Awareness of warning signs among suburban Nigerians at high risk for stroke is poor: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Although stroke is a leading cause of morbidity and mortality in Nigeria, there is no information on awareness of its warning signs. This study was designed to assess awareness of stroke warning signs in Nigerians at increased risk.</p> <p>Methods</p> <p>A hospital-based cross-sectional study conducted at Irrua Specialist Teaching Hospital, in southern Nigeria. Patients with a diagnosis of hypertension, diabetes or both were interviewed for the warning signs of stroke in the outpatient clinic by trained interviewers. The main outcome measure was ability to identify at least one stroke warning sign.</p> <p>Results</p> <p>There were 225 respondents with a mean age of 58.0 ± 11.7 years. Only 39.6% could identify at least one stroke warning sign while the commonest sign identified was sudden unilateral limb weakness (24.4%). On multivariate logistic regression analysis, male sex (β = 0.26, 95% CI = 0.14–0.39, p < 0.001) and 11 or more years of education (β = 0.16, 95% CI = 0.03–0.29, p = 0.02) emerged the independent predictors of ability to identify at least one warning sign.</p> <p>Conclusion</p> <p>Awareness of stroke warning signs is poor among Nigerians at increased risk for the disease. Efforts should be made to improve on the level of awareness through aggressive health education.</p

Investigations In Neurology

Much of the progress in clinical neurology during the last two decades has come from the development of new diagnostic procedures. The most dramatic progress has occurred in the field of neuroimaging, where computerized tomography and magnetic resonance imaging have revolutionalized the diagnosis of central nervous system diseases. Advances in ultrasound technology such as duplex and colour Doppler have made diagnostic ultrasonography the primary non-invasive technique for screening the cerebrovascular system. PET and SPECT are powerful imaging techniques which enable in vivo examination of brain function. They are increasingly being used in clinical neurology to improve the understanding of disease pathogenesis, to aid with diagnosis, and to monitor disease progression and response to treatment. Electrodiagnostic studies, including EMG, nerve conduction studies, and evoked potentials, are integrated methods used in the evaluation of patients with neuromuscular disorders. The diagnosis of neuromuscular disorders also sometimes requires the biopsy of nerves or muscles. The EEG's major clinical application is in epilepsy where it is fundamental in the classification of epileptic seizures and syndromes. Despite moves towards less invasive neurodiagnostic procedures, lumbar puncture with CSF analysis remains useful in the diagnosis and treatment of a variety of CNS disorders, especially CNS infections. Similarly, brain biopsy is considered essential in the diagnosis and appropriate management of most primary brain tumours. NQJHM Vol. 15 (1) 2005: pp. 23-2

MRI white Matter Lesions in a Stroke Clinic Population: Correlation with Increased Carotid Intima-media Thickness on Ultrasonography

Cerebral white matter lesions (WML) on MRI have been related not only to age but also to cerebrovascular disorders. This study aimed to determine the prevalence of WML in a population of patients attending a stroke clinic and relate it to the presence of carotid atherosclerosis as determined by increased carotid intima-media thickness (IMT) on ultrasonography. Subjects were recruited from patients attending a stroke clinic at the National Hospital for Neurology and Neurosurgery, Queen square, London. The patients had cranial MRI and carotid ultrasonography (amongst other investigations). WML on MRI were graded according to the rating scale of the Task force on age-related white matter changes and a WML score was obtained based on the WML grades and geographical distribution. Patients with carotid intima-media thickness > 1cm on ultrasonography were considered to have increased intima-media thickness. WML was present in 63.46% of subjects. Patients with WML had a significantly higher mean age than those without (67.5 vs 53.5 years). Increased carotid IMT was found in 33.3% of those with WML and in 15.8% of those without. The difference was not statistically significant. There was no significant association between the presence of any grade of WML and increased carotid IMT. Similarly, the mean WML scores for patients with and without increased carotid IMT were not significantly different. A high proportion of patients in the stroke clinic had WML on MRI. Presence of WML was not associated with the presence of carotid atherosclerosis as shown by increased carotid intima-media thickness. Nigerian Medical Practitioner Vol. 52 (2) 2007: pp. 38-4

