[Serum selenium and dilated cardiomyopathy in Cotonou, Benin]. / Sélénium plasmatique et cardiomyopathie dilatée à Cotonou (Bénin).

PURPOSE: Peripartum cardiac failure is common in savannah-Sahelian Africa. It is due to a form of dilated cardiomyopathy (DCM) known as peripartum cardiomyopathy (PPCM) that results from undetermined causes. Numerous risk factors have been identified and dietary selenium deficiency has been proposed as a possibility. The purpose of this study was to measure serum selenium levels in patients presenting cardiac insufficiency due to PPCM and DCM (nonpostpartum) in Cotonou, Benin and to compare patients with healthy postpartum women with comparable or identical obstetric features. METHODS: Measurements of selenium status were performed in 10 women (mean age, 27.1 years) with PPCM, 18 patients of both sexes (male/female, 11/7; mean age, 38.9 years) with DCM (non-peripartum), and 46 healthy recent post partum women (mean age, 29.8 years). The Wilcoxon nonparametric test was used for data analysis with a statistical significance level at a p-value <0.05. RESULTS: Mean serum selenium values were near similar in patients presenting PPCM and DCM (non peripartum): 94 +/- 12 microg/L versus 97 +/- 19 microg/L respectively. This difference was not significant. No value was less than 72 microg/L. Conversely significantly lower mean values were observed in the 46 healthy recent postpartum women: 76 +/- 13 microg/L (p = 0.0002). The lowest value was 57 microg/L. CONCLUSION: Serum selenium measurements in Cotonou showed that levels were higher in patients presenting PPCM or DCM (nonperipartum) than in healthy controls. Extremely low values were never observed. These results differed from those obtained in Bamako, Mali and in Niamey, Niger and argue against considering selenium deficiency as a risk factor for development of DCM (peripartum or not) in Cotonou.

Selenium plasmatique et cardiomyopathie dilatée à Cotonou (Bénin)

RÉSUMÉ â€¢ Objectifs. L'insuffisance cardiaque péripartum, fréquente en Afrique soudano-sahélienne, est liée à une cardiomyopathie dilatée (CMD) de cause inconnue appelée cardiomyopathie du péripartum (CMPP). Parmi les facteurs de risque identifiés, la carence alimentaire en sélénium est discutée. Le but de ce travail est d'évaluer le taux de sélénium plasmatique de patientes en insuffisance cardiaque par CMD, péripartum ou non, à Cotonou (République du Bénin)et de le comparer à celui de parturientes en bonne santé à statut obstétrical proche ou identique. Méthodologie. Afin de préciser le statut en sélénium à Cotonou les auteurs ont dosé le sélénium plasmatique chez 10 béninoises(âge moyen = 27,1 ans) atteintes de CMPP, chez 18 patients/es atteints/es de CMD (11 femmes,7 hommes, âge moyen = 38,9 ans) et chez 46 béninoises « témoins » en bonne santé ayant accouché récemment (âge moyen = 29,8 ans). Le test de Wilcoxon (non paramétrique) a été utilisé pour la comparaison statistique avec un seuil < 0,05. Résultat. Les valeurs de sélénémie sont très proches (94 ± 12 µg/L et 97 ± 19 µg/L), avec des différences non significatives, dans les 2 groupes de patients/es porteuses de CMPP ou de CMD.Aucune valeur n'est inférieure à 72 µg/L. Les valeurs sont par contre significativement plus basses(76 ± 13 µg/L, P = 0,0002) chez les 46 témoins, accouchées récentes en bonne santé, la valeur la plus basse étant à 57 µg/L. Conclusion. Les sélénémies des malades, porteuses de CMPP ou de CMD, sont plus élevées que celles des patientes du groupe témoins en bonne santé à Cotonou. Il n'existe aucune valeur très basse (< 40 µg/L), qu'il s'agisse des malades ou des témoins. Ces résultats, différents de ceux observés dans des études antérieures à Bamako (République du Mali) et surtout à Niamey (République du Niger), vont à l'encontre de l'hypothèse d'un déficit en sélénium à l'origine des CMD, péripartum ou non, à Cotonou

[Ventricular dysfunction during acute fever in Dakar, Senegal. Clinical data and serological studies]. / Dysfonction ventriculaire aiguë fébrile à Dakar. Données cliniques et enquête sérologique.

