Frequency of neurological deficits in Sudanese lepromatic patients

Leprosy has been a major burden on humanity over thousands of years. Perhaps no other disease in the history of mankind has been associated with such a strong social stigma as leprosy. Failure in early detection often leads to serve disability in spite of eradication of mycobacteria at a later date. Untreated the disease is progressive and results in permanent damage to the skin, nerves, limbs and eyes. To study the pattern of neurological manifestations among adult Sudanese leprosy patients seen in Khartoum Dermatology hospital in the period from March 2006 to August 2006. This is a prospective cross-sectional hospital-based study. Seventy adult Sudanese leprosy patients were studied using simple, direct standardized questionnaire including history and neurological examination, during the period from March to August 2006. The most common age group affected was 19-27 years. Male to female ratio was 3:1. Numbness was the most common neurological symptom seen in 77.14%. Each of visual disturbance, headache and bilateral ulnar sensory impairment was detected in 7.14%. Half of the patients had upper limbs sensory nerve dysfunction while 42.86% exhibited sensory nerve dysfunction in the lower limbs. "Gloves and stoking" sensory impairment was the most common finding [30%] while bilateral lateral politeal sensory impairment was the most common finding [30%] while bilateral lateral politeal sensory impairment was seen with the same percentage. Bilateral median and unilateral posterior tibial sensory impairment ware found in 1.43% each. Unilateral radial cutaneous sensory impairment was seen in 2.86%. Approximately half [48.57%] of the patients had upper limbs motor dysfunction. Bilateral ulnear distribution motor affection was seen in 4%. A significant number [41.43] had upper limbs muscle wasting. Impaired olfaction was the most common cranial nerve sign seen in 12.86%. Leprosy reactions were detected in 21.43%; type 2 reaction in 14.27% while type 1 reaction in 7.14%. Numbness and limbs weakness were the most common neurological symptoms in leprosy patients. Peripheral nerve sensory impairment was found in half of the patients with "Gloves and stokes" peripheral sensory neuropathy being the most common sensory disturbance. Motor dysfunction was found in 48.57%. Ulnar and median nerves motor affection was the most common motor dysfunction. Signs related to cranial nerves involvement were less common. Leprosy reactions were present in one-fifth of the patients

study of knowledge, attitude, practice towards epilepsy among relative of epileptic patients in Khartoum state

People with epilepsy are suffering from a lot of un tolded negative impacts on their lives; due to misunderstanding of the disease and from the associated stigma. The objective of this study is to assess the knowledge, attitude, and practice among relatives of Sudanese epileptic patients seen in Sheik Mohamed Kheir Neurological clinic and Elshaab Teaching Hospital. This is a descriptive cross- sectional community based study, 313 respondents were included, the duration of the study was from November 2008 to June 2009. Most of the respondents knew the disease, and had witnessed an attack. One third mentioned a brain lesion as the underlying cause of epilepsy. Most of the respondents mentioned loss of consciousness as the major symptom. More than two thirds mentioned that it is not contagious. Most of the respondents claimed that it can be controlled, and two thirds preferred medical treatment. The study revealed that half of the respondents had shown favourable attitudes and practice. The study revealed that the level of knowledge, attitude, and practice towards epilepsy needs community educational programmes to fill the gaps, and minimize the stigma

Cervical cord compression secondary to mycetoma infection

Mycetoma is a chronic granulomatous subcutaneous infection caused by actinomycetes [actinomycetoma] or by true fungi [eumycetoma]. Clinically the disease is characterized by swelling, and sinuses in the affected part. Another characteristic feature of mycetoma is the formation of aggregates of the organism [grains] in the tissues, which are visible to the naked eye and are discharged through sinuses in the skin. The grains vary in colour, size and consistency depending on the causative agent [1, 2]. These features are helpful in making a tentative diagnosis of the causative organism. We report a 75 year's Sudanese female with spastic paraplegia of gradual onset, she has discharging sinuses in her neck. Cervical X-RAY and cervical MRI showed destruction of cervical vertebrae. Identification of the agent was established by the histological examination of the grains, by culture and serologic techniques. Mycetoma is a local chronic and progressive infection of the skin, subcutaneous tissues and bone. It is characterized by swelling that is often grotesque and disfiguring and by multiple sinus tracts that drain granule-containing pus [3]

Psychiatric disturbance associated with epilepsy in a tertiary health service in Sudan

Co morbid psychiatric Disorders are common in epileptic patients. This relationship had not been studied before in Sudanese patients. To study the common psychiatric disturbances and their correlates among epileptic patients attending a tertiary health service in the Sudan. Sixty two patients with idiopathic epilepsy were submitted to psychiatric assessment using the General Health Questionnaire [GHQ], a semi-structured questionnaire and direct clinical assessment. Thirty patients [48.4%] of them emerged as probable psychiatric cases. Severity of epilepsy showed a slightly less strong correlation with the GHQ score. Social class [P<0.05], together with vocational, educational [P<0.05] and social relations difficulties [p<0.07] showed significant correlation with the GHQ score. The study showed that psychiatric co-morbidity is a common complication of epilepsy that is related to severity of epilepsy and social stress of being epileptic

Flaccid paralysis [guillian barre like syndrome] in Sudanese patients

To study clinical presentation of 24 Sudanese patients who had flaccid paralysis. The study was conducted in Elshaab Teaching Hospital [Sudan] in the period from January 2005 to November 2005, 24 patients were included in the study. A full detailed history and proper clinical examinations were performed by the authors. A list of investigations were done including urine, stool analysis, complete haemogram, urea and electrolytes BFFM, liver function test, Lumbar, Dorsal or Cervical MRI if needed, Brain M.R.I, nerve conduction study and C.S.F analysis. The study for viral infection revealed no evidence of circulating antibodies. Out of 24 patients 12 were males and 12 were females, fever was the commonest prodromal symptoms. Weakness of upper or lower limbs occurred either 24 or 48 hours following the prodromal symptoms. The facial nerve was the commonest cranial nerves affected. Four patients had sphincteric disturbances. Twelve patients had sensory disturbances. Two patients had respiratory muscles involvement and one patient had autonomic nervous system involvement. CNS showed an evidence of demylination in 16 patients while four had both demylination and axonal degeneration. CSF analysis revealed heigh proteins in eight patients. All patients showed remarkable improvement. This was acute paralysis which mimics G.B.S

pattern of clinical presentation and etiology of non-traumatic quadriparesis in Sudanese patients

Quadriparesis is a major disabling health problem. Its importance is due to the incapacitating disability that often persists despite treatment. The study was aimed at detecting the etiologies and clinical presentation of Sudanese patients with quadriparesis, as there was no available documented information about quadreparesis in Sudan. This is a descriptive hospital based cross-sectional study of 100 patients admitted to Elshaab Teaching Hospital [ETH] from January 2002 to October 2003, who presented with four limbs weakness. Out of 100 patients 55 were males and 45 were females. 55% were in the age group of 18-44. Patients were originally from different states and different racial groups. Weakness was the presenting complains in all patients. 75% of the patients presented with gradual onset weakness. MRI detected the lesion in all patients with cervical cord compression. Cervical cord compression, acute inflammatory demyelinating polyradiculopathy, motor neuron disease and muscular dystrophy constituted the etiological bulk of quadriparesis in the Sudan