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Volume 24, Number 8—August 2018
Synopsis

Case Series of Severe Neurologic Sequelae of Ebola Virus Disease during Epidemic, Sierra Leone

Patrick J. HowlettComments to Author , Anna R. Walder, Durodami R. Lisk, Felicity Fitzgerald, Stephen Sevalie, Marta Lado, Abdul N’jai, Colin S. Brown, Foday Sahr, Foday Sesay, Jonathon M. Read, Paul J. Steptoe, Nicholas A.V. Beare, Reena Dwivedi, Marylou Solbrig, Gibrilla F. Deen, Tom Solomon, Malcolm G. Semple, and Janet T. Scott
Author affiliations: King's College London & King's Health Partners, London, UK (P.J. Howlett, A.R. Walder, M. Lado, C.S. Brown); University of Sierra Leone, Freetown, Sierra Leone (D.R. Lisk, A. N’jai, G.F. Deen); University College London Great Ormond Street Institute of Child Health, London (F. Fitzgerald); Save the Children, United Kingdom and Sierra Leone, London (F. Fitzgerald); University of Nairobi, Nairobi, Kenya (S. Sevalie); 34th Military Hospital, Republic of Sierra Leone Joint Armed Forces Joint Medical Unit, Freetown (S. Sevalie, F. Sahr, F. Sesay); Lancaster University, Lancaster, UK (J.M. Read); University of Liverpool, Liverpool, UK (J.M. Read, P.J. Steptoe, N.A.V. Beare, M.G. Semple, J.T. Scott); Royal Liverpool University Hospital, Liverpool (N.A.V. Beare, R. Dwivedi); University of Manitoba, Winnipeg, Manitoba, Canada (M. Solbrig); Institute of Global Health, Walton Centre NHS Foundation Trust, Liverpool (T. Solomon)

Main Article

Table 2

Demographics, diagnoses, and management and outcome of 35 Ebola virus disease case-patients in whom neurologic and psychiatric conditions were diagnosed at preliminary and specialist neurology and psychiatric clinics, Sierre Leone*

Patient no.
 Age, y/sex
 Diagnoses
 Management and outcome
1
 21/M
 Migraine headache, psychosocial issues
 MH follow-up
2
 47/M
 Resolved migraine headache, left retinal detachment
 Review at 1 y: no change in symptoms
4
 33/M
 Migraine headache
 DNA specialist clinic
5
 54/F
 Psychosocial issues, undifferentiated headache
 Referred to psychiatry for assessment but did not attend
6
 18/F
 Undifferentiated headache
 Referred return to general survivor’s clinic
7
 21/F
 Tension-type headache, major depressive disorder
 Local MH follow-up
8
 29/F
 Undifferentiated headache
 Referred return to general survivor’s clinic
9
 26/F
 Migraine headache
 Referred to MH for assessment but did not attend Review at 1 y: improvement in symptoms
10
 27/F
 Right brachial plexus neuropathy
 Physiotherapy. Review at 1 y: substantial improvement in weakness
11
 42/F
 Right striatocapsular infarct, generalized anxiety disorder
 Physiotherapy, MH follow-up
13
 58/F
 Undifferentiated headache
 Referred return to general survivor’s clinic for nonneurologic and other symptoms
14
 38/M
 Possible anterior uveitis, undifferentiated headache
 Ophthalmology referral
15
 49/F
 Tension-type headache
 Referred return to general survivor’s clinic for nonneurologic symptoms
16
 31/F
 Migraine headache
 Propranolol 20 mg/d; symptoms improved (unable to quantify)
17
 51/F
 Undifferentiated headache, peripheral sensory neuropathy
 Referred return to general survivor’s clinic for nonneurologic symptoms
18
 32/F
 Tinnitus, anterior uveitis
 Ophthalmology referral. MH follow-up. Review at 1 y: improvement in tinnitus, now occasional
19
 38/M
 Undifferentiated headache
 Local MH follow-up
20
 30/F
 Resolved migraine headache
 Review at 1 y: new onset headache with cluster-type features
21
 32/F
 Migraine headache, right eye cataract, tinnitus
 Ophthalmology referral
22
 21/F
 Migraine headache, tinnitus
 Propranolol 20 mg/d. Headache improved from 8/10 to 4/10. Review at 1 y: no further headache
23
 46/M
 Essential tremor, undifferentiated headache
 DNA specialist clinic
24
 43/F
 Migraine headache
 Propranolol 20 mg/d, initially 10/10 headache pain now better (not able to quantify). Review at 1 y: decreased frequency of headaches, now occasional
25
 42/M
 Extensive right MCA infarct, major depressive disorder
 Physiotherapy, MH follow-up. Review at 1 y: improvement in symptoms. Patient subsequently died.
26
 25/F
 Ulnar nerve palsy
 DNA specialist clinic
27
 25/M
 Migraine headache, asymmetric lower limb muscle wasting
 MH follow-up. Review at 1 y: decreased frequency of headaches, now occasional
28
 21/F
 Tension-type headache
 Review at 1 y: decreased frequency of headaches; now occasional. Fever/rash during pregnancy; miscarriage
29
 61/F
 Migraine headache, bilateral cataract
 Local MH follow-up
30
 19/F
 Anterior uveitis, undifferentiated headache
 Urgent referral to local ophthalmology clinic
31
 33/F
 Migraine headache, generalized anxiety disorder
 Propranolol 20 m/d; improved headache from 10/10 to 6/10. MH follow-up
32
 43/F
 Undifferentiated headache, arthralgia
 Referred to local ophthalmology clinic
33
 41/F
 Migraine headache, anxiety
 MH follow-up, simple analgesia. Review at 1 y: decreased frequency of headaches, now occasional
34
 25/F
 Undifferentiated headache
 Referred to general survivor’s clinic
35
 35/M
 Migraine headache, asymmetric sensory peripheral neuropathy, major depressive disorder
 MH follow-up, propranolol 20 mg/d, gabapentin 300 mg each night; diet advice and review in diabetic clinic referral. Headache improved (unable to quantify); pain in feet improved. Review at 1 y: decreased frequency of headaches, now occasional; improvement in neuropathy
37
 12/F
 Severe neurocognitive impairment, postviral encephalitis
 Referral to orphanage for 24-h care
38
 21/M
 Undifferentiated headache, arthralgia
 ND
*MH, mental health; MCA, middle cerebral artery; ND, no data.

Main Article

Page created: July 17, 2018
Page updated: July 17, 2018
Page reviewed: July 17, 2018
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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