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Hydrocephalus is currently managed by cerebrospinal fluid diversion from the cerebral ventricles to other body sites, but this is complicated by obstruction and infection in young infants, thus adding to morbidity and mortality. Studies have reported caffeine to be a pleiotropic neuroprotective drug in the developing brain due to its antioxidant, anti-inflammatory, and antiapoptotic properties, with improved white matter microstructural development. In this study, we investigate the use of caffeine administration as a possible means of pharmacological management for hydrocephalus.A total of 76 three-day-old mice pups from 10 dams were divided into four groups: hydrocephalus was induced in the pups in two groups by intracisternal injection of kaolin suspension, and their dams were given either caffeine (50 mg/kg by gavage) or water daily for 21 days; the dams in the other 2 (non-hydrocephalic) groups similarly had either caffeine or water; the pups received caffeine administered via lactation. Developmental neurobehavioral tests were performed until day 21, when the pups were sacrificed. Their brains were removed and processed for Cresyl and Golgi staining; both quantitative and qualitative analyses were then carried out.Improved developmental motor activities and reflexes were observed in the hydrocephalus + caffeine-treated pups. Caffeine administration was associated with reduced cell death and increased dendritic arborization of the neurons in the sensorimotor cortex and striatum of hydrocephalic mice pups.Caffeine administration appears to have promise as an adjunct in hydrocephalus management, and its use needs to be further explored.

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. Methods: We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)—a composite of life expectancy, education, and income measures—into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. Findings: Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24–51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34–69) and the youngest in the low HDI tier (median 28 years, IQR 20–38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6–32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55–5·2) and high HDI tier (2·26, 1·23–4·15), but not the low HDI tier (1·66, 0·61–4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17–2·49). Interpretation: Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. Funding: National Institute for Health Research Global Health Research Group.

Objective We assessed the hypothesis that nonoperative management would be a viable treatment option for patients with underlying degenerative disease who have traumatic cervical spinal cord injury (TCSI) without neurological deterioration and/or spinal instability during hospitalization. Methods Data were collected prospectively from 2011 to 2016. All the patients had been treated nonoperatively with hard cervical collar immobilization. The clinical parameters assessed included the Frankel grade at presentation and discharge, the occurrence of deep vein thrombosis, urinary tract infection, sphincter dysfunction, and pressure sores. The radiographic data collected included magnetic resonance imaging signal cord changes. P ≤ 0.05 represented a significant association between the Frankel grade at presentation and the outcome parameters. Results A total of 28 patients were included in the present study. Of the patients who had presented with Frankel grade B, 85.71% had improved to a higher grade, 90.91% of the patients with Frankel grade C had improved to a higher grade, and 14.29% of the patients with Frankel grade D had improved to Frankel grade E. All the patients had satisfactory spinal stability, as evidenced by dynamic radiographs, after treatment. Conclusion The findings from the present study have shown that nonoperative management can result in improved neurological outcomes for patients with underlying degenerative disease who have experienced TCSI without evidence of neurological deterioration and spinal instability. The Frankel grade at presentation was significantly associated with outcome parameters such as the neurological outcome on discharge and the occurrence of urinary tract infection. The results from the present study could be helpful to neurological surgeons in rural and other low-resource settings because the cost savings realized by nonoperative treatment will not sacrifice the provision of adequate care to their patients.

