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.