Biomedical subjects

Arne Lindgren

Publications and source records attributed to Arne Lindgren.

10 recordsLinked to original sources

PubMed2006

Shoulder pain after stroke: a prospective population-based study.

BACKGROUND AND PURPOSE: Shoulder pain is a well-known complication after stroke, but data on prevalence, predictors, and outcome in unselected stroke populations are limited. METHODS: During a 1-year period, 416 first-ever stroke patients were included in the population-based Lund Stroke Register. After 4 months, 327 patients were followed up and 1 year later, the surviving 305 patients were followed up again. General status (National Institutes of Health Stroke Scale score) was registered at stroke onset. Shoulder pain intensity (visual analog scale, score 0 to 30=no-mild and 40 to 100=moderate-severe pain); arm motor function; restricted dressing and/or ambulating; and functional status (Barthel Index) were registered at both follow ups. RESULTS: Shoulder pain onset within 4 months after stroke was reported by 71 patients (22%). Among the 61 patients able to score the visual analog scale, 79% had moderate-severe pain. One year later, 8 of these 71 patients had died, 17 had no remaining pain, and 28 additional patients had developed shoulder pain since the first follow up. Lost or impaired arm motor function and high National Institutes of Health Stroke Scale score were predictors of shoulder pain. Shoulder pain restricted daily life often or constantly when dressing for 51%/31% and when ambulating for 29%/13% of the patients at 4 and 16 months, respectively. CONCLUSIONS: Almost one third of the 327 patients developed shoulder pain after stroke onset, a majority with moderate- severe pain. Shoulder pain restricts patients' daily life after stroke. The increased risk of shoulder pain for patients with impaired arm motor function and/or low general status needs close attention in poststroke care.

Adolescent↗

PubMed2005

Prevalence of stroke and vascular risk factors among first-degree relatives of stroke patients and control subjects. A prospective consecutive study.

BACKGROUND: Genetic and environmental factors may be of importance for stroke risk. We assessed the prevalence of stroke and vascular risk factors among first-degree relatives and spouses of stroke patients and control subjects. METHODS: As a part of the Lund Stroke Register study, we asked 925 consecutive patients with first-ever stroke and 286 control subjects to complete a questionnaire about all their first-degree relatives and spouses. The questionnaires addressed whether these relatives had been affected by stroke or TIA, hypertension, heart disease, diabetes mellitus, and if they were smokers. RESULTS: A total of 606 patients and 261 control subjects returned the questionnaire, providing information on 4,972 first-degree relatives and 738 spouses. The prevalence of stroke or TIA was 12.3% among first-degree relatives of patients and 7.5% among first-degree relatives of control subjects (OR 1.74, 95% CI 1.36-2.22). Corresponding results for hypertension were 21.0 and 16.7% (OR 1.33, 95% CI 1.10-1.60). The prevalences of heart disease, diabetes mellitus and smoking did not differ significantly between first-degree relatives of patients and control subjects. Spouses of patients and control subjects had similar prevalences of stroke or TIA and vascular risk factors. CONCLUSIONS: The prevalences of stroke or TIA and hypertension are higher among first-degree relatives of stroke patients than among first-degree relatives of control subjects. This, and the lack of differences between spouses of patients and control subjects, indicates that an increased risk of stroke may in part be explained by heritability of hypertension.

Aged↗

PubMed2005

Determinants of quality of life in stroke survivors and their informal caregivers.

BACKGROUND AND PURPOSE: We examined longitudinal changes of quality of life (QOL) covering physical and mental factors in an unselected group of stroke patients and their informal caregivers. Our hypothesis was that informal caregivers would have better QOL than patients at both follow-ups, and that changes, if any, would be related to the patients' status. METHODS: QOL of 304 consecutive stroke patients and their 234 informal caregivers from the population-based Lund Stroke Register was assessed 4 months after stroke onset with the Short Form 36 (SF-36) questionnaire. SF-36 was repeated for both groups after 16 months together with Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-20) for patients. RESULTS: The patients' mean QOL scores improved between 4 and 16 months after stroke in the socio-emotional and mental SF-36 domains and decreased in the domain physical function. Multivariate analyses showed that the patients' most important determinants of QOL after 16 months were GDS-20 score, functional status, age, and gender. Informal caregivers had better QOL than patients except for the domain role emotional and the mental component summary. The caregivers' most important determinants of QOL were their own age and the patients' functional status. CONCLUSIONS: Our study highlights depressive symptoms in determining QOL of stroke patients. Despite self-perceived deterioration in physical function over time, several other components of QOL improved, suggesting internal adaptation to changes in their life situations. Informal caregivers of stroke patients may be under considerable strain as suggested by their lower emotional-mental scores.

