THE OFFICIAL JOURNAL OF THE ACADEMIA BRASILEIRA DE NEUROLOGIA

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1 Volume 72, Suppl 2, 2014, São Paulo, SP, Brazil THE OFFICIAL JOURNAL OF THE ACADEMIA BRASILEIRA DE NEUROLOGIA Vision: Arquivos de Neuro-Psiquiatria will be the main Latin America peer-reviewed journal in neurosciences. Mission: Arquivos de Neuro-Psiquiatria will provide clinical neurologists and other neurocientists with sigfnificant peer-reviewed articles, editorials, reviews and clinical reports to improve neurological practice, education, clinical research, professional improvement and brazilian neurology international visibility. Editors José Antonio Livramento, SP Luís dos Ramos Machado, SP Special Editors Acary Souza Bulle Oliveira, SP Alberto Alain Gabbai, SP Carlos Alberto Mantovani Guerreiro, Campinas SP Paulo Caramelli, Belo Horizonte MG Founding Editor Oswaldo Lange Emeritus Editor Antonio Spina-França Netto Arquivos de Neuro-Psiquiatria Dr. Oswaldo Lange Association Luís dos Ramos Machado, SP, President José Antonio Livramento, SP, Vice-President Carlos Alberto Mantovani Guerreiro, SP, Secretary Acary Souza Bulle Oliveira, SP, Treasure Alberto Alain Gabbai, SP Carlos Augusto Takeuchi, SP José Píndaro Pereira Plese, SP Luiz Alberto Bacheschi, SP Maria Fernanda Mendes, SP Paulo Caramelli, MG Osvaldo M. Takayanagui, SP Executive Office Adriana Spina França Machado, SP, manager Rua Vergueiro 1421 cj 804 Torre Sul São Paulo SP Brasil Fone (5511) ; Fax (5511) Publishers Caboverde Tecnologia e Serviços Ltda. Marketing EPM - Editora de Projetos Médicos phone/fax: (5511) / (5511) epm@plugnet.com.br Academia Brasileira de Neurologia Elza Dias Tosta, DF, President Rubens José Gagliardi, SP, Vice-President Gilmar Fernandes do Prado, SP, Secretary Mônica Santoro Haddad, SP, Treasurer Francisco Eduardo Costa Cardoso, MG, Delegate to WFN academia@abneuro.org Cataloguing ISSN X - paper publication ISSN online publication NLL (National Lending Library of Sciences and Technology, Boston, UK, 1947) WHO/UNESCO (Word Medical Periodicals, 1949) EMBASE - Excerpta Medica (Elsevier, Amsterdam, 1960) MEDLINE (National Library of Medicine, Bethesda USA, 1966) ISI (Institute for Scientific Information, Philadelphia USA, 1969) JCR, 2003 LILACS (BIREME, São Paulo, 1982) SCOPUS (Elsevier, 1998) SIMAGO (Elsevier, 1998) SciELO (1999) QUALIS/CAPES (B2, 2009) DOAJ LATINDEX Circulation Monthly, 3000 copies Apoio:

2 INTERNATIONAL ADVISORY BOARD Andrew J Lees, London (UK) Arturo Carpio R., Cuenca (Ecuador) Christina Marra, Seattle (USA) Gérard Saïd, Paris (France) James F. Toole, Wiston-Salem (USA) Jun Kimura, Kyoto (Japan) Maria José Sá, Porto (Portugal) Pedro L. Ponce, Caracas (Venezuela) Roberto E. P. Sica, Buenos Aires (Argentina) Vladimir Hachinski, London (Canada) Editorial Advisory Board Amauri Batista da Silva, Brasília DF Amilton Antunes Barreira, Ribeirão Preto SP (USP-RP) Aroldo Luiz da Silva Bacellar, Salvador BA Ehrenfried Othmar Wittig, Curitiba PR Elza Dias Tosta da Silva, Brasília DF Fernando Cendes, Campinas SP (UNICAMP) Fernando Coroneti, Botucatu SP (UNESP) Fernando Otávio Quaresma Cavalcante, Belém PA Gilberto Belisario Campos, Belo Horizonte MG Gilson Edmar Gonçalves e Silva, Recife PE (UFPE) Joaquim Pereira Brasil Neto, Brasília DF (UnB) Marco Aurélio Lana-Peixoto, Belo Horizonte MG (UFMG) Marcos Raimundo Gomes de Freitas, Niterói RJ (UFF) Milberto Scaff, São Paulo SP Newra Tellechea Rotta, Porto Alegre RS Paulo Norberto Discher de Sá, Florianópolis SC Ricardo Nitrini, São Paulo SP (FMUSP) Rubens José Gagliardi, São Paulo SO (FCM-Sta Casa SP) Sérgio Roberto Haussen, Porto Alegre RS Vicente de Paulo Leitão de Carvalho, Fortaleza CE ASSOCIATE EDITORS Cerebrovascular disorders Adriana Bastos Conforto, São Paulo SP (FMUSP) Ayrton Roberto Massaro, São Paulo SP (Hospital Sírio Libanês and Hospital Albert Einstein) Fábio Iuji Yamamoto, São Paulo SP (FMUSP) Jefferson Gomes Fernandes, São Paulo SP (Hospital Alemão Oswaldo Cruz) Rubens José Gagliardi, São Paulo (Santa Casa - SP) Clinical neurophysiology Carlos Otto Heise, São Paulo SP (FMUSP) Francisco José Carchedi Luccas, São Paulo SP (Hospital São Luiz) João Aris Kouyoumdjian, São José do Rio Preto SP (FAMERP) Lineu Correa da Fonseca, Campinas SP (PUC) Clinical practice Alberto Allain Gabbai, São Paulo SP (UNIFESP) Eduardo Genaro Mutarelli, São Paulo SP (FMUSP) Cognitive disorders Jerson Laks, Rio de Janeiro RJ (UFRJ) Jerusa Smid, São Paulo SP (FMUSP) Paulo Caramelli, Belo Horizonte MG (UFMG) Epilepsy Carlos Alberto Mantovani Guerreiro, Campinas SP (UNICAMP) Eliana Garzon, São Paulo SP (FMUSP) Luiz Ataíde Jr, Recife PE (FMUFP) Experimental neurology Fulvio Alexandre Scorza, São Paulo SP (UNIFESP) Roberta Monterazzo Cysneiros, São Paulo SP (Univ. Mackenzie) Headache and pain Getúlio Daré Rabello, São Paulo SP (Hospital Samaritano SP) José Geraldo Speciali, Ribeirão Preto SP (FMUSP RP) Pedro André Kowacs, Curitiba PR (UFPR) Renan Barros Domingues, Lille, France (Université Lille) History of neurology Hélio Afonso Ghizoni Teive, Curitiba PR (UFPR) Péricles Maranhão-Filho, Rio de Janeiro RJ (UFRJ) Rubens Reimão, São Paulo SP (FMUSP) Tarso Adoni, São Paulo SP (FMUSP) Infectious diseases of the nervous system Abelardo Queiroz Campos Araújo, Rio de Janeiro RJ (FIOCRUZ) Osvaldo Massaiti Takayanagui, Ribeirão Preto SP (FMUSP RP) Paulo Pereira Christo, Belo Horizonte MG (Santa Casa BH MG) Ronald Salamano, Montevideo (Uruguai) Ronaldo Abraham, Taubaté SP (UNITAU) Interventionist neuroradiology Paulo Puglia Jr, São Paulo SP (FMUSP) Movement disorders Carlos Rieder, Porto Alegre RS (UFCSPA) Hélio Afonso Ghizoni Teive, Curitiba PR (UFPR) Henrique Ballalai Ferraz, São Paulo SP (UNIFESP) João Carlos Papaterra Limongi, São Paulo SP (FMUSP) Myopathy Anamarli Nucci, Campinas SP (UNICAMP) Lineu César Werneck, Curitiba PR (UFPR) Suely Kazue Nagahashi Marie, São Paulo SP (FMUSP) Neurogenetics Fernando Kok, São Paulo SP (FMUSP) Iscia Lopes Cendes, Campinas SP (UNICAMP) Laura Bannach Jardim, Porto Alegre RS (UFRGS) Neuroimaging Antonio José da Rocha, São Paulo SP (Santa Casa SP) Claudia da Costa Leite, São Paulo SP (FMUSP) Emerson Leandro Gasparetto, Rio de Janeiro RJ (UFRJ) Leandro Tavares Lucato, São Paulo SP (FMUSP) Luiz Antonio Pezzi Portela, São Paulo SP (Hospital Alemão Oswaldo Cruz) Neuroimmunology Douglas Kazutoshi Sato, Sendai, Japan (Tohoku University) Maria Fernanda Mendes, São Paulo SP (Santa Casa SP) Maria Lucia Brito Ferreira, Recife PE (HR SSEPE) Yara Dadalti Fragoso, Santos SP (UNIMES) Neuro-oncology Suzana Maria Fleury Malheiros, São Paulo SP (UNIFESP) Suely Kazue Nagahashi Marie, São Paulo SP (FMUSP) Neuropathology Carmen Lúcia Lancellotti, São Paulo SP (Santa Casa SP) Leila Chimelli, Rio de Janeiro RJ (UFRJ) Sérgio Rosemberg, São Paulo SP (FMUSP) Neuropsychology Eliane Miotto, São Paulo SP (FMUSP) Neurosurgery Fernando Gomes Pinto, São Paulo SP (FMUSP) Guilherme Lepski, São Paulo SP (FMUSP) Hamilton Matushita, São Paulo SP (FMUSP) José Píndaro Pereira Plese, São Paulo SP (FMUSP) Mario Augusto Taricco, São Paulo SP (FMUSP) Roberto Sérgio Martins, São Paulo SP (FMUSP) Otoneurology Cristiana Borges Pereira, São Paulo SP (FMUSP)

