[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.

[Intra-hospital and three-month outcomes of patients with cerebral venous thrombosis in the department of neurology in Befelatanana, Madagascar: a retrospective cohort study]. / Evolution intra-hospitalière et à trois mois des thromboses veineuses cérébrales auprès du service de neurologie de Befelatanana, Madagascar: une étude de cohorte rétrospective.

The prognosis of cerebral venous thrombosis (CVT) is much better than that of cerebral artery (CAI) infarct. The purpose of this study is to describe intra-hospital and three-month outcomes of patients with CVT in the Department of Neurology of Befelatanana as well as the role of anticoagulants in the management of patients with CVT, without and with haemorrhagic suffusion. We conducted a retrospective cohort study of patients with CVT from January 01, 2014 to December 31, 2019 (72 months). Patients´ clinical characteristics and their intra-hospital and three-month outcomes data were collected. Data were analyzed using the R software, by comparing data of patients with CVT, with and without haemorrhagic suffusion and with a significant p ≤ 0.05. We recorded 21/4227 (0.49%) cases of CVT, of whom 11 (52.38%) had CVT with haemorrhagic suffusion. The average age of patients was 38.05 years. The age group 18-34 years (47.62%) was most represented. Women were the predominant gender (76.19%; n=16). On admission, NIHSS score < 10 was found in 85.71% of patients (n=18) and mRS score < 3 was found in 61.90% of patients (n=13). All patients were receiving anticoagulants. Upon discharge from hospital, NIHSS score < 10 was stable (90.47% (n=19)) with an increase in patient with mRS score < 3 (85.71% (n=18)), of whom 3 were in the haemorrhagic suffusion group. The average hospital stay was 16.04 days. One patient in the group without haemorrhagic suffusion died during hospitalisation. At 3 months after discharge, only 9 patients were reachable. Their neurological status improved (NIHSS score < 10 in 100% (n=9) of patients, mRS score= 0 in 88.89% (n=8) of patients). No statistically significant differences were found between the two groups in terms of disability (p=0.757), with a relative risk (RR) of 0.91 CI [0.04; 6.55] and of death (p=0.282) (0 deaths in a group) between the two groups receiving and not receiving anticoagulants. Mortality and disability in patients receiving anticoagulants during the evolution of CVT are very low. The availability of a low-cost brain CT angiography could allow better management of CVT in our Neurology Department.

[Multiple hemorragic brain lesions revealing metastatic melanoma]. / Lésions cérébrales hémorragiques multiples révélatrices d'un mélanome métastatique.

Nearly 75% of patients with metastatic melanoma develop brain metastases. We here report the case of an 83 year-old woman hospitalized for secondarily generalized clonic seizures of the left leg with partial convulsive seizures in the Resuscitation Department. Melanoma resection of the left ankle had been performed 6 months before her admission. Neurological examination showed left ataxic crural monoparesis. Electro-encephalogram showed central and right frontal focus with left-sided dissemination. Gadolinium-enhanced magnetic resonance imaging (MRI) of the brain showed multiple supratentorial and subtentorial encephalic lesions with varying size and shape, with T1 hypersignal (A and A'), haemorrhage on T2*-weighted sequences (B and B'), gadolinium-enhancing T1 with perilesional edema on Flair sequences. Positron emission tomography (PET) showed multiple lymph node and bone metastases. Lymph node biopsy was negative for VE1 antibody with no BRAFV600E mutation by immunohistochemistry. An increase in the number of metastatic lesions was observed during control brain CT scan despite 10 brain radiotherapy sessions motivating palliative care. Epileptic seizures were controlled with levetiracetam. In patient with multiple hemorrhagic and spontaneous brain lesions, it is essential to obtain informations on patient's history of melanoma and to perform a thorough dermatologic examination in order to investigate its cause and to establish adequate therapeutic treatment.

[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.