Pattern and determinants of outcomes of neurological emergencies admitted into children emergency ward in a tertiary hospital in Port Harcourt, Nigeria

Background: Neurological emergencies are life-threatening central nervous system disorders, significantly contributing to childhood morbidity and mortality. The sequelae may be irreversible and may impact negatively on the quality of life of affected children and their families. This study identified the morbidity pattern and determinants of the outcomes of children with neurological emergencies in the Children Emergency Room (CHER) of the Rivers State University Teaching Hospital (RSUTH). Method: A 4-year retrospective study was carried out in the CHER. Data on demography, diagnosis and outcomes of children with neurological disorders were extracted from the records. Data analysed with SPSS 24 were expressed in percentages and frequency tables. Results: Of the 3040 children admitted in the CHER, 364(12%) aged 0-15 years had neurological emergencies, commoner among males (59.3%) and children aged less than five years (70.9%). Meningitis (40.2%) and febrile convulsion (28.2%) were the topmost diagnoses made. Raised intracranial pressure (17.4%) and head injuries (25.5%) were significantly more prevalent among children aged five years and above. The mortality rate was 61(16.8%) and more among adolescents (30.6%). All the mortalities took place within the first 48hours of admission especially among those with head injuries (46.5%) and perinatal asphyxia (95%), (p < 0.05). Conclusion: Meningitis and febrile convulsion were the commonest neurologic emergencies seen in this study. Mortality rate was high, especially in the first 48 hours of admission and mainly from perinatal asphyxia and head injuries. Education on the prevention and management of neurologic emergencies should be strengthened.

Pattern of neurological disorders managed in neurology clinics in Kano, Nigeria

To determine the pattern of neurological disorders managed in some neurology clinics in Kano, Nigeria. Materials and Methods: A five-year retrospective descriptive survey (2016-2020) of patients with neurological disorders attending neurology out-patient clinics at three selected hospitals in Kano metropolis. A research proforma was used to collect information on socio-demographic and health characteristics of the participants. Case folders and outpatient registers were used as a source of information about the patients. Data obtained was analyzed using IBM Statistical package for social science (SPSS) version 20 and results presented using descriptive statistics of frequency and percentage. Results: Out of the 433 cases with neurological disorders surveyed, 58% were adult and 42% were pediatric. Males (54.3%) were found to be more affected. Majority (83.4%) of the participants were from an urban area, with married (79.7%) individuals mostly affected. Stroke was the most prevalent (33.7%) neurological disorder. Hypokinesia (5.1%) and hyperkinesia(3%) as a primary and secondary movement disorder respectively were the most prevalent forms of movement disorder. Psychotic symptoms, weakness, paresthesia, fever, vomiting and convulsion were the most common manifestations that comes with the neurological disorders. Of the common neurological disorders, stroke was most associated with motor (56.2%), sensory (36.4%) and psychiatric (43.5%) manifestations. Conclusion: Paediatric age group contributed close to half of neurological disorders. Stroke was the most prevalent form of neurological disorder and most associated with motor, sensory and psychiatric manifestations. Hypokinesia and hyperkinesia had close prevalence and were the most common primary and secondary movement disorders respectively.

Prioritising maternal mental health and infant neurodevelopment research in Africa ­ A call for action amidst the backdrop of the COVID­19 pandemic

No abstract

Stem cell therapy for neurological disorders

Neurological disease encompasses a diverse group of disorders of the central and peripheral nervous systems, which collectively are the leading cause of disease burden globally. The scope of treatment options for neurological disease is limited, and drug approval rates for improved treatments remain poor when compared with other therapeutic areas. Stem cell therapy provides hope for many patients, but should be tempered with the realisation that the scientific and medical communities are still to fully unravel the complexities of stem cell biology, and to provide satisfactory data that support the rational, evidence-based application of these cells from a therapeutic perspective. We provide an overview of the application of stem cells in neurological disease, starting with basic principles, and extending these to describe the clinical trial landscape and progress made over the last decade. Many forms of stem cell therapy exist, including the use of neural, haematopoietic and mesenchymal stem cells. Cell therapies derived from differentiated embryonic stem cells and induced pluripotent stem cells are also starting to feature prominently. Over 200 clinical studies applying various stem cell approaches to treat neurological disease have been registered to date (Clinicaltrials.gov), the majority of which are for multiple sclerosis, stroke and spinal cord injuries. In total, we identified 17 neurological indications in clinical stage development. Few studies have progressed into large, pivotal investigations with randomised clinical trial designs. Results from such studies will be essential for approval and application as mainstream treatments in the future

Déficiences neurologiques et musculo-squelettiques rencontrées chez les hémodialysés chroniques du Centre National Hospitalier et Universitaire de Cotonou

