Postoperative fatal hypothermia in hydranencephaly with pre-operative hypothermia and a nerve palsy: a case report and review of the literature.

Hydranencephaly is a rare condition characterised by complete or near complete absence of the cerebral hemispheres within relatively normal sized meninges and skull, the resulting cavity being filled with cerebrospinal fluid. The following is a case report of a five month old hydranencephalic child with right upper motor facial nerve palsy who presented with signs of hydrocephalus who developed intractable hypothermia rapidly post ventriculo-peritoneal shunt insertion and demised. Her preoperative condition was associated with hypothermia.

[Causes of neuropaediatric morbidity in Africa]. / Causas de morbilidad neuropediátrica en Africa.

INTRODUCTION: The causes of child morbidity in Africa, which are extremely varied, raise a series of aetiopathogenic questions related to socio economics, socio-politics culture, religion and medicine. Development and conclusions. The paper analyses the morbid particularities of malaria in African children, in which numerous (often poorly understood) neurological manifestations are predominant. We also deal with the role played by arterial cerebrovascular malformations, above all in vascular obliterations due to congenital anomalies of haemoglobin or caused by clots formed by the accumulation of Plasmodium falciparum. Apart from malaria, paediatric mortality in Africa, which is made worse by the absence of an equitable form of medicine, is not only due to insufficient involvement by the State but, above all, to the increase in the appearance of orphan pathologies. The most important examples of such conditions are inborn malformations of the cerebrospinal system, traumatic brain or spine injuries and brain tumours. Paediatric neuroAIDS has recently appeared as a new problem to be added to the common infectious pathologies that are a frequent source of neurological complications in African children.

Causas de morbilidad neuropediátrica en África / Causes of neuropaediatric morbidity in Africa

Introducción. Las causas de morbilidad infantil en África,que son extremadamente variadas, levantan un abanico de preguntasetiopatogénicas relacionadas con la socioeconomía, la sociopolítica,la cultura, la religión y la medicina. Desarrollo y conclusiones.Se analizan además las particularidades mórbidas delpaludismo en el niño africano, dominadas por múltiples manifestacionesneurológicas, a menudo mal conocidas, y se aborda la participaciónde las malformaciones cerebrovasculares arteriales, enparticular sobre las obliteraciones vasculares debidas a anomalíascongénitas de la hemoglobina o debidas a los trombos formadospor la acumulación de Plasmodium falciparum. Además del paludismo,la mortalidad pediátrica en África, agravada por la ausenciade una medicina equitativa, se debe no sólo a la insuficienteimplicación del Estado, sino sobre todo al aumento de la apariciónde patologías huérfanas, en particular las malformaciones congénitasde la esfera cerebroespinal, los traumatismos craneales o raquídeosy los tumores cerebrales. A las patologías infecciosas corrientes,fuente frecuente de complicaciones neurológicas en el niñoafricano, ha venido a añadirse el neurosida pediátrico, de apariciónreciente

Introduction. The causes of child morbidity in Africa, which are extremely varied, raise a series of aetiopathogenicquestions related to socio economics, socio-politics culture, religion and medicine. Development and conclusions. The paperanalyses the morbid particularities of malaria in African children, in which numerous (often poorly understood) neurologicalmanifestations are predominant. We also deal with the role played by arterial cerebrovascular malformations, above all invascular obliterations due to congenital anomalies of haemoglobin or caused by clots formed by the accumulation of Plasmodiumfalciparum. Apart from malaria, paediatric mortality in Africa, which is made worse by the absence of an equitable form ofmedicine, is not only due to insufficient involvement by the State but, above all, to the increase in the appearance of orphanpathologies. The most important examples of such conditions are inborn malformations of the cerebrospinal system, traumaticbrain or spine injuries and brain tumours. Paediatric neuroAIDS has recently appeared as a new problem to be added to thecommon infectious pathologies that are a frequent source of neurological complications in African children

Pediatric neurosurgery in Africa--present and future.

There is no doubt that the development of neurosurgery in general and paediatric neurosurgery in particular has lagged behind in many African countries, and in some unfortunate areas there is not even one single neurosurgeon. In contrast to this alarming situation, there are some excellent neurosurgical centres in northern and southern Africa, which developed fairly rapidly in the 1960s. To date, there are still striking contrasts in Africa where, of the neurosurgeons who are present there at all, some work in extremely difficult conditions while others have better facilities comparable to those in some of the best centres in the world. There is a general strong desire for neurosurgery in Africa to be developed using first what is available locally, then what is available in Africa and only then to turn to the world at large, and there is also consensus that this is the way to proceed. This paper will analyse the current status of paediatric neurosurgery in Africa and the problems that are hampering its development, and suggestions will be made about its future development. It is obvious that Africa is a huge continent and it might sound rather presumptuous to pretend to speak for it in detail. Taking account of this limitation, I will speak mostly about what is accepted nowadays as fact and reality common to most African countries, and for illustrative purposes some details will be given from Zimbabwe, which is where I practice.

Neuropathic pain--from mice to men.

