Some peculiar lesions of traumatic brain injuries encountered in our practice with brief discussion-imaging manuscript

The advent of neuroimaging like computed tomography and magnetic resonance imaging has facilitated the diagnosis of traumatic brain injuries. Emphasizing certain diagnostic features of some peculiar traumatic brain injuries. The following lesions of traumatic brain injuries were pictorially depicted, namely Tension pneumocephalus, Blow out orbit, Bilateral subacute subdural haematomata, Acute-onchronic subdural haematoma, Middle cranial fossa acute epidural haematoma, Traumatic basal ganglial haematoma and Acute intra-ventricular haematoma. Mount Fuji sign is typical of tension pneumocephalus while herniation of extra-ocular muscles into the maxillary sinus is diagnostic of blowout orbit. Rabbit ear appearance is observable in bilateral subacute subdural haematomata

Aetiological patterns and management outcome of paediatric head trauma: one-year prospective study.

BACKGROUND: Trauma is the most common cause ofpaediatric deaths. In 75% ofpaediatric trauma deaths, head injury is responsible, and most are from falls. Recent reports from Nigeria, however, appear to indicate a predominance of road traffic accidents, instead of falls. OBJECTIVE: To evaluate the aetiology of paediatric head trauma, management protocols and outcome from our Centre, in order to acquire a baseline data base and recommend measures to reduce childhood trauma. PATIENTS AND METHODS: A prospective study of all paediatric head trauma cases presenting to Nnamdi Azikiwe University Teaching Hospital, Nnewi, for 12months from April 21, 2006 to April 20, 2007, was done and collated data subsequently analyzed. The paediatric age group was taken as = 15 years, and grading of head injury was with the Glasgow Coma Scale (3-15) and the modified scale for non-verbal children; while outcome was measured with the Glasgow Outcome Scale (1-5). RESULTS: Out of 334 patients treated within the period of study, 210 were head trauma cases. Of these, 52 were paediatric head trauma, representing 24.8% of all head trauma cases; and 19.2% (10 of 52) of them were aged 0-2 years. About 62% (32 of 52) were males. Falls and RTA were each responsible in 25 (48.1%) cases. Mild head injury occurred in 31 (59.6%), and 49 (94.2%) patients were evaluated by plain radiography. Treatment was conservative in 39 (75%) cases; with satisfactory outcome in 36 (69.2%), and a mortality rate of 15.4%. CONCLUSIONS: Road traffic injury, mostly from motorcycles, has become the major cause of morbidity and mortality amongst the paediatric age group, especially the male gender, and outcome from management is mostly satisfactory.

Congenital orbital teratoma.

Congenital orbital teratoma though rare is available in this environment. This is a case report of a baby with a protruding orbital mass in the left eye with all classical clinical features of teratoma. Though the histopathological report fell short of confirming the diagnosis the clinical features and outcome of management strongly suggest that the lesion is a teratoma. Multidisciplinary approach to the management not only saved the life of the baby in question but also enhanced the outcome of treatment. Good and compliant follow up for six months was experienced. Cytological test is mandatory for any suspected cases ofteratoma.

Traumatic Brain Injury in the Accident and Emergency Department of a Tertiary Hospital in Nigeria

Background: Traumatic brain injury is a major public health problem in Nigeria; as it could be associated with long term and life long deficits. Unlike other parts of the world; in our country; motorcycles are possibly the main cause of this injury. Unfortunately; we do not have a national epidemiological data base yet. This study was aimed at defining the peculiar demographic and associated risk factors in traumatic brain injury among our patients; as part of a multi-institutional data pool for a future meta-analysis to generate the national data base. Methods: This was a 24-month retrospective study of all head injury patients who met the criteria for traumatic brain injury in the Accident and Emergency Department of a tertiary health institution. Data were collected from the emergency cards and case notes; then collated and analyzed using the descriptive statistics on SPSS 13; with the p value taken as 0.05. Results: A total of 9;444 patients were attended to during the 24 months; 510 (5.4) of them met the inclusion criteria for the study. This translated to a presentation rate of 5.3 cases per week and an incidence rate of 2;710 per 100;000 per year. Males accounted for 404 (79.2) of the cases. The peak age incidence (31.2) was in the 20 - 30 year age group. Traders constituted the highest occupational group 125 (24.5). Most (58.8) of the cases resulted from motorcycle accident. There were 28 deaths giving a mortality rate of 5.5or 148 deaths per 100;000 per year. Conclusion: The risk factors were the male gender; motorcycle riding; illiteracy; trading; extremes of age and active daytime period of 12:01 - 18:00hours. The incidence rate was much higher than in the developed countries; but could reduce with the use of crash helmets; seat belts; speed limits and safety/protective vehicular devices; with better road rehabilitation

Aetiological Patterns and Management Outcome of Paediatric Head Trauma: One-Year Prospective Study

