Intracranial suppurations surgically managed at Jos, North Central Nigeria: a nine-years retrospective review

Background: Intracranial suppurations are rare but can be fatal entities consisting of pus collection within the intracranial cavity.  The aim of the study was to document the clinical and radiological findings in our patients and the outcome of treatment.Methods: A retrospective analysis of all consecutive patients presenting to the Jos University Teaching Hospital from January 2012 to December 2019. Data of interest were retrieved from their folders and entered into SPSS version 22 and descriptive statistics run on the variables.Results: There were 33 patients within this period, but only 21 had complete records and thus used for the analysis. The median age was 18 years (IQR=29), males accounted for 81% of the patients. The median time to presentation was 14 days (IQR=23). The most common cause of abscess in our series was trauma (surgical and non-surgical) in 38.1%, followed by contiguous spread from the ear or paranasal sinuses (23.8%). The most common symptom was fever occurring in 61.9%, followed by headache 42.8%. In two thirds of the patients, the abscess was intra-axial (the frontal lobe being the most common site). Patients were managed surgically with either a craniotomy (28.6%) or a burr whole (71.4%). A positive culture was obtained in 33.3% of cases.Conclusions: Intracranial suppurations are uncommon, but can occur in the setting of predisposing factors. A high index of suspicion is required to clinch the diagnosis

Traumatic infratentorial epidural haematoma: presentation and treatment outcome at the Jos University Teaching Hospital, North Central Nigeria

Background: Traumatic infratentorial epidural haematoma (TIEH), also called posterior fossa epidural haematomas when compared to their supratentorial counterparts, are very rare and their presentation nonspecific, accounting for 0.1-0.3% of all head trauma. Data on TIEH in our environment is very scanty. Our objective was to document the different presentations of TIEH and the outcome of management of these patients in our setting.Methods: This was a retrospective study of consecutive patients with head injury in whom non contrast cranial CT scan showed the presence of an infratentorial epidural haematoma and who presented to the Jos university teaching hospital between January 2012 to December 2020. The patients’ demographics, aetiology, clinical features, CT scan findings and outcome of treatment were extracted from the case folders and analysed using simple proportions.Results: There was a total of seven patients with TIEH out of a total of 308 patients with traumatic epidural haematoma, thus accounting for 2.3% of epidural haematomas in our series. All the TIEH were caused by road traffic collisions, all but one (85.7%) occurred in adults. Six (85.7%) of the patients had occipital skull fractures detected with cranial CT scan or at surgery. Two (28.6%) of the patients were managed non-operatively under close monitoring and did well. Five (71.4%) of the patients were managed surgically. There was one death, giving an overall mortality of (14.3%).Conclusions: TIEH is rare, the presentation is non-specific and early surgical decompression is lifesaving in selected patients

Fundus first laparoscopic cholecystectomy in patients with gall stone disease and the Fitz-Hugh-Curtis syndrome

Background: To present this experience using the fundus-first technique during laparoscopic cholecystectomy for the management of symptomatic gall stone disease with an intra-operative finding of Fitz-Hugh-Curtis syndrome.Methods: This is a prospective review of patients who had the fundus-first dissection during laparoscopic cholecystectomy. The study was carried out at the Jos University Teaching Hospital (JUTH), and FOMAS hospital, both of which are tertiary hospitals located in Jos. Patients were recruited from January 2017 - January 2019. All patients undergoing laparoscopic cholecystectomy who had an intraoperative diagnosis of Fitz-Hugh-Curtis syndrome, and who had the fundus-first dissection, were included in the study. Patients who had fundus-first dissection for indications other than Fitz-Hugh-Curtis syndrome, were excluded from the study. Demographic and clinical information of patients included age, sex, duration of surgery, complications, and duration of hospital stay. Descriptive statistics were applied.Results: A total of 76 patients had elective laparoscopic cholecystectomies over the study period. Of that number, 17 (22.4%) patients had an intra- operative diagnosis of Fitz-Hugh-Curtis syndrome, and had the fundus-first dissection. The mean patient age was 46.3 years (SD = 11.7 years). All patients were female. The mean operating time was 70 minutes (SD = 23 minutes). The duration of hospital stay was 24 hours. There was one conversion due to uncontrollable intraoperative bleeding.Conclusions: This study revealed that the fundus-first dissection is suitable for removing the gall bladder during laparoscopic cholecystectomy in patients with gall stone disease, and an intraoperative finding of Fitz-Hugh-Curtis syndrome

Maternal and neonatal characteristics of babies admitted with congenital CNS anomalies in a tertiary hospital in North Central Nigeria

