Computed tomographic patterns of intracranial infarcts in Ghanaians.

Computed tomography has given a boost to intracranial imaging in general, and the diagnosis of the subtypes of Cerebrovascular Accident (CVA) in particular. In this study of 1,172 cases of CVA examined by Computed Tomography (CT), 552 (47.10%) showed features of cerebral infarction. There was a male prevalence in the study and the mean age was 59.8 years. As in all infarcts the diagnostic appearance was a wedge shaped hypodensity within the brain parenchyma. This was most often found in the parietal lobe (73.6%) and was always without a mass effect. Even though solitary infarcts were frequent, multiple lesions were reported in 9.3% of cases and these group of respondents presented mostly with seizures. Diabetes mellitus was an important predisposing factor and was found in 163% of cases, while hypertension was found in only 9.1% of cases studied. Other CT findings were cerebral and cerebrellar atrophy. Calcification of the falx and the basal ganglia were also noted.

Spontaneous intracranial haemorrhage: computed tomographic patterns in Accra.

The diagnosis of stroke and the ability to distinguish the subtypes is central in the management of patients. This CT study has confirmed an increased prevalence of stroke (CVA) among Ghanaians. It has also reaffirmed a relatively higher incidence (52.9%) of spontaneous intracranial haemorrhage over cerebral infarcts among the 1,172 stroke patients studied. The study points to a male preponderance and a mean age of 55.7 years. Parenchymal haemorrhage was found to be the commonest variety of these haemorrhages. It occurred in 83.6% of cases while primary subarachnoid haemorrhage was reported in only 8.1% of cases. Ventricular extension of the parenchymal haemorrhage was reported in 22.7% of cases. The latter were mostly unilateral and on the left side especially in the parietal lobe (70.9%), subdural haemorrhage like the parenchymal variety was also reported to be more on the left, mainly unilateral and acute. Haemorrhages in the cerebellum and pons which are normally difficult to diagnose were also outlined with ease in the CT images. Other CT findings in these patients include parilesional oedema and mass effect found in 87.10% and 77.4% respectively.

Stroke-related mortality at Korle Bu Teaching Hospital, Accra, Ghana.

OBJECTIVES: To determine whether mortality from and the pattern of stroke have changed since the last study in Accra in 1981, the sites of the different types of stroke and the role of hypertension and cerebrovascular disease and to describe the age and sex distribution. DESIGN: Cross-sectional study of fatal stroke cases over a five-year period. SETTING: Korle Bu Teaching Hospital, Accra, Ghana. SUBJECTS: All fatal strokes in persons aged 20 years and above, confirmed at autopsy. RESULTS: Mortality from stroke constituted eleven per cent of autopsies carried out at the Korle Bu Teaching Hospital, Accra, in the five-year period 1994 to 1998. A similar study in 1981 showed the same proportion indicating that the proportion of deaths due to stroke has not changed. The overall male to female ratio was 1.2:1 but the relative risk (RR) of death from stroke was higher for females at 1.23 (95% CI=1.10-1.38). Although haemorrhagic stroke was still more common than cerebral infarction the proportion (61 %) was much less than that of the previous study (89%). Males were more likely (RR 2.07 95% CI=1.75-2.45) to die from haemorrhagic stroke than females (RR 1.32, 95% CI=1.10-1.57). Sixty nine per cent of stroke patients died in less than 24 hours after onset of stroke. The peak age of fatal haemorrhagic stroke was 50-59 years and that of infarction was 60-69 years. Male mortality exceeded female mortality in all age groups up to 60-69 years after which female mortality became preponderant (chi2 with Yates correction = 4.28,0.05>p<0.02). Hypertension was the dominant factor in haemorrhage and an important factor in infarction while cerebral atherosclerosis was the major factor in infarction. Haemorrhage into intraparenchymal sites, mainly the cerebral hemispheres, was more common than into the subarachnoid space. CONCLUSION: The proportion of deaths from stroke in autopsy cases has not changed since the last study in 1981 and stroke still remains an important cause of death in Accra. Cerebral haemorrhage is still a more common cause of fatal stroke than infarction, although the pattern appears to be changing gradually. Females have a slightly greater risk of dying from stroke than males. A community-based study is needed to provide more insight into some aspects of the problem and to provide the basis for appropriate interventions and policy, especially with regard to a control of risk factors.

Computerised tomographic scan of the head in evaluation of stroke in Ghanaians.

