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BMC Neurol. 2019 Jan 15;19(1):10. doi: 10.1186/s12883-019-1236-3.

Epidemiology of non-traumatic spinal cord injury in Uganda: a single center, prospective study with MRI evaluation.

Author information

1
Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda. amusubire@yahoo.com.
2
Department of Medicine, School of Medicine, College of Health Sciences, Makerere University and Mulago Hospital Kampala, Kampala, Uganda. amusubire@yahoo.com.
3
Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda.
4
Department of Medicine, School of Medicine, College of Health Sciences, Makerere University and Mulago Hospital Kampala, Kampala, Uganda.
5
Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.
6
Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
7
Department of Radiology and Biomedical Imaging ,Yale School of Medicine, Yale University, New Haven, CT, USA.

Abstract

BACKGROUND:

A few reliable national data concerning the etiology of non-traumatic spinal cord injury (SCI) in sub-Sahara Africa exists, mainly because of the limitations of diagnostic imaging. These are both expensive and mostly unavailable in several resource-limited settings. Only a few studies have employed the magnetic resonance imaging (MRI) in documenting non-traumatic SCI and most of these studies are from South Africa. We sought to describe the clinical presentation, MRI radiological patterns, and one-year survival among subjects with non-traumatic SCI in Uganda.

METHODS:

We enrolled a prospective cohort of 103 participants with non-traumatic SCI at Mulago National Referral Hospital Kampala, Uganda in 2013-2015. Participants received standard of care management, with surgical intervention as needed, with one-year follow up. Data were analyzed using Descriptive statistics.

RESULTS:

In 103 participants with non-traumatic SCI, the median (IQR) age was 37 (18, 85) years and 25% of the participants were HIV-infected. Paraplegia/paraparesis was the most common clinical presentation in 70% (n = 72). Severe disease was present in 82% (n = 85) as per American Spinal Injury Association (ASIA) scale A-C. On MRI, 50% had extradural lesions. However, bone lesions accounted for only 75% of all the extradural lesions. More than 60% of the patients had lesions that could only be diagnosed on MRI. Deaths occurred in 42% (n = 44) of participants, with the highest mortality among those with extradural lesions (60%).

CONCLUSION:

The mortality following non-traumatic spinal cord injuries in Uganda is high. We demonstrated an equal distribution between extradural and intradural lesions, which differs from the historical predominance of extradural lesions. Increased utilization of MRI particularly among young age groups is needed to make a diagnosis.

KEYWORDS:

MRI; Mortality; Myelopathy; Non-traumatic spinal cord injury; Sub-Saharan Africa; Uganda

PMID:
30646840
PMCID:
PMC6332574
DOI:
10.1186/s12883-019-1236-3
[Indexed for MEDLINE]
Free PMC Article

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