Search

Background: The December 2019 Chinese epidemic of Corona Virus Disease [COVID-19], which erupted in Wuhan, South China, was declared a pandemic, by the World Health Organization [WHO], on 12th January 2020. The worldwide spread from China was rapid, but Africa was the last port-of-call. Her first diagnosed case was two months after China’s, on 14th February, 2020 in Egypt. The morbidity and mortality rates have, however, remained lower in Africa than in the developed world, and analysts believe that it was more of a temporary respite, since Africa’s poor health infrastructure will become her eventual albatross. Methodology: Data were collected on COVID-19 and records of the socio-economic capacity of Africa by accessing the relevant previous and current peer-reviewed publications from multiple search engines on internet. The data were, then, collated and comparatively analyzed. Results: The available data revealed that Africa had, mostly, the milder forms of COVID-19, and so, morbidity and mortality were low. Her shrinking elderly population and hot climate were believed to be contributory, but lately, as the pandemic spread, the role of these factors was not exactly predictive. Being low on healthcare infrastructure, Africa could tenaciously leverage on the supportive and preventive measures prescribed by WHO, while the world awaited a vaccine. The role of ventilators in the care of critically ill patients, also, came under scrutiny as some workers were questioning the underlying pathology, and advocating a paradigm shift from high-tech positive end expiratory pressure ventilation to plasmapheresis and packed cell transfusion. Conclusion: Africa faces a huge challenge with COVID-19, but the predicted heavy mortalities may be reduced by some local confounding factors, control of spread and re-focusing of critical care away from the expensive and unavailable ventilators.

Background The Nigerian Academy of Neurological Surgeons in 2019 resolved to standardize the practice of neurosurgery in Nigeria. It set up committees to standardize the various aspects of neurosurgery, such as neurotrauma, pediatrics, functional, vascular, skull base, brain tumor, and spine. The Committee on Neurotrauma convened and resolved to study most of the available protocols and guidelines in use in different parts of the world. Objective To formulate a standard protocol for the practice of neurotrauma care within the Nigerian locality. Methods The Committee split its membership into 3 subcommittees to cover the various aspects of the Neurotrauma Guidelines, such as neurotrauma curriculum, standard neurotrauma management protocols, and neurotrauma registry. Each subcommittee was to research on available models and formulate a draft for Nigerian neurotrauma. Results All the 3 subcommittees had their reports ready on schedule. Each concurred that neurotrauma is a major public health challenge in Nigeria. They produced 3 different drafts on the 3 thematic areas of the project. The subcommittees are: 1. Subcommittee on Fellowship, Training and Research Curriculum; 2. Subcommittee on Standard Protocols and Management Guidelines; and 3. Subcommittee of the Nigerian Neurotrauma Registry. Conclusion The committee concluded that a formal protocol for neurotrauma care is long overdue in Nigeria for the standardization of all aspects of neurotrauma. It then recommended the adoption of these guidelines by all institutions offering services in Nigeria using the management protocols, opening a registry, and mounting researches on the various aspects of neurotrauma.

Background: Over the years, different approaches to the treatment of hydrocephalus have evolved across all age groups; however, ventriculoperitoneal shunting (VPS) remains the most widely used procedure, albeit with many complications. Aims: The aim of our study is to prospectively look at the incidence of complications following VPS in our centre, and to suggest ways of minimizing these complications. Patients and Methods: Between April 2006 and March 2008, all patients who had VPS in our centre were recruited for the study using a structured protocol from the time of admission to the time of discharge; data were augmented with case notes along with clinic and theatre records. Our centre is located in south-east Nigeria, and we commenced neurosurgical services in April 2006. Results: Within this 2-year period, 49 patients were definitively diagnosed with hydrocephalus and 32 underwent VPS, following which 9 (28%) had various complications – with shunt infection being the most common (n = 3; 9.3%). Conclusion: VPS is the definitive treatment modality for hydrocephalus in our centre, and shunt infection (as reported by several other authors) is the most common complication we encounter. Adopting a strict protocol for the prevention of perioperative contamination, as well as educating caregivers, is advocated to reduce this complication in any new neurosurgical centre.

