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Introduction Status epilepticus (SE) is one of the most common neurologic emergencies and is associated with significant morbidity and mortality. The underlying cause of SE varies between patients with epilepsy and those presenting without. The aim of this study was to evaluate the epidemiology, risk factors and outcomes of patients presenting with convulsive SE in the emergency department (ED) of a tertiary hospital in Mogadishu. Methods This was a cross-sectional study conducted between July 2021 and June 2022. The study included both patients with epilepsy and those without epilepsy presenting to the ED with SE. Risk factors and underlying etiologies were evaluated in the patients in both the pediatric group (0–18 years) and adult group (18 years and above). Clinical history, neurologic examinations, neuroimaging, electroencephalography findings, and laboratory investigations were all evaluated. Results The mean age for pediatric patients was 6 (SD±4.7), while the mean age for adult patients was 38 (SD±10.4). About 33 (36%) of the subjects had previous history of epilepsy, while 59 (64%) presented to the ED with their first seizure. About 80 (87%) had generalized seizure while 12 (13%) had focal seizure. Poor antiepileptic compliance was the most common risk factor for SE 20 (21.7%), followed by CNS infections 14 (15%), and prolonged febrile seizures 7 (7.6%). Poor antiepileptic drug compliance, cerebrovascular disorders, electrolyte imbalance, metabolic conditions, and drug abuse were the most common underlying etiologies of SE in patients older than 18 years. Prolonged febrile seizure, meningitis, encephalitis, systemic infections, and structural brain abnormalities were the most common underlying etiologies of SE in patients younger than 18 years. Conclusion CNS infections, CVDs, metabolic disturbances, electrolyte imbalances, and systemic infections are major etiological risk factors of SE in patients without prior history of epilepsy. Medication adherence was the major etiological risk factor for SE identified in patients with epilepsy.

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INTRODUCTION:Basic in Somali. a country in East Africa, no data are available about key features of stroke such as incidence, prevalence, and mortality or stroke subtypes. So. we decided to conduct this study to make sure the rate burden of stroke in our population and become a starting data for further research.MATERIALS AND METHODSWe performed a retrospective hospital-based study in Mogadishu, Somali, to assess risk factors and etiology of stroke. Patients were recruited from January 1, 2019, to December 31, 2019, at the MogadishuSomali–Turkey Recep Tayyip Erdoğan Training and Research Hospital.RESULTSA total of 292 participants with stroke (65.4% male and 34.6% women) were analyzed. The prevalence of Ischemic and Hemorrhagic Strokes were 66.8% and 33.2% respectively. A system for categorization of subtypes of ischemic stroke mainly based on etiology has been developed for the Trial of Org 10172 in Acute Stroke Treatment (TOAST)[7], the most prevalent were stroke of other determined etiology (28.7%), undetermined (24.6%) and large artery disease (22.1%) while the least common ischemic strokes were lunar stroke (11.3%) and cardio embolic (13.3%). The most prevalent hemorrhagic strokes were Basal ganglia CONCLUSIONS: In Somalia there is no previous data for the prevalence and risk factors of the stroke. We concluded that the prevalence of hemorrhagic stroke in Somalia is more compared than the other countries (from 20% worldwide to 33.2% Somali). And the most risk factors were hypertension and diabetes mellitus.

