Traumatic Extradural Hematoma in Enugu, Nigeria

Aim: Acute traumatic extradural hematoma (EDH) is life threatening and requires prompt intervention. This is a study of incidence and outcome of consecutive patients with EDH managed in Enugu, Nigeria against a background of delayed referral. Materials and Methods: We retrospectively examined all consecutive trauma cases managed between 2003 and 2009 and analyzed patients with acute traumatic extradural hematoma in isolation or in combination with other intra cranial lesions. Age, sex, cause of injury, time of presentation, Glasgow Coma Score (GCS), pupil reactivity, treatment and clinical outcomes were determined.Results: Of 817 head injuries, 69 (8.4%) had EDH, a mean of 9.9 patients per year. Males were 57 (83%) and females 12 (17%). Peak age incidences were the second and third decades of life, with a mean age of 30.2 years. Causes were road traffic accidents (57%), assault (22%) andfalls (9%). Twenty-six (38%) patients presented within 24 h of injury and only one patient presented within 4 h. The average time lag before presentation was 94.2 h. At presentation 39% had GCS of 13-15, 27% had 9-12 and 34% had 3-8. The most common location of hematoma was temporal (27.5%). Forty (59%) patients had surgery while 14 (20%) were managed conservatively. Ten patients (14.5%) died and of these 70% hadGCS <8 and 60% had a seizure.Conclusion: We conclude that early appropriate treatment of EDH results in good high quality survival (Glasgow Outcome Score 4 or 5). Low GCS should not be an absolute contraindication for surgery. Seizure prophylaxisshould be considered in patients with GCS <8.  Keywords: Demography, extradural hematoma, head injury, outcom

Epilepsy in primary intracranial tumors in a neurosurgical hospital in Enugu, South‑East Nigeria

Background: Seizures may be manifestation of intracranial tumor (IT) and demand thorough neurological evaluation. This paper examines epidemiology, lesion characteristics and outcome of seizures associated with primary IT.Methods: Retrospective analysis of medical records, computed tomography and magnetic resonance imaging of patients diagnosed with IT who presented with seizure from 2003 to 2013 at Memfys Hospital for Neurosurgery Enugu. Postoperative seizure outcome was based on Engel classification and correlated with tumor histology, patient age, anatomical location, time of presentation and extent of tumor resection. Data were analyzed using descriptive and inferential statistics.Results: Sixty‑two patients (34.6%) presenting with seizures were analyzed. Peak age at presentation was in 6th decade. Age of seizure onset had bimodal peak at 4th and 6th decades. Apart from IT located in posterior fossa with mortality of 62.5%, postoperative mortality did not depend on anatomical location of tumor. Postoperative seizure outcome and mortality depend on tumor histology (P = 0.025) and preoperative seizure duration (P = 0.036). Seizure duration shorter than 1 month had poor postoperative seizure outcome and high mortality. Although more patients with meningioma experienced seizures compared to glioma (P = 0.025), there was no difference in proportion of patients with meningioma and glioma who presented with seizure (P = 1.00). Extent of resection predicts postoperative seizure outcome based on meningioma sub‑group analysis. Overall, 59.7% of patients had good postoperative seizure outcome, 21.0% had poor outcome and 19.3% died.Conclusion: Seizures of short duration, IT located in posterior fossa and gliomas are associated with poor postoperative seizure outcome and high patient mortality. Tumor histology does not seem to affect seizure predisposition. Most seizures associated with IT occur in fifth and sixth decades of life and affect frontal lobe most often.Key words: Intracranial tumors, postoperative seizure outcome, seizure

Neuroimaging findings in pediatric patients with seizure from an institution in Enugu

Background: Pediatric seizures in developing countries are often poorly investigated and consequently poorly managed. Sociocultural misconceptions, financial difficulties, and lack of facilities are often blamed. This study studies the structural intracranial abnormalities associated with pediatric seizures and the proportion of these structural lesions that may benefit from surgery.Methods: Prospective study of 311 pediatric patients referred with seizure disorders, for computed tomography and magnetic resonance imaging to the Memfys Hospital for Neurosurgery, Enugu, between 2003 and 2014. All patients had contrast studies. Angiography was done for selected cases. Demography, imaging findings, and potential benefits of surgery were analyzed using descriptive and inferential statistics.Result: Analysis of 311 patients representing 21% of all pediatric head scans. Male to female ratio was 1.2:1.0. Definite structural lesion was identified in 53.4%. Lesions that may benefit from surgery were identified in 27.7% of all cases representing 51.8% of abnormal scan findings. Under.5 had the least scan rate of 25.1% compared with 42.4% in the adolescents. Although the older age groups had more abnormal findings, the proportion of abnormal to normal scan findings was the highest (1.7:1.0) in the under.5. Under.5 age group had more lesions that may benefit from surgery (P = 0.001). Intracranial tumor was diagnosed in 10.6%, vascular abnormalities (10.3%), hydrocephalus (5.8%), brain abscess (2.9%), and chronic subdural hematoma (2.6%) (P = 0.001).Conclusion: Structural lesions are common and diverse in pediatric seizures. Significant proportion of these patients may benefit from surgery, and these benefits override financial and sociocultural  considerations.Key words: Convulsion, imaging, pediatrics, surger

The pattern of significant lesions found in computerized tomography scan of recurrent seizure patients at a center in Enugu, Nigeria

