Normal diameter of the optic nerve using magnetic resonance imaging: A retrospective Nigerian study.

PURPOSE: The variations in the diameter of the optic nerve (ON) are important clinically in the diagnosis of conditions associated with the ON such as raised intracranial pressure, meningioma, optic neuritis, and Grave's orbitopathy. This study determined the normal diameters of the ON in adult Nigerians seen in a Hospital in Delta State. METHODS: Axial T1-weighted brain magnetic resonance imaging images of 150 patients (75 males and 75 females) aged ≥20 years were retrieved from the hospital's radiological database and retrospectively used to evaluate the diameter of the ON on axial and coronal sections. The data were analyzed and summarized using descriptive statistics. The mean diameters were compared based on gender, side, and age groups and correlated with age using inferential statistics. The significance level was considered at 5%. RESULTS: The diameter of the ON measured 0.45 ± 0.07 cm on the coronal section, besides 0.50 ± 0.07 cm, and 0.46 ± 0.06 cm at 0.3 cm and 0.8 cm from the posterior pole of the globe, respectively, on the axial slices. The diameters were significantly larger in males than in females (P < 0.05) and were symmetrical. However, they lacked significant association with age (P > 0.05). The three diameters measured had a significant positive correlation with each other (P < 0.05). CONCLUSION: The study provides a normal range of ON diameter in the study center to aid in the diagnosis of raised intracranial pressure and pathologies involving the nerve and its sheath.

Magnetic Resonance Imaging Infarct Volume Correlates with Carotid Intima-Media Thickness and Plaque Echotexture in Ischemic Stroke.

Objective: To determine the correlation between cerebral infarct volume, carotid intima-media thickness (CIMT), and plaque echotexture in patients with ischemic stroke. Materials and Methods: This was a cross-sectional study of 70 patients with ischemic stroke who were imaged using the head coil of a 1.5T Toshiba magnetic resonance machine. The volumes of infarcts were documented and calculated using the manual tracing of the infarct perimeter method. The common carotid CIMT was measured on ultrasound using a linear high-frequency 7.5 MHz transducer. Results: Seventy subjects were evaluated. The mean magnetic resonance imaging cerebral infarct volume was 8.07% volume. Hyperechoic plaques were the most prevalent (36.7%) compared to the hypoechoic (33.3%) and isoechoic (30%) plaques. There was a moderate positive correlation between CIMT and infarct volume (r = 0.70; P = 0.001) in the entire study population. Similarly, positive correlations between CIMT and infarct volume were recorded in both the male (r = 0.73; P = 0.001) and female (r = 0.67; P = 0.001) subjects. Furthermore, subjects who presented in the acute phase (1-3 days) of ictus showed a moderate positive correlation (r = 0.621; P = 0.0001) between CIMT and infarct volume, while there was a strong positive correlation (r = 0.74; P = 0.0001) in subjects that presented in the subacute phase (4-7 days). Conclusion: Common carotid artery CIMT correlated positively with cerebral infarct volume in patients with ischemic stroke. Furthermore, hyperechoic plaques were associated with significantly larger infarct volumes compared to hypoechoic and isoechoic plaques.

Association of Cervical Spine Magnetic Resonance Imaging Abnormalities with Chronic Neck Pain in Southern Nigeria.

Objective: This study was done to evaluate the relationship between cervical spine magnetic resonance imaging (MRI) findings and clinical features in adults with chronic neck pain (NP) at our tertiary hospital. Materials and Methods: This was a prospective cross-sectional study of the cervical spine MRI of 90 adult patients with chronic NP. The clinical history, biodata, and cervical spine MRI findings were analysed. Statistical tests were considered significant at P ≤ 0.05. Results: The mean age of the participants was 54.72 (13.51) years (range = 28-79 years). There were 52 (58%) males and 38 (42%) females. Cervical disc desiccation and disc herniation were the most prevalent MRI findings. C4/C5 and C5/C6 disc levels were most commonly affected. Disc height reduction correlated with shoulder pain (r = 0.23, P = 0.030), unsteady gait (r = 0.27, P = 0.010), and lower limb weakness (r = 0.23, P = 0.029). Vertebral collapse correlated with shoulder pain (r = 0.22, P = 0.036), upper limbs burning sensation (r = 0.33, P = 0.001), and loss of dexterity (r = 0.22, P = 0.037). Spondylolisthesis correlated significantly with unsteady gait (r = 0.34, P = 0.001), dizziness/vertigo (r = 0.29, P = 0.005), painful neck movement (r = 0.32, P = 0.002), loss of dexterity (r = 0.37, P < 0.001) and sphincteric dysfunction (r = 0.23, P = 0.031). Modic changes correlated with loss of dexterity (r = 0.39, P < 0.001) and upper limbs burning sensation (r = 0.21, P = 0.048). Cervical canal stenosis did not correlate significantly with any symptom. Conclusion: Cervical disc disease (C4/C5 and C5/C6 levels) was the most prevalent finding on MRI. Disc height reduction, vertebral collapse, spondylolisthesis, and Modic changes correlated with various clinical symptoms.