3 Pediatric neurology José Luiz Dias Gherpelli, São Paulo SP (FMUSP) Marilisa Mantovani Guerreiro, Campinas SP (UNICAMP) Umbertina Conti Reed, São Paulo SP (FMUSP) Peripheral neuropathy Osvaldo J. M. Nascimento, Rio de Janeiro RJ (UFF) Wilson Marques Jr, Ribeirão Preto SP (FMUSP RP) Psychiatry Antonio Egídio Nardi, Rio de Janeiro RJ (UFRJ) Cássio Bottino, São Paulo SP (FMUSP) Quirino Cordeiro, São Paulo SP (FMUSP) Physiotherapy / speech therapy Márcia Radanovic, São Paulo SP (FMUSP) Rehabilitation in neurology Marta Imamura, São Paulo SP (FMUSP) Marco Orsini, Rio de Janeiro RJ (UFF) Sleep disorders Rosana Cardoso Alves, São Paulo SP (FMUSP) Stella Tavares, São Paulo SP (FMUSP) Tricks of the trade Laura Moriyama, London UK (UCL Institute of Neurology) EDITORIAL AREA SUPERVISORS Cerebrovascular disorders Charles André, Rio de Janeiro RJ (UFRJ) Jorge El Kadum Noujaim, Rio de Janeiro RJ (HFSE RJ) Clinical practice Sérgio Augusto Pereira Novis, Rio de Janeiro RJ (Santa Casa RJ) Sebastião Eurico de Mello e Souza, Goiânia GO (Instituto de Neurologia) Experimental neurology Antonio Carlos Guimarães de Almeida, São João Del-Rei MG (UFSJ) Monica Levy Andersen, São Paulo SP (UNIFESP) Headache and pain Silvia R. D. Tesseroli de Siqueira, São Paulo SP (FMUSP) Motor neuron disease Dagoberto Callegaro, São Paulo SP (FMUSP) Movement disorders Egberto Reis Barbosa, São Paulo SP (FMUSP) Francisco Cardoso, Belo Horizonte MG (UFMG) José Luiz Pedroso, São Paulo SP (UNIFESP) Neuroethics Luiz Alberto Bacheschi, São Paulo SP (FMUSP) Neuroimmunology Angelina Maria Martins Lino, São Paulo SP (FMUSP) Maria Lúcia Vellutini Pimentel, Rio de Janeiro RJ (Santa Casa RJ) Maria José Sá, Porto (Portugal) Neurological critical care José Manuel Rocha Fernandes, São Paulo SP (FMUSP) Neuropsychology Alessandra Gotuzo Seabra, São Paulo SP (Univ. Mackenzie) Neuroregeneration Guilherme Lepski, São Paulo SP (FMUSP) Pediatric neurology Alexandra Pruffer Queiroz Campos Araújo, Rio de Janeiro RJ (UFRJ) Physiotherapy / speech therapy Letícia Lessa Mansur, São Paulo SP (FMUSP) Lúcia Iracema Zanotto Mendonça, São Paulo SP (FMUSP) Psychiatry Alexandre Shoji, São Paulo SP (FMUSP) Rafael Bernardon Ribeiro, São Paulo SP (FMUSP) Rehabilitation in neurology Paulo Nicolau Borsoi Salum, São Paulo SP (FMUSP) Sérgio Lianza, São Paulo SP (Faculdade de Ciências Médicas da Santa Casa SP) Arquivos de Neuro-Psiquiatria is a periodic registered in the Departamento de Imprensa e Propaganda (11795), Departamento Nacional de Propriedade Industrial (97414) and 1º Ofício de Títulos e Documentos de São Paulo, Brasil. Its owner and publisher is the Arquivos de Neuro-Psiquiatria Dr. Oswaldo Lange Association, no provide society registered in the 6º Ofício de Registro de Pessoas Jurídicas de São Paulo (12770), in the Ministério da Fazenda (CNPJ / ) and in the Secretaria de Finanças do Município de São Paulo (CCM ). It is the Official Journal of the Academia Brasileira de Neurologia / Brazilian Academy of Neurology since It is published monthly since 2012, with absolute regularity over these 70 years since its foundation in Permission to photocopy articles: This publication is protected by copyright. Permission to reproduce copies of articles for noncommercial use may be obtained from the Copyright Clearing Center: Annual subscription rates for 2015: Brazil R$ 380,00; other countries $ Subscription prices outside Brazil must be prepaid. Prices subjected to change without notice. Information: anprev@globo.com; phone (5511) ; fax (5511) Manuscripts submission: The announcer is entirely responsible for the advertisements included in this issue. The authors are fully responsible for the opinions and concepts expressed in the manuscripts published in this issue, which do not necessarily reflect the opinion of the editors.

4 DIRETORIA ABN Presidente: Elza Dias Tosta da Silva Vice-presidente: Rubens José Gagliardi Secretário Geral: Gilmar Fernandes do Prado 1ª Secretária: Márcia Maiumi Fukujima Tesoureira Geral: Mônica Santoro Haddad 1º Tesoureiro: Luiz Henrique Martins Castro COMISSÃO ORGANIZADORA Presidente do congresso: Hélio A. G. Teive Coordenadora da Comissão Científica: Viviane Flumignan Zetola Tesoureiro: Pedro Kowacs Presidente de Honra Lineu Werneck COMISSÃO CIENTÍFICA Coordenadora da Comissão Científica: Viviane Flumignan Zetola Departamentos Cientificos ABN Diretor Científico: Joaquim Perereia Brasil Neto DC de Atenção Neurológica e Neurorreabilitação Coordenador: Cristiano Milani Vice-Coordenadora: Carla Heloísa Cabral Moro Secretária: Adriana Bastos Conforto DC de Cefaléia Coordenador: Mauro Eduardo Jurno Vice-Coordenador: Cláudio Manoel Brito Secretário: Fernando Kowacs DC de Doenças Cerebrovasculares, Neurologia Intervencionista e Terapia Intensiva em Neurologia Coordenadora: Sheila Cristina Ouriques Martins Vice-Coordenador: Norberto Luiz Cabral Secretária: Gisele Sampaio Silva DC de Doenças do Neurônio Motor/ELA Coordenador: Marco Antonio T. Chieia Vice-Coordenador: Mário Emilio T. Dourado Jr. Secretário: Francisco Tellechea Rotta

5 DC de Neurossonologia Coordenadora: Ana Cláudia Celestino Bezerra Leite Vice-Coordenadora: Viviane Flumignan Zetola Secretária: Daniela Laranja Gomes Rodrigues DC de Dor Coordenador: Pedro Schestatsky Vice-Coordenador: Jaime Olavo Marquez Secretário: José Geraldo Speciali DC de Epilepsia Coordenador: Luciano de Paola Vice-Coordenador: Carlos Eduardo Soares Silvado Secretário: Vera Cristina Terra DC de História da Neurologia Coordenadora: Marleide da Mota Gomes Vice-Coordenador: Hélio Afonso Ghizoni Teive Secretário: Francisco Eduardo Costa Cardoso DC de Líquido Cefalorraqueano Coordenador: Sérgio Monteiro de Almeida Vice-Coordenadora: Cristiane Nascimento Soares Secretário: Sandro Luiz de Andrade Matas DC de Moléstias Infecciosas Coordenador: Ronaldo Abraham Vice-Coordenador: Hideraldo Luís Souza Cabeça Secretário: Marcus Tulius Teixeira da Silva DC de Moléstias Neuromusculares Coordenadora: Cláudia Ferreira da R. Sobreira Vice-Coordenadora: Juliana Gurgel Gianetti Secretário: Elmano Henrique Torres de Carvalho DC de Neuroepidemiologia Coordenador: Tarso Adoni Vice-Coordenador: Jefferson Becker Secretária: Nívea de Macedo Oliveira Morales DC de Neurofisiologia Clínica Coordenador: Paulo André Teixeira Kimaid Vice-Coordenador: Rinaldo Claudino Secretário: Marcondes Cavalcante França Jr. DC de Neurogenética Coordenador: Orlando Graziani Povoas Barsottini Vice-Coordenador: Renato Puppi Munhoz Secretária: Laura Silveira Moryama DC de Neuroimunologia Coordenadora: Doralina G. Brum Souza Vice-Coordenadora: Claudia Cristina F. Vasconcelos Secretária: Elizabeth Regina C. Frota DC de Neurologia Cognitiva e do Envelhecimento Coordenadora: Sonia Maria Dozzi Brucki Vice-Coordenador: Norberto Anízio Ferreira Frota Secretário: José Ibiapina Siqueira Neto DC de Neurologia Infantil Coordenadora: Marilisa Mantovani Guerreiro Vice-Coordenardora: Umbertina Conti Reed Secretário: José Luiz Dias Gherpelli DC de Neuropatias Periféricas Coordenador: Susanie Amâncio Gonçalves Rigatto Vice-Coordenador: Amilton Antunes Barreira Secretário: Fernando de Mendonça Cardoso DC do Sono Coordenadora: Rosana Souza Cardoso Alves Vice-Coordenador: Raimundo Nonato Delgado Rodrigues Secretário: Leonardo Lerardi Goulart DC de Transtornos do Movimento Coordenador: Egberto Reis Barbosa Vice-Coordenador: Henrique Ballalai Ferraz Secretário: Vitor Tumas Subcomitê Local Subcomitê Cefaleia/ Dor Elcio Juliato Piovesan Mario Luiz Giublin Pedro Kowacs Subcomitê Desmielinizante/ Neuroimunologia Monica Parolin Patrícia Coral Rosana Herminia Scola Subcomitê Distúrbios do Movimento Hélio A. G. Teive Renato Munhoz Subcomitê Doenças Cerebrovasculares, Neurologia Intervencionista e Terapia Intensiva em Neurologia/ Neurossonologia Edison Matos Nóvak Marcos Christiano Lange Viviane Flumignan Zetola Subcomitê Doenças Neuromusculares/ Eletroneuromiografia/ Potencial Evocado Cláudia Suemi Kamoi Kay Paulo Jose Lorenzoni Rosana Herminia Scola Subcomitê Epilepsia/ Sono/ Eletroencefalografia/ Polissonografia Carlos Eduardo Soares Silvado Luciano de Paola Márcia Assis Subcomitê História da Neurologia Francisco Germiniani Hélio A. G. Teive Walter Oleschko Arruda Subcomitê Moléstias Infecciosas/ Líquido Cefalorraqueano Sérgio Almeida Subcomitê Neuroepidemiologia Norberto Luiz Cabral

6 Subcomitê Neurofisiologia Clínica Luciano de Paola Rosana Herminia Scola Subcomitê Neurogenética Lineu Werneck Salmo Raskin Subcomitê Neuroimagem Arnolfo de Carvalho Guilberto Mingueti Subcomitê Neurologia Cognitiva e do Envelhecimento Mauro Piovezan Ricardo Krause Martinez Souza Subcomitê Neurologia Infantil Ana Crippa Isaac Bruck Sérgio Antoniuk Subcomitê Neuropsicologia Maria Joana Mader (Coordenadora) Mauren Carneiro da Silva Rubert Denise Ribas Jamus Raphael Borguezan Subcomitê Neurorreabilitação Marise Bueno Zonta Nilson Becker Renato Nickel Subcomitê Semiologia Edison Matos Nóvak Elcio Juliato Piovesan ConvidadoS Ricardo Nitrini Ayrton Massaro

7 Volume 72, Suppl 1, 2014, São Paulo, SP, Brazil Oral Presentation Headache...13 Vestibular and Balance Disorders...13 Cerebrovascular Diseases...14 Other Motor Neurone Disease...20 Muscle Disorders...20 Transcranial Doppler...20 Epilepsy...21 Amyotrophic Lateral Sclerosis Neurologic Manifestations of Systemic Diseases...24 Neuroepidemiology...24 Clinical Neurophysiology...24 Neurogenetics...25 Neuroimaging...28 Neuroimmunology, Multiple Sclerosis and other Demyelinating Disorders...29 Neuroinfection...31 Cognitive Neurology and Neurology of Aging...32 Neurology of Sleep / Polysomnography...35 Child Neurology...35 Interventional Neurology...36 Peripheral Neuropathy...37 Rehabilitation and Neurology Care...38 Neuro-ICU...39 Movement Disorders...39 Videos Child Neurology...45 Muscle Disorders...45 Movement Disorders...45 Neuroinfection...47 Cerebrovascular Diseases...48 Rehabilitation and Neurology Care...48 Other Motor Neurone Disease...48 Posters Headache...51 Cerebrovascular Diseases...61 Muscle Disorders...90 Pain Epilepsy Amyotrophic Lateral Sclerosis...112

8 History of Neurology Neuroimaging Interventional Neurology Neuro-ICU Vestibular and Balance Disorders Other Motor Neurone Disease Transcranial Doppler Cerebrospinal Fluid Neurologic Manifestations of Systemic Diseases Miscellaneous Neuroepidemiology Neurogenetics Neuroimmunology, Multiple Sclerosis and other Demyelinating Disorders Cognitive Neurology and Neurology of Aging Clinical Neurophysiology Neuroinfection Neurology of Sleep / Polysomnography Child Neurology Peripheral Neuropathy Rehabilitation and Neurology Care Movement Disorders...256