Background: Each year world-wide about 65 million people sustain a mild traumatic brain injury (mTBI). Fatigue is a common and distressing symptom after mTBI. We examine the effect of tranexamic acid (TXA) on fatigue in patients with mTBI using data from the CRASH-3 trial. Methods: The CRASH-3 trial randomised 9,202 patients with traumatic brain injury and no significant extracranial bleeding to receive TXA or placebo within 3 hours of injury. The primary outcome was death from head injury within 28 days of injury. The methods and results are presented elsewhere. Fatigue was recorded as “None”, “Moderate” or “Extreme.” This study examines the effect of TXA on extreme fatigue in the 2,632 patients with mTBI (Glasgow Coma Scale [GCS] score≥13). Our analyses were not prespecified. Results: Our study primary outcome, extreme fatigue, was reported for 10 (0.8%) of 1,328 patients receiving TXA and 19 (1.5%) of 1,288 patients receiving placebo (risk ratio [RR]=0.51, 95% confidence interval [CI] 0.24-1.09). Death within 28 days of injury was reported for 34 (2.6%) of 1,328 patients receiving TXA versus 47 (3.6%) of 1,288 patients receiving placebo (RR=0.70, 95% CI 0.45-1.08). Among patients allocated to TXA, 44 (3.3%) patients either died or reported extreme fatigue versus 66 (5.1%) patients among those allocated to placebo (RR=0.65, 95% CI 0.44-0.94). Conclusions: Early tranexamic acid treatment may reduce fatigue in mTBI patients, but these results need to be confirmed in a larger trial. Registration: ISRCTN (ISRCTN15088122, 19/07/2011), ClinicalTrials.gov (NCT01402882, 26/07/2011), EudraCT (2011-003669-14, 25/07/2011), Pan African Clinical Trial Registry (PACTR20121000441277, 30/10/2012).

To describe the profile and determine the risk factors for the development of intracranial infections (ICI) in paediatric patients with myelomeningocele (MMC). Retrospective analysis of data from the records of patients with MMC admitted into our hospital between January 2006 and December 2015. We managed a total of 688 paediatric non-trauma neurosurgical patients in our facility during the study period. 29.4% of these patients had MMC. We found the records for 49% of the patients. The male: female ratio was 1.3:1. Most of the MMCs were located in the lumbosacral region (71.7%). The lesion was ruptured in 42.4%, unruptured in 53.5%, and indeterminate in 4.0% of the patients. 48.5% of the MMCs were infected at presentation. Surgical repair of the spinal dysraphism was performed in 74.7% of the patients. Postoperative complications observed in our series include wound dehiscence, cerebrospinal fluid leak, and pseudomeningocele which occurred in 13.5%, 12.2%, and 2.7% of the operated cases of MMC respectively. 28.3% of the patients with MMC developed ICI during the course of hospitalization. 71.4% of patients with MMC-associated ICI had septic neural placode at the initial clinical evaluation. 70% of the patients who had wound dehiscence post-operatively developed ICI. Loculations and abscesses occurred only in patients who had surgical repair. A multivariate logistic regression analysis revealed that septic neural placode, hydrocephalus, a supra-lumbar location of the MMCs and surgical intervention were predictive of ICI (p

Introduction: Paediatric spinal tumours are rare, accounting for 1–10% of all childhood central nervous system tumours. There is a paucity of information on spinal tumours in Sub-Saharan Africa. This is particularly so in the Nigerian paediatric population where neuro-oncologic data are limited. Indeed, there is no previously published work on paediatric spinal tumours in the Nigerian neurosurgical literature. The authors aim to document the profile of paediatric spinal tumours in a Nigerian tertiary institution and to contribute to the available data on paediatric central nervous system tumours in West Africa. Methods: We retrospectively evaluated data on paediatric patients who underwent surgery for spine tumours over a 20-year period at our institution. Results: A total of 12 patients were managed for paediatric spine tumours during the study period. These had a male:female ratio of 1:1.4, and their ages ranged between 3 and 18 years (mean: 12.83 ± 4.75 years). The highest incidence (6/12) was seen in the 15–18 years age group. The mean duration of symptoms was 10.2 months. More than half (7/12) of the patients presented with symptoms with duration of at least 6 months. Motor deficit was present in all patients at presentation. Two-thirds of the tumours were in the thoracic region, 1 was located in the cervical region, while the remaining 3 tumours were cervicothoracic. The tumour was extradural in location in 8 of our patients and intramedullary in the remaining 4. Astrocytoma, intramedullary in all cases, was the most predominant histological tumour type (3/12) in our series. Postoperative neurological improvement occurred in 7 of the patients while 5 remained the same. There was no permanent postoperative neurological deterioration or perioperative mortality. Conclusion: Paediatric spinal tumours mostly affected older children in our study group and were predominantly astrocytic in nature. The most common tumour location was extradural, involving mostly the thoracic spinal level. The preoperative neurological status correlates with the postoperative functional outcome. Therefore, the need for early diagnosis and treatment of these tumours cannot be overemphasized.

