Shoulder pain after a stroke.
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Biomedical subjects
Publications and source records attributed to H F Jespersen.
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Thrombosis of intracranial sinuses and veins is a rare but potentially lethal syndrome. It often affects young adults, but occurs in all ages. It is frequently seen in association with hormonal changes (puerperium, pregnancy and the use of oral contraceptives), inflammatory bowel disease, cancer, and various states of hypercoagulability, or as a consequence of infection. The clinical picture is extremely variable and the diagnosis can be difficult unless one specifically searches for it. The combination of magnetic resonance imaging and magnetic resonance angiography is a powerful and non-invasive tool for diagnosing the syndrome. Treatment with heparin (and for the septic form antibiotics) improves the outcome.
BACKGROUND: Many aspects of stroke-related headache, such as its incidence, pathophysiology, risk factors, and relation to stroke severity and outcome, are uncertain. DESIGN: A prospective, community-based study including 1,128 consecutive acute stroke patients; 867 (77%) were able to communicate. Stroke severity and the clinical course were assessed using the Scandinavian Stroke Scale (SSS). CT was performed in 84% of patients. In the data analysis, multivariate regression analyses were used when appropriate. RESULTS: Two hundred forty-one (28%) of the 867 patients had headache in relation to stroke onset. Independent risk factors were age (odds ratio [OR] per 20 years, 0.57; 95% confidence interval [CI], 0.43 to 0.86; p = 0.0001), female sex (OR, 1.6; CI, 1.2 to 2.2; p = 0.003), intracerebral hemorrhage (OR, 2.8; CI, 1.5 to 5.4; p = 0.002), stroke in the vertebrobasilar territory (OR, 1.7; CI, 1.1 to 2.3; p = 0.02), and ischemic heart disease (OR, 1.5; CI, 1.1 to 2.2; p = 0.01). In those patients in whom headache was lateralized (46%), it was ipsilateral to the lesion in 68% of cases (p = 0.01). There was no correlation between headache and (1) initial stroke severity as measured with the SSS (p = 0.75), (2) lesion size (p = 0.77), (3) whether or not CT showed cortical involvement (p = 0.29), (4) stroke outcome as measured with the SSS (p = 0.9), or (5) mortality (p = 0.75). CONCLUSION: Stroke-related headache is associated with factors such as age and sex. In patients capable of providing reliable headache information, headache is more frequent in strokes confined to the vertebrobasilar than to the carotid territory and is not associated with stroke severity or whether or not the cortex was involved. Stroke-related headache is not related to stroke outcome.
In a cardiological department (Coronary Care Unit) routine treatment of asystole and electromechanical dissociation has comprised intracardiac injection (ICI) of drugs, usually given by trained nurses, using the parasternal approach into the right ventricle, followed by continued external cardiac massage. A 7-year experience is presented with 543 consecutive ICIs to 247 patients. Cardiac action was restored in half of the patients (125/247); 7.7% (19/247) were discharged alive. Autopsy was done in 80% of fatal cases (182/228). A left-sided pneumothorax was demonstrated in 9 of the 80 patients surviving ICI for greater than 1 h, a minor haemopericardium in three, but serious consequences in none. Lesions of the coronary artery or of the myocardium attributable to the ICI were never seen. Asystole in some patients was converted into ventricular fibrillation or ventricular tachycardia which in six patients proved intractable, but other serious cardiac arrhythmias having a possible connection with the ICI were not observed. It is concluded that during a cardiac standstill, drug treatment by ICI with good technique carries a low risk, quite acceptable in these circumstances, and from a theoretical point of view can be expected to have advantages over administration of the drug into a peripheral vein.