Episodes Of Unconsciousness Research Articles

Epileptic seizure prediction via multidimensional transformer and recurrent neural network fusion

BackgroundEpilepsy is a prevalent neurological disorder in which seizures cause recurrent episodes of unconsciousness or muscle convulsions, seriously affecting the patient’s work, quality of life, and health and safety. Timely prediction of seizures is critical for patients to take appropriate therapeutic measures. Accurate prediction of seizures remains a challenge due to the complex and variable nature of EEG signals. The study proposes an epileptic seizure model based on a multidimensional Transformer with recurrent neural network(LSTM-GRU) fusion for seizure classification of EEG signals.MethodologyFirstly, a short-time Fourier transform was employed in the extraction of time-frequency features from EEG signals. Second, the extracted time-frequency features are learned using the Multidimensional Transformer model. Then, LSTM and GRU are then used for further learning of the time and frequency characteristics of the EEG signals. Next, the output features of LSTM and GRU are spliced and categorized using the gating mechanism. Subsequently, seizure prediction is conducted.ResultsThe model was tested on two datasets: the Bonn EEG dataset and the CHB-MIT dataset. On the CHB-MIT dataset, the average sensitivity and average specificity of the model were 98.24% and 97.27%, respectively. On the Bonn dataset, the model obtained about 99% and about 98% accuracy on the binary classification task and the tertiary upper classification task, respectively.ConclusionThe findings of the experimental investigation demonstrate that our model is capable of exploiting the temporal and frequency characteristics present within EEG signals.

Eikenella corrodens isolated from pleural effusion: A case report

BACKGROUND The bacterium Eikenella , classified as a gram-negative member of the phylum Proteobacteria, is distinguished by its rarity, corrosive nature, facultative anaerobic properties, and conditional pathogenicity. It represents the sole species within its genus-Eikenella corrodens (E. corrodens )-and can be found colonizing both human and animal oral and nasopharyngeal regions. Additionally, it occasionally inhabits the gastrointestinal or urogenital tracts. However, its slow growth rate can be attributed to its high nutritional requirements. However, there is an uneven distribution of construction and diagnostic capacity in China which poses undeniable challenges for the clinical examination and analysis of this case, especially in the basic hospitals. CASE SUMMARY Here we presented a case of empyema associated with E. corrodens infection in a 67-year-old male patient without any previous history of infectious diseases in our primary hospital in Dongguan district of China. The patient was admitted due to recurrent worsening cough, sputum production, and dyspnea for 3 d, which had persisted for over 20 years. Moreover, the patient experienced a one-hour episode of unconsciousness. Upon admission, immediate comprehensive examinations were conducted on the patient which subsequently led to his admission to the intensive care unit. Meanwhile, the patient presented with drowsiness and profuse sweating along with bilateral conjunctival edema observed during initiation of non-invasive ventilation, suggesting empyema. A significant amount of coffee-colored malodorous pleural fluid was drained during the procedure above and sent to the laboratory department for inspection. Finally, laboratory culture results confirmed the presence of E. corrodens infection in the pleural fluid sample. The patient received antimicrobial therapy until died on day 22 in the hospital. CONCLUSION In this report, we presented a case of empyema associated with E. corrodens infection. Multiple courses of morphological examination, viable culture analysis, and biochemical identification revealed its difficulties in detecting distinctive characteristics, as well as a detection model worth promoting. It’s just that there were still certain deficiencies in terms of morphological assessment, biochemical identification, and drug susceptibility testing.

