THREE SHORT CASE REPORTS Dr.Apollo O.Epuwatt, Consultant Physician Klinics of St.Francis,Tororo

I – 55yr old word woman with a Posterior Communicating Aneurysm Referred by Ophthalmologist H/o unexplained Rt. Ptosis, Headache for 2/7 Plain CT Scan 24 hrs earlier reported normal Cl. Diagnosis of IC Aneurysm of Post. Comm. Aneurysm of the Circle of Willis Recommended Enhanced CT Scan – declined Transferred to Nairobi Hospital next day Craniectomy & aneurysm clipped 4/7 later

Posterior Comm.Aneurysm Discharged 10/7 later, on - antihypertensive drugs - anti-platelet drugs Ptosis virtually reversed one year later. Currently gets episodes of palpitations Take: Good clinical assessment and acumen combined with appropriate investigative procedures, and prompt intervention remains key in diagnosis and management of even the most evasive and complicated conditions.

78 yr old woman with a CHRONIC SUB-DURAL HAEMATOMA following a ‘friendly’ slap H/o Lt. hemiparesis >4/12, “known pt of stroke” Last 4/7 in ‘miracle healing venue’ “hard slap” by husband some time back Cl.Dx of CSDH Reffered to,and called, Neurosurgical Unit to expect pt – arrive same day CT scan brain –same evening- revealed CSDH Craniotomy (burr holes) next day – up and speaking 48 hrs late

Chronic Subdural Haematoma Take: Proper and adequate history taking, guided and/or enhanced referral were/are key to diagnosis and management in this rewarding outcome.

III- SICKLE CELL TRAIT WITH SERIOUS PATHOLOGY 1)SC Trait (AS) with Stroke: - 16 yr boy suffered sudden Rt. Hemipledgia at age 4yrs, residual hemiparesis and dysphasia - ‘sickling test’ negative then - Hb electrophoresis AS, with malaria 2) SC Trait with Severe Anemia: - MS 4yr old male with ill health for 2yrs - Had had blood transfusion - Hb Electrophoresis AS

SC Trait Take: -SC (AS) trait not so benign as portrayed - not so protective as hailed - pathology not emphasized - recognize as premorbid state that - needs to be sought out and prevented by promoting awareness, screening by Hb Electrophoresis, and appropriate counseling which should be ‘universally available, to the community, and avoid this preventable morbidity due to the sickling gene.