The pattern of distribution of encephalocele in University of Port Harcourt Teaching Hospital--a three year experience.

BACKGROUND: Encephalocele is a congenital anomaly that results from failure of complete neural tube closure during foetal development. It is a known cause of mortality and morbidity in infants. This study was carried out to highlight its distribution pattern in University of Port Harcourt Teaching Hospital over a three-year-period. METHODOLOGY: This is a retrospective study of children with encephalocele admitted from January 2007 to December 2009. The following information were obtained from their medical records: sex, age at diagnosis, distribution pattern, place of origin, detailed antenatal history, maternal occupation/level of education, family history, associated anomalies and outcome of surgery. RESULTS: 17 cases (10 females and 7 males) were seen over this period. 12 presented as frontal encephalocele while 5 were occipital. Their ages at diagnosis were: prenatal (determinded by abdominal ultrasound) 5, 0-6 months 11, and 7-12 months 1. 9 of 17 mothers were unbooked. Pregnancy was uneventful in all cases. None had family history of encephalocele. 5 had multiple anomalies while 12 had only encephalocele. 10 patients had surgery, of which 9 were successful. 1 died in the immediate postoperative period. 7 patients did not have surgery. Among these, 3 died before surgery while the parents of 4 children refused operation. 10 mothers had primary education, 5 secondary, while 2 had attained tertiary education. CONCLUSION: Encephalocele may be frontal or occipital. The distribution pattern of our cases was in favour of frontal location, with slight female preponderance.

Evaluation of the level of awareness of the role of folic acid in the prevention of neural tube defects amongst women of reproductive age in a tertiary health institution.

BACKGROUND: Neural tube defects are major cause of infant mortality and disability. Their occurrence has been linked to folate deficiency during pregnancy. Periconceptional use of folate has been shown to significantly reduce their incidence. Awareness of this relationship is key to adopting appropriate measures to prevent them. This study was carried out to assess the level of this awareness among reproductive-age female employees in a tertiary hospital. METHODOLOGY: Questionnaires designed to assess respondents' knowledge about neural tube defects and folic acid were completed by women of child-bearing age working in various departments of the University of Port Harcourt Teaching Hospital. Data were collated and analysed by a third party who had no knowledge of the respondents. RESULTS: 94.4% of the respondents had some knowledge about folic acid. 29.6% knew something about neural tube defects. 24.1% were aware that folate has a beneficial role in their prevention. 70.4% said they would not take it daily if they were not pregnant. CONCLUSION: The level of awareness about the role of folate in prevention of neural tube defects among respondents in this study is low; and thus there is poor response to suggestions regarding its periconceptional use. There is need to enhance this awareness to ensure that populations at risk benefit from research on the subject.

Oxidative stress following traumatic brain injury: enhancement of endogenous antioxidant defense systems and the promise of improved outcome.

BACKGROUND: Management of brain injury can pose enormous challenges to the health team. There are many studies aimed at discovering or developing pharmacotherapeutic agents targeted at improving outcome of head-injured patients. This paper reviews the role of oxidative stress in neuronal loss following traumatic brain injury and presents experimental and clinical evidence of the role of exogenous antioxidants as neuroprotectants. METHOD: We reviewed published literature on reactive oxygen species and their role in experimental and clinical brain injuries in journals and the Internet using Yahoo and Google search engines. RESULTS: Traumatic brain injury causes massive production of reactive oxygen species with resultant oxidative stress. In experimental brain injury, exogenous antioxidants are useful in limiting oxidative damage. Results with clinical brain injury are however more varied. CONCLUSION: Oxidative stress due to excessive generation of reactive oxygen species with consequent impairment of endogenous antioxidant defence mechanisms plays a significant role in the secondary events leading to neuronal death. Enhancement of the defence mechanisms through the use of exogenous antioxidants may be neuroprotective, especially if the agents can penetrate cell membranes, are able to cross the blood-brain barrier and if they are administered within the neuroprotective time window.

