Knowledge, Attitudes, and Management of General Practitioners of the Hospital Districts of Ouagadougou about Migraine (Burkina Faso).

BACKGROUND: Migraine is a common neurological disorder characterized by severe headache attacks that may be debilitating. The objective of this study is to determine the knowledge and attitudes of general practitioners in the hospital districts of the city of Ouagadougou on migraine. METHODS: This cross-sectional study was carried out in hospital districts of Ouagadougou. The data were collected during three months from February 1 to April 30, 2020. RESULTS: The study included 116 general practitioners. Thirteen percent of them were suffering from migraine. All participants had previous experience with migraine diagnosis before the survey. Eighty percent of general practitioners had a good level of knowledge of ICDH-3 criteria (knowing 6-7 criteria). The most widely recognized IHS criteria were pulsatility quality (93.1%), photophobia or sonophobia (80.2%), and mild-to-moderate intensity (80%). Ninety-five (81.9%) general practitioners rarely ordered brain imaging. The most common acute treatments were nonsteroidal inflammatory drug (39.47%), paracetamol (44.74%), and derivate of ergot (3.95%). The most common preventive treatments were amitriptyline (27.8%), derivate of ergot (18.9%), and NSAID (16.7%). The majority of general practitioners (56.9%) have referred headache patients to a colleague or specialist. CONCLUSIONS: Our study found that diagnostic criteria and acute treatment of migraine were well known by the majority of general practitioners, in contrast of preventive treatment.

[Central Post-Stroke Pain at the Tingandogo University Teaching Hospital of Ouagadougou (Burkina Faso): Frequency, Clinical Profile, Quality of Life of Patients and Associated Factors]. / La Douleur Centrale Post Accident Vasculaire Cérébral au Chu Tingandogo de Ouagadougou (Burkina Faso): Fréquence, Profil Clinique, Qualité de Vie des Patients et Facteurs Associés.

Objective: Few studies have been done on central post-stroke pain (CPSP) in Sub-Saharan Africa, while taking it into account would improve the quality of life of stroke survivors. The purpose of this study was to determine the prevalence of CPSP, to describe its clinical profile, to assess the quality of life of patients and to identify the factors associated with its occurrence, from a prospective hospital series in Ouagadougou, Burkina Faso. Methodology: It was a prospective, descriptive and analytical longitudinal follow-up study, conducted from January 2015 to March 2020, at the Tingandogo University Hospital, in Ouagadougou, Burkina Faso. The study involved all patients over the age of 16, consecutively hospitalized for stroke confirmed by CT and / or brain MRI, then reviewed every three months in outpatient Neurology, during at least 9 months after their stroke. The sociodemographic and clinical characteristics of the patients, the nature of the stroke, the existence of CPSP and, if applicable, its clinical characteristics, its treatment and its impact on the quality of life of the patients were recorded; a bivariate then multivariate analysis with logistic regression step by step, made it possible to search for the factors associated with the occurrence of CPSP. The significance threshold used was p < 0.05. Results: A total of 236 patients were collected, out of which 28 patients presented a CPSP (11.9%), after a mean duration of post-stroke follow-up of 12.9 months. Cerebral infarction, intracerebral hemorrhage and cerebral venous thrombosis accounted for 69.5%, 29.7% and 0.8% respectively. The mean age of patients with CPSP was 54.6 years, with a male predominance (53.6%). The mean time to onset for CPSP was 3.8 months after stroke. Pains such as burning (75%) and allodynia (67.8%) were the most common. The average CPSP intensity was 7.6 / 10 on the visual analog scale. Hypoaesthesia (96.4%) and paraesthesia (71.4%) were the signs or symptoms most commonly associated with CPSP. CPSP had a moderate to severe negative impact on usual work, general activity and mood of patients in 60.7%, 50% and 46.4% of patients, respectively. Amitriptyline (75%) and / or level II analgesics (60.7%,) were the most used molecules, and effective in 57% of cases. Only age ≤ 50 years was independently associated with the occurrence of CPSP (OR 2.86; p = 0.03). Conclusion: CPSP affects more than 1 in 10 stroke patients and moderately to severely affects the quality of life for most of these patients. Screening and adequate management of CPSP as part of multidisciplinary post-stroke follow-up will contribute to improve the quality of life of stroke patients and will facilitate their social and professional reintegration.

[Prognosis for motor deficits after strokes in Burkina Faso]. / Pronostic du handicap moteur au cours des accidents vasculaires cérébraux au Burkina Faso.

