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Tuesday, June 07, 2005There is a growing concern among neurologists that, in many cases, patients and other doctors aren't recognizing or acting on the symptoms of a ministroke, a warning sign that often means a larger, more devastating stroke is on its way. Strokes are the leading cause of disability in the U.S., and the No. 3 cause of death. Many of these major strokes are preceded by a ministroke, in which symptoms such as numbness and vision changes often vanish within an hour or two. Because these symptoms go away, people often ignore them and some doctors miss them, misdiagnosing symptoms as a migraine, low blood pressure, a heart attack, anxiety or a seizure. It is often difficult to tell when a symptom such as vertigo or numbness is something mundane, such as an inner disturbance or a nerve entrapment and when it's the sign of an impending stroke. One neurologist quoted in the article says that duration is key: "If someone has a numb hand, and they woke up with it, they'll say, 'Maybe I slept on it,' " says Joseph Broderick, chairman of neurology at the University of Cincinnati College of Medicine. He says that if this numbness persists for five or 10 minutes or more, "that isn't sleeping on it funny, and it requires urgent attention." But carpal tunnel syndrome can certainly cause numbness that lasts more than 5 or 10 minutes, and it also tends to be exacerbated by a sleeping hand's position. What's more, there are, by far, more people with carpal tunnel syndrome than with mini-strokes: Neurologists estimate that there are up to 500,000 ministrokes annually in the U.S. That compares to 700,000 full-blown strokes a year, according to the American Stroke Association. The prevalence of carpal tunnel syndrome, on the other hand, is 2.7% of the adult population - in other words, millions. The figures for degenerative disc disease are even higher. My point isn't to minimize the significance of mini-strokes, but to temper the article's slant with a dose of reality. Not every case of numbness or dizziness warrants admission and work-up for an impending stroke. If your arm numbness gets worse when you move your neck or wrist or shoulder a certain way, then you likely have slept on it wrong. Admitting every case of dizziness or limb numbness indiscriminately would dramatically increase the cost of healthcare. And it isn't at all clear that there would be much gained in lives saved or disabilities avoided. posted by Sydney on 6/07/2005 10:44:00 PM 0 comments
Saturday, June 04, 2005The patient was promptly taken to the operating room, where she underwent transesophageal echocardiography, which showed no evidence of aortic dissection. A diagnosis of postinfarction rupture of the ventricular free wall was suspected on the basis of clinical, laboratory, and imaging findings. A median sternotomy was performed, and the pericardium was opened. After the evacuation of 600 ml of clotted blood, a bleeding site was identified in the right coronary artery, with bleeding due to perforation of the artery just before its bifurcation. Furthermore, when the diaphragmatic side of the heart was pulled up, a wooden toothpick, 3.5 cm long, was found and its passage through the diaphragm was identified. After ligation of the right coronary artery, bypass grafting with a saphenous vein was performed. A laparotomy was carried out after closure of the chest; neither inflammation nor intestinal content was found in the peritoneum. In addition, we did not find the passageway of the foreign body through the gastric wall. The postoperative course was uneventful. The patient was discharged after six days, and she returned to work after two months. The patient remembered having eaten meat rolls secured with toothpicks at a barbecue the night before her chest pain began. The authors say that tooth-pick injuries occur in the United states at a rate of 3.6 per 100,000 person-years. (Based on one survey that found 8176 toothpick-related injuries over a four year period.) Everything's a hazard. posted by Sydney on 6/04/2005 05:19:00 PM 0 comments
Friday, June 03, 2005posted by Sydney on 6/03/2005 07:55:00 AM 0 comments
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