Calvarial hemangioma causing seizure disorder: A case report with review of literature

Calvarial hemangiomas are rare benign tumours of the skull bone for which seizure as a presentation is unusual; neurological deficits are uncommon.We report a case of cavernous hemangioma of the parietal bone causing seizure disorder in a 47 year old man. The tumor was removed enbloc with satisfactory methylmethacrylate cranioplasty. Pathological examination confirmed the diagnosis. Patient received short course of antiepileptic drugs with satisfactory recovery. This case demonstrates that seizure disorder can occur in Calvarial haemangiomas as a rare complication. A review of relevant literature is included herein

Armoured brain: A case of bilateral calcified chronic subdural haematoma complicating infantile hydrocephalus

Chronic Subdural haematoma is one of the late complications of shunting procedures. Calcified Chronic Subdural haematoma (CCSDH) which is very rare, follows untreated or asymptomatic Chronic subdural haematomas. When it occurs bilaterally it gives the typical appearance of an “armoured brain” also known as “Matrioska head”. The authors present a case of bilateral CCSDH found on follow-up CT brain scan 15 years after the shunt procedure. The parents had objected to surgical drainage at the time the initial diagnosis was made. The patient is neurologically stable with functional ventriculoperitoneal shunt. The discussion includes a review of relevant literature and treatment options

Ventriculoperitoneal shunt surgery in a Nigerian city: A single institutional experience

Introduction. Improvements in surgical techniques and advancements in antibiotic management have significantly reduced the complications associated with Ventriculoperitoneal Shunting which is still the most common procedure for the treatment of hydrocephalus. These complications are believed to be highest in Low and middle-income countries due to delayed presentation to care facilities. The authors report our experience of managing paediatric hydrocephalus in an institution with evolving Neurosurgical practice in North Central Nigeria. Material and methods. We retrospectively reviewed all cases of VP shunting from 2011 to 2018 taking into consideration the demographics, aetiologies of hydrocephalus, length of hospital stay, postoperative morbidity and mortality, and overall outcome. Complications sought included, Surgical Site infections, shunt exposure, obstruction or any other cause of shunt malfunction. The minimum follow-up period was 24 months Results. There were 27 VPS procedures done in 25 patients of whom 15 were males and 10 females (M:F ratio of 1.5:1). The age range was 8 days to 9 years with a median age of 5 months. Of the 25 cases, 24 (96%) were non-tumoral in origin comprising 17 congenital and 7 acquired hydrocephalus. At 2 years post shunt insertion, 21 (84%) of the 25 initial cases were still functional. The total complication rate was 28%, comprising Surgical Site infection, shunt exposure, shunt obstruction, seizure, and one death, There were 3 (12%) shunt failures from shunt obstruction (2) and shunt exposure (1). Conclusion With meticulous control of the surgical environment and improved experience in ventriculoperitoneal shunting, the complication rate can be significantly reduced. There is a need to increase the awareness of the population to the availability of care for seemingly hopeless conditions. The burden of the cost of care on individuals should be lightened through better health insurance coverage

Non-missile penetrating spinal injury with an impaled knife

Retention of all or part of the weapon following a non-missile penetrating spinal injury is a rare occurrence. The authors report a case of thoracic spinal cord stab injury in a young man. The patient presented with a knife blade lodged in his back and with Brown-Sequard-plus syndrome. At surgery, the wound with the knife in situ was explored and the knife was removed. Although the wound healed without evidence of cerebrospinal fluid leakage or infection, he developed a complete neurologic deficit post-operatively. This was an unlikely outcome for incomplete spinal cord injury resulting from non-missile penetrating spinal injury, historically known to have a favourable outcome. Pre-operatively, patients with incomplete neurological injury following penetrating spine injury with the retained foreign body should be specifically counselled on the possibility of a worsened neurological outcome after surgical intervention

What do medical interns in Nigeria think of the white coat? a cross sectional study