Stroke is a common, severe, and disabling condition that is recognized as a major public health problem. Our goal was to study the clinical features and prognosis of motor deficits in stroke patients hospitalized in the neurology department of the Yalgado-Oeudraogo University Hospital in Burkina Faso. This cross-sectional study took place from March 1 through September 30, 2012. The study included all patients with motor disabilities following a CT-confirmed stroke that had occurred within the previous month. Patients were reviewed at one month (M1) and three months (M3) to assess their current treatment and their autonomy, by the Barthel Index. During the study period, 59 patients were hospitalized for stroke, 56 with motor disabilities for a 95% prevalence of stroke with motor deficit. Their mean age was 57.8 ± 17.7 years (range: 20 to 84 years), and the sex-ratio of 1.6 (male/female). Overall, 61% of the strokes were ischemic and 39% hemorrhagic, with an equal distribution of right and left hemiplegia (46.4% each) and 7% of the patients showing bilateral involvement. The mortality rate before M1 was 29% and before M3, 40%. On admission, 4% of patients had a Barthel Index greater than 60, at M1 35%, and at M3, 60%. Only 51% of patients received physical therapy. Characteristics significantly associated with functional recovery were age younger than 65 years (p = 0.0026), sphincter disorders at M1 (p = 0.002), hemorrhagic stroke (compared to ischemic) (p = 0.0038), functional rehabilitation (p = 0.0012), and right (versus left) hemisphere damage (p = 0.010).

[Polyneuropathies of pregnancy and the postpartum period in Burkina Faso]. / Les polyneuropathies de la grossesse et du post-partum au Burkina Faso.

Polyneuropathies of pregnancy and the postpartum period are considered rare but also understudied in Sub-Saharan Africa. They are usually related to a thiamine deficiency in under- or malnourished women. Our aim was to study the clinical and etiological factors of this disease in the Yalgado Ouédraogo University Hospital of Ouagadougou in Burkina Faso. Our prospective cross-sectional study lasted for 20 months, from August 2008 to April 2010. During the period, 27 women received this diagnosis. Their mean age was 27.5 years (range: 20 to 38). All but two (92%) had no or a very small or a modest income. Their monotonous diet was based on local cereals and available irregularly. Almost all (24/27, 89%) had developed one or more diseases during pregnancy, primarily excessive vomiting (70%) and severe anorexia (89%). Sensory symptoms were present in 70% of cases, and sensorimotor symptoms in 30%. The cause was always a deficiency-related polyneuropathy. All patients were treated with vitamin B complex and all symptoms disappeared by the third month of treatment. We conclude that polyneuropathies during pregnancy and during the postpartum delivery occur in women eating an unbalanced diet and living in a deprived social and economic situation and that it is manifested by serious vomiting and anorexia.

[Strokes and hemoglobinopathies in Burkina Faso]. / Accidents vasculaires cérébraux et hémoglobinopathies au Burkina Faso.

S and C hemoglobinopathies are a group of inherited blood disorders including sickle cell disease, characterized by the presence of abnormal S and C hemoglobins. They are common in tropical Africa. Stroke is a common complication of sickle cell disease. Studies of the relation between these two diseases are virtually nonexistent in sub-saharan Africa. Our work aimed to study the influence of these hemoglobinopathies on the onset of strokes in adults. This cross-sectional study took place from 1st December 2009 to 31st May 2010 at University Hospital Yalgado Ouedraogo. Out of 142 patients admitted to our neurology department during this period, 74 patients had had strokes. Their mean age was 55.9 years and their sex ratio 1.53. Ischemic strokes accounted for 57% of the total, followed by cerebral hemorrhage (39%). Forty-six patients (62%) were AA genotype, 27 (36%) patients had sickle cell trait (16 AC and 11 AS) and three patients were homozygous CC. This study showed a higher prevalence of hemoglobinopathies in patients with stroke than in the general population. Unlike heterozygous SC and homozygous SS forms, the existence of sickle cell trait in this population does not appear to increase the risk of onset of ischemic stroke but may reduce the age at onset of cerebral hemorrhage.

[Post-partum thunderclap headaches in a patient from Burkina Faso: reversible cerebral vasoconstriction syndromes]. / Céphalées en "coup de tonnerre" du post-partum chez une Burkinabé: syndrome de vasoconstriction cérébrale réversible.