Background: Pressure ulcers are lesions caused by unrelieved pressure over bony prominences, resulting in damage to underlying tissues. The etiology is multifactorial including prolonged immobility. They usually complicate spinal cord injuries with long periods of bed confinement. The use of bed replacements markedly reduces the incidence of pressure ulcers, but the unaffordability of these replacements in low‑income countries has necessitated the need to explore cheaper alternatives. Aim and Objective: The aim of this study was to ascertain whether the use of our cheap and locally improvised waterbeds would reduce the incidence of pressure ulcers in patients on prolonged bed confinement due to spinal injury.Methodology: Over a 16‑month period, 51 patients (age range 1-80 years) with spinal injuries were managed conservatively in our service using improvised waterbeds in 21 (41.2%), while using the regular hospital bed/ foam in 30 (58.8%). Biodata, the time interval between injury and presentation to the hospital, nature of the injury, use of improvised waterbed and development of pressure ulcer, were collected, collated, and analyzed. Statistical significance was calculated with the Chi‑square test. Results: Most were males (98%), in the age range of 21–30 years (25.5%), and due to fall from heights (35.3%). Of 21 patients who were managed on improvised waterbeds, 6 (28.6%) had pressure ulcers, and of the 30 who did not use the waterbed, 17 (56.7%) developed ulcers. The χ2 = 3.9381, while P = 0.0472. This difference was statistically significant. Conclusion: The improvised waterbed, which is much cheaper than the standard waterbed, was observed to have significantly reduced the incidence of pressure ulcers among our patients. Nonetheless, further studies would still be needed to confirm this observation.Keywords: Neurological deficits, plastic sachet, table water

Background Acute extradural hematoma (EDH) is the collection of blood in the potential space between the dura mater and endocranium within 3 days of an incident. It is usually, but not always, a neurosurgical emergency, and early treatment reduces morbidity and mortality, although the outcome is still affected by some other determinants. In Nigeria, the National Health Insurance Scheme does not cover neurosurgical cases, and patients have to pay for all of their treatment regardless of the emergency status. We evaluate epidemiologic patterns, management protocols, and outcome, especially in relation to timely operative intervention, in patients with acute extradural hematoma who presented to our recently established neurosurgical service. Methods This prospective study comprised cases managed in our center from May 2006 to July 2013. Data of all patients with acute EDH were collected on Microsoft Excel software and complemented with hospital charts and operative records. Demographic data, etiologic factors, time interval from injury to presentation in our service, time interval from presentation to definitive treatment, and outcome were collected and analyzed. Results Within the 86-month study period, 1648 patients presented to our service with head injuries. Acute EDH constituted 3.03%, with a mean of 7.14 cases per year. Among the cases of acute EDH, 92% involved male patients (male-to-female ratio, 11.5:1). Peak age incidence (42%) was 21–30 years (mean, 23 years), and motorcycle road traffic accident was the most common etiologic factor (72%). Operative treatment was performed in 84% of the cases (in 57.1%, operative treatment occurred within 1 week of presentation). Conservative management was employed in 10% of cases. Mortality was 14.9%; most (10%) had severe head injury, although 2.1% had mild injury known to be associated with 0% mortality. Conclusions Acute EDH is a potentially fatal condition that is easily treatable if presentation, diagnosis, and treatment occur promptly. Our outcomes could be improved if the present logistics associated with the cash-and-carry health care delivery system in Nigeria could be reduced or obviated.

