Difficultés diagnostiques de la tuberculose cérébrale / Diagnostic difficulties of cerebral tuberculosis

La tuberculose est une des maladies infectieuses les plus répandues dans le monde .Elle représente un problème de santé publique majeur dans les pays en voie de développe ment, y compris l'Algérie . À l'échelle mondiale et parmi tous les cas de tuberculose, l'OMS rapporte 14 % de tuberculose extra-pulmonaire (TEP) sans atteinte pulmonaire concomitante. Dans notre pays et durant ces dernières années, une recrudescence de la tuberculose extrapulmonaire a été observée. L'objectif de cet article était de présenter un cas atypique de tuberculose cérébrale dont le diagnostic a été tardif, posé par l'examen anatomopathologique avec une revue de la littérature. C'est le cas d'une jeune patiente hospitalisée dans le cadre de l'urgence pour un syn drome d'hypertension intracrânienne avec troubles neurologiques. La tomodensitomé trie cérébrale a objectivé de multiples localisations cérébrales avec une hydrocéphalie active. Le bilan d'extension était sans anomalie. La patiente avait bénéficié d'une inter vention chirurgicale, les suites opératoires ont été favorables. L'examen anatomo-pa thologique était en faveur d'une lésion inflammatoire spécifique granulomateuse faite de larges plages de nécrose caséeuse. La patiente a répondu au traitement antituber culeux. Le problème diagnosticque et les résultats seront discutés avec une revue de la littéra ture. La tuberculose cérébrale est une forme rare de la tuberculose extra-pulmonaire. Le tableau clinique ainsi que la neuro-imagerie (TDM, IRM) sont atypiques. Le diagnostic était postopératoire, reposant sur l'examen anatomopathologique. Le pronostic dépend de la précocité du diagnostic, du siège de la lésion et de la réponse au traitement antituberculeux.

Tuberculosis is one of the most widespread infectious diseases in the world. It constitutes a major public health problem, especially in developing countries, including Algeria. Globally and among all tuberculosis cases, WHO reports 14% extra-pulmonary tuberculosis (EPT) without concomitant pulmonary involvement. In our country and in recent years, an upsurge in extrapulmonary tuberculosis has been observed. The objective of this article was to present an atypical case of cerebral tuberculosis whose diagnosis was late, made by anatomopathological examination with a review of the literature. We report the case of a young patient hospitalized in emergency for an intracranial hypertension syndrome with neurological disorders. Cerebral computed tomography revealed multiple brain locations with active hydrocephalus. The extension assessment was without anomaly. The patient underwent a surgical intervention, the operative consequences were favorable. The pathological examination was in favor of a specific inflammatory granulomatous lesion made up of large areas of caseous necrosis. The patient was cured under anti-tuberculosis treatment. The diagnostic problem and the results will be discussed with a review of the literature. Cerebral tuberculosis is a rare form of extrapulmonary tuberculosis. The clinic as well as the neuroimaging (CT, MRI) are atypical. The diagnosis is postoperative, based on the pathological examination. The prognosis depends on the early diagnosis, the site of the lesion and the response to anti-tuberculosis treatment.

Pattern of neurological disorders managed in neurology clinics in Kano, Nigeria

To determine the pattern of neurological disorders managed in some neurology clinics in Kano, Nigeria. Materials and Methods: A five-year retrospective descriptive survey (2016-2020) of patients with neurological disorders attending neurology out-patient clinics at three selected hospitals in Kano metropolis. A research proforma was used to collect information on socio-demographic and health characteristics of the participants. Case folders and outpatient registers were used as a source of information about the patients. Data obtained was analyzed using IBM Statistical package for social science (SPSS) version 20 and results presented using descriptive statistics of frequency and percentage. Results: Out of the 433 cases with neurological disorders surveyed, 58% were adult and 42% were pediatric. Males (54.3%) were found to be more affected. Majority (83.4%) of the participants were from an urban area, with married (79.7%) individuals mostly affected. Stroke was the most prevalent (33.7%) neurological disorder. Hypokinesia (5.1%) and hyperkinesia(3%) as a primary and secondary movement disorder respectively were the most prevalent forms of movement disorder. Psychotic symptoms, weakness, paresthesia, fever, vomiting and convulsion were the most common manifestations that comes with the neurological disorders. Of the common neurological disorders, stroke was most associated with motor (56.2%), sensory (36.4%) and psychiatric (43.5%) manifestations. Conclusion: Paediatric age group contributed close to half of neurological disorders. Stroke was the most prevalent form of neurological disorder and most associated with motor, sensory and psychiatric manifestations. Hypokinesia and hyperkinesia had close prevalence and were the most common primary and secondary movement disorders respectively.

