Objective Hdijia, S. Sakkaa, H. Haj Kacema, N. Rekikb, C. Mhiria To study the epidemiology and characteristics of the course of aHabib Bourguiba Hospital, Neurology, Sfax, Tunisia stroke in Uzbekistan in the ﬁrst quarter of 2019 according to the bHabib Bourguiba Hospital, Emergency, Sfax, Tunisia register.

Background and aims Materials-methods Stroke is the leading cause of seizures and epilepsy in the elderly. The stroke register was carried out by the population-territorial The aim of this study was to assess the incidence of post‐stroke method on the questionnaire of the national stroke register for epilepsy (PSE) in a population‐based study and to describe possible patients over 18 years of age. All new and repeated cases of cerebral predictors. stroke among permanent residents of Uzbekistan were recorded.

Methods Results fi Data from the prospective population were collected to describe 11353 patients with stroke were identi ed in the RUz. The the frequency of PSE. Patients with history of epilepsy and provoked average incidence of 1.4 and mortality 0.31 per 1000 population. In seizures were excluded. Patients were followed up one month after 81.1% of cases accounted for patients older than 50 years. Ischemic fi stroke. Predictors of PSE were identified. stroke were diagnosed in 69.4% of cases, 14.5% of unspeci ed stroke, 13.2% of intracerebral and 2.9% of subarachnoid hemorrhage. Results Representation of risk factors: arterial hypertension 81.1%, heredity fi Two hundred patients, with a mean age of 68.45 ± 13.97 years, 62.3%, obesity 20.4%, smoking 19.8%, atrial brillation 16.2%, diabetes were identified (123 males (61.5%) and 77 females (38.5%)). One mellitus 9.7% and myocardial infarction 5.8%. Neuroimaging was hundred and fifty nine patients (79.5%) had ischemic stroke while 41 performed in 15.6% of patients. patients (20.5%) had hemorrhagic stroke. Eleven percent had seizures within one month, 15 (68.2%) suffered cerebral infarct and Conclusion fi 7 (31.8%) with hemorrhagic stroke. Five (22.7%) and 7 patients The true incidence and mortality from cerebral stroke in the rst (31.8%) with seizure had cardioembolic etiology (atrial fibrillation) quarter of 2019 was revealed, which is necessary information for the and a past history of previous stroke respectively. Statistical analysis ministry of health when planning the health care network. A large demonstrated that male gender (P = 0.011), the occurrence of early share in the structure of the incidence of stroke is a cryptogenic symptomatic seizures (b7 days) (P b 0.001) and stroke severity stroke, which is probably due to the inaccessibility of neuroimaging based on initial NIHSS (P b 0.001) as predictors for PSE. methods.

doi:10.1016/j.jns.2019.10.650 Conclusions The incidence of PSE was quite high in our study during the ﬁrst month. Patients with cerebral infarct had a higher incidence of seizure than hemorrhagic stroke. Predictors for PSE in the present study was male gender, the occurrence of an early symptomatic WCN19-1537 seizures and stroke severity, according to the literature. Seizures in PSE is easily controlled by routine treatment. Poster shift 01 - channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - doi:10.1016/j.jns.2019.10.649 Part I /stroke /training in neurology - Part I and traumatic brain injury

WCN19-1526 Predictive value of C-reactive protein for the outcome after stroke

Poster shift 01 - channelopathies /neuroethics /neurooncology / K.S. Moallaa, M. Damaka, O. Chakrounb, N. Farhata, S. Sakkaa,S. pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Daouda, O. Hdijia, H. Haj Kacema, N. Rekikb, C. Mhiria Part I /stroke /training in neurology - Part I and traumatic brain aHabib Bourguiba Hospital, Neurology, Sfax, Tunisia injury bHabib Bourguiba Hospital, Emergency, Sfax, Tunisia

Clinical and epidemiological characteristics of stroke in Uzbeki- Introduction stan according to the register Stroke carries high morbidity and mortality rates. Several factors have been suggested as predicting the outcome. The value of C- Z. Abdullaev, Y. Majidova, X. Maksudova, N. Abdumavlyanova, O. reactive protein (CRP) in predicting a poor outcome is unclear, and Yunusov ﬁndings have been contradictory. ARTICLE IN PRESS

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Aim TIA and CHD in people aged 42–60 years were found in 18.9% of We tested in our population-based cohort whether elevated CRP cases. There was a significant predominance of atherosclerosis, levels on admission (b24 h after ictus) are associated with an arterial hypertension, ischemic heart disease, TIA, rheumatism in unfavorable outcome. men (p b 0.05), and diabetes mellitus and heart rhythm disturbances in women (p b 0.05). Methods We identified all subjects with stoke during four months among a Conclusion north African population of Sfax, Tunisia, and extracted their CRP There was a leveling of gender differences in the structure of values on admission from the laboratory records. The correlation background diseases due to an increase in the proportion of between elevated CRP and mortality at 1 month was studied. atherosclerosis in women (p b 0.05), and diabetes in elderly men (p b 0.05). At the same time, the proportion of the prevalence of IHD Results and TIA in the structure of background diseases (p b 0.05) prevailed Of 200 patients, 187 (93.5%) had CRP available within 24 hours of in the sick men of senile age. admission. Mean age was 68.36 years. Stroke was ischemic in 151 doi:10.1016/j.jns.2019.10.652 patients (80.7%) and hemorrhagic in 36 patients (19.3%). Elevated CRP values (N5 mg/l) was noted in 95 patients (50,8%), 24 of whom had urinary tract infection and 22 had pneumonia. The mean of the initial NIHSS was 8.4 and 13 in patients with normal and elevated CRP respectively (p b 0.001). 28.4% of patients with elevated CRP WCN19-1548 died (p = 0.003). Poster shift 01 - channelopathies /neuroethics /neurooncology /pain Conclusions - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / In our study, elevated CRP on admission is a predictor of an stroke /training in neurology - Part I and traumatic brain injury unfavorable outcome and is associated with age, hypertension, the clinical severity of the stroke and the presence of concomitant New gender-influenced stroke study: Cognitive manifestations in infections. acute ischemic stroke in Uzbekistan doi:10.1016/j.jns.2019.10.651 M. Ergasheva, N. Vakhabova Tashkent Medical Academy, Department of Neurology, Tashkent, Uzbekistan WCN19-1538 Objective Neuropsychological disturbances associated with cognitive and Poster shift 01 - channelopathies /neuroethics /neurooncology / psycho-emotional sphere changes are serious complications of Acute pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Ischemic Stroke (AIS), which have a significant impact on the Part I /stroke /training in neurology - Part I and traumatic brain rehabilitation time, quality of life and the severity of disability of injury patients. We study the gender characteristics of cognitive manifestations in AIS in Uzbekistan. Gender, aging and background diseases influence on the new Materials and methods neuronosological structure of acute ischemic stroke in The study included 187 elderly (71.1%; 60–74 years old) and Uzbekistan senile (28.9%; (75–90 years old)) people from 60 to 87 years old; the average age is 69.7 ± 7.8 years, including 83 women (44.3%) and 104 M. Ergasheva, N. Vakhabova, G. Rakhimbaeva men (55.6%). Evaluation of cognitive functions was performed Tashkent Medical Academy, Department of Neurology, Tashkent, according to the MMSE scale. Uzbekistan Results of the study Objective When assessing the state of cognitive functions on the MMSE We study the effects of the age factors on the nosological scale, we established the following patterns. So in elderly patients, structure of stroke in elderly people with ischemic stroke. the score on the MMSE scale was 24.8 ± 0.53 (P b 0.001), and in senile aged patients, the score was 23.4 ± 0.09 (P b 0.001), indicat- Materials and methods ing moderate cognitive disorders. In-depth analysis included of 282 cases of different types of AIS in Our analysis of the severity of cognitive impairment according to – individuals aged 42 60 years (95 observations), elderly (133 the MMSE test by sex showed that in male patients (20.6 ± 1.6) the – – patients aged 60 74 years) and senile (54 patients aged 75 90 cognitive deficit was more pronounced than in women (22.4 ± 2.7) years) age. (P b 0.05).

Results Conclusion Among people aged 42-60 years, atherothrombotic stroke (ATS) Cognitive impairment was observed in the form of pre-mental were occurred 49.5%, cardioembolic stroke (CES) - 16.8%, lacunary disorders in 64.2%, mild dementia - in 28.3% of cases. Moreover, the stroke (LS) - 20.0%, hemodynamic stroke (HS) - 13.7%. highest percentage of occurrence of predment disorders was – – Among men aged 42 60 years and 60 74 years, there was a recorded in male and senile aged patients. signiﬁcant (P b 0.05) prevalence of ATS (p b 0.05), which was 65.6% and 66.7%, respectively, compared with 21.9% and 31.1% of ATS doi:10.1016/j.jns.2019.10.653 observations in women. ARTICLE IN PRESS

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WCN19-1557 R. Minavarkhujaev, J. Sabirov, G. Rakhimbaeva Tashkent Medical Academy, Department of Neurology, Tashkent, Uzbekistan Poster shift 01 - channelopathies /neuroethics /neurooncology /pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / Objectives stroke /training in neurology - Part I and traumatic brain injury We aim to increase the effectiveness of treatment and study of quality of life in children with brain tumors. Who is the target population for shortening prehospital delay in acute stroke? Methods 105 patients operated in Tashkent Medical Academy and in the K.S. Moallaa, M. Damaka, O. Chakrounb, N. Farhata, O. Hdijia, S. Sakkaa, Republican Neurosurgery Scientific Center Hospital during the period S. Daouda, H. Haj Kacema, N. Rekikb, C. Mhiria of 2012-2018. The average age of children at the moment of aHabib Bourguiba Hospital, Neurology, Sfax, Tunisia diagnostics is ranged from 2 to 15 years. The boys - 56, girls - 49. bHabib Bourguiba Hospital, Emergency, Sfax, Tunisia The statement of diagnosis is based on clinic-neurological examination and the instrumental research, with anamnestic data from 6 Introduction months to 6 years. Prehospital delay is the main barrier of early administration of thrombolytic therapy in patients with acute ischemic stroke. Many Results studies suggested that stroke awareness had a great impact on early Assessment of condition of patients was carried out using the arrival at hospital. Karnovsky scale. By localization: frontal lobe - 17, temporal lobe - 15, parietal lobe - 21, the occipital lobe - 8 a few shares - 44. Volume of Aims removal was as follows: the dominant hemisphere - 47 patients not Our purpose is to identify the target population to emphasize the dominant hemisphere - 58 patients. For primary total removal – importance of recognizing stroke symptoms and early arrival at hospital. operation - 20 patients, subtotal 58, partial - 14, 13 - data is not aware of patients. Postoperative mortality - 12. In the group of Methods patients whom recurrence is marked the total removal of the tumor - – A prospective study was conducted during 4 months in Habib 20 of from 4 cases, subtotal - 29 not known - 11. Thus, tumor Bourguiba Hospital of Sfax (Tunisia). Patients with ischemic stroke or regrowth was observed more often in group the incomplete removal transient ischemic attack were enrolled. Exact time of symptoms of blastomatous tissue. onset, initial symptoms and signs, initial GCS, NIHSS, and stroke risk factors were registered by doctors. We defined prehospital delay less Conclusions than 2 h as “early arrival group”. To all patients, with tumors of the III and IV degree of anaplasia, postoperative adjuvant therapy was performed. Radiotherapy or fi Results chemotherapy did not signi cantly affect on the frequency of One hundred ninety seven patients with definite time of reinterventions. However, in patients with malignant tumors prehospital delay were included (66 patients among early arrival observed depending in life expectancy on the of adjuvant therapy. group). Younger patients and those using emergency medical service (EMS) consult earlier (p = 0,029 and 0,004 respectively). Within all doi:10.1016/j.jns.2019.10.655 stroke risk factors, hypertension, diabetes mellitus dyslipidemia and prior stroke were not associated with early arrival, whereas, heart disease (atrial fibrillation and coronary artery disease) was associated with early arrival (p = 0.007 and 0.012 respectively). Among all WCN19-1562 initial symptoms and signs, consciousness disturbance is the only symptom associated with early arrival (p = 0.05). A lower GCS and Poster shift 01 - channelopathies /neuroethics /neurooncology / intracerebral hemorrhage were correlated with reduced prehospital pain - Part I /sleep disorders - Part I /stem cells and gene therapy - delay (p = 0.013 and 0,05 respectively). Part I /stroke /training in neurology - Part I and traumatic brain Conclusions injury Our analysis suggested that to shorten prehospital delay, elderly and people with prior stroke, hypertension, diabetes mellitus and Cerebrovascular reactivity significantly impaired post-stroke, dyslipidemia are the priority populations, and stroke symptoms more so ipsilaterally: a TCD based case-control study other than consciousness should be emphasized as well. S. Narayan, U. Shah doi:10.1016/j.jns.2019.10.654 Jawaharlal Institute of Postgraduate Medical Education and Research, Neurology, Pondicherry, India

Background and objectives WCN19-1558 Cerebrovascular reactivity (CVR) has been fascinating neurologists and stroke specialists because of its potential roles in Poster shift 01 - channelopathies /neuroethics /neurooncology /pain pathogenesis and therapeutics. We aimed to investigate whether and how far CVR differed in stable stroke patients compared to - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / healthy matches. stroke /training in neurology - Part I and traumatic brain injury Method Brain gliomas in central Asian children: Surgical treatment, Case control study. Study participants were 50 middle cerebral neurological care and qualities of life artery (MCA) territory ischemic stroke (one month after stroke), and ARTICLE IN PRESS

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50 age and sex matched healthy controls (HC). Transcranial Doppler clinical manifestation was pain in the spine. The most influencing was used to assess breath holding index (BHI) from both MCA factor on the postoperative neurological status was the pre-operative simultaneously, in supine position, using standard technique. BHI neurological deficit. Even with repeated operations, the prognosis was compared between case and control groups. Association of IS depended on the preoperative neurological status. An important risk factors with low CVR was also investigated. factor affecting the outcome of the surgical treatment of intramedullary spinal cord tumors is the preoperative neurological status. Results Among the stroke patients, mean age 56 ± 14 years, 92% males. Conclusions Median NIHSS-5, Subtype SVO (48%), LVO (44%). The MCA, BHI was To sum up, it is desirable to remove intramedullary tumors as 47% ipsilateral and 61% on the contralateral side, Mean 54%; while in soon as a diagnosis has been made - until a gross neurological deficit the controls mean BHI was 88% (P = 0.003). In the stroke patients, increases. Late surgical interventions impair post-surgical neurolog- VMR impairment was significantly more on ipsilateral side 0.47 and ical results. 0.61 on contralateral side (p value, 0.015). On multivariate analysis, presence of stroke and age were independently associated with doi:10.1016/j.jns.2019.10.657 impaired BHI (b0.69); p = 0.026 and 0.027.

Conclusion Post stroke VMR was signiﬁcantly impaired bilaterally in MCA WCN19-1565 territory stroke. Presence of stroke and age were independently associated with low BHI. Further studies are needed to determine whether this association preceded stroke and how long it persists. Poster shift 01 - channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - doi:10.1016/j.jns.2019.10.656 Part I /stroke /training in neurology - Part I and traumatic brain injury

Microrna as biomarkers to distinguish intracerebral and sub- WCN19-1563 arachnoid hemorrhage pathology

a a a b c Poster shift 01 - channelopathies /neuroethics /neurooncology / A. Shirazian , D.H. Nguyen , V. Tran , O. Sulaiman , I. Iwuchukwu aOchsner Medical Center, Research, New Orleans, USA pain - Part I /sleep disorders - Part I /stem cells and gene therapy - bOchsner Medical Center, Neurosurgery, New Orleans, USA Part I /stroke /training in neurology - Part I and traumatic brain cOchsner Medical Center, Neurology, New Orleans, USA injury Intracerebral hemorrhage (ICH) and subarachnoid hemorrhage Post-surgical neuroanalysis: Intramedullary tumors in combina- (SAH) are associated with different clinical outcomes. We hypoth- tion with hydrosyringomyelitic cysts in Uzbekistan esize that extracellular miRNA profile in plasma (PL) and cerebrospinal fluid (CSF) reflect the underlying pathophysiology. R. Minavarkhujaev, G. Rakhimbaeva, J. Sbirov After informed consent, matched plasma and CSF were collected Tashkent Medical Academy, Department of Neurology, Tashkent, from ICH and SAH patients (n = 5 each) within 24 h of admission. Uzbekistan Non-ICH/SAH samples serve as controls (n = 2). MiRNA expression was analyzed by real time PCR and normalized to miR-92a-3p. The Objectives relative quantity (RQ) values were used to obtain relative RQ values We aim to analyze the neurological results of surgical treatment (RRQ), and relative RRQ values (RRRQ) were used for comparison. of patients with intramedullary tumors in combination with The Wilcoxon signed-rank test was used for statistical analysis. hydrosyringomyelitic cysts. In control PL, miR-92b-3p and miR-338-3p were undetectable. In SAH, miR-338-3p expression increased 100 fold in PL, but was Methods unchanged in ICH. MiR-125b-5p increased 3 fold in ICH PL and We examined 16 patients operated with a diagnosis of an decreased by 25 fold in SAH PL. Mir-338-3p was downregulated by 2 intramedullary spinal cord tumor. The patients were in the fold in ICH CSF and 60 fold in SAH CSF. MiR-92b-3p increased 190 neurology department for neurorehabilitation after surgical treat- fold in ICH CSF and decreased by 7 fold in SAH CSF. In a comparison ment at the Tashkent Medical Academy. There were 6 men, 10 of relative RRQ (RRRQ) values, miR-92b-3p, miR-338-3p and miR- women; average age was 41.2 years. To characterize the neurological 125b-5p expressions were 200-, 21- and 7-fold fold higher in ICH CSF status of patients, a modified ASIA scale was used. Neurological than in SAH CSF respectively (p b 0.05). status was evaluated in the presurgical and early postsurgical periods Based on validated targets for these miRNA, matrix metallopro- (at the time of discharge of the patient from the hospital). teinases, namely MMP-2 and MMP-9, were identified as targets, implicating their role in regulation of the blood brain barrier Results integrity and tissue necrosis. Differences in miR-338-3p, miR-92b The main clinical manifestations characteristic of intramedullary and miR-125b expressions in PL and CSF may be indicative of SAH- spinal cord tumors were: pain in the spine - in 14 patients, or ICH-specific pathology. deterioration of movements in the extremities - in 9 patients, sensory disorders on the body and bones - in 3, dysfunction of the doi:10.1016/j.jns.2019.10.658 pelvic organs - in 5 patients. In the vast majority of patients, the first ARTICLE IN PRESS

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WCN19-1569 U. Makhmudova, G. Rakhimbaeva, N. Vakhabova Tashkent Medical Academy, Department of Neurology, Tashkent, Uzbekistan Poster shift 01 - channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Objective Part I /stroke /training in neurology - Part I and traumatic brain We aim to study the characteristics of risk factors and background injury diseases in elderly and senile patients with acute ischemic stroke (AIS). First results of the implementation of pen-protocol for the stroke reduction as the element of the stroke roadmap in Kyrgyzstan Materials and methods In-depth analysis included 282 observations of different types of I. Lutsenko AIS in individuals aged 42–60 years (95 observations), elderly (133 Kyrgyz State Medical Academy, Neurology, Bishkek, Kyrgyzstan patients aged 60–74 years) and senile (54 patients aged 75–90 years) age. PEN-protocol is the package of essential noncommunicable disease interventions administered by WHO in a low resource Results – settings and countries. The aim of the study was to identify Among people aged 42 60 years, there was a 2-fold predomi- opportunities to improve the implementation of the PEN in nance of men with AIS (66.2%) as compared with senile aged Kyrgyzstan with the use of the electronic stroke registries and patients (31.5%). The pattern of prevalence of women with age was – questionnaires regarding the stroke risk factors and management. established, so if at the age of 42 60 years their percentage with AI was 33.7%, then at the age of 75–90 years - 68.5%. Among men aged – – ﬁ b Methods 42 60 years and 60 74 years, there was a signi cant (P 0.05) b We conducted interviews, made educational workshops on the prevalence of Atherotrombotic Stoke (AS) (p 0.05), which was clinical settings rearrangements with the clinical staff, created the 65.6% and 66.7%, respectively, compared with 21.9% and 31.1% of AS stroke pathway for the 2 main hospitals, introduced NIHSS and mRS observations in women. Patients aged 42-60 years in the structure of in Kyrgyzstan. We made educational campaigns for the stroke background diseases revealed the prevalence of arterial hypertension recognition, assessed the stroke awareness level in population. (AH) (90.5%), the presence of atherosclerosis (87.4%) of cardiac rhythm and rheumatism (45.3 and 47.4%, respectively), diabetes ﬁ Results mellitus (23.2%). There was a signi cant predominance of athero- Our team implemented the RES-Q stroke registry which enrolled sclerosis, arterial hypertension, ischemic heart disease, TIA, rheuma- b 10 stroke centers with 1021 patents in 2 years. The median age was tism in men (p 0.05), and diabetes mellitus and heart rhythm b 61 (48;71), 55% were males, leaving 71% for the ischemic stroke. disturbances in women (p 0.05). Median NIHSS was 5 (4;11) with the most severe strokes at the high altitudes with mean NIHSS 11. Stroke risk factors were high altitude Conclusion OR 8 (2–11, 95% CI), smoking, animal fat consumption. The There was a leveling of gender differences in the structure of predictors for the worst outcome was the late admission and non- background diseases due to an increase in the proportion of b compliance to the preventive therapy. We educated 78 neurologists atherosclerosis in women (p 0.05), and diabetes in elderly men b with the NIHSS and mRS use and via telemedicine trained them (p 0.05). repeatedly. For the remote regions lacking internet we developed the doi:10.1016/j.jns.2019.10.660 paper-based version of RES-Q stroke registry.

Conclusion Our team made it possible to implement the PEN-protocol settings (included in stroke Roadmap) in the framework of ESO- WCN19-1575 EAST Project, to reorganise stroke service and make a preparations of several hospitals to the pilot implementation of the thrombolysis. Poster shift 01 - channelopathies /neuroethics /neurooncology / doi:10.1016/j.jns.2019.10.659 pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain injury

WCN19-1571 Gender dependent neuropsychological manifestations study in patients with acute ischemic stroke in Uzbekistan

Poster shift 01 - channelopathies /neuroethics /neurooncology / U. Makhmudova, N. Vakhabova pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Tashkent Medical Academy, Department of Neurology, Tashkent, Part I /stroke /training in neurology - Part I and traumatic brain Uzbekistan injury Objective New approach of risk factors and background diseases role in Gender dedicated study on the Acute Ischemic Stroke (AIS) has acute ischemic stroke in elderly and senile-aged patients in not previously conducted in Uzbekistan. We aim to study the gender Uzbekistan characteristics of neuropsychological manifestations in AIS. ARTICLE IN PRESS

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Materials and methods (NIHSS, modified Rankin scale (mRS) and monitor the improvement The prospective study included 187 people from 60 to 90 years of stroke patients, while this was not described in previous old; the average age is 69.7 ± 7.8 years, including 83 women (44.3%) publications on strokes. Scale variables (age, NIHSS score, mRS and 104 men (55.6%). Neurological deficits were assessed using the score) made it possible to detect the age-stroke score correlation in NIH-NINDS Stroke Scale, Bartel Scale, SNSS, Rankin Scale, and MMSE. Chi-Square test. Multivariate analysis of risk-factors with adjusting for age and Kaplan-Meyer curve were firstly possible with SITS. Results The dependence of these indicators on gender was established, Conclusion since the indicators of the Barthel scale were significantly higher in SITS is the first registry in Kyrgyzstan which is able to reflect the men (39.0 ± 3.8 and 27.2 ± 3.0 points, respectively; P b 0.05), and rigorous data and to monitor stroke patients’ condition in the acute NIH-NINDS in women (15.3 ± 0.6 and 13.7 ± 1.1 points, respec- and subacute period by telephone monitoring and reflects the first tively). The average score on the SNSS scale was 34.4 ± 1.8 points, correct interhospital statistics on stroke epidemiology. Electronic while for men it was slightly higher than for women (37.2 ± 2.5 and registries allow clinicians and policy makers realistic planning of 31.7 ± 2.2, respectively). Rankin scale: men, in contrast to women, health policies and stroke best practice implementation. needed less assistance (3.6 ± 0.22 and 4.3 ± 0.24 points, respectively; P b 0.05). Studies of motor function on the CNS scale: the doi:10.1016/j.jns.2019.10.662 severity of indicators in women was 6.2 ± 0.4 points, and in men - 7.5 ± 0.6 points. According to the MMSE test, male patients (20.6 ± 1.6) showed a more cognitive deficit than women (22.4 ± 2.7) (P b 0.05). WCN19-1586 Conclusion Cognitive sphere changes were observed in the form of predment Poster shift 01 - Channelopathies/neuroethics/neurooncology/ disorders in 64.2%, mild dementia - in 28.3% of cases. Moreover, the pain - Part I/sleep disorders - Part I/stem cells and gene therapy - highest percentage of occurrence of pre-mental disorders was Part I/stroke/training in nuerology - Part I and traumatic brain registered in male patients. injury doi:10.1016/j.jns.2019.10.661 Ischemic stroke in a case of Koyanagi Harada syndrome

