Cerebral venous thrombosis in a sub-saharan African country: A preliminary monocentric study of a 70 case series at the neurology department of Fann teaching hospital in Dakar - Senegal.

INTRODUCTION: Cerebral venous thrombosis (CVT) are underdiagnosed in sub-saharan Africa where publications are uncommon. Our study aim was to describe the CVT diagnostic and therapeutic features through a senegalese case series. PATIENTS AND METHOD: A monocentric retrospective and prospective study was conducted at the adult Neurology department of Fann Teaching Hospital in Dakar (Senegal), between January 01, 2013 and April 30, 2020. It had included all CVT cases diagnosed by neurovascular imaging. RESULTS: Seventy CVT cases were collected including 48 women (68.6%). The average age of the patients was 35.2±14 years. The main neurological signs were headache (92.8%) and motor deficit (41.4%), with subacute onset in 67.2% of cases. The superior sagittal sinus (54.3%) and the transverse sinus (38.6%) were the most affected with multiple involvements in 27 patients (38.6%). Thirty patients (42.8%) had indirect parenchymal signs such as venous infarction (15.7%), cerebral edema (11.4%) or intracerebral hemorrhage (12.8%). The etiological factors were mostly infectious (41.4%) with meningoencephalitis (12.8%) and otorhinolaryngological infection (10%). Gyneco-obstetric factors (27%) and Behçet's disease (7%) were the main aseptic factors. In the short-term clinical course, curative anticoagulation (98.6%) had enabled a favourable outcome (mRS 0-1) in half of the patients. CONCLUSION: Our study, the largest series in sub-saharan Africa to this date, confirms that CVT is a young women disease. Infectious etiology is the most frequent at the Fann national teaching hospital (41.4% in Dakar against 6.5% in Germaine Bousser's series) even if the etiological assessment is limited by financial constraints (no coagulopathy/thrombophilia check-up).

[Management of neurological emergencies in developing country: example of Senegal]. / Prise en charge de l'urgence neurologique dans un pays en développement : exemple du Sénégal.

Senegal, like many African countries is facing the so-called demographic and epidemiological transition leading to the development of neurological diseases. These diseases dominated by stroke and status epilepticus are public health priorities with a high prevalence, high lethality and high cost of care. These diseases are managed at the department of neurology, Fann Teaching Hospital, Dakar-Senegal (the only one) with a 65 beds capacity. Unfortunately, access care to the clinic is lately associated with human and material resource scarcity. To improve the management of patients at the clinic, it is important to increase resources (human and material), sensitize the population on early access to health services and prevention of risk factors.

[Report of the 4th International Conference on Envenomations by Snakebites and Scorpion Stings in Africa, Dakar, April 25-29, 2011]. / 4(e) Conférence internationale sur les envenimations par morsures de serpent et piqûres de scorpion en Afrique : Dakar, 25-29 avril 2011.

The authors present a summary of the proceedings and the recommendations of the Fourth International Conference on Envenomations by Snakebites and Scorpion Stings in Africa, held from 25 to 29 April 2011 in Dakar. After a two-day workshop for Senegalese health personnel on the most relevant aspects of the management of envenomations, about 270 participants met to share their experiences in the field. Nearly a hundred oral and poster presentations were made on the epidemiology of snakebites and scorpion stings in Africa, the composition and action of venoms and the manufacture and use of antivenoms. The last day was devoted to an institutional debate involving experts, representatives of national health authorities and concerned professionals (physicians, pharmacists, nurses and traditional healers) as well as members of the pharmaceutical industry to discuss and elaborate a set of recommendations. It was agreed that it is necessary to improve knowledge of the epidemiological situation by case reporting. Quality control of antivenoms and procedures for their registration at the level of national health authorities should aim at improving the distribution of safe and effective antivenoms in peripheral health centers for the better assessment of victims. It was also recommended that adequate training should be provided for health personnel in all aspects of medical management of envenomations. Equitable distribution of funding and the establishment of a network of African experts were also discussed in the conference.

[Cryptococcal meningitis in children: description of 3 cases]. / Cryptococcose neuroméningée de l'enfant : à propos de 3 cas.

