Cerebral venous thrombosis. Clinical presentation and outcome in a prospective series from Sudan

To describe the presentation and outcome of treatment of cerebral venous thrombosis [CVT] in patients from Sudan, an example of a developing country. In a prospective study, we described the clinical features, risk factors, and outcome of CVT in patients admitted to the National Center for Neurological Diseases, Khartoum, Sudan, the only specialized neurological hospital in the country, during the period from February 2001-October 2006. Patients were referred from other hospitals in the town or from nearby hospitals in Khartoum state. We recruited only adult and adolescent patients aging >/= 15 years. We reviewed 15 patients [12 females and 3 males] with a mean [ +/- SD] age of 33.9 +/- 11.8 years. Headache [n=15], papilledema [n=13], paresis [n=3], and generalized seizures [n=3] were the most common symptoms, and signs encountered. A prothrombotic risk factor was often identified [n=12]. At the time of the first visit namely, 12 weeks after discharge, 7 patients [46.7%] attained complete neurological recovery, 4 [26.7%] developed optic atrophy, and 2 [13.3%] died of pulmonary embolism. The clinical features and risk factors of CVT in Sudan are not different from elsewhere, but the outcome is less favorable. Places with less privileged health service resources, late presentation or delayed accessibility to appropriate diagnostic tools may negatively influence the final outcome

Patterns of pituitary adenoma among adult Sudanese patients

The objective of this study is to determine the clinical presentation and hormonal secretions of patients with pituitary adenomas. This is a descriptive, prospective study on 53 adult Sudanese patients with pituitary adenoma. Only adults [16 years or more] were included. The study was conducted in Al-Shaab Teaching Hospital in the period from January 2001 to February 2007. Twenty eight [52.8%] patients were females and 25 [47.2%] were males. Their ages ranged between 16 -80 years [mean 40.8 +/- 15.6 years]. Twenty seven [50.9%] patients had functioning pituitary adenomas [FPA] and 26 [49.1%] patients had nonfunctioning pituitary adenomas [NFPA]. Hormonal secretion of the adenomas was found to be prolactin in 16 patients [14 females and 2 males], growth hormone in 8 patients [3 females and 5 males], ACTH in 2 patients [one female and one male] and TSH in one female. Macroadenoma was found in 44 patients [83%], while microadenoma was found in 9 patients. All non functioning adenomas were found to be macroadenomas, while functioning adenomas were found in 18 patients with macroadenoma and in 9 patients with microadenoma. In our series all NFPAS were macroadenomas. They were usually discovered late after assuming mass effect or incidentally on imaging for other reasons. Patients with functioning adenomas tend to present earlier with hormonal dysfunction and hence are diagnosed earlier before the tumors assume big sizes. Prolactin secreting tumors are the commonest among functioning pituitary adenomas and tend to predominate in females

Intracranial meningioma: findings from Sudan

The objective of this article is to determine the pattern of neurological presentation of meningiomain adult Sudanese patients. In this study we described the clinical presentation and neuroimaging findings in fifty patients with Intracranial meningioma. In all patients the diagnosis was histologically verified. The age distribution of the patients ranged between 19 -70 years, the mean age was 44.5 +/- 13.33 years. Females were 36 [72%] and males 14 [28%]. Male: female ratio was 1:2.6. The presenting symptoms were headache and nausea in 37 [74%] patients, behavioral changes in 34 [68%], visual disturbance in 23 [46%], generalized seizure in 20 [40%], limb weakness in 20 [40%], vomiting in 13 [26%], speech disturbance in 13 [26%], sphincteric disturbances in 11 [22%], focal seizures in 10 [20%], anosmia in 4 [8%], and deafness in 2 [4%]. Meningiomas were located in anterior fossa in 18 patients [40%], parasagittal in 9 [20%], sphenoidal ridge in 8 [18%], posterior fossa in 7 [15.9%], lateral convexity in 5 [11.3%], olfactory groove in 4 [9%], middle fossa in 2 [4.5%] and supraseller area in one [2.2%]. All meningiomas enhanced with gadolinium. Peritumoural oedema was found in 24 [54.5%] patients, hydrocephalus in 11 [25%] and hyperostosis in 9 [20.5%] patients. It has been concluded that the clinical presentation and MRI findings did not differ much from what is reported worldwide

Ataxia telangiectasia: findings from two families in the Sudan

We report herein two families with ataxia telangiectasia. Patients in both families fulfilled the diagnostic criteria and showed unusual presentations that are rarely reported in literature. No patient developed malignancy yet. To the best of our knowledge this is the first report on Ataxia telangiectasia from Sudan

Invasive aspergillosis of paranasal sinuses: findings from the Sudan

The Sudan is endemic for Aspergillus species, especially Aspergillus flavus. They commonly invade the paranasal sinuses, but massive invasion of the brain in immunocompetent patients is rare. To describe the clinical presentation and MRI findings in immunocompetent patients with massive paranasal aspergillosis with extensive invasion of the brain. Four patients, who are negative for HIV and other immunocompromizing disorders were studied in this article. Two females 55 and 25 year old, 2 males 29 and 62 year old were described. All cases showed extensive invasion of the paranasal sinuses and the adjacent structures. Invasive paranasal Aspergillosis can affect immunocompetent patients and the commonest organism is Aspergillus flavus

