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R Salvesen

Publications and source records attributed to R Salvesen.

At least 19 recordsLinked to original sources
PubMed2006

Is uncertain diagnosis a more frequent reason for referring migraine patients to neurologist than other headache syndromes?

The objective was to assess whether the physician's uncertainty of diagnosis was a more frequent motivation for referring migraine patients than other headache patients to a neurologist. In this population based survey we included 846 consecutive patients referred to and examined at a specialist centre for headache during a period of 2 years. As primary outcome we compared cross-sectionally frequency of referring patients with migraine and other headaches to neurologist. According to the patients, uncertainty of diagnosis was the main reason for referral to a neurological specialist consultation, i.e. in 51% of cases. Thirty-nine per cent of patients classified as having migraine were referred because of an uncertain diagnosis, compared with 62% in patient with other headaches (95 CI 0.13-0.33), (P < 0.0001). Headache subtypes other than migraine and younger age were associated to more uncertainty of diagnosis. We conclude that diagnostic uncertainty was an important factor amongst half the headache patients seen by neurologists and uncertain diagnoses as reason for referral was more important amongst patients with non-migrainous headache.

Diagnosis, Differential↗
PubMed2005

Seasonal variation in migraine.

Our group has previously shown that migraineurs, as opposed to individuals with other headaches, are more likely to have headache during the bright arctic summer than during the polar night season. We set out to investigate the impact of seasonal light exposure in migraine with and without aura. We performed a questionnaire-based study of 169 female volunteer migraineurs in an arctic area where light conditions during summer and winter seasons are extreme. We included 98 patients with migraine with aura (MA) and 71 with migraine without aura (MoA). One hundred and seven patients (63%) reported seasonal variation in migraine attack frequency. Close to half (47%) of patients with aura, but only 17% of patients without aura, reported more frequent attacks during the light season (P < 0.001). Patients with MA reported interictal light hypersensitivity and light exposure as an attack precipitating factor significantly more often than individuals with MoA. They also reported significantly more frequent use of sunglasses to prevent attacks. We found no significant differences between MA and MoA as regards sleep disturbances, use of oral contraceptives, impact of headache or circadian variations. Seasonal periodicity of migraine in an arctic population with more frequent attacks during the light season is a convincing phenomenon in MA but not in MoA. The amount of light exposure seems to be pivotal to this variation.

Adult↗
PubMed2004

Is obstructive sleep apnea syndrome associated with headache?

OBJECTIVE: Obstructive sleep apnea syndrome (OSA) is a common disorder in the general population. Although the mechanisms remain obscure, an association with headache has been reported. We aimed to assess the frequency of OSA in a population of headache patients based on a stratified sampling technique using questionnaire and polysomnography (PSG). METHODS: The survey was provided to new outpatients examined by a neurologist for headache over a 2-year period of time. The patients completed a headache diary during 30 days and those at risk of OSA went through a PSG examination. RESULTS: Of 903 headache patients, 75 reported heavy snoring and episodes of interrupted nocturnal breathing (8%). Among 43 patients examined with PSG, 14 (1.5% of the total study population) had an apnea/hypopnea index of 5 or higher. Eleven of the patients reported morning headache. CONCLUSION: The frequency of OSA in a patients referred to specialist for headache problems is not higher than what is reported for the general population. The relatively low rate of OSA in this selected group of patients with headache referred to neurology for second opinion does not support the notion that OSA brings about headache.

Adult↗
PubMed2002

Drug-associated headache is unrecognized in patients treated at a neurological centre.

OBJECTIVE: We studied the frequency of unrecognized headache associated with overuse of analgesic drugs in a population of headache patients treated at a neurological centre. METHODS: Patients in North Norway referred to a neurologist for headache during a 2-year period completed a questionnaire. From a total of 945, 262 patients (28%) reported headache 3 days or more per week and used analgesic drugs on a daily bases. RESULTS: A specific diagnoses given by the neurologist was reported in 134 of the patients (51%). Only two patients reported that they suffered from a possible drug-associated headache. CONCLUSION: This study shows that drug overuse may be the cause of chronic headache in more than 1/4 patients referred to neurologists. Drug-associated headache is a difficult diagnosis which deserves more attention because it is a common and treatable condition.

Adolescent↗
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↗