Exotic injuries of the central nervous system

Head injuries are the most common reason for admission among the injured at the University Hospital of the West Indies. Intentional injuries account for 52 percent of all trauma admissions. We report a unique group of 6 patients with central nervous system injuries, all intentional with the offending weapon in situ on arrival at hospital. 4 patients had weapons embedded in the head: two were knives, and one each was an ice-pick and a harpoon from a fishing device. The two other patients sustained spinal, cord injuries from ice-pick wounds. Principles of management involved radiological assessment of the injury to elucidate the position of the weapon, removal of the weapon under controlled circumstances in the operating theatre suite, prevention of infection and seizure prophylaxis. Operations performed were craniotomy, craniectomy and exploration of the spinal injuries. Two deaths occurred. In one, a spinal abscess developed six months after injury with the patient succumbing to sepsis. The other was an unexplained death following craniotomy and removal of a knive which severed the internal carotid artery. The cost of managing these intentional injuries was far greater than for the average patient and significantly demonstrates the burden on the taxpayer to treat these injuries(AU)

Neuro-behavioural correlates as predictors of drug abuse in the Jamaican population current evidence

There is growing recognition that pharmacological agents, when abused, significantly affect the central nervous system (CNS) and as a consequence neuropsychological functions. This makes it necessary to devise procedures to identify inter-alia the neurophysiological, behavioural, cognitive and emotional patterns of CNS dysfunction induced by substance abuse. The National Survey of Substance Abuse in Jamaica (1994), indicated that 2.4 percent of respondents endorsed greater than 50 percent of items on the Drug Involvement Scale (DIS). The DIS characterizes the severity of drug abuse, assessing how it dominates the persons life, inflicts behavioural disruption, thus reflecting the severity of drug dependence. Drug abusers endorsing <50 percent of DIS-items also manifested tendencies of attentional deficit hyperactivity disorder (ADHD), memory loss, severe bouts of aggression, mood-swings and other behavioural problems. Furthermore, this group of people endorsed inter-alia 37 percent of the items of domains concerned with behaviour patterns, family systems and behaviour disorders indicating a generalized psychosocial-functional-disruption. Evidence will be adduced indicating the trigger effects of drugs on certain brain mechanisms producing specific neuropsychological correlates. The data generated behavioural and social correlates associated with substance abuse. These features indicated those persons who could be regarded as vulnerable to a variety of risky behaviours, including substance abuse. This observation led to the formulation of a screening strategy to tease out drug abusers and those people likely to be vulnerable. Thus, the neuro-drug diagnostic procedure (NIDEP), a computerized device, was established to assess the population for addictions and related psychological disabilities. The NIDEP consisted of twenty-one components selected from various domains covering a complex of dysfunctional behaviours and experiences (e.g. problems of memory, cognition, emotions, conduct disorders and disturbed family situations). NIDEP was programmed to select respondents with a score of greater than 66.6 percent endorsements. In this regard, the procedure selected 6,986 people. Following the application of DIS 4,455 persons were assessed as being heavily involved with drugs. These population estimations were calculated utilizing the National Sample age range of 15-50 years. (AU)

A cluster of central nervous system defects in Jamaica

Information was collected on all stillbirths and neonatal deaths on the island of Jamaica during the 12-month period between September 1986 and August 1987. There were 33 such deaths with anencephaly, spina bifida and hydrocephalus out of an estimated 54,400 total births. There was a statistically significant cluster in respect to time of conception in one small rural area of the island. There were no obvious differences between parents involved in the cluster and the rest of the population, but particular Jamaican fruit and vegetables have been shown to be teratogenic in animals. It is postulated that the cluster may have been associated with an unripe crop. (AU)

Fatal malformations in Jamaica

Babies with major malformations were identified during the Jamaica Perinatal Morbidity and Mortality Survey. They were found in 96 (8.6 percent) of 1112 perinatal and neonatal deaths coming to necropsy and in 28 (2.6 percent) of 1085 not so examined. The central nervous system was most commonly affected, followed by the renal, gastrointestinal, and cardiovascular systems in decreasing order of frequency. Many infants had abnormalities in more than one system and 10 malformations syndromes/sequences were identified. Although at the present time, major malformations make only a small contribution to perinatal and neonatal mortality in Jamaica, their importance will increase when deaths from other causes, such as birth asphyxia, decline. The type of malformation currently fatal in a particular population is relevant when planning diagnostic and surgical services for neonates and infants. It is also important to any discussions about provision of prenatal diagnostic services. (AU)

Mortality from congenital malformations in England and Wales: variations by mother's country of birth

Stillbirth and infant mortality from congenital malformations in England and Wales during 1981-5 was investigated according to the mother's country of birth. Significant differences remained after standardising for maternal age and social class. The highest overall mortality was in infants of mothers born in Pakistan (standardised mortality ratio 237), followed by infants of mothers born in India (standardised mortality ratio 134), East Africa (standardised mortality ratio 126) and Bangladesh (standardised mortality ratio 118). Caribbean and West African mothers showed an overall deficit. Mortality was inversely related to social class in all groups except the Afro-Caribbean. Infants of mothers born in Pakistan had the highest mortality in every social class except I, and for most anomalies investigated. Their ratios were particularly high for limb and musculoskeletal anomalies (standardised mortality ratio 362), genitourinary anomalies (standardised mortality ratio 268), and central nervous anomalies (standardised mortality ratio 239). Our findings highlight the need for further research to identify the causes underlying these differences. (AU)

The neuroepidemiology of tropical spastic paraparesis

Recent neuroepidemiological studies of endemic tropical spastic paraparesis (TSP) have confirmed the existence of high-prevalence foci in several tropical islands, including Jamaica and Martinique in the Caribbean, Tumaco off the Pacific coast of Colombia, and the Seychelles in the Indian Ocean. There is a net preponderance of TSP in persons of Black African ancestry, although Caucasian, Hindu, Amerindian, and Orientals have been affected. The epidemiological, clinical, laboratory, and neuropathological features of TSP are reviewed here, as well as the evidence in favor of its retroviral origin. (AU)

Intellectual levels of school children severely malnourished during the first two years of life

Intellectual functioning at school age was studied in boys who had been severely malnourished during the first 2 years of life (index cases). IQ in these index cases was compared with that of male siblings closest in age and unrelated class mates or neighbors matched for sex and age (comparisons). Full scale, verbal and performance IQs were lowest for the index cases. All IQ measures were significantly lower in the index cases than in the comparisons. full scale and verbal IQ were significantly lower in the index cases than in the siblings. Siblings differed from comparison children only in performance IQ. No association was found between the intellectual level of index cases and the ages at which they had been hospitalized for the treatment of severe malnutrition during the first 2 years of life. (AU)

Nerve lesions associated with general anaesthesia

In the conscious person, any undue pressure or stretching of nerves is usually acutely appreciated and immediate steps taken by the subject to remove the source of annoyance. However, the unconcious patient is unable to complain of any discomfort and so damage to vulnerable nerves may occur. The commoner sources of injury to the nervous system have been described