Autonomic dysreflexia within 24 hours of spinal cord injury

Background: Autonomic dysreflexia (AD) is a potentially life-  threatening condition, characterized by episodes of  dangerously elevated systolic blood pressures of up to 300 mmHg that typically affects quadriplegic and high paraplegic patients with spinal cord lesions above the T6 segment. Such lesions lie above the origin of the splanchnic sympathetic innervation and therefore interrupt their supraspinal regulation.Case report: The condition usually occurs in the chronic stages of spinal cord injury, it rarely occurs in the acute phase postinjury. This case report describes a patient who developed AD within 24 hours of injury.Conclusion: To the best of our knowledge, no such case has been reported before in literature. French title: Dysreflexie autonome dans les 24 heures suivant un traumatisme medullair

Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study.

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice. Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant. Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P = 0.023, Phi = 0.26), lack of access to journals (P = 0.002, Phi = 0.332), and limited access to conferences (P = 0.019, Phi = 0.369) were associated with the country income category. Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group

CRYOTHERAPY: A NON-SURGICAL MANAGEMENT OPTION FOR SEVERE, MEDICALLY REFRACTORY SPASMS AFTER SPINAL CORD INJURY: TWO CASE REPORTS

Introduction: Neuromodulation in its various forms is emerging as a promising method of dealing with chronic pain and movement disorders. The scale of ablative vs augmentative procedures seems to be tilting towards augmentative procedures. We observed 8 patients who had failed medical treatment for muscle spasm respond to the cold application. Case summary: We report 2 cases of complete traumatic spinal cord injury patients, who developed severe, medically intractable muscle spasms. We applied cryotherapy to their legs with significant improvement. Outcome measurements: The spasm frequency score dropped immediately from a 4 to 0 in one patient. The other dropped from a 2 to 1 on day one then disappeared by day 7. Spasm severity dropped significantly on the first day in both cases. Conclusion: Cryotherapy as a form of neuromodulation, Is an effective, simple but safe way to symptomatically manage severe medically refractory muscle spasms in spinal cord injured patients. It becomes an important adjunct in the management of these patients in resource-limited settings where surgical options are not readily available

Non-traumatic spinal cord compression at Parirenyatwa Hospital in Harare, Zimbabwe

Compression of the spinal cord by encroachment on its space is of major importance as a cause of injury to its tissues, with serious neurological consequences. Patients with non-traumatic spinal cord compression represent a significant proportion of paraplegic/paretic individuals attended to in the neurosurgical units in Zimbabwe.Objective: This study was carried out to retrospectively identify the various causes of spinal cord compression in our setting at Parirenyatwa Hospital, Harare from 1998 to 2004.Setting: Parirenyatwa Hospital, Harare.Design: Patient files of patients admitted and treated as cases of non-traumatic spinal cord compression between January 1998 and December 2004 were retrieved and analysed retrospectively.Subjects: All records found of patients diagnosed of spinal cord compression were incorporated into the study. Eighty patients were therefore enrolled into the study.Main Outcome Measures: Data was compiled from patient records and from pathological and radiological reports onto a closed questionnaire designed for computer analysis.Results: Spinal tuberculosis was the commonest cause of cord compression (42.5% of all cases). Metastatic disease was next being responsible for 22.5% and primary tumours third, causing compression in 16.3%.Conclusion: Spinal cord compression occurs more commonly in man than women in our setting with a ratio of 1.6:1. Spinal tuberculosis was the commonest cause of cord compression (42.5% of all cases)

The Impact of COVID-19 on Neurosurgical Services in Africa

Introduction: COVID-19 has affected the global provision of neurosurgical services. We sought to review the impact of COVID-19 on the neurosurgical services in Africa. Methods: A cross-sectional survey was distributed to African neurosurgeons seeking to review demographics, national and neurosurgical preparedness, and change in clinical services in April 2020. Results: A total of 316 responses from 42 countries were received. Of these, 81.6% of respondents were male and 79.11% were under the age of 45 years. In our sample, 123 (38.92%) respondents were in training. Most (94.3%) respondents stated they had COVID-19 cases reported in their country as of April 2020. Only 31 (41.50%) had received training on managing COVID-19. A total of 173 (54.70%) respondents were not performing elective surgery. There was a deficit in the provision of personal protective equipment (PPE): surgical masks (90.80%), gloves (84.80%), N95 masks (50.80%), and shoe covers (49.10%). Health ministry (80.40%), World Health Organization (74.50%), and journal papers (41.40%) were the most common sources of information on COVID-19. A total of 43.60% had a neurosurgeon in the COVID-19 preparedness team; 59.8% were concerned they may contract COVID-19 at work with a further 25.90% worried they may infect their family. Mental stress as a result of COVID-19 was reported by 14.20% of respondents. As of April 2020, 73.40% had no change in their income. Conclusions: Most African countries have a national COVID-19 policy response plan that is not always fully suited to the local neurosurgery services. There is an ongoing need for PPE and training for COVID-19 preparedness. There has been a reduction in clinical activities both in clinic and surgeries undertaken