Reversible cerebral vasoconstriction syndrome (RCVS) is considered as rare but is probably under-recognized. It is characterized by the association of acute severe headache and/or focal neurological deficits and/or seizures and segmental vasoconstriction of cerebral arteries that resolve within one to three months. The purpose of this report is to describe the first case of post-partum RCVS from Burkina Faso. Diagnosis of RCVS was based on clinical setting (post-partum), absence of vascular risk factor, sudden onset, rapid resolution of signs and symptoms within eight days, brain scan findings (spontaneous bilateral posterior low density areas of cerebral ischemia), and elimination of other possible causes, i.e., meningeal or cerebellar hemorrhage, cerebral venous thrombosis, HELLP syndrome.

[Infectious ventriculitis in relation with neurocysticercosis in Burkina Faso]. / Ventriculite infectieuse secondaire à une neurocysticercose au Burkina Faso.

INTRODUCTION: Ventriculitis is an uncommon entity, which is defined as localized meningitis in the cerebral ventricles. It usually occurs in a context of immunodepression, where its presence may suggest primary brain lymphoma, certain viral infections including cytomegalovirus (CMV) and much more rarely, tuberculous meningitis. OBSERVATION: A 48-year-old immunocompetent male was admitted to the neurology department of the Ouagadougou teaching hospital with the diagnosis of infectious ventriculitis in relation with neurocysticercosis (NCC). The diagnosis was based on several arguments including brain CT scan (dilated lateral and third ventricles with ependymal enhancement and scattered parenchymatous cystic hypodensities exhibiting enhancement after contrast injection), the notion of exposure (the patient raised pigs), residence in an endemic zone of cysticercosis, and test results: CSF analysis (aseptic meningitis), positive ELISA for NCC in both CSF and blood. The good clinical and biological outcome after treatment with albendazole was another argument favoring the diagnosis. CONCLUSION: This illustrates the importance of searching for NCC in patients with ventriculitis residing in an endemic zone for cysticercosis.

[A case of focal hand dystonia combined with carpal tunnel syndrome in Ouagadougou (Burkina Faso)]. / Un cas de crampe des écrivains dystonique combinée à un syndrome du canal carpien à Ouagadougou (Burkina Faso).

INTRODUCTION: Focal hand dystonia and carpal tunnel syndrome are linked to impairment of the central and peripheral nervous systems, respectively. We report a singular case combining these two entities. CASE REPORT: A 44-year-old right-handed male pharmacy employee whose daily activity for 18 years was to fill out and staple insurance vouchers and unload and store boxes of medicines, presented, almost concomitantly, the combination of right focal hand dystonia and homolateral carpal tunnel syndrome. CONCLUSION: This observation corroborates the results of experimental studies on repetitive manual activity which would be a source of central and peripheral changes, affecting the hand somatotopy in the sensory-motor cortex and the descending control of basal ganglia, explaining dystonia, and leading to median nerve compression related to repeated microtrauma, inflammatory reactions and fibrosis of the carpal tunnel.

[Knowledge of epilepsy and practices of parents in Mali: a community study]. / Connaissances a propos de l'epilepsie et attitudes des parents d'enfant au Mali: etude communautaire.

The prevalence of epilepsy in Sub-Saharan Africa is about 15 per thousand; against 6 to 8 per thousand in industrialized countries. Health, social, economic conditions and misknowledge could explain this situation. The objective of this survey was to study the knowledge of parents of children with or without epilepsy about this disease in Mali. 423 adults were interviewed, 15% children with epilepsy. The mean age was 34 ± 9,3 years; females represents 60% of the population. 26% of interviewed subjects heard about epilepsy from their neighbourhood, 20% from traditional healers, 11% from health care professional; the tonic-clonic crisis was the most known form of the disease. 59% thought epilepsy to be contagious. The organicity of the disease was known by 51% of the population. 23 % of the population believed there was a link between the onset of the crisis and the presence of the hole moon. 78% of subjects have already seen at least one crisis of epilepsy, but only 33% have got an attitude of first help that was to pour fresh water on the face of the patient in 22% of cases. 57% of subject's acknowledge having as first recourse traditional medicine. The fight against epilepsy in Mali as in the others countries of the third world should go through information and education of the population, in particular parents.

[Cerebral venous thrombosis in the hospital environment in Ouagadougou (Burkina Faso)]. / Les thromboses veineuses cérébrales en milieu hospitalier à Ouagadougou (Burkina Faso).

