Näin tunnistat sinustromboosin

Sinustromboosin diagnoosi on haastava monimuotoisen oirekuvan vuoksi. Epäile sinustromboosia, jos potilaalla esiintyy voimakasta jatkuvaa päänsärkyä tai päänsärkyä yhdessä neurologisten oireiden kanssa. Sinustromboosin, alaraajan laskimotukoksen ja keuhkoembolian riskitekijät ovat usein yhteiset

Näin tunnistat sinustromboosin

Vertaisarvioitu. English summary• Sinustromboosin diagnoosi on haastava monimuotoisen oirekuvan vuoksi. • Epäile sinustromboosia, jos potilaalla esiintyy voimakasta jatkuvaa päänsärkyä tai päänsärkyä yhdessä neurologisten oireiden kanssa. • Sinustromboosin, alaraajan laskimotukoksen ja keuhkoembolian riskitekijät ovat usein yhteiset

Antikoagulaatiohoito aivoverenkiertohäiriöiden erityistilanteissa

Antikoagulaatiohoitoa käytetään joskus myös muista syistä kuin eteisvärinästä johtuvissa aivoverenkiertohäiriöissä. Tällaisia erityistilanteita ovat esim. sinustromboosi, kallonpohjavaltimon tukos ja kaulavaltimon dissektoituma. Tutkimustietoa niistä on vähän. Ensisijaisia lääkkeitä ovat pienimolekyyliset hepariinit ja varfariini. Suorien antikoagulanttien käyttö lisääntynee tutkimustiedon karttuessa. Suurin osa aivoverenvuodon saaneista eteisvärinäpotilaista näyttää hyötyvän antikoagulantin aloittamisesta uudelleen muutaman kuukauden kuluttua vuodosta. Rutiininomaisen käytön hyödystä tromboosiprofylaksiassa ei ole näyttöä. Hyödyt ja riskit punnitaan potilaskohtaisesti.</p

Changes in ischemic stroke occurrence following daylight saving time transitions

Background: Circadian rhythm disruption has been associated with increased risk of ischemic stroke ( IS). Daylight saving time (DST) transitions disrupt circadian rhythms and shifts the pattern of diurnal variation in stroke onset, but effects on the incidence of IS are unknown.Methods: Effects of 2004-2013 DST transitions on IS hospitalizations and in-hospital mortality were studied nationwide in Finland. Hospitalizations during the week following DST transition (study group, n = 3033) were compared to expected hospitalizations (control group, n = 11,801), calculated as the mean occurrence during two weeks prior to and two weeks after the index week.Results: Hospitalizations for IS increased during the first two days (Relative Risk 1.08; CI 1.01-1.15, P = 0.020) after transition, but difference was diluted when observing the whole week (RR 1.03; 0.99 -1.06; P = 0.069). Weekday-specific increase was observed on the second day (Monday; RR 1.09; CI 1.00 -1.90; P = 0.023) and fifth day (Thursday; RR 1.11; CI 1.01-1.21; P = 0.016) after transition. Women were more susceptible than men to temporal changes during the week after DST transitions. Advanced age (> 65 years) (RR 1.20; CI 1.04-1.38; P = 0.020) was associated with increased risk during the first two days, and malignancy (RR 1.25; CI 1.00-1.56; P = 0.047) during the week after DST transition.Conclusions: DST transitions appear to be associated with an increase in IS hospitalizations during the first two days after transitions but not during the entire following week. Susceptibility to effects of DST transitions on occurrence of ischemic stroke may be modulated by gender, age and malignant comorbidities. (C) 2016 Elsevier B.V. All rights reserved

Case fatality of hospital-treated intracerebral hemorrhage in Finland - A nationwide population-based registry study

Case-fatality of Intracerebral hemorrhage (ICH) has been reported to have improved in some areas recently. Previous reports have shown that in Finland ICH survival has improved already from the 1980s. We aimed to investigate if this trend has continued and to assess possible predictors for death.All patients hospitalized for ICH in Finland in 2004-2018 over 16 years of age were identified from a national registry. Survival was analyzed using the national causes of death registry with median follow-up of 5.1 years (max 15.0 years).20,391 persons with ICH (53.5% men) were identified. Patient age increased during the study period with men being younger than women. One-month case-fatality was 28.4% and decreased during the study period. One-month and long-term case-fatality increased with patient age. Five-year survival was over 64% in patients 75 years of age. In a multivariate analysis patient age, sex, comorbidity burden and diagnoses of atrial fibrillation, hypertension and coagulopathy were all independently associated with both 30-day and long-term survival. Survival was better in men than women at all time points but in the multivariate analysis male sex was associated with a slightly higher risk (hazard ratio 1.10, 95% CI 1.06-1.14) of death in the long-term follow-up. Compared to general population, excess case-fatality was high and highly age-dependent in both sexes.Case-fatality of hospital-treated ICH has continued to decrease in Finland. Prognosis is strongly associated with patient age and more modestly with patient sex and comorbidities.</div

Adult Migraine Hospital Admission Trends in Finland: A Nationwide Registry Study

Population-level data on migraine hospital admission trends are unavailable. Changes in stroke care may have influenced these, since migraine is one of the most common stroke mimics. In this study, all hospital admissions on neurological, internal medicine, and pediatric wards in Finland with migraine as the primary diagnosis for persons at least 16 years of age in 2004-2014 were studied, resulting in an analysis of 6195 individuals with 7764 migraine discharges. The number of discharges increased by 4.2% annually (p = 0.000084), with no change in age of the admitted patients. Comorbidity burden was low but increased during the study period (p < 0.0001). The frequency of common vascular risk factors as comorbidities increased by 11-19% annually. Admission duration shortened by 2% annually (p < 0.0001). An intravenous thrombolysis was given in four admissions. It seems that migraine hospital admissions have become more frequent and the patients more often have cardiovascular risk factors, suggesting increased awareness and more aggressive acute evaluation of suspected stroke as the cause