Pott’s puffy tumour is a rare clinical condition, especially in this antibiotic era. It presents as frontal skull osteomyelitis with resultant frontal subperiosteal abscess, arising usually from frontal sinusitis. Other extracranial regions may also be unusually involved in addition to intracranial, periorbital and intra-orbital extensions, with various clinical manifestations, including neurological deficits, and potentially lethal complications. Its potential to cause significant morbidity emphasizes the need for a high index of suspicion in the setting of frontal scalp swellings in order to facilitate optimal outcome. This report, which is the case of a 7-year old male sickle cell anaemia patient with Pott’s puffy tumour and unusual involvement of both parietal bones, in addition to the usual frontal bone affectation, serves to highlight the need for a thorough evaluation of patients with hemoglobinopathies and skull bosselations, in order not to miss this potentially lethal disease.

Childhood cerebral hemiatrophy is an uncommon clinical entity. Its aetiologies are diverse but can generally be grouped into congenital and acquired. The congenital type is intrauterine in origin while the acquired type occurs early in life, usually before two year of life. When childhood cerebral hemiatrophy occurs, it evokes a spectrum of compensatory calvarial sequlae. These include ipsilateral calvarial thickening, diploe widening, hyper-pneumatization of paranasal sinues/ mastoids, elevation of petrous bone and small middle cranial fossa. MRI is very effective in high lightening brain atrophy, associated parenchymal changes and even the above enumerated skull changes. Our two case reports of left hemi-cerebral atrophy in male Cameroonian children seen in our MRI practice aptly demonstrated some of the aforementioned radiological features of childhood cerebral hemiatrophy noted in literature review.

Background: Spina bifida is a long-known disease arising from the incomplete fusion of the caudal neuropore in the first month of intrauterine life. It is thought to have a multifactorial etiology, the most important of which is folic acid deficiency. In evaluating its etiology, the role of antifolate agents like antimalarial drugs is rarely given a strong mention. Methods/Patients: This is a 44-month prospective study of consecutive cases of spina bifida cystica presenting to the Neurosurgery Unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East Nigeria. Data collection was with a structured proforma from presentation, and collation done with Microsoft Excel broadsheet and data analysis with SPSS and χ2 test. Results: A total of 41 cases of spina bifida were attended to within the period, with 92.7% cases of spina bifida cystica. Most presented by >12–24 months, with a consistent history of maternal ingestion of antimalarial drugs during the first trimester of pregnancy. Conclusion: Spina bifida cystica was diagnosed mostly in children whose mothers ingested antimalarial drugs during the first trimester of gestation. There may be a need to critically evaluate the contribution of antimalarial drugs to the etiopathogenesis of this malformation and develop safer antimalarial treatment in pregnancy.

Congenital orbital teratoma though rare is available in this environment. This is a case report of a baby with a protruding orbital mass in the left eye with all classical clinical features of teratoma. Though the histopathological report fell short of confirming the diagnosis the clinical features and outcome of management strongly suggest that the lesion is a teratoma. Multidisciplinary approach to the management not only saved the life of the baby in question but also enhanced the outcome of treatment. Good and compliant follow up for six months was experienced. Cytological test is mandatory for any suspected cases ofteratoma.

Trauma is the most common cause ofpaediatric deaths. In 75% ofpaediatric trauma deaths, head injury is responsible, and most are from falls. Recent reports from Nigeria, however, appear to indicate a predominance of road traffic accidents, instead of falls.To evaluate the aetiology of paediatric head trauma, management protocols and outcome from our Centre, in order to acquire a baseline data base and recommend measures to reduce childhood trauma.A prospective study of all paediatric head trauma cases presenting to Nnamdi Azikiwe University Teaching Hospital, Nnewi, for 12months from April 21, 2006 to April 20, 2007, was done and collated data subsequently analyzed. The paediatric age group was taken as = 15 years, and grading of head injury was with the Glasgow Coma Scale (3-15) and the modified scale for non-verbal children; while outcome was measured with the Glasgow Outcome Scale (1-5).Out of 334 patients treated within the period of study, 210 were head trauma cases. Of these, 52 were paediatric head trauma, representing 24.8% of all head trauma cases; and 19.2% (10 of 52) of them were aged 0-2 years. About 62% (32 of 52) were males. Falls and RTA were each responsible in 25 (48.1%) cases. Mild head injury occurred in 31 (59.6%), and 49 (94.2%) patients were evaluated by plain radiography. Treatment was conservative in 39 (75%) cases; with satisfactory outcome in 36 (69.2%), and a mortality rate of 15.4%.Road traffic injury, mostly from motorcycles, has become the major cause of morbidity and mortality amongst the paediatric age group, especially the male gender, and outcome from management is mostly satisfactory.

