Mobilization after thrombolysis (rtPA) within 24 hours of acute stroke

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Abstract Submission Form
7th Annual Leaders in Medicine Research Symposium
October 30th, 2015 1:00 – 6:30 pm
Abstract Submission deadline: Friday, October 2, 2015
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methods (if appropriate), results and a conclusion.
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 Examples of abstracts are provided below.
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Please submit to: limsymposium@gmail.com
Abstract Example
Example:
(from Muhl et al. BMC Neurology 2014, 14:163)
Mobilization after thrombolysis (rtPA) within 24 hours of acute stroke: what factors
influence inclusion of patients in A Very Early Rehabilitation Trial (AVERT)?
Linnéa Muhl1, Jenny Kulin1, Marie Dagonnier2,3, Leonid Churilov2,3, Helen Dewey2,3,4, Thomas
Lindén5, and Julie Bernhardt2,3
1
Linköpings University, Linköping, Sweden; 2AVERT, Early Intervention Research Program,
The Florey Institute of Neurosciences and Mental Health, Austin Campus, 245 Burgundy St,
Heidelberg 3084, VIC, Australia; 3The University of Melbourne, Melbourne, Australia;
4
Department of Neurology, Austin Health, Heidelberg, Australia; 5The Centre of Brain Research
and Rehabilitation, Gothenburg University, Gothenburg, Sweden.
Introduction: A key treatment for acute ischaemic stroke is thrombolysis (rtPA). However,
treatment is not devoid of side effects and patients are carefully selected. AVERT (A Very Early
Rehabilitation Trial), a large, ongoing international phase III trial, tests whether starting out of
bed activity within 24 hours of stroke onset improves outcome. Patients treated with rtPA can be
recruited if the physician allows (447 included to date). This study aimed to identify factors that
might influence the inclusion of rtPA treated patients in AVERT.
Methods: Data from all patients thrombolysed at Austin Health, Australia, between September
2007 and December 2011 were retrospectively extracted from medical records. Factors of
interest included: demographic and stroke characteristics, 24 hour clinical response to rtPA
treatment, cerebral imaging and process factors (day and time of admission).
Results: 211 patients received rtPA at Austin Health and 50 (24%) were recruited to AVERT
(AVERT). Of the 161 patients not recruited, 105 (65%) were eligible, and could potentially have
been included (pot-AVERT). There were no significant differences in demographics,
Oxfordshire classification or stroke severity (NIHSS) on admission between groups. Size and
localization of stroke on imaging and symptomatic intracerebral heamorrhage rate did not differ.
Patients included in AVERT showed less change in NIHSS 24 hours post rtPA (median change =
1, IQR (−1,4)) than those in the pot-AVERT group (median change = 3, IQR (0,6)) by the
median difference of 2 points (95%CI:0.3; p = 0.03). A higher proportion of rtPA treated
AVERT patients were admitted on weekdays (p = 0.04).
Conclusion: Excluding a possible clinical instability, no significant clinical differences were
identified between thrombolysed patients included in AVERT and those who were not. Over 500
AVERT patients will be treated with rtPA at trial end. These results suggest we may be able to
generalize findings to other rtPA treated patients beyond the trial population.
Please submit to: limsymposium@gmail.com
Abstract Example
(Case Study)
Example:
(from Hirohata et al. BMC Neurology 2014, 14:150)
Subarachnoid hemorrhage secondary to a ruptured middle cerebral aneurysm in a patient
with osteogenesis imperfecta: a case report
Toshio Hirohata1,2, Satoru Miyawaki1,2, Akiko Mizutani3, Takayuki Iwakami1, So Yamada1,
Hajime Nishido1, Yasutaka Suzuki1, Shinya Miyamoto1, Katsumi Hoya1, Mineko Murakami1,
and Akira Matsuno1,2
1
Department of Neurosurgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki,
Ichihara City, Chiba 299-0111, Japan; 2Department of Neurosurgery, The University of Tokyo,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; 3Teikyo Heisei University, 2-51-4 HigashiIkebukuro, Toshima-ku, Tokyo 170-8445, Japan.
Background: Osteogenesis imperfecta (OI) is a heterogeneous group of inherited disorders that
occur owing to the abnormalities in type 1 collagen, and is characterized by increased bone
fragility and other extraskeletal manifestations. We report the case of a patient who was
diagnosed with OI following subarachnoid hemorrhage (SAH) secondary to a ruptured saccular
intracranial aneurysm (IA).
Case Presentation: A 37-year-old woman was referred to our hospital because of sudden
headache and vomiting. She was diagnosed with SAH (World Federation of Neurosurgical
Society grade 2) owing to an aneurysm of the middle cerebral artery. She then underwent
surgical clipping of the aneurysm successfully. She had blue sclerae, a history of several
fractures of the extremities, and a family history of bone fragility and blue sclerae in her son.
According to these findings, she was diagnosed with OI type 1. We performed genetic analysis
for a single nucleotide G/C polymorphism (SNP) of exon 28 of the gene encoding for alpha-2
polypeptide of collagen 1, which is a potential risk factor for IA. However, this SNP was not
detected in this patient or in five normal control subjects. Other genetic analyses did not reveal
any mutations of the COL1A1 or COL1A2 gene. The cerebrovascular system is less frequently
involved in OI. OI is associated with increased vascular weakness owing to collagen deficiency
in and around the blood vessels. SAH secondary to a ruptured IA with OI has been reported in
only six cases.
Conclusion: The patient followed a good clinical course after surgery. It remains controversial
whether IAs are caused by OI or IAs are coincidentally complicated with OI.
Please submit to: limsymposium@gmail.com
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