INTRODUCTION: Cerebral venous thrombosis (CVT) is a rare condition difficult to diagnose because of the wide variability of the clinical presentations. The goal of our survey was to study the clinical, etiological and progressive aspects of the CVT in Burkina. PATIENTS AND METHOD: We conducted a prospective study for two years, including patients with a diagnosis of CVT based on clinical and imaging criteria. Age, gender, clinical findings and results of complementary tests were recorded as was the clinical outcome. RESULTS: The study included 17 patients (seven men and ten women) mean age 42.5 years. The inaugural signs were sub-acute in two-thirds of the patients. Headache was a constant finding (n=17 patients, 100%); 15 patients (88%) had unilateral or bilateral motor deficits. An infectious syndrome was common (60%). The brain CT scan generally revealed spontaneous high density signals from a sinus. d-dimeres were high in 15 cases. Four patients were HIV-1 seropositive and four had rhino-sinusitis. The other etiological factors were rare. Heparin was administred in 80% of patients, followed by oral anticoagulation for three months on average. CONCLUSION: Our cohort presents a relatively different clinical picture compared with the literature due to the high frequency of the infectious etiologies. A prospective multicentric study with more specific diagnostic tools could be useful to learn more about the epidemiology of CVT in Subsaharan Africa.

[Painful ophthalmoplegia in a woman from Burkina Faso: cerebral venous thrombosis (CVT) of the cavernous sinus]. / Ophtalmoplégie douloureuse chez une Burkinabé: thrombose veineuse cérébrale (TVC) du sinus caverneux.

Cerebral venous thrombosis (CVT) is a rare cerebral vascular pathology with highly variable clinical features and outcome. The purpose of this report is to describe a case of CVT of the cavernous sinus that presented as painful ophthalmoplegia. A 26-year-old woman with a contraceptive implant for seven months consulted at the Neurology Department of Yalgado Ouedrago hospital for a painful ophthalmoplegia that was initially diagnosed and treated as ophthalmoplegia migraine. One month later, clinical symptoms had progressed to asymmetric muscle weakness in all four limbs, right cerebellum ataxia and involvement of the trigeminal ophthalmic branch. Computerized axial tomography of the brain depicted a zone of unusual contrast extending from the cavernous sinus up to the tentorium cerebelli and a mass effect on the fourth ventricle. Analysis of the cerebrospinal fluid demonstrated a cellular reaction with 8 lymphocytes and high protein rate (0.64 g/L). The levels of C reactive protein (CRP) and D-Dimeres were elevated: 16.6 mg/L and 0.99 microg/mL respectively. Based on a presumptive diagnosis of CVT, heparin treatment was undertaken and led to almost complete remission of the signs and symptoms. This case again shows the wide range of clinical features and outcomes of CVT that can oscillate between encephalitis, intracranial tumor or infection. As a result, CVT should be considered as a possible diagnosis in patients with focal neurological signs, intracranial hypertension syndrome, loss of consciousness or cavernous sinus syndrome whenever the context is right (post-partum, oestroprogestative, congenital thrombophilia).

[Epilepsy and women's life: particularities of their management. Literature review]. / Epilepsie et vie de la Femme : Specificite de la Prise en Charge Revue de la Litterature.

Eight in 1,000 people in the world suffer from epilepsy, and 80 % of them are in the developing countries [1]. Sub-Saharan Africa and Latin America have higher median prevalence's 15.4 % and 12.4 %, respectively, compared to the prevalence in Europe, 5.4 %, and in North America, 5-10 % [2]. On this epidemiological inequality overlays a considerable disparity in the quality of care given to people with epilepsy, between developed and developing countries, and rural and urban areas. In this context, one of the most controversial subject regarding epilepsy is the care given to epileptic patients and their offspring. In fact, being a woman with epilepsy is not as being a man. The specific concerns about women with epilepsy are essentially sexual development, contraception, reproduction, fertility, and anatomic and cognitive teratogenicity of anti-epileptic drugs. The awareness campaign of women with epilepsy starts from puberty until menopause. About one third of epileptic women experience variations in their disease linked to menses, probably due to the neurotoxicity of oestrogens (not counterbalanced by progestatives). The problem with the teratogenicity of anti-epileptic drugs is not resolved yet despite the availability of new molecules. A close collaboration between health practitioners (obstetricians and neurologists) and an awareness of health professionals are essential for a global care of pregnant epileptic women or at age to conceive.

