The clinical records and computed tomography scans of 50 consecutive patients with intracerebral haemorrhage (ICH) were analysed. Putaminal (48%) and thalamic (16%) ICH comprised the largest group, followed by cerebellar haemorrhage (12%). Intraventricular haemorrhage was observed in 14 cases, a majority being secondary to parenchymal haemorrhage. Hypertension remained the most important risk factor, occurring in 64% of the whole group and 83% of those with putaminal ICH. No predisposing factors for the haemorrhage were identified in 28% of patients. Twenty-seven patients were comatose; the incidence of coma in association with intraventricular haemorrhage was 79%. At the third week, 13 patients had died, a mortality rate of 26%.

A middle-aged male resident of Benghazi, northeastern Libya, with radiological features of skeletal fluorosis associated with cervical radiculomyelopathy is reported. This is believed to be the first documentation of such a disorder from this non-tropical, non-endemic region.

Echocardiographic observations in 200 subjects with mitral valve prolapse (MVP) are presented. The diagnostic criteria used were: (1) abrupt late systolic posterior motion of one or both leaflets of the mitral valve, and (2) holoor pansystolic posterior motion of 3 mm of one or both leaflets of the mitral valve. Most of the subjects were young--72% were aged less than 30 years. Prolapse of posterior leaflets was noted in 98% of subjects--69.5% late systolic, 28.5% pansystolic, and 2% had prolapse of the anterior mitral leaflet only. Mitral valve prolapse was considered to be primary--being the only abnormality in 78.5% of the subjects. In the remaining 21.5% MVP was associated with other cardiac lesions, the commonest being, atrial septal defect (2.5%), dilated aortic root (2%), bicuspid aortic valve (2%), cardiomyopathy (5%), rheumatic heart disease (4%) and ischaemic heart disease (1.5%). Mitral valve prolapse was considered to be important enough to result in haemodynamically significant mitral regurgitation in only 8% of subjects. Mitral valve prolapse was the commonest single echocardiographic abnormality (16%) observed in patients referred to this university hospital, which is the referral centre for approximately half of Libya. Although this does not indicate the prevalence of MVP in the general population, this study indicates MVP to be the commonest valvular abnormality seen in hospital practice in Libya.

During a 4-year study period, January 1983 to December 1986, 24 patients (18 index cases) with spinal muscular atrophy (hereditary motor neuropathy, HMN), 9 with myasthenia gravis (MG), 6 with progressive supranuclear palsy (PSP), and 5 with subacute sclerosing panencephalitis (SSPE) were diagnosed in Benghazi. The HMN group comprised 6 acute infantile, 12 chronic childhood, and 3 each with adult-onset proximal, and distal forms of the disease. The crude average annual incidence of acute infantile HMN was 0.3/100,000 total population and 1/12,500 births in Benghazi. The crude prevalence rates of chronic childhood, adult-onset proximal, and distal types of HMN were 2.3, 0.6 and 0.6/100,000, respectively. The larger family size and the high rate of consanguineous marriages contribute to the high frequency of HMN in the study area. Distal HMN constituted 12.5% of the total cases. The adjusted average incidence of MG was 4.4/million/year, 2.1 for males and 6.8 for females. The female:male incidence ratio was 3.2:1. The crude average annual incidence rates/million inhabitants for PSP asnd SSPE were 3 and 2.4, respectively. The frequency of occurrence of SSPE among the subtropical Arab community under investigation is comparable with other surveys from the Middle East and Mediterranean region.

An intensive search for 2 years for patients with Bell's palsy, conducted through the polyclinics, university hospitals and physiotherapy centres in Benghazi, revealed a total of 242 cases. The average annual incidence per 100,000 population was 23.35 and the age-adjusted incidence 35.72. The incidence increased with age up to the sixth decade. Seasonal clustering was noted in the months of December and January. Hypertension and diabetes mellitus were associated in 4.1% and 7% of patients, respectively. Only four patients presented during pregnancy. Recurrent facial paralysis was encountered in 5.4% of patients and was characterized by male preponderance and a tendency to recur more frequently on the same side as the initial paralysis. Familial incidence and bilateral involvement were rare features. Twelve per cent of patients who were followed up had moderate to severe residual weakness.

During a 2-year period, a total of 43 incident cases of central nervous system infections occurred in the adult (aged 15 years and above) population in Benghazi, Libya. This comprised 17 patients with aseptic meningitis, 10 acute bacterial meningitis, four tuberculous meningitis, five encephalitis, four neurosyphilis, two hydatidosis and one bilharzial myelopathy. The aetiology of the aseptic meningitis and encephalitis could not be established. The annual incidence rates of aseptic, septic and tuberculous meningitis, and encephalitis were 3.4, 2, 0.8 and 1 per 100,000 population, respectively.

An epidemiologic study of adult patients (aged greater than 15 years) with epilepsy was made over a 2-year period, through the policlinics, EEG laboratory, and university hospitals in Benghazi, northeastern Libya. Based on a total of 568 patients (310 male and 258 female), the prevalence rate on 31 December 1984 was 2.3/1,000 in the population above the age of 15 years (1.9, if age standardized). The age-specific prevalence per 1,000 population decreased from 3.6 in the 15-24 year age group to 1 in the greater than 60-year age group. For 70.8% of the patients the onset of epilepsy occurred in the first 2 decades of life, and for 7.6% it commenced after the age of 40. The duration of epilepsy when first seen in the study period was less than 1 year in 14.6%, and greater than 10 years in 25.7%. The percentages of primary generalized, partial seizures secondarily generalized, simple partial, and partial complex seizures were 55.6, 18.8, 10.4, and 14.6%, respectively. Antecedents that could be considered potential causes of epilepsy were found in 17.5% of cases. Fifty-five patients had status epilepticus, 24 of whom had symptomatic epilepsy and eight recurrent status. EEG revealed generalized epileptic activity in 199 cases and focal seizure activity in 118. Computerized tomography (CT) scan, done in 219 patients, disclosed abnormal results in 50. Among those with abnormal CT scans, 84% had partial seizures. Monotherapy with carbamazepine or phenytoin was used in the majority of cases. The influence of social, cultural, and religious factors in the diagnosis and management of epilepsy as seen in Benghazi are discussed.