Cryptococcal meningitis is much less common in children than adults. The purpose of this report is to describe 3 cases of cryptococcal meningitis observed in children admitted to the Neurology Department of the Fann University Hospital Center in Dakar, Senegal between July 2003 and November 2008. There were 2 girls whose ages were 8 and 15 years and one 9-year-old boy. All 3 patients presented acute or chronic meningoencephalitis. Diagnosis was based on direct microscopic examination of India ink preparations of cerebrospinal fluid (CSF) showing Cryptococcus neoformans at direct exam. Two patients were immunocompromised including one presenting severe protein-caloric malnutrition and one infected by HIV-1. The third patient was immunocompetent. All 3 patients were treated by intravenous Fluconazole. The immunocompetent boy died after 1 month of hospitalization due to cardiovascular and respiratory insufficiency. Both girls survived with severe neurosensory sequels. Cryptococcal meningitis that is relatively frequent in adulthood may be underestimated in children and should be tested for in any children presenting meningoencephalitis of undetermined cause.

[Meningoencephalitis due to Morganella morganii: a case report]. / Méningoencéphalite à Morganella morganii : à propos d'un cas.

A central nervous system infection due to Morganella morganii is uncommon. We report a case diagnosed at the neurological department of Fann teaching hospital in Dakar, Senegal. A 12-year-old boy was hospitalized for acute meningoencephalitis. The CT scan was normal and the study of cerebrospinal fluid (CSF) revealed cytological and biochemical abnormalities and M. morganii. HIV and syphilitic serologies were negative and blood CD4 lymphocyte count showed 354 per mm(3). The treatment with cefotaxime associated with gentamicin for 6 weeks was successful. The outcome of infection depends on many factors such as the onset and quality of treatment, the virulence of the germ and the status of immune system.

[Total hip arthroplasty after avascular necrosis due to sickle cell disease in Senegal: series of 48 replacements]. / Arthroplastie totale de hanche dans l'ostéonécrose aseptique du drépanocytaire au Sénégal: série de 48 prothèses.

The purpose of this study is to describe the outcome of total hip arthroplasty for management of aseptic osteonecrosis of the femoral head due to sickle cell disease. This consecutive series carried out over a 7-year period in 38 patients with a sickle-cell anaemia includes a total of 48 cemented prosthesis. The mean follow-up period was 5 years. Arthroplasty restored normal hip function (PMA score = 18) in 64% of cases. In 32% of cases the PMA score was more than 15. Pain was greatly reduced with total relief being achieved in 94% of cases. Walking ability also improved with 85% of patients having an unlimited walking distance. Radiological examination demonstrated edging on 36% of cupulas and 29% of the shafts. Complications were observed in 19% of cases. The main complications were loosening and dislocation of the prosthesis. Although the complication rate was high, functional outcomes in this series were good. These findings indicate that arthroplasty should be considered as the treatment of choice for aseptic osteonecrosis due to stage 3 and 4 sickle-cell disease in young patients. Use of uncemented implant and type of frictional torque are discussed.

[Neuro-Behçet in a Sub-Saharan Africa Country: a Series of Sixteen Patients in Fann Teaching Hospital, Dakar, Senegal]. / Neuro-Behçet dans un pays d'Afrique subsaharienne : une série de 16 patients au centre hospitalier national universitaire de Fann de Dakar, Sénégal.

Neuro-Behçet (NB) African studies are mainly North African, but Sub-Saharan Africa is not to be outdone. Our aim was to describe diagnostic and therapeutic features of NB in a Senegalese series collected in Dakar. This was a descriptive and retrospective study conducted at the Neurology department of Fann Teaching Hospital in Dakar, Senegal. All patients who met the NB's diagnostic criteria were included. Sixteen patients were collected, 14 males and 2 females with an average age of 40 years [18-71]. The main neurological signs were motor deficit (13 cases), headache (10 cases), and language disorders (4 cases). Extra-neurological signs were dermatological (14 cases), ocular (2 cases), and articular (2 cases) with aseptic unilateral gonarthritis. Fever was present in 9 patients. Neurological involvement was mostly isolated parenchymal (8 cases) or mixed (6 cases). The main clinical forms of NB were rhombencephalitis (8 cases) and retrobulbar optic neuritis (4 cases). Seven patients had a cerebral angio-Behçet with cerebral venous thrombosis (3 cases), ischemic stroke (2 cases), and intracerebral hematoma (2 cases). Under prednisone (16 cases) and azathioprine (3 cases), the short-term clinical outcome was mostly favorable (14 cases) with a modified Rankin scale at 2. NB is an under-diagnosed adult male disease in Sub-Saharan Africa and further studies are needed.

