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Acute evaluation of the acute vestibular syndrome – differentiating posterior circulation stroke from acute peripheral vestibulopathies
Abstract This review article aims to provide an evidence‐based approach to evaluating the patient who presents with acute prolonged, spontaneous vertigo in the context of the acute vestibular syndrome (AVS). Differentiation of posterior circulation stroke presenting as an acute vestibular syndrome has been regarded as an important diagnostic challenge for physicians involved in acute care. Current evidence suggests that a targeted approach to history taking and physical examination with emphasis on the oculomotor examination, more specifically the HINTS (Head Impulse/ Nystagmus/Test‐of‐skew) examination battery, yiel...
Source: Internal Medicine Journal - July 11, 2017 Category: Internal Medicine Authors: Benjamin Kwok ‐Tung Tsang, Alex Siew‐Kar Chen, Mark Paine Tags: Review Source Type: research

Recognition of giant cell arteritis in patients with polymyalgia rheumatica who have a stroke: a cautionary tale
Abstract An 82‐year‐old woman with polymyalgia rheumatica (PMR) on prednisone 7 mg daily was admitted to an acute stroke unit with a right homonymous hemianopia, a left posterior cerebral artery occlusion and occipital lobe infarct. She had raised inflammatory markers, did not have a temporal artery biopsy, and was discharged on the same dose of prednisone. After 21 months, off prednisone, her ophthalmologist, concerned about giant cell arteritis (GCA), restarted prednisone 40 mg daily, with rapid, profound visual improvement. After 3 days her general practitioner, noting normal baseline inflammatory markers, stopp...
Source: Internal Medicine Journal - October 9, 2017 Category: Internal Medicine Authors: Donald H. Gutteridge, Frank L. Mastaglia Tags: Brief Communication Source Type: research

Acute evaluation of the acute vestibular syndrome: differentiating posterior circulation stroke from acute peripheral vestibulopathies
Abstract This review article aims to provide an evidence‐based approach to evaluating the patient who presents with acute prolonged, spontaneous vertigo in the context of the acute vestibular syndrome (AVS). Differentiation of posterior circulation stroke (PCS) presenting as an AVS has been regarded as an important diagnostic challenge for physicians involved in acute care. Current evidence suggests that a targeted approach to history taking and physical examination with emphasis on the oculomotor examination, more specifically the HINTS (Head Impulse/Nystagmus/Test‐of‐skew) examination battery, yields a higher sensi...
Source: Internal Medicine Journal - December 10, 2017 Category: Internal Medicine Authors: Benjamin K. T. Tsang, Alex S. K. Chen, Mark Paine Tags: Review Source Type: research

Burden of Atrial Fibrillation in M āori and Pacific People in New Zealand: A Cohort Study
ConclusionAF screening and stroke thromboprophylaxis in Māori and Pacific people could start below the age of 65 years in NZ.
Source: Internal Medicine Journal - October 16, 2017 Category: Internal Medicine Authors: Yulong Gu, Robert N Doughty, Ben Freedman, John Kennelly, Jim Warren, Matire Harwood, Richard Hulme, Chris Paltridge, Ruth Teh, Anna Rolleston, Natalie Walker Tags: Original Article Source Type: research

Atrial fibrillation in older inpatients: are there any differences in clinical characteristics and pharmacological treatment between the frail and the non‐frail?
ConclusionsFrailty status had little impact on antithrombotic prescription and no impact on anti‐arrhythmic prescription.
Source: Internal Medicine Journal - September 19, 2015 Category: Internal Medicine Authors: T. N. Nguyen, R. G. Cumming, S. N. Hilmer Tags: Original Article Source Type: research

Does measurement of ankle‐brachial index contribute to prediction of adverse health outcomes in older Chinese people?
ConclusionsABI measurement (<0.9) predicted adverse outcomes with high specificity but low sensitivity. However it added little incremental value to prediction of adverse outcomes using traditional cardiovascular risk factors.
Source: Internal Medicine Journal - February 21, 2013 Category: Internal Medicine Authors: J Woo, J Leung Tags: Original Article Source Type: research

Recent advances in the management of transient ischaemic attack: a clinical review
Abstract Transient ischaemic attack (TIA) if untreated carries a high risk of early stroke and is associated with poorer long‐term survival. There have been recent advances in the understanding of TIA, its investigations, management and organisation of services for patient care. Clinically, patients are diagnosed TIA if they have transient sudden‐onset focal neurological symptoms which usually completely and rapidly resolve by presentation. Patients with residual symptoms should be evaluated as potentially having stroke, if they present within 4.5 h of onset, should be urgently evaluated for their potential eligibili...
Source: Internal Medicine Journal - April 1, 2013 Category: Internal Medicine Authors: T. G. Phan, L. Sanders, V. Srikanth Tags: Review Source Type: research

