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Oyemolade TA, Adeleye AO, Ekanem IN, Akinwalere AK, Kareem AO. Outcome of Nonoperative Management of Selected Cases of Acute Traumatic Intracranial Hematomas in a Rural Neurosurgical Service of a Developing Country. World Neurosurg 2024; 182:61-68. [PMID: 37995994 DOI: 10.1016/j.wneu.2023.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE In resource-limited settings, the standard of care prescribed in developed countries for either operative or nonoperative management of traumatic intracranial hematomas (TICHs) frequently has to be adapted to the economic and infrastructural realities. This study aims to present the outcome of selected cases of TICHs managed nonoperatively without routine intensive care unit admission, repeated cranial computed tomography (CT) scan or intracranial pressure monitoring at a rural neurosurgical service in a developing country. METHODS This was a retrospective analysis of a cohort of our patients with cranial CT-confirmed TICHs selected for nonoperative treatment from our prospective head injury (HI) register over a 42-month period. RESULTS There were 67 patients (51 males) in this study with a mean age of 38.6 (standard deviation, 17.6) years, having mild HI in >half, (55.2%, 37/67) and anisocoria in 22.4% (15/67). Road traffic accident was the most common (50/67, 74.7%) trauma etiology. Isolated acute-subdural hematoma, intracerebral hemorrhage, and epidural hematoma occurred in 29.9%, 25.4%, and 22.4% of the patients respectively. Only 2 of 8 patients in whom intensive care unit admission was deemed necessary could afford admission. Repeat cranial CT scan was requested in 8 patients (8/67, 11.9%); only 5 of these could afford the investigation. The outcome of care was good in 82.1% patients (55/67). Increasing severity of the HI (P < 0.01) and presence of pupillary abnormality (P = 0.03) were significant predictors of poor outcome. CONCLUSIONS In a Nigerian rural neurosurgery practice, nonoperative management of a well-selected cohort of TICHs was attended by acceptable level of favorable outcome.
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Affiliation(s)
- Toyin Ayofe Oyemolade
- Division of Neurosurgery, Department of Surgery, Federal Medical Centre, Owo, Ondo, Nigeria.
| | - Amos Olufemi Adeleye
- Department of Neurological Surgery, University College Hospital, UCH, Ibadan, Oyo, Nigeria; Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
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Oyemolade TA, Adeolu AA, Badejo OA, Balogun JA, Shokunbi MT, Malomo AO, Adeleye AO. Efficacy of 48 hours dose of phenytoin in prevention of early post-traumatic seizure. BMJ Neurol Open 2023; 5:e000377. [PMID: 36644000 PMCID: PMC9835875 DOI: 10.1136/bmjno-2022-000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023] Open
Abstract
Background Antiseizure medications, such as phenytoin sodium, have been shown in some reports to reduce the incidence of early post-traumatic seizure. These medications, however, are not without side effects which may be dose related or duration related. The risks associated with short-term therapy are minimal and often dose related (and hence avoidable). This study intends to determine the efficacy of a short-course (48-hour dose) of phenytoin in prevention of early post-traumatic seizure. Methods This was a prospective randomised double-blind clinical intervention study. Head injured patients presenting within the first 24 hours were randomly assigned to either 48-hour dose of phenytoin or control groups, and were observed for clinical seizure over a week. The difference in the incidences of early post-traumatic seizure between the two groups was determined by χ2 test. A p<0.05 was considered as statistically significant. Results A total of 94 patients were included in the study, 47 each in the control group and the phenytoin group. There were 77 males and 17 female (M:F 4.5:1). Both groups had similar demographic and clinical profile. The incidence of seizure was 21.3% in the control but 2.1% in the treatment arm (p<0.01). All seizures occurred within 24 hours of trauma in the control, while the only episode of seizure in the treatment group occurred later. Conclusion A short-course (48-hour dose) of phenytoin might be an effective prophylactic treatment to reduce the incidence of early post-traumatic seizure.
