Disorders in sexual function constitute one of the most prevalent and least discussed problems following head injury. The disorders are often the outcome of an interaction between the neurological sequelae, the psychological makeup of the individual, and the sociocultural context of the couple. In a study of 34 head-injured patients, only 13 reached their premorbid level of sexual functioning over a period of 1 year. Deviant behavior, total loss of sexual function, and sexual dysfunction were noted in the rest. Deviant behavior was consistently associated with frontal lobe damage. Otherwise, neurological indices of head injury in the dysfunctional group were not different from those of the clinically recovered group. Associated psychiatric disturbances, gender-role differences, the impact on the marital harmony of the couple, and the role of sociocultural beliefs in the etiology of the disorders are analyzed and discussed, with a particular emphasis on Indian culture.

BackgroundThe UK Supreme Court recently ruled that when consenting patients for treatments or procedures, clinicians must also discuss any associated material risks. We surveyed medical staff at a large UK teaching hospital in order to ascertain knowledge of consent law and current understanding of this change.Materials and methodsEmail survey sent to medical staff in all specialities at Norfolk and Norwich University Hospital in February 2016.Results245 responses (141 Consultants and 104 junior doctors, response rate 32%). 82% consent patients for procedures at least monthly and 23% daily. 31% were not familiar with the concept of material risk. 35% were familiar with the recent change in consent law, 41% were not. 18% were “very uncertain” and 64% “a little uncertain” that their consenting process meets current legal requirements. >92% think that landmark cases and changes in law should be discussed through professional bodies and circulated better locally.ConclusionThe majority were not familiar with the concept of material risk and recent legal changes. A majority were not confident that their practice meets current requirements, suggesting that recent changes in consent law may not be widely understood at this hospital. We suggest more guidance and education may be necessary than is currently available. Increased understanding of recent changes to consent law will reduce the risk taken by NHS trusts and offer patients a service compliant with Supreme Court guidance.

Carotid cavernous fistulae (CCF) are abnormal communication between cavernous segment of the internal carotid artery and cavernous sinus. These entities are usually encountered in 0.2-0.8% of patients with traumatic skull base fractures. Traumatic cerebral aneurysms are rare and account for less than 1% of intracranial aneurysms. CCF due to ruptured intradural traumatic aneurysm is very rare and difficult to treat by surgical methods. We present one such case of a 40-year-old man with post-traumatic CCF due to a ruptured intradural aneurysm successfully treated with endovascular embolization.

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