9 CARTA DE BOAS VINDAS Prezados Colegas, Chegou o grande dia! O evento máximo e bianual da Academia Brasileira de Neurologia: o XXVI Congresso Brasileiro de Neurologia, ou, como carinhosamente o chamamos: o Neuro2014. São todos bem vindos à Curitiba e ao Neuro2014. Aproveitem a cidade, suas belezas, seus parques e seus inúmeros restaurantes. Um passeio de trem ao litoral, pela Serra do Mar é uma experiência inesquecível. Porém aproveitem principalmente o Congresso. O que dizer? Foi pelo menos um ano de preparativos incessantes e cuidadosos, desde a escolha do local, dos convidados estrangeiros, dos palestrantes, dos coordenadores de sessão e do programa, o qual pensamos que está instigante. As principais modificações que introduzimos na estrutura do congresso foram importantes, e visaram valorizar as atividades científicas que julgamos ser o objetivo principal do evento, contemplando desde a neurociência básica às novidades na neurogenética, agregando o neurologista clínico e o pesquisador. E a NEUROCOPA 2014, outra inovação, promete ser tanto erudita quanto divertida. Acreditamos que nossos esforços foram recompensados. O congresso contará com 31 palestrantes estrangeiros, 349 palestrantes nacionais, em um total mais de 130 sessões, sem contar com os 12 Simpósios Satélites. Ao todo, houve a submissão de trabalhos sendo destes selecionados para apresentação ou pôster. Contando com mais de participantes inscritos até o momento final. Agradecemos o auxílio de muitos no preparo deste Congresso. Muito devemos aos Departamentos Científicos, à Comissão Local, aos nossos Patrocinadores e às nossas famílias, as quais não apenas aceitaram que deduzíssemos nosso tempo de convívio mútuo como nos apoiaram nessa empreitada. Aproveitem o XXVI Congresso Brasileiro de Neurologia, o Neuro2014! Hélio Afonso Ghizoni Teive Presidente Viviane Flumignan Zetola Coordenadora da Comissão Científica Pedro André Kowacs Tesoureiro Comissão Organizadora do XXVI Congresso Brasileiro de Neurologia

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13 Oral Presentation AO-001 Headache OBESITY AND OBSTRUCTIVE SLEEP APNOEA SYNDROME IN CHRONIC HEADACHE Grassi V 1, Stelzer FG 2, Tomiozzo Junior JC 1, Fornari LHT 1, Eckeli A 3, Barea LM 2 1 UNIVERSIDADE FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE (UFCSPA); 2 IRMANDADE SANTA CASA DE MISERICÓRDIA DE PORTO ALEGRE (ISCMPA); 3 UNIVERSIDADE DE SÃO PAULO DE RIBEIRÃO PRETO (USP-RIBEIRÃO PRETO) Background: Morning headache (MH) and obesity are usually accepted as part of clinical findings of obstructive sleep apnoea syndrome (OSA). Obesity, snoring and sleep disorders are considered potentially modifiable risk factors for chronic headache. However, headache, obesity and OSA are common disorders in general population. There is a possibility that these observed associations are occurring by chance. Aim: The aim of this study was to estimate obesity and OSA prevalence between patients with chronic headache. Methods: A transversal and prospective study including 409 adult patients (over 18 years old) referred to full night polysomnography (PSG) between January and December 2013, in our Sleep Laboratory at Hospital São José Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA). All individuals were interviewed by neurologists to establish headache characteristics and to diagnose sleep disorders. The patients weight, height, waist circumference and body mass index (BMI) were also registered. This study was approved by the research ethics committee of the ISCMPA and all patients gave written informed consent. Results: There were 409 patients referred to PSG in the study period and OSA was present in 318 individuals (77.7%). In this sample, 41.2% were women (n=131), median age of 52.3±13.8 years. About 52.8% were obese (n=168), with median BMI of 31.7 kg/m2. Obesity was not related with higher prevalence or frequency of headache, as expected. On the contrary, there was a higher frequency of headache in life (91.1 versus 97.3%; p=0.030) and in the last year (74.4 versus 84.7%; p=0.027) in non-obese individuals. There was no association between obesity and headache semiologic features, like pain topography, duration, frequency, daytime period, triggers, relief factors or association with menstrual cycle. There was also no correlation between obesity and the use of pain killers medication or prophylactic treatment (0.8 versus 3.9%, NS). However, the mean intensity of pain (on pain rating scale 0 10) was higher in the obese individuals (5.6±1.9 versus 5.0±1.9; p=0.030). Discussion: In our study, we found no association between obesity and headache frequency. Higher BMI was not associated with headache cronification or the use of pain killers medication among OSA individuals. Disclosure: Nothing to disclose. AO-002 POST-TRAUMATIC HEADACHE IN PATIENTS OF THE NEUROSURGERY SERVICE OF THE HOSPITAL GOVERNADOR CELSO RAMOS, FLORIANÓPOLIS, SC Bem MLP, Queiroz LP SERVIÇO DE NEUROLOGIA DO HOSPITAL GOVERNADOR CELSO RAMOS Introduction: Post-Traumatic Headache (PTH) is one of the main causes of secondary headache. It is estimated that the most common consequence of cranioencephalic traumatism is headache. Definitions about the epidemiology, pathophysiology and specific headache features of PTH are yet under construction. Objectives: To evaluate the relevance and characteristics of PTH in patients with head trauma, followed by the Neurosurgery Service at the Hospital Governador Celso Ramos, in Florianópolis, SC, and to verify the relationship of PTH with the presence of pre-existing headache and with the severity of the traumatic head injury (THI). Methods: Between May 2013 and October 2013, 45 patients seen in consultation post-thi were interviewed. The THI occurred between January 2012 and August A structured questionnaire was applied, consisting of items about the characteristics and intensity of the THI, the presence or not of pre-existing headache, and the characteristics of the pre-existing headache and of the PTH. Results: Most patients (39) with head trauma were male, from 15 to 74 years of age (most in the third decade of life). The most frequent (49%) type of head trauma was due to car accident. Pre-existing headache was present in 42% (19) of the patients. After the THI, 75% (34) complained of headache. THI increased 4.23 times the risk of having a PTH (p<0.001). Of the PTH cases, 56% had only new headaches; 20% noted a worsening of their previous headache. The characteristics of the PTH was similar to primary headaches in 44% of the cases (migraine 29%; tension-type headache 15%). The presence of pre-existing headache did not determine greater tendency to present PTH. In 82,4% of the PTH cases, the THI was moderate or severe. In PTH cases, headache tended to occur with higher frequency and intensity. In 56% of the PTH cases, the frequency of the headaches was 15 days/month; and in 53%, the pain was severe. Patients who lost the conscience for 30 minutes, when they had THI, reported a higher frequency and/or more severe headaches. Conclusions: PTH is very frequent in patients who had a THI, regardless of having or not a pre-existing headache. Contrary to the usually reported in the literature, the great majority of our patients had a moderate to severe head trauma. Many PTH patients described a headache that resembles primary headaches. Headaches are usually very frequent and severe, especially if patients had lost their conscience for more than 30 minutes. AO-003 QUINTI DIGITI SIGN AND HEMIPLEGIC MIGRAINE : A FUNCTIONAL MAGNETIC RESONANCE IMAGING Silva RVB, Sanchez TA, Gasparetto EL, Vincent MB UFRJ Background: The Quinti Digiti Sign (QDS) has been noted in some patients with hemiplegic migraine interictally. This suggests that somehow these patients have motor cortex dysfunction during motor activation tasks. A Resting State protocol of functional magnetic resonance imaging (fmri) of mild motor impairment after XXVI Congresso Brasileiro de Neurologia stroke has been studied suggesting a recovery of connectivity after rehabilitation nighty days following stroke. Objective: The aim of this work was to verify if patients with hemiplegic migraine and subtle hemiparesis as demonstrated by the presence of the QDS show distinct activations during fmri. Methods: Ten patients and thirteen healthy controls were recruited at the headache clinic of the Clementino Fraga Filho Hospital, Rio de Janeiro, Brazil. Neurological examination concerning motor strength, power and reflexes was carefully recorded. To access the QDS, subjects were asked to horizontally extend both arms forwards, parallel to the floor, with palms facing down. A digital picture was taken perpendicularly having both hands in a single shot. Two clinical evaluations including picture recordings separated by a week were made during the interictal period. A blind examiner analyzed the pictures measuring the angle formed by the prolongations of the lines passing by the axis of both fourth and fifth fingers. fmri was used to investigate brain responses during a simple motor task of the affected finger in a blocked design consisting of 20 repetitions of 6 seconds of activity followed by 18 seconds of rest. Analysis was done using the general linear model (BrainvoyagerTM). Results: The quantitative analysis showed significant differences between the two populations. The cortical activation corresponding to the QDS s hand was smaller as compared to the contralateral side (p<0,038). The volume differences between the two sides versus differences between controls hands were greater in first group (p<0,041). The Beta values were smaller comparing the patitents QDS hands with the same side of controls (p<0,023) and was also smaller when the pantient s healthy hands were compared with the same hands in controls (p<0,038). BLM analysis showed a smaller amplitude in QDS hands when was compared with the opposite hand (p<0,029). Conclusions: Mild hemiparesis with the presence of QDS in HM is associated with different cerebral motor cortex activation in fmri interictally, favoring difficulties for appropriate finger tonus and movements. AO-004 Vestibular and Balance Disorders CLINICAL NEUROLOGICAL DEFICITS AND BALANCE CONTROL IN PATIENTS WITH MULTIPLE SCLEROSIS Vignola BA 1, Pereira CB 2, Callegaro D 2 1 USP; 2 HOSPITAL DAS CLÍNICAS FMUSP Balance disorders are one of the most disabling symptoms in multiple sclerosis (MS) and may occur even in patients with minimal neurological signs on clinical examination. However, in these cases, imbalance is usually underestimated. Usually, when patients complain about balance disorders, physicians focus the neurological examination on cerebellar or somatossensory signs. The aim of this study was to describe the clinical neurological deficits related to balance disorders in MS patients with low disability. Methods: We evaluated 35 MS outpatients with low disability (Expanded Disability Status Scale EDSS: 0 3,5). They were divided into two groups: without 13

