RESUMO
Background: Aneurysmal Subarachnoid Haemorrhage (aSAH) is a vascular injury with significantly high mortality, especially when poorly managed. This study seeks to outline the experiences in setting up a neurovascular service in Lagos, Nigeria. Methods: A series of 45 patients were operated after aSAH over a period of 10 years. Patients consecutively were recruited following computed tomography angiography (CTA) diagnosis of aSAH. Clinical data were recorded on a predesigned form after obtaining informed consent; aSAH was classified using the WFNS classification, intraoperative findings were documented. Challenges in the management were analysed in a post-operative root cause analysis (RCA) review. Outcomes and factors responsible for the observed outcomes and actions taken were recorded. Results: Forty-five patients were operated after aSAH was confirmed; there were 29 females and 16 males. (M:F 1:1.8), the age ranged from 14 to 76 years (mean 49.1±13.58). All the aneurysms were on the anterior circle of Willis, mainly on Anterior Communicating Artery aneurysm (18/48).Thirty-eight patients (84.4%) survived and were discharged within an average of 10 days after surgery. Lower GCS at presentation was associated with poor prognosis (p = 0.026); however, data analysis demonstrated that other factors (financial issues, lack of appropriate instrumentation and equipment, experience of the surgeon) played a significant role in determining the outcome. Conclusions: Aneurysmal Subarachnoid Haemorrhage (aSAH) is a challenging pathology and its management may be further burdened in resource constrained countries, as shown by the data analysed in this study from Lagos, Nigeria. Specialized and well-funded Neurovascular centres are needed to overcome the challenges faced and to improve care for aSAH patients in Nigeria.
RESUMO
Background: Intracranial subdural empyema (SDE) is a seemingly uncommon life-threatening ailment with varying presentations and outcomes. A variety of risk factors have been associated with predisposition to intracranial SDEs; however, they may be cryptogenic. There is an increased predilection for intracranial SDE in children and teenagers with paranasal sinusitis or middle ear infections. The clinical presentation is non-specific and thus a high index of suspicion is required. Neuroimaging is an invaluable diagnostic tool for early diagnosis and surgical intervention. There have been multiple proponents for either burr hole or craniotomy to treat intracranial SDEs; however, despite surgical intervention, adverse neurologic sequelae and even mortality still occur. Extended antibiotic therapy is mandatory and impacts significantly on patients' outcomes. Objectives: This study describes the demographics, clinical presentation, and surgical outcomes in patients with intracranial SDEs over the study period. Design: This is a retrospective single-centre case series. Setting: This study takes place in a tertiary referral centre, university hospital. Materials and Methods: This was a retrospective review of patients presenting with intracranial SDEs over a 10-year period in a tertiary neurosurgical unit serving south-western Nigeria. Demographic, clinical, and radiologic data were retrieved from patient records. Results: Forty-nine patients presented with intracranial SDEs during the review period. These patients aged between 16 months and 75 years, most of whom were 20 years of age and below. The mean age was 21.37 ± 19.29 years with a median age of 15 years. There were 35 males and 14 females giving a male-to-female ratio of 2.5:1. The most common presentations were headache (73.5%), altered sensorium (55.1%), and seizures (38.8%). Forty patients (81.6%) had evacuation of SDE by burr hole and subdural washout. There was a significant post-op residual SDE in six patients. There were eight (16.3%) mortalities in this series. Forty-seven (95.9%) patients had sterile cultures of the subdural pus collection. Conclusion: Intracranial SDE affects mostly children and teenagers. Early diagnosis, emergent surgery, extended antibiotic therapy, and concurrent source control employing a multidisciplinary approach are essential in managing this condition. Burr hole and subdural washout help control the disease process, reduce operation time, and may yield outcomes similar to craniotomies, which are more invasive.
RESUMO
Summary. With increasing use of motorcycle as means of transport in developing countries, traumatic brain injuries from motorcycle crashes have been increasing. The only single gadget that protects riders from traumatic brain injury is crash helmet. Objective. The objectives were to determine the treatment outcome among traumatic brain injury patients from motorcycle crashes and the rate of helmet use among them. Methods. It was a prospective, cross-sectional study of motorcycle-related traumatic brain injury patients managed in our center from 2010 to 2014. Patients were managed using our unit protocol for traumatic brain injuries. Data for the study were collected in accident and emergency, intensive care unit, wards, and outpatient clinic. The data were analyzed using Environmental Performance Index (EPI) info 7 software. Results. Ninety-six patients were studied. There were 87 males. Drivers were 65. Only one patient wore helmet. Majority of them were between 20 and 40 years. Fifty-three patients had mild head injuries. Favorable outcome among them was 84.35% while mortality was 12.5%. Severity of the injury affected the outcome significantly. Conclusion. Our study showed that the helmet use by motorcycle riders was close to zero despite the existing laws making its use compulsory in Nigeria. The outcome was related to severity of injuries.
