Introduction: Status epilepticus (SE) is one of the most common neurologic emergencies and is associated with significant morbidity and mortality. The underlying cause of SE varies between patients with epilepsy and those presenting without. The aim of this study was to evaluate the epidemiology, risk factors and outcomes of patients presenting with convulsive SE in the emergency department (ED) of a tertiary hospital in Mogadishu. Methods: This was a cross-sectional study conducted between July 2021 and June 2022. The study included both patients with epilepsy and those without epilepsy presenting to the ED with SE. Risk factors and underlying etiologies were evaluated in the patients in both the pediatric group (0– 18 years) and adult group (18 years and above). Clinical history, neurologic examinations, neuroimaging, electroencephalography findings, and laboratory investigations were all evaluated. Results: The mean age for pediatric patients was 6 (SD± 4.7), while the mean age for adult patients was 38 (SD± 10.4). About 33 (36%) of the subjects had previous history of epilepsy, while 59 (64%) presented to the ED with their first seizure. About 80 (87%) had generalized seizure while 12 (13%) had focal seizure. Poor antiepileptic compliance was the most common risk factor for SE 20 (21.7%), followed by CNS infections 14 (15%), and prolonged febrile seizures 7 (7.6%). Poor antiepileptic drug compliance, cerebrovascular disorders, electrolyte imbalance, metabolic conditions, and drug abuse were the most common underlying etiologies of SE in patients older than 18 years. Prolonged febrile seizure, meningitis, encephalitis, systemic infections, and structural brain abnormalities were the most common underlying etiologies of SE in patients younger than 18 years. Conclusion: CNS infections, CVDs, metabolic disturbances, electrolyte imbalances, and systemic infections are major etiological risk factors of SE in patients without prior history of epilepsy. Medication adherence was the major etiological risk factor for SE identified in patients with epilepsy.

Autoimmune encephalitis (AE) is an inflammatory disease of the brain parenchyma that is mediated by many specific autoantibodies and is not caused by bacterial or viral causes. A diverse and growing number of autoantibodies have been identified in association with different types of AE. These antibodies can target either intracellular or cell-surface antigens. Advances are being made in understanding the clinical spectrum and treatment of AE. The prevalence and incidence of AE are increasing, although they remain comparable to those of infectious etiologies. The clinical presentation and management of AE are complex, with overlapping features. AE should be considered in the differential diagnosis of treatment-resistant epilepsy. Prompt diagnosis and treatment are critical in preventing seizures from developing into epilepsy. However, the broad differential diagnosis, the inability to detect specific autoantibodies in every patient, and delays in receiving antibody test results impede early diagnosis and treatment. Immunosuppressive agents are primarily used in treatment; first-line options include corticosteroids, intravenous immunoglobulin, and plasmapheresis, while rituximab and cyclophosphamide are used as second-line treatments. This review aims to provide a concise and accessible summary of this topic for readers and researchers.

Introduction and Importance: Lateral medullary syndrome (LMS) is a less common form of a brainstem stroke. It is the result of occlusion of the posterior inferior cerebellar artery (PICA). It is caused by atherosclerosis, thrombosis, or emboli from another source. Case Presentation: A 60-year-old male patient presented to the emergency department with vertigo, vomiting, slurred speech, hiccups, and left-side weakness associated with paresthesia for 1 day. He had a past medical history of uncontrolled hypertension and a smoking habit. The neurological examination revealed ataxia, and left hemiparesis associated with paresthesia. A cranial nerve examination revealed slight right-sided ptosis, mouth deviation, and loss of sensory sensation on the right side of the face. Brain MRI showed right medullary infarct consistent with LMS. Electrocardiogram, echocardiography, and vertebral artery color Doppler were normal. He was admitted to the neurology ward and was treated with low molecular weight heparin 60 mg subcutaneously, aspirin 300 mg, neuroprotective agents, and antihypertensive treatment. After 6 days of medical treatment, his condition has improved massively (dysarthria and dysphagia disappeared). He was discharged for physical rehabilitation. Clinical Discussion: LMS (Wallenberg syndrome) is one of the brainstem stroke syndromes caused by occlusion of PICA. Vertigo, vomiting, dysphagia, dysarthria, ipsilateral ataxia, Horner’s syndrome, and contralateral hemiparesis define this syndrome. Brain MRI is necessary for diagnosis alongside clinical syndrome. Conclusion: LMS is a rare form of brainstem stroke and carries a favorable prognosis if early hospitalization and treatment is applied. Brain MRI, including diffusion sequence, is the most useful diagnostic tool for detecting LMS.