Les études africaines sur le neuro-Behçet (NB) sont majoritairement maghrébines, mais l'Afrique noire n'est pas en reste. L'objectif de l'étude était de décrire les particularités diagnostiques et thérapeutiques du NB dans une série sénégalaise colligée à Dakar. Il s'agit d'une étude rétrospective à visée descriptive menée à la clinique de neurologie du centre hospitalier universitaire de Fann de Dakar, au Sénégal. Tous les patients répondant aux critères diagnostiques de NB ont été inclus. Seize patients ont été colligés, 14 hommes et deux femmes avec un âge moyen de 40 ans [18­71]. Les principaux signes neurologiques étaient un déficit moteur (13 cas), des céphalées (10 cas) et un trouble du langage (4 cas). Les signes extraneurologiques étaient dermatologiques (14 cas), oculaires (2 cas) et articulaires (2 cas) à type de gonarthrite unilatérale aseptique. Une fièvre était présente chez neuf patients. L'atteinte neurologique était majoritairement parenchymateuse isolée (8 cas) ou mixte (6 cas). Les principales formes cliniques de NB étaient la rhombencéphalite (8 cas) et la névrite optique rétrobulbaire (4 cas). Sept patients avaient un angio-Behçet cérébral à type de thromboses veineuses cérébrales (3 cas), d'infarctus cérébraux (2 cas) et d'hématomes intracérébraux (2 cas). Sous prednisone (16 cas) et azathioprine (3 cas), l'évolution clinique à court terme était majoritairement favorable (14 cas) avec un score de Rankin modifié de 2 au moment de l'exeat. Le NB est une maladie de l'homme adulte sous-diagnostiquée en Afrique noire. Des études ultérieures multicentriques nationales et sous-régionales sont souhaitables.

[Epilepsy in a cohort of Senegalese children]. / Epilepsie dans le contexte neuropédiatrique sénégalais.

Epilepsy is a significant health public problem in Senegal with an estimated prevalence of 8 to 14%. The aim of this study was to determine the clinical and electroencephalographic features of epilepsy in a cohort of Senegalese infants, search for etiological factors and determine the impact of disease on school life. This retrospective study concerned 459 children who attended the neurological outpatients clinic at the Fann hospital, Dakar, Senegal, between July 2003 and December 2006. All were aged under 19 years. Among the 135 children with idiopathic epilepsy, 23.7% had parental consanguinity and 37.77 % familial epilepsy. Rolandic epilepsy and epilepsy with absences were more frequent but several infants with idiopathic epilepsy were not classified. Non-idiopathic epilepsy was noted in 312 children. In this group, estimates of parental consanguinity and familial epilepsy were of 21.79 and 17.94%, respectively. Etiological factors were predominantly pregnancy and birth abnormalities (28.84%) and central nervous system infection (20.19%). Twelve children had febrile seizures. Of patients with idiopathic epilepsy, 65.18% were attending school versus only 9.29 with non-idiopathic epilepsy.

[Neuromeningeal cryptococcosis in patients apparently non-immunodeficient: report of 3 cases in Dakar, Senegal]. / Cryptococcose neuroméningée chez des patients apparemment non-immunodéprimes: à spropos de 3 cas à Dakar, Sénégal.

Cryptococcal infection is common in immunocompromised patients. Its occurrence in immuno-competent patients is rare. We report here 3 cases of neuromeningeal cryptococcosis in patients without any immunosuppressive documented factors. They were respectively 25, 36 and 50 years old presenting clinical signs of chronic meningo-encephalitis. The HIV test was negative for all of them and the CD4 counts were normal. One patient died on the seventh day of the treatment with amphotericin B; the second was discharged on parents' request, while the third patient improved with intravenous fluconazole. This study suggests that when facing a sub-acute or chronic meningitis, an investigation for cryptococcal infection is recommended as before AIDS epidemic.

Childhood arterial ischemic stroke in Senegal (West Africa).

Etiological factors of childhood ischemic stroke depend on the epidemiological context. The purpose of this study was to determine the risk factors, the clinical and radiologic features, and the outcome of arterial ischemic stroke in a case series of Senegalese children. We carried out a retrospective registry-based study on arterial ischemic stroke in children hospitalized in the neurology department of Fann Teaching Hospital and Albert Royer Children's Hospital, from January 2005 to December 2015. We enrolled 116 cases with an age range from 2 months to 18 years. The mean age at stroke occurrence was 71.5 months. The most common manifestations were hemiparesis (84%), aphasia (19%), and partial motor seizures (10%). The middle cerebral artery was the most affected (81%). Risk factors were predominantly sickle cell disease (38%), embolic heart disease (9%), and anemia (3%). Twenty-eight percent of patients were lost to follow-up, 62% had neurological impairments, and 4% died. Secondary prevention was based on antithrombotic agents. Prevention must be prioritized and public health actions need to focus on sickle cell disease, rheumatismal disease, anemia, and related disorders. It will be necessary to set up policies that fight against consanguineous marriage, endemic infections, and argue for better nutrition.

