Prevalence, demographics and clinical characteristics of multiple sclerosis in Qatar.

No published epidemiologic data on multiple sclerosis (MS) in Qatar exist. Our objectives were to determine the prevalence, demographics and clinical characteristics of MS in the Middle Eastern country of Qatar. We analyzed data for Qatari MS patients fulfilling the McDonald diagnostic criteria. A total of 154 patients fulfilled the inclusion criteria. On 31 April 2010, the crude prevalence of MS in Qatar was 64.57 per 100,000 inhabitants (95% CI: 58.31-70.37). The female-to-male ratio was 1.33:1. A positive family history was found in 10.4% of included MS patients. We conclude that Qatar is now a medium-to-high risk area for MS, with some important differences in clinical characteristics as compared to other countries in the region.

Hypothalamic hamartoma presenting with gelastic seizures, generalized convulsions, and ictal psychosis.

We report a case of hypothalamic hamartoma in an adult female who presented with gelastic seizures, generalized convulsions, and ictal aggressive psychotic behavior. Anticonvulsant treatment was ineffective in controlling the epileptic seizures. Surgical excision after accurate imaging diagnosis 3 decades after the onset of symptoms markedly ameliorated her condition. Delayed and erroneous diagnosis had unnecessarily prolonged the suffering of our patient.

Cerebral venous thrombosis. Clinical presentation and outcome in a prospective series from Sudan.

OBJECTIVE: To describe the presentation and outcome of treatment of cerebral venous thrombosis (CVT) in patients from Sudan, an example of a developing country. METHODS: In a prospective study, we described the clinical features, risk factors, and outcome of CVT in patients admitted to the National Center for Neurological Diseases, Khartoum, Sudan, the only specialized neurological hospital in the country, during the period from February 2001-October 2006. Patients were referred from other hospitals in the town or from nearby hospitals in Khartoum state. RESULTS: We recruited only adult and adolescent patients aging >/=15 years. We reviewed 15 patients (12 females and 3 males) with a mean (+/-SD) age of 33.9+/-11.8 years. Headache (n=15), papilledema (n=13), paresis (n=3), and generalized seizures (n=3) were the most common symptoms, and signs encountered. A prothrombotic risk factor was often identified (n=12). At the time of the first visit namely, 12 weeks after discharge, 7 patients (46.7%) attained complete neurological recovery, 4 (26.7%) developed optic atrophy, and 2 (13.3%) died of pulmonary embolism. CONCLUSION: The clinical features and risk factors of CVT in Sudan are not different from elsewhere, but the outcome is less favorable. Places with less privileged health service resources, late presentation or delayed accessibility to appropriate diagnostic tools may negatively influence the final outcome.

Anticardiolipin antibodies in stroke patients in Sudan. Appraisal of their significance in a region of high burden of endemic infections.

OBJECTIVE: To screen and evaluate the significance of anticardiolipin seroprevalence in patients with acute ischemic stroke, in patients with infectious disease, and in healthy subjects resident in Sudan, a tropical country endemic for several infectious diseases. METHODS: We conducted the study in Khartoum Teaching Hospital in Khartoum, Sudan between July 2003 and January 2005. We included 89 stroke cases, 30 infectious disease patients, and 30 asymptomatic healthy subjects. We estimated IgG and IgM anticardiolipin antibody titers in serum samples from all subjects in the 3 study categories at the time of hospital admission. RESULTS: We found a significantly higher prevalence of anticardiolipin antibodies in the stroke and infection groups compared to the healthy subjects. However, there was no significant difference in anticardiolipin seroprevalence between patients with stroke and patients with infectious disease. CONCLUSION: Caution is necessary when interpreting the presence of antiphospholipid antibodies as a stroke risk in patients harboring infection or living in places with high endemicity of infectious diseases.

Guillain-Barré syndrome following acute falciparum malaria.

Plasmodium falciparum malaria is often complicated by involvement of the gastrointestinal, cardiovascular, and nervous systems. The development of Guillain-Barré syndrome in 10 patients who had had acute P. falciparum malaria during its seasonal exacerbation is reported.

Parasite diversity in adult patients with cerebral malaria: a hospital-based, case-control study.

