![](3D"OlowoyoNMJ64No4Page461_files/image002.gif")
![3D"Text](3D"OlowoyoNMJ64No4Page461_files/image003.gif")
![](3D"OlowoyoNMJ64No4Page461_files/image005.gif")
<=
/p>
The Pattern of Neurological Conditions in a Tertiary
Institution
in Nigeria: Six Years Experience in Ekiti State, Nigeria<=
o:p>
*Paul Olowoyo1, Ariyo Olumuyiwa2,
Gbenga Popoola3, Oluwatosin Oguntoye1, Segun Atolani<=
sup>2,
Olukayode Talabi2, Olusegun Adegbaye2, Ogunmola
Osironmuro2, Segun Momoh2, Kikelomo Olowoyo4,
Rufus Akinyemi5, Mayowa Owolabi5.
1Department of Medicine, College of Medicine and Health
Sciences, Afe Babalola University, Ado-Ekiti, and Federal Teaching Hospital,
Ido-Ekiti, Nigeria 2Department of Medicine, Federal Teaching
Hospital, Ido-Ekiti, Nigeria 3Department of Mental Health, Feder=
al
Teaching Hospital, Ido-Ekiti, Nigeria 4Department of Nursing, Ek=
iti
State University Teaching Hospital, Ado-Ekiti, Nigeria 5Departme=
nt
of Medicine, University College Hospital, Ibadan/ University of Ibadan,
Nigeria.
![](3D"OlowoyoNMJ64No4Page461_files/image007.gif")
Background: Neurological disorders constitute major causes of morbidi=
ty,
and globally, they are the leading causes of death. There is a dearth of
neurologists in most African countries and the very few available ones are
concentrated in urban areas. The cardiovascular and communicable risk facto=
rs
responsible for most cases of acute and chronic neurological disorders are =
also
prevalent in rural areas. Although patients from the neighbouring states at=
tend
the study centre, the majority are indigent. Therefore, there is a need to
observe the pattern of these disorders in Ekiti, to appreciate the disease
burden as it would help in the judicious allocation of human and other
healthcare resources.
Methodology: We reviewed t=
he
case files of patients seen at the neurology clinic and admitted via the
emergency department into the Federal Teaching Hospital, Ido-Ekiti, over a
period of 6 years (2016 to 2021).
Results: A total of 881patien=
ts
were seen during the study period, and they were mostly
elderly male patients with chronic disorders in
which stroke was the most common neurological disorder (44.9%) followed by
seizure disorder (13.1%), and neurodegenerative disorders (9.9%). Tumors and
myopathies were the least seen disorders.
Conclusion: Health literacy on
cardiovascular risk factors and even the distribution of manpower and mater=
ial
resources will help reduce the burden of neurological disorders among the
attendees of the Ekiti tertiary health institution.
Keywords: Neurological disorder=
s,
Ekiti, Nigeria
=
*Correspondence: Dr
Olowoyo Paul Department of Medicine, College of Medicine and Health Science=
s, Afe
Babalola University and Federal Teaching Hospital, Ido-Ekiti, Nigeria. Email:olowoyop@abuad.edu.ng<=
/span>=
This is an open access journal, and articles are distributed und=
er
the terms of the Creative Commons Attribution-NonComme=
rcial-Share
Alike 4.0 License, which allows others to remix, tweak, and build upon the =
work
non-commercially, as long as appropriate credit is given and the new creati=
ons
are licensed under the identical terms.
How to cite this article: Olowoyo P, Olumuyiwa A, Popoola G, Oguntoye O, Atolani S,
Talabi O, Adegbaye O, Osironmuro O, Momoh S, Olowoyo K, Akinyemi R, Owolabi
M.The Pattern of Neurological Conditions in a Tertiary Institution in Niger=
ia:
Six Years Experience in Ekiti. Niger Med J 2023;64(4): 461-470. Accepted: A=
ugust
20, 2023. Published: September 21, 2023.
