Fatima Pantiu

Role of EMSE and STESS scores in the outcome evaluation of status epilepticus

Status epilepticus (SE) is a severe neurological condition with significant morbidity and mortality. A reliable tool for prognosis is needed to take decision regarding treatment strategies. We compared 2 available prognostic scores of outcome: the Status Epilepticus Severity Score (STESS) and the Epidemiology-based Mortality score in SE (EMSE). We included 46 patients with SE evaluated out the last 5years in our hospital. We excluded patients with postanoxic encephalopathy or incomplete data. Among the 46 patients with SE, in-hospital mortality was 28%. The receiver operating characteristic (ROC) curve for predicting of death by STESS had an area under the curve (AUC) of 0.80 with cutoff point ≥4. The best EMSE variable combination to predict mortality was EMSE-AEL using an optimized cutoff point of 34 (age/etiology/loss of consciousness) with an area under the ROC of 0.79. The STESS and EMSE would be useful tools to predict in-hospital mortality in SE.

BLOOD PRESSURE EVOLUTION IN YOUNG PATIENTS WITH ACUTE ISCHEMIC STROKE: A new model for understanding the natural course of spontaneous hypertension?

ABSTRACT Background: Approximately 80% of patients suffering an acute ischemic stroke develop transient hypertension. The physiopathological mechanism remains unclear. Due to the lack of vascular risk factors, young adults could be a useful model for understanding blood pressure (BP) evolution in this setting. Methods: Patients between 18 and 55 years old admitted with an acute ischemic stroke were included. BP was evaluated during the following 48 h. Hypertension was defined as: systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg. Patients were divided into two groups: RF group included those who had a previous vascular risk factor and/or other medical condition known to affect the autonomic function; noRF group included patients without any of the previously stated conditions. Results: Thirty-nine patients were included: mean age: 44.26 years old, 21 were males (53.8%). Mean SBP and DBP at admission were 139.77 ± 5.35 mmHg (range: 90–243) and 84.44 ± 3.02 mmHg (range: 60–128), respectively; 43.58% patients were hypertensive at admission. SBP decreased significantly during the first 48 h (p = 0.044) for the entire population. RF group has higher SBP (p = 0.009) and DBP (p = 0.011) at admission than the noRF group. Conclusion: Most patients were normotensive at admission and BP fell spontaneously despite BP at admission. Young patients without medical conditions that could alter the autonomic system function could be a useful model for understanding acute hypertension in ischemic stroke.

S47. Sensory Guillain Barré syndrome

Introduction The classic Guillain Barre syndrome (GBS) is characterized by motor weakness, hyporreflexia, but limited sensory deficits. Sensory variants involving either small or large fibers or both are unusual and represent a diagnostic challenge. Methods We described 6 patients presenting with the sensory variant of GBS and retrospectively analyzed the clinical and electrophysiological findings of patients fulfilling the criteria for Sensory GBS according to Oh et al. criteria. Results Six patients were identified (mean age 38 years: range 15–54 years). Four had a previous infection. They all consulted due to distal painful paresthesias and allodynia. On examination the 6 patients presented normal strength and normal cranial nerves through the course of the disease with reduced knee and ankle reflexes in 3 patients. Distal hyperesthesia to pinprick was identified in 3 and one of them additionally had hyperhidrosis and constipation. Two additional patients presented hypoesthesia to pinprick and temperature. One patient had distal proprioceptive sensory loss with sensory ataxia. CSF albumin cytological dissociation was present in 3 patients. Nerve conduction studies (NCS) identified a sensory motor demyelinating neuropathy in 2 patients. Among the 4 with normal NCS, 2 had abnormal cold and warm threshold in their QST evaluation. All patients received symptomatic treatment for the neuropathic pain and only two IvIg therapies. Longstanding pain, fatigue or both were persistent findings in 5 patients after a mean follow up of 6 months. Conclusion The sensory variant of GBS is both an infrequent presentation and a diagnostic challenge. Longstanding pain and fatigue are common persisting findings.

