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Biomedical subjects

M T Shokunbi

Publications and source records attributed to M T Shokunbi.

At least 19 recordsLinked to original sources
PubMed2006

Factors influencing visual and clinical outcome in Nigerian patients with cranial meningioma.

We retrospectively analysed the impact of selected clinicopathological factors on visual and clinical outcome in patients with histologically verified cranial meningioma. The 60 patients analysed for tumour characteristics consisted of 32 females and 28 males (sex ratio 1.1:1) aged 9-77 years (mean 40 years) seen between 1977 and 1999 at the University College Hospital, Ibadan, Nigeria. The patients for whom sufficient clinical data was available (n=35) presented within 2-60 months (mean 18 months) of symptom onset with large tumours (mean size 52 mm), and perifocal oedema (26/35), poor vision, focal neurological deficits, seizures and clinical evidence of intracranial hypertension. The most common tumour site was the convexity. There was loss of vision in 30/35 (85.7%) patients. Loss of vision was significantly related to tumour site and tumour size as well as perifocal oedema, (P<0.05). The case-mortality rate was 11.4% at 1 month and 20% at 6 months post-operation and was significantly correlated with intracranial hypertension. Neither age nor sex affected the outcome (P>0.05).

Brain Neoplasms↗
PubMed2006

Non-operative management of benign intracranial hypertension presenting with complete visual loss and deafness.

Benign intracranial hypertension (BIH) may lead to blindness and rarely deafness. We describe the case of a rapidly deteriorating 14-year-old African girl who presented with headaches associated with complete visual and hearing loss due to BIH. This was managed non-operatively with lumbar cerebrospinal fluid tap, weight reduction, nicotinic acid and acetazolamide. Response to treatment was quite dramatic with resolution of severe headaches and regaining of light perception 8 days after commencing treatment. By 3 months hearing recovered to normal and there was resolution of vision. This to the best of our knowledge is the first reported case of complete visual and hearing loss occurring in a patient with BIH, which was managed successfully non-operatively. When indicated, non-operative management is an effective treatment option even in malignant BIH.

Acetazolamide↗
PubMed2006

Solitary intracranial tuberculoma in patients without immuno-suppression: a report of three cases.

BACKGROUND AND OBJECTIVE: Poverty, drug resistance and the advent of human immunodeficiency virus infection (HIV) have led to a recent upsurge in the incidence of tuberculosis including intracranial tuberculosis. In this article, we report 3 patients who had solitary brain tuberculomas and were otherwise healthy to underscore the importance of continuing vigilance for this disease. CASE REPORTS: Three patients (57 years, female; 52 years, male; 7 years male) presented to our unit with features of intracranial tumours. They were all HIV negative with no previous history of tuberculosis. Cranial computed tomography scans demonstrated uniformly contrast enhancing falcine supratentorial masses in the adult patients and a cerebellar hemispheric lesion with peripheral contrast enhancement in the paediatric patient INTERVENTION: All the patients had gross total tumour excision. The histology confirmed a tuberculoma. They all had antituberculous therapy after histological confirmation. The outcome was good in all the patients. CONCLUSION: Intracranial tuberculoma can occur in otherwise healthy individuals and should always be considered in the differential diagnosis of solitary intracranial mass lesions in sub-Saharan Africans so that minimally invasive procedures can be used to establish the correct diagnosis.

Antitubercular Agents↗
PubMed2006

HIV seroprevalence in Nigerian patients with surgical lesions of the brain: implications for management.

BACKGROUND AND OBJECTIVE: This study was done to estimate the seroprevalence rate among Nigerian patients presenting to hospital with neurosurgical disease. PATIENTS AND METHOD: We reviewed our patients' hospital records from October 1996 to October 2001 for clinical presentation and diagnosis, cranial CT findings, results of retrovirus screening and mode of management. RESULTS: Sixteen (10 males and 6 females) out of 601 patients screened for HIV by ELISA were confirmed by Western Blot to be positive, giving a seroprevalence rate of 2.7% . Twelve of the HIV-positive patients were asymptomatic for HIV disease. CONCLUSION: There is a low but definite risk of HIV transmission to health workers managing patients with surgical lesions of the brain in areas where HIV is prevalent. Asymptomatic seropositive HIV patients with surgically curable intracranial disease should be managed with the most minimally invasive procedure appropriate for the surgical lesion under universal protective measures.

Adolescent↗
PubMed2006

An unusual faciocerebellar arrow injury: successful surgical removal in a peasant Nigerian: a case report.