14 Oral Presentation balance complaint (w/obc, n=21) and with balance complain (w/bc, n=14). We excluded patients with other neurological diseases, vertigo or dizziness, and cognitive impairment. All patients underwent a complete clinical neurological examination. Balance was tested with the dynamic posturography, Pro Balance Master (NeuroCom). We applied the modified Sensory Organization Test (msot) that measures the relative contributions of visual, vestibular, and somatosensory systems during standing. Statistical analysis was performed by the Mann-Whitney test and t Student test. Results: Our results did not showed differences in age, onset of disease and EDSS between groups. msot test proved that balance was worse in w/bc group than in w/obc group. We found significant differences (p<0,05) between groups in the clinical neurological examination of motor strength of the legs (reduced in 42,8% and 85%, w/obc and w/bc groups, respectively), spasticity (present only in w/bc group, 75%), superficial sensibility (reduced in 42,8% and 85%, w/obc and w/bc groups, respectively) and proprioception (impaired only in w/bc group, 75%). Visual acuity was not difference between groups and clinical evidence of cerebellar impairment was absent in our sample. Conclusions: It is common belief that cerebellar lesions are the primary cause of imbalance in MS, for this reason imbalance is usually underestimated in MS patients without cerebellar signs. Our results showed that MS patients with low disability did not have cerebellar impairment, even patients with complaints about balance. We proved that strength, spasticity and superficial sensibility are also important on balance control and have to be considered, mainly in patients with low disability and minimal neurological impairments. AO-005 SCREENING MIGRAINEURS WITHOUT VERTIGO COMPLAINS WITH VESTIBULAR BEDSIDE TESTS Maranhão ET 1, Maranhão Filho P 2, Vincent MB 2 1 UNIVERSIDADE FEDERAL DO RIO DE JANEIRO. HUCFF; 2 UNIVERSIDADE FEDERAL DO RIO DE JANEIRO- HUCFF-NEUROLOGIA Introduction: Migraine and vertigo are common disorders with lifetime prevalence of 16% and 7% respectively; and co-morbidity around 3.2%. Vestibular syndromes and dizziness occur more frequently in migraine patients (30 50%). Due to the relatively higher prevalence of vestibular disorders in migraineurs, clinical tests specifically designed to detect even subtle vestibular dysfunctions are expected to be abnormal in this condition. A systematic search for bedside clinical signs indicative of vestibular dysfunction in migraineurs has not been performed. Objective: To compare vestibulo-ocular (VOR) and vestibulo-spinal (VSR) responses as estimated by bedside tests in migraineurs without history of vertigo with controls. Patients and Methods: In this cross-sectional study sixty individuals, thirty migrainous patients; 25 women, y-o (median 39.3 years) without vertigo complains and thirty sex and age healthy paired controls were evaluated. Bedside tests were used to assess the VOR and VSR reflexes. For the first, the head impulse test (HIT), head shaking manoeuvre (HSM), dynamic visual acuity test (DVA), and the subjective visual vertical test (SVV) were performed; and for the second the applied tests were the clinical test of sensory integration and balance (CTSIB), sharpened Romberg test (SRT), Fukuda stepping test (FST), and past pointing test (PPT). All subjects underwent a neurootological examination 14 including the minimal ice test (MIT). The Wilcoxon Signed Rank test and the McNemar chi-square test were used for statistical comparisons. p values <0.05 were considered significant. This study was approved by the local Ethics Committee. Results: There was a tendency for migraineurs to perform worse in all tests except for the VVS test, but head to head comparisons showed that only the SRT was statistically different between patients and controls (p=0.039). Taken together, considering the frequency of abnormal responses, patients performed significantly worse than controls (p=0.003, Wilcoxon). Conclusion: Migraine patients consistently showed abnormal vestibular bedside tests when compared with healthy controls. This indicates that the vestibular function is impaired subclinically in migraineurs without vestibular complains and that bedside tests are suitable to detect such dysfunctions. Whether these changes are specific for migraine remains to be determined. AO-006 Cerebrovascular Diseases ACUTE STROKE CARE: FACTORS ASSOCIATED WITH EARLY MEDICAL ASSESSMENT IN THE EMERGENCY DEPARTMENT OF A REFERRAL CENTER IN NORTHWESTERN BRAZIL Barreto ES 1, Brito FS 1, Farias CA 2, Paranhos DR 1, Guimarães VP 1, Maldonado IL 3 1 EBMSP; 2 FTC; 3 UFBA Introduction: In the Brazilian public health system, a significant proportion of stroke victims still search and/or obtain medical attention several hours or days after the initial vascular event. In 2012, the Brazilian Ministry of Health published the decrees 664 and 665, which are official protocols for thrombolytic treatment. Previous data from our research unit showed that in 2013 there were a greater proportion of patients that were admitted in the first 24 hours after onset of symptoms in comparison with the year 2011, which was before publication of the official protocols. Purpose: The aim of the present study was to identify factors that were associated with a smaller interval of time from the onset of signs and symptoms to the hospital admission, in a referral center at Salvador-Bahia. Method: This was a cross-sectional study with a retrospective and observational design. The sample consisted of patients received in an emergency unit of a public referral center. The following variables were recorded: time of symptom onset, hospital admission (registered electronically), level of consciousness according to the Glasgow coma scale, location of origin, age, severity of motor deficit and presence of language disorder. Results: One hundred thirty-three patients were included in the study. Factors associated with first medical assessment in the emergency department before 4h30min were ambulance transportation and GCS 13. Very few patients came were from out of the city, and all of those patients arrived with more than 24h from the neurological deficit. Conclusions: Rapid ambulance transportation and a relatively preserved level of consciousness seem associated with shorter pre-hospitalar times from the onset of neurological deficit to hospital arrival. This strengthens the importance of an effective public pre-hospitalar care organization AO-007 ASSESSMENT OF RECANALIZATION IN CEREBRAL VENOUS THROMBOSIS RELATED TO TIME IN THERAPEUTIC RANGE OF ANTICOAGULATION WITH WARFARIN Suzano FL, Cordellini MF, Cavalli H, Rizelio V, Kowacs PA INSTITUTO DE NEUROLOGIA DE CURITIBA Introduction: Cerebral venous thrombosis is an uncommon disease, whose treatment with anticoagulation is imperative. Few studies have investigated the process of recanalization of the cerebral venous system, and in an unprecedented way, this study correlates this data to treatment with oral anticoagulation. Objectives: assess whether the time percentage in therapeutic range of anticoagulation (INR 2.0) influenced the degree of recanalization of the dural venous sinuses and cortical veins in patients treated with warfarin after a diagnosis of Cerebral Venous Thrombosis. Methods: retrospective, descriptive study including 17 patients. A comparative analysis was made of the extent of recanalization, through images of brain magnetic resonance imaging (MRI) and cerebral venous magnetic resonance angiography performedin the acute phase and after treatment for 6 months and 12 months, respectively, with the outcome being total or partial recanalization. The International Normalized Ratio (INR) values up to or above 2.0 were considered to calculate the time percentage in therapeutic range. Variables included age, gender, risk factors and location of thrombosis. Results: The rate of partial recanalization in this population was 64.7% (11). The variables age, gender and risk factors, as well as percentage of time in therapeutic range of anticoagulation did not influence the final extent of recanalization. We found partial recanalization in 83% of patients with sigmoid sinus thrombosis (p<0.05) and in 82% with transverse sinus thrombosis (p=0.109). All patients who spent more than 90% of the time in therapeutic range of anticoagulation showed partial recanalization. The treatment time for total recanalization was 6 months. No patient with partial recanalization, evolved to total recanalization with extending treatment for 12 months. Conclusion: total venous recanalization was not related to the efficiency of anticoagulant treatment in this sample. It is suggested that it may be related to risk factors and the location of the thrombus. AO-008 ATRIAL FIBRILLATION IN STROKE: ETIOLOGIC PROFILE IN JOINVILLE/SC Cunha RGD, Zalli M, Diegoli H, Schulz VC, Moro CHC HOSPITAL MUNICIPAL SÃO JOSÉ Introduction: Stroke is an important cause of morbidity and mortality worldwide. Thus, it is clearly important in determining the etiology of the event for secondary prevention. According to the TOAST classification, there are five possible etiologic mechanisms: cardioembolic, atherothrombotic, lacunar, or other undetermined causes. Atrial fibrillation is the most frequent cause of cardioembolic mechanism. Nevertheless, it is known that many patients are

15 XXVI Congresso Brasileiro de Neurologia not diagnosed at the time of etiologic investigation by the difficulty to identify paroxysmal AF, impairing adequate secondary prevention. Recent study showed that 2.2% of patients who underwent ECG monitoring for 24 hours were diagnosed with FA, while 14.8% of those who had monitoring for 4 weeks. CRYSTAL-AF Study, which entered implantable monitoring system that points out the number of paroxysmal AF, detected nearly 4 times greater than the control study. Objectives: To determine the prevalence of cardioembolic stroke in atrial fibrillation and stroke of undetermined origin in Joinville/SC in the period October 2009 to June 2014; Compare the prevalence of cardioembolic stroke by AF and stroke of undetermined origin in Joinville/ SC with data from other large centers. Methods: From October 2009 to June 2014, all patients with clinical stroke in the city of Joinville were recorded and classified using the TOAST criteria. All the patients were asked for previous atrial fibrillation (AF) and were submitted to at least one electrocardiogram (ECG). We considered AF present in the patients that referred the disease or in which the ECG showed signs of it. All data were collected from the JOINVASC Study. Results: From October 2009 to June 2014, were recorded in Joinville/SC 2789 cases of ischemic stroke, of which 676 (24.24%) were atherothrombotic; 808 (29.01%) were cardioembolic; 598 (21.44%) were lacunar; 573 (20.54%) were of undetermined origin; and 133 (4.77%) had other causes. Of the 808 cardioembolic, 322 (39.85%) are due to AF and 486 (60.15%) are other cardioembolic sources. The FA rate in the sample was 13.4%. Conclusion: Atrial fibrillation is the cause of a significant proportion of cardioembolic strokes, even in our service that uses only electrocardiogram (ECG) and Holter 24h in selected cases. It is concluded that the implementation of more sensitive methods for diagnosis of paroxysmal AF in the etiology of ischemic stroke is needed. AO-009 BASILAR ARTERY OCCLUSION: CALL FOR A MORE AGRESSIVE TREATMENT? Dias FA, Cougo-Pinto PT, Alessio-Alves FF, Castro- Afonso LH, Camilo MR, Santos-Pontelli TEG, Abud DG, Pontes Neto OM HCFMRP-USP Background: Acute basilar artery occlusion (BAO), which accounts for only about 1% of acute ischemic strokes, usually leads to severe disability and mortality (80 90%). Intravenous (IV) thrombolysis within 4.5 hours was proven safe and effective for the treatment of acute ischemic stroke in randomized, phase 3 trials. Endovascular therapy has been tested up to 8 hours for ischemic stroke. However, the number of patients with posterior circulation ischemia more specifically with BAO included in these studies was small. Therefore, the most appropriate recanalization strategy in patients with BAO is still controversial. Objective: To assess the clinical outcomes of patients with BAO within each modality of recanalization therapy in a tertiary academic hospital in Brazil. Study methods: This is a retrospective analysis of patients with BAO selected from the hospital-based, prospective stroke cohort (REAVER) at Ribeirão Preto Medical School. Primary outcomes were mortality and non-severe disability [modified Rankin Scale (mrs)<4] at 90 days. Results: Between August 2004 and August 2014, 26 patients (61.5% male), were diagnosed with BAO, based on transcranial ultrasound, computed tomography angiography or magnetic resonance imaging angiography. The most common stroke risk factors were hypertension (69.2%); diabetes (26.9%); smoking (26.9%); and 9 (34.6%) had a previous stroke. The median National Institutes of Health Stroke Scale was 26 [interquartile range (iqr): 14 38], and the median time from symptoms onset to admission was 4.5 hours (IQR: ). Ten patients received no recanalization therapy, 7 received IV thrombolysis and 9 received endovascular therapy. Patients treated conservatively had 80% mortality and no patient achieved a mrs<4 at follow-up. Patients treated with IV thrombolysis and endovascular therapy had 57.1% and 44.4% of mortality and 14.2% and 22.2% of mrs<4 at follow-up, respectively. Only one patient in the whole sample had an excellent outcome (mrs=1) after being treated with IV thrombolysis. There was no significant statistical difference between the outcomes in each group. Conclusions: BAO is a catastrophic event with high morbidity and mortality. Current recanalization therapies did not seem to alter the dramatic course of disease in our sample. There is an urgent need for randomized studies to evaluate the best therapeutic strategy for this condition. AO-010 DABIGATRAN ETEXILATE VERSUS WARFARIN IN MANAGEMENT OF NON-VALVULAR ATRIAL FIBRILLATION IN PATIENTS FOLLOWED AT A REFERENCE CENTER OF SALVADOR, BAHIA, BRAZIL Monteiro JMC, Sousa TRM, Pinto BM, Costa BAL, Campana IG, Bouza CB, Martin DLS, Jesus PAP UFBA Introduction: the RE-LY study showed superiority of the use of dabigatran in patients with non-valvular atrial fibrillation (NVAF) compared to warfarin for prevention of thromboembolic events, particularly stroke, and reduction of bleeding. However, there are few data about the use of dabigatran in brazilian population. This study aims to evaluate the effectiveness of these medications in a group of patients with NVAF. Methods: case-control study with patients with NVAF and oral anticoagulation therapy with dabigatran (cases) or warfarin (controls) followed at a reference stroke center in Salvador, Brazil, between January/2012 and August/2014. Clinical characteristics and number of consultations were compared between the groups. A non-parametric test was performed to assess differences between groups related to ratio variables. Results are described using mean ± standard deviation, median [interquartile range] or proportion. The p-value is shown for a two-tailed and exact test. Results: 58 patients were collected (21 cases, 42.9% females and 37 controls, 56.8% females) with similarity between cases and controls for age s distribution (69.7±10.6 vs 63.8±18.6 years, p=0.078) and gender. All cases and 12 controls had stroke. The CHA2DS2Vasc was higher in cases than controls (5[4 5.5] vs 3[2 4.5], p<0.001). Small bleeding was found in five patients of control group and two patients of case group. Stroke occurred in two controls during the treatment. The number of appointments adjusted by time of follow-up in years (AA) was lower in cases than in controls (3.4[ ] vs 9.2[ ], p<0.001). The number of AAs on which was necessary reduction or interruption of medication was higher in controls compared with cases (1.9[ ] vs 0[0 1.4], p<0.001). On the sub-groups analysis with stroke patients, the number of AAs was lower in cases compared with controls (1.5[ ] vs 9.7[ ], p=0.001), as well as the number of AAs that were necessary reduce or interrupt the medication (0[0 1.4] vs 3.4[ ], p=0.007), being necessary to do more consultation in controls for RNI evaluation when compared to main group. Conclusion: the data indicate the usage of dabigatran is safe and allow better therapeutic control reducing number of appointments and adjust of dose on patients with NVAF. Patients with stroke s history can present better thrombotic risk control and lower intervention when using this medication. AO-011 EFFECT OF THROMBOLYTIC THERAPY ON THE OCCURRENCE OF MILD COGNITIVE IMPAIRMENT AND DEMENTIA AFTER STROKE Silva ES 1, Dalpizol L 2, Rodrigues F 1, Röhers P 1, Martins SCO 1, Chaves ML 1 1 HCPA; 2 HCA Introduction: Thrombolytic therapy reduces functional dependence and mortality after acute stroke but its action upon cognitive condition is still unknown. Objectives: To evaluate the influence of the thrombolytic therapy on the incidence of cognitive impairment and dementia after stroke. Methods: Quasi-experimental study with post acute ischemic stroke patients of the neurovascular unit of a public hospital in southern Brazil. The thrombolytic therapy followed the standard protocol. A questionnaire was administered to patients or family members in the post ischemia period to assess pre-stroke functional and memory conditions, and depression. Patients with cognitive impairment, depression and aphasia were excluded. The first assessment was carried out between 30 and 90 days after ischemia and the second after 6 months. The primary outcome was cognitive impairment or dementia defined by the CDR scale. The instruments used were the NIHSS scale, modified Rankin and Barthel, Mini Mental State Examination, semantic verbal fluency, clock drawing test, Boston Naming Test, digit span forward and reverse, basic and instrumental activities of daily living scale, Fulg-Meyer scale and Beck Depression Inventory. Results: Two hundred and thirty two (232) patients and/or their relatives were interviewed, from whom 90 (38.8%) were included in the study (27 pertained to the thrombolized group). Thrombolized patients were significantly more severely affected (according to the stroke scales). In the first assessment, thrombolized patients had more depressive symptoms and poorer cognitive, functional and motor performance. At 6 months of follow-up, 28 patients met criteria for mild cognitive impairment (MCI) or mild/ moderate dementia, from whom 12 (42.9%) pertained to the thrombolized group and 16 (57.1%) from the non-thrombolized group (p=0.074). The non-thrombolized group showed greater stability of the cognitive status at 6 months compared to the first assessment, while the thrombolized group showed significant migration either for enhancement and for deterioration (p=0.02). Conclusion: Patients submitted to thrombolytic therapy showed higher incidence of MCI/ dementia at 6 months of follow-up, but showed greater category migration both for enhancement and for deterioration than the non-thrombolized patients. A longer follow-up is in progression to clarify these findings. 15

