Atrial fibrillation in cryptogenic stroke and transient ischaemic attack - The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Rationale and design.

PURPOSE: Paroxysmal atrial fibrillation is often suspected as a probable cause of cryptogenic stroke. Continuous long-term ECG monitoring using insertable cardiac monitors is a clinically effective technique to screen for atrial fibrillation and superior to conventional follow-up in cryptogenic stroke. However, more studies are needed to identify factors which can help selecting patients with the highest possibility of detecting atrial fibrillation with prolonged rhythm monitoring. The clinical relevance of short-term atrial fibrillation, the need for medical intervention and the evaluation as to whether intervention results in improved clinical outcomes should be assessed. METHOD: The Nordic Atrial Fibrillation and Stroke Study is an international, multicentre, prospective, observational trial evaluating the occurrence of occult atrial fibrillation in cryptogenic stroke and transient ischaemic attack. Patients with cryptogenic stroke or transient ischaemic attack from the Nordic countries are included and will have the Reveal LINQ® Insertable cardiac monitor system implanted for 12 months for atrial fibrillation detection. Biomarkers which can be used as predictors for atrial fibrillation and may identify patients, who could derive the most clinical benefit from the detection of atrial fibrillation by prolonged monitoring, are being studied. CONCLUSION: The primary endpoint is atrial fibrillation burden within 12 months of continuous rhythm monitoring. Secondary endpoints are atrial fibrillation burden within six months, levels of biomarkers predicting atrial fibrillation, CHA2DS2-VASc score, incidence of recurrent stroke or transient ischaemic attack, use of anticoagulation and antiarrhythmic drugs, and quality of life measurements. The clinical follow-up period is 12 months. The study started in 2017 and the completion is expected at the end of 2020.

[Neurology referrals in Troms and Finnmark]. / Henvisning til nevrolog i Troms og Finnmark.

BACKGROUND: A system of giving all patients referred to hospital a guaranteed priority has been introduced in Norway. We wished to investigate whether the frequency of first- time referrals from general practioners to neurological out-clinics varied between the two northernmost counties and between selected municipalities in that region of Norway. MATERIAL AND METHODS: We studied referrals for specialist consultations at the neurological out-clinic in Tromsø during 12 months. Inclusion criteria were: 1) referral from a general practitioner and 2) referral for diagnosis. RESULTS: Of totally 2260 referred patients, 1265 were referred without a specific diagnosis (56 %). The mean age for patients referred from Finnmark county (45.5 years) was somewhat lower than for Troms county (48.0 years). The frequency of referral varied from 0.5 % in Troms and 0.6 % in Finnmark to 1 % in the small municipality of Lyngen. Neurological examination showed abnormal findings in about a third of the patients. Information about patients' ability to work was reported for 23 % of those referred. Locums were less likely to include this information. INTERPRETATION: In spite of a lower age and a greater distance to the out-clinic, there were slightly more referrals from Finnmark than from Troms. This may indicate that ambulatory organization of neurologists visiting patients in their home area involves no great change in referral practice.

[Idiopathic intracranial hypertension]. / Idiopatisk intrakranial hypertensjon.

BACKGROUND: Idiopathic intracranial hypertension is a rare syndrome of increased intracranial pressure without a massive lesion or abnormal cerebrospinal fluid. Common symptoms include headache and visual disturbances such as transient visual obscurations or visual loss. Treatment may alleviate symptoms and prevent serious complications. In this study, we present 10 cases illustrating aspects of the disease including causes and treatment options. We also evaluated the effect of treatment and compared the incidence with other studies. MATERIAL AND METHODS: We registered all patients and reviewed the medical notes on patients with intracranial hypertension treated at Tromsø University Hospital over a five-year period (1999-2003). RESULTS AND INTERPRETATION: We identified 10 patients with intracranial hypertension; 6 of them fulfilled the criteria of the International Headache Society for idiopathic intracranial hypertension while 4 had secondary intracranial hypertension caused by medication such as oral contraceptives or tetracycline, or by surgical therapy. Idiopathic or secondary intracranial hypertension should be considered in patients with unexplained chronic headache.