Idiopathic acquired progressive left facial hemiatrophy (Parry-Romberg syndrome) in a 21-year-old man in semi-urban, south-west Nigeria

Idiopathic progressive hemifacial atrophy, or Parry-Romberg syndrome, is a rare entity, seldom described in medical texts. Though first described in 1825, as yet there are no clear-cut diagnostic criteria. It is of interest mainly because of the numerous features with which it may be associated, which are largely in the central nervous system, and, more importantly, because it can easily be confused with localised scleroderma en coup de sabre. Some classify it as one of the trophoneuroses; others believe it is a variant of localised scleroderma. Most of the sufferers present because of the attendant cosmetic loss from the facial disfigurement. Treatment is multifactorial, and includes facial reconstructive surgery and immunosuppressants. Here we present the case of a 21-year-old Nigerian with idiopathic progressive left hemifacial atrophy. To the best of our knowledge, it is probably the first case from Nigeria to be reported in literature

Functional Motor Recovery in Stroke Survivors-Determinants in a Sub-Saharan African Stroke Unit

Objective: To find out the determinants of functional motor recovery in stroke survivors.Design: A prospective cross-sectional studySetting: Stroke outpatient clinic tertiary care hospitalSubjects: One hundred and two stroke survivors had their basic data  captured as well as the modified Rankin score (both at the time of  discharge after admission and at the time of evaluation in the clinic).Results: Twenty nine (28.4%) had functional recovery versus 73(71.6%) that did not. Younger age (OR = 0.95{CI 0.90-0.99} P=0.048), higher Rankin score at discharge (OR = 2.35{CI 1.40-3.95} P = 0.001), fewer informal caregivers at home (OR = 0.68{0.48-0.97} P = 0.034) and higher frequency of visits to the physical therapist (OR = 1.30{0.99-1.71}P = 0.05) predicted functional recovery. Age, modified Rankin score at discharge, duration between discharge from in-patient care and evaluation in clinic and frequency of visits to the physical therapist predicted group membership between functional recovery and others.Conclusion: In spite of the lean neurorehabilitation facilities in the setting of this study, increased frequency of visits to the physical therapist  predicted functional recovery in stroke survivors as in more resource robust climates. It should therefore be prescribed until functional recovery is achieved

Orthostatic hypertension: profile of a Nigerian population

Background: The aim of this study was to determine the prevalence, age, sex distribution and blood pressure (BP) pattern of patients with orthostatic hypertension in a cohort of hypertensives.Method: A total of 179 patients on follow-up treatment in a hypertension clinic were assessed for age, sex and BP in the seated position, and after two minutes in the erect position, on three consecutive visits. Orthostatic hypertension was defined as an increase in systolic blood pressure (SBP) of ≥ 20 mmHg on more than one occasion in the erect position. Orthostatic hypotension was defined as a decrease in BP on more than one occasion, between the seated and erect SBP, of ≥ 20 mmHg. The mean ages of the participants with and without orthostatic hypertension were compared by t-test for any significant difference. The means of the seated SBP of participants with and without orthostatic hypertension were also compared with the t-test. The effect of gender on orthostatic hypertension was tested with a chi-square (χ²). The differences between the mean seated and mean erect SBPs of participants with and without orthostatic hypertension were compared with the paired t-test.Results: Thirty-eight (21.23%) of the participants had orthostatic hypertension. The mean age of those with orthostatic hypertension was not significantly different from that of the participants without orthostatic hypertension (p-value = 0.789). There was no significant effect of gender on orthostatic hypertension (p-value = 0.795). The mean of the seated SBP was significantly lower in the participants with orthostatic hypertension (p-value = 0.008). The mean seated SBP was significantly different from the mean erect SBP for those with orthostatic hypertension, compared to those without orthostatic hypertension (p-value = 0.000 vs. p-value = 0.169). Five (2.79%) of the participants had orthostatic hypotension.Conclusion: Orthostatic hypertension, a form of BP dysregulation, may be more common among treated hypertensives than what is presently known.Keywords: orthostatic hypertension, prevalence, BP, Nigerian

