Bony anomalies of the craniocervical junction.

A review of the literature on bony anomalies of the craniovertebral junction was carried out with emphasis on anomalous manifestations associated with the occipital bone, atlas and axis vertebrae. A summary of the evolution and normal development of the above bony structures and the embryological structures contributing to the bony anomalies is presented. In addition the diagnostic measurements used for the diagnosis of the bony anomalies of the craniocervical junction and their clinical presentation were summarised. This review was prepared with the aim of providing reference material for neurosurgeons and radiologists.

Non-traumatic paraplegia [correction of paraplegis] in a Zimbabwean population--a retrospective survey.

OBJECTIVES: To ascertain the aetiology of non-traumatic paraplegia in a Zimbabwean population and to compare findings with other studies from Africa. DESIGN: Retrospective survey over a six year period. SETTING: National Rehabilitation Centre, Ruwa, Zimbabwe. SUBJECTS: 159 patients referred to the National Rehabilitation Centre with non-traumatic paraplegia. RESULTS: The commonest causes of non-traumatic paraplegia were neoplasms (28% of cases) of which a third were metastatic, followed by tuberculosis (TB) (27%). Transverse myelopathy of unknown aetiology was diagnosed in 11% of cases and 6% had Guillain Barré syndrome. Miscellaneous conditions included: degenerative bone and joint conditions, degenerative cord disorders and infections. In 7% of cases no diagnosis was reached. On admission all patients were confined to wheelchairs. On discharge 49% had regained some degree of mobility. A year after discharge 48% were known to be alive and 18% had died. The fate of 34% was not known. CONCLUSIONS: The aetiology of non-traumatic paraplegia in a Zimbabwean population is similar to that reported from other African countries, with tumours and tuberculosis accounting for over half the cases. Survival appears to be related not only to the primary condition but also to the severity of the disability.

Problems, struggles and some success with spinal cord injury in Zimbabwe.

Spinal cord injury is a common occurrence in Zimbabwe and carries with it a high morbidity and mortality. In the past almost all patients discharged from hospital were dead within a year. Reasons for this high mortality are presented. The establishment of the National Rehabilitation Centre has had a profound impact on the survival of these individuals as well as on improving their quality of life. The results of a retrospective survey on the mortality and life situation of individuals with spinal cord injuries sustained through trauma are presented. However major unresolved problems are inadequate housing, lack of financial support, practically no prospect of employment and depression compounded by boredom.

The influence of racial and environmental factors on EEG photoparoxysmal responses in Zimbabwe.

OBJECTIVE: This study examined the influences of environmental and racial factors on the incidence of EEG photoparoxysmal responses (PPRs) to intermittent photic stimulation (IPS) in a multi-racial population exposed to seasonal variations in sunshine intensity. MATERIALS AND METHODS: The records of patients referred for EEG examination in Harare, Zimbabwe were screened for the presence of PPRs to IPS. The age, sex and racial classification of patients manifesting PPRs were studied. The relationship between sunshine duration and intensity and the frequency of PPRs was also studied. RESULTS: EEG records of 16,496 patients referred for EEG examination were studied. Of these, 136 patients (0.8%) showed PPRs to photic stimulation. The highest age-specific PPR (2.0%) occurred in the 16-20 year age group. The race-specific PPRs were 1.5% for white patients, 1.18% for Asian patients, 0.36% for colored patients and 0.09% for black patients (chi3[2] = 95.21, P = 0.001). The incidence of PPRs did not show any significant variation with the mean monthly sunshine duration (P = 0.8254) or with the mean monthly sunlight radiation (P = 0.2631). CONCLUSION: The findings of this study support a role for genetic rather than environmental factors in the relative rarity of PPRs in black Zimbabweans.

Electroencephalographic photosensitivity among Zimbabwean youths.

To clarify the factors associated with electroencephalographic (EEG) photosensitivity, the records of patients who had EEG examinations in the city of Harare, Zimbabwe between 1968 and 1996 were studied. EEG photosensitivity was confirmed in 107 of a total of 9082 youths (aged 0-25 years), giving an overall photosensitivity prevalence of 1.17% in the study population. Photosensitivity occurred more frequently in females than in males, and the peak age period for its occurrence was during adolescence. A significantly higher prevalence of photosensitivity was recorded among Whites and Asians than among Blacks, while the Coloured population had an intermediate prevalence. The monthly and seasonal incidence of photosensitivity in the present study showed no correlation with the prevailing mean monthly or seasonal temperatures, sunshine duration and sunlight intensity in Harare during the period covered by the study. These findings indicate that sunshine-related factors do not play a dominant role in the occurrence of photosensitivity, thereby negating previous opinions which attributed the relative rarity of photosensitivity in black Africans to high levels of exposure to sunshine in tropical Africa. Our findings therefore corroborate the view that photosensitivity depends primarily on genetic rather than environmental factors.

Peripheral neuropathy in individuals with HIV infection in Zimbabwe.

Peripheral neuropathy is associated with HIV infection. The prevalence and types of peripheral neuropathy encountered in a randomly-selected HIV infected African population at different stages of disease were investigated. HIV positive individuals were categorized into 1 of 3 groups: asymptomatic, symptomatic and AIDS. HIV negative individuals formed the control group. Nerve conduction data were obtained using standard electrophysiological procedures and CD4+ levels were measured. The type of neuropathy was determined from the history, clinical presentation and electrophysiological abnormalities. The prevalence of peripheral neuropathy was 44%: subclinical neuropathy (SCN) accounted for 56%, acute inflammatory demyelinating polyneuropathy (AIDP) for 15% and distal symmetrical polyneuropathy (DSPN) for 22% of cases of neuropathy. SCN was found in all categories whereas AIDP predominated in the symptomatic category and DSPN in individuals with AIDS. The pattern and frequency of neuropathies seen in our African population is similar to that reported from other continents.