Trauma is themost common cause of paediatric deaths. In75of paediatric trauma deaths; head injury is responsible; and most are from falls. Recent reports from Nigeria; however; appear to indicate a predominance of road traffic accidents; instead of falls. To evaluate the aetiology of paediatric head trauma; management protocols and outcome from our Centre; in order to acquire a baseline data base and recommendmeasures to reduce childhood trauma. Aprospective study of all paediatric head trauma cases presenting toNnamdiAzikiwe University Teaching Hospital; Nnewi; for 12months from April 21; 2006 to April 20; 2007; was done and collated data subsequently analyzed. The paediatric age group was taken as =15years; and grading of head injurywaswith theGlasgowComa Scale (3 15) and themodified scale for non-verbal children;while outcome wasmeasuredwith the Glasgow Outcome Scale (1 5). Out of 334 patients treated within the period of study; 210 were head trauma cases. Of these; 52 were paediatric head trauma; representing 24.8of all head trauma cases; and 19.2(10 of 52) of them were aged 0- 2years. About 62(32 of 52) were males. Falls and RTA were each responsible in 25(48.1) cases. Mild head injury occurred in 31(59.6); and 49(94.2) patients were evaluated by plain radiography. Treatment was conservative in 39(75) cases;with satisfactory outcome in 36(69.2); and amortality rate of 15.4. Road traffic injury; mostly from motorcycles; has become the major cause of morbidity and mortality amongst the paediatric age group; especially the male gender; and outcome from management is mostly satisfactory

Patterns of Spinal Injury in a New Neurosurgical Centre: A 2-Year Prospective Study

Background: Spinal injury is a major cause of morbidity and mortality worldwide. Road traffic accident is the main aetiologic factor; affecting mostly the male gender in the 15 - 40-year age group. The aim of this study was to establish our local hospital patterns of spinal injury and compare them with published reports. Methods and Patients: A prospective study of all spinal injury patients treated in our service in the two-year period; April 21; 2006 - April 20; 2008 was undertaken. Data collection was done using a structured proforma from the time of admission into our service to the time of discharge; and subsequent follow-up in the few cases that kept to their appointment. Data was then collated and simple data analysis done. Results: Spinal injury was diagnosed in 62 of our 826 patients; mostly males; aged 15-40years 28 (45.2); and road traffic accident was the main aetiologic factor with an unusually high case incidence from motorcycles. There were neurological deficits in 49(79) and cervical cord injuries were the most common. Evaluation of the injuries was mostly with plain radiography; and treatment was non-operative in all cases. omplete cord injuries remained without improvement; and complications were mostly pressure ulcers; with no incident of deep venous thrombosis. Mortality was 13(21). Conclusion: Spinal injury was an important indication for neurosurgical consultations in our service. Complete cord injuries were more common than incomplete injuries contrary to other previous reports; and the case incidence from motorcycles was remarkably high

Could Parkinsonism complicate craniotomy and excision of convexity meningioma? A case report.

Parkinsonism is a neurodegenerative clinical disorder characterized by varying combinations and degrees of rest tremor, rigidity, slowing of voluntary movements and postural instability. Amongst the aetiologic factors, massive post-craniotormy haematoma has not been previously considered. This report is to arouse the suspicion that vascular displacement in the midbrain resulting from a massive unilateral intracranial haematoma could lead to the unusual complication of Parkinsonism. This is the report of a 55-year old retired male banker, without any previously identifiable risk factor except for his age, who developed Parkinsonism following a huge acute extradural haematoma that complicated a craniotomy for the excision of a haemorrhagic convexity meningioma. The patient was placed on medical treatment resulting in a slow but progressive neurological improvement. Reports of Parkinsonism following post-tumour excision are probably, very rare. We, hereby, report a case of Parkinsonism complicating a gross total excision of a convexity meningioma.

Determinants of outcome in operative treatment of traumatic extradural haematoma.

BACKGROUND: Traumatic extradural haematoma is a rare condition and treatment in a majority of cases is by operative evacuation. Outcome from treatment is influenced by several factors. OBJECTIVE: To evaluate the operative treatment of traumatic extradural haematoma in our centre and assess the impact on outcome of some of the historical factors. METHODS: A retrospective study of cases managed January 1993-February 2004 using records from the Emergency Room, Wards, Theatre and Radiology Unit. Only the cases definitively diagnosed as extradural haematoma resulting from trauma and had operative evacuation, were recruited. The Glasgow Coma Scale was used to measure the severity of injury; whereas postoperative outcome was considered good in those with minimal or no neurological deficits. Collated data were analyzed and the patients were divided into 3 groups--good, moderate and fatal (poor) based on the outcome; the impact of the various historical factors was compared among the groups. Statistical analysis was done using the chi-square test and p-value of 0.05 or less was considered significant. RESULTS: Majority of the patients were young, with mild head injury and good outcome, and a surprisingly long mean preoperative time lag of 123.1 hours. Outcome was good in 24 (64.9%), moderate 6 (16.2%) and fatal 7 (18.9%). There were skull fractures in 26 (70.3%), but there was no significant difference in outcome among those with and those without fractures. CONCLUSION: Age of the patient and severity of head injury (a reflection of concomitant brain injuries), more than other factors appear to dominantly prognosticate outcome from operative evacuation in our service.

