Complications de l' epaule de l'hemiplegique vasculaire : prevalence et facteurs associes au sein d 'une population de cerebroleses vasculaires au Chu d'Abidjan (Cote D'ivoire)

Objectif Evaluer la fréquence des complications de l'épaule de l'hémiplégique vasculaire et identifier les facteurs associés à ces complications Méthodes C'est une étude prospective réalisée entre Juin et Octobre 2005 au Centre hospitalo-universitaire de Cocody (Abidjan, Cote d'Ivoire). Elle concerne des patients admis en consultation de rééducation fonctionnelle (RF) ou en hospitalisation de neurologie.Résultats Cinquante patients âgés en moyenne de 56,6 ± 13,4 ans (extrêmes de 29 et 85 ans) avec un sexe ratio de 1,17 en faveur des femmes, recrutés le plus souvent en RF (60%) ont été inclus dans cette étude. Ils avaient un accident vasculaire cérébral (AVC) principalement ischémique (72%), qui évoluait en moyenne depuis 11,3 ± 12,9 semaines. Parmi eux 28 (56%) avaient une complication de l'épaule qui était : une douleur (DL, n=25), un syndrome épaule-main (SEM, n=10) ou une subluxation (SUB, n=18). Ces complications étaient associées dans 46,4% des cas. Ces patients étaient plus âgés, avaient un AVC plus ancien, un index moteur du membre supérieur plus faible mais un niveau d'autonomie globale semblable à celui des patients sans complications. Ni l'âge, ni la durée d'évolution de l'AVC n'était différent selon le type de complication diagnostiqué. La fonctionnalité était associé à la SUB (dans 72,2% des SUB le Frenchay arm test était égal à 0 vs 37,5% chez les patients sans SUB p=0,02) tandis que le tonus des adducteurs du bras était associé à la DL (dans 40% des DL le tonus des adducteurs était égal à 1 vs 84% chez les patients ne présentant pas de DL p=0,006).Conclusion L'épaule douloureuse de l'hémiplégique est donc une complication fréquemment retrouvée dans notre étude. Des études ultérieures seront utiles pour conforter la fréquence de ces complications, l'impact des différents facteurs qui semblent s'y associer et analyser les possibilités de prise en charge tant curative que préventive dans notre milieu

Influence of terrain on metabolic and temporal gait characteristics of unilateral transtibial amputees.

The difficulties confronted by amputees during overground walking are rarely investigated. In this study, we evaluated, in real-world situations, the influence of ground surface on walking in young, active amputees by measuring temporal and spatial gait parameters (free walking speed [FWS], step length [SL], step rate), energy expenditure (EE) (e.g., oxygen uptake, oxygen cost [O(2)C]), and Rating of Perceived Exertion (RPE). Ten active transtibial amputees and ten nondisabled control subjects walked at self-selected speeds on three types of ground surface (asphalt, mown lawn, and high grass). No significant differences were observed between the two groups on asphalt and mown lawn. Differences between nondisabled subjects and amputees occurred for FWS (p = 0.03) and O(2)C (p = 0.04) on asphalt and mown lawn and for all variables in high grass. When amputees (even though very active) were exposed to a particularly difficult environment, their FWS decreased (p = 0.008) and their EE and RPE increased (p = 0.005) compared with nondisabled subjects. In high grass, both groups reduced their self-selected speeds (-15% for control subjects and -16% for amputees). Control subjects reduced their velocity by reducing both SL (-8.7%) and cadence (-7.1%), whereas amputees reduced their velocity by reducing SL (-17%) only.

[Tuberculosis and stroke: case report and literature review]. / Tuberculose et accident vasculaire cérébral: un cas et revue de la littérature.

UNLABELLED: Tuberculosis remains a public health problem in Côte-d'Ivoire, a sub-saharan region country, where infection with a prevalence of 2-10% increase tuberculosis incidence assesed to 290 per 100,000 habitants. Authors report a case of a ischemic stroke (IS) and unknown HIV and tuberculosis infection; discuss these infections responsibility in the occurrence of this IS and past neurological signs. The patient presented with a left hemiparesis without infectious sign nor drowsiness. Medical history noticed a weight loss and two months ago a completely regressive tetraparesia. CT cerebral scan didn't found other sign than a IS located in the right middle cerebral artery territory as describe in the literature. The cerebrospinal fluid (CS) blood cell count was high and Mycobacterium tuberculosis (MT) was found at direct exam. Positive HIV blood serology and MT where noticed at direct spit smears without chest radiograph lesion. After MT six month treatment progresses was good with no MT in CS and spit smears. Because of financial problems HIV treatment was unitialized at this time and MT was prolonged to 12 months. Literature point out different forms sometimes associated of intracranial tuberculosis (meningitis, hydrocephalus, tuberculoma, milliary, abscess, empyema). MT at direct exam was scarce, in spite of news biological methods MT diagnosis can be difficult and need a biopsy or a test treatment. Arachnoid's enhancement is frequent but MT can be misdiagnosed by CT scan which is sometimes less efficient than IRM. CONCLUSION: This case argue that tuberculosis may be evocated as a stroke aetiology especially in presence of HIV infection even if some cardiovascular risk factors are present.

