Stroke and syphilis: A retrospective study of 53 patients.

OBJECTIVE: The aim of this study was to describe the clinical, biological and radiological characteristics of patients with syphilitic vasculitis, and to assess the outcome after treatment. METHODOLOGY: A retrospective review was carried out based on the records of patients with ischemic stroke, and reactive CSF TPHA and VDRL results. None of these patients showed symptoms of any other diseases or had received high doses of penicillin. RESULTS: A total of 53 patients with stroke met the diagnostic criteria for syphilitic arteritis. Their average age was 41±12 years. Nine patients had a history of genital ulcer (17%), and the median duration of illness after presenting a chancre was 8 [range: 1-14] years. A prodromal syndrome was seen in 27 patients (50.9%) and included changes in mental status in 14 patients (26.4%), seizures in 10 cases (18.9%), headache in eight (15.1%) and memory loss in seven (13.2%). Neurological events included focal motor deficits in 29 cases (54.7%), ataxia in 11 (20.8%) and movement disorders in 15 (28.3%). HIV serology was performed in 31 patients and proved negative in every case. Disease evolution was generally favorable: 12 patients (22.6%) were autonomous at the time of hospital discharge; 29 (54.7%) had partially recovered; and only seven (13.2%) still had signs of severe sequelae. CONCLUSION: A diagnosis of syphilitic stroke should be suspected in young patients as a manifestation of syphilis, and tests for neurosyphilis should be routine in neurology departments to make a prompt diagnosis, thereby preventing psychological sequelae.

[Quality of life and multiple sclerosis: Arabic language translation and transcultural adaptation of "MSQOL-54"]. / Qualité de vie et sclérose en plaques: traduction en langue arabe et adaptation transculturelle du "MSQOL-54".

INTRODUCTION: Quality of life assessment of multiple sclerosis patients in Morocco appears essential, considering the early age of onset and the significant functional, psychological and social impact of disease symptoms and disorders. Our goal was to translate the MSQOL-54 into Arabic followed by cross-cultural adaptation, and validation of the translated version. METHODS: Patients with multiple sclerosis were recruited over a period of 7 months, from February to August 2007. Sociodemographic data and a detailed clinical description (neurological examination, EDSS, MMS) were collected before administration of the questionnaire. The MSQOL-54 was translated and test validation techniques were applied: back translation, revision by a committee of experts, study of acceptability, multivariate analysis, reliability and clinical validity. RESULTS: Seventy-eight patients were included. There were 23 men and 55 women of various ages, various stages of disability (EDSS from 1 to 8.5) and various clinical forms. Evaluation of the 78 completed questionnaires revealed a satisfactory acceptability considering the limited number of missing answers and the average time to complete the test (24 minutes). The reliability and the multimultivariate analysis were excellent (coefficient of Cronbach ≥0.7 with a percentage of convergence and divergence validity around 100%). A very significant relationship was found between physical scores and EDSS. CONCLUSION: Measuring the quality of life is an approach that confirmed its usefulness through this study. We propose a valid Arabic version of MSQOL-54.

[Efficacy and safety of cyclophosphamide treatment in progressive multiple sclerosis]. / Efficacité et tolérance du cyclophosphamide dans le traitement de fond des formes progressives de la sclérose en plaques.

INTRODUCTION: Cyclophosphamide (CPM) is used empirically in the treatment of progressive multiple sclerosis. The purpose of this study was to evaluate its efficacy in naive patients with progressive multiple sclerosis. PATIENTS AND METHODS: Thirty-one patients were retrospectively included (17 secondary multiple sclerosis, 14 primary progressive multiple sclerosis), and received infusions of CPM (600mg/m(2)) every eight weeks, for 18 months. Evaluation was based on time to EDSS progress. RESULTS: Among patients with secondary progressive multiple sclerosis, 94% were stable or improved at six months, 77% at 12 months, and 75% at 18 months. The same result was reported in 69.2% of primary progressive multiple sclerosis at six months, 64% at 12 months, and 55.5% at 18 months. We found no difference between the two groups. CONCLUSION: Our results suggest that the CPM is efficient in progressive multiple sclerosis; however, its place must be reconsidered before establishing an international consensus for treatment; open label studies are needed to validate the present findings.