Thirty adult patients with cerebral malaria (CM) were recruited for this study. Two clinical groups were used as controls: those with mild malaria (n = 20) and asymptomatic volunteers (n = 20). Thick and thin blood smears were examined for detection of Plasmodium falciparum and estimating infection intensity. A nested polymerase chain reaction (PCR) using allele-specific primers for merozoite surface protein gene was used to determine the parasite diversity of Plasmodium falciparum causing CM. Plasmodium falciparum was detected in blood smears of all malaria patients. No significant difference in parasite count was found between the groups. Thirteen (65%) of the asymptomatic volunteers had a positive PCR for P. falciparum. Multiple alleles were found in 17 (58.6%) patients with CM, but only in 7 (35.6%) with uncomplicated malaria. Multiple alleles were also found in 6 (46.2%) of the 13 PCR-positive asymptomatic individuals. We could not identify a specific strain or strains of P. falciparum that showed a significant association with disease severity. Therefore, we assume that the development of CM in adults residing in endemic areas is more dependent on strain multiplicity rather than on a specific strain or strains of P. falciparum, and that the parasite intensity has no relationship with disease severity. Asymptomatic adults may repeatedly be exposed to low levels of a wide range of different strains during low transmission season and acquire sub-patent parasitemia. This may also confer premunition that renders them relatively resistant to CM.

Acute stroke type, risk factors, and early outcome in a developing country: a view from Sudan using a hospital-based sample.

This hospital-based prospective study was conducted to determine stroke type, risk factors, and early outcome in patients admitted with acute stroke in both Khartoum and Shaab hospitals located in the capital city of Sudan. Consecutive stroke patients presenting within 48 hours of onset were included in the study. Data were obtained from history taking, physical examination, and investigations. Cranial computed tomography (CT) scanning was performed on 18 patients. The diagnosis of stroke type in patients who did not have CT examination was determined by clinical criteria. Ninety-six patients, 56 males and 40 females, were studied. The peak age group was 61 to 80 years. Stroke caused by infarction was found in 58.3% while stroke caused by hemorrhage was found in 41.6%. Hypertension was the most common associated risk factor, constituting 46.9%. Cardiac disease was found in 16%, diabetes mellitus in 14.6%, syphilis in 4.1%, and previous transient ischemic attack in 2.1%. The overall mortality was higher than in western countries. Risk factors for stroke in Sudan are the same as elsewhere; however, the peak age group is one decade earlier than in developed countries. In developing countries, promoting hypertension and acute stroke health care programs are essential to cutting morbidity and mortality rates.

Autosomal dominant cerebellar ataxia type 1 in a Sudanese family.

OBJECTIVE: To study a large Sudanese family with a progressive autosomal dominant cerebellar ataxia and describe the clinical features and identify the genotype of the disorder. METHODS: This study was conducted during the year 1999 in the University Neurology Department of Shaab Teaching Hospital in Khartoum, Sudan. Affected individuals were identified by clinical examination or by reliable narrative data obtained from relatives of diseased or inaccessible family members. Routine laboratory blood and urine tests, cerebrospinal fluid analysis, cranial computerized tomography and nerve conduction studies were performed on the index patient and, if possible, family members. The genotype was identified by deoxyribonucleic acid analysis. RESULTS: Ten males and 12 females spanning 4 generations were affected by autosomal dominant spinocerebellar ataxia. Genetic studies identified the mutation to be at the spinocerebellar ataxia 1 locus on chromosome p6. CONCLUSION: This is a report of a Sudanese family suffering from Type 1 autosomal dominant spinocerebellar ataxia.

Neurological manifestation of recreational fatal and near-fatal diethylene glycol poisonings: case series and review of literature.

Diethylene glycol is a common industrial solvent which is responsible for accidental and epidemic poisoning as early as the 1930s. Due to the unavailability and unaffordability of ethanol, people in Qatar among the low income group are consuming household chemicals, some of which contain diethylene glycol, for recreational purposes.The history of ingestion is usually not volunteered and the initial clinical presentation is usually nonspecific, making it difficult to diagnose from the clinical presentation. Moreover, the biochemical profile varies with time, making the diagnosis more difficult. The neurological course and toxicity is less well characterized than its renal counterpart. Moreover, reports in the literature of such recreational poisoning is lacking particularly in the region.Three cases of recreational diethylene glycol poisoning seen in Hamad General Hospital, Doha, Qatar from 2009 to 2012 are detailed here.These illustrate the clinical course with emphasis on the neurological sequelae that include encephalopathy and multiple cranial and peripheral neuropathies with fatal and near-fatal outcomes. Neuroimaging in 2 were initially normal, but follow-up imaging showed brain atrophy. The third patient's neuroimaging showed diffuse brain edema with evidence of transtentorial herniation. Nerve conduction studies were performed in 2 of the 3 cases and showed evidence of mixed sensorimotor neuropathy. The outcomes were death in 1 and severe neurological morbidity and disability in 2 cases.Diethylene glycol is a dangerous substance when ingested and can result in mortality and severe morbidity, particularly from the renal and neurological manifestations. Whereas the mechanism of damage is less well known, the damage is likely dose related. The typical clinical pattern of evolution of the poisoning in the absence of cost-effective ways to detect it in the serum can help clinicians in making the diagnosis.Neurological manifestations may include encephalopathy and multiple cranial and peripheral neuropathies with subsequent brain atrophy. Public awareness of the danger of such recreational use should be raised.