E. Ellouz, S. Daoud WCN19-1576 Gabes hospital, Neurology, Gabes, Tunisia

Background Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Vogt-Koyanagi-Harada (VKH) syndrome is a rare multisystem pain - Part I/sleep disorders - Part I/stem cells and gene therapy - inflammatory disorder characterized by uveitis associated with Part I/stroke/training in nuerology - Part I and traumatic brain neurological, cutaneous, and auditory manifestations. The neurolog- injury ical symptoms described are headaches, aspeptic meningoencepha- litis and meningismus. Strokes can also occurred and were described Advantages in the conducting research using the first innovative in few reports. electronic stroke registry sits in Kyrgyzstan Patient I. Lutsenkoa, A. Sultanovab A 57-year-old man, who had bilateral visual disturbance due to aKyrgyz State Medical Academy, Online and Distance Education, VKH disease, was admitted to our hospital because of headache and Bishkek, Kyrgyzstan speech disorder. On examination at entry, no abnormalities except bBishkek City Clinic 1, Vascular Neurology, Bishkek, Kyrgyzstan for loss of bilateral visual acuity, patches of vitiligo and dysarthria were found. Laboratory data were normal and the cerebral magnetic resonance imaging showed ischemic lesions of the left basal ganglia Objective in the territory of lenticulostriate arteries and a lesion in the left To describe the advantages in the conducting of research on the internal capsule. Our patient improved after treatment with SITS stroke registry in Kyrgyzstan (Safe Implementation of Treat- intravenous and oral steroids. ment in Stroke) in the framework of the Stroke Roadmap development and optimisation of the e-health system in Kyrgyzstan. Discussion and conclusion Only a few previous reports have described cerebral ischemic Method lesions in VKH syndrome. Our patient’s history of uveitis, the absence We compared the research findings of the SITS Registry with the of other cause of stroke and response to steroid treatment suggest an publications on stroke in Kyrgyzstan before the electronic registry inflammatory mechanism. In fact, this vascular event was probably implementation. related to inflammatory arteriopathy. Based on our patients and on previous reports, we emphasize the fact that cerebral ischemic Results episodes could be included in the neurological symptoms of VKH SITS-Kyrgyzstan was established in Kyrgyzstan in 2015 and has syndrome. the data of 1200 patients with stroke. The data are received by National Coordinator in unified file with demographic and clinical variables, the data of patients are encrypted and GDPR-protected. doi:10.1016/j.jns.2019.10.663 The SITS data permit to operate the variables on functional outcomes ARTICLE IN PRESS

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WCN19-1589 F. Rahbariana, H. Baharvahdatbc, S. Zabihyanb, H. Etemadrezaiehb,M. Shabestarid, F. Karamianb, F. Karamianb, P. Sasannejade, F. Farzadf,B. Ganjeifarb Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain aNorth khorasan university of medical science, Neurosurgery, Boujnord, Iran - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ bMashhad University of Medical Sciences, Neurosurgery, Mashhad, Iran stroke/training in nuerology - Part I and traumatic brain injury cRazavi hospital, Neurosurgery, Mashhad, Iran dRazavi hospital, Cardiology, Mashhad, Iran Cerebral amyloid angiopathy-related inﬂammation: An under- eMashhad University of Medical Sciences, Neurology, Mashhad, Iran diagnosed cause of dementia fRazavi hospital, Anesthesia, Mashhad, Iran

B. Nadiaa,S.Sakkab,N.Farhatb,O.Hdijic,M.Dammakb,M.Chokrid, Purpose T. Dhakera The optimal treatment modalities of ruptured cerebral artery aUniversity Habib bourguiba hospital, Neurology, Sfax, Tunisia aneurysm are still controversial. The objective of this study is to bHabib Bourguiba University Hospital, Neurology, Sfax, Tunisia analyze the outcomes of patients with ruptured cerebral artery cHabib Bourguiba University Hospital, Neurology, Sfax, Tunisia aneurysms treated by endovascular intervention in North east of Iran. dHabib Bourguiba Unversity Hospital, Neurology, Sfax, Tunisia Methods Background From October 2012 to January 2018, 447 patients with 447 Cerebral amyloid angiopathy (CAA) is a common pathology of the ruptured cerebral artery aneurysms received endovascular interven- elderly, which is related to age. The inflammatory cerebral amyloid tion including simple coiling, stent-assisted coiling, balloon-remod- fl angiopathy form (CAA-ri) is very rare and represents a little known eling and coiling, and ow diverter stent in Mashhad hospitals. cause of dementia. Results Objective 447 patients included in this study, mean age of patients were To describe clinical and evolutive features of CAA-ri 54.3±13.7 years. 302 patients (67.6%) had good WFNS grade (WFNS 0–2) at admission and 145 patients had poor WFNS (3–5). The Methods location of 381 (85.2%) aneurysms were anterior circulation and 66 We report the case of a patient that was hospitalized in (14.8%) were posterior. 340 (76.1%) were treated by simple coiling Neurology's department of Habib Bourguiba Hospital of Sfax for with or without balloon remodeling, 84 (18.8%) by stent-assisted fl cerebral amyloid angiopathy revealed by rapidly progressive demen- coiling and 15 (3.4%) by ow diverter stent. Complete and near tia and epilepsy. complete occlusion was achieved in 82.6%. Intraoperative perforation of aneurysms occurred in 19 procedures (4.3%). Thrombotic Results complications occurred in two procedures (0.4%). Brain infarction A 65-year-old man with a history of chronic headaches with occurred in 52 patients (11.6%). Regarding functional outcome (mRS – memory impairment evolving for 6 months, admitted for generalized at discharge), 379 patients (84.7%) had good outcome (MRS = 1 3) – tonic-clonic epileptic seizures. The neurological examination re- and 68 patients (15.2%) had poor outcome (MRS = 4 6). vealed dementia with the right Parkinsonian syndrome. Brain MRI revealed a T2 and FLAIR asymmetric hyperintensity of the white doi:10.1016/j.jns.2019.10.665 matter predominating in posterior regions, with the involvement of the subcortical U-fibers, without contrast enhancement, with numerous cortical and sub-cortical micro bleeds on the T2⁎sequence. The cerebrospinal fluid showed hyperproteinorachy, and biomarkers WCN19-1596 assay showed increased Tau proteins, with decreased beta-amyloid (1–42) and (1–40) proteins and a decreased ratio BA 40 / BA 42. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ According to the Chung et al criteria, the diagnosis of CAA-ri was pain - Part I/sleep disorders - Part I/stem cells and gene therapy - probable. Treatment with corticosteroids was started and allowed a rapid clinical improvement. Part I/stroke/training in nuerology - Part I and traumatic brain injury Conclusion Identifying this rare type of cerebral amyloid angiopathy, and also Sleep habit and internet use of preschoolers a rare cause of dementia, is crucial considering the efficiency of corticosteroids and/or immunosuppressive treatments. Y. Okaa, K. Itohb, T. Norimic aEhime University Hospital, Center for Sleep Medicine, Toon City, Japan doi:10.1016/j.jns.2019.10.664 bUbe Frontier College, Nursery Department, Ube, Japan cShikoku University, School of Nursing, Tokushima, Japan

Objectives WCN19-1595 Sleep habit of children may be inﬂuenced by internet overuse. Parental use of internet may impact on sleep habit and internet use Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain of children. The aim of the study was to elucidate the sleep habit and internet use of children especially focusing on the caregivers - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ inﬂuence on children. stroke/training in nuerology - Part I and traumatic brain injury Methods Endovascular approach for treatment of ruptured aneurysm in Preschool children between 4-5 years of age attending kinder- Northeast of Iran gartens and nursery schools in Yamaguchi City, Japan were included ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 121 in the study (n=737). Child and Adolescent Sleep Checklist (CASC) Results was distributed to all caregivers of children. Sleep habits and internet We developed the unique algorithm “SOKKU” and taught 42 use of both caregiver and children were compared between the two patients. Patients’ mean age was 57.08 土 11.401 years. Women were groups: caregivers using internet more than two hours a day 62,5%. In our sample only 17.6% saw information about stroke (n=261) and less than two hours a day (n=476). before. After being taught patients independently named the main four signs of stroke, risk factors and actions to be done. Before Result explaining the algorithm patients named two symptoms and after Caregivers who use internet more than two hours a day showed named four. significantly delayed bedtime and wake time. Wake time of children was significantly later among children whose caregivers use internet Conclusion more. Use of internet of children was twice as longer (0.2 vs 0.4 Analogy of such an algorithm in Kyrgyz language didn’t hours on weekdays and 0.4 hours vs 0.8 hours on holidays) among exist earlier. We managed to spread algorithm among Kyrgyz children whose caregivers use internet more than two hours. speaking patients. Our study proved the effectiveness of using “SOKKU” algorithm in increasing awareness of the first symptoms Conclusions of stroke. Use of internet of caregivers impaired sleep habit of both caregivers and children, and also significantly affected the use of doi:10.1016/j.jns.2019.10.667 internet of children. Careful attention on caregiver's behavior over internet may be necessary to prevent internet overuse of children in later life. WCN19-1604 doi:10.1016/j.jns.2019.10.666

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - WCN19-1600 Part I/stroke/training in nuerology - Part I and traumatic brain injury

Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain Cryptogenic or recurrent strokes due to occult malignancies: A - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ case series highlighting missed opportunities for earlier cancer stroke/training in nuerology - Part I and traumatic brain injury diagnosis

ﬁ Implementation of the rst algorithm of recognition stroke C. Mithi, S. Mbugua, S. Karar, S. Mwanzi, D. Sokhi symptoms for Kyrgyz speaking branch of patients at neurological Aga Khan University Medical College of East Africa, Department of departments of Bishkek Medicine, Nairobi, Kenya

a b c c A. Orunbaeva , I. Lutsenko , A. Sultanova , N. Moloshova The cause of stroke can sometimes not be determined i.e. a Student, General Medicine, Bishkek, Kyrgyzstan cryptogenic stroke. Occult malignancy can be a cause of stroke. b Kyrgy State Medical Academy, Faculty of the Distance Learning Cryptogenic stroke is more common in cancer patients, yet screening Department, Bishkek, Kyrgyzstan for malignancy is not part of standard diagnostic work-up of stroke c Kyrgyz State Medical Academy, General Medicine, Bishkek, Kyrgyzstan patients. The Aga Khan University Hospital, Nairobi, is a regional tertiary Implementation Of The First algorithm Of Recognition Stroke referral centre for neurology and oncology. We have audited Symptoms For Kyrgyz Speaking Branch Of Patients At Neurological ischaemic stroke patients referred to the hospital from 2016-2018, Departments Of Bishkek and present a subset of cryptogenic/recurrent stroke cases that were eventually diagnosed with cancer (see table). Our Institutional Background and aims Review Board (IRB) waived formal approval. Admission in a short time, involves the identification of stroke For the ten cases (male=3), first stroke occurred at the average symptoms by patients and understanding the need for quick age of 66.5 years (range 54-88). 5 cases had recurrent strokes despite hospitalization. The aim of study was to teach patients, using antiplatelet/anti-coagulation therapy; 3 had no traditional stroke risk algorithm “SOKKU”, to recognize stroke in the departments of factors. Each case developed red-flag symptoms/signs which led to neurology at City Civil Clinic and Chui Regional Joint Hospital. the cancer diagnosis: 6 were from the gastrointestinal/hepatobiliary tract, and the rest were from lung (n=2), prostate, or ovaries. The Materials and methods average delay from stroke-onset to cancer diagnosis was 9.3 months We held an interview using a special questionnaire to reveal the (range: b1 to 30 months). patients’ knowledge about the first signs and actions done if stroke Our case series highlight the importance of investigating for occurs. Then we explained the algorithm “SOKKU”. “SOKKU” is an occult malignancy in cryptogenic strokes, especially in patients with: abbreviation, where every letter means a symptom. The first four little/no stroke risk factors; advanced age; and recurrent multiple letters mean stroke symptoms and the letter “U” stands for the “cardioembolic” strokes despite antiplatelet/anticoagulation. Gastro- importance of “time”. At the end of interview, we gave the patients intestinal and hepatobiliary cancers seem more common. We printed out algorithms and asked to share with others. recommend additional history taking of cancer symptoms, full ARTICLE IN PRESS

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physical examination, and appropriate first-line investigations to Objective direct more invasive definitive testing such as biopsies. Screening for Use of Surpass FDS (Stryker Neurovascular, Fremont, CA, USA) in occult malignancy in such stroke patients can be a missed the treatment of acutely ruptured aneurysm has not been well opportunity to detect and treat cancer early. studied and reported in literature. We retrospectively evaluated the data on the safety and efficacy of Surpass flow diverter (FD) in the doi:10.1016/j.jns.2019.10.668 treatment of acutely ruptured aneurysm from four participating Indian centers.

Material and methods WCN19-1607 We retrospectively reviewed patients having subarachnoid hemorrhage who were treated by Surpass FD placement at four centers between June 2016 and May 2018. Detail analysis of medical Poster shift 01 - Channelopathies/neuroethics/neurooncology/ records were done to obtain patient age, gender, clinical history, pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Hunt-Hess grade, Fischer grade, results of radiographic and proce- Part I/stroke/training in nuerology - Part I and traumatic brain dural details including technical success and complication, clinical injury outcome and follow up angiographic results.

Surpass flow diverter in the treatment of acutely ruptured Results fi aneurysms: Indian multi-center experience Our search identi ed 15 patients with 17 aneurysms out of which fourteen (82.3%) aneurysms were in the anterior circulation and three (18%) aneurysms in the posterior circulation. Only one Surpass B. Dasa, G. Goelb, A. Mahajanc, V. Bangad, V. Singhe FD was used in each patient with size ranging from 3x25mm to aFortis Memorial Research Institute, Neurology and Neurointervention, 4x50mm. 14 patients achieved favorable clinical outcome (mRS 0-1) Gurgaon, Delhi, India at 3 months. One patient died due to Invasive fungal infection. bMedanta THe Medicity, Neurointervention, Gurgaon, Delhi, India Angiographic follow up results were assessed by O'Kelly-Marotta cMedanta The Mediicty, Neurointervention, Gurgaon, Delhi, India grading scale and showed Grade D (no filling) was noted in 13/15 dGurgaon Delhi, India aneurysms (87%) at 3 months. eMedanta The Mediicty, Neurosurgery, Gurgaon- Delhi, India ARTICLE IN PRESS

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Conclusion WCN19-1620 Surpass FD can be safely and effectively utilized for the treatment of ruptured intracranial aneurysm which are difficult to treat by conventional clipping and coiling, however larger and comparative Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain studies with long term follow up are needed to confirm our findings. - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ stroke/training in nuerology - Part I and traumatic brain injury doi:10.1016/j.jns.2019.10.669 The implementation of the educational tools of the angels initiative project in the stroke departments in Kyrgyzstan

WCN19-1611 I. Lutsenko Kyrgyz State Medical Academy, Neurology, Bishkek, Kyrgyzstan

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Background pain - Part I/sleep disorders - Part I/stem cells and gene therapy - The Angels Initiative is an international non-proﬁt volunteer Part I/stroke/training in nuerology - Part I and traumatic brain organization whose goal is to optimize the management of care and injury treatment of patients with acute stroke [3]

Daft (dual aspiration and fluff technique) for stent retrievers in Objective acute ischemic stroke with large vessel occlusion: A successful To introduce into the practice of acute stroke departments in new technique for early recanalisation Kyrgyzstan the tools of the anti-stroke program of the "Angels Initiative". B. Dasa, G. Goelb, A. Mahajanb, B. Vinitb, G. Arunc aFortis Memorial Research Institute, Neurology and Neurointervention, Results Gurgaon- Delhi, India 5 volunteer students and 5 doctors underwent “Train the Trainer” bMedanta The Medicity, Neurointervention, Gurgaon, Delhi, India trainings, after which 18 doctors in stroke departments were trained cMedanta The Medicity, Neurology, Gurgaon, Delhi, India in the use of the NIHSS scale. Upon returning to Bishkek, volunteers of the project ESO-EAST, Kyrgyzstan conducted 20 training sessions fi Newer techniques of thrombectomy are evolving for early and on the NIHSS scale, 10 trainings on the classi cation of ischemic fi effective recanalisation. We evaluated the efficacy of new DAFT (Dual stroke on the TOAST classi cation. We conducted the training on the Aspiration and Fluff Technique) in the treatment of acute stroke with correct assessment of swallowing, temperature and glucose mea- large vessel occlusion. surements according to the FeSS protocol for the nurses of 3 stroke units .We led the massive educational campaign with Kyrgyz version “ ” Materials and methods of FAST ( SOKKU ) algorithm and trained more than 240 patients We retrospectively reviewed the 23 patients with acute large and their relatives. The project volunteers gave speeches on the local vessel occlusion using a new DAFT technique. We used dual radio and carried out informing the population about the stroke, risk fi fi aspiration pump at both 5 MAX ACE aspiration and Neuron MAX factors and possible consequences and the identi cation of the rst 088 6F catheter along with stent retriever. Patients’ demographic symptoms of stroke. profile and time determining factors like puncture to recanalisation time, pass required, reperfusion grade and mRS at 90 days was Conclusion noted. Informed consent was taken in all the patients. Angels Initiatives volunteer training led to improved patient care during the acute period of stroke, with emphasis on the use of Results diagnostic scales for tracking the dynamics of the condition, testing First-pass mTICI 3 reperfusion was achieved in 18 out of 23 swallowing in patients with stroke, and serum glucose. patients (78%) with a mean groin puncture to reperfusion time of 39.0min ± 12 and mTICI 3 was accomplished in 19 out of 23 cases doi:10.1016/j.jns.2019.10.671 (82%) with a maximum of 3 attempts. Successful reperfusion (mTICI ≥ 2b) was achieved in 21 patients (91.30%) with a mean time from groin puncture to reperfusion of 45min ± 20.3. At presentation, the median National Institutes of Health Stroke Scale (NIHSS) score was WCN19-1630 12 and favourable clinical outcome at discharge by the modified Rankin score (mRS ≤ 2) was achieved in 14 out of 23 patients (61%). Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain Ninety days follow up was completed in 18 patients with 16 patients (88.89%) showing favourable outcome. This is significant compared - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ to other conventional techniques. stroke/training in nuerology - Part I and traumatic brain injury

Conclusion Timing to start anticoagulants after ischemic stroke in patients DAFT is an effective technique in for early complete reperfusion in with non-valvular atrial ﬁbrillation patients with LVO. A. Al Bakra, R. Al Omarb, M. Nadac, N. Memona, D. Al Jaafaria, K. doi:10.1016/j.jns.2019.10.670 Hathiaha, A. Zafara, R. Shahida, A. Al Majida, H. Khalida, M. Al Abdalia aImam Abdulrahman Bin Faisal University, Neurology, Alkhober, Saudi Arabia ARTICLE IN PRESS

124 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx bImam Abdulrahman Bin Faisal University, Family Medicine, Alkhobar, Method Saudi Arabia Retrospective data analysis of all medical records concerning cCairo University, Neurology, Cairo, Egypt patients with brain metastasis who have been treated at the Dept of Respiratory Medicine and Allergy and Dept of Neurosurgery, Objective Karolinska University Hopsital – Solna during 01012003–31122008 To identify timing for initiation of anticoagulation therapy in acute ischemic stroke (AIS) with non-valvular AF as regards safety Results and efficacy by detecting the rate of intracranial hemorrhage (ICH) The number of patients were 385, 188 (49,3%) male and 113 and recurrent ischemic symptoms (RIS) during follow-up. (50,7%) female. 52,4% were smoker or ex-smoker, data on 12,2% were missing. The most common type of primary tumor was non- Methods small cell lung cancer 77,1% and the others were small cell lung This is a prospective observational cohort study conducted at cancer. In 23,3% of the patients the first symptom was from the brain King Fahd Hospital of the University in Saudi Arabia that included metastasis. The most common treatment was stereotactic radiation 120 patients with AIS/TIAs in the period between July 2016- July 41,3%, followed by whole brain radiation in 33,4% and surgery plus 2018. We compared patients who received anticoagulants 1-6 days radiotherapy in10,8%. 67,3% of the patients have also treated with (Group I (45.83%), 7-14 days (Group II (35%), and N 14 days after oral steroids. 67% of the patients were dead at the end of 2008. the ischemic event (Group III (19.17%). Follow-up was at least 3 months and included identifying the presence of ICH or evidence of Conclusion RIS. Brain metastasis is common among patients with lung cancer. This will lead to furthure worsning the prognosis. Patients who were Result treated with stereotactic radiotherapy or surgery had better survival. During follow up, ICH has occurred in 26.67% (n=32) of our More data will be presented during the congress patients with a highly statistically significant association with time of treatment (P-value = 0.01) being higher in group I (n=17) doi:10.1016/j.jns.2019.10.673 compared to only 1 case in group III. Subgroup analyses on the ICH patients (n=32) has revealed statistical significant association with the type of anticoagulants used (p=0.02) (higher with VKA (40.63%) and higher score in NIHSS (P= 0.001). There was no statistical WCN19-1641 significant association between RIS (occurred in 5.83% (n=7) with time of treatment (P=0.41). Functional outcome at 3-6 months Poster shift 01 - Channelopathies/neuroethics/neurooncology/ measured by mRS did not differ between 3 groups (worst mRS in group I). pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in nuerology - Part I and traumatic brain Conclusion injury Early anticoagulation was associated with an increased risk of ICH. Risk of recurrent ischemic event and clinical outcome were not Correlation between transcranial doppler, systemic arterial dis- increased in patients in whom anticoagulation therapy was started ease and cerebral microangiopathy in patients of Medica Sur late. Hospital doi:10.1016/j.jns.2019.10.672 B.K. Gonzalez Alonsoa, J. Nader Kawachib, A. López León Franciscoa,F. Morales Morenob, Y. Pino Peña Carolinab, A. Rodríguez Herrera Rebecab aMedica Sur Hospital, Imagenology, Mexico, Mexico WCN19-1637 bMedica Sur Hospital, Cerebrovascular Center, Mexico, Mexico

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Introduction Microvascular damage is the main cause of white matter brain pain - Part I/sleep disorders - Part I/stem cells and gene therapy - disease. Atherosclerotic disease of small vessels (MVD) is related to Part I/stroke/training in nuerology - Part I and traumatic brain aging, vascular risk factors and brain White Matter Hyperdensities injury (WMH) in Magnetic Resonance Image (MRI). We previously described on TCD spectra, a flattening of MCA systolic peak in Brain metastases manifestaion of advanced non-small cell lung patients with WMH "Meseta Sign"(MS) in an attempt to demon- cancer (NSCLC) strate the relationship between systemic and brain circulation. As MVD can be find simultaneously in retina and the kidneys, and they H. Koyia, E. Brandéna, K. Dahamb are associated with progressive cognitive loosening, gait distur- aGavle Hospital, Department of Respiratory Medicine, Gavle, Sweden bances and urinary deterioration, we agree that microvascular bKarolinska University Hospital - Solna, Department of Respiratory damage can be part of a systemic disease or an epiphenomenon. Medicine, Stockholm, Sweden Methods Background To demonstrate the previous concept, we select 33 patients Lung cancer has a poor prognosis and is a common cancer disease having WMH in MRI. Images were classified by Fazekas scale. in the world. Brain metastasis is very common. The purpose of this Patients were studied with TCD and systemic US carotid, renal and study was to evaluate the tumor type, treatment, and survival among abdominal aorta Doppler. Blood flow velocities, PI and RI were patients with brain metastasis in our department. included in a database for statistical analysis. ARTICLE IN PRESS

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Results probably the result of lesions both in the dorsal and ventral streams. We found direct relationship between renal artery IR and cerebral Discussed further is the variability in the performance of the IP common carotid artery values. Furthermore, these two data subjects. showed a direct relationship with Fazekas scale; by the other side, there was no correlation between Fazekas scale and MS. doi:10.1016/j.jns.2019.10.675

Conclusion Results show correlation between abnormalities of systemic arteries and WMH, demonstrating that MVD can be part of a WCN19-1676 systemic disease. Since we found a relationship between renal IR, cerebral IP and MH; high renal resistance can be used as a biological marker of global increased vascular resistance in order to prevent Poster shift 01 - Channelopathies/neuroethics/neurooncology/ MV brain damage. pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in nuerology - Part I and traumatic brain doi:10.1016/j.jns.2019.10.674 injury

Subdural hematoma as a manifestation of cerebral venous thrombosis. Case report WCN19-1669 P.Ó. González Vargasa, R. Castorena-Avilab, M.J. Angeles Vazquezb,D. c a Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Rebolledo Garcia , C. Arias Rivera aHospital Materno Perinatal Monica Pretelini, Neurology Service, Toluca, pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Mexico Part I/stroke/training in nuerology - Part I and traumatic brain bHospital Materno Perinatal Monica Pretelini, Obstetric Intensive Unit, injury Toluca, Mexico cHospital General “Dr. Nicolás San Juan”. ISEM, Internal Medicine On the neural model of paraphasia: Examining the lesion data Service, Toluca, Mexico

a b a a a V. Balasubramanian , M. Brower , J. Terrezza , A. Stamey , S. Sabu Background a Seton Hall University, Speech-Language Pathology, Nutley, NJ, USA Cerebral venous thrombosis (CVT) is a common complication in b Seton Hall University, Speech-Language Pathology, Nutley, New Jersey, pregnant, postpartum and eclampsia patients in a developing USA country, more common with another pathology prothrombotic proﬁle. Commonly, acute non-traumatic subdural hematomas are Introduction rare in young patients without haematological disorders. Paraphasia refers to phonologically and/or semantically altered productions of target words that are commonly observed in aphasia Objectives and other neurogenic disorders of language. The neural processes We reported a case of acute subdural hematoma (ASH) in a involved in the production of both phonological and semantic patient with cerebral venous thrombosis. paraphasia were discussed within the dual stream model of language processing (Hickok, 2012., Hickok & Poeppel, 2007). According to Methods this model, the dorsal stream is involved in phonological production A 34-year-old postpartum woman who present seizure in a and the ventral stream provides interface between sound and postpartum period, was studied in the ICU of our hospital. She is meaning. under sedation and CT cranial study to show hyperdensity in the The objective of the present study is to further verify the superior longitudinal sinus and the left transverse sinus with diffuse prediction that lesions involving the dorsal stream will produce subcortical cortical hypodensity in both parietal and occipital lobes phonological paraphasia and lesions in the ventral stream will result and delta sign. All date according a CVT. In addition, a subdural in semantic paraphasia. Brain lesions that encompass both streams hematoma is appreciate in the left temporal region. The manage- will result in both phonological and semantic types of paraphasia. ment was non-surgical and a subsequent CT cranial scan showed Method. Subjects. Three aphasic cases, with an age range of 66-74 resolution of the hematoma. Subsequently prothrombotics studies years, served as subjects: JL, PP, and RW. All three had similar, but ruled out a hematological problem. The patient was discharged not identical, lesions in the left parietal lobe including supramarginal asymptomatic and with anticoagulant treatment. and angular gyri and in posterior temporal lobe (See Figures 1-3) Conclusions Procedure Patients with CVT are frequently in our environment but it Two tests were administered: Boston Diagnostic Aphasia Exam- does not exist a large number of studies from the neurological ination, and 2) Boston Naming Test. All paraphasic responses were point of view. Neurological manifestations are varied and infre- derived from the confrontation naming responses. These were quent in a general neurological approach. Our case illustrates that broadly classiﬁed into phonologic, semantic and mixed types of subdural hematomas can be a symptom of cerebral venous paraphasia thrombosis.