Caffeine is the most widely consumed psychoactive drug in the world, ingested as natural components of chocolate, coffee and tea and as added components to soda and energy drinks. Here we assessed behavioural changes caused by chronic caffeine administration as well as morphological changes within specific regions of the adult mice brain: the hippocampus and amygdala. Twenty-four adult male albino mice were randomly divided into three groups. Caffeine was administered daily by gavage for 8 weeks at a dosage of 20 mg/kg for low dose (LD) group and 60 mg/kg for high dose (HD) group while the third group served as control (CNT). After the period of administration, neurobehavioural tasks were carried out; Morris water maze for learning and memory open field test and elevated plus maze test for anxiety. The mice were sacrificed; their brain tissues were harvested and processed for HE, Cresyl violet and Golgi staining, and assessed qualitatively and quantitatively. Quantitative data from the neurobehavioural tests and neuronal cell counts were expressed as means ± standard errors of means and compared across the groups using analysis of variance (ANOVA). Significance was set at p0.05. Mice in the high dose group learnt faster and had significantly increased number of platform crossings in the Morris water maze test. There was, however, a slightly increased level of anxiety in the caffeine-treated mice, compared to controls. Histo-morphometric analysis revealed significantly increased number of pyramidal neurons in the hippocampus in the low dose group, but a decreased neuronal count in the amydala of the low dose and high dose groups compared to controls. The pyramidal neurons in the hippocampus of the caffeine-treated mice had increased apical dendritic length compared to the controls. Our findings strengthen the available data suggesting that prolonged caffeine intake improves cognition, and this process could be mediated by promoting the growth of dendrites and increased number of neurons. However, this is coupled with an increased tendency to be anxiogenic.

Supplementary Table 1. Effect of tranexamic acid on all-cause mortality within 24 hours of injury, after 24 hours and at 28 days stratified by severity and country income in patients randomised within 3 hours of injury. Supplementary Table 2. Effect of tranexamic acid on head injury death within 24 hours, after 24 hours and at 28 days by severity and country income in patients randomised within 3 hours of injury, excluding those with GCS 3 or bilateral unreactive pupils. Supplementary Table 3. Effect of tranexamic acid on head injury death within 24 hours, after 24 hours and at 28 days by severity and country income in patients randomised within 3 hours of injury.

