Day 2 :
Chinese University of Hong Kong
Time : 10:00 AM - 10:40AM
Professor WK Tang was appointed to professor in the Department of Psychiatry, the Chinese University of Hong Kong in 2011. His main research areas are Addictions and Neuropsychiatry in Stroke. Professor Tang has published over 100 papers in renowned journals, and has also contributed to the peer review of 40 journals. He has secured over 20 major competitive research grants. He has served the editorial boards of five scientific journals. He was also a recipient of the Young Researcher Award in 2007, awarded by the Chinese University of Hong Kong.
Depression is common following an acute stroke. Post stroke Depression (PSD) has notable impacts on the function recovery and quality of life of stroke survivors. Incidence decreased across time after stroke, but prevalence of PSD tend to be stable. Many studies have explored the association between lesion location and the incidence of PSD. For example, lesions in frontal lobe, basal ganglia and deep white matter have been related with PSD. Furthermore, cerebral micro bleeds and functional changes in brain networks have also been implicated in the development of PSD. In this presentation, evidences of such association between the above structural and functional brain changes and PSD will be reviewed.
Department of Radiology, Salmaniya Medical Complex, Bahrain
Keynote: Imaging of ischemic Stroke
Time : 10:40AM - 11:30AM
Finished her High School attended: Khawla secondary girl’s school; 2003-2006. GPA= 99.3% Graduated from Medical university attended: Royal College of Surgeons in Ireland. 2006-2011 Completed internship in Salmaneya Medical Complex- Bahrain Completed Bahrain licensure exam in June 2012 Completed Saudi licensure exam in June 2012. Previous job: ultrasound specialist and patient support consultant in Abbott laboratories from September 2012 to august 2013. Current Job: Slamaniya Medical Complex- Radiology Department.
Stroke is the third leading cause of death and a leading cause of acquired disability. It is divided into ischemic and haemorrhagic. Ischaemic strokes are divided themselves according to territory affected or the causing mechanism. Knowledge of the pathophysiologic mechanisms of neuronal injury in stroke is essential to target treatment. The goals of an imaging evaluation for acute stroke are to establish a diagnosis as early as possible and to obtain accurate information about the intracranial vasculature and brain perfusion for guidance in selecting the appropriate therapy. A comprehensive overview including the current radiological investigations and their implications will be discussed , for example: CT angiography can depict intravascular thrombi. Diffusion-weighted MR imaging helps in detection of hyperacute ischemia. Gradient-echo MR sequences is helpful in detecting a hemorrhage. The status of neck and intracranial vessels can be evaluated with MR angiography, and a mismatch between findings on diffusion and perfusion MR images may be used to predict the presence of a penumbra.
- Neuropharmacology | Brain Tumors & Neuro Oncology | Neurology and Nursing | Neurosurgery | Neurology: Research and Treatments | Therapeutic Approaches for Neurological Disorders | Clinical Trails & Case Reports
Double Bond Pharmaceutical AB, Sweden
Iulia Karlsson has completed her PhD in Medical Biosciences at the age of 29 years from Swedish Pharmaceutical Company and works today as Regulatory Affairs Specialist and Head of Companion Diagnostics and Biomarker Development at Double Bond Pharmaceutical, an innovative pharmaceutical company founded in 2014 in Sweden. She has extensive experience in clinical studies both in human and veterinary medicine and a profound knowledge in human biology.
INTRODUCTION: The efficacy of the local chemotherapeutical drug Temodex, constituted of temozolomide as active pharmaceutical ingredient and dextran phosphate as carrier, was studied in a phase II clinical trial.
AIM: To assess whether Temodex improves the standard of care treatment (Stupp) for patients with operable neuroepithelial brain tumors when administered into the cavity formed after tumor resection.
METHODS: An open, controlled, comparative, retro-prospective study with overall survival (OS) as primary endpoint. Totally 95 patients with Grade II-IV glioma were included in the control group and 41 in the Temodex group.
