<strong>Introduction:</strong> The epilepsy classification in under developed countries faces many difficulties in reporting, work-up and management strategies. Exploring local practice in general hospital...<strong>Introduction:</strong> The epilepsy classification in under developed countries faces many difficulties in reporting, work-up and management strategies. Exploring local practice in general hospitals will positively add to the welfare of patients with epilepsy. The objectives of this study were to assess the current medical practice in epilepsy work up and to study the selection of AEDs as per ILAE guidelines. <strong>Methods:</strong> This was a cross sectional-retrospective hospital based study, conducted between April and September 2016 in Omdurman Teaching Hospital, Khartoum, Sudan. Patients aged 18 years old and above were enrolled. Epilepsy was defined as having at least two non-provoked seizures in the least 6 months in a patient who was assessed by clinical review and electroencephalogram (EEG). Epilepsy was classified as generalized, focal or unclassified. Medications refer to all internationally licensed antiepileptic medications (AEDs) in 2016.<strong> Results:</strong> One hundred adult Sudanese patients were enrolled for this study. The most common event described during the ictal phase was tongue biting in 50% of participants followed by body stiffness in 46%. Epilepsy was classified as generalized in 84%, focal in 11% and unclassified in 5% patients. In generalized epilepsy, the MRI detected 23.3% abnormal findings higher than the CT which detected 14.8% (4/27), p value = 0.032. In focal epilepsy, the CT detected 75% abnormal findings higher than the MRI which detected 33.3%, p value = 0.02. The AEDs used were as follows: Carbamazepine (CBZ) 48%, Na valproate (VP) 33%, Lamotrigine (LMT) 2%, Levetricetan (LVT) 1%, CBZ + VP 14% and CBZ + Oxcarbazepine (OXC) 2%. <strong>Conclusion:</strong> The current medical practice in Omdurman teaching hospital should be modified to match the international league against epilepsy (ILAE) guidelines in workup, management, AEDs selection and classification of epilepsy.展开更多
Introduction: Autonomic nuclei affection results in variations in hemodynamics, temperature, sweating and ECG. Medullary strokes are challenging in their presentation, bizarre clinical signs, work and neurological out...Introduction: Autonomic nuclei affection results in variations in hemodynamics, temperature, sweating and ECG. Medullary strokes are challenging in their presentation, bizarre clinical signs, work and neurological outcome. The commonest cause is infarction of the posterior inferior cerebellar artery (PICA). Anatomical areas affected include the inferior cerebellar peduncle, dorsolateral medulla, nuclei of the Trigeminal, vestibular nuclei, Ninth and Vagus nerves. The descending sympathetic tracts and spin thalamic tracts. Serious cardiopulmonary events can complicate 11% of cases. Case Presentation: A middle-aged female developed sub-acute dizziness associated with vomiting and right head pains. She was unable to walk but remained cognitively clear. Her gastrointestinal symptoms were disabling and this was the main factor for presenting to the emergency room. The risk factors included hypertension and diabetes mellitus. Imaging studies were essential for posterior circulation stroke diagnosis and follow-up. She manifested remarkable autonomic features regarding the skin and hemodynamics. Nevertheless, the hospital course was controllable. Discussion: This case report was consistent with relevant literature in the contra lateral vaso motor changes and drop in body temperature during the acute phase. Moreover, our patient developed clinical and radiological extension through double antiplatelets. Superiority of the magnetic resonance imaging (MRI) scans in this patient enabled better diagnostic accuracy in a brainstem stroke. Conclusion: The autonomic features, in this case, represent major symptomatology and clinical signs. The variation in the hemodynamics and persistence of symptoms is thought provoking. This increases the awareness of emergency doctors for acute stroke presenting with autonomic features will enable early detection and helps outcome.展开更多
<strong>Background:</strong> The diverse modes in geographical locations, environmental factors, genetic and racial characteristics play a complex role in determining the pattern of neurological disorders ...<strong>Background:</strong> The diverse modes in geographical locations, environmental factors, genetic and racial characteristics play a complex role in determining the pattern of neurological disorders worldwide. Determining the pattern of neurological disorders enables health policymakers to plan evidently for service, training, and research priorities. Few prevalence studies in neurology were conducted in Sudan. <strong>Methods:</strong> This is a retrospective hospital-based study that reviewed the medical records of patients who attended a Dedicated Neurology Clinic (DNC) in Omdurman, the national Capital of Sudan, for 24 months, from January 2016 to January 2018. This study aimed to determine the DNC pattern of neurological disorders as a representative subset prevalence in Sudan. Neurologists conducted the medical workup for diagnosis after at least two visits. All patients have ethically consented. <strong>Results: </strong>The total number of patients was 1050. Only 749 patients (71.3%) fulfilled the inclusion criteria. The mean age was 46.5 ± 1.9, and males were 45.3%. 72% were from the Capital. The presenting symptoms were headache (16.6%), seizures (11.5%), limbs weakness (11.2%), and lower percentages for other neurological symptoms. The commonest diagnoses were Stroke 12.4%, Epilepsy 9.3%, Primary Headache 8.8%, Movement Disorders 7.3%, Peripheral Neuropathy 6%, Dementia 4% Neuroinfections 1.4%, Demyelinating Disorders 2.6%, Spinal Spondylotic Radiculopathy 2.6% and 1.7% for Cerebral Venous Thrombosis. <strong>Conclusion:</strong> The data from Sudan-DNC showed that the most common neurological disorders descendingly were Stroke, Epilepsy, Headache, Movement Disorders, Peripheral Neuropathy, Dementia, Infections, Demyelinating Disorders, Spinal Spondylotic Radiculopathy, and Cerebral Venous Thrombosis. The demyelinating disorders and peripheral neuropathy showed a higher percentage than our previous preliminary prevalence study in 2012 compared to the other conditions, which showed similar rates in that study.展开更多
