Mohamed Sheikh Hassan

Bilateral facial nerve palsy is a rare neurological condition in children and is infrequently associated with primary Varicella (chickenpox) infection. We report the case of a 10‐year‐old previously healthy girl who developed simultaneous bilateral lower motor neuron facial weakness 3 weeks after a self‐limiting varicella infection. The patient presented with acute onset inability to close both eyes, difficulty smiling, drooling of saliva, and impaired oral competence. At presentation, the characteristic vesicular rash had completely resolved. Neurological examination demonstrated bilateral lower motor neuron facial nerve palsy with loss of forehead creases, lagophthalmos, flattening of the nasolabial folds, inability to puff the cheeks, and bilateral Bell's phenomenon, without additional neurological deficits. Laboratory investigations and brain magnetic resonance imaging (MRI) were unremarkable. Based on the temporal relationship with recent varicella infection and exclusion of alternative etiologies, a diagnosis of bilateral facial nerve palsy secondary to varicella‐zoster virus infection was established. The patient was treated with intravenous aciclovir, corticosteroids, supportive eye care, and facial physiotherapy. Follow‐up after 6 weeks demonstrated marked clinical improvement, including restoration of facial symmetry, improved eye closure, recovery of smiling ability, and resolution of drooling. This case highlights a rare neurological complication of primary varicella infection and emphasizes the importance of early recognition and multidisciplinary management to achieve favorable neurological outcomes.

Chronic dizziness in elderly patients, particularly when reproducibly triggered by upper limb exertion, should prompt evaluation for arm‐exertion‐provoked vertebrobasilar hypoperfusion due to subclavian steal syndrome. Duplex ultrasonography can identify complete retrograde vertebral artery flow and confirm complete Grade III subclavian steal physiology, highlighting a treatable vascular cause that may otherwise be misattributed to vestibular, medication‐related, or neurodegenerative disease.

Background: Neurogenic ST-segment elevation is a rare but clinically significant cardiac manifestation that can occur after acute ischemic stroke with hemorrhagic transformation. It may closely mimic acute ST-elevation myocardial infarction (STEMI), leading to potentially inappropriate diagnostic or therapeutic interventions. Case presentation: We report on a 46-year-old man who presented with right-sided weakness and expressive aphasia for 1 day. He had a history of untreated hypertension. On admission, vital signs were notable for a BP of 190/100 mmHg and an HR of 100 bpm. The ECG revealed ST-segment elevation in leads V1–V4. Brain MRI confirmed an acute left parietotemporal ischemic stroke with hemorrhagic transformation. Echocardiography showed preserved left ventricular function with mild hypertrophy. Laboratory tests revealed elevated troponin and BNP levels. Given stable hemodynamics and the absence of regional wall motion abnormalities, cardiology recommended conservative management with close monitoring. Management and outcome: The patient received antihypertensive therapy, mannitol infusion, head-of-bed elevation, and physiotherapy. Serial ECG monitoring demonstrated resolution of ST-segment elevation by day 5. Neurological improvement was progressive, and the patient was discharged after 8 days with follow-up recommendations. Discussion: This case highlights a reversible pattern of ST-segment elevation secondary to neurogenic myocardial injury following acute ischemic stroke with hemorrhagic transformation. Recognition of this phenomenon is essential to avoid misdiagnosis and unnecessary cardiac interventions. Conclusion: In patients with acute ischemic stroke and hemorrhagic transformation presenting with ECG changes suggestive of STEMI, integrated neurological and cardiac assessment with serial ECG and biomarker monitoring is crucial to guide safe management and prevent iatrogenic harm.

