East African Journal of Neurological Sciences

Qualitative and mixed methods research: underutilized tools in neuroscience research within the East African context

Felix Njoroge — 2024-07-29

Neuroscience, the intricate study of the nervous system, has traditionally relied heavily on quantitative research methods to decode the complexities of brain function, neural activity, and cognitive processes. However, the growing recognition of the limitations of purely quantitative approaches has led to an increasing appreciation for qualitative and mixed methods research globally. These approaches offer a richer, more nuanced understanding of the human brain, particularly when it comes to the investigation of experiences, behaviour, and societal impact. In the East African context, where cultural, social, and economic factors significantly influence health and disease, the application of these methodologies is particularly pertinent. This editorial article looks into the potential applications of qualitative and mixed methods research in neuroscience in East Africa, exploring how these methodologies can enrich our understanding of neuroscience.

Epidemiology and surgical outcomes of primary brain tumours managed at a tertiary hospital in Arusha, Tanzania.

Faraja Magwesela — 2024-07-29

Introduction: The epidemiology and outcome of brain tumours varies globally. We aimed to analyze the epidemiology and postsurgical outcomes of intracranial tumours in our setting. Methods: This is a retrospective cohort study. Data were obtained from patient clinical records between 2019 and 2020. Sub-group analysis was done to identify factors associated with postoperative outcomes (morbidity, improvement/deterioration of symptoms and mortality). Estimates of demographic and clinical data were expressed as percentages. A chi-square was used to compare the various patient outcomes between sub-groups with α <0.05. Results: 39 patients with primary brain tumours underwent surgery. Gliomas were the most common tumour (13/39) overall and craniopharyngiomas in pediatric patients (3/11). The majority presented late (>3 months), and had a poor Karnofsky performance status before surgery. Gross tumour resection was low (25.6%) and few patients underwent adjuvant therapy (28.2%). 30-day mortality rate and one-year mortality rate were high. Pediatric patients had a much worse outcome. Males had higher postoperative mortality, though females were more likely to have poor postoperative Karfnofsky performance status. Patients with gliomas accounted for the majority of the deaths. Conclusion: Delayed presentation and poor access to adjuvant therapies are common in our setting. Surgery improves patients’ performance status.

A radiological assessment of the morphology and morphometry of the Vidian canal in a select Kenyan population

Jimmy Njoroge — 2024-07-29

Background: The increased use of endoscopic approaches to the skull base has necessitated the identification of landmarks that assist in avoiding iatrogenic injury to structures within the skull base. The vidian canal (VC) is an established landmark for the petrous portion of the internal carotid artery (ICA). Although population differences have been reported in the literature, the area remains relatively unexplored in African populations. Materials and methods: Axial and coronal sections of 96 high-resolution computed tomography scans of Kenyan skulls were analyzed to determine VC morphometry. The VC length was determined using axial sections, and the VC - medial pterygoid plate (MPP) distance was determined using coronal sections. Results: The mean VC length studied was 16.50±2.30mm (10.50-22.40mm). No statistically significant differences were noted between sides (p=0.686) or sexes (p= 0.826, 0.593). The mean VC-MPP distance was 9.60±2.70 mm (2.40-21.40mm). No statistically significant differences were noted between sides (p=0.237) or sexes (p=0.886,0.850). The relational configurations of the VC to the SS were noted as follows: Type I (wholly within the cavity of the SS)-21.35%, Type II (VC on the floor of the SS or partially protruding into the SS) -76.57%, Type III (VC within the sphenoid corpus)- 2.08%. No significant correlation was noted between the type of VC configuration described and the side of the skull studied (p= 0.499). However, a significant correlation was noted between the type of VC configuration and sex (p=0.001). Conclusion: The increased prevalence of type I VCs among males indicates an increased risk during transsphenoidal surgical approaches in them.

Inflammatory myopathies in Lome: a review of two cases with delayed diagnosis

Ephoevi-Ga Adama Mawulikplimi — 2024-07-29

Inflammatory myopathies (IMDs) are a group of heterogeneous autoimmune diseases affecting the muscles. We report 2 cases of IMD managed in Lomé, Togo. The first patient is a 37-year-old black female, who had progressive onset of peripheral neuropathy for about ten years. Clinical assessment revealed pseudo-hypertrophy of the calves and shoulders, muscular atrophy of several muscle groups, bilateral steppage gait, and tetraparesis. CPKs were 6 times above the normal, and the electroneuromyogram (ENMG) showed an IMD pattern. Antinuclear autoantibodies came back positive at 320. The second patient is a 32-year-old black female with a history of myopathy who was admitted for constrictive retrosternal chest pain. Clinical assessment was remarkable for fever and pigmented macules in the upper limbs. Echocardiography was in favour of pericarditis, ENMG showed an IMD pattern, a thoracic CT showed bilateral posterobasal septal thickening, and 24-hour proteinuria was positive. Antinuclear autoantibodies were positive at 1280. Both patients were diagnosed with systemic lupus erythematosus-myositis overlap syndrome and were treated with corticosteroids and methotrexate. In conclusion, IMDs exist in Togo. Their diagnosis is challenging due to clinical polymorphism and a limited technical platform.