Do physicians correctly calculate thromboembolic risk scores? A comparison of concordance between manual and computer‐based calculation of CHADS2 and CHA2DS2‐VASc scores
CONCLUSIONWe have found a strong concordance between manual and computer‐based score calculation of both CHADS2 and CHA2DS2‐VASc risk scores with minimal changes in anticoagulation recommendations. The use of CHA2DS2‐VASc score significantly improves classification of atrial fibrillation patients at low and intermediate risk of stroke into higher grade of thromboembolic score. Moreover, CHA2DS2‐VASc score could identify ‘truly low risk” patients compared to CHADS2 score.
Source: Internal Medicine Journal - March 1, 2016 Category: Internal Medicine Authors: María Asunción Esteve‐Pastor, Francisco Marín, Vicente Bertomeu Martínez, Inmaculada Roldán Rabadán, Ángel Cequier Fillat, Lina Badimon, Javier Muñiz García, Mariano Valdés, Manuel Anguita Sánchez, Tags: Original Article Source Type: research

Burden of Atrial Fibrillation: A Retrospective Review of Patients Presenting to Acute Medical Services
ConclusionAnti‐coagulation for stroke prevention in AF remains under‐utilised in eligible patients presenting to acute medical services at a tertiary level hospital.
Source: Internal Medicine Journal - June 30, 2016 Category: Internal Medicine Authors: Evan Jolliffe, Vivian Fu, Jeremiah Lanford, Mark Weatherall, Ian Rosemergy Tags: Original Article Source Type: research

Left atrial appendage occlusion with the Watchman device in a patient with paroxysmal atrial fibrillation and intolerance of all forms of anticoagulation due to hereditary haemorrhagic telangiectasia
Abstract An elderly woman presented to our attention because of paroxysmal atrial fibrillation and cerebrovascular events requiring systemic anticoagulation and a concomitant, serious bleeding diathesis (the Osler‐Weber‐Rendu syndrome, or hereditary haemorrhagic telangiectasia). Her risk of suffering a major stroke was significant given a CHA2DS2VASc score of 6. However, she was unable to tolerate any form of anticoagulation because of torrential epistaxis and previous gastrointestinal haemorrhage on antiplatelet therapy. We proceeded with percutaneous occlusion of the left atrial appendage with a Watchman device. Ten ...
Source: Internal Medicine Journal - March 13, 2014 Category: Internal Medicine Authors: R. Spina, B. Gunalingam Tags: Brief Communication Source Type: research

Elevated mean platelet volume is associated with silent cerebral infarction
ConclusionMPV is a novel index for SCI regardless of classical cardiovascular risk factors.
Source: Internal Medicine Journal - April 21, 2014 Category: Internal Medicine Authors: Bing Li, Xin Liu, Zhi‐gang Cao, Ying Li, Tie‐min Liu, Rui‐tao Wang Tags: Original Article Source Type: research

Stroke physician versus stroke neurologist: can anyone thrombolyse? – a general hospital experience and perspective
Source: Internal Medicine Journal - September 1, 2015 Category: Internal Medicine Authors: T. R. Bates, A. C. Boudville, D. K. Ghia, L. K. Kho, P. L. Silbert, M. Lee Tags: Letter to the Editor Source Type: research

Outcomes of Transcatheter Aortic Valve Implantation in High Surgical Risk and Inoperable Patients with Aortic Stenosis ‐ A Single Australian Centre Experience
ConclusionsTAVI with various valve systems, delivered via a number of approaches, is feasible in high surgical risk and inoperable patients with severe aortic stenosis, with acceptable outcomes at short‐ and intermediate‐term follow‐up.
Source: Internal Medicine Journal - October 1, 2015 Category: Internal Medicine Authors: Vijayakumar Subban, Dale Murdoch, Michael L Savage, James Crowhurst, Ramakrishna Saireddy, Karl K Poon, Alexander Incani, Nicholas Bett, Darryl J Burstow, Gregory M Scalia, Andrew Clarke, Owen Christopher Raffel, Constantine N Aroney, Darren L Walters Tags: Original Article Source Type: research

Outcomes are superior in patients with acute stroke from new zealand versus rest of world: data from the efficacy of nitric oxide in stroke (enos) trial
Source: Internal Medicine Journal - May 14, 2016 Category: Internal Medicine Tags: Abstracts Source Type: research

Capturing atrial fibrillation post acute stroke: stroke unit versus coronary care monitored telemetry
Source: Internal Medicine Journal - May 8, 2017 Category: Internal Medicine Authors: Valente M, Dewey HM, Choi PM Tags: Abstracts Source Type: research

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