An audit of CT brain findings in adults with new-onset seizures in a resource restricted setting in South Africa

Background: Globally, adults presenting with seizures account for 1% ­ 2% of visits to emergency departments (EDs), of which 25% are new-onset seizures. Neuroimaging is essential as part of the initial workup. Multiple studies have demonstrated abnormal CT brain (CTB) findings in these patients. Objectives: To review the CTB findings in adults presenting with new-onset seizures in a resource restricted setting. Method: A retrospective review of 531 CTBs was conducted at a tertiary hospital in Gauteng on adults presenting to the ED with new-onset seizures. Results: The mean age of the patients was 45.6 ± 17.1 years, and the male to female ratio was 1.2:1. Generalised and focal seizure types were almost equally represented. Of the total 531 patients, 168 (31.6%) were HIV positive. The CTB findings were abnormal in 257 (48.4%) patients, albeit vascular pathology accounted for 21.9%. Infective pathology accounted for 14.1% with a statistically significant association with HIV (p = 0.003). Trauma related pathology was 2.4%, whilst neoplastic pathology was seen in 3.0%. Other causes included congenital pathology, calcifications, atrophy and gliosis. Clinical factors associated with abnormal CTB findings were age ≥ 40 years, HIV infection, hypertension, focal seizures, low Glasgow Coma Scale (GCS), raised cerebrospinal fluid (CSF) protein and presence of lymphocytes. Conclusion: A high yield of abnormal CTB findings was noted in adult patients who presented with new-onset seizures, supporting the use of urgent CTB in patients with certain clinical risk factors. Patients without these risk factors can be scanned within 24­48 h in a resource restricted setting.

Brain Plasticity Mechanims Underlying Stroke Recovery

"Spontaneous recovery represents the only hope of regaining autonomy; for the majority of stoke victims especially in developing countries like Morocco. This recovery is mainly based on the brain's reorganization capacities; referred to as ""adaptive plasticity"". Rehabilitation is one of the most powerful modulators of brain plasticity that; if well administered; can improve post-injury recovery."

Diabetes Mellitus and the Brain : Special Emphasis on Cognitive Function : Review

Diabetes mellitus (DM) is a major public health problem. Cognitive deficits are common with DM which range from subclinical or subtle to severe deficits such as dementia. Both hypoglycaemia and hyperglycaemia are causes of cognitive impairment with DM. In patients with DM; not only severe hypoglycaemia but also recurrent mild or moderate hypoglyacemia have deleterious effect on the brain. Recurrent mild/moderate hypoglycaemia is associated with intellectual decline; reduced attention; impaired mental abilities and memory deficits. Hypoglycaemia may result in abnormalities of neuronal plasticity; synaptic weakening and scattered neuronal death in the cerebral cortex and hippocampus. Chronic hyperglycaemia in type 1 and type 2 DM is associated with low IQ (verbal; performance and total) and abnormalities in testing for different domains of cognitive function such as verbal relations; comprehension; visual reasoning; pattern analysis; quantitation; memory; learning; mental control; psychomotor efficiency; mental and motor processing speed and executive function. The suggested mechanisms incriminated in the pathogenesis of hyperglycaemia-related cognitive dysfunction include; macro- and microvascular disease or vasculopathy; hyperlipidaemia; hypertension; insulin resistance and hyperinsulinaemia; stress response; direct toxic effect of chronic hyperglycaemia on the brain; advanced glycation end-products; inflammatory cytokines and oxidative stress. Hyperglycaemia causes oxidative stress; amyloidosis; angiopathy; abnormal lipid peroxidation; accumulation of ?-amyloid and tau phosphorylation; neuro-inflammation; mitochondrial pathology; apoptosis and neuronal degeneration in the cortex and hippocampus. Depression has been identified as a risk for accelerated cognitive decline with DM. The knowledge that diagnosis at an early age; frequency of hypoglycaemia; poor glycaemic control and presence of risk factors negatively affect cognitive functions in DM will have important implications for treatment and research purposes