[Causes of encephalopathy: descriptive study at Abidjan (Cote-d'Ivoire)]. / Etiologies des encéphalopathies: étude descriptive à Abidjan (Côte d'Ivoire).

OBJECTIVE: Assess the etiology and course of cases of encephalopathy seen in the neurology department of the Cocody University Hospital in Abidjan (Côte-d'Ivoire), a city of more than three million inhabitants. METHODS: Retrospective analysis of patients admitted to the hospital neurology unit from 1 December, 1998, through 31 December, 2000; with a lesion of the brain, brainstem, cerebellum or meninges. Lesions were either confirmed by computed tomography or clinically obvious; MRI was unavailable. RESULTS: Overall, 1011 subjects met the inclusion criteria: 58% were male; their median age was 45 years (range: 1 to 93 years); more than 40% were not working, and 92% had a medical history. The etiology was vascular (445), infectious (380) or undetermined (125); rare cases were degenerative (5) or traumatic (4). Of 35 cases of metabolic encephalopathy, half were associated with another etiology. Pathological confirmation of cerebral tumors (22) was unavailable. All cases of toxic encephalopathy (11) involved adults and alcohol. Global lethality was 26% and did not differ significantly according to whether or not the etiology was identified (26% vs 28.8%). Another 13% were lost to follow-up (left without discharge), and 61% patients recovered and were discharged after a median hospitalization of 12.5 days. CONCLUSION: The proportion of cases with an undetermined etiology is worrisome. Better knowledge would be useful to develop indicators to evaluate improvements in the medical management of these diseases.

Transcranial magnetic stimulation for diagnosis of residual limb neuromas.

OBJECTIVE: To analyze the mechanism and examine the potential diagnostic contribution of transcranial magnetic stimulation (TMS) in diagnosing painful, clonic, and/or autonomic manifestations in amputees' residual limbs. DESIGN: Prospective study. SETTING: Regional rehabilitation institute at a medical school in France. PARTICIPANTS: Thirty-four amputees (24 with myoclonus, stump pain, or trophic skin disorders; 10 controls with no stump symptoms). INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: TMS performed before and after correcting prosthesis adaptation. RESULTS: TMS induced pain in 12 amputees, clonic manifestations in 4, and autonomic manifestations in 2. Twelve patients underwent magnetic resonance imaging that showed neuromas in all 12. After neuroma resection in 9 amputees, TMS no longer provoked abnormal manifestations. TMS did provoke abnormal manifestations after resection in 3 patients who had postoperative recurrent neuromas. The response to TMS was negative in subjects with a clinically silent neuroma (n=7). The response was also negative in all patients with other stump anomalies whose clinical manifestations fully regressed after conservative treatment. There was a highly significant correlation between the presence of a pathologic neuroma and TMS-induced abnormal manifestations (P<.0001). CONCLUSIONS: TMS can provoke symptoms in patients who experience spontaneous or evoked symptoms related to a neuroma. Induced symptoms are proportional to spontaneous symptoms. Removing the neuroma can stop stump symptoms and reverse the TMS effect. The response to TMS was negative in the control subjects with clinically silent neuromas; conservative treatment was successful in these cases. TMS-induced abnormal manifestations underlying mechanisms are discussed (ephaptic transmission in neuromas).

Eye movements and verbal reports in neglect patients during a letter reading task.

OBJECTIVES: To study different typolologies from visuo-verbal behavior concerning the arrest and the treatment of visual information in patients with spatial hemineglect. METHODS: Ocular movements were monitored by photo-oculography in thirty controls and twenty-three patients with neglect. During a letter reading task, the movements, number of entries into predetermined zones of the visual field, time spent in each zone, and the verbal responses were recorded. Four profiles may be anticipated for such trials: normal scanning and reading (S+R+), normal scanning without reading (S+R-), absence of both scanning and reading (S-R-), abnormal scanning with reading (S-R+). RESULTS: The letter projected in each of the 4 quadrants was scanned and correctly identified by all of the controls with no differences in scanning times. Among patients, the 4 possible behavior patterns were found along with differences in exploration duration per zone (p < 0.05) and number of times specific zones were attained (p < 0.05). CONCLUSIONS: Our results confirmed the heterogeneity of the mechanisms of neglect and suggest that rehabilitation procedures adapted to each profile might be useful.