Undiagnosed Epileptic Case Since Childhood of Sturge-Weber Syndrome: First Case Report from Somalia.

Sturge-Weber syndrome is a rare, sporadic, progressive neurocutaneous condition that presents with congenital hamartomatous malformations, epilepsy, and a variety of facial symptoms. We discussed a rare case of an eighteen-year-old female child who came to our neurology department with status epilepticus, mental impairment, and a port-wine in the lateral left side of her face. We diagnosed Sturge-Weber syndrome after a thorough neurological and radiological evaluation. The purpose of presenting this case is to illustrate both the characteristic presentation and the complications associated with managing Sturge-Weber syndrome.

Magnetic Resonance Imaging Findings and Their Association with Electroencephalographic Data in Children with Epilepsy at Tertiary Care Hospital in Mogadishu Somalia.

Introduction: Epilepsy is a neurological disorder characterized by abnormal, fast, synchronous neuronal discharge from the cerebral cortex. This abnormal excitation of the brain is usually short and self-limiting and can last anywhere from a few seconds to a few minutes. Neuroimaging and electroencephalography (EEG) are two widely used techniques to differentiate, verify, or exclude the diagnosis of epilepsy. The study aims to identify the frequency of EEG and MRI abnormalities in pediatric epilepsy and their correlations, aiming to improve diagnostic and treatment methods for these children. Materials and Methods: In this cross-sectional retrospective study, we evaluated pediatric patients aged 0-18 years who visited the Neurology Polyclinic between July 2022 and July 2023, were diagnosed with epilepsy in accordance with the ILAE 2014 epilepsy guidelines, and had undergone neuroimaging at the hospital's radiology department. Demographic information and clinical data, including the patient's age, gender, history of trauma, and congenital infection, were assessed. In all patients, a surface electroencephalogram (EEG) and brain magnetic resonance imaging (MRI) were performed. Results: Our study recruited 102 pediatric patients aged between 0-18 years, including 63 (61.8%) boys and 39 (37.2%) girls. An electroencephalogram (EEG) and MRI study have been done on all patients. An abnormal EEG study was seen in 79 (77.45%) participants, and an abnormal MRI was noted in 45 (44.1%) patients. The EEG and MRI were both abnormal in 34 cases (33.3%). The study found no significant correlation between magnetic resonance imaging and electroencephalographic findings (P =0.779). Conclusion: We observed multiple abnormalities on neuroimaging in pediatric epileptic patients. Even though our sample size was small, our results demonstrated that there is no statistically significant relationship between EEG and MRI results.

Tramadol-induced intracerebral hemorrhage: A rare case report.

A previously healthy middle-aged man with no vascular risk factors developed a hemorrhagic stroke. He had been using tramadol due to erectile dysfunction for 2 years. So, the patient developed right basal ganglia due to tramadol addiction.

Isolated Inferior Sagittal Sinus Thrombosis in Young Patient: Rare Case Report.

Cerebral venous thrombosis (CVT) is a less common type of stroke, mostly in young patients. The majority of these cases are due to thrombosis of superior sagittal sinus and transverse sinus. Isolated thrombosis of the inferior sagittal sinus is very rare. Here, we report a 22-year-old male patient with no significant past medical history who presented to the emergency department of our hospital with a convulsion, decreased level of consciousness, and right side weakness. His laboratory investigations, including the coagulation profile, were normal. A non-contrast brain CT showed a 5 × 3 cm hematoma in the left parasagittal parietal lobe with no associated midline shift or intraventricular extension. The cerebral magnetic resonance (MR) angiogram did not show any underlying aneurysm or vascular lesion. However, the cranial MR venogram showed inferior sagittal sinus thrombosis, while other cranial veins and dural sinuses were patent. The patient was admitted to the hospital and managed with low-molecular-weight heparin and warfarin sequentially. He had significant improvement (consciousness and weakness have improved, and seizures are under control). This present case illustrates a rare case of isolated cerebral venous thrombosis and also reviews the known literature on this condition.

Warfarin-induced isolated spontaneous subarachnoid hemorrhage: Rare case report.

Introduction and importance: Subarachnoid hemorrhage (SAH) is mostly associated with head trauma. Non-traumatic subarachnoid hemorrhage is mostly due to vascular abnormalities: either hemorrhage from ruptured aneurysm or bleeding from arteriovenous malformation. Aneurysmal hemorrhage is the biggest cause in non-traumatic cases. Warfarin is associated with cerebral intraparenchymal hemorrhage, but it is rarely associated with SAH. Case presentation: Here, we report the case of a 45-year-old male patient who was admitted to the neurology ward of our hospital due to acute ischemic stroke. The patient was treated with a vitamin K antagonist (warfarin). However, on the third day, his condition deteriorated (his GCS regressed from 11/15 to 5/15). His pupils were anisocoric. Brain CT showed extensive subarachnoid hemorrhage without intraparenchymal involvement. Cerebral magnetic resonance angiography ruled out aneurysmal rupture. The patient was intubated and transferred to the intensive care unit. Due to his poor condition, neurosurgical intervention could not be done. The patient was managed conservatively, but the patient passed away 4 days later in the intensive care unit. Clinical discussion: Non-traumatic SAH is mostly caused by aneurysmal rupture. Warfarin increases the risk of intracranial hemorrhage and mostly causes intraparenchymal hemorrhage. Isolated warfarin-related SAH without parenchymal involvement is a rare event. Here we present a young male patient with an isolated warfarin-induced SAH. Conclusion: Warfarin is rarely associated with isolated subarachnoid hemorrhage. This case highlights a young male patient with spontaneous SAH after warfarin therapy for acute ischemic stroke. Aneurysmal rupture and trauma should be excluded before a diagnosis of warfarin-induced SAH is made.