Activities of Daily Living↗

PubMed2004

Dipyridamole and headache--a pilot study of initial dose titration.

Headache is reported by about one third of patients using dipyridamole (DP) after stroke or TIA. No study has systematically examined if initial dipyridamole titration may affect this headache. We therefore randomised patients to (1) standard aspirin and dipyridamole treatment b.i.d. for 2 weeks or (2) titration with aspirin only in the morning and aspirin and dipyridamole in the evening for 5 days, followed by 9 days of standard aspirin and dipyridamole treatment. Among 57 patients included for analysis, moderate to severe headache was reported by 28% in the standard treatment group and 25% in the titration group (n.s.). Headache for more than two consecutive days occurred in 24% and 11%, respectively. Rescue medication because of headache for more than 2 days was used by 14% and 0% in the respective groups. The cumulative number of days with headache was more than twice as high in the standard treatment group. The total numbers of other side effects were 25 and 11 in the two groups. The observed differences in this pilot study were not statistically significant, but nevertheless suggest that titration with an initially lower dose of dipyridamole may be considered to reduce headache and thereby increase compliance. A larger study is needed to clarify this with sufficient statistical power.

Aged↗

PubMed2004

[A national curriculum in neurology for medical education].

The knowledge within medicine is growing rapidly. It has become more and more difficult to decide what knowledge that has to be taught to medical students during their University Medical Degree (MD) education and what has to be omitted from their study plans. As help for teachers and students, a core curriculum of the education defines what is of importance for all students. However, there is a risk of "curriculum overload" with too much information being put into a short time interval. To avoid this and to define what is really the "core" of a course, a national consensus decision may be useful. As an example of this approach, we here report a new joint Swedish core curriculum in neurology for medical students. Teachers responsible for neurological education at all six universities giving University MD education in Sweden have in January 2003 agreed upon the core curriculum that we present. It is our hope that this method can be useful also for other clinical specialities.

Clinical Competence↗

PubMed2004

[Increased risk of stroke after TIA. New data support the need of urgent management].

The prognosis after TIA may be more serious than previously thought. Recent studies suggest that the risk of subsequent stroke after a TIA may be 5% within the first two days after a TIA, which emphasizes the need for urgent management and institution of therapy. A correct diagnosis is essential, but sometimes difficult because many conditions mimic TIA symptoms. Routine diagnostic procedures include a careful patient history, neurological examination, EKG, CT scan of the brain, and in selected cases carotid and cardiac ultrasound examinations. A recent survey of clinical management after TIA indicates that these investigations are sometimes delayed, particularly in non-hospitalized patients. Patients with a new TIA should immediately be referred to hospital, and ultrasound examination of the carotid arteries (when indicated) should be performed within one week (preferably even earlier) after the TIA onset.

Carotid Arteries↗

PubMed2003

Diffusion-weighted MRI findings in patients with capsular warning syndrome.

BACKGROUND AND PURPOSE: The 'capsular warning syndrome' (CWS) of recurrent stereotyped episodes of motor or sensory dysfunction is clinically well recognized, and is associated with a high risk of imminent lacunar infarction with permanent deficits resembling those of CWS. However, the pathophysiology of CWS has not been well characterized. We report a clinicoanatomic correlation with MR imaging studies in the acute and chronic phases in patients with CWS. MATERIAL AND METHODS: Between April 1997 and March 2001, we prospectively studied 8 patients, mean age 73.3 years, presenting with 4-17 motor or sensorimotor transient ischemic attacks (TIAs; duration 2-90 min) up to 3 days after onset of the first episode. Four patients were free of symptoms between the attacks and had no residua, whereas 4 patients developed a pure motor or sensorimotor stroke within 1-3 days after symptom onset. Diffusion-weighted echoplanar MRI (DWI) and T(2)-weighted MRI studies were performed within 1 week after symptom onset and were repeated 1-2 months later. RESULTS: Seven of the 8 patients had an appropriate lesion on DWI in the acute phase. DWI abnormalities in the 3 patients with TIAs were 4-10 mm in diameter and confined to the lateral thalamus or medial globus pallidus without involving the internal capsule, whereas 4 patients who developed a stroke had abnormalities localized to the putamen extending to corona radiata (3 patients), or the pontomesencephalic junction (1 patient). All 6 patients who underwent follow-up MRI had an infarct on T(2)-weighted images corresponding to, but usually smaller than, the acute phase DWI abnormality. CONCLUSIONS: Small infarcts in the basal ganglia or the pons, close to central motor pathways, appear to be the primary lesion in CWS. The pathophysiology of CWS is complex, and may involve hemodynamic mechanisms in penetrating arterial territories, as well as molecular mechanisms, such as peri-infarct depolarizations affecting adjacent motor pathways.