RESULTS: Median OS of patients with highly malignant, Grade III-IV, tumors was significantly improved in the Temodex group compared to control group (14.4 vs 9.1 months, respectively, p=0.0001). Median OS for all patients (Grade II-IV) in the Temodex group was 8.5 months longer compared to control (p=0.0001). Median PFS of patients with Grade III-IV tumors was 13.6 months in the Temodex group compared to 7.8 months in control (p=0.0001). Median PFS in patients with Grade IV tumors in the Temodex group was 12.9 months compared to 7.2 months in control (p=0,0001). One-year cumulative survival ratio of patients with Grade III-IV tumors was 51.9% higher in Temodex group compared to control (p=0.0001). At the time of the latest analysis, 74.4% patients in Temodex and 94.4% patients in the control groups had died.
CONCLUSION: The current study of Temodex efficacy in combination with adjuvant chemo-radiotherapy against Grade II-IV tumors demonstrates an increase in both median OS as well as in median PFS.
Imperial College NHS Trust, Imperial College of London, UK
I am a qualified neurosurgeon with a background of 5 years of training and 4 years of practice as a neurosurgery specialty doctor, now working as a Neuro-oncology Neurosurgery Fellow at the Imperial College of London – Imperial College NHS Trust.
Our group’s research is focused on: 1) implementation of new technologies in neurosurgery to improve both diagnosis and treatment of brain tumours; 2) molecular pathways in brain tumours; 3) improving neurological and neuro-cognitive assessment in patients with brain tumours.
Statement of the problem: Resection and biopsy of brain gliomas is challenging. Extent of resection has been proven to be an independent prognostic factor to predict both progression free survival and overall survival, but tumour margins are often hard to identify, and intraoperative targeting areas of suspected high grade components might be difficult only basing on pre-operative imaging. We previously explored role of intra-operative 3D US on intrinsic brain tumours resection, and the possibility of combining pre-operative spectroscopy MRI scan and PET with neuronavigation in order to target high grade areas. We have now investigated role of a new diagnostic tool, the iKnife, in combination with 3D US technology.
Methodology and theoretical orientation. Twenty-five patients diagnosed with suspected gliomas were treated with intraoperative use of 3D US and iKnife. Data were collected regarding extent of resection based on 3D US finding and targeting of the high grade components as defined by neuronavigation data, iknife results, and histological analysis according to WHO classification.
Findings. Use of 3D US was confirmed to be helpful in terms of tumour resection and verifying real-time changes. Both ultrasound and iknife data both showed areas within a transforming tumour that corresponded with a higher cell count and mitotic index on histology. iKnife use is technique and operator dependant, needing a strictly standardized protocol to obtain reproducible results.
Conclusions and significance. Intraoperative 3D US confirmed to be an extremely useful tool to both identify margins of resection and account for real time intraoperative changes. iKnife data were closely related to histological analysis, thus encouraging further data collection and studies to prove their efficacy and reliability.
Dr. Arshad Zaman is an experienced neuro specialist with over 15 years’ experience in developing and clinically applying functional Magnetic Resonance Imaging (fMRI) at international centers of excellence. Previous studies encompass a spectrum of clinical applications (epilepsy, oncology) to state-of-the-art applications (e.g. pain relief, mental health, brain training). Current commitments centre around further development and clinical utilisation of fMRI.
Functional magnetic resonance imaging (fMRI) allows non-invasive assessment of human brain function in vivo by detecting blood flow differences. From a powerful research tool actively utilised in cognitive neuroscience, clinical fMRI has evolved and matured into a robust clinical tool, implemented with a wide spectrum of patients. In this study, we further push the limits of this unique tool with paediatric patients. The purpose of this study is to present the experience of a large teaching hospital centre in the utility of clinical fMRI in a paediatric cohort and in particular focusing on the typical problems, pitfalls, solutions and benefits.