16 Oral Presentation AO-012 HOSPITALIZATIONS AND DEATHS BY VASCULAR BRAIN INJURY IN SOME CAPITAL OF BRAZIL: AN ANALYSIS OF SECONDARY DATA Guimarães VP, Pires MS, Figueirôa F ESCOLA BAHIANA DE MEDICINA E SAÚDE PÚBLICA Introduction: The stroke is the second major cause of death in the world, and also an importante cause of hospitalization and parcial or complete disabillity between elderly and middle-age adults. The brazilian epidemiological profile is marked by a high increase of deaths for cerebrovascular diseases and also for a higher number of people with chronic diseases and incapacities, mainly because of the increased populational aging. Thereby, it becomes necessary the analysis and comparison of the epidemiological profile at the main brazilian capitals, in a way to understand the profile of the pacients most affected by this clinical condition for the creation of more incisive and directed public policies. Objective: Describe and analyze the profile of hospitalization and deaths by stroke on some brazialian capitals, according to gender and age. Methods: A descriptive study was conducted using secondary data from the Hospital Information System of the Unified Health System (SIH / SUS), deaths in the Mortality Information System (SIM / SUS) and resident at the IBGE Census 2010 population, based on available Datasus of the Ministry of Health. The study was conducted in the main capital of each one of the five regions of Brazil: Manaus, Salvador, Sao Paulo, Brasilia and Curitiba. Results: The proportion of hospitalization for stroke in Brazil showed the most significant increase in the Northeast. The Southeast region decreased the proportion of such admissions over this period, from 49.78% in 2008 to 45.99% in Most regions showed that there was a higher frequency of hospitalizations among males, but in Salvador and Brasilia was a reversal of these values. The number of hospitalizations was higher in individuals years, but the death rate tends to increase with increasing age of patients, reaching 18,192 cases in individuals aged 80 or over in Discussão: Higher rates of hospitalization was observed in men, although the number of deaths is higher in females, which may be associated with increased life expectancy of women, which also seek medical care in greater proportion per year, translating into better health prevention. AO-013 INTRAVENOUS THROMBOLYSIS IN VERY ELDERLY PATIENTS WITH ACUTE ISCHEMIC STROKE Camilo MR, Pinto PTC, Barreira CMA, Dias FA, Alves FFA, Rocha LJA, Libardi MC, Martins Filho RKV, Santos RSA, Pontelli TS, Abud DG, Pontes Neto OM FMRP-USP Background: The population of elderly individuals is growing worldwide and advanced age is a strong predictor of stroke. However, the routine use of intravenous thrombolysis (IVT) remains debated in very elderly patients, mostly duo to safety concerns. The aim of this study was to determine the rate of symptomatic intracranial hemorrhage (SIH) and in-hospital mortality among elderly patients with ischemic stroke treated with IVT in a public Brazilian academic hospital. Methods: Consecutive stroke patients aged 80 years old and older were retrospectively selected from a single-center, hospital-based prospective registry of stroke patients. Collected 16 data included treatment with IVT, demographics, cerebrovascular risk factors, comorbidities, National Institutes of Health Stroke Scale (NIHSS) at admission and in-hospital mortality. Brain computed tomography scans were blindly reviewed to assess the occurrence of SIH (defined according to the ECASS 3 criteria). Results: Between January 2006 and July 2014, 285 patients aged 80 years old were admitted with ischemic stroke. Among those, forty-five (15.8%) received IVTaccording to our institutional protocol. Seven (15.5%) of those also received endovascular rescue treatment. The mean age was 83.9±3.8 years with predominance of females (62.2%). Arterial hypertension was the most frequent risk factor for stroke (80%) followed by atrial fibrillation (44.4%). The mean time between symptoms onset and IVT was 203.6±69 minutes. Thirty-one (68.9%) patients had total anterior circulation syndrome on admission. The median baseline NIHSS was 18 (IR: ). There were 14 (31.1%) in-hospital deaths and only two (4.4%) cases of SIH. Six (85.7%) of the seven patients who underwent endovascular therapy died. Conclusions: IVT was safely administered in very elderlyacute stroke patients and was not associated with an increase risk in SIH at a high volume academic stroke center in Brazil. Further studies should addressthe safety of endovascular rescue treatment for this population. AO-014 IS THERE A CORRELATION BETWEEN RIGHT-TO- LEFT SHUNT SIZE WITH STROKE PHENOTYPIC CLASSIFICATION IN DETERMINING THE CARDIOEMBOLIC EVENTS? Chamma JF, Zetola VF, Hadas TC, Lange MC, Novak EM UFPR Background: ASCOD is a new system to phenotype patients with ischemic stroke to better describe the overlap between diseases underlying a cerebral ischemic event. The finding of FOP has better causal correlation when associated with other cardiac anatomical abnormalities and cryptogenic stroke. Objetive: We hypothesized that the larger size of the shunt D/E and the passage of microbubbles without Valsalva detected by DTC may have better correlation with cardioembolic event. Methods: Retrospective analysis of patients with RLS selected through the database of reports of Neurosonology Laboratory associated with the review of medical records with permission of the physcian assistant. The RLS size was classified according to the following criteria obtained by DTC: below 10 microbubbles (MES) was considered small, and greater than 10 MES was considered significant. We also correlate the passage of MES without Valsalva. The ASCOD classification was obtained from medical records. For data analysis we excluded all patients with rating of C1 with cardiac findings unrelated to shunt. Results: A total of 124 patients were included divided in two groups according to the classification of ASCOD (C): 55 patients in group 1 classified as C2 and 69 in group 2 as C3. In 38 (69%) patients of group 1 and 46 (66%) in group 2 were classified as significant RLS we found no correlation. In 44 (80%) patients of group 2 and 45 (65%) in group 3 also had a MES during the rest test we found a statistical trend (p=0.069). Conclusion: At date there is no evidence linking the size of the shunt or the rest passage of MES with higher risk of cerebrovascular events. The FOP is usually classified as probable or simply a finding depends on the clinical and EET exam. Probably further information evaluated in additional tests (TCD) may bring future considerations for decision making. AO-015 IS THERE A CORRELATION BETWEEN THE ROPE SCORE AND THE RECURRENCE OF CEREBROVASCULAR EVENTS? Zetola VF, Chamma J, Lange MC, Hadas TC, Bruch T, Novak EM UFPR Background: The RoPE score (Risk of Paradoxical Embolism) was recently published with the goal of identifying the probability of the detection of patent foramen oval represent the cause of cryptogenic cerebrovascular event or just an incidental finding. According to the literature it is possible that this score can also be used to demonstrate low recurrence rate when the isquemic event is related to the FOP. Objetive: Apply retrospectively score the Rope in patients with cryptogenic stroke and correlate with the time of follow-up for recurrence. Methods: Selected 105 patients in outpatients with cerebrovascular diseases without defined etiology (CS = cryptogenic) but with the presence of shunt D / E detected by transcranial Doppler or echotransesophageal exam. We classified in two groups. The group 1= probable PFO-related stroke once the RoPE score >6 points and group 2= probable PFO incidental finding once RoPE score 6. The recurrence rate was obtained by the own patient s records during their follow-up. For all patients we performed a phone call in July 2014 for the latest information. We excluded patients who died by unknown cause and those who could not obtain information or reliable information. Results: Of total 75 patients, 24(32%) were been followed for less than 2 years, 32 (42%) between 2 and 8 years and 19 (25,3%) more than 8 years. There was no statistically difference among the three follow-up groups and rates of recurrence (p=0,20), as well for the values assigned in RoPE score (p=0,27). In group 1 (n=38) we found 18% and in group 2 (n=39) 25% of recurring events, no significant difference (p=0,79). Conclusion: In this retrospective study there was no significant correlation between the rates of recurrent stroke and the values assigned by the RoPE score. Further studies are necessary to validate the RoPE score. AO-016 IS THERE A GOOD CORRELATION BETWEEN TRANSCRANIAL DOPPLER WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY TO DETECT RIGHT-TO-LEFT SHUNT (RLS)? Chamma JF, Zetola VF, Mendes DC, Lange MC, Novak EM UFPR Background: Right-to-left shunt (RLS) can be identified by transesophageal echocardiography (TEE) or by transcranial Doppler (TCD) during the monitorization. Both techniques use intravenous injection of agitated saline with air in a peripheral vein as a contrast agent. Once uniform protocols for detection and interpretation are not established, each service seeks to improve its own agreement. Objetive: Assess agreement between ctee and ctcd examinations in detecting RLS. We also evaluated the correlation between the tests to qualify between small and large shunt considering the literature data Methods: We retrospectively analyzed a database from Neurossonology Laboratory of the Hospital de Clinicas

