Setting up the Brunei Neuroscience Stroke and Rehabilitation Centre 12,000 km away with the help of telemedicine

WCN 2013 No: 2319 Topic: 3 — Stroke Setting up a neuroscience stroke and rehabilitation centre 12,000 km away with the help of telemedicine U. Meyding-Lamade, E. Craemer, C. Jacobi, C. Mohs, C. Schwark, K. Enk, I. Jafaar, A. Masri, C. Chan, B. Kress. Neurology, Krankenhaus Nordwest, Frankfurt/Main, Germany; Bruneian Stroke and Rehabilitation Centre, Jerudong, Brunei; Neuroradiology, Krankenhaus Nordwest, Frankfurt/Main, Germany Background: Due to world-wide aging population neurologists are urgently needed for stroke/non-stroke. In Brunei Darussalamwe set up a national stroke unit, intensive care unit, neurorehabilitation on-site including tele-neurology and tele-teaching. Objective: The aim of this project “to teach to treat–to treat to teach” was to set up a world class centre of neurology. Methods: In 7/2010 set-up of the Bruneian Neuroscience Stroke and Rehabilitation Centre (BNSRC) has started. To overcome the distance of 12,000 km a telemedical network between the Department of Neurology (KHNW) and BNSRC started. This international cooperation includes a “specialist neurology” training program, accredited in Brunei Darussalam by an international advisory board. Daily teleteaching, 24/7 tele-neurology service, as well as all neurological laboratories have been set up on site by tele-cytology, and teleelectrophysiology including EEG and ultrasound. Awareness campaigns and telescience have been successfully started. Results: The BNRSC already has been successfully audited according to the STU requirements of the German Stroke Society. Over 2000 patients have been treated so far. Several Bruneian doctors are enrolled in the specialist curriculum. Conclusion: The program to teach to treat–to treat to teach resulted in a local set up of a BNSRC, being built up by KHNW. This outstanding project of a cooperation between the KHNW and BNSRC succeeded in building up a centre of excellence of high end acute neurological department including a stroke unit and neurorehabilitation. doi:10.1016/j.jns.2013.07.927 Abstract — WCN 2013 No: 2345 Topic: 3 — Stroke Stroke in patients with active and non-active malignancy WCN 2013 No: 2345 Topic: 3 — Stroke Stroke in patients with active and non-active malignancy A.G. Sliwinska, G. Gromadzka, M.A. Karlinski, A. Czlonkowska. Second Department of Neurology, Institute of Psychiatry and Neurology, Poland; Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warszawa, Poland Background: Global burden of stroke and cancer is steadily increasing over the years. According to the previous studies, the pattern of stroke in cancer patients may differ from the conventional one. Objectives: To compare vascular risk factors, stroke etiology and outcome among patients with positive or negative history of cancer, with emphasis on the activity of the malignancy. Methods: All consecutive acute stroke patients admitted to our department between September 2006 and September 2011 were included. We distinguished between patients: 1) with active malignancy (the diagnosis of cancer within 12 months before stroke, AM); 2) with non-active malignancy (non-AM); 3) cancer-free patients (CF), used as a reference. Results: Of 1558 acute stroke admissions, 90 (5.8%) had an additional diagnosis of cancer, including 41 cases of AM (2.6%) and 49 cases of non-AM (3.1%). Compared to CF group, non-AM patients did not differ in terms of vascular risk factors; theymore frequently had stroke due to small vessel occlusion (18.4% vs 7.0%, p = 0.003). AM patients less frequently had atrial fibrillation (7.3% vs 23.5%, p = 0.016) and history of previous stroke (2.4% vs. 24.9%, p = 0.018). Themost frequent stroke etiology in the AM group was undetermined (61.0%) and they had higher levels of serum inflammatory parameters. Stroke severity and outcome were similar across all groups. Conclusions: Compared to the CF patients, the pattern of stroke in non-AM patients appears similar. However, stroke pattern in patients with AM may be different from the conventional one, but it does not affect the short term prognosis. doi:10.1016/j.jns.2013.07.928 Abstract — WCN 2013 No: 2355 Topic: 3 — Stroke Late cerebrovascular complications of radiation therapy for pediatric primary central nervous system tumors WCN 2013 No: 2355 Topic: 3 — Stroke Late cerebrovascular complications of radiation therapy for pediatric primary central nervous system tumors J. Passos, H. Nzwalo, J. Marques, A. Azevedo, S. Nunes, D. Salgado. Neurology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Neurology, Hospital de Faro EPE, Faro, Portugal; Neurology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Pediatric Neuro-Oncology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal Background: Radiation therapy (RT) plays an important role in the management of primary central nervous system tumors (PCNST) in children. Despite field and dose optimization, late cerebrovascular complications (LCCs) still occur. However, the number of studies assessing the burden of these complications is limited. Objective: To describe the occurrence of LCCs in adult survivors who underwent RT for PCNST during childhood. Methods: Retrospective consecutive case series description of LCCs from a cohort of adult survivors of pediatric PCNST. Diagnosis of hemorrhagic LCCs was confirmed by gradient-echo MRI sequence. Results: We identified LCCs of RT in 35 of a total of 103 patients (34.0%); median age at RT was 8.4 years; and median follow-up was 18.7 years. Histological diagnoses were: medulloblastomas/primitive neuroectodermal tumors (16/45.7%), gliomas (15/42.9%) and germ cell tumors (4/11.4%). The most frequent PCNST site was the posterior fossa (21/60%). Mean total radiation dose was 48 Gy (18– 54 Gy);most patients received focal plus entire neuraxis RT (23/65.7%). Thirty-three patients had microbleeds, all asymptomatic; cavernomas occurred in eleven patients, causing epilepsy in 2; two patients had a symptomatic ischemic stroke (6 and 25 years after RT); two patients presentedwith symptomatic superficial siderosis (15 and 26 years after RT) and one patient developed symptomatic moyamoya syndrome 4 years after RT. In some patients, microbleeds and cavernomas increased in number during follow-up. Abstracts / Journal of the Neurological Sciences 333 (2013) e215–e278 e238