Etiology and electroclinical pattern of late onset epilepsy in Ibadan, Southwestern Nigeria

BackgroundLate onset epilepsy (LOE) is a common neurological problem throughout the world. It is an area that has not been fully explored in the developing countries like Nigeria. The aim of the present study is to  determine the pattern of presentation of late onset epilepsy with the view to identifying the etiologic as well as describe their electro-clinical pattern.Methods120 consecutive patients presenting at the University College Hospital with LOE were recruited. A  detailed history was obtained in every case, and complete neurological examination was performed. EEGs were done in all patients. Contrast CT Scans and MRI were performed.ResultOne hundred and twenty subjects comprising 71 (59.2%) males and 49 (40.8%) females were studied. The ages of the patients ranged between 25 and 85 years with a mean of 53years (sd =14.6). The ages at onset of epilepsy ranged between 25 and 84 years with a mean of 52 (sd=14.8). All the subjects had classifiable seizure types, 31 (25.8%) had generalized seizure. The most common type of seizure was partial seizure diagnosed in 89 (74.2%) subjects. Fifty two (43.3%) of the subjects had abnormal neurological findings. Twenty one (30.9%) had cerebral infarcts and 20 (29.4%) had cerebral tumor. Those with symptomatic epilepsy were more likely to have neurologic deficit, simple partial seizure, secondarily generalized seizure, focal epileptiform discharges and focal slow waves.ConclusionThe most common abnormalities in LOE were cerebral infarct and brain tumor. A careful history, neurological examination and an EEG are adequate in the initial work-up of patients with LOE

Factors associated with death and predictors of one.month mortality from stroke in Kano, Northwestern Nigeria

Background: In resource-poor setting, identification of predictors of death is of paramount importance for clinicians, so that specific therapies and management strategies can be applied to patients at high risk of dying. This study aims to determine the factors associated with death and predictors of in-patient mortality for stroke among a cohort of stroke patients in two tertiary centers in Northwestern Nigeria. Materials and Methods: This was a prospective study of consecutive patients with acute stroke who were admitted to tertiary hospitals in northwestern Nigeria. A single observer, using pre-defined diagnostic criteria, recorded the information of interest including length of stay, outcome (dead or alive all through 30 days), time of death. Result: A total of 273 patients comprising 179 male and 94 female stroke patients were recruited. One hundred and seventy-four (63.7%) had infarctive stroke while 99 (36.3%) had hemorrhagic stroke (91 intracerebral and 8 sub-arachnoid hemorrhage). One-month mortality was 37%, and the majority was patients with hemorrhagic stroke (69.6%). About two-third (74.5%) of the mortalities occurred during the first week of the event. Logistic regression showed that severe systolic blood pressure, severe diastolic pressure, second or more episode of stroke, severe GCS, seizures, abnormal pupillary size, hemorrhagic stroke type, presence of aspiration pneumonitis, RBS > 200 mg/dl were independent predictors of mortality in stroke. Conclusion: The present study provides information on factors associated with death in stroke. GCS < 8, seizures, abnormal pupillary size, hemorrhagic stroke, aspiration pneumonitis were independent predictors of mortality

Clinical profile of parkinsonian disorders in the tropics: Experience at Kano, northwestern Nigeria

Background: No data exists on Parkinson’s disease (PD) and secondary Parkinsonism in Northwestern Nigeria. This study was designed to create a database, document the clinical profile of PD in Kano, northwestern Nigerian, and compare this to prior observations within and outside Nigeria. Materials and Methods: A database was documented on prospective patients presenting consecutively to the Neurology out-patients clinic of the two tertiary health facilities in Kano northwestern Nigeria over a period of 4 years. Demographic and clinical data at presentation were documented for all patients. Cases were classified as PD or secondary Parkinsonism. The severity at presentation and at last visit was classified using the H and Y scale. Results: Over a period of 4 years, out 1153 a total of 96 patients comprising 74 males and 22 females were enrolled. Eighty (83.3%) of them had clinically diagnosed PD while 16 (16.7%) had clinical features compatible with secondary Parkinsonism. The mean age at onset of symptoms in the PD patients (mean 58.2 ± 6.72 yrs ) was more than in secondary Parkinsonism (mean 51.4 ± 10.04 and P = 0.001). There was male preponderance in both idiopathic Parkinsonism (PD) (m:f = 3.2:1) and secondary Parkinsonism (m:f = 4.3:1). Out of the patients with secondary Parkinsonism, 10 (62.5%) and 5 (31.3%) had vascular Parkinsonism and drug-induced Parkinsonism, respectively. Duration of symptoms prior to presentation ranged between 3 months and 16 years. The mean (SD) time interval from the onset of motor symptoms to diagnosis of PD was 3.6 ± 3.4 yrs and time interval for men and women (male 3.8 ± 3.7; female 2.8 ± 2.1; P = 0.249). Conclusions: Clinical profile of patients with PD and secondary Parkinsonism in Kano is similar to that from other populations within Nigeria and other developing countries. However, delayed presentation, less frequent family history, lower frequency of Young-onset PD as well as treatment challenges occasioned by poverty, inadequacy of expert, and lack of newer drugs and treatment options contrasts the situation in western populations

Comparative analysis of electrophysiological parameters of sural nerve in normal and type-2 diabetic subjects