INTRODUCTION: Reports of penetrating injuries of the cranium have been mainly craniocerebral or faciocerebral, craniocerebellar projectiles are few. CASE: We present a case of a 23 year old Nigerian with a craniofacial penetrating injury by a hunting arrow. The trajectory of the arrow through the facial skeleton across the craniocervical junction into the posterior fossa makes this unique in the literature. Successful operative retrieval by a joint team of neurosurgeons and otorhinolaryngologists, problems of delayed presentation and inadequate diagnostic facilities are highlighted. CONCLUSION: The morbidity-free outcome of surgical removal despite the delay in presentation and management in our practice setting with limited facilities are the salient points of this presentation.

Adult↗
PubMed2005

Gross morphological studies on the effect of cyanide on the developing cerebellum of wistar rat (rattus novegicus).

The teratogenic effect of maternal cyanide consumption on the gross morphology of the post-natal phase of the developing rat cerebellum was studied. Twenty pregnant female rats weighing between 170 g and 190 g were separated into control and experimental groups. The control animals were fed a standard diet of mice cubes, while the experimental animals were fed 500 ppm potassium cyanide, mixed with the standard diet. The diets were fed to the animals and their litters in separate cages and water provided ad libitum during gestation and to the offspring after birth. After birth, the offspring (five per group) of days 1, 9, 14, 21, 28 and 50 were weighed, killed by cervical dislocation and the gross parameters studied. In the experimental animals, no significant differences were observed in the studied parameters between the control and experimental animals on day 1. A significant reduction in body weight was observed on day 14 (P < 0.05). The brain weight was significantly reduced on day 9 (P < 0.05). Similarly, the cerebellar weight was significantly reduced on days 14,21 and 28 (P < 0.05). The maximum vermal length was significantly reduced on day 50 (P < 0.05), and the maximum side-to-side dimension of the cerebellum was also reduced on day 28 (P < 0.05). There was no reduction in the thickness (anteroposterior dimension) of the cerebellum in the experimental group (P > 0.05). From the result, it is inferred that maternal consumption of 500 ppm cyanide causes reduction in the cerebellar weight, vermal length and side-to-side dimension of the developing cerebellum in postnatal life in rats.

Animals↗
PubMed2005

Conservative management of third trimester cervical spinal cord injury using Gardner-Wells tongs traction.

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 incident 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.

Accidents, Traffic↗
PubMed2005

The effect of dexamethasone, metronidazole and ascorbic acid on the morphological changes induced by gamma rays on the spinal cord of Wistar rats.

We studied the effects of dexamethasone, ascorbic acid, and metronidazole on the irradiated spinal cord of Wistar rats. Thirty adult Wistar rats were randomly assigned into 3 groups. Five rats served as the control group. Another group of 5 rats were irradiated in the neural axis with 2.5 Gy of gamma rays. The last group of 20 rats were irradiated and then divided into four subgroups of 5 rats each: one subgroup was administered dexamethasone alone, a second subgroup had metronidazole alone, a third subgroup was treated with dexamethasone and metronidazole combined, and a fourth subgroup had ascorbic acid alone, given intraperitoneally for 7 days before exposure to radiation, and also for 5 days after-irradiation. All irradiated animals demonstrated similar vascular changes in form of splitting of the smooth muscle layers of the arterioles of the anterior spinal arteries. Similarly, all the irradiated spinal cord demonstrated shrinkages as noted in the diminution of the neuronal sizes measured by a microscope with a micrometer embedded in the eye-piece objective. The drugs did not individually protect neurons from damage at the level of our investigation. However, the combination of dexamethasone and metronidazole produced a reduction of the degenerative effect of radiation on the neurons when the post-irradiation diameters of the neurons were compared with the control and those of the other experimental groups. We conclude that gamma ray induced damage in the spinal cord may be ameliorated by combining dexamethasone with metronidazole but not by individual treatment with any of the three drugs.

Animals↗
PubMed2005

Intradural spinal arteriovenous malformation of the glomus type: a case report.

Spinal arteriovenous malformations (AVMs) being even rarer than cranial ones, constitute 3 - 4% of all spinal tumours, with an overall male:female ratio of 4:1. We report the case of a 24-year old female Youth Corps member who presented with an apoplectic onset of a left hemiparesis, progressively deteriorating to an incomplete quadriplegia with motor power of 2 and 0 in the right and left lower limb muscle groups, respectively. Magnetic resonance imaging (MRI) showed a vascular malformation whose precise nature was indeterminate; the definitive diagnosis of a Glomus AVM was only made intra-operatively. Laminectomy with complete surgical excision was done and she gradually improved to ambulate with minimal support. The experience in our unit tends to support the observation in literature that spinal arteriovenous malformations could be very rare, and depending on the location, could be amenable to complete surgical excision and recovery of neurological function.