During a study, the authors observed clinical and ultrasound evidence of "ventricular dysfunction during acute fever" due to ue to "severe acute myocarditis" supports therapeutic management since 4/8 patients in this study were infected either by Chlamydia (CT and especially CP) or by Mycoplasma pneumoniae, that are both sensitive to antimicrobial therapy using macrolides. Five of 8 patients presented coinfection with 2 and even 3 infectious agents (CP-enterovirus-adenovirus).

[Plasma selenium and peripartum cardiomyopathy in Bamako, Mali]. / Sélénium plasmatique et cardiomyopathie péripartum a Bamako (Mali).

Peripartum heart failure due to unexplained dilated cardiomyopathy is a common disorder as Savannak-Sahelian Africa. One of the many suspected risk factors identified is selenium deficiency. The purpose of this study was to measure plasma selenium levels in patients with peripartum heart failure due to cardiomyopathy in Bamako, Republic of Mali and compare data with healthy Sahalian women with the same obstetrical status. Plasma selenium was measured in a patient group consisting of 28 Malian women presenting peripartum heart failure and in a control group of 28 healthy breast-feeding Nigerien women of comparable age. The criteria for matching the two groups was parity (similar number of deliveries) since multiparity is a risk factor for peripartum cardiomyopathy. The Wilcoxon test (nonparametric) was used to compare the 2 groups considering up value < 0.05 as significant. Plasma selenium was significantly lower in patients from Mali than in controls from Niger (65 +/- 17 ng/ml vs. 78 +/- 17 ng/ml, p = 0.01). The results of this study showing lower plasma selenium in Bamako patients with peripartum cardiomyopathy than in a matching healthy control population confirms the previous data from the Niamey study.

Sélénium plasmatique et cardiomyopathie péripartum à Bamako (Mali)

L'insuffisance cardiaque péripartum, fréquente en Afrique soudano-sahélienne,est une cardiomyopathie dilatée de cause inconnue. Parmi les facteurs de risque identifiés une carence alimentaire en sélénium est discutée. Le but de ce travail est de définir le sélénium plasmatique de patientes en insuffisance cardiaque par cardiomyopathie péripartum à Bamako (République du Mali) et de le comparer à celui de sahéliennes en bonne santé à statut obstétrical identique. Afin de préciser le statut en sélénium à Bamako (République du Mali) les auteurs ont dosé le sélénium plasmatique chez 28 Maliennes atteintes de cardiomyopathie dilatée péripartum. Elles ont été appariées à 28 Nigériennes en bonne santé, d'âge comparable et allaitantes, constituant le groupe témoins. Le critère d'appariement a été la parité des malades et des témoins (nombre identique ou proche d'accouchements). Le test de Wilcoxon (test non paramétrique) a été appliqué pour comparer les 2 groupes, une valeur de p < 0,05 étant significative. Le sélénium plasmatique des patientes de Bamako (65 ± 17 ng/ml) est significativement plus bas que celui des Nigériennes en bonne santé de Niamey (78 ± 17 ng/ml, p = 0,01). Conclusion. La sélénémie des malades avec cardiomyopathie dilatée péripartum à Bamako est plus basse que dans la population témoin appariée,en accord avec les faits constatés antérieurement à Niamey

[The experience in emergency medical care in Lagos (Nigeria): cost-benefit analysis ... politics?]. / L'experience du SAMU de Lagos (Nigeria): rapport cout-efficacite ... politique?

In both the South and North, meeting the demand for health care services is a major issue in establishing political stability for sustainable development. Neither the need for emergency medicine nor the emergency need for medical care can escape this reality. At first glance, "bringing medical care outside hospitals ... to the bottom of the tree" by implementing an advanced rescue system would seem to overstep the usual goal of providing basic health services and capabilities in a developing country. However, the operational, tactical and strategic implications of a "French style SAMU" medical controlled system may contribute to the fair and equitable distribution of emergency health care resources during critical situations in a given environment. In this respect, such system cannot only become a measurable component in responding to increasingly intolerable health disasters, but also an institutional tool for health resources management in any insecure environment, where access to medical facilities usually involves a number of economic, structural, and ethical obstacles. In France, the effectiveness of such a system is still under evaluation with good results in terms of overall health performance for the year 2000. In 1997 the Nigerian authorities with the support of the French Embassy began a novel experience by setting up a state run SAMU services in Lagos. The purpose of this prospective approach was to answer the question "what emergency care system, for what environment?" with an ultimate goal: developing a sustainable service, not only in terms of medical and economic factors, but also ethical and political considerations.