Epilepsie et vie de la femme : specificite de la prise en charge : revue de la litterature

Huit personnes sur 1000 soufrent d'epilepsie dans le monde et 80se trouvent dans les pays en developpement [1]. L'Afrique sub-saharienne et l'Amerique latine ont des prevalences medianes elevees avec respectivement 15;4et 12;4; par comparaison aux prevalences observees en Europe (5;4) 0 et a 5 a 100 en Amerique du nord [2]. Sur cette inegalite epidemiologique se superpose une disparite considerable dans la qualite des soins dispenses aux epileptiques; entre les pays a revenu faible et eleve et entre le milieu urbain et rural. Dans ce contexte; l'un des sujets les plus controverses dans le domaine de l'epileptologie est la prise en charge des femmes epileptiques; de surcroit enceintes et de leur progeniture. En effet; etre une femme epileptique n'est pas comme etre un homme. Les preoccupations specifiques aux femmes epileptiques concernent essentiellement la sexualite; la contraception; la reproduction; la fertilite et la teratogenicite anatomique et cognitive des medicaments anti-epileptiques. La sensibilisation des femmes epileptiques commence depuis la puberte jusqu'a la menopause. Environ un tiers des femmes epileptiques subissent des variations de leur maladie liees au cycle menstruel; probablement du fait d'une neurotoxicite des oestrogenes (non contrebalancee par les progestatifs). Le probleme de la teratogenicite des medicaments antiepileptiques (MAE) n'est pas resolu malgre la mise sur le marche des nouvelles molecules. Une collaboration etroite entre sages femmes; obstetriciens et neurologues et une sensibilisation des professionnels de sante sont essentielles pour une prise en charge globale des femmes epileptiques enceintes ou en age de procreer

[Athetosis in relation with intracranial tuberculomas in a patient from Burkina Faso]. / Mouvements anormaux chez un Burkinabé.

Athetosis is generally characterized by involuntary movements due to damage of the extrapyramidal tract secondary to neonatal cerebral anoxia or nuclear icterus. The purpose of this report is to describe the case of a 41-year-old man who was admitted to the neurology department of the Ouagadougou teaching hospital in Burkina Faso for right hemiathetosis in relation with intracranial tuberculomas ongoing for two years. Diagnosis was based on clinical findings, i.e., lymph node tuberculosis and positive HIV1 serology; on CT scans showing multiple low density nodular lesions of variable size with annular contrast at the level of the right cerebellum and calcification at the left parietal level and in projection of the left capsulolenticular area; and on favorable response to tuberculosis treatment.

[Epilepsy by bovine (zebu) goring: a case report in Burkina Faso]. / Epilepsie par encornement bovin (zébu): a propos d'un cas au Burkina Faso.

The post-traumatic epilepsy is responsible for 20% of the symptomatic epilepsies. Accidents on public highway constitute more than 70% of the causes. We report a singular case of fronto-polar post-traumatic epilepsy by zebu goring which appeared two years after the traumatism. The neurological examination of the patient was normal apart from a inconspicuous expansiveness of humor underlined by an excess of familiarity and hypersyntony. The cerebral scanner revealed a left fronto-basal cortico-under-cortical low density up to the homolateral fronto-polar area. The electroencephalogram (EEG) showed some left fronto-polar bursts of spike and wave on a normal bottom line. This clinical observation draws our attention on the fact that in Sahelian tropical environment where bovine breeding holds a major place, the cranio-encephalic traumatism by goring is not rare and can be responsible for epilepsy in the same way as accidents on public highway, or ballistic traumatism.

[Wallenberg syndrome and neurocysticercosis: about one case in Ouagadougou, Burkina Faso]. / Syndrome de Wallenberg et neurocysticercose: a propos d'un cas a Ouagadougou, Burkina Faso.

Neurocysticercosis (NCC) frequently appears by seizures following parenchymatous location of encysted worms of Taenia solium. We report a case of NCC revealed by a Wallenberg's syndrome. A man of 44 years old, without any cardiovascular risk factor was admitted at the neurology department of Yalgado-Ouédraogo hospital in Ouagadougou for an abrupt onset of vertigos, recurrent falls on the right side, hiccough, and deglutition weakness. The clinical examination found a blood pressure at 130 mmHg/80 mmHg, a CMI at 24, a Wallenberg's syndrome. The CT scan showed a laterobulbar lacunar infarct with punctiform calcifications of cerebellum, third ventricle, frontal, right temporal, occipital and left parietal lobes. The CSF showed a raise of cells number at 23 lymphocytic elements, proteins rose to 1.5 g/l, glucose and chloride were normal. Cysticercosis blood and CSF serologies were positive. The blood cells count showed only an eosinophilia and the blood sedimentation rate reached 119 mm in the first hour. The accepted diagnosis was: laterobulbar lacunar infarct following a NCC angiitis. The course of the disease under albendazole at 15 mg/kg during two weeks combined with a short steroid therapy by prednisolone at 1 mg/kg during 5 days was favourable. NCC should be more and more regarded as a cerebrovascular risk factor in endemic area, especially in young people.