RESUMO
Background: Intracranial aneurysms (IAN) are rare in the Sub-Saharan Africa unlike other parts of the world. The debate is whether the low frequency might be apparent because of the scarcity of advanced neuroimaging services, or real. This study investigated if improved imaging facilities would debunk the rarity of IAN in our subregion. Methods: This is a retrospective cohort study of prospectively recorded data of patients with subarachnoid hemorrhage (SAH) and IAN managed over 19 years (2003-2021), at the study center with a catchment population of over 47 million. The center witnessed progressive improvements in neuroimaging facilities: 2-Slice, 8-slice, and 64-slice computed tomography (CT) and 0.35T, 1.5T magnetic resonance imaging (MRI) during the period. Results: There were 241 cases of SAH, but only 166 aneurysms were confirmed in 158 patients. Between 2003 and 2008, only 27 IAN patients (4.5 IAN/year) were diagnosed. After introduction of CT angiography/magnetic resonance angiography MRA using 8-slice CT/0.35T magnetic resonance imaging (MRI), between 2009 and 2014, the frequency of IAN increased to 8/year. Between 2015 and 2018 after installation of a 64-slice CT in 2014, the IAN remained the same (8/year). MRI 1.5T was added in 2018, the frequency doubled to 17 cases/year. The females were more (67.7%), the mean age was 46.3 years, but peak incidence was the sixth decade. Internal carotid artery aneurysms including posterior communicating artery were the most common (43%) followed by ACA with anterior communicating artery (24%) and middle cerebral artery (20%). Multiple aneurysms were seen in ten patients. Conclusion: Improved neuroimaging between 2003 and 2021 did not debunk the rarity of IAN in our region.
RESUMO
Background: Balo's concentric sclerosis (BCS) is a rare variant of multiple sclerosis (MS) that usually runs a benign course. Typically, brain magnetic resonance imaging (MRI) shows concentric lamella of areas of demyelination alternating with normal zones of myelin preservation. Clinically, it may be mistaken for other intracranial space-occupying lesions, especially in our subregion, where neuroimaging facilities are scarce or not affordable. The authors report a rare case of BCS in a young Nigerian male diagnosed and managed in Enugu, Nigeria. This is possibly the first reported case in sub-Saharan Africa. Case Description: The patient presented with behavioral changes, focal seizures, cranial neuropathy, long tract signs, and cerebellar dysfunction causing severe disability and functional impairment with a Modified Rankin Score (mRS) of 4. Brain MRI showed multiple heterogeneous lesions in the right cerebral hemisphere, brainstem, and cerebellum with features in keeping with BCS. Cerebrospinal fluid oligoclonal bands were negative and C-reactive protein was normal. He had high-dose steroids and immunosuppressive therapy. He made a gradual neurological improvement and significant symptom resolution and was able to return to work after a year (mRS-1). Conclusion: BCS is a rare variant of MS in sub-Saharan Africa. The mainstay of diagnosis is MRI which shows the typical concentric demyelinating pattern. Steroids and immunosuppressive therapy are effective in the treatment of BCS.
RESUMO
Background: Repetitive seizures are neurological emergencies which may occur in people with epilepsy. Ascertaining the incidence of these episodes of such seizures in the community is wrought with many challenges and few reports exist in sub-Saharan Africa, a region with a high burden of epilepsy. The aim of this study was to describe the caregiver reported frequency of acute recurrent seizures in people with epilepsy attending neurology outpatient clinic in Enugu. Methods: This cross-sectional study was performed in the medical out-patient clinics in Enugu Nigeria. Data were collected using a structured questionnaire from an existing epilepsy register. Cluster seizures were defined as frequent repetitive seizures (two or more) occurring more than usual within a week. Epilepsy was defined based on ILAE criteria. Results: A total of 73(45.3%) reported a lifetime history of cluster seizures; similar in males 39(48.1%) and females 34(45.9%). P=0.73. About36.4% and 38.2% of PWE who had a history of traumatic brain injury and stroke had also experienced at least one SC. A large proportion of PWE with SC also had experienced status epilepticus in the past. Seizure cluster was correlated by older age of onset, having various forms of seizures and longer seizure freedom. Conclusions: The reported lifetime history of cluster seizures among people with epilepsy attending a tertiary hospital clinic is high. This may suggest both poor seizure control and severity. Careful patient education will improve both adherence and emergency management of epilepsy to reduce the morbidity of epilepsy in the community.