Adesola Ogunniyi

Epidemiology of dementia in Nigeria: results from the Indianapolis-Ibadan study.

We determined the prevalence of dementia in a cohort of 2494 elderly Nigerians residents in Idikan Community, Ibadan, Nigeria. We utilized the Community Screening Instrument for Dementia to select subjects for clinical assessment in the second stage. The findings were compared with those of 2212 African Americans living in Indianapolis, studied simultaneously using similar methodology. The overall age‐adjusted prevalence rates of dementia and Alzheimers disease in Ibadan were 2.29% and 1.41%, respectively. These rates were much lower than the respective values of 8.24% and 6.24% obtained for African Americans. In Ibadan, Alzheimers disease accounted for 64.3% of the cases, with old age and female gender being the significant risk factors, whilst ‘living with others’ appeared to be protective (Pu2003<u20030.05). Amongst African Americans, on the other hand, old age, rural living below the age of 19u2003years, low educational attainment and family history of dementia were the risk factors. There was a lack of association between Alzheimers disease and possession of the apolipoprotein E ε4 allele in the Nigerian sample, unlike the finding in African Americans, where significant association was shown. In addition, the frequencies of the vascular risk factors investigated were lower in Nigerians.

Pattern of Presentation of Multiple Sclerosis in Saudi Arabia: Analysis Based on Clinical and Paraclinical Features

We studied 89 MS patients comprising 38 males and 51 females seen over a 10-year period. The hospital frequency was 25/100,000 patients. The diagnosis was mainly clinical and was supported by neuroimaging, cerebrospinal fluid analysis and neurophysiological tests. Sixty-five patients (73%) were Saudis and the peak age of onset was in the third decade. Fifty-two patients (58.4%) had clinically definite MS, 17 (19.1%) had laboratory-supported definite MS, 15 (16.9%) were clinically probable MS cases and the remaining 5 (5.6%) had laboratory-supported probable MS. The mean age at onset of Saudi patients (25.9 years) was lower than that of the non-Saudis (29.4 years; p < 0.001). Involvement of the pyramidal system was the commonest mode of presentation. The clinical course was relapsing-remitting in 60.7%, progressive-relapsing in 20.2% and primary progressive in 19.1%. The number of systems involved was significantly associated with the duration of disease (p < 0.001). The demographic features and the variability of clinical presentation of Saudi MS patients is similar to the results from neighbouring countries. Combination of clinical features and paraclinical tests is essential for accurate determination of extent of dissemination and for unmasking clinically silent lesions.

Syringomyelia developing as an acute complication of tuberculous meningitis

BACKGROUNDnTuberculosis of the nervous system has protean manifestations. Syringomyelia, though an uncommon complication of it, is usually of late onset.nnnMETHODSnWe report two patients with tuberculosis meningitis who developed syringomyelia acutely. The diagnosis was supported by neuroimaging and findings at laminectomy.nnnRESULTSnThe two patients developed syringomyelia between 11 days and 6 weeks of the onset of tuberculous meningitis. They both had cord swelling and softening.nnnCONCLUSIONSnAcute-onset syringomyelia should be suspected in any patient being treated for tuberculosis meningitis who subsequently develops limb weakness and/or sphincteric dysfunction. Inflammatory edema and cord ischemia appeared to be the underlying mechanisms in these early onset cases rather than arachnoiditis which is important in late-onset cases.

Memory performance in HIV/AIDS--a prospective case control study.

BACKGROUNDnMemory impairment, usually impaired retrieval of information, has been described in HIV/AIDS, especially among those with severe illness. Neuro-cognitive disturbances in HIV/AIDS have been linked to poor quality of life and medication adherence. This prospective, case-control study was designed to assess the verbal and non-verbal memory as well as the attention abilities of Nigerian Africans with HIV/AIDS and correlate their performances with their CD4+ T lymphocytes (CD4+) counts.nnnMETHODSnA total of 288 randomly selected subjects, comprising 96 HIV-positive symptomatic patients, 96 HIV-positive asymptomatic patients and 96 HIV-negative controls, participated in the study. The subjects were age-, sex-, and level of education matched. The Recognition Memory Test and Choice Reaction Time tasks, components of the computer-assisted neuropsychological tests battery- the Iron Psychology FePsy were used for cognitive assessments.nnnRESULTSnThe mean memory scores of the HIV-positive asymptomatic subjects did not differ significantly from the controls (p > 0.05) but the HIV-positive symptomatic subjects scores were significantly lower than the controls (p < 0.05). Both HIV-positive groups had psychomotor slowing and impaired attention (p < 0.05). The HIV-positive subjects with CD4+ counts < 200/microl and between 200 and 499/microl had significant memory impairment (p < 0.001 and p < 0.001 respectively) but there was no significant impairment among those with count > or = 500/microl. Impaired ability for sustained attention was however present irrespective of the CD4+ level relative to controls (p < 0.001).nnnCONCLUSIONSnWe concluded that there was no significant memory disturbance among HIV-positive asymptomatic subjects despite the presence of impaired attention and psychomotor slowing, and that the severity of immune suppression (as indicated by the CD4+ T lymphocytes count) is a strong determinant of cognitive decline in HIV/AIDS.

