Intensive care unit deaths among neurosurgery patients in a tertiary hospital in South Western Nigeria

Neurosurgical patients are the most critical ICU admissions. While advancements in neurosurgical ICUs (NICU) have improved outcomes of care globally, ICU mortality remains a major clinical issue in developing nations. This study evaluates ICU mortalities of neurosurgical patients in a general ICU setting at the UNIOSUN Teaching Hospital, Osogbo, Nigeria. Method: Case records of neurosurgery patients who died in the ICU of UNIOSUN Teaching Hospital, Osogbo, South-Western, Nigeria from June 2012 to May 2022 were reviewed. Simple descriptive statistics of data on demographics, clinical diagnoses, management and outcome were done. Results: Mortality rate was 38.9% (84 of 216 admissions). Males were 67(79.8%) and the mean age was 41.5years (Range: 2-85years). The average duration of ICU stay was 3.5days (Range: 30minutes-20days). Most patients had severe traumatic brain injury (TBI) (62, 73.8%). This was followed by cerebrovascular diseases (12, 14.3%) and brain tumours (6, 7.1%). Two had brain abscess. One patient each had mixed subacute/chronic subdural haematoma and severe cervical spondylotic myelopathy. Of the 69 whose case files were found, 7(10.1%) had a diagnosis of brainstem death before eventual 'final' death after an average of 13.5 additional hours on mechanical life support. The identified secondary causes of death included raised ICP, sepsis, primary surgical haemorrhage, seizures, acute kidney injury, malignant hypertension, poor glycaemic control and aggressive blood pressure lowering. Only 1 patient had autopsy. Conclusion: Most ICU mortalities among neurosurgical patients were from severe TBI. The establishment of NICU is necessary to improve outcome of care of neurosurgical patients

Scourge of Peripheral Artery Disease in a Low-Income-Setting: The Role of VascularSurgery

Background: Peripheral artery disease (PAD) is a progressive disorder characterized by stenosis and/or occlusion of large and medium-sized arteries, other than those that supply the heart (coronary artery disease, CAD) or the brain (cerebrovascular disease). It is increasingly becoming a challenge in developing countries owing to poverty and ignorance. Objective: To review the scourge of peripheral artery diseases in our institution in a low-income setting with a view to determining the role of a vascular surgeon. Materials and method: Over a period of 15 years (2006 to 2021), patients with documented PAD were reviewed. Data of the patients were retrieved from the record department and such data included demography, aetiology/risk factors, clinical features and investigative parameters as well as modes of treatment especially vascular surgery. Results: There were 35 patients which comprised 20 males and 15 females with male to female ratio of 4:3. Age range affected most was 71-80 years. Aetiologically, artherosclerosis was dominant. Leriche Fontaine classification used in clinical evaluation showed that type III was dominant. 6 Ps (pain, pulselessness, paralysis, paraesthesie, pallor and poikilothermia) of vascular ischemia were evident. Doppler/duplex ultrasound and computer angiography were used in diagnosis. Medical and or surgical treatments were used in patients' management. Vascular and or orthopedic surgery played significant role. Conclusion: PAD affects the lower extremities more commonly than the upper extremity vessels especially in the elderly leading to intermittent claudicationn which is the most recognized symptomatic subset of lower extremity PAD. Morbidity and mortality emanating from inadequate revascularization are burden to emerging economy like ours.

Cerebrovascular accidents indicative of COVID-19 infection: about 4 observations in Guinea

Introduction: coronavirus is a virus with potential to target the nervous and respiratory systems. The aim of this work is to establish the prevalence of strokes in COVID19 positive patients in Guinea. Methods: all patients with stroke confirmed by brain imaging and COVID-positive PCR were included in this study. Retrospective patient data were obtained from medical records. Informed consent was obtained. Results: the RT-PCR confirmed the initial diagnosis and the chest CT scan provided a good diagnostic orientation. Brain imaging identified ischemic brain lesions. We report the case of four patients with stroke and a COVID-19 incidental finding in Guinea.Conclusion: this work shows that the onset of ischemic stroke associated with COVID-19 is generally delayed, but can occur both early and late in the course of the disease. More attention is needed because the early symptoms of viral attack are not just pulmonary