![](3D"OlowoyoNMJ64No4Page461_files/image009.gif")
=
Introduction
Neurological
disorders constitute major causes of morbidity, and globally, they are the
leading causes of death.[3] They are either primary disorders of the nervous system =
or
neurological manifestations of other systemic diseases.[3] Most neurological disorders are viewed as spiritual atta=
cks,
therefore, patients and their relations prefer to visit spiritual homes for
remedy.[4] This is further compounded by low educational levels,
poverty, and inefficient hospital treatment due to the dearth of neurologis=
ts in
most African countries.[6] In Nigeria, for instance, the few available neurologists=
are
concentrated in urban centers of the country where the adoption of Western
lifestyles is believed to contribute more to the increasing incidence of
neurovascular and cardiovascular events such as stroke and other cardiovasc=
ular
diseases.[4] This is no longer the case as there is an increasing lev=
el
of socialization and urbanization in rural areas as well, predisposing them=
to
cardiovascular risk factors.[1] There is a need to observe the
pattern of these disorders in Ekiti, to appreciate the disease burden as it
would help in judicious allocation of human and other health care resources=
.
Methodology
The
admission books and case files of patients seen at the emergency department,
neurology clinic, and the medical wards of the Federal Teaching Hospital,
Ido-Ekiti, Nigeria were retrieved for the extraction of information used for
this study. The hospital is a referral centre for the general and specialist
hospitals in Ekiti State and neighbouring states: Ondo, Kogi, and Kwara.
Records were taken from January 2015 to December 2020. Two reviewers ensured
that there was no duplication of records, especially for those patients that
were admitted via the emergency department and the neurology clinic to the
medical wards. Diagnoses were made by the hospital neurologist and confirme=
d by
the available diagnostic equipment such as MRI, CT machine, EEG machine, and
well-equipped medical laboratories. Patients were referred for nerve conduc=
tion
studies. Cases of stroke were confirmed with brain CT/MRI within a week of
admission and for those who were not stable enough to be transferred for
neuroimaging, the updated definition of stroke for the 21st cent=
ury,
according to the American Heart Association and American Stroke Association=
was
used.[7] Diagnosis and classification of seizures were based on i=
ctal
semiology and EEG. We used the UK Parkinson’s Disease Study Brain Bank
criteria for the diagnosis of Parkinson’s disease while oth=
er
movement disorders were diagnosed clinically based on the pattern.
Neuropsychiatric disorders were diagnosed using the ICD-10 criteria<=
!--[if supportFields]> ADDIN EN.=
CITE
<EndNote><Cite><Author>Van
Vliet</Author><Year>2007</Year><RecNum>1384</Rec=
Num><DisplayText><style
face=3D"superscript">[6]</style></DisplayText><=
record><rec-number>1384</rec-number><foreign-keys><=
key
app=3D"EN" db-id=3D"evvvrzz20stp29erpwwv9tvwwv2wwtsw2vaa&quo=
t;
timestamp=3D"1642069857">1384</key></foreign-keys>=
<ref-type
name=3D"Journal Article">17</ref-type><contributors&g=
t;<authors><author>Van
Vliet, IM</author><author>De Beurs,
E</author></authors></contributors><titles><titl=
e>The
MINI-International Neuropsychiatric Interview. A brief structured diagnostic
psychiatric interview for DSM-IV en ICD-10 psychiatric
disorders</title><secondary-title>Tijdschrift voor
psychiatrie</secondary-title></titles><periodical><ful=
l-title>Tijdschrift
voor
psychiatrie</full-title></periodical><pages>393-397</p=
ages><volume>49</volume><number>6</number><da=
tes><year>2007</year></dates><isbn>0303-7339<=
/isbn><urls></urls></record></Cite></EndNote&=
gt;[6] in addition to neuroimaging and other biochemical
investigations to rule out organic brain disorders. Cord compression syndro=
mes
were confirmed with X-ray and MRI.
Results
A total of 881 patients were seen during the study period
with males constituting 51.2 percent. Most
of the patients were predominantly (69.8%) seen in the clinic with a median=
age
of 58.23
± 18.33 years.
