Primary cerebral angitis of the central nervous

We report a case of a 28 year old female who presented with variedly progressive stroke like illness and raised intracranial pressure. Brain MRI scans revealed pericallosal and periventricular hyperintensities with oedema. Various medications like intravenous immunoglobulin, antibiotics, acyclovir, methyl prednisolone and management for raised intracranial pressure were instituted. She rapidly deteroriated and died on tenth hospital day. Only at autopsy was the diagnosis of primary angitis of central nervous system established. East African Medical Journla Vol. 85 (6) 2008: pp. 306-30

Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis.

INTRODUCTION: HIV-associated cryptococcal, TB and pneumococcal meningitis are the leading causes of adult meningitis in sub-Saharan Africa (SSA). We performed a systematic review and meta-analysis with the primary aim of estimating mortality from major causes of adult meningitis in routine care settings, and to contrast this with outcomes from clinical trial settings. METHODS: We searched PubMed, EMBASE and the Cochrane Library for published clinical trials (defined as randomized-controlled trials (RCTs) or investigator-managed prospective cohorts) and observational studies that evaluated outcomes of adult meningitis in SSA from 1 January 1990 through 15 September 2019. We performed random effects modelling to estimate pooled mortality, both in clinical trial and routine care settings. Outcomes were stratified as short-term (in-hospital or two weeks), medium-term (up to 10 weeks) and long-term (up to six months). RESULTS AND DISCUSSION: Seventy-nine studies met inclusion criteria. In routine care settings, pooled short-term mortality from cryptococcal meningitis was 44% (95% confidence interval (95% CI):39% to 49%, 40 studies), which did not differ between amphotericin (either alone or with fluconazole) and fluconazole-based induction regimens, and was twofold higher than pooled mortality in clinical trials using amphotericin based treatment (21% (95% CI:17% to 25%), 17 studies). Pooled short-term mortality of TB meningitis was 46% (95% CI: 33% to 59%, 11 studies, all routine care). For pneumococcal meningitis, pooled short-term mortality was 54% in routine care settings (95% CI:44% to 64%, nine studies), with similar mortality reported in two included randomized-controlled trials. Few studies evaluated long-term outcomes. CONCLUSIONS: Mortality rates from HIV-associated meningitis in SSA are very high under routine care conditions. Better strategies are needed to reduce mortality from HIV-associated meningitis in the region

Dystonia: case series of twenty two patients

Objective: Dystonia is a rare neurological disorder characterised by sustained muscle contraction with resultant bizarre muscle movements and hence bizarre posturing. The pathophysiology is not well understood but it is believed there is dysfunction of the cortico-striatal-thalamo-cortical circuitry and projections. There is very scanty literature in sub-Saharan Africa.Design: Retrospective descriptive case series.Setting: Outpatient clinics of the authors, the Nairobi Hospital and the Mater Hospital, Nairobi, Kenya.Subjects: A cohort of twenty two consecutive patients of indigenous Kenyan origin, seen by the authors between 1996 and January 2005 were described. This study was carried out to describe characteristics of 22 patients.Results: Males comprised of 15 (68.2%) of the cases. Late onset dystonia was found in 12 (54.5%) cases. Over half of the patients had focal dystonia and only 13.6% had generalized dystonia, all of whom were of early onset variety. There was significant delay in diagnosis of dystonia with 68.2% of patients being diagnosed after 12 months of onset of symptoms.Conclusion: Dystonia is rare; however, multi-centre studies are required to map out prevalence rates of the disease in the country. There is need to highlight the presentation of the disease amongst clinicians and patients as this would improve diagnosis rate, early intervention and appropriate management. Genetic studies need to be done. East African Medical Journal Vol. 82(9) 2005: 463-46

Lyme disease: report of two cases

Lyme disease is a tick-borne multisystem disease. It was first described in Lyme, Connecticut, USA in 1975. Cases have been reported in Canada, Switzerland, Austria, Australia and Great Britain. It is an inflammatory disease that has varied clinical manifestations ranging from skin rash (erythema migrans), arthritis, fibromyalgia, and regional lymphadenopathy, cardiac conduction defects to neurological manifestations of meningoencephalitis, Bell\'s palsy, peripheral neuropathy, and painful radiculoneuropathy. There has been no case record of Lyme disease in Kenya and indeed literature on Lyme disease in Africa is very scanty. We present two cases of Lyme disease with predominant neurological manifestations; outline their clinical presentation and management.East African Medical Journal Vol. 82(5) 2005: 267-26

Hemifacial spasm: case report

A 53 year old lady with diabetes mellitus presented with right hemi-facial spasm (HFS). Brain MRI Scan revealed extensive pan-sinusitis and mild bilateral mastoiditis. She responded well to intravenous ceftriaxone therapy and the hemifacial spasm resolved. The symptoms of hemifacial spasm and pain over the right cheek and peri-orbital area recurred after three weeks. She was admitted to hospital for Functional Endoscopic Sinus Surgery (FESS); following findings on repeat para-nasal sinus CT-Scan. Several reviews over six month's period revealed complete resolution of hemi facial spasm symptoms save for mild intermittent right blepharospasm; particularly on exposure to wind. This is a very rare cause of hemifacial spasm and clinicians should be on the look out for infective/inflammatory aetiology of hemifacial spasm; particularly in patients who present with recent onset HFS and have features of infection and or inflammation in the cranium. East African Medical Journal Vol. 83(7) 2006: 401-40