Results and discussion doi:10.1016/j.jns.2019.10.676 As predicted, all three subjects produced both phonologic and semantic types of paraphasia. This pattern of performance is ARTICLE IN PRESS

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WCN19-1680 A. Elrekaby, J. Giles Colchester general Hospital /stroke, Medicine, Colchester, United Kingdom Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ Aim stroke/training in nuerology - Part I and traumatic brain injury This study provides an overview of the evaluation and management of stroke in young adults presenting to Colchester General Endovascular treatment for acute ischemic stroke: Eligibility in a Hospital. This standard will be compared to the national standard Brazilian stroke unit and to the recent recommendation by the stroke society on the management of stroke patients, to determine if our practice is R.T. Martins, V.O. Oliveira, R.M. Castilhos, H.L. Moser Filho meeting the set requirements. Hospital Nossa Senhora da Conceição, Neurology, Porto Alegre, Brazil Results Background 466 patients were admitted to the stroke unit between January Since confirmation of benefit of endovascular treatment to large 2015 to September 2015, of which 84 met our criteria. 28 were vessel occlusion ischemic stroke, estimation of demand of this female (33.7%) and 56 were male (66.3%). 10 patients were between intervention in different settings became necessary. 25-45 years of age and 74 patients between 46-65 years. The main risk factors highlighted from this study were cardio- Objective vascular; hypertension (35.35%), LDL N2.5 (30.88%) and previous We estimated demand of this treatment modality in a tertiary CVA (24.1%). stroke unit in Brazil. Strokes most commonly involved the anterior circulation (partial 41.2%, total 5.9%) or were a lacunar stroke (27.9%). The majority of Material and methods strokes clinically affected the left side (39.7%), with the minority We applied basic endovascular treatment eligibility criteria to our affecting posteriorly (25%). hospital registry of acute stroke code activations: previous indepen- Patients had access to basic and extended investigations. dence, measurable deficit, large vessel occlusion, absence of hip- Patients were managed according to the national standard, odensity on CT, no coagulopathy and able to start procedure in time- 17.64% of patients underwent thrombolysis. window. Every stroke code activation was classified as eligible or not 72.1% of patients were discharged home with early supported to endovascular intervention. discharge (ESD). In addition, 11.7% of patients were able to return home independently. Patient who has MRS 3 went for further Results rehabilitation. Of 340 acute stroke code confirmed ischemic strokes,102 cases (30%) would be eligible to endovascular intervention. Of these 102 Conclusion cases, 79 (78%) received IV-TPA and 23 (22%) did not but were still All young stroke patients presenting to CGH were managed by eligible to endovascular approach. Eligible cases had more severe the stroke service team and had access to basic and extended strokes, higher NIHSS (16 vs 7, pb0.01), higher glycaemia investigations. The majority of patients were discharged home with (7.16mmol/l vs 6.62mmol/l, p=0.04), arrived earlier to the hospital minimum support and advanced rehabilitation was offered . young (107 vs 134 minutes, p b0.01), had hyperdense arterial sign more patients were offered phone consultation or drop in consultation often (56% vs 20%, pb0.01) and cardioembolic etiology (50% vs 29%, pb0.01). Of IV-TPA treated cases, 79 (50%) would be eligible to doi:10.1016/j.jns.2019.10.678 endovascular treatment. Arrival stroke severity (NIHSS) (pb0.01), IV- TPA use (pb0.01) and presence of hyperdense arterial sign (p=0.04) were associated with endovascular eligibility. WCN19-1715 Conclusion Our endovascular demand estimation was 30% of cases, which was Poster shift 01 - Channelopathies/neuroethics/neurooncology/ higher than previously reported. Our results may be due to stroke severity of earlier arrivals and non-response to intravenous TPA. pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in nuerology - Part I and traumatic brain doi:10.1016/j.jns.2019.10.677 injury

Elevated homocysteine may result in an increased risk of spontaneous hemorrhagic transformation in patient with acute WCN19-1712 ischemic stroke

Q. Wu, Y. Wang, Q. Song, J. Liu, M. Liu Poster shift 01 - Channelopathies/neuroethics/neurooncology/ West China Hospital- Sichuan University, Department of Neurology, pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Chengdu, China Part I/stroke/training in nuerology - Part I and traumatic brain injury Background and objective Elevated level of serum homocysteine (hcy) is identiﬁed to be Overview and evaluation of stroke management and outcome in related to increasingly mortality and poor outcome after acute young patients who presented to Colchester general hospital, ischemic stroke (AIS). However, the association between elevated Essex, England hcy and spontaneous hemorrhagic transformation (HT) after AIS is ARTICLE IN PRESS

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128 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx rarely explored. We aimed to investigate whether elevated hcy can somewhere between the risk of patients with normal glucose increase the risk of spontaneous HT in patients with AIS. metabolism and with diabetes. The objective of the study was to identify the stroke outcomes Methods using the Modified Rankin Scale (mRS) and to compare the stroke Patients diagnosed with AIS within seven days were consecu- outcomes of pre-diabetic patients to that of the diabetic and non- tively and prospectively enrolled in the Chengdu Stroke Registry diabetic stroke patients’ outcome. Their mRS scores were recorded at Database. Baseline characteristics including serum hcy levels within 0 and 3 months post stroke and these scores were compared among 48 hours were collected and analyzed. The patients included were the three groups. divided into two groups, elevated group (hcyN20umol/L) and normal A total of 39 patients were enrolled. Differences in stroke group (hcy≤20 umol/L). MRI or later CT were used to define outcomes across the study groups were analysed using Kruskal- spontaneous HT in patients without undergoing intravenous throm- Wallis test. The mRS at 0 month of non-diabetic subjects are bolysis or endovascular treatment. Univariable analysis and binary collectively less serious while mRS at 0 month of diabetic subjects logistic regression were used to determine whether elevated hcy was are collectively more serious than the other two groups. This was associated with spontaneous HT. also the same for the mRS at 3 months post stroke.The differences were not statistically significant. Results No significant difference was observed among the stroke A total of 758 patients (476 males, mean age, 64.6 years) were outcomes of patients in the study groups. Collectively poorer finally included, of which 82 (10.8%) had elevated hcy and 67 (8.8%) outcomes were observed in the diabetes group. Less serious developed spontaneous HT within seven days after admission. outcomes wee observed in non diabetic group. This suggests that Univariable binary logistic regression indicated that elevated hcy outcomes for pre-diabetic subjects lie somewhere in between the was associated with an increased risk of spontaneous HT (P=0.020, two groups. OR=2.17, 95% CI 1.13-4.18). After adjustment for age, gender, NIHSS on admission and atrial fibrillation, elevated hcy was independently doi:10.1016/j.jns.2019.10.680 associated with spontaneous HT after AIS (P=0.019, OR=2.36, 95% CI 1.15-4.83).

Conclusion WCN19-1725 Elevated level of homocysteine was independent associated with increased risk of spontaneous HT after acute ischemic stroke, which should be veriﬁed in larger cohorts in the future. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in nuerology - Part I and traumatic brain doi:10.1016/j.jns.2019.10.679 injury

Stroke syndromes: A case of eight and a half syndrome

WCN19-1720 K.A. Camagay Baguio General Hospital and Medical Center, Department of Adult Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Neurology, Baguio, Philippines pain - Part I/sleep disorders - Part I/stem cells and gene therapy - This is a case of a sixty-two year old male, who had a one day Part I/stroke/training in nuerology - Part I and traumatic brain history of sudden double vision. With noted frozen right eye; injury unable to perform any movement on horizontal gaze, and with right sided facial asymmetry. He is hypertensive for more than ten Pre-diabetes among stroke patients and its effect on stroke years. He has a strong family history of hypertension, and a forty outcome pack year smoker as well. Left eye is exotropic, with no adduction. Right eye is frozen on horizontal gaze, and primary gaze is at P. Dadgardoust, M. Yumul midline. Right sided peripheral facial palsy is seen on examination. University of Santo Tomas Hospital, Department of Neurology and Cranial non-contrast magnetic resonance imaging with time of Psychiatry, Manila, Philippines ﬂight is done revealing an infarct in the right posterior pontine area, and a narrow right vertebral artery due to a probable Pre-diabetes is generally deﬁned as impaired fasting glucose. The occlusion. underlying disturbances responsible for the development of type 2 Here we have a stroke syndrome presenting as an ipsilateral diabetes are also expressed in people with pre-diabetes, putting lower motor neuron: seventh nerve palsy, and an ipsilateral them at risk of the same vascular complications including stroke. horizontal gaze palsy with internuclear ophthalmoplegia of the Acute hyperglycemia is not only associated with mortality, but also contralateral eye (failure of adduction) termed as CN VII, + 1 ½ with unfavorable functional outcome post stroke. It's likely that syndrome or Eight and a Half Syndrome. This is caused by a lesion patients with pre-diabetes have a risk of poor functional outcome involving the paramedian pontine reticular formation (PPRF) which ARTICLE IN PRESS

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sends signals towards the ipsilateral abducens nerve (CN VI) and to the lesion. An occlusion in the tip of the paramedian pontine contralateral medial longitudinal fasciculus (MLF). These structures artery, a branch of the basilar artery, as the most common etiology. lies in close proximity to the nucleus and intraaxial fascicles of cranial nerve VII manifesting as facial weakness of the ipsilateral side doi:10.1016/j.jns.2019.10.681 ARTICLE IN PRESS

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WCN19-1734 S. Misraa, P. Talwara, A. Mishraa, A. Kumara, P. Kumarb, A. Raia,A. Gulatic, P. Aggarwald, A.K. Pandita, K. Prasada, D. Vibhaa aAll India institute of Medical sciences, Department of Neurology, New Delhi, Poster shift 01 - channelopathies /neuroethics /neurooncology /pain India - Part I /sleep disorders - Part I /stem cells and gene therapy - part I / bResearch & Referral Army Hospital, Department of Paediatrics, New Delhi, stroke /training in neurology - Part I and traumatic brain injury India cAll India institute of Medical sciences, Clinical Epidemiological Unit, New Factors affecting the quality of life in patients with traumatic Delhi, India brain injury dAll India institute of Medical sciences, Department of Emergency Medicine, New Delhi, India B. Amonova, N. Mirzaevab, I. Qilichevb, R. Matmurodova aTashkent medical academy, Neurology, Tashkent, Uzbekistan Background bUrgench branch of the Tashkent Medical Academy, Neurology, Urgench, A seasonal variation in stroke has been reported in various parts Uzbekistan of the world. India is a tropical country with various seasons that may influence the occurrence of stroke. The progression of finishing symptoms of traumatic brain injuries (TBI) depends not only on the severity of the disease, but also on Objective many factors that affect the quality of life and disability of patients. To determine the seasonal and monthly variation of stroke and its subtypes in the north Indian population. Aim To examine the main clinical and non-clinical factors affecting the Methods th th quality of life of patients with TBI. From 4 July 2017 to 10 May 2019, consecutive ischemic stroke (IS) and intracerebral hemorrhage (ICH) patients admitted to the Material and methods Emergency and Neurology Department of All India Institute of A survey of 38 patients with TBI and the control group identified 20 Medical Sciences, New Delhi were recruited in this ongoing cross- patients without TBI. The diagnosis of TBI was established in accordance sectional study. Seasons were categorized as: spring (March to May), with the criteria. All patients underwent a clinical neurological summer (June to August), autumn (September to November), and examination, including a psychological assessment of cognitive and winter (December to February). The entire statistical analysis was mental disorders using special neuropsychological testing. European conducted in STATA version 13.0 software. questionnaire of quality of life from 5 questions (EuroQoL-5D). Results Results A total of 410 stroke patients (243-IS, 167-ICH) have been The survey results showed that “mobility” occurred in 88.6%,“pain/ recruited in the till date with a mean age of 53.96±15.82 for IS and discomfort”- 85.2%, and “anxiety/depression” in 95.6%, they received 55.95±12.03 for ICH. Overall stroke was found to be most prominent “certain” or “significant” problems and in the control groups 55.2%, in winters (31.46%) with the highest occurrence observed in the 56.3% and 61.5%, respectively, pb0.001). When conducting regression month of December (13.02%). Occurrence of IS was most in winters analysis of motor and non-motor manifestations and quality of life (27.69%) closely followed by summer (25.21%) and spring (23.97). indicators of patients with TBI, a significant relationship was found Occurrence of ICH was most in winters (38.18%) followed by autumn (pb0.05) between the indicators of quality of life and the degree of BI, (21.82%), spring (21.21%) and summers (18.79%).Significant seasonal ongoing diseases, cognitive impairment, depression and anxiety, differences in the occurrence of IS and ICH were observed in males vegetative disorders, psychosis, pain and sleep disorders. It was found (p=0.03). that 42.1% patients with TBI never went to the doctor after injury. In these patients, mobility, pain/discomfort-and anxiety/depression- Conclusion 85.1%, 78.4%, and 76.2%, respectively (pb0.05). Our study suggests that the incidence of stroke is highest in the winters in north India. These findings may help in developing Conclusion strategies for preventing stroke. The quality of life of patients with TBI depends not only on the degree of the disease, but also on non-clinical factors that see a doi:10.1016/j.jns.2019.10.683 doctor out of time. doi:10.1016/j.jns.2019.10.682 WCN19-1745

Poster shift 01 - Channelopathies /neuroethics /neurooncology / WCN19-1744 pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain Seasonal and monthly variation of stroke and its subtypes in the injury north Indian population Parametric survival analysis in stroke patients with Weibull Poster shift 01 - channelopathies /neuroethics /neurooncology / distribution approach pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain R. Fajar injury Yogyakarta State University, Mathematics, Yogyakarta, Indonesia ARTICLE IN PRESS

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Parametric survival analysis is one of the survival analysis that WCN19-1766 has a distribution of survival data that follows a certain distribution. Weibull distribution is a distribution that is often used in parametric survival analysis. The purpose of this study is to determine Poster shift 01 - Channelopathies /neuroethics /neurooncology / parametric survival models using the Weibull distribution and to pain - Part I /sleep disorders - Part I /stem cells and gene therapy - determine the factors that can influence the recovery of stroke Part I /stroke /training in neurology - part I and traumatic brain patients. This study uses data on stroke patients in the Sultan Daeng injury Raja Hospital, Bulukumba, Sulawesi Selatan, Indonesia in 2018. The best model obtained in this study is a model that consists of two High frequency RTMS on cortical reorganization of chronic stroke predictor variables, namely the age and the body mass index (BMI). fl Therefore the factors that can in uence the recovery of stroke N. Kuthiala, P. Srivastava MV, R. Sharma, S. Sharma patients are age and BMI. All India Institute of Medical Sciences, Neurology, New Delhi, India doi:10.1016/j.jns.2019.10.684 Background The purpose of the study was to investigate the effect of high frequency rTMS with Rehabilitation on cortical reorganization of chronic stroke patients with upper extremity motor deficits. fMRI as WCN19-1759 a technique provides a window into functional activity in multiple brain areas, and has good accessibility, safety, and spatial resolution. Poster shift 01 - Channelopathies /neuroethics /neurooncology / The evidence of cortical reorganization was used to assess in response to intensive physiotherapy treatment with rTMS using pain - Part I /sleep disorders - Part I /stem cells and gene therapy - blood oxygenation-level dependent (BOLD) Part I /stroke /training in neurology - Part I and traumatic brain injury Methodology This study is a RCT. This included (N=60) chronic stroke patients The complex approach to the rehabilitation of patients with from 3 to 18 months of index event. Patients were randomized to motor deficit in the early recovery period of ischemic stroke CIMT alone (Group A n=30) & rTMS with CIMT (Group B n=30). rTMS (10 Hz, 750 pulses with 110%RMT) was administered for 3 F. Devlikamovaa, F. Khabirova, T. Khaibullina, E. Granatovb weeks (5days/week). Radiological Assessment of the patients was aKazan State Medical Academy, Department of Neurology, Kazan, Russia done with fMRI (BOLD) along with assessment of Fugl Meyer (FM), bRepublican Clinical Neurological Center, Department of Neurophysiol- Barthel Index, and modified Rankin Scales, at baseline, 15th &90th ogy, Kazan, Russia day

We aimed to evaluate the efficacy of complex rehabilitation: Results kinesiotherapy, navigation TCMS (nTCMC), and Cerebrolysin (neu- The mean FMA score at baseline, 15th and 90th day in Group A ropeptide preparation drug proved to contain fragments of neuro- was 34.53+6.02, 42.47+6.1, 42.50+6.0 in comparison to Group B trophic factors), in patients with ischemic stroke (IS). 34.07+6.4, 51.47+7.7&52.07+7.6 showing the significant improve- 110 patients (34–71 years) with IS and motor deficit (at least 2 ment (pb.000) in Group B. there was no statistical significant points on motor functions of the NIHSS) were randomized into 4 improvement seen in other two scales. The BOLD cluster activation groups (G): G1 (n = 33) only kinesiotherapy (PNF, 1 session/day, 14 was compared between two groups. days); G2 (n = 32) kinesiotherapy and cerebrolysin (20.0 ml IV daily, 14 days); G3 (n = 25) kinesiotherapy and nTCMS (precentral Conclusion gyrus, 5 Hz, 5 sec., 20 sec. rest, 500 pulses, 1 session/day, 14 days); Alterations in cortical activations (fMRI-BOLD) was observed after G4 (n = 20) kinesiotherapy, cerebrolysin, nTCMS. Indicators (EEG, intensive rehabilitation with rTMS (Group B) in patients with STREAM, Bartel Index) were evaluated at the beginning of treatment chronic stroke. Activation and functional changes in fMRI and TMS and after 6 months. correlated significantly with the degree of clinical improvement in The nonparametric Kruskal-Wallis ANOVA statistics showed most upper extremity function. pronounced recovery in G4 (p b0.05): STREAMS (Me [LQ; UQ] - 17 [12,5; 22], 19 [14; 24], 23 [18; 25,5], 29 [26; 31] points in G1-4) and doi:10.1016/j.jns.2019.10.686 the Bartel Index (Me [LQ; UQ] - 75 [60; 80], 75 [65; 80], 80 [70; 85], 90 [85; 95] points in G1-4). Most pronounced decrease in the spectral power of the delta rhythm and the increase in the spectral power of the alpha rhythm in the affected hemisphere were WCN19-1777 observed in G4 (391, 355, 394, 234 and 101, 111, 96, 131 μV2/ Hz in G1-4 (p b0.05). The complex combination therapy including kinesiotherapy, Poster shift 01 - Channelopathies /neuroethics /neurooncology / nTCMS, and cerebrolysin proved to be most effective in pain - Part I /sleep disorders - Part I /stem cells and gene therapy - restoring motor disorders and normalizing the functional state of Part I /stroke /training in neurology - part I and traumatic brain the brain injury doi:10.1016/j.jns.2019.10.685 ‘Prehospital’ delay in acute stroke reperfusion therapy in Delhi: Time for introspection ARTICLE IN PRESS

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J. Sharmaa, P. Srivastavaa, R. Bhatiaa, R. Rajana, R. Singha, V. Goyala, Objective M. Singha, A. Gargb, V. Vishnua The aim of the study was to quantitatively assess the prognostic aAll India Institute of Medical Sciences- New Delhi, Neurology, New Delhi, significance of effect of Copeptin levels on patient survival using a India meta-analysis approach. bAll India Institute of Medical Sciences- New Delhi, Neuroradiology, New Delhi, India Method A literature survey was performed for published studies in stroke Background for the respective biomarker till 2017 using databases like Pubmed, The reasons for prehospital delay in acute stroke reperfusion care Medline, Google scholar and OVID. The keyword search used was: are many including delay in seeking medical care or delay after the “COPEPTIN” AND “PROGNOSIS” OR “OUTCOME” OR “MORTALITY” Initial Medical Contact (IMC). We tried to find out the timing of IMC AND “BRAIN STROKE” OR “CEREBRAL INFARCTION”. Random effect of patients coming to AIIMS Delhi Emergency Stroke Services. model was used since heterogeneity was more than 50% otherwise fixed effect model could be used. Methods The data was collected prospectively (July10, 2018-Mar10, 2019) Result from the feasibility screening log of an on-going RCT (PROLEVIS).All A total of 13 studies from 2009 to March 2019 involving 2780 Stroke patients admitted in Unit 2 were included. Time of onset of subjects were included in the present meta-analysis. The mean age stroke, neuroimaging, arrival time at IMC/AIIMS were collected of the subjects was 61.7 years. The pooled results suggested that the prospectively. plasma Copeptin level was significantly higher in the subjects who died compared to those who survived brain stroke at the end of the Results last follow-up. Standardized mean difference (SMD 1.55; 95% CI, We screened 127patients and 3 were excluded for insufficient 1.11-1.99), p-valueb0.0001 data. Forty nine patients arrived AIIMS directly and 75 patients had IMC elsewhere. Of these 75 patients (Ischemic stroke-35, ICH- Conclusion 32, CVT-8), 61 (IS-27) reached within 4.5 hrs, 65 (IS-30 )within 6 Finding of the meta-analysis is suggestive of high plasma hrs, 72 within 24 hrs. Of the 30 ischemic stroke patients (IMC b 6 Copeptin level being a contributing factor for predicting mortality hrs),29 (39%) had neuroimaging before referral, but only 2 rate in patients with acute stroke. Further prospective studies are patients were thrombolysed (AIIMS). Among the IS with IMC required to validate the findings observed in this meta-analysis. outside AIIMS, 13 patients were wake up stroke (11 patients are within 4.5 hrs). doi:10.1016/j.jns.2019.10.688 Out of 49 patients (IS-40, ICH-9) who directly reached AIIMS, 34 were within 4.5 hrs (IS-26), within 6 hrs-37 (IS-28), within 24 hrs -47 (IS-38). Eight patients within 4.5 hrs were wake up stroke. 35% (14/40, IVT-10, MT-4) of Ischemic stroke patients reaching AIIMS WCN19-1802 directly underwent acute stroke reperfusion therapy.

Poster shift 01 - Channelopathies /neuroethics /neurooncology / Conclusion Nearly half of (46%) Ischemic stroke patients reaching AIIMS have pain - Part I /sleep disorders - Part I /stem cells and gene therapy - IMC outside and 77.1% of these reach IMC within 4.5 hrs. Part I /stroke /training in neurology - part I and traumatic brain injury doi:10.1016/j.jns.2019.10.687 Impact of pre-admission treatment with vitamin k antagonists on stroke severity in patients with acute ischemic stroke

WCN19-1793 A. Szczepańska-Szereja, S. Beatab aMedical University of Lublin, Neurology, Lublin, Poland bJohn Paul II Autonomous Public Voivodeship Hospital, Neurology, Zamość, Poster shift 01 - Channelopathies /neuroethics /neurooncology / Poland pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - part I and traumatic brain Background and aims injury Vitamin K antagonists (VKA), alongside new oral anticoagulants, are still one of the common standards in the treatment of patients Relationship between serum Copeptin level and severity outcome with atrial ﬁbrillation (AF). It is estimated that about 30-40% of in patients with ischemic stroke: A meta-analysis patients taking VKA suffer an ischemic stroke (IS). The aim of this study was to evaluate the impact of pre-admission VKA therapy on IS A. Kumar, R. Sagar, S. Misra severity. All India Institute of Medical Sciences- New Delhi, Neurology, New Delhi, India Methods Analysis of medical data of 181 AF patients with either no Background pre-admission AVK (n=91) or existing AVK therapy (n=90) Copeptin is a c-terminal part of a neuroendocrine marker consecutively admitted to the two stroke units with acute IS. provasopressin. Literature survey suggests that plasma Copeptin level is associated with functional outcome and mortality in patients Results with acute stroke. It has emerged as a novel prognostic biomarker for There were no signiﬁcant differences in values of mean predicting stroke outcome. CHA2DS2-VASc scores (4,1±1,5 vs 4,4±1,7,n.s.) between both ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 133 groups. Pre-admission AVK therapy was associated with significantly Material and methods lower NIHSS and mRS scores at discharge (median NIHSS score 3 It is a prospective, open label, nonrandomized observational ±2,1 vs 6±4,9, pb0,001, median mRS score 2,6±1,5 vs 3,4±1,7, Registry. Patients satisfying the eligibility criteria were thrombolysed pb0,001), lower number of cases with TACI in OCSP classification with injection TenectaseR (Tenecteplase manufactured by Gennova (20% vs 37,4%, pb0,01) and shorter time of hospitalization (11±7 Pharmaceuticals, India) at 0.2mg/Kg as intravenous bolus within 3 days vs 16±13 days, pb0,001). This positive effect was also observed hours of onset and followed for 3 months. when values of INR were b 2 (55 patients, 61,2%). There were no differences regarding the frequency of symptomatic haemorrhagic Primary safety outcome transformation of IS between both groups (pN0,05). Symptomatic intracerebral haemorrhage (sICH) within 30- 42hours of thrombolysis (post treatment scan) with worsening Conclusion National Institute of Heath Stroke Scale (NIHSS) score by 4 or death. Pre-admission AVK therapy had positive impact on the acute natural history of IS which was also observed in cases with values of Secondary efficacy outcome variables INR lower than the therapeutic window. A. Improvement in NIHSS score by 4 or more or 0 at 24hours and 7days doi:10.1016/j.jns.2019.10.689 B. Functional Independence: modified Rankin Scale (mRS) 0-2 at 3months C. Excellent Outcome- mRS 0-1 at 3months

WCN19-1810 Results We analysed 240 patients from November 2017 to January 2019. There was a lower incidence of sICH(1.68%) and lower 3 month Poster shift 01 - Channelopathies /neuroethics /neurooncology / mortality (5%). Improvement in NIHSS score was seen in 39% at 24 pain - Part I /sleep disorders - Part I /stem cells and gene therapy - hours and 59% at 7 days. At 3 months, excellent outcome was seen in Part I /stroke /training in neurology - part I and traumatic brain 59%, while 76% had functional independence. These compared injury favourably with other registries using Alteplase.

