Intracranial hypertension with reversible cerebral edema: Atypical presentation of neuropsychiatric systemic lupus erythematosus.

We described in this article a 19-year-old girl with an intracranial hypertension as an initial presentation of neuropsychiatric lupus. The brain MRI showed diffuse, bilateral and symmetrical white and grey matter hyperintensities. These lesions completely disappeared after 3 months of treatment. Diffuse cerebral edema with or without leukoencephalopathy in neuropsychiatric systemic lupus erythematosus is an extremely rare entity.

Spinal cord infarction complicating acute aortic syndrome: about 2 cases.

Spinal cord infarction is an uncommon but devastating disorder caused by various conditions. It remains however a rare neurological complication in acute aortic injuries. In this context, aortic dissection is the most frequent etiological factor. Acute aortic intra mural hematoma and atheromatous penetrating ulcer remain exceptional. We encountered two cases of spinal cord infarction associated with acute aortic intra mural hematoma in one case and atheromatous penetrating ulcer in the other case that presented without typical severe pain. Thus, acute aortic injuries should be considered a cause of spinal cord infarction even if there is little or no pain.

Repeated intravenous thrombolysis in early recurrent stroke secondary to carotid web: Case report.

Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the first effective approved treatment for reducing ischemic stroke disability, and having a stroke within 3 months is usually a contraindication to thrombolysis. In this paper, we describe the case of a 58-year-old patient who received repeated intravenous thrombolysis at 10 days interval for a recurrent ischemic stroke, with dramatic improvement. The carotid diaphragm was behind this recurrent stroke and it was treated by stenting.

[Gayet-Wernicke encephalopathy: clinical features and radiological anomalies]. / L'encéphalopathie de Gayet Wernicke: aspects cliniques et anomalies radiologiques.

Gayet Wernicke encephalopathy (EGW) is a neurological emergency secondary to thiamine deficiency (vitamin B1). This is more often secondary to chronic alcoholism. The purpose of this study is to remind clinicians of some clinical signs different from ethylism, suggesting EGW as well as to report four cases characterized by different types of anomalies shown by MRI. The average age of patients was 40 years (2 females 2 males). The neurological picture was characterized by disorders of vigilance in all patients, oculomotor disorders in 2 cases, and cerebellar ataxia in one patient. Chronic vomiting was reported in two cases, prolonged fasting in the first case and alcoholism in the second case. MRI of the brain showed anomalies suggesting EGW in all patients with contrast enhancement in one case. Thiamin deficiency was confirmed in two patients. In our context EGW seems to be more frequent in pathological circumstances other than chronic alcoholism (chronic vomiting, severe malnutrition, severe starvation, and chemotherapy...). The clinical signs can suggest other pathologies such as cerebral venous thrombosis, stroke, or other metabolic disorders but MRI excluded them and allowed the diagnosis of EGW. MRI of the brain has an essential role in the diagnosis of EGW. Absence or delay in treatment may influence the prognosis.

Stroke Mimics: Experience of a Moroccan Stroke Unit.

BACKGROUND: Stroke mimic is a medical condition presenting with acute neurological deficit and simulate real stroke. The objective of this study was to evaluate the frequency and the various etiologies of stroke mimics in our center. METHODS: We retrospectively reviewed the Thrombolysis Alert registry and we studied the frequency and characteristics of patients with stroke mimic. RESULTS: Among 673 patients who were admitted to the emergency department within 4.5 hours for sudden focal neurological deficit suggestive of acute stroke, 105 patients (15.6 %) had a stroke mimic. The mean age of patients with mimics and brain strokes were 66.3 and 64.8, respectively. The mean Onset-to-door time was 136.82 minutes and the mean door-to-imaging time was 32.63 minutes in stroke mimics. Seizure (28.5%) was the most common diagnosis of stroke mimics followed by conversion disorder (25.7%). CONCLUSIONS: Stroke mimic is frequent and heterogeneous entity that can be difficult to identify. Fortunately, most previous studies show no harmful effects when using thrombolysis in a stroke mimic.

Thrombolysis Alert in Hassan II University Teaching Hospital of Fez (Morocco): A Prospective Study of 2 Years.