Table
1: Age and sex distribution of the patients
|
Variable <=
o:p>
|
Frequency<=
o:p>
|
Percent
|
|
Age (years=
)
|
=
;
|
=
;
|
|
18 - 44
|
210
|
23.8
|
|
45 - 64
|
333
|
37.8
|
|
≥ 65
|
338
|
38.4
|
|
Mean ± SD
|
58.23 ± 18.33
|
|
Range
|
18
– 105
|
|
Sex <=
/o:p>
|
=
;
|
=
;
|
|
Male
|
451
|
51.2
|
|
Female
|
430
|
48.8
|
|
Place
|
=
;
|
=
;
|
|
Clinic
|
615
|
69.8
|
|
Ward/Emergency<=
/p>
|
266
|
30.2
|
The
Years 2016 and 2017 recorded the highest number of patients (27.5 and 26.1%=
respectively)
with a progressive decline to 2020. There were few confirmed neurological c=
ases
seen and admitted in 2015 (1.4%). The Year 2020 also recorded a low patient
turnout (2.8%).
![](3D"OlowoyoNMJ64No4Page461_files/image011.gif")
Figure
1: Distribution of the patients based on the year
Vascular
events (ischemic and hemorrhagic strokes) constituted the highest proportion
(44.9%) of neurological disorders seen over the 6-year period. This was
followed by seizures and movement disorders, 13.1% and 9.9% respectively.
Myopathies (1.0%) and tumors (0.5%) were the least seen. (Figure 2).
![](3D"OlowoyoNMJ64No4Page461_files/image013.gif")
Figure
2: Neurology cases seen from 2015 to 2020=
Cases
of stroke were commoner in females (50.5% of all cases recorded) and in tho=
se
above the age of 65 years (59.8% of all cases seen). The highest proportion=
of
seizure disorders was recorded in the youngest age group (18 to 45 years) a=
nd
commoner in males (13.3% of total cases). Movement disorders were most comm=
on
(13.3%) among the elderly and commoner in males (14.2% of total cases). The
diagnoses and patterns according to age group and sex distribution are show=
n in
Table 2 and Figures 3 and 4 respectively.
Table
2: Diagnosis based on age and sex distribution=
of
the patients
|
|
Age (years)
|
|
Sex
|
|
|
|
18 – 44
|
45 – 64
|
≥ 65
|
|
Male<=
/p>
|
Female
|
Total=
|
|
Diagnosis=
|
n=3D210(%)
|
n=3D333(%)
|
n=3D338(%)
|
|
n=3D451(%)
|
n=3D430(%)
|
N=3D881(%)
|
|
=
Vascular
|
=
36(17.1)
|
=
158(47.4)
|
=
202(59.8)
|
=
|
=
179(39.7)
|
=
217(50.5)
|
=
396(44.9)
|
|
=
Infection/inflammatory=
|
=
28(13.3)
|
=
31(9.3)
|
=
19(5.6)
|
=
|
=
42(9.3)
|
=
36(8.4)
|
=
78(8.9)
|
|
=
Seizure/ Epilepsy
|
=
63(30.0)
|
=
27(8.1)
|
=
25(7.4)
|
=
|
=
61(13.5)
|
=
54(12.6)
|
=
115(13.1)
|
|
=
Movement disorder
|
=
12(5.7)
|
=
29(8.7)
|
=
46(13.6)
|
=
|
=
64(14.2)
|
=
23(5.3)
|
=
87(9.9)
|
|
=
Neuropsychiatry=
|
=
7(3.3)
|
=
16(4.8)
|
=
25(7.4)
|
=
|
=
19(4.2)
|
=
29(6.7)
|
=
48(5.4)
|
|
=
Neuroimmunology
|
=
5(2.4)
|
=
5(1.5)
|
=
1(0.3)
|
=
|
=
8(1.8)
|
=
3(0.7)
|
=
11(1.2)
|
|
=
Headache
|
=
17(8.1)
|
=
10(3.0)
|
=
1(0.3)
|
=
|
=
10(2.2)
|
=
18(4.2)
|
=
28(3.2)
|
|
=
Others
|
=
17(8.1)
|
=
25(7.5)
|
=
9(2.7)
|
=
|
=
26(5.8)
|
=
25(5.8)
|
=
51(5.8)
|
|
=
Cord compression syndrome
|
=
17(8.1)
|
=
28(8.4)
|
=
9(2.7)
|
=
|
=
35(7.8)
|
=
19(4.4)
|
=
54(6.1)
|
|
=
Tumor
|
=
2(1.0)
|
=
2(0.6)
|
=
0(0.0)
|
=
|
=
2(0.4)
|
=
2(0.5)
|
=
4(0.5)
|
|
=
Myopathy
|
=
6(2.9)
|
=
2(0.6)
|
=
1(0.3)
|
=
|
=
5(1.1)
|
=
4(0.9)
|
=
9(1.0)
|
All the
neurological cases recorded the highest hospital presentation between 2016 =
and
2017 with a steady decline from 2018 except for cord compression syndrome w=
hich
peaked that year (11.7%) of cases. In the following year, there was a sharp
drop in cases of cord compression syndrome to 3.4%. The diagnoses of the ot=
her
neurological disorders per year are shown in Table 3.
