Tension pneumocephalus - a rare but treatable cause of rapid neurological deterioration in traumatic brain injury. A case report

Pneumocephalus is a frequent complication following head injury and craniotomies. It can become an acute neurosurgical emergency when associated with raised intracranial pressure and neurological deterioration. Early diagnosis and timely appropriate intervention will reduce morbidity and unnecessary mortality from a case as this

Early results of two methods of posterior spinal stabilization in Nigerians

Background: In this study, early outcomes of the spinous process wiring with vertical strut (SPWVS) were compared with that of standard pedicle screw and rod (PSR) in our patients.Materials and Methods: We obtained patients' bio‑data, diagnosis, investigations, cost of implant, operative circumstances, complications, and outcomes from clinical documentation. Outcome measures, including postoperative infection and persistent/recurrent instabilities, implant related problems, operative blood loss and time and cost, were compared in the two groups of patients.Results: Forty one (M:F‑0.9:1) patients had PSR and 35 (M:F‑2.2:1) had SPWVS. There was no difference in the occurrence of post‑operative instability (P = 0.630), surgical site infection (P ≥ 0.416), neurological deficits (P ≥ 0.461) and implant related complications (P ≥ 0.461) in the two groups of patients. Cost of implant in the PSR group range from N138,000 (for 2 level fusion) (1USD = N159) to N246,000 (for 4 level fusion) with an average of N192,000 (Standard deviation [SD] N44,090.81) depending on the number of level fused while the cost of implant for SPWVS was N8,000 irrespective of the number of level of fusion being carried out (P = 0.000). Mean estimated blood loss intra‑operatively was higher for PSR (761.33 [SD 396.24] ml) than SPWVS (524.58 [SD 504.70] ml) (P = 0.005). Mean operation time was 397.17 (SD 122.183) min and 249.44 (SD 130.31) min PSR and SPWVS (P = 0.000).Conclusion: SPWVS appears to be a good alternative to PSR, especially in our resource limited environment, in view of similar post‑operative infection rate, implant complication, stability and post‑operative neurological  deterioration as well as shorter operation time, less estimated blood loss and much cheaper cost of implant in the former.Key words: Fusion, outcome, pedicle screws, spinal wirin

Women's perspectives on epilepsy and its sociocultural impact in south western Nigeria

Background There has been little study of the specific implications of living with epilepsy for women in societies where they already face gender based marginalization. Purpose Understanding the sociocultural aspects of epilepsy in women will help to improve the management of epilepsy in the community. Methods A series of six focus groups were held in urban and rural Southwest Nigeria.Results Epilepsy was commonly attributed to a spiritual attack, witchcraft and other supernatural causes. Denial of the diagnosis of epilepsy was common among women with nocturnal or focal seizures. Majority of women with epilepsy preferred multiple modalities of care in the following order: traditional, spiritual and western. The cost of traditional care was astronomical and most were already impoverished by the time they sought western care. WWE experienced stigma, social exclusion, isolation particularly from paternal relations, in -laws, and community members. Epilepsy related stigma contributed to schooling problems, difficulty in getting married, separation, divorce and problems with childcare and role fulfilment. One unanticipated result of this study was that public announcements made to identify rural study participants created a demand for western health services in rural populations previously unaware that epilepsy could be controlled through western medication.Conclusion Women with epilepsy face significant and persistent social, economic and cultural barriers. There is the need to educate women, their family and community members to reduce misconceptions and stigma. Community based medical treatment can be improved by taking into consideration the surrounding social, economic and cultural challenges faced by women with epilepsy. The care of epilepsy need to be incorporated into the primary health care system; regular awareness campaigns to be carried out in order to improve knowledge and attitudes and reduce stigma and social exclusion of women with epilepsy. Specific social welfare programmes and educational programme should be established to encourage the full integration of women with epilepsy in the society

Sexual assault against women at Osogbo Southwestern Nigeria

Background: Sexual assault against women is common all over the world. However, reliable data on the subject in developing countries including Nigeria is not available.Objective: To review the patterns of sexual violence against women treated at the hospital over a 7‑year period.Materials and Methods: Review of hospital records of victims of sexual assault who presented at the hospital from 1 January 2003 to 31 December 2009. Data obtained were analyzed using descriptive statistics and Chi squire test.Results: Sexual assault cases constituted 2.1% of female consultation outside pregnancy during the period under study while proportion of cases increased over the years under review. Mean age of the victims was 15.8 (SD 8.1) years ranging from 5 to 48 years. Most (73.7%) were less than 18 years while 93.2% were single (never married). About 81% of the victims less than 18 years were sexually abused in the day time. Majority (79.6%) knew their assailant. About 40% of the victims presented within 24 h of sexual abuse but none had postexposure prophylaxis.Conclusion: Sexual assault among women is an important health problem in this environment. There is need for hospital based management protocol.&#160