Dementia in Saudi Arabia: experience from a university hospital

Objectives ‐ To describe the pattern of presentation, the types of dementia and the associated conditions in Saudi patients. Materials and methods ‐Hospital‐based study using DSM‐IV and ICD 10 criteria for consensus diagnosis of cases from clinical information and results of investigations. Dementia subtypes were made according to NINCDS‐ADRDA, NINDS‐AIREN and ICD 10 criteria while CDR was used for severity grading. Results ‐ A total of 77 demented patients (49 males, 28 females) were studied. The hospital frequency was 19.3/100,000 patients. The mean age at presentation was 74.6 years and age at onset was below 65 years in 17 patients. The types of dementia were: Alzheimers disease (51.9%), vascular dementia (18.2%), mixed cases (15.6%), dementia with Parkinsons disease (7.8%) and treatable dementia (5.2%). Only 3 patients were in the severe clinical stage and infections were important causes of deterioration. Conclusion ‐ The hospital frequency appears to be low probably because of the relatively young population. The pattern of dementia with preponderance of AD is similar to that in western countries and intervention directed at the risk factors for stroke could reduce the burden of vascular dementia.

Sociodemographic Factors and Primary Headache Syndromes in a Saudi Community

BACKGROUND AND PURPOSEnThere is increasing evidence that the pathophysiologic mechanisms are different between migraine and tension-type headache. The aim of the study was to determine possible sociodemographic differences in Saudi Arabia subjects with headache.nnnMETHODOLOGYnA community-based door-to-door survey with identification of headache cases based on IHS criteria. A comparison of sociodemographic variables was made between subjects with migraine and tension-type headache.nnnRESULTSnHeadache prevalence was 8% (95% CI = 7.3-8.7%) with a preponderance of tension-type headache (39%). Females were more often affected than males (ratio 2:1). Migraine subjects were more often in the professional occupational group compared with tension-type headache (p < 0.05).nnnCONCLUSIONnHeadache prevalence in the community was low. Subjects with migraine and tension-type headache were similar with respect to many demographic variables. Occupational association needs verification in further studies.

Epilepsy classification and factors associated with control in Saudi adult patients

There is insufficient information on the epilepsies in Saudi Arabia. The objectives were to classify the patients according to seizure types and epilepsies as well as to determine the factors associated with control. In a hospital-based study, clinical information, electroencephalographic and neuroimaging findings were utilized to classify the cases into seizure types and epilepsies according to ILAE criteria and to determine the factors statistically associated with control. In the study there were 826 patients (454 males and 372 females; mean age = 28.7 years; >80% below 30 years at onset). The seizure types were: generalized tonic-clonic (43.8%), partial seizure secondarily generalized (41.9%), myoclonic (8.4%), simple partial (1.3%), complex partial (1.3%) and absence (0.4%). About 15% of the classifiable epilepsies were symptomatic. Most symptomatic epilepsies occurred in people over the age of 50 years. One-year remission rate was 80% and the factors associated with control were: compliance, monotherapy, therapeutic drug level and seizure type. The results showed that epilepsy predominantly affected young adults and confirmed the association of partial epilepsy with clinical and CT abnormalities. The 1-year remission rate was comparable with reports from other studies as well as the factors associated with control in our patients.

Cognitive dysfunction in diabetes mellitus in Jos, north-central Nigeria

Background: Cognitive dysfunction is a common source of morbidity and mortality, usually observed in late stages of diabetes complications. Dementia is one of the commonest and most disabling late life mental disorders. The fact that data are scanty in the tropic cannot be overemphasized. There is a need to describe the association of cognitive dysfunction among our diabetics and its attendant risks such as duration of DM, age of patient, presence of hypertension and glycaemic control. Methods: a sample size of 180 patients was obtained with 120 diabetic subjects and 60 non-diabetics as controls. The mini-mental state examination (MMSE) was used to grade the severity of cognitive states. Result: twenty-six (21.7%) of the diabetic subjects had cognitive dysfunction with a score of less than twenty-four based on the mini-mental state examination (MMSE) while 6 (10.0%) of the controls had dementia. Conclusion: This study clearly shows that in a clinic setting, diabetes is associated with a greater trend toward impairments of cognitive function than in the non-diabetic population.

The pseudo-delta sign is unreliable in differentiating between aneurysmal SAH and sinus thrombosis in unenhanced brain CT

The pseudo-delta sign (PDS) consists of a hyperdense extra-axial triangular image surrounding the low density of the superior sagittal sinus (SSS) in the unenhanced brain CT scan (Fig. 1) [1]. The true delta or empty-delta sign, described by Buonanno et al. in 1978, is only visible on contrast-enhanced films (Fig. 2) [1–4]. The PDS has been described in association with interhemispheric subdural hemorrhage, subarachnoid hemorrhage (SAH) and superior sagittal sinus thrombosis (SSST) [1–5]. The sign has also been encountered with increased attenuation of normal dura surrounding the SSS, diffuse cerebral edema in children and sluggish flow resulting from raised intracranial pressure. Others include calcification of arachnoid granulations and possibly brain death [3,4,6–8]. In an autopsy study of 12 patients with ‘empty triangle sign’, another descriptive term for the PDS, Zilkha et al. found that five of of the patients had SSST. However, they noticed that this sign was not specific for SSST as it was also observed in SAH [3]. The aim of this study was to compare the frequency of PDS in our patients with SAH, SSST as well as in other neurological conditions and to infer its diagnostic accuracy.