80 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0131 Neurology
Age, Sex and Stroke Type Differences in Stroke Pa- tients at Mukalla, Hadhramout: Analysis of 1072 Cases
Rasheed Mohammed BAMEKHLAH1, Nabeel MUSAIAN2, Hussain ALGHAZALI1 Hadhramout University, Yemen1, Hadhramout University, Yemen2
Background: Stroke is the third leading cause of death, and a cause of long-term dis- ability among survivors. Our aim was to identify age, sex and stroke type differences in stroke patients.
Methods: A cross-sectional study of stroke patients admitted at Ibnseena Hospital, Hadhramout, Yemen in (2009- 2011).
Results: stroke cases were 1072 (66.1±14.6) years; ischemic 78.5% and hemorrhagic 21.5%. Males 56.5% and females 43.5%. Patients ˃60 years 72%, in middle-aged 25.5%, while young ˂40 years 2.5%. Hypertension in 63.7% and 53.2% of mid- dle-aged & elderly, and in 29.6% of young. Diabetes in 36.3% and 39.5% of mid- dle-aged and old, while in 7.4% of young. Elderly had =2 risk factors (89.9%), 68.9%
of middle-aged and 55.6% of the young. Ischemic type increased with age, while hemorrhagic was more in young. Coma was more in the young (29.6%), than in mid- dle-aged (18.3%) and old (19.6%). Nonsignifi cant difference in hypertension, diabetes, previous attack and family history between males & females, Smoking had signifi cant difference between males & females, 94.2% of males had =2 risk factors and females (70%). Ischemic type in 76.2% of males and 81.3% of females while the hemorrhagic in 32.8% and 18.7%. Hypertension in hemorrhagic was signifi cantly higher (81.4%) than in ischemic (48.2%), nonsignifi cant difference between diabetes in ischemic and hemorrhagic. Previous attack was signifi cantly higher in hemorrhagic than ischemic.
Sudden onset was signifi cantly higher in hemorrhagic (98.7%) than ischemic (83.2%), coma was higher in hemorrhagic (38.1%) than in ischemic (14.4%)
Conclusions: Stroke increased with age. Ischemic type was more in old and hemor- rhagic in young patients. Males were more affected. No sex differences with risk fac- tors. Hemorrhagic stroke was more related to hypertension, previous attacks, sudden onset and coma.
PS 0132 Neurology
In-Hospital Fatality in Stroke Patients in Relation to Risk Factors and Clinical Presentation at Hadhramout:
Analysis of 1072 Cases
Rasheed Mohammed BAMEKHLAH1, Nabeel MUSAIN2, Hussain ALGHAZALI1 Hadhramout University, Yemen1, Hadhramout University, Yemen2
Background: Stroke is the third leading cause of death, and a cause of long-term disability among survivors. our aimwas to identify the frequency of in-hospital deaths among stroke patients admitted in Ibnseena Teaching Hospital, Mukalla, Hadhramout, Republic of Yemen.
Methods: A retrospective cross-sectional study of stroke patients admitted at Mukalla, Hadhramout in 1/2009- 12/2011. Data were collected in a questionnaire from patients’ fi les
Results: There were 1072 stroke cases; ischemic stroke were 78.5% and hemorrhagic 21.5%. Males were 56.5% and females 43.5%. In-hospital deaths were signifi cantly higher in old (36.5%) than in middle-aged and young (23.8% and 25.9% respectively), non-signifi cantly higher in females (35.2) than in males (31.4%), highly signifi cantly higher in hemorrhagic Stroke (50.6%) than ischemic type (28.2%). Hypertension, di- abetes, smoking, previous attacks and family history of stroke signifi cantly increased in-hospital deaths. Deaths among patients without risk (22.2%), with one risk factor (25%) and with =2 risk factors (34.6%). Death in late hospitalization (˃24 hours from onset) was signifi cantly higher (43.4%) than in early (within 24 hours from onset) (29%). Death in comatose cases was signifi cantly higher (67.5%) than fully (21.8%) or disturbed conscious (31.2%).
Conclusions: In-hospital death was more common in elderly, in females, in hemor- rhagic stroke, and in patients with hypertension, with diabetes, with previous attacks, and with family history. Multiple risk factors, late hospitalization, and coma at hospital admission also increased fatality.
PS 0133 Neurology
Hypertensive Neuropathy in Rat
Hitoshi NUKADA1, Masayuki BABA2, Denise MCMORRAN3, Soroku YAGIHASHI4 University of Otago, The Nukada Institute for Medical & Biological Research, New Zealand1, Aomori Prefectural Central Hospital, Japan2, University of Otago, New Zealand3, Hirosaki University, Japan4 Background: Hypertension is identifi ed as a risk factor for the development of poly- neuropathy. We examined nerve conduction and pathology in spontaneously hyper- tensive rats (SHR).
Methods: Motor nerve conduction velocity (MNCV) in sciatic-tibial nerve and sensory nerve conduction velocity (SNCV) in sural nerve were measured. Pathological inves- tigations include spinal cord, dorsal root ganglion, and hindlimb nerves in SHR and Wistar-Kyoto rats (WKY) aged from 4 to 64 weeks.
Results: Blood pressure was signifi cantly higher in SHR than WKY at 4 weeks and elevated further with aging. MNCV and SNCV were signifi cantly slowed in SHR when compared with WKY after 24 weeks old. Prominent nerve pathology in SHR included axonal atrophy and myelin splitting. SHR nerves revealed microangiopathy with redu- plication of basement membrane.
Conclusions: Sustained severe hypertension results in neuropathic processes with en- doneurial microangiopathy. Hypertensive target organ damage includes the peripheral nervous system, and subjects with uncontrolled hypertension could develop neuropa- thy.
PS 0134 Neurology
A Rare Case of Colchicine Induced Myopathy
Sarah WONG1, Ashish SULE1, Jam Chin TAY1 Tan Tock Seng Hospital, Singapore1
Introduction: This case report presents a rare case of myopathy due to intermittent dosing of colchicine, which was proven on electromyography. Symptoms resolved after cessation of colchicine with improvement in renal and liver functions.
Case Report: A 66 year old Chinese gentleman, with background history of hyperten- sion on olmesartan and chronic gout on intermittent dosing of colchicine, presented with acute weakness of bilateral lower limbs for investigation. He was noted to have acute kidney injury with raised creatinine kinase (CK) level and deranged liver enzyme levels. Differential diagnoses included fi rst presentation of polymyositis, Guillain Barre syndrome, rhabdomyolysis or myopathy.
Progress: Nerve conduction studies and electromyography were performed, revealing characteristic changes of acute colchicine induced myopathy; namely resting mem- brane instability, positive sharp waves and fi brillations in affected proximal muscles.
Cessation of colchicine led to improvement in renal and liver function as well as reso- lution of symptoms.
Discussion: This case highlights the pharmacokinetics and metabolism of colchicine as well as its clinical signs and symptoms of varying degrees of toxicity. It is vital that patients on colchicine should be adequately eduated on the side effects of colchicine and be monitored for symptoms of toxicity. Creatinine kinase should be measured when myotoxicity is suspected.