Effects of long-term consumption of energy drinks on the body and brain weights of adult Wistar rats

Background: Effects of long-term consumption of energy drinks commonly used as flavored beverage drinks on the body and brain weights of adult Wistar rats was carefully studied. Materials and Methods: Twenty adult Wistar rats; with average weight of 200 g were randomly assigned into treatment (n = 10) and control (n = 10) groups. The rats in the treatment group received energy drinks and distilled water alternatively on a daily basis for 10 h and 14 h liberally for 30 days while the control group received distilled water liberally for the 30 days. The weight of the rats were measured daily during the period of the study. The rats were sacrificed by cervical dislocation on the 31st day of the experiment; and the brain was carefully dissected out; weighed using Mettler Toledo weighing balance. The values obtained from the control and treatment groups were recorded and compared statistically using the unpaired sample t-test and symmetric measured test of the statistical package for social sciences. Results: The results of this experiment indicated that there was a significant (P 0.05) increase in the body and brain weights (g); and a significant (P 0.05) decrease in relative brain weight () of the treated animals with energy drinks as compared to the control group. Conclusion: Long-term consumption of energy drinks could; therefore; have adverse effects on the body and brain weights of adult Wistar rats. Recommendation: We suggest that further studies aimed at corroborating these observations in humans be carried out

Surgical Anatomy of the Vertebrobasilar Territory and Posterior Circle of Willis

BACKGROUND: In the present era of microscopic and neuroendoscopic procedures; the surgical anatomy of the skull base vessels has gained increased significance. The pattern of the vertebrobasilar arterial complex and the posterior circle of Willis (COW) in Nigerians has not been previously reported despite various variants of these complexes existing in different populations. OBJECTIVE: To review and document the size; distribution and anomalies of the vertebrobasilar territory and posterior COW pattern in a Nigerian set of brains. Methods: The target population for this study was a group of Nigerian adults 18 years and above. Specimens from patients with an ante-mortem or post-mortem evidence of meningitis or atherosclerosis were excluded. The size; distribution and anomalies of the vertebrobasilar artery; its branches; and the posterior COW were defined in 50 brains. RESULTS: The male: female ratio was 1.9:1 and a mean age of 44 years. Statistical analysis showed significant differences between the sizes of posterior inferior cerebellar arteries and anterior inferior cerebellar arteries (Student's t = -30.189; p-value = 0.000). Fifty-six percent of the brains had no anomalies. Thirty anomalies were noted in posterior COW compared with six in the vertebrobasilar territory. There were no aneurysms in all the specimens studied. CONCLUSION: Anomalies in the region of the posterior COW are commoner than the vertebrobasilar territory and the region of the posterior communicating artery is the most common site of anomalies in the posterior COW territory. These variations should be taken into account during skull base and carotid surgeries; and cerebral angiography

The neuroendocrinological sequelae of stress during brain development: the impact of child abuse and neglect

Severe stress during the sensitive periods of neurodevelopment, (which include the prenatal period, infancy, childhood and adolescence), has a long-lasting organizing effect on the brain and stress axes. Child abuse and neglect thus exert a cumulative harmful effect on neuroendocrinological development, which persists into adulthood. It is not merely the memory of the trauma which leaves a mark, but rather the effect on neurodevelopment which negatively influences the ability of adult survivors of childhood maltreatment to cope with current stressors. The victims of child abuse and neglect are likely to maltreat their own children and so perpetuate the intergenerational transmission of child maltreatment. In this paper relevant normal brain development is first summarized. Child abuse / neglect is next discussed with detailed reference to the aberrant neuroendocrinological development that is known to occur. We specifically examine effects on the hypothalamo-pituitary-adrenal and central noradrenergic-sympathoadrenomedullary stress axes and other neurotransmitter systems before turning to changes described in the cerebral volumes, corpus callosum and cortical hemispheres, prefrontal cortex and amygdalae, superior temporal gyrus, hippocampus as well as the cerebellar vermis