Introduction : Les complications neurologiques et musculo-squelettiques sont fréquentes chez les hémodialysés chroniques. But : Déterminer les déficiences neurologiques et musculo-squelettiques rencontrées chez les hémodialysés chroniques du CNHU-HKM. Méthodes : Il s'agit d'une étude transversale à visée descriptive et analytique qui s'est déroulée du 5 février au 5 mai 2014 à la Clinique Universitaire de Néphrologie Hémodialyse de CNHU-HKM de Cotonou. Les déficiences neurologiques et musculo-squelettiques telles que la douleur, les troubles sensitifs et neurologiques, la force musculaire et les limitations articulaires étaient recherchées à partir d'un examen clinique minutieux et rigoureux. Les limitations fonctionnelles étaient déterminées par l'échelle de HAQ (Health Assessment Questionnaire) modifiée et les facteurs associés étaient identifiés par régression logistique en analyse univariée et multivariée. Résultats : L'âge moyen des patients était de 49,98 ± 12,96 ans et le sex-ratio de 1,5. Les déficiences observées étaient les douleurs (52,7%), les troubles sensitifs (29,8%), les faiblesses musculaires (44,3%) et les limitations articulaires (25,9%). Les limitations fonctionnelles étaient retrouvées chez 49,6% des hémodialysés. Les facteurs associés aux limitations fonctionnelles en analyse univariée étaient l'âge avancé (p < 0,001), le sexe féminin (p = 0,026), l'absence de profession (p = 0,001), la fréquence de 3 séances d'hémodialyse par semaine (p = 0,021), la durée de vie avancée en hémodialyse (p = 0,016) et l'hypocalcémie (p = 0,003). En analyse multivariée, seuls l'âge avancé (p < 0,001), le sexe féminin (p = 0,044) et l'hypocalcémie (p = 0,014) restaient associés aux limitations fonctionnelles. Conclusion : Les déficiences neurologiques et musculo-squelettiques sont très fréquentes chez les hémodialysés. Il est important d'organiser une prise en charge rééducative nécessitant une collaboration étroite entre néphrologues et kinésithérapeutes

Prise en charge des douleurs neuropathiques au Sénegal : expérience du centre national d'appareillage orthopédique de Dakar

Introduction : Les douleurs neuropathiques sont graves et de prise en charge difficile. L'efficacité du traitement est jugée sur l'amélioration de la qualité de vie.Objectifs : Déterminer la fréquence des douleurs neuropathiques et apprécier l'efficacité de thérapeutiques utilisées et les difficultés à l'instauration des recommandation dans un centre à Dakar.Méthodologie : Une étude prospective de 4 mois a été menée au Centre National d'Appareillage Orthopédique dont l'objectif a été d'apprécier les obstacles à l'instauration des recommandations internationales sur la prise en charge des douleurs neuropathiques. Les patients reçus pour des douleurs chroniques ont répondu aux questionnaires DN4 et ceux qui ont eu des douleurs neuropathiques inclus. L'intensité de la douleur, le retentissement fonctionnel, et la qualité du sommeil, ont été évalués avant et après traitement. Les effets secondaires des médicaments, les raisons d'une non adhérence au traitement ont été notés et la conformité des examens complémentaires vérifiée.Résultats : 53 patients avec un âge moyen de 50,22 ans ont été inclus. L'EVA moyen a été de 5,75. La marche a été anormale dans 33,96% des cas, impossible (4 cas), la montée et descente des escaliers impossible (18,83%), le périmètre de marche inferieur à 1000m (18,86%) et 13,20% des patients incapables de ramasser un objet à terre. Les activités professionnelles suspendues dans 2 cas et le sommeil perturbé dans 33,96% des cas. Le traitement de première intention a été l'Amitriptyline (54,71%) et a été responsable d'effets secondaires dans 3 cas. Après un recul de 2 mois, la reprise effective des différentes activités a été obtenue dans 94,53%.Discussion et Conclusion : Même si la diminution de l'EVA au cours des douleurs neuropathiques sous traitement est parfois minime, le retentissement sur la qualité de vie doit être apprécié avant de conclure à une inefficacité thérapeutique. Le choix des molécules doit tenir compte de l'accessibilité du médicament. La rééducation doit être effectuée surtout en cas de retentissement fonctionnel et/ ou d'association à d'autres déficiences neurologiques

Electroencephalographic Findings in Patients Referred for Electroencephalogram in a University Teaching Hospital in Northern Nigeria