Background: CNS anomalies are an important group of largely preventable congenital anomalies. Knowledge of maternal and neonatal sociodemographic characteristics could identify a pattern of population at risk in order to target preventive interventions.Methods: This was a 3-year retrospective review of health records of all neonates admitted with CNS anomalies in Jos University Teaching Hospital (JUTH), Jos, central-Nigeria.Results: Out of a total of 27 neonates with congenital CNS anomalies reviewed, 25 had neural tube defects, 1 hydrocephalos and 1 anencephaly. The peak age group of mothers were 20-29years (44.4%) and 30-39 years (44.4%). Twenty-two (81.5%) mothers had antenatal care (ANC). No mother booked in the 1st month and only 7 (25.9%) booked in the first trimester. Twenty-four (88.9%) mothers took folic acid during pregnancy. No mother had peri-conceptional folic acid use. There were 11(40.7%) home births with 14(87.5%) of the 16 hospital births taking place in lower tier health facilities. Twenty-six (96.3%) mothers had vaginal delivery. An obstetric ultrasound scan was reported by one (3.7%) mother and did not detect the anomaly. Five (18.5%) of the mothers had HIV infection. Twenty-six were term with a male: female ratio of 1.1:1. The median age at presentation was 2 (interquartile range 1, 8) days.Conclusions: Neonates with congenital CNS anomalies in JUTH frequently had mothers aged <35 years who did not receive preventive care before and during delivery. We therefore recommend interventions to improve the efficiency of health care delivery to cater for this gap

Acute Traumatic Spinal Cord Injury; does a Low Tesla Magnetic Resonance Imaging Features Correlates with Neurological Status and Predict Early Outcome?

Background: Traumatic spinal cord injury (TSCI) is a devastating disease, hence the need to identify clinical and radiological injury features that predict neurological improvement. Aims: The aim is to determine the correlations between American Spinal Injury Association (ASIA) Impairment Scale (AIS) and magnetic resonance imaging (MRI) features in patients with TSCI and identify predictors of neurological improvement. Settings and Design: This is a prospective cohort study. Subjects and Methods: Seventy-three patients with TSCI managed over a period of 18 months were studied. Neurological assessment of these patients was done at admission and 3-month post-injury using the AIS score form. The various MRI (0.3 Tesla Machine) features of these injuries were identified and measured using a RadiAnt DICOM Viewer 4.0.3 (64-bit). Statistical Analysis: Correlation and regression analysis were done using Spearman’s rank correlation, and logistic regression, respectively. A P < 0.05 was used as the level of significance. Results: Spinal cord edema (26.0%) and cord contusion (34.2%) were seen in most patients with incomplete injury, while spinal cord hemorrhage and transection were observed in patients with ASIA A injury. Asignificant correlation exists between maximum canal compromise (MCC) (ρ = −0.39, P < 0.001), maximum spinal cord compression (MSCC) (ρ = −0.44, P < 0.001), and length of spinal cord lesion (ρ = −0.77, P < 0.001) with AIS at admission. The independent predictors of AIS improvement include MSCC, MCC, length of spinal cord signal change, and cord contusion. Conclusions: MRI features significantly correlate with the neurological status of TSCI and can be used to predict early neurological improvement in these patients

Giant Encephalocele in Sokoto, Nigeria: A 5-Year Review of Operated Cases.

OBJECTIVE: Encephalocele is a common congenital malformation of the central nervous system; however, giant encephaloceles are rare. The use of folic acid supplementation and termination of pregnancies, which are prenatally diagnosed with encephaloceles and other congenital malformation of the central nervous system, has significantly reduced the occurrence of this type of congenital malformation, especially in developed countries. METHODS: This was a retrospective review over a 5-year period from January 2006 to December 2010 at the Department of Neurosurgery, Regional Centre for Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. The records of patients with giant encephalocele were retrieved from the case notes of patients who had excision and repair for encephalocele. RESULTS: Seventy-three patients had excision and repair of encephalocele over the study period. However, the records of only 50 patients were retrieved. Fourteen (28%) of the 50 whose records were retrieved had giant encephalocele. There were 4 male and 10 female patients (1:2.5). Thirteen (92.9%) had the lesion located in the occipital region, whereas in 1 patient (7.1%) the lesion was at the vertex. Three (21%) of the cases had microcephaly, 1 (7.1%) had macrocephaly, and 1 (7.1%) developed postoperative hydrocephalus. The average size of defect was 2.43 cm, and the size of the lesion ranged from 12 × 6 cm to 40 × 50 cm. The average maternal age was 20.3 years (n = 6), and the paternal age was 29 years (n = 4). Four out of 7 (57%) mothers had febrile illness in early pregnancy. Seven out of 10 patients (70%) did not have antenatal care. CONCLUSIONS: This condition is more common in children conceived during the period when farm products are yet to be harvested, and whose mothers did not attend antenatal care visits. It is recommended that mothers should be educated on the necessity of preconception folic acid. Implementation of a national strategy on food fortification is also advised. We recommend surgery after the first month of life to reduce poor early postoperative outcomes. In developing countries and centers with suboptimal pediatric intensive care units, surgical intervention is preferred after the first month of life with good temperature control, adequate fluid replacement following rupture of the sac, blood transfusion availability, and, only if necessary, complex cranial reconstruction