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Biomedical subjects

Rolf Salvesen

Publications and source records attributed to Rolf Salvesen.

16 recordsLinked to original sources
PubMed2006

[Patient satisfaction with assessment of headache by specialist consultation].

BACKGROUND: Headache is a common cause for referral of patients from a general practitioner to a neurologist. We have investigated patient satisfaction with neurological consultations for headache in Northern Norway. MATERIAL AND METHODS: We sent a postal questionnaire to all patients referred for headache from general practice to departments of neurology in Northern Norway from 1998 to 2000. RESULTS: Of 1403 patients, 942 (67%) responded to all relevant items in the questionnaire.160 of the patients were seen in Vefsn, 191 in Bodø and 591 in Tromsø. About 54% (510/942) of the patients were satisfied with the specialist consultation. Patients examined at the department in Bodø were significantly more satisfied (62 %) than patients examined in Tromsø (54%) or Vefsn (44%). Patients investigated in Tromsø reported improvement after treatment significantly more often than those seen in Vefsn. There was no difference in satisfaction between the three locations in the subgroup of patients with migraine. Patients who received a diagnosis or were given some kind of therapy were more content than others. INTERPRETATION: Almost half of the patients were not satisfied with the consultation. The degree of satisfaction varied between departments. More investigations are needed to clarify which patients with headache will benefit from a specialist consultation.

Adult↗
PubMed2005

EEG should be performed during induced hypothermia.

Induced hypothermia has improved neurological outcome after cardiac arrest. Even though anoxic insults to the brain often provoke epileptic activity, it is unclear whether EEG monitoring is necessary in these patients. We report the case of a 53-year-old female who suffered cardiac arrest. During induced hypothermia extensive shivering was managed by sedation and curare. After their discontinuation convulsions appeared and status epilepticus was disclosed on EEG recording, and was treated by thiopental infusion for 10 days. The patient recovered slowly and has now regained independent living (CPC 1). In induced hypothermia several factors including the use of curare, may conceal clinical signs of epileptic activity. We therefore suggest a broader use of EEG in these patients.

Curare↗
PubMed2005

[Surgical treatment of carotid stenoses at a county hospital].

BACKGROUND: High-degree stenosis of the internal carotid artery is a significant risk factor for cerebral infarction. It has been clearly demonstrated that endarterectomy reduces this risk if perioperative complications are maintained on a low level. MATERIAL AND METHODS: We studied the files of all patients undergoing carotid surgery in our hospital from 1985 through 2001. We also mailed questionnaires to all who were still alive in 2002. RESULTS: Over the period, 195 operations were performed on 168 patients (mean 12 operations per year). Their mean age was 63; 67% were men. In 30 cases (15%) the stenosis was asymptomatic. Within 30 days after surgery four patients had a disabling stroke, one had a retinal infarction and one patient died. The rate of perioperative stroke or death was 6.1%, while the rate for disabling stroke or death was 2.6%. Peripheral nerve injury, most often transitory, occurred in 5.7%. INTERPRETATION: The risk of moderate or serious perioperative complications is comparable to the multicentre studies that provide the rationale for the treatment (NASCET and ECST). Carotid endarterectomy in our hospital is safe in preventing stroke and should still be offered patients presenting to our centre.

Adult↗
PubMed2005

[Occurrence of multiple sclerosis in Nordland, 1970-1999].

BACKGROUND: Epidemiologic data for multiple sclerosis in Nordland County in Norway has not been recorded for more than 50 years. MATERIAL AND METHODS: Cases between 1970 and 1999 were identified by diagnostic code searches in the files of Nordland Central Hospital, the county's only hospital with a department of neurology. Several cases from Nordland were also identified in hospital files in neighbouring counties. RESULTS: The raw prevalence of multiple sclerosis was determined to be 105.6 per 100,000 as at December 31, 1999. The crude annual incidence in the 1970-1999 period was 3.6 per 100,000 (95 % CI: 3.1-4.0). There was a pronounced rise in incidence from the late 1970s up until the early 1980s. From 1985 to 1999, the average annual incidence rate has been stable at 5.1 per 100,000 (95 % CI: 4.4-5.8). INTERPRETATION: Compared to other Norwegian counties for which there are epidemiologic data, Nordland represents a medium risk zone for multiple sclerosis. The increase in incidence from the late 1970s to the early 1980s is most likely due to improved diagnosis and better record-keeping.

Adolescent↗
PubMed2004

[A 71-year-old man with Cushing reflex].

