Profile, determinants and mechanisms of cerebral injury and cognitive impairment following stroke

PhD ThesisOne in three people over a life time will develop a stroke, dementia or both but little is known about stroke - related cognitive impairment despite current epidemiologic transition in sub - Saharan Africa. The CogFAST Study was established in Newcastle to unmask risk factors, pathological substrates and cellular mechanisms underlying cerebral injury and cognitive impairment following stroke. The overall aim of this thesis was to establish a comparative cohort in Nigerian African stroke survivors and explore mechanisms in post - mortem brains accrued from the Newcastle cohort. Two hundred and twenty Nigerian African stroke survivors were screened three months after index stroke out of whom 143 eligible participants underwent cognitive assessment in comparison with 74 stroke - free healthy controls. We found a high frequency (49.3%) of early vascular cognitive impairment and significant association with older age and low education. Pre-stroke daily fish intake and moderate – to - heavy physical activity were inversely associated. The frequency of vascular cognitive impairment no dementia (vCIND) in the cohort (39.9%) was relatively higher than earlier report from Newcastle (32%) but neuroimaging studies revealed significant findings of MTLA and correlative white matter changes in tandem with previous reports from the Newcastle cohort. Given these, we investigated neurodegenerative hippocampal Alzheimer pathology and synaptic changes, as well as frontal and temporal white matter abnormalities in post - mortem brain tissue from the Newcastle cohort. We found increased Alzheimer pathology in the post - stroke groups but largely this did not differ between the demented (PSD) and non - demented (PSND) sub - groups. However, we found significantly higher hippocampal expression of synaptic markers (vesicular glutamate transporter – 1 and Drebrin) but lower expression of microglial, astrocytic and axonal injury markers in PSND compared to PSD subjects. The protective effect of educational attainment, pre-stroke physical activity and fish intake have public brain health implications.ORS Award from Newcastle University, a Research Fellowship from the International Brain Research Organization (IBRO) and laboratory visit support from the International Society of Neurochemistry (ISN)

Menstrual-Related Headaches Among a Cohort of African Adolescent Girls

Introduction: Migraine attacks associated with menstruation are generally perceived as more severe than attacks outside this period. Aim and Objective: The study aimed at determining the frequency of menstrual-related headaches among a cohort of senior secondary school girls in Abeokuta, Nigeria. We also determined its burden among these school girls. Methodology: This study was cross-sectional using a validated adolescent headache survey questionnaire. A self-administration of the instrument was done during a school visit. A headache was classified using the ICHD-II criteria. Results: Of the 183 students interviewed, 123(67.2%) had recurrent headaches. Mean age ±SD, 16.18± 1.55 (range 12– 19). The prevalence of definite migraine was 17.5% while the prevalence of probable migraine was 6.0%. The prevalence of tension-type headache was 41.0%. Migraine was significantly menstrual-related (p=0.001, 95% CI=1.06– 6.63). Median pain severity score was higher among MRH group (p=0.043). The median number of days of reduced productivity and missed social activities was significantly higher in the MRH group; p= 0.001 and p=0.03, respectively. Subjects with MRH were more incapacitated by their headaches (p= 0.003). Conclusion: Menstrually related headache is prevalent even among the adolescent and it has adversely affected their productivity and social life. Care of adolescent with headaches should be intensified

Impact of intermediate home-based care on functional health of older adults with stroke in low-income and middle-income countries: A systematic review