Table 3: Diag=
nosis
per year
|
=
|
Year
|
=
|
|
=
|
2015<=
/p>
|
2016<=
/p>
|
2017
|
2018<=
/p>
|
2019<=
/p>
|
2020<=
/p>
|
Total=
|
|
Diagnosis
|
n (%)=
|
n (%)
|
n (%)
|
n (%)
|
n (%)
|
n (%)
|
N (%)=
|
|
=
Vascular
|
=
9(75.0)
|
=
101(41.7)
|
=
98(42.6)
|
=
86(43.7)
|
=
81(46.3)
|
=
21(84.0)
|
=
396(44.9)
|
|
=
Infection/inflammatory=
|
=
2(16.7)
|
=
20(8.3)
|
=
19(8.3)
|
=
12(6.1)
|
=
24(13.7)
|
=
1(4.0)
|
=
78(8.9)
|
|
=
Seizure/ Epilepsy
|
=
0(0.0)
|
=
33(13.6)
|
=
36(15.7)
|
=
27(13.7)
|
=
16(9.1)
|
=
3(12.0)
|
=
115(13.1)
|
|
=
Movement disorder
|
=
0(0.0)
|
=
24(9.9)
|
=
26(11.3)
|
=
24(12.2)
|
=
13(7.4)
|
=
0(0.0)
|
=
87(9.9)
|
|
=
Neuropsychiatry=
|
=
0(0.0)
|
=
18(7.4)
|
=
13(5.7)
|
=
3(1.5)
|
=
14(8.0)
|
=
0(0.0)
|
=
48(5.4)
|
|
=
Neuroimmunology
|
=
0(0.0)
|
=
2(0.8)
|
=
4(1.7)
|
=
1(0.5)
|
=
4(2.3)
|
=
0(0.0)
|
=
11(1.2)
|
|
=
Headache
|
=
0(0.0)
|
=
8(3.3)
|
=
9(3.9)
|
=
4(2.0)
|
=
7(4.0)
|
=
0(0.0)
|
=
28(3.2)
|
|
=
Others
|
=
1(8.3)
|
=
22(9.1)
|
=
8(3.5)
|
=
11(5.6)
|
=
9(5.1)
|
=
0(0.0)
|
=
51(5.8)
|
|
Cord compression syndrome
|
=
0(0.0)
|
=
10(4.1)
|
=
15(6.5)
|
=
23(11.7)
|
=
6(3.4)
|
=
0(0.0)
|
=
54(6.1)
|
|
=
Tumor
|
=
0(0.0)
|
=
0(0.0)
|
=
1(0.4)
|
=
3(1.5)
|
=
0(0.0)
|
=
0(0.0)
|
=
4(0.5)
|
|
=
Myopathy
|
=
0(0.0)
|
=
4(1.72)
|
=
1(0.4)
|
=
3(1.5)
|
=
1(0.6)
|
=
0(0.0)
|
=
9(1.0)
|
|
=
Total
|
=
12(100.0)
|
=
242(100.0)
|
=
230(100.0)
|
=
197(100.0)
|
=
175(100.0)
|
=
25(100.0)
|
=
881(100.0)
|
Discussion:
They were mostly elderly male patients with chronic disord=
ers similar
to the findings at a southeastern teaching hospital by Ekenze
et al.[4]There was a =
sharp
increase in the number of cases seen in 2016 as a result of the participati=
on
of the institution in research on stroke (Stroke Investigative Research and
Education Network, SIREN).[2] As part of =
the
recruitment process, patients were educated on the risk factors for stroke =
and
both the primary and secondary preventive measures. Those with identified r=
isk
factors were referred to the hospital immediately for urgent clinical
interventions. This might have contributed to the progressive steady declin=
e in
the new cases of stroke recorded per year. This emphasizes the role of pati=
ent
education in health promotion. In the year 2020 where there was a significa=
nt drop
in admission due to the COVID-19 pandemic. There was total lockdown across =
the
country and only a few patients with emergencies, mainly stroke and seizure=
s,
presented to the hospital for admission.