Oxidative Stress Following Traumatic Brain Injury: Enhancement of Endogenous Antioxidant Defence Systems and the Promise of Improved Outcome

Background: Management of brain injury can pose enormous challenges to the health team. There are many studies aimed at discovering or developing pharmacotherapeutic agents targeted at improving outcome of head-injured patients. This paper reviews the role of oxidative stress in neuronal loss following traumatic brain injury and presents experimental and clinical evidence of the role of exogenous antioxidants as neuroprotectants. Method: We reviewed published literature on reactive oxygen species and their role in experimental and clinical brain injuries in journals and the Internet using Yahoo and Google search engines. Results: Traumatic brain injury causes massive production of reactive oxygen species with resultant oxidative stress. In experimental brain injury; exogenous antioxidants are useful in limiting oxidative damage. Results with clinical brain injury are however more varied. Conclusion: Oxidative stress due to excessive generation of reactive oxygen species with consequent impai rment of endogenous antioxidant defence mechanisms plays significant role in the secondary events leading to neuronal death. Enhancement of the defence mechanisms through the use of exogenous antioxidants may be neuroprotective; especially the agents can penetrate cell membranes; are able to cross the blood-brain barrier and if they are administered within the neuroprotective time window

Disorders presenting with headache as the sole symptom.

Headache is one of the commonest medical complaints, and ranks high among the reasons why people consult neurologists and general practitioners. Most headache patients are, however, managed suboptimally; and indeed, many neurologists find outpatient headache management one of the least engaging parts of their job. Headache may present as part of a symptom complex or it may present alone. When it is part of a complex, the total presentation of the patient serves as pointer to any underlying disease. When it is the sole symptom however, identifying the specific cause can be more difficult. Even though the diagnosis and management of most cases of headache probably do not require sophisticated neurological skills or investigations, failure to recognise an underlying disorder or an attitude of total neglect can be fatal. In this paper, we briefly review some of the disorders reported to have presented with headache as the sole symptom with the aim of drawing attention to the need for proper attitude to every headache complaint even when it initially appears to be trivial. Two groups of headache are recognised - primary and secondary. More than 90% of headaches seen in practice are of the primary type, which includes migraine, tension and cluster headaches. Secondary headache results from a wide range of disorders which may be intracranial, extracranial or systemic. Intracranial causes of headache include tumours, haematomas, infections, idiopathic intracranial hypertension and vascular disorders. Some of the more common extracranial and systemic causes are shown in Tables 1 and 2 respectively. Recognition of these conditions requires a standardised diagnostic approach to history and examination, wherein the patient's history alerts the physician while the physical examination provides support for the diagnosis.

Orgasmic Cephalgia : an Uncommon Presentation

Background: Orgasmic cephalgia is rare; but it is likely that its prevalence is underestimated because of patients' arriere pensee when it comes to disclosing personal information concerning their sexual activities. Aim: To report a case of orgasmic cephalgia in a 34-year-old housewife. Method: All information was obtained from her medical records and investigation results. Relevant literature on headaches associated with sexual activity was also reviewed. Result: Patient developed sudden onset severe headache at orgasm; which rapidly worsened over 6 months to the extent that she began to dread all forms of sexual activity. She had only used unprescribed medication. She responded well to naratriptan and anxiolytics. By the third month of treatment; her headaches had completely disappeared. Conclusion: Most cases of orgasmic cephalgia are benign and probably do not require specific treatment. Triptans are useful for those that do not respond to conventional analgesics

Alterations in Family Psychodynamics Following a Ventriculoperitoneal Shunt Placement

