Hémosidérose du système nerveux central: apport diagnostique de l'Imagerie par Résonnace Magnétique / Hemosiderosis of the central nervous system: diagnostic contribution of Magnetic Resonnace Imagery

Introduction. L'hémosidérose du système nerveux central est une pathologie rare liée au dépôt d'hémosidérine à la surface du cerveau, des nerfs crâniens et de la moelle épinière secondaire à un saignement chronique. Nous rapportons un cas d'hémosidérose du système nerveux central chez une patiente jeune dans un tableau de méningite. A travers notre observation nous voulons décrire l'apport diagnostique de l'Imagerie par Resonnace Magnétique dans cette pathologie. Observation. Patiente de 39ans, sans antécédents particuliers, avait consulté au service des urgences pour des céphalées d'apparition brutale associées à des nausées. Le scanner cérébral objectivait un discret effacement des sillons corticaux et une sinusite sphénoïdale. L'Imagerie par Resonnace Magnétique cérébrale et médullaire objectivait un dépôt d'hémosidérine en hyposignal T2 Echo de gradient au niveau du cortex cérébral et de la moelle épinière. Le bilan étiologie du saignement chronique était négatif à l'angio-Imagerie par Resonnace Magnétique du polygone de Willis. La glycorachie était à 1,5g/l pour une glycémie à 5,6g/l (hypoglycorachie), la protéinorachie était à 2,43g/l sans bactériémie mais présence de 590 éléments dont 72% de lymphocytes et 27% de polynucléaires neutrophiles. Conclusion. L'Imagerie par Resonnace Magnétique est une technique indispensable au diagnostic de l'hémosidérose cérébro-méningée.

Cases of neuro-ferritinopathy from Sudan

Neuro-ferritnopathy (NBIA) is a bag of diseases due to abnormal iron metabolism. It has different underlying genetic and enzymatic abnormalities. On the other hand, they share some radiological features. Patients present with a wide range of cerebral symptoms and signs. Diagnosis depends on the semiology, genetic testing and MRI imaging. No specific treatment is available for these cases and they represent a challenge to the treating neurologist. Here we illustrate two interesting cases with their clinical and imaging findings to raise the awareness of such rare diseases and help diagnosing them in a low- resource setting

Intelligence quotient of neurologically impaired children attending neurology clinic in a nigerian tertiary institution

Background: The need to identify the intellectual capability of neurologically impaired children dictates their educability which can be estimated through their intelligence quotient (IQ). Draw-a-man test for IQ estimation is available, easy and has been validated in Nigeria. Method: Through a prospective, cross-sectional study that lasted 12 months (January-December, 2011), children aged 4 years and above attending neurology clinic were recruited once they have no severe motor or sensory limitations affecting their upper limbs and can obey the instruction to draw a person. Anthropometry was carried out on them and they were comfortably seated to draw a person. The parents or caregivers were instructed not to make any suggestion or hint to them and no time limit was given. Their drawings were assessed using the 52 parameters of Ziler and interpreted accordingly. Ethical procedures were adhered to. The analysis was done using SPSS version 16 and an interactive calculation tool for chi-square tests of goodness of fit and independence. Results: Seventy-five (45 male, 30 female) children met the inclusion criteria. Their clinical conditions were Epilepsy 48 (64%), Cerebral Palsy 6 (8%), ADHD 5 (6.7%), Down Syndrome 4 (5.3%), Speech/Hearing impairment 3 (4.0%), Hypothyroidism 2 (2.7%) and 7 (9.3%) others. Their ages ranged from 4 years to 16 years (mean±SD = 9.7± 3.8 years). Their IQ distribution were Normal 4 (5.3%), Borderline 12 (16.0%), Mild Mental Retardation 16 (21.3%), Moderate Mental Retardation 19 (25.3%), Severe and Profound Mental Retardation 24 (32.0%) with no significant difference in relation to their birth order. Conclusions: Ninety-six per cent of the study population had IQ below normal. Epilepsy was the commonest condition seen in the Paediatric Neurology clinic and all categories of IQ are seen among children with epilepsy

Knowledge of electromyography (EMG) among Sub-saharan African patients - a pilot survey

Background: Electromyography (EMG) is one of the common diagnostic procedure in neurology but still scarce in sub-Saharan Africa. Objective: This cross-sectional study evaluated the knowledge of EMG among patients undergoing this procedure, considering the type, quality and reliability of the information they have. Methodology: Consecutive patients who underwent EMG for the first time between 2014 and 2016, at the WFNR/Blossom Medical Centre Ibadan, Nigeria were interviewed prior to their test. Data on patient's demography, type of referring physicians were collated. Knowledge of EMG was also assessed. A patient was considered "informed" if she/he knew, at least, that the EMG is a test that uses an electric current or a needle, that it may be painful or cause discomfort, and that it is used to study the function of muscles and nerves. Descriptive and inferential statistics were performed to know the determinants of EMG knowledge. Result: 55 patients. 32 males and 23 females (mean ages 48.69± 18.32 and 43.30±14.88 respectively) were interviewed. Twenty-three (41.8%) patients were adjudged informed about the nature of EMG while 32 (58.2%) were uninformed about the procedure. Twenty one (38.2%) were informed about the procedure by their doctors while 4 (7.3%) got information from friends and relatives and 4 (7.3%) from the internet. Level of education was associated with being informed (p=0.039) Multivariate logistic regression analysis revealed no significant predictor or EMG knowledge. Conclusion: Knowledge of EMG is poor and could be improved upon. More patient education needs to be done to prepare the patients, and allay their fears about the procedure

