ABSTRACT
BACKGROUND: Anti-epileptic drug (AED) prophylaxis in the first-seven days post-traumatic brain injury (TBI) is known to reduce seizure frequency acutely. AED efficacy is equivalent; therefore, choice of AED may rest with their side-effects. We hypothesise that AEDs that impair balance will prolong recovery, shown by a longer hospital stay. We compared length of hospital stay (and reported dizziness) in TBI patients receiving the commonest AEDs used in our TBI patients, Phenytoin (which may cause imbalance), and Levetiracetam (which does not affect balance). METHOD: A retrospective observational study was performed on TBI patients admitted to a Major Trauma Unit between October 2013 and June 2018. 100 of 278 patients treated with phenytoin or levetiracetam monotherapy for seizure prophylaxis were included. The inclusion criteria of admission Glasgow Coma Score of 14 or more and length of stay less than 3 weeks minimised confounding variables such as non-ambulant patients. Length of hospital stay and incidence of dizziness were assessed. RESULTS: The length of hospital stay was longer for patients on Phenytoin versus Levetiracetam, i.e., 10.74 vs. 7.58 days (p = 0.015; unpaired, two-sided t test). Dizziness reported by patients on phenytoin was 24% and levetiracetam was 8% (p = 0.018; Chi-squared test). CONCLUSION: In this cohort, using Phenytoin for acute TBI, seizure prophylaxis was associated with longer length of stay and more dizziness compared to Levetiracetam. Given their equivalent AED efficacy in acute TBI seizure prophylaxis, our data suggest that Levetiracetam is preferable to Phenytoin for early seizure prophylaxis in TBI. This requires evaluation in larger, prospective studies.
Subject(s)
Anticonvulsants/pharmacology , Brain Injuries, Traumatic/therapy , Dizziness/chemically induced , Length of Stay , Levetiracetam/pharmacology , Phenytoin/pharmacology , Postural Balance/drug effects , Seizures/prevention & control , Adolescent , Adult , Aged , Aged, 80 and over , Anticonvulsants/adverse effects , Brain Injuries, Traumatic/complications , Female , Glasgow Coma Scale , Humans , Levetiracetam/adverse effects , Male , Middle Aged , Phenytoin/adverse effects , Retrospective Studies , Seizures/etiology , Treatment Outcome , Young AdultABSTRACT
Papillary tumour of the pineal region (PTPR) is a relatively new and rare pathological entity, which appears to run a spectrum of clinical courses. We add another case with detailed description of the clinical course documented with serial imaging over the total of 7 years. In accordance with previous reports we recommend total surgical resection with subsequent focal radiotherapy. Clinical and radiological follow up of the entire cerebrospinal axis is mandatory.
Subject(s)
Adenocarcinoma, Papillary/surgery , Hydrocephalus/diagnosis , Peritoneovenous Shunt/methods , Pineal Gland/surgery , Adenocarcinoma, Papillary/diagnostic imaging , Adult , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/surgery , Disease Progression , Humans , Hydrocephalus/surgery , Male , Pineal Gland/diagnostic imaging , Radiography , Treatment OutcomeABSTRACT
A 3570 gram male newborn was born to a 29-year-old mother at the gestational age of 40 weeks with gross abnormalities of flexion contracture of third and fifth fingers and fourth toes bilaterally. After birth, cyanotic spell while feeding was found, and a series of examinations were done. The abnormalities were focused on brain echogram, computed tomogram and magnetic resonance imaging examination, which showed a large posterior fossa cyst, cerebellar hypoplasia complicated with multiple severe supratentorial anomalies, including marked ventricular dilatation, cerebral agyria, agenesis of corpus callosum, absence of thalamus and basal ganglion, and optic nerve atrophy. Clinically, the patient had neonatal seizure and high fever. The diagnosis of Dandy-Walker complex type A was made according to the new classification presented by Barkovick et al. in 1989.