Twenty children (5 - 16 years) underwent fMRI, over a period of 2 years, as part of the regional epilepsy pre-surgical evaluation programme. fMRI was performed on a 3T Philips scanner. Some of the children additionally underwent DTI (tractography). Paediatric dedicated fMRI paradigms consisted of motor, sensorimotor, visual, auditory, memory and speech tasks. In some cases we also compared pre- and postoperative fMRI. MRI image analysis was performed using SPM12.
In all cases, fMRI successfully revealed activation of the desired eloquent cortical territories. Speech and memory fMRI was challenging for some of the younger children in our cohort. Numerous cases successfully revealed evidence of neuroplasticity.
fMRI can be successfully applied in children and holds significant promise for both research and clinical purposes. Using dedicated paediatric protocols and paradigms can result in a more effective and successful clinical fMRI investigation. fMRI allows more accurate assessment of cortical resection margins and can determine if surgery is best performed with the patient awake or asleep. Clinical fMRI has significant potential to replace Wada for this challenging age group. Fusion of fMRI and DTI yields further useful clinical information in relevant cases.
Stroke is the third leading cause of death and a leading cause of acquired disability. It is divided into ischemic and haemorrhagic. Ischaemic strokes are devided themselves according to territory affected or the causing mechanism. Knowledge of the pathophysiologic mechanisms of neuronal injury in stroke is essential to target treatment.
The goals of an imaging evaluation for acute stroke are to establish a diagnosis as early as possible and to obtain accurate information about the intracranial vasculature and brain perfusion for guidance in selecting the appropriate therapy.
A comprehensive overview including the current radiological investigations and their implications will be discussed , for example: CT angiography can depict intravascular thrombi, Diffusion-weighted MR imaging helps in detection of hyperacute ischemia. Gradient-echo MR sequences is helpful in detecting a hemorrhage.
The status of neck and intracranial vessels can be evaluated with MR angiography, and a mismatch between findings on diffusion and perfusion MR images may be used to predict the presence of a penumbra.
Bahauddin Zakariya University Pakistan
Currently there are no uniform standard treatments for newborn suffering from cerebral hypoxia-ischemia (HI) and to find new and effective strategies for treating the HI injury remains a key direction for future research. Present study was designed to demonstrate that optimal dose (1 or 3%) of Creatine monohydrate (Cr) for the treatment of neonatal HI in female albino mice. On postnatal day 10, animals were subjected to left carotid artery ligation followed by 8% hypoxia for 25 minutes. Following weaning on postnatal day 20, mice were divided into three treatments on the basis of diet supplementation (Normal rodent diet, 1% and 3% creatine supplemented diet) for 10 week. A battery of neurological tests (Rota rod, open field and Morris water maze) was used to demonstrate effect of Cr supplementation on neurofunction and infarct size following HI.
Open field test results indicated that Cr supplementation had significantly improved locomotory and exploratory behaviour in subjects. It was observed that Cr treated mice showed better neuromuscular coordination (rota rod) and improved spatial memory (Morris Water Maze test). A significant affect of creatine supplementation in reducing infarct size was also observed. Post hoc analysis of post hoc multiple comparisons revealed that mice supplemented with 3% Cr for 10 weeks performed better during Morris water maze test while 1% Cr supplementation improved the exploratory behaviour and gain in body weight than control group indicating that Cr supplementation has the potential to improve the neurofunction following neonatal brain damage.
King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia
Statement of the Problem: Stroke caregiver burden is becoming a renowned universal issue. Several studies were done globally to investigate the burden of stroke among caregivers, but the gulf region generally and Saudi Arabia specifically had little or no share of these studies. The purpose of this study is to investigate the prevalence of depression and strain among stroke caregivers and to determine factors related to increased depression and strain levels.
Methodology & Theoretical Orientation: A cross-sectional design was used with a convenience sample of 137 subjects. The Patient health questionnaire (PHQ-9)” and the Caregiver Strain Index were used to identify caregiver depression and burden, respectively. Multinomial Logistic regression analysis identified the influence of independent variables on caregiver depression and caregiver burden.