Adult↗
PubMed2004

Surgical management of tuberculum sellae meningioma in a patient with a twin pregnancy: case report.

BACKGROUND: Meningioma in twin pregnancy is rare. The tumor has an accelerated growth during the pregnancy and may enlarge or become symptomatic during this period. This relationship makes management of patients with this tumor quite challenging. CASE DESCRIPTION: We describe a case of a rapidly deteriorating 35-year-old woman harboring an extensive tuberculum sellae meningioma who underwent craniotomy during the 24th week of pregnancy because of rapid deterioration. The surgical procedure and postoperative period were relatively uneventful. CONCLUSION: To the best of our knowledge, this is the first reported case of surgical management of a meningioma in a patient carrying a twin pregnancy (one missed abortus). When indicated, craniotomy is a safe and effective treatment option for huge frontobasal tumors during the second trimester of pregnancy.

Adult↗
PubMed2003

Shunt-responsive dementing illness in a Nigerian--a case report.

Dementia is a growing medico-social problem worldwide because of the rising population of the elderly. About 10-30% of the cases have been found to be treatable or reversible with the improvement in neuro-diagnostic and neuro-imaging techniques. These reversible cases should be diagnosed without over-investigating the many patients with irreversible disease. We present a case of a reversible dementia due to Normal Pressure Hydrocephalus with dramatic surgical therapeutic response.

Acute Disease↗
PubMed2003

Computerised tomography of intracranial subdural haematoma in Ibadan.

The high mortality and morbidity associated with intra-cranial subdural hematoma (SDH), has declined significantly with the introduction of Computerised Tomography (CT) for the evaluation of the brain in suspected cases. One hundred patients with CT-diagnosed SDH at the Radiology department of the University College Hospital, Ibadan between January 1999 and December 2000 were reviewed. The mean age was 47.4 years. The most frequent cause of SDH was head injury 61 (61%). The observed CT appearances of SDH included 66 (66%) of chronic (hypodense), 30 (30%) of acute (hyperdense) and 4 (4%) of acute-en-chronic (mixed density) lesions. There were more unilateral 83 (83%) lesions than bilateral 17 (17%). The lesions were right-sided in 45 (45%) cases and left-sided in 38 (38%). A total of 169 lesions were detected as some patients had multiple sites, however, the parietal 78 (46.2%) and frontal 64 (37.9%) lobes were mostly affected. We conclude that brain CT scan offers the advantage of prompt determination and precise anatomical localization of SDH, which significantly aids management.

Adolescent↗
PubMed2002

A comparison of visual function scores in hydrocephalic infants with and without lumbosacral myelomeningocoele.

PURPOSE: The cerebrum is frequently malformed in children with myelomeningocoele. This anomaly renders them potentially susceptible to cerebral visual impairment. In these patients, hydrocephalus is an important and frequent complicating lesion which compromises intellectual function and may also cause cerebral visual impairment. In this study, we determined whether hydrocephalic patients with lumbar myelomeningocoele (HLM) are at a greater risk of visual impairment than hydrocephalic patients without this lesion (H). METHODS: In this prospective study, we assessed five parameters of visual function in 20 hydrocephalic children with lumbar myelomeningocoele and compared the total visual function scores (TVFS) obtained with those from hydrocephalic children without overt spinal dysraphism, but similar in age, sex and ventricular size. The parameters, which were assessed with the aid of a quantitative grading scale, were pupillary size and reaction, optic atrophy, visual fixation and tracking. RESULTS: The age and sex distributions of the patients in the two groups were similar. The anterior and posterior dimensions of the lateral ventricles were also similar. The mean (SD) of the TVFS were 24.25 (3.63) and 24.20 (3.47) respectively for the two groups (P = 0.90). CONCLUSIONS: The results suggest that, in hydrocephalic infants with lumbar myelomeningocoele, visual function is not further diminished by the associated dysraphism and that ventricular dilatation is the major determinant of visual impairment.

Age Distribution↗
PubMed2002

Pattern of fatal head injuries in Ibadan--a 10 year review.

