Olalekan Oyinloye

Ischemic stroke following abuse of Marijuana in a Nigerian adult male

Cannabis is the most widely used illicit drug among adolescents and young adults. Despite its widespread use, only a few reports exist on the association of cannabis use and stroke. A 26-year-old Nigerian male, developed right-sided ischemic stroke few hours after smoking three wraps of cannabis. He had smoked cannabis consistently for the past 4 years prior to the development of the stroke. Known stroke etiology and abuse of other illicit drugs were ruled out from history and investigations. Neuroimaging studies of the brain revealed infarcts in basal ganglia secondary to occlusion of blood flow in the left anterior and middle cerebral arteries. The mechanism of stroke in this patient was thought to be a cannabis-induced vasculopathy. Many cases of stroke in the young are increasingly being seen in hospitals in resource scarce countries. There seems to be a predilection for the basal ganglia in ischemic stroke following cannabis abuse. Therefore, cannabis abuse should be considered in young adults with basal ganglia infarcts, after excluding other known etiologies.

Posterior reversible encephalopathy syndrome in a adult female

Posterior reversible encephalopathy syndrome is a clinico-neuroradiologic diagnosis, with rapidly evolving neurologic condition, characterized by headache, confusion, altered mental status, seizures, cortical blindness, lethargy, stupor, and occasionally, focal neurological signs accompanied by a typical computed tomography or magnetic resonance imaging pattern. With early recognition and treatment, complete resolution of symptoms occurs. Typical imaging findings characteristically involve the white matter bilaterally in the parieto-occipital regions. Atypical imaging finding of contrast enhancement of lesion can occur, but is less common. A 20-year-old primiparous lady presented with posterior reversible encephalopathy syndrome. To the best of our knowledge, this is the first documented case in Nigeria. This case-report highlights the importance of recognizing the salient imaging features in this lethal but reversible entity with prompt management.

Traumatic diaphragmatic hernia masquerading as left- sided hydropneumothorax: a case report

Abstract Traumatic diaphragmatic rupture (TDR) is rare in children and can be easily overlooked because of lack of awareness of late presentation and concomitant injuries. A 4-year-old girl presented with respiratory distress 2 months after a road traffic accident. The initial differential diagnosis was pneumonia or pulmonary tuberculosis with associated pleural effusion. On further assessment, a diaphragmatic hernia was suspected. The initial radiograph showed left hydropneumothorax. Fluoroscopy, follow-up chest radiographs and barium swallow confirmed the diagnosis of left TDR. Surgery was undertaken but unfortunately she did not survive. Awareness of delayed presentation of TDR is essential for prompt management.

Development and Reliability of a User-Friendly Multicenter Phenotyping Application for Hemorrhagic and Ischemic Stroke

BACKGROUND Annotation and Image Markup on ClearCanvas Enriched Stroke-phenotyping Software (ACCESS) is a novel stand-alone computer software application that allows the creation of simple standardized annotations for reporting brain images of all stroke types. We developed the ACCESS application and determined its inter-rater and intra-rater reliability in the Stroke Investigative Research and Educational Network (SIREN) study to assess its suitability for multicenter studies. METHODS One hundred randomly selected stroke imaging reports from 5 SIREN sites were re-evaluated by 4 trained independent raters to determine the inter-rater reliability of the ACCESS (version 12.0) software for stroke phenotyping. To determine intra-rater reliability, 6 raters reviewed the same cases previously reported by them after a month of interval. Ischemic stroke was classified using the Oxfordshire Community Stroke Project (OCSP), Trial of Org 10172 in Acute Stroke Treatment (TOAST), and Atherosclerosis, Small-vessel disease, Cardiac source, Other cause (ASCO) protocols, while hemorrhagic stroke was classified using the Structural lesion, Medication, Amyloid angiopathy, Systemic disease, Hypertensive angiopathy and Undetermined (SMASH-U) protocol in ACCESS. Agreement among raters was measured with Cohens kappa statistics. RESULTS For primary stroke type, inter-rater agreement was .98 (95% confidence interval [CI], .94-1.00), while intra-rater agreement was 1.00 (95% CI, 1.00). For OCSP subtypes, inter-rater agreement was .97 (95% CI, .92-1.00) for the partial anterior circulation infarcts, .92 (95% CI, .76-1.00) for the total anterior circulation infarcts, and excellent for both lacunar infarcts and posterior circulation infarcts. Intra-rater agreement was .97 (.90-1.00), while inter-rater agreement was .93 (95% CI, .84-1.00) for TOAST subtypes. Inter-rater agreement ranged between .78 (cardioembolic) and .91 (large artery atherosclerotic) for ASCO subtypes and was .80 (95% CI, .56-1.00) for SMASH-U subtypes. CONCLUSION The ACCESS application facilitates a concordant and reproducible classification of stroke subtypes by multiple investigators, making it suitable for clinical use and multicenter research.

