Neurological manifestaions among Sudanese patients with multiple myeloma

Background: Multiple myeloma may involve the nervous system at every level, including the neuromuscular junction, peripheral nerve, plexus, spinal nerve root, spinal cord, meninges, and brain. Such involvement may be primary or secondary, as well as non-invasive paraneoplastic effects.Objective: To find out the perevalence and pattern of CNS manifestations in Sudanese patients with multiple myeloma seen in Al-Shaab Teaching Hospital and Khartoum Nuclear Hospital.Methodology: This is a prospective descriptive cross sectional, hospital based study. It was conducted in Al-Shaab Teaching Hospital and Khartoum Nuclear Hospital in the period from June2009 to June 2010. 50 patients with multiple myeloma were included in the study.Results: Males were more than females with ratio of 2.8:1. The common (36%) age of presentation was between 55-64 years. There was increased incidence of multiple myeloma in patients from the west of Sudan. Farmers and free workers had high incidence of multiple myeloma (34% and 27%respectively). The study demonstrated that the most common non-  neurological symptoms was locomotor symptoms (24%) ,while the most common neurological symptoms were backache and neck pain .The most common neurological findings were cord compression (8%) followed by peripheral neuropathy (2%) and CVA (2%). 22% of patients completed treatment with good response, 12% with partial response, 18% with no response and 48% are still on treatment.Conclusion: CNS involvement among our studied group was not  uncommon.Keywords: neuromuscular, paraneoplastic, monoclonal immunoglobulin

Aetiology of Proximal Weakness among Adult Sudanese patients

Objective: To determine the aetiology of proximal myopathy among adult Sudanese patients seen in Elshaab Teaching Hospital. Methods: This is a descriptive cross sectional hospital based study conducted in Elshaab Teaching Hospital, during the period from January 2004 September 2005. 100 adult Sudanese patients with proximal myopathy were reviewed, detailed history and proper clinical examination was done by the authors. Results: The most frequent cause of proximal myopathy was found to be muscular dystrophy which accounted for 30% of the cases, followed by myasthenia gravis 20%, polymyositis and dermatomyositis 14%, Guillain Barre 8%, diabetes mellitus 5%, connective tissue diseases 5%, thyrotoxicosis 3%, chronic renal failure 3%, malignancy 2%, drugs (steroids and chloroquine) 2%, alcohol 2%. Spinal muscular atrophy, hypokalaemia, and hypocalcaemia each accounted for 1%. Conclusion: The study showed that the incidence of proximal myopathy is more common among females. Proximal muscle weakness involved the lower limbs more than the upper limbs. Keywords: myopathy, Guillain Barre, dermatomyositis, polymyositis, hypokalaemia, atrophy.Sudan Journal of Medical Sciences Vol. 3 (1) 2008: pp. 17-2

Prevalence of Neurological Manifestations of Lung Cancer among Adult Sudanese Patients

The objective: is to study the prevalence of neurological manifestations among adults Sudanese patients with lung cancer seen in the Radiation and Isotope Centre in Khartoum.Methods: This is a prospective cross sectional hospital based study, conducted at Radiation and Isotope Centre in Khartoum. Sample of 52 adults Sudanese patients with lung cancer were included in the study. The period of the study was from February 2006 to July 2006. Data were collected by self administered questionnaire; this was constructed in sections to address the different aspects of the study as follows: personal data, presentation, physical examination, and investigations.The results: showed that 41 patients were males. Most of the patients were above 50 years of age. Fifty percent of our patients’ were from Khartoum state. All of our patients had chest findings except one. The most common symptoms observed were of cranial nerves involvement, headache, limb weakness, numbness, and sphincteric disturbance. More than half of the patients were smokers. Other extrapulmonary manifestations noticed include: clubbing, lymph node enlargement, bone metastasis or fracture, gynaecomastia, superior vena cava obstruction, hepatomegaly, and ascites. Chest X-ray abnormalities showed pleural effusion, consolidation, hilar lymphadenopthy, collapsed lung, and fibrosis in the majority of patients. Most of our patients had adenocarcinoma, followed by squamous cell carcinoma, poorly differentiated carcinoma, and small cell carcinoma.Conclusion: The common neurological manifestations of lung cancer were found to be cranial nerves palsies, followed by lower limbs weakness, numbness, and sphincteric disturbances.Key words: Cerebellar, numbness, neuropathy, convulsion