[Submitral annular aneurysm, postpartum cardiomyopathy, and anti-Chlamydia pneumoniae antibodies in Niamey (Niger)]. / Anevrisme annulaire sous-mitral, cardiomyopathie postpartum et anticorps anti-Chlamydia pneumoniae a Niamey (Niger).

Idiopathic annular submitral left ventricular aneurysm has been described mainly in young Africans living in tropical countries. Association with peripartum cardiomyopathy has been previously pointed out. The purpose of this report is to describe 3 patients with idiopathic annular submitral left ventricular aneurysm identified in a series 50 patients with peripartum cardiomyopathy in Niamey, Republic of Niger. Anti-Chlamydia pneumoniae antibody status was determined in all 50 patients using the micro-immunofluorescence technique that differentiates IgG, IgA and IgM antibodies. Findings showed that all 3 patients with annular submitral left ventricular aneurysm had significantly elevated plasma IgG and IgA anti-Chlamydia pneumoniae antibody levels at the time of diagnosis. In one patient analysis of 2 samples collected 3 months apart indicated chronic elevation with exceptionally high IgG antibody levels (1/2048e). These previously unreported data suggest a possible link between Chlamydia pneumoniae and development of peripartum cardiomyopathy and annular submitral left ventricular aneurysm. This possibility is supported by recent evidence that specific IgA anti-Chlamydia pneumoniae antibodies may be predictive of aortic abdominal aneurysms.

[Chlamydia infection and peripartum dilated cardiomyopathy in Niger]. / Infection à Chlamydia et cardiomyopathie dilatée peripartum au Niger.

Peripartum cardiac failure due to cardiomyopathy is common in sub-saharan Africa. The etiology is unknown. This study was performed in Niger to assess a possible relationship between peripartum cardiomyopathy and Chlamydia. A total of 50 African women presenting peripartum cardiomyopathy underwent testing for infection by Chlamydia pneumoniae, Chlamydia trachomatis, and Chlamydia psittaci. The inclusion criteria were cardiac failure during the last three months of pregnancy or first 6 months postpartum with echocardiographic evidence of dilated cardiomyopathy. Similar testing was carried out in a control group of 25 African women from the same geographical location without cardiac disease. Detection of specific IgG, IgA and IgM antibodies was performed using the microimmunofluorescence technique. The cut-off values were > or = 1/32 for specific IgG antibody and > or = 1/16 for specific IgA and IgM antibody. Statistical comparison of the patient and control groups was achieved using the chi 2 test. For Chlamydia pneumoniae, 48 patients (96 p. 100) versus 20 controls (80 p. 100) controls were positive for IgG antibodies (p < 0.025) and 39 patients (80 p. 100) versus 14 controls (56 p. 100) were positive for IgA antibodies (p < 0.05). No patient or control demonstrated IgM antibodies for Chlamydia pneumoniae. For Chlamydia trachomatis and Chlamydia psittaci, differences in positive rates were not statistically significant. This is the first study demonstrating infection in patients with peripartum cardiomyopathy. The possible role of Chlamydia pneumoniae is discussed.

[Congenital malaria. Parasitological and serological studies in Niamey (Niger)]. / Paludisme congénital. Etudes parasitologique et sérologique à Niamey (Niger).

Congenital malaria is defined as the presence of Plasmodium parasites in the erythrocytes of newborns less than seven days old. The aim of this study was to determine the incidence of congenital malaria and its possible clinical consequences. We carried out a prospective survey in Niamey, the capital of Niger (600,000 inhabitants) from July to September 1993. Niamey is in an area of mesoendemic malaria and this period of the year corresponds to the rainy season, when malaria transmission is maximal. Ninety mothers and their newborns were included. We assessed the clinical status of the mother and child at the time of the delivery, and took blood smears to check for parasitemia and blood samples to check for antimalaria antibodies by indirect immunofluorescence (IIF). The placenta was not examined. Clinical signs of malaria (fever, splenomegaly, anemia and jaundice) were absent in all mothers and children and 88 of the 90 children had normal birth weights. Plasmodium falciparum was the only parasite detected, with 49 of the 90 mothers and 12 of the 90 newborns having positive blood smears. Serological tests detected the presence of antimalaria antibodies in 73 of the 90 mothers (81.1%) and 68 of the 90 newborns (75.5%). Thus, we found no cases of congenital malaria with clinical signs in this study, despite the high frequency of parasites and antimalaria antibodies. The reasons for this absence of cases of congenital malaria with symptoms are discussed.

