Læknablaðið : fylgirit - 01.05.2002, Blaðsíða 29

ABSTRACTS / 3 3RD SNC & 2ND SCNN
34 - Is stroke in the young primarily of non-embolic origin? The
Copenhagen Stroke Study
Jorgensen HS, Mosegaard D, Olsen TS
Dept. of Neurology, Gentofte Hospital, Copenhagen, Denmark
Purpose: It is our clinical observation that stroke in the young is
often characterized by being mild, nonexplained, having a good
prognosis, and recurrency is rare. We wanted to test the hypothesis
that stroke in the young may often be of noncardioembolic origin.
Methods: The Study is community-based. We prospectively inclu-
ded 1,197 patients with acute stroke. Patients were stratified into two
groups according to age (young<50 years). Stroke was considered
likely if the patient had either atrial fibrillation (AF) or ischemic
heart disease (IHD). Uni- and multivariate statistics were used.
Rcsults: 45 (4%) patients were young. Compared to the elderly
they were more often men (71% vs 45%, p<0.01;OR 2.7), and had
less often AF or IHD (2% vs 35%, p<0.001;OR 0.04). No difference
was found regarding diabetes or hypertension. Young patients had
in general less severe strokes (Scandinavian Stroke Scale score 48
vs 35 points, p<0.001). Mortality was 2% vs 21%, p<0.001, and both
neurological and functional outcomes were significantly better in
the young. 5-year survival was 89% vs 35%, p<0.001. The better
outcome was explained by less severe stroke and not by age. In
survivors, 4% vs 16% had a recurrent stroke during the 5-year
follow-up period, p=0.1.
Conclusion: In the young, cardioembolic risk factors are rare,
stroke is less severe and often unexplained, and recurrent stroke is
infrequent in comparison to in the elderly. Stroke in the young
seems therefore often to be of non-cardioembolic origin. We sug-
gest that stroke in the young is frequently due to a localized
cerebrovascular abnormality such as malformation or vasospasm.
Short- and longterm prognosis is exellent and recurrency rare.
35 - Cerebral embolization is reduced by carrying out coronary
artery bypass surgery “at a beatíng heart”
Lund C', Lundblad FT, Sundet K3, Tennoe B4, Fosse E5, Brucher R',
Russell D'
Depts. of 'Neurology, ;Thoracic and cardiovascular surgery, ’Psychosomatic
Medicine, 4Radiology, 'Tlie Interventional Centre; Rikshospitalet, University of
Oslo, Norway
Objective: Coronary artery bypass surgery (CABG) using cardio-
pulmonary bypass (on-pump surgery) carries a substantial risk for
cerebral injury due to cerebral embolization. This is due to the
whole-body inflammatory response which is induced by the heart-
lung-machine, and the fact that cannulation and cross clamping of
the ascending aorta produces atheromatous embolization. CABG
performed without cardiopulmonary bypass (off-pump surgery)
may therefore lead to a reduced risk of cerebral embolization and
subsequent cerebral injury. In this prospective, randomised study
we have assessed the rate of cerebral embolization during off-pump
compared to on-pump surgery.
Material and niethods: Transcranial Doppler (TCD) was used to
determine the number of cerebral microemboh in the left middle
cerebral artery during coronary artery bypass surgery in 52 patients,
of which 29 were carried out off-pump. Clinical, neuroradiological
and neuropsychological assessments were also performed one day
prior to surgery and at three months later.
Results: There was significantly fewer cerebral microemboli in the
off-pump group compared to the on-pump group (16 (range 0-131)
versus 66 (range 15-274), p<0.0001). One ischemic stroke occurred
in the on-pump group. There was no significant difference with
regard to neuroradiological and neuropsychological findings.
Conclusíon: Perioperative cerebral microembolization is signifi-
cantly reduced using the off-pump technique. TCD monitoring
allows identification of which surgical procedures that induces em-
bolization. A larger patient population will be assessed to deter-
mine if off-pump surgery is better for neurocognitive functions.
36 - Spondylotic Cervical Myelopathy: Conservative vs Surgical
Results in a Three-year Follow-up Study
Kadanka Z, Mares M, Bednanik J, Smrnka V, Krbec M, Stejskal L,
Chaloupka R, Surelová D, Novotný 0, Urbánek I, Dusek L
Departments of Neurology and Orthopaedic Surgery*, Faculty Hospital Brno
Study Design: A 3-year prospective randomised study. Objectives:
To compare conservative and operative treatments of mild and
moderate, non-progressive, or slowly progressive, forms of SCM.
Methods: Sixty-eight patients were randomised into two groups.
Group A, treated conservatively, consisted of 35 subjects, while group
B, treated surgically, was made up of 33 patients. The clinical outcome
was evaluated by modified JOA score, timed 10-m walk, score of daily
activities recorded by video and evaluated by two observers blinded
to the type of therapy, and by subjective assessment by the patients
themselves at months 6,12,24, and 36 of the follow-up.
Summary of Background Data: It is not known whether the results
of decompressive surgery of the mild and moderate forms of
spondylotic cervical myelopathy (SCM) are any better than those
of the conservative approach.
Results: There was, on average, no significant deterioration in
mJOA score within the two groups over 3 years of follow-up, but
there was a slightly expressed decrease in the self-evaluation score
in group B, and a slight deterioration of the score for daily activities
in group A. Comparison of the two groups showed significant
difference in the timed 10 m walk test in favour of group A, but no
difference in mJOA score and self evaluation by patients them-
selves (with the exception of a better score at month 6 in favour of
group B). Conclusions: The 3-year follow-up study did not show, on
average, that the surgery is superior to the conservative treatment
of mild and moderate forms of SCM.
Acknowledgments: This study was supported by the Internal Grant
Agency of the Ministry of Health of the Czech Republic, grant
number NF 6521-3.
37- Does aerobic training improve endurance in mild MS?
Bjarnadóttir ÓH’, Konradsdóttir ÁD’, Reynsidóttir K’, Ólafsson E’
'Reykjalundur Rehabilitation Centre, Mosfellsbær, Iceland, ;Dept. of Neurology,
Landspítali University Hospital Hringbraut. Reykjavík, Iceland
Objective: To determine the influence of intense physical training
for five weeks on cardiorespiratory fitness of individuals with mild
MS.
Material and methods: Twenty three patient with definitive MS,
agedl8-50 with EDSS < 3,5 were recruited. They were randomized
to exercise group (EG) (n=ll) and control group (CG) (n=12).
Læknablaðið/Fylgirit 43 2002/88 29