Stroke ranks as the third leading cause of death and the most common cause of permanent disability in adults. Timely recognition and treatment is imperative to reduce stroke-related morbidity and mortality. Patients with acute ischemic stroke should be evaluated for administration of intravenous tissue plasminogen activator (t-PA); those who do…
To receive a CME certificate for 2 hours in category 1 credit toward the AMA Physician’s Recognition Award, complete all sections of this form and mail it with a check (payable to SMA) for $15 ($30 for nonmembers) to: Publications Department, SMA, PO Box 190088, Birmingham, AL 35219-0088. The completed…
In this study, the effect of different risk factors (hyperglycemia, hypertension, hyperlipidemia, hyperuricemia) on endothelial damage was evaluated in 61 (two of them were type 1; the other patients were type 2) diabetic patients. von Willebrand factor antigen was used as the marker of the endothelial damage. Although there was…
Background Patients facing end-of-life issues have spiritual concerns that may have an impact on their medical decision-making. Methods To determine whether physicians address spiritual concerns in this context, we reviewed the charts of 92 elderly hospitalized patients facing decisions regarding resuscitation status or feeding tube placement. Results The average age…
Any terrorist attack using weapons of mass destruction will result in substantial psychological trauma and stress. Primary care and emergency clinics will likely see patients who have stress-related emotional or physical symptoms, or exacerbations of preexisting health concerns. Significant psychological and behavioral reactions to an attack with weapons of mass…
We report a case of anterior myocardial infarction in a middle-aged man without risk factors for atherosclerosis in whom myocardial bridge was diagnosed several years later. An abnormal wall motion during acute myocardial infarction masked the characteristic angiographic findings of myocardial bridge and rendered it unappreciable during the initial angiographic…
We present a case of hydrocephalus as the primary manifestation of neurosarcoidosis. Neurologic involvement is a significant cause of morbidity and mortality in patients with sarcoidosis. Detection and management of neurosarcoidosis remains problematic. Although the typical presentation of facial nerve palsy in a documented case of sarcoidosis is not a…
We report four cases of cerebral histoplasmosis and discuss features of six additional cases reported in the medical literature in the past 10 years, when azoles have been available for therapy. Most patients with this disease are immunocompromised or have a history that suggests heavy exposure to Histoplasma capsulatum. Fever…
Ahmed A, Maisiak R, Allman RM, DeLong JF, Farmer R. Heart failure mortality among older Medicare beneficiaries: Association with left ventricular function evaluation and angiotensin-converting enzyme inhibitor use. South Med J 2003;96(2):124–129. The figures that appeared on page 127 of this article in the February 2003 issue of Southern Medical…
Stroke is a treatable disease. Despite the therapeutic nihilism of the past, the advent of thrombolysis has changed the way stroke is approached. Acute ischemic stroke is a challenging and heterogeneous disease. Treatment needs to be based on an understanding of the underlying pathophysiology of ischemia. Interventions are designed to…
Cardioembolic stroke accounts for approximately 15% of all strokes and is thought to be one of the more preventable types of strokes. Features that have been reported to support cardioembolism as a mechanism for ischemic stroke have included documented cardiac source of embolism, maximal neurologic deficit at onset, multiple cerebrovascular…
Arterial hypercoagulability can lead to cerebrovascular disease. Common causes of venous thromboembolism, including factor V Leiden, the prothrombin 20210 mutation, deficiencies of proteins C and S, and antithrombin deficiency are not likely to be associated with stroke. Rather, polymorphisms in fibrinogen, the factor XIII gene, and platelet glycoproteins are congenital…
Living in a society of animal lovers, the dangers are often not always apparent. Injury from bites and scratches is an occupational hazard for those people who work with animals. Despite the high risk of secondary wound infection as a result of an animal bite, many patients do not receive…
Klein KP. Research centers in arteriosclerosis, stroke, and cancer at Wake Forest University School of Medicine. South Med J 2002;95(11):1238–1242. On page 1242 of this article published in the November 2002 issue of Southern Medical Journal, the correct name of the 1999 recipient of a grant from the Research Base…
Stroke is a severe, expensive, and common disorder. As Dr. Caplan 1 points out in his editorial in this special Stroke Continuing Medical Education (CME) issue of Southern Medical Journal, the patient’s life is never the same after a major disabling stroke, because of the loss of vocational, personal, and…
Statistics are impressive, but even more important for me is the effect of stroke on the individual. What could be worse than suddenly to become unable to talk; stand; walk; use a hand, arm, or leg; see; read; feel; understand spoken language; write; or remember? Loss of function is often…
Stroke is a preventable tragedy for nearly 750,000 people each year. Primary stroke prevention measures applicable to the general public include a healthy diet containing fruits, vegetables, fish, and low fat; exercise; smoking cessation; limiting alcohol to moderate use; and perhaps avoidance of stress. Screening for hypertension, cholesterol, heart disease,…
The relationship between vascular disease of the brain and cognitive impairment is unclear. It is known that extensive vascular lesions in the brain, large or small, can cause dementia. What is not known is how often this occurs and by what mechanism. Also unclear is the extent of overlap between…
Because current therapies for acute stroke are limited, attention must be paid to primary and secondary prevention of stroke. This article focuses on the treatment of chronic hypertension in particular. There is no “one-size-fits-all” treatment, although recent randomized trials have shown that certain agents may be more helpful. Although an…
Direct Diagnosis Herbert W. Copelan. Chapel Hill, NC: Professional Press, 2002. ISBN: 0971972907. The practice of clinical medicine is both an art and a science. Recent advances in evidence-based medicine and the vast array of laboratory investigations available are gradually shifting the balance toward the cold, impersonal, scientific aspect of…
Drug Facts and Comparisons: 57th Edition Facts and Comparisons. St. Louis: Facts and Comparisons, 2003. 2,496 pages. $194.95. ISBN: 1574391356. The often subtle differences between medications in the same therapeutic category mandate that clinicians have ready access to an unbiased, reliable, concise, practical reference source to better appreciate these differences…
Science on the Witness Stand: Evaluating Scientific Evidence in Law, Adjudication, and Policy Tee L. Guidotti and Susan G. Rose. Beverly Farms, MA: OEM Press, 2001. 428 pages. $46.00. ISBN: 1883595312. Lawyers often ask physicians to provide expert opinions and to testify in court. Because of their different backgrounds, training,…
Stroke is a leading cause of death and disability worldwide. Three decades ago, the diagnosis of stroke was largely dependent on bedside clinical methods. Our knowledge of the localization and the nature of the underlying pathologic process could only be verified independently postmortem; this seriously hampered initial attempts at developing…
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