The use of prophylactic anticonvulsants is controversial but there has been little prospective study of their use. The incidence of seizures in those receiving anticonvulsants is similar to that in those not receiving prophylaxis, with most studies showing no benefit in preventing early or late seizures. However, seizures can be devastating in SAH patients, with a significant morbidity in the perioperative period. Status epilepticus occurs in 10% of individuals, with an associated mortality of greater than 10%. Seizure activity increases CBF and blood pressure, with the associated risk of re-bleed. Re-hemorrhage, hypoxia and hyperthermia all contribute to secondary brain injury. Short-term usage of anti-convulsants has few risks and most side effects are reversible and, as a result, many authors suggest a short 7-10-day course of perioperative cover, increasing to 3-12 months in those who are most at risk of developing delayed seizures. Phenytoin is generally the first-line treatment. It can be given intravenously, has a lower incidence of skin reactions (compared with carbamazepine) and is less sedative (compared with phenobarbitone).
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.