Open Access Case Study

Headache Due to Cerebral Venous Thrombosis after Carbonmonoxide Intoxication

G. Tekgol Uzuner, Y. Dinc, N. Uzuner

International Neuropsychiatric Disease Journal, Page 1-5
DOI: 10.9734//INDJ/2017/33495

Carbon monoxide; CO is a colourless, odourless, tasteless and non-irritant type of gas. CO emerges as a consequence of poor combustion of carbon-based fuels, which can lead to acute and chronic poisoning. Despite the same exposure conditions, individuals may be confronted with different symptoms of CO poisoning. There are no qualitative studies on the long-term effects of CO poisoning on the headache, but there exist some reports of headache after chronic poisoning. The combination of cerebral venous thrombosis; CVT with carbonmonoxideintoxication has not been reported before. The most common symptom of patient's admission for CVT was reported as headache [6]. This rate has been reported as between 77-88% in various studies. Papillary oedema and optical atrophy after CO toxicity have often been reported, but this situation could not be related to increased intracranial pressure.Here we present a patient with headache due to carbon monoxide poisoning 3 months later.The headache of this patient was temporally related to carbon monoxide intoxication,and CVT and intracranial hypertension findings were detected. We have never encountered such a case presentation in the literature before. It is interesting because of the first instance. We would like to draw attention to the possibility of intracranial hypertension and CVT in a headache after carbon monoxide poisoning.

Open Access Original Research Article

Clinical Profile of Children with Cerebral Palsy in Jos, North-Central Nigeria

Emeka U. Ejeliogu, Esther S. Yiltok, Akinyemi O. D. Ofakunrin

International Neuropsychiatric Disease Journal, Page 1-8
DOI: 10.9734/indj/2017/v9i213505

Aim: The aim of this study was to describe the clinical profile of children with cerebral palsy (CP) at Jos University Teaching Hospital (JUTH), Jos, North-Central Nigeria.

Study Design: This was a case series study.

Place and Duration of Study: Paediatric neurology clinic, Jos University Teaching Hospital, Nigeria between January 2015 and December 2016.

Methodology: We recruited consecutive patients with CP attending the paediatric neurology clinic of JUTH. We used structured questionnaires and hospital records to document all relevant information of the patients and their parents. We also conducted detailed physical examination for each patient and performed specialized examinations and investigations if necessary. Data obtained was analysed with EpiInfo version 7.2. Ethical approval for this study was obtained from the Health Research Ethical Committee of JUTH. Informed consent was obtained from the parent/guardian of each participant.

Results: A total of 168 children with CP were seen within the study period, 93 (55.4%) were males while 75 (44.6%) were females. Home delivery was the commonest place of delivery (32.7%), followed by delivery at primary health centres (25.0%). Despite the fact that no socio-economic class was spared, most (60.1%) of the children with CP were in lower class. The commonest presenting complaint observed was delayed developmental milestones. About 71% of the children with CP were malnourished while 26% were severely malnourished. Spastic hemiplegic CP was the commonest type of CP seen. Associated disabilities were very common in children with CP in our study with 92% of them having one or more disabilities. The commonest disability we observed was seizure disorder (45.2%) followed by intellectual disability (28%).

Conclusion: In our study, CP was commonly associated with other disabilities and malnutrition. Each child with CP should be assessed comprehensively and managed by a multidisciplinary care team comprising of all relevant professionals so that the child’s long term outcome can be improved.

Open Access Original Research Article

Do Socio-demographic Characteristics Influence the Performance of Children on Raven Progressive Matrices in Enugu, Nigeria?

Kenechukwu K. Iloh, Agozie C. Ubesie, Ogochukwu N. Iloh

International Neuropsychiatric Disease Journal, Page 1-6
DOI: 10.9734//INDJ/2017/32267

Background: Poor socioeconomic status and lower level of maternal education have been identified to contribute significantly to lower cognitive function of HIV-positive children. This study was designed to determine if there are significant associations between performance in Raven Progressive Matrices (RPM) scores and socio-demographic factors.

Materials and Methods: A cross-sectional study of 100 school-aged children seen at the Children Outpatient Clinic of the University of Nigeria Teaching Hospital. Cognitive function was assessed using the Raven Progressive Matrices. Data were analyzed with SPSS version 19.

