First year of 24/7 Acute Stroke Unit. Part 2: outcome of stroke thrombolysis using telemedicine

OBJECTIVE: To evaluate the safety and efficacy of intravenous recombinant tissue plasminogen activator (IV-rtPA) for acute ischaemic stroke through telemedicine consultation …published_or_final_versio

Clinical features, management, and prognostic factors of status epilepticus in Chinese

Poster PresentationINTRODUCTION: Status epilepticus (SE) is a neurological emergency with significant mortality and morbidity. There are currently limited data regarding the causes and outcomes of SE in our locality, and identification of prognostic factors, especially those available at presentation, could lower risk of under- or over-treatment in SE. METHODS: We retrospectively studied the clinical characteristics, management, and clinical outcome of adults diagnosed with incident SE, excluding episodes due to cerebral anoxia, at a regional hospi…published_or_final_versio

Prognosis and functional outcome after ischaemic stroke in Chinese

Oral PresentationINTRODUCTION: Ischaemic stroke (ISS) is a significant cause of disability and mortality worldwide. Here, we studied the subtypes and long-term prognosis of ISS in our locality. METHODS: A total of 1214 patients with ISS receiving rehabilitation at Tung Wah Hospital during 2004-2008 were prospectively followed-up for a mean of 76±18 months. Presence of recurrent stroke and all-cause mortality during the follow-up period was documented. The modified Rankin Score (mRS) at 1-year follow-up was delin…published_or_final_versio

First year of 24/7 Acute Stroke Unit. Part 1: eligibility and utilisation of intravenous thrombolysis

INTRODUCTION: Intravenous recombinant tissue plasminogen activator (IV-rtPA) is the standard therapy for acute ischaemic stroke. Because of its narrow therapeutic time window, eligibility and utilisation rates of this treatment remained low. Our IV-rtPA programme was enhanced to a 24/7 protocol since September 20…published_or_final_versio

Outcomes of first-ever stroke

The long-term prognosis after first-ever stroke is poor—5 years after their stroke, 39.7% of patients had died and 10.7% were dependent in terms of activity of daily living; 136 (21%) who survived at least 30 days after the initial stroke, had a recurrence within 5 years.published_or_final_versio

Stroke Patients with a Past History of Cancer Are at Increased Risk of Recurrent Stroke and Cardiovascular Mortality

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Clinical and neuroradiological features of viral encephalitis: a hospital-based study

Oral PresentationThis journal supplement contains abstracts from the 17th MRC; Dept. of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong KongTopics: Basic science, translational and clinical researchINTRODUCTION: Viral encephalitis is an important infection of the central nervous system with significant morbidity and mortality. We studied the clinical, laboratory and radiological characteristics of viral encephalitis patients managed in our hospital, focusing on factors associated with poor prognosis. METHODS: We retrospectively studied the clinical features of patients diagnosed …published_or_final_versionThe 17th Medical Research Conference (MRC), Department of Medicine, University of Hong Kong, Hong Kong, 14 January 2012. In Hong Kong Medical Journal, 2012, v. 18 suppl. 1, p. 31, abstract no. 3

Production and validation of putonghua- and cantonese-chinese language national institutes of health stroke scale training and certification videos

Background and purposes: The National Institutes of Health Stroke Scale (NIHSS) is an integral part of acute stroke assessment. We report our experience with new Putonghua- and Cantonese-Chinese language NIHSS (PC-NIHSS and CC-NIHSS) training and certification videos. Methods: A professional video production company was hired to create the training and certification videos for both PC-NIHSS and CC-NIHSS. Two training and certification workshops were held in Chengdu and Beijing, and two workshops in Hong Kong. The instruction, training and group A certification videos were presented to workshop attendees. Unweighted κ statistics were used to measure the agreement among raters, and the inter-rater agreements for PC-NIHSS and CC-NIHSS videos were compared with those of original English language NIHSS (E-NIHSS) videos. Results: The pass rates using PC-NIHSS and CC-NIHSS videos were 79% and 82%, respectively. All possible responses on individual scale items were included. Facial palsy and limb ataxia (13%) showed poor agreement, nine (60%) to 10 (67%) items showed moderate agreement (0·4<. κ<0·75), and three (20%) to four (27%) items showed excellent agreement. When compared with E-NIHSS videos, the agreements on best gaze, visual fields, facial weakness and aphasia were less for PC-NIHSS videos, and the agreements on commands for level of consciousness and visual fields were less for CC-NIHSS videos. Nevertheless, there was no difference between PC-NIHSS or CC-NIHSS and E-NIHSS videos in the agreement on total score. Conclusions:Compared with E-NIHSS videos, PC-NIHSS and CC-NIHSS videos show good content validity and inter-rater reliability. Availability of these videos may facilitate the proper use of NIHSS among physicians and nurses in Putonghua- or Cantonese-speaking communities. © 2010 The Authors. Journal compilation © 2010 World Stroke Organization.link_to_OA_fulltex

