Clin Med
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Epilepsy is common and has a variety of causes and associated pathologies. Increased understanding of the pathophysiology underlying the epilepsies and advances in classification, diagnostic imaging and drug treatments have led to a reduction in stigma and growing demand for services to be improved for patients. A number of important reports and guidelines have emerged in the UK in recent years, which are summarised here. Diagnosis, classification, management and models of care are discussed as well as the management of drug intractable seizures, status epilepticus, and approaches to special patient groups: women in the fertile years, the elderly and those with learning difficulties.
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Evidence shows clear benefit of anticoagulation for prosthetic heart valves but consideration must be given to coexisting medical conditions.
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This questionnaire-based study assessed the attitudes of the general public to the symptoms of a transient ischaemic attack (TIA) and determined the current level of knowledge about the management of TIA among doctors. The public chose to wait for symptom recurrence before seeking medical advice for amaurosis (41%) and upper limb (UL) monoparesis (51%), sensory loss (68%), or paraesthesia (95%). However, medical advice would be sought most often for slurred speech alone (89%) or combined with UL monoparesis (99%). ⋯ In conclusion, the general public does not recognise the importance of TIA symptoms and the need for rapid assessment. This is compounded by deficiencies in the medical management of TIA. Stroke guidelines will remain ineffective without public awareness campaigns and physician education.
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In 2003, occasional military patients with hyponatraemia, hypokalaemia and alkalosis were encountered in Iraq. Development of central pontine myelinolysis in one patient indicated treatment should be cautious. Two years later, heat illness continued to occur during the very hot summer months and 23 cases were admitted to a British military field hospital near Basra, Iraq. ⋯ These electrolyte changes were compatible with secondary hyperaldosteronism but field conditions constrained further investigation. Hyponatraemia was probably due to salt deficiency rather than overhydration. In some military personnel summer salt supplementation could be essential during operations in hot countries.