Search & Filter

Bilateral stroke is an extremely rare event. In a study of 1,838 patients, bilateral anterior infarctionaccounted for only 0·27% of stroke patients. We report the case of an 84-year-old woman who presentedwith bifrontal haemorrhagically transformed infarcts in the anterior cerebral arteries.

Stroke is a major complication in patients with diabetes and hypertension. Patients should be made aware of the complications and the importance of stroke-prevention strategies. Patients with diabetes and hypertension should be treated intensively to achieve a target value of 130/80 mmHg or lower, since optimum blood-pressure goals are achieved in only 5% of patients with diabetes. Target blood pressure is achievable only by active participation of patients in their care, patients' education, involvement of multidisciplinary health workers in the community, and timely secondary-care input. Local guidelines on blood-pressure control should be implemented rigorously for stroke prevention and improved care.

Apomorphine was first synthesised in 1869, and has been used in the treatment of Parkinson's disease for morethan 50 years. It is a potent non-selective dopamine agonist. Current use is restricted to patients with advancedParkinson's disease who have lengthy and unpredictable off periods. It has also been used as a diagnostic tool forParkinsonian disorders. Many trials, albeit with small numbers of patients, have shown efficacy of subcutaneousapomorphine. Particular benefits are reductions in duration and frequency of off periods (comparable to that oflevodopa), and reduction in daily levodopa requirements. NICE has provided guidance regarding apomorphineas a second-line agent, but states that it should not be used as a diagnostic test. Apomorphine is not widely usedin the UK, yet specialist centres have acknowledged the potential of this drug. Further evidence is still neededfrom large clinical trials, therefore, its use will remain limited. However, apomorphine has its place in thetreatment of Parkinson's disease and should be considered before invasive measures.

We report a case of spontaneous intramural haematoma in an elderly woman.

We report on a patient with acute-onset facial and bulbar palsy that deteriorated within a weekneeding ventilatory support. He was initially treated for Guillain-Barre syndrome in view of the acuteonset and non-fluctuating course of illness, absence of previous history of palsy, and acute respiratorydecompensation. The patient's tensilon test was negative but his acetylcholine-receptor antibody titrewas high, confirming a diagnosis of myasthenia gravis. There were no associated features of thymoma.He responded well to pyridostigmine and prednisolone.

The rise in life expectancy and fall in mortality at older ages has brought with it a fear of an increasedburden of chronic disease to society. Data suggest that these fears are perhaps overly pessimistic and thatthe proportion of one's life spent in ill health may actually be falling. There are numerous advancementsand strategies, medical and non-medical, that are already being implemented to compress morbidity insociety. Our ageing population is definitely not a crisis but is a challenge we need to address.

Trigeminal neuralgia is a severe unilateral intermittent facial pain that is unresponsive to normal analgesics. First-line drug treatment is carbamazepine, but side-effects are common. Additionally, several surgical techniques are available with varying risks and efficacy, meaning that options exist for all patients, even the very frail.

The inexorable progression of type 2 diabetes frequently leads patients to need insulin replacement. Manybarriers exist to starting insulin therapy, including reluctance of patients to accept lifelong injections.Inhalation of insulin has been suggested for many years, and recent advances in technology made thismethod a reality. Exubera was the first inhalable insulin product to launch, and several other inhaledinsulin systems are in development. Inhaled insulin is effective at lowering plasma glucose, and manypatients express a preference to use it over injecting insulin. Concerns over cost-benefit and pulmonaryadverse effects do not allow recommendation of widespread use of this treatment. Nevertheless, it couldbe helpful for overcoming barriers to insulin therapy in some patients with diabetes who need insulin.The untimely withdrawal of Exubera for non-clinical reasons, therefore, is a substantial therapeuticloss for some patients patients who are unable to inject insulin.

More than 16,000 people die from bowel cancer each year in the UK. It is the second most commoncause of death from cancer.1 The aim of the NHS Bowel Cancer Screening Programme is to reducethe number of deaths by diagnosing patients at an earlier and more treatable stage. Bowel Cancer UK'sDirector of Press, Public Relations, and Public Affairs, Ian Beaumont, talks to Dawn Powell aboutbowel cancer and the screening programme.

We report on an unsual case of difficulty walking in an octogenerian on warfarin therapy.

Coeliac disease is an increasingly recognised autoimmune disease against gluten, a protein found infood such as wheat. This disease is controlled with a gluten-free diet. The consequences of coeliacdisease, especially if diagnosed later in life, include anaemia, reduced bone-mineral density, andgastrointestinal tumours.

This article discusses the evolution of central dual-energy X-ray absorptiometry (DXA) as a tool forthe diagnosis and management of postmenopausal osteoporosis. The derivation of normal values isconsidered and this is then linked with guidance on clinical interpretation. Peripheral densitometry canindicate risk of fracture in certain situations, but is not covered here.

This article focuses on the diagnosis and treatment of men with breast cancer. Risk factors for developingthe condition are also examined. Because of the relative rarity of the condition in men, research evidenceis scant resulting in difficulties in identifying best practice. Collaborative international research mayhelp to address this problem.

Alzheimer's disease seems to share the same vascular risk factors as vascular dementia and cardiovasculardisease. The evidence for this, although far from complete, continues to grow, and the potential toprevent and control Alzheimer's disease should add increased urgency and enthusiasm to the controlof shared risk factors. Research also suggests that the brain has considerable cognitive recuperativepotential, which is maximised by control of vascular risk factors. Doctors and health-care professionalsshould be more active in informing and educating those at risk, from middle-age onwards, of thepotential benefits of controlling these common risk factors and adoption of healthier life styles. Patientsmust be involved in their own health care to enable them to attain optimum health.

Sexual health in postmenopausal women€”a report of the meeting women of a certain age: the unspokensymptoms, held at the Royal College of Obstetricians and Gynaecologists, London, on March 11, 2008. Amix of health-care workers of differing backgrounds came together to raise awareness among colleaguesin frank and open discussion of the sexual health issues that affect older women. This subject is not onthe agenda for many consultations with older women, but as they say, the first step is acknowledgingthe problem. Doctors need to be aware of postmenopausal genital disorders and ask patients if they areliving with any symptoms, because the patient might never ask.