[Hyperammonaemic encephalopathy due to valproic acid].

Introduction: One of the less frequent idiosyncratic side effects of valproic acid (VPA) is encephalopathy. Here we report one case.

Case Report: An 83-year-old female with no relevant past history, who received treatment with VPA following a post-traumatic subarachnoid haemorrhage and two convulsive seizures.

Absence of the superior vena cava: difficulties for pacemaker implantation.

Endocardial pacemaker electrode implantation can be difficult in patients with anomalous superior vena cava (SVC). Venography and CAT scan showed that the patient lacked SVC venous drainage and that systemic veins drained into the inferior vena cava through the azygos vein. A temporary stimulation electrode was placed by puncture of the femoral vein, permanent stimulation by venotomy of the epigastric vein, with the electrode inserted through the external iliac vein.