Oxidative Stress Following Traumatic Brain Injury: Enhancement of Endogenous Antioxidant Defence Systems and the Promise of Improved Outcome

Background: Management of brain injury can pose enormous challenges to the health team. There are many studies aimed at discovering or developing pharmacotherapeutic agents targeted at improving outcome of head-injured patients. This paper reviews the role of oxidative stress in neuronal loss following traumatic brain injury and presents experimental and clinical evidence of the role of exogenous antioxidants as neuroprotectants. Method: We reviewed published literature on reactive oxygen species and their role in experimental and clinical brain injuries in journals and the Internet using Yahoo and Google search engines. Results: Traumatic brain injury causes massive production of reactive oxygen species with resultant oxidative stress. In experimental brain injury; exogenous antioxidants are useful in limiting oxidative damage. Results with clinical brain injury are however more varied. Conclusion: Oxidative stress due to excessive generation of reactive oxygen species with consequent impai rment of endogenous antioxidant defence mechanisms plays significant role in the secondary events leading to neuronal death. Enhancement of the defence mechanisms through the use of exogenous antioxidants may be neuroprotective; especially the agents can penetrate cell membranes; are able to cross the blood-brain barrier and if they are administered within the neuroprotective time window

Orgasmic Cephalgia : an Uncommon Presentation

Background: Orgasmic cephalgia is rare; but it is likely that its prevalence is underestimated because of patients' arriere pensee when it comes to disclosing personal information concerning their sexual activities. Aim: To report a case of orgasmic cephalgia in a 34-year-old housewife. Method: All information was obtained from her medical records and investigation results. Relevant literature on headaches associated with sexual activity was also reviewed. Result: Patient developed sudden onset severe headache at orgasm; which rapidly worsened over 6 months to the extent that she began to dread all forms of sexual activity. She had only used unprescribed medication. She responded well to naratriptan and anxiolytics. By the third month of treatment; her headaches had completely disappeared. Conclusion: Most cases of orgasmic cephalgia are benign and probably do not require specific treatment. Triptans are useful for those that do not respond to conventional analgesics

Alterations in Family Psychodynamics Following a Ventriculoperitoneal Shunt Placement

Background: The emotional stress of a young couple whose child has hydrocephalus can be immense. When a shunt has to be inserted without the parents being thoroughly educated on every aspect of the procedure; the situation can be overwhelming and significant psychosocial problems can develop. Aim: To report the case of behavioural change in the father of a hydrocephalic child who underwent shunt placement and the threat of family collapse due to misconceptions about the procedure. Method : The records of the child; including history; examination; investigations and treatment were evaluated. The mother was extensively interviewed during follow-up out-patient visits. Relevant literature on shunt complications was reviewed. Result: Following shunt insertion for hydrocephalus in an only child of a young couple born after 3 years of marriage; the father started withdrawing from his family and gradually began to manifest symptoms of depressive illness. Recommendations: The parents of every child scheduled to have shunt insertion should be properly counselled together on all aspects of the procedure preoperatively. This would help ensure that any consent given is on the basis of their mutual understanding and acceptance of the situation. Where problems are anticipated; it might be necessary to take pre-emptive measures to forestall their occurrence

Alterations in family psychodynamics following a ventriculoperitoneal shunt placement

Background: The emotional stress of a young couple whose child has hydrocephalus can be immense. When a shunt has to be inserted without the parents being thoroughly educated on every aspect of the procedure; the situation can be overwhelming and significant psychosocial problems can develop. Aim: To report the case of behavioural change in the father of a hydrocephalic child who underwent shunt placement and the threat of family collapse due to misconceptions about the procedure. Method: The records of the child; including history; examination; investigations and treatment were evaluated. The mother was extensively interviewed during follow-up out-patient visits. Relevant literature on shunt complications was reviewed. Result: Following shunt insertion for hydrocephalus in an only child of a young couple born after 3 years of marriage; the father started withdrawing from his family and gradually began to manifest symptoms of depressive illness. Recommendations: The parents of every child scheduled to have shunt insertion should be properly counselled together on all aspects of the procedure preoperatively. This would help ensure that any consent given is on the basis of their mutual understanding and acceptance of the situation. Where problems are anticipated; it might be necessary to take pre-emptive measures to forestall their occurrence