17 XXVI Congresso Brasileiro de Neurologia of the Federal University of Paraná that showed a presence of RLC in at least one of the exam. We consider the descriptive reports of both examinations to qualify the size of the shunt. Regarding the TCD report the detection over than 10 microembolus was considered large. We excluded patients who had undergone just one test. Results: Of the total of 106 selected patients, 93 (87.7%). had positive results in both tests. No agreement was found in 13 of the tests. In 2 patients the RLS was evidenced only by the TEE and 11 only by TCD in patient. We assumed 100% of positivity in each exam and found that TCD had a 98,12% sensitivity and TEE had a 89.62%. When the descriptive data for each test were compared, we could not find any information regarding the RLS size in 33.96% of the reports in the TEE. The agreement between the tests was obtained in only 52.5% of the cases where both tests were reported correctly. Conclusion/Comments: Our comparative study confirms literature data that show high sensitivity of both TCD and TEE for detect RLS. The goal of performing both tests includes support decision making involving the consideration of a large or small shunt. Although the literature reinforces the difference between the operators and the technics of examiners, our work reveals that there is also a necessity to adjust the report prior to comparing. Our work calls for urgent guideline activity in the areas of TEE and DTC so that the results may contribute to clinical decision making. AO-017 MEASURES TO REDUCE THE DOOR-TO-NEEDLE TIME IN STROKE THROMBOLYSIS: A BRAZILIAN EXPERIENCE Tansini G, Ducci RD, Nóvak EM, Germiniani FMB, Zetola VF, Lange MC UFPR Background: The door-to-needle time (DNT) is an important goal in order to reduce the time to treatment in intravenous thrombolysis (IVT). The use of simple measures could reduce significantly the DNT. Aims: To analyze if the inclusion of some of those measures, in addition to specific local actions could reduce DNT in a Brazilian hospital. Methods: Patients admitted for emergency neurological evaluation with ischemic stroke who were submitted to IVT within 4.5 hours after symptoms onset were separated in two groups: in the first group, patients arrived in the CT room for neurological evaluation and brain image and were admitted in the Emergency Room for IVT (ER Group); in the second group, after arrival in the CT room, patients were admitted in an exclusive bed [ Thrombolysis Bed (TB)] in the general neurology ward (TB Group) for IVT. Median DNT for both groups was analyzed. We also evaluated the results of a subset of patients treated within 60 minutes of admission. Results: Patients from the ER Group [45( ) min] had a higher median DNT when compared to the TB Group [37( ) min], p= Sixty-eight (86.0%) patients from TB Group were treated in the first 60 minutes of arrival as compared to only 48 (67.6%) in the ER Group ER (p=0.011). Conclusion: The introduction of a TB associated to the previous implementation of simple measures in a general hospital setting can markedly reduce the DNT, thus allowing more than 85% of patients to be treated within the first hour of admission. AO-018 The admission in a Stroke Unit (SU) is one of the most important measures that modify the prognosis of patients with ischemic stroke (IS) Ferreira LFT, Ducci RD, Lange MC, Zetola VF, Nóvak EM UFPR Introduction: The admission in a Stroke Unit (SU) is one of the most important measures that modify the prognosis of patients with ischemic stroke (IS). Objective: Analyze the complications and the mortality rate in patients admitted in a SU compared to patients admitted in a general ward of neurology (GW). Methods: Patients with IS were selected in two different periods, 91 patients before (GW group) and 91 patients after the establishment of the SU (SU group). Those groups were compared in relation to their mortality rate, their level of independence and their following in-hospital complications: pneumonia, urinary tract infection (UTI), deep venous thrombosis (DVT), pressure ulcer (PU) and hemorrhagic transformation (HT). Results: There were no statistical differences between the studied groups for all the variables analyzed. There were three deaths in the GW compared to eight deaths in the SU, p= Forty-seven of the GW patients were independent in the discharge compared to 55 SU patients, p= Pneumonia occurred in 10 GW patients versus 12 SU patients, p= UTI occurred in five patients from the GW and in three patients from the SU, p= There were no cases of DVT in both groups. Two patients had PU in the GW and one in the SU, p=1.00. The number of HT cases were the same in both groups, three cases, p=1. Conclusion: The SU implemented in our hospital used the same facilities and professionals as the previous GW of neurology. In addition, the groups were similar in previous risk factors related to bad outcome after IS. These facts might explain the results observed in the study. AO-019 PAEDIATRIC NEUROVASCULAR CONSULTATION IN SICKLE CELL DISEASE Silva RL, Manita M, Conceição C, Maia R, Kjollerstrom P CENTRO HOSPITALAR LISBOA CENTRAL Introduction: Cerebrovascular disease strongly contributes to mortality and morbidity in Sickle Cell Disease (SCD) patients. Since the STOP Study (published in 2008) systematic transcranial doppler (TCD) is recommended in order to stratify stroke risk and implement regular blood transfusions if elevated blood flow velocities are present. Our Hospital is a SCD reference center and a Pediatric Neurovascular Consultation was created in articulation with the Hematology and the Neurosonology Units to improve the neurological care of these children and adolescents. Objectives: To evaluate the neurological surveillance and stroke prevention programme of the paediatric SCD patients followed in our Hospital. Materials and methods: Data were collected from SCD children/adolescents followed in the Haematology Unit with at least one appointment since January 1st Variables analysed were age, gender, TCD and MRI findings, formal neurological evaluation and the occurrence of stroke, learning disability and headache in this population. Results: The Paediatric Haematology Unit currently follows 96 patients with SCD (91% HbSS), 55% male, 64% between 7 and 18 years and 29% between 2 and 7 years old. Positive stroke history was present in 4 (4%) patients, occurred from 3,5 to 12 years of age, mainly in the middle cerebral artery territory and with recurrence in one patient. Of the 91 patients older than 2 years of age, 88% had performed TCD according to the International Guidelines, 94% with normal blood flow velocities and 2,5% with pathologically elevated values. MRI was performed in only 25 (26%) patients and 52% of them had pathological findings, namely 2 with intracranial arterial stenosis, 5 with isolated silent infarcts and 4 with stroke (2 with silent infarcts and 2 also with moyamoya pattern). A formal Paediatric Neurology evaluation was obtained so far in 55 (57%) children/adolescents with SCD. Among these, headaches were present in 23 (41%) and learning disability in 19 (41%). Conclusions: Our SCD patients are followed according to the International Guidelines, 88% of them had performed TCD regularly and 4% have a positive history of stroke. The Paediatric Neurovascular Consultation had an important role, promoting the communication between the Haematology and Neurosonology Units, preventing cerebrovascular disease and improving the care of these children and adolescents. AO-020 PILOT STUDY OF CARDIAC MAGNETIC RESONANCE IMAGING IN CRYPTOGENIC ISCHEMIC STROKE Ferreira IL, Barreto-Neto N, Torreão JA, Fernandes RD, Gonçalves BM, Andrade AL, Reis CC, Resende LL, Jesus AA, Lordelo MJ, Abbehusen C, Reis F, Jesus PA, Oliveira Filho J UFBA Background: Defining the underlying mechanism of ischemic stroke (IS) is one of the cornerstones of secondary prevention, but up to 30% of all IS are cryptogenic. We aimed to determine the added clinical value of cardiac magnetic resonance imaging (CMRI) in patients with cryptogenic stroke. Methods: Consecutive patients admitted to an outpatient university-based stroke clinic were investigated for stroke etiologic subtyping using the Causative Classification of Stroke. Patients with undetermined cause of stroke were further investigated using CMRI. Chagas disease (CD) status was also determined in these patients using an ELISA assay. Results: We studied 38 patients, mean age 54±15 years, 18 (47%) female, 10 (29%) with CD. A potential source for cardioembolism was found in eight (22%) patients: eight (22%) with wall fibrosis, four (11%) with wall edema and two (5%) with intracardiac thrombus. CD was associated with a greater number of abnormalities on CMRI when compared to non-cd patients (median zero, range 0 3 versus zero, range 0 1, respectively, p=0.027). Conclusions: Potential sources of cardioembolism are found on CMRI in a significant proportion of patients previously classified as having cryptogenic stroke, especially among patients with CD. 17