文摘<strong>Introduction:</strong> The epilepsy classification in under developed countries faces many difficulties in reporting, work-up and management strategies. Exploring local practice in general hospitals will positively add to the welfare of patients with epilepsy. The objectives of this study were to assess the current medical practice in epilepsy work up and to study the selection of AEDs as per ILAE guidelines. <strong>Methods:</strong> This was a cross sectional-retrospective hospital based study, conducted between April and September 2016 in Omdurman Teaching Hospital, Khartoum, Sudan. Patients aged 18 years old and above were enrolled. Epilepsy was defined as having at least two non-provoked seizures in the least 6 months in a patient who was assessed by clinical review and electroencephalogram (EEG). Epilepsy was classified as generalized, focal or unclassified. Medications refer to all internationally licensed antiepileptic medications (AEDs) in 2016.<strong> Results:</strong> One hundred adult Sudanese patients were enrolled for this study. The most common event described during the ictal phase was tongue biting in 50% of participants followed by body stiffness in 46%. Epilepsy was classified as generalized in 84%, focal in 11% and unclassified in 5% patients. In generalized epilepsy, the MRI detected 23.3% abnormal findings higher than the CT which detected 14.8% (4/27), p value = 0.032. In focal epilepsy, the CT detected 75% abnormal findings higher than the MRI which detected 33.3%, p value = 0.02. The AEDs used were as follows: Carbamazepine (CBZ) 48%, Na valproate (VP) 33%, Lamotrigine (LMT) 2%, Levetricetan (LVT) 1%, CBZ + VP 14% and CBZ + Oxcarbazepine (OXC) 2%. <strong>Conclusion:</strong> The current medical practice in Omdurman teaching hospital should be modified to match the international league against epilepsy (ILAE) guidelines in workup, management, AEDs selection and classification of epilepsy.
文摘Introduction: Autonomic nuclei affection results in variations in hemodynamics, temperature, sweating and ECG. Medullary strokes are challenging in their presentation, bizarre clinical signs, work and neurological outcome. The commonest cause is infarction of the posterior inferior cerebellar artery (PICA). Anatomical areas affected include the inferior cerebellar peduncle, dorsolateral medulla, nuclei of the Trigeminal, vestibular nuclei, Ninth and Vagus nerves. The descending sympathetic tracts and spin thalamic tracts. Serious cardiopulmonary events can complicate 11% of cases. Case Presentation: A middle-aged female developed sub-acute dizziness associated with vomiting and right head pains. She was unable to walk but remained cognitively clear. Her gastrointestinal symptoms were disabling and this was the main factor for presenting to the emergency room. The risk factors included hypertension and diabetes mellitus. Imaging studies were essential for posterior circulation stroke diagnosis and follow-up. She manifested remarkable autonomic features regarding the skin and hemodynamics. Nevertheless, the hospital course was controllable. Discussion: This case report was consistent with relevant literature in the contra lateral vaso motor changes and drop in body temperature during the acute phase. Moreover, our patient developed clinical and radiological extension through double antiplatelets. Superiority of the magnetic resonance imaging (MRI) scans in this patient enabled better diagnostic accuracy in a brainstem stroke. Conclusion: The autonomic features, in this case, represent major symptomatology and clinical signs. The variation in the hemodynamics and persistence of symptoms is thought provoking. This increases the awareness of emergency doctors for acute stroke presenting with autonomic features will enable early detection and helps outcome.
文摘<strong>Background:</strong> The diverse modes in geographical locations, environmental factors, genetic and racial characteristics play a complex role in determining the pattern of neurological disorders worldwide. Determining the pattern of neurological disorders enables health policymakers to plan evidently for service, training, and research priorities. Few prevalence studies in neurology were conducted in Sudan. <strong>Methods:</strong> This is a retrospective hospital-based study that reviewed the medical records of patients who attended a Dedicated Neurology Clinic (DNC) in Omdurman, the national Capital of Sudan, for 24 months, from January 2016 to January 2018. This study aimed to determine the DNC pattern of neurological disorders as a representative subset prevalence in Sudan. Neurologists conducted the medical workup for diagnosis after at least two visits. All patients have ethically consented. <strong>Results: </strong>The total number of patients was 1050. Only 749 patients (71.3%) fulfilled the inclusion criteria. The mean age was 46.5 ± 1.9, and males were 45.3%. 72% were from the Capital. The presenting symptoms were headache (16.6%), seizures (11.5%), limbs weakness (11.2%), and lower percentages for other neurological symptoms. The commonest diagnoses were Stroke 12.4%, Epilepsy 9.3%, Primary Headache 8.8%, Movement Disorders 7.3%, Peripheral Neuropathy 6%, Dementia 4% Neuroinfections 1.4%, Demyelinating Disorders 2.6%, Spinal Spondylotic Radiculopathy 2.6% and 1.7% for Cerebral Venous Thrombosis. <strong>Conclusion:</strong> The data from Sudan-DNC showed that the most common neurological disorders descendingly were Stroke, Epilepsy, Headache, Movement Disorders, Peripheral Neuropathy, Dementia, Infections, Demyelinating Disorders, Spinal Spondylotic Radiculopathy, and Cerebral Venous Thrombosis. The demyelinating disorders and peripheral neuropathy showed a higher percentage than our previous preliminary prevalence study in 2012 compared to the other conditions, which showed similar rates in that study.