The paucity of published reports from West Africa on the outcome of spinal cord injuries (SCI) reflects the limitations of the developing health care delivery system in this part of the world.To review the outcome of the spinal cord injuries managed in our centre and relate same to those of published reports.We conducted a prospective study by utilizing a structured proforma on all SCI cases admitted to and managed in our service from April 21, 2006 to April 20, 2008. The collated data were then analyzed and compared to the literature.Spinal injury (neural and non-neural) was diagnosed in 62 (7.5%) of 826 total consultations in the two-year period under study. Thirty five (56.5%) of them were less than 40 years with fewer cases at the extremes of age, and most 47 (76%) were males. Forty nine (79%) had neural injuries of which the majority (94%) involved the spinal cord. Treatment was nonoperative in all cases, and all those with complete cord injury remained without neurological recovery, whereas 91% of cases of incomplete injuries made varying degrees of recovery. Mortality from the cord injuries was 13 (28.3%), and all were in the cervical region. Twenty (32.3%) were followed up in the outpatient clinic for a mean period of 13.7 weeks (range 1.4 to 63.4 weeks) following discharge.Our findings support the reports that cases of incomplete cord injury make neurological recovery, while those of complete injury do not. Our mortality rate of 28.3% compares closely with the mortality rates from other local series.

Neurosurgery has become endangered species in Nigeria. We have only 15 practising neurosurgeons for our population of 150 million, giving a ratio of one neurosurgeon to 10 million Nigerians. Of the 26 accredited medical schools, only 6 offer neurosurgery. This study is a preliminary evaluation of the perceptions about neurosurgery before the commencement of neurosurgical services in a tertiary health institution, and a comparison with the situation in other African countries.A questionnaire designed after the 5-point Likert rating scale was distributed to doctors, nurses, final-year medical/nursing students, paramedics and administrative staff of the 350-bed health institution. The completed questionnaires that were returned, were collated and data analysis done.Out of 200 questionnaires distributed, 164 were completed and returned. Most of the respondents were females 59.1%, and most were in the 20 30 year age group, 57.3%; more than 96% stated that they have heard of neurosurgery previously, but rated the available services in Nigeria as inadequate 50.6%, and quality of services as fair 39.6% or poor 36.6%, respectively. In their opinion, political and administrative lapses rather than funding are responsible for the poor state of affairs, culminating in unavailability of adequate manpower and facilities. Health policy changes and provision of facilities with manpower training were suggested by 78% of respondents as the solution to the problem. Most, however agree that neurosurgery has good prospects 78%, in the institution.Neurosurgical service in Nigeria is grossly inadequate both in availability and quality, and these have resulted from bad government policies. It is therefore of utmost necessity that services and training be urgently provided in this specialty, at least in the tertiary institutions in Nigeria.

Head injury is a disease afflicting mainly young males, and road traffic accident is the most common aetiologic factor. This report evaluates the findings in a one-year prospective study done from April 21, 2006-April 20, 2007 in the first year of services in one of Nigeria's new neurosurgical Centres, to establish the baseline epidemiological patterns of head injury. Data was collected using a questionnaire from the point of presentation till discharge of each head injury patient, and augmented with theatre and outpatient records, and analyzed. The Glasgow Coma and Outcome Scales were used for grading. Our Centre is a tertiary health facility that receives referrals from private, primary and secondary facilities. Of the 334 total patients treated, 210 (62.9%) had head injuries. Males were 158 (75.2%), and 145 (69%) resulted from road traffic accident, mostly from motorcycles. Fractures were mostly basal 86 (41%), brain pathology was mostly cerebral contusion 74 (35.2%), and treatment mostly nonoperative 137 (65.2%), with good outcome in 144(68.6%). Mortality was 40 (19.1%). Trauma is the main reason for neurosurgical consultation in our Centre and the unsafe use of roads, especially with motorcycles, remains the major cause of head injury.