Findings: Caregivers had high scores of both depression and burden indices. Greater levels of depression and strain were associated with caring for dependent females with haemorrhagic type of stroke. Caregiver’s gender, satisfaction with income, and receiving help in caring for patient were related to caregiver depression. Those who were females, not satisfied with income, and did not receive help in caring for patients had significantly higher levels of depression and strain.
Conclusion & Significance: The study indicated significant strain and depression levels among caregivers of stroke patients.
Recommendations: Awareness should be spread and further research should be conducted about strategies which may help in decreasing burden and depression.
Raquel Neves. Nursing graduation in 2006 in Nursing School of Lisbon, Portugal. Completed her Master and Post-Specialization in Rehabilitation in 2013, Lisbon, Portugal. Working since 2006 with stroke patients in stroke wards. In the past she worked in Portugal (7years), KSA (2 years) and at the moment is a stroke coordinator in Amana Healthcare Hospital, Abu Dhabi, UAE.
Ischaemic hearth disease and stroke are the leading two cases of premature death1 and stroke continues to increase, with 16.9 million of people being affected by stroke annually.
An estimated 50 million stroke survivors worldwide currently cope with significant physical, cognitive and emotional deficits and 25% to 74% of these survivors require some assistance or they need fully assistance of caregivers for activity of daily living2.
Following a stroke an individual may experience cognitive, physical and psychological deficits.
Evidence shows that the earlier rehabilitation is commenced the better the outcome for the stroke survivor and this principles should be applied in the acute and post-acute settings.
Following a stroke an individual may experience cognitive, physical and psychological deficits.
After the stroke, the first aim is to stabilize medical condition during the acute phase, and then to retrain the previously learnt tasks through actual trial and performance in the rehabilitation phase.
The main goal for stroke rehabilitation is to help stroke survivors relearning skills that are lost when part of the brain is damaged and to adjust him to this new condition.
Stroke rehabilitation is proactive, person-centered and goal-oriented process that should begin the first day after stroke. And the literature shows rehabilitation is not only related with physical recovery but also with reintegration of the person into the community and therefore the transition between hospital and community care.
A multidisciplinary team with a holistic, comprehensive and interactive approach should be in place to implement a stroke rehabilitation program as soon as possible, by setting realistic goals with the stroke survivor and family
Aligarh Muslim University, India
Saima Nusrat has her expertise in biophysical, calorimetric and microscopic techniques. She is currently pursuing Ph.D. in Biotechnology from Aligarh Muslim University, Aligarh, India. Her area of research work is specified as protein folding and misfolding studies, protein-ligand interaction, protein aggregation and inhibition. She has published around 15 research articles in peer reviewed journals like ABB, PLoS ONE, JPCB etc. Her H index is 5 and total citation is around 71
Amyloid related neurodegenerative diseases and non-neuropathic systemic amyloidosis have attracted much research efforts however no curative drugs have been known till date other than the symptomatic cure. Therapeutic compounds that can either inhibit or disaggregate fibrillar species have been explored and many more are yet to be discovered. The current research describes an inclusive biophysical, microscopic and computational study establishing that L-3, 4-dihydroxyphenylalanine (Levodopa) to be promising against the inhibition and disaggregation of thermally induced amyloid fibrillation of human lysozyme (HL). The IC50 value of Levodopa was estimated to be 63.0±0.09 µM. Levodopa interferes amyloid fibrillation by forming hydrophobic interaction and hydrogen bond formation with the amino acid residues present in the amyloid fibril forming prone region of HL as explained by molecular simulation results. Levodopa was also found to disaggregate mature amyloid fibrils into unordered species and the DC50 value was calculated to be 19.95±0.06 µM. Thus, Levodopa and compounds with similar structure could be operative as a strong inhibitor towards the therapeutic development against systemic amyloidosis.
Ospital ng Makati, Philippines
Euodia Guinmapang trained in the field of Internal Medicine at Ospital ng Makati located in the Philippines. Her love for medicine drives her passion to pursue her chosen field in the spirit of serving her fellow countrymen. She has also recently passed the Philippine Specialty Board of Internal Medicine (PSBIM) Examination.
