Ischemic strokes revealing neurosyphilis: Study of six (6) observations at the neurology Department of the University Hospital of Conakry.

Introduction: In sub-Saharan Africa (SSA), stroke is a major public health problem and the etiological aspects are poorly studied and documented because of under-medicalization; the syphilitic etiology is rarely mentioned. Patients and methods: We performed a retrospective study of 472 patients hospitalized for ischemic stroke between 2016 and 2021 in the Neurology Department of the University Hospital of Conakry, confirmed by neuroradiological explorations (brain CT, MRI-Angio) and a biological workup including VDRL-TPHA serological reactions in blood and CSF. Results: Syphilitic etiology was retained for six (6) patients (4 men and 2 women) with a mean age of 43 years (extremes 36 and 49 years). The clinical picture was dominated by carotid syndromes: superficial and deep sylvian syndrome, anterior cerebral artery syndrome and vertebro-basilar syndromes and one case of lacunar syndrome.The diagnosis was based on the positivity of serological reactions (VDRL-TPHA) in blood and cerebrospinal fluid (CSF) and the presence of a predominantly lymphocytic hypercellularity and a hyperproteinorachy in the CSF in the absence of any other etiology. Conclusion: These neurological vascular syndromes consecutive to a cerebral treponematous attack are often the result of a still poorly conducted management of primary and secondary syphilis in our country.

EPILEPTIC SEIZURES REVEALING STURGE WEBER'S DISEASE IN A TROPICAL ENVIRONMENT: STUDY OF EIGHT CASES.

In sub-Saharan Africa (SSA), the etiological factors of epilepsy are multiple and phacomatoses, in particular Sturge weber's disease, are rarely reported due to under-medicalization and insufficient multidisciplinary care. We carried out a retrospective study of 216 patients hospitalized for recurrent epileptic seizures between 2015 and 2022 in the neurology and pediatrics department of the University Hospital Center of Conakry, among whom eight (8) patients were identified for Sturge Weber's disease in order to reassess this pathology from a clinical and paraclinical point of view in a tropical environment. Sturge Weber's disease was retained in eight (8) on the presence of symptomatic partial epileptic seizures (age 6 months to 14 years) with frequency of status epilepticus, homonymous lateral hemiparesis linked to occipital involvement, piriform calcifications on imaging and ocular disorders. The delay in consultation and medical care revealed severe mental deterioration in our patients. This study shows a stereotyped clinical picture in a context of aggravation of signs related to a delay in multidisciplinary management. These results are important for the diagnostic, therapeutic and prognostic discussion.

Insights in the pathophysiology of haemorrhagic strokes in a sub-Sahara African country, an epidemiological and MRI study.

OBJECTIVE: Intra-cerebral Haemorrhage (ICH) seems more prevalent in sub-Saharan Africa (SSA) than in High-Income Countries (HIC) with poorer clinical outcome. Higher impact of hypertension and/or amyloid angiopathy could account for this disproportion. Here, we sought to (i) retrospectively compare ICH clinical and imaging patterns in Belgium and Guinea and in a subsequent cohort (ii) prospectively compare brain MRI characteristics to seek evidence for a different proportion of amyloid angiopathy patterns. METHODS: Ninety one consecutive patients admitted for spontaneous ICH at Brussels Erasme-ULB Hospital and at Conakry Ignace Deen-UGANC were retrospectively compared in terms of ICH volume estimated with the ABC/2 method, clinical characteristics and modified ranking (mRS) score at 30 days. mRS was dichotomised as good outcomes (≤3) and poor outcomes (>3). A prospective cohort of 30 consecutive patients with ICH admitted at CHU Conakry Ignace Deen-UGANC was prospectively included to undergo brain MRI. Results of the Guinean MRI were compared to 30 patients randomly selected from Brussels' initial cohort. Paired Student's t-test and Mann-Whitney u-test were used for group comparisons. RESULTS: Age of ICH onset was higher in Belgium (68 ± 17 years vs. 56 ± 14 years, P < 0.01) while ICH volume and 30-day mortality rate were higher in Guinea (20 ml vs. 11 ml, P < 0.01 and mortality 33% vs. 10 %, P < 0.01). ICH burden in survivors in Conakry and Brussels showed respectively good outcomes in 56.7% and 60.4% (P = 0.09) and poor outcomes in 10.3% vs. 29.6% (P < 0.001). MRI analysis of the prospective cohort failed to disclose significant differences regarding brain MRI characteristics. CONCLUSIONS: Intra-cerebral Haemorrhage affected patients 15 years younger in Guinea with larger haematoma volumes and higher mortality than in Belgium. MRI findings did not show more prevalent amyloid angiopathy pathology suggesting that better primary prevention of hypertension could positively impact ICH epidemiology in Guinea.

