Hypothalamic hamartoma presenting with gelastic seizures, generalized convulsions, and ictal psychosis

We report a case of hypothalamic hamartoma in an adult female who presented with gelastic seizures, generalized convulsions, and ictal aggressive psychotic behavior. Anticonvulsant treatment was ineffective in controlling the epileptic seizures. Surgical excision after accurate imaging diagnosis 3 decades after the onset of symptoms markedly ameliorated her condition. Delayed and erroneous diagnosis had unnecessarily prolonged the suffering of our patient

Cerebral malaria in adult patients in the Sudan: clinical presentation and outcome

In endemic areas adults are less vulnerable to cerebral malaria [CM] than children because of acquisition of partial immunity. This prevalence difference is one of the reasons why we see fewer epidemiological and case studies in adult CM. The objective of this study was to determine the clinical presentation and outcome of CM in adult Sudanese patients. A prospective hospital-based study was conducted in Khartoum Teaching Hospital. Thirty adult Sudanese patients presenting with CM conforming to the World Health Organization [WHO] definition of the disease were recruited. Their presenting features, laboratory investigations and clinical outcome were documented and studied. The mean age at presentation was 32.2 years +/- 15.4 SD. Nineteen patients [63.3%] were males and 11 [36.7%] were females. The predominant initial symptoms of CM were fever, excessive sweating, headache, nausea and vomiting. Before lapsing into coma, 15 patients [50%] manifested psychotic symptoms and 14 [46.7%] developed generalized convulsions. The neurological manifestations appeared after an average of six days from the onset of the febrile illness and reached its nadir within 24 hours. The level of coma was often deep, and 56.6% of patients had scored

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

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

Humoral immune IgG response to Plasmodium falciparum in adults: the role of subclass-IgG in clinical immunity to cerebral Malaria

Although antibodies are essential mediators of immunity, high levels of IgG antibodies against a wide range of blood-stage antigens of P. falciparum are poor predictors of clinical protection. It is the qualitative and the functional specificity of the antibodies to malaria antigens that predict the development of a clinically potent protective immunity. The objective of this work is to study the pattern of IgG sub-class in healthy and malaria-infected adults resident in a malaria-endemic area in Sudan. Total plasma IgG and IgG subclasses [IgG1, 2, 3 and 4] against the C-terminal region of the MSA-1[19] antigen of Plasmodium falciparum were measured by a quantitative enzyme-linked immunosorbent assay [ELISA] in 30 adult patients presenting to the emergency department with cerebral malaria [CM]. The levels of IgG antibody profile in CM patients were compared with those in patients with uncomplicated acute malaria [n=20] and in clinically healthy asymptomatic volunteers [n=20]. Total plasma IgG level was significantly higher in CM patients. The level of the sub-class IgG1 antibody against MSA-119 was significantly lower in patients infected with P. falciparum; the lowest values being observed in CM patients and the highest values in the clinically healthy volunteers. Our data suggest that acquisition of IgG1 antibody to MS A-1[19] is associated with a clinically protective immunity and that low production or defective IgG1 response may be associated with severe form of malaria in adults

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