Tranexamic acid reduces surgical bleeding and decreases mortality in patients with traumatic extracranial bleeding. Intracranial bleeding is common after traumatic brain injury (TBI) and can cause brain herniation and death. We aimed to assess the effects of tranexamic acid in patients with TBI.This randomised, placebo-controlled trial was done in 175 hospitals in 29 countries. Adults with TBI who were within 3 h of injury, had a Glasgow Coma Scale (GCS) score of 12 or lower or any intracranial bleeding on CT scan, and no major extracranial bleeding were eligible. The time window for eligibility was originally 8 h but in 2016 the protocol was changed to limit recruitment to patients within 3 h of injury. This change was made blind to the trial data, in response to external evidence suggesting that delayed treatment is unlikely to be effective. We randomly assigned (1:1) patients to receive tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Patients were assigned by selecting a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was head injury-related death in hospital within 28 days of injury in patients treated within 3 h of injury. We prespecified a sensitivity analysis that excluded patients with a GCS score of 3 and those with bilateral unreactive pupils at baseline. All analyses were done by intention to treat. This trial was registered with ISRCTN (ISRCTN15088122), ClinicalTrials.gov (NCT01402882), EudraCT (2011-003669-14), and the Pan African Clinical Trial Registry (PACTR20121000441277).Between July 20, 2012, and Jan 31, 2019, we randomly allocated 12 737 patients with TBI to receive tranexamic acid (6406 [50·3%] or placebo [6331 [49·7%], of whom 9202 (72·2%) patients were treated within 3 h of injury. Among patients treated within 3 h of injury, the risk of head injury-related death was 18·5% in the tranexamic acid group versus 19·8% in the placebo group (855 vs 892 events; risk ratio [RR] 0·94 [95% CI 0·86-1·02]). In the prespecified sensitivity analysis that excluded patients with a GCS score of 3 or bilateral unreactive pupils at baseline, the risk of head injury-related death was 12·5% in the tranexamic acid group versus 14·0% in the placebo group (485 vs 525 events; RR 0·89 [95% CI 0·80-1·00]). The risk of head injury-related death reduced with tranexamic acid in patients with mild-to-moderate head injury (RR 0·78 [95% CI 0·64-0·95]) but not in patients with severe head injury (0·99 [95% CI 0·91-1·07]; p value for heterogeneity 0·030). Early treatment was more effective than was later treatment in patients with mild and moderate head injury (p=0·005) but time to treatment had no obvious effect in patients with severe head injury (p=0·73). The risk of vascular occlusive events was similar in the tranexamic acid and placebo groups (RR 0·98 (0·74-1·28). The risk of seizures was also similar between groups (1·09 [95% CI 0·90-1·33]).Our results show that tranexamic acid is safe in patients with TBI and that treatment within 3 h of injury reduces head injury-related death. Patients should be treated as soon as possible after injury.National Institute for Health Research Health Technology Assessment, JP Moulton Charitable Trust, Department of Health and Social Care, Department for International Development, Global Challenges Research Fund, Medical Research Council, and Wellcome Trust (Joint Global Health Trials scheme).For the Arabic, Chinese, French, Hindi, Japanese, Spanish and Urdu translations of the abstract see Supplementary Material.

Hydrocephalus is especially prevalent in countries with limited resources, where its treatment is still a challenge. However, long-term neuropathological changes in untreated hydrocephalus remain largely unexplored. The present study looks at cortical parenchyma and neuroinflammation in acquired, chronic hydrocephalus. Intracisternal kaolin injections were performed in 3-week-old rats, followed by -1, 4- and 8-week survival; matched control rats received saline injections. Ventriculomegaly has been previously reported to stabilize by the third week in this model. Single and triple immunocytochemical approaches were used to highlight neurones, astrocytes, microglia, and the pro-inflammatory cytokine interleukin (IL)-1β in the parietal cortex, utilizing cell counts and densitometry. Microglial protein ionized calcium binding adaptor molecule 1 (Iba1) and IL-1β expressions were monitored with Western blotting in the parietal cortex and hippocampus. In the parietal cortex, which showed progressive disruption of cytoarchitecture, neuronal density was significantly increased at 8 weeks post-induction but not at earlier time points, indicating on-going cortical damage in chronic hydrocephalus. Astrocyte and microglia hypertrophy, and Iba1 expression indicated glial cell activation which peaked at 4 weeks. IL-1β expression also peaked at 4 weeks and was then down-regulated. Overall the findings indicate that neuroinflammatory features build up in the first month after hydrocephalus induction implicating marked IL-1β upregulation. The data also show that astrocytes are the main source of IL-1β in this disorder.

