Search

Background: Anticonvulsant prophylaxis (ACP) for early post-traumatic seizures (PTS) is recommended in patients with traumatic brain injury (TBI). Phenobarbital (PB) may be used to prevent alcohol withdrawal syndrome (AWS) in at-risk patients. The dual-purpose use of PB in the TBI population would allow for consolidation of pharmacotherapy. Objective: The primary objective of this study was to determine the frequency of early PTS in TBI patients at risk of AWS treated with PB as ACP. Secondary objectives included determining rates of over sedation and endotracheal intubation. Methods: Patients received an intravenous (IV) loading dose of PB at 15-20 mg/kg followed by 1 mg/kg every 12 hours for 7 days with a goal level of 15-20 mcg/mL. Medication data, seizure frequency, and episodes of over sedation and endotracheal intubation were collected. Results: Eighty patients were treated with PB over a 1-year period. Thirty-nine patients were analyzed. Median loading dose was 19.9 (Interquartile Range 19.1-20.0) mg/kg with a median post load level of 21.7 mcg/mL (IQR 18.3-25.8) mcg/mL. One patient (2.6%) had electrographic evidence for early PTS. PB was discontinued in 4 (10.3%) patients out of concern for over sedation. One patient required endotracheal intubation after rapid PB loading. Conclusion: The frequency of early PTS was low when PB was used as primary ACP in patients with TBI at risk for AWS. Over sedation is a potential adverse effect that should be considered in the choice of ACP. No conclusions can be drawn as to the effectiveness of PB in preventing AWS. [ABSTRACT FROM AUTHOR]

We describe a 31-year-old woman who presented with acute right-sided weakness and was found to have a subarachnoid hemorrhage in the left Sylvian fissure and an ipsilateral frontal intraparenchymal hemorrhage. CT angiography revealed an occlusion of the left middle cerebral artery's M1 segment and a saccular aneurysm at its bifurcation. A cerebral angiogram confirmed these findings, and the patient subsequently underwent microsurgical aneurysm resection, which revealed a partially thrombosed pseudoaneurysm. Further stroke workup identified mitral valve vegetation, confirming the diagnosis of infective endocarditis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Singh et al.)

Encephalitis is characterized by inflammation of the brain parenchyma with typical presenting symptoms of altered mental status and seizures. However, diagnostic workup is complex given the multitude of possible etiologies for encephalitis. Further, recurrence of encephalitis is rare, and understanding its risk factors, mechanisms, prognosis, and optimal treatment remains incomplete. Here, we present the case of a 69-year-old woman admitted to our hospital with altered mental status who was diagnosed with encephalitis based on clinical and imaging findings. This case highlights the diagnostic approaches required to obtain the final diagnosis and the treatment plan that resulted in the patient's eventual return to baseline and functional independence., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Okar et al.)