Portal vein congestion index in patients with and without chronic liver disease.

Aim of the study: Portal vein congestion index has shown promise in detecting early portal venous hemodynamic changes in chronic liver disease. The aim of this study was to compare the portal vein congestion index of adult patients with chronic liver disease to that of healthy controls, and to evaluate the differences in portal vein congestion index, if any, between the common etiologies of chronic liver disease (chronic viral hepatitis, alcoholic liver disease, and non-alcoholic fatty liver disease). Method and materials: Eighty participants with chronic liver disease and 80 healthy controls had their sociodemographic variables, anthropometric indices, liver size/echotexture, spleen size, presence of ascites, and portal vein parameters (diameter, cross-sectional area, velocity, and congestion index) evaluated. P ≤0.05 was considered statistically significant. Results: There were 48 (60%) males and 32 (40%) females in the control group, while 56 (70%) males and 24 (30%) females were included in the chronic liver disease group (p = 0.185). Of the eighty people with chronic liver disease, 57 (71.2%) were diagnosed with alcoholic liver disease, while 23 (28.8%) were diagnosed with chronic viral hepatitis. There were no cases of non-alcoholic fatty liver disease during the study period. The mean liver spans of the control and chronic liver disease groups were 13.45 ± 0.85 cm and 16.50 ± 4.96 cm, respectively. All the controls had normal hepatic parenchymal echogenicity, while 45 (56.3%) subjects with chronic liver disease (36 alcoholic liver disease and 9 chronic viral hepatitis) had increased hepatic echogenicity. The mean values of the portal vein congestion index for the control and chronic liver disease groups were 0.0775 ± 0.02 cm/sec and 0.1037 ± 0.03 cm/sec, respectively (p <0.0001). Conclusion: The chronic liver disease group showed a significantly higher mean portal vein congestion index than the control group.

Variations of the Nasal Septum in Adult Nigerians: Computed Tomography Study

Abstract Introduction The morphological variants of the nasal septum have been implicated in sinus pathology and pose a challenge during endoscopic surgeries. Objectives The present study aimed at evaluating the prevalence of nasal septum variants in adult Nigerians. Methods The present study was performed at the Radiology Department of Delta State University Teaching Hospital, Nigeria, following ethical approval. Brain computed tomography (CT) scan images of 336 adults were evaluated for nasal septum variants. The angle of the deviated nasal septum was measured, and the severity was classified. Data were analyzed using IBM SPSS Statistics for Windows, version 23.0 (IBM Corp., Armonk, NY, USA). The angle of deviation was presented in means and standard deviation. Frequencies of the variants were presented in percentages. The Student t-test was used to compare the angle of deviation, while the chi-squared test was used to compare the frequencies in the different groups. A p-value < 0.05 was considered statistically significant. Results The prevalence of straight and deviated nasal septum was 59.5% and 40.5%, respectively. Deviation was predominant in females (46%) and, more frequently, of moderate severity (75%). The angle of deviation was significantly larger in males (12.55 ± 2.99°) than in females (11.13 ± 2.41°;p = 0.003). Nasal spur had a prevalence of 11.9%, and its coexistence with deviated nasal septum was observed in 5.06%. Septal pneumatization was seen in 10 patients (3%). Conclusions Deviation of the nasal septum occurred more in females and toward the left; however, the angle of deviation was significantly higher in males. Nasal septal spur and pneumatization were the least prevalent variants.

Variations of the Nasal Septum in Adult Nigerians: Computed Tomography Study.

