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[P06.130] Dural Sinus Thrombosis Local Experience at Shifa International Hospital, Islamabad

Maimoona Siddiqui, Ismail A. Khatri, Nadia Mehboob, Arsalan Ahmad, Islamabad, Pakistan

OBJECTIVE: To describe presentation, causes and outcome of dural sinus thrombosis (DST) in a tertiary care private teaching hospital of Pakistan. BACKGROUND: Dural sinus thrombosis is an uncommon disorder with high morbidity and mortality, particularly in young adults. A high index of suspicion is needed to reach the diagnosis. A variety of etiologies of DST have been reported. There is very limited literature about DST in developing nations, particularly Pakistan. DESIGN/METHODS: Observational, chart review was conducted on patients admitted from July 2009 to June 2010. A standard structured questionnaire was completed for every patient. RESULTS: Twenty one patients had DST; majority were females (57.1%). Mean age was 36 16 (range 8 months to 75 years). Most common presenting complaints were headache (52.3%); followed by unilateral weakness and seizures (38.1% each). Protein S deficiency and elevated homocysteine were found in 7 patients each (33.3%); antithrombin III deficiency in 4 (19%) and protein C deficiency in 2 (9.5%). Leucocytosis and anemia were found in 10 (47.6%) and 9 (42.8%) patients respectively. CT scan and/or CT venogram was done in 16 (76.19%); others had magnetic resonance imaging (MRI) or MR venogram (MRV). Superior sagittal and transverse sinus (71.4% each) were most commonly involved, followed by sigmoid sinus (61.9%). Nine (42.8%) patients had modified Rankin scale (mRS) score of <3 on admission; whereas on discharge 13 (61.9%) had mRS of <3. No patient had died and no recurrence of symptoms had been reported in follow-up of 15 patients up to 1 year; 6 patients have been lost to follow-up. CONCLUSIONS: DST is more common in women. Protein S deficiency and elevated blood homocysteine levels were the most common causes in our patients. Leucocytosis and anemia were also frequently seen. In this small series, none of the patients died, and most patients improved.
Category - Cerebrovascular Disease: Clinical Aspects

Thursday, April 14, 2011 7:30 AM

[P04.184] Clinical Application of the Hygiene Hypothesis: Probiotic Helminth Treatment May Induce a Neuroprotective Immune Environment in RRMS

Jessica Boland, Andrea Isaak, Aaron Field, Zsuzsanna Fabry, John Fleming, Madison, WI

OBJECTIVE: To characterize the immunological environment associated with exposure to a probiotic helminth in subjects enrolled in the phase 1 Helminth-induced Immunomodulatory Therapy (HINT) clinical trial of Trichuris suis ova (TSO) in relapsing-remitting multiple sclerosis (RRMS). BACKGROUND: The hygiene hypothesis posits that insufficient exposure to microorganisms due to modern sanitation can predispose susceptible individuals to immune dysregulation. Accordingly, animal models of multiple sclerosis (MS) and correlative studies in MS patients have demonstrated an association between helminth infection and less severe disease course. These observations provide a basis for investigating the effects of TSO in MS. Systemic responses of RRMS patients to this potentially beneficial agent have not been previously studied in a prospective clinical trial. DESIGN/METHODS: In exploratory studies, sera were collected from three RRMS subjects before, during, and after TSO treatment. Subsequently, a panel of 89 serum proteins were measured by immunoassay (Human Map v1.6; Rules Based Medicine, Austin, TX). Disease activity was monitored by blinded assessment of new enhancing lesions on brain MRIs. In two subjects (002 and 003) a dramatic decline in MRI activity was observed in parallel with TSO administration (high responders, HR), while in the third subject (004) MRI responses were less marked (low responder, LR). RESULTS: CRP and EN-RAGE were mildly elevated while IL-1 declined during TSO treatment in all subjects. IL-13, BDNF, EGF, Eotaxin-1, CD40, plasminogen activator inhibitor 1, and ICAM-1 were observed to be elevated in one or both of the HR subjects while being unchanged or decreased in the LR subject. Alpha-2 macroglobulin, IL-3, IL-8, and IL-12p40 decreased in the HR subjects and increased or remained unchanged in the LR subject. CONCLUSIONS: Our data suggest that TSO treatment may promote an anti-inflammatory, neuroprotective milieu favorable for repair processes in subjects with active RRMS. Supported by: National Multiple Sclerosis Society research grant RG 3613A4/1 (JF) and NIH 1R56AI091462-01 (ZF).
Category - MS and Related Diseases: Clinical Science

Wednesday, April 13, 2011 7:30 AM

S40: Multiple Sclerosis: Animal Models and Immunology
[S40.001] ONX-0914, a Selective Inhibitor of the Immunoproteasome, Protects Against Experimental Autoimmune Encephalomyelitis and Suppresses the TH17 Response - 03:00 PM
[S40.002] p66SchA Inactivation Is Neuroprotective in a Model of Multiple Sclerosis - 03:15 PM
[S40.003] Roles of Th1 and Th17 Cells in Autoimmune and Viral Models for Relapsing-Remitting Versus Progressive Multiple Sclerosis - 03:30 PM
[S40.004] An Endogenous Aryl Hydrocarbon Receptor Ligand Acts Directly on Dendritic Cells and T Cells To Suppress EAE - 03:45 PM
[S40.005] TCR Peptide Therapy of EAE Requires Foxp3+ Treg-Cells and Inhibits Heterogeneous T-Effector Cells - 04:00 PM
[S40.006] Hepatocyte Growth Factor Inhibits Central Nervous System Autoimmunity by Inducing Tolerogenic Dendritic Cells and Foxp3+ Regulatory T Cells - 04:15 PM

[P01.263] Ultrasound Evaluations of Chronic Cerebrospinal Venous Insufficiency (CCSVI): Important Factors to Consider

Mei Lu, Larry Raber, Leasa Baus, Afghanistan, Caudiu Diaconu, Cleveland, OH, Irene Katzan, Fairview Park, OH, Soo Hyun Kim, Alexander Rae-Grant, Robert Fox, Cleveland, OH

OBJECTIVE: To identify potential factors that can affect the results of ultrasound done to detect the presence of chronic cerebrospinal venous insufficiency (CCSVI).

BACKGROUND: CCSVI is a proposed vascular condition diagnosed by venous ultrasound which is reported to be related to multiple sclerosis. A clearly-defined ultrasound protocol and CCSVI criteria are needed in order to provide reproducible ultrasound assessments that can be easily implemented in different centers with comparable results.

DESIGN/METHODS: We used intracranial and extracranial ultrasound methods including Quality Doppler Profiles (QDP) technology to evaluate CCSVI and identified potential factors that may affect the validity of the test results.

RESULTS: We identified several factors that may affect the result of an ultrasound study for CCSVI. These include 1) study design, including choice of control group, number of technicians and blinding of examiner; 2) physiological factors, such as head position, hydration status, and respirations; 3) technical aspects, including pressure applied during scanning and pulse repetition frequency (PRF) adjustment; 4) measurements details, such as reference points for measurements and definitions of abnormalities.

CONCLUSIONS: Intracranial and extracranial ultrasound is one of the key approach for evaluate CCSVI. We identify several factors that need additional attention in order to achieve reproducible and widely applicable implementation of ultrasound assessments for CCSVI. The inconsistency of the previous study results may have arisen from different ultrasound methods and interpretations.

Supported by: National MS Society (RC 1004-A-5).
Category - Neural Repair/Rehabilitation: Clinical: Multiple Sclerosis