The study was designed to evaluate sural nerve conduction of type-2 diabetes mellitus (T2DM) patients that were asymptomatic for neuropathy and compare their findings with age and sex matched healthy individuals. Using a standard technique, sural nerve conduction study was conducted on 100 T2DM patients with no clinical features suggestive of neuropathy and 100 healthy volunteers, matched for age and sex, serving as control. Sural nerve latency, Amplitude and Conduction Velocity (CV) were measured using Nihoen Kohden EMG Machine. On comparison of the sural nerve conduction parameters, sural nerve distal latencies were significantly lower in the control group while the sural nerve conduction velocities and amplitudes were significantly higher in the T2DM group. The study showed significant difference between the sural nerve conduction parameters in T2DM patients without clinical features suggestive of peripheral neuropathy when compared with apparently healthy individuals.Keywords: Sural nerve; Diabetic neuropathy; Electrophysiolog

Related Factors and Predictors of Cognitive Dysfunction in Chronic Kidney Disease on Maintenance Hemodialysis in Nigeria

Background: Previous studies suggest a high frequency of cognitive impairment (CI) in persons with chronic kidney disease (CKD); however, factors associated with CI and predictors of CI in persons with CKD remain largely unclear. The aim of this study was to determine the factors associated with CI and predictors of CI in CKD patients on maintenance hemodialysis. Materials and Methods: The first stage of the study included recruitment of 100 apparently healthy participants aimed at determining the reference values. The second stage of the study included eighty CKD patients on maintenance hemodialysis. The iron psychology (FEPSY) was used to assess the memory, psychomotor speed, concentration, and attention using simple auditory reaction time (ART) and visual reaction time (VRT) tasks, recognition memory tests (RMT), finger tapping task (FTT), and binary choice task (BCT). Results: Using normative values generated in this study, 41 (51.3%) and 43 (53.8%) CKD patients had abnormal scores on ART dominant (D) and nondominant (ND) sides, respectively. Forty (50%) and 42 (52.5%) patients had abnormal scores on VRT D and ND sides, respectively. Twenty-one (26.3%) and 68 (85%) had abnormal scores on BCT and computer-assisted visual scanning task, respectively. Sixty-four (80%) and 65 (81.3%) had abnormal scores on RMT (words) and RMT, respectively. Fifty-two (65%) and 48 (60%) patients had abnormal scores on D and ND sides of (FTT), respectively. Factors associated with psychomotor speed impairment were duration of CKD from diagnosis (P = 0.0001 and 0.043 in D and ND ART, respectively), duration on dialysis (P = 0.0001 across board in D and ND ART as well as in D and ND VRT, respectively), and plasma urea (PU) and plasma creatinine (PCr) (P < 0.05). Factors found to be associated with memory impairment included age (P = 0.045 and 0.025 on words and figures RMT, respectively), PU (P = 0.002 and 0.005 on words and figures RMT, respectively), and PCr (P = 0.012 and 0.040 on words and figures RMT, respectively). Duration on dialysis (P = 0.032) and PCr (P = 0.001) were associated with attention and concentration. Only psychomotor speed was independently predicted by duration of CKD. Conclusion: Factors associated with psychomotor speed impairment were duration of CKD, duration on dialysis, and PU and PCr while age, PU, and PCr were associated with memory. Duration on dialysis and PCr were associated with attention and concentration. Only psychomotor speed was independently predicted by duration of CKD

Hemorrhagic infarctive stroke in COVID-19 patients: report of two cases and review of the literature

There is growing evidence in support of ischemic stroke as a manifestation of COVID-19 infection. However, hemorrhagic transformation of ischemic stroke is rare. We present two cases of hemorrhagic infarction as presenting features in COVID-19 patients who did not have traditional cardiovascular risk factors for ischemic or hemorrhagic stroke. While the hemorrhagic infarct was from a large artery in one of the patients, the other patient had a small artery related hemorrhagic infarct. We highlighted the possible underlining mechanisms from the literature and the implication of hemorrhagic infarct for routine anticoagulant therapy in patients with COVID −19 related ischemic stroke

Methanol induced stroke: report of cases occurring simultaneously in two biological brothers

Methanol bears semblance to ethanol in smell and taste, thus, individuals who indulge in alcohol may fall back on it in societies where alcohol consumption is illegal or difficult to come by despite the life-threatening neurologic sequelae of methanol toxicity. Stroke is an uncommon outcome of methanol poisoning. We presented two cases of methanol-induced infarctive and hemorrhagic stroke in biological brothers who were simultaneously involved in an illicit ingestion of methanol. One of them developed infarctive stroke while the other had infarctive stroke with hemorrhagic transformation. We have highlighted the differences and similarity in the course of their illnesses

Study of electroencephalography in people with generalized epilepsy in a Saudi population

Background Electroencephalography (EEG) remains a vital tool in the diagnostic evaluation of patients with epilepsy (GE), however, there is scarcity of information on the yield and potential clinical variables that are associated with EEG abnormalities in people with GE. Objective The study aimed to evaluate the yield and pattern of EEG abnormalities in patients with GE with the view to determining factors that are independently associated with abnormal EEG in them. Methods We characterized EEG features and evaluated associated factors in a sample of people with GE in a Saudi population. Standard definition of interictal epileptiform discharges was used. Results A total of 1105 (77%) out of 1436 GE patients had EEG. Five hundred and ninety-five (53.85%) patients had abnormal EEG. Factors associated with EEG abnormalities before adjustment for confounders were age, gender, duration of epilepsy, and seizure frequency. However, only frequency of seizure (P = 0.0018), gender (P < 0.0001), and age (P < 0.0001) were independently associated with EEG abnormalities. Conclusion The study showed a modest yield (54%) of abnormal EEG in the cohort of patients with GE. Frequency of seizure, age, and gender, independently predicted the presence of EEG abnormality in people living with GE