Introduction The morphological variants of the nasal septum have been implicated in sinus pathology and pose a challenge during endoscopic surgeries. Objective The present study aimed at evaluating the prevalence of nasal septum variants in adult Nigerians. Methods The present study was performed at the Radiology Department of Delta State University Teaching Hospital, Nigeria, following ethical approval. Brain computed tomography (CT) scan images of 336 adults were evaluated for nasal septum variants. The angle of the deviated nasal septum was measured, and the severity was classified. Data were analyzed using IBM SPSS Statistics for Windows, version 23.0 (IBM Corp., Armonk, NY, USA). The angle of deviation was presented in means and standard deviation. Frequencies of the variants were presented in percentages. The Student t -test was used to compare the angle of deviation, while the chi-squared test was used to compare the frequencies in the different groups. A p-value < 0.05 was considered statistically significant. Results The prevalence of straight and deviated nasal septum was 59.5% and 40.5%, respectively. Deviation was predominant in females (46%) and, more frequently, of moderate severity (75%). The angle of deviation was significantly larger in males (12.55 ± 2.99°) than in females (11.13 ± 2.41°; p = 0.003). Nasal spur had a prevalence of 11.9%, and its coexistence with deviated nasal septum was observed in 5.06%. Septal pneumatization was seen in 10 patients (3%). Conclusion Deviation of the nasal septum occurred more in females and toward the left; however, the angle of deviation was significantly higher in males. Nasal septal spur and pneumatization were the least prevalent variants.

Influence of Sociodemographic and Anthropometric Factors on Gallbladder Volume in Pregnancy in a Tertiary Hospital in Nigeria.

Objectives: Our study sought to determine the effect of age, parity, body mass index (BMI), and previous oral contraceptive use on gallbladder volume and ejection fraction in pregnancy to enable obstetricians to identify patients at risk of gallbladder disease in pregnancy. Methods: We conducted a prospective cross-sectional study involving 190 pregnant women who were evaluated within 32 and 40 weeks gestation at the Fetal Assessment Unit of the Department of Radiology, University of Ilorin Teaching Hospital, Nigeria. Patients were scanned with a commercially available Siemens Ultrasound scanner using a curvilinear probe and a transducer frequency of 3.5 MHz. The fasting gallbladder volume (FGBV) and 30 minutes postprandial gallbladder volume (PGBV) were calculated using the prolate ellipsoid method. Gallbladder ejection fraction was determined using FGBV and PGBV. Each patient's biodata, medical history, and somatometric parameters were documented. Results: A total of 190 volunteers were included in the study. BMI showed statistically significant positive, though weak correlations with FGBV (r = 0.179, p =0.015) and PGBV (r = 0.216, p =0.003). Maternal age, parity, and previous oral contraceptive use did not show any statistically significant correlation with gallbladder parameters. Conclusions: BMI showed a statistically significant but weakly positive correlation with FGBV and PGBV in pregnancy. Our study demonstrated that gallbladder volume in pregnancy might be dependent on BMI. Thus, high BMI may predispose to large gallbladder volume, increasing the risk of biliary stasis and gallstone formation in pregnancy. This is relevant for early detection and prevention of gallbladder disease and follow-up, including expectant management of subjects that may develop gallbladder disease in pregnancy.

Secondhand smoke exposure is independently associated with stroke among non-smoking adults in West Africa.

BACKGROUND: Stroke is a leading cause of disability and mortality worldwide, but little is known about the contribution of secondhand smoke exposure (SHSE) to stroke epidemiology among indigenous Africans. OBJECTIVE: To evaluate the association of SHSE with stroke among indigenous Africans. METHODS: We analyzed the relationship of SHSE with stroke among 2990 case-control pairs of adults who had never smoked (identified in the SIREN study) using conditional logistic regression at a two-sided P < 0.05. RESULTS: Multivariable-adjusted odds ratio and 95% confidence interval; 1.25 (1.04, 1.50; P = 0.02) revealed SHSE was positively associated with stroke independent of stroke subtypes. CONCLUSION: Culturally relevant primary prevention strategies targeted at SHSE might be promising in preventing stroke among Africans.

Carotid and Vertebral Atherosclerosis in West African Stroke Patients: Findings from the Stroke Investigative Research and Education Network.

