Epilepsy in primary intracranial tumors in a neurosurgical hospital in Enugu, South-East Nigeria

Mezue, WC; Ndubuisi, CA; Chikani, Mark C; Onyia, Ephraim; Iroegbu, L; Ohaegbulam, SC

doi:10.4103/1119-3077.158980

Cited by 7 publications

(10 citation statements)

References 28 publications

(40 reference statements)

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“…Furthermore, this study observed that as high as 34% of the patients present with seizure as a major symptom. Generally, seizures are underinvestigated in Nigeria,[ 17 18 ] and it may be possible that there are many cases of low-grade and high-grade gliomas being missed out as a result of inadequate seizure investigation.…”

Section: Discussionmentioning

confidence: 99%

“…Environmental pollutions from oil and gas resources and improper disposal of industrial waste products are common in Nigeria, and these may increase the risks of nongerm line mutations in favor of a more aggressive tumor growth. [ 1 9 18 ] Further studies need to be carried out to identify some peculiar genetic and nongenetic predisposing factors in this environment that may account for relatively younger age at patient presentation. It may be useful to also look at the biological behavior of the tumors managed to assess if the individuals in this locality present with more aggressive diseases, especially the malignant tumors.…”

Section: Discussionmentioning

confidence: 99%

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Histologically Confirmed Intracranial Tumors Managed at Enugu, Nigeria

Ndubuisi

Ohaegbulam

Iroegbu

et al. 2017

Journal of Neurosciences in Rural Practice

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Background:There is controversy about the global distribution of intracranial tumors (ICTs). The previous reports from Africa suggested low frequency and different pattern of distribution of brain tumors from what obtains in other continents. The limitations at that time, including paucity of diagnostic facilities and personnel, have improved.Objective:The objective of this study is to analyze the current trend and distribution of histology confirmed brain tumors managed in Enugu, in a decade.Methods:A retrospective analysis of ICTs managed between 2006 and 2015 at Memfys Hospital, Enugu. Only cases with conclusive histology report were analyzed. The World Health Organization ICT classification was used.Results:This study reviewed 252 patients out of 612 neuroimaging diagnosed brain tumors. Mean age was 42.8 years and male-to-female ratio was 1.2:1.0. Annual frequency increased from 11 in 2006 to 55 in 2015. Metastatic brain tumors accounted for 5.6%, and infratentorial tumors represented 16.3%. Frequency of the common primary tumors were meningioma (32.9%), glioma (23.8%), pituitary adenomas (13.5%), and craniopharyngioma (7.5%) (P = 0.001). Vestibular schwannoma accounted for 1.2%. Meningioma did not have gender difference (P = 0.714). Medulloblastoma, glioma, and craniopharyngioma were the most common pediatric tumors. About 8.7% presented unconscious (P < 0.001). There was no significant difference between radiology and histology diagnosis (P = 0.932).Conclusion:Meningioma is the most frequent tumor with increasing male incidence, but the frequency of glioma is increasing. Metastasis, acoustic schwannoma, lymphoma, and germ cell tumors seem to be uncommon. Late presentation is the rule.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Histologically Confirmed Intracranial Tumors Managed at Enugu, Nigeria

Ndubuisi

Ohaegbulam

Iroegbu

et al. 2017

Journal of Neurosciences in Rural Practice

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“…[ 18 ] The need for neuroimaging in patients presenting with seizures has been argued. [ 19 20 ] Since there is no pathognomic clinical feature, the diagnosis of brain abscess should be primarily based on CT or MRI. [ 4 20 ]…”

