RESUMO
BACKGROUND: Trauma is the most common cause ofpaediatric deaths. In 75% ofpaediatric trauma deaths, head injury is responsible, and most are from falls. Recent reports from Nigeria, however, appear to indicate a predominance of road traffic accidents, instead of falls. OBJECTIVE: To evaluate the aetiology of paediatric head trauma, management protocols and outcome from our Centre, in order to acquire a baseline data base and recommend measures to reduce childhood trauma. PATIENTS AND METHODS: A prospective study of all paediatric head trauma cases presenting to Nnamdi Azikiwe University Teaching Hospital, Nnewi, for 12months from April 21, 2006 to April 20, 2007, was done and collated data subsequently analyzed. The paediatric age group was taken as = 15 years, and grading of head injury was with the Glasgow Coma Scale (3-15) and the modified scale for non-verbal children; while outcome was measured with the Glasgow Outcome Scale (1-5). RESULTS: Out of 334 patients treated within the period of study, 210 were head trauma cases. Of these, 52 were paediatric head trauma, representing 24.8% of all head trauma cases; and 19.2% (10 of 52) of them were aged 0-2 years. About 62% (32 of 52) were males. Falls and RTA were each responsible in 25 (48.1%) cases. Mild head injury occurred in 31 (59.6%), and 49 (94.2%) patients were evaluated by plain radiography. Treatment was conservative in 39 (75%) cases; with satisfactory outcome in 36 (69.2%), and a mortality rate of 15.4%. CONCLUSIONS: Road traffic injury, mostly from motorcycles, has become the major cause of morbidity and mortality amongst the paediatric age group, especially the male gender, and outcome from management is mostly satisfactory.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Traumatismos Craniocerebrais/etiologia , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Causas de Morte , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/terapia , Feminino , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Humanos , Lactente , Masculino , Nigéria/epidemiologia , Pediatria , Estudos Prospectivos , Distribuição por Sexo , Índices de Gravidade do Trauma , Resultado do TratamentoRESUMO
Congenital orbital teratoma though rare is available in this environment. This is a case report of a baby with a protruding orbital mass in the left eye with all classical clinical features of teratoma. Though the histopathological report fell short of confirming the diagnosis the clinical features and outcome of management strongly suggest that the lesion is a teratoma. Multidisciplinary approach to the management not only saved the life of the baby in question but also enhanced the outcome of treatment. Good and compliant follow up for six months was experienced. Cytological test is mandatory for any suspected cases ofteratoma.
Assuntos
Neoplasias Orbitárias/congênito , Neoplasias Orbitárias/cirurgia , Teratoma/congênito , Teratoma/cirurgia , Feminino , Humanos , Lactente , Neoplasias Orbitárias/diagnóstico , Teratoma/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Parkinsonism is a neurodegenerative clinical disorder characterized by varying combinations and degrees of rest tremor, rigidity, slowing of voluntary movements and postural instability. Amongst the aetiologic factors, massive post-craniotormy haematoma has not been previously considered. This report is to arouse the suspicion that vascular displacement in the midbrain resulting from a massive unilateral intracranial haematoma could lead to the unusual complication of Parkinsonism. This is the report of a 55-year old retired male banker, without any previously identifiable risk factor except for his age, who developed Parkinsonism following a huge acute extradural haematoma that complicated a craniotomy for the excision of a haemorrhagic convexity meningioma. The patient was placed on medical treatment resulting in a slow but progressive neurological improvement. Reports of Parkinsonism following post-tumour excision are probably, very rare. We, hereby, report a case of Parkinsonism complicating a gross total excision of a convexity meningioma.
Assuntos
Neoplasias Encefálicas/cirurgia , Craniotomia/efeitos adversos , Meningioma/cirurgia , Doença de Parkinson Secundária/etiologia , Antiparkinsonianos/uso terapêutico , Neoplasias Encefálicas/diagnóstico , Hematoma/diagnóstico , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/cirurgia , Levodopa/uso terapêutico , Masculino , Meningioma/diagnóstico , Pessoa de Meia-Idade , Doença de Parkinson Secundária/tratamento farmacológico , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Traumatic extradural haematoma is a rare condition and treatment in a majority of cases is by operative evacuation. Outcome from treatment is influenced by several factors. OBJECTIVE: To evaluate the operative treatment of traumatic extradural haematoma in our centre and assess the impact on outcome of some of the historical factors. METHODS: A retrospective study of cases managed January 1993-February 2004 using records from the Emergency Room, Wards, Theatre and Radiology Unit. Only the cases definitively diagnosed as extradural haematoma resulting from trauma and had operative evacuation, were recruited. The Glasgow Coma Scale was used to measure the severity of injury; whereas postoperative outcome was considered good in those with minimal or no neurological deficits. Collated data were analyzed and the patients were divided into 3 groups--good, moderate and fatal (poor) based on the outcome; the impact of the various historical factors was compared among the groups. Statistical analysis was done using the chi-square test and p-value of 0.05 or less was considered significant. RESULTS: Majority of the patients were young, with mild head injury and good outcome, and a surprisingly long mean preoperative time lag of 123.1 hours. Outcome was good in 24 (64.9%), moderate 6 (16.2%) and fatal 7 (18.9%). There were skull fractures in 26 (70.3%), but there was no significant difference in outcome among those with and those without fractures. CONCLUSION: Age of the patient and severity of head injury (a reflection of concomitant brain injuries), more than other factors appear to dominantly prognosticate outcome from operative evacuation in our service.
