East African Journal of Neurological Sciences

Management of Chronic Subdural Hematomas with Bedside Placement of Twist Drill Subdural Evacuation Port System: A Single Center Retrospective Review

2024-07-02T06:06:46+00:00

Objective: Chronic subdural hematoma (cSDH) is prevalent globally and its management is evolving to minimize morbidity while optimizing theater utilization. We present our institution’s experience with subdural evacuation port system (SEPS) as a first-line treatment approach to cSDHs.

Methods: A retrospective review was performed of patients undergoing bedside SEPS placement in a single institution. Pre- and post-procedural radiographic and clinical data were collected and analyzed to identify predictive variables of procedural success for the SEPS approach. For procedure failures, subsequent procedures were analyzed for rates of success.

Results: 268 patients were identified for a total of 326 initial procedures. Pre-procedural variables associated with improved odds of a good outcome were: unilateral cSDH, prior use of anticoagulation, GCS > 13 at presentation, larger cSDH, and greater degree of midline shift (MLS). 65% success rate was observed for initial SEPS placement and an overall success of 78% after repeat SEPS. Bilateral SDH with bilateral SEPS placement had 56% success, a significantly lower success rate than unilateral placement (p=0.0147). Patients with subsequent failures underwent craniotomy. Patients who had a successful SEPS procedure had an average LOS of 13 ± 39 days compared to 25 ± 65 in incidents of failure (p=0.047). Average follow-up after discharge was 2.8 ± 3.8 months.

Conclusions: Bedside SEPS placement is a low-risk option for first-line treatment of cSDH and may spare patients from the risks of general anesthesia while reducing burden on surgical theaters in resource-limited settings. Performing a repeat SEPS procedure is a reasonable surgical option if the first procedure fails to completely evacuate the cSDH.

Blood Pressure Variability and Shifting in Clinical Outcome Amongst Stroke Patients in Southwestern Uganda

2024-07-02T06:14:48+00:00

Background: Higher blood pressure variability is associated with shifting towards worse outcome among stroke patients.

Methods: We conducted a prospective cohort study of CT head confirmed ischemic and hemorrhagic stroke admitted within 7 days of onset of motor weakness. Blood Pressure Variability (BPV) indice; Standard Deviation (SD) of systolic and diastolic Blood pressure (BP) between 0 and 7 days after admission was calculated with subsequent modified Rankin Scale (mRS) score on day 14 and day 30 post-stroke. Ordinal logistic regression was fitted to determine the adjusted odds ratios (aOR) for shifting towards worse clinical outcome at 30 days among patients with stroke that had survived beyond 14 days with 95% CI and p value<0.05 used as statistical significance.

Results: Out of 120 patients, 32 patients passed on by day 14, 88 patients survived beyond day 14. Fourteen patients had a 1 point shift in MRS towards worse outcome at 30 days of stroke onset. Blood pressure variability SD systolic BP tertiles (2&3) had aOR: 1.6, p= 0.306 (95%C.I: 0.6-4.1) and 5.8, p = 0.002 (95%C.I: 1.9-17.5) respectively. NIHSS≥16 had aOR=3.8 (95%CI: 1.5-9.6) P=0.004 and time to presentation ≥ 3 days had aOR=2.8 (95% C.I:1.2-6.3) p=0.013.

Conclusion: Higher BPV (tertile 3), late presentation ≥ 3 days and high NIHSS conferred statistically significant odds of shifting towards a bad functional outcome.

Statins: An Alternative To Surgical Treatment Of Chronic Subdural Haematoma In The Poly Pathological Elderly?

2024-07-02T06:23:42+00:00

Chronic subdural haematoma is a frequent pathology of the elderlý especially in comorbid terrain. The treatment is almost always surgical. Sometimes this surgery is not possible and a medical treatment based on corticosteroids is most often required. We report the cases of two patients followed for chronic subdural haematoma with several comorbidities and ineligible for surgery. A statin-based treatment was initiated. The aim is to consolidate the hypothesis of medical management of chronic subdural haematoma. The first case was about an 87-year-old patient followed in cardiology for cardiac arrhythmia with a Pacemaker insertion in 2021 on Aspirin 100mg and oral anti-diabetic and insulin therapy for 15 years. Clinically, he presented with intense headaches without neurological deficit. The brain scan performed revealed a chronic left hemispheric subdural hematoma with mass effect. Treatment with atorvastatin at a dose of 20mg/ day for three months was initiated. The evolution was marked by the disappearance of headaches after two weeks. After three months of treatment, the haematoma disappeared completely. The second patient was an 83-year-old man also followed in cardiology for heart failure and in gastroenterology for a gastric tumour undergoing chemotherapy who had been suffering for three weeks from intense headaches with left hemiparesis. Brain CT scan: right hemispheric subdural hematoma with mass effect. Treatment with atorvastatin 20mg was started for three months with radiological controls at one month and three months with a favourable evolution.

Conus Medularis Neuroschistosomiasis In A 12-Year-Old Boy

2024-07-02T06:34:26+00:00

Introduction: Neuroschistosomiasis, an infrequent consequence of schistosomal infection, typically presents with deteriorating motor and sensory function coupled with sphincter dysfunction. Diagnosis involves a clinical history, physical examination, cerebrospinal fluid studies, and imaging.

Case report: We detail the case of a 12-year-old boy hailing from Machakos County, who manifested lower limb weakness and urine retention for two weeks. Examination unveiled diminished lower limb tone and areflexia, with a power grade of 0 in distal muscles below the knee and normal muscle bulk. Magnetic resonance imaging revealed a cauda equina region tumor. Subsequent histopathology after tumor-debulking surgery unveiled schistosomal-associated necrotizing granulomatous inflammation. Following tumor resection at T1-L1 and receipt of histopathology results, the patient underwent optimum pain management and praziquantel therapy. Clinical improvement ensued, albeit with distal paralysis.

Conclusion: Our case highlights the necessity of heightened suspicion for cauda equina tumors in young patients from schistosoma-endemic regions, advocating early diagnosis and management involving praziquantel treatment.

Mood Disorders Associated With Pituitary Adenoma

2024-07-02T06:42:37+00:00

Pituitary adenomas have been found to exhibit associations with various mood disorders, including depression, mania, and anxiety disorders. Additionally, these adenomas have been observed to manifest other psychiatric symptoms, such as psychosis, eating disorders, apathy, and suicidal ideation. A comprehensive literature review was conducted, employing diverse search engines including PubMed, Cochrane, and Google Scholar. The search terms utilised encompassed "pituitary adenomas," "mood disorders," "Hypothalamo-pituitary axis," "hypopituitarism," "acromegaly," "depression," "mania," and "psychosis." The publications that were chosen consisted of case reports and relevant research articles. There is a high prevalence of comorbidity between pituitary adenomas and depressive and anxiety disorders. The manifestation of these symptoms can be attributed to the endocrine dysfunction associated with pituitary adenomas, as well as the physical impact and infiltration of the tumours into the brain. Furthermore, it has been noted that apathy syndrome and chronic fatigue syndrome may be mistakenly diagnosed as depression among individuals within this specific patient demographic. Mood disorders can impact the process of diagnosing and treating pituitary adenomas. Diseases of this nature can potentially impact patients' daily functioning and their ability to engage in social activities. These individuals require suitable medical intervention to enhance their prognosis.