Tanzila Shams

Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) Criteria: A 7M Management Approach to Developing a Stroke Interventional Laboratory in the Era of Stroke Thrombectomy for Large Vessel Occlusions.

Brain attack care is rapidly evolving with cutting-edge stroke interventions similar to the growth of heart attack care with cardiac interventions in the last two decades. As the field of stroke intervention is growing exponentially globally, there is clearly an unmet need to standardize stroke interventional laboratories for safe, effective, and timely stroke care. Towards this goal, the Society of Vascular and Interventional Neurology (SVIN) Writing Committee has developed the Stroke Interventional Laboratory Consensus (SILC) criteria using a 7M management approach for the development and standardization of each stroke interventional laboratory within stroke centers. The SILC criteria include: (1) manpower: personnel including roles of medical and administrative directors, attending physicians, fellows, physician extenders, and all the key stakeholders in the stroke chain of survival; (2) machines: resources needed in terms of physical facilities, and angiography equipment; (3) materials: medical device inventory, medications, and angiography supplies; (4) methods: standardized protocols for stroke workflow optimization; (5) metrics (volume): existing credentialing criteria for facilities and stroke interventionalists; (6) metrics (quality): benchmarks for quality assurance; (7) metrics (safety): radiation and procedural safety practices.

A Case of Neuro-Behcet’s Disease Presenting with Central Neurogenic Hyperventilation

Patient: Female, 46 Final Diagnosis: Central hyperventilation Symptoms: Hyperventilation Medication: — Clinical Procedure: None Specialty: Neurology Objective: Unusual clinical course Background: Behcet’s disease is a chronic inflammatory disorder usually characterized by the triad of oral ulcers, genital ulcers, and uveitis. Central to the pathogenesis of Behcet’s disease is an autoimmune vasculitis. Neurological involvement, so called “Neuro-Behcet’s disease”, occurs in 10–20% of patients, usually from a meningoencephalitis or venous thrombosis. Case Report: We report the case of a 46-year-old patient with Neuro-Behcet’s disease who presented with central neurogenic hyperventilation as a result of brainstem involvement from venulitis. Conclusions: To the best of our knowledge, central neurogenic hyperventilation has not previously been described in a patient with Neuro-Behcet’s disease.

Baseline Quality of Life and Risk of Stroke in the ALLHAT Study (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)

Background and Purpose— The visual analogue scale is a self-reported, validated tool to measure quality of life (QoL). Our purpose was to determine whether baseline QoL predicted strokes in the ALLHAT study (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial) and evaluate determinants of poststroke change in QoL. In the ALLHAT study, among the 33 357 patients randomized to treatment arms, 1525 experienced strokes; 1202 (79%) strokes were nonfatal. This study cohort includes 32 318 (97%) subjects who completed the baseline visual analogue scale QoL estimate. Methods— QoL was measured on a visual analogue scale and adjusted using a Torrance transformation (transformed QoL [TQoL]). Kaplan–Meier curves and adjusted proportional hazards analyses were used to estimate the effect of TQoL on the risk of stroke, on a continuous scale (0–1) and by quartiles (⩽0.81, >0.81⩽0.89, >0.89⩽0.95, >0.95). We analyzed the change from baseline to first poststroke TQoL using adjusted linear regression. Results— After adjusting for multiple stroke risk factors, the hazard ratio for stroke events for baseline TQoL was 0.93 (95% confidence interval, 0.89–0.98) per 0.1 U increase. The lowest baseline TQoL quartile had a 20% increased stroke risk (hazard ratio=1.20 [95% confidence interval, 1.00–1.44]) compared with the reference highest quartile TQoL. Poststroke TQoL change was significant within all treatment groups (P⩽0.001). Multivariate regression analysis revealed that baseline TQoL was the strongest predictor of poststroke TQoL with similar results for the untransformed QoL. Conclusions— The lowest baseline TQoL quartile had a 20% higher stroke risk than the highest quartile. Baseline TQoL was the only factor that predicted poststroke change in TQoL. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.

Cerebrovascular Diseases Complicating Ventriculoperitoneal Shunt Response in Secondary Normal Pressure Hydrocephalus (P07.191)

Objective: To describe outcomes in two patients with cerebrovascular disease and secondary normal pressure hydrocephalus (NPH) with poor response to ventriculoperitoneal shunting (VPS). Background The prediction of VPS response in secondary NPH remains challenging, given its complex etiologies and comorbidities. Cerebrovascular disease (CVD) is a common comorbidity in NPH, and previous CVD insults may contribute to the development of secondary NPH, making it an important consideration in patient selection and outcome of VPS in secondary NPH. Design/Methods: We report the pre-operative and post-operative clinical features, surgical, neuroimaging, and ancillary testing data in two such cases, with videotaped exam in the second case. Results: Patient #1, a 79-year- old woman with known basilar tip aneurysm and pituitary macroadenoma, developed progressive gait disturbance/ataxia, cognitive decline, and urinary and fecal incontinence in the setting of moderate ventriculomegaly and transependymal CSF migration on brain MRI. Right-sided occipital VPS provided minimal improvement and post-operative imaging demonstrate enlarging basilar tip aneurysm with mild midbrain compression. Clinically, three months after VPS, she developed mild features of akinetic mutism. Patient #2, an 81- year- old woman with recent history of a right-sided subdural hematoma and evacuation, who upon recovery developed fluctuating cognition with mildly decreased interactiveness and gait dysfunction, was found to have significant ventriculomegaly and moderate ischemic white matter disease on head CT. After a robust response in gait speed to a large volume lumbar puncture, a right pre-coronal VPS was placed, with only temporary benefits. After shunt malfunctions were revised twice, benefits could not be recaptured, and she developed significant akinetic mutism. Conclusions: Decisions to place a VPS in secondary NPH in the setting of CVD, large artery aneurysms, and after subdural hematomas are challenging and may prove to be negative predictive factors to shunt response. Disclosure: Dr. Rao-Frisch has nothing to disclose. Dr. Shams has nothing to disclose. Dr. Smyth has nothing to disclose. Dr. Lerner has nothing to disclose.