Poster Abstracts Thursday, November 10, 2005 $425

whereas positively correlated with HDL (13 = 0.0002) and a13o-Al (13 = 0.0039) levels. There was no significant correlation between adiponectin and TC (p 0.6630) levels. Conclusion: In patients with past history of stroke, serum adiponectin levels correlated well with other markers of cardiovascular disease's risk, indicating necessity of investigating whether or not adiponectin levels could be a reliable marker of stroke recurrence.

I274 Sleel~disordered breathing in patients with recent Isctlaemic Stroke

Noradina T l, Harnidon B ~, Roslan H 1, Raymond A ~ . 1Department of Medicine, Universiri Kebangsaan Malaysia

Intxoduction: Several studies reported a higher frequency of sleep disordered breathing (SDB) among ischaemic stroke patients. Many showed prevalence between 43% and 72%, taking the apnoea hypo13noea index (AHI) of _>10. Hypertension and coronary heart disease are known risk factors of stroke, which are also consequences of SDB that can contribute to stroke mortality and morbidity. Objectives: The objectives were to detemrine the frequency of SDB in patients with recent ischaemic stroke admitted to H U K M and the relationship between SDB and known risk factors of ischaemic stroke. Method: This was a cross-sectional prospective study involving 28 consequtive acute ischaemic stroke patients admitted to H U K M over three months. Sleep studies were done within 1 to 4 weeks after stroke onset using ResMed Autoset portable 11 plus system. Results: The prevalence of SDB in ischaemic stroke depending on the AHI cut off was: 92.8% for AHI > 5, 78.5% for AHI > 10, 44.5% for AHI _> 15 and 37.7?,'; for AHI _> 20. We discovered that diabetes mellitus (DM) and smoking history were important factors predicting significant SDB (AHI _> 15) in recent ischaemic stroke. Conclusion:There was a high prevalence of SDB in recent ischaemic stroke patients in H U K M comparable to other studies. DM and smoking history were strong predictors of the occurrence of SDB after an ischaernic stroke.

1275 Hyperhomoeysteinemia as a Risk Factor for Ischemie Stroke

Noroozian, M 1, Sina, A 1, Masoud Rad, W, Shaigany, S 1. ZTehran University Of Medica! Sciences (TUMS)

Background: The aim of this study is to investigate the correlation between plasma Homocysteine (Hey) level and ischemic stroke by better controlling risk factors for the ischemic stroke and factors affecting the levels of plasma Hey. Method: We conducted a case-control study with 31 cases who had never had a Transient Ischemic Attack (TIA), all within one week of their first-ever ischernic stroke. Both the patients and control subjects were paired for age, sex, cardiac disease, hypertension and smoking status. Their total fasting plasma Hey level was determined, using High-Performance Liquid Chromatography (HPLC) method. Results: Mean plasma Hey level was significantly higher in cases than controls (mean, 20.79 -c 11.938 versus 14.45 ± 8.028 gmol/L; P < 0.017). After using the multivariate logistic, regression model, we found a significant correlation between plasma Hey level and stroke (OR 1.149 with 95% CI of 1.032-1.280 for each 1/~mol/L increment). Conclusion: This finding indicates a correlation between increasing plasma Hey level and ischemic stroke; although further researches is needed to prove the cause and effect relationship between the two.

1276 Stroke in South West Nigeria - a ten year review

Ogun, y1, Ojini, F z, Ogungbo, B 3, Kola13o , K1, Danesi, M z. ~Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria," 2Lagos University Teaching Hospital, Lagos, Nigeria," 3Division Of NeuroSurgery, New Castle Upon Tyne, United Kingdom

Background and Purpose: Stroke is a significant economic, social and medical problem worldwide. This retrospective follow-up study aimed to review the pattern, types and case fatality of stroke in Nigeria. Methods: Records of all stroke patients adnfitted into Ogun State University Teaching Hospital (OSUTH), sagamu, from December 1993 to November 2003 were reviewed. Patients were classified into haemorrhage or infarct using the WHO criteria. Information was obtained as to the time of death in those who died and case fatality at 24 hours, 7 days, 30 days and 6 months recorded. Autopsy records were also reviewed. Results: A total of 708 stroke patients were reviewed and this constituted 2.4% of all emergency admissions. On clinical grounds, 49% of the patients had cerebral infarction (CI), 45% intracerebral haemorrhage (ICH) while 6% had subarachnoid haemorrhage (SAH). Stroke constituted 1.8% of all deaths at the emergency unit and the case-fatality was 9% at 24 hours, 28% at 7 days, 40% at 30 days and 46% at 6 months. Conclusion: Stroke constitutes a significant cause of mortality and the need for prompt institution of intensive treatment is em13hasised. A changing pattern with an increasing frequency of haemorrhagic stroke in our population is suspected. However, as this was a retrospective study based on clinical exanfination in a highly selected stroke population, neuro-imaging confirmation would be needed for any future prospective hospital or population-based studies.

