S Fridriksson

University Hospital Linköping, Linköping, Östergötland, Sweden

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Publications (7)14.79 Total impact

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    ABSTRACT: Sudden onset headache is a common condition that sometimes indicates a life-threatening subarachnoid haemorrhage (SAH) but is mostly harmless. We have performed a prospective study of 137 consecutive patients with this kind of headache (thunderclap headache=TCH). The examination included a CT scan, CSF examination and follow-up of patients with no SAH during the period between 2 days and 12 months after the headache attack. The incidence was 43 per 100 000 inhabitants >18 years of age per year; 11.3% of the patients with TCH had SAH. Findings in other patients indicated cerebral infarction (five), intracerebral haematoma (three), aseptic meningitis (four), cerebral oedema (one) and sinus thrombosis (one). Thus no specific finding indicating the underlying cause of the TCH attack was found in the majority of the patients. A slightly increased prevalence of migraine was found in the non-SAH patients (28%). The attacks occurred in 11 cases (8%) during sexual activity and two of these had an SAH. Nausea, neck stiffness, occipital location and impaired consciousness were significantly more frequent with SAH but did not occur in all cases. Location in the temporal region and pressing headache quality were the only features that were more common in non-SAH patients. Recurrent attacks of TCH occurred in 24% of the non-SAH patients. No SAH occurred later in this group, nor in any of the other patients. It was concluded that attacks caused by a SAH cannot be distinguished from non-SAH attacks on clinical grounds. It is important that patients with their first TCH attack are investigated with CT and CSF examination to exclude SAH, meningitis or cerebral infarction. The results from this and previous studies indicate that it is not necessary to perform angiography in patients with a TCH attack, provided that no symptoms or signs indicate a possible brain lesion and a CT scan and CSF examination have not indicated SAH.
    Cephalalgia 06/2002; 22(5):354-60. · 3.49 Impact Factor
  • S Fridriksson, J Hillman, A M Landtblom, J Boive
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    ABSTRACT: Forty percent of patients with aneurysmal subarachnoid hemorrhage have prodromal warning episodes and difficulties in identifying these events are repeatedly documented. Modifications of diagnostic and referral patterns through educational programs of local doctors may help to identify such patients before a major devastating rupture occurs. A teaching program about sudden onset headache, targeting referring doctors, was systematically applied and its impact on early misdiagnosis of ruptured aneurysms was prospectively studied. Forty percent of all studied patients experienced a warning episode, manifested as apoplectic headache, prior to hospitalization. An initial diagnostic error was evident in 12% of the patients. Diagnostic errors were reduced by 77% as a result of continuous interaction between neurosurgeons and local physicians. Misdiagnosed warning episodes cause greater loss of lives and higher morbidity on a population basis than does delayed ischemic complications from vasospasm in aneurysmal SAH. Teaching programs focused on local physicians have a profound impact on outcome at low cost.
    Acta Neurologica Scandinavica 05/2001; 103(4):238-42. · 2.47 Impact Factor
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    ABSTRACT: Transportation of unstable neurosurgical patients involves risks that may lead to further deterioration and secondary brain injury from perturbations in physiological parameters. Mobile computerized tomography (CT) head scanning in the neurosurgery intensive care (NICU) is a new technique that minimizes the need to transport unstable patients. The authors have been using this device since June 1997 and have developed their own method of scanning such patients. The scanning procedure and radiation safety measures are described. The complications that occurred in 89 patients during transportation and conventional head CT scanning at the Department of Radiology were studied prospectively. These complications were compared with the ones that occurred during mobile CT scanning in 50 patients in the NICU. The duration of the procedures was recorded, and an estimation of the staff workload was made. Two patient groups, defined as high- and medium-risk cases, were studied. Medical and/or technical complications occurred during conventional CT scanning in 25% and 20% of the patients in the high- and medium-risk groups, respectively. During mobile CT scanning complications occurred in 4.3% of the high-risk group and 0% of the medium-risk group. Mobile CT scanning also took significantly less time, and the estimated personnel cost was reduced. Mobile CT scanning in the NICU is safe. It minimizes the risk of physiological deterioration and technical mishaps linked to intrahospital transport, which may aggravate secondary brain injury. The time that patients have to remain outside the controlled environment of the NICU is minimized, and the staff's workload is decreased.
    Journal of Neurosurgery 10/2000; 93(3):432-6. · 3.15 Impact Factor
  • Journal of The Neurological Sciences - J NEUROL SCI. 01/1997; 150.
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    ABSTRACT: A study of the overall management of ruptured posterior fossa aneurysms was conducted over a 1-year period (1993) in five neurosurgical centers in Sweden, serving a population of 6.93 million people. Forty-nine cases were identified and treated. One-third of the patients were in the seventh or eighth decade of life. Good overall management outcomes at 6 months were achieved in 30 cases (61%). The overall mortality rate was 27%. Patients with Hunt and Hess Grades I and II had a good overall recovery rate of 87%. On admission, 69% of the patients were assigned Hunt and Hess Grades III to V. The impact on patient outcomes of the intraoperative difficulties encountered, especially in the basilar tip area, is stressed. The authors found that delayed operation is not warranted in most cases. Frequent devastating rebleeding was observed among patients not offered early aneurysm clipping and the operative results were not at significant variance between the early and late surgical groups. Only 50% of the patients scheduled for delayed surgery ultimately made a good recovery, whereas 72% of patients scheduled for early operation did so. The data demonstrate that overall management results with posterior fossa aneurysms, comparable to achievements with supratentorial lesions, are within the reach of modern strategies, even in centers not specializing in these problems.
    Journal of Neurosurgery 08/1996; 85(1):33-8. · 3.15 Impact Factor
  • Lakartidningen 11/1995; 92(42):3904, 3907.
  • S M Fridriksson, J Hillman, H Säveland, L Brandt
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    ABSTRACT: Thirteen percent of Sweden's population (8.6 million) is aged 70 years or older, and this percentage is expected to increase over the coming decades. We have traced every diagnosed case of subarachnoid hemorrhage in patients older than 70 years in a well-defined catchment population of 953,000 individuals. The age-specific incidence for this group was 16 per 100,000 individuals per year, corresponding to 2.3 per 100,000 inhabitants per year. In most recent population-based surgical series on ruptured aneurysms, few patients in this age group are included, corresponding to only 20 to 25% of the actual number of patients, as shown in this study. Surgery is, in many cases, refused to the "elderly" because of age. However, patients who are neurologically intact after the bleed and who are without severe intercurrent diseases are potential candidates for surgical treatment. In our series, surgery yielded good results in two-thirds of 76 patients aged 70 to 74 years who returned to independent living in good mental condition. Among matched patients being refused surgery because of age, 75% suffered morbidity and mortality, with more than half of the patients having died within the 1st 3 months. When calculated for the entire population of Sweden, our data show that a 14% increase in the number of individuals achieving complete remedy from aneurysm rupture each year can be expected with more active therapy among the elderly. Most of these patients are between 70 and 74 years old. In the 9th decade of life, aneurysm surgery probably best remains an exception.
    Neurosurgery 11/1995; 37(4):627-31; discussion 631-2. · 2.53 Impact Factor