Brain Metastasis of Cardiac Myxoma : Case Report

Cardiac myxoma is the most common benign heart tumor. Cardiac myxoma can be a sporadic lesion (93of cases) and usually occurs in women over 30 years. Complete surgical removal of the myxoma and its cardiac attachement is usually curative. The frequency of recurrences in cardiac myxomas was varies between 3for sporadic cases and 22for cases of Carney complex. Recurrence has been related to incomplete excision multifocality and embolism of tumor fragments. We report a case with multiple brain metastases revealed by mycotic aneurysm and seizure intractable

Reversible Cortical Blindness Following Successful Surgical Repair of Two Wounds in the Heart

This report describes a case of cortical blindness that followed successful surgical repair of two stab wounds in the heart in a 29-year old Libyan man. The patient presented in a state of pre cardiac arrest (shock and low cardiac output status); following multiple chest stab wounds. Chest tube was immediately inserted. Surgery was urgently performed suturing the two wounds; in the root of the aorta and in the left ventricle; and haemostasis was secured. Cardiac arrest was successfully prevented. The patient recovered smoothly; but 24 hours later he declared total blindness. Ophtalmic and neurological examinations and investigations that included fundoscopy; Electroencephalograms (EEGs) and Computed Tomography Scans revealed no abnormalities; apart from absence of alpha waves in the EEGs. We diagnosed the case as cortical blindness and continued caring for the patient conservatively. Three days later; the patient regained his vision gradually and was discharged on the 7th postoperative day without any remarks

Micro anatomie du sinus petreux inferieur

Le sinus petreux inferieur est un sinus veineux basicranien interpose entre le confluent veineux petro-clival et la veine jugulaire interne. Il offre une voie pour l'embolisation du sinus caverneux mais egalement pour le diagnostic differentiel centro-peripherique d'un syndrome de Cushing. Pourtant la litterature le concernant est peu abondante. Une etude micro anatomique du sinus petreux inferieur a ete faite pour repondre a ce besoin. L'accent a ete mis sur les differents modes d'abouchement de ce sinus et sur ses rapports au niveau du foramen jugulaire. Vingt sinus petreux inferieurs ont ete disseques sous magnification optique (Microscope Zeiss OPMl 9FC); et photographies (Boitier Nikon FE; film Kodak ektachrome 160T puis numerises). Six sinus petreux inferieurs ont ete injectes par voie jugulaire interne au Rhodopas puis corrodes a l'acide sulfurique. Le sinus petreux inferieur a ete observe entre les dures-meres encephaliques et periostee de la suture petro occipitale. Il s'abouchait dans la majorite des cas a hauteur du foramen jugulaire (88;46pour cent) avec une predominance dans le bulbe superieur de la veine jugulaire interne (84;61pour cent). L'abouchement du sinus petreux inferieur en dehors du foramen jugulaire; dans l'espace parapharyngien ou plus bas dans la region cervicale etait peu frequente (11;54pour cent). L'absence d'abouchement du sinus petreux inferieur dans la veine jugulaire interne est rare [1 a 7pour cent dans les grandes series (12; 44)] et n'a pas ete observe dans notre etude. Les types I et Il demeuraient les modes d'abouchement les plus frequents et representaient 88;61pour cent (22 de nos cas). La presence de valvule ostiale a ete observee dans 90pour cent de nos cas comme chez la plus part des auteurs. Le sinus petreux passait habituellement entre le nerf glossopharyngien lateralement et les nerfs vague et accessoire medialement. Le mode d'abouchement de la terminaison du sinus petreux inferieur est un element determinant pour son catheterisme. Meme si les types I et Il qui representent les modes les plus frequents sont faciles a catheteriser; il ne faut pas oublier les types IV; V et VI qui peuvent etre a l'origine de difficultes du catheterisme