Internuclear ophthalmoplegia caused by an isolated ischemic lesion affecting the medial longitudinal fascicle

Abstract

WCN 2013 No: 950 Topic: 3 — Stroke Internuclear ophthalmoplegia caused by an isolated ischemic lesion affecting the medial longitudinal fascicle T. Rab, I. Vastagh, V. Varadi, K. Szőke, G. Bozsik, G. Varallyay, G. Rudas, D. Bereczki. Department of Neurology, Semmelweis University Faculty of Medicine, Hungary; MRA Research Center, Semmelweis University, Budapest, Hungary Background: Internuclear ophthalmoplegia (INO) frequently appears in multiple sclerosis, but is rare as an isolated sign in stroke. Objective: To present clinical and imaging data of 3 cases of ischemic stroke with unior bilateral INO. Patients and methods: Two patients with unilateral and another one with bilateral INOwere investigated by a 3 Tesla Philips Achieva scanner. Results: A 66-year-old female and a 62-year-old male were admitted with acute right sided and an 80-year-old male with bilateral INO. Diffusion weighted MRI scans (DWI) confirmed restricted water diffusion in the medial longitudinal fascicle (MLF) in all cases. Unilateral INO was associated with unilateral MLF lesion whereas in the patient with bilateral signs the MLF was also affected on both sides. Hypertension was present in all three patients. Two patients had hyperlipidemia, one had diabetes, and one was a heavy smoker. The patient with bilateral INO had malignant melanoma which could also have caused prothrombotic state. Antiplatelets (aspirin or clopidogrel) were administered in all patients. The clinical signs were resolved in the patient with bilateral INO after two months. Patients with unilateral INO also improved during the first month after their stroke and their follow-up is ongoing. Conclusion: INO due to a small infarct affecting the MLF may cause unior bilateral signs. As Fisher proved, signs can be bilateral if the terminal branch of a paramedian artery divides and these vessels supply the MLF on both sides. Such small arteries are not visible however even for a 3 Tesla MRI. doi:10.1016/j.jns.2013.07.735 Abstract — WCN 2013 No: 949 Topic: 3 — Stroke Assessment on preadmission treatment of cardioembolic stroke patient in Malaysian hospital WCN 2013 No: 949 Topic: 3 — Stroke Assessment on preadmission treatment of cardioembolic stroke patient in Malaysian hospital N.N. Sidek, Z. Abdul Aziz, I. Looi, P.H. Chee, H. Md. Rafia. Pharmacy Department, Hospital SultanahNur Zahirah, Kuala Terengganu, Malaysia; Neurology Department, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia; Medical Department, Hospital Seberang Jaya, Seberang Perai, Malaysia; Medical Department, Hospital Kepala Batas, Kepala Batas, Malaysia; Neurology Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia Background: Atrial fibrillation (AF) increases the degree of stroke risk up to five times and doubled the overall mortality rate. Hence, anticoagulant as stroke primary prevention is vital. Objectives: We aim to assess the preadmission treatment received by the cardioembolic stroke patients, and review the mortality rate according to pre-treatment received. Method: This prospective study has been carried out from 1st Jan 2010 to 31st December 2012 by 11 Malaysian hospitals. Data have been collected by using Malaysian National Stroke Registry (NSR) case report form which then will be transferred to web application. For analysis, data was extracted and analyzed by using PASW 18. Results: There were 126 cardioembolic stroke patients registered to NSR with mean age of 65.97 ± 12.72 years old. Of all, only 45 patients were on Warfarin with 13 (10.3%) of them were within therapeutic and 32 patients (25.4%) received subtherapeutic Warfarin. 3.2% of patients received dual antiplatelet therapy, 26.2% on single antiplatelet therapy and 34.9% of patient did not received any treatment. The mortality rate was significantly high in no treatment group (34.1%) as compared to Warfarin (13.3%) and antiplatelet group (16.2%) with p value of 0.038. However, the mortality rate between Warfarin therapeutic (7.7%) with sub-therapeutic group (15.6%) and between single antiplatelet (18.7%) with dual antiplatelet were not significantly different. Conclusion: Our findings warrant greater effort to prevent stroke in AF patients, thus high mortality outcome which was significantly associated with treatment received prior to stroke event. doi:10.1016/j.jns.2013.07.736 Abstract — WCN 2013 No: 937 Topic: 3 — Stroke Establishing the aetiology of stroke in a young cohort WCN 2013 No: 937 Topic: 3 — Stroke Establishing the aetiology of stroke in a young cohort R. O'Connor, I. Noone, S. O'Riordan, N. Tubridy, C. Mc Guigan. Department of Neurology, St Vincent's University Hospital,