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Affiliation(s)
- Toyin Ayofe Oyemolade
- Department of Surgery, Federal Medical Centre, Owo, Nigeria,Department of Neurological Surgery, University College Hospital, UCH, Ibadan, Nigeria
| | - Augustine A Adeolu
- Department of Neurological Surgery, University College Hospital, UCH, Ibadan, Nigeria,Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oluwakemi A Badejo
- Department of Neurological Surgery, University College Hospital, UCH, Ibadan, Nigeria,Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - James A Balogun
- Department of Neurological Surgery, University College Hospital, UCH, Ibadan, Nigeria,Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Matthew T Shokunbi
- Department of Neurological Surgery, University College Hospital, UCH, Ibadan, Nigeria,Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adefolarin O Malomo
- Department of Neurological Surgery, University College Hospital, UCH, Ibadan, Nigeria,Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Amos O Adeleye
- Department of Neurological Surgery, University College Hospital, UCH, Ibadan, Nigeria,Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Oyemolade TA, Adeleye AO, Ehinola BA, Olusola AJ, Ekanem IN, Adesola DJ. Neurotrauma: a burgeoning, yet understudied disease of rural areas in developing countries. J Neurosurg 2022; 138:1069-1076. [PMID: 36057116 DOI: 10.3171/2022.7.jns22996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is a paucity of data-driven reports on neurotrauma from the rural areas of developing countries, despite a disproportionally higher and burgeoning disease burden from those areas. This study aims to define the burden of neurotrauma in a new rural neurosurgical practice of a developing sub-Saharan country in Africa (Nigeria). METHODS The authors conducted a prospective observational study of all neurotrauma patients managed at their center over a 36-month period beginning in August 2018. RESULTS There were 1067 patients, 816 (76.5%) of them male, accounting for 79% of all the neurosurgical patients seen at the authors' center during the study period. The peak incidence of neurotrauma was in the 20- to 29-year age group. The median trauma duration was 9 hours before presentation. The neurotrauma involved only head injury (HI) in 78% of the patients and only the spine in 4%. HIs were predominantly mild in severity (79%). Spinal cord injuries were largely incomplete (86%) and cervical in location (72%). Road traffic accidents caused approximately 79% (845/1067) of this neurotrauma burden, mostly from motorcycle crashes (69%, 581/845). Fifty-three patients (5%) were managed surgically. The median time from trauma to surgery for the operated patients was 82 hours. Treatment outcome was good in 81.2% of the patients. CONCLUSIONS Neurotrauma, mostly caused by motorcycle crashes and other road accidents, accounts for the bulk of the neurosurgical workload in this rural neurosurgical center. Although late presentation and delayed surgical interventions were prominent features of this level of care, the in-hospital outcome was fortuitously good in the majority of patients.
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Affiliation(s)
- Toyin A Oyemolade
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| | - Amos O Adeleye
- 2Department of Neurological Surgery, University College Hospital, Ibadan, Oyo State.,3Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Oyo State; and
| | - Busayo A Ehinola
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| | - Ayodele J Olusola
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| | - Inwonoabasi N Ekanem
- 4Department of Accident and Emergency, Federal Medical Center, Owo, Ondo State, Nigeria
| | - Damilola J Adesola
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
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Adeleye AO, Oyemolade TA, Malomo TA, Okere OE. Mannitol Dosing Error during Pre-neurosurgical Care of Head Injury: A Neurosurgical In-Hospital Survey from Ibadan, Nigeria. J Neurosci Rural Pract 2021; 12:171-176. [PMID: 33531778 PMCID: PMC7846338 DOI: 10.1055/s-0040-1722093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives Inappropriate use of mannitol is a medical error seen frequently in pre-neurosurgical head injury (HI) care that may result in serious adverse effects. This study explored this medical error amongst HI patients in a Nigerian neurosurgery unit. Methods We performed a cross-sectional analysis of a prospective cohort of HI patients who were administered mannitol by their initial non-neurosurgical health care givers before referral to our center over a 22-month period. Statistical Analysis A statistical software was used for the analysis with which an α value of <0.05 was deemed clinically significant. Results Seventy-one patients were recruited: 17 (23.9%) from private hospitals, 13 (18.3%) from primary health facilities (PHFs), 20 (28.2%) from secondary health facilities (SHFs), and 21 (29.6%) from tertiary health facilities (THFs). Thirteen patients (18.3%) had mild HI; 29 (40.8%) each had moderate and severe HI, respectively. Pupillary abnormalities were documented in five patients (7.04%) with severe HI and neurological deterioration in two with mild HI. Mannitol administration was deemed appropriate in only 43.7% (31/71). Data on mannitol dosing in 60.6% (43/71) of the patients showed 8/43 (18.6%) receiving continuous 10% mannitol infusion. The remaining 35/43 received mannitol as a 20% solution but also showing dosing error in 62.9% (22/35): overdosing in 7/35 (20%), and nonbolus administration in 15/35 (42.9%). The distribution of the dosing error among the referring health facilities (all the 13 [100%] patients from private hospitals, 66.7% from PHF, 60% from SHF, and 45.5% from THF) showed a trend of better performance ( p = 0.002) by the THFs. Conclusion Mannitol use is apparently fraught with an understudied medical error in the pre-neurosurgical care of the head injured.
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Affiliation(s)
- Amos Olufemi Adeleye
- Department of Surgery, Division of Neurological Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
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Oyemolade TA, Adeleye AO. Scalp laceration: Still a cause of death from head injury in rural settings. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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