A Rare Case of Ventricular Standstill and High-Grade AV Block in Patient with Thyrotoxicosis

Background Stokes-Adams Syndrome can be caused by high-grade AV Block, ventricular tachycardia, and one of the uncommon cause, ventricular standstill. Although thyrotoxicosis is commonly presented as tachycardia, it’s unusual for AV blocks to occur, especially a high-grade one.Case Illustration A 45-year-old female was admitted with fatigue, dizziness, and recurrent episodes of unconsciousness. She had a history of hyperthyroid, routinely managed with Propylthiouracil and Propranolol. Physical examination showed HR: 30 x/min, and other unremarkable systemic examinations. Initial ECG showed 3:1 AV Block. Patient was managed with Dopamin and moved to ICU for further observation. In the ICU, suddenly she had a Stokes-Adam episode presented as a seizure, her monitor showing P waves with an absence of ventricular activity lasting for few seconds. Due to the condition of ventricular standstill, a Temporary Pacemaker (TPM) was installed urgently, and so patient’s vital sign was stable with pacing rhythm. We found Free Thyroxine (T4) level of 46.85 pmol/l, TSH of 0.005 ulU/ml, and unremarkable echocardiographic findings. Considering these results, we suspect that the cause of the ventricular standstill was due to thyrotoxicosis. Propylthiouracil and dexamethasone were given to manage the disease. After 7 days of treatment, she was discharged with sinus rhythm on her ECG. Conclusion Ventricular standstill is frequently associated with conduction blockages, but it can sometimes occur without them. Ventricular standstill treatment often necessitates the use of temporary pacing wires or a pacemaker. In thyroid crises, high-degree AV-block is uncommon, but when the euthyroid condition is restored, clinical status and conduction problems can be reversible.

Effects of modafinil on epileptiform activity in absence epilepsy: Results of a study in WAG/Rij rats

Absence epilepsy (AE) presents with brief episodes of unconsciousness limited to generalized ∼3-Hz spike-and-wave complexes. Modafinil is a drug that is well-tolerated and is used to treat conditions such as hypersomnia, attention deficit disorder, and cocaine addiction. This study was conducted to explore how modafinil affects epileptiform activity in WAG/Rij. A total of 42 adult male WAG/Rij rats were used in this study. The rats were divided into six groups, each containing seven rats. Then, 1 ml/kg of 0.9% serum physiologic was given intraperitoneally (i.p.) to the control group, and modafinil (1 mg, 2 mg, 4 mg, 45 mg, and 180 mg/kg) was given i.p. to the other groups for 7 days. Electrocorticography (ECoG) was used for electrophysiological recording. The total number and mean duration of the SWDs were evaluated after injections of 0.9% serum physiologic solution and different doses of modafinil. There was a notable distinction observed between the control group and the modafinil group concerning the number and average duration of SWDs. Modafinil dose-dependently decreased the total overall count and average duration of SWDs compared to the control group at all doses (p < 0.001). Modafinil may play an important role in the prevention of epileptic seizures. Our results showed that modafinil may dose-dependently ameliorate the total SWD number and mean duration in WAG/Rij rats. Because this was the first study to investigate the effect of modafinil on AE in WAG/Rij rats, we believe that our data will form the basis for further research.

Epilepsy as the symptom of a spinocerebellar ataxia 13 in a patient presenting with a mutation in the KCNC3 gene

BackgroundThe spinocerebellar ataxias (SCAs) refer to a diverse group of neurodegenerative illnesses that vary clinically and genetically. One of the rare subtypes within this group is SCA13, caused by mutations in the KCNC3 gene. Currently, the prevalence of SCA13 remains uncertain, with only a couple of cases being documented in the Chinese population. This study presented a case study of SCA13, where the patient exhibited clinical symptoms of epilepsy and ataxia. The confirmation of the diagnosis was done through Whole Exome Sequncing.Case presentationSince childhood, the seventeen-year-old patient has not been capable of participating in numerous sporting activities and has experienced multiple episodes of unconsciousness within the last two years. The neurological evaluation showed a lack of coordination in the lower limbs. Cerebellar atrophy was detected through brain magnetic resonance imaging (MRI). The patient’s gene detection results showed that they exhibit a heterozygous c.1268G > A mutation in the KCNC3 gene located at chr19:50826942. Antiepileptic treatment was promptly administered to the patient, and as a result, her epileptic seizures were resolved quickly. She has since remained free of seizures. After a one-year follow-up, there was no apparent improvement in the patient’s health status except seizure free, which may have worsened.ConclusionThe case study highlights the importance of actively combining cranial MRI with genetic detection in patients with ataxia of no known cause, particularly in children and young patients, to establish an possibly obvious detection. Patients who are young and have ataxia that is first accompanied by extrapyramidal and epilepsy syndromes should be aware of the potential of having SCA13.

