Title
Facial nerve function and general outcome of patients operated for Cerebellopontine angle tumors in Addis Ababa, Ethiopia, a retrospective study.
Cerebellopontine angle (CPA) tumors consist of ...10% of brain tumors. Surgical outcome is measured using functional status and cranial nerve preservation.
A hospital based retrospective cross-sectional descriptive study was done between August 31, 2015 and August 31, 2020. Fifty-five patients operated in the study period were enrolled in this study. Our study used House Brackmann Scale and Extended Glasgow Outcome Score. Fisher’s extract test was used to identify factors associated with outcome. P value < .05 was considered significant.
The mean age of the study participants was 36.64 years with male predominance (52.7%). Hearing loss (85%) was the commonest presentation. The mean tumor size was 4.4 cms ± 1.02. The tumors were operated through Retro-sigmoid approach without neurophysiologic monitoring. Post-operative CT scan shows GTR in 77.8%. At one year there were 66.7% patients with good facial nerve outcome, 20.8% with acceptable outcome and 12.5% with poor outcome. The post op GOS-E showed GOS-E of 8 in 25.5% and GOS-E of 7 in 23,6% of the patients. The operative mortality was high and predictors of mortality were postoperative infections (P=.003) and pre-operative facial palsy(P<.001)
Our patients presented with larger tumor sizes. The rate of functional facial nerve preservation was low and the researchers advocate for improved microsurgical techniques and acquiring neuromonitoring to improve outcome. Health facilities evaluating the patients initially should have a systemic approach to diagnose the patients earlier and refer to a capable neurosurgical facility. The overall outcome was acceptable and surgery is a better option for the management of cerebellopontine angle tumors in our set-up.
While both DKA & CSDH/subdural hygroma/ are known to cause significant morbidity and mortality, there is no a study that shows the role & effect of DKA on CSDH/subdural hygroma/ & vice versa to ...authors' best knowledge; hence this work will show how important relation does exist between DKA & CSDH/ hygroma. This study highlights the diagnostic & management challenges seen for a case of a 44 years old female black Ethiopian woman admitted with a diagnosis of newly diagnosed type 1 DM with DKA + small CSDH/subdural hygroma/ after she presented with sever global headache and a 3 month history of lost to her work. She needed burrhole & evacuation for complete clinical improvement besides DKA's medical treatment.
DKA induced cerebral edema on the CSDH/subdural hematoma/ can have a role in altering any of the parameters (except the thickness of CSDH) for surgical indication of patients with a diagnosis of both CSDH +DM with DKA. Hence, the treating physicians should be vigilant of different parameters that suggests tight brain &/ cerebral edema (including midline shift, the status of cisterns, fissures & sulci) and should not be deceived of the thickness of the CSDH/subdural hygroma/alone; especially when there is a disproportionately tight brain for the degree of collection. Whether DKA induced cerebral edema causes a subdural hygroma is unknown and needs further study.
Introduction Traumatic brain injury (TBI) is one of the leading causes of all injury-related deaths and disabilities in the world, especially in low to middle-income countries (LMICs) which also ...suffer from lower levels of funding for all levels of the health care system for patients suffering from TBI. These patients do not generally get comprehensive diagnostic workup, monitoring, or treatment, and return to work too quickly, often with undiagnosed post-traumatic deficits which in turn can lead to subsequent incidents of physical harm. Methods Here, we share methods and results from our research project to establish innovative, simple, and scientifically based practices that dramatically leverage technology and validated testing strategies to identify post-TBI deficits quickly and accurately, to circumvent economic realities on the ground in LMICs. We utilized paper tests such as the Montreal cognitive assessment (MoCA), line-bisection, and Bell’s test. Furthermore, we combined modifications of neuroscience computer tasks to aid in assessing peripheral vision, memory, and analytical accuracies. Data from seventy-one subjects (51 patients and 20 controls, 15 females and 56 males) from 4 hospitals in Ethiopia are presented. The traumatic brain injury group consists of 17 mild, 28 moderate, and 8 severe patients (based on the initial Glasgow Comma Score). Controls are age and education-matched subjects (no known history of TBI, brain lesions, or spatial neglect symptoms). Results We found these neurophysiological methods can: 1) be implemented in LMICs and 2) test impairments caused by TBI, which generally affect brain processing speed, memory, and both executive and cognitive controls. Discussion The main findings indicate that these examinations can identify several deficits, especially the MoCA test. These tests show great promise to assist in the evaluation of TBI patients and support the establishment of dedicated rehabilitation centers. Our next steps will be expansion of the cohort size and application of the tests to other settings.
Neural tube defects (NTDs) are prevalent congenital defects associated with pre-pregnancy diet with low levels of maternal folate. They are linked to severe morbidity, disability, and mortality, as ...well as psychological and economic burdens.
The goal of this study was to determine the levels of folate, vitamin B12, and homocysteine in the blood of women who had a pregnancy impacted by NTDs.
A hospital-based case-control study was undertaken between September 2019 and August 2020. The study comprised a total of 100 cases and 167 controls. Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of folate, vitamin B12, and homocysteine in the serum.
