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Background: Complications associated with ventriculoperitoneal shunt insertion constitute a significant cause of morbidity and mortality among hydrocephalus patients. Despite this, VP shunt placement has remained the mainstay of treatment for hydrocephalus. The aim of this study is to evaluate the complications of VP shunt surgery in our environment and to identify the risk factors associated with it. Methodology: Patients who had VP shunt surgery over a period of two years (Jan 2015-December 2016) were evaluated retrospectively by reviewing their hospital records. The patients' demography, aetiology and clinical presentation of the hydrocephalus, and complications were analysed using SPSS version 26.0. Results were presented in tables and figures. Results: A total of 69 patients who had VP shunt over the study period had complete medical records available for review. Their age ranged between 2days and 68years with a male to female ratio of 1.8:1. Overall complication rate was 30.4%. Shunt malfunction (11.5%) and shunt infection (7.2%) were the commonest complications recorded. Late presentation was the most important risk factor for shunt complications. Conclusion: The rate of shunt complications seen in this study compares fairly with studies in other parts of the world.
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INTRODUCTION: Chest infections are a frequently encountered problem in patients admitted to the intensive care unit (ICU), more so in tracheostomised patients. This study aimed to audit the tracheostomy care practices in patients with neurosurgical pathologies in the ICU of Wellington Clinics Abuja, a tertiary neurosurgical hospital in Nigeria. METHODS: We conducted a closed-loop audit with mixed methods involving analysis of 24 patients who had tracheostomy within the first two weeks of neurosurgical pathology at a tertiary neurosurgical hospital and semi-structured interviews to determine tracheostomy care practices among the primary caregivers - nurses, intensivists, and doctors. RESULTS: Of the 161 ICU admissions in the first cycle, 22 patients received tracheostomy, 16 met the eligibility criteria. At re-audit (second cycle), eight of 40 patients met the criteria. All the patients received open suctioning through a dual cannula-cuffed tracheostomy tube and had independent portable suction units. In the baseline audit (first cycle), suction catheters were reused for 12-24 hours in each patient and were stored in varying combinations of normal saline and Savlon antiseptic (5 mg of cetrimide (0.5% w/w) and 1 mg of chlorhexidine digluconate (0.1% w/w)). The frequency, technique, and assessment of the need for airway suctioning were inconsistent among caregivers interviewed. All 16 patients had at least one episode of pneumonia, 10 patients had a second episode, and two patients had > two episodes. One mortality was recorded directly attributable to the complications of pneumonia. While in the re-audit, with adherence to recommendations, three patients suffered one episode of pneumonia and only one had a second episode. No mortality was recorded. CONCLUSION: A standard practice guideline was necessary for tracheostomy care in our ICU. In low-resource settings, stated recommendations such as single-use suction catheters and improved hygienic practices can reduce rates of pneumonia in tracheostomised patients.
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Fever is often associated with infectious, traumatic, or allergenic etiologies, a known consequence of the systemic inflammatory response. Its association with a rise in intracranial pressures (ICP) is an uncommon presentation. We herein describe two patients who developed acute hydrocephalus and presented with high-grade fever. This febrile component was resistant to conventional antipyretics and was only relieved by cerebrospinal fluid (CSF) diversion.
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Background Acute traumatic subdural hematoma is life-threatening and is associated with high unfavorable outcomes in developing countries. Objective We aim to identify factors contributing to outcomes after severe traumatic brain injury (TBI) due to acute subdural hematoma (SDH) in patients admitted to National Hospital Abuja, Nigeria. Methods This was a retrospective review of 34 patients who consecutively underwent neurosurgery for acute SDH over five years (from January 2015 to December 2019). Demographic data, clinical characteristics, and the time intervals from injury to surgery were investigated to determine the interactions between all these factors and outcome. Outcome was graded according to the Glasgow outcome scale at the three-month follow-up. Results Out of 34 patients who had surgical evacuation for traumatic acute subdural hematoma, 15 patients died (44.1%). A significant correlation was identified between outcome and the Glasgow coma scale score at admission. No significant correlation was seen between the outcome and the age, gender and the time from injury to surgery (chi2 test, p>0.05). Conclusion The rate of unfavorable outcomes in acute subdural hematoma is high. The Glasgow coma score at admission is an important predictor for outcome in traumatic acute subdural hematoma.
