Search PubMed⌕ Search

Biomedical subjects

R Salvesen

Publications and source records attributed to R Salvesen.

At least 19 recordsLinked to original sources
PubMed2001

[Cluster headache--clinical aspects, pathophysiology and treatment].

EPIDEMIOLOGY: Cluster headache afflicts somewhat less than one in thousand in the general population. The majority of sufferers are men. CLINICAL FEATURES: The syndrome is characterized by frequent attacks of intense pain localized in and around the eye on one side, characteristically accompanied by conjunctival injection and lacrimation in this eye, along with nasal stuffiness on the same side and sometimes a Horner's syndrome. All symptoms and signs are strictly unilateral and occur during attacks lasting between 15 minutes and three hours. The attacks occur from once to eight times daily during a period lasting from some weeks to months. After a remission of varying duration, the same pattern recurs. PATHOPHYSIOLOGY: Recent findings suggest a pivotal role of the hypothalamus in relation to the pathophysiology. TREATMENT: Sumatriptan injection or oxygen inhalation aborts pain attacks in most patients. The most frequently used prophylactic agents are verapamil, lithium and steroids.

Cluster Headache↗
PubMed2001

Innervation of sweat glands in the forehead. A study in patients with Horner's syndrome.

The amount of sweating in lateral and medial sites in the forehead was investigated with quantitative evaporimetry in 18 patients with Horner's syndrome: eight cases with a central (1st), five with a preganglionic (2nd), and five with a postganglionic (3rd) neurone lesion. The amount of sweating was measured after body heating, and, at another occasion, after intracutaneous injection of the cholinergic drug pilocarpine. The two sites were at the root of the nose (medial position) and at the lateral angle of the eye (lateral position). Generally, there was a reduced level of sweating on the symptomatic versus the non-symptomatic side in both positions during body heating, except in the lateral part of the forehead in the 3rd neurone lesions, where sweating was greater on the symptomatic than on the non-symptomatic side. There was a nearly symmetrical sweating response after pilocarpine injection at all sites. There was one exception to this rule; the lateral position in the preganglionic neurone lesion group where pilocarpine induced more sweating on the non-symptomatic side. Thus, the results suggest a relative supersensitivity to pilocarpine in the medial position for all patients and in the lateral position for the central neurone lesion group. The findings suggest that the innervation of sweat glands in the medial and lateral parts of the forehead is different, the medial part being supplied by nerve fibres from the sympathetic plexus of the internal carotid artery, while the sweat glands in the lateral part is furnished from the plexus surrounding the external carotid artery.

Autonomic Fibers, Postganglionic↗
PubMed2001

Are headache patients who initiate their referral to a neurologist satisfied with the consultation? A population study of 927 patients--the North Norway Headache Study (NNHS).

BACKGROUND: Headache is a common problem in primary care. Although most patients are treated by GPs, many are referred to specialist consultation. Knowledge of how the referrals can be improved is therefore an important issue. OBJECTIVES: The aim of this study was to determine the relationship between self-initiating referral to a neurologist and the patient's satisfaction with the specialist consultation. METHODS: All patients who had been examined by a neurologist for headache within a 2-year period from three neurological centres in North Norway completed a questionnaire. RESULTS: A total of 1052 patients from a population of 1403 headache patients (75%) returned the questionnaire while 927 patients answered questions about initiating the referral to the specialist. Two hundred and twenty patients (24%) initiated the referral to the neurologist themselves; 52% of those who self-initiated the referral were dissatisfied with the specialist consultation compared with 42% of those referred by the doctor, P = 0.002. Chronic headache, tension-type headache (TTH) and daily use of analgesic drugs were associated with dissatisfaction. CONCLUSIONS: Patients with headache who initiated the referral to a neurologist themselves were less satisfied with the specialist consultation. Selecting referrals containing proper medical information may improve satisfaction in severe headache patients treated in a neurological practice.

Adult↗
PubMed2000

[Cluster headache].

Explore the source record for details and available documents.

Cluster Headache↗
PubMed2000

[Intracranial aneurysms associated with cerebral arteriovenous malformations].

BACKGROUND: Patients known to harbour a cerebral arteriovenous malformation that is inaccessible to therapy may have a second bleeding into the subarachnoid space, but from another source. MATERIAL AND METHODS: Two patients had previously bled from an intracranial arteriovenous malformation; both were considered inaccessible to surgical or endovascular repair. The patients were then admitted to hospital with symptoms and signs suggesting a second subarachnoid haemorrhage. RESULTS: Diagnostic work-up demonstrated an aneurysm as the probable source of haemorrhage in both patients. INTERPRETATION: Patients harbouring an intracranial arteriovenous malformation are much more likely to develop an associated intracranial aneurysm than patients without such malformations, and a second bleeding in these patients will more often arise from the associated aneurysm. The cause of the frequent association of an aneurysm is probably haemodynamic stress due to the increased blood flow through the feeding artery. These patients suffer subarachnoid haemorrhage more often than patients with either an aneurysm or a malformation alone. The therapeutic strategy should be carefully individualized and the aneurysm should more often have priority.