Head injury is an important cause of mortality worldwide. The objective of the present study was to analyse the pattern of fatal head injury among patients seen in University College Hospital, Ibadan. The study was based on retrospective investigation of cases of fatal head injury referred by the coroner to the Department of Pathology, University College Hospital, between 1991 and 2000. Pertinent clinical and postmortem findings were extracted from available coroner's autopsy records. There were 529 cases (402 males and 127 females). Their ages ranged from <1 year to 90 years (mean=33 years), the average age of females (27.8) being less than that of males (34.6) (p=0.00003). 83.8% were road traffic accidents, 8.9% falls from a height, 3.8% assault, and 3% gunshot injuries. 79.1% had a GCS of 8 or less at presentation. The mean survival period of children aged less than 15 years was 2 days while that of adolescents and adults aged 15 years and above was 5.6 days (p=0.02). Subdural (62.4%), subarachnoid (24.6%), epidural (10.2%), and intracerebral (10%) haemorrhages were the major causes of death. Skull fractures occurred in 38.2%, while cerebral contusions occurred in 22.1%. Intracranial infection was relatively uncommon in these patients. The present study has shown that young adults, predominantly males in their most productive years of life, are especially prone to fatal head injury.

Adolescent↗
PubMed2002

Size, course, distribution and anomalies of the middle cerebral artery in adult Nigerians.

OBJECTIVE: To determine the size, course, distribution and anomalies of the middle cerebral artery in adult Nigerians. DESIGN: A retrospective study. SETTING: Department of pathology, University College Hospital, Ibadan between April and September 1999. SUBJECTS: One hundred middle cerebral arteries from patients' asymptomatic for central nervous system lesions, obtained at autopsy from fifty adult Nigerians were examined. RESULTS: The MCA arose as the wider of the two terminal branches of the internal carotid artery (ICA). Its mean diameter was 3.49 mm (CI = 3.39-3.59 mm), while the mean pre-division length was 15.43 mm (CI = 14.59-16.27 mm). In 92% of specimens, the first branches were perforators. The early branches were destined solely to the temporal lobe pole in most hemispheres (85%). In most specimens, (81%) the main trunk bifurcated while in 13% it trifurcated. One accessory MCA, and the early branches were given off before the perforators in two middle cerebral arteries, making an incidence of anomalies of 3%. There was no aneurysm. CONCLUSION: These results 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 rarity at autopsy of aneurysms of the MCA in asymptomatic Nigerian Africans is not explained by the gross morphology of this vessel.

Adult↗
PubMed2002

Acute isovolaemic haemodilution in two Jehovah's Witnesses presenting for major intracranial surgery.

The Jehovah's Witnesses (JWS) is a religious sect with strong convictions against acceptance of blood and its products for medical care, including surgery. We present two cases of JWS, aged 24 and 19 years old, who had craniectomy for trauma and craniotomy for tumour excision, respectively. A team approach was employed in the care of both patients. During exhaustive preoperative discussions they re-affirmed their religious convictions but agreed to some modifications. Both patients accepted Acute Isovolaemic Haemodilution (AIH). However one of them insisted on non-discontinuation of the line used in collecting the blood from the vein, as that would constitute blood storage. The preoperative Packed Cell Volume (PCV) was 45% and 41% for the trauma and the tumour patients respectively. Two units of blood (1000 ml) were collected from each patient resulting in post donation PCV of 40% and 33%. The intraoperative blood loss was 300 ml and 2000 ml, respectively, and the units and crystalloid fluids were transfused for replacement. Postoperative PCV were 42% and 25%. The latter improved to 30% over the following two weeks with oral haematinics. The two cases are discussed in the light of the experience gained.

Adult↗
PubMed2000

Intracranial neoplasms in Ibadan, Nigeria.

OBJECTIVE: To determine the pattern of histopathological variants of intracranial neoplasms, relative distribution of the variants in the age groups and also to determine the gender differences that exist in these tumours. DESIGN: Case control study. SETTING: Department of Pathology, University College Hospital, Ibadan, Nigeria. PATIENTS: Two hundred and ten histologically confirmed cases of intracranial neoplasms seen during eleven-year period (1980 to 1990) were analysed. INTERVENTIONS: Slides of tumours stained with haematoxylin and eosin, reticulin and phosphotungstic acid haematoxylin. RESULTS: Two hundred and ten intracronial neoplasms comprising 172 primary and 48 secondary neoplasms were seen. One hundred and thirty five neoplasms occurred in adults and 75 in children. There was no gender difference, the ratio being 1:1. Gliomas accounted for the largest group of tumours followed by metastases to the brain. Of the gliomas, astrocytoma was the commonest. Craniopharyngiomas were found to be common in children. Germ cell tumours were found to be uncommon. CONCLUSION: Gliomas are the commonest group of intracranial neoplasms in both adults and children. This is followed by metastatic tumours. Tumours of the sella turcica are predominantly found in children. Involvement of the brain in disseminated Burkitt's lymphomas is predominantly found in Africans as the Burkitt's tumour is uncommon in non Africans.

Adolescent↗