Background: Intermediate care services are designed to facilitate transition from medical dependence to functional independence, ultimately improving the overall quality of life. Despite the recognized benefits of intermediate care in rehabilitation, data on its impact on functional outcomes for older adults with stroke in low- and middle-income countries are limited. Objective: This systematic review aimed to evaluate the effectiveness and outcomes of an intermediate care model among older adults with stroke. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Scopus, EMBASE, PubMed, CINAHL, MEDLINE, Google Scholar, and reference lists of manually selected articles were searched. Only studies published in English from 2012 to 2023 were included. Randomized controlled trials and quasi-experimental studies focusing on functional improvement in motor function, activities of daily living (ADLs), and quality of life in older adults with stroke receiving home-based or community intermediate care were considered. Data extraction utilized the PICO framework. Three reviewers independently conducted a critical appraisal and risk of bias assessments, with two additional reviewers resolving any discrepancies. Results: Eleven studies from low- and middle-income countries were included. The interventions varied, encompassing exercise programs, therapy sessions, video-based programs, reminiscence therapy, and caregiver-assisted therapy, targeting various aspects of stroke recovery and rehabilitation. The interventions demonstrated positive effects on functional outcomes, significantly improving ADLs and overall quality of life. Conclusions: Despite variability in functional outcomes, the study highlights that implementing home-based intermediate care can be crucial for stroke patients in low-resource settings

Case report: A rare case of catastrophic Takayasu arteritis: acute ischemic stroke and anterior ischemic optic neuropathy

Acute ischemic stroke (AIS) is a known complication of Takayasu arteritis (TAK); however, it is infrequently the first symptom observed. There have been no reports of concomitant AIS and anterior ischemic optic neuropathy (AION) as an initial manifestation of TAK. We present a case of TAK causing stroke and painless vision loss in a young Nigerian woman. A 33-year-old female patient presented with abrupt onset weakness in the right extremities and painless vision loss in her left eye. Her medical history included joint pain, malaise, syncope, and dizziness, along with peripheral vascular collapse, requiring recurrent hospital admissions. She had an absent left radial pulse, reduced left carotid pulse, and unrecordable blood pressure in her left arm. There was a relative afferent pupillary defect (RAPD), with fundoscopy findings indicating optic disc pallor. She had expressive aphasia, right facial paresis, and right flaccid hemiparesis. Brain computed tomography (CT) showed an infarct in the left middle cerebral artery (MCA) territory. The brain CT angiography showed diffuse enhancing aortic arch wall thickening and multiple aortic arch branch obstructive disease. The diagnosis was TAK complicated by left hemispheric infarctive stroke and left AION. She began treatment with prednisolone, azathioprine, and secondary stroke preventive care. Her vision improved to the ability to count fingers, with good functional outcomes and reduced disease activity. This case highlights the challenging diagnostic trajectory of TAK in a Nigerian female patient, featuring a unique multi-vessel affectation. Clinicians should be aware of the protean clinical presentations of TAK to reduce adverse cardiovascular complications

Impact of intermediate home-based care on functional health of older adults with stroke in low-income and middle-income countries: A systematic review

Background: Intermediate care services are designed to facilitate transition from medical dependence to functional independence, ultimately improving the overall quality of life. Despite the recognized benefits of intermediate care in rehabilitation, data on its impact on functional outcomes for older adults with stroke in low- and middle-income countries are limited. Objective: This systematic review aimed to evaluate the effectiveness and outcomes of an intermediate care model among older adults with stroke. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Scopus, EMBASE, PubMed, CINAHL, MEDLINE, Google Scholar, and reference lists of manually selected articles were searched. Only studies published in English from 2012 to 2023 were included. Randomized controlled trials and quasi-experimental studies focusing on functional improvement in motor function, activities of daily living (ADLs), and quality of life in older adults with stroke receiving home-based or community intermediate care were considered. Data extraction utilized the PICO framework. Three reviewers independently conducted a critical appraisal and risk of bias assessments, with two additional reviewers resolving any discrepancies. Results: Eleven studies from low- and middle-income countries were included. The interventions varied, encompassing exercise programs, therapy sessions, video-based programs, reminiscence therapy, and caregiver-assisted therapy, targeting various aspects of stroke recovery and rehabilitation. The interventions demonstrated positive effects on functional outcomes, significantly improving ADLs and overall quality of life. Conclusions: Despite variability in functional outcomes, the study highlights that implementing home-based intermediate care can be crucial for stroke patients in low-resource settings

