Stroke subtypes on imaging in a Jamaican population a hospital-based study: estudio en un hospital / Subtipos de accidente cerebrovascular en la imagen médica en una población Jamaicana

OBJECTIVE: To examine the pattern of stroke subtypes found on Computed Tomography (CT), Magnetic Resonance Imaging (MRI) at the University Hospital of the West Indies (UHWI), Kingston, Jamaica. METHOD: A retrospective review was conducted for all patients diagnosed with stroke and who were subjected to CT or MRI evaluation at UHWI between January 2001 and December 2004. Data were collected for patient age and gender and type of stroke. RESULTS: Four hundred and thirty-three patients were identified and classified as having cerebral infarct, intra-parenchymal haemorrhage or subarachnoid haemorrhage. There were 414 patients who had CT scans and 19 had MRI scans. Within and across genders, over 80% suffered infarcts with no significant statistical difference between male and female patients. Subarachnoid haemorrhage was the least frequent subtype and occurred in younger patients. CONCLUSION: The pattern of stroke subtypes seen in this population was similar to that of Australian and European cohorts of patients but differed from that reported in Asians. Ischaemic infarct was the most frequent stroke subtype followed by intra- parenchymal haemorrhage and subarachnoid haemorrhage. There was no gender predilection for any specific type of stroke.

OBJETIVO: Examinar el patrón de los subtipos de accidente cerebrovascular encontrados en las imágenes de TAC y MRI en el Hospital Universitario de West Indies (HUWI), Kingston, Jamaica. MÉTODO: Se realizó un examen retrospectivo de todos los pacientes con diagnóstico de accidente cerebrovascular, sometidos a evaluación mediante TAC o MRI, entre enero 2001 y diciembre 2004. Los datos fueron recogidos teniendo en cuenta la edad y el género del paciente, así como el tipo de accidente. RESULTADOS: Cuatrocientos treinta y tres (433) pacientes fueron identificados y clasificados como pacientes con un infarto cerebral, hemorragia intraparenquimal o hemorragia subaracnoidea (HSA). Hubo 414 pacientes examinados con TAC y 19 con MRI. Dentro de ellos, ambos géneros incluidos, más del 80% sufrió infartos sin que hubiese diferencias estadísticas significativas entre hombres y mujeres. La hemorragia subaracnoidea fue el tipo menos frecuente, y se produjo en pacientes jóvenes. CONCLUSIÓN: El patrón de subtipos de accidente cerebrovascular en esta población fue similar al de cohortes de pacientes australianos y europeos, pero diferente al reportado para los asiáticos. El infarto isquémico fue el subtipo de accidente cerebrovascular más frecuente, seguido por la hemorragia intraparenquimal y la hemorragia subaracnoidea. No hubo preferencia de géneros en relación con ninguno de los tipos específicos de accidente cerebrovascular.

Intrathoracic and pelvic extramedullary haematopoiesis in sickle cell disease: a case report

Intrathoracic extramedullary haematopoiesis is a rare entity encountered in patients with long standing anaemias such as thalassaemia and congenital spherocytosis. It is rare in patients with homozygous sickle cell disease; only 11 cases of intrathoracic and two cases of pelvic extramedullary haematopoiesis have been documented in the literature. We report the case of a 30-year old man with homozygous sickle cell disease with intrathoracic and pelvic extramedullary haematopoiesis, the first case to be documented from the Caribbean.

La hematopoyesis extramedular intratorácica es una entidad que raras veces se encuentra en pacientescon anemias de larga duración tales como la talasemia y la esferocitosis congénita. También es rara en pacientes que padecen la enfermedad de células falciformes homocigóticas. En la literatura se han documentado sólo 11 casos de hematopoyesis extramedular intratorácica y dos casos de hematopoyesis extramedular pélvica. Reportamos el caso de un hombre de 30 años de edad con la enfermedad decélulas falciformes homocigóticas con hematopoyesis extramedular intratorácica y pélvica – el primercaso que se documenta en el Caribe.

Granulosa cell tumour of the ovary with bilateral mature cystic teratomas. A case report

Granulosa cell tumour with synchronous mature cystic teratoma is extremely rare and only eight cases are documented in the literature. Granulosa cell tumours are low-grade malignancies and need a close follow-up for recurrences which may be late. We report a case of granulosa cell tumour and mature cystic teratoma occurring synchronously in the same ovary in a post-menopausal woman

Granulosa-theca cell tumour of the ovaries. A late metastasizing tumour

Granulosa-theca cell tumours are ovarian neoplasms of low malignancy with hormone secreting potential, accounting for 2-3of all ovarian cancers. They have an uncertain clinical course and a potential for late recurrence after surgical removal. Clinical features of a patient presenting with pulmonary metastases 21 years after removal of the primary tumour are described, along with a review of the management options.

