SHORT-TERM OUTCOME OF OPERATED TRAUMATIC BRAIN INJURY PATIENTS FOR INTRACRANIAL HEMORRHAGE AT TIKUR ANBESSA SPECIALIZED TEACHING HOSPITAL (TASTH), ADDIS ABABA, ETHIOPIA.

Background: Traumatic brain injury is the leading cause of death and disability in people younger than 40 years of age worldwide. Objective: The study primarily aims at assessing the short-term outcome of patients operated for traumatic intracranial hemorrhage. Patients and Methods: This is a hospital based cross sectional study on patients with traumatic brain injury at Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia, between February 2013 and February 2014. Standardized and structured questionnaire was used to collect sociodemographic data. All patients with traumatic brain injury operated following intracranial hemorrhage were included. Glasgow Coma Scale was used to determine the outcome. Difference in proportions was examined using Chi-square test. Results: The study reviewed 91 patients with traumatic brain injury. Their age ranged from 13 to 60 years with a mean (SD) of 32.3 (±12.1). Eighty-seven (95.6%) of the cases were males and 4(4.4%) females and 34(37.4%) of them cases had mild and 30(33%) had severe traumatic brain injury. Acute Epidural Hematoma was seen in 79(86.8%), Acute Subdural hematoma had the highest proportion, 4/11(36.4%), of deaths and it was also significantly associated with unfavorable Glasgow Outcoma Scale at 3 months (p=0.03). Overall, the proportion patients who died was 18.7% with older patients (>50 years) had a significantly higher proportion of death (p=0.01). Most of the patients had favorable Glasgow Outcoma Scale ,unfavorable was seen in 22/30 (73.3%) and 17/30 (56.7%) of patients with severe traumatic brain injury at 3 and 6 months, respectively. Conclusion: In conclusion, male predominance was substantially high. Acute Subdural hematoma and old patients had high death rates and unfavorable outcome. Overall the death rate was not different from global figures.

An Ethiopian Training Program in Neurosurgery with Norwegian Support.

After a 4-year planning period, a joint Ethiopian/Norwegian training program in neurosurgery was started in June 2006. The collaborating partners were Addis Ababa University; Department of Surgery, Tikur Anbessa Specialized Hospital; University of Bergen; Haukeland University Hospital; and Myungsung Christian Medical Center, a Korean missionary hospital in Addis Ababa, Ethiopia. A memorandum of understanding was signed at dean/chief executive officer levels. Although other initiatives have been involved in supporting neurosurgery in Addis Ababa during the same period, this institutionally founded program has been the main external contributor to neurosurgical capacity building through the education of 21 Ethiopian neurosurgeons, and in supporting a sustainable environment for neurosurgical training within a network of 5 centers in Addis Ababa. This article gives an account of the strategies underlying the program planning, the history of the program, and on the experience gained by it. Finally, ethical problems and challenges encountered in the program are discussed.

Short-term outcome of operated traumatic brain injury patients for intracranial hemorrhage at Tikur Anbessa specialized teaching hospital (Tasth), Addis Ababa, Ethiopia

Background: Traumatic brain injury is the leading cause of death and disability in people younger than 40 years of age worldwide.Objective: The study primarily aims at assessing the short-term outcome of patients operated for traumatic intracranial hemorrhage.Patients and Methods: This is a hospital based cross sectional study on patients with traumatic brain injury at Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia, between February 2013 and February 2014. Standardized and structured questionnaire was used to collect sociodemographic data. All patients with traumatic brain injury operated following intracranial hemorrhage were included. Glasgow Coma Scale was used to determine the outcome. Difference in proportions was examined using Chi-square test.Results: The study reviewed 91 patients with traumatic brain injury. Their age ranged from 13 to 60 years with a mean (SD) of 32.3 (±12.1). Eighty-seven (95.6%) of the cases were males and 4(4.4%) females and 34(37.4%) of them cases had mild and 30(33%) had severe traumatic brain injury. Acute Epidural Hematoma was seen in 79(86.8%), Acute Subdural hematoma had the highest proportion, 4/11(36.4%), of deaths and it was also significantly associated with unfavorable Glasgow Outcoma Scale at 3 months (p=0.03). Overall, the proportion patients who died was 18.7% with older patients (>50 years) had a significantly higher proportion of death (p=0.01). Most of the patients had favorable Glasgow Outcoma Scale ,unfavorable was seen in 22/30 (73.3%) and 17/30 (56.7%) of patients with severe traumatic brain injury at 3 and 6 months, respectively.Conclusion: In conclusion, male predominance was substantially high. Acute Subdural hematoma and old patients had high death rates and unfavorable outcome. Overall the death rate was not different from global figures

