Can J Neurol Sci
-
The American Academy of Neurology recommended using phenytoin or carbamazepine to prevent early post-traumatic seizures (PTS) in severe traumatic brain injuries (TBI). In this study, we examined the effects of using phenytoin prophylaxis on mild, moderate, and severe TBIs. There have been no studies looking at compliance rate and side effects of systematic use of phenytoin at a large population scale. The goal of this study is to determine 1) the proportion of TBI patients receiving phenytoin prophylaxis; 2) which parameters decided when to decide administer phenytoin; 3) prophylaxis efficacy and complication rate. ⋯ Phenytoin is used according to guidelines, with CT scan being the main decision factor for its use. The frequency of early PTS rate is low and side effects are rare. However, earlier administration of phenytoin and adequate levels could further prevent early PTS.
-
The objective of this study was to investigate whether medical television dramas portray proper seizure first aid. ⋯ The first aid management of seizures performed by actors portraying health care professionals was inappropriate in nearly half of all cases. Inaccurate depiction of seizure first aid management may contribute to misinformation of the general public. The television industry could easily incorporate the simple first aid EFA seizure guidelines as a public service without sacrificing dramatic impact.
-
There have been great advances in the neurological sciences in recent years including some in the higher functions of the brain such as memory but one of the more critical of these with close ties to memory is consciousness which remains an enigma. Revolutionary developments in genetics during the last two decades, referred to as epigenetics, have provided opportunity for discovery. ⋯ DNA is also directly activated or inhibited by methyl groups and by non-coding RNAs. Epigenetics is a determinant in long-term cell memory consolidation and, as recently demonstrated in animal and human studies and described here, these effects enable a rapid and extraordinarily complex cognitive matching of cell memory to experience during consciousness.
-
Delirium affects a diverse patient population, may present with highly variable clinical features, is a source of distress for patients and their caregivers, prolongs hospital stays and may herald a poor prognosis. Many cases of delirium are reversible and therefore a full history, physical examination and investigations should be performed. Ahigh degree of suspicion is required for detecting delirium and thorough investigations are necessary in order to determine the underlying etiology and to maximize the potential for reversibility. The following review outlines important aspects of a clinical approach to delirium, the differential diagnosis of delirium, investigation of a patient presenting with delirium, management of delirium, the pathophysiology of delirium and the prognosis accompanying delirium.