Indian registry in ischemic stroke- tenecteplase (IRIS- TNK)- An Conclusion interim analysis Intravenous Tenecteplase at 0.2mg/kg given within 3 hours of stroke onset has a good safety profile and is an effective option with ease of administration and affordability for developing countries. U.K. Misraa, R. TcRb, S. Kumaraveluc, D. Arjundasd, R. Wadiae, R. Nairf, A. Alurkarg, S. Pujaraih, M. Udhari, N. Palasdeonkari, S.S. Buddhaj,S. doi:10.1016/j.jns.2019.10.690 Kumark, M.S. Salvadeeswaranl, S. Deasaim, V. Pammidimukkalan,M. Sharmao, K. Kumarp, G. Percivalq, S. Hegder, K. Machhavadas aSanjay Gandhi Post Graduate Institute of Medical Sciences, Neurology, Lucknow, India bKG Hospital, Neurology, Coimbatore, India WCN19-1815 cRamesh Hospitals, Neurology, Guntur, India d Vijaya Hospitals, Neurology, Chennai, India Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain eRuby Hall Clinic, Neurology, Pune, India - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ fSIMS Hospital, Neurology, Chennai, India stroke/training in neurology - Part I and traumatic brain injury gKEM Hospital, Neurology, Pune, India hNoble Hospital, Neurology, Pune, India iSahayadri Hospital, Neurology, Pune, India Analysis of d-dimer as stem cell treatment marker and cytokines jRamesh Hospitals, Neurology, Vijayawada, India as prognostic marker in intravenous transplantation of umbilical kApollo Hospitals, Neurology, Hyderabad, India cord-derived mesenchymal stem cells for acute stroke lApollo Hospitals, Neurology, Madurai, India mSree Krishna Hospital, Neurology, Karamsad, India O.J. Kim nLalitha Superspeciality Hospital, Neurology, Guntur, India CHA Bundang Medical Center- CHA University, Neurology, Seongnam-si, oApollo Hospital, Neurology, Ahmedabad, India Gyeonggi-do, Republic of Korea pYashoda Hospital, Neurology, Hyderabad, India qJubilee Mission Hospital, Neurology, Thrissur, India Objective rA J Institute of Medical Sciences, Neurology, Mangalore, India Stem cell clinical trials for stroke patients have been increasingly sZydus Hospital, Neurology, Ahmedabad, India investigated, but their results have controversy. We recently performed the human umbilical cord-derived mesenchymal stem Introduction cells (Cordstem-ST) intravenous transplantation in acute cerebral Tenecteplase, a promising third generation Tissue Plasminogen infarction and found that Cordstem-ST had effects on functional Activator due to greater fibrin specificity and long half-life was improvement in stroke. In this study, we evaluated the possibility of approved in 2016 by Indian Regulatory Authority. The IRIS-TNK was therapeutic marker through the D-dimer and cytokine analysis in opened to study its safety and efficacy. The present study is its treatment of Cordstem-ST for stroke. interim analysis. Methods Aim In total 19 patients, we investigated the differences of D-dimer To study whether regular use of tenecteplase within 3 hours of between placebo (4 patients) and stem cell groups (15 patients). ischemic stroke onset is Safe and Beneficial. And then, we analyzed differences of interval changes of various ARTICLE IN PRESS

134 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx cytokines level between groups. Also, we investigated association Results between interval change of various cytokines and prognosis (good A total of four studies involving 834 patients with acute ischemic and poor) among stem cell group. stroke were used in the meta-analysis. Pooled analysis suggested, a significant association between high BUN/Creatinine ratio N15 (OR= Results 2.48; 95% CI 1.38 to 3.57, pb0.001) and poor outcome after acute D-dimer on following day after administration of Cordstem-ST ischemic stroke. was markedly increased in stem cell group than placebo group with significance on day 1. In interval change of D-dimer, there were Conclusions significant differences on 1, 3, and 7 days. Although d-dimer was BUN/Creatinine ratio may be used as a predictive marker for poor increased, but suspicious inflammatory symptoms and signs such as clinical outcome in AIS patients. Further prospective studies with fever and leukocytosis was not accompanied. IL-1 alpha and IL-21 large sample size are required to validate the present findings. was markedly decreased in stem cell group than placebo group. Good prognosis group had higher level of BDNF, CCL2, CXCL10, doi:10.1016/j.jns.2019.10.692 PDGF-BB, and PLGF than poor prognosis group.

Conclusion It was suggested that D-dimer was a marker of stem cell treatment. WCN19-1826 And we found that Cordstem-ST increased cytokines related to anti- inﬂammation, neuronal regeneration and neovascularization. Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain doi:10.1016/j.jns.2019.10.691 - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ stroke/training in neurology - Part I and traumatic brain injury

Comparison of knowledge, attitude, practices among the differ- WCN19-1823 ent age group of Himachal Pradesh

S. Sharma, P. Srivastava, N. Kuthiala Poster shift 01 - Channelopathies/neuroethics/neurooncology/ AIIMS-New Delhi, Neurology, Delhi, India pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Background injury Stroke is the third cause of death worldwide after cancers and cardiovascular disease. Rising incidence of stroke and higher Blood urea nitrogen/creatinine ratio for prediction of poor mortality among Indian population needs focused attention for outcome in patients with acute ischemic stroke: A meta-analysis prevention and early management.

S. Gulatia, S. Gulatib, A. Kumara, R. Sagara, A. Gulatic, S. Mishraa Aims aAll India Institute of Medical Sciences, Neurology, New Delhi, India To assess the knowledge, attitude and practice towards Stroke bDr.Ram Manohar Lohia Hospital New Delhi, Medicine, New Delhi, India among different age groups. cAll India Institute of Medical Sciences, Clinical Epidemiology Unit, New Delhi, India Methods KAP study was conducted in the Districts of Himachal Pradesh using epidemiological surveys, questionnaires regarding the diseases, Background behavioral responses, stigmas and beliefs were asked to school Ischemic stroke (IS) is the second most leading causes of death and children, teachers, community paramedical staff, medical personnel disability worldwide. The measurement of early prediction of outcome and general public in district. after the ischemic stroke is still controversial. In recent studies, it has been shown that high Blood urea nitrogen (BUN)/creatinine ratio is Results associated with poor outcome after acute ischemic stroke. 1100 subjects were recruited in the study and were divided into three groups according to their ages i.e. group A b20years1 (n=682), Aim group B 21 to 45 Years2 (n=341), group C N45 Years3 (n=77). M:F To determine the pooled effect size for association of high levels 2:3.The responses were recorded as yes, no, don’t know but in this of baseline BUN/Creatinine ratio with poor clinical outcome after we have calculated only yes responses. There was significant ischemic stroke using meta-analysis approach. difference seen between the knowledge, attitude, practices among different age group (as shown Table 1). In group C only 27.2% Methods subjects were aware of “stroke - as a disease of brain” and about Literature survey was performed for earlier published studies in 90.9% of population thought that “stroke is a hereditary”. stroke relevant for association between blood urea creatinine ratio and outcome after acute ischemic stroke from January to December Conclusion 2018. Search engine used were Pubmed, Medline, Google scholar. The results concluded lack of awareness among all the age groups The keyword search was: “Blood Urea and creatinine ratio” OR but in elderly group level of knowledge was very poor and had “blood urea” OR creatinine AND “PROGNOSIS” OR “OUTCOME” OR presumably rampant negative attitude, myths and misconceptions “MORTALITY” AND “BRAIN STROKE” OR “CEREBRAL INFARCTION”. about stroke. Further KAP studies are recommended among different BUN/Creatinine ratio N15 was classified as high at baseline. Random age groups for betterment in the awareness of stroke. effect model was used since heterogeneity was more than 50% otherwise fixed effect model was used. All the statistical analysis was doi:10.1016/j.jns.2019.10.693 conducted in STATA software. ARTICLE IN PRESS

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WCN19-1828 tissue inhibitors of metalloproteinases (TIMPs), a family of glycosyl- ated protein comprised of four members (TIMP-1 to -4).

Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain Objective - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ To conduct a systematic review and meta-analysis of all stroke/training in neurology - Part I and traumatic brain injury published studies for determining an association between TIMP-1 (rs4898) and TIMP-2 (rs7503726) gene polymorphisms and risk of Involvement of apoptosis related proteins in the neuro-protective ICH. effect of dihydromyricetin in transient local ischemia reperfusion injury in rats Methods A comprehensive literature search was carried out till May 12, K. Reeta, D. Singh, H. Wasan 2019 in PubMed, Cochrane, Medline, OVID, and Google Scholar All India Institute of medical Sciences, Pharmacology, New Delhi, India databases. The following combination of keywords was used: (‘Tissue Inhibitors of Metalloproteinases’ OR ‘TIMP’) AND (‘Single ’ ‘ ’ ‘ Neuronal apoptosis plays a crucial role in mediating cell death Nucleotide polymorphisms OR SNP ) AND ( Intracerebral Hemor- ’ ‘ ’ fi after ischemia reperfusion injury. Dihydromyricetin (DHM), a rhage or ICH ). Pooled Odds Ratio (OR) and 95% Con dence Interval flavonoid, has shown to be neuro-protective by its anti-oxidant, (CI) were reported. The entire statistical analysis was conducted in anti-inflammatory and anti-apoptotic properties. The present study STATA 13.0 software. investigates whether DHM treatment exerts neuro-protection by modulating apoptosis related proteins after ischemia reperfusion Results injury. Male Wistar rats (270 ± 20 g) were used after ethical Total two studies each for TIMP-1 (rs4898) and TIMP-2 approval. Middle cerebral artery was occluded for 90 min using a (rs7503726) were included in the meta-analysis. TIMP-1 (rs4898) fi silicon coated doccol sutures followed by reperfusion for 3 days. polymorphism was found to be signi cantly associated with risk of DHM (100 mg/kg) was administered immediately and 2 h after ICH in females (OR 1.49; 95% CI 1.03 to 2.17) under recessive model fi reperfusion followed by single dose every 24 h for next 2 days. On while no signi cant association was found under dominant model. fi day 3, rats were sacrificed, brain samples homogenised in RIPA buffer TIMP-2 (rs7503726) polymorphism was not found to be signi cantly and expression of apoptosis related proteins like Bcl2 and Bax were associated with risk of ICH under both dominant (OR 0.98; 95% CI checked by western blot. For apoptosis, rats were euthanized, 0.77 to 1.24) as well as recessive model (OR 1.16; 95% CI 0.65 to perfusion fixed with paraformaldehyde, cryosections were stained 2.07). with TUNEL assay kit. The results indicated that compared to sham group, there were significantly (pb0.001) higher number of TUNEL Conclusion positive cells indicating more apoptosis in middle cerebral occlusion Our meta-analysis suggests that TIMP-1 (rs4898) gene polymor- (MCAo) group. Treatment with DHM significantly (pb0.05) reduced phism might be a risk factor for ICH in the females. However, more the number of apoptotic cells when compared to MCAo group. The studies with adequate sample size need to be conducted to validate fi expression of Bax was also increased in MCAo group as compared to our ndings. sham. DHM treatment significantly normalised the expression of Bax doi:10.1016/j.jns.2019.10.695 when compared with MCAo. MCAo induced decreased Bcl2 expression was also normalised by DHM. Our results thus showed that the neuro-protective effect of DHM in ischemia reperfusion injury may be due to normalization of apoptosis related proteins. WCN19-1830 doi:10.1016/j.jns.2019.10.694 Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain WCN19-1829 injury

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Unusual strokes? Think of unusual etiology ! pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain P. Ojha, V. Aglave, K. Jagiasi, G. Soni, R. Singh, R. Ansari, P. Barvalia injury Grant government Medical college and Sir JJ Hospital, Neurology, Mumbai, India Relationship between tissue inhibitors of metalloproteinases (TIMPS) gene polymorphisms and risk of spontaneous intracere- Background bral hemorrhage: A systematic review and meta-analysis Unusual causes of stroke are multiple and hence not uncommonly seen, typically in young stroke patients. Takayasu’s arteritis is a rare P. Talwar, S. Misra, A. Rai, A. Mishra, A. Kumar, A.K. Pandit, K. Prasad, vasculitis typically affecting young women, with occasional neuro- D. Vibha logical presentation. Here we present case series of 4 patients with All India Institute of Medical Sciences, Department of Neurology, Takayasu’s Arteritis with a varied neurological presentation. New Delhi, India Case 1: 18 years old female presented with recurrent TIA’s since 7 months, sudden vision loss in left eye 5 months back and acute Background painful diminution of vision of right eye since 1 month. Spontaneous intracerebral hemorrhage (ICH) is a devastating Case 2: 26 years old primigravida, previously healthy, presented stroke subtype.The proteolytic effects of MMPs are dampened by at term with catastrophic headache and drowsiness. ARTICLE IN PRESS

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serologicalmarkersforANA,antimi-2 and p-ANCA and had additional Case 3: 48 years old male patient presented with history of 3 evidence of optic neuritis. Case 2 had presented with accelerated stroke events in past 1 year. hypertension at term pregnancy with intracerebral bleed and also had Case 4: 22 years female presented with a 3 days history of evidence of venous sinus thrombosis. Case 3 was a 48 year old male with recurrent syncopal attacks. type 1 aortoarteritis conﬁrmed on imaging. Case 4 presented with recurrent syncopal episodes due to subclavian steal phenomenon. Results I have obtained patient and/or Institutional Review Board approval, as necessary. An Institutional Review Board and /or Animal Use Committee Conclusion have waived the requirement for their formal approval of the study. Here we have presented 4 cases with varied and rare neurologic presentations and associations of Takayasu’s arteritis. Case 1 had positive doi:10.1016/j.jns.2019.10.696 ARTICLE IN PRESS

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WCN19-1835 WCN19-1842

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Part I/stroke/training in neurology - Part I and traumatic brain injury injury

Vascular territory (anterior vs posterior circulation) can inﬂuence Chronic kidney disease is associated with hematoma retraction in outcome after thrombolysis? patients with intracerebral hemorrhage

M.Y. Euna, J.H. Hanb, I. Jungc, S.H. Leec, J.M. Jungc I. Iwuchukwua, L. Cannizzaroa, V. Tranb, S. Alirezab, D. Arroyob,M. aSchool of Medicine- Kyungpook National University Chilgok Hospital, Talahamaa, H. McGradea Neurology, Daegu, Republic of Korea aOchsner Medical Center, Neurocritical Care- Neurology- Neurosurgery, bAsan Medical Center, Neurology, Seoul, Republic of Korea New Orleans, USA cKorea University Ansan Hospital- Korea University College of Medicine, bOchsner Medical Center, Institute of Translational Research, New Neurology, Ansan, Republic of Korea Orleans, USA

Objectives Introduction It is still inconclusive that stroke of vascular territory (anterior vs. Chronic kidney disease (CKD) is associated with an increased risk posterior circulation) could influence the effect of thrombolysis due of bleeding due to coagulation disorder and platelet dysfunction. In to lack of randomized controlled trial regarding this. this study we tested the hypothesis that CKD is associated with an increased hematoma expansion (HE) in patients with intracerebral Methods hemorrhage (ICH). Using 3 university hospital-based registry (Anam, Guro and Ansan), we investigated the safety and efficacy of intravenous (IV) Methods and/or intra-arterial (IA) thrombolysis according to vascular terri- We retrospectively reviewed our ICH database from November tory. Symptomatic intracranial hemorrhage (sICH), mortality, and 2012 to December 2017 and collected data on demographics, clinic- favorable functional outcome at 3 month (modified Rankin scoreb2) radiological characteristics and discharge disposition. We calculated were evaluated. ICH volume using the ABC/2 formula. We defined CKD as a glomerula filtration rate b30 mL/min/1.73 m2;HEasN30% increase in Results hematoma volume on repeat 24-hr neuroimaging; home and acute A total of 767 patients enrolled from 2007 to 2018, were classified rehab discharge as good disposition. Chi-square and t-tests used for into 643 for anterior and 124 for posterior circulation. IV thrombol- statistical analysis were appropriate. ysis was undertaken to 648 patients (538 for anterior and 110 for posterior) and IA thrombolysis including chemical thrombolysis and Results endovascular thrombectomy was 119 patients (105 for anterior and 548 patients with ICH were included and 76 patients met the 14 for posterior). For IV thrombolysis, the posterior stroke group had criteria for CKD. Demographics did not differ between groups. a similar tendency toward a risk of sICH [Relative Risk (RR) 0.64, 95% Hypertension, diabetes mellitus, congestive heart failure and confidence interval (CI) 0.22–1.85) for NINDS criteria, 0.82 (0.10- infratentorial ICH were significantly higher in the CKD group. ICH 7.01) for ECASS II, 0.46 (0.11-1.97) for ECASS III and 0.51 (0.12-2.20) volume did not differ between groups (27.7ml SD 46.6 vs 34.9ml SD for SITSMOST. Favorable outcome and mortality was similar (1.41, 45.1 p = 0.214). Frequency of HE did not differ between groups 0.93–2.15 and 0.44, 0.13-1.47). This trend corresponded to IA (15.4% vs 17.8% p = 0.835). However mean percentage change in thrombolysis; sICH [(0.54, 0.07–4.51) for NINDS criteria, 0.82 (0.10- ICH volume (−16% SD 0.61 vs 14.6% SD 1.76 p = 0.009) and 7.01) for ECASS II, and 0.73 (0.09-6.18) for SITSMOST], favorable frequency of hematoma retraction (66.2% vs. 51.2% p = 0.08) outcome (1.44, 0.46–4.46), mortality (1.08, 0.22-5.36) and recanali- suggested a tendency towards hematoma retraction in the CKD zation rate (1.35, 0.42-4.30). group. The CKD group were less likely to have a good discharge disposition (6.8% vs 93.2% p = 0.016). Conclusions Posterior stroke is not different from anterior circulation in terms Conclusion of safety and efficacy after thrombolysis according to thrombolysis In our cohort, CKD was not associated with a larger frequency of modality. However, further large scale studies is needed due to HE. On the contrary, hematoma retraction was observed at follow up limitations of this observational study. neuroimaging. doi:10.1016/j.jns.2019.10.697 doi:10.1016/j.jns.2019.10.698 ARTICLE IN PRESS

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WCN19-1843 A. Alkhotania, N. Alrishib, W. Alzahranic, M. Alharthid aUmm Alqura University/King Abdulla Medical City, Medicine/ Neurology, Makakh, Saudi Arabia Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain bKing Abdulla Medical City, Neurology, Makkah, Saudi Arabia - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ cKing Abdullah Medical City, Neurology, Makkah, Saudi Arabia stroke/training in neurology - Part I and traumatic brain injury dUmm Alqura University, Medicine/Neurology, makkah, Saudi Arabia

Analysis of the effectiveness of the organization of anti-stroke Introduction services in Uzbekistan according to the register Rivaroxaban is one of the noval anticoagulant therapy. It act by direct factor Xa inhibition. It is started to be used frequently in due Z. Abdullaeva, Y. Madjidovaa, K. Maksudovaa, N. Mavlyanovaa,S. to the convenience in being administered as once daily and doesn’t Shoxyusupovb need monitoring. The aim of this study is to review the cases of aTashkent Pediatric Medical Institute, Neurology- Pediatric Neurology Rivaroxaban associated intracranial hemorrhage and their and Medical Genetics, Tashkent, Uzbekistan outcomes. bTashkent Pediatric Medical Institute, Neurology- Pediatric Neurology nd Medical Genetics, Tashkent, Uzbekistan Method We reviewed the electronic charts for all patients on Rivaroxiban Relevance between 2014 and 2018. Cases with intracranial hemorrhage fi The stroke register is the optimal method for determining the identi ed. Charts were reviewed for demographic data, neurological fi morbidity, mortality and effectiveness of the organization of an anti- presentation, radiological ndings and the outcomes. stroke service Result fi Objective Out of 696 patients on Rivaroxiban, ve cases (0.7%) of fi To analyze the system of medical care for patients with acute intracranial hemorrhage identi ed. Median age was 62. Four cases cerebrovascular accident in Uzbekistan in the first quarter of 2019, were intracerebral hemorrhage and one was subdural hematoma. according to the register, with the subsequent improvement of the Two patients scored 3 on HAS BLED Score. None had major bleeding system of prevention and patient care from other sites. One patient had hematoma expansion and 2 required surgical intervention. None of the patients received Materials-methods antidote. One patient died as a complication of intracranial The stroke register in the first quarter of 2019 was carried out by hemorrhage. the population-territorial method according to the questionnaire of the national stroke register for patients over 18 years of age. All new Conclusion and repeated cases of cerebral stroke, developed during the The incidence of Rivaroxiban associated intracranial hemorrhage fi observation period of permanent residents of the Republic of is low. No signi cant hematoma expansion is noted with it. HAS Uzbekistan and all deaths from cerebral stroke were registered BLED Score in our study did not relate with the development of intracranial hemorrhage. Results 11353 new cases were identified. The first medical examination doi:10.1016/j.jns.2019.10.700 was performed in 69.2% of cases by an ambulance doctor, in 20.1% by a general practitioner, in 6.1% by a emergency room doctor and in 4.6% by a neurologist in an outpatient clinic. 78.6% of patients were hospitalized, of those hospitalized 74.4% - in the first 6 hours from WCN19-1847 the time of development, 25.6% after. Mortality rate was 19.4% Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Findings pain - Part I/sleep disorders - Part I/stem cells and gene therapy - 1. The necessity of the implementation of preventive measures on the basis of the cerebral stroke register, which showed a high Part I/stroke/training in neurology - Part I and traumatic brain prevalence of the disease, low public awareness of the stroke injury and the delayed therapy 2. The study allows us to develop a scientifically-based prognosis Pain reducing properties of the Mollii suit on adults with chronic and evaluate the effectiveness of the activities of treatment- pain syndromes and-prophylactic institutions for the treatment and prevention of cerebral stroke N. Riachia, G. Khazena, R. Ahdaba, S. Jörgenb aLebanese American University School of Medicine, Neurology, doi:10.1016/j.jns.2019.10.699 Achrafieh, Lebanon bMetier Medical, Clinical Director, Cessnock, Australia

Background WCN19-1844 The Mollii suit, a garment with 58 built in electrodes, provides transcutaneous electrical stimulation to selected regions across Poster shift 01 - Channelopathies/neuroethics/neurooncology/pain the body. The stimulation induces pain inhibiting mechanisms in the central nervous system (CNS) and affects neurohormonal levels, - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/ leading to modulation of the CNS through activation of sensory stroke/training in neurology - Part I and traumatic brain injury afferent pathways. It is an approved non-pharmacological, non- invasive treatment to reduce spasticity and improve motor function Rivaroxiban associated intracranial hemorrhage in atrial ﬁbrilla- in individuals with CNS lesions. Anecdotal evidence shows beneﬁtin tion patients individuals with chronic pain syndromes. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 139

Aim of admission. Samples were grouped according to BMI-Low (b30) v Investigate the Mollii Suit effect on pain in adults with different BMI-High (N30). Total RNA containing small RNA were isolated from pain diagnoses. Paxgene Blood RNA samples and used to profile 2,515 known miRNA using uParaflo Microfluidic Biochip. Gene expression was carried out Methods using RNAseq and EgdeR. Gene set enrichment analysis (GSEA) for An open-label uncontrolled study included 200 adults (75 males KEGG pathways and Gene Ontology (GO) were done using GAGE and and 115 females) who used miRWalk 2.0. Mollii suit therapy for one-hour. 72 were diagnosed with Fibromyalgia, 29 with Parkinson, Results while other diagnosis had a frequency b 20. Patients were asked In plasma, we found 23 highly expressed miRNA, 11 of which to fill a Visual Analogue were downregulated in BMI-H. GSEA for KEGG pathways and GO Scale (VAS) just before the intervention (VAS-0), immediately showed enrichment for protein translation and ribosome biogenesis afterwards (VAS-1) and twenty-four hours (VAS-24) later. for upregulated genes in BMI-H. Conversely, GSEA of downregulated genes in BMI-H favored inflammation and recruitment of cytokines Results and signaling. Importantly, KEGG pathway analysis identified TNF VAS-0 was 6.5±1.24. A highly significant drop was noted in VAS- signaling and cytokine-cytokine receptor interaction. However, pro- 1 (3.46±1.4) and VAS-24, (4.72±1.68), paired test p-values b0.001. inflammatory cytokines were higher in BMI-H vs BMI-L, notably A mixed-effect model, used to assess VAS change while CXCL1, MMP-9, PF4V1, IL-18R1. controlling for sex, age, and diagnosis type, showed a significant drop in VAS-1 and VAS-24. The VAS-1 coefficient was -3.036 (p- Conclusion valueb0.001) while the VAS-24 coefficient -1.789 (p-valueb0.001). In our study, there was a paradoxical lower expression of pro- The results were not affected by patients’ diagnoses, age or sex. inflammatory genes in BMI-H compared to BMI-L. However, protein levels were higher in BMI-H suggesting a possible epigenetic effect Conclusion from miRNA expression. Wearing the Mollii suit for 1 hour demonstrated significant subjective improvements in VAS scores. Placebo controlled studies doi:10.1016/j.jns.2019.10.702 are needed to further prove the efficacy of Mollii suit in treatment of pain. doi:10.1016/j.jns.2019.10.701 WCN19-1857

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ WCN19-1850 pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain injury Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - A-hospital-based study of hyper-acute stroke in young from Part I/stroke/training in neurology - Part I and traumatic brain Teaching Hospital of Jaffna, Sri Lanka injury S. Kunathilagama, A. Keshavarajb, N. Prathabanb, S. Pratheepanb BMI-intracerebral hemorrhage paradox: The role of inﬂammatory aNorthern Central Hospital, Neurologiy Unit, Jaffna, Sri Lanka cytokines and microrna proﬁle bTeaching Hospital of Jaffna, Department of Neurology, Jaffna, Sri Lanka

a b b b c I. Iwuchukwu , V. Tran , L. Traina , D. Nguyen , O. Sulaiman Objectives a Louisiana State University New Orleans, Neurology and Neurosciences, To describe the profile of young hyper-acute strokes (HAS) New Orleans, USA admitted in Teaching Hospital-Jaffna. bOchsner Medical Center, Institute of Translational Research, New Orleans, USA Method c Ochsner Medical Center, Institute of Translational Research- Neurosur- This descriptive study was conducted at Teaching Hospital, Jaffna. gery, New Orleans, USA Data on young (15-45 years) HASs, who fulfilled the WHO’s stroke definition, admitted between January-August 2018, were extracted Introduction from the Stroke registry and analyzed. Obesity, classified as BMIN30.0, is a known risk factor for cardiovascular disease. Obesity is associated with a chronic inflam- Results matory state due to increased adiposity. In this study, we compare Totally 333 strokes (mean age: 67.34 ± 13.87), consists of 192 circulating miRNA profile and expression pattern with inflammatory males and 141 females, showing male preponderance were recorded. cytokines in patients with and without obesity following acute Among all, 6% (20) were young HASs ranging from 15-45 years intracerebral hemorrhage (ICH). (mean: 37.75 ± 7.63). Male: female ratio among young strokes was 3:2 with mean age of 35.66 (±8.76) and 40.87 (±3.75) years Methods respectively. Among the presenting symptoms reported, hemiparesis After informed consent, patients with acute spontaneous ICH (95%) was the commonest followed by speech disturbance (60%). (n=16) were consented and blood samples collected within 48 hrs Modified Rankin Score (MRS) on admission was b3 in 65% (13) and ARTICLE IN PRESS