Near-death experiences and the change of worldview in survivors of sudden cardiac arrest: A phenomenological and hermeneutical study.

Near-death experiences (NDEs) can occur during episodes of unconsciousness from life-threatening conditions, such as sudden cardiac arrests (SCAs). This study is based on interviews with patients who had an NDE. The interviews were analyzed with phenomenological hermeneutical method for their lived experiences and the meaning for the view of life and death. Four participants were interviewed 10 weeks after their NDE. Four themes emerged: being on the other side, in another dimension; not dreaming, this is a real experience; being in a non-physical condition without my body; and comparing views of life and death before and after the NDEs. The participants described the NDEs as an experience of another realm as non-physical in nature and existing beyond space and time. This study shows that this experience of another state of being, through the lived experiences of NDEs, gave the participants an entirely new meaning on life and death. To them, death was no longer viewed as an end but a passage into something else and that life continues after death. This realization instantly changed their worldview.

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BackgroundSubacute sclerosing panencephalitis (SSPE) is a progressive neurological disorder of children and young adults that affects the central nervous system (CNS). It is a slow, but persistent, viral infection caused by defective measles virus. Dissociation in a case of SSPE is rare, so is very difficult to diagnose as the symptoms mimics neurobehavioural changes often seen in SSPE.Case PresentationThe child, 11yrs old girl, student, brought with complaints of pain in lower limbs from last 4 months and 3 episodes of unconsciousness & abnormal behaviour from last 3 months. Semiology- pain in lower limbs→ pricking sensation in LL→whole body→loss of consciousness→tightening of all 4 limbs. All episodes were precipitated by some stress at home. Also she had become irritable and there were multiple spells of anger outburst from last 3 months. There is a past h/o measles at 4 yrs. of age and fever f/b 1 episode of fits at 5 yrs. of age. EEG showed rademaker complexes & Antinuclear antibody IIF was positive both s/o SSPE.ResultsChild has been prescribed Tab Sodium Valproate 400mg and Tab. Aripiprazole 5mg along with JPMR exercises and coping skill training. Parents were taught contingency management principles after which she showed good improvement.DiscussionWill be done at the time of presentation.

Management of epilepsy in elderly

The prevalence of seizures and epilepsy in the elderly is generally underestimated. Epileptic seizures are not a rare occurrence in the elderly and their prevalence increases with age. The clinical manifestations of seizures, the aetiology, the treatment and the psychosocial impact of the epilepsy diagnosis may differ in the elderly. Differential diagnosis with episodes of unconsciousness and/or fall or other non-epileptic manifestations is often difficult. The presence of comorbidities, the polypharmatherapy and the age-related pharmacokinetic changes can represent a problem for the treatment of epilepsy in the elderly, with a higher risk of adverse effects and potentially inappropriate drug interactions. Epileptic seizures in the elderly can have semiological characteristics similar to those of other age groups. On the other hand, the richness of the electroclinical syndromes of childhood and adolescence is not found in the elderly, and, in particular, idiopathic generalized epilepsies are rarely expressed at this age. Symptomatic seizures related to acute structural injury or metabolic causes are particularly frequent. Therapy management of the elderly with an epileptic seizure should concern not only neurologists, but also general practitioners, geriatricians, and cardiologists, therefore involving a wide range of clinical specialties. This review aims to summarize the management of epilepsy in the elderly, reporting also differences in epidemiology, electroclinical features, aetiology and diagnostic procedures.

