Search

Introduction: The incidence rates and location of nontraumatic intracerebral hemorrhage (ICH) have been shown to vary between population and races. Knowledge of ICH patterns may give some insight into the etiology of ICH and help reduce its burden particularly among Africans where health infrastructure is poorly developed. We present a retrospective review of ICH using a modern neuroimaging technique. Objectives: To determine the pattern and location of ICH among patients presenting in a tertiary hospital in Enugu. Methods: All the medical and computer tomography records of patients with a clinical diagnosis of hemorrhagic stroke with the location of hemorrhage clearly specified and complete patients’ data were reviewed. The study duration was 11 years (January 2003 to December 2013). Relevant data were obtained, and statistical analysis was done using SPSS version 19 (IBM Corporation, New York, USA). Results: A total of 139 (17.4%) out of 799 scans done over the period under review were analyzed. The frequency of lobar and deep cerebral hemorrhages (LH and DCHs) was 46.8% and 53.2%, respectively. The most common types of hemorrhage in men and women were deep cerebral (52.2% and 55.3%, respectively). Five percent (7/139) of all hemorrhages occurred in the cerebellum. Age distribution of the location of ICH shows that LHs peaked at 16 39 years while DCHs peaked at 40–49 years. There was not statistically significant difference between mean ages of occurrence of LH and hemorrhages of other locations. Conclusion: Frequency of LH and DCH varied with age as LH peaked before the age of 40 while deep cerebral at 40–49 years. The age distribution of different types of ICH may suggest a higher role of other factors apart from hypertension. Further studies are required to establish the risk factors of LH and DCHs in our environment. Keywords: Deep cerebral hemorrhage, intracerebral hemorrhage, lobar hemorrhage, Nigeria

Cow horn eye injuries are not common but are devastating causes of uniocular blindness amongst young active population. Early and appropriate intervention can save the life of the patient depending on the severity of the injury. This uncommon cause of unilateral visual loss can be prevented if slaughtering of cows are done by trained and appropriately equipped personnel.

In a study of 212 children at the University of Nigeria Teaching Hospital, Enugu who received ventriculo peritoneal shunt for hydrocephalus over a 13-year period (1977-1989, 14 had infected shunts and one developed shunt nephritis. Staphylococcus aureus was responsible for 36.4% of the positive cultures and was responsible for the only case of shunt nephritis. This is about the fourth case of shunt nephritis associated with Staphylococcus aureus shunt infection, in the literature. The pertinent features of this case were intraventricular haemorrhage as the cause of the hydrocephalus, frequent revision of shunts before the onset of nephritis and full recovery following intravenous antibiotic therapy and reimplantation of a new shunt.

In a ten year period (1977--1986) one hundred and fifty children with hydrocephalus who received ventriculo-peritoneal shunt as their modality of treatment were followed up. Seventy-one per cent of these children were neonates and infants, the majority of them presenting within the first 3 months of onset of symptoms and signs. The major causes of hydrocephalus in these children were congenital malformations, meningitis, tumours and trauma. Pudenz shunt systems were favoured in the 1977--81 period, while 1982--86 period witnessed an upsurge of self devised catheters because of dwindling national economy. The latter were cheaper and more readily available. Apart from blockage of shunts which occurred more in self devised catheters, the performance of these catheters in terms of shunt infections and other complications were same in both self devised and conventional catheters. The main complications encountered were blockage and infection of the shunts, while rare complications included migration and extrusion of shunts to and from the peritoneal cavity, CSF ascites and recurrent abdominal cysts.

After Robert Bartholow in 1872 described the clinical presentation of internal carotid artery aneurysms (probably referring to those of the cavernous carotid artery), interest in the anatomy of the cavernous carotid artery (CCA) was stimulated. The development of carotid angiography provided further impetus, paving the way in unraveling numerous pathological conditions which affect this portion of the carotid artery.

Cranial nerves II–VI have intimate relations to the sella and cavernous sinus (CS). They are, however, variable in number and course (Nathan et al. 1973; Umansky and Nathan 1982; Lang 1983). These nerves also provide excellent anatomical landmarks for the surgical exposures of this region (Diaz et al. 1988). We used gross- and microdissection to study the surgical anatomy of the region.

The cavernous sinus (CS) is the venous space on either side of the sella turcica. It extends from the superior orbital fissure to the apex of the petrous temporal bone. There have been several reports on direct surgery within the CS. Parkinson (1965) introduced direct surgery within the CS through a transdural opening in the dural wall. We have used a superior approach through the roof of the CS for direct surgery on intracavernous aneurysms. This study evaluates the microanatomical features of the CS that form the basis for surgery through the roof or the lateral wall of the CS.

Aneurysms in the cavernous sinus region produce mechanical changes which affect the cranial nerves contained within the confines of the venous sinus, producing the symptom complex known as the superior orbital fissure syndrome. The size of the aneurysm frequently exceeds 25 mm, and therefore these aneurysms are often giant in nature. Parkinson (1973) reported the direct approach to the sinus with the aid of cardiac standstill. Dolenc (1985) reported on the approach to aneurysms within the cavernous sinus through an extradural route. We present our experience with aneurysms in the cavernous sinus region treated through an intradural approach.

