Neurological deterioration after spinal anaesthesia: a rare mode of presentation of spinal tumours

Spinal anaesthesia is a safe and widely performed mode of anaesthesia with low complication rate. It may however be complicated infrequently with neurological deterioration as a result of injury to nerve root and spinal cord or epidural haematoma. Rarely neurological deterioration may occur following spinal anaesthesia in the presence of spinal tumours. We presented a case of neurological deterioration following spinal anaesthesia for caesarean section in a patient with previously undiagnosed thoracic spinal tumour

Proliferaton index in pituitary adenomas from a black African population

Background: The WHO has recognized a variant of pituitary adenomas with potential aggressive behaviour which have been termed atypical pituitary adenomas. This group of tumours are recognized by their mitotic rate of more than >3%, p53 expression and invasion of surrounding structures. There has however been no study of the occurrence of these tumours in a black African population. This study is a preliminary attempt to examine this group of tumours in blacks.Methods: This study retrospectively reviewed fifty-seven histologically diagnosed and immunohistochemically characterized pituitary adenomas received in our department over a twenty-one year period. Specimens were stained with ki67, a nuclear marker of cell proliferation which has been identified as the single best predictor of atypical pituitary adenoma.Results: Twelve of the tumours showed atypical features with eight (67%) of these tumours being prolactinomas. Two of the tumours were gonadotrophs and two were null cell adenomas. There was no correlation with age or gender. Two of the tumours required neurosurgical re-exploration with one of these showing a higher mitotic index in the second biopsy.Conclusion: The study suggests similarity in the rate of occurrence of pituitary adenomas with atypical features in a black African population with what is seen in Caucasians. Prolactinomas constitute a significant percentage of the tumours with this feature.Keywords: Pituitary adenoma, Immunohistochemistry, Atypical, Ki6

Evaluation of spinous process wiring techniques for accidental canal penetration

Background and Objective: Accidental canal penetration with attendant complications constitutes one of the reasons for abandoning the use of wires for posterior spinal fusion techniques. However, there is dearth of information on this risk when the wire is introduced through the base of spinous process as against sublaminar passage. This study was designed to evaluate hardware‑related postoperative complications, especially canal penetration, in our patients who had spinal process wiring in two types of posterior wiring techniques. Materials and Methods: Patients who had either of two spinous process wiring techniques formed the population for the study. The clinical records were reviewed and the following data were extracted: Age, sex, diagnosis, operation (fusion type), preoperative neurological status, postoperative neurologic deterioration, other postoperative complication and radiologic evidence of canal encroachment. Results: One hundred and seventy four spinous processes were instrumented in 42 patients. The age of the patients ranged from 11 to 78 years while male to female ratio was 2.5:1. Majority of the spinal wiring were for trauma (29 patients; 69.0) while the remaining were tumor (6; 14.3%), degenerative diseases (4; 9.5%) and infections (3; 7.1%). The Rogers technique was performed in 16 (38.1%) patients while 26 (61.9%) underwent Adeolu et al. technique. One patient (2.3%) had neurologic deterioration while 5 patients (11.1%) had varying type of complications from wound infection to fracture of spinous processes. There was no patient with radiological or clinical evidence of canal compromise. Conclusion: Spinous process wiring techniques for posterior spinal stabilization appears to be safe as demonstrated in this study

Chance Fracture in an Unbelted Rear Seat Passenger

Chance fracture occurs from flexion-distraction injury in motor vehicle road crash usually when the patient is on a seat belt. It is often associated with intra-abdominal injuries. We managed a 22-year old female unbelted rear seat passenger of a bus which was involved in a lone accident. We highlighted the possible mechanism of chance fracture in an unbelted passenger and satisfactory spinal stability on conservative care with neither internal nor external fixation

Persistent missed diagnosis of adult Chiari 1 malformation in a developing country: a neurosurgical case series

