Effect of Temperature on the Incidence of Cerebro-Spinal Meningitis and Its Management in Funtua Local Government Area, Katsina State, Nigeria

This study was aimed at analysing the effect of temperature on the incidence of cerebro-spinal meningitis and its management in Funtua General Hospital of Katsina State, Nigeria from 1986-2015. For each year, monthly and annual incidence of CSM occurrence in the study area for the 30 years period was subjected to time series analysis. Linear trend line equation was fitted in order to determine the direction of change in the incidence of CSM. The relationship between temperature and the incidence of meningitis was analysed using simple correlation. To determine the management method of CSM in the area, a questionnaire was used to generate information from sampled respondents and analysed using descriptive statistics. The monthly distribution of CSM cases (1986-2015) indicated April and March had the highest incidence cases (1606 and 1128 respectively) while the lowest cases were recorded in September and October with (1 case) each. The seasonal variation also showed that the highest incidence cases fell within the hot-dry season which mark the period with the highest average temperatures while the lowest incidence cases fell within the hot-wet season when humidity is high in the area. Annual trend of CSM indicated an increasing trend (approximately 60 persons) over the 30year period in the study area. There is a significant and positive relationship between mean monthly temperature and incidence of meningitis with an observed value of (p < 0.05 and r = 0.592). The observed correlation (r = -0.141, p>0.05) indicated that there was negative and insignificant relationship between annual temperature and the incidence of meningitis in the study area. In conclusion, meningitis in the study area over the 30years under review has been a recurrent epidemic however; the rate of occurrence differs from year to year. Majority (78%) used the orthodox method to manage CSM while 22% used the traditional method who claimed it was effective as they recovered from the disease.

Potential disease trigger as a therapeutic option: infliximab for paradoxical reaction in tuberculosis of the central nervous system

A 36-year-old man of central Asian origin was diagnosed with subacute disseminated tuberculosis. Initially, central nervous system involvement was suggested by an encephalopathic condition and MRI showing extensive basal and spinal meningitis. After initiation of anti-tuberculosis drugs and corticosteroid therapy, clinical and radiological deterioration of spinal damage was noted. We interpreted this in the context of a paradoxical reaction, which is suggested to be an overshooting inflammatory response after reconstitution of the immune system. Despite increased dosage of corticosteroids, a gradual worsening of gait ataxia over several weeks was noted. After administration of infliximab, the patient’s condition progressively improved.

Characteristics of Cerebrospinal Meningitis Cases in 2017 Outbreak, Sokoto State, Nigeria: A Secondary Data Analysis

Introduction: Cerebro-Spinal Meningitis (CSM) is an acute illness affecting surrounding layers of the brain and spinal cord, mostly caused by bacterial infection. The disease is responsible for the occurrence of epidemic meningitis in the African Meningitic belt. For many years, this region has experienced a large serogroup A epidemic every 7-10 years. A sharp decrease in the number of reported cases was demonstrated in countries where Men Afrivac has been introduced. However, serogroup replacement with serotype C was noted in the region, which has posed a serious threat to eliminating CSM epidemics. We describe the characteristics of cerebrospinal meningitis cases in the 2017 outbreak in Sokoto state, Nigeria. Methodology: We obtained CSM data from the state epidemiology unit from 7th February to 24th May 2017. We extracted data on demographic characteristics, clinical features, case management and outcome of cases. We used Microsoft Excel and SPSS to analyze the data for proportions, cross-tabulations and chi-square test to find associations between variables. Results: A total of 4969 CSM cases were recorded, with 283 deaths (case fatality rate: 5.7%). The cumulative attack rate was 96.4/ 100,000 populations. The highest proportion of cases was among ≥ the 15-year age group 2063(41.5%), and males were more affected, 2843(57.2%). Of the total 4969 suspected CSM cases, specimens were collected for only 225 (4.4%) cases, of which 58 (25.8%) were positive. Most 48 (82.8%) of the positive specimen were of NmC serotype. Only age was found to predict outcome (aOR: 1.52; 95% CI= 1.18 – 1.97). Conclusion: Sokoto State outbreak of Cerebro-spinal meningitis in 2017 was huge and largely caused by NmC. Those aged less than 15 years might be at higher risk of dying from CSM and we therefore recommend that specific preventive interventions such as vaccination and awareness creation should target this age group.

