Background: This study describes the pattern of idiopathic intranuclear facial palsy (facial neuropathy) and highlights the role of human immunodeficiency virus (HIVJ/AIDS in its occurrence and management. Patients and Methods: This study conducted in lle-lfe, Nigeria, assessed individuals with idiopathic facial neuropathy seen at the neurology; maxillofacial surgery; and ear, nose and throat outpatient clinics between 1994 and 2006. Results: Eighty-eight patients with idiopathic facial neuropathy were seen during the 13-year study period. Forty-six (52.3%) were males, and the age range was 15 to 76 years, with a median of 35.5 years and interquartile range of 24.5 to 54 years. The right side was affected in 59.1%, compared with 40.9% on the left side. Twenty-six patients (29.5%) were HIV positive at presentation: 16 males, 10 females; mean age for HIV-positive patients was 29.15 ± 8.12 years and 44.39 ± 18.48 years for HIV-negative patients. There was a significant relationship among the status of the patients and the severity at presentation (p =.035), treatment given (p =.019), and the occurrence of flu-like symptoms (p =.004). Conclusion: A high index of suspicion of seroconversion is essential in patients presenting with idiopathic facial neuropathy since it has implications for management. Serological testing for HIV, especially in patients at risk and those with history of recent flu-like symptoms, is recommended.

Background: Tuberculous meningitis is common in developing countries and accounts for about 7.8% to 14% of all cases of tuberculosis in Nigeria. Case presentation: Case 1 was a 17-year-old woman who presented with a 3-week history of weakness of the right upper and lower limbs, a 6-hour history of inability to speak and irrational behaviour. She had no remarkable past medical history. Physical examination revealed pyrexia (temperature of 38.2C) and altered level of consciousness (Glasgow coma score = 7/15). The signs of meningeal irritation were present and she had anisocoria and right spastic hemiparesis. Other aspects of physical examination were normal. Laboratory investigations showed an elevated erythrocyte sedimentation rate, normal cerebrospinal fluid protein and reduced glucose. The brain computed tomography scan showed features in keeping with obstructive hydrocephalus and she was immediately commenced on antituberculous drugs, intravenous steroids and mannitol. She made a remarkable clinical recovery and was discharged home 6 weeks after admission. Case 2 was a 40-year-old man who presented with a 6-week history of headache and fever and a 2-week history of alteration in level of consciousness. There was no history of neck pain and/or stiffness, nausea or vomiting. He had no other remarkable past medical history. He had been placed on various intravenous antibiotics in private hospitals before presentation, with no clinical improvement. Physical examination showed a young man in a coma (Glasgow coma score = 4/15) and febrile (temperature of 38.5C) with signs of meningeal irritation. The brain stem reflexes were impaired and he had spastic quadriparesis. Further physical examination was essentially normal. The cerebrospinal fluid analysis showed features in keeping with meningeal inflammation and he had a raised erythrocyte sedimentation rate. The brain computed tomography scan showed features in keeping with obstructive hydrocephalus. He was placed on antituberculous drugs and intravenous steroids but despite this his clinical condition deteriorated and he died on the sixth day after admission. Conclusion: Late presentation of tuberculous meningitis is not rare in Nigerians and we report two cases of tuberculous meningitis that presented late to our health care facility. This report is intended to make clinicians aware of the unusual clinical presentations of tuberculous meningitis.

Background and purpose: Stroke is a leading cause of death and neurological disability in adults, and imposes a heavy emotional and financial burden on the family and society. We carried out this study to describe the epidemiological pattern of stroke at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife and also to describe the risk factors, the computerized tomography (CT) scan findings and the outcome of stroke in our practice setting. Methods: We prospectively studied one hundred and thirty five consecutive patients presenting to the neurology unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife over a six year period (2000- 2005). The socio-demographic and clinical data as well as the CT scan findings were collected. Statistical analysis was done using SPSS version 11.0. Results: The 135 patients comprised 76 male and 59 female with a mean age of 62+ 12years. The major risk factors were hypertension and diabetes mellitus. Cerebral infarction was the most common subtype of stroke seen. The case fatality rate was 15.6% and among the survivors the outcome was poor as only 3% made full recovery. Conclusion: Stroke is still a major problem and the major predisposing factor remains uncontrolled hypertension. The case fatality was very high and there is a risk of moderate to severe neurological disability among the survivors. The utilization of CT scan is sub-optimal even when it is available because of financial constraints. CT scan is recommended for all cases of stroke for definitive diagnosis and timely as well as accurate management.

Stroke, a major cause of morbidity and mortality is on the increase and with increasing mortality. Our retrospective review of all stroke admissions from 1990 - 2000 show that cerebrovascular disease accounted for 3.6% (293/8144) of all medical admissions; has a case fatality rate of 45% with the majority (61%) occurring in the first week; mean age of stroke deaths was 62 years (SD +/- 13); and severe as well as uncontrolled hypertension is the most important risk factor. Community based programmes aimed at early detection and treatment of hypertension in addition to screening for those with high risk factors should be put in place.