Background: Electroencephalogram (EEG) is a valuable investigation for the assessment of patients with seizures and some other neuropsychiatric disorders. The literature is scanty of reports describing its application and usefulness in Nigerian patients. In this study we analyzed the EEG records of a series of patients who were referred with various provisional diagnoses. Materials and Methods: EEG records of the entire 200 consecutive cases referred from various clinics within and outside a tertiary hospital in Northern Nigeria during a 1 year period were analyzed. Information on biodemographic data; clinical description of symptoms and provisional diagnosis made by referring physicians and the EEG diagnosis were obtained from the records. Results: Most of the attendees were aged between 10 years and 29 years (59.5) and mostly males (63.5). About 80 of the attendees had received a provisional diagnosis of seizure disorder (generalized and partial). The EEG diagnosis of seizure disorder accounted for 75; normal EEG record accounted for 21 and organic brain disorder accounted for 4 of all EEG diagnosis. Generalized seizure disorder was the commonest seizure type by EEG diagnosis (50). There was a significant association between the provisional diagnosis and EEG diagnosis (P 0.05). Conclusion: Most of the patients referred for the EEG had their reports consistent with clinical suspicion. EEG was found to be a useful tool in the evaluation of seizures and organic brain disorder in our study

Neurocritical Care Audit in a Tertiary Institution

Background:The `open' intensive care unit (ICU) predominates in most low and middle economy societies. This is associated with paucity of personnel and cost challenges involved for its maintenance and smooth unning despite the great public demand for this service. Data on neurocritical care in scare in Nigeria and the subregion as a whole. Our objective is to audit our neurocritical care facility; human resources; patient admission and outcome. Patients and Method: We conducted a retrospective audit of all patients admitted to our `open' ICU following a neurological indication. This study was carried out over a one year period (January 2008-December 2008). In addition to patients' boidata; we recorded date of admission; indication for admission; treatment (operative/non-operative); ventilatory support if any; and outcome (Alive or dead). Results: One hundred and twenty-nine patients were admitted during the study period; 85 (65.9) of which was due primarily to a Neurosurgical indication. The overall mortality was 25.9while mortality of ventilated patients was 64.5Mortality rate was significantly by ventilation.Conclusion: Neurological patients account for most of our ICU admission. Hospitals with ICUs should ensure that they have a proper high dependency unit. We also ecommend that appropriate equipments and staff training in the area of neurocritical care be incorporated into existing `open' ICUs in our environment. The use of protocol for ventilated patients and managing common ICU cases and common procedures should enhance treatment outcomes

Profile of Neurological Admissions at the University of Nigeria Teaching Hospital Enugu

The burden of Neurological diseases may be on the increase especially in developing countries. Improved outcome in these settings may require appreciation of the spectrum of Neurological diseases and the impediments to their management. We aim to determine the profile of neurological admissions and the challenges of managing these diseases at the University of Nigeria Teaching Hospital Enugu South East Nigeria. Methods: Analysis of Neurological admissions into the medical wards of the University of Nigeria Teaching Hospital Enugu from January 2003 to December 2007. Results: Neurological admissions comprise about 14.8of medical admissions. There were 640 (51) males and 609 (49) females. The spectrum of neurological diseases were stroke 64.9; central nervous system infections (21.8); HIVrelated neurological diseases 3.5; hypertensive encephalopathy (3.4); dementia (3); subarachnoid haemorrhage (2.2); Guillian Barre syndrome (1.2); Parkinson's disease (1.1); myasthenia gravis (1.0); motor neurone disease and peripheral neuropathy and accounted for 0.8and 0.6respectively. Overall; non infectious disease accounted for 78.2of neurological admissions while infectious diseases accounted for 21.8. Conclusion: A wide spectrum of neurological diseases occurs in our setting. The high incidence of CNS infections indicates that efforts should be geared towards preventive measures. A major challenge to be addressed in the management of neurological diseases in our setting is the lack of specialized facilities

The Prevalence of Neurological Complications among Adult Sudanese Diabetic Patients

"The objective of this study was to identify the prevalence of neurological complications among adult Sudanese diabetic patients attending the outpatient clinics of El Shaab Teaching Hospital in Khartoum. Methods: This is a descriptive cross sectional hospital based study; it was conducted at El Shaab Teaching Hospital; Khartoum; Sudan during the period from ebruary !!"" to #ctober !!$.esultset '!! diabe(c pa(ents were included in the study; $ were male and )* females. +ore than *;- were above the age of ); years and ;$- were in the age group );- $"". The pa(ents were from di/erent tribes and di/erent states. Sixty percent of the patients were from the northern Sudanese states while the rest of patients were from eastern and western states. Seventy seven percent of the patients had type diabetes mellitus and 7*.""- of them had diabetes for more than one year. Hypertension was found in *- of our pa(ents. The study revealed that $!- of the diabe(c pa(ents have neurological manifesta(ons. The main neurological complication found was peripheral sensory-motor neuropathy. Conclusion: There is significant positive correlation between age; duration of diabetes; glycaemic control and occurrence of the neurological complications."

