82 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0139 Neurology
Clinical and ECG Parameters as Predictors of Early Neu- rological Deterioration (END) and in-Hospital Mortality After Acute Hemorrhagic Stroke: A Hospital-Based Retrospective Cohort
Bernard Benjamin P. ALBANO1, Josephine C. GUTIERREZ2, Jose P. TIRONA3 Department of Internal Medicine, De La Salle University Medical Center, Philippines1, Section of Neurol- ogy, Philippine General Hospital, Philippines2, Section of Adult Cardiology, De La Salle University Medical Center, Philippines3
Background: Identifi cation of outcome predictors in stroke remains important for the application of early aggressive treatment and establishment of a reliable prognosis.
Methods: The objective was to determine the clinical characteristics of Filipino pa- tients with hemorrhagic stroke and identify parameters that predict early neurological deterioration (END) and death. Charts of hemorrhagic stroke patients that met the inclusion criteria were reviewed. Relevant data on admission were recorded. Canadian Stroke Score (CSS) and Glasgow Coma Scale (GCS) on the fi rst 3 hospital days and mortality at any time during hospital stay were also recorded.
Results: Eighty-eight patients were included (49 male), mean age was 56.7+12.9. The most common presenting symptom was hemiparesis (29.5%), and the most common location was striatocapsular (31.8%). Forty nine patients (55.7%) had severe stroke and 31 (35.2%) had severe impairment of consciousness. Fifty six patients (67%) had ECG abnormalities. The incidence of END was 38.6% (95%CI 28.9, 49.1), while in-hos- pital mortality rate was 29.5% (95% CI 20.7, 39.7).
Conclusions: Independent predictors of in-hospital death were high systolic blood pressure (SBP), “severe” stroke, presence of intra-ventricular (IV) extension and sub- arachnoid hemorrhage (SAH). Independent predictors of END were high SBP, “severe”
stroke and presence of leukocytosis. In hemorrhagic stroke, the ECG score has a role in risk stratifi cation and that aggressive SBP reduction may signifi cantly reduce the occurrence of END and in-hospital mortality.
PS 0140 Neurology
Diagnosing and Prognosticating Tuberculous Menin- gitis(TBM) in Resource Limited Settings - Experience of a North Indian Tertiary Care Centre
Arjun KHANNA1, Virendra ATAM2
VMMC and Safdarjang Hospital, India1, King George’s Medical University, India2
Background: Background In spite of the common occurrence of TBM it is often mis- diagnosed. Many of the commonly used methods such as PCR, Culture etc. are either expensive, or not easily available in resource limited settings. The aim of this study was to evaluate the usefulness of CSF ADA for diagnosis of TBM and to correlate the initial levels of CSF ADA with the neurological outcome.
Methods: This is a prospective cohort study including 83 patients. Patients with his- tory and clinical features suggestive of TBM were analysed using the Thwaites criteria.
CSF ADA levels were estimated in patients fulfi lling these criteria. ADA> 10 IU/L were taken as positive, and these patients were followed up at 30 and 90 days and the neurological outcome was assessed using the modifi ed Rankin scale (MRS).
Results: CSF ADA levels in all 83 patients labelled as TBM using the Thwaites criteria was found to be above 10IU/L (10.64-25). The mean ADA was 30.01 IU/L. A total of 6 patients expired, the mean ADA in this group was 100.4, which was signifi cantly more than the mean ADA levels. 30 patients had residual disability at discharge (MRS= 1).
The mean ADA levels in this group were 33.12 IU/L.
Conclusions: CSF ADA levels were elevated in all 83 patients (100% sensitivity) im- plying its usefulness as a simple, inexpensive test to aid in the diagnosis of TBM. The initial CSF ADA levels were much higher than the mean in patients who expired, sug- gesting its role as a marker in predicting mortality in these patients. Also, to establish a primary diagnosis of TBM we utilized the Thwaites criteria, which is easily utilized and does not require extra, expensive investigations.
PS 0142 Neurology
Stroke in Hadhramout, Republic of Yemen
Rasheed Mohammed BAMEKHLAH1, Hussain ALGHAZALI2, Nabeel MUSAIAN3 Internal Medicine, Hadhramout University, Yemen1, Internal Medicine, Hadhramout University, Yemen2, Family Medicine, Hadhramout University, Yemen3
Background: Stroke is the third leading cause of death, and a cause of long-term disability among survivors. Our province is lacking studies about stroke. our aim was to analyze data collected from our Hospital Registery.