Capsular warning syndrome as a manifestation of isolated middle cerebral artery dissection in a Latin American patient

Dear editor, Isolated middle cerebral artery dissection (MCAD) is a rare cause of stroke usually reported in Asian populations. Capsular warning syndrome (CWS) as a manifestation of MCAD is exceptional. We report on a Latin American patient who presented several episodes of transient motor symptoms secondary to MCAD. A 39-year-old right-handed male patient suffered several episodes of transient right hemiparesis and dysatrhria with mild headache during 72 h. After hospital admission, he suffered more than 10 episodes. Each time they started with mild right-perioral dysesthesia that progressed to severe dysarthria (the patient said: ‘‘I can feel the symptoms coming on’’) with spontaneous resolution in less than 10min. There was no loss of consciousness, or cortical signs or symptoms. The laboratory and the EEG were normal. Brain MRI and magnetic resonance angiography revealed a subcortical brain infarct and a string sign at the M2 segment of the left middle cerebral artery (Figure 1(a) and (b)). Digital subtraction angiography confirmed MCAD (Figure 1(c)). He was treated with aspirin and clopidogrel. He did not repeat any new episodes. MCAD is more likely to be idiopathic, and it is more often in Asian patients than in other regions (Europe and North America). It has been postulated that the higher prevalence found in Asian populations may be due to hemodynamic or genetic differences between ethnicities. A recent literature review of the disease, described a series of 61 cases with a male frecuency of 62.3%, most of the reported cases were from Asian countries (78.7%) and the M2 portion of the MCAD was rarely affected (21.7%). CWS is a distinct form of transient ischemic atack, clinically located at the internal capsule that usually leads to early infarction. It tended to occur over seconds with some patients describing a feeling as ‘‘coming on’’; most patients experience a pure motor hemiparesis often accompanied by sensory symptoms. There were only two reports that described the CWS in patients with MCAD. Our patient presented several brief transient deficits without cortical involment compatible with the syndrome. The CSW in MCAD might be a consecuence of the occlusion of the ostia of the lenticulostriate by the intimal end of the dissected artery or as of an embolic phenomenon. MCAD diagnosis requires a high degree of suspicion due to the low prevalence of the disease in our region; physicians should be awared of the CWS as a form of presentation of MCAD especially in young patients.

RAPIDLY PROGRESSIVE DEMENTIA SECONDARY TO AUTOIMMUNE ENCEPHALITIS: NEUROPSYCHOLOGICAL PROFILES AND RESPONSE TO IMMUNOTHERAPY

P2-313 IS CUED RECALL OF SHARED AUTOBIOGRAPHICAL KNOWLEDGE USEFUL IN CLINICAL DEMENTIA ASSESSMENT? Claudia Frankenberg, Maren Knebel, Christina Degen, Nadeshda Andrejeva, Petra Wetzel, Lina Sidonija Gorenc-Mahmutaj, Sabrina Dominique Navratil, Inga Meyer-K€uhling, Britta Wendelstein, Johannes Schr€oder, Section of Geriatric Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; Interdisciplinary Ageing Research, Faculty of Educational Sciences, Goethe University, Frankfurt am Main, Germany; Institute of Gerontology, University of Heidelberg, Heidelberg, Germany. Contact e-mail: Claudia.Frankenberg@med.uni-heidelberg.de

Multiple cranial nerve palsies due to perineural invasion

A 69-year-old man presented with a recent history of painless diplopia and left eye conjunctival injection. He had a cutaneous adenosquamous carcinoma removed from the left forehead 3 years before. The examination showed complete left ophthalmoplegia, exophthalmos, ptosis, and ipsilateral V1 hypoesthesia. Brain MRI revealed thickening and contrast enhancement of the external wall of the left cavernous sinus (figure 1). Because of skin cancer history, biopsy specimens of the previously resected tumor were reassessed, exhibiting neoplastic perineural spread (figure 2). Cavernous sinus invasion due to centripetal perineural spread from a supposedly removed skin cancer has been previously reported.1,2