Orbital psuedotumour with intracranial extension: a case report

Inflammatory pseudotumour of the orbit is an unusual condition of unknown aetiology which rarely extends beyond the orbit. To our knowledge 19 cases with intracranial extension have been reported, none of which involved the pituitary fossa or sphenoid sinus. Most required cytotoxic agents, surgery or radiotherapy in addition to corticosteroids. We present a case of orbital pseudotumour with extension into the pituitary fossa, sphenoid sinus and cavernous sinuses with vascular compression. Marked clinical improvement occurred on steroid therapy alone.

Angiomyofibroblastoma: a rare but distinct entity

A case of angiomyofibroblastoma of the vulva in a 23-year-old woman is presented. Clinical, histological and immunohistochemical features as well as the differential diagnosis and prognosis of this rare but distinct entity are discussed. Only about 65 cases are documented in the literature and to our knowledge this is the first case to be reported from the Caribbean.

Thyrotoxic periodic paralysis in a Jamaican male patient

A case of thyrotoxic periodic paralysis occurring in a Black Jamaican male patient is described. Diagnosis is based on history and confirmed by evaluation of serum electrolyte during attacks and thyroid function studies. The physiopathology, associations, therapy and prognosis are discussed. It is important that clinicians recognise the condition as all forms of periodic paralysis are amenable to treatment, and progressive weakness can be prevented or even reversed.

Syndrome of inappropriate antidiuretic hormone secretion in a patient with intrasellar neurofibroma of the sixth nerve

The syndrome of inappropriate antidiuretic hormone (SIADH) secretion has been described in a wide range of neurological and other disorders. We wish to add an extremely rare case of a solitary, large invasive neurofibroma of the sixth cranial nerve extensuvely destroying the sella turcica in the skull base and causing inappropriate secretion of antidiuretic hormone in a 44-year-old black man in the absence of neurofibromatosis.

Intrasellar abscess simulating a pituitary tumour

A case of an abscess of the sella turcica discovered during craniotomy for pituitary tumour in a 20-year-old man is presented. The clinical features of this unusual intrasellar lesion are discussed. The importance of early diagnosis, high-dosage antibiotics and surgical intervention in reducing the high mortality associated with abscesses in this location are emphasized. It is suggested that abscess of the sella turcica should be considered in the differential diagnosis of a sella mass in any patient with a recent history of cerebrospinal fluid rhinorrhea, sphenoid sinusitis or meningitis

Midline communicating spinal extradural arachnoid cyst

A case of communicating spinal extradural arachnoid cyst arising from the thoracic midline dural defect is reported in a 17-year-old lad. The condition is a rare cause of spinal cord compression, and usually presents with progressive spastic paraparesis in adolescence. Fifty-eight per cent of the cases reported are of the communicating type. Myelography establishes the diagnosis if the cysts can be filled with contrast medium. Surgical removal of the cyst and obliteration of the communication usually lelads to prompt improvement in neurological symptoms

Giant cranial intradiploic epidermoid cyst

A case of giant cranial intradiploic rpifrtmoif cyst in a 53-year-old man is reported. These cysts are uncommon and very rarely attain giant sixe

Polyarteritis nodosa in jamaicans

This report describes the main features of the 5 cases of polyarteritis nodosa seen at the University Hospital of the West Indies over a 10-year period. The disease manifestations are protean and only 2 of the 5 patients were diagnosed antemortem, indicating the need to increase physician awareness, especially since response to therapy has improved significantly in recent years

Em-plaque subdural sarcoidosis: a rare neurological entity

En-plaque subbdural sarcoidosis is reported in a 74-year-old black woman. The diagnosis was mad at autopsy. The patient also had adenocarcinoma of the sigmoid colon with liver metastases. Subdural sarcoidosis is very rare in that only four cases have been previously reported, all of which were diagnosed clinically and treated

Tumours of hte central nervous system: analysis of 476 cases observed at the University Hospital of the West Indies

A statistical survey of the incidence, age and sx distribution, and preferential sites of occurrence of tumours of the central nervous system observed at the University Hospital of the West Indies during a 15-year period is presented. Four hundred and seventy-six histologically confirmed neoplasms were recorded. Intracranial tumours were 7 times as common as those of the spinal cord. Of 416 intracrianl neoplasms, ther were 40% neuropithelial tumors, 21% meningiomas, 15% pituitary adenomas, 9% metastic lesions, 6% congenital tumours, 5% vasoformative tumours, 3% nerve sheath tumours and 1% unclassified neoplasms. Men and women were equally affected. Meningiomas and pituitary adenomas were more frequent than in otherreported series. Metastases were relatively more frequent in the spinal than in the intracranial group. Of the primary spinal tumours, those of nerve sheath origin were nearly three times as common as the meningiomas

Intramedullary schwannoma of the spinal cord

A rare case of solitary, dorsally locared, intramedullary schwannoma of the thoracic spinal cord is reported in a 54-year-old man. The pathogenesis of the rumour in this location is discussed