INTRODUCTION: The role of inflammation in atherosclerosis has been well established over the past years. From a pathological perspective, all stages, ie, initiation, growth, and complication of the atherosclerotic plaque might be considered to be an inflammatory response to injury. The main trend amongst cardiovascular diseases is both primary and secondary prevention. The Neutrophil-Lymphocyte Ratio (NL Ratio) is one of potential early markers that can be correlated to mortality or morbidity with it being a readily available, cost effective a routinely requested laboratory. The primary objective of this study is to determine the association of NL Ratio in the 30-day Mortality among patients with acute hemorrhagic and non-hemorrhagic stroke.
METHODOLOGY: This is a retrospective cohort study which included 228 patients with a first episode Acute Ischemic Stroke (AIS). The demographic and clinical profiles were tabulated including co-morbidities and baseline NIHSS (National Institute Stroke Scale). The baseline NL Ratio was taken from the CBC taken within 24 hours of admission. The diagnosis of Ischemic stroke was based on clinical and imaging studies done. The length of hospital stay, recurrence of stroke and mortality was noted during the course of admission and a period of 30 day follow up records were reviewed.
RESULTS: The group with low NL Ratio (<5.9) had mostly minor to moderate strokes, while those with higher NL Ratio (>5.9) had a similar distribution with a higher proportion for moderate and moderate to severe stroke. The median number of hospital days was longer for the high NL Ratio group. (5 versus 3 days, p = 0.012). There was a greater proportion of mortalities for the high NL Ratio group (31% versus 14%, p = 0.003). On further analysis however, upon comparing the expired and surviving patients, there was insufficient evidence to demonstrate a difference between the two groups. Also, the NIHSS has a more significant correlation to mortality as compared to the NL Ratio.
CONCLUSION: The NL ratio has a direct proportion to patients with non-surviving patients because of its proportion to higher NIHS scale patients. It is cost effective and has the potential to be a short term mortality predictor. Compared to NIHSS however, the association of NL Ratio still lacks the direct correlation to mortality.
The determination of NL ratio invites researchers to further pursue in both acute and chronic cardiovascular diseases which may help in managing our future patients.
- POSTER PRESENTATIONS
Masaryk Hospital, Ústí nad Labem, Czech Republic
David Černík, MD was born on 14.4.1982, Chomutov Czech republic Employer Krajská zdravotí a.s., Masaryk Hospital Ústí nad Labem, Czech Republik, Comprehensive Stroke Center, Department of Neurology since 2011 Post graduated in Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic since 2015
Introduction: Mechanical thrombectomy is recommended as the standard treatment of occluded large cerebral artery within first 6 hours since stroke onset. Beyond this standard therapeutic time window, thrombectomy may be beneficial in strictly selected patients only and upper treatment time limit has been still unknown. The aim was to document a positive clinical effect of thrombectomy performed after 14 hours since stroke onset.
Methods: We describe a case of 73 y/o female, who presented with sudden severe left-sided hemiparesis at home. She was admitted to the stroke center after eleven hours after stroke onset with severe and fluctuating hemiparesis. Admission CT scan showed partial occlusion of right internal carotid artery (ICA) and occlusion middle cerebral artery (MCA) and relatively large ischemic penumbra on CT perfusion scans. Based on clinical symptoms, CT and MRI findings, the mechanical thrombectomy with successful recanalization of ICA and MCA were performed 14 hours after stroke onset with an excellent clinical outcome.
Conclusion: Mechanical thrombectomy is recommended a standard treatment of occluded large cerebral artery within first 6 hours since stroke onset. Strictly selected patients with ischemic penumbral patterns may have benefit from mechanical thrombectomy even beyond standard therapeutic time window.