BACKGROUND: Anthropometry is one of the oldest and widely used measures of human variation. Dermatoglyphics is a valuable technique in human population studies by virtue of its uniqueness, genetic determination, and less vulnerability to selection than other genetic markers. AIMS: The study aims (1) to elucidate the traditional ethnic identities in Nigeria which are increasingly facing disintegration due to improved means of communication and urbanization and reduced inbreeding and (2) to describe ethnic characteristics that may be valuable for forensic application and future studies of effects on human diversity. SUBJECTS AND METHODS: We obtained quantitative anthropometric and dermatoglyphic data from 560 volunteers of both sexes, of Yoruba, Igbo, and Hausa origin. The sampling fraction used to attain target sample size for random selection of eligible volunteers was based on the national population figure. STATISTICAL ANALYSIS: Univariate analysis of variance was used to determine patterns variations, while multivariate analysis was used to determine discrimination among ethnic populations. RESULTS: The anthropometric and dermatoglyphic variables revealed a discrimination that is consistent with ethnohistorical affiliations. Multiple discriminant analysis of the anthropometrics showed higher discrimination power than the dermatoglyphic variables. The derived ethnic classifying equations from anthropometric parameters classified volunteers as Yoruba 78.2%, Hausa 82.4%, Igbo 91.4%; the dermatoglyphic parameters classified volunteers as Yoruba 66.8%, Hausa 57.4%, Igbo 65.3%. The canonical discriminant function of the anthropometric and dermatoglyphic variables showed clustering of the ethnic populations around each ethnic centroid. CONCLUSIONS: The results provide ethnohistorical insights into the structure of the ethnic populations and demonstrate the relationship of the gene flow in the ethnic groups through their exhibited phenotypic characteristics.

Background: Worldwide, traumatic brain injury (TBI) kills or hospitalises over 10 million people each year. Early intracranial bleeding is common after TBI, increasing the risk of death and disability. Tranexamic acid reduces blood loss in surgery and death due to bleeding in trauma patients with extra-cranial injury. Early administration of tranexamic acid in TBI patients might limit intracranial bleeding, reducing death and disability. The CRASH-3 trial aims to provide reliable evidence on the effect of tranexamic acid on death and disability in TBI patients. We will randomly allocate about 13,000 TBI patients to an intravenous infusion of tranexamic acid or matching placebo in addition to usual care. This paper presents a protocol update (version 2.1) and statistical analysis plan for the CRASH-3 trial. Results: The primary outcome is head injury death in hospital within 28 days of injury for patients treated within 3 hours of injury (deaths in patients treated after 3 hours will also be reported). Because there are strong scientific reasons to expect that tranexamic acid will be most effective in patients treated immediately after injury and less effective with increasing delay, the effect in patients treated within one hour of injury is of particular interest. Secondary outcomes are all-cause and cause-specific mortality, vascular occlusive events (myocardial infarction, pulmonary embolism, deep vein thrombosis, stroke), disability based on the Disability Rating Scale and measures suggested by patient representatives, seizures, neurosurgical intervention, neurosurgical blood loss, days in intensive care and adverse events. Sub-group analyses will examine the effect of tranexamic acid on head injury death stratified by time to treatment, severity of TBI and baseline risk. Conclusion: The CRASH-3 trial will provide reliable evidence of the effectiveness and safety of tranexamic acid in patients with acute TBI. Registration: International Standard Randomised Controlled Trials registry (ISRCTN15088122) 19/07/2011, and ClinicalTrials.gov (NCT01402882) 25/07/2011.

Background: In hydrocephalus, the impairment of cognitive and motor functions is thought to be partly due to injury to the myelin sheath of axons in the central nervous system. The exact nature of this injury is not completely understood. Methods: We induced hydrocephalus in 3-week-old rats with an intracisternal injection of kaolin suspension (0.04 ml of 200 mg/ml) and examined paraffin and ultrathin sections of the subcortical white matter from coronal slices of the cerebrum obtained at the level of the optic chiasm after sacrifice at weekly intervals for 4 weeks. Results: Over time, there was a progression of injury to the myelin sheath consisting of attenuation, lamella separation and accumulation of myelin debris, focal degeneration, and the appearance of casts and loops. Conclusion: The results suggest that myelin injury in kaolin-induced hydrocephalus progresses with the duration and severity of ventriculomegaly.

