Les infarctus cerebraux de petite taille en Côte d'ivoire : Etude retrospective clinique et scannographique de 113 cas

Description : Avec l'avenement de l'imagerie; en particulier l'IRM; le terme de lacunes est parfois employe pour designer des petits infarctus; independamment de la clinique; de la localisation et de l'etiologie. En Cote d'Ivoire le scanner est le seul moyen neuroradiologique disponible pour le diagnostic des accidents vasculaires cerebraux (AVCObjectif : le but de ce travail est d'evaluer l'importance des lacunes en milieu hospitalier ivoirien et de decrire les aspects cliniques et scannographiques de cette forme particuliere d'AVC .) Methodes Il s'agit d'une etude retrospective. Nous avons analyse 113 dossiers recenses dans les trois CHU et les principales cliniques de la ville d'Abidjan de fevrier 1997 a aout 1999. Les donnees concernant les aspects socio-demographiques; les aspects cliniques et le scanner craniocerebral ont ete recueillies sur des fiches d'enquete. Une analyse statistique a ete faite. Nos resultats ont ete compares aux donnees de la litterature.ResultatsLes lacunes representent 13;5des AVC admis en hospitalisation. Les sujets sont ages de plus de 60 ans dans 61;07 des cas. 51; des patients ont presente un deficit moteur pur hemicorporel. L'hypertension arterielle; l'age et le diabete etaient les facteurs de risque les plus frequents. Ces trois facteurs etaient associes dans 80des cas. Le scanner a montre que les lacunes etaient en majorite localisees dans le territoire carotidien (dans 92;5 des cas). Le territoire sylvien representait 78;77 de ces localisations. Les territoires profonds sont atteints avec predilection (61;07). L'evolution clinique a un mois a ete favorable dans 80 des cas.Conclusion Les aspects cliniques et scannographiques sont superposables aux tableaux classiques bien connus dans la litterature. La prevention primaire et secondaire des lacunes par un traitement correct de l'hypertension arterielle et du diabete et par la prescription systematique des antiagregants plaquettaires apres un AVCischemique pourrait avoir une incidence sur la frequence des AVC lacunaires

Widenings of the myelin lamellae in a typical Guillain-Barré syndrome.

The so-called "widening of the myelin lamellae" are thought to be specific ultrastructural features of peripheral nerve myelin in patients with peripheral neuropathy associated with a monoclonal dysglobulinemia of IgM type and antiglycolipid activity. We report here a case of Guillain-Barré syndrome with no evidence of serum monoclonal dysglobulinemia, presenting the typical widenings of the myelin lamellae in small-diameter myelinated fibers from a sural nerve biopsy. In view of the positive reaction with anti-C3d complement on direct immunofluorescence, an immunological mechanism may be involved in the widenings of the myelin lamellae.

Lack of association between peripheral neuropathy and HTLV-I infection in west Africa. Epidemiological, serological and nerve biopsy study.

Patients (n = 1166) with various neurological disorders hospitalized in Dakar, Abidjan, Lomé and Ouagadougou were examined prospectively over a 42-month period. Seropositivity for HTLV-I alone was found to be 1.8%, which is comparable to that estimated for the general population in Africa. Eighteen of the patients with TSP and only 5 with PN were HTLV-I positive, but co-infections were found in 30-40% of cases. Discrete and unspecific lesions were observed on light and electron microscopic examination of peripheral nerve biopsies from 11 patients. Since spastic paraparesis emerges as the disorder containing the largest number of HTLV-I-positive individuals, it may be premature to conclude that HTLV-I is a causal agent in PN. Nevertheless, their rarity and the frequency of retroviral co-infections distinguish these cases of African HTLV-I-associated myelopathy from comparable cases observed in other parts of the world.

[Peripheral neuropathies and hemopathies]. / Neuropathies périphériques et hémopathies.

In our experience, the incidence of an association between peripheral neuropathy and hemopathy is around 7%. The corresponding nerve involvement may reveal or complicate a known hemopathy. The exact cause-effect relationship is not always easy to identify. We discuss here the peripheral nerve complications of acute leukemia, myeloproliferative disorders, monoclonal dysglobulinemia, non-Hodgkin's malignant lymphoma and Hodgkin's disease. The peripheral neuropathy arising in cases of monoclonal dysglobulinemia, non-Hodgkin's malignant lymphoma have most benefited from ultrastructural examination and advances in immunological and immunocytochemical techniques. Accurate determination of the lesional mechanism should help devise appropriate therapeutic strategies.

Human retroviruses HTLV-I, HIV-1, and HIV-2 and neurological diseases in some equatorial areas of Africa.