COVID-19 complications in a small-town hospital in South Africa

South Africa has experienced three deadly waves of the COVID-19 pandemic with devastating consequences, but little is known about the experiences in small-town hospitals in the country. Between May 2020 and June 2021, author GC treated ~100 confirmed COVID-19 cases. This retrospective case series report describes 10 of these cases, 7 with unusual complications and 3 with sudden death.

Neurologic emergencies in resource-limited settings: a review of stroke care considerations

Background: The current guidelines and evidence supporting acute stroke management have limitations in resource austere environments despite being a leading cause of death worldwide. Developing countries face a rapidly increasing and disproportionate burden of cerebrovascular disease yet differences in setting and resource limitations bring challenges that have a major influence in management options - especially with routine imaging and interventional considerations. In addition; general awareness; diagnosis and management of stroke remain poor.Objectives :To outline current acute stroke management and critical interventions that should be integrated into current practice while highlighting resource-limited care considerations.Methods :A systematic search of Ovid MEDLINE and reference lists of the literature on stroke; guidelines; and acute stroke management including care considerations in resource-limited settings was conducted through March 2014. Recommendations :Within emergency medicine; emphasis should be placed on establishing a robust stroke assessment and care process that is resource appropriate and scalable. Adherence as resources allow to current stroke care guidelines including acute management; stroke center coordination; palliation and resource allocation may improve outcomes. Further research related to resource-limited management is essential. Risk reduction through population-based interventions and early recognition may help to reduce the burden of disease

La thrombolyse dans les AVC a Kinshasa; c'est possible

L'AVC est une urgence absolue Tout deficit neurologique brutal; transitoire ou prolonge; impose l'appel immediat du SAMU centre 15.Le medecin regulateur doit proposer en priorite tout patient ayant des signes evocateurs d'AVC a une UNV Les patients ayant des signes evocateurs d'un AVC doivent avoir tres rapidement une imagerie cerebrale; si possible une IRM; un scanner peut etre realise pour les contre-indications ou en son absence.Apres avis neurovasculaire; et si elle est indiquee; la thrombolyse doit etre effectuee le plus tot (Recommandations HAS 2009). Kinshasa; capitale-province de 10 millions d'habitants; dont la population est exposee aux facteurs de risque de l'AVC; peut; moyennant certains amenagements aux recommandations internationales ci-haut citees; beneficier de la thrombolyse qui a fait ses preuves partout ailleurs

Sequelles du neuropaludisme dans le service de pediatrie du CHU Gabriel Toure (Bamako; Mali)

Introduction :Le paludisme est l'un des rares fleaux de sante publique qui ait traverse les siecles sans perdre de son activite. Il sevit dans la ceinture de pauvrete du monde et represente la maladie parasitaire la plus repandue dans le monde intertropical. La region afro tropicale; qui ne compte que 8 de la population supporte le plus lourd fardeau du paludisme avec 80 90 des cas (200 a 280 millions) dont 90dus a plasmodium falciparum Objectif: L'objectif de cette etude etait d'etudier les sequelles du neuropaludisme dans le service de pediatrie. Materiel et Methode. De Fevrier 2009 a Janvier 2010; nous avons realise une etude portant sur les sequelles du neuropaludisme dans le service de pediatrie du CHU Gabriel Toure. L'etude concernait les enfants de 0 a 15 ans; hospitalises et gardes des sequelles neurologiques apres un neuropaludisme. Resultats: 2230 patients ont ete admis pour paludisme dont 1320 hospitalises pour neuropaludisme. Nous avons recense 92 cas (6;97) de sequelles neurologiques .Il y avait 57 contre 35 filles soit un sexe ratio de 1;63.La tranche d'age de 0 a 5 ans etait la plus representee; soit 67;39.L'hypotonie axiale etait la sequelle. La plus frequemment rencontree (65;22).Elle etait associee a l'aphasie chez trente sept patients (40;22) et a l'hypertonie peripherique chez dix-huit patients (19;57). Sept patients (7;61) sont devenus epileptiques et six (6;52) ont presente une dystonie. La recuperation des sequelles a ete de 50 a court terme et de 73;9

