Frenchay Hospital

The advantages of airbags in reducing the rate of severe injuries and fatalities in motor vehicle crashes are well known but the physical act of airbag deployment can lead to injury to the passenger and the spectrum of airbag trauma resulting from deployment of vehicle airbags has been extensively reported. We present the first reported case of a pediatric burn injury resulting from the accidental deployment of an airbag in an aircraft. A four-year-old female child sustained injuries to the left side of her face and body while she was aboard a stationary airplane and the airbag concealed within the seat belt of her airplane seat unexpectedly and inexplicably deployed just before departure. We are presenting the case to increase awareness of the possibility of this injury in aircraft and to enable minimization of such accidents as well as help establish protocols for dealing with such mishaps if there were to happen.

Acute headaches or marked exacerbation of long-standing headaches can present as an emergency. Patients with chronic headache disorders remain at the same risk as the background population for developing life-threatening new headache conditions such as subarachnoid hemorrhage or brain tumour. A comprehensive history, particularly the history of the presenting complaint, is crucial for correct diagnosis. A careful neurological examination looking for evidence of localizing signs secondary to a focal intracranial disturbance is considered. Differential diagnoses used for basic investigations are blood test, imaging, and lumbar puncture (LP). Obtain imaging to exclude an intracranial mass lesion or obstructive hydrocephalus in patients with impaired consciousness or focal neurological deficits or papilloedema prior to performing an LP due to the risk of acute tonsillar herniation, which results in permanent neurological disability or death.

This chapter discusses epidemiology, aetiology and prevention, risk factors, clinical features, investigations, management and prognosis of transient ischaemic attacks. Aetiology is similar to thromboembolic stroke and due to artery-to-artery emboli or cardiac emboli. Prevention includes management of risk factors that is antihypertensives, good diabetic control, cholesterol-lowering agents, regular exercise, and smoking cessation, limitation of alcohol intake and judicious use of HRT in high-risk patients. The risk of stroke is highest very early after Transient ischaemic attacks (TIA); therefore, patients with suspected TIA require easy and rapid access to specialist review and investigation. The ABCD2 score is widely used to estimate individual risk of stroke after TIA and guide management. The chapter presents the differential diagnoses for TIA. Patients with cerebral damage from previous stroke frequently have recurrence of their stroke symptoms when systemically unwell, for example due to infection.

This chapter discusses symptoms, clinical conditions, basic clinical investigation and basic management of gait assessment and disturbance. Gait assessment is an important part of the neurological examination. Gait disturbance may be due to dysfunction within the cortex, cerebral white matter tracts, extrapyramidal system, cerebellum, brainstem, spinal cord or peripheral nervous system. A peripheral gait disturbance may be due to abnormality within a single lumbosacral root or multiple roots, lumbosacral plexus, single or multiple peripheral nerves, the neuromuscular junction or skeletal muscle. Localisation of gait problem requires combining bed testing findings with gait observation. The aetiology, however, is often revealed by the temporal nature of the disturbance and by eliciting the presence or absence of particular associated features. Assessing and managing falls and falls risk is very important for managing gait disturbance.

Alzheimer's disease (AD) is the commonest cause of dementia; other primary causes include frontotemporal lobar degeneration leading to frontotemporal dementia (FTD), Lewy Body dementia (LBD) and Prion disease. Genetic factors play a role in both familial and sporadic cases of AD. This chapter discusses epidemiology, aetiology, pathology/pathogenesis, history, examination, investigations, management, complications, and prognosis of AD. Cerebral atrophy tends to involve the hippocampus and medial temporal lobe structures first, before affecting the rest of the cortex. In AD, symptoms of memory loss are the commonest initial complaint. An important role of investigations, in addition to clinical examination, is to exclude structural or reversible and treatable causes for dementia. Treatment of AD is largely supportive. There are several cholinesterase inhibitors licensed for treatment in mild and moderate dementia in AD to improve cognitive function.

As we leave the “Decade of the Brain” neuropsychiatry has emerged as one of the most exciting and challenging fields in which to work. The BNPA was founded in December 1987 at the suggestion of Dr Jonathan Bird. Professor W A Lishman, the founding Chairman, describes its formation as follows: “The Association was created to provide a forum for cross-disciplinary discussion of matters of common interest among psychiatrists, neurologists, neuropsychologists and workers in the related neurosciences. All suitably qualified persons with an interest in brain function in relation to behaviour would be welcome to join. For this reason, we did not seek formal affiliation with other bodies, such as the Royal College of Psychiatrists, but decided to stand as an independent association. Young members bringing fresh ideas would be particularly encouraged to join, by keeping fees to a minimum and the establishment of appropriate prizes”. At the 2015 AGM Dr Jonathan Bird was awarded an honorary fellowship of the BNPA. Jonathan’s fellowship was proposed by Professor Alwyn Lishman (Honorary Life President) who hoped the BNPA would recognise Jonathan’s “sustained work and service over many years in the promotion of present day neuropsychiatry”. In his commendation, he revealed that it was in fact Jonathan who first to suggested, to a group of like-minded colleagues, including Alwyn himself, the formation of the BNPA. Jonathan went on to serve as the secretary throughout its early years. The ability to bring people together towards common goals has continued and Jonathan was instrumental in forming the Section of Neuropsychiatry at The Royal College of Psychiatrists, and then serving as its first chair. He helped, although ably assisted by Dr Rafey Faruqui who succeeded him as chair, in guiding the nascent section through to the establishment of the status of Faculty, which is a major step forward as a mechanism for improving services and the development of recognised training. Jonathan originally read medicine at the University of Bristol, where he achieved the Prize for Physiology and did his junior training in the region. He went on to the Maudsley Hospital for his higher training, winning the prestigious Gaskell medal of the Royal College of Psychiatrists. He then worked as Clinical fellow at McMaster and was exposed to many of their revolutionary teaching approaches before returning to the Maudsley and then completing the circle with a return to Bristol to take up a consultant post at Burden Centre for Neuropsychiatry, Neuropsychology and Epileptology, Frenchay Hospital, Bristol. He has been active throughout his consultant career in Epilepsy Action and served as Chairman of their Professional Advisory Panel.

A 51-yr old Caucasian man who ran a successful plumbing business was admitted with sudden left hemiparesis and confusion. MRI confirmed an acute right frontal lobe cerebral infarction. Neuropsychological assessment revealed impaired visual perception and construction, and left visual neglect. There was impairment with sequencing of tasks, working memory, and higher executive function. His hemiparesis resolved quickly but the cognitive deficits subsequently resulted in loss of his business and a massive financial debt accumulation.