<=
/o:p>
The
acute cases were more of stroke, highest in the year 2016 because of increa=
sed
advocacy on the awareness of symptoms and timely hospital presentation as p=
art
of SIREN protocol. The survivors were followed up in the subsequent years w=
ith
an emphasis on secondary and tertiary stroke prevention strategies.
Stroke
had the highest prevalence similar to the findings of Talabi et al ADDIN EN.CITE
<EndNote><Cite><Author>Talabi</Author><Year>2=
003</Year><RecNum>1341</RecNum><DisplayText><sty=
le
face=3D"superscript">[2]</style></DisplayText><=
record><rec-number>1341</rec-number><foreign-keys><=
key
app=3D"EN" db-id=3D"evvvrzz20stp29erpwwv9tvwwv2wwtsw2vaa&quo=
t;
timestamp=3D"1641389941">1341</key></foreign-keys>=
<ref-type
name=3D"Journal Article">17</ref-type><contributors&g=
t;<authors><author>Talabi,
OA</author></authors></contributors><titles><tit=
le>A
3–year review of neurologic admissions in University College Hospital
Ibadan, Nigeria</title><secondary-title>West African Journal of
Medicine</secondary-title></titles><periodical><full-t=
itle>West
African Journal of Medicine</full-title></periodical><pages&=
gt;150-151</pages><volume>22</volume><number>2</=
number><dates><year>2003</year></dates><isbn&=
gt;0189-160X</isbn><urls></urls></record></Cite&=
gt;</EndNote>[2] in Ibadan a=
nd
also the experience of Owolabi et al,[3] and Ibrahim=
et al[2] both in Kan=
o,
Nigeria. It was commoner in females, and in those above the age of 65 years=
as
it was found by Desalu et al,[2] six years b=
efore
this study, in the same geographical area. Ogun et al,[6] in another
southwestern tertiary institution in Nigeria, found a similar female
preponderance. The reason for the slight female preponderance in this study=
, as
opposed to other studies,[2, 3] is the long=
er
female life span to the age that stroke is most prevalent. Seizure disorders
were recorded as the second most prevalent disease in this study similar to
findings in some other countries where it is
predominant in the young age group, and commoner in males as reported in mo=
st
African countries.[1] However, a
similar study at Ile-Ife, Nigeria, by Komolafe et al[11] found epile=
psy as
the most common neurological disorder, followed by stroke. This, probably, =
must
have been because their cohorts were outpatients only. Movement disorders
ranked third on the list and were most common among elderly men. The common=
est
seen in our cohort is Parkinson’s disease which is a neurodegenerative
disease with a peak incidence of 70-79 years.[6] The order of
prevalence observed in this study is the same as that of the neurology clinic of the KomfoAnokye
Teaching Hospital in Kumasi, Ghana. The exponential rise in the incidence of cardiovascular risk
factors such as diabetes mellitus, obesity, and sedentary lifestyle,
hypertension, dyslipidemia in many African countries explains why
there are escalating rates of stroke and ischemic heart diseases.[3, 10] It is quite c=
lear
why stroke is the most common neurologic disorder in our cohort.<=
span
lang=3DEN-US style=3D'font-size:12.0pt;font-family:"Times New Roman",serif'=
>
Stroke,
movement disorders, and neurodegenerative conditions were seen more in the
elderly while seizure/epilepsy was the only disorder most prevalent among y=
oung
individuals. This observation implies that there is ample time to prevent t=
he
development of these disorders. This calls for actions to reduce the burden=
of
stroke by emphasizing primordial and primary prevention of stroke. ADDIN EN.CITE
<EndNote><Cite><Author>De
Freitas</Author><Year>2001</Year><RecNum>1349</R=
ecNum><DisplayText><style
