Metastatic tumours of the brain and its enveloping structures in Ibadan, Nigeria.

Fifty-two cases of secondary tumours of the brain and its enveloping structures which were encountered at the University College Hospital (UCH), Ibadan, Nigeria bewteen January 1965 and December 1970 are reported. All lesions were hisologically verified, forty-six at autopsy and the remaining six from biopsy specimens of the skull deposits. There were forty females and twelve males; 77% of the subjects were in the third, fourth and fifth decades of life, 15% in the sixth and seventh, and the rest in first two decades. Thirty-four of the metastases were found in the substance of the brain and the remaining eighteen in its enveloping structures (the scalp, skull and dura-mater). Of the thirty-four brain secondaries, twenty-four (70%) originated from chorion carcinoma of the uterus, six from the lungs and two each from the breast and kidney. Metastases to the skull came from many sources--cervix, uterus, prostate, adrenals, liver, bladder colon and the thyroid gland. Of the later group, follicular thyroid carcinoma was the commonest single source of secondaries.

Tumours within the spinal column.

Sixty-six cases of mass lesions compressing the spinal cord are presented. The masses were neoplastic in 86.36% of the cases. Epidural masses (80.30%) remain by far the largest group, consisting chiefly of Burkitt's lymphoma and various metastatic carcinomas. Only 6.06% of the lesions were intramedullary and the glioma/paraglioma remains virtually absent.

The neurology of metastatic chorion carcinoma.

Although chorion carcinoma of the uterus is the seventh commonest in the comparative frequency of malignant tumours seen at the Cancer Registry of the University College Hospital, Ibadan, Nigeria (being exceeded in order of commoness by the reticuloendothelial tumours, carcinoma of the cervix, liver, breast, stomach and ovary), it is the most frequent source of tumour deposit of the brain in this hospital. Between 1960 and 1969, 197 Nigerians with chorion cancer of the uterus were admitted to UCH; in twenty-five of them the nervous system was involved during the course of their disease. The neurological involvement presented as acute cerebrovascular accident in fourteen, encephalitis in five; as primary intracranial space-occupying lesion in three cases and in one patient, as cord compression. There were no obvious neurological features in two cases in which necropsy revealed brain metastases. Involvement of the nervous system carries a poor prognosis in chorion cancer of the uterus.

Gliomas of the brain among Nigerians.

At the UCH in Ibadan, Nigeria, we have seen forty-three patients with verified neoplasms of the brain comprising most histologic types of the glioma/paraglioma series. The astrogliomas formed the largest group, followed by the pinealomas in 16.27% and the medulloblastomas and ependymomas, each occurring in 13.95% of the patients. By the end of the third decade of life 83.7% of these neoplasms have become clinically manifest; the largest number being found in the first decade. Just over half (51.16%) of all the neoplasms and also two-thirds of the patients in whom the masses were found in the posterior fossa were children under 15 years. In nearly all cases the duration of symptomatology on admission to hospital was under 6 months. Headaches, papilloedema and altered states of consciousness were frequent; and the prognosis in general has been poor. The classical glioblastoma multiforme and the acoustic neurinoma are quite uncommon in the Nigerian African; but a fairly full spectrum of the 'gliomas' has been clearly identified in the group of primary brain tumours at Ibadan.

Subgaleal hematoma in head injuries.

We have carried out clinical, radiological and some hematological evaluation of post-traumatic subgaleal hematoma in 55 Nigerians who were treated for head injuries at the he University College Hospital, Ibadan, Nigeria, in 1970. Most hematomas spontaneously resolved within four weeks of the injury, so that masterly inactivity should be the first line of treatment for this entity.

A syndrome characteristic of tangential bullet wounds of the vertex of the skull.

Six patients with tangential missile wounds of the vertex of the skull presented symptoms of limb paresis which were more marked proximally in the arms and distally in the legs where there was also sensory loss of a cortical type. Carotid cerebral angiography and operative treatment showed patency of the longitudinal sinus and injury to the medial aspects of the frontoparietal cortex. The term "longitudinal sinus syndrome" formerly applied to these cases is therefore a misnomer since the main underlying cause is cortical injury and not thrombotic occlusion of the superior longitudinal sinus, as previously suspected.

Epilepsy after missile wounds of the head.

Two hundred and thirty-seven Nigerians with missile head injury were treated at the University College Hospital (UCH) Ibadan, between July 1964 and January 1970. Among the 165 of these patients who have been followed up for over a year, the incidence of epilepsy has been 11·4%, 18·75%, and 33·3% in a follow-up period ranging between one to two years, two to three years, and three to five years respectively.Wounds in the parietal region, especially those at the vertex, were followed by epilepsy more frequently than injuries elsewhere on the head. Of these wounds, tangential skull injuries and through-and-through brain injuries were more epileptogenic than others.Fits which occurred within a fortnight of wounding have been designated as `early' fits, and they appeared to differ in their aetiology from `late' fits.