OBJECTIF: L'hémorragie intracérébrale (HIC) semble plus répandue en Afrique subsaharienne (ASS) que dans les pays à revenu élevé (PRE), avec des résultats cliniques moins bons. Un impact plus élevé de l'hypertension et/ou de l'angiopathie amyloïde pourrait expliquer cette disproportion. Ici, nous avons cherché à (i) comparer rétrospectivement les schémas cliniques et d'imagerie de l'HIC en Belgique et en Guinée et dans une cohorte subséquente (ii) comparer de manière prospective les caractéristiques de l'IRM cérébrale pour rechercher des preuves d'une proportion différente des profils d'angiopathie amyloïde. MÉTHODES: 91 patients consécutifs admis pour HIC spontanée à l'hôpital Erasme-ULB de Bruxelles et à Ignace Deen-UGANC de Conakry ont été rétrospectivement comparés en termes de volume d'HIC estimé avec la méthode ABC/2, les caractéristiques cliniques et le score de classement modifié (mRS) à 30 jours. Le mRS a été dichotomisé en bons résultats (≤3) et mauvais résultats (>3). Une cohorte prospective de 30 patients consécutifs atteints d'HIC admis au CHU Ignace Deen-UGANC de Conakry a été incluse de manière prospective pour subir une IRM cérébrale. Les résultats de l'IRM guinéenne ont été comparés à ceux de 30 patients sélectionnés aléatoirement dans la cohorte initiale de Bruxelles. Le test t de Student apparié et le test u de Mann-Whitney ont été utilisés pour les comparaisons de groupe. RÉSULTATS: L'âge d'apparition de l'HIC était plus élevé en Belgique (68 ± 17 ans vs 56 ± 14 ans, P < 0,01) tandis que le volume de l'HIC et le taux de mortalité à 30 jours étaient plus élevés en Guinée (20 ml vs 11 ml, P < 0,01 et mortalité 33% vs 10%, P <0,01). La charge de l'HIC chez les survivants à Conakry et à Bruxelles a montré respectivement de bons résultats dans 56,7% et 60,4% (P = 0,09) et de mauvais résultats dans 10,3% vs 29,6% (P < 0,001). L'analyse IRM de la cohorte prospective n'a pas permis de révéler de différences significatives concernant les caractéristiques de l'IRM cérébrale. CONCLUSIONS: L'HIC a touché des patients 15 ans plus jeunes en Guinée avec des volumes d'hématomes plus importants et une mortalité plus élevée qu'en Belgique. Les résultats de l'IRM n'ont pas montré de pathologie angiopathique amyloïde plus répandue, ce qui suggère qu'une meilleure prévention primaire de l'hypertension pourrait avoir un impact positif sur l'épidémiologie de l'HIC en Guinée.

Acute parasitic and other infectious myelopathies in the tropics: 26 cases at the University Hospital in Conakry.

In tropical countries, laboratory-confirmed diagnostic certainty of parasitic and other infectious causes of acute myelopathy is difficult because of a shortage of medical professionals and consulting delays. We performed a retrospective study of 168 patients hospitalized for spinal disorders between 2007 and 2013 and identified 26 diagnosed with acute non-compressive myelopathy of presumed sudden onset. An parasitic or other infectious cause was established for all. A preliminary clinical infection preceding the development of neurologic signs was reported for 22 patients (84.6 %). Neurological signs were limited to the existence of a progressive sensorimotor symptomatology with sphincter disorders.

Surface-recorded auditory brainstem responses in the dog.

Surface-recorded auditory brainstem responses were obtained from 8 dogs. Trains of clicks were presented by earphone at a level approximately 80 db re human threshold. In one dog an undetected otitis media was signalled by wave-form latency delay. Jewett Waves I-V were found with order and spacing much as with human Ss, but the early waves were more prominent. It was concluded that electric response audiometry may have a bright future in electrophysiological, veterinary, and pharmacological research on audition in animals.