Contexte Dans les pays développés, de nombreux critères cliniques de présomption ainsi que la vulgarisation particulière de l’imagerie par résonance magnétique (MRI), permettent aujourd’hui, contrairement aux seuls arguments cliniques utilisés dans le passé, de disposer d’arguments diagnostiques divers dans la malformation de Chiari I chez l’adulte. La situation est cependant différente dans les pays en voie de développement où, en raison des raisons diverses, cette affection est rarement diagnostiquée. Nous rapportons ici une série de 3 cas initialement non diagnostiqués et suivis dans le service.Patients et méthodes Il s’agit d’une étude descriptive de patients adultes présentant une malformation de Chiari I pris en charge pendant plus de 30 mois dans un pays d’Afrique subsaharien.Résultats Trois cas avaient été colliges. Le premier était un ouvrier qualifié de 44 ans avec une scoliose thoracique remontant à l’enfance. Il a consulté pour des troubles inauguraux de la main datant de 9 ans, associant une impotence fonctionnelle du poignet et une quadri parésie spastique du territoire C4 avec un niveau sensitif remontant à C5. Dans le deuxième cas, il s’agissait aussi d’un ouvrier, âgé de 32 ans avec une quadri parésie spasmodique d’installation progressive en C4 et un niveau sensitif C2. Le dernier patient âgé de 32 ans, présentait une symptomatologie cérébelleuse dont une ataxie, une amyotrophie de la main et une faiblesse musculaire du membre inferieur droit remontant à 1 an développée aux décours d’une fracture négligée de la tête fémorale. Dans aucun cas, le diagnostic clinique n’avait été suspecté par les médecins référant. Les explorations d’IRM cranio-vertébrales réalisées dans notre service avaient révélé des anomalies de la fosse postérieure typiques d’une malformation de Chiari I ainsi que des syrinx médullaires extensifs, aux limites variées. Deux patients avaient été opérés dans notre service avec des résultats encourageants tandis que le troisième avait choisi de se faire soigner à l’étranger.Conclusion Au Nigeria, il existe un réel besoin de sensibilisation sur l’existence de la malformation de Chiari I de l’adulte, afin de limiter les retards diagnostiques et les difficultés de prise en charge d’une pathologie très handicapante mais de traitement facile

Relationship between injury severity, random blood glucose and management outcome in a cohort of Nigerian patients with head injury

Objective: This study was designed to evaluate the relationship between injury severity, admission Random Blood Glucose [RBG] and management outcome in a cohort of Nigerian patients with Head Injury [HI]. Materials and Methods: RBG was determined at admission, twenty four hours as well as seventy two hours after admission in patients with head injury. Severity of injury was graded using Glasgow Coma Scale (GCS). Outcome of management was determined by Glasgow Outcome Score at discharge. Serum glucose level of ≥ 11.1 mmol/l was taken as hyperglycaemia. Analyses of variance [ANOVA] was used to determine level of significance and a P value of < 0.05 was considered significant. Results: There were 146 male and 30 female patients (range: 2 years to 78 years; mean; 34.4 years, SD: 16.4 years). Most (36.4%) of the patients had severe HI. Only 2.5% of the patients had hyperglycaemia at admission. Death occurred in 25% of the patients, moderate disability occurred in 30.1% and good outcome occurred in 35.8%. Hyperglycaemia occurred in one patient each in mild and severe head injuries and in two patients with moderate head injury. All the patients with hyperglycaemia had favourable outcome. Conclusion: Random blood glucose of ≥ 11.1 mmol/l was not common at admission in head injured patients in this cohort of patients and the value was not associated with severe injury or poor outcome

Clinical profile and outcome of surgical management of intramedullary spinal cord tumours: A single center study in a developing country

Objective: There is as yet a paucity of data on intramedullary spinal cord tumours (IMSCTs) in sub-Saharan Africa. This study aims to define the clinical profile and outcome of management of IMSCTs in a Nigerian tertiary hospital. Methods: This is a retrospective study of all the patients who had surgery for IMSCTs in our hospital over a 14 year period. Results: There were 20 patients, 9 males, 11 females, in this study. The median age was 33 years (range = 7–78 years). The median duration of symptoms was 12 months (range = 1–120 months). Motor deficit was present in all but one (95%) of our patients. Only 25% of the patients presented in good functional status (McCormick grades I and II). The tumours were confined to the thoracic region in 10 patients (50%), while tumours in the thoracic region extending to the adjoining cervical and lumbar regions were seen in 6 patients (30%). Gross total tumour resection was achieved in 60% of the patients and subtotal resection in the remaining 40%. Astrocytoma and ependymoma were the most common tumours, each occurring in 35% of the cases. Six patients (30.0%) improved, 12 patients (60.0%) remained neurologically the same, while 2 patients (10.0%) deteriorated at the time of last follow up. The mortality rate was 15%. The preoperative functional status was a significant predictor of postoperative outcome (p = 0.03). Conclusion: Astrocytoma and ependymoma were the most common histological tumour types among our patients. Late presentation and poor pre-operative functional status were prominent features of our patients’ cohort

Perceived causes and prevention of catheter-associated urinary tract infections among spinal cord injured patients

Catheter-associated urinary tract infection (CAUTI) is among the most common nosocomial infections especially in acute care settings. Its economic and unanticipated health implications make it burdensome for the healthcare providers and patients. The paper examined the perceived causes and mode of preventing urinary tract infections in patients with spinal cord injury. Qualitative research approach was utilized; the study site was a Tertiary Hospital in Nigeria. Eight (8) in-depth interviews (IDI) were conducted with healthcare providers managing patients with spinal cord injured in the hospital. The major risk factors causing urinary tract infection identified include financial problems, organization of care, human error, hospital environment and patient-related factors. To prevent urinary tract infections among patients in the hospital, a number of suggestions were made by the participants such as training of caregivers and educating patients and relations. The authors concluded that the incidence of CAUTI could be reduced in the hospital if the opinions of stakeholders are fairly considered