Audiological Findings in a Group of Neurologically Compromised Children: A Retrospective Study

Background. Hearing loss is more prevalent in developing countries. Later diagnosis of hearing loss will result in delayed access to rehabilitation. It is typically more difficult to obtain subjective information required in a hearing test from neurocompromised children; causing audiologists to frequently turn to objective measures such as the auditory brainstem response (ABR) measure to obtain this information.Objective. To describe the ABR results in a group of neurologically compromised children and to establish a relationship between ABR findings and behavioural audiometry results; where these existed.Methods. A retrospective review was conducted on 40 ABR patient records of neurologically compromised participants aged 5 months - 10 years. Behavioural audiometry results were sought where these existed. Hearing status was described per ear for objective and behavioural results; and descriptive statistics were conducted.Results. Behavioural audiometry results were obtained in 72.5% of ears. Results correlated between ABR and behavioural audiometry for only 7.5% of ears; which were all diagnosed with normal hearing. About12.5% of ears were misdiagnosed with behavioural audiometry. Premature infants were most likely to cope with behavioural audiometry. Hearing loss was highest in participants with cerebral palsy; Down syndrome; prematurity and retroviral disease.Conclusions. Behavioural audiometry appears to be a largely unreliable method of testing the hearing of children diagnosed with neurological disorders; as results were obtained in only 27.5% of the study sample; however; it remains the gold standard in paediatric hearing testing to evaluate the entire auditory system and provides information on how a child processes sound. Hearing thresholds should be established via objective testing. Conditioning should continue for a behavioural audiological test battery; with adaptations for the child's developmental ability

Troubles neurologiques au cours de la grossesse et du post-partum dans le service de neurologie du CHU du Point-G et du centre et du centre de référence de la commune v de Bamako

Objectifs :Decrire les caracteristiques epidemiologiques; et cliniques des AVC; de l'epilepsie et de l'eclampsie. Observes au cours de la grossesse et du post-partum. Methode : il s'agit d'une etude de prospective sur 19 mois allant d'Aout a 2005 a Fevrier 2007; qui s'est deroulee dans le service de neurologie du CHU du Point-G et dans le centre de sante de reference de la commune V du district de Bamako. Etaient concernees par ce travail toutes les femmes en age de procreer ( 15 a 45 ans) consentantes; ayant ete examinees et/ou hospitalisees pour troubles neurologiques apparus pendant la grossesse et /ou les six mois suivant l'accouchement; dans nos differents site d'etude. Resultat : Au cours de notre etude nous avons recrute 20 patientes en consultation externe (sur 629 ) et 17 patientes en hospitalisation ( sur 629 ); soit au total 37 malades ( sur 6914) qui repondaient a nos criteres. La frequence globale des troubles neurologiques associes a la grossesse et au postpartum etait de 3;02. La tranche d'age la plus representee etait celle de15 a 25 ans avec 48;70des cas. Le diagnostic d'epilepsie a ete retenu chez 51;40de nos patientes ; l'AVC et l'eclampsie ont occupe les deuxieme et troisieme rangs avec les taux respectifs de 37;80et 10;80. L'evolution de la grossesse etait en generale favorable ; les accouchements ont ete dans la plupart des cas; eutociques; nous avons enregistre 1 seul cas de cesarienne

Characteristics of Craniofacial Trauma in a Rural Hospital in South India

Background/Purpose:Purpose of this study was to evaluate the population characteristics of patients with both head injury and facial fractures in rural centre.Methods:This study was a retrospective study performed at Justice K.S. Hegde Charitable Hospital; Deralakatte (Mangalore) and a total of 36 patients were reviewed. Type of fracture; mechanism; clinical features and pattern of injuries were noted. All patients who sustained both cranial and facial injuries were included in this study.Results: Mean age was 32.64 years (range; 4 years to 70 years) with a male to female ratio of 35:1. Motor vehicular accidents (44.4) were most common cause of injury followed by fall (22.2). Most common areas involved were upper face (36.1) and lower face (25) followed by combination of upper and middle face (11.1) other areas were less commonly involved. Headache and vomiting were most common clinical features followed by loss of consciences. Closed head injuries were the most common neurological injury (14 cases) followed by skull fractures (5 cases). Most patients with upper facial fractures or combination of it had associated injuries. There was no mortality in the present series.Conclusion: This study further supports that injury patterns in developing countries particularly in rural area are no different from developed countries and needs to follow similar preventive and counseling measures

The paediatric suprasellar cistern as an important CT review area

Pathology affecting the suprasellar cistern is varied in paediatric neuroradiology practice. Although MRI is the imaging modality of choice for lesions of the suprasellar cistern; abnormalities can be detected on CT with knowledge of the normal anatomy and a sound approach to the possible pathological entities. We present our approach to pathology affecting the suprasellar cistern and highlight this using various cases seen at our institution in the recent past