1277 Pure agraphia tot Romaji, tile thixd JapaneSe writing system utilizing alphabet and phonological rules

Ogura, K 1, Suzuki, K 1, Mori, E 1. 1Tohoku University Graduate School of Medicine, Sendai, Japan

We report a Japanese man who developed pure agraphia selectively affecting Romaji. Romaji is an alphabetic writing system for Japanese based on phonological rules, the ttfird Japanese writing system after Kana and Kanji, which is in general used exclusively for typewriting. The patient was a 51-year-old right-handed Japanese clerical worker with 12 years of education, who was referred to us because o f difficulty in typing. MRIs revealed an infarct affecting a lower part of the precentral gyms and pars opercularis o f the inferior frontal gyrus. Hand-writing was defective as well. Neurological examination was unremarkable including spoken language and praxia. The agraphia had following features: (1) many errors in Romaji, occasional errors in Kana (syllabograms), and no error in Kanji (morphograms); (12) the same nature of errors in oral spelling, hand-writing, and typing of Romaji; (13) errors consisting mainly of substitution with another letters with proper consonant/vowel structure in a syllable. These findings suggest that the basic defect of the Romaji agraphia in this patient is a selective functional disruption within the 13honeme-to - grapheme conversion system, and that the neural mechanism proces- sing consonants is distinct for that for vowels in Japanese.

1278 Combined Occlusive Anterior Cerebral Artery in patients with Acute Middle Cerebral Axtery Occlusion

Hyung Geun Oh l, Kwang Ho Lee 1, Gyung Moon Kim 1, Chin-Sang C.hung 1, Tai Hwan Park a. 1Department of NeurMogy, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 2Department of Neurology, Chungang University Medical Center, Seoul, Korea

Background: Le13tomeningeal collateral flow (LCF) from anterior cerebral artery (ACA) and/or posterior cerebral artery (PCA) can be a potential source of blood supply in the territory distal to the occluded middle cerebral artery (MCA). Methods: We reviewed clinical and attgiographic findings in 29 patients with acute MCA occlusion. Digital subtraction angiography was

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performed within 6 hours after symptom onset. Stenosis (i_>50%) or occlusion of ipsilateral ACA was investigated and correlated with attgiographic grade of LCF: 0 - no collaterals to the ischemic site even at venous phase; 1 - collaterals to the periphery of the ischemic site with persistence of some of the defect; 2 -- collaterals with complete attgiographic blood flow of the ischemfic bed by the late venous phase. Results: Eleven (38?/;) patients showed stenosis or occlusion of ACA. Occlusive AC.As were observed in 6 out of 7 patients with grade 0 LCF compared to 1 out of 14 patients with grade 2 LCF (P -- .001). Patients with occlusive ACAs had significantly lffgher baseline median NIHSS score than those without (117 vs 10.5, P < .01). Follow-up median NIHSS scores were also higher in patients with occlusive AC.As at 1 day (118 vs 8, P < .01), and at 7 day (113.5 vs 4, P - .01) after thrombolyfic therapy. Independency rate was lower in patients with occlusive ACAs (118°,5 vs 61 °,5, P - .052). Conclusions: Combined stenosis or occlusion of ACA was not uncommon in acute MCA stroke and may suggest poor collateral flow, severe clinical manifestation, and less favorable outcome after thrombolytic therapy.

1279 Stroke incidence and relapsing patterns in rmal geriatric Japanese area

Okada, K l, Umegae, N ~, Yamaguchi, T ~, Hongo, E l, and Kobayashi, S. ZDepartment of Neurology, Oda ~unicipal Hospital'Oda, Shimane, Japan; 2 Departemnt of Neurology, Hematol- ogy & Rheumatology, Faculty of Medicine, Shimane University, Izumo, A~imane, Japan

Background: The incidence of stroke and relapse is an important medical and socioeconomic problem in Japan. Our hospital is located in an area of Japan in which 34.6°,5 of the 70,000 inhabitants are over 65 years old. To reveal the specific features of stroke in tiffs geriatric society, we compared stroke subtype and relapse patterns for our hospital with data from the Japan Standard Stroke Registry Study OSSRS). Methods: The JSSRS databank is a computer-based multi-center stroke database covering 115 hospitals nationwide. Our hospital joined this data bank since 2000. We collected 485 ischemfic stroke cases between 2001 and 2004. We analyzed the registered data, focusing on stroke subtype and relapse patterns in the acute and chronic periods. Results: The mean age of our ischemic stroke subjects was 76.4 years compared with 70.9 years for the JSSRS. In our hospital, the stroke subtypes were atherothrombotic infarction (AI: 36%), lacunar infarction (iLl: 42%), and cardiogenic embolism (ICE: 21%). The respective rates for the JSSRS were AI 33?/;, LI 32?/;, and CE 27?/;. Seventy-four subjects (115.2%) suffered a relapse: 69 subjects had an ischemic stroke and 5 subjects had cerebral bleeding. The subtypes of relapse in acute stage were AI 47%, CE 29°,5, and LI 21°,5. By contrast, relapses in chronic stage were A133%, CE 28°,5, LI 25 °,5, and cerebral bleeding 14%. Conclusion: The specific features in a geriatric population in Japan revealed the importance of considering stroke subtypes for secondary prevention.