BACKGROUND: The Cushing reflex in comatose intensive care patients usually indicates that intracranial perfusion is about to be abolished. MATERIAL AND METHODS: A 71-year-old man suffered an attack during which he became comatose. After 14 hours he developed polyuria, dilated fixed pupils and Cushing reflex. The cause was believed to be a global anoxic brain oedema. Coma, apnoea and absent brain stem reflexes suggested brain death. RESULTS: Angiography with contrast injected into the aortic arch showed preserved circulation in both internal carotid, middle and anterior cerebral arteries, but absence of basilar artery circulation. A cerebral CT scan was initially normal, but 14 hours later a new scan demonstrated infarction of the brain stem, cerebellum and occipital lobes. The Norwegian criteria for organ donation were not fulfilled as these require stop of all intracranial circulation. The respirator was disconnected and the patient died. INTERPRETATION: The Cushing reflex can be seen after profound ischaemia in the posterior cerebral circulation with preserved circulation to the forebrain. Ischaemia of the brain stem alone may be sufficient to elicit the Cushing reflex.

Aged↗
PubMed2003

Brain magnetic resonance imaging white-matter lesions and cerebrospinal fluid findings in patients with acute intermittent porphyria.

BACKGROUND: Case reports display similarities between multiple sclerosis and acute intermittent porphyria (AIP). This study examines whether patients with AIP in general demonstrate white-matter lesions on brain magnetic resonance imaging (MRI) and/or abnormalities in plasma and/or cerebrospinal fluid (CSF) when examined outside attacks. We looked particularly for the presence of oligoclonal bands (OB) of immunoglobulin (Ig) in liquor. METHODS: Eight AIP gene carriers without previous episodes of porphyria, mean age 42.8 years (range 30-60), and 8 AIP gene carriers with previous episodes of porphyria, mean age 42.8 years (range 33-62), were examined with brain MRI, venous blood samples and lumbar punctures. RESULTS: Two male AIP gene carriers with previous episodes of porphyria, 58 and 35 years of age, had multiple white-matter, high-signal lesions on T(2)- weighted MRI sequences. Two AIP gene carriers without previous episodes of porphyria, 1 male and 1 female, had less than 5 such lesions. No OB were seen in the CSF in any patient, but 1 carrier had an increased level of protein in the CSF. Seven of 16 subjects (44%) had increased levels of HbA1c (>6.0), suggesting protracted hyperglycemia, and 3 further subjects had borderline levels (5.9). CONCLUSION: T(2)-weighted MRI sequences demonstrated multiple white-matter, high-signal lesions in 4 out of 16 AIP gene carriers (25%). No carrier demonstrated OB of Ig in CSF, making it unlikely that demyelinating lesions play a pivotal role in the pathogenesis of CNS symptoms in AIP. Only 1 AIP gene carrier had an increased level of protein in CSF; this contrasts with studies during acute attacks of porphyria. Seven subjects (44%) had abnormally high levels of HbA1c, in spite of the fact that no patient had a previous diagnosis of diabetes mellitus.

Adult↗
PubMed2003

[Drug therapy in secondary prophylaxis after transient cerebral ischemia or cerebral infarction].

BACKGROUND: Stroke is the third leading cause of death in western countries and the leading cause of dependence in activities of daily living. Efforts to reduce its prevalence should therefore be given the highest priority. Uncertainty prevails as to the significance of the various types of intervention. METHODS: This review is based on personal experience, though mostly on a search for relevant literature in the Cochrane Library. RESULTS: Important measures are treatment of hypertension with target area 140/90 mm Hg, anticoagulation in patients with atrial fibrillation and other potential sources of cardioemboli, and for the remainder antiplatelet agents in the form of acetylsalicylic acid, probably preferably combined with dipyradimole. One should also consider drugs reducing serum lipids. INTERPRETATION: Adequate secondary prophylaxis after transient ischaemic attack (TIA) or ischaemic stroke is of potential great benefit in reducing the incidence of new stroke, myocardial infarction or premature vascular death. Standardised guidelines may facilitate implementation of these measures, if they are regularly updated and adjusted to the needs of the individual patient.

Anticholesteremic Agents↗
PubMed2003

[Cervicogenic headache].

BACKGROUND: Cervicogenic headache means headache caused by a dysfunction in the neck. MATERIAL AND METHODS: The review is based on the authors' experience and a systematic search in Medline. RESULTS AND INTERPRETATION: Various anatomical structures may be responsible for cervicogenic headache, i.e. the vertebral artery or its surrounding sympathetic nerve plexus, spinal nerve roots, intervertebral discs and facet joints in the cervical spine.

Diagnosis, Differential↗
PubMed2003

[Osler's disease--a risk factor for stroke].

BACKGROUND: Osler's disease is an inherited disease of blood vessels that causes haemorrhage from the nasal mucosa, gastrointestinal tract, lungs or the urinary tract. Patients may also have abnormal intracerebral vessels. MATERIAL: A patient with Osler's disease and recurrent epistaxis suffered a cerebellar infarction. He had no other risk factors for stroke. An arteriovenous fistula was demonstrated in the right lung. This fistula was the probable source or aberrant pathway of an embolus to the cerebellum. The patient was treated with endovascular occlusion of the fistula to prevent further emboli to the brain. INTERPRETATION: Embolisation of thrombi from arteriovenous fistulae in the lungs is a rare cause of stroke, though important since secondary prophylaxis is very effective. Physicians should consider this possibility in the occasional patient with embolic stroke in whom no other risk factor is established.