Introduction: Spontaneous Intracerebral hemorrhage (ICH) in young patients is less common and not well studied compared to ICH in older patients. The etiology, risk factors and outcome of ICH in young patients may have regional and ethnic differences. The study aims to investigate the clinical characteristics, risk factors, etiology and outcome of spontaneous intracerebral hemorrhage in young adults in Somalia. Methods: The study enrolled 168 young patients with ICH (16– 50 years) admitted to the neurology department of a tertiary hospital from 2019 to 2022. The information about the demographic details, documented ICH risk factors, etiology and patients’ clinical status were retrieved. The etiology of ICH was determined based on clinical, laboratory and radiological findings. Intra-hospital survival status and associated factors were assessed. Results: The mean age of the patients was 35± 8.6 years. 99 (59%) of patients were male while 69 (41%) were females. Hypertension 48 (29%) was the most common risk factor, followed by substance abuse. Hypertensive hemorrhage was the most common etiology of ICH 60 (35.7%), followed by cerebral venous thrombosis (CVT) 5(15%), substance abuse 23 (13.7%) and arteriovenous malformation (AVM) in 10 (6%). AVM, CVT, cavernoma, eclampsia, substance abuse and cryptogenic etiology were more common in the 2nd and 3rd decades whereas hypertension was more common in the 4th and 5th decade. Intrahospital mortality was 28% in this study. Factors predicting intrahospital mortality were hematoma volume of greater than 30mL, thrombolytic etiology, brainstem ICH location, substance abuse related etiology, presence of associated mass effect, low GCS score on admission, high systolic blood pressure on admission, and the presence of chronic renal failure. Conclusion: In this study, hypertension, substance abuse, CVT and vascular malformation are the leading causes of ICH in young adults. Intracerebral hemorrhage in the young has different spectrum of etiologies and factors associated with short-term mortality compared to older patients.

Objective: The plant known as Catha edulis, commonly referred to as Khat, holds significant cultural significance within the populations of East Africa and Southwestern Arabia. The objective of this study is to ascertain and assess the association between the act of chewing khat and the incidence of acute stroke. Materials and Methods: The present study was carried out in a prospective observational manner at the Mogadishu-Somalia Turkish Training and Research Hospital. Data were gathered over a period of three years, from January 2021 to December 2023. The study encompassed all stroke patients who presented at the hospital’s emergency department who had the habit of khat consumption and did not have previous risk factors of stroke. The study included a sample size of 52 patients. Results: The study involved 52 male patients who were diagnosed with acute stroke. Among the participants, 75% (n = 39) were aged between 18 and 39 years, while 25% (n = 13) were aged between 40 and 64 years. The findings indicate that hemorrhagic stroke was the prevailing stroke type, accounting for 88.5% (n = 46) of cases, while ischemic stroke accounted for only 11.5% (n = 6). All 52 participants in the study reported using khat. In addition to the act of chewing khat, it was found that 70% (n = 36) of the participants had been using khat for a period exceeding 5 years; none of the participants exhibited any additional risk factors for stroke. Conclusion: The findings of our study indicate that Catha edulis, commonly known as khat, is a significant risk factor and potential causative agent for stroke. Khat consumption has been identified as a contributing factor to the incidence of cerebrovascular diseases.

Background and Aims: The etiological investigation of the potential cardiac source of acute ischemic stroke is important for the secondary prevention of recurrent and future embolization. Transthoracic echocardiography is one of the most useful investigations for the assessment of the potential cardiac etiology of ischemic stroke. Our aim is to evaluate echocardiographic findings in patients with acute ischemic stroke admitted to a tertiary care hospital in Mogadishu, Somalia. Methods: This was a retrospective observational study conducted in the neurology department of a tertiary care hospital in Mogadishu, Somalia. We enrolled 315 patients with acute ischemic stroke admitted to the hospital who had undergone transthoracic echocardiography between March 2019 and March 2022. We analyzed transthoracic echocardiography findings, ischemic stroke subtypes, and their associated comorbidities. We also compared the demographic data, comorbidity, and survival status of patients with abnormal echo findings to those with normal echo findings. Findings: The mean age of patients was 62± 12 years. Co-morbidities were present in about 251 (80%) of the subjects, hypertension was the most common comorbidity 99 (31.4%), followed by diabetes 72 (23%), and hyperlipidemia 37 (11.7%). Overall cardiac pathology in this study was 170 (54%). Forty-seven (15%) of the patients had low ejection fraction on transthoracic echocardiography. Male patients had slightly less left ventricular systolic dysfunction than female patients. 100 (32%) had left ventricular diastolic dysfunction (LVDD), while 113 (36%) had left ventricular hypertrophy (LVH). Patients with hypertension and diabetes had more echo abnormalities compared to others (P-values of 0.047 and 0.024, respectively). More abnormal echo findings were seen in patients who died during hospitalization than in those who survived (P = 0.008). Severe left ventricular systolic dysfunction was associated with higher mortality (P < 0.001). Conclusion: Most patients with stroke in this study had abnormal echocardiograms; however, only a few had cardioembolic strokes. Abnormalities in echocardiography were more common in patients who died during hospitalization than in those who survived.