Seasonality of stroke in Finland

INTRODUCTION: The burden of stroke is increasing globally. Reports on seasonal variations in stroke occurrence are conflicting and long-term data are absent.METHODS: A retrospective cohort study using discharge registry data of all acute stroke admissions in Finland during 2004-2014 for patients ≥18 years age. A total of 97,018 admissions for ischemic stroke (IS) were included, 18,252 admissions for intracerebral hemorrhage (ICH) and 11,271 admissions for subarachnoid hemorrhage (SAH).RESULTS: The rate of IS admissions increased (p = 0.025) while SAH admission rate decreased (p < 0.0001), and ICH admission rate remained stable during the study period. The lowest seasonal admission rates were detected in summer and the highest in autumn for all stroke subtypes. Seasonal variation of IS was more pronounced in men (p = 0.020), while no sex difference was detected in ICH or SAH. The seasonal patterns of in-hospital mortality and length of stay (LOS) differed markedly by stroke subtype. Diagnoses of hypertension, atrial fibrillation, or diabetes showed no seasonality.CONCLUSIONS: All major stroke subtypes occurred most commonly in autumn and most infrequently in summer. Seasonality of in-hospital mortality and length of hospital stay appears to vary by stroke subtype. The seasonal pattern of ischemic stroke occurrence appears to have changed during the past decades. Key messages All major stroke subtypes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) occurred most frequently in autumn and least frequently in summer. Seasonal patterns of in-hospital mortality and length of stay differed markedly by stroke subtype. The seasonal pattern of ischemic stroke occurrence in Finland seems to have changed compared to 1982-1992.</div

Epidemiology of Guillain-Barré syndrome in Finland 2004–2014

At total mean incidence of 0.84-1.1/100,000 the occurrence of Guillain-Barre syndrome (GBS) is reported to be low in Finland compared to other Caucasian populations. However, a recent study from Southwestern Finland reported an incidence of 1.82/100,000 which is comparable to other Caucasian populations. We analyzed discharge data covering the years 2004 through 2014 on all neurological admissions in all Finnish university and central hospitals with a primary diagnosis of GBS. A total of 989 admissions due to GBS (917 individuals) were identified. The standardized (European population) annual incidence rate was 1.70/100,000 person-years (95% confidence interval 1.60-1.81). GBS incidence had an increasing trend with age. The likelihood of GBS was higher among girls and adolescent women than boys and men of same age (male:female incidence rate ratio [IRR] 0.56), while in the older age groups (>19years) the occurrence of GBS was higher among males than females (male:female IRR 1.59). The incidence of GBS remained stable during the study period. There was no seasonal variation in GBS admission frequencies (p=0.28). No significant effect of the 2009-2010 H1N1 influenza or vaccination against it for GBS occurrence was observed. We suggest that GBS is as common, and has similar age-distribution in Finland as in other European countries. Sex-associated susceptibility for GBS appears to be different in children-adolescents and adults

Extension of Public Smoking Ban Was Not Associated with Any Immediate Effect on Stroke Occurrence in Finland

We investigated the association between the widening of a nationwide restaurant smoking ban, enacted on 1 June 2007, and stroke admissions. All acute stroke admissions between 1 May 2005 and 30 June 2009 were retrieved from a mandatory registry covering mainland Finland. Patients aged >= 18 years were included. One annual admission per patient was included. Negative binomial regression accounting for the at-risk population was applied. We found no difference in stroke occurrence before and after the smoking ban within 7 days (p = 0.217), 30 days (p = 0.176), or the whole study period (p = 0.998). Results were comparable for all stroke subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage). There was no sign of decreased occurrence in June 2007 compared to June in 2005-2006, and all subtypes of stroke occurred at least as frequently in both May and June of 2008 as in May and June of 2007. In conclusion, the nationwide restaurant smoking ban Finland enacted in June 2007 was not associated with any immediate reduction in stroke occurrence

Stroke hospitalization trends of the working-aged in Finland

BackgroundThe age-standardized incidence of stroke has decreased globally but, for reasons unknown, conflicting results have been observed regarding trend in incidence of major stroke subtypes in young adults. We studied these trends among people of working age in a population-based setting in Finland, where cardiovascular risk factor profiles have developed favorably.MethodsAll hospitalizations for stroke in 2004-2005 and 2013-2014 for persons 18-64 years of age were identified from a national register. The search included all hospitals that provide acute stroke care on mainland Finland.ResultsHospitalizations for both intracerebral hemorrhage (ICH; -15.2%; p = 0.0008) and subarachnoid hemorrhage (SAH; -26.5%; p<0.0001) decreased overall and for both sexes separately. Concerning IS, hospitalizations decreased only for men (-6.3%; p = 0.0190) but not for women or overall. However, there was an increase in IS hospitalizations in men 35-44 years of age (+37.5%; p = 0.0019). The length of stay (LOS) of IS patients declined in nearly all subgroups (overall -20.8%, p<0.0001) whereas no change in LOS was observed for patients with ICH or SAH. In-hospital mortality decreased in patients with IS (-42.8%; p = 0.0092) but remained unchanged in patients with ICH or SAH.ConclusionsStroke hospitalizations of young people declined in Finland, except for men 35-44 years of age for whom IS hospitalizations increased. Declining LOS and in-hospital mortality of IS patients suggests admission of less severe cases, improved care or both