Parkinsonism is a neurodegenerative clinical disorder characterized by varying combinations and degrees of rest tremor, rigidity, slowing of voluntary movements and postural instability. Amongst the aetiologic factors, massive post-craniotormy haematoma has not been previously considered. This report is to arouse the suspicion that vascular displacement in the midbrain resulting from a massive unilateral intracranial haematoma could lead to the unusual complication of Parkinsonism. This is the report of a 55-year old retired male banker, without any previously identifiable risk factor except for his age, who developed Parkinsonism following a huge acute extradural haematoma that complicated a craniotomy for the excision of a haemorrhagic convexity meningioma. The patient was placed on medical treatment resulting in a slow but progressive neurological improvement. Reports of Parkinsonism following post-tumour excision are probably, very rare. We, hereby, report a case of Parkinsonism complicating a gross total excision of a convexity meningioma.

Background: Cranial neuroendoscopy has been safely applied to the surgical treatment of different lesions of the brain in our center since its introduction in September 2009. This article summarizes our experience with neuroendoscopy, highlighting the salient challenges and outcome.Methods: A single institution, retrospective analysis of prospectively acquired cases over a 2.5‑year period (September 2010 to February 2013). Challenges experienced during the course of patient care as well as complications and outcomes were recorded and analyzed using SPSS (SPSS Inc. Chicago IL, USA) version 17. Tests of statistical significance were set at 95% level.Results: Of the 291 cranial procedures performed during the study period, 37 (12.7%) were neuroendoscopic interventions. Patients were between the ages of 0.25 years and 25 years with a mean of 5.7 ± 1.5 years (95% confidence interval (CI)). Aqueductal stenosis was the most common indication for endoscopic intervention in 22 (59.5%) patients. Endoscopic third ventriculostomy was the most commonly performed neuroendoscopic procedure in 21 patients (56.7%). Major challenges experienced were patient dependent in 28 ± 1.0 patients (95% CL), learning curve related in 21 ± 0.4 patients, and poor endoscopy support infrastructure in 15 ± 0.5 patients. Complications were significantly more common in the first 6 months of neuroendoscopy (χ2 = 7.57, df = 1, P < 0.05). Overall, 30 (81.1%) patients in our study experienced a positive outcome. The permanent morbidity and mortality rates in our series were 2.7% and 8.5%, respectively.Conclusion: Highlighted are the myriad obstacles which interface the successful set up of neuroendoscopy service especially in resource‑constrained settings. Endoscopic procedures become safer with experience and complications reduce significantly after a steep learning curve.Keywords: Challenges, developing country, neuroendoscopic surgery, outcome

Spinal arteriovenous malformations (AVMs) being even rarer than cranial ones, constitute 3 - 4% of all spinal tumours, with an overall male:female ratio of 4:1. We report the case of a 24-year old female Youth Corps member who presented with an apoplectic onset of a left hemiparesis, progressively deteriorating to an incomplete quadriplegia with motor power of 2 and 0 in the right and left lower limb muscle groups, respectively. Magnetic resonance imaging (MRI) showed a vascular malformation whose precise nature was indeterminate; the definitive diagnosis of a Glomus AVM was only made intra-operatively. Laminectomy with complete surgical excision was done and she gradually improved to ambulate with minimal support. The experience in our unit tends to support the observation in literature that spinal arteriovenous malformations could be very rare, and depending on the location, could be amenable to complete surgical excision and recovery of neurological function.

