Biomedical subjects
John F Rothrock
Publications and source records attributed to John F Rothrock.
Fatal puerperal transverse sinus thrombosis.
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Assessing the ability of topiramate to improve the daily activities of patients with migraine.
OBJECTIVE: To assess the impact of topiramate on the daily activities of patients with migraine. PATIENTS AND METHODS: We performed a randomized, double-blind, placebo-controlled multicenter trial Initiated on March 1, 2001, and completed on April 4, 2002. Patient-reported data from the Migraine Specific Questionnaire (MSQ) and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) were collected at baseline and at weeks 8, 16, and 26 from an intent-to-treat population receiving either topiramate, 50, 100, or 200 mg/d, or placebo. Two activity-related MSQ domains (role restrictive [MSQ-RR] and role prevention [MSQ-RP]) and 2 activity-related SF-36 domains (role physical [SF36-RP] and vitality [SF36-VT]) were the prospectively designated secondary outcome measures. The changes in MSQ and SF-36 scores for each treatment group were calculated by measuring the area under the curve from week 8 (the beginning of the maintenance period) through week 26 of the double-blind phase, relative to the prospective baseline. A mixed-effect piecewise linear regression model was used to estimate average domain score over time. RESULTS: Patients receiving topiramate, 100 or 200 mg/d, had significantly reduced mean monthly (28-day) migraine frequency (P = .008 and P < .001, respectively) compared with placebo, but not patients receiving topiramate, 50 mg/d (P = .48). Topiramate significantly improved mean MSQ-RR domain scores (50 mg/d [P = .02], 100 mg/d [P< .001], and 200 mg/d [P < .001]) and mean MSQ-RP domain scores (50 mg/d [P = .007], 100 mg/d [P = .001], and 200 mg/d [P= .002]) vs placebo. Topiramate, 100 and 200 mg/d, significantly improved mean SF36-RP domain scores vs placebo (P = .02). Topiramate (all doses) improved SF36-VT domain scores, although not significantly vs placebo. Changes in prospectively designated domain scores were significantly correlated with changes in mean monthly migraine frequency (P < or = .001 [MSQ domains], P < or = .002 [SF-36 domains]). CONCLUSION: Patient-reported migraine-specific outcomes measured by the MSQ-RR and MSQ-RP domains improved significantly for those receiving topiramate (all doses) vs placebo. The SF36-RP domain scores improved significantly for patients receiving 100 or 200 mg/d of topiramate. Improvements in all 4 prospectively selected MSQ and SF-36 domains were significantly correlated with decreases in mean monthly migraine frequency.
Headaches due to vascular disorders.
The association between stroke and headache is complex, ranging from highly nonspecific, wherein headache is largely irrelevant to diagnosis and therapeutic management, to highly specific and even causative. In short, acute headache may accompany the acute stroke process, chronically complicate stroke, or, in rare instances, serve as the primary cause of stroke. With the first instance, the incidence of acute headache is highly dependent on the stroke sub-type and etiology. In this article, the headaches accompanying or causing acute stroke are addressed in some detail.
Low pressure headache and pseudosubdural hematomas.
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Intractable cluster headaches in a migraineur.
Some migraineurs have the additional misfortune of suffering from cluster headaches; this situation can be challenging.
Hospital presentation after stroke in a community sample: the Mobile Stroke Project.
BACKGROUND: Existing data regarding time between stroke and presentation for treatment are largely derived from hospital-based or multicenter databases and may not accurately reflect presentation patterns for most hospitalized stroke patients. METHODS: We evaluated a consecutive series of all hospitalized patients in Mobile County, Alabama. RESULTS: We identified 1,010 hospitalized stroke patients. Of all patients with out-of-hospital stroke, 42% came to a hospital within 3 hours of symptom onset. There were no statistically significant interhospital differences. Being asleep at the time of stroke or being transported by family or friends significantly increased the likelihood of late arrival. CONCLUSIONS: A minority of stroke patients arrive at a hospital early enough to qualify for acute intervention. Until development of acute therapies with longer therapeutic windows or more robust therapeutic benefit than tissue plasminogen activator (t-PA), effective stroke prevention strategies will exert a greater influence on stroke incidence and morbidity.
