Apport de l'IRM multimodale dans la prise en charge des tumeurs encéphaliques chez l'adulte à Abidjan / Contribution of multimodal MRI in the management of brain tumors in adults in Abidjan

Dans le monde, le nombre de nouveaux cas de tumeurs encéphaliques était de 14 millions en 2014 avec environ 8 millions de personnes décédées. Objectif: déterminer l'efficacité diagnostique de l'IRM multimodale dans la prise en charge des tumeurs encéphaliques dans notre contexte. Matériels et Méthodes: Etude rétrospective à visée descriptive, multicentrique sur une période de 2 ans allant de février 2017 à mars 2019, dans 2 services de radiologie et 2 services de Neurochirurgie, à Abidjan. Nous nous sommes intéressés àtous les patients ayant réalisé une IRM multimodale pour suspicion d'un processus tumoral encéphalique, et qui ont eu une exérèse chirurgicale suivie d'un examen anatomopathologique de la pièce opératoire. Les examens d'IRM multimodale encéphaliques ont été réalisés selon un protocole standard sur des appareils de 1,5 Tesla, et lus par des radiologues séniors. Nous avons confronté les résultats anatomopathologiques aux diagnostics posés à l'imagerie IRM multimodale.Résultats: Ont été retenu 18 dossiers. On notait une prédominance masculine avec un sex-ratio de 1,57. L'âge moyen était de 42,8 ans avec des extrêmes de 20ans et 61ans et un écart type de 10,75.La corrélation diagnostique entre l'examen anatomopathologique et l'IRM a été de6 sur 7 cas, 4 sur 5 cas, 2 sur 2 cas, 2 sur 2 cas et 1 sur 1 cas respectivement pour le méningiome, le gliome, les métastases, l'adénome hypophysaire, le lymphome cérébral primitif.Conclusion:Les tumeurs encéphaliques dans notre étude, étaient variéeset concernaient la population jeune. Les motifs d'erreur diagnostique étaient essentiellement en rapport avec la variété de présentations des tumeurs à l'IRM et l'expérience récente de nos radiologues sur l'utilisation efficace des séquences avancées.

Worldwide, the number of new cases of brain tumors was 14 million in 2014 with approximately 8 million people dying.Objective: determine the diagnostic effectiveness of multimodal MRI in the management of brain tumors in our context.Methods: Retrospective study with a descriptive aim, multicenter over a period of 2 years from February 2017 to March 2019, in 2 radiology departments and 2 neurosurgery departments, in Abidjan. We were interested in all patients who had a multimodal MRI for suspicion of a brain tumor process, and who had a surgical excision followed by an pathological examination of the surgical specimen. The multimodal brain MRI examinations were carried out according to a standard protocol on 1.5 Tesla devices, and read by seniorradiologists. We compared the pathological results with the diagnoses made on multimodal MRI imaging.Results:18 files were retained. There was a male predominance with a sex ratio of 1.57. The average age was 42.8 years with extremes of 20 and 61 years and a standard deviation of 10.75. The diagnostic correlation between the pathological examination and MRI was 6 out of 7 cases, 4 out of 5 cases, 2 out of 2 cases, 2 out of 2 cases and 1 out of 1 case respectively for meningioma, glioma, metastases, pituitary adenoma, primary cerebral lymphoma.Conclusion: The brain tumors in our study were varied and concerned the young population. The reasons for diagnostic error were mainly related to the variety of tumor presentations on MRI and the recent experience of our radiologists on the effective use of advanced sequences.

Serum levels of Selenium and C-reactive protein in comatose patients with severe traumatic brain injury during the first week of hospitalization: case-control study

