Normal pressure hydrocephalus with onset following a traumatic experience

Background: Normal Pressure Hydrocephalus (NPH) is a neurological disorder caused by excessive accumulation of cerebrospinal fluid (CSF) with resultant pressure to the brain. It is a rare syndrome usually found in the sixth and seventh decades of life. The condition is often misdiagnosed because of its non specific symptoms and chronic nature, but recently NPH is receiving a great deal of media and medical attention, leading to a more efficient and timely diagnosis and treatment.Methods: This is a case report of a 40 year old widow, who presented with eight weeks history of recurrent vomiting, fearfulness and withdrawal to self following a traumatic experience. Prior to above presentation patient was normal and stable with no past history of physical or mental illness.Results: Clinical features met the criteria for diagnosis of Post Traumatic Stress Disorder following a traumatic experience. Clinical examination and investigations including (skull xray) conducted were all within normal limits. Two weeks into admission patient developed seizure, facial nerve palsy, and progressive weakness of lower limbs which warranted further investigation. The patient had Computer Tomography scan which revealed NPH, she had a ventro-peritoneal shunt at the neurosurgical unit of the hospital.Conclusion: Despite the advances in the diagnosis and treatment of hydrocephalus, there is still much to be learned about hydrocephalus and the subtle forms it can take. Even though it is more common in infants and elderly, it can occur at any time in life and as a result of a variety of causes.Keywords: Hydrocephalus, Post Traumatic Stress Disorder, Female, Adul

Complex partial seizure, disruptive behaviours and the Nigerian Legal System

Background: Complex partial seizure is an epileptic seizure which results in impairment of responsiveness or awareness such as altered level of consciousness. Complex partial seizures are often preceded by an aura such as depersonalization, feelings of de javu, jamais vu and fear. The ictal phase of complex partial seizure is often associated with complex activities where an individual may still be able to perform routine task such as walking, though such movements are not planned and are often purposeless. Witnesses' around may not recognize anything wrong.Method: This is a case of a 43 year old commercial motor cycle driver, who was accused of first degree murder in the year 2000. He was convicted and sentenced to death. Prior to commission of crime, he was diagnosed with complex partial seizure with secondary generalization in 1990 at a tertiary hospital in Nigeria.Results: During his 15 years stay on death row at a maximum security prison in Nigeria, he had several episodes of seizure and subsequently developed a depressive disorder. He was placed on medication which includes anticonvulsants and antidepressants by the Forensic Psychiatry team. With regular follow-ups and available medication, he became stable. He was pardoned by the state Governor in 2015 following a recommendation by the Forensic Psychiatry team.Conclusion: Complex partial seizure comes with altered consciousness and  disruptive behaviour, which could result in  commission of a crime. Therefore, the strict adherence to the M'Naghten rule by the Nigerian legal system results in strict reliance by judges and not considering these rules in most cases bothering on  insanity. This is without taking into cognizance the peculiarity of each case.Keywords: complex partial seizure, death row, murder, pardon

Relationship between quality of life and postpartum depression among women in North-Central, Nigeria

Background: Postpartum depression is a problem of public health interest and impacts negatively on the perception of quality of lifer of sufferers. Quality of life' (QoL) as an outcome measure, is scantly used on women with postpartum depression in Nigeria. The current study was designed to assess the QoL of women with postpartum depression (PPD) in a tertiary hospital in North-Central, Nigeria.Method: A two-stage cross sectional procedure was used to recruit 550 participants 6 to 8 weeks postpartum in Jos, Northcentral, Nigeria. The Edinburgh Postnatal Depression Scale (EPDS), the World Health Organization Quality of Life-BREF-26 (WHOQoL-BREF-26) questionnaire and the Depression Module of the Structured Clinical Interview for DSM-IV axis I Diagnosis (SCID) were used.Results: The studied participants were 531 out which 21.8% with postpartum depression had significantly poor perception in all the four domains of the WHOQoL-BREF-26 i.e., in the physical health (p<0.001), psychological (p<0.001), social relationships (p<0.001) and environmental (p<0.001) domains. On the whole, the overall rating of quality of life (p=0.002) and satisfaction with general health (p<0.001) were also perceived to be poor when compared to those without depression. However, regression model analysis showed that the presence of postpartum depression in a participant predicts a significant negative perception on physical and environmental domains of quality of life, but a positive prediction on the general satisfaction with health.Conclusion: Postpartum depression as a disorder of public health importance impacts on the perception of quality of life of women who suffer from it. Early detection and treatment will improve the quality of life of women with postpartum depression.Keywords: Quality of life, WHOQoL-BREF-26, Postpartum Depression, prevalence, North-Central, Nigeri