128 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0305 Geriatrics
The Effect of Extracranial and Transcranial Doppler Ultrasound in the Management of Old and Very Old Stroke Patients: An Observational Study
Mariana ALVES1, Ana MIRANDA1, Luis MIEIRO1, Teresa FONSECA1 Medicina 3A, CHLN- Hospital Pulido Valente, Portugal1
Background: Stroke patients are recommended to undertake carotid and vertebral ultrasound(CVU) to identify signifi cant carotid stenosis that could benefi t from early carotid endarterectomy(CEA). Carotid disease increases with age and older patients (>75 yo) benefi t from CEA, as it reduces absolute risk of recurring stroke when life expectancy is greater than 3y. Transcranial Doppler(TCD) is useful for the diagnosis of abnormalities of large cerebral arteries and it is the only technique able to identify circulating intracranial emboli, due to left-right shunt. The authors aim to assess the infl uence of age in disease detected in CVU and the effect of this tool in treatment strategies.
Methods: 26-month retrospective study at our stroke unit. Ischemic strokes and transient ischemic attacks were analyzed. Patients were stratified into groups by age:=64yo;65-75yo and=76yo. The effect of vascular ultrasonography in therapeutic outcome was assessed.
Results: 311patients were diagnosed as ischemic strokes or transient ischemic attacks.
Mean age was 74yo, 48%male, =64yo(n=55),65-75yo(n=79) and=76yo(n=177). CVU was performed in 89%, 81% and 50% of the patients, by age group respectively. We report carotid occlusion in 8%, 10% and 6%; 70-99% stenosis in 0%, 3% and 3%;
50-69% stenosis in 13%, 14% and 16%; artery dissection in 2%, 0% and 0% of the cases per age group respectively. TCD detected intracranial stenosis in 15%, 22% and 20%; and microembolic signals in 23%, 2% and 1%.
Conclusion: Stroke prevalence increases among the oldest, supposedly in part due to the atheromatous disease. Despite atheromatous disease being more common in the older patients, the number of hemodynamically signifi cant carotid stenosis benefi ting from early CEA is still very low in this cohort. These fi ndings query the cost-effective- ness of this diagnostic tool in very old stroke patient.
PS 0306 Geriatrics
Neuronal and Behavioral Changes Intuberous Sclerosis
Joao Gomes PEREIRA1, Julio FERNANDES2
C. Hosp. Lisboa Norte - Hospital De Santa Maria, Portugal1, C. Hosp. Lisboa Norte - Hospital De Santa Maria, Portugal2
Introduction: Tuberous sclerosis is a genetic disorder caused by mutations in the TSC1 or TSC2 genes, with an incidence of 1:6000 births. 30% of cases have a family history with autosomal dominant pattern and the remaining 70% are “de novo” mutations. It is multi-systemic with characteristic skin, central nervous system, pulmonary, renal, cardiac and hepatic involvement. The clinical expression of central nervous system involvement is highly variable, being composed primarily of intellectual defi cit, specifi c neuropsychiatric defi cits, behavioral disorders and epilepsy.
Case Report: A 69 year old patient with angiofi bromas of the face and toes, multiple cerebral hamartomas, angiomyolipomas and cystic kidney disease, hepatic hemangi- omas and lymphangioleiomyomatosis conditioning respiratory failure, and diagnos- tic criteria of tuberous sclerosis with no family history relating to that entity, was hospitalized for neuropsychiatric changes with months of evolution. It consisted of behavioral disorders, simple calculation and drawing errors, altered sleep-wake cycle, nocturnal restlessness, slowed speech, rigidity and postural tremor. However, it was observed that these changes gradually improved over several months on medication.
Conclusion: The neuropsychiatric changes in tuberous sclerosis are probably due to the tumors in the central nervous system, but mainly because of specifi c molecular mechanisms resulting from disinhibition of mTOR (‘mammalian target of rapamycin “).
New studies of these mechanisms are in order control this disease, particularly inhibi- tors of mTOR.
PS 0307 Geriatrics
Association of Hypertriglyceridemia with Ischemic Stroke, Study in Dhaka Medical College Hospital
Enamul KARIM1, Shekhar MONDAL1 Dhaka Medical College Hospital, Bangladesh1
Background: Hypertriglyceridemia fosters the development of atherosclerosis via sev- eral mechanisms and lead to ischemic stroke (IS) through its contribution to thrombo- genicity.