The reported higher incidences of intracranial arterial aneurysms (IAA) in Africa and Asia raised the question of possible racial differences in aneurysm incidence. This prompted a retrospective study of the 244 cases of IAA seen at the Henry Ford Hospital (HFH) from 1979 to 1985. There were 171 whites and 73 blacks in the study group. The results showed a higher white to black case ratio (2.3:1) than the white to black hospital population ratio (1.14:1). If only bleeding aneurysms were considered, there were 81 whites and 52 blacks, with a white to black case ratio of 1.6:1, thus giving only a borderline racial difference. The peak age of aneurysm incidence was the fifth decade for blacks and the sixth decade for whites. The most common aneurysms sites were: [table: see text]

Spinal epidural meningiomas are rare. Also the location of meningiomas in the region of the cauda equina is uncommon. A case is presented in which a combination of both rare situations occured.

A series of 32 patients with aneurysms in the cavernous sinus region is presented. All of them have been operated upon through an intradural pterional approach and the aneurysms directly attacked. Only in 6 patients was the complete dissection of the internal carotid artery and of the aneurysm impossible because of the size of the aneurysms. In these cases the aneurysm has been traped by ligation of the internal carotid artery in the neck and its supraclinoid course and at the same time and extracranial intracranial anastomosis performed. One patient died from massive cerebral infarction after a trapping procedure and another died from a transoperative haemorrhage; another two developed a moderate hemiparesis which resolved within the first six postoperative weeks, and in two patients a preoperative severe visual impairment progressed postoperatively to complete visual loss. All others had a complete resolution of their preoperative symptoms and remained well. The advantages and disadvantages of the different approaches to intracavernous carotid artery aneurysms are discussed and the related literature reviewed.

1089 patients treated for head injuries at the Unversity of Nigeria Teaching Hospital, Enugu, are analysed. Seventy-two percent of them were males. The age group 20-30 years was most vulnerable, accounting for 32% of the total. Road traffic accidents were responsible for a staggering 80% of the total. Most of the children in this group were pedestrians hit by vehicles on the roads. About 42% of the head injuries were complicated, but the incidence of intracranial haematoma was only 1.3%. The mortality rate was 9% and most of the deaths (83%) occurred few hours after the accident. Road traffic accident was responsible for 97% of the deaths. Bronchopneumonea and brain oedema was the cause of death in 70.6% of the inpatient deaths from head injury.

A rare case of ectopic epidural calvarial fibroblastic meningioma is reported in a 31-year-old male. Arising from the inner table of the skull, it produced an intracranial mass which resulted in hemiparesis and Jacksonian epilepsy.

Over a five-year period, there were 48 cases of intracranial tumors at the University of Nigeria Teaching Hospital, Enugu, Nigeria. All the patients were Nigerian Negroes. Glial tumors accounted for 20.8%, pituitary tumors 18.8%, and meningiomas 16.7%. There were five cases of tuberculomas and five cases of metastatic tumors. Miscellaneous tumors contributed 22.9% of the total. There were more males than females, especially in the meningioma and tuberculoma groups. Nearly one-half of the tumors were in people in their first and second decades of life; two-thirds of the tumors were in those under 30 years of age. One-third of the patients have died within the five years under review. The results of this survey are strikingly different from Caucasian series. The relatively low incidence of gliomas and the high incidence of meningiomas and pituitary tumors in this study are interestingly similar to the results of other workers who studied Negro populations and may underscore the importance of genetic factors in the development of some brain tumors.

An unusual case of intermittent cerebrospinal fluid ascites complicating a ventriculoperitoneal shunt is presented. The patient developed hydrocephaly secondary to blockage of the third ventricle by a recurrent craniopharyngioma. The ascites responded to paracenteses and on several occasions resolved spontaneously. There was no satisfactory explanation for the "rejection" of the cerebrospinal fluid by the peritoneal cavity. The ascites was resolved without conversion of the ventriculoperitoneal shunt to a ventriculoatrial shunt being required.

Three cases of unusual craniocerebral injuries caused by deliberate driving of nails into the head are reported. All injuries were on or near the midline in the parietal area and the nails measured about 10 cm. Two of the patients experienced little pain during the procedure and did not lose consciousness. The extraction of each nail was extremely easy. The only patient who died was admitted in a coma and had meningitis.

Low incidence of intracranial arterial aneurysms has been reported from India, Iran, and many parts of Africa. From Enugu, Nigeria, five proven cases and two suspected cases of intracranial arterial aneurysms are reported over a three year period. Only one of these was situated in the anterior communicating artery, the others were in the region of the posterior communicating artery. The epidemiology and pathogenesis of aneurysms are reviewed. According to the experience reported intracranial aneurysm in Nigerians is not different from that in Caucasians. Research efforts should be focused on congenital factors rather than on the acquired ones which are common in Nigeria.

No deaths have occurred in 15 consecutive cases of intraparenchymatous brain abscesses in Nigerian patients who were treated by aspiration, systemic antibiotics, dexamethasone and anticonvulsants. Four patients had persistent convulsions which responded well to drug therapy and two patients had hemiparesis but were able to return to their jobs. The simplicity of this method of treatment and the results, achieved without the benefit of computerised tomographic scan, raise the question as to whether the recent trend towards excision of brain abscess is justifiable.

Der Verfasser berichtet uber den seltenen Fall eines 40-jahrigen symptomfreien Nigerianers, dessen plotzlicher Tod durch emotionalen Stres verursacht wurde. Der Obduktionsbefund ergab ein blutendes Meningiom im mittleren Drittel der Crista Sphenoidalis.