DUAL-CHAMBER PACING FOR POSTOPERATIVE RESIDUAL LEFT VENTRICULAR GRADIENT AFTER AORTIC VALVE REPLACEMENT AND CONCOMITANT SEPTAL MYECTOMY FOR SEVERE AORTIC STENOSIS AND SUBVALVULAR OBSTRUCTION

Aortic stenosis (AS) is occasionally associated with subvalvular obstruction and it is possible that remaining obstruction may at times be found after aortic valve replacement (AVR) and concomitant septal myectomy. A 69-year-old woman with a history of several episodes of unconsciousness was

Diving exposure and health effects in divers working in different areas of professional diving

The aim of the present study was to compare diving exposure and health effects in different areas of professional diving. The Norwegian Labour Inspection Authority's Diving Register contains data on all professional inshore divers who have held a diving certificate at any time since 1980. Of these divers, the "Norwegian diver 2011" questionnaire was completed by 2848 (48.7%). A total of 1167 male divers reported that they often worked in one area of diving only (rescue diving, diving instruction, fish farming, quay/construction work and offshore/oil related). In the analysis of these divers, rescue divers were used as referents as they reported the lowest number of dives. Age distribution, the proportion of retired divers and the mean number of dives completed varied between the different areas of professional diving. Compared to rescue divers, divers in fish farming, quay/ /construction work and offshore/oil related work more often experienced physically demanding diving. Divers in fish farming more often had no day off after 3 days of physically demanding work compared to rescue divers. All groups except offshore divers reported making further dives after one physically demanding dive on the same day. All groups reported more frequent decompression sickness than did the referents and divers in quay/construction and offshore/oil related diving reported more frequent episodes of unconsciousness during diving than did the referents. Divers in fish farming, in quay/construction work and oil/ /offshore related diving obtained a higher symptom score than the referents and the two latter groups also reported more frequent adverse health effects due to diving than the referents. Health related physical and mental component summary scores were lower in all other groups than in referents. Compared to the rescue divers, divers in quay/construction work and offshore/oil related divers reported more adverse health effects and obtained a higher symptom score.

Citrullinemia Type I - A Case Report

Citrullinemia type I (CTLN1) is an inherited urea cycle disorder where the enzyme argininosuccinate synthetase is deficient. It can lead to recurrent hyperammonemic crisis that may result in permanent neurological sequelae, even death. Vomiting in patients with urea cycle disorders may either be the result or cause of acute hyperammonemia, particularly if due to an illness that leads to catabolism. Therefore, age-appropriate common etiologies of vomiting must be considered when evaluating these patients. We present a case of a 2 year 5 month old female child with CTLN1 who had a history of frequent vomiting after the age of one year and some recent neurological manifestations like excessive crying and lethargy and one episode of unconsciousness. Investigations revealed high level of ammonia. Amino acid profile using tandem mass spectrometry showed markedly increased plasma level of citrulline. After administration of sodium benzoate and protein restricted diet there was dramatic improvement of all the symptoms.J Bangladesh Coll Phys Surg 2015; 33(2): 98-100

First Polish implantations of the smallest minimally invasive implantable loop recorder.

According to the current guidelines in patients with infrequent, but recurrent, and undiagnosed syncope, an implantable loop recorder (ILR) might be a very useful diagnostic tool to establish the cause. At present, the Medtronic Reveal LINQTM Insertable Cardiac Monitoring System is the smallest ILR available on the market. Its innovative features include: simple and minimally invasive delivery system, up to three years longevity, magnetic resonance imaging compatibility, wireless communication, and remote monitoring with internet access. On 29 September 2014, concurrently in two Polish referral cardiology centres, implantation of a Reveal LINQTM was performed. Patient 1 was a 39-year-old man in whom for the past four years syncope and episodes of unconsciousness and injuries occurred. Despite numerous studies, including electrocardiogram (ECG) Holter monitoring, echocardiography, tilt test, and electrophysiological study (EPS) with ajmaline challenge, the reason for these symptoms was not revealed. Patient 2 was a 63-year-old man with a history of periodic fainting and complete loss of consciousness. Basic diagnostics of syncope, including repeated Holter ECG monitoring, echocardiography, coronary angiography, and neurological examination, did not revealed significant abnormalities. However, due to his high body weight, tilt was not performed and the patient did not agree to EPS. Images from the procedure are presented in Figure 1. A film of the procedure is available at: https://www.youtube.com/watch?v=6B7Zz0NDygI. Due to low ventricular sensed amplitude in Patient 2 there was a need for device displacement with two skin incisions. After 62 days of follow-up Patient 2 developed full syncope. When he regained consciousness he recorded transmission with a rhythm in the normal range; however, in the memory there was stored an episode of significant pause (Fig. 2A). The patient was given a permanent pacemaker. Patient 1, 84 days after implantation, is still asymptomatic, and the only recorded findings have been numerous (42) episodes of sinus tachycardia (Fig. 2B).