Background: Neurological disorders are common and contribute significantly to disease burden, disability-adjusted life years and death. Objective: To assess the distribution of neurological disease in patients presenting to our hospital. Methods: The records of the Adult Neurology Clinic in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun state, Nigeria were reviewed retrospectively for the years 2003-2005 and 2010-2014, and diagnoses as made by the Consultant were obtained and analyzed. Results: The total number of complaints was 1,524 and 86.4% of these were neurological in nature. Episodic and paroxysmal disorders (ICD-10) accounted for 54.1% of the diagnoses, and epilepsy and stroke were the most common of these. Of the 1,226 patients seen during the period, 91.4% had neurological disorders. The peak occurrence of these disorders was within the first three decades of life. Conclusion: Epilepsy and stroke are the commonest neurological disorders in the outpatient setting and there should be more studies in the community on their prevalence and impact.

Background: There is a complex inter-relationship between sleep disorders and epilepsy, and there are few studies in Nigeria on sleep disorders in epilepsy. This study was carried out to determine the prevalence, pattern and predictors of sleep disturbances among persons with epilepsy (PWE).

BACKGROUND: Metastatic brain cancer constitutes about 24-25 % of brain tumours worldwide and in Nigeria it constitutes about 40% of brain tumors. The clinical presentation of metastatic tumors may be atypical. OBJECTIVE: To present a middle aged Nigerian woman with a metastatic brain cancer who had a stroke-like syndrome. Methods: The patient was a 47-year old woman who presented with a two-week history of progressive weakness of the right upper and lower limbs, associated with headache, blurring of vision and slurring of speech. There was a history of weight loss but no history of cough or evening pyrexia. She was not a known hypertensive or diabetic patient though, there were positive history of diabetes mellitus in her father and elder senior brother. Her other systemic review and past medical history were not contributory. RESULTS: Examination revealed a woman with expressive dysphasia and right spastic hemiparesis. Her pulse, blood pressure and heart sounds were normal. There was no carotid bruit. Imaging studies showed metastases in the brain, liver, chest, cervical lymph nodes and bone marrow. Cervical lymph node histology showed metastatic adenocarcinoma. She was managed with chemotherapy, steroids and other supportive therapy but she died on the 40th day of admission due to disease progression and aspiration pneumonitis. CONCLUSION: Metastatic brain cancer may manifest atypically. Physicians should screen any patient with stroke without any apparent risk factors for possibilities of underlying metastatic brain cancer.

Introduction: Devic's neuromyelitis optica is an inflammatory demyelinating disease that targets the optic nerves and spinal cord. It has a worldwide distribution and distinctive features that distinguish it from multiple sclerosis. There has been no previous report of neuromyelitis optica from our practice environment, and we are not aware of any case associated with antiphospholipid syndrome in an African person. Case presentation: We report the case of a 28-year-old Nigerian woman who presented with neck pain, paroxysmal tonic spasms, a positive Lhermitte's sign and spastic quadriplegia. She later developed bilateral optic neuritis and had clinical and biochemical features of antiphospholipid syndrome. Her initial magnetic resonance imaging showed a central linear hyperintense focus in the intramedullary portion of C2 to C4. Repeat magnetic resonance imaging after treatment revealed resolution of the signal intensity noticed earlier. Conclusion: Neuromyelitis optica should be considered in the differential diagnoses of acute myelopathy in Africans. We also highlight the unusual association with antiphospholipid syndrome. Physicians should screen such patients for autoimmune disorders. © 2008 Komolafe et al; licensee BioMed Central Ltd.

Objectives: To assess response and toxicity to Imatinib mesylate (Glivec) in Nigerian Patients with chronic myeloid leukemia. Methods: From August 2003 to August 2007, 98 consecutive, consenting patients, 56 (57%) males and 42 (43%) females, median age 36 years (range, 11-65 years) diagnosed with CML, irrespective of disease phase received Imatinib at a dose of 300-600mg/day at the OAU Teaching Hospitals, Nigeria. Response to therapy was assessed by clinical, haematological and cytogenetic parameters. Blood counts were checked every two weeks in the first three months of therapy. Chromosome analysis was repeated sixth monthly. Overall survival (OS) and frequency of complete or major cytogenetic remission (CCR/MCR) were evaluated. Results: Complete haematologic remission was achieved in 64% and 83% of patients at one and three months, respectively. With a median follow-up of 25 months, the rates of CCR and MCR were 59% and 35% respectively. At 12 months of follow-up, OS and progression- free survival (PFS) were 96% and 91%, respectively. Achievement of CR at six months was associated with significantly better survival (p = 0.043).Conclusions: Compared to treatment outcome with conventional chemotherapy and alpha interferon, as previously used in Nigeria, the results obtained with this regimen has established Imatinib as the first-line treatment strategy in patients with CML, as it is in other populations, with minimal morbidity.