18 Oral Presentation AO-021 POLYPHARMACY IN INDIVIDUALS ATTENDING AN OUTPATIENT REFERRAL OF STROKE IN SALVADOR, BAHIA, BRAZIL Passos Neto CEB, Echegaray MVF, Matias LG, Pinto BM, Souza IFB, Fukuda TG, Jesus PAP UFBA Introduction: Polypharmacy (PP) is defined as the use of five or more medications. Patients who have suffered stroke deserve attention regarding the use of drugs, since there is a need to control risk factors and the frequency of comorbidities is high. Objectives: To describe the frequency of PP in an outpatient referral for secondary prevention of stroke in Salvador, Bahia, Brazil. Methods: This study was a cross-sectional study of 219 patients attending an outpatient referral of stroke, assessed from April 2014 to August It is an analytical study, with data collected from medical records and through pre-defined interview. Measures of central tendency and frequency were used for description. For univariate analysis, chi-square tests (categorical variables) and Mann-Whitney test (numerical variables) were made; logistic regression by backward conditional method was used for multivariate analysis. The data were analyzed using the software SPSS v21. Results: The sample included 219 patients. 119 subjects (54.3%) were women and 100 (45.7%) were men. The average age was years old. 170 subjects (77.6%) have hypertension, 168 (76.7%) dyslipidemia, 60 (27.4%) type 2 diabetes mellitus, 41 (18.7%) post-stroke epilepsy, 28 (12.8%), congestive heart failure, 21 (9.65%) atrial fibrillation and 18 (8.2%) coronary artery disease. 5 (2.3%) patients uses only one medication, 69 (31.5%) uses 2 to 4, 130 (59.4%) uses 5 to 8, and 12 (5.5%) uses 9 to 13. Thus, 142 have PP (65%). Univariate analysis found a statistically significant correlation between PP and age (p<0.001), hypertension (p<0.001), diabetes mellitus (p<0.001), dyslipidemia (p<0.001) and congestive heart failure (p<0.072) and smoking (p<0.113). In multivariate analysis, there was an association between PP and hypertension (p<0.001, OR: 7.757, CI: to ) and diabetes mellitus (p<0.001, OR: 6.547, CI: to 9.304) and a trend towards association with dyslipidemia (p<0.070) and congestive heart failure (p<0.129). Age (p<0.669) showed no association. Conclusions: PP is a problem in stroke patients, represented by 65% of the patients in this study, surpassing more than 2 times its occurrence in the SABE Study (31.5%) and about 5 times its occurrence in the elderly in the city of Fortaleza (13.6%). The study confirms the need for careful and judicious selection in prescription medications for this population. AO-022 PREDICTORS OF HEMORRHAGIC TRANSFORMATION IN PATIENTS TREATED WITH INTRA-ARTERIAL THROMBOLYSIS AND MECHANICAL THROMBECTOMY: A REAL WORLD EXPERIENCE Silva GS, Massaud RM, Vaccari AMH, Miranda RCAN, Cendoroglo Neto M HIAE Introduction: Hemorrhagic transformation (HT) is a feared complication of intra-arterial (IA) thrombolytic therapy in patients with acute ischemic stroke (AIS). Predictors of HT in the era of mechanical thrombectomy are not well established. The aim of our study was to evaluate 18 the frequency of HT and its predictors in a series of patients with AIS treated with either IA thrombolysis and/or mechanical thrombectomy outside a clinical trial. Methods: We evaluated a database of consecutive patients admitted to a Brazilian tertiary hospital with AIS treated with either IA thrombolysis and/or mechanical thrombectomy from January 2009 to December Categorical comparisons were made by the chi-square or Fisher exact test. We used logistic regression analysis to investigate predictors of any HT. Results: Forty-eight patients were treated. The median baseline National Institutes of Health Stroke Scale score was 16 [11 21], and mean age was 68.8±16.5 years. A total of 33.3% of the patients were treated with IA thrombolysis and mechanical thrombectomy (solitaire and/ or penumbra devices used), 24.9% received only IA thrombolysis, 22.9% only mechanical thrombectomy, 12.5% intravenous (IV) rtpa followed by mechanical thrombectomy, 6.4% IV rtpa followed by mechanical thrombectomy and IA thrombolysis. Any HT occurred in 14 patients (29.8%). The rate of any HT was similar in patients treated with pure IA thrombolysis, versus combined IV-IA thrombolysis and mechanical thrombectomy. Systolic blood pressure at admission (OR 1.01 [ , p=0.02), ASPECTS scores (OR 0.44 [ , p=0.01), platelet count (OR 0.98 [ ], history of diabetes (OR 4,5 [ ] and hyperthermia in the first 48 hours peri-procedure (OR 5.5 [ ], p=.03) were univariate predictors of HT. On multivariate analysis, only the ASPECTS score remained as an independent predictor of HT. Conclusions: In this real world series of patients treated with IA thrombolysis and/or mechanical thrombectomy the burden of ischemic lesion at admission measured using the ASPECTS scores was the only independent predictor of HT. AO-023 RELEVANCE OF ENDOTHELIAL NITRIC OXIDE SINTASE, ELASTIN, ENDOGLIN AND COLLAGEN GENETIC VARIANTS IN FAMILIAL INTRACRANIAL ANEURYSM Gregório ML 1, Neiva CM 1, Pinhel MAS 2, Nakazone MA 3, Madureira LS 3, Lauletta LFM 3, Santos MLT 3, Ferraz Filho JRL 3, Souza DRS 3, Tognola WA 3 1 UNIFRAN; 2 USP; 3 FAMERP Background: Intracranial aneurysm (IA) risk factors can be environmental like smoking and alcoholism, and genetic like variants of endothelial nitric oxide sintase (enos), elastin (ELN), endoglin (ENG) and collagen (COL). Objectives: Analyze enos, ELN, ENG and COL polymorphisms, environmental risk factors and the association with IA. Methods: 836 individuals divided in 6 groups: G1-40 (familial IA); G2-176 (G1 family); G3-113 (sporadic IA); G4-277 (G3 family); G5-104 (controls); G6-126 (G5 family). Polymorphisms analysis enos, ELN, ENG and COL was done by PCR (polymerase chain reaction). Significance level P<0.05. Results - enos: allele A more prevalent in G1 (0,93), G2 (0,83), G3 (0,79), G4 (0,89) than G5 (0,61) and G6 (0,75; P<0,0001). A/A genotype more frequent in G1 (86%); G2 (77%) G3 (79%) and G4 (78%), than G5 (26%) and G6 (50%; P<0,0001). ELN: similarity between groups (P>0,05). ENG: allele Wt more prevalent in G5 (0,81) than in G1 (0,61; P=0,01); allele I more prevalent in G2 (0,30) than G6 (0,19; P=0,003) and in G3 (0,34) than G5 (0,24; P=0,027). Genotype -/Wt more frequent in G5 (89%) than G1 (69%; P=0,009) and in G2 (77%) than G4 (88%; P=0,003). Genotype II prevailed in G2 (22%), rather than G6 (8% P=0,001). COL: C/C genotype more frequent in G2 (25%) than G6 (13,2%) (P=0,016). C/G genotype more prevalent in G3 (69,6%) than G5 (49,1%) (P=0,003) and G4 (67,9%) than G6 (44,9%) (P<0,0001). Smokers and alcoholics more prevalent in G1 (79%; 40%, respectively) and G3 (61%; 36%), than G5 (29%; 20%; P<0,05). Conclusions: enos, ENG and COL genetic polymorphisms are associated with IA, differentiating familial or sporadic IA and controls, as well as smoking and alcoholism. AO-024 ROPE SCORE, PATENT FORAMEN OVALE AND THE ETIOLOGY OF STROKE AMONG YOUNG BRAZILIAN PATIENTS Libardi MC, Fábio SRC, Camilo MR, Martins Filho RKV, Rocha LJA, Santos RSA, Coletto FA, Barreira CMA, Dias FA, Pinto PTC, Alves FFA, Pontes Neto OM FACULDADE DE MEDICINA DE RIBEIRÃO PRETO - FMRP-USP Introduction: The etiology of stroke in young patients may be a diagnostic challenge and many cases remain classified as cryptogenic. Patent foramen ovale (PFO) is present in 25% of the general population. Among stroke patients with PFO, paradoxical embolism is a possible etiology. The Risk of Paradoxical Embolism (RoPe) trial has developed a score to identify stroke-related vs incidental PFO in cryptogenic strokes through clinical variables. Nevertheless, the Rope score has never been validated in a population of young Brazilian patients with stroke. Objectives: to study the clinical profile and the clinical utility of the RoPe score among young patients with cryptogenic and non-cryptogenic stroke admitted to the emergency department of a public tertiary academic hospital in Brazil. Methods: Retrospective analyses of 71 young stroke patients with 50 years-old or less admitted to our emergency unit over the period of one year. Patients were blindly evaluated with a Transcranial Doppler Bubble Test (BT) to screen for PFO, which was subsequently confirmed by Transesophageal Echocardiography. According to the TOAST system, patients were classified as cryptogenic and non-cryptogenic strokes. RoPe score was blindly determined. A ROC curve was built and the area under the curve (AUC) was used to estimate the accuracy of the RoPe score for cryptogenic stroke among patients with PFO. Results: In non-cryptogenic stroke group (n=40), the mean age was 37.9 years (SD:6,9), 57.5% were female, 52.5% smoked and 42.5% had hypertension. According to the TOAST classification: small vessels (15%), large vessels (27.5%), embolic source (20%) and 75% other causes. We found 35% of patients with PFO and 60% had superficial lesions. The RoPe score median was 7.5 (QI 5 8). On the cryptogenic stroke group (n=31), the mean age was 36 (SD: 8,6), 64.5% female, 38% smoked, 42% had dyslipidemia and 29% hypertension. The BT was positive in 61% (p=0.03) of patients. The RoPe score median was 8 (QI 7 9) (p=0.06) and its AUC was non-significantly predictive for cryptogenic etiology among patients with PFO (AUC: 0.64; p=0.19). Conclusion: In a small sample of young patients with stroke in Brazil, we found a high prevalence of cerebrovascular risk factors. The RoPe score was not accurate to predict cryptogenic stroke among young patients with PFO. Regional characteristics and epidemiologic profile may have impact on the utility of the RoPe score when applied to young stroke patients.

19 XXVI Congresso Brasileiro de Neurologia AO-025 STROKE INCIDENCE FALL IN BRAZIL OVER 16 YEARS: HAEMORRHAGIC STROKE FASTER THAN ISCHEMIC STROKE? Cabral NL 1, Longo A 1, Moro CH 1, Vivian 2 2, Garcia AC 2, Venancio VG 2, Goncalves AR 1 1 UNIVERSIDADE REGIAO DE JOINVILLE; 2 JOINVILLE STROKE REGISTER Background: From 1990 to 2010 a non-significant 6% increase in the incidence of first-ever ischemic stroke (IS) and a significant 22% increase in the incidence of first-ever haemorrhagic stroke (HS) was reported in low and middle-income countries. In contrast, we previously showed one-third fall in the incidence of first ever stroke in Joinville, Brazil from 1995 to Now, we aim to expand these trends in all strokes and between IS and HS until Methods: Using multiple overlapped sources, we ascertained the changes in stroke incidence in 1995, and , in Joinville, Brazil. The premorbid medication in patients with first ever and recurrent strokes was ascertained in the last 6 years. Results: We registered 320 first-ever strokes in 1995, 759 in and 859 in From 1995 to 2011, the age-adjusted incidence of first-ever stroke fell by 33% (relative incidence 0.67, 95% CI, ) and in young people ( 44 years) fell by 39% (RI 0.61, 0.42 to 0.84). In the last six years, HS incidence decreased 53% (RI 0.47, 0.26 to 0.78). IS and subarachnoid haemorrhage (SAH) incidences did not change significantly. Obesity, use of drugs for diabetes and dyslipidemia has doubled in patients under primary and secondary prevention in the last six years. Use of drugs for hypertension, antiplatelets, anticoagulants and active smoking didn t changed significantly in patients under primary prevention and secondary prevention. Conclusions: Stroke incidence has decreasing in Joinville been over the last 16 years. HS might be more responsible for the rates fall than IS. We found an alarming increase in obesity prevalence and in proportion use of lower lipid and anti-diabetes drugs. AO-026 THREE-YEAR SURVIVAL AND RECURRENCE AFTER FIRST EVER STROKE: THE JOINVILLE STROKE REGISTER Cabral NL 1, Muller M 1, Franco SC 1, Nagel V 2, Longo A 1, Moro CH 1, Costa G 1, Gonçalves AR 1 1 UNIVERSIDADE REGIAO DE JOINVILLE; 2 REGISTRO DE AVC DE JOINVILLE Background and Purpose: Despite continuous mortality fall over the last three decades, stroke remains the first cause of death in Brazil. We had shown that incidence, case-fatality and mortality have been decreasing over the last 18 years in Joinville, Southern of Brazil. We aim to determine the recurrence and survival rates and cause of death over 3 years after stroke in a population-based setting. Methods: From Joinville Stroke Registry, we ascertained all first ever stroke ocurred in Joinville, Brazil between Multiple overlapping sources of information were used to ensure completeness of case ascertainment. Patients were followed-up prospectively at 1 month, 6, months, 1 year, 2 years and 3 years after the index event. Results: We registered 406 first-ever events who were followed-up at 3 years by which time 148 (36%) had died. In the first year of stroke the risk of death was 34.9% (95% CI, 29.6% to 40.43%). Beyond the first year, approximately 3 to 4% of survivors continued to die each year. Over the follow-up, we registered 7.9% (32/406) of stroke recurrence. Among IS, the proportion of surviving free of recurrent stroke or death was 80.4% (74/92; 95% CI, ) in small artery oclusion; 73% (8/11; 95% CI, ) in other determined; 61.4% (35/57; 95% CI, ) in large artery oclusion; 47.3% (43/91; 95% CI, ) in undetermined and 42% (36/84; 95% CI, ) in cardioembolic. First stroke, recurrent stroke or miocardial infarction was the most common causes of death in 30 days (96%) and in 3 years (67%). Conclusions: In Joinville, one third of patients died in 3 years after first stroke. This finding is similar as other series done one decades ago in high income countries. The most common cause of death after a first stroke is cardiovascular disease. Long-term survival after stroke may be improved by early, active, and sustained implementation of effective strategies for preventing subsequent cardiovascular events. AO-027 THROMBOPHILIA SCREENING IN YOUNG ADULTS WITH ISCHEMIC STROKE: A SYSTEMATIC REVIEW OF LITERATURE AND INVESTIGATION PROPOSAL BASED ON EVIDENCE Monteiro JMC, Martin DLS, Rodrigues Neto VF, Souza IFB, Carmo CO, Sousa TRM, Jesus PAP UFBA Introduction: Ischemic stroke (IS) in young adults (less than 45 years) is an important cause of morbidity and usually presents an extensive and expensive etiological evaluation. In some of these individuals, an evaluation for prothrombotic states is usually performed to identify possible thrombophilias (Ts), taken as a risk factor. However, evidence of the presence of this condition and its possible causality with stroke is contradictory between different studies. The request of the tests should be performed focusing on current evidence, due to the high cost of research, varying from R$910 ($406) to R$4,000 ($1,786) among different state capital cities in Brazil. This study aims to review the literature on Ts as a risk factor for stroke, proposing a rational flowchart to request these examinations especially in Brazilian public health system (SUS). Methods: Systematic review of the literature according to the PRISMA guidelines, performed in Medline and CAPES Journals in the last 20 years. The terms thrombophilia and stroke were used in the search. Pediatric population was excluded. Results: 479 articles were found in Medline and 1,081 in CAPES Journals and 62 articles were selected, most of these case-control type. There was high variation among the different conditions evaluated and important methodological limitations. The most frequent Ts among cases, after adjusting for the control groups, were antiphospholipid syndrome (APS), protein C and S deficiency and hyperhomocysteinemia. The methylenetetrahydrofolate reductase (MTHFR) mutation was extremely common among several studies in both controls and cases. Factor V Leiden mutation (FVL) also had high frequency in the study controls, but associated with venous thrombosis. A mutation in the prothrombin gene, despite having been implicated as risk factor for stroke in young adults, presents high heterogeneity between studies. There are insufficient data on deficient anti-thrombin III and stroke risk among different studies. Conclusion: in young adults with IS, a directed research should be done starting with intra-and extracranial vessels study and a cardiology research before deciding if order tests for Ts. In the absence of clinical signs suggestive of a probable cause, it is advisable to divide the screening into four stages, 1º evaluation for APS; 2º protein C, S and homocysteine; 3º resistance to activated protein C or FVL and MTHFR mutation; 4º prothrombin mutation and antithrombin III activity. AO-028 WHAT DOES IT KILL MORE IN BAHIA SEMI ARID, ACUTE MYOCARDIAL INFARCTION OR STROKE? AN ECOLOGICAL AND ECONOMIC ANALYSIS Santos AAO, Souza AS, Faria GAS, Cardoso E, Nascimento MA UEFS Introduction: The main cause of death and permanent disability in Brazil are cardiovascular diseases. These diseases comprise a broad spectrum of clinical syndromes, such as cerebrovascular disease and acute myocardial infarction (AMI) with high morbidity and impact on quality of life and in the productivity of afected population. Therefore is important a proper training of health professionals who treat these medical conditions. Methodology: An ecological study including hospitalized inpatients of both genders in the Cleriston Andrade General Hospital (the largest reference hospital of the Bahia countryside) from January 2012 to December The hospitalization inpatient data were provided from DATASUS and have included hospitalization, death, mortality, length of stay, gender, age and average length of stay. Results: Of all the hospitalizations, it was identified 757 cases of AMI and 1506 of stroke. Of all the AMI patients, a greater frequence of male was observed: 58% (444), while between those with stroke, the variation between gender was more slight, with approximately 51% (768) of female. The age groups with the highest frequence of hospitalizations for stroke were years (312) and 80 and over (302). For AMI were years (185), years (170) and 70 to 79 years (170). The length of stay for AMI were 7,270 with average stay of 9.6 and AVE way to 14,619 and 9.0 days of stay and average length of stay, respectively. Concerning the hospitalizations, 124 admitted with AMI have died, conferring a mortality rate of 16.38, while the number of death by stroke were 487, with mortality rate of The total amount spent on AMI was R $713, and on stroke was R $1,653, Conclusion: Results show a higher cost with stroke (the value is % more than the AMI cost). In spite of the higher costs, the number of days stayed, deaths and mortality rates of stroke are greater than that of AMI. So, it was identified an incompatibility among the cost and effectiveness of treatment. For this reason it is necessary improving the quality of patient care through of creating measures of performance in meeting these diseases and especially of stroke. AO-029 YOUNG PATIENTS WITH HYPERTENSION IN SECONDARY STROKE PREVENTION. A NEGLECT AND A HIGH-RISK GROUP? Diegoli H 1, Garcia VP 1, Starling F 2, Moro CHC 2, Longo AL 2, Gonçalves AR 2, Cabral N 2 1 HOSPITAL MUNICIPAL SÃO JOSÉ DE JOINVILLE; 2 UNIVILLE Introduction: Hypertension is the highest population-attributable risk for stroke. Reducing the prevalence of uncontrolled hypertension is a worldwide challenge. Objectives: In a secondary prevention cohort of patients who survived a stroke event in Joinville, Brazil, we aim to 19