Hypoglycemic coma due to insulin autoimmune syndrome induced by methimazole: A rare case report.

Insulin autoimmune syndrome (IAS) is a rare cause of hypoglycemia characterized by the presence of insulin-binding autoantibodies and fasting or late postprandial hypoglycemia. The number of reports on the association of human leukocyte antigen (HLA) genotype with this disease in adolescents in China is limited. This is the case report of a 17-year-old female patient with Graves’ disease who was treated with methimazole (MTZ). After 4 weeks of continuous MTZ treatment, the patient suffered an episode of unconsciousness during the late postprandial phase and was admitted to the hospital, where the blood glucose level was found to be 2.88 mmol/l. The symptoms were relieved following intravenous glucose administration. Imaging studies of the pancreas were unremarkable, but the laboratory investigations on admission revealed high serum levels of total insulin, associated with relatively low levels of free insulin and markedly elevated insulin autoantibody (IAB) levels. HLA testing revealed DRB1*0406/0901 and the patient discontinued MTZ and was prescribed propylthiouracil. During the long-term follow-up, the total insulin and IAB levels gradually declined. There was no other episode of hypoglycemia. Therefore, in adolescents with Graves’ disease receiving antithyroid treatment with MTZ who experience hypoglycemia, the IAB levels should be assessed to exclude or confirm IAS as the underlying cause.

Plasma brain-type natriuretic Peptide level following seizure and syncope: pilot study.

To explore the clinical feasibility of plasma brain-type natriuretic peptide (proBNP) level to differentiate the two major causes of transient unconsciousness, seizure and vasovagal syncope (VVS) in adult patients. ProBNP levels were evaluated within 24 hours following attack in patients who had experienced a transient episode of unconsciousness. For confirmatory diagnosis, clinical history was reviewed thoroughly and several work-ups including electroencephalography and cerebral imaging and tilt-table test, were performed in cases of putative VVS, as a part of routine clinical approaches. According to various relevant evaluations, 15 patients were diagnosed as seizure (age, 40.3±13.8 years) and 12 patients were VVS (age, 38.1±17.1 years). Plasma concentrations of pro-BNP were not different between two groups (p=0.714). Median level was 34.3 pg/mL (interquartile range: 12.9-91.1) in post-seizure group and 32.3 pg/mL (interquartile range 8.9-77.4) in post-VVS group. Additionally, it was not correlated with the sampling times within 24 hours after the episodes. The plasma level of pro-BNP has a limited clinical value in differentiating seizure and vasovagal syncope in adults. However, the more validated results with a large population should be sought in the future studies to confirm its value.

