Rectus sheath haematoma or leaking aortic aneurysm - a diagnostic challenge: a case report

© 2009 Shaw et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Chance of aneurysm in patients suspected of SAH who have a ‘negative’ CT scan but a ‘positive’ lumbar puncture

In patients with sudden severe headache and a negative computed tomography (CT) scan, a lumbar puncture (LP) is performed to rule in or out a subarachnoid haemorrhage (SAH), but this procedure is under debate. In a hospital-based series of 30 patients with sudden headache, a negative CT scan but a positive LP (defined as detection of bilirubin >0.05 at wavelength 458 nm), we studied the chance of harbouring an aneurysm and the clinical outcome. Aneurysms were found in none of both patients who presented within 3 days, in 8 of the 18 (44%) who presented within 4–7 days and in 5 of the 10 (50%) who presented within 8–14 days. Of the 13 patients with an aneurysm, 3 (23%) had poor outcome. In patients who present late after sudden headache, the yield in terms of aneurysms is high in those who have a positive lumbar puncture. In patients with an aneurysm as cause of the positive lumbar puncture, outcome is in the same range as in SAH patients admitted in good clinical condition

Focus on the management of thunderclap headache: from nosography to treatment

Thunderclap headache (TCH) is an excruciating headache characterized by a very sudden onset. Recognition and accurate diagnosis of TCH are important in order to rule out the various, serious underlying brain disorders that, in a high percentage of cases, are the real cause of the headache. Primary TCH, which may recur intermittently and generally has a spontaneous, benign evolution, can thus be diagnosed only when all other potential underlying causes have been excluded through accurate diagnostic work up. In this review, we focus on the management of TCH, paying particular attention to the diagnostic work up and treatment of the condition

Reporting and Interpreting Intentions in Defamation Law

The interpretation and the indirect reporting of a speaker’s communicative intentions lie at the crossroad between pragmatics, argumentation theory, and forensic linguistics. Since the leading case Masson v. New Yorker Magazine, Inc., in the United States the legal problem of determining the truth of a quotation is essentially equated with the correctness of its indirect reporting, i.e. the representation of the speaker’s intentions. For this reason, indirect reports are treated as interpretations of what the speaker intends to communicate. Theoretical considerations, aimed at establishing the pragmatic meaning of an utterance and differentiating between presumptive and non-presumptive interpretation, are thus interwoven with the practical legal need of distinguishing a correct indirect report from an indirect one or a misquotation. An incorrect report or a misquotation has the dialectical effect of attributing to the misquoted party commitments that he never held, which the latter needs to rebut. This shifting of the burden of persuasion can be increased by using strategically the conflict between the presumptive interpretation of an utterance and the non-presumptive one, i.e. the different types of pragmatic ambiguity. When an interpreter is confronted with an utterance taken out of its dialogical context, his interpretative process is not guided by the actual context or intention, but rather the most frequent or prototypical dialogical setting or the most typical individual purpose that it could have served to achieve. This presumptive reconstruction can be used to provide a prima facie case that the other party needs to reject. The stronger the interpretative presumptions a speaker needs to rebut, the more effective the misquotation strategy. The conflict between the systematic and the presumptive process of interpretation can be represented as an argumentative mechanism of reconstruction of the individual intention, which allows one to assess the reasonableness of the interpretative reasoning

Stroke in women — from evidence to inequalities

Stroke is the second largest cause of disability-adjusted life-years lost worldwide. The prevalence of stroke in women is predicted to rise rapidly, owing to the increasing average age of the global female population. Vascular risk factors differ between women and men in terms of prevalence, and evidence increasingly supports the clinical importance of sex differences in stroke. The influence of some risk factors for stroke — including diabetes mellitus and atrial fibrillation — are stronger in women, and hypertensive disorders of pregnancy also affect the risk of stroke decades after pregnancy. However, in an era of evidence-based medicine, women are notably under-represented in clinical trials — despite governmental actions highlighting the need to include both men and women in clinical trials — resulting in a reduced generalizability of study results to women. The aim of this Review is to highlight new insights into specificities of stroke in women, to plan future research priorities, and to influence public health policies to decrease the worldwide burden of stroke in women