Outcome of a posterior spinal fusion technique using spinous process wire and vertical strut

Background/Objective: Spinal fusion is a rapidly developing area of spine surgery. Many of the implants often used are not within the reach of the patients in the developing world. In this study, we describe the outcome of a novel technique of posterior spinal fusion using the rush nail and spinous process wire.Materials and Methods: We prospectively evaluated patients who  underwent the technique since October 2006. We reviewed the patients’ biodata, clinical diagnosis, imaging studies, indications for surgery, type of operations, and complications related to the implants and the technique. Clinical test of instability was also determined.Results: The technique was used in 11 female and 19 male patients. The age range was 11-82 years. The indication for surgery was trauma in 15 patients, degenerative disease in seven patients, tuberculosis of the spine in four patients, and four patients had neoplasms. Occipitocervical fusion was performed in three patients, cervical fusion in six patients, thoracic fusion in 10 patients, thoracolumbar fusion in seven patients, lumbar  fusion in three patients, and lumbosacral fusion in one patient. The distal segment of the implant backed out in one patient following fracture of the spinal process. The implant was eventually removed. Clinical evidence of instability necessitating external orthotics was also seen in one patient. Two patients had wound infection. These were managed without removingthe implants. We did not observe significant complications in other patients.Conclusion: The technique appears safe and effective in carefully selected cases. The technique needs further evaluation in a larger patient population and with a longer duration of follow-up.Keywords: Outcome, spinous process wire, vertical strut

Profile Of Stroke In Nigerians: A Prospective Clinical Study

Background and purpose Stroke is a leading cause of death and neurological disability in adults, and imposes a heavy emotional and financial burden on the family and society. We carried out this study to describe the epidemiological pattern of stroke at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife and also to describe the risk factors, the computerized tomography (CT) scan findings and the outcome of stroke in our practice setting. Methods We prospectively studied one hundred and thirty five consecutive patients presenting to the neurology unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife over a six year period (2000- 2005). The socio-demographic and clinical data as well as the CT scan findings were collected. Statistical analysis was done using SPSS version 11.0. Results The 135 patients comprised 76 male and 59 female with a mean age of 62+ 12years. The major risk factors were hypertension and diabetes mellitus. Cerebral infarction was the most common subtype of stroke seen. The case fatality rate was 15.6% and among the survivors the outcome was poor as only 3% made full recovery. Conclusion Stroke is still a major problem and the major predisposing factor remains uncontrolled hypertension. The case fatality was very high and there is a risk of moderate to severe neurological disability among the survivors. The utilization of CT scan is sub-optimal even when it is available because of financial constraints. CT scan is recommended for all cases of stroke for definitive diagnosis and timely as well as accurate management. Introduction Les accidents vasculaires cérébraux (AVC) causent une mortalité et un handicap importants dans la population adulte entraînant également une forte charge émotionnelle au sein des familles et de la population. Objectifs Nous avons mené une épidémiologique sur la configuration des AVC à l'université Obafemi Awolowo Teaching Hospitals Complex, Ile-Ife Méthodes Nous avons étudié cent trente-cinq patients de manière consécutive à l'université Obafemi Awolowo Teaching Hospitals Complex, Ile-Ife, sur une période de six ans (2000-2005). Les données socio-démographiques ainsi que celles du CT-scan ont été recueillies. L'analyse statistique a été réalisée à l'aide du SPSS version 11.0 Résultats Parmi les 135 patients, 76 étaient de sexe masculin et 59 de sexe féminin avec une moyenne d'âge de 62+12 ans.Les facteurs de risque prédominant étaient l'hypertension artérielle (HTA) et le diabète. L'infarcissement cérébral était observé le plus fréquemment. Le taux de mortalité était de 15.6% et parmi les survivants seuls 3% avaient eu une récupération complète. Conclusions Les AVC restent un problème majeur de santé en rapport avec un mauvais contrôle de l'HTA. Le taux de mortalité est très élevé et la morbidité variable. Le CT-scan est sous utilisé compte tenu des contraintes financières. Son utilisation devrait être la règle Keywords: Stroke, Clinical profile, computerized tomography scan, NigeriansAfrican Journal of Neurological Sciences Vol. 26 (1) 2007: pp. 5-1

Aetiology of vertigo in a Nigerian tertiary health facility, a multidisciplinary approach

