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.

<p class="abstract">Spinal anaesthesia is a safe and widely performed mode of anaesthesia with low complication rate. It may however be complicated infrequently with neurological deterioration as a result of injury to nerve root and spinal cord or epidural haematoma. Rarely neurological deterioration may occur following spinal anaesthesia in the presence of spinal tumours. We presented a case of neurological deterioration following spinal anaesthesia for caesarean section in a patient with previously undiagnosed thoracic spinal tumour.</p>

Background and Study Aims: There is paucity of data-driven study on pediatric traumatic spinal cord injury (SCI) in the developing countries. This study aims to define the clinical profile of pediatric traumatic SCI in a rural tertiary hospital in a sub-Saharan African country. Material and Methods: This was a prospective observational study of all children with spinal cord injury managed at our center over a 42-month period. Results: There were 20 patients, 13 males, mean age of 11.5 years. Road traffic crash was the etiology in 70% of the cases (motorcycle accident= 45%), and fall from height in 25%. Pedestrians were the victims of the road traffic crash in 42.9% (6/14) of the cases, while 21.4% (3/14) and 28.6% (4/14) were passengers on motorcycles, or in motor vehicles respectively. The cervical spine was the most common location of injury, occurring alone in 90% of the cases (18/20). Seventy-five percent of the patients (15/20) had transient deficits, but were grossly normal neurologically on examination (ASIA E); 2 patients had ASIA D, while 1 patient each had ASIA C, B, and A injuries. All patients were managed non-operatively. The patients with incomplete deficits improved, while those with complete injury did not make any motor or sensory gain. Conclusion: Road traffic accident, mostly motorcycle crash, was the most common etiology of pediatric SCI in this series, and most of the injuries were located in the cervical spine. Disabling injury constituted a small proportion of pediatric SCI in our practice.