[Paul-Louis Simond and the Marchoux mission in Brazil]. / Paul-Louis Simond et la mission Marchoux au Brésil.

In 1900 the role of a particular mosquito called Stegomyia fasciata in the transmission of yellow fever was proved by a board of American medical officers. This discovery was the beginning of several scientific missions in South America, mostly in Brazil. As yellow fever was increasing in its West African colonies, the French government decided to send a scientific mission to Rio de Janeiro, to find new ways of prevention against the disease. Under the authority of the Institut Pasteur, Paul-Louis Simond, who had just discovered the role of the flea in the transmission of plague, was designated to carry through this mission together with Emile Marchoux and Alexandre Salimbeni, eminent Pasteurians like him. From November 1901 to May 1905, the three men studied the epidemiological and clinical aspects of the disease in Rio. They worked on the intermediate host's entomology, the Stegomyia female mosquito, improving the knowledge of yellow fever and its means of transmission. They also realized experiments on 25 healthy volunteers, submitting them to the bite of infected mosquitoes. They were among the first to proceed to yellow féver vaccinations by means of virulent serum heated to 55 degrees C or filtered. Their work led to the establishment of new sanitary rules to prevent the spread of the disease. This contributed to the success of the "yellow fever campaign" initiated by Oswaldo Cruz in the town of Rio. One of the most original contribution of their studies was to show that the yellow fever agent (which was still unknown) could be transmitted from an infected female Stegomyia to its eggs and larvaes. After this mission, the French authorities were able to fight yellow fever efficiently in their African colonies as well as in the West Indies and French Guyana.

[AS heterozygote hemoglobinopathy and coronary risk]. / Hémoglobinopathie hétérozygote AS et risque coronaire.

There have been several reports of vaso-occlusive events and sudden death in subjects with sickle cell trait. However, the precise mechanism underlying these episodes remains unclear. The clinical observations have been supported by in vitro studies in which haemoglobin AS (Hb AS) red cells showed abnormalities of their filterability, probably related to gelling or polymerisation of the Hb AS. These in vitro studies and reports in the literature of sickle-cell hearts led the authors to investigate the possible association between AS subject and coronary risk. The results of coronary angiography in 9 patients with Hb AS, paired with respect to the usual cardiovascular risk factors, were compared with those of 18 AA subjects. The number of patients who underwent coronary bypass surgery for three-vessel disease was much greater in the AS subjects. However, the difference was not statistically significant. This tendency of AS subjects to develop thrombosis and coronary artery disease requires further study with larger numbers of patients.

Postpartum cardiac failure in Sudanese-Sahelian Africa: clinical prevalence in western Niger.

Postpartum cardiac failure (PPCF) is the most frequent clinical form of heart failure in hospitalized women in Sudanese-Sahelian Africa. We have previously studied this disease in a hospital setting. Although the incidence is relatively high in rural areas, no systematic field study has been carried out. In this report, we describe a retrospective study conducted in the western part of Niger in July-August 1991. Sixty-two villages were visited and a thorough search for patients was initiated (from a population of 79,941 inhabitants, 19,941 females 14-40 years of age, corrected census of 1988). Twenty-eight patients from 27 villages were included. The subject patients were those presenting with predefined symptoms (dyspnea and cough) and physical signs (edema of the legs) of congestive heart failure during the six-month period following delivery. Apart from arterial hypertension and previous PPCF, diagnosis of another cardiac disease was an exclusion criterion. The prevalence of PPCF was 1.40 per 1,000 females of child-bearing age. The clinical profiles of these cases were in accordance with those of a previous study in 1989 carried out at Niamey Hospital. These results were a mean +/- SD age of 28 +/- 7 years, multiparity (mean = 4 children), poor socioeconomic status, postpartum ablutions with hot water, and a high sodium intake. This is the first study on the clinical prevalence of PPCF in a Sudanese/Sahelian population living in a rural area.