Introduction: mortality and morbidity related to traumatic brain injuries still remain high in patients. Many authors reported the importance of Selenium in maintaining the integrity of brain functions. This fact is supported by clinical evidence that therapy with selenium supplementation could help patients suffering from brain disorders like neurodegenerative diseases. The aim of our study was to assess the relationship between Selenium concentration in serum and evolution of comatose patients with severe traumatic brain injury, in the first week of admission, and the correlation between selenium and C-reactive protein.Methods: this case-control study was conducted with 64 comatose patients with TBI, in the Department of Anesthesiology and Reanimation, IbnSina University Hospital and Hospital of specialties in Rabat-Morocco, and healthy volunteers recruited in Blood transfusion center of Rabat. Blood sampling was collected from TBI patients, in the first week (3h after admission and each 48h during one week), and from healthy volunteers one time. Concentration of Se in serum was determined by electrochemical atomic absorption spectrometry. Statistical analysis was performed using Statistical software (SPSS) and the cases and controls were compared using the Mann-Whitney U test. A P-value < 0.05 was considered to be statistically significant.Results: comparison selenium concentration in the first day (D0), third day (D2) and fifth day according to the death and survival statue in patients did not show statistical significance (p > 0.05). Selenium concentration of D0 in patients and Selenium concentration in control group also did not show statistical significance (p > 0.05). Similarly, we did not report a correlation between selenium and C-reactive protein.Conclusion: according to our data selenium and CRP may not play a role in progression of coma state in patients with severe traumatic brain injury

Short-term outcome of operated traumatic brain injury patients for intracranial hemorrhage at Tikur Anbessa specialized teaching hospital (Tasth), Addis Ababa, Ethiopia

Background: Traumatic brain injury is the leading cause of death and disability in people younger than 40 years of age worldwide.Objective: The study primarily aims at assessing the short-term outcome of patients operated for traumatic intracranial hemorrhage.Patients and Methods: This is a hospital based cross sectional study on patients with traumatic brain injury at Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia, between February 2013 and February 2014. Standardized and structured questionnaire was used to collect sociodemographic data. All patients with traumatic brain injury operated following intracranial hemorrhage were included. Glasgow Coma Scale was used to determine the outcome. Difference in proportions was examined using Chi-square test.Results: The study reviewed 91 patients with traumatic brain injury. Their age ranged from 13 to 60 years with a mean (SD) of 32.3 (±12.1). Eighty-seven (95.6%) of the cases were males and 4(4.4%) females and 34(37.4%) of them cases had mild and 30(33%) had severe traumatic brain injury. Acute Epidural Hematoma was seen in 79(86.8%), Acute Subdural hematoma had the highest proportion, 4/11(36.4%), of deaths and it was also significantly associated with unfavorable Glasgow Outcoma Scale at 3 months (p=0.03). Overall, the proportion patients who died was 18.7% with older patients (>50 years) had a significantly higher proportion of death (p=0.01). Most of the patients had favorable Glasgow Outcoma Scale ,unfavorable was seen in 22/30 (73.3%) and 17/30 (56.7%) of patients with severe traumatic brain injury at 3 and 6 months, respectively.Conclusion: In conclusion, male predominance was substantially high. Acute Subdural hematoma and old patients had high death rates and unfavorable outcome. Overall the death rate was not different from global figures

The Effects of Fatigue and the Post-Concussion Syndrome on Executive Functioning in Traumatic Brain Injury and Healthy Comparisons

In this study; behavioural manifestations of compromised executive control; including perseveration and reduced inductive reasoning; on the Wisconsin Card Sorting Test (WCST) were investigated. Performance was affected by fatigue in both a head-injured and matched population; which has implications for health care professionals involved in rehabilitation and assessment. A fatigue condition was manipulated for 15 moderate to severe traumatic brain injury (TBI) individuals through the course of a three-hour neuropsychological testing session. A comparison sample of 15 participants in a group of 'no history of TBI' was fatigued through the same approach. All fatigued participants (with and without TBI) displayed trends towards increased levels of perseveration and reduced inductive reasoning on the WCST. Thus; the effects of fatigue on high-level functioning are pervasive even when not head-injured. This finding supports the sub-optimal performance in cognitive skills; specifically in executive control; that is often found in fatigued people. These findings are relevant for the manner in which rehabilitation interventions and medico-legal assessments are structured. Importantly; the order of tests; their interpretation and rest sessions should be clearly indicated and interpreted in assessment reports and rehabilitation sessions

Oxidative Stress Following Traumatic Brain Injury: Enhancement of Endogenous Antioxidant Defence Systems and the Promise of Improved Outcome