One thousand and three patients clinically diagnosed as stroke cases were investigated using computerised tomographic (CT) scan. No diagnosis was made in 56 (5.58%) of the patients. While 56 cases had the CT scans reported as normal, in 40 (4.99%) of the patients disorders other than stroke were diagnosed. They included remediable causes like subdural haematoma (ten cases), cerebral abscess (eight cases), meningioma (four cases), other brain tumours (eighteen cases). Nine hundred and seven of the patients were proven to have suffered a stroke; 547 (60.3%) were haemorrhagic and 360 (39.7%) were infarctive. These results are at variance with previous studies from West Africa which made infarcts the commoner stroke type, but reflect those found in Blacks elsewhere in South Africa and America. Our results were achieved through the use of the CT scan as opposed to the earlier clinically-diagnosed West African studies. The larger number of haemorrhagic strokes had therapeutic implications. Trepidation in the use of anticoagulants, thrombolytics and fibrinolytics before proof of the pathological type is advised. Although clinical evaluation may be more cost-effective in the management of stroke, brain imaging techniques are recommended for accuracy in diagnosis and appropriate management.

Epilepsy: knowledge, attitude and practice in literate urban population, Accra, Ghana.

A cross sectional survey was conducted among Government workers and the general public in Accra, Ghana. A total of 380 persons were interviewed. Almost everybody could describe accurately, an epileptic person. However, 172 (45.3%) out of the 380 respondents did not know the cause of epilepsy, and 37.6% did not know how it could be treated. Out of the 358 responses to the cause of epilepsy, 114 (31.8%) said it was inherited disease, 100 (27.9%) said it was due to witchcraft/juju or spiritual. With respect to treatment, 150 out of 333 responses mentioned sending the individual to the medical doctor, 95 (28.5%) said the use of herbs/visits to fetish priest, 59 (17.7%) suggested prayers, 20 (6.0%) said to do nothing. For prevention, 77 (29.1%) out of 319 responses indicated prayers, 49 (15.45%) cautioned marrying into epileptic family, and 13 (4.1%) responses indicated not to touch patient fitting. Those who answered "don't know" regarding knowledge about epilepsy were mostly the young, the lower educational status and the single respondents. However, the most important characteristic of the respondent that was associated with the appropriateness of the responses was the educational status. Although a lot of misconceptions about epilepsy existed in the study population, e.g. epilepsy can be spread by contact and that epileptics must be isolated or avoided, several respondents would share a room, eat or employ persons with epilepsy. The study has shown that the traditional beliefs and attitudes about epilepsy are still held firmly by the adult working population and that the educational level of the respondent was positively related to the appropriateness of the responses. It is therefore suggested that additional efforts must be made to increase the knowledge of the general population through the use of social marketing strategies in order to improve the management of persons with epilepsy.

The safety and efficacy of amocarzine in African onchocerciasis and the influence of ivermectin on the clinical and parasitological response to treatment.

The hundred men from a forest area of Ghana, without vector control or ivermectin distribution, were randomized to receive a single dose of ivermectin (150 micrograms/kg body weight) on day 1 followed by amocarzine (3 mg/kg twice daily after meals) on days 8, 9 and 10 (34 patients), the ivermectin alone (33 patients) or the amocarzine alone (33 patients). Detailed clinical and laboratory examinations were made before, during and after drug administration. On day 120, all palpable nodules were excised, fixed, sectioned, stained and examined by two blinded observers and the results compared with those for nodules from untreated controls. Mazzotti-type reactions, such as itching, rash, peripheral sensory phenomena and swellings, were more severe or frequent with amocarzine than ivermectin. Pretreatment with ivermectin markedly suppressed these reactions to amocarzine but did not affect other manifestations such as dizziness and gaze-evoked nystagmus. Ocular effects were minor in all groups. Ivermectin produced minor macrofilaricidal effects on the adult male worms, marked degeneration of intra-uterine embryos, and potent microfilaricidal effects and suppressed skin microfilariae. Amocarzine did not affect the male worms or the intra-uterine embryos, was a less potent microfilaricide and did not suppress skin microfilariae. The efficacy of ivermectin plus amocarzine was similar to that of ivermectin alone. The present results do not support the findings from the Americas and show that amocarzine has no role in the treatment of onchocerciasis in Africa.

An aetiological survey of paraplegia in Accra.

Sixty-four cases of non-traumatic paraplegia in Accra, Ghana, were investigated. The commonest cause of paraplegia was tuberculosis (29.69%). Next were transverse myelitis and the Guillain-Barré syndrome, each accounting for 10.94% of cases. Parasitic causes were not seen in this study. The other important causes are neoplastic conditions (14.07%) and degenerative conditions namely, cervical spondylosis with myelopathy (12.5%), and motor neurone disease (6.25%). It is concluded that the major causes of non-traumatic paraplegia in Accra are related to non-parasitic microbial infections (51.57%).

Relationship between load carrying on the head and cervical spondylosis in Ghanaians.

Three hundred and five patients (164 males and 141 females) with mean age 39.9 with standard deviation 7.3 and a range of 29-78 years were involved in a study to find out the relationship between load carrying on the head and cervical spondylosis. Out of 225 patients who carried loads on their head, 143 (63.6%) had cervical spondylosis, and of the 80 people who did not carry load on their head, 29 (36%) had cervical spondylosis. 131 (58%) of those who carried load did so regularly with an average weight of about 15 kg or more over a period 10-15 years or more. It is concluded that cervical spondylosis is not exclusively an ageing phenomenon, but that regular heavy load carrying on the head plays an aetiological role.