PIP: A descriptive retrospective study conducted in 62 villages in Western Niger in July-August 1994, examined the prevalence of postpartum cardiac failure (PCF). This condition, the most frequent clinical form of heart failure in hospitalized women in Sudanese-Sahelian Africa, has not previously been investigated in a field study. Meetings with village leaders were used to identify women who had just given birth and those who were ill. Through this method, 60 ill women who had given birth in the preceding 9 months were identified. PCF was diagnosed in 28 of these women from 27 villages on the basis of predefined symptoms (dyspnea and cough) and physical signs (edema of the legs) of congestive heart failure during the 6 months after delivery. The prevalence of PCF was 1.40/1000 women of childbearing age; likely an underestimate since the field identification criteria did not take into account women who had already died. The mean age of identified patients was 28 years, with a mean parity of 4. Low socioeconomic status, postpartum ablutions with hot water, and a high sodium intake were common in these women. A comparison of 17 clinical and epidemiological factors in this series with those of 66 patients who previously had PCF confirmed at Niamey National Hospital did not reveal any significant differences in the incidence of symptoms between the 2 groups, although functional discomfort was more severe in the hospital study. Untreated cardiac failure is usually a fatal disease. Timely identification of PCF is hindered, however, by well-tolerated symptoms.

Nutritional status and plasma trace elements in peripartum cardiomyopathy. A comparative study in Niger.

BACKGROUND: Peripartum cardiomyopathy is a frequent condition of unknown origin in Sahelian West Africa. OBJECTIVE: To identify the nutritional and trace-elements status, plasma concentrations of albumin, pre-albumin (trans-thyretin), retinol binding protein, copper, selenium and zinc were assayed in 35 African women living in a Sahelian area, hospitalized in the Hôpital national, Niamey (Republic of Niger) with peripartum cardiac failure due to peripartum cardiomyopathy. METHODS: Plasma albumin was assayed by an automatic method; pre-albumin and retinol binding protein by radial immunodiffusion (Mancini's method); and plasma copper, selenium and zinc by neutron activation and particle-induced X-ray emission. The results were compared with those for a control group of African women living under the same conditions but without peripartum cardiac failure. RESULTS: Plasma albumin and pre-albumin were lower in patients with peripartum cardiomyopathy than they were in controls (P < 0.001). For retinol binding protein, the difference was not statistically significant. The plasma concentrations of selenium and zinc were lower in patients than they were in controls (48 +/- 25 versus 77 +/- 16 ng/ml and 0.90 +/- 0.21 versus 1.17 +/- 0.25 micrograms/ml, respectively, P < 0.001) whereas that of copper was higher (2.03 +/- 0.37 versus 1.23 +/- 0.20 micrograms/ml, P < 0.001). The mean zinc: copper ratio was lower in patients than it was in controls (0.44 versus 0.95). CONCLUSION: Such differences may be aetiological factors or biological consequences of the peripartum cardiac failure due to cardiomyopathy. Nutritional abnormalities may play a role in the pathophysiology of the disease.

Hepatitis B, C, and D virus infections in patients with chronic hepatitis, cirrhosis, and hepatocellular carcinoma: a comparative study in Niger.

Eighty-nine Sahelian African patients with chronic active hepatitis (CAH) (14), cirrhosis (49), hepatocellular carcinoma (HCC) (26), and 47 controls were tested for hepatitis B virus (HBV, hepatitis B surface antigen [HBsAg]) and hepatitis D virus (HDV, anti-HDV antibody). Seventy-three percent of the patients were positive for HBsAg versus 29.8% of the controls (P < 0.0001). With anti-HDV test, 55.0% of the patients were positive versus 17.0% of the controls (P < 0.0001). To assess the prevalence of antibody to hepatitis C virus (HCV), we used an enzyme-linked immunosorbent assay for screening (anti-HCV2): 19.1% of the patients were positive versus 6.4% of the controls (P < 0.05). An association between HBsAg and anti-HDV-positive test results was found in 46.1% of the patients versus 6.4% of the controls (P < 0.0001). A combination of HBsAg and anti-HCV2-positive test results was found in 13.5% of the patients versus 2.2% of the controls (P < 0.05). Anti-HDV and anti-HCV2 test results were positive in 13.5% of the patients versus 2.2% of the controls (P < 0.05). Triple-positive test results (HBsAg, anti-HDV, and anti-HCV2) were found in 11.2% of the patients but in none of the controls (P < 0.025). Triple-negative test results were found in 14.6% of the patients versus 57.4% of the controls (P < 0.0001). The predominant association of the chronic HBV infection with CAH, cirrhosis, and HCC is confirmed in Sahelian Africa. The HDV superinfection (chronic HBV plus HDV infections) may be a major etiology.(ABSTRACT TRUNCATED AT 250 WORDS)

[Septic meningitis in children in Rwanda from 1983 to 1990. Retrospective study at the Kigali Hospital Center]. / Les méningites septiques de l'enfant au Rwanda de 1983 à 1990. Etude rétrospective au Centre Hospitalier de Kigali.