Background: The emotional stress of a young couple whose child has hydrocephalus can be immense. When a shunt has to be inserted without the parents being thoroughly educated on every aspect of the procedure; the situation can be overwhelming and significant psychosocial problems can develop. Aim: To report the case of behavioural change in the father of a hydrocephalic child who underwent shunt placement and the threat of family collapse due to misconceptions about the procedure. Method : The records of the child; including history; examination; investigations and treatment were evaluated. The mother was extensively interviewed during follow-up out-patient visits. Relevant literature on shunt complications was reviewed. Result: Following shunt insertion for hydrocephalus in an only child of a young couple born after 3 years of marriage; the father started withdrawing from his family and gradually began to manifest symptoms of depressive illness. Recommendations: The parents of every child scheduled to have shunt insertion should be properly counselled together on all aspects of the procedure preoperatively. This would help ensure that any consent given is on the basis of their mutual understanding and acceptance of the situation. Where problems are anticipated; it might be necessary to take pre-emptive measures to forestall their occurrence

Sylvian cleft meningioma: surgical approach and postoperative morbidity.

BACKGROUND: Meningiomas without dural attachments are rare, and are commonly diagnosed postoperatively. We here report a case of meningioma and examine the surgical options. METHOD: We reviewed the case record of the patient who presented with a right sylvian cleft meningioma as well as relevant literature on the subject. RESULT: Brain CT scan performed on a 73-year-old woman on admission for non-specific symptoms revealed. a heterodense temporoparietal mass which was demonstrated on carotid angiography as being fed by the middle cerebral artery. Preoperatively, a glioma was considered as being most probable because of its radiological features. The mass, which at surgery was found to be located in the sylvian fissure, was however histologically confirmed to be a meningotheliomatous meningioma with fibroblastic component CONCLUSION: The surgical approach to meningioma of the sylvian cleft is a prime determinant of outcome following tumour resection. Making an appropriate approach largely depends on making a correct preoperative diagnosis for which a high index of suspicion is necessary.

Alterations in family psychodynamics following a ventriculoperitoneal shunt placement

Background: The emotional stress of a young couple whose child has hydrocephalus can be immense. When a shunt has to be inserted without the parents being thoroughly educated on every aspect of the procedure; the situation can be overwhelming and significant psychosocial problems can develop. Aim: To report the case of behavioural change in the father of a hydrocephalic child who underwent shunt placement and the threat of family collapse due to misconceptions about the procedure. Method: The records of the child; including history; examination; investigations and treatment were evaluated. The mother was extensively interviewed during follow-up out-patient visits. Relevant literature on shunt complications was reviewed. Result: Following shunt insertion for hydrocephalus in an only child of a young couple born after 3 years of marriage; the father started withdrawing from his family and gradually began to manifest symptoms of depressive illness. Recommendations: The parents of every child scheduled to have shunt insertion should be properly counselled together on all aspects of the procedure preoperatively. This would help ensure that any consent given is on the basis of their mutual understanding and acceptance of the situation. Where problems are anticipated; it might be necessary to take pre-emptive measures to forestall their occurrence

Catecholamine alterations in experimental hydrocephalus.

Experimental hydrocephalus was induced in rats by intracisternal injection of kaolin suspension. The amounts of norepinephrine and dopamine were determined in the whole brain and specific brain regions at 1 week (acute phase) and 4 weeks (chronic phase). The turnover of catecholamine, an index of the activity of catecholamine-containing neurons, was determined by measuring the decrease in catecholamine contents 2 h after intraperitoneal injection of alpha-methyl-p-tyrosine (250 mg/kg), an inhibitor of tyrosine hydroxylase. We observed that the catecholamine contents in kaolin-induced hydrocephalus were not significantly different from control values. Following injection of alpha-methyl-p-tyrosine, there was decrease in levels of catecholamines in both control and hydrocephalic rats. This decrease was, however, significantly less in induced hydrocephalus than in control animals. This result suggested that in hydrocephalus, the activities of norepinephrinergic and dopaminergic neurons are reduced.

Intracranial lipomas: current perspectives in their diagnosis and treatment.