The histology of the middle cerebral artery (MCA) in Nigerian Africans has not been previously studied. One hundred MCAs obtained at autopsy from fifty adult Nigerians were studied. The vessels were processed and stained with Ehrlich's haematoxylin and eosin, elastic Van Gieson and Masson's trichrome stains. Early branches were given off before the perforators in two middle cerebral arteries, and there was one accessory MCA, making an incidence of anomalies of 3%. No aneurysm was observed in any of the cases. The internal elastic laminas were well developed but the external elastic laminas of the vessels were poorly developed. Cióse to the bif urcations the túnica media tapered gradually and at the bif urcations, the túnica media was completely deficient being replaced by the túnica adventitia (Forbus raphé). The túnica adventitia was thicker at the bifurcations (0.21mm) compared to other sites of the vessel. The average thickness of the MCA túnica media atits origin was 0.12mm while thatof the túnica adventitia was O.lOmm. Theseresults are similar to what has been described in the literature for Caucasians. It buttresses the assertion that anatomical anomalies of the MCA are rare. The seemingly low frequency of MCA aneurysms in Nigerian Africans is not due to its anomalies or histology.

This study investigated the effects of the administration of 25mg/kg/bodyweight of artemether for a period of 7 days on the trapezoid nuclei and behavioural functions in male Wistar rats. This was to establish the neurotoxic potential of artemether as an antimalarial drug. All rats showed normal morphological appearances at the completion of the experimental procedure. Statistical analyses showed no significant differences between the average brain weight of the control group and the experimental group. The assessment of brainstem nuclei showed patchychromatic appearance of neurons of the trapezoid nuclei in the experimental group as against the normal vesicular appearance of neurons of the trapezoid nuclei in the control group. The density of damaged trapezoid nuclei was significantly higher in the experimental group than in the control group. The rats in the control group displayed normal balance and coordination, while rats in the experimental group showed abnormalities in balance and coordination. This study observed that administration of 25mg/kg/bodyweight of artemether for a period of 7 days had neurotoxic effects on the trapezoid nuclei of Wistar rats.

Background: There is increasing body of evidence that maternal caffeine use during pregnancy predisposes the embryo and foetus to spontaneous abortion but data on its influence on foetal morphometry is scarce. Aim: This study aimed to evaluate experimentally the effects of caffeine on morphometric parameters of newborn of Wistar rats. Materials and Methods: Thirty, experimentally naive, adult female Wistar-albino rats weighing 100–150 g were mated. After confirming pregnancy by vaginal plug method, the pregnant rats were randomly assigned into four groups (Group A–D). The dams in Group A served a normal control. They had 0.2 ml/kg body weight of normal saline intraperitoneally from day 9 to 20. Experimental Group B rats had 25 mg/kg body weight of caffeine intraperitoneally. Group C had 50 mg/kg body weight of caffeine intraperitoneally and Group D dams had 100 mg/kg body weight of caffeine intraperitoneally. Dams in both experimental and control groups were sacrificed on day 20 after caffeine administration. The foetuses were weighed and their crown-rump lengths were measured. Their body mass index of the litters (foetuses) was calculated and their placentas were weighed. Results: The mean crown-rump length of the litters (Group A) was significantly more (5.61 ± 0.29) than the experimental which were 5.10 ± 0.22 cm, 4.72 ± 0.24 cm and 3.81 ± 0.16 cm for Group B, C and D litters, respectively (P < 0.0001). The mean foetal weight of Group A litters was significantly more (1.56 ± 0.38) than the experimental which were 1.25 ± 0.41 g, 1.15 ± 0.77 cm and 0.78 ± 0.34 cm for Group B, C and D litters, respectively (P < 0.0001). The mean placenta weight of the foetuses was significantly lower in the females from the experimental Group B, C and D compared to the control group (P < 0.0001). Conclusion: This study showed a significantly reduced foetal weight, crown-rump length and placenta weight in the offspring of experimental female rats treated with caffeine compared to the control.

