Epilepsy is a long-term neurological condition that results in recurrent seizures. Approximately 30% of patients with epilepsy have drug-resistant epilepsy (DRE). The ketogenic diet (KD) is considered an effective alternative treatment for epileptic patients. The aim of this study was to identify the metabolic role of the KD in epilepsy. Ketone bodies induce chemical messengers and alterations in neuronal metabolic activities to regulate neuroprotective mechanisms towards oxidative damage to decrease seizure rate. Here, we discuss the role of KD on epilepsy and related metabolic disorders, focusing on its mechanism of action, favorable effects, and limitations. We describe the significant role of the KD in managing epilepsy disorders.

Bowel ischemia is a critical entity that mandates an early and proper diagnosis. Causes of bowel ischemia are numerous, yet, identifying and treating the exact cause is challenging. Methamphetamine-induced bowel ischemia is rare but of clinical significance due to its high disease burden. We describe a case of a 67-year-old man who presented with colicky abdominal pain shortly after methamphetamine intake. CT angiography was done and failed to show occlusive causes, which pointed to a non-occlusive cause of bowel ischemia. The patient was hemodynamically stable on admission. Diagnostic laparoscopy was converted to laparotomy; segmental gangrene of both the small and large bowels was found. Resection of the ischemic part was done. The patient improved and was hemodynamically stable postoperatively. In conclusion, a holistic approach to patient history and physical examination can grab attention to unusual pathologies that lead to early intervention and fastened life-saving measures. Questions about stimulant drug use are crucial not only in younger patients but in older patients as well. In this case, we highlight the surgical, medical, and mental aspects of methamphetamine abuse in the elderly population.

Vertebral artery dissection (VAD) is a common cause of stroke in middle-aged individuals. Patients with VAD usually describe a trivial minor neck trauma preceding the event. Such traumas may be associated with spinal manipulation or sudden movements of the neck. Our case is a 43-year-old lady who presented with a history of sudden-onset dizziness, dysarthria, nausea/vomiting, tinnitus, and imbalance. Two days prior to her presentation, she experienced a new-onset moderate to severe intensity headache along with neck pain. The patient mentioned a first-time use of a home massage device three weeks prior to headache onset. After investigations, the patient was diagnosed with VAD, and treatment was initiated. She was discharged in stable condition. With the recent increased popularity of home massage devices, we report this case to raise awareness about the safe use of massage devices in order to prevent the occurrence of such injuries and complications.