Brain Computed Tomography of Patients with HIV/AIDS before the Advent of Subsidized Treatment Program in Nigeria

Background: The objective is to study intracranial complications of HIV/AIDS using brain-computed tomography in patients who presented with neurological features before the advent of subsidized HIV/AIDS treatment program with highly active antiretroviral therapy (HAART) in Nigeria. Materials and Methods: Retrospective study of patients' records retrieved from radiology and medical records departments of the hospital. The studied patients had HIV/AIDS and presented with neurological features and underwent CT scan. Results: A total of 36 patients who tested positive for HIV and who presented with neurological features suspected to be complications of AIDS were examined with CT scan. They consisted of 24 male and 12 females. The male to female ratio was 2:1. The age of the patients ranged from 27 to 45 years. Seventeen patients (47.2) were aged 30-34 years. Twenty-four patients (60) were single while 12 (40) were married. Twenty-seven patients (75) were infected with HIV 1 and 2; five patients (13.9) were infected only with HIV-1 while four were infected with only HIV-2. Presenting neurological complaints include left hemiplegia 13 (36.1); right hemiplegia 6 (16.7); coma 7 (19.4); memory loss/dementia complex 5 (13.9); convulsion with coma 2 (5.6); left hemi-pariesis with memory loss 2 (5.6); and staggering gait 1 (2.8). The findings in CT scan include infarcts-like lesions 14 (38.9); multiple ring-enhancing lesions 7 (19.4); cerebral atrophy 5 (13.9); multiple nodular lesions 4 (11.1); acute intracerebral hemorrhage 3 (8.3); cerebral hemiatrophy 2 (5.6); and solitary ring-enhancing lesions 1 (2.8). Eight patients with single or multiple ring enhancing lesions were treated with empirical treatment for toxoplasmosis but only three (37.5) made full recovery. Conclusion: Brain CT scan showed extensive structural damages in patients with HIV/AIDS who were not treated with HAART. Out-of-pocket payment for investigations and treatment and absence of HAART could be partly responsible for high rate of advanced disease

Evaluation des manifestations neurologiques et psychiatiques de la trypanosomiase humaine africaine en deuxieme phase dans le foyer de L'Ouham; Republique Centraficaine

La trypanomiase humaine africaine (THAo) demeure encore un reel probleme de sante publique en Afrique. Le diagnostic de la THA est difficile et la maladie est letale sans traitement specifique .Cette maladie evolue en 2 phases ; hemo-lymphatique et neurologique ; De plus ; le diagnostic de l'atteinte nerveuse est difficile aux stades precoces avec le risque soit d'attribuer les traitements neurotoxiques au stade hemo-lymphatique et /ou d'engendrer des rechutes tardives quand le stade nerveux n' a pas ete identifie. Cependant; la nature; la duree les consequences et la liaison des manifestations neuropsychiatriques avec le traitement n'ont jamais ete etudiee precisement; le plus souvent par absences de procedure standardisee d'evaluation. Les auteurs ont effectue un recueil standardise des manifestations neurologiques et psychiatriques au cours de la THA en utilisant des echelles habituelles en clinique de neurologie et de psychiatrie et proposer un canevas de prise en charge afin de proposer des procedures simples et standardisees aux agents de sante des foyers de trypanosomiase. L'anxiete; la depression ainsi que les signes neurologiques ont pu etre depistes avec l'echelle de Goldberg; Minimental Test et le NeuroPsychiatric Inventory

