Computed Tomography in the Evaluation of Recurrent Unprovoked Seizure Disorders at the University of Port Harcourt Teaching Hospital (UPTH), Nigeria.

AIMS AND OBJECTIVES: To evaluate the efficacy of cranial Computed Tomography (CT) Scan in detecting intracranial structural diseases related to recurrent unprovoked seizure disorder. PATIENTS AND METHODS: This was a retrospective analysis of the findings in 120 patients who had cranial CT scan for recurrent unprovoked seizure disorders in the Department of Radiology of University of Port Harcourt Teaching Hospital from August 2010 to September 2012. RESULTS: Of the 1,240 cranial CT scans performed during the period under review, only 120 (9.7%) cases had recurrent unprovoked seizure as indication for the procedure and were therefore included in the study. The patients were 71 (59.2%) males and 49 (40.8%) females. The ages of patients ranged from 1 month to 90 years. The mean age was 29.7+21.8 years. The highest prevalence of seizure disorder (25.8%) occurred in the less than ten year age group. The commonest lesions found were cerebral tumours 11 (9.2%), cerebral infarction 11 (9.2%) and cerebral atrophy 7 (5.8%). Cranial CT Scans were normal in 76 (63.3%) patients with recurrent unprovoked seizure disorders. The most frequent seizure type was generalized tonic clonic (76.7%). CONCLUSION: The use of Cranial CT Scan as a diagnostic tool led to the detection of intracranial lesions in 36.7% of patients with recurrent unprovoked seizure disorders. The detection of intracranial lesions in these patients would facilitate early and appropriate intervention.

Gallbladder carcinoma with skeletal metastasis in a Nigerian woman: a case report and review of literature.

AIMS AND OBJECTIVES: To present a case of skeletal metastasis from a gallbladder malignancy, a rare occurrence. CASE REPORT: A 75 year old Nigerian woman presented in the surgical outpatient clinic of the University of Port Harcourt Teaching Hospital with a two month history of right hypochondrial pain and three weeks swelling on the forehead. Physical examination revealed an ill looking, emaciated elderly woman in mild painful distress. She was pale, afebrile and anicteric. Skull x-ray revealed a well circumscribed soft tissue mass over a lytic bone defect in the frontal region. Abdominal ultrasound scan showed an enlarged gallbladder with a thickened wall and intraluminal echogenic mass, surrounding lymphadenopathy and intrahepatic metastasis. Radiological diagnosis of advanced gallbladder carcinoma with both local and distant metastases was made. CONCLUSION: Carcinoma of the gallbladder with skeletal metastasis is a rare finding. However, in any patient with gallbladder malignancy distant metastasis with skeletal involvement should be sought.

Stroke in young Nigerian adults.

Stroke in adults under the age of 45 results in a greater loss of potential years of life than for other adults. This premature loss of life is associated with a high social and economic burden. Few data are available regarding stroke among young Nigerian adults in the Niger Delta Basin. This study sought to determine the incidence, risk factors, stroke subtypes and case fatality of stroke among young Nigerian adults. The medical records of all 18- to 45-year-old patients admitted with stroke in the medical wards of the University of Port Harcourt Teaching Hospital (UPTH) from January 2003 to December 2008 were retrospectively reviewed. Of the 611 patients admitted with stroke, 54 (8.8%) were aged 18-45 years. There were 26 males and 28 females. Hypertension was responsible for 42 (77.8%) stroke cases. Other important risk factors were excessive alcohol intake (27.8%), heart disease (13%), diabetes mellitus (11.1%), cigarette smoking (11.1%) and HIV infection (7.4%). The total case fatality was 29.6% with intracerebral hemorrhage (ICH) having higher case fatality of 69.2% than cerebral infarction (CI) with a case fatality of 16.7%. Among the young Nigerian adults who presented with stroke, 53.7% survived. The authors conclude from the above information that the incidence of stroke in young patients at UPTH is low. Hypertension is the most important risk factor of stroke; however, other less common but important risk factors in the young adults are cigarette smoking, diabetes mellitus and HIV. Efforts should be made to reduce the impact of stroke in this age group by focusing on these risk factors, which are either preventable or modifiable.