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≥3 in the rest. Except for two, others were on anticoagulants on Conclusions admission. Hypertension was the commonest risk factor, present in Successful rate of emergency CAS (95.6%) and intracranial EVT 65% (13); among them, 38.4% (5) were newly diagnosed. Unsafe after IV-tPA (69.5%) were high. The good functional outcome (mRS alcohol consumption, consumption of alcohol more than 14 units per 0-2) was 46.7% in patients treated with emergency CAS and the week, and smoking were not reported significantly. Of all, 19.05% (4) overall clinical outcome would be acceptable. reported diabetes, 9.5% (2) had past history of stroke and none had ischemic heart diseases. CT findings demonstrated infarction in all doi:10.1016/j.jns.2019.10.704 patients which developed into hemorrhagic infarction in 20% (4). No Carotid stenosis was reported. Further, of all young cases, only 10% (2) underwent thrombolysis fulfilling NIHS thrombolysis criteria. WCN19-1865

Conclusion Ischemic stroke was reported by all young HASs; however, only Poster shift 01 - Channelopathies/neuroethics/neurooncology/ 10% were eligible to undergo thrombolytic therapy. Further mea- pain - Part I/sleep disorders - Part I/stem cells and gene therapy - sures are required to control hypertension (major risk factor) in our Part I/stroke/training in neurology - Part I and traumatic brain study group. injury doi:10.1016/j.jns.2019.10.703 Unusual presentation of ﬁbromuscular dysplasia presented with hand knob syndrome associated with ipsilateral proximal internal carotid atherosclerotic stenosis

WCN19-1858 M. Alshanqiti, S. Alzahrani King Fahad General Hospital- Ministry of Health, Neurology, Jeddah, Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Saudi Arabia pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Background Part I/stroke/training in neurology - Part I and traumatic brain Fibromuscular dysplasia (FMD) is a noninflammatory, non- injury atherosclerotic arteriopathy of medium-sized arteries affecting less than 1% of the population. Few case reports studies revealed that Feasibility for extracranial carotid artery stenting in acute ipsilateral atherosclerosis of the carotid artery bifurcation may be ischemic stroke patients after IV-TPA treatment present in only 20% of individuals with more distal carotid FMD, otherwise we could not find any clear association between FMD and E.G. Kim, J.W. Seo carotid atherosclerotic disease. Pusan Paik Hospital-Inje University, Neurology, Busan, Republic of Korea Methods Background and aims Case report Emergent CAS in AIS patients receiving IV-tPA who have extracranial occlusion is a big hurdle because adequate antiplatelet Clinical history treatment was not recommended within 24 hours after IV-tPA. We A 62-year-old female Presented with history of sudden isolated were concerned about in-stent thrombosis or occlusion. Therefore, left hand weakness for 4 days with normal sensation and no vascular we evaluated the safety of emergent CAS in AIS patients receiving IV- risk factors. tPA. MRI diffusion sequence of the brain confirmed the presence of acute local infarction of the right cortical motor area. CTA showed Methods severe luminal narrowing around 70% involving the proximal We analyzed single-center registry data retrospectively from segment of the right ICA. Conventional angiography performed one 2006 to 2018. Emergent CAS was performed as an endovascular week later, and Successful stenting of the right proximal ICA was treatment (EVT) in patients with extracranial carotid artery occlu- done with evidence of multiple arterial beads suggesting an sion. IV-tPA was given to patients who arrived within 3 hours or 4.5 underlying FMD. hours since the onset of symptoms. All patients didn’t take antithrombotics as a preparation within 24 hours of receiving IV-tPA. Conclusion Fibromuscular dysplasia affecting the extracranial carotid artery Results is still not a well-elucidated disease process. Concurrent severe Among 177 consecutive patients with AIS treated with IV-tPA and atherosclerosis at the carotid bifurcation poses a unique treatment EVT, twenty-three (12.9%) patients underwent emergent CAS. dilemma. The development of cerebral ischemia may necessitate Eighteen patients (78.3%) had tandem occlusions. Successful CAS mechanical treatment of the offending lesion. However, it is not was done in 22 patients (95.6%) except for one patient and multiple always possible to determine which of the 2 concurrent lesions is carotid stent was implanted in two patients due to carotid dissection. causing the cerebral symptoms. We present an unusual case of FMD Embolic protection device was used in 13 patients. 4 patients concomitant with ipsilateral atherosclerotic ICA stenosis which was experienced thromboembolic complications, such as in-stent throm- treated successfully with endovascular stenting with no complica- bosis and distal migration of emboli during the procedure. Final tions. We recommend further studies to determine the association recanalization was successful (mTICI 2b-3) in 16 patients (69.5%). between FMD and carotid atherosclerotic diseases. Eleven patients (47.8%) had good functional outcomes at 3 months (modified mRS 0-2). Intracranial hemorrhage occurred in 4 cases. doi:10.1016/j.jns.2019.10.705 There were 2 mortality cases. ARTICLE IN PRESS

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WCN19-1868 WCN19-1876

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Part I/stroke/training in neurology - Part I and traumatic brain injury injury

Fever, hyperglycaemia, swallowing and hypertension manage- Aberrant origin of vertebral artery; a case report ment in acute stroke: A cluster randomized controlled trial under Indian stroke research network: A study protocol S. Esmaeili, M. Bahadori, M. Mehrpour, F. Shojaei Iran University of Medical Sciences, Neurology, Tehran, Iran A. Raia, P. Dheera, A. Kumara, S. Misraa, P. Talwara, D. Joshib, S.P. c d e e f a Gorthi , S. Sharma , S. Desai , V. Patel , B.K. Roy , A.K. Pandit ,D. The vertebral arteries (VA) are important arteries of the neck, a a g h a Vibha , A.K. Srivastava , S.N. Dwivedi , A. Gulati , G. Shukla ,K. which typically originate from the posterosuperior of the ﬁrst part of a Prasad subclavian artery. Each vessel ascends posterior to the internal a All India Institute of Medical Sciences, Neurology, New Delhi, India carotid artery and inside the skull and merge to form the basilar b Banaras Hindu University, Neurology, Varanasi, India artery at the base of the pons. There are variations in the course, size c Kasturba Medical College, Neurology, Manipal, India and origins of the VA. This artery is a common target for vascular d North Eastern Indira Gandhi Regional Institute of Health and Medical surgeries or diagnostic procedures in head and neck region hence it Sciences, Neurology, Shillong, India is crucial to be aware of possible origins and courses of VAs when e Pramukhswami Medical College, Neurology, Anand, India they are not found in their normal place. f Bangur Institute of Neurosciences, Neurology, Kolkata, India Herein we present a 39-year-old woman who was a case of VA g All India Institute of Medical Sciences, Biostatistics, New Delhi, India dissection and on contrasted angiography it was incidentally found h All India Institute of Medical Sciences, Clinical Epidemiological Unit, that the right VA originated from right common carotid artery New Delhi, India (CCA), and the left VA from aortic arch. This is a very rare variation. Few numbers of Right VA originated from right CCA has Background been reported before, and aortic arch as the origin for left VA is a Of all the interventions in acute stroke, the widest applicable and well-known variation, though coincidence of these two variations effective could be management of fever, sugar, swallowing, and is rare. hypertension (FeSSH). doi:10.1016/j.jns.2019.10.707 Objective To evaluate the impact of a multidisciplinary team-building intervention designed speciﬁcally to improve evidence-based management of fever, hyperglycemia, hypertension and swallowing in WCN19-1878 patients following acute stroke within 48 hours of onset.

Method Poster shift 01 - Channelopathies/neuroethics/neurooncology/ In a pilot study, 12 hospitals (six district and six medical colleges) pain - Part I/sleep disorders - Part I/stem cells and gene therapy - across the India will be randomized into two groups: Intervention Part I/stroke/training in neurology - Part I and traumatic brain and control in a 1:1 ratio in parallel group randomized open label injury multicentric study with blinded endpoint evaluation in India. Hospitals in the intervention arm will receive two multidisciplinary Intravenous thrombolysis for acute ischemic stroke due to workshops, two standard educational programs and those in the cardiac myxoma control group will be forwarded, a copy of subsection of FeSSH guidelines. The primary outcome of the study is proportion of S. Esmaeili, M. Bahadori, M. Mehrpour patients above 38°C in the first 72 hours following admission to the Iran University of Medical Sciences, Neurology, Tehran, Iran hospital, Secondary outcome is a mean blood glucose level for the first 72 hours following admission, swallowing dysfunction as Myxoma may cause systemic embolization and frequently measured by swallowing screening undertaken within the first 24 presents as ischemic stroke. There has been debates whether it is hours of admission to the hospital, telephonic mRS at day 90, in- safe to use r-TPA in patients with underlying cardiac myxoma who hospital mortality and day 90 mortality. In the main phase of the are presented with ischemic strokes at emergency department. we study 16 medical colleges and 16 government hospitals will be describe a case of atrial myxoma with initial presentation of acute involved to achieve the final sample size of 1208 subjects. cerebral infarction symptoms. He was treated with intravenous rt-PA at with no complications. Cardiac Surgery was performed with no Discussion complications on the fourth day of his admission. was discharged This is the first study to determine the effects of Indian, Quality with MRS of 0.Follow ups showed overall improvement in his general Improvement in stroke care to bridge the evidence–based gap in function. management of stroke in Indian population.

doi:10.1016/j.jns.2019.10.708 doi:10.1016/j.jns.2019.10.706 ARTICLE IN PRESS

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WCN19-1881 showed up an Acute DWI positive restriction with ADC mapping in medulla, suggestive of an acute brainstem infarct. The clinical dilemma was to start high dose Aspirin for two Poster shift 01 - Channelopathies/neuroethics/neurooncology/ weeks, as per the NICE Stroke guidelines, but the BNF advises this to pain - Part I/sleep disorders - Part I/stem cells and gene therapy - be avoided whilst breast feeding due to the possible risk of Reye’s Part I/stroke/training in neurology - Part I and traumatic brain syndrome and other potential side-effects, especially in higher doses. injury Further, the safety of other licensed antiplatelet drugs, used in acute stroke disease is not established in breast feeding mothers, and the Multiple intracerebral hemorrhage as initial presentation of manufacturers’ advice is to avoid them. There is not much of data acute leukemia: A case report available to define the cause-effect relationship between aspirin intake and Rye’s syndrome and the overall incidence of Reye’s fi L.E. Quiles, J.J. Tiongson syndrome has signi cantly declined in the UK from a hundred in The Medical City, Neurology, Pasig City, Philippines 1984 to only one reported in 2002. Certainly, the risk of Reye's syndrome from salicylate in breast milk is unknown. In view of this prescribing dilemma, we took a balanced Intracerebral Hemorrhage had been a harbinger of morbidity and approach, after weighing the potential risk/benefits and explaining mortality in patients diagnosed with hematologic malignancy. them to the patient. Certainly, this area requires more research which Spontaneous Intracerebral hemorrhage prior to diagnosis is Leuke- could eventually be incorporated in the national guidelines. mia however, is very rare and to our knowledge, only 6 have been reported. This is a case of a 21-year-old female, who was rushed to the doi:10.1016/j.jns.2019.10.710 emergency department due to decrease in sensorium. Patient had no significant headaches, no signs of increased intracranial pressure, and no signs of bruising or bleeding prior. Plain cranial CT scan revealed multiple intracerebral Hemorrhages of at least 18 in WCN19-1891 number. The Results of cytology revealed Acute Myeloid Leukemia. Several factors from previous comprehensive studies have been Poster shift 01 - Channelopathies/neuroethics/neurooncology/ highlighted to increase the risk of Intracerebral Hemorrhage amongst these populations. Approximately 5% of patients with Acute leukemia pain - Part I/sleep disorders - Part I/stem cells and gene therapy - will develop intracerebral hemorrhage and predictors for mortality Part I/stroke/training in neurology - Part I and traumatic brain have different in reported studies. Hyperleukocytosis is a strong injury consideration for increased mortality, the level of which still undetermined due to lack of literature. Although a probable associa- Cerebral venous thrombosis due to hereditary anti Thrombin III tion between Hyperleukocytosis and survival has been theorized, deficiency there is still insufficient data to conclude with certainty. More case reports or retrospective studies are needed so that an association may A.V. Valappila, K.A.S. Nahaa, R. Kizhedathb, K. Puthusserib be established that can help in acute management of these patients. aMeitra Hospital, Neurology, Kozhikode, Kerala, India bMeitra Hospital, Radiology, Kozhikode, Kerala, India doi:10.1016/j.jns.2019.10.709

Hereditary anti thrombin III (AT III) deficiency is usually associated with increased risk of venous thrombosis and pulmonary embolism. Cerebral venous thrombosis (CVT) is a rare manifestation. WCN19-1885 We report a case of hereditary AT III deficiency causing cerebral vein thrombosis in 3 members of a family. Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Case report A 29 year old unmarried lady presented with 1 week history of Part I/stroke/training in neurology - Part I and traumatic brain severe headache and neck pain. Examination was unremarkable injury except for mild papilloedma. A contrast MRI and MRV revealed acute thrombosis involving left transverse, sigmoid sinuses and internal Antiplatelets – to prescribe or not to prescribe in lactating jugular veins. All relevant blood investigations were normal except for mother with acute ischaemic stroke low antithrombin III activity –46% {normal: 80-120}. Her mother had 2 thrombotic events, one episode of cerebral vein thrombosis and one M. Moqsitha, A. Raoofa, H. Barotb, K. Ayesa episode of probable renal artery thrombosis and she is asymptomatic aKettering General Hospital NHS England, Stroke Medicine, Kettering, now. Her AT III level was low-51%. Her sister had an episode of cerebral United Kingdom vein thrombosis during post-partum period and her AT III level was bKettering General Hospital NHS England, General I Medicine, Kettering, also low – 56%. Genetic study done in the index patient showed United Kingdom compound heterozygous mutation of SERPINC1 gene confirming the diagnosis of hereditary AT III deficiency. She recovered well with We present a case of 30year old, 10 days post-delivery of a anticoagulation and was advised to continue it lifelong. healthy child and having had an uncomplicated pregnancy. There is no previous history of venous thromboembolic disease or miscar- Conclusions riages or any cardiovascular risk factors. She presented with acute Evaluation for hereditary thrombophilia should be done in unilateral focal neurological symptoms associated with speech patients with cerebral venous thrombosis especially if there is a disturbance. A clinical possibility and likelihood of Cortical Venous family history of venous thromboembolism or unprovoked CVT. Thrombosis was suspected at this stage, but an urgent MRI/MRV scan Diagnosing these conditions is important in planning anticoagulation ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 143 and proper counselling of asymptomatic family members regarding control brain imaging revelead growing lesion and contrast enhance- prophylaxis for VTE in high risk situations. ment. He had undergone operation and diagnosed as GBM. doi:10.1016/j.jns.2019.10.711 Case 2 A 63-year-old male patient was observed with seizures when he evaluated in the emergency department because of blurring of consciousness. Diffusion restriction was observed in the medial of left WCN19-1893 temporal lobe. He hospitalized with the diagnosis of encephalitis and started treatment. The patient's cerebrospinal fluid HSVtype2 IgM was positive. After evaluating the atypical contrast enhancement on Poster shift 01 - Channelopathies /neuroethics /neurooncology / control MRI (Fig. 2) the patient was operated and diagnosed as GBM. pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain Conclusion injury In the first case, the patient who presented with acute onset encephalitis clinic was diagnosed with GBM in our follow-up, while Acute viral ensefalitis and glioblastoma multiforme; 2 case in the second case the presence of concurrent GBM was noted of the fi reports patient who was diagnosed with de nite encephalitis by viral markers. For evaluation of patients with encephalitis, high-grade brain tumors should be considered for bearer and additional G. Akdag, F. Akkoyun Arıkan, M. Guler, M. Cetiner, S. Canbaz Kabay diagnosis and followed up clinically/radiologically. Kutahya University of Health Sciences, neurology, Kutahya, Turkey doi:10.1016/j.jns.2019.10.712 Introduction Viral encephalitis is an acute febrile disease, manifested by changes in consciousness, focal neurological findings, and seizures, causing damage to the parenchymal tissue of the central nervous system. Glioblastoma multiforme (GBM) is the most malignant WCN19-1927 astrocytic tumor that is mostly supratentorial, multifocal/multicentric, with low differentiation, vascular proliferation, necrosis, Poster shift 01 - Channelopathies /neuroethics /neurooncology / fi and intense in ltration into surrounding tissues. pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain Case 1 injury A 55-year-old male patient was evaluated in the emergency department due to a sudden onset of consciousness change and fi behavior disorder. Leukocytosis and T2-FLAIR hyperintense lesion in Evaluation of neuroprotective effects of sa namide in experi- the left temporal lobe were detected (Fig. 1). LP couldn’t be performed mental model of ischemic stroke because it was not allowed. The patient improved with treatment. The ARTICLE IN PRESS

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H. Wasana, D. Singha, B. Joshia, U. Sharmab, N. Jagannathanb, K. Reetaa with the approval of Institute Ethics Committee and after obtaining aAll India Institute of Medical Sciences, Pharmacology, Delhi, India written informed consent from the study participants. The average bAll India Institute of Medical Sciences, Nuclear Magnetic Resonance, power spectral density of all channels revealed higher spectral Delhi, India power (expressed as μV2/Hz) in the theta band (5-7 Hz frequency range) for the patient group (1.901 ± 1.687) when compared with Background that of the control group (1.559 ± 0.812). Lower spectral power in Ischemic stroke is a leading contributor to morbidity and the alpha band (8-12 Hz frequency range) was also noted in the mortality worldwide. Developing more effective approaches for patient group (3.401±3.624) when compared to the control group prevention and therapy is a key objective in stroke research. (4.864±4.173). The limitation in sample size may have been the Inhibiting voltage gated sodium and calcium channels by safinamide reason for not obtaining statistical significance (p value = 0.485 for may be critical in constraining glutamate release after stroke. Hence, theta power comparison and p value = 0.314 for alpha power this study was planned to evaluate neuroprotective effects of comparison) for the differences noted between the two groups. safinamide in experimental model of ischemic stroke. Although the data obtained from power spectra of EEG is not confirmatory, increased theta activity and decreased alpha activity Materials and methods may underlie the pathophysiological mechanisms involved in In male Sprague Dawley rats (260-290g), middle cerebral artery chronic neurogenic pain. was occluded (MCAo) for 90 minutes using silicon coated monofil- ament (Doccol suture). Safinamide (20, 40 & 80 mg/kg) was administered at two time points, 10-15 minutes after occlusion and Keywords: Neurogenic pain, EEG, Power spectra, Theta activity, 10-15 minutes after reperfusion in 2 divided doses. After 24 hr, Alpha activity battery of neurobehavioral examinations like neurological deficit score (NDS), motor-incoordination by grip strength and rota rod Abbreviations: EEG=electroencephalography were carried out. Rats were sacrificed; 2 mm thick coronal brain sections were stained with TTC to estimate% infarct damage.

doi:10.1016/j.jns.2019.10.714 Results NDS was significantly high in MCAo rats. Treatment with safinamide significantly (pb0.05) reduced NDS at 80 mg/kg when compared to MCAo. Motor incoordination as assessed by decreased time spent on rota rod and higher grip strength value were WCN19-1939 normalised significantly (pb0.05) with safinamide 80 mg/kg dose. fi b TTC staining revealed signi cantly (p 0.05) reduced infarct size with Poster shift 01 - Channelopathies /neuroethics /neurooncology / safinamide (19.74 ± 2.72% of ipsilateral area) as compared to MCAo pain - Part I /sleep disorders - Part I /stem cells and gene therapy - group (38.35% ± 3.4%). Part I /stroke /training in neurology - Part I and traumatic brain Conclusion injury Safinamide improved neurobehavioral outcome and infarct damage after ischemic stroke when given immediately after Non stenotic carotid plaque and embolic stroke from reperfusion. The results suggest the neuroprotective potential of undeterminated source (ESUS): Is there a link ? safinamide in ischemic stroke model M. Nagazi, N. Daoussi, M. Aissi, M. Frih Ayed doi:10.1016/j.jns.2019.10.713 Tunisia, Fattouma Bourguiba University Hospital Monastir Tunisia, Monastir, Tunisia

Background WCN19-1938 Recent data have suggested anticoagulation is no better than antiplatelet therapy in preventing stroke recurrence in patients with embolic stroke from undetermined source (ESUS). This argues Poster shift 01 - Channelopathies /neuroethics /neurooncology / against the cardioembolic mechanism of ESUS and suggests a pain - Part I /sleep disorders - Part I /stem cells and gene therapy - possible role of non-stenotic carotid plaque as a mechanism of Part I /stroke /training in neurology - Part I and traumatic brain stroke in these patients. injury Aim Theta dominance in the power spectra of eeg in chronic To determine if non-stenotic carotid plaque is associated to neurogenic pain ipsilateral ESUS rather than cardiac source of embolism (CE)

J. Rajana, G.S. Gaura, S. Karthika, S. Adinarayananb Methods aJIPMER, Physiology, Puducherry, India Consecutive adults admitted to the department of neurology of bJIPMER, Anesthesiology, Puducherry, India Monastir university hospital during the year 2018 with acute anterior circulation infarcts were included if they met criterion of To identify the theta over activity in power spectra of EEG in ESUS or cardiac source of embolism (CE) according to the ﬁ chronic neurogenic pain patients, spectral analysis of resting EEG of modi ed TOAST criteria. The primary outcome was the presence the patients (n=15, 41-64 years, median 48 years, 6 men) in the of carotid plaque less than 50% luminal narrowing in routine eye closed state was compared with that of healthy controls carotid duplex ultrasonography and was compared between ESUS (n=15, 39-62 years, median 48 years, 6 men). The study was done and CE. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 145

Results immunocompromised individuals. We wanted to discuss the case Among 139 patients, 53 were included. The diagnosis of ESUS was of PML, which is thought to be related to Rituksimab use. retained in 38 (27.3%) patients and cardio-embolism in 20 (14.3%). Carotid duplex ultrasonography showed non-stenotic plaque in 16/ Case 38 (42,1%) patients with ESUS and 3/20 (15%) with CE (pb0,04). In A 61-year-old female patient presented with complaints of comparison of ESUS and CE, there were no significant differences in generalized condition disorder and blurring of consciousness. The gender, risk factors and stroke severity. Patients in the ESUS group patient was diagnosed with Bcell-lymphoma six months ago and were younger (pb0,05) and had more non-stenotic carotid plaque received Rituksimab 600mg, Cyclophosphamide1200mg, Adriamisin (OR=4,12; IC95%; 1.09-15,54). 80mg Vincristine 2mg. In his neurological examination; consciousness was drowsy, the eyes opened with tactile stimulus, non- Conclusion cooperative,localizing the painful stimulus with upper extremities. Our data suggest that non-stenotic carotid plaque may be an On the magnetic resonance imaging (MRI), diffuse T2/FLAİR important source of embolism in patients with ESUS. hyperintense lesions without Gd enhancement (Figs. 1,2). The protein levels were mildly elevated on cerebrospinal fluid (CSF) doi:10.1016/j.jns.2019.10.715 examination. With history, clinical and MRI findings PML was considered. JCV was determined by polymerase chain reaction (PCR) in CSF, but no virus was detected in CSF. A stereotaxic brain biopsy planned but couldn’t sent to a biopsy because the patient was WCN19-1947 intubated due to respiratory failure. Five sessions of plasmapheresis applied the patient with the diagnosis of PML with no response to treatment, and patient died. Poster shift 01 - Channelopathies /neuroethics /neurooncology /pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / Discussion stroke /training in neurology - Part I and traumatic brain injury The diagnosis of PML can be made by showing JCV in cerebrospinal fluid, by neuroimaging and histopathological findings. Progressive multifocal leukoencephalopathy due to Rituximab Stereotaxic biopsy is recommended for those who can’t show JCV by use CSF PCR. The association of monoclonal antibodies with PML has been reported in the literature. Rituximab-dependent PML were fi F. Arıkan, G. Akdag, O. Temel, M. Cetiner, S. Canbaz Kabay considered in our case with clinical and imaging ndings. Because ’ fi Kutahya University of Health Sciences, neurology, Kutahya, Turkey stereotaxic-biopsy couldn t be performed, no de nitive diagnosis could be made. Introduction Progressive multifocal leukoencephalopathy (PML) is a rare and fatal subacute demyelinating disease of the central nervous doi:10.1016/j.jns.2019.10.716 system. Latent John Cunningham virus (JCV) is reactivated in ARTICLE IN PRESS

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WCN19-1948 (N=1541), spontaneous intracerebral haemorrhage (ICH), patients with intermediate Glasgow Coma Scale (GCS) between 9 to 12 may benefit from surgery, whereas those with higher or lower GCS may Poster shift 01 - Channelopathies /neuroethics /neurooncology / not [2]. pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain Why middle east? injury According to WHO, every-year there were 10.3 million new cases and, overall high prevalence of 67% Ischemic strokes (IC) (Fig. 1) Honing the surgical corridors: Diffusion imaging tractography were observed in Middle East countries. Also, the incidence rate for guided single-fraction stereotactic radiosurgery for stroke man- females were high when compared to male [3]. agements in middle east countries Future directions A. Bhonslea, G. Elumalaib, V. Jangidc, S. Elayarajac The tissue plasminogen activator (tPA) is the only approved aYoung Scientific Researcher, Neuroscience, Georgetown, Guyana medication for IS, which must be administered within a three-hour bTeam NeurON - College of Medicine, Texila American University, space from the onset of symptoms for recovering results. Unfortu- Neuroscience, Georgetown, Guyana nately, only 3- 5 percent reach the hospital in time, and the actual cCollege of Medicine, Texila American University, Neuroscience, George- use of tPA is considerably low. This tPA also carries risk of increased town, Guyana intracranial hemorrhage so it is not used for haemorrhagic stroke [4]. Management with surgery opted as least priority, because surgery fi Introduction bene ts some and harms others [2]. Stroke or cerebrovascular accident (CVA) is a sudden occurrence, focal and non-convulsive neurologic deficit [1]. In recent analysis Approach selection The integration of stereotactic diffusion tensor imaging (DTI) tractography (Fig. 2) with Gamma Knife radiosurgery (GKRS) has increased therapeutic potential and safety [5]. The procedure affects white matter tracts (predominantly the optic radiation and fasciculus - arcuate) are more vulnerable to radiation during stereotactic radiosurgery.