Epidemiological patterns of head injury in a newly established neurosurgical service: one-year prospective study.

Head injury is a disease afflicting mainly young males, and road traffic accident is the most common aetiologic factor. This report evaluates the findings in a one-year prospective study done from April 21, 2006-April 20, 2007 in the first year of services in one of Nigeria's new neurosurgical Centres, to establish the baseline epidemiological patterns of head injury. Data was collected using a questionnaire from the point of presentation till discharge of each head injury patient, and augmented with theatre and outpatient records, and analyzed. The Glasgow Coma and Outcome Scales were used for grading. Our Centre is a tertiary health facility that receives referrals from private, primary and secondary facilities. Of the 334 total patients treated, 210 (62.9%) had head injuries. Males were 158 (75.2%), and 145 (69%) resulted from road traffic accident, mostly from motorcycles. Fractures were mostly basal 86 (41%), brain pathology was mostly cerebral contusion 74 (35.2%), and treatment mostly nonoperative 137 (65.2%), with good outcome in 144(68.6%). Mortality was 40 (19.1%). Trauma is the main reason for neurosurgical consultation in our Centre and the unsafe use of roads, especially with motorcycles, remains the major cause of head injury.

Neurosurgery in Nigeria--an evaluation of the perception of health personnel in a new centre and a comparison of the Nigerian situation with that of other African states.

BACKGROUND: Neurosurgery has become endangered species in Nigeria. We have only 15 practising neurosurgeons for our population of 150 million, giving a ratio of one neurosurgeon to 10 million Nigerians. Of the 26 accredited medical schools, only 6 offer neurosurgery. This study is a preliminary evaluation of the perceptions about neurosurgery before the commencement of neurosurgical services in a tertiary health institution, and a comparison with the situation in other African countries. METHODOLOGY: A questionnaire designed after the 5-point Likert rating scale was distributed to doctors, nurses, final-year medical/nursing students, paramedics and administrative staff of the 350-bed health institution. The completed questionnaires that were returned, were collated and data analysis done. RESULTS: Out of 200 questionnaires distributed, 164 were completed and returned. Most of the respondents were females 59.1%, and most were in the 20 30 year age group, 57.3%; more than 96% stated that they have heard of neurosurgery previously, but rated the available services in Nigeria as inadequate 50.6%, and quality of services as fair 39.6% or poor 36.6%, respectively. In their opinion, political and administrative lapses rather than funding are responsible for the poor state of affairs, culminating in unavailability of adequate manpower and facilities. Health policy changes and provision of facilities with manpower training were suggested by 78% of respondents as the solution to the problem. Most, however agree that neurosurgery has good prospects 78%, in the institution. CONCLUSION: Neurosurgical service in Nigeria is grossly inadequate both in availability and quality, and these have resulted from bad government policies. It is therefore of utmost necessity that services and training be urgently provided in this specialty, at least in the tertiary institutions in Nigeria.

Intradural spinal arteriovenous malformation of the glomus type: a case report.

Spinal arteriovenous malformations (AVMs) being even rarer than cranial ones, constitute 3 - 4% of all spinal tumours, with an overall male:female ratio of 4:1. We report the case of a 24-year old female Youth Corps member who presented with an apoplectic onset of a left hemiparesis, progressively deteriorating to an incomplete quadriplegia with motor power of 2 and 0 in the right and left lower limb muscle groups, respectively. Magnetic resonance imaging (MRI) showed a vascular malformation whose precise nature was indeterminate; the definitive diagnosis of a Glomus AVM was only made intra-operatively. Laminectomy with complete surgical excision was done and she gradually improved to ambulate with minimal support. The experience in our unit tends to support the observation in literature that spinal arteriovenous malformations could be very rare, and depending on the location, could be amenable to complete surgical excision and recovery of neurological function.

Intracerebral abscesses: outcome following management in the CT era.

BACKGROUND: There are no pathognomonic presenting features of intracerebral abscesses. Their clinical features could be confused with those of a tumour or any other space occupying lesion. STUDY DESIGN: We analyzed the symptoms, predisposing factors, diagnostic modalities, prevalent causative microbes, management and outcome in 11 patients, for whom complete records were available and who were managed for confirmed intracerebral abscess in our Neurosurgical Unit from 1996 to 2000 and compared our findings with those from other series. RESULTS: In these patients focal neurological deficit was the most common clinical feature, trauma was the most predisposing event and Computerised Tomography (CT) Scanning remained the most dependable diagnostic tool. In our practice, burr hole drainage augmented with a minimum of 4 weeks intravenous antibiotics, was the most frequently used treatment modality. CONCLUSION: The outcome was satisfactory (ability to return to pre-morbid activities and duties, with no disabling neurological deficits) in 72.8% cases. There was one death. This modality remains an effective way of treating patients with intracebrebral abscess.