This is an overview of current new developments in acute stroke care focusing on recent developments, including intravenous thrombolysis and mechanical thrombectomy. It demonstrates that, in the context of a stroke unit which is embedded in the acute setting within the prehospital and intrahospital area, successful therapies can be performed.

Stroke is a common disease worldwide, with an estimated incidence of 150 per 100 000 in developed countries. Moreover, stroke is a leading cause of disability and rehabilitation is a major part of patient care. Most research into stroke rehabilitation has focused on the effect of interventions on recovery in different forms of impairment and disability. The substantial increase in the number of clinical trials investigating rehabilitation in the past 20 years shows the rising interest of rehabilitation clinicians in evidence-based care. The most promising options for motor recovery of the arm include constraint-induced movement therapy (CIMT) and robotic-assisted strategies. Beneficial interventions to improve postural stability and gait include fitness training, high-intensity therapy and repetitive task training. However, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Nevertheless, we believe that neuroplasticity enhanced due to neuromodulation of different neuronal systems will play a major role in the field of neurorehabilitation in the future.

The aim of this article is to describe the different causes of hyponatraemia in traumatic brain injury (TBI) patients in the intensive care unit (ICU). We carried out a retrospective observational analytical study in the ICU of 442 patients diagnosed with various TBIs, including 150 patients who developed hyponatraemia during their stay in the ICU. A diagnostic algorithm was followed to identify different causes of hyponatraemia. The data were collected using a convenience sampling technique. The results showed that 87% of patients were male and 13% were female. Fourteen per cent were paediatric patients (≤ 12 years) and the remaining 84% were adults. Sixty per cent of cases had severe head injuries. The predominant age group was 25–36 years (47/150). The incidence of hyponatraemia was 34%. The mean time to onset of hyponatraemia after TBI and ICU admission was 7.74 days. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) was diagnosed in 34 (26%) patients and cerebral salt wasting (CSW) in 32 (21%) patients as a cause of hyponatraemia. Other causes were found in the remaining patients (79/150), mainly dehydration, during weaning and postextubation phase, overuse of fluids, use of hypotonic fluids, overtreatment with desmopressin acetate, postoperative phase, and use of diuretics. Comorbid conditions were found in only 10% of cases; all other patients (90%) were previously healthy. No cases of hyponatraemia as a result of adrenal insufficiency or hypothyroidism were found. In conclusion, SIADH and CSW are still the most common causes of hyponatraemia in TBI patients, but various other causes of hyponatraemia in the setting of the ICU exist.

A 31-year-old man presented to an outpatient clinic with a painless lump in the groin, which increased in size over the course of 6 months, without other significant manifestations. The patient had a family history of different malignancies. A diagnostic approach was used to investigate the lump in the patient's groin. It was concluded that the lump was a diffuse large B-cell lymphoma (DLBCL): an aggressive or fast-growing lymphoma arising in lymph nodes or outside the lymphatic system. DLBCL is the most common form of non-Hodgkin's lymphoma (NHL), but there are several subtypes, which may affect prognosis and treatment. The first symptom of DLBCL is a painless lump, and this followed by an occasionally painful yet rapidly growing swelling in the neck, armpit or groin caused by enlargement of lymph nodes. Other symptoms include night sweats, unexplained fevers and weight loss, all of which were absent in this case. Most DLBCL patients are adults, although this type of lymphoma is sometimes is observed in children.

The incidence of human tuberculosis (TB) is increasing worldwide, mainly because of the spread of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and the emergence of drug resistance. Pulmonary TB occurs more commonly than genitourinary TB (GUTB). Symptoms of GUTB are vague and are frequently go undetected. This review serves as a reminder that GUTB exists and, if undiagnosed, may cause unnecessary morbidity. GUTB occurs in 4–20% of patients with pulmonary TB. Onset of GUTB is insidious, and with pyuria and microscopic haematuria in 90% of patients. Diagnosis is achieved by the demonstration of tubercle bacilli in urine. Imaging features include calcifications, calyceal distortion and infundibular and ureteral strictures. Early changes include erosion and blunting of the calyces, narrowing of collecting system infundibula, overt papillary necrosis and parenchymal scarring/calcification. Prostatic involvement is nodular and non-tender. Genital TB presents with superficial ulcers in both males and females. Obstruction of the vas deferens causes infertility. Tuberculous orchitis may mimic other testicular mass lesions. Treatment is with antituberculous therapy. Early endourological decompression of ureteric strictures improves the salvage rate of the kidney.

Clinical differentiation between direct and indirect inguinal hernias is a skill that has been taught and practised for decades. Its accuracy and value have recently been challenged. Modern radiological tools (e.g. ultrasound, colour duplex scanning, computerized axial tomography and magnetic resonance imaging) have been shown to have a superior diagnostic value if such differentiation is deemed necessary. In the current century, the clinical skill may remain to be of some academic value for teaching medical students. However, in clinical life its routine practice might represent a medical dogma.