Aged↗
PubMed2000

Limb-threatening ischemia due to ergotamine: case report with angiographic evidence.

A 29-year-old woman presented with severe leg pain that had lasted for several weeks. During that period, she had taken painkillers in order to achieve sleep. In the week before she was admitted to hospital, she had noticed numbness and a cold feeling below her knees. There were no arterial pulsations below her groin, the skin of her legs being cold and pale. She had a history of chronic daily headache and had ingested Cafergot compound corresponding to ergotamine 2 to 3 mg daily for the previous 2 or 3 months. Angiography demonstrated severe narrowing of both superficial femoral arteries for a distance of about 5 to 6 cm and a subtotal stenosis of the right popliteal artery. After discontinuation of ergotamine, the patient's symptoms gradually disappeared within a few days. Angiography was repeated 2 days after the first examination and demonstrated regression of the spasms in the femoral arteries and reestablished flow in the distal vessels. Ergotamine tartrate can induce life-threatening ischemia of an extremity. Discontinuation of ergotamine is usually sufficient to reverse the ischemia, however, intravenous infusion of sodium nitroprusside may occasionally be necessary to avoid limb amputation.

Adult↗
PubMed2000

Familial mydriasis, cardiac arrhythmia, respiratory failure, muscular weakness and hypohidrosis.

OBJECTIVES: To describe a family with some sort of progressive autonomic failure in one generation (2 affected of a sibship of 7 sisters). The main features were: mydriasis, cardiac arrhythmia, cardiomegaly, hypohidrosis, respiratory failure, and muscular weakness. METHODS: Pupillometry, evaporimetry, and isokinetic power measurements were carried out. RESULTS: The autonomic dysfunction pattern (mainly cardiac abnormalities, mydriasis) seems to differ somewhat from that of progressive autonomic failure (Shy-Drager syndrome). "Lewy body-like" inclusions were present, in particular in substantia nigra, but also in locus ceruleus and raphe nuclei (cell loss only in locus ceruleus). There were no oligodendroglial, cytoplasmatic inclusions, apparently a marker in multiple system atrophy. Proper Lewy bodies were also present. Differences seemed to prevail vs the Shy-Drager syndrome. Various traits: muscular weakness pattern (e.g. preferential peroneal distribution), minor elbow contractures, and arrhythmia were reminiscent of Emery-Dreifuss muscle dystrophy (E-D). Distinguishing features included: hereditary pattern, mydriasis, and hypohidrosis. CONCLUSION: Conceivably, this disorder is close to, but still not identical with E-D.

Adult↗
PubMed1999

[Raeder's syndrome].

Raeder's syndrome was first described by the Norwegian ophthalmologist J.G. Raeder in 1918 and again in 1924 by the same author. The seminal report was a description of a young male patient with unilateral periocular pain combined with ipsilateral miosis and ptosis, and with slight objective signs of trigeminal nerve involvement. Autopsy demonstrated a tumour at the base of the skull in the middle cranial fossa. Raeder coined the term "paratrigeminal" for the reported clinical picture. Later case reports by Raeder and other authors have included patients experiencing a more benign clinical course, some with spontaneous remissions, with unilateral periocular pain and ipsilateral signs of oculosympathetic paresis as the common denominator. This article is a chronological survey of the main contributions to the medical literature. Various definitions of the syndrome are outlined, including the more recent classification, as well as some pathophysiological and prognostic considerations.

Aortic Dissection↗
PubMed1999

[Current viewpoints on etiology and physiopathology of migraine].

Migraine is an inheritable disease, and the mutation causing a rare variant of migraine (familial hemiplegic migraine) has now been demonstrated. The mutated gene encodes a subunit of a brain-specific calcium channel in cell membranes. Brains of patients with recurrent migraine attacks seem to behave differently from other brains, also when examined outside attacks, in that they commonly demonstrate lack of habituation when exposed to serial stimuli. The patho-physiological process of the attack might well consist of a spreading cortical depression starting in the occipital region and gradually involving other parts of the cortex. It is primarily a cerebral process secondarily accompanied by reduced cerebral blood flow, later converting into increased flow. The pain of migraine probably is mediated by way of the trigeminal nerve which releases vasoactive peptides leading to dilatation of the greater blood vessels. During an attack there is increased metabolism in cranial parts of the brain stem, demonstrated as areas of increased blood flow in PET studies. This increased metabolism persists even when the symptoms of migraine have disappeared after drug treatment, perhaps because the migraine attacks may be generated in this region. The primary dysfunction in migraine probably is located in the brain rather than in blood vessels.

