Encephalopathy following ingestion of Lead-contaminated opium; magnetic resonance imaging findings.

BACKGROUND: Encephalopathy is an uncommon but serious presentation of lead toxicity. OBJECTIVE: We aimed to determine and follow-up the brain magnetic resonance imaging (MRI) abnormalities in the patients with lead encephalopathy due to ingestion of lead contaminated opium. METHODS: In a cross-sectional study during lead-contaminated opium outbreak, all lead-poisoned patients with any signs/symptoms of encephalopathy were included. RESULTS: Of 19 patients with lead encephalopathy, five died early and other five could not be sent to MRI during their hospitalization period. Mean age was 51 ± 11 years and males were dominant (89%). Median [IQR] blood lead level (BLL) was 101 [81, 108] µg/dL (range; 50 to 200 µg/dL). There was no correlation between MRI findings and signs/symptoms. MRI was normal in six and abnormal in three. Bilateral symmetric involvement of parieto-occipital lobes was observed. Gray matter, gray-white matter junction, and subcortical white matter were also affected. Follow-up MRI was performed in two with abnormal MRI which showed complete and near complete resolution of the abnormalities after cessation of opium use and treatment. CONCLUSION: There was no correlation between MRI findings and BLL. Complete recovery of brain MRI lesions was detected after cessation of opium use.

High incidence of primary cerebral lymphoma in tumor-induced central neurogenic hyperventilation.

An awake patient presented with central neurogenic hyperventilation induced by a cerebral tumor. Corticosteroid therapy and brain irradiation while the patient was anesthetized and respiration controlled under pancuronium-induced respiratory paralysis were followed by tumor regression and resolution of hyperventilation. Recurrence of tumor 6 weeks later was not accompanied by recurrence of hyperventilation. Cytologic study of cerebrospinal fluid revealed B-cell lymphoma. This patient brings to 10 the number of cases recorded with tumor-induced central neurogenic hyperventilation. Five of the eight patients with known tumor histology had a primary cerebral lymphoma, a rare neoplasm that comprises only 1% of all intracranial neoplasms. The disproportionately high frequency of central neurogenic hyperventilation in patients with cerebral lymphoma has therapeutic implications that are briefly reviewed.

[Life-threatening hypernatremia caused by faulty preparation of fully adapted infant formula]. / Lebensbedrohliche Hypernatriämie durch fehlerhafte Zubereitung volladaptierter Säuglingsmilch.

Two male newborns developed severe life threatening hypernatremia with serum sodium levels of 181 and 196 meq/l respectively. Both children were fed a two-to fivefold concentrated powdered infant formula since birth. Shortly before admission diarrhea developed in both patients. The children were admitted during the third week and fourth week respectively, of their lifes with clinical signs of severe hyperosmolar dehydration. In both, treatment of shock was instituted and was followed by rehydration therapy. Great care was taken to lower serum sodium by not more than 15 meq/l/day in order to prevent cerebral edema. Inspite of these measures, the first patient developed cerebral seizures 5 hours after initiation of fluid replacement. The patient was intubated, and measures aimed at prevention of cerebral edema were started (hyperventilation). The eventual outcome was satisfactory, on follow up the patient showed no signs of persistent cerebral damage. In the second patient the same management was started from the beginning and no cerebral problems occurred. Restoration of stable body functions with a normal electrolyte status was achieved within five days.

Incidence and 30-day case fatality rate of first-ever stroke in urban Nigeria: the prospective community based Epidemiology of Stroke in Lagos (EPISIL) phase II results.

BACKGROUND: Stroke is a leading cause of death worldwide and a major contributor to global disease burden. Although epidemiologic information from a community perspective is important in determining the magnitude of the burden in specific regions, and directing equitable distribution of health resources, data on the incidence of stroke in developing countries in Africa are scarce. AIMS: To determine the current incidence rate and short-term (30-day) case fatality rate (CFR) of stroke in urban Nigeria, and provide age-adjusted and gender-specific incidence rates to enable comparison with global populations. METHODS: The study was a prospective community-based stroke registry enrolling hospitalized and non-hospitalized first-ever in a lifetime stroke cases presenting at all health facilities (hospitals, homeopathic caregivers, physiotherapy clinics) located in the designated community. Pre-hospitalization deaths due to stroke were not included in our study. The study was conducted between January 1st and December 31st 2007 in Surulere Local Government Area of Lagos State, south western Nigeria, a mixed-income urban locality with a population of approximately 750,000 based on data from the National Population Commission. Stroke was defined using the World Health Organization (WHO) clinical criteria. Case fatality at 30-days post stroke was determined at follow-up on 160 hospitalized stroke cases. RESULTS: 189 first-ever strokes, comprised of 112 men and 77 women (mean±SD age 58.5±13.5 years) were documented, giving a crude incidence rate of 25.2 per 100,000 per year (95% confidence interval 21.6- 28.8). The gender-specific rates were 28.3/100,000 and 21.3/100,000 for males and females respectively. The age-adjusted incidence rate was 54.08 per 100,000 per year (adjusted to the WHO New World Population). Hospitalization rate was 84.6%, while the CFR (hospitalized) was 16.2%. CONCLUSIONS: The stroke incidence in this urban sub-Saharan African community remains lower than that in emerging and developed economies, although the age- and gender-related trends and CFR are comparable to that in developed countries.