Possible neurogenic disorder in a female buried in the monastic cemetery at Ghazali (ca. 670–1270 CE), northern Sudan

Abstract

During the archaeological excavations of a Christian monastic cemetery in northern Sudan, a double-vaulted tomb was discovered housing the remains of three individuals, among them a 50+-year-old female. The skeletal remains of this individual displayed significant asymmetry of the lower limbs, with apparent muscle atrophy and shortening of the left extremity, in combination with other symptoms suggestive of a neurogenic background of the condition. This paper presents a differential assessment, considering various possible etiologies of the observed lesions, including poliomyelitis, cerebral palsy, and Rasmussen's encephalitis. The morphology and patterning of the observed lesions suggest the first known occurrence of poliomyelitis from medieval Sudanese contexts.

An identified case of poliomyelitis: contribution to diagnosis in ancient human remains

“…In the vertebral column, the spinous processes from L1 to L5 are very close to each other, which is consistent with Baastrup's syndrome (Philipp et al, 2016), resulting from excessive lordosis or the loss of intervertebral space (Kacki et al, 2011). A slight scoliosis was observed in both thoracic and lumbar region, although scoliosis is not pathognomonic of polio (Winkler and Großschmidt, 1988;Roberts and Manchester, 2010;Schrenk et al, 2016;Ciesielska and Stark, 2019;Berner et al, 2021). Besides, in post-polio syndrome, the paralysis and subsequent muscle atrophy lead to the alteration in the load axis of the spine (with or without scoliosis), resulting in degenerative changes (Grados et al, 2015), namely spinal OA, which may be exacerbated with age.…”

“…While poliomyelitis is estimated to have affected more than one million people worldwide, there are only a few possible cases described in the osteoarchaeological literature (e.g. Winkler and Großschmidt, 1988;Umbelino et al, 1996;Kozlowski and Piontek, 2000;Roca de Togores et al, 2001;Roberts and Manchester, 2010;Zimerman, 2012;Novak et al, 2014;Thompson, 2014;Schrenk et al, 2016;Tesorieri, 2016;Ciesielska and Stark, 2019;Berner et al, 2021). Several factors may be responsible for this, one of which is the fact that human remains are frequently incomplete or poorly preserved, making it difficult to have a holistic vision of the skeleton and its alterations, which is crucial for the diagnosis of such a complex disease as poliomyelitis.…”

The changing shape of palaeopathology: The contribution of skeletal shape analyses to investigations of pathological conditions

“…In terms of diagnosis, poliomyelitis was the focus of all the “shape” articles that met our meta‐analysis criteria, although linear measurements ( not classified as shape studies) have also been commonly used to identify unloading as part of a potential poliomyelitis differential diagnosis by authors such as Ciesielska and Stark (2020) and Novak et al (2014). Poliomyelitis has the potential to develop into a paralytic form that can affect various body regions in varying patterns (Smallman‐Raynor et al, 2006).…”

Beyond Mortality

“…-1-0-+1- Modern bio archae ol o gi cal studies have discussed possible cases of the paralytic form of poliomyelitis in archaeological skeletons based on the observation of skeletal traits indicative of the associated disuse and altered function. The most commonly reported skeletal changes include shortened limbs, bone atrophy, and torsion and abnormal curvature of long bones (Castells Navarro et al 2017;Ciesielska and Stark 2020;Gładykowska-Rzeczycka and Śmiszkiewicz-Skwarska 1998;Kozlowski and Piontek 2000;László 2017;Novak et al 2014;Thompson 2014). Scoliosis and skeletal evidence of clubfoot are also regularly mentioned (e.g., Castells Navarro et al 2017;Winkler and Grosschmidt 1988).…”

“…However, Long COVID also emerged early on as a concern, as COVID-19 survivors suffering from lasting effects of the disease (aka "long-haulers") sought to raise awareness (see Perego et al 2020), in the hopes of ending stigma and prompting more medical research toward possible treatments. Long COVID has brought to mind the sequelae of other diseases, such as neurological disorders following influenza (Honigsbaum and Krishnan 2020), cognitive impairment following cerebral malaria (John et al 2008), and eyesight and hearing loss consequent to infection with Ebola virus (Clark et al 2015). Furthermore, new research around post-COVID-19 sequelae has highlighted how medical interventions such as mechanical ventilation and life support have their own associated potential sequelae (Torres-Casto et al 2021; for physical impairments associated with postintensive care syndrome, see Ohtake et al 2018).…”