Estimated Glomerular Filtration Rate and Risk of Survival in Acute Stroke

Objective: To assess the risk of survival in acute stroke using the MDRD equation derived estimated glomerular filtration rate.Design: A prospective observational cross-sectional study.Setting: Medical wards of a tertiary care hospital.Subjects: Eighty three acute stroke patients had GFR calculated within 48 hours of admission after basic data were captured.Outcome measures: Stroke outcome was defined as either discharged or still-in-care (survived) or all cause in-hospital death. GFR was estimated by the MDRD equation, stroke severity was assessed by the Canadian Neurological Scale (CNS). Data were compared between the GFR groups of < 60ml/min and . 60ml/min. Relative risks (RR) and odds ratios (OR) for stroke outcomes (survival and death) were estimated between the GFR groups and the homogeneity of the odds ratios among the different layers of stroke severity (CNS < 6.5 and . 6.5) was determined by Breslow-Day and Taronefs test. Matanel Hazensel and Cochranfs tests were used to determine conditional independence and the common odds ratio with stroke severity as a layering variable.Results: No significant differences were found between the age and sex distribution of the two GFR groups. Serum urea and creatinine and CNS were significantly different between the GFR groups (p<0.001, <0.001, <0.001). RR of survival and death for the GFR groups-less than 60ml/min and above or equal to 60ml/min were (0.425 and 1.204) and (2.360 and 0.830). The OR of survival for GFR below 60ml/min compared to GFRabove or equal to 60ml/min was 0.353. There was homogeneity across the two layers of stroke severity (CNS score less than 6.5 and above or equal to 6.5), p=0.612 and 0.612.Conclusion: Independent of stroke severity, GFR is a surrogate in the assessment of the risk of survival in acute strok

Blood Pressure Abnormalities in Parkinson's Disease in a Nigerian Population

To compare the effect of posture on blood pressure in levodopa-treated Parkinson's disease (PD) patients with that of age-matched controls. The design is a case control study. Blood pressure was recorded manually in the seated position with Accossons® mercury sphygmomanometer in 30 consecutive patients with PD on levodopa who had no hypertension and it was repeated after two minutes in the erect position to test for orthostatic hypotension (OH). The results were compared with blood pressure in the seated and erect positions in 30 consecutive age-matched controls that had no hypertension. The mean seated and erect systolic and diastolic blood pressures of both groups were compared with t-test for any significant difference(s); the mean seated and erect systolic and diastolic blood pressures of each group were also compared with paired t-test for any significant difference(s) and the proportion of study participants in both groups with orthostatic hypotension were determined. (a) Mean seated and erect systolic and diastolic blood pressures were significantly higher in PD subjects than age matched controls (p=0.000, 0.000) and (p=0.001, 0.000) (b) Mean erect systolic blood pressure was significantly lower than seated blood pressure in PD and significantly higher in controls (p=0.025 and 0.027) (c) OH was found in 6/30(20%) versus 0/30(0%) for cases and controls respectively. Higher seated and erect blood pressures and OH were found in levodopa treated PD compared to age-matched controls and these abnormalities should be assiduously looked out for in the evaluation of PD.Key words: Parkinson's disease, blood pressure, orthostatic hypotension, Nigerians

Clinical imaging dissociation in stokes in a southern Nigerian tertiary hospital: Review of 123 cases

No Abstract Availabl

First-ever generalised tonic-clonic seizures in adults in the emergency room: Review of cranial computed tomography of 76 cases in a tertiary hospital in Benin-city, Nigeria