Conclusion Integration of stereotactic tractography into Single-fraction stereotactic radiosurgery (SF-SRS) represents a promising tool for preventing the surgical complications in white matter tracts [6].

Keywords: Stroke, DTI Tractography, Single-fraction stereotactic radiosurgery

doi:10.1016/j.jns.2019.10.717 ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 147

WCN19-1951 Objective The aim of this study was to investigate the role of vitamin D deficiency in chronic headache etiology. One of the factors involved Poster shift 01 - Channelopathies /neuroethics /neurooncology /pain in the etiology of chronic headache may be vitamin D deficiency. - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / Vitamin D is directly associated with lifestyle and eating habits, and stroke /training in neurology - Part I and traumatic brain injury many patients face vitamin D deficiency.

Assessment of the rehabilitation potential of patients with Material method traumatic brain injury at the stages of rehabilitation in Uzbekistan This study was performed in patients aged 18-65 who applied to Neurology outpatient clinic with headache between 01.12.2017 and N. Khasanova, M. Turabbaev, G. Rakhimbaeva, M. Tadjenov 31.03.2018. Ethics committee approval was obtained for the study. Tashkent Medical Academy, Department of Neurology, Tashkent, VAS was used to evaluate the pain severity of the patients. The Uzbekistan relationship between age, gender and vitamin D levels and pain scores were evaluated. Objective We studied the rehabilitation potential in patients with traumatic Results brain injury of varying severity and assessed the effectiveness of 782 patients with headache were included in the study. In Group provided treatment. I; 482 in Group II; 211, in Group III; 89 patients were detected. 32% of the patients were male and 68% were female. In 62% of patients, Materials and methods vitamin D levels were found to be below 10 ng/ml, 26% to 10-25 We examined 36 patients (19 men and 17 women) who were ng/ml, and 12% to 25 ng / ml. The relationship between vitamin D fi fi b treated in the 1st and 2nd clinic of the TMA with a diagnosis of de ciency and VAS was statistically signi cant (p 0.01). Traumatic brain injury, from 10.10.2018 to 20.02.2019. The age range ranged from 21 to 65 years with varying degrees of severity of Discussion traumatic brain injury. All patients are divided into two groups. The There was a relationship between headache and vitamin D fi first group: 26 patients with mild to moderate traumatic brain injury. de ciency. Similarly, Prakash et al. Found that the relationship fi The second group: severe traumatic brain injury 10. All patients were between pain score and vitamin D was statistically signi cant in 100 examined using a scale: Mini COH, Bartella’s motor function score, patients in their study investigating the relationship between tension fi drawing test hours. headache and vitamin D de ciency.

Results Conclusion fi In the first group, in the case of minor and medium degree People cannot bene t from this sunlight due to their unhealthy fi trauma on the mini-COH scale and the clock drawing test, 25 lifestyle. Vitamin D de ciency should not be ignored in patients patients had mild and moderate cognitive impairments in the form presenting with chronic headache. of: decreased attention, impaired memory, sleep disturbance. doi:10.1016/j.jns.2019.10.719 In the second group, severe trauma was observed in 10 (severe cognitive deficit patients, confusion, sensory motor aphasia, impaired motor function. They needed help (physically), dysfunction of the pelvic organs, patients needed additional help with eating, dressing, bathing. Two of the patients examined were in a coma. WCN19-1967

Conclusion Poster shift 01 - Channelopathies /neuroethics /neurooncology / According to research data, only 62.5% of patients with traumatic pain - Part I /sleep disorders - Part I /stem cells and gene therapy - brain injury who left the hospital in the early recovery period returned to active work and a normal life. 37.5% - for a long time Part I /stroke /training in neurology - Part I and traumatic brain were on the list of incapacity for work. injury doi:10.1016/j.jns.2019.10.718 Y stent technique for treatment of wide-based neck cerebral aneurysm

D. Kheradmanda, P. Sasannejada, S. Zabihyana, H. Etemadrezaiea,F. WCN19-1966 Fazelib, B. Humainab aNeuroendovascular Section, Neurosurgical Department, Ghaem Hospi- tal, Mashhad University of Medical Sciences, Mashhad, Iran Poster shift 01 - Channelopathies /neuroethics /neurooncology / b Neuroendovascular Section, Razavi Hospital, Mashhad, Iran pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain Abstract injury Background The relationship between vitamin D deﬁciency and chronic Wide-based neck bifurcation aneurysms can be treated with tension type headache stent-assisted coiling using 2 stents making Y-shape to protect both branches. Endovascular progression resulted in safe and efﬁcacy management of these procedures. In this study we evaluate the A. Çağaç clinical outcomes and feasibility of Y-stenting using Lvis Jr stents for Van Yüzüncü Yil University, Faculty of Medicine, Department of treatment of cerebral wide-neck bifurcation aneurysms. Neurology, Van, Turkey ARTICLE IN PRESS

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Methods a recent left parieto-temporal ischemic lesion and cerebrospinal fluid In this study patients in whom Y-stenting was attempted using examination disclosed neutrophilic pleocytosis (220 cells/uL) and LVIS Jr were entered. Clinical outcomes, interventional success rate, isolation of Staphylococcus Aureus. A subsequent transesophageal and morbidity were assessed. echocardiogram showed severe aortic insufficiency with endocarditic vegetation, while MRI revealed were other minute and multiple Results bilateral embolic lesions with mild gyral contrast enhancement. Ad- Y-stenting with coiling was attempted for 23 patients. Mean age hoc antibiotic treatment was then started, with clinical was 60±8.2 years and 14 patients were male. 13 patients (56%) were improvement. presented with SAH. 12 patients with A.com aneurysms , 7 with basilar tip artery and 4 with MCA aneurysms were included. Coiling Conclusions was performed by microcatheter passing through both stents Faced with complex diagnostic situations, having diagnostic without jailing. All procedures were successful. In one procedure, tools sometimes small and inadequate, and tight deadlines, in both stents were closed by thrombosis, that is completely resolved emergency setting neurologist may be forced to opt for a by 24 hours of IV Integrilin and doubling Plavix doses. Patient did not therapeutic choice that could then prove to be inadequate or even experience any deficit. All 23 patients had good outcomes. MRS score contraindicated. was 0 in 20 patients and mRS score 1 in 3 patients in 12 months follow-up. doi:10.1016/j.jns.2019.10.721

Conclusions Y-stenting by LVIS Jr stents and coiling for wide-based neck aneurysms seems to be feasible and safe with low rates of WCN19-1979 complications. It can use in ruptured aneurysms with safety.

On neurology and policy

WCN19-1974 E. Neua, M. Michailovb, P. Birkenbihlb, H.W. Bauerc, E. Gornikd,A. Hofstettere, G. Iyengarf, C. Luetgeg, D. Martinb, M. Schratzh, G. Weberi, Poster shift 01 - Channelopathies /neuroethics /neurooncology / E.R. Weissenbacherj, U. Welscherb, D.G. Weissk, H. Zoepfll a pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Inst. Umweltmedizin c/o ICSD e.V., Pharmaco-Physiology, Munich, Part I /stroke /training in neurology - Part I and traumatic brain Germany bInst. Umweltmedizin c/o ICSD/IAS e.V.- POB 340316- 80100 M. Int. injury Council Sci.Develop./Int.Acad.Sci. Berlin-Bratislava-Innsbruck- Muenchen-NewDelhi-Paris-Sofia-Vienna, Pharmaco-Physiology, Different shades of acute aphasia Muenchen, Germany cUniv. Muenchen and Free Univ. Berlin, Med. Fak., Muenchen, Germany V. Poretto, V. Bignamini, S. Piffer, L. Cucurachi, B. Giometto dTechn. Univ. Vienna, Faculty for Physics, Vienna, Austria Neurology Unit Santa Chiara Hospital, Department of Emergency, eUniv. Muenchen, Klinikum Grosshadern Dir.a.D., Muenchen, Germany Trento, Italy fIAEA, New York-Vienna, Vienna, Austria gTechn. Univ. Muenchen, Inst. Ethics Dir., Muenchen, Germany Introduction hUniv. Innsbruck, School Educ., Innsbruck, Austria Working in emergency regime often requires reaching diagnostic iUniv. Luxembourg&Vienna, Fac. Psychology, Vienna, Austria conclusions and subsequent therapeutic acts in a very short time, jUniv. Muenchen Med. Fak., Premium Med. Clinic Dir., Muenchen, sometimes relying on decision-making protocols or algorithms, to Germany which some cases may escape. kUniv. Rostock, Inst. Physiol. Dir.a.D., Rostock, Germany lUniv. Muenchen, Univ. School Pedagogics Dir. a.D., Muenchen, Germany Case report A 42-year-old man referred to Emergency Room for acute onset Introduction of global aphasia and right hemianopsia three hours before. He Science is leading factor for total social life on global level. Misuse reported previous smoking and intravenous drug abuse and of discoveries leads to disastrous situation of humanity. Nobel prizes hyperpyrexia two days before hospital admission, associated to are essential performance for scientific evaluation. headache and neck pain, without evidence of meningism at neurological examination. Urgent blood test showed mild increase Conception fl of in ammation indexes, while basal CT and CT angio were The IUM reported on necessity of paradigm changes in Nobel unremarkable. Interestingly an extemporaneous toxicological test prize policy. Nobel committees have scientific and political respon- proved a recent intake of methadone and benzodiazepine but bed- sibility to support science counteracting self-destruction of human- fi side cardiac echo did not reveal pathological ndings. Patient was ity. An enlargement of Nobel prizes is proposed, concordant with the treated with intravenous rtPA and admitted to Stroke Unit. Soon present situation of the world. The scandal situation with the Nobel after an electroencephalogram revealed irritative abnormalities on prizes for literature (failure of prizes for 2019) demonstrates left-temporo-occipital regions, responsive to lorazepam administra- necessity for enlargement of prizes given by the Nobel committee tion, without concomitant clinical improvement. Control CT revealed in Oslo. Prizes about philosophy-logic (incl. mathematics- ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 149 informatics), anthropology (pedagogy, psychology, theology), soci- symptom onset to femoral puncture was 5.6±2.3 hours. Initial NIHSS ology (peace, economics, communication, law, politology, etc.) could score was 16.5±5.1. Mean of passage numbers was 2.4±1.5 (1-8). be established in memory of Alfred Nobel, similar to economic MCA, ICA and vertebrobasilar artery occlusion was seen in 57 sciences. Neurology as interdisciplinary science, related to ethics, patients (50%), 49 patients (43%) and 8 patients (7%) respectively. psychology, psychosomatics, physiology, pathology, etc. could open At the end of MT, successful recanalization rate (TICI 2b or more) discussion about this conception. This is the reason to propose to the was 75.4%. ADAPT method was used as ﬁrst-pass in 67 patients congress WCN-2019 Dubai a session/conference under auspices of (58.7%), stentrieval in 56 (46.4%), and solumbera technique in 21 EMINS to discuss this matter. patients (18.5%). Large symptomatic ICH was seen in 15 patients (13.2%). 21 patients need decompressive craniectomy. 58 patients Conclusion (50.9%) had good mRS (0-2) at 3 months follow-up. Realisation of this conception by help of WFN, EMINS could support essentially UNO-Agenda 21 for better science, health, Conclusion economy, ecology on global level. In our center, mechanical thrombectomy is a safe and effective treatment in LVO in acute ischemic stroke similar to other studies. Ref. Philosophy-psychology FISP-2018-Peking (in press); 2013-Athens (World-Congr. Philos.), doi:10.1016/j.jns.2019.10.723 Abs.-Book:464-5&503-4&766; 2008-Seoul DVD-2010/Vol.45:229- 237, 4:101-108; 20:203-214; 37:195-202; 2003-Istanbul 279-280. EFPA-2009 Oslo (psychology), 55-56. EACME-2010-Oslo, AB:55-56. IVR-2015-Washington (Int. Ass. Philos. of Law) Progr. Book: 116/ WCN19-1981 3,8,9,124/5,127/3,129/3. 2019-Lucerne (in press). doi:10.1016/j.jns.2019.10.722 Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain injury WCN19-1980 Sleep disorders/disturbances in people with epilepsy in an onchocerciasis-endemic area Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - A.K. Njamnshia, L. Ngarkab, A.C. Zoung Kanyi Bissekc, N.L. Njamnshid, Part I /stroke /training in neurology - Part I and traumatic brain S.E. Chokote Tolod, M.K. Mengnjoc, F.N. Siewe Josephe, G.Y. Tatahf,E. injury N. Tabahg, F. Demah, R. Colebunderse aFaculty of Medicine and Biomedical Sciences, Neurology, Yaounde, Mechanical thrombectomy of large vessel occlusion in acute Cameroon ischemic stroke: A single-center study bYaounde Central Hospital, Neurology department, Yaounde, Cameroon cFaculty of Medicine and Biomedical Sciences, Internal Medicine and M. Pishjooa, M. Javdani Yektaa, M. Farzanb, E. Vafadarc, M. Sobhanid,F. Specialties, Yaounde, Cameroon Fazelie, H. Dehghani Zadea, H. Baharvahdatf, M. Rezaeed dYaounde Central Hospital, Neurology, Yaounde, Cameroon aResident of Neurosurgery, Mashhad University of Medical Sciences, eGlobal Health Institute University of Antwerp, Global Health, Antwerp, Mashhad, Iran Belgium bRazavi Hospital, Mashhad, Iran fCH St Nazaire, Neurology, Saint Nazaire, France cEmergency Medicine, Mashhad, Iran gMinistry of Public Health, Buruli Ulcer and Yaws control program, dResident of Neurology, Ghaem Hospital, Mashhad, Iran Yaounde, Cameroon eRazavi Hospital, Anesthesiology, Mashhad, Iran hYoko District Hospital, Neurology, Yaounde, Cameroon fGhaem Hospital, Mashhad University of Medical Sciences, Neuroendovascular Section, Neurosurgical Department, Mashhad, Iran Introduction Sleep is restorative, a good quantity and quality sleep is required Background for memory consolidation, synaptic plasticity and immune function. Mechanical thrombectomy (MT) has become the standard Poor sleep quality or quantity in PWE may worsen seizure control. treatment of large vessel occlusion (LVO) in acute ischemic stroke There is paucity of data on this subject in Sub-Saharan Africa. The in western countries. In this study, we reported our experiences in objective was to study epilepsy associated sleep disorders/distur- mechanical thrombectomy of LVO in acute ischemic stroke in bances in people with epilepsy (PWE) in the Mbam division, northeast of Iran. Cameroon.

Method and material Methods This Study was conducted in Mashhad (North-East of Iran) in In this community-based case-control study, 40 PWE and 40 age- 2018 and 2019. All patients with following criteria were included and sex-matched controls were interviewed and clinical data into study: acute ischemic stroke and large vessel occlusion. The collected. We used Epworth Sleepiness Scale, Berlin Questionnaire clinical characteristic of patients, success of MT, and clinical and Pittsburg Sleep Quality Index to evaluate sleep in both groups. outcomes (using modiﬁed rankin scale, mRs) were assessed. Results Results The mean age was 25.78years. Obstructive Sleep Apnea was the 114 patients were included in the study. The mean age was 55.9 main sleep disorder with prevalence 55% in cases against 12.5% in ±13.5 years (19-79 years) with 56% male. The time interval between controls p=0.006. Other sleep disturbances in cases and controls ARTICLE IN PRESS

150 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx respectively were: Poor sleep efficiency (47.5% against 17.5%; Methods p=0.006), reduced sleep duration (50% against 25%; p=0.077), poor We conducted open administration of OnabotulinumtoxinA in sleep quality (37% against 2.5 pb0.001), sleep onset insomnia (67.5% patients with trigeminal neuralgia and follow them up for 5 years. against 45% p=0.036), day time sleep disturbances (52.5% against One hundred units of OnabotulinumtoxinA were injected into the 12.5% ;p=0.001)and excessive day time sleepiness (30% against most painful areas as well as trigger zones of the affected trigeminal 2.5%; p=0.001. Atleast one seizure a week, use of Phenobarbital and nerve branches. Improvement in pain and daily living activities were or Carbamazepine and compliance to treatment were associated measured. Subjects fulfilled the criteria of the International Head- with sleep disturbances. ache Society (IHCD-III) for trigeminal neuralgia. Patients reported medication use (analgesics and preventative treatment) that was Conclusion and recommendation recorded before and after (30, 90, 180 and 270 days) BoNT/A The most common sleep disorder in PWE was OSA. Other sleep injections. Assessment by medical observation and by patient’s disturbances; daytime sleepiness, sleep onset insomnia, poor sleep subjective rating and Visual Analog Scale (VAS) was conducted. quality and efficiency, and reduced sleep duration were more common in PWE compared to healthy controls. Factors associated Results with these were seizure frequency ≥1/week, use of AEDs like Six patients fulfilled the inclusion criteria. After phenobarbital and or Carbamazepine and compliance to these drugs. OnabotulinumtoxinA treatment, all patients had a significant improvement in pain without side effects and presented a reduction in doi:10.1016/j.jns.2019.10.724 the use of analgesics and neuromodulator medication compared to baseline (Table 1).

Conclusion WCN19-1986 In our 6 patients, OnabotulinumtoxinA was effective in the prophylactic treatment of trigeminal neuralgia.

Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - doi:10.1016/j.jns.2019.10.725 Part I /stroke /training in neurology - Part I and traumatic brain injury

Therapeutic effect of onabotulinumtoxina in trigeminal neuralgia WCN19-1987 in El Salvador Poster shift 01 - Channelopathies /neuroethics /neurooncology / R. Lopez Castellanosa, R. Lopez Contrerasb pain - Part I /sleep disorders - Part I /stem cells and gene therapy - aUniversity of Arkansas for Medical Sciences, Department of Neurology, Part I /stroke /training in neurology - Part I and traumatic brain Little Rock, Arkansas, USA bInstituto Salvadoreño del Seguro Social, Clínica de Movimientos injury Anormales- Servicio de Neurología, San Salvador, El Salvador General anesthesia versus conscious sedation in mechanical Background thrombectomy for acute ischemic stroke OnabotulinumtoxinA (BoNT/A) is effective in movement disor- a b b a ders and chronic migraine. Recent studies have suggested that is also M. Pishjoo , F. Fazeli , M. Hashemi , M. Javdani Yekta ,M. a c d e effective in the treatment of trigeminal neuralgia. Mashhadinejad , M. Farzan , P. Sasannejad , H. Baharvahdat aResident of Neurosurgery, Mashhad University of Medical Sciences, Objective Mashhad, Iran b To evaluate the therapeutic and preventative effect of Razavi Hospital, Anesthesiology, Mashhad, Iran c OnabotulinumtoxinA in patients with trigeminal neuralgia that failed Razavi Hospital, Cath lab, Mashhad, Iran d to respond to conventional treatment. Mashhad University of Medical Sciences, Neurology, Mashhad, Iran ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 151 eGhaem Hospital, Mashhad University of Medical Scinences, learning program designed to teach basic principles and clinical Neuroendovascular section, Neurosurgical Department, Mashhad, Iran application of EEG. This study aimed to determine which learning modality within the program was associated with the best outcome Background in final test scores and which one was most preferred by learners. Mechanical thrombectomy (MT) has become the standard care of treatment for eligible patients with large vessel occlusion (LVO) Methods leading to acute ischemic stroke. In this study we review and One hundred and sixty participants (71 neurologists, 55 neurol- compare compromise the outcome of general anesthesia (GA)and ogy residents and 22 neurology technologists, 12 other doctors) from conscious sedation (CS) in mechanical thrombectomy over 15 mostly African countries registered on EEGonline between June 2017 and December 2018, were enrolled. Pre- and Post-course Method and material multiple-choice question (MCQ) test results and EEGonline user logs This Study was conducted in Mashhad, Iran in 2018 and 2019.All were analysed. Differences in pre- and post-test performance were patients with following criteria were included into study:acute correlated with quantified exposure to various EEGonline learning ischemic stroke and large vessel occlusion. We compare procedural modalities. Participants’ impressions of EEGonline efficacy and outcome, imaging outcome and clinical outcome between two usefulness were assessed through Pre- and Post-course perception groups of GA and CS. surveys.

Results Preliminary results 114 patients were included into the study. Mean of age was 55.9 Ninety-one participants attempted both pre- and post-course tests. ±13.5 years (19-79). Mean of passage was 2.4±1.5 (1-8). MCA, ICA Mean scores were 46.7% before the course and 64.1% after the course and vertebrobasilar artery occlusion were seen in 57 patients (50%), (pb0.0001). Initial analysis revealed that post-course test performance 49 patients (43%) and 8 patients (7%) respectively. 74 patients was better in participants accessing interactive EEG-activities versus (64.9%) underwent CS and 40 patients (35.1%) GA for mechanical didactic lecture-notes. Additional results of the analysis correlating thrombectomy. In CS group, successful recanalization (TICI 2b or post-course test performance with overall use of EEGonline and its more) was 81% and in GA group successful recanalization was 65%. various learning modalities will be presented. Preferred tools of Despite better recanalization in GA group, the difference was not learning based on most frequent use will also be presented signiﬁcant (p=0.057). Time interval between symptom onset and femoral puncture was 5.7 ± 2.5 for GA and 5.4 ± 2.2 hours for CS doi:10.1016/j.jns.2019.10.727 (p=0.639). Mean passage number in GA and CS was 2.4±1.4 and 2.3 ±1.6 respectively. The difference was not signiﬁcant (p=0.753). Good outcome (mRs 0-2) was 46.3% in CS group and 40.7% in GA group (p=0.635). WCN19-2034

Conclusion Poster shift 01 - Channelopathies /neuroethics /neurooncology / Our results showed type of Anesthesia (GA versus CS) do not signiﬁcantly affect the time interval between symptoms onset and pain - Part I /sleep disorders - Part I /stem cells and gene therapy - femoral puncture, passage number, successful recanalization, and Part I /stroke /training in neurology - Part I and traumatic brain clinical outcome of patients. injury doi:10.1016/j.jns.2019.10.726 Challenges of the informed consent in the mena region: A literature review

F. Abou-Mrada, T. Habibb, K. Richab aLebanese University, Faculty of Medical Sciences, Saint Charles WCN19-1991 Hospital, Neurology, Fayadieh, Lebanon bLebanese University, Faculty of Medical Sciences, Medical Ethics, Hadat, Poster shift 01 - Channelopathies /neuroethics /neurooncology / Lebanon pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain Background injury The world of medicine has seen a shift from a paternalistic to a patient-centered approach along with a surge in medical research in the MENA region. This medical revolution is accompanied by Online EEG teaching – Identifying the most effective and ethical challenges, most importantly concerning the informed preferred learning methods on a web-based EEG training course consent. Countries in the MENA region have become aware of this as several studies aim to study these challenges, their cause, and M. Asukilea, C. Viljoenb, E. Lee Pana, R. Eastmana, L. Tuckera their solution. This article summarizes all the major ﬁndings of aUniversity of Cape Town, Department of Medicine, Division of these studies Neurology, Cape Town, South Africa bUniversity of Cape Town, Department of Medicine, Division of Material and methods Cardiology, Cape Town, South Africa 45 articles were reviewed in order to form a proper idea about the importance of informed consent and its applicability in the Introduction MENA region. Literature review included the following countries: Web-based, distance learning programs may provide effective Algeria, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, electroencephalogram (EEG) training in resource-poor settings. Libya, Malta, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Sudan, EEGonline is an interactive, web-based, 6-month multi-modality, Syria, Tunisia, UAE, and Yemen. ARTICLE IN PRESS

152 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

Results Conclusion Challenges of the informed consent in the MENA region are the When assessing the factors affecting the restoration of aphasia, it result of several interrelated factors unique to the MENA region is necessary to take into account the multitude of data that are socio- including cultural, religious, and legislative. biological, including gender, age, education, type of activity, data of neuroimaging on CT. Conclusion Efforts have been made to improve the ethical behavior of doi:10.1016/j.jns.2019.10.729 physicians in the MENA region, however we are still far behind as several undeniable factors play a signiﬁcant role, thus forcing an adapted informed concept form and procedure to every country and every population WCN19-2041

Poster shift 01 - Channelopathies /neuroethics /neurooncology /pain doi:10.1016/j.jns.2019.10.728 - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / stroke /training in neurology - Part I and traumatic brain injury

Clinical pathway as a system that inﬂuences clinical outcome WCN19-2038 improvement of acute ischemic stroke in stroke unit RSUP Dr. Sardjito Yogyakarta

Poster shift 01 - Channelopathies /neuroethics /neurooncology / N. Artriawan, S. Sutarni, P. Paryono, I. Setyopranoto, I. Setyaningsih, pain - Part I /sleep disorders - Part I /stem cells and gene therapy - A. Asmedi Part I /stroke /training in neurology - Part I and traumatic brain Faculty of Medicine, Public Health and Nursing Universitas Gadjah injury Mada, Neurology, Yogyakarta, Indonesia