Frequency of Neurological Deficits in Sudanese Lepromatic Patients

"Leprosy has been a major burden on humanity over thousands of years. Perhaps no other disease in the history of mankind has been associated with such a strong social stigma as leprosy. Failure in early detection often leads to severe disability in spite of eradication of mycobacteria at a later date. Untreated the disease is progressive and results in permanent damage to the skin; nerves; limbs and eyes. Objectives: To study the pattern of neurological manifestations among adult Sudanese leprosy patients seen in Khartoum Dermatology Hospital in the period from March 2006 to August 2006.Methodology:This is a prospective cross-sectional hospital-based study. Seventy adult Sudanese leprosy patients were studied using simple; direct; standardized questionnaire including history and neurological examination; during the period from March to August 2006. Results: The most common age group affected was 18- 27 years. Male to female ratio was 3:1. Numbness was the most common neurological symptom seen in 77.14. Each of visual disturbance; headache and bilateral ulnar sensory impairment was detected in 7.14. Half of the patients had upper limbs sensory nerve dysfunction while 42.86exhibited sensory nerve dysfunction in the lower limbs. ""Gloves and stoking"" sensory impairment was the most common finding (30) while bilateral lateral popliteal sensory impairment was seen with the same percentage. Bilateral median and unilateral posterior tibial sensory impairment were found in 1.43each. Unilateral radial cutaneous sensory impairment was seen in 2.86. Approximately half (48.57) of the patients had upper limbs motor dysfunction. Bilateral ulnar distribution motor affection was seen in 40. A significant number (41.43) had upper limbs muscle wasting. Impaired olfaction was the most common cranial nerve sign seen in 12.86. Leprosy reactions were detected in 21.43; type 2 reaction in 14.29while type 1 reaction in 7.14. Conclusion:Numbness and limbs weakness were the most common neurological symptoms in leprosy patients. Peripheral nerve sensory impairment was found in half of the patients with ""Gloves and stokes"" peripheral sensory neuropathy being the most common sensory disturbance. Motor dysfunction was found in 48.57. Ulnar and median nerves motor affection was the most common motor dysfunctions. Signs related to cranial nerves involvement were less common. Leprosy reactions were present in one-fifth of the patients."

Prevalence of neurological manifestations of lung cancer among adult sudanese patients

The objective: is to study the prevalence of neurological manifestations among adults Sudanese patients with lung cancer seen in the Radiation and Isotope Centre in Khartoum. Methods: This is a prospective cross sectional hospital based study; conducted at Radiation and Isotope Centre in Khartoum. Sample of 52 adults Sudanese patients with lung cancer were included in the study. The period of the study was from February 2006 to July 2006. Data were collected by self administered questionnaire; this was constructed in sections to address the different aspects of the study as follows: personal data; presentation; physical examination; and investigations. The results: showed that 41 patients were males. Most of the patients were above 50 years of age. Fifty percent of our patients' were from Khartoum state. All of our patients had chest findings except one. The most common symptoms observed were of cranial nerves involvement; headache; limb weakness; numbness; and sphincteric disturbance. More than half of the patients were smokers. Other extrapulmonary manifestations noticed include: clubbing; lymph node enlargement; bone metastasis or fracture; gynaecomastia; superior vena cava obstruction; hepatomegaly; and ascites. Chest X-ray abnormalities showed pleural effusion; consolidation; hilar lymphadenopthy; collapsed lung; and fibrosis in the majority of patients. Most of our patients had adenocarcinoma; followed by squamous cell carcinoma; poorly differentiated carcinoma; and small cell carcinoma. Conclusion: The common neurological manifestations of lung cancer were found to be cranial nerves palsies; followed by lower limbs weakness; numbness; and sphincteric disturbances

Seizure Activity and Neurological Sequelae in Ugandan Children who have Survived an Episode of Cerebral Malaria