Thirty-Day Case Fatality of Stroke at the Lagos University Teaching Hospital

Background: There is some evidence that the case fatality rate of stroke has declined in recent years, although it is not certain that this reduction has been caused by changes in stroke management. There has been no recent review of the case fatality rate of stroke at the Lagos University Teaching Hospital [LUTH]. Objective: To determine the 30-day case fatality rate of stroke at LUTH over the five-year period of 1995 to 1999. Materials and Methods: The medical records of stroke patients admitted to the teaching hospital from January 1995 to December 1999 were retrospectively reviewed, and information obtained on the number of stroke patients admitted during this period and the number that died within 30days of stroke. The 30-day case fatality rate of stroke at the hospital for this period was determined. Results: A total of 715 stroke patients were admitted during this period: 18 were discharged against medical advice and 287 died within 30days of onset of their stroke, giving a 30-day case fatality rate of 41.2%. Conclusion: The 30-day case fatality rate of stroke at the Lagos University Teaching Hospital has improved over the years, but is still considerably higher than the 30-day case fatality rates of stroke in Europe and North America. There is the need for a stroke unit in the hospital to improve the management of stroke patients. NQJHM Vol. 14 (1) 2004: pp. 64-6

Effect Of Admission Hyperglycaemia On Short-Term Outcome In Adult Nigerians With A First Acute Ischaemic Stroke

Background There is no information from a prospective study on the relationship between admission hyperglycaemia and stroke outcome in Nigerians. This study was designed to determine the impact of admission hyperglycaemia on short-term stroke outcome (case fatality rate and functional outcome) in adult Nigerians with acute ischaemic stroke. Methods 100 consecutively attending first-ever acute ischemic stroke patients attending our tertiary facility within 72 hours of stroke onset were recruited. Stroke severity on the NIHSS and random blood glucose levels were documented on admission. The outcome measures (case fatality rate and functional status on the NIHSS in survivors) were assessed at 30 days from stroke onset. Results The frequency of admission hyperglycaemia (random blood glucose &#8805;140mg/dL) was 34%. Baseline stroke severity on the NIHSS was worse in hyperglycaemic patients (median NIHSS 14) compared to normoglycaemic patients (median NIHSS 8). The 30-day case fatality rate was significantly higher in hyperglycaemic compared to normoglycaemic patients (41.2% vs. 21.2%,

Pattern And Outcome Of Neurological Manifestations Of Hiv/Aids - A Review Of 154 Cases In A Nigerian University Teaching Hospital - A Preliminary Report

Background The HIV is neurotropic and clinicians need to be aware of its myriad neurologic manifestations, as these may be the only clinical presentation. Objective To evaluate the clinical spectrum and outcome of the neurologic manifestations in patients with HIV / AIDS over a ten year period. Design case - note based retrospective follow-up study. Settings Olabisi Onabanjo University Teaching Hospital; Nigeria. Participants Patients attending the HIV outpatient clinic and medical in-patients with AIDS. Intervention Treatment was symptomatic and specific treatment was administered for indicator diseases. Highly Active Anti-retroviral Therapy (HAART) was not used routinely. Main Outcome Measure Neurologic impairment related to HIV / AIDS and its sequelae within 6 months. Results A total of 362 patients with HIV / AIDS were reviewed over a ten-year period, of which 154 patients, (42.5%) had neurological manifestations. Forty-five (29%) patients had Herpes zoster, 40 (26%) had TB meningitis (TBM), 19 (12%) had vacuolar myelopathy (VM), another 19 (12%) had AIDS dementia complex (ADC), 15 (9.7%) had toxoplasma encephalitis, 10 (6.5%) had distal sensory polyneuropathy, 4 (2.6%) had inflammatory demyelinating polyneuropathy, and 2 (1.3%) had subacute combined degeneration of the spinal cord. An overall 6-months fatality of 45% was recorded with ADC, VM and TBM as predictors of high fatality. Conclusion Herpes zoster appears to be the commonest neurological manifestation while TBM is the commonest AIDS defining illness. Our experience indicates that unusual neurological manifestations could be the first manifestation of HIV/AIDS, and there is need for awareness of these entities by practising doctors for prompt diagnosis and treatment. Screening of all patients with Herpes zoster for HIV is also advised.Introduction Le VIH est neurotrophique et les praticiens doivent être vigilants compte tenu du caracère polymorphe des manifestations neurologiques cliniques. But Evaluer les aspects cliniques et l\'évolution des manifestations cliniques chez des patients HIV/SIDA durant une période de 10 ans. Méthodes Il s\'agit d\'une étude rétrospective réalisée à l\'Olabisi Onabanjo University Teaching Hospital (Nigeria) chez des patients en ambulatoire pour les séropositifs ou hospitalisés, pour les sidéens. Le traitement était symptomatique et rarement trithérapie. Résultats 362 patients VIH / SIDA ont été étudiés sur une période de dix ans. 154 patients (42.5%), présentaient des manifestations neurologiques. Quarante cinq patients (29%) avaient un zona, 40 (26%) une méningite tuberculeuse (TBM), 19 (12%) une myéopathie vacuolaire (VM), 19 (12%) une démence (AIDS dementia complex, ADC), 15 (9.7%) une toxoplasmose cérébrale, 10 (6.5%) une polyneuropathie distale sensitive, 4 (2.6%) une polyneuropathie démyélinisante inflammatoire, and 2 (1.3%) une myélopathie subaiguë subacute. Conclusion Le zona apparaît comme étant la manifestation neurologique la plus commune. Notre expérience montre que les manifestations neurologiques inhabituelles peuvent être les premières manifestations du VIH/SIDA et interpelle tout médecin en présence de tout malade atteint d\'un zona. Keywords: Africa, AIDS, HIV, Nigeria, Neurological, Afrique, neurosida, VIH, SIDAAfrican Journal of Neurological Sciences Vol. 24 (1) 2005: pp. 29-3