Frequency of neurological deficits in Sudanese lepromatic patients

Leprosy has been a major burden on humanity over thousands of years. Perhaps no other disease in the history of mankind has been associated with such a strong social stigma as leprosy. Failure in early detection often leads to severe disability in spite of eradication of mycobacteria at a later date. Untreated the disease is progressive and results in permanent damage to the skin, nerves, limbs and eyes.Objectives: To study the pattern of neurological manifestations among adult Sudanese leprosy patients seen in Khartoum Dermatology Hospital in the period from March 2006 to August 2006.Methodology: This is a prospective cross-sectional hospital-based study. Seventy adult Sudanese leprosy patients were studied using simple, direct, standardized questionnaire including history and neurological examination, during the period from March to August 2006.Results: The most common age group affected was 18- 27 years. Male to female ratio was 3:1. Numbness was the most common neurological symptom seen in 77.14%. Each of visual disturbance, headache and bilateral ulnar sensory impairment was detected in 7.14%. Half of thepatients had upper limbs sensory nerve dysfunction while 42.86% exhibited sensory nerve dysfunction in the lower limbs. "Gloves and stoking" sensory impairment was the most common finding (30%) while bilateral lateral popliteal sensory impairment was seen with the samepercentage. Bilateral median and unilateral posterior tibial sensory impairment were found in 1.43% each. Unilateral radial cutaneous sensory impairment was seen in 2.86%. Approximately half (48.57%) of the patients had upper limbs motor dysfunction. Bilateral ulnar distribution motor affection was seen in 40%. A significant number (41.43%) had upper limbs muscle wasting. Impaired olfaction was the most common cranial nerve sign seen in 12.86%. Leprosy reactions were detected in 21.43%; type 2 reaction in 14.29% while type 1 reaction in 7.14%. Conclusion: Numbness and limbs weakness were the most common neurological symptoms in leprosy patients. Peripheral nerve sensory impairment was found in half of the patients with "Gloves and stokes" peripheral sensory neuropathy being the most common sensory disturbance. Motor dysfunction was found in 48.57%. Ulnar and median nerves motor affection was the most common motor dysfunctions. Signs related to cranial nerves involvement were less common. Leprosy reactions were present in one-fifth of the patients.Keywords: Mycobacterium leprae, granulomatous, numbness, poplitea

Epilepsy among elderly Sudanese patients

Objective: The aim of this study was to evaluate the clinical presentation and characteristics of elderly Sudanese patients with epilepsy. Methodology: This is a prospective study (from Feb. 2005 to Jun 2008). The study population included 240 elderly epileptic patients (age 60 years or above). Results: Cerebrovascular accident was found to be the most common cause of secondary epilepsy (31%).Generalize epilepsy was seen in 120 (50%) of patients. Abnormal neurological findings were more common (49%) among patients with partial epilepsy. Fifty percent of our patients showed abnormal EEG. Abnormal CT brain findings were common among patients with partial epilepsy. Conclusion: The pattern of clinical presentation of epilepsy among elderly Sudanese epileptic patients is similar to what was mentioned in the literature except that the percentage of epilepsy following infections was more among our studied group (6%Keywords: Cerebrovascular, EEG, seizure

The patterns of clinical presentations of cerebellar syndromes among adult Sudanese patients

Cerebellar syndromes are one of the commonest neurological diseases.Objectives: To study the patterns of clinical presentations of cerebellar syndromes and to identify the possible causes.Methods: This is a prospective hospital based, cross-sectional study. One hundred adult Sudanese patients with cerebellar syndromes were included in the study during the period from January 2006– January 2007.Results: The most common age group affected was 18 – 25 years. Male to female ratio was 1.5: 1 unsteadiness on walking was the most common symptom (83%). Gait-ataxia was the most common sign (83%). Cerebrovascular disease was the most common aetiology (25%).Conclusion: Cerebellar syndromes are not rare in Sudan. However, they were diagnosed more commonly at the central regions of the country probably because of more awareness of patients and better facilitiesfor diagnosis. The age of onset, the male predominance, the presentation and clinical findings were not different from reported literature. This also goes for the common causes apart from alcohol which is a strikingly rare as a cause in this study and could be accounted for the implementation of Elshariya (Islamic laws) Laws in Sudan.Keywords: ataxia, dysmetria, disdiadochokenesis, decomposition, nystagmus, dysarthria

Hepatitis C virus infection in Saudi Arabian recipients of renal transplantation

Background: Studies of recipients most of whom had been infected prior to transplantation, had yielded conflicting conclusions in regard to the clinical impact of hepatitis C virus [HCV] infection. We determined the frequency of new HCV infection and assessed its effect on patient and graft survival and occurrence of chronic hepatitis in renal transplant recipients. Methods: We studied 54 Saudi recipients [37 males and 17 females; mean age (SD); 38.2(17.1) years] they were anti- HCV negative at the time of transplantation and followed for 3 to 19 years [mean = 8.1]. The prevalence of anti-HCV at the time of censorship was compared with the rates in 99 hemodialyzed patients, 400 healthy volunteers and 113 hospitalized patients. Results: The period prevalence of anti-HCV in recipients was 37% [20 of 54], compared to hemodialyzed patients [17.1%], hospital patients [1.8%] and healthy volunteers [2.3%]. [P < 0.01]. Seroconversion to anti-HCV positivity occurring from 2 to 11 years [mean =7.8] after transplantation and was not influenced by age, gender or source of donor kidney. Cumulative frequency of HBsAg was 14.8%. Graft loss occurred in 1 HCV positive recipient. Serum aminotransferase was abnormal [>2 - fold elevation] in 2 anti-HCV positive recipients transiently. No deaths occurred among the recipients. Conclusion: The acquisition of new HCV infections had a relatively high frequency among renal transplant recipients in the study. The course of the infection was benign in the medium term, with no discernible progression to clinically recognized chronic liver disease. Further studies are required to determine cost- benefit of antiviral therapy in such patients. Sudan Joural of Medical Studies Vol. 2 (1) 2007: pp. 9-1

Pattern of plasma lipoprotein (a) in Sudanese patients with coronary artery disease

No Abstract. Sudan Journal of Medical Sciences Vol. 2 (3) 2007: pp. 197-20