P.074 Management, timing of anticoagulation and outcomes of patients with cerebral venous sinus thrombosis: a single centre chart review

Background: Cerebral venous sinus thrombosis (CVST) accounts for <1% of all strokes. Our objectives were to describe the clinical features and examine the association between timing of anticoagulation therapy and outcomes in CVST patients. Methods: We conducted a retrospective chart review of patients admitted to Hamilton Health Sciences from 2015 – 2020 with imaging confirmed CVST. Results: We included 96 patients, mean age of 47.9 (SD 18.1). The most common clinical presentation was headache (43.8%). Brain trauma was the most common identified risk factor (15.6%), while 27% of individuals had no identified cause. Most patients (57.3%) received anticoagulation within 24hrs of identified CVST, while 26% had a delay (≥48hrs) and 16.7% were not anti-coagulated. The rationale for delaying or not starting anticoagulation included traumatic brain injury (31.8%), neurosurgical procedure (9.1%), presence of venous infarct and/or haemorrhage (27.1%) and unclear rationale (31.8%). At a median of 8 days, more patients without clear indications for delayed or no anticoagulation were disabled (defined by modified Rankin Scale, mRS, score ≥ 2) or dead (mRS 6), compared to those anti-coagulated in 24hrs (87.5% versus 31.8%; RR 2.75; 95% CI 1.74 – 4.35). Conclusions: Unjustified delay in anticoagulation may result in poorer clinical outcomes in CVST patients.

TO ANALYZE THE SENSITIVITY OF DIFFUSION WEIGHTED IMAGING (AT HIGHER B VALUE, IN DIFFERENT IMAGING PLANES AND COMPARISON WITH ADC, FLAIR, T2W IMAGING).

Background- The danger of intracranial pathology is that expansion in an enclosed space leads to brain compression causing ischemia, swelling and loss of function that can be permanent and possibly fatal. Methods- This was a simple observational prospective study carried out at the Department Of Radio-Diagnosis and Modern Imaging, S.P.M.C. & A.G. Of P.B.M. Hospitals, Bikaner. All the patients presented for MR brain study with some neurological complaints and showed positive findings on MRI were included in this study. Results-Mean ADC value in different type of intracranial lesions and found that abscess had mean ADC value of 0.35±0.11, acute arterial infarcts had 0.44±0.11, ADEM had 0.38±0.06, encephalitis had 0.38±0.04, glioma had 0.47±0.02, HIE had 0.36±0.03, ICH had 0.58±0.17, lymphoma had 0.52±0.15, meningioma had 0.61±0.16, metastasis had 0.51±0.03, subacute arterial infarct had 0.44±0.11, TBM had 0.48±0.05 and diffuse axonal injury, pontine myelinolysis and venous infarct had mean ADC value was 0.43, 0.52 and 0.42 respectively Conclusion- The diffusion weighted MR images should be interpreted along with other sequences and also along with clinical details of the patient. Keywords: MRI, Brain, lesion.

TO ASSESS VARIOUS BRAIN LESIONS ON MRI

Background- The danger of intracranial pathology is that expansion in an enclosed space leads to brain compression causing ischemia, swelling and loss of function that can be permanent and possibly fatal. Methods- This was a simple observational prospective study carried out at the Department Of Radio-Diagnosis And Modern Imaging, S.P.M.C. & A.G. Of P.B.M. Hospitals, Bikaner. All the patients presented for MR brain study with some neurological complaints and showed positive findings on MRI were included in this study. Results- out of total 120 stroke cases, there were 33 cases of acute arterial infarct, 4 of HIE, 6 cases of ICH, 76 of subacute arterial infarct and 1 case of venous infarct. Similarly, out of total 17 cases of tumors, 9 cases were of meningioma, 4 of lymphoma, 2 of glioma and metastasis each. Out of total 9 cases of infections, there were 3 cases of abscess, 2 of encephalitis and 4 of tubercular meningitis. There were 1 case of pontine myelinolysis, 2 cases of ADEM and 1 cases of diffuse axonal injury in this study. Conclusion- Stroke comprised the majority of lesions at 120 cases (80% of the total cases studied). Keywords: MRI, Brain, lesion.

Epileptic Spasms Predict Poor Epilepsy Outcomes After Perinatal Stroke

Perinatal stroke is a significant cause of severe epilepsy, including epileptic spasms. Although epileptic spasms due to underlying structural lesion often respond poorly to treatment and evolve into drug-resistant epilepsy, outcomes are not uniformly poor, and predictors of outcomes are not well described. We performed a single-institution retrospective review of epileptic spasms following perinatal stroke to determine if outcome depended on vascular subtype. We identified 24 children with epileptic spasms due to perinatal ischemic stroke: 11 cases of perinatal arterial stroke and 13 cases of perinatal venous infarct. Initial response to treatment was similar between groups; however, although children with perinatal arterial stroke who responded to epileptic spasms therapy had high rates of seizure freedom, many children with perinatal venous infarct, regardless of initial response, had residual drug-resistant epilepsy. We consider whether the mechanism for epileptogenesis may be different between arterial and venous strokes, and whether these 2 groups should be monitored for epileptic spasms, and subsequent epilepsy, differently.