Relationship between admission serum C-reactive protein and short term outcome following acute ischaemic stroke at a tertiary health institution in Nigeria

Background: There is evidence of an association between mediators of inflammation, particularly C-reactive protein (CRP), and outcome of acute ischaemic stroke. This provides a potential opportunity for interventions aimed at improving outcome. There is sparse data exploring the role of inflammatory markers such as CRP and stroke outcome in Africans. The study objective was to determine the association between admission serum CRP levels and short-term outcome in the Nigerian patient presenting with acute ischaemic stroke.Materials and Methods: Consecutive patients hospitalized for first-ever acute ischaemic stroke at the Lagos University Teaching Hospital, Lagos, Nigeria, were prospectively enrolled between October 2007 and June 2008. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Serum CRP was determined on samples obtained within 7 days of stroke onset. All stroke patients were followed up till day 30 post-stroke. Outcome measures were 30 day Glasgow outcome scale score and functional impairment on the modified Rankin Scale (mRS). An age- and gender-matched healthy control group had serum CRP determined at inclusion. Elevated CRP was defined as any level above the cutoff (mean +2 x standard deviation of CRP level of controls).Results: Eighty patients with acute ischaemic stroke (47 men and 33 women) and 40 controls (27 male and 13 female) (P = 0.47) were studied. Mean age in cases was 59.1 ± 15.0 years. Mean CRP was significantly higher in stroke cases than controls (17.7 ± 14.4 mg/L versus 1.1 ± 1.7 mg/L respectively) (P < 0.00001). The frequency of elevated CRP (>4.5 mg/L) was 76.3% in stroke (N = 61) and 5% (N = 2) in controls (P < 0.0001). The case fatality rate in stroke with elevated CRP (32.8%) was significantly higher than stroke with normal admission CRP (0%; P= 0.015). The association of higher admission CRP with fatality () was statistically significant (P < 0.0001). Amongst survivors, mean CRP levels were markedly higher in the patients with unfavorable motor outcome (moderate/severe disability; n = 22; 21.5 ± 11.1) compared to those with favorable outcome (mild disability; n = 38; 6.5 ± 6.2) (P < 0.00001). In multivariate regression analysis, only high NIHSS score (P = 0.004) and admission CRP (P = 0.008) were independently associated with case fatality.Conclusions: Elevated admission CRP and high NIHSS score are independent predictors of short-term case fatality and adverse functional outcome following acute ischaemic stroke in Nigerians.Key words: C-reactive protein, ischaemic stroke, outcom

Awareness of warning signs among suburban Nigerians at high risk for stroke is poor: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Although stroke is a leading cause of morbidity and mortality in Nigeria, there is no information on awareness of its warning signs. This study was designed to assess awareness of stroke warning signs in Nigerians at increased risk.</p> <p>Methods</p> <p>A hospital-based cross-sectional study conducted at Irrua Specialist Teaching Hospital, in southern Nigeria. Patients with a diagnosis of hypertension, diabetes or both were interviewed for the warning signs of stroke in the outpatient clinic by trained interviewers. The main outcome measure was ability to identify at least one stroke warning sign.</p> <p>Results</p> <p>There were 225 respondents with a mean age of 58.0 ± 11.7 years. Only 39.6% could identify at least one stroke warning sign while the commonest sign identified was sudden unilateral limb weakness (24.4%). On multivariate logistic regression analysis, male sex (β = 0.26, 95% CI = 0.14–0.39, p < 0.001) and 11 or more years of education (β = 0.16, 95% CI = 0.03–0.29, p = 0.02) emerged the independent predictors of ability to identify at least one warning sign.</p> <p>Conclusion</p> <p>Awareness of stroke warning signs is poor among Nigerians at increased risk for the disease. Efforts should be made to improve on the level of awareness through aggressive health education.</p

Migraine headaches among university students using id migraine test as a screening tool

<p>Abstract</p> <p>Background</p> <p>Migraine is a significant health problem, especially for the young people, due to its frequency and accompanying morbidity, causing disability and loss of performance. In this study, our aim was to determine the prevalence of migraine headaches among university students in Edirne, a Turkish city.</p> <p>Methods</p> <p>In this cross-sectional and descriptive study, study population was composed of students registered to Trakya University in the academic year of 2008-2009. Out of these, 3694 of them accepted to participate. Participants who had two or more headaches in the last 3 months formed the headache group. Afterwards, two preliminary questions were applied to the headache group and participants with at least one affirmative response were asked to perform the validated ID-Migraine™ test.</p> <p>Results</p> <p>The mean age of 3694 students participated in the study was 19.23 ± 1.84 (17-39 years), with adolescents:adult ratio being 2.5:1. 1613 students (43.7%) did have at least two headaches in the last three months. Migraine-type headache was detected in 266 subjects (7.2%) based on the ID-Migraine™ test. Of the migraine group, 72 were male (27.1%) and 194 were female (72.9%). There was no significant difference in migraine prevalence between adolescent and adult age groups.</p> <p>Conclusions</p> <p>With a prevalence similar to adults, primary care physicians should be aware of the probability of migraine headaches in university students in order to maintain a successful school performance.</p