Assuntos
Traumatismos Craniocerebrais/complicações , Hematoma Epidural Craniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Adulto , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/cirurgia , Feminino , Seguimentos , Hematoma Epidural Craniano/diagnóstico , Hematoma Epidural Craniano/etiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Índices de Gravidade do Trauma , Resultado do TratamentoRESUMO
Head injury is a disease afflicting mainly young males, and road traffic accident is the most common aetiologic factor. This report evaluates the findings in a one-year prospective study done from April 21, 2006-April 20, 2007 in the first year of services in one of Nigeria's new neurosurgical Centres, to establish the baseline epidemiological patterns of head injury. Data was collected using a questionnaire from the point of presentation till discharge of each head injury patient, and augmented with theatre and outpatient records, and analyzed. The Glasgow Coma and Outcome Scales were used for grading. Our Centre is a tertiary health facility that receives referrals from private, primary and secondary facilities. Of the 334 total patients treated, 210 (62.9%) had head injuries. Males were 158 (75.2%), and 145 (69%) resulted from road traffic accident, mostly from motorcycles. Fractures were mostly basal 86 (41%), brain pathology was mostly cerebral contusion 74 (35.2%), and treatment mostly nonoperative 137 (65.2%), with good outcome in 144(68.6%). Mortality was 40 (19.1%). Trauma is the main reason for neurosurgical consultation in our Centre and the unsafe use of roads, especially with motorcycles, remains the major cause of head injury.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Traumatismos Craniocerebrais/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Traumatismos Craniocerebrais/classificação , Traumatismos Craniocerebrais/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Neurocirurgia , Nigéria/epidemiologia , Prognóstico , Estudos Prospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Neurosurgery has become endangered species in Nigeria. We have only 15 practising neurosurgeons for our population of 150 million, giving a ratio of one neurosurgeon to 10 million Nigerians. Of the 26 accredited medical schools, only 6 offer neurosurgery. This study is a preliminary evaluation of the perceptions about neurosurgery before the commencement of neurosurgical services in a tertiary health institution, and a comparison with the situation in other African countries. METHODOLOGY: A questionnaire designed after the 5-point Likert rating scale was distributed to doctors, nurses, final-year medical/nursing students, paramedics and administrative staff of the 350-bed health institution. The completed questionnaires that were returned, were collated and data analysis done. RESULTS: Out of 200 questionnaires distributed, 164 were completed and returned. Most of the respondents were females 59.1%, and most were in the 20 30 year age group, 57.3%; more than 96% stated that they have heard of neurosurgery previously, but rated the available services in Nigeria as inadequate 50.6%, and quality of services as fair 39.6% or poor 36.6%, respectively. In their opinion, political and administrative lapses rather than funding are responsible for the poor state of affairs, culminating in unavailability of adequate manpower and facilities. Health policy changes and provision of facilities with manpower training were suggested by 78% of respondents as the solution to the problem. Most, however agree that neurosurgery has good prospects 78%, in the institution. CONCLUSION: Neurosurgical service in Nigeria is grossly inadequate both in availability and quality, and these have resulted from bad government policies. It is therefore of utmost necessity that services and training be urgently provided in this specialty, at least in the tertiary institutions in Nigeria.
Assuntos
Atitude do Pessoal de Saúde , Neurocirurgia/educação , África , Feminino , Política de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Neurocirurgia/tendências , Nigéria , Inquéritos e Questionários , Recursos HumanosRESUMO
Spinal arteriovenous malformations (AVMs) being even rarer than cranial ones, constitute 3 - 4% of all spinal tumours, with an overall male:female ratio of 4:1. We report the case of a 24-year old female Youth Corps member who presented with an apoplectic onset of a left hemiparesis, progressively deteriorating to an incomplete quadriplegia with motor power of 2 and 0 in the right and left lower limb muscle groups, respectively. Magnetic resonance imaging (MRI) showed a vascular malformation whose precise nature was indeterminate; the definitive diagnosis of a Glomus AVM was only made intra-operatively. Laminectomy with complete surgical excision was done and she gradually improved to ambulate with minimal support. The experience in our unit tends to support the observation in literature that spinal arteriovenous malformations could be very rare, and depending on the location, could be amenable to complete surgical excision and recovery of neurological function.
Assuntos
Malformações Arteriovenosas/diagnóstico , Laminectomia , Doenças Vasculares da Medula Espinal/diagnóstico , Medula Espinal/anormalidades , Adulto , Malformações Arteriovenosas/cirurgia , Feminino , Humanos , Doenças Vasculares da Medula Espinal/cirurgiaRESUMO
BACKGROUND: There are no pathognomonic presenting features of intracerebral abscesses. Their clinical features could be confused with those of a tumour or any other space occupying lesion. STUDY DESIGN: We analyzed the symptoms, predisposing factors, diagnostic modalities, prevalent causative microbes, management and outcome in 11 patients, for whom complete records were available and who were managed for confirmed intracerebral abscess in our Neurosurgical Unit from 1996 to 2000 and compared our findings with those from other series. RESULTS: In these patients focal neurological deficit was the most common clinical feature, trauma was the most predisposing event and Computerised Tomography (CT) Scanning remained the most dependable diagnostic tool. In our practice, burr hole drainage augmented with a minimum of 4 weeks intravenous antibiotics, was the most frequently used treatment modality. CONCLUSION: The outcome was satisfactory (ability to return to pre-morbid activities and duties, with no disabling neurological deficits) in 72.8% cases. There was one death. This modality remains an effective way of treating patients with intracebrebral abscess.