Anticardiolipin antibodies in stroke patients in Sudan. Appraisal of their significance in a region of high burden of endemic infections

To screen and evaluate the significance of anticardiolipin seroprevalence in patients with acute ischemic stroke, in patients with infectious disease, and in healthy subjects resident in Sudan, a tropical country endemic for several infectious diseases. We conducted the study in Khartoum Teaching Hospital in Khartoum, Sudan between July 2003 and January 2005. We included 89 stroke cases, 30 infectious disease patients, and 30 asymptomatic healthy subjects. We estimated IgG and IgM anticardiolipin antibody titers in serum samples from all subjects in the 3 study categories at the time of hospital admission. We found a significantly higher prevalence of anticardiolipin antibodies in the stroke and infection groups compared to the healthy subjects. However, there was no significant difference in anticardiolipin seroprevalence between patients with stroke and patients with infectious disease. Caution is necessary when interpreting the presence of antiphospholipid antibodies as a stroke risk in patients harboring infection or living in places with high endemicity of infectious diseases

Adult onset polymyositis-dermatomyositis: Findings from Sudan

Polymyositis [PM] and dermatomyositis [DM] are rare inflammatory muscle diseases affecting children and adults. Resulting disability is very variable. To the best of our knowledge no study addressed this problem before in Sudan. The objective of this study is to determine the patterns of presentation of PM/DM in adult Sudanese patients. This is a prospective hospital based descriptive study conducted in Elshaab and Khartoum Teaching Hospitals in Khartoum, Sudan. The study was conducted in the period from July 1997 to January 2007.During this period all patients with PM/DM admitted to these hospitals and fulfilling the criteria for the diagnosis of PM/DM were included in the study. Thirty patients were included in this study. Twenty two were females [73.3%] and 8 were males [22.7%]. Their ages ranged between 15-65 years [mean age 34.8 +/- 14.7 years]. Twenty patients [66.7%] were found to have PM and 10 [33.3%] have DM.. The commonest presentation was proximal muscle weakness in 30 patients [100%], joint pain in 29 patients [96.7%] and muscle pain in 28 patients [93.3%]. Overlap syndrome was found in 3 patients [10%], malignancies in two patients [6.7%] and interstitial lung disease in 1 patient [3.3%]. Muscle enzymes were found to be high on presentation in 28 [93.3%] patients and were normal in 2 [6.7%] patients. The results show that the pattern of presentation of PM/DM in this study does not differ much from disease elsewhere world

Spontaneous resolution of bilateral spontaneous subdural hamatomas: Case report

In this communication we present a young woman with spontaneous bilateral subdural haematomas following spontaneous vaginal delivery. She presented with severe headache and diplopia. There was no history of trauma, bleeding disorder, jaundice or febrile illness. Physical examination revealed right 6[th] nerve palsy. Investigations for bleeding disorders were negative. CT scan of the brain revealed bilateral subdural haematomas. She was treated conservatively and within month the haematomas resolved completely

Pott's disease of the spine: findings from Sudan

Spinal tuberculosis is the commonest type of skeletal tuberculosis. It has variable presentations, but commonly presents with backache and weakness of lower limbs. Its prevalence is increasing world wide after the epidemic of HIV. To the best of our knowledge there are no studies addressing the clinical presentation of this disease in Sudan. In this study we included 84 patients with spinal tuberculosis. The study was conducted in two major hospitals in Khartoum in the period from January 2002 to December 2006. Results show males constituted 46 patients [54.8%] and females 38 [45.2%]. Their ages ranged between 16 years and 80 years, the mean age was 44.46 +/- SD 16.99. All patients had pain and or tenderness at the site of the lesion. Paraplegia or paraparesis was reported in 36 patients [42.8%], quadriplegia or quadriparesis in 25 [30%], Sciatica and root weakness in 22 [26.1%] and right brachial monoplegia in one patient. Evidence of active pulmonary tuberculosis was found in 15 patients [17.8%], abdominal tuberculosis in 7 patients [8.3%], lymphatic Tuberculosis in 1 patient [1.2%]. Cervical vertebrae were affected in a total of 26 patients [30.9%], the dorsal in 39 patients [46.4%] and the lumbar in 30 patients [35.7%]. One vertebra was affected in 3 patients [2.57%], 2 adjacent vertebrae in 48 patients [57.14%], 3 vertebrae in 24 patients [28.57%], 4 vertebrae in 4 patients [4.76%], 5 vertebrae in 1 patient [1.19%] and 6 vertebrae in 4 patients [4.76%]. HIV test was negative in all patients. Tuberculin test was positive in 80 patients [95%] and negative in 4 patients [5%]

Osteopetrosis: a rare disease with rare presentations

At least eight types of osteopetrosis have been described in humans. The primary underlying mechanism involved in all forms is the failure of normal osteoclastic bone resorption. Osteopetrosis tarda, the benign adult form, is inherited as an autosomal dominant trait. Patients typically are asymptomatic and have good long-term survival rates because bone marrow failure rarely occurs. A more common and malignant form, osteopetrosis congenita, presents in infancy and results in bone marrow failure caused by complete replacement of the marrow spaces with osteoclasts. Other forms are rare and have variable manifestations. In this communication we report 2 cases on possibly a rare form of osteopetrosis, the intermediate form