Ophthalmic Manifestations in Patients with Intracranial Tumours

Background: This study was aimed at determining the ophthalmic manifestations of patients presenting with brain tumours in a Nigerian tertiary hospital. Method: A retrospective crossectional review of patients with brain tumors in the Neurosurgical Unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife from January 2003 to December 2007 was conducted. Data on biodata, source of referral, diagnosis, visual acuity at presentation and management were recorded and analyzed for simple frequency using the SPSS version 11. Visual acuity was classified using the WHO classification for presenting acuity in the better eye. Results: Out of a total of 94 patients, 88 with complete information were reviewed. There were 53 [60.2%] males and 35 [39.8%] females; the mean age was 36.2±20 years. Fourteen [15.9%] patients were referred by Ophthalmologists. Meningiomas(36.4%), craniopharyngioma(13.6%) and gliomas(9.1%) were the most common brain tumours encountered. Fifty nine(67.9%) had visual complains at presentation; poor vision (46.6%) and double vision (12.5%) were the most common ocular symptoms while opticatrophy was the commonest ocular sign (23.9%). 46 (52%) %) were blind while 14(16%) had visual impairment. Patients with visual impairment and blindness were more likely to have visual complains at presentation (88.3%) compared with 50% amongst patients with normal vision (P=0.003). Conclusion: Ophthalmic signs and symptoms form a major part of presentation in patients with intracranial tumours. Health education and complete ophthalmic evaluation is essential in patients with brain tumours

Retinal diseases in a tertiary hospital: the need for establishment of a vitreo-retinal care unit.

AIM: To evaluate the need for vitreo-retinal care for suburban and rural communities of southwestern Nigeria. METHODOLOGY: A retrospective review of patients with posterior segment diseases attending the general ophthalmology clinics of Obafemi Awolowo University Teaching Hospital's complex, Ile Ife, southwestern Nigeria, between January 2001 and December 2006 was conducted. The age, sex and diagnosis were analyzed and needs assessment conducted. RESULTS: Three-thousand, one-hundred-thirty-one new cases were reviewed of which 407(13%) patients presented with retinal diseases. Their mean age was 46.3 +/- 21.4 years, mode 60 years and male:female ratio 1.3:1 (P=0.05). Macula diseases (35.6%), hypertensive retinopathy (12%), retinochoroiditis (11.5%) and diabetic retinopathy (9.6%) were the predominant retinal diseases. Age-related macular degeneration was the most frequent of the macular diseases (38.6%), with a female preponderance (p=0.06). It is estimated that fundus photography +/- fluorescein will be beneficial in 89.4%, laser photocoagulation in 36.4% and vitreo-retinal surgical procedure in 16.4%. CONCLUSION: Posterior segment diseases are not uncommon in rural communities of southwestern Nigeria. Facilities for fundus angiography, laser photocoagulation and a vitreoretinal surgical unit in trained hands will improve the capacity for specific diagnosis and appropriate management of vitreo-retinal diseases in these communities.

Compound elevated skull fracture: a forgotten type of skull fracture.

BACKGROUND AND OBJECTIVE: We report 4 patients who presented with a rare type of vault fracture. This form of fracture has only been described in few instances in the literature. CASE DESCRIPTION: All the patients presented with elevation of free skull fracture fragments. The etiologies were assault (1 patient), domestic accident (1 patient), and road traffic accident (2 patients). All the fractures were compound as in previously reported cases. Delay in surgery resulted in cerebral abscess in 1 patient. Surgery was performed in all the patients: wound debrident, duroplasty, and reduction of fracture in 3 patients and craniotomy with excision of abscess in 1 patient. Two of the patients did well after surgery. The patients with abscess died 9 days after surgery. Another patient developed CSF fistula after surgery, and died of aspiration while waiting for the closure of the fistula. CONCLUSION: Elevated skull fractures in our series were all compound fractures. Both long, sharp objects as well as blunt objects can cause this injury. Delay in surgery could result in intracranial sepsis. We suggest that this fracture should be included in the classification of skull fractures.