S Fridriksson

University Hospital Linköping, Linköping, Östergötland, Sweden

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Publications (5)15.08 Total impact

  • Journal of Neurosurgery 10/2002; 97(4):751-752. · 3.23 Impact Factor
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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. DOI:10.1046/j.1468-2982.2002.00368.x · 4.12 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. DOI:10.1034/j.1600-0404.2001.103004238.x · 2.44 Impact Factor
  • Journal of the Neurological Sciences 09/1997; 150. DOI:10.1016/S0022-510X(97)84995-7 · 2.26 Impact Factor
  • 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. DOI:10.1227/00006123-199510000-00004 · 3.03 Impact Factor