face=3D"superscript">[1,
10154]</style></DisplayText><record><rec-number>134=
9</rec-number><foreign-keys><key
app=3D"EN" db-id=3D"evvvrzz20stp29erpwwv9tvwwv2wwtsw2vaa&quo=
t;
timestamp=3D"1641469563">1349</key></foreign-keys>=
<ref-type
name=3D"Journal
Article">17</ref-type><contributors><authors><=
author>De
Freitas, GR</author><author>Bogousslavsky,
J</author></authors></contributors><titles><titl=
e>Primary
stroke prevention</title><secondary-title>European journal of
neurology</secondary-title></titles><periodical><full-=
title>European
journal of
neurology</full-title></periodical><pages>1-15</pages&=
gt;<volume>8</volume><number>1</number><dates>=
;<year>2001</year></dates><isbn>1351-5101</isbn&=
gt;<urls></urls></record></Cite><Cite><Aut=
hor>Pandian</Author><Year>2018</Year><RecNum>135=
0</RecNum><record><rec-number>1350</rec-number><=
foreign-keys><key
app=3D"EN" db-id=3D"evvvrzz20stp29erpwwv9tvwwv2wwtsw2vaa&quo=
t;
timestamp=3D"1641469727">1350</key></foreign-keys>=
<ref-type
name=3D"Journal
Article">17</ref-type><contributors><authors><=
author>Pandian,
Jeyaraj D</author><author>Gall, Seana
L</author><author>Kate, Mahesh P</author><author>Si=
lva,
Gisele S</author><author>Akinyemi, Rufus
O</author><author>Ovbiagele, Bruce
I</author><author>Lavados, Pablo
M</author><author>Gandhi, Dorcas
BC</author><author>Thrift, Amanda
G</author></authors></contributors><titles><titl=
e>Prevention
of stroke: a global perspective</title><secondary-title>The
Lancet</secondary-title></titles><periodical><full-tit=
le>The
Lancet</full-title></periodical><pages>1269-1278</page=
s><volume>392</volume><number>10154</number><=
dates><year>2018</year></dates><isbn>0140-6736&l=
t;/isbn><urls></urls></record></Cite></EndNot=
e>[1, 10154] Alzheimer&#=
8217;s
disease and vascular dementia can also be prevented by adequate and timely
control of cardiovascular risk factors.[4] Neuroinfect=
ious
conditions (including NeuroAIDs, meningitis, te=
tanus,
and transverse myelitis), and cord compression syndromes, (surprisingly
cervical spondylosis) were common=
er
among the young patients. Presentatio=
ns
were neck pain radiating to the forearms and paresthesia in the hands. There
were two cases of lumbar spondylosis that presented with priapism which wer=
e subsequently
referred to the neurosurgeon for laminectomies. Cord compression cases at t=
he
neurology clinic dropped as the hospital got a neurosurgeon in year 2018. M=
ost
of the neurological conditions in this cohort were more in males, except for
stroke, neuropsychiatric disorders, and headaches.[4] Most of our
stroke patients are postmenopausal
as stroke rates increase among postmenopausal women compared with age-match=
ed
men.[12]
Our experien=
ce in
Ekiti, Nigeria, shows that stroke is the most common neurological disorder
followed by seizures and movement disorders. The observed progressive decli=
ne
in the cases of stroke may be attributable to health education and timely
intervention on detected cardiovascular risk factors which if intensified c=
an
also reduce the incidence of Alzheimer’s disease and vascular dementi=
a.
1. &=
nbsp; Feigin
VL, Vos T, Nichols E, Owolabi MO, Carroll WM, Dichgans M, et al. The
global burden of neurological disorders: translating evidence into policy. =
The Lancet Neurology. 2020;19:255-65.
2. =
Cojocaru
IM, Cojocaru M, Silosi I, Vrabie CD. Peripheral nervous system manifestatio=
ns
in systemic autoimmune diseases. M&=
aelig;dica.
2014;9:289.<=
/p>
3. =
Uwakwe
R. The pattern of psychiatric disorders among the aged in a selected commun=
ity
in Nigeria. International Journal of
Geriatric Psychiatry. 2000;15<=
/b>:355-62.