Evaluation of cardiac sources of embolism

Cerebrovascular disease is a leading cause of mortality and morbidity .20% of cerebral infarcts are due to cerebral embolism of cardiac origin. Conditions associated with cardiogenic emboli are either rhythm abnormalities such as atrial fibrillation (AF) responsible for 50% , or structural abnormalities .Whereas left ventricle thrombus ,left atrium thrombus ,vegetation , tumor and protruding atherosclerotic plaque are considered as direct sources of embolization , others such as valvular disease , wall motion abnormality , atrial septal defect (ASD) , patent foramen ovale(PFO) , atrial septal aneurysm (ASA) and spontaneous echocardiographic contrast (SEC) are considered as indirect cardiac sources of embolization . In this article evaluation of cardiacsources of embolism and the role of echocardiography are discussed. Though both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) play an important role,TEE appears to be more sensitive in identifying potential abnormalities in patients with suspected cardiac sources of emboli

Brain imaging and urodynamic correlation in patients with cerebrovascular stroke

Objective: To identify urodynamic abnormalities in patients with cerebrovascular accidents and correlate both with CT or MRI findings. Patients and Methods: From September 2001 to March 2003; a total of 44 males and 16 females were prospectively examined urodynamically in different phases after cerebrovascular accidents; and as early as two days after stroke. Results: In most cases; the urodynamic findings could be correlated with CT or MRI findings. The most determining factor was the site of the lesion followed by the size. Small lesions were frequently silent unless located in critical sites. It was found that frontal; frontoparietal; parietal; basal ganglia and internal capsular ischemic lesions were associated in most cases with detrusor hyperreflexia; whereas thalamic; pontine and cerebellar infarcts were linked to detrusor hyporeflexia. Multiple lesions within the same group produced the same effect; while mixed lesions produced variable ef-fects. There was no effect of laterality or dominance and an initial shock phase could not be identified. Detrusor-sphincter-dys-synergia (DSD) and hence upper tract deterioration were not observed. The effect of stroke was also modified by already present or predominant conditions such as BPH. Conclusion: Correlating urodynamic and CT findings is very difficult in stroke patients because of the diffuse nature of the lesions; the unknown function of many brain centers in micturition control; the innumerable connections between the different brain regions and the extremely complicated influences that the brain regions exert upon each other and upon the bladder. The optimal understanding of the problem is dependent upon the better understanding of the function of each part of the brain. Further studies in this direction are recommended

Transient ischaemic attacks and strokes : overview

Although there is paucity of data on the incidence of Transient Ischaemic attacks and stroke in Africa; in developed countries cerebrovascular disease constitutes the third commonest cause of death after Ischaemic Heart Disease and cancer. There is need for epidemiological surveillance of these conditions in Africa since the classic risk factors like smoking are on the increase. In order to reduce the enormous socio-economic burden from disabilities of completed strokes; rehabilitation of patients; use of volunteers to manage dysphasia and early recognition of poor prognostic features (urinary incontinence; paralysis of the arm; loss of sitting balance; hemianopia and advanced age) should always be borne in mind

Les accidents vasculaires cerebraux a Kinshasa: etude tomodensitometrique

Au bout de 4 ans (juillet 88-juillet 92) de pratique d'une technique nouvellement acquise; la tomodensitometrie par ordinateur (TDM) dans notre milieu; les auteurs analysent 121 cas d'accident vasculaire cerebral (AVC) chez les Noirs Africains de Kinshasa. L'AVC est une pathologie du sujet jeune et plus frequemment chez celui du sexe masculin (2/1). L'hemorragique est moins frequent que l'ischemique (2/3). L'AVC survient dans le territoire de l'artere cerebrale moyenne (77;5 pour cent) et plus volontiers a gauche. L'hypertension arterielle reste l'antecedent morbide le plus rencontre suivi de la drepanocytose

Stroke in Sierra Leoneans

The clinical and laboratory data of eighty-seven Sierra Leoneans with clinical stroke are presented. Male predominance and younger age distribution are consistent with other African series. Hypertension was present in 60 per cent of cases and tended to be more severe in fatal cases. Hypercholesterolaemia was also common. A larger and more detailed longitudinal study is required to determine fully the role of these and other risk factors of this condition in the Sierra Leone

Subarachnoid haemorrhage - changing trends

Bleeding into the subarachnoid space (Subarachnoid Haemorrhage - SAH) is a dramatic and potentially fatal event that should not be missed. Modern trends have seen a decline in morbidity and mortality mainly due to advancements in neuroradiology and neurosurgical techniques coupled with early intervention. The review presents the problems faced in the past and highlights the developments in various aspects of this catastrophic disease whose morbidity and mortality remain unacceptably high despite the improvements