'Khatatonia' - cathinone-induced hypertensive encephalopathy.

Khat consumption is an under-recognised cause of hypertensive encephalopathy and intraparenchymal brain haemorrhage. We report the radiological findings of extensive periventricular, subcortical and brain stem white matter pathology of a patient who had consumed excessive amounts of Khat. The Khat plant contains cathinone, an amphetamine-like alkaloid which has been associated with chronic hypertensive end-organ damage, but is seldom considered a cause of cerebrovascular events in northern Europe.

Post Traumatic Tension Pneumocephalus: The Mount Fuji Sign.

Pneumocephalus is defined as the presence of intracranial air. This is most commonly secondary to a traumatic head injury. Tension pneumocephalus presents radiologically with compression of the frontal lobes and widening of the interhemispheric space between the frontal lobes. It is often termed the Mount Fuji sign due to a perceived similarity with an iconic mountain peak in Japan. We present the case of a 52-year-old gentleman who presented to the emergency department shortly before 8am on a Saturday morning following an assault. He was alert and ambulatory with no clinical evidence of raised intracranial pressure. A plain radiograph of the facial bones showed significant pneumocephalus. A later CT was consistent with a tension pneumocephalus which usually necessitates urgent decompression.The patient showed no clinical signs or symptoms of raised intracranial pressure and was managed conservatively. He was discharged home 16 days later with no neurological deficit.

The role of gut tissue in the energy metabolism of growing lambs fed forage or concentrate diets.

The role of the gastrointestinal tract (GIT) in explaining the less efficient utilization of metabolizable energy (ME) in growing lambs fed forage rather than concentrate-based diets was investigated by feeding forage (legume-grass silage) and concentrate (whole shelled maize) diets, at isoenergetic intakes (ME basis), using five groups of lambs. One group of seven lambs was an initial slaughter group and of the two groups (eight lambs per group) fed each diet, one group was fed for 8 weeks, whereas the other group was fed for 16 weeks. All lambs were slaughtered between 18.5 and 20 h following their last meal. Retained energy (as a percentage of ME intake) was higher (concentrate-fed 28, forage-fed 17; P<0.001) for the concentrate-fed animals. Weight-specific mucosal O2 uptake (ml/g DM per h), measured in vitro, was 37 % higher for the forestomach (reticulum, rumen and omasum) and small intestine (jejunum) than for the abomasum and large intestine (caecum and colon), but there was no evidence for a diet effect (except colon; forage-fed 5.3, concentrate-fed 4.2; P=0.036). Total GIT heat loss was estimated as 14 (forage-fed) and 18 (concentrate-fed) % of the whole-body heat loss. Although the GIT did not contribute to increased thermogenesis in the forage-fed lambs in the present study, greater relative contribution of GIT tissue to whole-body mass, i.e. GIT as a percentage of empty-body weight(forage 7.6, concentrate 6.6; P<0.001) in the forage-fed animals supports a role for the GIT in contributing to higher thermogenesis observed in ruminants fed forage as opposed to concentrate diets.