Methods: a cross-sectional study of stroke patients admitted at Mukalla, Hadhramout in 2009- 2011. Data were collected from Hospital Registery
Results: stroke cases were 1072; ischemic 78.5% and hemorrhagic 21.5%. Males 56.5% and females 43.5%. Patients ˃60 years 72%, middle-aged 25.5%, while young
˂40 years 2.5%. Hypertension and diabetes are higher in middle-aged & elderly than in young ones. Elderly had =2 risk factors (89.9%). Ischemic type increased with age, while hemorrhagic was more in young than in the middle-aged and old. Coma was more in the young, than in middle-aged and old. Nonsignifi cant difference in hyper- tension between males & females, diabetes, previous attack in family history. Smoking was signifi cantly higher in males, Hypertension in hemorrhagic was signifi cantly high- er, nonsignifi cant difference between diabetes in ischemic and hemorrhagic. Previous attack was significantly higher in hemorrhagic than ischemic. Coma was higher in hemorrhagic than in ischemic stroke. In-hospital deaths were signifi cantly higher in old patients, non-signifi cantly higher in females, highly signifi cantly higher in hemor- rhagic Stroke than ischemic type. Hypertension, diabetes, smoking, previous attacks and family history of stroke signifi cantly increased in-hospital deaths. Death in late hospitalization was signifi cantly higher than in early. Death in coma was signifi cantly higher than in full or disturbed consciousness.
Conclusions: Ischemic stroke was more in elderly and hemorrhagic in young. Hemor- rhagic stroke was more related to hypertension, previous attacks, and coma. In-hos- pital death was more common in elderly, in females, in hemorrhagic stroke, and in pa- tients with hypertension, with diabetes, with previous attacks, and with family history.
Late hospitalization, and coma at admission also increased fatality.
PS 0143 Neurology
Brainstem Auditory Evoked Potentials’ Responses in Hypothyroidism and Hyperthyroidism
Vikash GAUTAM1, Dilip THAKUR1, Bishnu Hari PAUDEL1, Kopila AGRAWAL1, Madhab LAMSAL2
Department of Basic and Clinical Physiology, BP Koirala Institute of Health Sciences, Nepal1, Depart- ment of Biochemistry, BP Koirala Institute of Health Sciences, Nepal2
Background: To correlate brainstem auditory evoked potentials’ (BAEPs) amplitude and la- tency within different thyroid status (hypothyroidism, hyperthyroidism and euthyroidism).
Methods: BAEP and Thyroid Function Tests (TFT) were assessed in consenting 75 subjects (hypothyroid=24, hyperthyroid=25, euthyroid= 26). The mean age in hypothyroid, hyper- thyroid, and euthyroid group were 31.46±4.191; 31.52±4.134 and 27.12±2.732 respectively.
The BAEP parameters viz, wave I-V latencies, interpeak latencies and amplitudes were re- corded. One way ANOVA was used to compare BAEP parameters among three groups and Pearson’s correlation to fi nd relation between thyroid hormones (fT3, fT4, TSH) and BAEP parameters. P value less than 0.05 was considered statistically signifi cant.
Results: Wave I (1.78±0.21 vs. 1.64±0.22, vs. 1.56±0.15, p= 0.001), wave III (3.96±0.19 vs.
3.90±0.30 vs. 3.74±0.30, p= 0.001) and wave V (5.97±0.36 vs. 5.91±0.37 vs. 5.60±0.24; p=
0.001) latencies (ms) were signifi cantly more in hypothyroid and hyperthyroid than euthyroid.
Wave interval latencies (ms) III-V (2.01±0.32 vs. 2.01±0.41 vs. 1.86±0.32, p= 0.044) and I-V (4.19±0.43 vs. 4.26±0.41 vs. 4.03±0.28, p= 0.007) were longer in hypothyroid and hyper- thyroid than euthyroid. Also, the wave I-V amplitude (μV) was more in hypo-hyperthyroid than euthyroid (0.15±0.11 vs. 0.22±0.17 vs. 0.20±0.16, p= 0.052). TSH & Wave I-V am- plitude (r= -0.193, p= 0.04); fT3 and wave I latency (r= -0.269, p=0.004) were negatively correlated. However, a positive correlation was between TSH & wave I latency (r= 0.285, p=0.002).
Conclusion: Both hypo- and hyperthyroidism led to conduction delay in auditory neurons in adults, possibly adversely affecting function of myelin since, T3 and T4 are known to affect myelinization and synaptic transmission. The prominent auditory evoked potential abnor- malities in hypothyroidism and less change in hyperthyroidism are consistent with a possi- bility that the auditory neuropathy is more common in thyroid defi ciency than its excess.