Motor recovery after acute hemiparesis caused by spontaneous cervical spinal epidural hematoma: a case report

Munkado Wilfried Meuga — 2024-07-29

Spontaneous Spinal Epidural Hematoma (SSEH) is a rare condition characterized by the accumulation of blood within the epidural compartment of the cervical spinal column, leading to compression of neurological structures. Swift medical and surgical intervention is imperative due to the severe neurological consequences that may arise. In this context, we present the case of a 69-year-old woman who exhibited profound right hemiparesis, ultimately unveiling a posterior epidural compression. Given initial suspicions of a neoplastic process, the administration of 80 mg prednisolone was initiated as an emergency measure, remarkably resulting in rapid clinical amelioration. Subsequently, the planned surgical intervention for this lesion was deferred, and the patient's medical treatment persisted for 6 days. Strikingly, a full recovery of the motor deficit was discerned within 48 hours from the commencement of the medical regimen. This case underscores the successful employment of corticosteroids in the resolution of a SSEH, as evidenced by the complete recovery of motor function within a 48-hour window after the inception of medical intervention.

Non-traumatic epidural hematoma in sickle cell disease and the role of neurosurgical intervention: a case report

Jofrey Amos Segeza — 2024-07-29

A 9-year-old male known to have Sickle-Cell Disease, presented with a headache, projectile vomiting, blurry vision, and one-sided weakness for seven days, without any history of trauma or assault prior. CT scan showed left temporal parietal epidural hematoma with significant mass effect, ventricles effacement and midline shift. Diagnosed with spontaneous epidural hematoma and underwent emergency craniotomy for hematoma evacuation. This case report discusses a rare case of spontaneous epidural hematoma in a child less than 10 years of age and role of early surgical intervention for better clinical outcomes.

The role of art therapy in neuroscience within the African context: a narrative review with insights from an art therapy session in Kenya

Felix Njoroge — 2024-07-29

Art therapy has been established as a powerful psychotherapeutic tool that utilizes artistic media to enhance mental and neurological well-being. This has been supported by various neuroimaging and electrophysiological studies which reveal its positive effects on brain function. This review emphasizes art therapy’s potential within the African context, where it could potentially help to address diverse neurological and psychological needs due to its adaptability to cultural nuances and effectiveness in non-verbal communication settings. The review also highlights an art therapy session aimed at addressing grief experienced by healthcare workers. This review also highlights the necessity for expanded educational programs, policy development, and research to integrate art therapy more comprehensively into African healthcare systems. These advancements are crucial for overcoming cultural and resource-related barriers, ensuring the accessibility and efficacy of art therapy within the African context.

Neuropathology of suicide: a narrative review article

Ahmad Sanusi — 2024-07-29

Suicide neuropathology is a multifactorial phenomenon influenced by psychological, social, and environmental factors. Researchers have primarily focused on the role of neurotransmitters, such as serotonin, in suicide. A deficiency in serotonin input to the anterior cingulate cortex and ventral prefrontal cortex is associated with suicide and suicidal behaviour and is linked to decision-making and suicide intent. The serotonin hypothesis proposed that low levels of serotonin in the brain contribute to an increased risk of suicidal behaviour. However, subsequent studies have produced mixed and inconsistent results, indicating that the relationship between serotonin and suicide is not straightforward. Recent research has expanded the focus to structural and functional brain abnormalities associated with suicidal behaviour. Advances in neuroimaging techniques have allowed researchers to investigate the brain's anatomy, connectivity, and activity patterns in individuals at risk of suicide. Genetic studies have provided insights into the genetic basis of suicide risk, with certain genetic variations associated with increased susceptibility to suicidal behaviour. Studies have found increased levels of pro-inflammatory markers in the brains of individuals who died by suicide, suggesting a link between inflammation and suicide risk. A drug targeting the glutamate pathway, ketamine, has recently drawn attention for its ability to rapidly treat depressive symptoms and holds great promise as a potential antisuicidal drug. Overall, further research is needed to better understand the neuropathological mechanisms underlying suicidal behaviour.