Objective: To determine the prevalence of intracranial lesions in first-ever generalized tonic-clonic seizures in adults presenting in the Emergency Department (ED). Main outcome measure was the prevalence of intracranial lesions in cranial computerized tomography (CT). Method: 76 consecutive patients aged 18 years and above, with first-ever, non-traumatic, generalised tonic-clonic seizures that were evaluated in the ED with cranial CT, had their CT films reviewed by a specialist Radiologist. Demographic characteristics of participants were computed. The participants were divided into two groups-the group with intracranial lesions and the other without and their characteristics were compared. Main outcome measure was the presence of intracranial lesions in cranial computerized tomography. Results: Intracranial lesions were found in 57.9% of cases; cerebral atrophy and acute vascular disorders (strokes) were the leading lesions. Mean age of cases with intracranial lesions was higher compared with those with normal CT findings (55.31±17.33 years versus 38.90 ±14.69 years; p<0.001). Age above 29 years was predictive of intracranial lesions (O.R=1.109, p=0.01). Gender was not significantly associated with intracranial lesions (p=0.084). Clinical and CT diagnoses agreed only in 8.4% of the cases. (p=0.198). Conclusion: In first-ever, non-traumatic, generalized, tonic-clonic seizures  in the ED, intracranial lesions are found frequently, cerebral atrophy and acute vascular insults are the leading intracranial lesions.Keywords: First-ever, seizure, generalized, tonic-clonic, emergency, non-traumatic

Should non acute and recurrent headaches have neuroimaging before review by a Neurologist?- A review in a Southern Nigerian Tertiary Hospital

Background: Headache is a common complaint in general practice and it is known that most headaches are primary and that the yield of neuroimaging like cranial computed tomography (CT) in headache is generally low. In this study, we were able to demonstrate that the yield of  neuroimaging in non-acute and recurrent headache could be higher if cases are reviewed first by a specialist Neurologist before cranial CT.Method: Seventy-four cases that were referred to the specialist neurology clinic with complaints of chronic and recurrent headaches without focal neurological defi cit that had CT scan were reviewed consecutively using theshort form of the International Classification of Headache Disorders second edition (ICHD 2) criteria after their demographics of age, sex were  captured, to find out the proportion and characteristics of study cases that had identifiable cranial lesions on cranial CT scan. All cases were reviewed by a specialist Neurologist before CT scan and all CT fi lms were reviewed by a specialist Radiologist. Age, sex and the distribution of CT findings were described from a frequency table and mean age of study cases with and without identifiable lesions on CT were compared with t-test for any signifi cant difference and the effect of gender on the presence of identifiable lesions was tested with chi square and the agreement between clinical and CT diagnoses were tested on kappa statistics.Results: (1) Mean age of cases was 37.55 (22.06) years. (2) No signifi cant effect of gender was found on intracranial lesions (P = 0.345). (3) Intracranial lesions were found in 47.3% of cases and the mean age was higher compared to cases with normal fi ndings on cranial CT (P = 0.019). (4) Clinical and CT diagnoses agreed in 56.2% of the cases (P = 0.000).Conclusion: The high yield of intracranial lesions may be accounted for by the method of selection of cases for cranial CT

The Nigeria Parkinson Disease Registry: Process, Profile, and Prospects of a Collaborative Project

BACKGROUND: Clinical disease registries are useful for quality improvement in care, benchmarking standards, and facilitating research. Collaborative networks established thence can enhance national and international studies by generating more robust samples and credible data and promote knowledge sharing and capacity building. This report describes the methodology, baseline data, and prospects of the Nigeria Parkinson Disease Registry. METHODS: This national registry was established in November 2016. Ethics approval was obtained for all sites. Basic anonymized data for consecutive cases fulfilling the United Kingdom Parkinson's Disease Brain Bank criteria (except the exclusion criterion of affected family members) are registered by participating neurologists via a secure registry website (www.parkinsonnigeria.com) using a minimal common data capture format. RESULTS: The registry had captured 578 participants from 5 of 6 geopolitical zones in Nigeria by July 2019 (72.5% men). Mean age at onset was 60.3 ± 10.7 years; median disease duration (interquartile range) was 36 months (18–60.5 months). Young‐onset disease (<50 years) represented 15.2%. A family history was documented in 4.5% and 7.8% with age at onset <50 and ≥ 50, respectively. The most frequent initial symptom was tremor (45.3%). At inclusion, 93.4% were on treatment (54.5% on levodopa monotherapy). Per‐capita direct cost for the registry was $3.37. CONCLUSIONS: This is the first published national Parkinson's disease registry in sub‐Saharan Africa. The registry will serve as a platform for development of multipronged evidence‐based policies and initiatives to improve quality of care of Parkinson's disease and research engagement in Nigeria