Poststroke anxiety disorders in a Nigerian hospital: Prevalence, associated factors, and impacts on quality of life

Background and Purpose: Anxiety disorders impact negatively on morbidity and mortality poststroke. Few studies have, however, been done on poststroke anxiety disorders (PSAD), particularly in Africa. The study aims to determine the prevalence, associated clinicodemographic factors, and impact of PSAD on quality of life (QoL) among outpatients at a tertiary hospital in Nigeria. Methods: Seventy stroke survivors attending Outpatient Clinics at Lagos University Teaching Hospital, Nigeria, were recruited into the study. Participants were assessed using sociodemographic/clinical questionnaire, the modified Mini–Mental State Examination, the Modified Rankin Scale, the Schedule for Clinical Assessment in Neuropsychiatry, and the World Health Organization-QoL-Bref. Data collection took 5 months and analyzed using the Statistical Package for the Social Sciences (SPSS®) software version 17.0. Results: The mean age of respondents was 57.43 (±9.67) years and 38 respondents (54%) were male. Majority of the stroke survivors had infarctive stroke 55 (78.6%), right hemispheric lesions 37 (52.9%), and significant poststroke disabilities 57 (81.4%). The prevalence of PSAD was 10% and agoraphobia with panic attacks was elicited in 42.8% of those diagnosed with PSAD. Participants with PSAD were significantly more likely to be unemployed (P = 0.01) and pay more than ₦10,000 ($62.50 at December 2013) monthly for health care. The mean QoL scores were lower in participants with PSAD across all QoL spheres, and significantly so for overall health (P = 0.04), health satisfaction (P = 0.02), and physical health (P = 0.01) domains. Conclusion: PSAD, especially agoraphobia in association with unemployment and high health-care costs correlated with poor well-being among stroke survivors. Proactive measures to ensure prompt identification and management may potentially improve outcome and QoL after stroke

Post-stroke depression: Prevalence, associated factors and impact on quality of life among outpatients in a Nigerian hospital

Objectives: To investigate the prevalence of post-stroke depression (PSD), its associated factors and impact on quality of life (QoL) among outpatients in a Nigerian hospital. Methods: This cross-sectional study was carried out among 140 adults made up of 70 stroke survivors and matched controls with stable hypertension. Participants were administered questionnaires to profile their socio-demographic and clinical characteristics. Subsequently, they were assessed with the modified mini-mental state examination (MMSE), modified Rankin Scale (mRS), schedule for clinical assessment in neuropsychiatry (SCAN) and World Health Organization Quality of Life-BREF (WHOQoL-BREF). Results: The mean ages (± s.d.) of stroke survivors and controls were 57.43 (± 9.67) years and 57.33 (± 9.33) years, respectively. Majority of stroke survivors (n = 55 [78.6%]) had infarctive stroke, and 37 (52.9%) had right hemispheric lesion. Sixteen (22.9%) stroke survivors had PSD, with moderate to severe depression (F32.1) being the most prevalent, while none of the controls was clinically depressed. PSD correlated positively with monthly health bill above 10 000 naira ($61), significant post-stroke disability and poorer scores on all QoL domains (p < 0.05). Conclusion: Depression was 20-fold prevalent in stroke survivors compared to controls with stable hypertension, and sevenfold the life-time prevalence reported among adult general population in Nigeria. Furthermore, increased health care bills per month, significant post-stroke disability and poorer QoL indicated survivors more likely to have depression. Findings in this study support the need to pay closer attention to psychosocial needs of stroke survivors to improve well-being. Future longitudinal study on psychosocial burden of stroke is warranted