Section: Discussionmentioning

confidence: 99%

Management of brain abscess: Changing trend and experience in Enugu, Nigeria

et al. 2017

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Background:Intracranial abscess remains a significant health-care problem. Its causes, diagnosis, treatment, and outcome are changing.Aim:This paper reviewed the demography, examined new trends, and compared outcomes with different treatment options.Methodology:Retrospective analysis of intracranial abscesses managed at Memfys Hospital, Enugu (2004–2014) and University of Nigeria Teaching Hospital (2009–2014). Patients were followed up for at least 6 months. All patients had neuroimaging before intervention. Microscopy and culture were performed for the specimens. Intravenous antibiotics were given for 2 weeks before conversion to oral.Results:Seventy-nine parenchymal abscesses (eight cases per year) were managed. Peak age was the second decade of life. Previous head injury (21.5%) and meningitis (16.5%) were the most common predisposing factors. The frontal lobe was most common anatomical location (32%). Only 24% had positive culture result. Three cases were fungal infections. Seventy percent of patients managed with burr hole drainage and 37.5% of craniotomy made complete recovery. Overall, 58% of patients made complete recovery, whereas 19.0% died. Nine percent of cases died before definitive intervention. Among the 24% of patients that presented in coma, 47% died within 6 months. Most important factor influencing mortality was admission level of consciousness. Abscess recurred in 6% of cases.Conclusion:Intraparenchymal abscesses in Enugu were mostly solitary lesions resulting from poorly managed head injury and meningitis. Predisposition from otitis media and systemic diseases has reduced. The proportion of fungal organisms is increasing. A significant proportion of the patients present in coma. Burr hole and aspiration of abscess is less invasive and has very good outcome.

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“…Late presentation is almost the rule. [1,12] The late presentation may be indirectly attributed to delay in diagnosis, a relatively poor patient referral system and an uneven spread of imaging and manpower services. Currently, there are about 70 neurosurgeons serving the over 170 million population of Nigeria.…”

Section: Discussionmentioning

confidence: 99%

“…Although not directly investigated in this study, there are also concerns of social and religious beliefs that may significantly influence patient's attitude toward surgery. [1,12] The effect of these is that patients are managed at a relatively poor Ks.…”

Section: Discussionmentioning

confidence: 99%

The Challenges of Management of High-grade Gliomas in Nigeria

Ndubuisi

Mezue

Nzegwu

et al. 2017

Journal of Neurosciences in Rural Practice

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Background:High-grade gliomas (HGG) are among the most challenging brain tumors despite many research efforts worldwide.Aim:The aim of this study was to evaluate the local challenges that may influence outcome of HGG managed in a neurosurgical center in Nigeria.Methodology:Retrospective analysis of prospectively recorded data of patients managed for intracranial HGG at Memfys Hospital for Neurosurgery, Enugu, Nigeria, between the year 2006 and 2015. Only cases with conclusive histology following surgery were analyzed.Results:Glioma was 60 (23.8%) of 252 histology confirmed brain tumors. HGG represented 53.8% of gliomas with male:female ratio of 2.2:1.0 and peaked from fifth decade of life. Glioblastoma multiforme accounted for 69% of HGG. At 1-year postsurgery, 53% of HGGs were dead and 88% of these deaths were in the World Health Organization Grade IV group. Only 40% of cases could receive adjuvant treatment with only 15% mortality at 1 year in this subgroup that received adjuvant therapy. In addition, 19% of cases had surgery at Karnofsky score (Ks) of ≥70%. However, 94% of mortality at 1 year was related to surgery at Ks of ≤60%. Only four patients had a tumor volume of ≤50 cm3, and among these cases, three patients were independent at 1 year. Patients with tumor volume above 50 cm3 accounted for 94% of mortality.Conclusion:The peak age incidence for HGG seems to be lower than in Caucasians. Most cases present late with poor Ks and big tumor volume. The proportion with access to adjuvant treatment is still poor. Preoperative Karnofsky, extent of resection, duration of hospital, and Intensive Care Unit stay have impact on outcome.

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Epilepsy in primary intracranial tumors in a neurosurgical hospital in Enugu, South-East Nigeria

Cited by 7 publications

References 28 publications

Histologically Confirmed Intracranial Tumors Managed at Enugu, Nigeria

Histologically Confirmed Intracranial Tumors Managed at Enugu, Nigeria

Management of brain abscess: Changing trend and experience in Enugu, Nigeria

The Challenges of Management of High-grade Gliomas in Nigeria

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