Current trends in the incidence of cerebrovascular accidents in Accra.

The incidence of cerebrovascular accidents (CVA) in Accra during three periods--1960-1968, 1976-1983, and 1990-1993, was compared. There was dramatic increase in the incidence between 1990-1993. Uncontrolled hypertension due to non-compliance with drug therapy seems to be the main cause. The economic plight of the people may explain the non compliance. The case fatality was between 41.9% to 50.3% for the years 1990-1993. Cardiovascular diseases, notably hypertension and CVA, have become the major causes of morbidity and mortality in Accra.

Symptomatology of temporal lobe epilepsy in Accra.

The symptoms of 80 patients diagnosed clinically and electro-encephalographically as suffering from temporal lobe epilepsy in Accra were studied. The symptoms included tonic and tonic-clonic seizures, vertigo, hallucinations, loss of consciousness and various behavioural abnormalities. The symptoms of T. L. E. in Accra are no different from elsewhere. The role of superstition in the African psyche in relation to epilepsy is stressed. The relationship between abnormal behaviour, epilepsy and psychosis is discussed. Delayed or inaccurate pathology are also discussed.

Korle-Bu Teaching Hospital: Bed Occupancy and Manpower Statistics (1991 and 1992)

In 1991; the daily bed occupancy rate for the hospital was 75.2 per cent with bed turnover rate of 2 per month and bed turnover interval of 4 days. There was a daily average of 57 floor-patients in the hospital. Nurses and other medical staff on admission formed about 2 per cent of the daily population. The seriously ill patients formed 6.4 per cent of the patient population. The average daily patient population was 1166 with average daily admissions of 92 patients (SD 21.2); discharges of 87 (SD 9.7) and the daily deaths of 11 (SD 3.7). The corresponding figures for 1992 were very close. In 1992; daily patient population was 1151; daily admissions was 103; discharges 90 and daily deaths was 11. Thus. about 10 per cent of the hospitals daily patient population is admitted daily and about 1 per cent die daily. With respect to the individual wards or departments; the highest daily admission rate was at Chenard Ward A; for gynaecological emergencies with about 10 patients a day. Children's wards followed with a rate of about 5 per day; then Medical wards with about 3 per day; Maternity wards and Surgical wards with 2 per day and Orthopaedic wards (Allied Surgical wards C; D; H; I and N) with about 1 per day. The highest number of deaths occurred in emergency wards; (Children's emergency; Neonatal Intensive Care Unit (NICU); Surgical/Medical emergency; Korle-Bu Polyclinic and Accident centre). The ranking order of departments with deaths in the wards were Children's; Medical; Chest; Surgical and Obstetrics (Maternity). On average there were 16 nurses and 7 orderlies to a ward running three shifts a day. Excluding housemen; Surgical wards had an average of 3 doctors to a ward; Medical wards had 8 doctors per ward; Obstetrics and Gynaecology had 6 doctors to a ward; Children's block had 8 doctors to a team and Allied Surgical wards had an average of 6 doctors to a ward.The policy implications of these statistics are discussed

Assessment of anthropometric measurements, blood analytes and liver enzymes in Ghanaian alcoholics.

Anthropometric measurements of alcoholics and non alcoholics of similar economic background were compared and the results reveal that there are no marked differences between the two. However, the biochemical analyses indicates that alcohol predisposes to fat storage, may contribute to iron deficiency and plays a direct etiologic role in liver disease.

Biochemical and haematological markers of alcohol intake in Ghanaians.

The serum gamma-glutamyltransferase (GGT), aspartate aminotransferase (AST), urate and triglyceride and mean cell volume (MCV) were determined in 60 total abstainers, 56 social drinkers and 100 alcoholics. Both enzymes and urate showed progressive rise with increasing alcohol intake. The mean cell volume was only moderately elevated. Gamma-glutamyltransferase (GGT), aspartate aminotransferase (AST), and urate are sensitive enough to detect people who take in alcohol regularly and yet may be regarded as normal and not alcohol dependent.

Nutritional status and levels of liver enzymes in Ghanaian alcoholics

The well nourished alcoholics appeared to have some protection from alcoholic liver damage; although their fat levels were higher which may predispose to cardiac disease. Alcoholics therefore; show some degree of impaired liver function which is more severe among those who are malnourished

The prevalence of inguinal hernia in adult Ghanaian males.

Indirect inguinal hernia imposes a heavy patient caseload on surgical services in Africa. This study, conducted in rural southern Ghana in 1973, showed a marked increase in prevalence in adult males aged 55 years and older. In contrast, hospitalized patients undergoing herniorrhaphy in Accra were evenly distributed through all age groups. As hospital services expand and rural patients have better access to surgical care, recent innovations such as short stay surgery may be important for coping with rising patient demand.