The past decade has seen great progress in understanding the syndrome of neuropathic pain, its causes and in finding new drugs that promise great benefit. For example, an early outcome of the research has been the observation that the new drugs do not blunt normal pain sensation--a pattern beginning to find explanation through the realisation that neural pain circuits rewire themselves, both anatomically and biochemically, after nerve injury. In this article, we discuss a case of a known diabetic patient with intractable pain and the course of management provided by the use of novel tools and devices coming to the fore in this rapidly expanding specialty.

Management of migraine--no longer a headache.

There have been important advances in the management of migraine headache. Revised diagnostic criteria, which were introduced in 1988 1 have led to more reliable assessment of the prevalence of migraine and the way it affects attendance and efficiency at work. In addition, the use of the 5HTI agonists has become established. The correct diagnosis of migraine and other headaches is of greatest importance as unless the right diagnosis is made, the right treatment cannot be given. In this article, we discuss how these changes have altered the management of migraine in adults.

Pain: friend or foe.

Pain, the most urgent of symptoms usually signals the presence of potential or on-going injury to tissue which requires attention. The warning that pain provides is, therefore, a good thing and in a way friendly. When pain continues or resumes after the healing process of injury is complete, it is no longer signalling on-going tissue damage but becomes a disease in its own right. That, in essence, is the presentation of most chronic pain syndromes referred to Pain Clinics for investigation and treatment.

Peripheral gangrene in African children: a clinical report of twelve cases.

Clinical observations of 12 cases of peripheral gangrene in children are reported. All patients presented with ischemia of one or more limbs without any history of trauma, vascular injury or snake bite. Prior to their admission, all these children had received some form of traditional "African" therapy. By means of exclusion severe vasospasm secondary to the traditional treatment was considered the causative factor of the peripheral gangrene in all the children. Surgical exploration of the arteries with a Fogarty embolectomy catheter in two patients and medical treatment in six patients was attempted. The overall results were disappointing, with most resulting in incapacitating amputations.

Radical resection of intramedullary spinal cord tumors without cavitron ultrasonic aspirator or CO2 laser: a "two stage" technique.

A simple and efficient procedure called the "two stage" technique for total removal of intramedullary tumors is described. MRI, CUSA, and CO2 laser have revolutionized the diagnosis and treatment of spinal cord tumors, allowing precise demonstration of the lesions and safe removal without exacerbating neurosurgical deficit. These useful and efficient apparatus are not only expensive, they are still not yet available in many neurosurgical centers throughout the world. Neurosurgeons deprived of these important tools can, however, approach or even equate the current clinical results. The "two stage" technique is not meant to substitute for CUSA, CO2 laser, and MRI.

Cavernous sinus thrombosis: a report of eight consecutive comatose patients.

Septic thrombosis of the cavernous sinus is a severe and lethal condition if left untreated. The mortality is particularly high in those patients admitted in a comatose state. Eight patients treated successfully in Bulawayo, Zimbabwe in Mpilo Central Hospital over a period of three years are reported. In the discussion, emphasis is placed on the treatment of raised intracranial pressure in this particular group of patients and early treatment with appropriate antibiotics. Clinicians must be aware of this serious complication of infections around the face and must treat them early and aggressively.

The sensate deep inferior epigastric musculocutaneous flap and the twelfth thoracic nerve.

A detailed anatomical study of the terminal branches of the twelfth thoracic nerve (subcostal nerve) based on observations made during dissections of 23 embalmed cadavers is presented. In all 23 cadavers, the twelfth thoracic nerve had an ascending branch which joined the deep inferior epigastric vascular pedicle about half way between the lower border of the umbilicus and the symphysis pubis. This observation, we believe, explains how it is possible to preserve sensation in the deep inferior epigastric musculocutaneous flap.

Meralgia paresthetica: a report on two cases treated surgically.

Meralgia paresthetica (Bernhart-Roth Syndrome) is characterised by pain, burning, or tingling paresthesias, and decreased touch and pain sensation on the anterolateral aspect of the thigh. It is due to neuropathy of the lateral femoral cutaneous nerve (LFCN). Conservative treatment is usually successful in relieving the symptoms in most of the patients. We describe two patients who required surgical treatment for intractable symptoms. Although neurolysis with transposition is the most common procedure, we preferred neurectomy with excision of a portion of the LFCN for its very low recurrence rate as opposed to neurolysis. The area of anesthesia generated by this procedure in the distribution of the LFCN tends to shrink with time. Moreover, this pathology, to our knowledge, has not been reported much in the African literature.

A further case of Bardet-Biedl syndrome.

Bardet-Biedl syndrome in a 10 year old boy from Botswana is described. The patient presented with retinitis pigmentosa, polydactyly, mental retardation, obesity and hypogenitalism. The patient has a twin brother who has the same clinical signs. This is the second time this condition has been described in the African literature and the first time reported in Black twins.

Ano-cutaneous fistula associated with Bardet-Biedl syndrome in an African child.

An ano-cutaneous fistula associated with a Bardet-Biedl syndrome in a 12-year old African boy is described. The patient presented with mental retardation, obesity, syndactyly, polydactyly, retinitis pigmentosa and hypogenitalism. Past history revealed that he had an imperforated anus with anocutaneous fistula at birth, which was repaired successfully. The the best of our knowledge, it is the first case described in the African literature.