Prognosis after Status Epilepticus

Session P07 - Epilepsy: Clinical Epilepsy: abstract P07.175OBJECTIVE: To determine the clinical characteristics and prognostic factors of status epilepticus (SE) in Hong Kong. BACKGROUND: SE is a neurological emergency with significant mortality and morbidity. There is currently limited data regarding the causes and outcomes of SE in our locality. DESIGN/METHODS: We retrospectively studied the clinical characteristics, clinical outcome of adults diagnosed with convulsive SE and managed at a regional hospital in Hong Kong during January 1st 2007 – December 31st 2011. RESULTS: A total of 38 patients with convulsive SE were identified during the study period. The mean age was 58 years (range 21-92 years) and 61% were males. Underlying cerebrovascular disease (34%), poor compliance to anti-convulsants in patients with known epilepsy (16%) and infection of the central nervous system (11%) were the main causes of convulsive SE. SE was associated with 21% mortality during hospitalization period and 32% mortality within 6-months of admission. Age 65 years, prior history of seizures, a higher blood glucose level during SE and a Status Epilepticus Severity Score (STESS) 4 were associated with 6-month mortality (p<0.05). Multi-variate analysis subsequently identified a STESS 4 as an independent predictor of poor prognosis (p=0.03). CONCLUSIONS: Convulsive SE in adults is most commonly due to underlying cerebrovascular disease and is associated with a high mortality. The STESS is a useful tool in predicting 6-month mortality.link_to_OA_fulltex

Variants, clinical characteristics and prognostic factors of Guillain Barre Syndrome in Chinese

Session P01 - Peripheral Nerve: Acute Inflammatory and Nutritional: abstract P01.135OBJECTIVE: To investigate the variants, clinical characteristics and prognostic factors of Guillain Barre Syndrome (GBS) in Hong Kong Chinese. BACKGROUND: The variants, clinical characteristics and prognostic factors of adults with GBS in Hong Kong has not been widely studied previously. DESIGN/METHODS: We performed a retrospective review of adults with GBS admitted to Queen Mary Hospital, Hong Kong during the period 1997-2011. RESULTS: Mean age of the patients was 57+/-17 years and the mean hospital stay was 36+/-69 days. Male:female ratio was 1.5:1. Of the 63 patients with GBS, 4.8% had acute motor axonal neuropathy, 17.5% with Miller-Fisher syndrome and 77.8% were of the acute inflammatory demyelinating polyneuropathy together with other unspecified subtypes. 49.2% had preceding upper respiratory tract illness, 4.76% preceding gastrointestinal illness, whilst 7.94% received vaccination during the 6weeks preceding onset of neurological symptoms. 22.2% patients were admitted to Intensive Care Unit and 12.7% patients required mechanical ventilation. 19.0% patients were treated conservatively, 39.7% received intravenous immunoglobulin only, 30.2% received plasmapharesis only and 11.0% received both intravenous immunoglobulin and plasmapharesis. 36.1% of patients was associated with poor functional recovery (requiring walking with aid at 6months after admission). Multivariate analysis revealed that necessity of mechanical ventilation during hospitalization (Odds Ratio = 43.3, 95% confidence interval: 1.2-1539.4, p=0.039) was an independent predictor of poor functional recovery at 6months after admission. Receiver Operating Characteristics curve also showed that an Erasmus GBS Outcome Score>4 was associated with good functional recovery with area under Receiver Operating Characteristic Curve being 0.87 (p<0.0001). CONCLUSIONS: Miller Fisher syndrome is more common in the Chinese population compared to the West. Necessity of mechanical ventilation during hospitalization is an independent predictor of poor functional recovery and the Erasmus GBS Outcome Score is a useful score in predicting functional recovery.link_to_OA_fulltex