The pattern of utilization of EEG services in Harare, Zimbabwe.

OBJECTIVE: In developing countries, EEG services represent a considerable investment in terms of financial costs and staffing requirements which demand appropriate and effective utilization. This study is an evaluation of the pattern of utilization of EEG services in our hospital. DESIGN: Cases series. SETTING: The EEG Department of the Parirenyatwa Hospital, Harare, over the six month period between January and June 1995. SUBJECTS: The EEG records of 237 patients (age range four months to 70 years, M:F ratio 1.5:1) recorded over a six month period were retrospectively studied. RESULTS: 47.3% of EEG records were normal while 52.7% were abnormal. Outpatient referrals accounted for 62.9% of all EEG recordings. While there was a broad spread of referrals from the major medical specialties, only 4.2% of all referrals were from the district hospitals. The majority of referrals were to confirm the diagnosis of epilepsy. Epileptiform abnormalities were detected in 49.4% of patients referred for epilepsy. A total of 47.2% of patients were on psychotropic or anti-epileptic drugs with potential confounding influences on the interpretation of EEG records. CONCLUSION: The major indication for EEG in our study is the confirmation of the diagnosis of epilepsy. All the indications for EEG referral in this study are further evaluated in the light of current clinical practice.

Multiple sclerosis in black South Africans and Zimbabweans.

Multiple sclerosis is rare among the indigenous black people of Africa. The first account of a black patient with multiple sclerosis in South Africa was published as late as 1987. Since then a search to find black patients with multiple sclerosis in Southern Africa has continued. Seven black patients have now been traced in South Africa and five in Zimbabwe in whom a diagnosis of multiple sclerosis can be accepted. Six of the 12 patients became blind, or nearly so, from severe optic neuritis. Multiple sclerosis in these few black patients more often resembled the disorder as it occurs in oriental people than among white people in southern Africa or the black people of North America or the Caribbean.

Advances in electrodiagnosis in Zimbabwe. Part II: "Evoked potentials".

This paper is a short review of the electrodiagnostic technique of "evoked potentials", a technique recently introduced to Zimbabwe. The types of evoked potentials recorded, the method of recording and their clinical applications are discussed. Abnormal evoked potentials from a variety of neurological disorders are illustrated. "Advances in electrodiagnosis in Zimbabwe" Part I discussed peripheral nerve conduction measurements and electromyography. This paper (Part II) will review the physiological basis of "Evoked Potentials" and their clinical applications.

Neoplasms involving the spinal cord in Zimbabweans: an analysis of 262 cases.

A review of 262 histologically verified spinal cord tumours in Black Zimbabweans who were operated on in Harare Central and Parirenyatwa Hospitals, Harare, Zimbabwe during the period 1st January 1972 to 31st December 1991 is presented. Fifty one pc of the neoplasms were found in the thoracic region, 53.4 pc were found extradurally, and of these the majority were metastatic (52 pc) and malignant tumours (85 pc). Most (96 pc) intradural-extramedullary tumours were benign with Schwannomas as the largest group (54 pc). Malignant astrocytomas presented as 71.4 pc of all intramedullary tumours. Metastatic tumours represented 28.6 pc of all spinal cord tumours. The most common sites of metastasis were from liver, thyroid and prostate.

Advances in electrodiagnosis in Zimbabwe. Part I: Peripheral nerve conduction studies and electromyography.

This paper reviews the two electrodiagnostic techniques--nerve conduction measurements and electromyography. A brief description of each technique is given followed by their clinical applications. Finally the types of abnormalities observed are discussed and where possible, illustrated.

Infection after Harare valve V-P shunt operations: a review of 92 cases.

Case files of 92 patients who had their hydrocephalus relieved by the insertion of the Harare Valve shunt system were reviewed. All patients had undergone surgery for shunt insertion at the Harare Central and Parirenyatwa Teaching Hospitals in Harare, Zimbabwe, between January 1986 and January 1988. All but one patient reviewed had Harare valve ventriculoperitoneal shunt insertions. The commonest indication for shunt insertion was congenital hydrocephalus alone or coexisting with other abnormalities (62 pc). Post meningitic hydrocephalus and hydrocephalus associated with intracranial tumours were next in frequency at 26 pc and 9 pc respectively. The etiology of hydrocephalus was not diagnosed in one four-year-old patient. The ages of the patients on admission ranged from one day to seven years (mean 12.4 months). Infection rates correlated well with the etiology of hydrocephalus; lowest (2 and half pc) in patients with simple congenital hydrocephalus and highest (29.2 pc) in post meningitic patients. A variety of organisms were isolated from CSF, blood, wounds and catheter tips. Lactose fermenting coliforms, S. epidermidis and E. coli predominated. Infection was combated by antibiotics, shunt removal or a combination of both. The antibiotics most commonly used were the penicillins, chloramphenicol, cloxacillin and gentamycin.

Blastomycosis in Africa: clinical features, diagnosis, and treatment.

Four cases of blastomycosis seen in two acute care hospitals in Harare, Zimbabwe, are described. All patients had symptoms of at least 2 months' duration before presentation, and all had radiographic evidence of pulmonary consolidation. Three patients had confirmed bone involvement, and two had chronic discharging sinuses. The features of blastomycosis in Africa are reviewed, and problems of diagnosis and treatment are discussed. It is concluded that blastomycosis in Africa may often be misdiagnosed as tuberculosis or pyogenic infection in the absence of adequate facilities for mycologic investigation.