Fifty-eight patients with occipital encephalocoeles were retrospectively examined. These comprised about one-half of the cases seen and evaluated for treatment at the University College Hospital, Ibadan, Nigeria, between January 1973 and December 1987. There was a female-to-male preponderance of 2:1. Of the patients 91% were treated during infancy. Only one patient was precluded from surgery because his large ulcerated lesion was associated with severe microcephaly and neonatal sepsis, to which he succumbed. About four-fifths of the lesions exceeded 5 cm in diameter. The operative mortality was 6%, all deaths occurring in patients who were neonates at the time of surgery and whose hernia sacs contained brain substance. Clinically apparent hydrocephalus was more frequently encountered postoperatively, than preoperatively. Developmental delay was apparent in 5 of the 13 patients in whom developmental milestones were assessed during follow-up. For most patients, the follow-up period was short, possibly a reflection of the poor prognosis of the disease.

Introduction Pituitary adenomas are the third most common intracranial tumours constituting about 15% in most series. Classification of pituitary adenomas is based on immunohistochemical staining properties of the tumours according to the 2007 WHO recommendations. This study was conducted to determine the distribution of the subtypes in a black African population. Materials and methods Fifty-nine archived biopsy samples of cases received over a 13 year period were retrieved. Tissue sections were stained with antibodies for prolactin, growth hormone, ACTH, TSH, FSH and LH. The tumours were classified according to the 2004 WHO classification of pituitary adenomas. Results Females constituted 54% of cases and also had the highest number of cases in all tumour types except gonadotrophs. Null cell adenomas were the most commonly occurring (33.9%) followed by gonadotroph adenomas (32.2%) and mammotrophs were third (18.6%). No thyrotroph adenoma was seen. Three of the adenomas showed plurihormonality with one staining for thyrotroph and corticotroph and two staining for thyrotroph and gonadotroph hormones. Discussion This study showed higher incidence of gonadotroph and null cell adenomas in the population studied. The lower levels of prolactinomas may be explained by medical therapy of patients but could also be due to racial differences.

Spinal cord injury, though an important cause of morbidity appears to be uncommon in pregnant women or perhaps, has not been accurately documented among them. Superimposed on the many impairments resulting from spinal cord injury is the presence of the foetus in the womb, which in itself normally brings about intense physiological alterations in the patient. Despite the complexities, neither the pregnancy nor the spinal cord injury needs jeopardize the optimal care of the other as long as the standard protocols are followed. In the past 10 years, the University college Hospital, Ibadan, Nigeria treated approximately 900 spinal cord injury patients, and only 3 of these were pregnant-an incidence of 0.30 per 90 patients per year, or 0.33%. We report here, the conservative management of one of these pregnant patients using the Gardner-Wells\' tongs traction, resulting in normal parturition and full neurological recovery. Key Words: Spinal cord injury, Third trimester pregnancy, Gardner-Wells\' tongs traction Nigerian Journal of Clinical Practice Vol 8(1) 2005: 46-50

Ocular complications occurred in 28% of children with head injury. Neuro-ophthalmological lesions made up one-third of these complications, mostly involved the optic nerve, and were associated with other focal neurological signs more frequently than non-neural ocular complications. Lesions of the posterior visual pathways were rare but tended to be permanent.

