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.

Gait and cognitive disorders revealing massive neurocysticercosis: a case report.

Neurocysticercosis is frequent in Madagascar. Its clinical presentations depends on the topography of the lesions. We report a case with gait and cognitive disorders. A 49-year-old man, right-handed, with progressive gait disorders (small steps with magnetization). On examination, he had gait disorders, associated with frontal syndrome with Frontal Assessment Battery (FAB) scale of 10/18, a Mini-Mental Status Examination (MMSE) scale of 24/30, a constructive apraxia and a clock test disturbance. The brain CT scan showed massive lesions of fronto-parietal and temporal neurocysticercosis, meningeal neurocysticercosis with racemose forms. Lesions had different ages associated with a communicating hydrocephalus. Gait disturbance and cognitive function were improved after an evacuating lumbar puncture and cysticidal treatments. This case illustrate the importance of neurological examination in a patient with neurocysticercosis. Neurocysticercosis could be a curable cause of dementia.

Cerebral venous thrombosis associated with infective endocarditis in a young patient.

Cerebral venous thrombosis (CVT) is a rare complication of infective endocarditis. It constitutes a diagnostic and therapeutic emergency. We report a case of cerebral thrombophlebitis due to infective endocarditis in order to discuss the diagnosis and management of this situation. The patient was a 19-year-old man presenting with sudden explosive headaches with meningeal syndrome, right hemiparesis and right hypoesthesia. The cerebral CT angiography showed a left parieto-occipital and intraventricular hematoma without classic aneurysm or mycotic aneurysm or arteriovenous malformation. The injected brain magnetic resonance imaging found a CVT in front of a stopped opacification of the left lateral branch of the superior sagittal sinus. The presence of fever, poor oral status and a heart murmur justified the prescription of transthoracic echodoppler. It showed vegetations on healthy aortic valves. The patient was put on antibiotics and anticoagulants with favorable evolution. The absence of usual risk factors for CVT, the negativity of thrombophilia tests, the inflammatory and prothrombotic state associated with the infection reinforce the causal link of infective endocarditis to CVT formation. The etiology of CVT is variable, can be multiple and requires a comprehensive assessment. Infective endocarditis is one of the rare etiologies of CVT. In this case, anticoagulation and antibiotic drugs are indicated, taking into account the risk of intracerebral bleeding.

[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.

[Clinical course of myasthenia gravis at the department of neurology in Antananarivo Madagascar]. / Evolution clinique de la myasthénie auto-immune en Neurologie à Antananarivo, Madagascar.

INTRODUCTION: myasthenia gravis (MG) is a rare disease affecting the neuromuscular junction. It can lead to a life-threatening condition, especially when it is associated with respiratory failure. Full remission is possible with treatment. Our aims are to describe the clinical course of patients with MG with under treatment, in order to further improve management and to implement a database of patients living in Madagascar. METHODS: we conducted a descriptive retrospective study in the Department of Neurology at the Befelatanana Antananarivo University Hospital Center between January 2010 and December 2017. This study involved all patients diagnosed with MG based on positive prostigmin test. RESULTS: among the 5814 hospitalized patients, 25 (0,42%) were included. Only 16 patients were on follow-up (64%) of whom 14 were receiving medical treatment. Three of them had undergone thymectomy. The mean follow-up period was 24 months. Among treated patients, 8 improved and 2 died. Among thymectomized patients, 2 improved and 1 died. CONCLUSION: myasthenia gravis is a rare but serious disease. Improvement is possible with treatment even in the absence of adequate technical equipment for its management in Madagascar. Currently, a campaign in partnership with Myasthenia Gravis Association in Madagascar is underway for breathing devices useful especially when myasthenic crises occur.

[Frequency and clinical profile of Parkinson's disease and other Parkinsonian syndromes seen in the Department of Neurology at the Befelatanana Hospital Antananarivo]. / Fréquence et profil clinique de la maladie de Parkinson et des autres syndromes Parkinsoniens vus au service de neurologie de l'hôpital Befelatanana Antananarivo.