Background: We evaluated the characteristics of carotid and vertebral atherosclerosis in indigenous West Africans with stroke. Methodology: Of the 3778stroke patients recruited between 01/2014 and 08/2017, 1070 (28.3%) received carotid and vertebral artery evaluation with B-mode Ultrasound. Carotid and vertebral intima-media thickness (IMT) using multiple site technique were measured bilaterally and plaque frequency was determined. Descriptive and comparative analyses between stroke types and vessels were carried out. Results: There were 809 (75.6%) patients with ischemic stroke. The prevalence of intima-media thickening in the study population was 84.0% (898/1070) [95% CI: 81.7-86.1], being higher in the ischemic stroke (688/809, 85.0%) [95% CI: 82.4-87.3] than in the hemorrhagic stroke group (211/261, 80.8%) [95% CI: 75.6-85.2]. Overall prevalence of plaques which was 26.1% [95% CI: 23.5-28.8], was found also to be higher in ischemic than hemorrhagic stroke (29.8%[95% CI: 26.7-33.0] vs. 14.6% [95% CI: 10.8-19.4], p < 0.05). The mean IMT (carotids: 2.01+1.33 mm; vertebrals: 0.96+0.54mm, p<0.001) and prevalence of plaques (carotids: 8.8%; vertebrals: 1.7%,p<0.001) were higher in carotid than vertebral arteries. Age, hypertension, level of formal education, history of smoking, average monthly income, and family histories of hypertension and stroke were associated with intima-media thickening in the carotids (all p< 0.05) in the ischemic stroke patients while family history of hypertension, diabetes mellitus, and level of formal education were independently associated with intima-media thickening in the carotids (all p< 0.05) in the hemorrhagic stroke patients. No CVRF showed an independent association with the presence of plaque in the carotid and vertebral arteries both stroke types. Conclusions: One off our stroke patients in our cohort had atherosclerotic plaques, with ischemic patients being twice as likely to have this burden compared to hemorrhagic patients, and carotid atherosclerosis being five times as frequent as vertebral atherosclerosis.

A Study to Evaluate the Practice and Training in Obstetric Ultrasound at Accredited Obstetrics and Gynaecology Training Institutions in Nigeria.

Background: There is a global trend towards domiciling Obstetric and Gynaecologic ultrasound scan services and training within the Obstetrics and Gynaecology Department. This requires readiness on the part of the Obstetrics and Gynaecology residency programmes to offer hands-on training and mentorship to its trainees. This study aims to assess the services and training potential of these centres in Obstetrics and Gynaecology ultrasound in Nigeria. Methodology: A cross-sectional descriptive questionnaire-based survey among the various tertiary health facilities which offer post graduate fellowship training in Obstetrics and Gynaecology in Nigeria was conducted. A list of all the centres accredited for obstetrics and gynaecology residency training by the National Postgraduate Medical College of Nigeria was obtained. An obstetrician was identified, and a pretested self-administered questionnaire was mailed to him as a hard copy and an electronic copy was forwarded as well. The questionnaire was filled by the Obstetrician and returned for collation. The completed forms were populated into an excel spreadsheet and summary and descriptive statistics carried out. Results: There was a valid 71% response rate from the 56 accredited centres. Thirty five percent of the centres had established subspecialty units. Only 10% had fully functional ultrasound service that catered for over half of their clients. Half of the responding centres did not have any ultrasound scan machines, and these too lacked any trained personnel in ultrasound within the department. Nearly all respondents supported the drive towards an obstetrician led ultrasound scan service but majority cited lack of protocols, trained personnel and dedicated time as major impediments to achieving this ideal. Conclusions: There is a lack of preparedness for domestication of obstetric ultrasound service and training in the obstetrics and gynaecology Department in Nigeria. There is the need to address the acute shortage of personnel to expand the frontiers of ultrasound service and training.

Pneumatization Patterns of the Sphenoid Sinus in Adult Nigerians and Their Clinical Implications.