Graves’ disease presenting as paranoid schizophrenia in a Nigerian woman: a case report

Paranoid syndromes in Graves’ disease are rare. The true incidence is lacking. Most reports have emanated from developed countries where medical investigations are readily available. No report of such has emanated from Nigeria. We report a 43-year-old female Nigerian with Graves’ disease associated with paranoid schizophrenia and review the literature

The 2022 symposium on dementia and brain aging in low- and middle-income countries: highlights on research, diagnosis, care, and impact

Two of every three persons living with dementia reside in low- and middle-incomecountries (LMICs). The projected increase in global dementia rates is expected toaffect LMICs disproportionately. However, the majority of global dementia care costsoccur in high-income countries (HICs), with dementia research predominantly focus-ing on HICs. This imbalance necessitates LMIC-focused research to ensure thatcharacterization of dementia accurately reflects the involvement and specificities ofdiverse populations. Development of effective preventive, diagnostic, and therapeu-tic approaches for dementia in LMICs requires targeted, personalized, and harmonizedefforts. Our article represents timely discussions at the 2022 Symposium on Demen-tia and Brain Aging in LMICs that identified the foremost opportunities to advancedementia research, differential diagnosis, use of neuropsychometric tools, aware-ness, and treatment options. We highlight key topics discussed at the meeting andprovide future recommendations to foster a more equitable landscape for dementiaprevention, diagnosis, care, policy, and management in LMIC

Enhancing Africa's stroke workforce to address the stroke burden: a proposal from the African's stroke organization's educational and training committee

Stroke is the second leading cause of death and disability in Africa, disproportionately affecting individuals in their most productive years and placing an immense socio-economic burden on families and healthcare systems. Despite the growing stroke burden, Africa faces a severe shortage of trained stroke specialists, with only three neurologists per 10 million people compared to up to 900 per 10 million in high-income countries. This gap has led to inadequate acute management, limited rehabilitation services, and poor long-term outcomes. To address this crisis, the African Stroke Organization (ASO) established an Education and Training Committee focused on developing a structured stroke education framework. This proposal outlines ASO's strategic initiatives to build stroke care capacity through research, professional training, service development, and advocacy. By implementing a comprehensive stroke education program-including online courses, hands-on workshops, conference-based training, and a future summer school, ASO aims to train 5,000 by 2030. Through this initiative, ASO seeks to empower African healthcare professionals, reduce disparities in stroke care, and ultimately improve stroke outcomes across the continent. This proposal presents the rationale, objectives, and implementation strategies for the ASO Stroke Education Program and calls for international collaboration to support this critical effort

Advancing Stroke Genomic Research in the Age of Trans-Omics Big Data Science: Emerging Priorities and Opportunities

Background—We systematically reviewed the genetic variants associated with stroke in genome-wide association studies (GWAS) and examined the emerging priorities and opportunities for rapidly advancing stroke research in the era of Trans-Omics science. Methods—Using the PRISMA guideline, we searched PubMed and NHGRI- EBI GWAS catalog for stroke studies from 2007 till May 2017. Results—We included 31 studies. The major challenge is that the few validated variants could not account for the full genetic risk of stroke and have not been translated for clinical use. None of the studies included continental Africans. Genomic study of stroke among Africans presents a unique opportunity for the discovery, validation, functional annotation, trans-omics study and translation of genomic determinants of stroke with implications for global populations. This is because all humans originated from Africa, a continent with a unique genomic architecture and a distinctive epidemiology of stroke; as well as substantially higher heritability and resolution of fine mapping of stroke genes. Conclusion—Understanding the genomic determinants of stroke and the corresponding molecular mechanisms will revolutionize the development of a new set of precise biomarkers for stroke prediction, diagnosis and prognostic estimates as well as personalized interventions for reducing the global burden of stroke