It’s amazing how long it has taken us to recognise the basic mechanisms of stroke. Peter Rothwell’s short editorial points out that in people with carotid plaque, processes similar to coronary occlusion can take place suddenly due to plaque instability. We now have the research tools to investigate the features of carotid plaque which can lead to stroke, but it will be years before they can be deployed clinically. In the meantime, we know that the time of maximal risk of a further event following a stroke or TIA is the first month: so carotid ultrasound should be followed where necessary by endarterectomy within days, not weeks or months.
Man’s best friend can bite the hand the feeds it: more seriously, dogs have been known to maul babies and children, and this paper warns that little ones should not be left unattended with the family pooch. A young doctor in a personal view goes so far as to cast doubt on the desirability of allowing pet dogs at all; a clear case of Woman Bites Dog. People should not make love; go outdoors; eat food they enjoy; they should avoid all unnecessary risks. But if they are so foolishly incautious as to get a dog bite, they can take some co-amoxiclav, just as you thought.
BMJ 24 Feb 2007
