Pseudotumor cerebri (with special reference to visual loss)

AIMS OF STUDY: 1. To analyse the patients . who have been treated at Groote Schuur Hospital over the last seven years for Pseudotumor Cerebri. 2. To document the clinical features of this group of patients. 3. To determine the visual prognosis of this group. 4. To assess the forms of treatment that have been used in this group. 5. To review the literature with regard to: a) a comparison of the results of other studies with the present one. b) the pathophysiology of the condition. c) treatment of the syndrome. d) the visual prognosis of the syndrome

The facts - Stroke

N/

Community-based care of stroke patients in a rural african setting

Background: In order to develop a community based-model of stroke care we assessed discharge planning of stroke patients, available resources, and continuity of care between hospital and community in a remote rural setting in South Africa. We sought to determine outcomes, family participation and support needs, as well as implementation of secondary prevention strategies. Methods: Thirty consecutive stroke patients from the local hospital were assessed clinically (including Barthel Index and modified Rankin scores) at time of discharge. Patients were re-assessed three months after discharge in their homes by a trained field worker using a structured questionnaire. Results: Two thirds of all families received no stroke education before discharge. At discharge 27 (90%) were either bed or chair-bound. All the patients were discharged into family care as there was no stroke rehabilitation facility available to the community. Of 30 patients recruited, 20 (66.7%) were alive at 3 months, 9 (30%) were deceased, and 1 was lost to follow-up. At 3 months, 55% of survivors were independently mobile as compared with 10% at discharge. A total of 13 (65%) patients in our cohort were visited by home-based carers. Only 45% reported taking aspirin at 3 months. Conclusions: The 3 month mortality rate was high. Most survivors improved functionally but were left with significant disability. Measures to improve family education and the level of home-based care can be introduced in a model of stroke care attempting to reduce carer strain and improve functional disability in rural stroke patients

Stroke outcomes in a socio-economically disadvantaged urban community

AIMS: To determine survival, disability and functional outcomes of stroke patients following their discharge from an acute stroke unit in an urban community with limited rehabilitative resources. METHODS: Stroke patients were recruited from a district hospital in Cape Town and followed-up for 6 months. Clinical characteristics, demographic and socioeconomic data, and disability and function as measured by modified Rankin Score (mRS), modified Barthel Index (mBI) at recruitment and 3 follow-up visits, were recorded. RESULTS: The study included 196 patients. Median age was 60 (IQR 51 - 69) years, 135 (68.9%) were female, 57.7% black, 42.3% coloured, and 45 (23%) died within 6 months. At discharge, median mBI score was 7 (IQR 3 - 12) and median mRS 4 (IQR 3 - 5). In the multivariate regression models, only function (mBI OR 0.88, 95% confidence interval (CI) 0.79 - 0.96, p<0.0001) and disability (mRS 0R 2.34, 95%CI 1.20 - 4.54, p<0.0001) were independently associated with risk of death. Shack housing was independently associated with moderate or severe disability (odds ratio 3.42, 95%CI 1.22 - 9.59, p=0.02). Despite limited rehabilitation resources, 67% of survivors had mild to moderate disability at 6 months. CONCLUSION: Apart from initial stroke severity, risk factors for poor survival were a severe disability category and the presence of impaired swallowing at discharge. Shack housing was independently associated with poor functional outcomes. These findings should be helpful in allocating home-based care and inpatient rehabilitation resources to high-risk groups to improve outcomes

The South African stroke risk in general practice study

Background. Incidence of stroke is increasing in sub-Saharan Africa and stroke prevention is an essential component of successful stroke management. General practitioners (GPs) are well placed to manage stroke risk factors. To design appropriate strategies for risk factor reduction we need to know the risk factor prevalence in each of the population groups attending GPs. The aim of this study was to establish the prevalence of stroke risk factors in the South African general practice population. Method. We conducted a multicentre, observational study of patients attending general practice in South Africa. Two hundred general practices were randomly selected from lists provided by pharmaceutical representatives. Each GP approached 50 consecutive patients aged 30 years and older. Patients completed an information sheet and the GP documented the patient’s risk factors. The resulting sample is relevant if not necessarily representative in a statistical sense. Results. A total of 9 731 questionnaires were returned out of a possible 10 000. The mean age of particpants was 50.7 years. Seventy-six per cent had 1 or more risk factors and 40% had 2 or more risk factors. Hypertension was the commonest risk factor in all population groups (55%) but was highest in black patients (59%). Dyslipidaemia was commonest in whites (37%) and least common in blacks (5%). Diabetes was commonest in Asians (24%) but least common in whites (8%). Risk factors other than smoking increased with age. Conclusion. This study provides unique data on the prevalence of stroke risk factors in a South African general practice population. Risk factors are common in all population groups, but differ in distribution among the groups. There is considerable opportunity to reduce the burden of stroke in South Africa through GP screening for and treatment of risk factors