Introduction: Seizures are common reasons for neurologic consultations and investigations. In the absence of magnetic resonance imaging, computerized tomography scanning of the brain is a reliable and cheaper alternative. Little is known about the pattern of brain lesions in patients with recurrent seizures in Nigeria.Objectives: To determine the pattern of significant intracerebral lesions in patients presenting with recurrent seizures in a tertiary hospital in Enugu. Methods: All the medical and computer tomography records of patients with a clinical diagnosis of recurrent seizures were reviewed. The study duration was 11 years (January 2003 to December 2013). Relevant data were obtained and  statistical analysis was done using SPSS version 19 and GraphPad Prism 6. Results: The diagnostic yield of CT was 55.1%. Twenty (9.3%) individuals had two lesions each. The significant findings were tumors (20.4%), encephalomalacia (18.9%) and strokes (7.7% (ischemic stroke, 4.1%, intracerebral hemorrhage,  3.1%, subarachnoid hemorrhage/intraventricular hemorrhage, 0.5%).  Hydrocephalus (HCP) was found in 18 (9.2%) cases, and 30% of them occurred together with other lesions. The diagnostic yield increased with age reaching 84.4% from the age of 60 years. Only patients with encephalomalacia were statistically older than those with normal imaging.Conclusion: Computed tomography scan has a high diagnostic yield, especially in elderly patients with recurrent generalized seizures. Brain tumors,  encephalomalacia, and HCP are most common causes of recurrent seizures in the adults.Keywords: Computed tomography, Nigeria, recurrent seizures, space‑occupying lesions, stroke

Characteristics of In-patient Deaths in a Private Health Facility

Background: Death in a private facility is a very traumatic event because of its far reaching economic and social consequences.The aim of the review is to establish the characteristics of deaths amongst admitted patients in a privte facility in Niger Delta , Nigeria. Methods: This was a 7 year retrospective review of deaths amongst admitted patients in a private facility from 2001 to 2007. Demographics and other characteristics were analysed bearing in mind the ortho-trauma bias of the facility. Simple statistical methods were adopted. Results: In the 7 year period 10,431 patients came for treatment, 3285 (31.49%) were admitted and 72 of the patient died with a crude mortality rate of 0.69%. Male to Female ratio was 1.25:1 with the mean age of 43+20. Presenting pathologies included head injury (11.9%), malignancies (10.9%), cervical spine trauma (9.5%), and cardiovascular pathologies (8.2%). A lot of the patients had long bone fractures (22.5%,n=19). Many patients died within 24 hours of admissiom(18.1%) or an intervention (20%). Septicaemia (19.4%), hypovolaemic shock and head trauma (9.7%) each were complications that provided the terminal exits. Conclusion: Standard facilities might reduce some of these deaths which are preventable.We recommend enforceable minimal standards of care.Questionable deaths must be audited by a goverment enabled body with ability to sanction culprits.It might be a step in the right direction. Keywords: admission, deaths, demographics, trauma Nigeria Journal of Orthopaedics and Trauma Vol. 7 (2) 2008: pp. 73-7

Decompressive craniectomy in the management of traumatic brain injury: a review of current practice

Wilfred Chukwuemeka Mezue,1 Chika Anele Ndubuisi,2 1Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, 2Memfys Hospital for Neurosurgery, Enugu, Nigeria Abstract: Decompressive craniectomy (DC) is now well established in the management of intractable raised intracranial pressure from various indications including trauma, ischemic strokes, and postoperative tumor surgery. In the setting of traumatic brain injury, the procedure has remained controversial – a difficulty that has not been completely resolved by available randomized studies. Available evidence suggests that there is a need for more clarity in the indications for DC in trauma, the intracranial pressure thresholds, and the timing of intervention. There is also a need to carefully distinguish between primary and secondary DC and to distinguish both from decompressive craniotomy if we are to resolve the current controversy. This article reviews the place and utility of DC in traumatic brain injury and the complications of the condition. Keywords: craniectomy, decompression, traumatic brain injur

The Pattern of Significant Lesions Found in Computerized Tomography Scan of Recurrent Seizure Patients at a Center in Enugu, Nigeria

Introduction: Seizures are common reasons for neurologic consultations and investigations. In the absence of magnetic resonance imaging, computerized tomography scanning of the brain is a reliable and cheaper alternative. Little is known about the pattern of brain lesions in patients with recurrent seizures in Nigeria. Objectives: To determine the pattern of significant intracerebral lesions in patients presenting with recurrent seizures in a tertiary hospital in Enugu. Methods: All the medical and computer tomography records of patients with a clinical diagnosis of recurrent seizures were reviewed. The study duration was 11 years (January 2003 to December 2013). Relevant data were obtained and statistical analysis was done using SPSS version 19 and GraphPad Prism 6. Results: The diagnostic yield of CT was 55.1%. Twenty (9.3%) individuals had two lesions each. The significant findings were tumors (20.4%), encephalomalacia (18.9%) and strokes (7.7% (ischemic stroke, 4.1%, intracerebral hemorrhage, 3.1%, subarachnoid hemorrhage/intraventricular hemorrhage, 0.5%). Hydrocephalus (HCP) was found in 18 (9.2%) cases, and 30% of them occurred together with other lesions. The diagnostic yield increased with age reaching 84.4% from the age of 60 years. Only patients with encephalomalacia were statistically older than those with normal imaging. Conclusion: Computed tomography scan has a high diagnostic yield, especially in elderly patients with recurrent generalized seizures. Brain tumors, encephalomalacia, and HCP are most common causes of recurrent seizures in the adults.Keywords: Computed tomography, Nigeria, recurrent seizures, space‑occupying lesions, stroke

Masculinity, Medical Mistrust, and Preventive Health Services Delays Among Community-Dwelling African-American Men

http://dx.doi.org/10.1007/s11606-010-1481-