Introduction and Importance: Bilateral thalamic infarction is an uncommon manifestation of cerebral venous thrombosis (CVT), particularly when caused by thrombosis of the internal cerebral veins. Venous infarctions affecting the bilateral thalami are exceptionally rare and often present with nonspecific clinical features, making early diagnosis challenging. Case presentation: Here we present a-28-year-old postpartum female who presented to the emergency room with severe headache, convulsions, and altered mental status, following 1-week of progressive headache and blurred vision. She had recently undergone uncomplicated spontaneous vaginal delivery. Neurological examination revealed a stuporous mental state and bilateral grade II papilledema. Initial noncontrast CT showed bilateral thalamic hypodensities, while magnetic resonance imaging (MRI) confirming acute infarction in the bilateral thalami. Cerebral magnetic resonance angiography (MRA) showed no arterial abnormality, where as MR venogram revealed thrombosis of internal cerebral vein, confirming CVT as the underlying etiology. The patient was managed in the ICU with therapeutic anticoagulation using low-molecular-weight heparin (LMWH), levetiracetam for seizure prophylaxis, and transitioned to warfarin for long-term anticoagulation treatment. Her clinical condition significantly improved, and she was discharged after 2 weeks of hospitalization. At 6-month follow-up, she remained asymptomatic and functionally independent. Clinical discussion: Bilateral thalamic infarction resulting from internal cerebral vein thrombosis is exceptionally rare. The internal cerebral veins drain deep brain structures, including the thalami, and their occlusion can lead to symmetrical infarction in these regions. Because bilateral thalamic infarcts are more commonly associated with arterial causes; diagnosis in venous infarction can be challenging and requires a high index of suspicion. Conclusion: This case highlights the importance of early diagnosis and management of cerebral venous thrombosis to prevent complications. A high index of suspicion is needed for CVT in cases of bilateral thalamic infarction specially in patient with risk factors for venous thromboembolism like postpartum state.

Neurological disorders are increasingly prevalent in developing countries, particularly in sub-Saharan Africa. However, data regarding the epidemiology of these conditions in Somalia remain limited. This study aims to analyze the patterns of neurological diagnoses among patients admitted to the neurology department of a tertiary referral hospital in Mogadishu, Somalia. We conducted a retrospective cross-sectional study at Somalia’s largest referral hospital in Mogadishu between July 2019 and July 2024. Data were extracted from electronic medical records of adult patients admitted with neurological conditions to the neurology ward, emergency department, and general intensive care units. Pediatric and trauma-related admissions were excluded. Descriptive statistics, Pearson chi-square tests, binary logistic regression, and Kaplan–Meier survival analysis were employed to assess the distribution of neurological diagnoses and factors associated with in-hospital mortality. A total of 2,126 patients were included in the study. The mean age was 56.03 ± 19.07 years (range: 18–98 years), and the majority were male (n = 1,274; 60%). Most admissions originated from the emergency department (n = 1,741; 82%). Over half of the patients had at least one comorbidity (n = 1,329; 62.5%), with hypertension being the most common (n = 654; 31%), followed by diabetes mellitus (n = 175; 8.2%), epilepsy (n = 138; 6.5%), heart disease (n = 118; 5.6%), and previous stroke or transient ischemic attack (TIA) (n = 67; 3.2%). The leading neurological diagnoses were ischemic stroke (n = 905; 42.6%), hemorrhagic stroke (n = 552; 26%), epileptic disorders (n = 166; 7.8%), cerebral venous thrombosis (n = 138; 6.5%), non-traumatic subarachnoid hemorrhage (n = 92; 4.2%), and Guillain–Barré syndrome (n = 47; 2.2%). Intrahospital mortality was recorded in 342 patients (23%). Poor survival outcomes were significantly associated with advanced age, comorbidities, multiple diagnoses, low Glasgow Coma Scale (GCS) scores, and ICU admission, underscoring the importance of early detection and targeted interventions to reduce mortality. This study represents the first comprehensive assessment of neurological admissions in Mogadishu, Somalia—a region with limited healthcare resources. Cerebrovascular diseases and epileptic disorders were the most common diagnoses. The high in-hospital mortality rate emphasizes the urgent need to strengthen preventative and therapeutic strategies targeting non-communicable neurological diseases in low-resource settings.

Background: Type 2 diabetes mellitus (T2DM) is a growing global health crisis, affecting hundreds of millions worldwide. Poor sleep quality—often under-recognized—impairs glycemic control and accelerates diabetes-related complications. Despite its clinical relevance, data on sleep quality among T2DM patients in Somalia are virtually nonexistent. This study aimed to evaluate the prevalence and determinants of poor sleep quality among T2DM patients in Mogadishu, Somalia. Methods: A hospital-based cross-sectional study was conducted between November 2024 and January 2025 at Mogadishu Somali-Turkiye Recep Tayyip Erdogan Training and Research Hospital. A total of 311 adults with T2DM were selected using systematic sampling. Data were collected using structured questionnaires and validated instruments including the Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9), and Oslo Social Support Scale (OSSS-3). Logistic regression analysis was employed to identify variables independently associated with suboptimal sleep quality. Results: Overall, 54.0% of participants reported poor sleep quality (95% CI: 48.3– 59.7). Multivariable analysis identified several significant predictors, including female gender, unemployment, low income, substance use, physical inactivity, and depressive symptoms. Clinical factors such as comorbidities, poor glycemic control, and diabetes-related complications were also independently associated with suboptimal sleep quality. Conclusion: Over half of T2DM patients in Mogadishu experience poor sleep quality, influenced by sociodemographic, behavioral, psychological, and clinical factors. The findings highlight the need to incorporate sleep evaluation and targeted interventions—focusing on mental health, lifestyle, and metabolic control—into routine diabetes care.