HTLV-I is associated with tropical spastic paraparesis (TSP) in the Caribbean area and with certain chronic myelopathies termed HAM (HTLV-I-associated myelopathy) in Japan. In order to investigate the situation in Africa, we tested for HTLV-I, but also for HIV-1 and HIV-2 antibodies, 94 patients with epidemic spastic paraparesis (ESP) from Zaire and Tanzania, 26 cases of sporadic spastic paraparesis (SSP) and 21 cases of tropical ataxic neuropathy (TAN), both from Ivory Coast, and 319 unselected neurological patients from Ivory Coast, Congo, and Tanzania. While none of the 94 ESP cases nor any of the 21 TAN patients exhibited antibodies to any retrovirus, 4 of the 26 sporadic spastic paraparesis patients had high HTLV-I antibodies in their sera and cerebrospinal fluid (CSF). Three of those were clinically and immunologically identical to TSP, as observed in persons from the Caribbean region, and the fourth case, a poorly explored chronic pyramidal syndrome, could also represent a TSP. Only one of these four cases originally had HIV-1 antibodies. Among the 319 unselected patients, only 5 (1.6%) had HTLV-I antibodies, but 32 (10%) had HIV-1 antibodies and 14 (4.4%) had HIV-2 antibodies, with a number of combined infections, indicating that retroviruses represent potentially important etiological agents for African neurological diseases.

[EEG and treatment with Arsobal in human African trypanosomiasis]. / EEG et traitement par l'arsobal dans la trypanosomiase humaine africaine.

EEG in patients suffering form HAT at the meningoencephalitis stage displays the characteristic features of the disease. Now since most of the patients are treated at an early stage, the majority of the EEG are normal or with mild abnormalities. Where abnormalities occur, they present a diminished background activity interrupted by bursts of synchronous and generalised polymorphic delta waves at 1.2 c/s. A strict correlation frequently exists between severity of clinical symptoms and the degree of EEG abnormality. These EEG abnormalities disappears very often, after the first period of the treatment by melarsoprol. EEG seems useful to follow the course of the patients treated by melarsoprol.

[Tropical African neuromyelopathies: 61 studied cases in the Ivory Coast]. / Neuromyélopathies tropicales africaines: 61 cas étudiés en Cote d'Ivoire.

Sixty one cases of tropical myeloneuropathies (TNM) from Abidjan, Ivory Coast, are reported. The mean age of patients was 35 years. The socioeconomic level was often very low and puerperality was a common initiating factor. Several clinical forms are noted: pure pyramidal (16 cases), pure ataxic (11 cases), sensory motor polyneuritis (8 cases), combined sclerosis of the spinal cord (1 case), ataxic polyneuritis (25 cases). In fact the extent of the pathobiological process was more severe as shown by slowings of peripheral motor nerve conduction velocities, prolonged central conduction time determined after cortical and spinal stimulations, and a severe sensory axonal impairment on nerve biopsies. These changes were observed with varying degrees in all clinical forms. As long as the etiological factors of TMN are not known (preventing from the possibility to split this disease in several entities) it is preferable to speak about one global disorder and not isolated various clinical forms (e.g. particulary: tropical spastic paraplegia). HTLV-I retrovirus seems to play a limited role in the etiology of TMN in Ivory Coast (1 positive case).

[Primary congestive cardiomyopathies of the adult in a tropical environment: nosologic, diagnostic and developmental data]. / Les cardiomyopathies congestives primitives de l'adulte en milieu tropical: données nosologiques, diagnostiques et évolutives.

The authors describe the cases of 86 black african patients (75 males and 11 females), affected by a congestive primitive cardiomyopathy (CMP), confirmed by echocardiography. Echocardiographic investigation revealed, in all cases, stigmas of a developed CMP: cavitary dilatation, hypokinesia and thinness of walls, offsetting and miniaturization of the valvula mitralis. Pericardial effusion was associated in 20 cases, and thrombosis of left cavities was recognized through bi-dimensional investigation. Angiography and hemodynamics performed in 15 patients pointed out in all cases a significant falling off of the pumping function and the muscular function. Angiography, in 8 cases, displayed a left ventricular cavity distended and hypokinetic, with a moderate mitral incompetency. Evolution was characterized by the following complications: heart failure: 68 cases--systemic thromboembolism: 5 cases--pulmonary embolism: 2 cases--auricular rhythmic irregularity: 20 cases--ventricular rhythmic irregularity: 42 cases--second or third degree atrioventricular blocks: 5 cases. Death rate was 25% (22 patients). Taking into account these 86 cases, the position of the congestive CMP defined among the tropical CMP and its classification studied as well as its echocardiographic and evolutive peculiarities.