Only 39% of the cases and 54.5% of control mothers reported periconceptional use of folic acid/multivitamin, which indicated a statistically significant difference (
= 0.014). Logistic regression indicated that periconceptional use of folic acid/multivitamin was associated with NTDs (
= 0.015, OR = 1.873, 95% CI: 1.131-3.101). We found that 57% of the cases and 33.5% of controls, as well as 43% of cases and 20.4% of controls had serum folate and vitamin B12 levels below the cut-off value, respectively. Twenty-seven percent of the cases and 6.6% of controls had hyperhomocysteinemia (HHcy). The median concentrations of folate, vitamin B12, and homocysteine in cases and controls were 4.78 and 8.86 ng/ml; 266.23 and 455 pg/ml; 13.43 and 9.7 μmol/l, respectively. The median concentration of folate (
< 0.001) and vitamin B12 (
< 0.001) were significantly lower in the cases than controls, while the homocysteine concentration (
< 0.001) was significantly lower in the controls than cases. Folate OR (95% CI) = 1.652 (1.226-2.225;
= 0.001), vitamin B12 OR (95% CI) = 1.890 (1.393-2.565;
< 0.001, and homocysteine OR (95% CI) = 0.191 (0.09-0.405;
< 0.001) levels were associated with NTDs.
Folate and vitamin B12 are deficient in both cases and control mothers. The lower levels of folate and vitamin B12 with an elevated homocysteine level in NTD-affected pregnancy may be an indication that these biochemical variables were risk factors for NTDs. Folate/multivitamin supplementation and/or food fortification should be promoted.
Summary After a four-year planning period, a joint Ethiopian/Norwegian training program in neurosurgery was started in June 2006. The collaborating partners were the Addis Ababa University, ...Department of surgery, Tikur Anbessa specialized hospital, the University of Bergen, Haukeland University hospital and Myungsung Christian Medical Center, a Korean missionary hospital in Addis Ababa. A Memorandum of understanding was signed at Dean/CEO levels. Although other initiatives have been involved in supporting neurosurgery in Addis Ababa during the same period, this institutionally founded program has been the main external contributor to neurosurgical capacity building through the education of 21 Ethiopian neurosurgeons, and in supporting a sustainable environment for neurosurgical training within a network of five centres in Addis Ababa. This article gives an account of the strategies underlying the program planning, the history of the program as well as on the experience gained by it. Finally, ethical problems and challenges encountered in the program are discussed.
Ethiopia is a fast-growing economy with rapid urbanization and poor occupational safety measures. Fall injuries are common and frequently result in traumatic brain injury (TBI) or spinal cord injury ...(SCI).
We prospectively included fall victims who were hospital-treated for neurotrauma or forensically examined in 2017 in Addis Ababa, Ethiopia. We registered sociodemographic factors, fall types, injuries, treatment, and outcome.
We included 117 treated and 51 deceased patients (median age 27 vs. 40 years). Most patients were injured at construction sites (39.9%) and only one in three used protective equipment. TBI (64.7%) and SCI (27.5%) were the most common causes of death among the deceased patients, of which most died at the accident site (90.2%). Many patients suffered significant prehospital time delays (median 24 h). Among treated patients, SCI was more frequent than TBI (50.4% vs. 39.3%), and 10.3% of the patients had both SCI and TBI. Most SCIs were complete (49.3%), whereas most TBIs were mild (55.2%). Less than half of TBI patients and less than one in five SCI patients were operated. There were twice as many deaths among TBI patients as SCI patients. Among those discharged alive, at a median of 33 weeks, 50% of TBI patients had a good recovery whereas 35.5% of SCI patients had complete injuries.
Falls at construction sites with inadequate safety measures were common causes of SCI and TBI resulting in severe disability and death. These results support further development of prevention strategies and neurotrauma care in Ethiopia.
•Trauma is a public health problem in low- and middle-income countries.•Neurotrauma is the most common indication for neurosurgery in Ethiopia.•Most fall-related neurotrauma occurred at construction sites.•Inadequate safety measures were common among construction workers.•Prevention strategies and further development of neurotrauma care is needed in Ethiopia.
•Traumatic brain injury is a disease with high mortality with increased intracranial pressure included in the emergency department.•Point -of-care ultrasound (POCUS) has been used for a bedside quick ...diagnosis of a trauma patient in emergency department.•ONSD can be performed by trained physicians and it can be used as an additional diagnostic/decision making tool when evaluating patients with TBI in limited resource settings.
Traumatic brain injury is a disease with high mortality partially from increased intracranial pressure including in the emergency department. Neuroimaging and intracranial pressure monitoring are limited in resource-limited settings. Optic nerve sheath diameter measurement to assess intracranial pressure indirectly using point-of-care ultrasound is appealing in diagnostics and decision-making.
We plan to evaluate the utility of point-of-care ultrasound of optic nerve sheath diameter and its role in traumatic brain injury patients.
Optic nerve sheath diameter measurement was performed at presentation, postoperatively and 24 h later by trained residents. The procedure was repeated if any change in clinical status was observed. Clinical data and demographics were recorded and reviewed.