Inhalation conscious sedation with nitrous oxide/oxygen in pediatric dentistry

Conscious sedation is a technique in which one or more pharmacological agents are employed to produce a mild depression in the central nervous system, without loss of consciousness so that verbal contact can always be maintained with the patient; this allows for certain dental procedures to be performed. The technique is associated with a great margin of safety. In Odontopediatrics, the sedative agents generally employed are nitrous oxide (N2O) and benzodiazepines, amongst other agents with sedative properties. The use of nitrous oxide/oxygen (N2O) is becoming more frequent for general and pediatric procedures in dental medicine and has become common practice in many countries. It is also frequently used in general pediatric medicine for procedures ranging from minor surgery to more invasive diagnostic procedures. Nitrous oxide, or protoxide of nitrogen (N2O), is a colorless gas with a sweetish taste. It has an anxiolytic and sedative effect, and also promotes muscular relaxation and analgesia. N2O is non-irritant for the respiratory tract, with minimal alveolar concentration and low solubility in tissues. It acts with a quick onset and a rapid recovery, the entire procedure only lasting for a few minutes. When N2O is administrated in concentrations ranging between 20% and 50% (along with 80-50% O2), the patient almost always stays awake, calm and capable of following spoken instructions. However, some patients may suffer episodes of unconsciousness when concentrations of N2O are higher than 50%. Sedatives such as N2O are classified by their route of administration or by their impact on patients’ conscience. Accordingly, N2O-O2 is an inhalation conscious sedation. Nevertheless, the 2007 Dentists’ Guidelines for utilization of general anesthesia published by the American Dental Association (ADA) recommend a more specific classification, qualifying conscious sedation as minimal, moderate or deep and for this purpose N2O-O2 is classified as moderate. The American Academy of Pediatric Dentistry Guidelines consider it a safe and effective basic control technique that allows the reduction of the child’s anxiety and promotes improvements in the communication between the Pediatric Dentist and the child. It is described as a “standard technique” for Pediatric Dentistry and as a successful procedure in 90% of adequately selected patients. This article’s main goal is to lay out up-to-date guidelines on the operation of inhalation sedation with nitrous oxygen/ oxygen (N2O-O2) for the management of child behavior during a Pediatric Dentistry appointment, highlighting aspects of this procedure which have been recently examined by international institutions such as the Council of European Dentists and the American Academy of Pediatric Dentistry.

Anteroventral pre‐optic neurones, control of breathing and H2S: physiology or toxicology?

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Sudden Death Due to Eagle Syndrome

Eagle syndrome represents symptoms manifested by compression of regional structures by elongation of the styloid process or ossification of the stylohyoid membrane. Various theories have been put forward toward the development of Eagle syndrome. Depending on the underlying pathogenetic mechanism and the anatomical structures compressed or irritated by the elongated styloid process, symptoms vary greatly, ranging from cervicofacial pain to cerebral ischemia. Because the symptoms are variable and nonspecific, patients land up in different clinics for treatment. In the present case, the victim had previous episode of unconsciousness along with frequent headache for which she visited various clinics on numerous occasions. The elongated styloid process was appreciated during the postmortem examination, and the diagnosis of sudden death due to mechanical irritation of the carotid sinus by elongated styloid process was made as the sign of acute cardiovascular failure was present and upon exclusion of other causes of death.

Type B insulin-resistance syndrome presenting as autoimmune hypoglycemia, associated with systemic lupus erythematosus and interstitial lung disease

We describe an unusual case of systemic lupus erythematosus with pulmonary manifestations presenting as hypoglycemia due to anti-insulin receptor antibodies. A 38-year-old female suffered an episode of unconsciousness and was admitted to hospital where her blood glucose was found to be 18 mg/dL. During the hypoglycemic episode, her serum insulin level was inappropriately high (2,207.1 pmol/L; normal range, 18 to 173) and C-peptide level was elevated (1.7 nmol/L; normal range, 0.37 to 1.47). Further blood tests revealed the presence of antinuclear antibodies, anti-double-stranded DNA antibodies, and anti-Ro/SSA, anti-La/SSB, anti-ribonucleoprotein, and anti-insulin receptor antibodies. A computed tomography scan of the abdomen, aimed at tumor localization, such as an insulinoma, instead revealed ground-glass opacities in both lower lungs, and no abnormal finding in the abdomen. For a definitive diagnosis of the lung lesion, video-associated thoracoscopic surgery was performed and histopathological findings showed a pattern of fibrotic non-specific interstitial pneumonia.