Differentiation of benign vs. malignant mass in a postirradiation cerebral arteriovenous malformation by 2-deoxy-2-[18F] fluoro-D-glucose positron emission tomography.
This report demonstrates the findings on two 2-deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography (FDG-PET) brain scans of a 16-year-old girl with previous radiation therapy for an arteriovenous malformation (AVM) that was transformed by radiation therapy to a mass in a deep and relatively inaccessible cerebral location. Clinical neurologic examination, brain CT without and with contrast, 1.5 T MRI of the brain without and with contrast, magnetic resonance angiography (MRA), (1)H magnetic resonance spectroscopic imaging (MRSI) of the brain, and two FDG brain PET scans were performed to characterize the lesion. Magnetic resonance imaging (MRI) and (1)H MR spectroscopic findings showed a mass and surrounding vasogenic edema in the deep left parietal lobe suggestive of malignant angiosarcoma. However, an FDG-PET scan of the brain identified a large area of hypometabolism involving the left parietal lobe. The PET findings were unchanged compared to a FDG-PET scan performed one year prior, suggesting that the lesion was benign. In addition, an MRI performed six months after the second PET scan was also consistent with a benign lesion, and was unchanged from the MRI performed two years prior. We present the first detailed imaging characteristics of a mass of high clinical suspicion for malignancy resulting from transformation of an arteriovenous malformation after radiosurgery treatment. Two FDG-PET scans performed for a one-year time interval provided a noninvasive method to establish that the lesion had nonmalignant characteristics.
Predictors of a negative response to topiramate therapy in patients with chronic migraine.
OBJECTIVE: To identify variables predictive of a negative response to prophylactic therapy with topiramate in patients with chronic migraine. BACKGROUND: While certain of the newer antiepileptic drugs (AEDs) have emerged as promising or definitely effective therapies for migraine prevention, we continue to lack biologic or clinical variables predictive of treatment response to these or other widely used prophylactic therapies. METHODS: A consecutive series of 170 patients with IHS-defined migraine who were experiencing 15 or more days of headache per month were treated with topiramate according to a uniform dosing protocol. Variables examined for their potential value in predicting treatment response included age, gender, prior experience with prophylactic therapy, prior experience with divalproex sodium specifically, headache frequency and, if present, duration of chronic daily headache (CDH). A positive treatment response was defined as a 50% or greater reduction in headache days during the second treatment month relative to the patient's pretopiramate baseline. Only patients who completed the treatment phase and achieved the 50 mg BID target dose were analyzed (efficacy analysis). Each variable prospectively selected was evaluated in regards to treatment outcome via a paired t-test, and a multiple regression analysis of all variables subsequently was performed. RESULTS: A total of 116 patients completed at least 60 days of treatment and consequently were available for analysis. In the efficacy analysis, 45 (38.8%) of the 116 responded positively to topiramate. Neither age nor gender influenced treatment response. Those patients with CDH of more than 6 months duration, patients who previously had tried and failed more than three prophylactic agents and patients who previously had failed to respond to divalproex sodium were more likely to be nonresponders, but after multiple regression analysis the only statistically significant predictor of a negative treatment response was CDH of more than 6 months duration (P<.001). CONCLUSIONS: Patients with chronic migraine who are treated with topiramate may respond positively at a rate approaching that reported from placebo-controlled trials involving topiramate or other AEDs administered to less severely afflicted migraineurs. Our analysis suggests that patients with chronic migraine least likely to respond to topiramate would be those with extensive and negative previous experience with prophylactic therapy, previous failure to respond to divalproex sodium, CDH, and, most notably, CDH of more than 6 months duration.