Een zeldzame oorzaak van dementie: de bestralingsencephalopathie.

We describe the clinical history of a 49-year old woman, who demonstrated progressive personality changes more than twenty years after radiation of a pituitary adenoma (prolactinoma), with apathy, loss of initiative, memory deficits, postural instability, dysarthria and faecal incontinence. Neuropsychological assessment showed impulsivity, loss of overview, desinhibition, fluctuating deficits of attention, and memory disturbances. MRI-scanning of the brain revealed a cystic lesion along the right ventricle. The clinical picture and the findings of the other investigations are typical for dementia due to radiation encephalopathy. Such a long period between radiation and cognitive deterioration is rare, although it has been described before.

Explanatory models and help-seeking behaviour of leprosy patients in Adamawa State, Nigeria.

In northern Nigeria 60 leprosy patients, 49 outpatients and 11 in-patients, were interviewed about their help-seeking behaviour and explanatory models before their first contact with the leprosy services. Most patients showed a delay of more than 1 year. After leprosy was provisionally diagnosed by lay persons, 27% of patients found their way to the leprosy services within 3 months. Chemists (popular sector) and the professional sector frequently missed the diagnosis. If early case finding is to be improved, it is important to involve them in case finding activities and to train them in adequate diagnostic skills. No significant correlations were found between total delay and sex, age, religion or leprosy classification, except with visible deformity at the time of the interview and illiteracy. Consultation of folk healers was the major reason for delay. Most patients consulted folk healers, who, although they claimed to have a positive attitude towards modern medicine in the case of leprosy, never referred patients to the leprosy services. While many patients held a variety of causes responsible for leprosy, most patients explained the disease in traditional terms (58%), while only a minority used modern concepts (20%). This emphasizes the need for continuous attention for health education of diagnosed patients and their families. No significant difference was found between male and female patients concerning their concept of leprosy. Denial of the leprosy diagnosis was rare.