INTRODUCTION: Currently we have no precise data on the parkinsonian syndromes in Madagascar. This study aims to collect data on these diseases and to describe the frequency and the clinical profile of parkinsonian syndromes in our Department of Neurology. METHODS: We conducted a retrospective and descriptive study in the Department of Neurology, in Befelatanana from January 2014 to June 2018. The demographic and clinical data of patients diagnosed as having a parkinsonian syndrome were collected. We assessed data rates and characteristics and then we compared patients with idiopathic Parkinson's disease and patients with other parkinsonian syndromes. Data were processed using R. software. RESULTS: The study included 104 of 3528 patients, seen in our Department. Among the patients with parkinsonian syndrome, 67(64.42%) had idiopathic Parkinson's disease (PD) and 37 (35.47%) another parkinsonian syndrome. The average interval between the onset of the disease and the consultation or the hospitalization in the Department was 2.5 years. For MP, the median age at onset was 58.5 [23; 80] years, the median age at diagnosis was 62 [28; 83] years and the sex ratio were 1.97. The median Hoehn and Yahr score were 2.0. Tremor-dominant Parkinson's disease was found in 24 (35.42%) of cases, a mixed phenotype was found in 28 (41.71%) of cases while akineto-rigid Parkinson's disease was found in 15 (22.38%) of cases. The other parkinsonian syndromes ocuurred in 27 (72.97%) men, with a median age at onset of 57.5 [26; 83] years, a median age at diagnosis of 59.3 [26; 83] years. Etiologies were dominated by Multiple System Atrophy 17/37 (46.64%). Patients with other parkinsonian syndromes had several cognitive disorders (p=0,0306) and MPs were more sensitive to dopamine (p=0.006). CONCLUSION: The patients with idiopathic parkinsonian syndrome had features different from those of patients with parkinsonism. There was a diagnostic delay as in other developing countries.

[Epilepsy and reproductive health: challenges and prospects]. / Epilepsie et santé de la reproduction: enjeux et perspectives.

Epilepsy complicates a woman's reproductive life. The physiological modification of the woman and the effects of antiepileptic drugs are generally the cause. Several complications may be added during treatment that requires careful monitoring. Antiepileptic drugs mainly cause teratogenic and malformative effects. To minimize these complications, epileptic women should be accompanied at pubertal age, in case of the associated contraception during pregnancy and delivery. Always prescribe antiepileptic therapy as monotherapy, avoiding known teratogenic drugs and preferably old drugs. Joint care by neurologists and gynecologists and obstetricians is more effective. During pregnancy, it is important to put the patient on folic acid. The administration of vitamin K, in late pregnancy and in the neonatal period, is a prevention of perinatal hemorrhagic complications. The choice of breastfeeding is individual because there is no formal contraindication of breastfeeding in epileptics under treatment. Respecting its conditions builds confidence and promotes a reassuring reproductive life for our epileptics.

Fréquence et profil clinique de la maladie de Parkinson et des autres syndromes Parkinsoniens vus au service de neurologie de l'hôpital Befelatanana Antananarivo

Introduction: actuellement nous n'avons pas de données précises sur les syndromes parkinsoniens à Madagascar. Nous voulions rassembler des données sur ces maladies. Alors l'objectif de notre étude étant de décrire la fréquence et le profil clinique des syndromes parkinsoniens dans notre Service de Neurologie.Méthodes: il s'agit d'une étude rétrospective descriptive allant de janvier 2014 à juin 2018 dans le Service de Neurologie, Befelatanana. Les données démographiques et cliniques des patients diagnostiqués comme ayant un syndrome parkinsonien étaient collectées. Nous en avons évalué les fréquences et les caractéristiques puis comparé les patients avec Maladie Parkinson idiopathique et les autres syndromes parkinsoniens. Les données étaient traitées par le logiciel R.Résultats: nous avons retenus 104 patients sur 3528, vus dans notre service. Parmi les patients avec un syndrome parkinsonien, 67(64,42%) avaient une maladie de Parkinson idiopathique (MP) et 37 (35,47%) un syndrome parkinsonien autre. L'intervalle moyen entre le début de la maladie et la consultation ou l'hospitalisation dans le service était de 2,5 ans. Pour les MP, l'âge moyen de début était à 58,5 [23; 80] ans, l'âge du diagnostic à 62 [28; 83] ans et la sex-ratio était de 1,97. La médiane de score de Hoehn et Yahr était de 2.0. Les formes de MP étaient tremblantes dans 24(35,42%), mixte 28(41,71%) et akineto-rigide 15(22,38%) des cas. Pour les autres syndromes parkinsoniens, 27(72,97%) étaient des hommes, l'âge moyen de début était à 57,5 [26; 83] ans, l'âge du diagnostic à 59,3 [26; 83] ans, les étiologies étaient dominées par l'Atrophie Multi-Systématisée avec 17/37(46,64%). Les patients atteints d'autres syndromes parkinsoniens avaient plus de troubles cognitifs (p=0,0306) et les MP étaient plus sensible au DOPAMINE (p=0,006).Conclusion: les patients parkinsoniens idiopathiques avaient des caractéristiques différentes de ceux avec autre parkinsonisme. Il y a avaient eu un retard diagnostique comme dans les autres pays en voie de développement

[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.