4. =
https://naijagists.com/Yoruba Actress Iy=
abo
Oko: Spiritual Attack Caused My Stroke. I'm Not Dead, I'm Recovering In India - NaijaGists.com - Pro=
udly
Nigerian DIY Motivation & Information Blog. Assessed 10 August 2023.
5. =
Nweke
MC, Eze CK. The place of spiritual and traditional beliefs in stroke
rehabilitation in sub-Saharan Africa: A scoping review. Journal of Complementary and Alternative Medical Research.
2019:1-16.
6. =
Mateen
FJ, Clark SJ, Borzello M, Kabore J, Seidi O. Neurology training in
sub‐Saharan Africa: A survey =
of
people in training from 19 countries. Annals of Neurology. 2016;79:871-81.
7. =
Gami
AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK, et al. Metabolic synd=
rome
and risk of incident cardiovascular events and death: a systematic review a=
nd
meta-analysis of longitudinal studies. Journal
of the American College of Cardiology. 2007;49:403-14.
8. =
Raimi
TH, Odusan O, Fasanmade O. High prevalence of central obesity in rural
South-Western Nigeria: Need for targeted prevention. 2015.
9. =
Oladapo
O, Salako L, Sodiq O, Shoyinka K, Adedapo K, Falase A. A prevalence of
cardiometabolic risk factors among a rural Yoruba south-western Nigerian
population: a population-based survey: cardiovascular topics. Cardiovascula=
r Journal of Africa. 2010;21:26-31.
10. Sacco=
RL,
Kasner SE, Broderick JP, Caplan LR, Connors J, Culebras A, et al. An updated
definition of stroke for the 21st century: a statement for healthcare
professionals from the American Heart Association/American Stroke Associati=
on. Stroke. 2013;44:2064-89.
11. Danie=
l S,
Lees A. Parkinson's Disease Society Brain Bank, London: overview and resear=
ch. Journal of Neural Transmission
Supplementum. 1993;39:165-=
72.
12. Van V=
liet
I, De Beurs E. The MINI-International Neuropsychiatric Interview. A brief
structured diagnostic psychiatric interview for DSM-IV en ICD-10 psychiatric
disorders. Tijdschrift Voor Psychia=
trie.
2007;49:393-7.
13. Ekenz=
e O,
Onwuekwe I, Ezeala B. Profile of neurological admissions at the University =
of
Nigeria Teaching Hospital Enugu. Ni=
gerian
Journal of Medicine. 2010;19:419-22.
14. Singh=
A,
Jenkins C, Calys-Tagoe B, Arulogun O, Sarfo S, Ovbiagele B, et al. Stroke
investigative research and education network: public outreach and engagemen=
t. Journal of Community Medicine & H=
ealth
Education. 2017;7:518. doi: 10.4172/2161-0711.10005=
18.
15. Talab=
i O. A
3–year review of neurologic admissions in University College Hospital
Ibadan, Nigeria. West African Journ=
al of
Medicine. 2003;22:150-1.
16. Owola=
bi L,
Shehu M, Shehu M, Fadare J. Pattern of neurological admissions in the tropi=
cs:
Experience at Kano, Northwestern Nigeria. Annals
of Indian Academy of Neurology. 2010;13:167.
17. Ibrah=
im A,
Owolabi LF, Musa BM, Aliyu S, Rabiu M, Yakasai AM. Pattern of in-patient
neurologic review: An experience from a Tertiary Hospital North-Western
Nigeria. Annals of African medicine=
.
2016;15:47.<=
/p>
18. Desal=
u OO,
Wahab KW, Fawale B, Olarenwaju TO, Busari OA, Adekoya AO, et al. A review of
stroke admissions at a tertiary hospital in rural Southwestern Nigeria. Annals of African Medicine. 2011;10:80-5.
19. Ogun =
S,
Ojini F, Ogungbo B, Kolapo K, Danesi M. Stroke in south west Nigeria: a 10-year review. Stroke. 2005;36:1120-2.
20. Njoku=
C,
Aduloju A. Stroke in Sokoto, Nigeria: A five year retrospective study. Annals of African Medicine. 2004;3:73-6.