Dominant vertebral artery injury during posterior atlantoaxial transarticular screw fixation in a juvenile rheumatoid arthritis patient with atlantoaxial subluxation.

Many authors have reported on iatrogenic vertebral artery (VA) injury, but, to our knowledge, this is the first report of a dominant VA injury with compensatory blood flow from the hypoplastic VA. A 23-year-old woman with juvenile rheumatoid arthritis and atlantoaxial subluxation sustained injury to her dominant VA after occipitocervical fusion using transarticular screws. This did not result in lethal consequences due to compensation from her hypoplastic contralateral VA. Postoperative angiography, however, illustrated occlusion of the dominant left side, while the hypoplastic VA of the right side was enlarged. The patient experienced vertigo and loss of consciousness several times during rehabilitation. At the 4-year follow-up exam, bony fusion was observed, with no neurological deficits or correction loss. She had had no episodes of unconsciousness and no recurrence of any symptoms over the previous 3 years.

Henry VIII’s obesity following traumatic brain injury

Henry VIII (1491–1547) is considered as one of the most prominent kings of England. Famous for his marriage to six wives and the renunciation of Roman Catholicism to establish the Anglican Church of England, Henry also bestowed patronage to several foundation medical institutes within the United Kingdom, which survive to this day. His modern image is frequently marred by a reputation for cruelty, pomposity and self-indulgence that were most notably manifest in his later years. Although Henry VIII was celebrated for his health in youth, demonstrating an enthusiasm for equestrianism, hunting and combative sports, his physical condition declined such that he became morbidly obese, suffered from depression and was noted to have bilateral leg ulcers (‘‘sorre legge’’) that were possibly due to severe venous hypertension as a result of deep vein thromboses [1]. His health status is identified in several reports that offer evidence of the progressive change in his body habitus (Fig. 1). Although he successfully recovered from smallpox when aged 24 and malaria when aged 30, his body mass and waist size changed dramatically with increased age (Table 1). Five months before his 45th birthday, Henry suffered from a jousting accident that rendered him unconscious for 2 h. From this incident onward, he is reported to suffer a decline of general health status, increase in body weight and the deterioration of his mood associated with depression. He died approximately 10 years later with a body habitus of super-obesity (BMI [50 kg/m) and symptoms of severe immobility and cardiac failure. Although Henry’s dramatic increase in body weight have traditionally been explained by over-eating and gluttony, contemporary sources consistently relate his increased body size with a decline in health and mood to follow his jousting accident. If this timeline of events are genuine, then Henry’s health deterioration may be associated with the likely traumatic brain injury (TBI) that resulted in his prolonged episode of unconsciousness. Traumatic brain injuries can cause several neuroendocrine effects [3] of which growth hormone deficiency (GHD) is amongst the most common hormonal changes [3, 4]. The symptoms of GHD in adults include changes in body composition reflected by increased fat mass with visceral obesity and reduced lean and bone mass, muscle weakness with increased morbidity and mortality and reduced quality of life. Patients with GHD also suffer from a higher prevalence of cardiovascular disease and a deterioration of cardiac function [5, 6]. Henry VIII’s final 10 years consisted of an unsuccessful war with France and the death of one wife (Jane Seymour) with the subsequent marriage to three others (Anne of Cleves, Catherine Howard and Catherine Parr), amongst whom one was subsequently beheaded. He increasingly relied on hoists and mechanical aids for mobility as a result of his body mass and decreased muscle strength. His overall decline in quality of life and increased obesity are consistent with the possibility of GHD following TBI in association with the complex socio-behavioural environment of leadership and kinghood. Increased obesity may have increased the severity of Henry’s venous hypertension and leg ulceration. Furthermore, the possibility of Henry’s GHD may have limited the healing response to his leg ulcers, as it has recently been H. Ashrafian (&) Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM-Building, Praed Street, London W2 1NY, UK e-mail: h.ashrafian@imperial.ac.uk