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Edited by Jonathan Wyatt; this scan coordinated by Walid Alsalim
Wernicke’s encephalopathy: room to improve recognition and treatment ▸
This review considers the management of one of the more difficult clinical problems among a notoriously difficult group of accident and emergency (A&E) patients, namely Wernicke’s encephalopathy in alcoholics. The authors hope to raise awareness of Wernicke’s encephalopathy, which they claim is currently significantly underdiagnosed among A&E patients (often for reasons that are entirely understandable). They argue for what appears at first sight to be quite an aggressive set of guidelines of prevention and treatment. Although implementation of these guidelines would have quite a significant impact upon the working practice of many A&E departments, it does seem to be appropriately supported by relevant research.
Corticosteroids and head injury ▸
This paper comprised the abstract of one of the Cochrane Database of Systematic Reviews together with a commentary regarding the possible routine role of corticosteroids in improving outcome among patients with head injury. Given the magnitude of the problem of head injury, even a small improvement in outcome associated with corticosteroids would have a dramatic effect. At the present time, the available data do not justify corticosteroid use, but there is a relative paucity of evidence in this area. Hopefully, the Corticosteroid Administration After Significant Head Injury (CRASH) study will change this and provide an evidence based pointer to guide future treatment.
Corticosteroids and spinal cord injury ▸
In contrast with the management of head injury, there are well established guidelines advocating the use of corticosteroids as part of the early management of spinal cord injury. Given the amount of time and effort that is being directed towards seeking an answer to the possible role of corticosteroids after head injury, it might seem rather perverse if parallel available guidelines for the management of spinal …