New onset neuromyelitis optica in a young Nigerian woman with possible antiphospholipid syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Devic's neuromyelitis optica is an inflammatory demyelinating disease that targets the optic nerves and spinal cord. It has a worldwide distribution and distinctive features that distinguish it from multiple sclerosis. There has been no previous report of neuromyelitis optica from our practice environment, and we are not aware of any case associated with antiphospholipid syndrome in an African person.</p> <p>Case presentation</p> <p>We report the case of a 28-year-old Nigerian woman who presented with neck pain, paroxysmal tonic spasms, a positive Lhermitte's sign and spastic quadriplegia. She later developed bilateral optic neuritis and had clinical and biochemical features of antiphospholipid syndrome. Her initial magnetic resonance imaging showed a central linear hyperintense focus in the intramedullary portion of C2 to C4. Repeat magnetic resonance imaging after treatment revealed resolution of the signal intensity noticed earlier.</p> <p>Conclusion</p> <p>Neuromyelitis optica should be considered in the differential diagnoses of acute myelopathy in Africans. We also highlight the unusual association with antiphospholipid syndrome. Physicians should screen such patients for autoimmune disorders.</p

CRASH-3 - tranexamic acid for the treatment of significant traumatic brain injury: study protocol for an international randomized, double-blind, placebo-controlled trial.

BACKGROUND: Worldwide, over 10 million people are killed or hospitalized because of traumatic brain injury each year. About 90% of deaths occur in low- and middle-income countries. The condition mostly affects young adults, and many experience long lasting or permanent disability. The social and economic burden is considerable. Tranexamic acid (TXA) is commonly given to surgical patients to reduce bleeding and the need for blood transfusion. It has been shown to reduce the number of patients receiving a blood transfusion by about a third, reduces the volume of blood transfused by about one unit, and halves the need for further surgery to control bleeding in elective surgical patients. METHODS/DESIGN: The CRASH-3 trial is an international, multicenter, pragmatic, randomized, double-blind, placebo-controlled trial to quantify the effects of the early administration of TXA on death and disability in patients with traumatic brain injury. Ten thousand adult patients who fulfil the eligibility criteria will be randomized to receive TXA or placebo. Adults with traumatic brain injury, who are within 8 h of injury and have any intracranial bleeding on computerized tomography (CT scan) or Glasgow Coma Score (GCS) of 12 or less can be included if the responsible doctor is substantially uncertain as to whether or not to use TXA in this patient. Patients with significant extracranial bleeding will be excluded since there is evidence that TXA improves outcome in these patients. Treatment will entail a 1 g loading dose followed by a 1 g maintenance dose over 8 h.The main analyses will be on an 'intention-to-treat' basis, irrespective of whether the allocated treatment was received. Results will be presented as appropriate effect estimates with a measure of precision (95% confidence intervals). Subgroup analyses for the primary outcome will be based on time from injury to randomization, the severity of the injury, location of the bleeding, and baseline risk. Interaction tests will be used to test whether the effect of treatment differs across these subgroups. A study with 10,000 patients will have approximately 90% power to detect a 15% relative reduction from 20% to 17% in all-cause mortality. TRIAL REGISTRATION: Current Controlled Trials ISRCTN15088122; Clinicaltrials.gov NCT01402882

Review of adult head injury admissions into the intensive care unit of a tertiary hospital in Nigeria

Background: Head injury is frequently associated with death and disability and imposes considerable demands on health services. Outcome after head injury is closely related to prompt management, including prevention of secondary brain injury and intensive care unit (ICU) management. This study aimed at determining the aetiological spectrum, injury characteristics, ICU admission patterns, and treatment outcomes of adult head-injured patients at a sub-Saharan tertiary hospital.Methods: A retrospective study on adult head-injured patients admitted to the ICU of a sub-Saharan tertiary hospital between July 2000 and June 2010.Results: A total of 198 head-injured adult patients were managed in the ICU during the study period. This included 128 males and 70 females with a male-to-female ratio of 1.8:1. The most common mode of injury was road traffic accident. All the patients admitted to ICU had either moderate or severe head injury, with 73.7% having severe head injury. About 26.3% of the patients had associated cervical spine injuries and 50% had various musculoskeletal and soft tissue injuries. Cranial computed tomography findings included brain contusions and intracranial haematomas. Mean duration of ICU stay was 18 days (range 24 hours-42 days), with 89.9% discharged out of ICU care. The overall mortality was 10.1%, although only 36.9% had satisfactory outcomes, as determined by the Glasgow Outcome Scale. Outcome had statistically significant (P &lt; 0.05) relationship with severity of head injury and surgical intervention.Conclusions: Head injury management in the ICU requires an approach to ensure prevention of secondary brain injury; appropriate and early neuroimaging to diagnose lesions that would benefit from timely surgical intervention; as well as management of fluid, electrolyte and haematological derangements.Keywords: head injury; admissions; IC

Open depressed skull fracture with embedded human tooth in the brain: case report

Traumatic brain injuries remain a leading cause of morbidity and mortality, especially, of the young adult population. A commonly associated complication is open depressed skull fracture where various objects have been implicated. We report the case of a young man who sustained open head injury from motorcycle accident who had a tooth embedded in the brain.Keywords: Debridement, elevation, skull base, traumatic brain injur

Dicephalus dibrachius dipus conjoined twins in a triplet pregnancy

Conjoined twins occurring in a triplet pregnancy is a rare occurrence. We present a case of undiagnosed dicephalic conjoined twins occurring in a multigravida with triple pregnancy delivered by caesarian section. The anatomical and pathologic findings in these twins after their demise are described with a brief review of the literature. Keywords: twins, congenital anomalies, conjoined VTropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 87-8

Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice

Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. Results: A total of 53 patients (34 males and 19 females) with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4%) presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32%) followed by ventriculoperitoneal shunt insertion (26.4%) for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32%) belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved

Tranexamic acid in trauma: we need stronger global health policy.

Tranexamic acid substantially reduces death in bleeding trauma patients. So why are the World Health Organization, the United Nations, the World Bank, and Unicef not ensuring global implementation, ask Ian Roberts and colleague