Background: The appeal of the white coat to both the doctors and the public is waning. In most developing countries such as Nigeria doctors' view of the white coat is not known.Objective: To determine the proportion of interns which supported wearing of white coat by doctors.Methods: A 10-item questionnaire was distributed to medical interns undertaking mandatory pre-registration training in a tertiary hospital. Characteristics of interns who were supportive of doctors wearing the white coat were compared to those who did not support or were indifferent to it.Results: Two hundred and thirty three interns returned completed questionnaires. About 54% (126) and 52% (107) of the participants were males and graduates of the College of Medicine, University of Lagos respectively. The majority of interns (167; 71.7%) supported the wearing of white coats by doctors when attending to patients; 22 (9.4%) were opposed to it while 44 (18.9%) were indifferent. Older interns, females and interns who had not rotated through Paediatrics were more likely to support the wearing of white coats by doctors. The commonest reason for wearing the white coat was for identification.Conclusion: The majority of medical interns supported the wearing of white coat by doctors. Prevention of infection is no longer the major reason for wearing the white coat. There is need to document the public's perception of the white coat.Keywords: doctors, medical interns, white coa

Non-missile penetrating spinal injury with an impaled knife: An uncommon injury with an unlikely outcome

Retention of all or part of the weapon following a non-missile penetrating spinal injury is a rare occurrence. The authors report a case of thoracic spinal cord stab injury in a young man. The patient presented with a knife blade lodged in his back and with Brown-Sequard-plus syndrome. At surgery, the wound with the knife in situ was explored and the knife was removed. Although the wound healed without evidence of cerebrospinal fluid leakage or infection, he developed a complete neurologic deficit post-operatively. This was an unlikely outcome for incomplete spinal cord injury resulting from non-missile penetrating spinal injury, historically known to have a favourable outcome. Pre-operatively, patients with incomplete neurological injury following penetrating spine injury with the retained foreign body should be specifically counselled on the possibility of a worsened neurological outcome after surgical intervention

Perception of quality of maternal healthcare services among women utilising antenatal services in selected primary health facilities in Anambra State, Southeast Nigeria

Background: This is a cross-sectional descriptive study aimed at assessing antenatal care service attendees′ perception of quality of maternal healthcare (MHC) services in Anambra State, southeast Nigeria. Materials and Methods: A total of 310 pregnant women utilising antenatal care (ANC) services in three purposively selected primary health centres (PHCs) in rural communities in Anambra State were studied. Reponses were elicited from the participants selected consecutively over a 4-month period, using a pre-tested, semi-structured interviewer-administered questionnaire on socio-demographic characteristics, utilisation and perception of MHC services. Data collected were analysed using SPSS version 17. Results: Findings showed that utilisation of facility for both antenatal (97.0%; 95% CI, 94.4-98.4%) and natal services (92.7%; 95% CI 89.2-95.2%) were quite high. Generally, most of the women were satisfied with MHC services (89.7%). Most of them were satisfied with the staff attitude (85.1%), waiting time (84.1%) and cost of services (79.5%). Being ≥30 years (X2 = 4.61, P = 0.032), married (X2 = 9.70, P = 0.008) and multiparous (X 2 = 9.14, P = 0.028), as well as utilisation of formal health facility for antenatal (X2 = 26.94, P = 0.000) and natal (X2 = 33.42, P = 0.000) services were associated with satisfaction with maternal health services. Conclusions: The study showed high level of satisfaction with quality of maternal health services among antenatal attendees and highlights the need to strengthen interventions that increase uptake of formal MHC services

Infantile subdural empyema: The role of brain sonography and percutaneous subdural tapping in a resource-challenged region

Background This study explored the outcome of children with patent anterior fontanelles who were treated with trans-fontanelle ultrasound scan (TFUSS), which is more affordable and available than CT scan and MRI in the diagnosis of childhood intracranial pathologies and treatment of subdural empyema, in developing countries. Patients and Methods: Seventeen infants with post-meningitic subdural empyema, diagnosed using trans-fontanelle ultrasound alone and treated with subdural tapping over a 31-months period, were studied. Results: Eleven patients presented with grades II and III Bannister and William grading for level of consciousness in intracranial subdural empyema. Aspirate from 7 (41.2%) patients were sterile. The most common organisms isolated were Streptococcus faecalis 3 (17.6%), Haemophilus Influenza 2 (11.8) and Staphylococcus aureus 2 (11.8), multiple organisms were isolated in three of the patients. Ninety-four percent (94%) of the patients had good outcome. Five subjects developed hydrocephalus, one patient had a recurrence of subdural empyema, four patients had residual hemiparesis, two of the four patients had speech difficulties, while one patient (~6%) died. Conclusion: While CT and MRI remain the gold standard for investigating intracranial lesions, transfontanelle ultrasonography is adequate for diagnosis of infantile subdural empyema in resource-challenged areas. Percutaneous subdural tap is an affordable and effective therapy in such patients with financial challenges