Methods: This was a case control study conducted in the Department of Medicine, Dhaka Medical College Hospital and data was collected in a questionnaire from Jan- uary to June’2013. Patients presented with ischemic stroke, confi rmed by CT scan of Head/ MRI of brain from fi rst day to 6 months and other than ischemic stroke were considered as case and control respectively.
Results: The mean age was found 61.0±8.3 years in case group and 60.5±8.1 years in control group. Male were predominant in both groups which was 80(80.0%) in case group and 84(84.0%) in control group. More than two third (68.0%) in cases and one fourth (25.0%) in controls patients had hypertension. 12 (12.0%) in cases and 2(2.0%) in controls patients had heart disease. Normal triglycerides was found 52(52.0%) in cases and 72(72.0%) in control. The mean TG was found 179.9±62.8 mg/dl in cases and 148.0±51.9 mg/dl in controls. Desirable cholesterol was found 16(16.0%) in cases and 25(25.0%) in controls. The mean cholesterol was found 238.0±4.0 mg/dl in cases and 213.0±42.0 in controls. Optimal LDL was found 12(12.0%) and 18(18.0%) in case and control group respectively. Mean LDL was found 167.0±35.2 mg/dl in cases and 141.0±36.1 mg/dl in controls. Low HDL was found 64(64.0%) in cases and 26(26.0%) in controls. Mean HDL was found 41.2±10.6 mg/dl in case group and 49.0±8.6 mg/dl in control group.
Conclusions: Ischemic stroke is signifi cantly associated with a higher level of TC, TG, LDL and HDL (inversely). Therefore, Hypercholesterolemia and Hypertriglyceridemia may be a risk factor for ischemic stroke.
PS 0308 Geriatrics
HIP Fracture Prognosis in Patients with and Without Hyponatremia
Nora Angelica FUENTES1, Diego Hernan GIUNTA1, Cristina Maria ELIZONDO1, Fernan GONZALEZ BERNALDO DE QUIROS1, Gabriel Dario WAISMAN1, Juan Carlos AYUS1 Clinical Research Unit, Hospital Italiano De Buenos Aires, Argentina1, Nephrology Unit, Hospital Italiano De Buenos Aires, Argentina2
Background: Hip Fracture (HF) is a leading cause of morbidity and mortality in elderly.
Related complications are cardiovascular (CVD), sepsis and venous thromboembolism (VTE), deep venous thrombosis (DVT) and pulmonary embolism (PE). In recent studies, chronic hyponatremia was observed to be an independent risk factor for hip fracture, nevertheless there is no evidence on prognosis of these patients compared to patients without hyponatremia.
Objective: To compare the prognosis and complications of HF in normonatremic pa- tients (N) and hyponatremic patients (H).
Methods: Retrospective cohort of hospitalized patients with HF, followed up to 30 days after diagnosis, at Hospital Italiano of Buenos Aires. Presence of complications (sepsis, DVT, PE, and CVD), hospital length of stay, mortality and readmission were evaluated.
Results: 1571 patients were included, 76,7% (1205) for N and 23,3% (366) for H. Most patients were female, 82.5% and 79.8% for H and N respectively. H were older, 85 vs.
82 years (p<0.001). Sepsis was the most frequent complication for H (OR 1.7, 95% CI:
1.13-2.6). Length of stay was 7 days vs. 8 days (p=0.053) for N and H. Readmissions were 12.9% for N vs. 15.8% for H (p=0.14). Hospital mortality was minor for N than for H (14.7% vs. 19.9%; p=0.016), crude OR was 1.45 (1.07-1.96) and adjusted OR was 1.15 (0.84-1.6). Survival was higher for N than for H (p<0.001). Crude hazard ratio (HR) of death for H compared to N was 1.8 (1.4-2.35) and adjusted HR was 1.45 (1.1-1.9).
Conclusions: Hyponatremic patients have higher risk of sepsis, hospital length of stay and mortality. Thus hyponatremia could represent a marker of severity of underlying diseases or be a consequence of treatments during the surgical procedures, it could serve as alert for potential risk on outcome of these patients.