REVIEW OF THE CLINICAL, COMPUTERIZED TOMOGRAPHY SCAN AND/OR MAGNETIC RESONANCE IMAGING FINDINGS OF INTRACRANIAL TUBERCULOMA IN AN ETHIOPIAN TEACHING HOSPITAL.

ackground: Ethiopia is one of the countries that has high burden of all forms of tuberculosis and there is no published report on computerized tomography scan and/or magnetic resonance imaging of intracranial tuberculomas. Objective : to review the clinical, computerized tomography and/or magnetic resonance imaging features of intracranial tuberculoma. Methods: retrospective review of patient's medical records of patients operated for intracranial mass that had computerized tomography and/or magnetic resonance imaging brain scans and had histopathological diagnoses, at Tikur Anbessa Specialized Hospital between January 2009 and June 2013. Results: Of 222 operated cases of intracranial mass subjected to histopathological test 29 (14.6%) were found to have tuberculomas, 28 (14.1%) had caseous necrosis and one was a tuberculous abscess, in 25 cases imaging was available for review and were included in the study . There were 15 males and 10 females with age range being 2 to 65 years and with the Median age being 13 years. Twenty patients had computerized tomography and five patients had magnetic resonance imaging. Seizure 15/25 (60%) and headache 11/25 (44%) were the commonest presentation. Solitary or confluent large lesions were seen in 12/25 (48%) of patients. 14/25 (56%) of the lesions had their size between 2 cm and 5 cm. Majority of the lesions 15/25 (60%) were in the frontal and parietal lobes. The lesions were isodense on CT in 18/25 (72%) of the pre-contrast studies and 21/25 (84%) showed ring or rim enhancement after intravenous administration of the contrast medium. Conclusion: Tuberculoma, more frequently, presented with non-specific clinical findings and chronic seizure disorder and comonly occurred in young patients and often seen infratentorialy. It is often complicated with hydrocephalus in the pediatric age group. Computerized tomography scan and/or magnetic resonance imaging features are not different from reports from other countries.

Review of the clinical, computerized tomography scan and/or magnetic resonance imaging findings of intracranial tuberculoma in an Ethiopian teaching hospital

Background: Ethiopia is one of the countries that has high burden of all forms of tuberculosis and there is no published report on computerized tomography scan and/or magnetic resonance imaging of intracranial tuberculomas. Objective : to review the clinical, computerized tomography and/or magnetic resonance imaging features of intracranial tuberculoma. Methods: A retrospective review of patient's medical records of patients operated for intracranial mass that had computerized tomography and/or magnetic resonance imaging brain scans and had histopathological diagnoses, at Tikur Anbessa Specialized Hospital between January 2009 and June 2013.Results: Of 222 operated cases of intracranial mass subjected to histopathological test 29 (14.6%) were found to have tuberculomas, 28 (14.1%) had caseous necrosis and one was a tuberculous abscess, in 25 cases imaging was available for review and were included in the study . There were 15 males and 10 females with age range being 2 to 65 years and with the Median age being 13 years. Twenty patients had computerized tomography and five patients had magnetic resonance imaging. Seizure 15/25 (60%) and headache 11/25 (44%) were the commonest presentation. Solitary or confluent large lesions were seen in 12/25 (48%) of patients. 14/25 (56%) of the lesions had their size between 2 cm and 5 cm. Majority of the lesions 15/25 (60%) were in the frontal and parietal lobes. The lesions were isodense on CT in 18/25 (72%) of the pre-contrast studies and 21/25 (84%) showed ring or rim enhancement after intravenous administration of the contrast medium.Conclusion: Tuberculoma, more frequently, presented with non-specific clinical findings and chronic seizure disorder and commonly occurred in young patients and often seen infratentorialy. It is often complicated with hydrocephalus in the pediatric age group. Computerized tomography scan and/or magnetic resonance imaging features are not different from reports from other countries

PATTERN OF SPINE AND SPINAL CORD INJURIES IN TIKUR ANBESSA HOSPITAL, ETHIOPIA.