Arteriovenous Fistula↗
PubMed2003

Prevalence of head trauma in patients with difficult headache: the North Norway Headache Study.

OBJECTIVE: To test whether chronic headache (>3 days/week) is more prevalent than episodic headache (<3 days/week) in patients with a previous history of significant head trauma. METHOD: We included 903 consecutive patients referred to a specialist center for headache during a period of 2 years. As the main parameter, we selected self-reported history of previous significant head trauma defined as loss of consciousness or hospitalization due to head trauma. RESULTS: One hundred eighty-nine out of 903 patients with difficult headache referred to a neurologist had a previous history of head trauma (21%). We identified 297 patients with headache 3 days or more per week (33%). Of these patients with chronic headache, 68 (23%) reported previous significant head trauma compared with 121/714 (17%) in other patients with headache (P =.18). Shorter length of education was associated with chronic headache; however, age, sex, or specific headache syndromes such as migraine or tension headache were not related to chronicity. CONCLUSION: Although the incidence of previous head trauma was prevalent in this highly selected group of patients with headache, such a history was not a predictor of chronicity.

Chronic Disease↗
PubMed2002

[Acute cerebral infarction--diagnosis of subgroups].

BACKGROUND: Subclassification of cerebral infarcts is crucial in order to optimise and differentiate therapy. If we are to apply specific treatment modalities early while neurological deficits are still reversible, we need a fast diagnosis that reliably predicts etiology. MATERIAL AND METHODS: The early clinical classification into Oxford subgroups is presented with an assessment of their predictive value in relation to aetiology (TOAST classification). RESULTS: The various Oxford subgroups correlate well to the topography of the infarction demonstrated by neuroradiology, to the vascular aetiology as demonstrated by ultrasound techniques, and to the "aetiologic" subgroup as determined by a full diagnostic work-up. However, the correlation is not sufficient to guide potentially specific treatments of subgroups if the treatment in question has serious side effects (e.g. thrombolysis). However, if the clinical diagnosis is supplemented with diffusion-weighted MRI and perhaps MR angiography, the predictive value of the diagnosis is extremely high. INTERPRETATION: Very early clinical diagnosis of cerebral infarction must be supplemented with diffusion-weighted MRI to make the diagnostic precision sufficiently high to guide the application of specific treatments with potentially serious side effects.

Acute Disease↗
PubMed2002

Patient satisfaction with a neurological specialist consultation for headache.

OBJECTIVE: To evaluate patient satisfaction with a specialist consultation for headache and thus identify subgroups of headache patients more satisfied than others. DESIGN: A survey of consecutive patients referred to a neurologist for headache. SETTING: Neurological outpatient clinics in North Norway. PATIENTS: We included 889 consecutive patients referred to a specialist centre for headache during a period of 2 years. Using a questionnaire, we recorded patients' satisfaction with the potential treatment initiated by the specialist. RESULTS: Sixty-three percent of migraine patients (95% CI, 0.58 to 0.68) were satisfied with the consultation, compared to 44% of patients with non-migrainous headache (95% CI, 0.40 to 0.70), (p = 0.01). Altogether 481 patients had some kind of measure recommended by the neurologist, and 317 of these (66%) were satisfied (95% CI, 0.62 to 0.70). Patients with tension-type headache and those who were not prescribed specific treatment modalities were less satisfied. CONCLUSION: The study confirms that patients with headache are satisfied with a neurological specialist consideration, especially in the case of migraine.

Adult↗
PubMedDate not supplied

Aspects of referral care for headache associated with improvement.

OBJECTIVE: To assess which aspects of referral care for headache are associated with improvement of pain and subjective quality of life. BACKGROUND: In managed care, referrals to a specialist are sometimes kept to a minimum. It has been questioned whether patients with headache do better after consultation with a specialist. METHODS: We mailed a questionnaire to all patients referred for headache to a neurologic center in northern Norway during a 2-year period (n = 1403). The questionnaire included items concerning diagnosis and treatment, along with simple visual analog scales to assess whether the patient's headache syndrome and self-perceived quality of life had changed after seeing the specialist. RESULTS: There were 1052 responders (75%). Headache generally decreased after consultation with a specialist; it decreased significantly more in the 527 patients who were assigned a diagnosis compared to the 344 patients who claimed they were not. Reduction of headache also was significantly more obvious in the 483 patients who had treatment prescribed, as compared to the 385 patients not receiving any therapeutic measure. Self-perceived quality of life was generally improved, significantly more when the patient was given a diagnosis, and even when the diagnosis did not lead to treatment. CONCLUSIONS: Patients referred to a neurologic center for evaluation of headache generally experience a significantly greater improvement in their headache syndrome and quality of life. This appears particularly so when they receive a diagnosis, even if no treatment is prescribed.

Headache↗