Out of 329 cases of stroke registered in Benghazi between November 1, 1983 and October 30, 1984, 63 patients comprising 32 males and 31 females belonged to the 15-40-year age group (stroke in the young). The annual age-specific crude incidence of stroke in the young was 39.3 and 40.3 per 100,000 for men and women, respectively. The age-adjusted incidence rate for both sexes for the age-specific (15-40 years) population was 47 per 100,000. The sex-dependent difference in the incidence was not statistically significant. These results emphasize that the high incidence of stroke in the young in Benghazi is not a reflection of the age distribution of the population. Hypertension, diabetes mellitus, heart disease and hypercholesterolemia were important components of high stroke profile in the young. One or more risk factors were identified in 78% of total young stroke victims and in all the patients under the age of 30. Eight young stroke subjects died during the study period.

A total of 23 patients with motor neuron disease (MND), encompassing 17 cases of amyotrophic lateral sclerosis, 4 of progressive muscular atrophy and 2 of progressive bulbar palsy, was diagnosed in Benghazi, north-eastern Libya, between 1980 and 1985. The male to female ratio was 2.3:1. The average incidence of MND was 0.89/100,000 population/year (0.87 when age and sex-adjusted to the Libyan population). Eighteen patients were alive on the prevalence day, September 15, 1985, which provided a prevalence rate of 3.47/100,000 population (3.42 if adjusted). Age-specific incidence rates were highest in the 50- to 59-year-old age group, 8.14/100,000/year for men and 6.10/100,000/year for women. The median age at the time of diagnosis was 51 years, and the median duration for the 5 dead MND patients after the onset of the disease was 30 months. The median survival time for all MND cases combined was 42 months.

An epidemiological study of Parkinsonism was carried out in Benghazi situated in North-Eastern Libya. On the prevalence day, January 1, 1985, a total of 163 patients with Parkinson's disease were found living in the investigated area, which had a population of 518,745. The crude prevalence rate was 31.4 per 100,000 population and the incidence rate was 4.5 per 100,000 population per year. The average age at death was 71.2 years and the mean duration of the illness was 6.7 years. Our findings suggest that the risk of Parkinson's disease observed in the present study is intermediate to that reported among the white and black races and comparable with the yellow race and the Sardinians.

An intensive search over a two-year period for cases of cerebellar and spinocerebellar degenerations in Benghazi, Libya, made through polyclinics, university hospitals and a centre for the handicapped, revealed a total of 52 patients, among whom 30 were index cases; the remainder were detected on family study. Twenty-five patients lived in Benghazi, giving a crude prevalence of 4.8/100 000 population. There were 24 patients (10 families) with hereditary spastic paraplegia (HSP), 13 (9 families) with early onset cerebellar ataxia with retained tendon reflexes (EOCA), 3 with Friedreich's ataxia (FA), 5 (1 family) with late onset cerebellar ataxia (LOCA) with pigmentary retinal degeneration and autosomal dominant inheritance, 6 single cases of LOCA and 1 with ataxia telangiectasia. There were 14 families with definite autosomal recessive inheritance and only 2 with dominant transmission. The large family size (average of 6.2 children per married woman in the patient group) and the high rate of consanguineous marriages contribute to the high incidence of familial cases, especially those with autosomal recessive inheritance. Nerve conduction studies were normal in HSP and abnormal in EOCA and FA. Computed tomographic scans revealed atrophy of the brainstem and cerebellum in 3 cases of EOCA and 2 with LOCA. No indigenous forms of the disease were observed and the clinical features differed little from the descriptions in literature. However, the relative rarity of patients with FA, in comparison with other types of hereditary ataxias, is striking.

Thirty-one patients with post-neonatally acquired infantile hemiplegia were assessed clinically, electroencephalographically and by CT scan. The mean age of onset of illness and when first seen in the neurology clinic were 20·2±20·1 months and 16·8±8·4 yr, respectively. Epilepsy was seen in 74 per cent of cases and mental retardation in 70 percent. Among patients with epilepsy, the EEG and CT scan were abnormal in 83 per cent and 87 per cent respectively. There was a positive correlation between an abnormal EEG and CT scan in 84 per cent of cases. The cause of hemiplegia could be clinically determined in only eight cases (26%). However, the CT scan showed abnormalities like cortical atrophy and porencephalic cyst, suggestive of a vascular or inflammatory aetiology in 68 per cent. The usefulness of CT in determining the aetiology in acquired infantile hemiplegia, especially when seen many years after the onset of illness is, emphasized.

The case of a 46-year-old male with syphilitic spinal neuroarthropathy complicated by paraplegia is reported. Marked sclerosis and osteophytes restricted to lumbo-dorsal spine, absence of ligamentous calcification and lack of long standing spinal symptoms in spite of the florid radiologic changes should raise the suspicion of neurogenic spinal arthropathy.