Neurologic disorders are common reasons for emergency consultations. The majority of neurologic disease manifestations in the emergency room (ER) are life-threatening and require urgent treatment. The goal of this study is to investigate the epidemiology and clinical characteristics of different neurological disorders among emergency department admissions in Mogadishu.This is a cross sectional study conducted in the emergency department of Mogadishu Somali Turkish Training and Research Hospital from July 2021 to February 2022. The clinical and epidemiological characteristics of adult patients with neurologic manifestations in the emergency room were evaluated. Age, gender, distribution of neurological disease manifestations, neurological examination findings, and neurological diagnoses made by consultant neurologists were assessed. During the study period, 321 patients out of 8,500 were included in the study accounting for 3.7 percent of all emergency admissions. The majority of the patients in the study were 50 years of age or older (59%). The male subjects accounted for 56% of the total, while females accounted for 44%. Hypertension was the most common co-morbidity among subjects (38%), followed by diabetes mellitus and heart disease. The admission rate was high (78.2%) after neurological evaluation. The most common reason for a neurology consultation (43.9%) was altered mental status, followed by motor deficits and seizures. Ischemic and hemorrhagic strokes were the most common diagnoses after neurological evaluation (38.9% and 20.2%, respectively). Among subjects evaluated due to altered mental status, stroke was the most common diagnosis, followed by encephalopathy and status epilepticus. Patients with neurological manifestations in the ER require a multidisciplinary approach. This study illustrates the pattern of neurological emergencies in Somalia’s largest referral hospital and also highlights the significance of neurological assessment by a neurologist in the ER. In our study, hemorrhagic and ischemic strokes were the most prevalent neurologic presentations in the ER, particularly among the elderly.

Background: Tramadol is a centrally acting synthetic analgesic, chemically related to morphine and codeine. Tramadol abuse is being used by many people with different adverse effects; most likely seizures, and respiratory depression. Some men use tramadol for erectile dysfunction. We report a case of tramadol-induced intracerebral hemorrhage. Case report: A 36-year-old male with no history of chronic diseases presented to the emergency department with a sudden onset of left-sided weakness. He had no other conventional vascular risk factors such as hypertension, diabetes, or dyslipidemia. A neurological examination showed right gaze preference and mild right facial droop with left-side hemiplegia, and the left Babinski sign was positive. He denied smoking cigars or consuming khat, and he had no family history of stroke. Routine vital signs were normal. The electrocardiogram was normal. And routine blood investigations were normal. NIH Stroke Scale = 22 when he came in. A CT head showed a 53x24 mm hemorrhage in the right basal ganglia region. He had an MRI angiogram, which showed normal intracranial and extracranial vessels. The patient confirmed that he had been using tramadol for two years due to erectile dysfunction. Conclusion: A previously healthy middle-aged male with no vascular risk factors developed a hemorrhagic stroke. It was reported that he had been using tramadol for two years. So, the patient developed the right basal ganglia due to tramadol addiction. It is the first time in the literature that tramadol-induced intracerebral hemorrhage has been reported.

Introduction and Importance: Lateral medullary syndrome (LMS) is a less common form of a brainstem stroke. It is the result of occlusion of the posterior inferior cerebellar artery (PICA). It is caused by atherosclerosis, thrombosis, or emboli from another source. Case Presentation: A 60-year-old male patient presented to the emergency department with vertigo, vomiting, slurred speech, hiccups, and left-side weakness associated with paresthesia for 1 day. He had a past medical history of uncontrolled hypertension and a smoking habit. The neurological examination revealed ataxia, and left hemiparesis associated with paresthesia. A cranial nerve examination revealed slight right-sided ptosis, mouth deviation, and loss of sensory sensation on the right side of the face. Brain MRI showed right medullary infarct consistent with LMS. Electrocardiogram, echocardiography, and vertebral artery color Doppler were normal. He was admitted to the neurology ward and was treated with low molecular weight heparin 60 mg subcutaneously, aspirin 300 mg, neuroprotective agents, and antihypertensive treatment. After 6 days of medical treatment, his condition has improved massively (dysarthria and dysphagia disappeared). He was discharged for physical rehabilitation. Clinical Discussion: LMS (Wallenberg syndrome) is one of the brainstem stroke syndromes caused by occlusion of PICA. Vertigo, vomiting, dysphagia, dysarthria, ipsilateral ataxia, Horner’s syndrome, and contralateral hemiparesis define this syndrome. Brain MRI is necessary for diagnosis alongside clinical syndrome. Conclusion: LMS is a rare form of brainstem stroke and carries a favorable prognosis if early hospitalization and treatment is applied. Brain MRI, including diffusion sequence, is the most useful diagnostic tool for detecting LMS.