Aged↗

PubMed2002

Stroke in Lund-Orup, Sweden: improved long-term survival among elderly stroke patients.

BACKGROUND AND PURPOSE: Several studies report declining early stroke case fatality, but the findings are not consistent across geographic areas. Corresponding changes in long-term survival are less well documented. We recently reported increased stroke incidence among patients aged <75 years and stable incidence among older persons. We now report temporal trends for early and late case fatality among patients with stroke onset during 1983-1985 and 1993- 1995. METHODS: Patients living within the Lund-Orup, Sweden, hospital district and fulfilling the diagnostic criteria for first-ever stroke during 1983-1985 (n=998) and 1993-1995 (n=1318) were followed up concerning survival status at 28 days, 1 year, and 3 years. Age and sex adjustments were performed. The possible influence of Oxfordshire Community Stroke Project (OCSP) stroke subtypes on survival was also analyzed. RESULTS: Overall survival improved between the study periods (Cox proportional hazards regression: hazard ratio, 0.84; 95% confidence limits, 0.75 to 0.94; P=0.0019). The 28-day case fatality was 15% for stroke patients from both study periods. One-year case fatality was 31% for 1983-1985 patients and 27% for 1993-1995 patients. The corresponding figures at 3 years were 44% and 40%, respectively. In the group aged <75 years, there were no significant changes in overall survival, but survival improved significantly among patients aged > or = 75 years beyond 28 days after stroke onset. OCSP stroke subtype was an independent predictor of death (P<0.0001). CONCLUSIONS: The recently observed increase in stroke incidence among patients aged <75 years was not accompanied by changing survival in that age group. However, among patients aged > or =75 years, survival improved beyond 28 days after stroke. The causes of this change in survival are unknown but may be related to improved long-term care of elderly stroke patients.

Age Distribution↗

PubMed2002

Vitamin supplementation normalizes total plasma homocysteine concentration but not plasma homocysteine redox status in patients with acute coronary syndromes and hyperhomocysteinemia.

Despite the growing evidence that elevated total homocysteine (tHcy) in plasma is a cardiovascular risk factor, the mechanism underlying the vascular injury is still unknown. Studies are difficult due to the fact that little is known about the formation of different homocysteine species in vivo. In the present study we have investigated the different fractions of tHcy in 21 patients with acute coronary syndromes and elevated concentration of plasma tHcy. A subgroup of the patients (n=16) was investigated before and after a 3 months study period with or without vitamin supplementation (folic acid 5 mg, pyridoxine 40 mg and cyanocobalamin 1 mg once daily). A major finding is that these patients had a lowered ratio (0.95%) between the concentration of reduced homocysteine (HcyH) and tHcy compared to controls (1.38%). A low ratio HcyH/tHcy in plasma in combination with elevated plasma tHcy concentrations might reflect increased oxidative activity or decreased reducing capacity in plasma from the patients. Another main finding in the present study is that, although vitamin supplementation of these patients normalized plasma tHcy, the ratio between HcyH and tHcy did not normalize. Since substantial evidence indicates that progression of arteriosclerosis is related to enhanced oxidant activity, the premature vascular disease associated with increased plasma tHcy concentration might be due to increased oxidative activity and the elevated plasma tHcy concentration may only reflect the increased oxidative stress.

Acute Disease↗

PubMed2002

Prediction of death in patients with primary intracerebral hemorrhage: a prospective study of a defined population.

OBJECT: Predictors of early (30-day) and long-term (1-year) mortality rates after primary intracerebral hemorrhage (ICH) were studied in a large population in southern Sweden. METHODS: All cases of primary ICH, verified using computerized tomography (CT) scanning or autopsy study, were prospectively registered at the 12 hospitals covering a defined population of 1.14 million during the calendar year 1996. Mortality was analyzed in relation to CT findings (hematoma location and volume and ventricular extension) and clinical parameters (patient age and sex, level of consciousness on admission, and history of preictal risk factors) by using univariate and multivariate statistical methods. Three hundred forty-one cases of primary ICH were detected. The overall mortality rate was 36% at the 30-day and 47% at the 1-year follow up. Multivariate analysis revealed that initial level of consciousness, hematoma volume, and a history of heart disease were independent predictors of death at 30 days postictus. One year after bleeding, independent predictors of mortality were the initial level of consciousness, patient age, and hematoma location. CONCLUSIONS: Primary ICH remains a stroke subtype associated with a high mortality rate and for which the level of consciousness on admission is the strongest predictor of fatal outcome both at 30 days and during the 1st year after bleeding. A preictal history of heart disease increased the 30-day mortality rate.

Adolescent↗