Intraoperative spinal cord monitoring: Lesional level diagnosis.

BACKGROUND: In spinal deformity surgery, iatrogenic spinal cord injury is the most feared complication. Intraoperative monitoring (IOM) of the spinal cord assesses its functional integrity and allows significant reduction of the rate of spinal cord injury. HYPOTHESIS: In case of severe IOM alert, lesional level diagnosis constitutes supplementary and useful information. MATERIAL AND METHODS: This study was retrospective and monocentric. In our institution, 1062 pediatric spinal deformity surgeries have been monitored since 2004. We review the records of the six patients who presented a severe and prolonged IOM alert with lesional level determination. Somatosensory evoked potentials (SSEP), neurogenic mixed evoked potentials (NMEP) and D-waves were performed. In cases of IOM alert, sequentially moving an epidural electrode along the spinal cord allows lesional level determination, using this electrode either for stimulation or recording. RESULTS: Six patients, aged 12 to 17 years, characterized by severe IOM alerts during spinal deformity surgery are reported. Postoperative neurological examination was normal for five out of six cases. For patient 2, lesional level diagnosis allowed to determine a bi-laminar claw between T2 and T3 as the etiology of IOM alert. This IOM alert was delayed in time, being detectable only 30minutes after the placement of this claw. Postoperative neurological examination was normal. For patient 6, a Stagnara wake-up test demonstrated paraplegia. Lesional level was established. Following corrective surgical maneuvers, postoperative neurologic deficit was limited to a pyramidal syndrome in one lower limb. Postoperative MRI demonstrated a spinal cord lesion at the determined lesional level. CONCLUSION: During an IOM alert, lesional level determination allows localization of spinal cord dysfunction. This data, obtainable whatever the IOM device, constitutes supplementary information in order to rapidly identify the etiology of IOM alert and thus to react in the most appropriate way. LEVEL OF EVIDENCE: IV, retrospective study.

An improved spectrophotometric assay of pyruvate dehydrogenase in lactate dehydrogenase contaminated mitochondrial preparations from human skeletal muscle.

In mitochondria-enriched preparations of human skeletal muscle, the measurement of pyruvate dehydrogenase activity, as determined by conventional spectrophotometric assay of NADH accumulation, is underestimated due to the oxidizing activity of the contaminating lactate dehydrogenase. Using a model reaction system consisting of varying mixtures of purified lactate and pyruvate dehydrogenases, we found that the presence of oxamate, a competitive inhibitor of the lactate dehydrogenase, allowed the measurement of a linear rate of pyruvate dehydrogenase activity without interference from lactate dehydrogenase. In the presence of 25 mM oxamate, this holds true up to a ratio of 30:1 for lactate to pyruvate dehydrogenases, respectively. A similar result was obtained when using human skeletal muscle mitochondria contaminated by lactate dehydrogenase. Rates of pyruvate dehydrogenase activity ranging from 50 to 120 nmol/min/mg protein could be routinely measured in such mitochondrial fractions. We concluded that the use of oxamate allows a spectrophotometric assay for pyruvate dehydrogenase activity to be utilized when screening for pyruvate dehydrogenase deficiency in mitochondria-enriched preparations of human skeletal muscle.

Susceptibility of rodents to infection with Schistosoma mansoni in Richard-Toll (Senegal).

The susceptibility of Arvicanthis niloticus, Mastomys huberti, Mastomys erythroleucus and Mus musculus was studied to assess the capacity of these rodents to transmit Schistosoma mansoni. The susceptibility was determined by the percentage of adult schistosomes recovered, the number of eggs per gramme of faeces, the viability of these eggs and the capacity of the rodents to maintain the life cycle of Schistosoma mansoni. The percentages of adult worms recovered were respectively 18%, 11.5%, 8.4% and 20.5% in A. niloticus, M. huberti, M. erythroleucus and M. musculus. After infection, they liberate in the environment viable eggs whose miracidia are infectious for the intermediate host (Biomphalaria pfeifferi). The mean egg load was 300 +/- 327.8 in A. niloticus; 664 +/- 673.5 in M. huberti; 240 +/- 304.8 in M. erythroleucus; 400 +/- 361.5 in M. musculus.