Background: Coronary artery spasm (CAS) refers to a sudden and intense narrowing of the coronary arteries caused by vasoconstriction, which can result in myocardial ischemia and potentially lead to acute myocardial infarction (AMI), even in individuals without significant atherosclerotic risk factors. Simultaneous multivessel coronary spasm is a rare clinical presentation that poses significant diagnostic and therapeutic challenges, with the potential for life-threatening complications. Case Report: We report a case of a 42-year-old male with no history of hypertension, diabetes, or dyslipidemia who presented with sudden-onset retrosternal chest pain radiating to the left arm and jaw, associated with diaphoresis. The electrocardiography (ECG) demonstrated ST-segment elevation in the inferior leads with reciprocal changes, while cardiac biomarkers confirmed myocardial injury. Urgent coronary angiography revealed diffuse spasm in both the right coronary artery and obtuse marginal artery without significant atherosclerotic lesions, which resolved after intracoronary nitrate administration. Management included sublingual nitroglycerin, calcium channel blockers, and lifestyle modifications. The patient remained thermodynamically stable during hospitalization, with no recurrence of symptoms. Conclusion: Simultaneous multivessel CAS is a rare but important cause of AMI, particularly in younger patients without typical risk factors. Early diagnosis and treatment are key, and this case underscores the need for greater awareness and research into its management.

Millard-Gubler condition (MGS) is a rare neurological syndrome caused by a single lesion in the basis pontis (ventral pons). This neurological syndrome is characterized by an ipsilateral palsy of the facial nerve (CN VII) and a contralateral hemiparesis, which are caused by corticospinal tract involvement in the pons above the pyramids' medullary decussation. Here, we present the case of a 60-year-old female patient who was admitted to the emergency room with the complaint of left facial palsy and weakness on the right side of her body due to pontine infarct. She had a history of hypertension with irregular medication use. An acute infarct on the ventral aspect of the pons was discovered following a brain MR diffusion, and it was consistent with Millard-Gubler syndrome. She was treated with dual antiplatelet therapy and strict blood pressure control. Eventually, her condition significantly improved, and she was able to return to her prior functional state after consistent physical therapy. MGS is a rare brainstem condition characterized by a unilateral lesion to the basal area of the ventral pons, which affects the facial (VII) cranial nerve and corticospinal tract. This case emphasizes the importance of considering pontine infarction in the differential diagnosis of patients presenting with MGS. Timely diagnosis and treatment are crucial for optimal patient outcomes.

Background: Cerebral venous thrombosis (CVT) is a rare but potentially life-threatening condition characterized by the formation of a blood clot in the dural venous sinuses or cerebral veins. CVT presents a diverse array of clinical symptoms, making its diagnosis challenging. Understanding regional variations and specific risk factors associated with CVT is crucial, especially in low-resource settings like Somalia, where epidemiological data is limited and healthcare resources are scarce. Objective: This study aims to investigate the clinical and risk factors associated with CVT in patients presenting to Mogadishu Somali-Turkey Recep Tayyip Erdogan Research and Training Hospital, a tertiary hospital in Mogadishu, Somalia. Methods: We conducted a retrospective observational study involving 68 patients diagnosed with CVT between January 2019 and December 2023. Data included demographic information, clinical presentations, risk factors, and anatomical thrombosis locations. Descriptive statistics and chi-square tests were used for analysis. Results: The majority of patients were female (86.76%) and aged 20– 40 years (86.76%). Significant risk factors included the postpartum period (77.94%) and pregnancy, with statistical analysis showing strong associations between CVT and the postpartum period (χ² = 62.96, p < 0.0001) and pregnancy (χ² = 5.21, p = 0.022). Postpartum CVT was linked to thrombosis location (p = 0.025). Headache was the predominant symptom (98.53%), followed by altered mental status (83.82%), focal motor deficits (80.88%), and seizures (70.59%). The superior sagittal sinus was the most commonly involved site (57.35%). Conclusion: This study emphasizes the postpartum period as a significant risk factor for CVT in Somalia and highlights the need for clinical vigilance and early intervention strategies. Larger, multicenter studies are needed to validate these findings.

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.