1280 Timing of Acute Stroke presentation and patient attitude towards Intravenous Thtombolysis in a Singapore Stroke mill

Ong, S 1, Elmnba, D 1 , De Silva, D 2 , Chang, H 2, Chen, C 2, Wong, M 2. ~Singapore General Hospital' Singapore; 2National Neuroscience Institute, Singapore

Background: Thrombolysis in acute cerebral infarction is proven to be efficacious but has a high risk ofintracranial bleeding. Singapore has just received its license for its usage in acute cerebral infarction. We aimed to study hospital presentation times of our patients, reasons for delay and their response to thrombolysis if offered.

Methods: This was a prospective study of 100 consecutive patients admitted from June 2004. All patients were interviewed with a standardized form. Data collected included stroke subtypes, choice of 9 options of reasons for delay and acceptance of thrombolysis if hypothetically offered. Results: There were 53% males, with a mean age of 66.73°,5 were Chinese, 127/; Malays, 14% Indians and 1% Eurasian. Median time of arrival to hospital from stroke onset was 965 minutes. 9% arrived within 2 hours, and another 3?/; within 3 hours. Factors significantly associated with presentation within 3 hours were large strokes (p -- 0.001), Indian race (p -- 0.04) and no pre-hospital consultation (lJ - 0.003). Main reasons for delay were lack of awareness of stroke symptoms and severity of condition (50?/;) andinability to seek medical attention unaided (12%). 34% would accept thrombolysis if offered. Conclusion: The majority of our patients arrived after the window period for thrombolysis. We have identified lack of awareness of stroke symptoms as the major obstacle to providing an effective throm- bolysis service in our hospital. Our resources should be focused at public education on recognition of stroke symptoms and the potential benefits of early presentation to hospital if eligible for thrombolysis.

1281 Acute Slroke mortality in South West Nigeria

Osalusi, B l, Ogun, S 1, Ojini, F ~, Danesi, M 2, Kolapo, K 1. lOgun state University Teaching Hospital' Sagamu, Nigeria; Z Lagos University Teaching Hospital' Lagos, Nigeria

Background: Stroke is a significant economic, social and medical problem worldwide. This retrospective follow-up study aimed to review the pattern and time trend mortality of stroke. Method: Record of all stroke patients adnfftted into Ogun State University Teaching Hospital, Sagamu, from December 1993 to November 2003 were reviewed. Patients were classified into haemor- rhage or infarct using the WHO criteria. Information was obtained as to the time of death in those who died and mortality at 24 hours, 7 days, 30 days and 6 months recorded. Autopsy records were also reviewed. Data analyses were done by standard statistical methods and the use of Epi-info 2002. Results: A total of 708 stroke patients were reviewed and tiffs constituted 2.4% of all adult emergency admissions. On clinical ground, 48.6% of the patients had infarctive stroke, 45.2?/; had intracerebral haemorrhage while 6.2% had subarachnoid haemor- rhage. Stroke constituted 1.8°,5 of death at the emergency unit and the case-fatality rate was 9% at 24 hours, 28% at 7 days, 40% at 30 days and 59% at 6 months. Hypertension, old age, obesity, 'cryptogenic/ unknown cause" and brain stem stroke were preditors of high mortality. Conclusion: A changing pattern of the stroke subtype with an increasing frequency of haemorrhagic stroke in our population is suspected. Stroke constitute a significant cause of mortality at all post- ictal period and the need for prompt institution of intensive care treatment within the first 24 hours and beyond, as well as other supportive measures was emphasised.

1282 Sulcal Hyperintensity on Fluid-Attenuated Inversion Recovery Imaging as a marker for Hemorrhagic Transformation in Acute Isehemic Stroke

Vedolin, L 1, Ouriques-Martins, SC z, Folgierini, M 1, Krutter, D ~, FrietMctl, M 2, Brondani R 2, Manenti E 2, Rech, R 2, Jaeger, C 2, Silveira, D 2, Komlts , M 3, Ehlers JA 2. 1Neuroradiologist, Vascular Unit of the M~e de Deus Hospita[, Porto Alegre, Brazil," 2Stroke Team, Vascular Unit of the Mde de Deus Hospital' Porto Alegre, Brazil," 3Radiologist trainee, Mde de Deus Hospital' Porto Alegre, Brazil

Background: Disruption of the blood-brain barrier resulting from reperfusion is a potential cause of hemorrhagic transformation (HT) and worse clinical outcome in hyperacute stroke. Our purpose was to