Ultrasound evaluation of brain infections and its complications in Nigerian infants

Summary Infantile meningitis is a clinical diagnosis. However, suspicion of its complications may warrant further investigations; and transfrontanelle ultrasound is a reliable and cheap way to evaluate the usefulness of ultrasonography in diagnosing the complications of infantile meningitis. This is a retrospective study of the transfrontanelle ultrasound findings in 40 infants presenting with clinical indicators of complicated acute bacterial meningitis. There were 20 boys and 20 girls aged 5–115 days (mean, 42.6 ± 30.1 days). The complications of meningitis detectable on ultrasound were: hydrocephalus (21[52.5%]); cerebral abscess (2[5%]); subdural empyema (2 [5%]); and ventriculitis (3[7.5%]). Twelve babies (30%) had no abnormal findings. Hydrocephalus is the most common complication of meningitis in our setting. Transfontanelle ultrasound proved to be very reliable in the initial diagnosis and follow-up of complicated meningitis.

Neuroimaging of young adults with stroke in Ilorin Nigeria

BACKGROUND Stroke in young adults is relatively uncommon. Computed tomography (CT) and magnetic resonance imaging (MRI) are the most valuable tools for the diagnosis of stroke. Recent data on stroke in young adults in Nigeria is sparse. The aim of this study is to document the imaging pattern in young patients aged 15-45 years with suspected cerebrovascular accidents (CVA) in the Nigerian environment. MATERIALS AND METHODS This was a retrospective study of 69 patients aged 15-45 years, with clinical diagnosis of stroke, referred for neuro-imaging, from October 2008 to November 2013. All patients with the clinical diagnosis of stroke within this age group were recruited into the study. Images were obtained from a four slice channel general electric CT machine and a 0.2 Tesla Siemens Magnetom Concerto MRI scanner. RESULTS A total of 69 patients (44 males and 25 females) were studied. Sixty out of 69 (87.0%) patients were accurately diagnosed with CVA, with 9 (13.0) cases of misdiagnoses. A total of 21 (35%) out of the 60 cases confirmed on imaging had intracerebral hemorrhage (ICH), 10 (16.7%) had subarachnoid hemorrhage (SAH) and 29 (48.3%) had cerebral infarct (CI). Hypertension was the common risk factor for all stroke subtypes. The most common location for ICH, was the basal ganglia in 8 (38.8%), while the commonest pattern for CI, was lacunar infarct in the basal ganglia (51.7%). CONCLUSION The incidence of hemorrhagic CVA (ICH and SAH combined) was slightly higher than ischemic CVA in this study. Lacunar infarcts in the basal ganglia and also ICH in the basal ganglia were the most common patterns, both are strongly linked to hypertension. A diagnostic protocol of stroke in young adults, to include neuroimaging and other ancillary investigations is advocated for stroke in young adults as some of the etiologies are treatable.

Variation of Carotid Intima Media Thickness With Body Mass Index in Healthy Adults of Black African Descent: Variation of Carotid Intima Media Thickness With Body Mass Index

Studies have shown that common carotid intima media thickness (CIMT) measured by B‐mode sonography increases with body mass index (BMI) among subjects with cardiovascular diseases in different populations. However, association of body fat and subclinical atherosclerosis in the absence of these cardiovascular diseases is understudied. We aimed to evaluate the correlation between BMI and CIMT in a healthy adult population of black African ancestry.

Posterior urethral valve with unilateral vesicoureteral reflux and patent urachus: A rare combination of urinary tract anomaliess

Posterior urethral valve (PUV) is a common cause of lower urinary tract obstruction in male infants with an incidence of 1:5000-8000. PUV continues to be a significant cause of morbidity and ongoing renal damage in infants and children. It can coexist with vesicoureteral reflux (VUR) in about 50% of cases and also with patent urachus in about one-third of cases. It is a case of a 22-day-old full-term male child who presented with poor urinary stream and progressive abdominal distension of 5-day duration as well as leakage of clear fluid from umbilicus of 1-day duration. Abdominopelvic ultrasonography showed bilateral hydronephrosis. Micturating cystourethrogram also showed features of bladder outlet obstruction and PUV. In addition, a grade V left VUR and a fistulous tract between the dome of the urinary bladder and the umbilicus, which was consistent with a patent urachus was demonstrated. In conclusion, this case demonstrates a rare combination of congenital urinary tract anomalies involving PUV, left VUR and patent urachus.

Right renal pelvic calculus mimicking an extrarenal pelvis

A 57-year-old man presented with recurrent intermittent colicky right flank pain of 1-year duration. Intravenous urogram (IVU) on two separate occasions suggested a right-sided, extrarenal pelvis. However, when pain became recurrent and persistent, he had a non-contrast computed tomography (CT) examination, which revealed a calculus in the renal pelvis. Diagnosis was missed in the initial imaging modalities because apart from the dilated pelvis, there was no evidence of hydronephrosis or calculus seen, hence a diagnosis of extrarenal pelvis. This case report highlights the superior utility of CT in imaging of suspected urolithiasis, especially when the patient remains symptomatic. Radiologists should be wary, especially in symptomatic patients with features of extrarenal pelvis on IVU.