Background: There are no pathognomonic presenting features of intracerebral abscesses. Their clinical features could be confused with those of a tumour or any other space occupying lesion. Study Design: We analyzed the symptoms, predisposing factors, diagnostic modalities, prevalent causative microbes, management and outcome in 11 patients, for whom complete records were available and who were managed for confirmed intracerebral abscess in our Neurosurgical Unit from 1996 to 2000 and compared our findings with those from other series. Results: In these patients focal neurological deficit was the most common clinical feature, trauma was the most predisposing event and Computerised Tomography (CT) Scanning remained the most dependable diagnostic tool. In our practice, burr hole drainage augmented with a minimum of 4 weeks intravenous antibiotics, was the most frequently used treatment modality. Conclusion: The outcome was satisfactory (ability to return to pre-morbid activities and duties, with no disabling neurological deficits) in 72.8% cases. There was one death. This modality remains an effective way of treating patients with intracebrebral abscess. Key Words: Intracerebral abscess, Computerized tomography, Burr hole, Craniotomy, Craniectomy. Resume Introduction: Il n'y avait pas de cas traits pathognomoniques d'abces intracerebraux. Leurs traits cliniques pourront etre confus avec ceux d'une tumeur ou n'import autre lesion dans l'espace. Plan d'etude: Nous avous analyse les symptoms des facteurs predisposants, modalites diagnostiques, la prevalence des microbes causetifs, la prise en charge et les resultats chez les 11 patients dont les dossiers detailes sont disponibles et chez qui on avait traite pour l'abces intracerebral dans notre Service Neurochirurgique de 1996 a 2000 et nous avons compare nos resultats avec ceux des autres series. Resultats: Chez ces patients, le deficit focal neurologique etait le trait clinique le plus courant. Le traumatisme etait un evenement le plus predisposant et le scanneur, Tomographie calculee, est toujours un instrument diagnostique le plus fiable. Dans notre domaine, le drainage burr hole augmente avec dec antibiotiques intraveineux de 4 semaines au minimum etait la methode du traitement le plus couramment utilise. Conclusion: Le resultat etait satisfaisant (capacite de reprendre des activites premorbides et des devoirs, sans aucune infirmite neurologique ou deficits) dans 72,8% des cas. Il y avait une mort. Cette methode reste toujours un moyen efficace de soigner des patients atteints d'abces intracerebral. West African Journal of Medicine Vol.23(1) 2004: 54-57

This study examined the effect of service compact (Servicom Service delivery) in Nnamdi Azikiwe University Teaching Hospital Nnewi. Questionnaire and face-to-face interviews were used in the collection of data. The hypotheses were tested using descriptive statistics. The study discovered among other things that with the inauguration of the SERVICOM Charter by the Federal Government of Nigeria, the Management of Nnamdi Azikiwe University Teaching Hospital Nnewi identified key areas that required re-evaluation and attention based on the submissions of every service unit and department, after an analysis of the Strengths, Weaknesses, Opportunities and Threats (SWOT) of each of the service areas. A pre-SERVICOM Charter workshop which was supervised by the Federal Government was held in the various institutions nationwide to enable care providers enumerate their current service capacity and identify their impediments. In the light of the foregoing, some of the recommendations proffered are that the SERVICOM Charter project should be sustained and supervision and control of the SERVICOM Charter project should be intensified in order to ensure that the Nigerian factor of service-fatigue would not supervene in care delivery in the near future.

A 36-year-old male painter presented to our service in 2007 with an ulcerated solitary scalp swelling of 8 months’ duration. The mass was a dormant, painless, pea-sized growth, which he had had since childhood and which he bruised in a passenger motorcycle road traffic accident 8 months prior to presentation. The accident caused it to flare up and progressively increase in size, with associated pain, contact bleeding, and ulceration. A work-up for excision biopsy was proposed, but the patient defaulted and presented 2 years later with an increased number of lesions all around the scalp and face and in an obviously deteriorating clinical status with regional lymph node involvement at this stage. An incisional biopsy was then carried out and the histological reports came out with three different diagnoses of glioblastoma multiforme, poorly differentiated angiosarcoma, and squamous cell carcinoma, constituting a major diagnostic dilemma for our service.