Background: Seizures are a common presenting feature in children with cerebral malaria (CM) and neurologic deficits have been described in survivors of CM. However few prospective studies have described the frequency of seizure activity and neurologic deficits in survivors of CM over time. Methods: Eighty-two children aged 3 to 12 years who survived an episode of CM were followed up and monitored for seizure activity and neurologic deficits at discharge; 3; 6 and 24 months. Seventy six children with uncomplicated malaria (UM) and 105 healthy community controls (CC) age 3 to 12 years were recruited as comparison groups and the frequency of seizures in the 6 to 24 month follow-up period was compared in the 3 groups. Results: Cumulative incidence of seizures increased over time in children with CM; with a total of 2 of 76 children (2.6) reporting seizures at 3 months; 3 of 74 children (4.1) at 6 months and 11 of 68 children (16.2) at 24 months (Chi square for trend = 9.36; P=0.002). In contrast; neurologic deficits almost completely resolved over time; occurring in 19 of 76 children with CM (25) at discharge; 2 of 74 children (2.7) at 6 months; and 1 of 68 (1.5) children at 24 months. Conclusions: During the 24 months following a CM episode; neurologic deficits resolve but the cumulative incidence of seizures increases in children with CM. Neurologic impairment after an episode of CM may not be limited to the neurologic deficits seen at discharge

Clinical Complications of Chikungunya Fever in Mauritius

Chikungunya fever; an emerging mosquito-borne viral disease; has affected Mauritius with two recent outbreaks in 2005 and 2006 respectively. A study was carried out in 2007 to describe the clinical complications post-Chikungunya infection. Ethical clearance was obtained for this study. Data collection was carried out in February and March 2007 on a sample of people who had suffered from Chikungunya fever by means of a comprehensive questionnaire. Participants comprised 77 people; there were 41 males and 36 females. Participants ranged from 6 to 69 years. 70 participants experienced persisting joint pains for at least 6 months following the acute phase. Of these; 35 had residual joint complaints after 6 months. 44 participants suffered from psychological sequelae. 10 participants had dermatological sequelae; 6 had iatrogenic complications due to non-steroidal anti-inflammatory drug (NSAID)-induced gastritis; and 3 participants with serologically confirmed Chikungunya fever had neurological manifestations and changes on CT/MRI which could correspond to demyelination. Statistical analysis demonstrated that there was a weak linear relationship between the number of complications and increasing age; there was a significant difference in the number of complications according to gender; females being more affected than males; participants with co-morbidities had more complications and psychological sequelae than previously healthy participants. This study highlights that Chikungunya fever; which causes a significant impact on health in the acute phase; can have significant sequelae months afterwards and this includes psychological sequelae

Epidemiologie de la neurocysticercose en Afrique Noire

La neurocysticercose constitue; quand le parasite est localise dans le systeme nerveux; une affection a signes neurologiques bruyants: epilepsie; convulsion; hydrocephalie. C'est une maladie cosmopolite qui sevit dans les pays en voie de developpement notamment en Afrique Noire ou des zones d'endemie existent. Ce sont les conditions defavorables d'hygiene qui permettent sa propagation. Les donnees epidemiologiques concernant la prevalence de la neurocysticercose sont limitees; et les differentes etudes quoi que difficilement comparables; montrent que l'affection est une cause tres importante de l'epilepsie. Les differentes methodes de depistage pour chaque pays et les facteurs environnementaux et socio-culturels qui influencent son developpement sont passes en revue. Les mesures preventives mises en oeuvre par les differents pays sont egalement rapportees

Accidents neurologiques de la vaccination anticoquelucheuse : a propos de 17 observations

Les sequelles neurologiques et les cas mortels representent tout le danger et la gravite de la vaccination anticoquelucheuse. De l'analyse de 17 observations; le traitement curatif des accidents neurologiques de cette vaccination ne peut etre que symptomatique alors que sa prevention reside dans le respect scrupuleux des contre-indications qui meritent d'etre enumerees: maladie infectieuse aigue; recente ou evolutive; les affections malignes; les cardiopathies decomposees; la nephropathie aigue; le traitement immuno-suppresseur; les antecedents personnels de souffrance aigue ou perinatale; de prematurite ou d'hypotrophie foetale; la survenue des convulsions et/ou d'autres signes neurologiques a la suite d'une vaccination anticoquelucheuse anterieure; les encephalopathies et la comitialite