Adolescent↗
PubMed1999

Do human lumbar discs reconstitute after chemonucleolysis? A 7-year follow-up study.

STUDY DESIGN: A retrospective, longitudinal study of 51 patients, covering a mean follow-up period of 81 months. OBJECTIVE: To observe the long-term temporal course of the height of human lumbar discs after chemonucleolysis. To document whether human lumbar discs reconstitute, thus characterizing the healing potential of central disc tissue. SUMMARY OF BACKGROUND DATA: Although reconstitution of disc height within some months of chemonucleolysis has been observed in animal experiments, human lumbar discs have shown no tendency to regain their initial height within 1 year of treatment. To date, there has been no report on longer follow-up periods. The different reactions of animal and human discs may be dose-related or related to differences in tissue properties, physiologic environment or in vivo loading conditions. METHODS: Using a new protocol, the heights of lumbar discs were measured from sets of lateral radiographic views of 51 patients subject to chemonucleolysis by treatment with chymopapain (doses of 4000 or 3000 picokatals [pkat]). The sets comprised a view taken before treatment, a view taken (on average) 4 months after treatment, and a view taken (on average) 81 months after treatment. In the majority of patients, untreated discs adjacent to discs treated with chemonucleolysis served as control discs. RESULTS: Shortly after injection of chymopapain, all treated discs decreased in height. The height decrease of treated discs amounted to 15.8% on average. In the subcohort treated with 4000 pkat, the loss did not reverse during the entire follow-up period; in the subcohort treated with 3000 pkat a small fraction of the lost height was regained. Untreated neighboring control discs showed a minor (3.4%) decrease in height. CONCLUSIONS: Human lumbar discs do not reconstitute after chemonucleolysis. Because the long-term temporal course of disc height in patients is in disagreement with observations from animal experiments, caution is suggested when generalizing results from animal studies to humans.

Chymopapain↗
PubMed1999

Cluster Headache.

The care of patients with cluster headache has at least two goals: 1) immediately abolishing an ongoing attack and 2) stopping or shortening a bout (a cluster period). The fierceness and the relative brevity of the attacks dictate the use of a fast-acting agent. There are probably three agents fulfilling these criteria: sumatriptan (by subcutaneous injection), oxygen (inhaled through a face mask), and ergotamines (by injection or, perhaps, sublingual tablets). An abundance of data from controlled studies as well as recent clinical experience probably favors sumatriptan as the most effective alternative, the most significant drawback being its high cost. Oxygen inhalation is free of side effects and may be effective but is inconvenient to use. Ergotamines in tablet form act less rapidly, and there are more contraindications to their use. In short-term prophylaxis, however, ergotamine may still be a drug of choice if the timing of the attacks allows planned use of the drug shortly before the attack. If the timing is more irregular, steroids may at least temporarily break a cycle (eg, prednisolone, 60 or 80 mg/d, gradually tapered to zero in 3 to 4 weeks). If more long-lasting prophylaxis is needed or expected, lithium carbonate, 900 mg/d, or verapamil, 360 mg/d, both have reasonable response rates. As for chronic cluster headache, lithium probably will still be the drug of choice. For a very limited group of patients with chronic cluster headache, surgery may be a last resort. The best surgical options are probably radiofrequency rhizotomy or microvascular decompression of the trigeminal nerve.

Journal Article↗
PubMed1999

Cervicogenic headache: long-term postoperative follow-up.

The patient, a 50-year old female had been suffering from right-sided head- and neck pain since she was 31 years of age. It started in connection with an indirect neck trauma. Analgesics were of little or no avail and operative procedures, including liberation of the greater occipital nerve (GON) (n = 2) and decompression of the C2 ganglion/root, had only a transitory effect. At 42, a magnetic resonance scan of the cervical spine demonstrated a degenerated disk C5-C6, with encroachment on the foramina and the cord. At 42 years of age, a stabilization operation at C5-C6 (Robinson-Smith) alleviated her discomfort--only some motor complaints in the ipsilateral upper extremity remaining and only in the first 12-18 months.

Cervical Vertebrae↗
PubMed1999

Raeder's syndrome.

Raeder's syndrome was first described by the Norwegian ophthalmologist J. G. Raeder in 1918, and the description extended in 1924 by the same author. The seminal report was a description of a young, male patient with unilateral periocular pain combined with ipsilateral miosis and ptosis, and with slight objective signs of trigeminal nerve involvement. Autopsy demonstrated a tumor at the base of the skull in the middle cranial fossa. The term "paratrigeminal" was coined for the picture reported. Later case reports by the same and other authors have included patients with a more benign clinical course, including spontaneous remissions, with unilateral periocular pain and ipsilateral signs of oculosympathetic paresis as the common denominator. This review is a chronological survey of the main contributions that have appeared in the literature and an outline of the various definitions of the syndrome, including a recent classification as well as some pathophysiological and prognostic considerations.

Eponyms↗