BackgroundHydrocephalus is a neurological condition known to cause learning and memory disabilities due to its damaging effect on the hippocampal neurons, especially pyramidal neurons. Vanadium at low doses has been observed to improve learning and memory abilities in neurological disorders but it is uncertain whether such protection will be provided in hydrocephalus. We investigated the morphology of hippocampal pyramidal neurons and neurobehavior in vanadium-treated and control juvenile hydrocephalic mice.MethodsHydrocephalus was induced by intra-cisternal injection of sterile-kaolin into juvenile mice which were then allocated into 4 groups of 10 pups each, with one group serving as an untreated hydrocephalic control while others were treated with 0.15, 0.3 and 3 mg/kg i.p of vanadium compound respectively, starting 7 days post-induction for 28 days. Non-hydrocephalic sham controls (n = 10) were sham operated without any treatment. Mice were weighed before dosing and sacrifice. Y-maze, Morris Water Maze and Novel Object Recognition tests were carried out before the sacrifice, the brains harvested, and processed for Cresyl Violet and immunohistochemistry for neurons (NeuN) and astrocytes (GFAP). The pyramidal neurons of the CA1 and CA3 regions of the hippocampus were assessed qualitatively and quantitatively. Data were analyzed using GraphPad prism 8.ResultsEscape latencies of vanadium-treated groups were significantly shorter (45.30 ± 26.30 s, 46.50 ± 26.35 s, 42.99 ± 18.44 s) than untreated group (62.06 ± 24.02 s) suggesting improvements in learning abilities. Time spent in the correct quadrant was significantly shorter in the untreated group (21.19 ± 4.15 s) compared to control (34.15 ± 9.44 s) and 3 mg/kg vanadium-treated group (34.35 ± 9.74 s). Recognition index and mean % alternation were lowest in untreated group (p = 0.0431, p=0.0158) suggesting memory impairments, with insignificant improvements in vanadium-treated groups. NeuN immuno-stained CA1 revealed loss of apical dendrites of the pyramidal cells in untreated hydrocephalus group relative to control and a gradual reversal attempt in the vanadium-treated groups. Astrocytic activation (GFAP stain) in the untreated hydrocephalus group were attenuated in the vanadium-treated groups under the GFAP stain. Pyknotic index in CA1 pyramidal layer of untreated (18.82 ± 2.59) and 0.15mg/kg vanadium-treated groups (18.14 ± 5.92) were significantly higher than control (11.11 ± 0.93; p = 0.0205, p = 0.0373) while there was no significant difference in CA3 pyknotic index across all groups.ConclusionOur results suggest that vanadium has a dose-dependent protective effect on the pyramidal cells of the hippocampus and on memory and spatial learning functions in juvenile hydrocephalic mice.

The possible radioprotective effect of Immunocal® (whey protein]) supplement and dexamethasone on gamma-irradiated cerebellar tissue of Wistar rat was investigated in this study. Forty male albino rats were acclimatized and randomized into four groups of 10 animals each. Group I rats served as control; Group II: received 2.5 Gy of gamma-radiation; Group III: received Immunocal® (286mg/kg) for 14 days, then 2.5 Gy gamma rays on day15 of experiment; Group IV: received dexamethasone (1mg/kg) i.p daily for 3 days, then 2.5 Gy gamma rays. All rats were euthanized 14 days post-irradiation. Rat brains were fixed in 10% formalin, processed with routine paraffin wax techniques and stained with Haematoxylin and Eosin. Histomorphometric studies showed that radiation significantly (p< 0.05) reduced the thickness of both the molecular and granular layers of the cerebellum when compared with the control group. This reduction was significantly (p< 0.05) increased in animals pretreated with Immunocal® and dexamethasone before irradiation. The densities of the Purkinje and outer stellate cells were significantly (p< 0.05) reduced in the irradiated animals compared with the control. The Purkinje cells and outer stellate cells were significantly increased (p< 0.05) in animals of Radiation + Immunocal® and Radiation + Dexamethasone groups relative to the radiation group. In conclusion, data from the present study showed that pre-treatment with Immunocal® and dexamethasone before exposure to a single dose of 2 Gy of gamma radiation on the 15th day of the experiment, protected rat’s cerebellum from gross and histological alterations from radiation injury.Keywords: Radioprotection, Immunocal®, Dexamethasone, Cerebellum, Purkinje cells