21. Onwuc=
hewa
A, BellGam H, Asekomeh Gs. Stroke at the university of port harcourt teachi=
ng
hospital, rivers state, Nigeria. Tr=
opical
Doctor. 2009;39:150-2.
22. Tegue=
u CK,
Nguefack S, Doumbe J, Fogang YF, Mbonda PC, Mbonda E. The spectrum of
neurological disorders presenting at a neurology clinic in Yaoundé,
Cameroon. The Pan African Medical
Journal. 2013;14:148.doi: 10.11604/pamj.2013.14.148=
.2330
23. Olubu=
nmi A.
Epilepsy in Nigeria–a review of etiology, epidemiology and management=
. Benin Journal of Postgraduate Medicine=
.
2006;8: 27-51.
24. Komol=
afe M,
Owagbemi O, Alimi T. The distribution and pattern of neurological disease i=
n a
neurology clinic in Ile-Ife, Nigeria. Nigerian
Journal of Clinical Practice. 2018;21:1520-4.
25. Muang=
paisan
W, Mathews A, Hori H, Seidel D. A systematic review of the worldwide preval=
ence
and incidence of Parkinson’s disease. Journal
of the Medical Association of Thailand. 2011;94:749- 55.
26. Sarfo=
FS,
Akassi J, Badu E, Okorozo A, Ovbiagele B, Akpalu A. Profile of neurological
disorders in an adult neurology clinic in Kumasi, Ghana. Eneurologicalsci. 2016;3:69-74.
27. Owola=
bi MO,
Adu D, Ramsay M, Ovbiagele B. Understanding the rise in cardiovascular dise=
ases
in Africa: harmonising H3Africa genomic epidemiological teams and tools:
cardiovascular topic. Cardiovascular
Journal of Africa. 2014;25=
:134-6.
28. Akiny=
emi
RO, Ovbiagele B, Adeniji OA, Sarfo FS, Abd-Allah F, Adoukonou T, et al. Str=
oke
in Africa: profile, progress, prospects and priorities. Nature Reviews Neurology. 2021;17:634-56.
29. De Fr=
eitas
G, Bogousslavsky J. Primary stroke prevention. European Journal of Neurology. 2001;8:1-15.
30. Pandi=
an JD,
Gall SL, Kate MP, Silva GS, Akinyemi RO, Ovbiagele BI, et al. Prevention of
stroke: a global perspective. The L=
ancet.
2018;392:1269-78.
31. Luchs=
inger
JA, Mayeux R. Cardiovascular risk factors and Alzheimer’s disease. Current Atherosclerosis Reports. 2=
004;6:261-6.
32. Wang =
C,
Tian F, Zhou Y, He W, Cai Z. The incidence of cervical spondylosis decrease=
s with
aging in the elderly, and increases with aging in the young and adult
population: a hospital-based clinical analysis. Clinical Interventions in Aging. 2016;11:47.
33. Thakur
K. The Global Burden of Neuroinfectious Diseases. 2017. American Academy of=
Nuerology
Institute 2017. Available at:
http://www.upandrunningnetworks.com/files/C222_2.pdf Assessed 10 August 202=
3.
34. Clayt=
on JA.
Sex influences in neurological disorders: case studies and perspectives. Dialogues in Clinical Neuroscience.
2016;18:357.=
35. Haast=
RA,
Gustafson DR, Kiliaan AJ. Sex differences in stroke. Journal of Cerebral Blood Flow & Metabolism. 2012;32:2100-7.<=
/span>
------=_NextPart_01DA02D5.6A5361F0
Content-Location: file:///C:/146356F1/OlowoyoNMJ64No4Page461_files/themedata.thmx
Content-Transfer-Encoding: base64
Content-Type: application/vnd.ms-officetheme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------=_NextPart_01DA02D5.6A5361F0
Content-Location: file:///C:/146356F1/OlowoyoNMJ64No4Page461_files/colorschememapping.xml
Content-Transfer-Encoding: quoted-printable
Content-Type: text/xml
![](3D"OlowoyoNMJ64No4Page461_files/image015.gif")
![](3D"OlowoyoNMJ64No4Page461_files/image017.gif")