The Pattern Of Neurological Admissions At The Lagos University Teaching Hospital

Objective: To determine the profile of neurological admissions at the Lagos University Teaching Hospital Methods: Neurological admission at the Lagos University Teaching Hospital, Lagos, Nigeria between 1995 and 1999 were reviewed using medical records. Result: Neurological admissions accounted for 19.635 of total medical admissions. Cerebrovascular diseases were the most common cause, accounting for 11.65% of medical admissions; followed by infection of the nervous system which made up 6.07%. Cerebral malaria, pyogenic meningitis and tetanus were the most common infections All the other neurological diseases constituted less than 2% of medical admissions. On the whole, non – communicable neurological disorders accounted for 13.56% while infection of the nervous system accounted for 6.07% of the total medical admissions Conclusion: Stroke is the commonest cause of neurological admissions at the Lagos University teaching Hospital; and it is now more frequent than infections of the nervous system. KEY WORDS: Neurological admissions, Medical admission, Lagos University Teaching Hospital. Nigerian Journal of Clinical Practice Vol.6(1) 2003: 38-4

Does Diagnosis of Hypertension Prevent Stroke? A Preliminary Investigation of Relative Frequency of Undiagnosed and Previously Diagnosed Hypertension Before First Stroke in a Lagos Hospital

Introduction: The present study was designed to determine the relative frequency of previously diagnosed and undiagnosed hypertension in first stroke in order to evaluate if previous diagnosis of hypertension can prevent stroke. Patients and Methods: One hundred and twenty nine first stroke patients presenting at the emergency unit of a tertiary hospital in Lagos, Nigeria, were prospectively studied. Presence of hypertension and other modifiable risk factors was documented. History of diagnosis of hypertension before onset of focal neurological features was sought to categorize patients as having either known (previously diagnosed) or unknown (previously undiagnosed) hypertension. Results: Significantly higher percentage of the 102 first stroke patients with hypertension were known hypertensives (77.4% versus 22.6% unknown). This was so irrespective of whether the patients had other modifiable risk factors. Conclusion: Majority of our patients presenting with stroke were previously diagnosed hypertensives. Thus, diagnosing hypertension alone does not prevent stroke. Further studies are required to clearly define the impact of inadequate blood pressure control after diagnosis of hypertension (including poor drug compliance) and other risk factors. Nig. Qt. J. Hosp. Med. Vol.12(1-4) 2002: 10-1

Admission Blood Pressure of Stroke Patients and Its Relationship to One-week Case Fatality - A Preliminary Study

Background: High blood pressure is often said to be associated with poor outcome in stroke. However, there remains some uncertainly about the relationship of blood pressure to mortality in stroke. Objective: This study seeks to determine the influence of admission blood pressure on early mortality of stroke patients at the Lagos University Teaching Hospital (LUTH). Methods: Clinical and laboratory data were collected prospectively according to a standardized protocol, from stroke patients admitted to LUTH in 1999 and 2000, and information obtained about the time of onset of stroke, history of hypertension, level of consciousness, admission blood pressure, ECG findings of left ventricular hypertrophy, and one-week outcome. Results: hypertension was present in 87.3% of strokes on presentation. Strokes with mild to moderate hypertension had the lowest case fatality of 5.6%, while those with isolated systolic hypertension had the highest fatality of 40%. There was a u-shaped relationship between admission blood pressure and one-week case fatality, with strokes that had mild to moderate hypertension having a significantly lower one-week case fatality than strokes with normal blood pressure and severe hypertension Conclusion: Most patients with stroke have hypertension on presentation. It appears that mild to moderate hypertension on presentation is associated with a significantly better one-week outcome for stroke patients than other categories of blood pressure. Nig. Qt. J. Hosp. Med. Vol.12(1-4) 2002: 40-4

Correlation of Admission Blood Pressures with 30-Day Outcome in Acute Ischaemic Stroke in Nigerians.

Background: There is a lot of controversy on the prognostic value of admission blood pressures in acute ischaemic stroke, but in Nigeria, there is no information on this. Objective: The objective of this study was to correlate the effect of blood pressures measured on admission with 30-day mortality and neurological handicap in Nigerians with acute ischaemic stroke. Methods: This was a prospective observational study carried out between February, 2003 and May, 2004 at the Lagos University Teaching Hospital, Lagos, Nigeria. All eligible consecutively consenting ischaemic stroke patients were recruited. Systolic (SBP) and diastolic blood pressures (DBP) were measured on admission while pulse pressure (PP) and mean arterial pressure (MAP) were derived. Patients were periodically evaluated for progress and/or development of complications. Primary outcome was mortality within 30 days while secondary outcome was level of handicap on the modified Rankin Scale. Results: 100 patients were studied (mean age 58.56±14.12 years); 53% were males. Overall 30-day case fatality rate was 28%. There was no significant correlation between admission blood pressures and 30-day mortality (SBP: r = -0.05, p= 0.62; DBP: r = -0.12, p= 0.23; PP: r = 0.01, p= 0.90; MAP: r = -0.09, p= 0.36) or modified Rankin Score (SBP: r = -0.11, p= 0.29; DBP: r = -0.13, p= 0.21; PP: r= -0.06, p= 0.54; MAP: r = -0.13, p= 0.21). Conclusion: Admission blood pressures do not have significant influence on 30-day mortality and level of handicap in Nigerians with ischaemic stroke. Keywords: correlation, ischaemic stroke, blood pressure, outcome, Nigerians Nigerian Medical Journal Vol. 48 (3) 2007: pp. 58-6