Background: Management of brain injury can pose enormous challenges to the health team. There are many studies aimed at discovering or developing pharmacotherapeutic agents targeted at improving outcome of head-injured patients. This paper reviews the role of oxidative stress in neuronal loss following traumatic brain injury and presents experimental and clinical evidence of the role of exogenous antioxidants as neuroprotectants. Method: We reviewed published literature on reactive oxygen species and their role in experimental and clinical brain injuries in journals and the Internet using Yahoo and Google search engines. Results: Traumatic brain injury causes massive production of reactive oxygen species with resultant oxidative stress. In experimental brain injury; exogenous antioxidants are useful in limiting oxidative damage. Results with clinical brain injury are however more varied. Conclusion: Oxidative stress due to excessive generation of reactive oxygen species with consequent impai rment of endogenous antioxidant defence mechanisms plays significant role in the secondary events leading to neuronal death. Enhancement of the defence mechanisms through the use of exogenous antioxidants may be neuroprotective; especially the agents can penetrate cell membranes; are able to cross the blood-brain barrier and if they are administered within the neuroprotective time window

Decompressive Craniectomy Following Brain Injury: Factors Important to Patient Outcome

Background: Decompressive craniectomy (DC) is often performed as an empirical lifesaving measure to protect the injured brain from the damaging effects of propagating oedema and intracranial hypertension. However; there are no clearly defined indications or specified guidelines for patient selection for the procedure. Aims: To evaluate outcome determinants and factors important in patient selection for the procedure. Methods: We reviewed the literature on DC; including single case reports and reported case series; to identify factors affecting outcome following the procedure; as well as its pitfalls and associated complications. Results: Glasgow coma score of 8 and above; age less than 50 years and early intervention were found to be among the most significant determinants of prognosis. Conclusion: Improving patient selection for DC may be expected to further improve the outcome following the procedure in severely brain-injured patients

Traumatic Brain Injury in Pediatric Age Group: Predictors of Outcome in Pediatric Intensive Care Unit

Objective: To determine predictors for outcomes of traumatic brain injury (TBI) in infants and children younger than twelve years admitted to our pediatric intensive care units (PICU).Methods: This is a retrospective cohort study from 2004-5; done at the PICU of King Fahad Hofuf Hospital; Eastern Province; Saudi Arabia. One hundred and six patients with TBI; 65 boys and 41 girls ages 12 or under; with a mean age of 5.7 years; were included. Of them; 11.3died (Deaths group); 11survived with neurological deficits (ND-group); and 77survived with no neurological deficits (NND-group). The potential predictors for death or neurological deficits were examined.Results: 83of deaths had initial Glascow coma scale (GCS) of = 4/15; 50of ND had initial GCS = 8 and 27of NND had GCS 12. The initial brain CT was abnormal in 92of deaths and ND groups; but in only 37of NND. Combined brain pathologies were found in 92of deaths; 63of ND and only in 5of NND. Hypotension was seen in 67of deaths; 17ND and only in 1of NND. Mechanical ventilation was required in all deaths and more than half of ND. Liver enzymes were high in 50of deaths and 66of ND but in only 20of NND. Serum albumin was low in 33of deaths; 42of ND and only 1NND.Conclusion: Glasgow coma score; brain CT findings; combined brain pathologies; hypotension; high liver enzymes and low serum albumin predict outcome after TBI in pediatric age group

Adolescents' Experience of a Parental Traumatic Brain Injury

This study explores the experiences of four adolescents; each living with a parent who has sustained a traumatic brain injury; against the theoretical backdrop of existential-phenomenological psychology. In-depth interviews were conducted and analysed within the context of the existential phenomenology; in an attempt to gain a deep understanding of the psychologically complex themes and patterns embedded in the experience. The phenomenon of parental traumatic brain injury was characterised by denial; anger; grief; guilt; anxiety; over-protectiveness; social isolation; and change in many areas of the participants' lives. The adolescents coped using both approaches and avoidance styles of coping. Religion was a theme in the lives of all four adolescents. Despite the professed negative impact of the experience of having a traumatically brain-injured parent; the adolescents in the current study managed to find some degree of positive meaning in having to cope with such a traumatic event and its consequences. The results are interpreted within an existential-phenomenological psychology framework

Scientific Letter : Profile of Children Diagnosed with Cerebral Palsy at Universitas Hospital; Bloemfontein; 1991-2001

Cerebral palsy is a term used for a group of non-progressive but often changing motor deficits; which are a result of a lesion of the brain occurring at an early developmental stage