San Raffaele Hospital, Italy
Federica Alemanno is a Neuropsychologist working in the Department of Specialistic Rehabilitation of Neurological, Cognitive and Motor Disorders, San Raffaele Hospital, Milan, Italy. She is specialized in the treatment of neurodegenerative diseases and cerebral focal lesions, and is responsible for the intraoperative monitoring of higher cognitive functions during awake neurosurgeries. She holds a PhD in Molecular Medicine and Experimental Neurology and underwent a Research Fellowship at the Department of Bioengineering, University of California San Diego (UCSD) with whom she still has ongoing collaborations. She lectures and mentors students of the Neuro-Psychological Faculty at the San Raffaele University, and is the lead Neuropsychologist in clinical trials on the use of non-invasive brain stimulation in aphasia; the use of virtual reality for neuro-cognitive rehabilitation; and pharmacological clinical trials on Alzheimer's disease (Biogen; Merck Serono). She also coordinates the Well Being Program for international private patients, at the San Raffaele Hospital.
Chronic pain, such as low back pain or facial pain, is a highly disabling condition severely degrading people’s quality of life. Pharmacological therapies are effective only in a minority of patients and alternative treatments have to be developed to relieve patients’ pain. Chronic pain can also cause severe anxiety or depression disorders, as well as complex cognitive impairments. The chronicity of pain can also lead to a dysperception of patient’s own body. Since clinical evaluation of pain lies on the subjective reports of patients, a “distortion of self” can lead to incorrect pain rating leading to incorrect treatment. Our project aims at defining a multimodal neurorehabilitative strategy to reduce chronic pain in patients presenting with low back pain and facial pain, using innovative technologies to help patients regain a correct somatotopic sensibility. Our approach combines virtual reality settings with well-validated and multimodal neurorehabilitation techniques in order to produce highly performing and personalized treatments to each patient. We first proceed to detailed physiotherapeutical and neuropsychological evaluations of patients. Then, the multidisciplinary team defines a neurorehabilitative strategy based on virtual reality rehabilitation combined with psychological support. The virtual-reality setting reinforces patients’ feedback in a multisensory point of view (visual, auditory and proprioceptive) and has the advantage of increasing patients’ compliance and motivation. Our technological setting also permits remote communications with patients from the hospital, allowing close follow-ups directly at patients’ homes. This has the great advantage of monitoring and helping maintain the benefits gained during rehabilitation. Our preliminary results demonstrated improvements in both patients’ groups, as revealed by a reduction of pain rating scale, analgesic drugs intake and improvement of quality of life. This treatment offers thus each patient a complete neuropsychological evaluation, a psychological support, and an innovative and efficient neurorehabilitative treatment, which is also associated with a better compliance of patients compared to standard rehabilitative care.
Department of Radiology, Salmaniya Medical Complex, Bahrain
Finished her High School attended: Khawla secondary girl’s school; 2003-2006. GPA= 99.3% Graduated from Medical university attended: Royal College of Surgeons in Ireland. 2006-2011 Completed internship in Salmaniya Medical Complex- Bahrain Completed Bahrain licensure exam in June 2012. Completed Saudi licensure exam in June 2012. Previous job: ultrasound specialist and patient support consultant in Abbott laboratories from September 2012 to August 2013. Current Job is radiology resident in Salmaniya Medical Complex.
Congenital absence of the internal carotid artery is a rare anomaly, occurring in less than 0.01% of the population. It includes agenesis, aplasia, and hypoplasia of the internal carotid artery.
Recognition of these anomalies has important implications during planned surgery, in thromboembolic disease, and in the surveillance and detection of associated cerebral aneurysms.
It is usually an incidental finding on color Doppler carotid ultrasonography, angiography, computed tomography, or magnetic resonance imaging of the head and neck taken for some other reasons. Most of the patients are asymptomatic due to the presence of sufficient cerebral circulation supplied by the communicating arteries of the circle of Willis, intercavernous anastomosis, external carotid artery and by persistent embryologic arteries to the carotid artery territory. Nevertheless, in some cases this anatomic variation may eventually lead to some clinical signs and symptoms
We present a case of left ICA aplasia diagnosed after work-up of neurological events.