BACKGROUND: Spinal injury is a major cause of morbidity and mortality worldwide. Fall and Road traffic accident are the main etiologic factor. OBJECTIVE: The aim of this study was to asses local hospital patterns of spinal injury and compare them with published reports. METHODS AND PATIENTS: This is a hospital based cross sectional study of patterns of patients with spine and spinal cord injury seen at the Emergency OPD, Tikur Anbessa Specialized Teaching Hospital (TASTH), Department of Neurosurgery, Addis Ababa, Ethiopia in the period between April 2008 and March 2012. Data was collected using structured questionnaires. The variables included were the Socio-demographic such as age sex, distance of patients' residence area from the TAH. In addition to the above profiles, causes of injuries, Occupation, diagnosis, time spent between arrival andAdmission and decision taken at OPD level. Differences in proportions were examined using Chi-square test. RESULTS: A statistically significant male predominance (84.9%) (p, 0.0001) was observed, the mean age was 32.8 years, with range 10 to 84 years. Mean duration of presentation to TASH was 4.3 days with a range 1 hour-60 days, Fall from height (P < 0.001) and Road traffic collisions were the main cause of spine and spinal cord injuries in 36.4% and 32.9% of the patients respectively. Most often the cervical spine was involved (33.0%), Sixty-nine (17.9%) patients had associated injuries, majority of respondents (25.5%) were farmers, Majority belonged to ASIA A grade. All the deaths, 7 (8.3%) occurred in patients with complete cervical spine lesion. CONCLUSION: Spinal injury was an important indication for neurosurgical consultations in our service. Complete cord injuries were more common than incomplete and the case incidence from fall was remarkably high.

Epidural and para spinal thoracic hydatidosis presenting with progressive paraparesis and paraplegia: a case report.

We report a 16 year old male patient from rural Ethiopia with pathologically and intraoperatively proven thoracic para spinal and epidural hydatidosis, a very rare involvement, who presented with progresive both lower limb weakness, loss of pain, touch and properioception and double incontinence of two weeks prior to hospital admission. The pathological, radiological (MRI and plain x-ray) and the intra operative findings are briefly discussed with literature review.

Attitudes toward neurosurgery in a low-income country: a qualitative study.

OBJECTIVE: To adapt a study exploring the needs of neurosurgery patients in a tertiary care hospital in Canada to examine, for the first time, the perspectives of neurosurgery patients in a low-income country with limited health care resources. METHODS: Semistructured interviews were conducted with 25 neurosurgery patients at Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia. Interviews were conducted in Amharic or Oromo, translated into English, and subjected to modified thematic analysis. RESULTS: The following 5 themes emerged: 1) With limited resources, many patients did not seek information outside of that obtained during the clinical encounter. 2) Patients valued direct verbal communication and deferred to the surgeon's authority. 3) Religion played an instrumental role in patient attitudes toward surgery. 4) Most patients did not feel anxious about surgery. 5) A few patients did not inform family members about their medical condition. CONCLUSIONS: Qualitative research methodology in neurosurgery can be successfully adapted from resource-abundant to resource-poor contexts. In low-income countries, patients are faced with limited options for self-education and self-empowerment, and fatalistic and paternalistic attitudes may be prevalent. Local cultural values and expectations can influence practice differently than they do in resource-rich countries.

Review of lumbar disc diseases at Tikur Anbessa Hospital.

BACKGROUND: Disc degeneration is common, the pattern and prevalence of various signs of disc degeneration is unclear. Neither hospital nor population-based data or study is available on lumbar disc diseases in Ethiopia. The sequelae of disk degeneration are among the leading causes of functional incapacity in both sexes and are a common source of chronic disability in the working years. Lumbar disc disease refers to a collection of degenerative disorders that can lead to low back pain as people age. OBJECTIVE: Review the pattern, clinical manifestation, diagnostic method and management decision of patients with degenerative lumbar disc disease at the neurosurgical referral clinic of Tikur Anbessa Hospital during the fiscal year 2009. PATIENTS AND METHODS: This is a hospital based cross sectional study of patterns of patients with lumbar disc diseases seen at the neurosurgical referral clinic, Tikur Anbessa Specialized Teaching Hospital (TASTH), Department of Surgery, Addis Ababa, Ethiopia in the period between January and December 2009 (12 months). Data taken while clerking patients and patents' medical record at referral clinic were main source of information. Standardized and structured questionnaire prepared for this purpose were used to analyze the sociodemographic, clinical manifestation, diagnostic modalities such as lumbar myelography, CT and MRI, patterns of disc disease in lumbar spine at NSRC with reference to age, severity and level distribution were reviewed. Difference in proportions were examined using Chi-square test. RESULTS: The study reviews 364 patients with lumbar disc diseases at the neurosurgical referral clinic, TASH over the one-year period (2009), their age ranged from 20 to 82 years (median, 44.0). Pain, numbness and neurologic claudication were the three most common presenting symptoms, occurring in 337(92.5%), 232 (63.7.6%) and 111 (30.5%) respectively. Lumbar MRI was the statistically significant investigation modality of choice (p < 0.0001). Two hundred thirty-five (70.1%) patients had disc prolaps (P < 0.0001), 18.5% had disc bulge. Lumbar degenerative disc disease was most frequently seen at L4-L5 level in 309 (54.5%) patients (P < 0.0001). both L4-L5 and L5-S1 accounted for 79.1% of the disc displacements. On MRI, disc displacements, were central in 61.2%, lateral in 9.3% and posterolateral in 15.8%.