The influence of various factors on the recovery dynamics of post- Background stroke aphasia Stroke has biggest threat causing long-term disability. Estimated 25% - 74% of 50 million stroke survivors will have physical, cognitive D. Rasulova, M. Rasulova, S. Kuranbaeva or emotional disorders and need total help for their daily activity. TMA, Neurology, Tashkent, Uzbekistan There are many problems arise in the treatment of strokes that result in poor outcomes. Clinical pathway (CP) is an evidence-based system One-third of stroke patients have speech disorders - aphasia. The that bridge the application of medical standard service on stroke prognosis for the recovery of both motor and speech disorders is patients that aim to improve the outcome. determined by many different factors affecting the recovery processes. Purpose The purpose of this study is to determine effect of CP Aim implementation in improving clinical outcome of acute ischemic To study the factors affecting the dynamics of the restoration of stroke (AIS) patients in the stroke unit RSUP Dr. Sardjito Yogyakarta. aphasia in post-insulin patients. Method Method This study use quasi-experimental design comparing clinical 30 patients with aphasia (13 women and 17 men) were outcome of AIS patients before and after CP implementation. Sample underwent to neurological status and CT who suffered a left brain taken with consecutive sampling from the stroke register for non CP cerebral stroke. group and patients treated in the stroke unit for CP group. AIS diagnosis obtained from head CT scan and clinical outcome assessed Results with NIHSS in admission and discharge from stroke unit. Mann In the acute period, only motor aphasia was in 16 patients, whitney used to analyze NIHSS improvement. sensorimotor aphasia in 11 patients, and total severe aphasia in 3 patients. The age was from 40 to 75 years. The impairment of the Result cortical branches in 16 patients, an extensive focus in 9 patients, an There were 50 AIS patients on each group, 30 male in CP group fi extensive focus and swelling of the brain in 5 patients. Education, 11 and 27 male in non CP group. Bivariate analysis show no signi cant people had a higher education, 19 secondary. Occupation, 5 patients difference in CP implementation and NIHSS improvement of AIS had a physical activity and 11 was engaged in intellectual labour, 14 patients (p = 0.06) but there are trend of better NIHSS improvement fi people were retired. Central paresis of the 7th and 12th nerve pair, in patients treated with CP. Multivariate analysis show no signi cant right-sided hemiparesis, hemiplegia with muscular strength from 4 difference (p = 0.068). to 0 points were observed. Only one patient underwent active speech therapy, spontaneous recovery was observed in 6 patients, elements Conclusion of motor aphasia in the early recovery period in 7 patients, motor In this study, patients treated with CP has tendency of better fi dysarthria in 7 patients, elements of sensorimotor aphasia in 9 NIHSS improvement but no signi cant differences were found. patients. doi:10.1016/j.jns.2019.10.730 ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 153

WCN19-2049 WCN19-2052

Background Objective Social factors modulating stroke outcomes are culturally inclined, To determine differences in lipid profiles between healthy human among these factors are social support and social constraints. Limited individuals and patients in a vegetative state (VS) or minimally studies are available in chronic illnesses and their impact on social conscious state (MCS) (Both males and females) and to identify life of women. biomarkers in human serum that can accurately distinguish VS patients from MCS patients. Aim The aim of the study is to determine the level of social support Methods available and social constraints faced by Hausa women who suffered Univariate and multivariate analyses were used to assess the stroke. significance of differences between lipid profiles. The performance of candidate lipid biomarkers for distinguishing VS from MCS was Materials and methods determined by a decision tree and evaluated through a leave-one- Seventy-four Hausa women who suffered stroke were recruited subject-out cross-validation based on the area under the receiver from Aminu Kano Teaching Hospital (AKTH), Murtala Muhammad operating characteristic curve. Specialist Hospital (MMSH) and Muhammad Abdullahi Wase Specialist Hospital (MAWSH) in this cross-sectional study. Socio- Results demographic, stroke-related attributes of participants were obtained. Compared with healthy controls, the VS and MCS groups had Perceived social support and social constraints were assessed using significantly different lipid profiles. The serum levels of almost all Multidimentional scale of perceived social support (MSPSS) and the lipids, whether detected using untargeted or targeted lipidomics, Social problem questionnaire (SPQ) respectively. The relationship were significantly lower in the VS/MCS groups compared and association between different variables was analysed using with healthy controls. More importantly, we identified certain ’ Pearson s correlation and Chi-square test respectively. lipids for which the levels differed substantially between the VS and MCS groups. Together, our findings suggest that lipid Results metabolism is significantly altered in patients with chronic Participants reported adequate level of social support (60.8%), disorders of consciousness; specifically, we found that phosphati- with fairly low levels of social constraints in both the Total Family dylcholine (38:5)-H (PC(38:5)-H) and arachidonic acid (AA) may Stress (91.9%) and Non-Child Related stress (90.5%). Socio-demo- be used to distinguish VS patients from MCS patients with 77.8% fi graphic features had no signi cant relationship with either social accuracy. support or social constraints (p N 0.05). Rather, an inverse relationship exists between social support and social constraints. Conclusion These lipid biomarkers are of great value because (1) they Conclusion significantly improve the accuracy of the diagnosis of between VS The outcome of this study suggests that adequate levels of social and MCS; (2) this biomarker approach is inexpensive and support results in reduced levels of social constraints following stroke. convenient. It is recommended that physiotherapist should assist by providing educative programmes that would increase caregiver’s knowledge of social support and how to develop it and cultural values that emphasize positive social interaction should be encouraged. doi:10.1016/j.jns.2019.10.731 doi:10.1016/j.jns.2019.10.732 ARTICLE IN PRESS

154 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-2060 Y. Baduro, J. Arroz, E. Lorenzo, C. Casas, N. Arroz, O. Ndala, D. Vaz, H. Buque, F. Sebastião, J. Baco Maputo Central Hospital, Medicine, Maputo, Mozambique Poster shift 01 - Channelopathies /neuroethics /neurooncology /pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / Background stroke /training in neurology - Part I and traumatic brain injury Stroke is currently recognized as a major public health problem throughout the world, including in low income countries. The Caeolin-1 regulated the epithelial-mesenchymal transition prevalence of hypertension (the major known risk factor for stroke) marker snail and enhances brain metastasis of non-small cell in Mozambique increased from 33.1% in 2005 to 38.9% in 2014/2015, lung cancer although awareness remained at very low levels (15%). The aim of this study is to characterize the clinical pattern of stroke in the S. Kima, H.S. Kimab, K. Eunheea, P. JongTaeac Department of Medicine (DM) of the Maputo Central Hospital (MCH) aChonnam National University Medical School, Department of Forensic Medicine, Gwangju, Republic of Korea Methods bChonnam National University Hwasun Medical School, Department of A cross-sectional study was carried out in the DM of MCH. Using Pathology, Hwasun, Republic of Korea systematic probabilistic sampling, clinical records were used to cChonnam National University Medical School, Department of Pathol- analyze data for the period 2014–16 ogy, Gwangju, Republic of Korea Results Background Of the 249 clinical records, 54.6% (95% CI: 48.4– 60.8) were Caveolin-1 (Cav-1) plays an important role in the development of female. The mean age was 61.41 years ± 13.48 SD. Around 94% was various human cancers. We investigated the relationship between an acute stroke event, and 90% was first episode. Forty percent did Cav-1 expression and non-small cell lung cancer (NSCLC) progres- not receive a CT scan for confirmation. Of the 149 CT scanned sion in the context of brain metastasis (BM). patients, 54.4% (95% CI: 46.4– 62.4) were ischaemic stroke. The area of middle cerebral artery was affected in 75.2% of the CT scanned Methods patients. The most common co-morbidity associated was hyperten- Cav-1 expression was investigated in a series of 102 BM samples sion (85.9%). The mean length of hospital stay was 6.03 days ± 4.60 and 49 paired primary NSCLC samples, as well as 162 unpaired SD, with a case-fatality of 25.7% (95% CI: 20.3– 31.1). primary NSCLC samples with (63 cases) or without (99 cases) metastasis to distant organs. Human lung cancer cell lines were used Conclusions for in vitro functional analysis. Stroke associated with hypertension is probably increasing in MCH, mostly likely due to an increase in hypertension prevalence Results and lack of awareness. Efforts for CT scan for all first episode of High Cav-1 expression in tumor cells was observed in 52% (38/73) of stroke should be emphasized by the DM managers squamous cell carcinomas (SQCs) and 33% (45/138) of non-SQCs. In SQC, high Cav-1 expression was increased after BM in both paired and Keywords: Stroke, Cross-sectional study, Maputo Central Hospital, unpaired samples of lung primary tumors and BM (53% vs. 84% in paired Mozambique samples, P = 0.034; 52% vs. 78% in unpaired samples, P = 0.020). Although the difference in median overall survival in patients NSCLC doi:10.1016/j.jns.2019.10.734 was not statistically significant, high Cav-1 expression in tumor cells (P = 0.005, hazard ratio 1.715, 95% confidence index 1.175–2.502) was independent prognostic factors of overall survival on multivariate Cox regression analyses, in addition to the presence of BM and non-SQC WCN19-2089 type. In vitro assays revealed that Cav-1 knockdown inhibited the invasion and migration of lung cancer cells. Genetic modulation of Cav-1 Poster shift 01 - Channelopathies /neuroethics /neurooncology / was consistently associated with SNAIL up- and down-regulation. pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Conclusions Part I /stroke /training in neurology - Part I and traumatic brain Cav-1 plays an important role in the BM of NSCLC, especially in injury SQC. The mechanism may be linked to SNAIL regulation. Results of the study of hormones and cytokines in patients in doi:10.1016/j.jns.2019.10.733 unresponsive wakefullness syndrome after TBI.

E. Kondratyevaa, M. Aybazovaa, N. Dryaginaa, A. Kondratyevb,S. Kondrateva WCN19-2074 aAlmazov National Medical Research Centre, Minimally Conscious State Research Groupe, St-Petersburg, Russia bAlmazov National Medical Research Centre, Intensive Care, St- Poster shift 01 - Channelopathies /neuroethics /neurooncology /pain Petersburg, Russia - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I / stroke /training in neurology - Part I and traumatic brain injury Research of 152 patients in a VS/UWS after TBI. Neurological examination was performed by 2 neurologists with assesment by Stroke in Maputo Central Hospital, Mozambique: A cross- CRS-R scale. In all patients blood samples for hormone levels, – sectional study 2014 16 interleukins, TNF, natriuretic peptide were collected during the ﬁrst ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 155 week from the time of admission. Significant direct relationship 6.4. For the group of patients without headache stroke is located in between SIRS and procalcitonin (r = 0.39), SIRS and leukocytes the territory of the anterior circulation in 80% of cases, with an levels (Spearman criterion r = 0.38, p b 0.05) was observed. Almost average NIHSS score of 9.5. There was no significant difference all patients showed increased levels of IL 6, 8, 10 and TNF. The between the two groups in terms of sex, cardiovascular history and interrelation between the level of IL and patient outcome was noted etiology of stroke. - an increased level of IL 6, 8 and 10 was associated with poor outcome. Use of the Fisher criterion did not show a direct Conclusion relationship between the outcome value in patients with a Infarction in the territory of the posterior circulation, the consequence of TBI and VS/UWS values, as well as in patients with involvement of the insula and the somatosensory cortex are consequences of hypoxia and TSH values, all other parameters were predictors of headaches in the acute phase of ischemic stroke. at meaning of 0.05 (that is, with a 95% probability). Regression analysis did not show positive results for any of the parameters. In doi:10.1016/j.jns.2019.10.736 our opinion, VS/UWS patients, in their humoral indicators, do not fit the concept of homeostasis, but are in a special variant of immune, vegetative and other systems interaction, for which term “allostasis” is more suitable. The reported study was funded by RFBR project number 19-29- WCN19-2095 01066/2019 Poster shift 01 - Channelopathies /neuroethics /neurooncology / doi:10.1016/j.jns.2019.10.735 pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain injury WCN19-2090 Cerebral venous thrombosis: A descriptive study of a series of 12 cases Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - O. Hernandez-Fustesa, C. Arteaga Rodriguezb, G. Mouchaileh E. Part I /stroke /training in neurology - Part I and traumatic brain Ferreirac a injury Complexo Hospital de Clínicas-UFPR, Neurology, Curitiba, Brazil bUniversidade Positivo, Neurology, Curitiba, Brazil c Predictors of headache in acute ischemic stroke Hospital das Nações, Neurology, Curitiba, Brazil

M. Missaoui, S. Naija, A. Hassine, M. Ben Halima, A. Nasr, R. Douma, S. Cerebral venous thrombosis (CVT) is a pathology that affects the Ben Amor cerebral venous sinuses causing an ischemic and / or hemorrhagic Sahloul University Hospital, Department of Neurology, Sousse, Tunisia brain, but, contrary to the arterial cerebral vascular accident, has a clinical presentation with varied signs and symptoms that are difﬁcult to diagnose in the its initial phase. Introduction Headache in the acute phase of ischemic stroke is a common Objective symptom. The incidence varies considerably according to epidemi- To present the clinical ﬁndings of twelve cases of CVT. ological studies, and depends on various factors.

Materials and methods Aims We reviewed the charts of patients admitted with a diagnosis of Establish a correlation between the presence of headache in CVT. ischemic stroke and the clinical and radiological parameters of the disease. Results We describe 8 females and 4 males, with mean age of 30 years. Materials and method The most common signs and symptoms were: headache (89%), This is a descriptive retrospective study concerns patient seizure (55.5%), cranial nerve palsy (44%) and hemiparesis (33%). All admitted to our neurovascular unit for first ischemic stroke from patients had diagnoses confirmed by MRI and digital subtraction January to March 2019. Anamnestic, clinical and radiological angiography. The risk factors found were the peripartum state, oral parameters were collected from patient records. We excluded known contraceptive use, protein S and protein C deficiencies and brain patients with chronic headache or migraine. abcess. All patients were treated with oral anticoagulant, with no death reported in this series. Results 121 patients were included in this study. The group with Conclusion headache represents 26.4% of the population. Patients were predom- Venous sinus thrombosis is an uncommon disease that requires a inantly male (72%) with a mean age of 71.3 years. For the group with high index of suspected diagnosis by the medical team. The mortality headache, the infarction concerns the posterior circulation in 68% of rate is low and the treatment is usually effective. the cases and the anterior circulation in 32% mainly represented by the superficial middle cerebral artery. The average NIHSS score was ARTICLE IN PRESS

156 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx doi:10.1016/j.jns.2019.10.737 aINSERM, Cardiovascular, Toulouse, France bAntwerp University, Laboratory of Physiopharmacology, Antwerp, Belgium

WCN19-2099 Atherosclerosis is one of the most common causes of stroke worldwide. Intracranial or extracranial atherosclerosis may occur concomitantly with systemic atherosclerosis involving other arterial Poster shift 01 - Channelopathies /neuroethics /neurooncology / beds, such as coronary, or peripheral arteries. A major mechanism of pain - Part I /sleep disorders - Part I /stem cells and gene therapy - stroke, involves unstable plaque as described in the coronary model. Part I /stroke /training in neurology - Part I and traumatic brain Vascular smooth muscle cells (VSMCs) regulate various aspects of injury vessel homeostasis, including contraction, dilation, and vessel remodeling. Consequently, VSMCs are one of the main cellular Spadin and shortened spadin analogs as efficient new antidepres- determinants in arterial pathology and several evidence indicates sants in mouse models of post-stroke depression that apoptosis of VSMCs is associated with features of high-risk/ vulnerable atherosclerotic lesions. Mitochondrial turnover is an M. Borsottoa, M. Pietrib, J. Mazellab, C. Heurteauxb essential aspect of the mitochondrial quality control in which aIPMC, UMR7275, Valbonne, France dysfunctional mitochondria are selectively eliminated through bIPMC, CNRS UMR7275, Valbonne, France autophagy. Even though successful autophagy promotes VSMC survival, it is unclear whether reduced autophagic flux affects mitochondrial quality control of VSMCs in atherosclerotic plaques. Stroke is a major disease associated with high mortality and By using a mouse model of atherosclerosis carrying a VSMC-specific serious long-term disability. Usual treatments fail to improve long- deletion of the essential autophagy gene Atg7, we observed that term recovery and thrombolysis is only efficient on 10% of patients. impaired VSMC autophagy promotes an unstable plaque phenotype Consequently, developing new treatments is necessary. The TREK-1 as well as the accumulation of fragmented mitochondria with channel was shown to be protective against stroke. We have reduced bioenergetic efficiency and more oxidative stress. Further- identified a peptide (spadin or PE 12-28) and its shortened analogs more, we demonstrate that disrupted autophagic flux is linked to that are potent antidepressant and are able to inhibit TREK-1. Our defective mitophagy and biogenesis of mitochondria, which exacer- aim was to demonstrate that these peptides have protective effects bate the apoptosis of VSMCs and plaque vulnerability. Overall, our against post-stroke depression. results indicate that mitochondrial quality control could be a For mimicking stroke on mice, we used the in vivo model of promising therapeutic target to stabilize atherosclerotic plaques MCAO. Thanks to electrophysiology studies, we developed a protocol and to decrease the risk of stroke. consisting in a two phase treatment, a low dose (0.03 mg/kg) for one week followed by a high dose (3 mg/kg) treatment for several doi:10.1016/j.jns.2019.10.739 weeks. At different time points, behavioral tests were performed in order measure both motor and cognitive performance of the animals. Treated mice showed a significant reduction of the immobility time in the Forced Swimming Test and in the latency to eat in the Novelty Suppressed Feeding test. Both tests demonstrate that the WCN19-2120 depressive state is improved. The learning capacity was increased in the Morris Water Maze and the motor coordination was improved in Poster shift 01 - Channelopathies /neuroethics /neurooncology / both rotarod and pole tests. Additionally, the increase in neuro- pain - Part I /sleep disorders - Part I /stem cells and gene therapy - genesis, measured by BrdU incorporation was still present even at 10 Part I /stroke /training in neurology - Part I and traumatic brain weeks post trauma. Taken together our results suggest that spadin and its analogs are injury very potent candidates for the development of new treatments improving stroke recovery, mainly by preventing the depression. Prevalence and pattern of post-stroke pain among stroke survivors in Kano metropolis, Nigeria doi:10.1016/j.jns.2019.10.738 J.S. Usman, M.A. Abba, H.Y. Ahmad Bayero University-Kano, Physiotherapy, Kano, Nigeria

WCN19-2107 Background Post-stroke pain is a vital sign that can affect functional use of a limb and mobility. Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Objective Part I /stroke /training in neurology - Part I and traumatic brain This study investigated the prevalence and pattern of post-stroke injury pain and its association with socio-demographic and clinical variables. Altered mitochondrial quality control in autophagy-deﬁcient vascular smooth muscle cells is linked to high-risk atheroscle- Methodology rotic plaque phenotype In this cross sectional study, participants were recruited using convenient sampling from three major Hospitals in Kano metropolis, a a a a b Nigeria. Before commencing the study, ethical approval to conduct H. Nahapetyan , M. Moulis , E. Grousset , M. Elbaz , W. Martinet ,C. Vindisa the study was granted by the Health and research ethics committee ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 157 of Aminu Kano Teaching Hospital, and Kano State Ministry of Heath. was used. A relatively stable pattern of stroke occurrence with high All participants consented to participate in the study. Nordic registered cases was observed during the study period. Musculoskeletal questionnaire and Leed Assessment of neuropathic symptom and sign pain scale were used to assess musculoskeletal Conclusions pain (MSP) and neuropathic pain (NP) respectively. Data was Stroke is an endemic disease for the Maputo Central Hospital, analysed with descriptive statistics and inferential statistics of Chi- with an epidemic pattern during the first semester of 2019. Adoption square at significance level of P b 0.05. of 3rd quartile threshold methods for stroke surveillance might well add value for the control of the stroke epidemics. Result A total of 83 stroke survivors participated in the study. Majority Keywords: Stroke, Epidemics, Endemic Channel, Cross-sectional of them were females (60.2%) aged between 54–62 years. Many study, Maputo Central Hospital, Mozambique participants (45.8%) had stroke duration of ≥1 year. Shoulder pain was the most common MSP in the past 7 days (53.0%) and 12 doi:10.1016/j.jns.2019.10.741 months (56.6%). NP occurred only in 9.6% of participants. Side of stroke was associated with shoulder pain (x2 = 5.355, p = 0.021). There was no significant association between NP and each of socio- demographic and clinical variables (p N 0.05). WCN19-2192

Conclusion and recommendation Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Shoulder pain is the most common MSP post-stroke and it is pain - Part I/sleep disorders - Part I/stem cells and gene therapy - signiﬁcantly associated with side of stroke affectation. NP occurs in low percentage. Managing post-stroke individuals should involve Part I/stroke/training in neurology - Part I and traumatic brain strategies to prevent and treat shoulder pain. injury doi:10.1016/j.jns.2019.10.740 Cerebral amyloid angiopathy-related inﬂammation presenting with posterior reversible encephalopathy syndrome

B.G. Yoo, S.Y. Lee, M.K. Kim WCN19-2142 Kosin University Gospel Hospital, Department of Neurology, Busan, Republic of Korea

Poster shift 01 - Channelopathies /neuroethics /neurooncology / Introduction pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Cerebral amyloid angiopathy-related inflammation (CAA-ri) is a Part I /stroke /training in neurology - Part I and traumatic brain rare CAA variant, characterized by headaches, seizures, acute or injury subacute encephalopathy, or focal neurological deficits. Radiologi- cally, CAA-ri presents with widespread white matter lesions on brain Stroke in Maputo Central Hospital, Mozambique 2019: A glimpse magnetic resonance imaging (MRI) in addition to the hemorrhagic of epidemic or endemicity? imaging features of CAA. We report a patient with CAA-ri who showed posterior reversible encephalopathy syndrome (PRES). Y. Baduro, J. Arroz, L. Elder, C. Casas, N. Arroz, N. Omer, H. Buque, D. Vaz, F. Sebastiao, J. Baco Case report Maputo Central Hospital, Medicine, Maputo, Mozambique A 77-year-old man presented with generalized tonic-clonic seizure that persisted for 30 minutes and decreased in consciousness level. He Background had past medical history of dementia, diabetes and hypertension. His Although not a communicable disease, the term “stroke epidemic” initial blood pressure was 170/90 mmHg, pulse rates were 144/ is being used widely in the literature. The “epidemic” of stroke might minute, respiratory rate were 25/minute, and body temperature was be due to over the time social transmission of unhealthy activities 36.9°C. On neurological examination, his consciousness level was fl such as unhealthy diet, physical inactivity, and smoking. The aim of stupor and there are no lateralization signs. Cerebrospinal uid this study is to determine the endemic/epidemic pattern of stroke in analysis was unremarkable except elevated protein level of 75 mg/ fl Maputo Central Hospital in the first semester of 2019. dL. Diffusion-weighted images (DWI) and uid-attenuated inversion recovery (FLAIR) images showed diffuse hyperintensities involving the Methods bilateral temporo-parieto-occipital lobes. Gradient-echo images re- A cross-sectional hospital-based study was carried out collecting vealed multiple microbleeds in bilateral cortical and subcortical secondary data (registered cases) from hospitalized patients with regions as can be seen in CAA. A diagnosis of CAA-ri was considered, stroke. Data from 2014–18 were used to generate the epidemic and the patient was started on steroids and valproic acid with clinical thresholds. Four threshold epidemic detection methods were used: improvement. Nine days after admission, follow-up DWI and FLAIR mean + 2SD; C-SUM; C-SUM + 1.96SD; and the 3rd quartile. Data images demonstrated improvement of previously shown lesions. from January to June 2019 were used to analyze the 2019 trend over the thresholds. Conclusions Aside from the most common subacute presentations, CAA-ri can Results have a PRES-like presentation. It is hypothesised that in this form, CAA- – An epidemic pattern of stroke was observed during the first ri causes altered vascular autoregulation and impaired blood brain semester of 2019 when 3rd quartile and C-SUM threshold epidemic barrier integrity in the face of precipitating factors such as hypertension. method was used. This epidemic pattern of stroke was not observed doi:10.1016/j.jns.2019.10.742 when mean+2SD and C-SUM+1.96SD threshold epidemic method ARTICLE IN PRESS

158 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-2173 WCN19-2175

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain Part I/stroke/training in neurology - Part I and traumatic brain injury injury

Predictors of stroke after carotid endarterectomy Novel canine stroke models using reversible MCA-occlusion alone vs RMCAO plus permanent ACA-occlusion to determine reproduc- L. Akhmadeevaa, L. Bikbulatovaa, I. Lackmanb, V. Plecheva,J. ibility and its potential use for translation stroke therapies Urazbakhtinab, B. Veytsmanc aBashkir State Medical University, School of Medicine, Ufa, Russia L. Guada, M. Watanabe, K. Bates, D. Yavagal bUfa State Aviatechnical University, Avionics- Energy and University of Miami/Jackson Memorial Hospital, Neurology, Miami, USA Infocommunication, Ufa, Russia c George Mason University, School of Systems Biology, Manassas, USA Background The Stroke Treatment Academic Industry Roundtable (STAIR) is in Goal the need of translation stroke models to test novel stroke therapies. To investigate factors leading to the occurrence of stroke after Our pilot study established a novel endovascular MCAo/ACAo model, carotid enderaterectomy. that can mimic a stroke in humans.