Results: Mean RPM scores of males and females were 31.8 ± 13.4 and 33.7 ± 12.2. Fifty-six children were above average/superior while 44 performed at or below average on RPM cognitive test. Twenty-one of 23 children (91.3%) children from upper social class, 27 of 48 (56.3%) from middle social class and only 8 of 29 (27.6%) from lower social class performed above average or superior on the RPM test (p<0.001).

Conclusions: Low socio-economic status and poor maternal literacy were significantly associated with below RPM scores whereas scores were not influenced by gender.

Open Access Original Research Article

EEG Characterizations and Clinical Features in Sudanese Patients with Panayiotopoulos Syndrome

M. Salah Elmagzoub, Sami F. Abdalla, Hiba A. Babikir

International Neuropsychiatric Disease Journal, Page 1-6
DOI: 10.9734//INDJ/2017/32646

Introduction: Panayiotopoulos syndrome (PS) is an age-related, and a relatively frequent benign epileptic syndrome, characterised by predominantly autonomic symptoms and/or simple motor focal seizures followed, or not, by impairment of consciousness. Interictal electroencephalograph (EEG) shows occipital spikes, although multifocal spikes with high amplitude sharp-slow wave complexes at various locations can be present.PS mimics gastroenteritis, encephalitis, syncope, migraine, sleep disorders or metabolic diseases.

Aim: The aim was to characterise the EEG waves among Sudanese patients with PS, presented at the EEG unit of The National Ribat University, and El magzoub neurosciences center.

Patients and Methods: Out of 4319 abnormal EEGs and based on the classical EEG findings and clinical presentations, the EEG of patients suggestive of PS were identified.

Results: EEG findings of patients with PS in the study agree with classical international studies, as they were clustering of sharp and slow waves, sometimes associated with brain spiking, but usually shifting from one region to the other with dominant occipital paroxysms of   sharp and slow waves. GIT upsets were the cardinal autonomic features; abdominal pain and vomiting were constant symptoms in most of the patients. Past history of febrile convulsions was positive in more than one-fourth of patients. All patients experienced febrile convulsions and this may be the main cause of seeking medical advice.

Conclusion: The results indicate that Panayiotopoulos syndrome in Sudanese children is not uncommon; moreover, the under diagnosis appears to be high. The classical autonomic manifestations and EEG features of Panayiotopoulos syndrome were well defined in Sudanese patients. EEG shows occipital or extra-occipital abnormalities.

Open Access Review Article

Practice Guidelines for Treatment of Somatic Pain and Depression

Sonali Sarkar

International Neuropsychiatric Disease Journal, Page 1-10
DOI: 10.9734//INDJ/2017/32908

Background: Somatic pain is often associated with depression. Patients presenting with this combination can be difficult to treat and create a significant financial burden on the medical system. The mechanisms of action linking somatic pain and the myriad of depression are not clearly understood thus highlighting a gap in knowledge between the scientific mechanism, pathogenesis, and psychiatry involved in depression and somatic pain.  The objective of this review article is to address etiologic factors and possible mechanisms associating chronic somatic pain and depression. Additionally, this article provides practice guidelines in the management of somatic pain patients with depression.

Methods: Systematic review of literature on human studies published in English language from 2000-2017 using PubMed, EBSCO, and Google Scholar was performed.

Results: Approximately, 76 studies that were recent and relevant were included in the final review. More than 75% of patients with comorbid depression complain of somatic pain such as headache, neck pain, stomach or back pain including generalized body pain. Socio-demographic factors (advanced age, female gender, marital/relationship status, low educational level), clinical correlates (pain location, duration, score, use of medications), psychosocial correlates (pain self-efficacy, coping skills, quality of life), medical conditions (type 2 diabetes mellitus, fibromyalgia, connective tissue diseases, musculoskeletal or autoimmune disorders), and patient determinants (doctor shopping, aberrant medication-related behaviors like prescription drug misuse or abuse, early refills) are associated with somatic pain in patients with psychiatric comorbidities. Practice guidelines include improving provider-patient relationship, detailed history taking, performing physical exam, obtaining laboratory and radiologic exams, administering validated screening method for pain and depression scales, pharmacotherapy with multi-target agents, psychotherapy, functional restoration program, physiotherapy for chronic pain, self-management strategies (yoga, mindfulness) and including a multi-disciplinary treatment team.

Conclusion: This article has important implications for clinical practice as it not only highlights the epidemiology and correlates of somatic pain and depression but also provides practice guidelines for managing somatic pain patients with comorbid depression.