Background: Vertigo is one of the most challenging problems faced by the otolaryngologist in every day practice. The aim of this study is to investigate the aetiology, and the clinical course of vertigo in our setting. Materials and methods: Forty-six consecutive patients attending the ENT Clinic of a Nigerian tertiary health institution with the chief complaints of vertigo were prospectively studied. The patients' history, clinical examination, the results of the laboratory investigations as well as the diagnostic imaging findings and the treatment modalities were reviewed. The patients were followed up for a minimum of 24 months.Results: There were 27(58.7%) males and 19(41.3%) females. The incidence of Vertigo was found to increase with age with a peak incidence in the 6th decade of life. The aetiologies of vertigo were found to be: Infectious diseases of the ear in 9(19.6%), Neoplasm 8(17.4%), Menieres 8(17.4.3%), Metabolic diseases 5(10.9%), while vascular disorders were found in 4(8.7%). Trauma occurred in 4(8.7%), Ocular pathology in 3(6.5%), while Vestibulotoxicity was found in 2(4.3%). Others include, Psychogenic causes in 2(4.3%) and vestibular neuronitis was the least found in 1(2.2%) of the patients. Laboratory investigations were unremarkable in all of the cases. Fasting blood sugar was found to be elevated in one of the patients with Diabetes and VDRL tests was found to be positive in the only patients with Otosyphilis. Electrocardiography (ECG), Vanyl Mandelic Acid (VMA), and thyroid function tests were normal in those patients where these investigations were indicated. Radiological investigations were helpful in detecting Temporal bone and cerebello-pontine angle tumours. Treatment consisted of labyrinthine sedative, the treatments of the primary cause and physiotherapy. Mortality was found in 2.2% of the patients. Conclusion: Infective ear diseases, Menieres' and neoplasms were found to be common. Vertigo in our centre represents an extremely broad spectrum of diagnosis. A thorough and a multidisciplinary evaluation of a vertiginous patient in a tertiary centre is hereby advocated.Keywords: vertigo, tertiary health institution, Nigeria Nigerian Journal of Otorhinolaryngology Vol. 2(2) 2005: 54-5

Successful Separation Of Two Pairs Of Conjoined Twins In Ile Ife, Nigeria: Case Reports

Conjoined twins are rare phenomena occurring in one in 1 in 50,000 live births. Successful surgical separation of conjoined twins is a major undertaking requiring careful planning by a multidisciplinary team. Reports of seperation of joined twins in developing countries like Nigeria are rare. Ten cases of conjoined twins were separated between 1936 and January 2003 (including the authors two new cases). There were five omphalopagus, two pygopagus, two heterpagus and one ishiopagus twins. Three underwent emergency separation with 83.3% mortality while seven underwent elective seperation with 64.3% survival. The overall mortality rate was 50%. Despite the absence of advanced technological resource selected group of conjoined twins can be successfully separated in a developing country like Nigeria. An improvement in facilities and availability of trained personnel in likely to be associated with improved outcome. East African Medical Journal Vol.82(1) 2005: 50-5

Demographic survey and management outcome of Post-Neonatal Tetanus at the Ekiti state university teaching hospital, Ado Ekiti

Background: Tetanus continues to threaten the survival of children in spite of it being a vaccine preventable disease. The objective of this study was to determine the prevalence of post-neonatal tetanus, review the vaccination of affected children, complications encountered and the outcome among affected children in a tertiary health institution in southwestern Nigeria. Methods: The study was a retrospective study. Case notes of children outside neonatal life admitted to the Paediatric ward with clinical diagnosis of tetanus between January 2012 and October 2018 were retrieved and evaluated to identify socio-demographic and clinical characteristics. A review of the immunization history and cards was done where the immunization cards were available. Results: 21children with post-neonatal tetanus were admitted over a period of six years (November 2012 to October 2018) with a prevalence of 0.3%. The M:F was 3.2:1. The mean age in years was 10.14 ±3.44 while the age range of the subjects was 4 to 16years. None of the patients had booster doses of tetanus toxoid (TT) outside the infancy period. Nine (42.9%) subjects had no previous TT vaccination, 2 (9.5%) had 3 doses of TT vaccine in infancy but developed tetanus at age ≥9 years, 1(4.8%) subject had a dose of TT while the remaining 9subjects had no proof of previous TT vaccination. The percentage mortality was 19% (4 out of 21). All the patients that died had no prior record of TT vaccination. Complications identified included laryngeal spasm and autonomic dysfunction. Conclusion: Post-neonatal tetanus is still common in our locality because booster doses of Tetanus Toxoid are not part of the national immunization schedule. Complete dose of tetanus toxoid vaccination during infancy and booster doses at school entry is necessary and should be part of school health programme to forestall post-neonatal tetanu