20 Oral Presentation evaluate which variables are related to uncontrolled hypertension and if it is related to death. Methods: We extracted demographic, socio-economic and clinical data from patients in the Joinville Stroke Registry who survived 6 months after a first-ever stroke from October 2009 to July These patients were followed-up through regular telephone calls for over 2 years, in which their last blood pressure (BP) was asked. The exclusion criteria were non-ischemic stroke, death within 6 months after admission, less than 45 years old, and no phone contact in at least half of the attempts. We calculated the mean blood-pressure (BP) reported in the phone calls, which was labeled uncontrolled if systolic >139 or diastolic >89mmHg. We compared the number of deaths in the follow-up between patients with controlled and uncontrolled hypertension. Results: The cohort had 1130 patients in secondary prevention, where 255 (22,5%) had uncontrolled hypertension and 59 (5.2%) didn t inform their BP in at least half of the interviews. Over the 2 years of follow up, 9.3% (76/816) patients with controlled BP died whereas 10.2% (26/255) died in the group of uncontrolled BP. Variables related to controlled BP were functional dependency (mrankin 4 5; relative risk [RR]: 0.55; 95% CI, 0.39 to 0.77 p<0,001) and age above 65 years (RR: 0.62, 0.50 to 0.78; p<0,001). In the multivariate analysis, the uncontrolled BP group had higher mortality than the controlled group (hazard ratio [HR]: 1.57, 1.00 to 2.47; p=0,047), and the group who didn t inform their BP had even higher mortality than the controlled group (HR: 4.63, 2.8 to 7.68; p<0,001). Conclusions: As expected, uncontrolled hypertension is related to higher mortality rates. Despite having a higher potential benefit from BP control, younger and less dependent patients have higher prevalence of uncontrolled hypertension. 20 Other Motor Neurone Disease AO-030 SPINAL CORD ATROPHY IN HEREDITARY SPASTIC PARAPLEGIA CAUSED BY SPG4 MUTATIONS Branco LMT, Lamas GM, Bergo FP, Lopes-Cendes I, França Junior MC UNICAMP Background: HSP is a very heterogeneous group of neurodegenerative disorders. SPG4-HSP is the most prevalent autosomal dominant HSP, especially in adults. Its core features are spastic paraplegia and progressive course. Although corticospinal tracts are known to be damaged in SPG4-HSP, there are few MRI-based studies that specifically investigated the SC in the disease. Objectives: To investigate spinal cord (SC) atrophy in patients with Hereditary Spastic Paraplegia caused by SPG4 mutations (SPG4- HSP). Methods: Eleven patients with molecular confirmation of SPG4-HSP and 22 age-andgender-matched healthy controls underwent MRI on a 3T Achieva PHILIPS scanner. We used T1-weighted 3D images covering the whole brain and the cervical SC to estimate cervical SC area and eccentricity at C2/C3 level based on a semi-automatic image segmentation protocol using a validated software (Spineseg). Acquisition parameters were: TE=3.2ms, TR=7.1ms, flip angle=8o, voxel size=1.0 x 1.0 x 1.0 mm3 and FOV =240x240. SC areas and eccentricity of patients and controls were compared using Mann-Whitney test. P values <0.05 were considered significant. Results: Mean age of patients was 49 years (range 15 68) and there were 7 men. The two groups were significantly different regarding SC areas (67.5±7.8 mm 2 vs 54.7±5.3 mm 2, p<0.001). However, eccentricity values were similar in both groups (p=0.917). SC areas did not correlate with age of the patients (p=0.336). Conclusions: Patients with SPG4-HSP have SC atrophy, but no flattening. Further studies are needed to determine the clinical relevance of these abnormalities. Supported by: Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) AO-031 Muscle Disorders ANTILIPEMIC AGENTS AND CREATINE PHOSPHOKINASE: EPIDEMIOLOGIC STUDY AND CLINICAL ANATOMICAL ANALYSES OF 55 PATIENTS Carvalho AAS, Delgado PO, Koch ME, Pagura JR, Feder D FACULDADE DE MEDICINA DO ABC Introduction: Lipid-lowering drugs, such as simvastatin, rosuvastatin, atorvastatin calcium etc., have been occasionally associated with neuromuscular symptoms and morphological changes in the muscle biopsy. Material and methods: We studied 453 muscle and nerve biopsies from a private center from 2007 to 2014 may. We selected the muscle biopsies from patients with hyperlipoproteinemia treated with lipid -lowering drugs (statins / fibrates) and we analyzed the clinical, epidemiological and anatomical pathologic features of these patients. No patients had neuromuscular disorder. Results: We selected 55 (12,1%) patients using antilipemic drugs. The patients had myalgia and proximal muscle weakness and cramps or elevated creatine phosphokinase(cpk). The CPK remained elevated although the drugs where withdrawn. The anatomical pathologic features found were: (1)variation in fibers diameters, (2) necrosis of fibers, (3) inflammatory infiltration, (4)the presence of vacuolated fiber (5) ragged-red fibers (6) COX negative fibers. Conclusion: The long-term use of statins ± fibrates can induce a chronic myopathy even in the absence of symptoms, although the muscle biopsy findings were nonspecific. Keywords: Statins, myopathy and muscle biopsy. AO-033 STUDY OF A COHORT OF BRAZILIAN CENTRONUCLEAR MYOPATHY PATIENTS Abath Neto OL 1, Martins CA 1, Carvalho M 1, Oliveira ASB 2, Reed UC 1, Bönnemann C 3, Laporte J 4, Zanoteli E 1 1 FMUSP; 2 UNIFESP; 3 NIH; 4 IGBMC Introduction: Centronuclear myopathy (CNM) is a rare clinically heterogeneous congenital myopathy characterized by a prominence of centralized nuclei in the muscle biopsy. So far, 7 genes have been associated to different forms of the disease: MTM1, DNM2, BIN1, RYR1, TTN, CCDC78 and SPEG. Objectives: To establish the molecular diagnosis and correlate clinical, histological and genetic features in a cohort of Brazilian patients with CNM. Methods: We identified muscle biopsy reports taken from two large biopsy banks of Sao Paulo, Brazil, in the last ten years. We then recruited families for clinical assessment and drawing of blood. For the molecular studies, we used a sequential approach involving Sanger sequencing, Multiplex Ligation-dependent Probe Amplification (MLPA), X inactivation studies, a gene panel for neuromuscular diseases, and exome sequencing. Results: A total of 24 patients from 21 families were recruited. We established a molecular diagnosis in 16 families. In 6 out of 7 families with boys affected by the severe X-linked neonatal form, which constituted a clinically and histologically homogeneous group, we found known and novel mutations in the MTM1 gene. This gene was also implicated in a milder manifesting carrier girl, in which a heterozygous macrodeletion was detected using MLPA. The girl was found not to have skewed X chromosome inactivation. Two sporadic families presenting the spokes of wheel histological marker showed mutations in the DNM2 gene, one of which had never been described. The RYR1 gene was the culprit in 7 families, all of which had compound heterozygous mutations, most in the form of a severe null mutation associated with a milder pathogenic missense, distributed throughout the length of the gene. This clinically heterogeneous group of patients had in common the finding of focal disruptions in the intermyofibrillar architecture of muscle fibers. The TTN gene is probably implicated in one sporadic family with a single affected boy harboring a compound heterozygous null mutation. In this Brazilian cohort, we did not find mutations in the rarely affected genes BIN1, CCDC78 and SPEG. Ongoing studies in the remaining families seek to find potential novel genes implicated in CNM. Conclusions: Features of Brazilian CNM patients follow findings described in the literature. Mutation distribution in our cohort suggests RYR1 is a frequently involved gene, while DNM2 is not as recurring as in other works. (CAPES 1286/51 2) AO-034 Transcranial Doppler TRANSCRANIAL DOPPLER ASSESSMENT AND CLINICAL OUTCOME FOLLOWING PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE IN PATIENTS WITH PREVIOUS ISCHEMIC NEUROLOGICAL EVENT Richartz M, Rizelio V, Leal AG, Selig FA, Balbi Filho EM, Kowacs PA INC Introduction: Right-to-left shunt due to patent foraman ovale (PFO) is associated with ischemic neurological events, especially in young individuals. Transcranial Doppler (TCD) with injection of gaseous contrast is a useful technique to identify this type of shunt (paradoxical embolism). In this context it is important to determine if