Background: The variant pneumatization patterns of the sphenoid sinus have significant surgical implications due to their associated inconsistent neurovascular relations. This study aimed at evaluating the pneumatization patterns of the sphenoid sinus in adult Nigerians. Methods: This was a retrospective study conducted at the Radiology Department of a Tertiary Hospital in Nigeria after obtaining institutional ethical approval. Brain Computed Tomography images of 336 patients (137 females, 199 males) aged ≥20 years were studied for the variant pneumatization patterns of the sphenoid sinus. Statistical Package for Social Sciences version 23 was used for data analysis. Chi-square test was used to assess for the association of the variants with gender and side. Pvalue was considered significant at <0.05. Results: The predominant pneumatization pattern in relation to the seller turcica was the sellar type (181;53.9%) followed by the presellar type (65;19.3%), post-sellar (62;18.5%), and lastly the conchal type (28;8.3%). The most prevalent clival recess was the subdorsal type (25;7.4%) followed by the dorsal (18;5.4%), combined (7;2.1%), and lastly occipital (3;0.9%). The frequency of pneumatized anterior clinoid process, greater wing of sphenoid and pterygoid process was 76;22.6%, 60;17.9% and 141;42% respectively and these showed significant side difference (P=0.001 each). None of the pneumatization patterns showed a significant gender difference. Sphenoid sinus agenesis was not observed. Conclusion: The pneumatization patterns in our study varied from the findings in previous Nigerian studies and other populations. There is therefore the need for preoperative evaluation before endoscopic transsphenoidal surgical procedures.

Development and Reliability of a User-Friendly Multicenter Phenotyping Application for Hemorrhagic and Ischemic Stroke.

BACKGROUND: Annotation and Image Markup on ClearCanvas Enriched Stroke-phenotyping Software (ACCESS) is a novel stand-alone computer software application that allows the creation of simple standardized annotations for reporting brain images of all stroke types. We developed the ACCESS application and determined its inter-rater and intra-rater reliability in the Stroke Investigative Research and Educational Network (SIREN) study to assess its suitability for multicenter studies. METHODS: One hundred randomly selected stroke imaging reports from 5 SIREN sites were re-evaluated by 4 trained independent raters to determine the inter-rater reliability of the ACCESS (version 12.0) software for stroke phenotyping. To determine intra-rater reliability, 6 raters reviewed the same cases previously reported by them after a month of interval. Ischemic stroke was classified using the Oxfordshire Community Stroke Project (OCSP), Trial of Org 10172 in Acute Stroke Treatment (TOAST), and Atherosclerosis, Small-vessel disease, Cardiac source, Other cause (ASCO) protocols, while hemorrhagic stroke was classified using the Structural lesion, Medication, Amyloid angiopathy, Systemic disease, Hypertensive angiopathy and Undetermined (SMASH-U) protocol in ACCESS. Agreement among raters was measured with Cohen's kappa statistics. RESULTS: For primary stroke type, inter-rater agreement was .98 (95% confidence interval [CI], .94-1.00), while intra-rater agreement was 1.00 (95% CI, 1.00). For OCSP subtypes, inter-rater agreement was .97 (95% CI, .92-1.00) for the partial anterior circulation infarcts, .92 (95% CI, .76-1.00) for the total anterior circulation infarcts, and excellent for both lacunar infarcts and posterior circulation infarcts. Intra-rater agreement was .97 (.90-1.00), while inter-rater agreement was .93 (95% CI, .84-1.00) for TOAST subtypes. Inter-rater agreement ranged between .78 (cardioembolic) and .91 (large artery atherosclerotic) for ASCO subtypes and was .80 (95% CI, .56-1.00) for SMASH-U subtypes. CONCLUSION: The ACCESS application facilitates a concordant and reproducible classification of stroke subtypes by multiple investigators, making it suitable for clinical use and multicenter research.

Phakomatosis pigmentovascularis type IIb in association with external hydrocephalus.

Phakomatosis pigmentovascularis (PPV) is a rare sporadic genetic disorder characterised by co-occurrence of an extensive vascular nevus and a large pigmentary nevus with or without extracutaneous manifestations. There are four types of PPV with subtype 'a' for cutaneous involvement only and subtype 'b' for cutaneous and systemic involvement. PPV type IIa consists of nevus flammeus, Mongolian spots and sometimes nevus anemicus. Prognosis depends on associated systemic disorders. Two independent cases of PPV type IIb presented with nevus flammeus, aberrant Mongolian spots, ocular and central nervous system anomalies. Case 1 had external hydrocephalus previously unreported in PPV while case 2 had hydrocephalus exvacuo. Both patients had seizure disorder and neurodevelopmental delay. They were on long-term neurologic and ophthalmologic management while their cutaneous lesions partially regressed. PPV affects all racial and ethnic groups. The occurrence of external hydrocephalus in PPV expands the spectrum of its systemic manifestations.