A review of electroencephalograms done at the Kenyatta National Hospital, Nairobi

Background: Electroencephalogram based studies done elsewhere suggest that epileptiform activity originates predominantly from the left cortical hemisphere. There is evidence that partial epilepsies (focal spike and wave epileptiform discharges on tracings) connotes focal;secondary structural cortical dysfunction.Studies seeking similar findings have not been done locally. Objective: To review electroencephalograms (BEGs) done at Kenyatta National Hospital (KNH); looking for various types of epileptiform discharges and their cerebral cortex of origin. Design: Retrospective observational study. Setting: Kenyatta National Hospital, Nairobi, Kenya- from January 1986 to June 2004 Results: A total10431EEG records were reviewed. Ninety Eight percent of referrals for EEG evaluation was for clinical differential diagnosis of epilepsy. AbnormalBEGs comprised 32.2% of the study population. Epileptiform abnormalities (i.e.focal spike and wave,generalized spike and wave and 3Hz spike and wave) discharges accounted for75.2% of all abnormal EEG waveform discharges.Of the epileptiform abnormalities, focal spike and wave discharges comprised 71%. Focal spike and wave discharge implies a possible secondary aetiology of epilepsy.The left cerebral hemisphere was the origin of 49.8% of focal spike and wave epileptiform EEG discharges. Multifocal loci in cerebral cortices (i.e. frontal, temporal and parietal) were the foci of origin of abnormal EEG waveforms in 69.9% of recordings. Conclusion: Focal spike and wave epileptiform discharges, with attendant likely secondary aetiology of epilepsy is predominantly evident in this study. It contrasts findings from western literature.The left cerebral hemisphere is more epileptogenic as is noted in other studies

Primary cerebral angitis of the central nervous system: case report

We report a case of a 28 year old female who presented with variedly progressive stroke like illness and raised intracranial pressure. Brain MRI scans revealed pericallosal and periventricular hyperintensities with oedema. Various medications like intravenous immunoglobulin, antibiotics, acyclovir, methyl prednisolone and management for raised intracranial pressure were instituted. She rapidly deteroriated and died on tenth hospital day. Only at autopsy was the diagnosis of primary angitis of central nervous system established

Radiation exposure in interventional procedures

The aim of this study was to estimate radiation doses patients and staff are exposed to during interventional procedures (IPs), compare them with the international diagnostic reference levels and to develop initial National Diagnostic Reference Levels. The IP survey was undertaken as the initial task of which, retrospective data were collected from the only four Kenyan hospitals carrying out interventional radiology and cardiology procedures at the time of the study. Real-time measurement of radiation dose to patients and staff during these procedures was done. To the patients, kerma-area product (KAP) and fluoroscopy time measurements were done using an in-built KAP meter, while peak skin dose (PSD) was measured using slow Extended Dose Range (EDR2. ®) radiographic films. The staff occupational doses were measured using individual thermoluminescence dosemeters. The maximum and minimum KAP values were found to be 137.1 and 4.2 Gy cm. 2, while the measured PSD values were 740 and 52 mGy, respectively. The fluoroscopic time range was between 3.3 and 70 min. The staff doses per procedure ranged between 0.05 and 1.41 mSv for medical doctors, 0.03 and 1.16 mSv for nurses, 0.04 and 0.78 mSv for radiographers and 0.04 and 0.88 mSv for clinical staff. The measured patient PSDs were within the threshold limit for skin injuries. However, with the current few IP specialists, an annual increase in workload as determined in the study will result in the International Commission on Radiation Protection annual eye lens dose limit being exceeded by 10 %. A concerted effort is required to contain these dose levels through use of protective gear, optimisation of practice and justification

Osmotic demyelination syndrome: Case report

We present a 40 year old man who was admitted to the hospital with convulsions. His final diagnosis was osmotic demyelination syndrome (ODS).We discuss the diagnostic and management challenges and the possible complications of this rare diagnosis

Headache associated disability in medical students at the Kenyatta National Hospital, Nairobi

Objective: To study headache associated disability in a group of medical students at the Kenyatta National Hospital. Study design: Cross sectional survey. Results: Between October 1994 and January 1995 we conducted a survey on headache characteristics on medical students at both the Kenya Medical Training Centre and the Medical School of the University of Nairobi. Six hundred and twenty-five (87%) of the 711 students surveyed admitted having had at least one episode of headache in the last six months. Using the International headache society (IHS) case criteria 314 students (50%) had tension type headache, 240 (38%) migraine headache and 71 (12%) unclassified headache. Eighty-six percent of the students with headache had their working ability disturbed to various degrees. Eighty-five percent of the students reported that their social activities were interfered with by headache. Migraine headaches had the greatest impact on both the working and social activities at a p-value of 0.0005 and 0.0004 respectively. One hundred and forty-one students (23.6%) had missed at least one day of work or school in the last one-year as a direct result of the headache. There was an association between headache severity with working ability and social effect. There was no association between the days students missed work or classes with the severity of the headache. No gender difference was found in the headache associated disability. Conclusion: Headache is a prevalent condition with disability both in working and social activities. (East African Medical Journal: 2002 79(10): 519-523

Clinical and laboratory characteristics of hospitalised patients with neurological manifestations of HIV/AIDS at the Nairobi Hospital

No Abstract. East African Medical Journal Vol. 84 (2) 2007: pp. 67-7

Osmotic demyelination syndrom: case report

No Abstract. East African Medical Journal Vol. 84 (10) 2007: pp. 496-49