Case description
16 year old boy from South Sudan referred to Sudan National Centre for
Neurological Sciences with mental deterioration and behavioral changes
for the last 9 months, to degree that he became unable to communicate
with his family and inattentive to his surroundings, he had poor school
performance ended by leaving school. There were no motor or sensory
symptoms, and no symptoms related to other systems.
His past medical history is only significant to African Trypanosomiasis
3 years back which had been treated by combination therapy.
He has no family history of similar condition or neurological diseases.
Physical Exam:
The patient was conscious disorientated to time ,place and persons .
Abbreviated mini mental score was zero. There was no signs of meningeal
irritation, intact cranial nerves, normal fundal examination. Normal
upper and lower limbs motor examinations. Sensations were intact. Stable
vital signs Other systems examinations were unremarkable.
Work up:
Routine laboratory investigations:
Complete haemogram was normal apart from low Hb% 8.9g\dl
M.C.V 65.5fl
ESR 61mm/hour
Renal and liver function tests were normal
Blood for trypanosomiasis:
Buffy coat preparation: no trypanosome seen
Wet preparation: no trypanosoma seen
Thin blood film: no trypanosoma seen
CSF Fluid Analysis:
Cells : less than 5 cells/ml,Glucose : 8.7 mg/dl,LDH : 27 u/l
Protein : 29.3 mg/dl
Card Agglutination Trypanosomiasis Test was positive
Radiological investigations:
MRI Brain was normal
US abdomen: was normal apart from slightly enlarged spleen with normal
texture
Electro-encephalogram EEG:
Was suggestive of on-going generalized seizure activity