To assess septic meningitis in pediatric units in terms of the bacteriologic distribution, mortality, and groups at risk, we conducted a retrospective study in the pediatric department of the Kigali Hospital Center (Rwanda). Based on bacteriologic study of 1215 cerebrospinal fluid samples, there were 321 cases of septic meningitis due to identifiable germs and 68 involving cloudy fluid with no detectable germs, i.e. 1.5% of admissions to the Pediatric Unit of the Kigali Hospital Center. The most common organisms were pneumococcus (36.5%), Haemophilus influenzae (31%), salmonella (13%), and meningococcus (11.5%). Most of the children (75%) presenting septic meningitis were under the age of 5 years. Overall mortality was 38% with rates of 52% and 39% for cases involving pneumococcus and salmonella respectively. The predominant clinical symptoms of pneumococcus meningitis were coma (p:0.000055) and respiratory compromise (p:0.02). In contrast Haemophilus influenzae meningitis was associated with a lower incidence of coma (p:0.05) and malnutrition (p:0.017). Salmonella meningitis was characterized by a higher incidence of fever over 38.9 degrees C (p:0.025) and malnutrition (p:0.01). In patients with meningococcus meningitis, the incidence of convulsions appeared to be higher, at the threshold of statistical significance (p:0.052), whereas coma (p:0062) and respiratory distress (p:0.0024) were uncommon. Independently of etiology, no clinical symptom was associated with a statistically higher risk for death.

[Peripartum dilated cardiomyopathy. A model of multifactor disease?]. / La cardiomyopathie dilatée péripartum. Un modèle de maladie polyfactorielle?

The peripartum cardiomyopathy is a rare condition in Europe but a very frequent disease in Sahelian Africa. The risk factors are: heat, hard physical exertion during pregnancy, hypertension, sodium diet, ablutions with hot water during the postpartum period, selenium deficiency and probably latent myocarditis (viral?)

A low plasma selenium is a risk factor for peripartum cardiomyopathy. A comparative study in Sahelian Africa.

A specific selenium deficiency is a risk factor for Keshan disease, an endemic cardiomyopathy observed in China. In a Sahelian area of Niger, plasma selenium concentration was measured by neutronic activation and particle induced X-ray emission in 35 black African women with peripartum cardiomyopathy and 36 breast-feeding women without cardiac failure as controls. The plasma selenium concentration in patients was lower (48 +/- 25 ng/ml, mean +/- standard deviation) than in controls (77 +/- 16 ng/ml) (P less than 0.0001). Moreover, 40% (14/35) patients with peripartum cardiomyopathy had very low plasma selenium concentrations, below 45 ng/ml, versus none in controls. A low plasma selenium concentration is a risk factor for the Sahelian peripartum cardiomyopathy.

[Neurologic diseases in Niger]. / Les maladies neurologiques au Niger.

The authors report the results of a study realized at National Hospital of Niamey (Republic of Niger) from october 1981 to may 1986. Among 4820 patients living in Western Niger, 410 (8.5%) had neurological disorders. Out of 16 recognized syndromes 6 constitute 75.2%: comas, paraplegias, cranial nerves palsies, convulsions, hemiplegias and sciaticas. An etiological diagnosis is made in 269 patients. From 15 diseases 4 totalize 73.5%: there are medullar compressions, infections of the central nervous system (bacterial meningitis, cerebral malaria), cerebral vascular disturbances and metabolic encephalopathies. POTT's disease is the most common cause of medullar compression with paraplegia and arterial hypertension is a very important etiologic factor of cerebral vascular attack (42.2 and 44.4% respectively). Parkinsonian syndrome and multiple sclerosis seem rare. The diagnosis of cerebral tumor is very uncommon but this is in relation to the absence of autopsy and of recent investigation (scanner). No case of tuberculous meningitis is noted and this can't be explained by the authors in a major tuberculous endemic area.