Survival within 12months after stroke in Madagascar.

The data on the long-term prognosis of stroke are scarce in Madagascar. Our objective was to determine survival within 12months after a stroke event. A longitudinal study was carried out on a hospital cohort of subjects with stroke in Mahajanga in western Madagascar. We included in the study all subjects admitted to adult emergencies at Mahajanga University Hospitals during the year 2019 and diagnosed with stroke. A follow-up by telephone call or by descent at the home of the patients was carried out after at least 12months from the onset of the disease. We analyzed in-hospital mortality and survival within 12months after the stroke. At the end of the study period, 144 stroke cases were retained. Strokes accounted for 5.07% of emergency admission causes. Male gender accounted for 51.4% of the population. The average age of the subjects was 60.7years. In-hospital mortality was 32.6%. Survival at 1month was 50%, at 3months 48.4%, and at 12months 43%. High blood pressure was found as a risk factor for stroke in 79.9% of patients, 76.5% of whom were undertreated. Stroke mortality was high in our population. Most of the deaths occurred during the first month. Improved prevention and care are needed in Madagascar.

[Frequency and clinico-therapeutic features of patients with status epilecticus hospitalized in the department of neurology of the Bafelatanana hospital, Antananarivo, Madagascar]. / Profil clinico-thérapeutique des états de mal épileptiques dans le service de neurologie de l'Hôpital Befelatanana, Antananarivo: une étude transversale descriptive.

Introduction: Status Epilepticus (SE) is a diagnostic and therapeutic emergency. The purpose of this study was to establish the frequency, the clinical and therapeutic features of patients with SE at the Department of Neurology of Befelatanana. Methods: we conducted a retrospective, descriptive study from January to June 2015. The sociodemographic and clinical features of patients were collected and analyzed on Epi info 7. Results: the study involved 53 patients, 54.71% of whom were epileptic (n=29). There was a predominance of patients under 65 years of age (86.79%). The average age of patients was 43.09 years with a sex-ratio of 1.30. Convulsive SE prevailed in 98.11% of cases (n=52). Generalized convulsive SE occurred in 66.03% of cases. STESS below 3 (77.35%) predominated. There were no epileptic abnormalities on standard EEG within 24 hours in all patients with SE. Non-adherence to antiepileptic therapy (9.43%) and sleep deprivation (18.86%) were reported as a trigger factor of SE. No seizure was reported for up to 72 hours after initiation of treatment in 84,90% of cases. We found no significant association between epileptic or non-epileptic status and STESS (p = 0.302), treatment protocol (p = 0.532), and 72-hour remission of seizures (p = 0.211). Conclusion: SE affects young and epileptic people. Our treatment protocol allowed for crisis remission within 72h in most cases. A validation study about this therapeutic protocol is required.

[Frequency and characteristics of strokes involving the perforating arteries in the Department of Neurology at the Befelatanana General Hospital, Antananarivo]. / Fréquence et caractéristiques des AVC impliquant les artères perforantes dans le Service de Neurologie de l'Hopital Bafelatanana, Antananarivo.

INTRODUCTION: Strokes of the perforating arteries are mainly arteriolopathies. They result in dementia and stroke recurrence. This study aimed to evaluate the frequency and characteristics of these strokes to better prevent these complications. METHODS: We conducted a descriptive, retrospective study in the department of neurology at the Befelatanana general hospital, Antananarivo over the period 01 March-25 September 2015. All patients with abrupt neurological deficit and deep brain involvement on brain scanner were included in the study. The features of strokes involving the perforating arteries were collected. Data were processed with SPSS 20 software. RESULTS: Out of 172 patients with a stroke, 83(48.25%) had stroke involving the perforating arteries. Stroke involving the perforating arteries affected young people (65.06%) aged less than 65 years and preferentially the male population (61.44%). Haemorrhagic forms accounted for 67.46%. Thirty-one patients (37.34%) had stroke recurrences and, among them, almost a quarter had 2 recurrences (38.70%) in less than a year. All patients with recurrence had dysexecutive disorder (p < 0.0001) and poor antihypertensive medication adherence. Mortality accounted for only 6.02% in patients with onset of these strokes during hospitalization. CONCLUSION: Specific neurologic follow-up is necessary after a first stroke involving perforating arteries in order to make an early diagnosis of dementia and to prevent recurrences.

[Broad ischemic stroke revealing infective endocarditis in a young patient: about a case]. / Accident vasculaire cérébral ischémique large chez un sujet jeune révélateur d'une endocardite infectieuse: à propos d'un cas.

Broad ischemic stroke is mainly due to a cardiac embolus or to an atheromatous plaque. In young subjects, one of the main causes of ischemic stroke (broad ischemic stroke in particolar) is embolic heart disease including infective endocarditis. Infective endocarditis is a contraindication against the anticoagulant therapy (which is indicated for the treatment of embolic heart disease complicated by ischemic stroke). One neurologic complications of infective endocarditis is ischemic stroke which often occurs in multiple sites. We here report the case of a 44-year old man with afebrile acute onset of severe left hemiplegia associated with a sistolic mitral murmur, who had fever in hospital on day 5 with no other obvious source of infection present. Brain CT scan showed full broad ischaemic stroke of the right middle cerebral artery territory and doppler ultrasound, performed after stroke onset, showed infective endocarditis affecting the small mitral valve. He was treated with 4 weeks of antibiotic therapy without anticoagulant therapy ; evolution was marked by the disappearance of mitral valve vegetations and by movement sequelae involving the left side of the body. In practical terms, our problem was the onset of the fever which didn't accompany or pre-exist patient's deficit, leading us to the misdiagnosis of ischemic stroke of cardioembolic origin. This case study underlines the importance of doppler ultrasound, in the diagnosis of all broad ischemic strokes, especially superficial, before starting anticoagulant therapy.