Clinical and MRI phenotypes of sarcoidosis-associated myelopathy

ObjectiveTo determine the characteristic clinical and spinal MRI phenotypes of sarcoidosis-associated myelopathy (SAM), we analyzed a large cohort of patients with this disorder.MethodsPatients diagnosed with SAM at a single center between 2000 and 2018 who met the established criteria for definite and probable neurosarcoidosis were included in a retrospective analysis to identify clinical profiles, CSF characteristics, and MRI lesion morphology.ResultsOf 62 included patients, 33 (53%) were male, and 30 (48%) were African American. SAM was the first clinical presentation of sarcoidosis in 49 patients (79%). Temporal profile of symptom evolution was chronic in 81%, with sensory symptoms most frequently reported (87%). CSF studies showed pleocytosis in 79% and CSF-restricted oligoclonal bands in 23% of samples tested. Four discrete patterns of lesion morphology were identified on spine MRI: longitudinally extensive myelitis (n = 28, 45%), short tumefactive myelitis (n = 14, 23%), spinal meningitis/meningoradiculitis (n = 14, 23%), and anterior myelitis associated with areas of disc degeneration (n = 6, 10%). Postgadolinium enhancement was seen in all but 1 patient during the acute phase. The most frequent enhancement pattern was dorsal subpial enhancement (n = 40), followed by meningeal/radicular enhancement (n = 23) and ventral subpial enhancement (n = 12). In 26 cases (42%), enhancement occurred at locations with coexisting structural changes (e.g., spondylosis).ConclusionsRecognition of the clinical features (chronically evolving myelopathy) and distinct MRI phenotypes (with enhancement in a subpial and/or meningeal pattern) seen in SAM can aid diagnosis of this disorder. Enhancement patterns suggest that SAM may have a predilection for areas of the spinal cord susceptible to mechanical stress.

Surgical treatment of a thoracic ventral intradural arachnoid cyst associated with syringomyelia: case report

The pathogenesis of thoracic ventral intradural spinal arachnoid cyst (ISAC) is unknown due to its extremely low incidence. In addition, its surgical treatment is complicated because of the ventral location, large craniocaudal extension, and frequent coexistence of syringomyelia. The optimal surgical strategy for thoracic ventral ISAC remains unclear and continues to be a matter of debate. In this report, the authors describe an extremely rare case presenting with a compressive thoracic ventral ISAC associated with syringomyelia that was successfully treated with a simple cyst-pleural shunt. The patient’s medical history revealed bacterial spinal meningitis along with an extensive spinal epidural abscess, suggesting the incidence of extensive adhesive arachnoiditis (AA) to be a plausible cause for this pathology. Thoracic ventral ISAC reportedly occurs secondary to AA and is commonly associated with syringomyelia. Placement of a cyst-pleural shunt is an effective, safe, and uncomplicated surgical strategy, which can provide sufficient cyst drainage regardless of the coexistence of AA, and thus should be considered as primary surgical treatment. Syrinx drainage could be reserved for a later attempt in case the cyst-pleural shunt fails to reduce the extent of syringomyelia.

Post spinal meningitis with subdural collection: an uncommon complication after spinal anaesthesia for caesarean section

Meningitis after spinal anaesthesia is a rare yet devastating complication of spinal anaesthesia. The exact incidence is unknown. Our patient developed signs and symptoms of meningitis 48 hours after spinal anaesthesia and required intensive care unit admission. Her cerebrospinal fluid was sterile. Computed tomography of brain showed left subdural collection. She recovered well after 6 weeks of intravenous antibiotics. No neurological sequela noted from subsequent follow-up examinations. Our case provides an important insight of meningitis with subdural collection after spinal anaesthesia for emergency caesarean section.

Matsumoto, Shunsuke (松本竣介, 1912–1949)

Matsumoto Shunsuke was an oil painter and essayist active in the years up to and through the Pacific War. His best-known paintings, most of which feature figures in urban landscapes, include several self-portraits such as Standing Figure (1942). Matsumoto contracted spinal meningitis at the age of eleven, which eventually led to the loss of his hearing, an event that steered him towards the career of professional artist, and encouraged him to become immersed in reading and the literary arts. Later, it also rendered him ineligible for the draft. At seventeen he dropped out of high school and moved to Tokyo, where he studied oil painting at the Pacific School of Fine Arts (Taiheiyô Bijutsu Gakkô) for three years. In 1935 he became a member of the avant-garde NOVA Art Society, the first of several exhibition collective and artist groups in which he would participate. Other groups including the Nikakai, the Nine-Room Society (Kyûshitsukai), and the Newcomers Painting Society (Shinjin Gakai). Like Ai Mitsu, Asô Saburô, and others with whom he associated, Matsumoto expanded his style to accommodate expanded Japanese interest in Abstraction and Surrealism during the 1930s, but he largely retained his interest in painting intimate portraits, set in non-idealized cityscapes, throughout his career.