Neurological disorders in rural Africa - a systematic approach

Background/Objectives Empirical knowledge suggests that neurological disorders are common in sub-Saharan Africa. However; to date prevalence studies are scarce.The aims of our study were to assess the hospital-based prevalence of neurological disorders in a rural African setting and to describe the pattern of disease by using a systematic approach. Methods The study was conducted at the Haydom Lutheran Hospital in northern Tanzania; Manyara region. Over a period of eight months all patients admitted to hospital were seen prospectively in consecutive order by a neurologist (ASW). Results Out of 8676 admissions 740 patients (8.5) were given a neurological diagnosis. The most frequent neurological disorders were seizures (26.6) and infectious diseases (18.1). The overall mortality of neurological disease was 21. Cases were grouped according to diagnostic certainty. We suggest three major categories for neurological disorders (group 1 = no diagnostic uncertainties; group 2 = minor diagnostic uncertainties; group 3 = major diagnostic uncertainties) with implications regarding therapy and prognosis.Conclusions The above data emphasizes that neurological disease contributes substantially to morbidity and mortality in a rural African hospital. Based on the observed pattern of neurological disorders we suggest a systematic approach

Clinical neuropsychiatric correlates and EEG findings among children with developmental disorders in Lagos, Nigeria

Abstract Objective: Developmental disorders with or without associated neuropsychiatric complications continue to be one of the major health problems in Africa. The grossly inadequate management/ rehabilitative facilities further worsen this. A prospective study aimed at finding the types of developmental disorders and associated neuropsychiatric complications among children aged ≤15 years that presented with developmental disorder in the study centers over 36 month study duration. Methods: The study was carried out in the paediatric and child psychiatric clinics as well as the Electroencephalographic (EEG) unit of two major health facilities in Lagos, Nigeria: Lagos University Teaching Hospital (LUTH) and Psychiatric Hospital, Yaba, Lagos. For each subject, socio-demographic data was obtained and appropriate clinical evaluation was carried out to obtain the necessary data and clinical diagnoses. Furthermore, each of the subjects had waking EEG recording using 20-channel computerized Medelec® EEG machine. The EEG interpretation was blinded to the clinical history of the subjects. Results: Overall, one hundred and eleven (111) subjects were evaluated over the 36 month study period. The cohort was made up of 63 (56.8%) males and 48 (43.2%) females. The mean age was 4.8 (±3.9) years, with most subjects falling in the age group of 0-5 years(69.4%). Mixed specific developmental disorders were most common (55%) followed by that of specific developmental disorders of speech and language (34.2%). Forty-one (36.9%) subjects suffered from one or more types of complications, with seizure, 22(19.8%) being the most common. The waking EEG recording was normal in 22 (19.8%) subjects; while abnormal epileptiform activities were found in 85 (76.6%) of recordings. No statistically significant relationship existed between EEG abnormalities and the factors of age and clinical diagnoses (i.e developmental abnormalities). Conclusion: The small number of subjects in this study is a major hindrance to drawing a general conclusion. However, it has been shown that a number of the cohort in addition to their developmental disorders suffered from such complications as seizures, hyperactivity etc. Furthermore, a significant proportion had EEG abnormalities of the epileptiform types possibly reinforcing the previously known fact of prevalent subtle brain damage among African children. The need for preventive health care is therefore emphasized

Neurological Aspects of Stuttering : Summary Overview of Scientific Fingings

The aim of this article is to provide a summary overview of some of the more important scientific evidence of neurological differences between stutterers and non-stutterers. Stuttering is a complex disorder of speech fluency; the aetiology of which is still largely unclear. Although most of the knowledge about stuttering has been derived from clinical observations; essential information obtained through laboratory research delineated some important neurological differences between people with a stuttering problem and people who do not stutter. These differences are identified in terms of neuroimaging; speech production processes and even in terms of auditory perception and feedback mechanisms. The development of new and improved neuroimaging techniques has greatly enhanced the potential to investigate neurological correlates of stuttering. Current knowledge is indicative of a complex neurological basis for stuttering. However; on the basis of current scientific evidence any currently held theory cannot be conclusively substantiated

Congenital malformations of the central nervous system at the University Teaching Hospital; Jos Plateau State of Nigeria

The Pattern of congenital malformation of the central nervous system (CNS) as seen in Jos University Teaching Hospital (JUTH) is slightly different from that seen in Europe; Japan and Southern Nigeria. Not all the various types of of CNS malformations reported from these centres have been seen in JUTH

Computerised axial tomographic scanning in neuropsychiatric disorders

The invention of the computerised tomography scanner - a product of modern bio-medical technology has significantly enhanced the diagnosis capability of physicians in the management of brain disorders. Despite the development of newer neuro-radiological equipment; the CT scanner remains a most invaluable diagnostic tool and should be given priority consideration in health vote allocation