Doctor’s Diary: Heard the good information?


The trend of prescribing blood-thinning medicines such as warfarin as a preventive measure against strokes in those with heart rhythm atrial fibrillation, markedly increases the risk of bleeding below the skull, known as a subdural haematoma. Neurosurgeons now see as numerous as 10 circumstances per week that could require a main operation to evacuate the clot of blood pressing on the brain.

The diagnosis, readily confirmed by a CT scan, is relatively easy in those with neurological signs and symptoms following a history of trauma or a fall. But the bleeding may possibly also happen spontaneously and, as Dr Elizabeth Teale of the Leeds Institute of Overall health Sciences observes, “the clinical functions can effortlessly be misinterpreted”.

It might, for example, result in behavioural or character modifications that can mimic a psychiatric illness or dementia. The hazards of a delay in diagnosis are clear adequate, and it is now suggested that people taking warfarin (or other blood-thinning medication, such as clopidogrel) should have a prompt CT scan each time they have even a minor head injury, or build novel mental or neurological symptoms.


The conundrum of last week’s “excruciating pains” has elicited several related accounts. “Mine also come up in either ear or lower jaw, then progress across my neck and shoulders,” writes a reader. “It is a quite unpleasant knowledge.”

The intensity of the discomfort and reasonably brief duration – lasting from 15 minutes to an hour – is also a feature of the syndrome of “cluster headaches”, prompting the suggestion that they might reply to the anti-migraine drug Sumatriptan.


Ultimately, further to the relevance of totally emptying the bladder as a preventive measure towards recurrent cystitis, a reader commends the simple if neglected treatment of potassium citrate (pot cit). Her 1st five years of married life was blighted by significant pain on intercourse brought on by repeated bouts of cystitis – until an elderly relative advised the treatment method. “Pot cit possibly saved my marriage,” she writes.

Electronic mail medical queries confidentially to Dr James LeFanu at kingdom. Solutions will be published each and every Friday, at kingdom/overall health

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