Intracranial lipomas are very rare lesions, which are probably congenital. Though they can occur anywhere in the intracranial space, a high proportion of cases tend to be ++located around the midline. They are usually asymptomatic. When symptoms do occur, they are frequently the result of co-existing general clinical conditions. Lipomas used to be reported mainly as incidental findings at autopsy, but advances in neuroimaging techniques have greatly improved the likelihood of their being discovered during life. Surgical extirpation is not necessary in the majority of patients, many of whom show remarkable clinical improvement following shunt procedures for obstructive hydrocephalus (when present) as well as vigorous treatment of co-existing conditions.

[The studies of melatonin values in the cerebrospinal fluid of hydrocephalic patients].

The changes in daytime levels of melatonin (MLT) in the cerebrospinal fluid (CSF) of twenty seven hydrocephalic patients were studied by the high-performance liquid chromatography (HPLC) method. Patients comprised three with congenital hydrocephalus (spina bifida 1, Chiari type II malformation 2), four post-meningitic hydrocephalus, fifteen brain tumors (chiasmal germinoma 3; malignant glioma of frontal 3, and temporal lobes 1; germinoma 1, teratoma 2, yolk sac tumor 1, epidermoid 1 in pineal region) and five cases of normal pressure hydrocephalus. CSF was collected between 0930 and 1030 h through puncture of the flushing device of shunt system or the lateral ventricle. The lowest value of MLT detected by HPLC was 15 pg/ml. Melatonin values were higher in patients aged under 10 years than over 20 years in the absence of meningitis or tumor in the pineal region. Even at ages over 15 years, higher CSF MLT values were obtained in the patients with meningitis or tumors in the pineal region. These results suggest that the inflammation or invasion of tumor into the pineal gland may stimulate the secretion of MLT by the pineal gland. However, lower MLT values were obtained in all patients over 40 years old. For these reasons, if one may use the changes of MLT values in CSF as a tumor marker or for determination of the treatment modality, time of CSF collection, age of patient, location or character of the tumor and presence of meningitis should be given due consideration. Also, the presence or absence of the rhythmical changes of melatonin values in a day following circadian rhythm are very important in determination of the treatment modality.

Central nervous system bioaminergic responses to mechanical trauma. An experimental study.

Changes in biogenic amines in the brain and spinal cord following penetrating injury were studied in male Wistar rats using high-performance liquid chromatography with electrochemical detection. Rapid increase in hemispheric concentration of these substances was noted beginning shortly after trauma. This trend continued until they were about three to four times control levels by about 24 to 48 hours postinjury. In the spinal cord, however, there was an initial sharp reduction in regional concentrations 2 hours postinjury followed by a slow rise thereafter. By 48 hours postinjury, levels of norepinephrine, dopamine, and serotonin of the cords of injured animals were still less than those of nontraumatized controls. This variation in the central nervous system bioaminergic response with the level of injury raises questions as to its precise role in neurological damage following mechanical insult.

Intracranial lipomas.

Intracranial lipomas are very rare, probably congenital lesions. Though they can occur anywhere in the intracranial space, a good proportion of cases tend to be located around the midline. Review of the literature as well as our own three cases--which forms the basis of this article--shows that they are mostly asymptomatic. When symptoms occur, they are frequently the result of coexisting general clinical conditions. Lipomas used to be reported mainly as incidental findings at autopsy. Advances in neuro-imaging techniques have vastly improved the likelihood of their being discovered during life. At present however, significant increase in the reported incidence of these tumours is yet to be seen. Surgical extirpation of the tumour is not considered necessary in the majority of patients, many of whom show remarkable clinical improvement following shunt procedures for obstructive hydrocephalus as well as treatment of coexisting conditions such as epilepsy.

Bilateral aseptic femoral head necrosis associated with steroid therapy for prolactinoma--case report.

The authors report a recent case of prolactin-secreting pituitary adenoma in a young male who had earlier received treatment for infertility. Following partial adenomectomy, he was placed on postoperative steroid substitution among other treatments, but developed femoral head necrosis several months later. Hormone studies at the time showed significant findings, including an elevated serum cortisol level. The authors conclude that this complication resulted from prolonged steroid therapy and offer suggestions as to how a similar situation may be avoided.