BACKGROUND: Thrombolysis alert (TA) is a procedure triggered every time a patient consults for sudden focal neurological deficit within 4.5 hours. OBJECTIVE: We aimed to determine firstly the etiological profile of TA and secondly to evaluate the delays in the management not only of thrombolyzed patients but also of nonthrombolyzed patients to determine the intrahospital delays to optimize. METHODS: Patients aged over 18 years who consulted for sudden focal neurological deficit within 4.5 hours for whom a TA has been triggered were included. Patients admitted within 4.5 hours for which a TA has not been triggered were not included. Patients with sudden focal neurological deficit who consulted more than 4.5 hours, but for whom TA has been triggered, were also included. RESULTS: We included 313 patients. The average onset-to-door time was 125.59 ± 62.78 minutes with an average National Institutes of Health Stroke Scale scores of 11.29 ± 5.98. The average door-to-imaging time was 28.36 ± 20.62 minutes. Ischemic stroke (IS) was the most common cause (70.3%), followed by hemorrhagic stroke (11.8%). Other nonstroke causes (stroke mimics) represented 17.9% of cases. They were seizures (46.4%), conversion disorders (26.8%), hypoglycemia (10.7%), brain tumors (10.7%), chronic subdural hematoma (1.8%), carbon monoxide intoxication (1.8%), and cavernoma (1.8%). Forty-six patients had been thrombolyzed. The average door-to-needle time was 90.89 ± 34.48 minutes. After 3 months, 52.1% of thrombolyzed patients were autonomous (modified Rankin scale between 0 and 2). Two patients had died (4.3%), all in the first week after the IS. CONCLUSION: Our study shows that efforts need to be made at the extra-hospital and intra-hospital level to improve delays to increase the proportion of the thrombolyzed patients.

Intravenous thrombolysis with rt-PA in stroke: experience of the moroccan stroke unit.

The majority of strokes are due to blockage of an artery in the brain by a blood clot. Prompt treatment with thrombolytic drugs can restore blood flow before major brain damage has occurred. We report the case series of all patients who were treated with rt-PA at Stroke Unit of HASSAN II University hospital between 2010 and 2013. There were 52 patients treated with intravenous rtPA during the study period. The mean age was 63 years with the no gender predominance (sex ratio 1.02). Hypertension was the most common vascular risk factor (31%) and 17% of patients suffered from atrial fibrillation. 17 of 52 patients (32.7%) were treated within a 3 hours window of stroke onset and 35 of 52 (67.3%) patients were treated within 3-4.5 h. Twenty five patients (48%) had significant early improvements within 24 hours and twenty one (40.3%) patients had good outcomes at 3 months and fifteen patients (29%) died within the same period.

Infectious endocarditis complicated by an ischemic stroke and revealing Marfan syndrome.

Marfan syndrome is a systematic genetic disease of the connective tissue. The cardiac affection would predict the prognosis and ischemic stroke might complicate it. The purpose of this work is to discuss the mechanisms of the ischemic stroke in Marfan syndrome which have to be considered in all young patients of ischemic strokes. We report the case of a 17-year-old male patient who presented with right hemiparesis with brachio-facial dominance, hemihypoesthesia and Broca's aphasia; these symptoms were followed by partial right somato-motor epileptic seizure. The cerebral computed tomographic (CT) scan demonstrated early signs of ischemic stroke in the left Sylvian artery. Cardiovascular examination revealed a systolic murmur in the mitral site. Marfan syndrome with infectious endocarditis complicated by ischemic stroke was diagnosed. However, the family pathological history was negative. The Marfan syndrome diagnosis was approved considering the following criteria: Ligamentous hyperlaxity, crystalline ectopia and mitral valve prolapsus with mitral insufficiency. The patient benefited of antibiotherapy for 4 weeks. The patient underwent sessions of motor physical therapy and orthophonic rehabilitation. Then, cardiac surgery was carried out and valvuloplasty was performed. The surgical treatment confirmed the presence of mitral insufficiency and prolapsus of the big mitral valve and multiple friable anterior-posterior vegetations with broken cordage of the small mitral valve. Replacement of the mitral valve was achieved, and the post-surgery follow-ups were simple. The diagnosis of Marfan syndrome was based on well-defined criteria. The evolution of the patient was marked by a complete improvement of the cardiac and motor deficits, and disappearance of the Broca's aphasia. A fibroelastic disease such Marfan syndrome has to be considered in unexplained ischemic stroke in all young patients. Hence, the diagnosis of Marfan syndrome involves an anticipation of the neurovascular complications by early cardiovascular care.