Methods Methods N=206 patients were subject to a longitudinal study (median A total of nine mongrel-hound (n=5 rMCAo, n=4 rMCAo + observation time 108 months, max 141 month, min 36 months). pACAo, age 12-36 months; BW 22±5 kg), underwent trans-femoral During the observation 33 patients had post-surgery stroke, and 37 endovascular-catheterization of the MCA-alone or MCA+ACA with a died, including 21 having stroke before death. The occurrence of single soft platinum-detachable coil embolization (2x8 mm for MCA, post-surgery stroke was modeled using Cox survival model, both in 2x4 mm for ACA). Total occlusion-time MCA: 60 min. MCA- the traditional form (W. N. Venables and B. D. Ripley. Modern recanalization established by coil-retraction. The dogs were survived Applied Statistics with S. Springer, 2010) and the Bayesian one for 30 days. Weekly neurological-scoring were performed. Brain-MR- (Zaixiang Tanget al. BMC Bioinformatics, 20(1):94, 2019). The model MRA at 2nd,15th,30th-days for stroke-volumes and Diffusion Tensor used the following parameters: age, gender, employment, marital imaging analysis of the CST. status, education, alcohol use, smoking, presence of angina and diabetes, initial diagnosis, taking of statins and aspirin, patient's Results compliance, regular visits to neurologists and cardiologists, Barthel, Successful MCAo-recanalization was achieved in 8/9, 1-dog from FIM and MMSE scores, anxiety and depression, and cholesterol ratio. the rMCAo/ACA-group died. We achieved reproducible stroke volume and significant neuro deficits at rMCAo+pACAo group, not Results the case for rMCAo alone. Avg-stroke vol for group rMCAo/ The most important predictors are shown in Table 1. Both models pACAo:15.2 cc(+/-2.9 cc) and rMCAo: 4.5cc (+/-5.5 cc), We chose age and Barthel score as the most predictive parameters. observed 88,8% feasibility on achieving rMCAo/ACAo. DTT/CST Traditional model added MMSE and retirement as predictors. correlated with the stroke vol and neuro/deficits. Presumably the work-related stress makes the prognosis better for retired patients. This finding underscores the importance of non- Conclusion medical factors in post-surgery prognosis. The study confirms the In our prior rMCAo model we were not able to achieved value of Barthel index for the prognosis: the more independent is the significant reproducibility in the stroke vol, also the time of rMCAo patient in the daily life, the better is the expected outcome. needed to achieved a neuro-deficit avg120 min. With this new occlusion model, a 60 min is enough to achieved a stroke vol size fi doi:10.1016/j.jns.2019.10.743 that reproduce a neuro-de cit that can be correlated with the one seen in humans. We report a successful reproducible stroke ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 159 model by anterior circulation approach for future stroke translational WCN19-2201 research. doi:10.1016/j.jns.2019.10.744 Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain injury WCN19-2182 Cognitive and imaging correlates in cerebral amyloid angiopathy subtypes Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - G.B. Bonifacioa, E. Chanb, M. Squitieria, S. Islamc, D. Werringa Part I/stroke/training in neurology - Part I and traumatic brain aUCL Institute of Neurology and the National Hospital for Neurology and injury Neurosurgery, Department of Brain Repair and Rehabilitation, London, United Kingdom Symptomatic seizures in cerebral venous sinus thrombosis bNational Hospital for Neurology and Neurosurgery, Department of Neuropsychology, London, United Kingdom A.O. Saroja, K.R. Naik, N.N. Thorat cUCL Institute of Neurology, Department of Statistics, London, United KLE Academy of Higher Education and Research, Neurology, Belagavi, Kingdom India There is increasing interest in studying cognitive decline in Introduction Cerebral Amyloid Angiopathy (CAA). Common clinical subtypes of Cerebral venous sinus thrombosis (CVST) is an eminently CAA are CAA with intracerebral haemorrhage (CAA-ICH), with treatable cause of stroke in the young. Raised intracranial tension, cognitive decline (CAA-cog), and with Transient Focal Neurological seizures and focal neurological manifestations are the presenting the Episodes (CAA-TFNE); most studies of cognition and neuroimaging common manifestations. Seizures can persist in a proportion of these on CAA, to date, have focussed on CAA-ICH. We therefore evaluated patients. the cognitive and imaging phenotypes across all the CAA subgroups. This is a retrospective cross-sectional study of cognition and Objectives imaging in 99 patients; 70 (71%) with CAA and 29 (29%) with This study was conducted to evaluate the occurrence and pattern presumed hypertensive arteriopathy (non-CAA). We measured of seizures in relation to location and type of infarction in CVT. impairment across the cognitive domains using a standardised test battery, and we described the imaging biomarkers via visual rating of Methods standardised MRI scans. Case records of patients with radiologically confirmed CVST 69% of patients had impairment in more than 2 domains. Overall, were retrieved. The demographic profile, clinical manifestations, 71% had impairment in the executive function, followed by non- biochemical and neuroradiological parameters were obtained. Sei- verbal IQ (59%) and verbal IQ (48%). Patients with CAA-TFNE had zure profile in relation to clinical, laboratory and neuroimaging data similar neuropsychological impairments to CAA-ICH. were evaluated. Outcome was measured using modified Rankin CAA-cog performed worse than CAA-ICH with verbal recognition b score. memory (p 0.05). CAA-TFNE had a higher prevalence of cSS compared to both CAA- b Results ICH and CAA-cog (p 0.01). Patients with CAA-ICH had a higher Among 559 patients with CVST, 328 (58.67%) had seizures burden of strictly lobar CMBs and severe Peri-ventricular White during admission of whom 229 (69.8%) had generalized seizures Matter Hyperintensities (PV-WMH) than CAA-TFNE patients. CAA- b and 99 (30.2%) had focal seizures. Serial seizures occurred in 88 cog had more CMBs compared to CAA-TFNE patients (p 0.01). fi fi patients and 18 had status epilepticus. Seizures occurred more Our ndings con rm high rates of cognitive impairment across fi frequently in patients with cerebral infarction (P b 0.00001), CAA subtypes, including CAA-TFNE. The cognitive pro le of CAA- hemorrhagic infarction (P b 0.001), pregnancy related CVST (P b TFNE was similar to that of CAA-ICH, despite differences in fi 0.001), anemia (P = 0.006) and altered sensorium. Patients with neuroimaging ndings. Thus, the effects of CAA on cognition can seizures had poor income (P = 0.024). Follow-up data was occur regardless of the presence of ICH. available in 284 patients and 174 of them seizures in acute phase. Seizures recurred despite medication in 35 patients (20.1%). Among doi:10.1016/j.jns.2019.10.746 110 patients who had no seizures in acute phase, 10 had seizures during follow-up.

Conclusion WCN19-2210 Seizures are frequent in acute CVST phase and adversely affect the outcome. Seizures persisted in 20% patients despite Poster shift 01 - Channelopathies/neuroethics/neurooncology/ medication and new onset seizures occur are frequent. Prophy- lactic anticonvulsant medication may be warranted in CVST pain - Part I/sleep disorders - Part I/stem cells and gene therapy - patients. Part I/stroke/training in neurology - Part I and traumatic brain injury doi:10.1016/j.jns.2019.10.745 Spontaneous intracerebral hematoma: Which etiologies? And what predictions prognosis? A study about 253 patients ARTICLE IN PRESS

160 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

J. Zaouali, M. Messelmani, I. Bedoui, A. Riahi, H. Derbali, M. Mansour, WCN19-2212 R. Mrissa Military Hospital, Neurology, Tunis, Tunisia Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Introduction pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Intra-cerebral hematoma (ICH) is a serious pathology, destructive Part I/stroke/training in neurology - Part I and traumatic brain for the parenchyma, whose mortality is very hight and had a injury reserved prognosis. The factors influencing the vital and functional prognosis are however poorly known and the decision to resuscitate Epidemiology, risk factors and predictors of severity and disabil- or evacuate a hematoma is sometimes very delicate in the acute ity in a cohort of Jordanian patients with the first ischemic stroke phase, M. Alqawasmeh, B. Aldabbour, K. El-Salem, D. Obeidat, A. Momani Methods King Abdullah University Hospital, Neurology, Irbid, Jordan We conducted a retrospective, descriptive and analytical study of 253 patients who presented spontaneous ICH collected at the Objectives Military Hospital of Tunis, over a period of 10 years. To identify the risk factors, subtypes, length of stay “LOS” and causes of prolonged hospitalization among patients with first Results ischemic stroke in Jordan, as well as predictors of stroke severity fi The rst cause of HIC was hypertension (54.1%). The mean age of and post-stroke disability. the patients was 62 years and the clinical manifestations were dominated by the motor deficit. Vascular malformations were the Methods main secondary causes of ICH. Radiologically, the lobar seat of the A retrospective cohort study of 142 patients who were admitted hematomas was the most recurrent with varying volumes depending to neurology department at King Abdullah University Hospital on the type of vascular malformation between July 2017 and March 2018 with a first ischemic stroke. In terms of prognosis, the leading cause of death from all causes Stroke subtypes were classified according to TOAST criteria. Severity was septic shock (17.39%). The ICH score has also been applied in our was represented by NIHSS score and disability by modified Rankin population and it has been observed that the mortality rate increases Score “mRS”. Prolonged LOS was defined as hospitalizations more in parallel with the ICH score. Complete functional recovery (Rankin than 75th percentile of the median LOS. Multivariate regression was b= 2) was seen in 29,2% of our patients whereas 70.8% had used to assess factors associated with discharge NIHSS and mRS moderate to severe disability (RankinN = 3). scores. IRB approval was obtained.

Conclusion Results Contemporary with the aging of the population, the frequency of Identiﬁed variables accounted for 58.58% of variability in the HIC is constantly increasing. Prognosis is generally less favorable dependent variable, with an F-value of 15.25 (p-value b 2.2e-16). than ischemic stroke with a high mortality rate. Thus acting on these factors associated with poor life and functional prognosis for better Conclusion management. Hyperlipidemia signiﬁcantly predicted higher stroke severity on discharge, while age and admission NIHSS scores predicted worse doi:10.1016/j.jns.2019.10.747 residual disability. ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 161

Disclosures WCN19-2217 None. doi:10.1016/j.jns.2019.10.748 Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain injury WCN19-2216 Paraneoplastic syndromes: Varied neurological presentations. A prospective case collection Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pain - Part I/sleep disorders - Part I/stem cells and gene therapy - K. Goela, J.D. Mukherjib, M. Kumarc, A. Kumard Part I/stroke/training in neurology - Part I and traumatic brain aDelhi Neurological Association, Neurology, Delhi, India injury bMAX Super Speciality Hospital, Saket, New Delhi, Neurology, India cMax Superspeciality Hospital, Saket, New Delhi, Neurology, India Clinical pathway application for pneumonia prevention in acute dVMMC & Safdarjung Hospital, New Delhi, Cardiology, India ischemic stroke patients Background S.P. Adisti, P. Paryono, S. Satiti Paraneoplastic neurologic disorders can affect any part of the University of Gadjah Mada, Neurology, Yogyakarta, Indonesia nervous system. The early detection of PNS can enable both early diagnosis and the treatment of malignancies and the early initiation Background and aims of rehabilitation process. Stroke causes high morbidity and mortality rates for the world population. It can be caused by pneumonia complication. Improv- Methods ing stroke services are needed because it has been shown to Prospective case collection over last 4 years form Neurology reduce mortality and morbidity caused by complications of department. pneumonia. One of the stroke services is clinical pathway. It is expected that the improvement of stroke services through the Results application of clinical pathways can prevent pneumonia in stroke Total of 6 cases were discussed. 5 cases were having no past h/o ischemic patients. malignancy. Presentation in first case was subacute onset cerebellar ataxia for last 1 month, second case acute onset cerebellar ataxia for Methods last 5 days and in third case it was motor sensory neuropathy for last This study used quasi experimental method, separate multiple 2 months. First case on investigations turned out to be tubo-ovarian groups after and before test design. The intervention group were adenocarcinoma (anti yo positive), second case anti yo positive stroke ischemic patients who were followed prospectively after the (primary yet to be determined). While third case a diabetic with h/o clinical pathway implementation in Stroke Unit Sardjito Hospital, bladder malignancy 2 years back was found to have antiamphiphysin while the control group were patients that identified before the antibody positive. IVIG was given in first and third case,which implementation of the clinical pathway in 2014. The results were showed some positive results. 4th case presented with clinical picture considered statistically significant if p b0.05. of neuromyotonia and turned out to be positive for anti VGKC positive. Primary is yet to be determined. 5th case was positive for Zic Results 4 antibody with presentation of focal neurological deficits, seizures In this study, 64 patients from each group met eligibility followed by altered sensorium.This case later turned out to be large B criteria. Pneumonia complications occurred in 12 patients (18.8%) cell lymphoma on brain biopsy. 6th case was a middle age gentleman in the control group and 4 patients (6.2%) in the intervention who presented with non convulsive status epileptcius along which group. The results of the chi-squre bivariate analysis showed a recovered with medical management followed by appearance of significant difference between the control group and the interven- imbalance. This gentleman was positive for SOX1 antibody in the tion group with p = 0.033 (RR = 3.00). Other variables that serum. Primary is yet to be determined. significantly influence the incidence of pneumonia complication are a history of atrial fibrillation, malnutrition, dysphagia, doi:10.1016/j.jns.2019.10.750 stroke severity, and level of consciousness. Variables that affect pneumonia complication in logistic regression multivariate analysis were clinical pathway, history of diabetes melitus, and malnutrition. WCN19-2222

Conclusions Clinical pathways application has been proven to prevent Poster shift 01 - Channelopathies/neuroethics/neurooncology/ pneumonia complication in acute ischemic stroke patients that pain - Part I/sleep disorders - Part I/stem cells and gene therapy - treated in Stroke Unit Sardjito Hospital Yogyakarta Part I/stroke/training in neurology - Part I and traumatic brain injury doi:10.1016/j.jns.2019.10.749 Therapeutic effects of transcranial direct current stimulation for ischemic stroke ARTICLE IN PRESS

162 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

S.M. Ahn, B.T. Choi first or recurrent ischemic stroke. CNFD was significantly lower Korean Medical Science Research Center for Healthy-Aging, School of (Pb0.05) and CNFT was significantly higher (Pb0.05) in patients with Korean Medicine, Yangsan, Republic of Korea recurrent stroke compared to first stroke and healthy controls. CNBD (Pb0.001) and CNFL (P=0.003) were equally reduced in patients with Transcranial direct current stimulation (tDCS) has been suggested first and recurrent stroke compared to controls. Corneal confocal as an adjuvant tool to enhance functional recovery after ischemic microscopy identified greater corneal nerve fibre loss in patients with stroke. In the preliminary experiments, anodal tDCS above the recurrent stroke compared to patients with first stroke and healthy prefrontal cortex of contralateral hemisphere promoted functional controls. Larger, longitudinal studies are required to determine the recovery from ischemic stroke. We performed the behavioral tests, prognostic utility of corneal nerve fiber loss in identifying patients at including corner, cylinder, rotarod, wire grip, novel object recogni- risk of recurrent ischemic stroke. tion, and object location recognition after unilateral anodal-tDCS on the contralateral hemisphere following ischemic stroke. Three doi:10.1016/j.jns.2019.10.752 different stimulation groups were used: 1) tDCS above the prefrontal cortex, 2) tDCS above the motor cortex, and 3) tDCS above the parietal cortex, in middle cerebral artery occlusion (MCAO) model in mice. tDCS above the motor cortex (M1/2; M) resulted in signif- WCN19-2236 icantly improved motor dysfunction and memory impairment after ischemic stroke. The largest effect of behavioral recovery was the Poster shift 01 - Channelopathies/neuroethics/neurooncology/ tDCS-M group, thus the followed experiments were conducted in tDCS-M group. In PCR analyses of growth factor gene expression, the pain - Part I/sleep disorders - Part I/stem cells and gene therapy - significant positive changes in six genes such as Bmp8b, Gdf5, Il4, Part I/stroke/training in neurology - Part I and traumatic brain Pdgfa, Pgf, and Vegfb were observed following tDCS in MCAO model, injury here we highlight alterations in growth differentiation factor 5 (GDF5) and platelet-derived growth factor subunit A (PDGFA). The Hybrid AI based stroke characterization with explainable model expression of GDF5 and PDGFA showed the similar tendency of increase in the ipsilateral and contralateral striatum, especially R. Patil, A. Shreya, P. Maulik, S. Chaudhury showed a higher expression level of GDF5 and PDGFA in the peri- Philips, Research, Bangalore, India infarct regions of striatum than the sham or MCAO group. These results indicate that applying tDCS after ischemic stroke may support Stroke is the fourth leading cause of death in the United States. functional recovery through the release of various growth factors Treatment pathway depends on the type of stroke and it is including GDF5 and PDGFA. imperative to provide a quick diagnosis of stroke type for the better outcome. The solution that is being provided in this work is that of doi:10.1016/j.jns.2019.10.751 hybrid approach of image processing and deep learning to rule out the presence of Intra Cranial Hemorrhage (ICH) accurately by analyzing the non-contrast CT images. The current solution is developed on a data of 379 scans (~180 subjects with ICH) and WCN19-2228 validated on 100 scans of different institution. A pre-trained Inception-ResNet V2 model was used for training with 10 epochs Poster shift 01 - Channelopathies/neuroethics/neurooncology/ while freezing the convolutional layers and for 50 epochs unfreezing them. The accuracy achieved on the training dataset is 97% with a pain - Part I/sleep disorders - Part I/stem cells and gene therapy - sensitivity of 95% and specificity of 98%. The model was tested on a Part I/stroke/training in neurology - Part I and traumatic brain blind dataset of different institution containing 100 subjects. It injury scored an accuracy of 91% with sensitivity of 90% and 100% specificity for ruling out the presence of ICH; we outperform the Corneal confocal microscopy demonstrates nerve damage in stroke characterization accuracy from state of art published work patients with recurrent stroke using hybrid AI approach. Further, the algorithm highlights affected region of ICH, maps to the anatomical part and provides the A. Khan quantification of the bleed area resulting into automated computa- Weill Cornell Medicine-Q, Research Division, Doha, Qatar tion of ICH score. In order to earn the radiologist’s confidence on the

Damage to corneal nerves may be a marker of atherosclerosis. This study was undertaken to determine if there is greater corneal nerve damage in patients with recurrent ischemic stroke. Corneal confocal microscopy (CCM) was used to quantify corneal nerve fiber density (CNFD), corneal nerve fiber tortuosity (CNFT), corneal nerve branch density (CNBD) and corneal nerve fiber length (CNFL) in 31 patients with recurrent ischemic stroke (age: 50.49 ± 9.47 years), 165 patients with a first acute ischemic stroke (age: 49.34 ± 9.49 years) and 23 healthy subjects (age: 52.0 ± 14.59 years). There was a significant difference in triglycerides (P=0.004, P=0.017), systolic BP (P=0.000, P=0.000), diastolic BP (P=0.000, P=0.000), HbA1c (P=0.000, P=0.000) and total cholesterol (P=0.035, P=0.196) in patients with first and recurrent stroke compared to healthy controls. However, there was no difference in BMI, HbA1c, triglycerides, LDL, HDL, total cholesterol, systolic BP, diastolic BP and NIHSS between patients with ARTICLE IN PRESS

Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx 163 developed model, we built a visualization engine to understand the WCN19-2257 learnings of the model for the corresponding prediction as shown in (See Fig 1.) Poster shift 01 - Channelopathies/neuroethics/neurooncology/ doi:10.1016/j.jns.2019.10.753 pain - Part I/sleep disorders - Part I/stem cells and gene therapy - Part I/stroke/training in neurology - Part I and traumatic brain injury

WCN19-2245 Assessment of real and potential losses due to premature death from cerebrovascular diseases as a tool for management decisions

Poster shift 01 - Channelopathies/neuroethics/neurooncology/ N. Rynhacha, O. Kurykb, T. Chernyib, O.O. Lytvynb pain - Part I/sleep disorders - Part I/stem cells and gene therapy - aPtoukha Institute for Demography and Social Studies of the National Part I/stroke/training in neurology - Part I and traumatic brain Academy of Sciences of Ukraine, Department of Demographic Modeling injury and Forecasting, Kyiv, Ukraine bState Institution of Science "Research and Practical Centre of Preventive Atypical presentation of isolated cortical vein thrombosis and Clinical Medicine" State Administrative Department, Scientific Department of Internal Medicine, Kyiv, Ukraine W. Gaba, A. Mahdi Sheikh Khalifa Medical City, Internal Medicine, Abu Dhabi, United Arab Aim Emirates To calculate and estimate the number of years of potential life lost due to premature mortality from cerebrovascular diseases in Introduction Ukraine, and its share in the array of losses from all diseases of the Isolated Cortical vein thrombosis is a subtype of cerebral venous circulatory system. sinus thrombosis. The main presenting symptoms are: Headache, Focal neurological deficit and Seizures. Main predisposing factors Materials and methods include pregnancy, oral contraceptives and CNS infections. The information base of the study was official data of the State Statistics Service of Ukraine in 2018. A comparative analysis of Case description mortality from cerebrovascular diseases in selected countries was A 74-years-old male presented with progressive dizziness that carried out using the European database of mortality and the happens mostly with movement and lasts for few minutes, database of the Global Study of Disease Burden, Injuries and Risk associated with occasional visual disturbance and mild to moderate Factors. The method of potential demography was used to estimate headache for the last 12 days but deteriorated in the last 3 days. Past demographic losses due to premature mortality from cerebrovascu- medical history includes uncontrolled hypertension, psoriasis and lar diseases. benign prostatic hypertrophy. On physical examination he was hypertensive with BP 180/115, GCS 15 and no focal neurological Results deficit. CT Head with CT Angiography revealed left posterior parietal The number of lost years of potential life due to premature subarachnoid hemorrhage with no underlying AVM or aneurysmal mortality from cerebrovascular diseases in 2018 reached 116,563 formation. Due to atypical presentation we did MRI, MRA and MRV thousand man-years (104,355 thousand in 2013), which accounted which showed left posterior parietal cortical vein thrombosis with for more than 18% of similar losses as a result of death from all surrounding venous congestion. Patient was started on Anti- cardiovascular diseases in Ukraine. Revealed a significant dispropor- coagulation therapy. Extensive investigations including tion of losses depending on gender - more than two thirds (69.1%) of thrombophilia and screening for occult malignancy was negative. the absolute number of lost years accounted for men. The patient’s symptoms improved and he was discharged after 4 days of inpatient observation. Conclusions Ukraine is losing more significant amounts of potential years of Discussion life due to high premature mortality from cerebrovascular diseases This case is unique because of the atypical presentation of Cortical compared to the developed countries of the world. We can vein thrombosis with dizziness & visual disturbances, atypical age recommend a methodology for arguing the development of strate- and sex. Initial imaging diagnosis of subarachnoid hemorrhage was gies and programs aimed at combating cerebrovascular diseases, suspicious in this patient. Cortical vein thrombosis should be assessing the dynamics of changes in the process of their implemen- considered as a possible diagnosis in patients having unclear tation, and as an indicator of effectiveness. neurological symptoms and suspicious imaging. doi:10.1016/j.jns.2019.10.754 doi:10.1016/j.jns.2019.10.755 ARTICLE IN PRESS

164 Abstracts / Journal of the Neurological Sciences (2019) xxx–xxx

WCN19-2258 H. Wichowicza, D. Gaseckib, G. Wisniewskic, J. Landowskia,M. Swierkockab, P. Lassd, A. Wilkowskaa, W. Nykab aMedical University of Gdańsk, Department of Psychiatry, Gdansk, Poster shift 01 - Channelopathies/neuroethics/neurooncology/ Poland pain - Part I/sleep disorders - Part I/stem cells and gene therapy - bMedical University of Gdańsk, Department of Adult Neurology, Gdansk, Part I/stroke/training in neurology - Part I and traumatic brain Poland injury cAvon&Wiltshire Mental Health Partnership NHS Trust, The Coast Resource Centre, Weston-s-Mare, United Kingdom d Comparison of stroke pattern, risk and outcome between non Medical University of Gdańsk, Department of Nuclear Medicine and diabetic, prediabetic and diabetic population Radiology Informatics, Gdansk, Poland

N. Ramrakhiania, S. Kurapathib, N. Jaina, R. Dubeya, P. Parabb Background aFortis Escorts Hospital Jaipur, Department of Neurology, Jaipur, India Post-stroke depression (PSD) is one of major devastating stroke’s bFortis Escorts Hospital Jaipur, Department of Medicine, Jaipur, India consequences. Because PSD appears some time following stroke it would be useful to identify prognostic factors of its development. Aim This could help with early prevention of PSD in a high-risk Comparison of stroke risk and outcome between non diabetic, population, for example by starting antidepressants before its prediabetic and diabetic population symptoms become apparent. It has been long postulated that results of neuroimaging investigations may serve as PSD’s prediction Methods markers, however outcomes of existing studies are inconclusive. In this prospective study, inclusion criteria were patients more than 18 years of age presenting with acute ischemic stroke with Aim of the study onset in less than 2 weeks. History of diabetes, intake of oral We tried to verify a hypothesis that abnormalities in regional fl hypoglycaemic agents, insulin, blood sugar on admission, HBA1C cerebral blood ow (rCBF) measured by SPECT within 5-10 days fi were recorded. Patients were divided into categories of non-diabetic, following the rst episode of ischemic stroke may be useful in prediabetic and diabetic on basis of history and HBA1C values as per predicting PSD development. ADA 2019 guidelines. mRS was recorded at admission and 3 months. Demographic data, vessel anatomy and classification of stroke were Material & method done through TOAST classification. 95 out of initial sample of 116 patients (Age:61.4±12, 74M/42F) investigated with SPECT were included into final rCBF/asymmetry Results indexes (AIs) analysis. Study population consisted of 365 patients with acute ischemic stroke. 135 (36.98%) patients were non diabetic, 95 (26.02%) were Results fl prediabetic and 135 (36.98%) patients were found to be diabetic. 20 29 patients suffered from depression (MADRS 20.8±6.1 re ects patients (5.4%) were found to be newly diagnosed diabetics as per moderate to severe depression); in 24 of them PSD started during fi fi HBA1C criteria. The mean age of patients was 59.13 years. rst 6 weeks following stroke. Signi cant differences between PSD Commonest stroke was large artery atherosclerosis in 137 (37.5%). (+) and PSD(-) groups measured by AIs were found in frontal b b Smaller vessel occlusion was seen in diabetic compared to non- regions (p=.0001), basal ganglia (p .01); to lesser extent (p .05) in diabetic subgroup which was statistically significant. Patients was parietal regions, and between rCBF of whole hemispheres (Mann- divided into ACA, MCA. PCA, AICA, PICA and SCA territory infarcts Whitney U test). In logistic regression model odds ratio of frontal without clear predilection for either subgroups. Thrombolysis was lobes AI was 3.06 (95% CI: 1.06-8.83). In ROC Curve analysis the same fi performed in 31 patients (8.49%), no clear difference in outcome in parameter showed sensitivity of 71% (95% CI: 51-87) and speci city three subgroups was noticed. A longer duration of hospital stay was of 70% (95%CI: 58-81%) as a potential test for predicting PSD. observed in diabetic subjects compared to non-diabetic population. However, no such difference was found in the prediabetic group Conclusion compared to non-diabetic subgroup. No statistically significant Our results suggest usefulness of AI in diagnosing early-onset difference was seen in post stroke events. depression following ischemic strokes. doi:10.1016/j.jns.2019.10.756 doi:10.1016/j.jns.2019.10.757

WCN19-2259

Prediction of post-stroke depression with spect-derived cerebral blood ﬂow asymmetry index