[Bulinus truncatus, intermediate host of Schistosoma haematobium in the Senegal River Basin (SRB)]. / Bulinus truncatus, hôte intermédiaire de Schistosoma haematobium dans le bassin du fleuve Sénégal.

To assess the role of Bulinus truncatus in the transmission of urinary schistosomiasis in the Senegal River Basin (SRB), the relations between B. truncatus and Schistosoma haematobium were studied. The compatibility study shows that B. truncatus is susceptible to infection with S. haematobium in the Upper Valley of the SRB. The malacological follow up reveals the presence of B. truncatus naturally infected with schistosomes cercariae in the Middle Valley. The identification of these schistosomes as S. haematobium by the Single Strand Conformational Polymorphism technique (SSCP) confirms the participation of B. truncatus in the dynamic transmission.

[Evaluation of the treatment of malaria using a 3-day regimen of quinine in Dakar]. / Evaluation du traitement du paludisme par la quinine en cure de 3 jours à Dakar.

The efficacy of quinine treatment for Plasmodium falciparum strains remains sound. However reports of decreased sensitivity and resistance of some strains in Asia and East Africa indicate that current treatment regimens should be re-adjusted. The purpose for the present study carried out in Dakar, Senegal, was to evaluate the local regimen for acute Plasmodium falciparum malaria using quinine at a dose of 20 mg/kg per day in two daily injections on 3 consecutive days. Thirty-seven patients with acute Plasmodium falciparum malaria including 10 severe cases were treated using the standard regimen and followed up clinically and parasitologically from Day 0 to Day 7. On Day 7 parasites were still detectable in the blood of four patients for a failure rate of 10.8%. Persistence of parasites despite disappearance of clinical symptoms suggests that the regimen should be increased to 25 mg/kg per day for at least for 3 days or longer if symptoms persist. Due to its adverse effects and cost (10 times higher than chloroquine treatment), quinine treatment should be prescribed only for patients with severe malaria forms.

Dose setting and auditing.

How have the new standards for dose setting and dose auditing been received by manufacturers and how are they responding to the challenges? From the view-point of a UK provider of contract sterilization services, this article comments on the situation faced by the different-sized companies in the industry.

[Drug resistant epilepsy in Senegal: therapeutic, clinical and socioeconomic factors]. / Epilepsies pharmacorésistantes au Sénégal: facteurs thérapeutiques, cliniques et socio-économiques.

The aim of our study was to emphasize factors which support pharmaco-resistance in Senegal. For this purpose, 23 patients with partial or generalized epilepsy were studied, after determining the plasmatic concentration of the antiepileptic drugs. The aetiologies were numerous: encephalitis, injuries, neonatal encephalitis. All patients were under traditional treatment before coming to the hospital. So antiepileptic drugs were taken a long time after the beginning of epilepsy later, they were Phenobarbital, Carbamazepine, Phenytoin, and Valproic acid. Only seven patients had sufficient plasmatic level of the antiepileptic drug. The low socio-economic conditions of patients which limit the choice of the most adapted drug in each case, is one of the most important reason of the pharmaco-resistance. Another factor of the pharmaco-resistance is cultural and is linked with the absence of notion of chronic disease necessitating long and regular treatment in senegalese traditional society.

[Familial congenital hypomagnesemia revealed by neonatal convulsions]. / Convulsions néonatales révélant une hypomagnésémie congénitale familiale.

Congenital hypomagnesemia is a rare disease, with an impact on cognitive and neurological development. We report on three familial cases of congenital hypomagnesemia, two boys and one girl who belong to the same consanguineous family. They all presented neonatal seizures and a psychomotor developmental delay. Cerebral computed tomography showed cerebral atrophy and calcifications in one case and magnetic resonance imaging found predominant cerebellar atrophy in the two other cases. All three patients also had hypocalcemia, hyperphosphoremia, and hypomagnesemia. The parathyroid hormone blood level was low in two cases and normal in the third. One 7-month old patient died. The others received a supplementation of calcium and magnesium, which normalized calcemia, phosphatemia but not magnesemia, which remained low despite high doses. They have both developed cognitive and behavioral impairments.