A total of 50 patients were enrolled. Twenty-one patients underwent neurosurgical intervention. Three patients died in hospital. Eighteen patients had optic nerve sheath diameters less than 5 mm, 20 patients had optic nerve sheath diameter between 5 mm and 6 mm, and 12 patients had optic nerve sheath diameter > 6 mm. In 2 patients with changes in clinical condition, the repeat optic nerve sheath diameter assessment showed an increase in optic nerve sheath diameter.
Despite limitations, trained healthcare providers could assess and measure optic nerve sheath diameter. Longer training time and quality assurance are needed to appreciate the impact.
Background
A chronic cranial subdural hematoma arising after post-spinal anesthesia is a rare but serious and life-threatening complication of spinal anesthesia. It usually mimics the typical ...post-spinal-anesthesia headache or post-dural-puncture headache, potentially masking its detection. Abducens nerve palsy tends to occur in chronic subdural hematoma of post-dural-puncture etiology rather than in cases attributed to other causes of subdural hematoma. Preferential damage to the abducens nerve is frequent and can be attributed to its anatomic course because the abducens nerve runs in the direction of the typical caudad displacement of the brain related to intracranial hypotension.
Observation
Here, we present a report on the clinical presentation, pathogenesis, and management of two cases that developed bilateral abducens nerve palsy following post-spinal anesthesia administered for cesarean sections due to obstetric indications.
Lesson
Post-spinal-anesthesia-induced chronic subdural hematoma, although a rare, life-threatening complication, must be differentiated from post-spinal-anesthesia headache and treated surgically. Cranial nerve palsy (more commonly called abducens nerve palsy) is more common in post-spinal-anesthesia-induced subdural hematoma than subdural hematomas of other etiologies as the cerebrospinal fluid brain cushioning is partly lost. Cranial nerve palsies resolve in most cases if surgery is performed in a timely manner.
Neural tube defects are common group of central nervous system anomalies of complex etiology and major public health importance worldwide. The occurrence of multiple neural tube defects, however, is ...an extremely rare event and has never been reported in Ethiopia so far. This study gives an insight into how the embryogenesis, management, and postoperative complications of multiple neural tube defects differ from the ordinary single neural tube defects on the basis of up-to-date existing literature.
This paper highlights a case of an 8 days old female black race Ethiopian neonate who was brought by her mother with the chief complaint of lower back and lower neck swelling since birth. The findings were a 5 × 4 × 5 cm sized ulcerated placode at the mid-lumbosacral area and a 1.5 × 1.5 × 1 cm sized fluctuant, nontender, transilluminating mass with overlying unruptured defect dysplastic skin at the cervicothoracic junction. With a diagnosis of multiple neural tube defects secondary to unruptured cervicothoracic meningocele and ruptured lumbosacral myelomeningocele, single-stage repair of the defects was done with good outcome.
There is insufficient evidence as to the exact mechanism of development of multiple neural tube defects. Similarly, whether patients with multiple neural tube defects had increased risk of post repair hydrocephalus compared with patients who have single neural tube defect is unknown. Hence, more research on the embryogenesis, management, and long-term outcome of multiple neural tube defects in particular and single neural tube defects in general should be done to better help patients with this costly and crippling problem. Lastly, the practice of folic acid supplementation is very low in resource-limited countries such as Ethiopia and, hence, should be improved.
Prevalence of neural tube defects (NTD) is high thus many children are born with a neural tube defect in Addis Ababa, and surgical closure is a commonly performed procedure at the pediatric ...neurosurgical specialty center.
The primary aim is to study the outcomes in children undergoing surgical closure of NTDs and to identify risk factors for readmission, complications and mortality.
Single-center prospective study of all surgically treated NTDs from April 2019 to May 2020.
A total of 228 children, mean age 11 days (median 4) underwent surgery during the study period. There were no in-hospital deaths. Perioperatively 11 (4.8%) children developed wound complications, none of them needed surgery and there was no perioperative mortality. The one-year follow-up rate was 62.7% (143/228) and neurological status remained stable since discharge in all. The readmission and reoperation rates were 38 % and 8 % and risk factors for readmission were hydrocephalus (80%) and open defects (88%). Hydrocephalus (P = 0.05) and younger age (P = 0.02) were identified as risk factors for mortality. The wound-related complication rate was 55% at and was associated with large defects (P = 0.04) and delayed closure due to late hospital presentation (P = 0.01).
The study reveals good perioperative surgical outcome and further need for systematic improvement in treatment and follow-up of NTD patients especially with hydrocephalus. We identified risk factors for wound-related complications, readmission and mortality.
•Ethiopia has a high prevalence of neural tube defects (NTD), and surgical closure is a commonly performed procedure.•Ethiopia's first prospective study: analyzed 228 children with NTD operations to assess surgical outcomes.•Acceptable peri-operative outcome (within 30-days after surgery) with minor morbidity and no mortality.•One-year followup was 62.7%, and the readmission and reoperation rates were 38 % and 8 %.•Hydrocephalus was identified as a risk factor for readmission, post-operative mortality and morbidity.
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