Abstract 157: No Need To Exclude Diabetics From Thrombolysis: Diabetic And Non-diabetic Stroke Patients Profit Equally Well. Report From The Austrian National Stroke Unit Registry

Background: Diabetes has been known to be a predictor for poor outcome after thrombolysis in stroke patients, and early poststroke glycaemia is known to be associated with higher rates of postthrombolytic symptomatic intracerebral haemorrhages. Therefore, diabetic stroke patients are often excluded from thrombolytic treatment. Up to now comparisons exist only from clinical trials (e.g. VISTA collaboration) and registry data of thrombolysed paients (e.g. SITS registry). No nation-wide data have been investigated for the outcomes of thrombolysis in diabetics and non-diabetics.

Methods: National database of the Austrian Stroke Unit Registry, 2003-2010 , comprising 34 acute stroke units, comparison of outcome data of thrombolysed and non-thrombolysed diabetic and non-diabetic stroke. Stratification according to sex, age, stroke severity, functional impairment before stroke and recurrent stroke to non-thrombolysed diabetic strokes and to non-diabetic thrombolysed and non-thrombolysed controls. Improvement was defined as the difference between stroke severity at admission and at discharge.

Results: A modelled cohort of 1,988 r-tPA thrombolysed diabetic stroke patients from 13,246 ischaemic stroke patients were compared according to sex, age, stroke severity, and prestroke disability. A regression model with improvement as depending variable and age, sex, stroke severity, aetiology of stroke, risk factors (including diabetes) and treatment (including thrombolysis) found no effect of diabetes (p=0.854) or the interaction diabetes x thrombolysis (p=0.277), whereas the effect of thrombolysis itself was highly significant (p=0.0001). No differences were found in the number of symptomatic intracerebral haemorrhages after thrombolytic treatment between diabetic strokes (5.2%) and non-diabetic strokes (4.0%). Both groups had a higher risk of intracerebral haemorrhages compared to the non-thrombolysed groups (diabetic 2.9%, non-diabetic 2.6%).

Conclusion: Data from this nation-wide survey show that diabetic stroke patients have a substantial benefit from thrombolysis and therefore diabetic strokes should not be excluded from thrombolysis treatment.

[Photoscreening for early detection of amblyogenic eye changes]

BACKGROUND

Congenital and early acquired ocular changes impairing the optic input induce amblyopia when left untreated. Amblyopia treatment must start early to be efficient. Therefore it seems necessary to employ screening tests in preverbal childhood.

PATIENTS AND METHODS

The reliability of two commercially available photoscreening devices, the "Visiscreen 100" (Vision Research Corp.) and the "MTI-Photoscreener" (Medical Technology Inc.), was tested. 180 children from a kinder-garten and 120 infants from our outpatient clinic were screened. The results were compared to the findings of a full ophthalmologic and orthoptic examination.

RESULTS

The efficacy of the photoscreening depended on the skill of the examiner and on the age of the children tested. The rate of interpretable photographs was 94% in the older group and 63.3% in the infants. The mean sensitivity for detection of amblyogenic factors was 63% in the older and 80% in the infant group. The mean negative predictive value was 90%, and 75%, respectively.

CONCLUSION

Modern photoscreening techniques can help to detect amblyogenic factors in early childhood. However, in addition to the non-interpretable photographs, about 20% of the affected children are missed. Therefore, photoscreening cannot be recommended for countries with a high number of ophthalmologists, such as Germany. Instead, an ophthalmologic and orthoptic investigation in early childhood would be preferable.