[Chronic otitis media complicated by Bezold's abscess and lateral sinus thrombophlebitis]. / Otite moyenne chronique compliquee d'un abces de Bezold et d'une thrombophlebite du sinus lateral : prise en charge d'un cas.

INTRODUCTION: Mastoiditis is a complication of otitis media and is defined as inflammation (usually infectious) of the mastoid air cells. Its incidence is 1.2 cases per 100,000 in children under 15 years of age, with a higher incidence in infants and a slight male predominance. OBSERVATION: This was a 15-year-old girl, a student living in Bamako, with a history of recurrent otitis suppurativa since childhood. The onset of symptoms was seven weeks after her admission, marked by a left purulent otorrhea of medium abundance of progressive onset associated with unquantified fever, anterior rhinorrhea and hypoacusis without vertigo or tinnitus. The general examination on admission revealed a vigilant patient with a fair general condition, the conjunctiva were well stained with a temperature of 39°c and good hemodynamic constants. The ENT clinical examination revealed a cervico-facial and left retro auricular swelling without disappearance of the retro auricular groove with pre-toric and latero-cervical extension, painful to palpation, firm consistency, skin in front of it with an infiltrated aspect (figure 1). Left otoscopy revealed an obstructive inflammatory stenosis of the external auditory canal (EAC). Cervical CT scan revealed a large phlegmonous abscess in the laterocervix and left pharynx measuring 108 x 58.5 mm (Figure 2 a and b). The patient had received intravenous (IV) bi-antibiotic therapy and effective anticoagulation with low molecular weight heparin. The evolution was marked at one week after the cervicotomy by a significant regression of the left laterocervical swelling and of the clinical and biological inflammatory syndrome. CONCLUSION: The diagnostic and therapeutic delay of chronic otitis media and ear washing can have often serious complications. In front of any latero-cervical mass in a context of otitis, it is necessary to think of a Bezold abscess. The management is well codified according to the literature.

INTRODUCTION: Une mastoïdite est une complication des otites moyennes, elle est définie par une inflammation (en général infectieuse) des cellules aériennes mastoïdiennes. Son incidence est de 1,2 cas pour 100 000 chez les enfants de moins de 15 ans, avec une incidence plus élevée chez les nourrissons et une légère prédominance masculine. OBSERVATION: Il s'agissait d'une jeune fille de 15 ans, élève résidant à Bamako, aux antécédents d'otite suppurée à répétition depuis l'enfance. Le début de la symptomatologie remontait à sept semaines de son admission, marqué par une otorrhée purulente gauche de moyenne abondance d'installation progressive associée à une fièvre non quantifiée, rhinorrhée antérieure et une hypoacousie sans vertige ni acouphène. L'examen général à l'entrée retrouvait, une patiente vigilante, avec un état général passable, les conjonctives étaient bien colorées avec une température à 39°c et des bonnes constantes hémodynamiques. L'examen clinique ORL retrouvait une tuméfactioncervico-faciale etrétro auriculaire gauche sans disparition du sillon retro auriculaire avec extension prétorienne et latero-cervicale, douloureuse à la palpation, de consistance ferme, peau en regard d'aspect infiltré (figure 1). L'otoscopie gauche a retrouvé une sténose inflammatoire obstructive du conduit auditif externe (CAE). La TDM cervicale retrouvait un abcès important phlegmoneux latéro-cervical et pharyngé gauche mesurant 108 x 58,5 mm (Figure 2 a et b). La patiente avait bénéficié d'une bi antibiothérapie par voie intraveineuse (IV) et d'une anticoagulation efficace par héparine à bas poids moléculaire.L'évolution a été marquée à une semaine de la cervicotomie par une régression importante de la tuméfaction latéro-cervicale gauche et du syndrome inflammatoire clinique et biologique. CONCLUSION: Le retard diagnostique et thérapeutique des otites moyennes chroniqueset le lavage de l'oreille peutavoir des complications souvent graves. Devant toute masse latéro-cervicale dans un contexte d'otite, il faut penser à un abcès de Bezold. La prise en charge est bien codifiée selon la littérature.

Carotid webs in large vessel occlusion stroke: Clinical, radiological and thrombus histopathological findings.

BACKGROUND: Carotid webs are an under-recognized embolic source in patients with cryptogenic stroke. Limited resources currently exist to assist clinicians in stroke prevention for patients with symptomatic carotid webs (SCW). We aimed at analysing the clinical, radiological and procedural features of stroke patients with SCW undergoing endovascular thrombectomy (EVT), and to describe the histopathological composition of their occlusive thrombi. METHODS: In a single-center observational study on consecutive patients with ischemic stroke treated by EVT, carotid web was defined symptomatic when it was ipsilateral to the ischemic lesion in a patient classified with stroke of otherwise undetermined etiology. Clinical, radiological and procedural data of patients with SCW were evaluated. Histopathological examination of the retrieved thrombi was performed. RESULTS: Out of 1430 patients with large vessel occlusion stroke treated by EVT, 11(0.7%) were found to have a SCW. Patients with SCW had a median age of 47 years old (IQR 38-50), they were prevalently women (55%), mostly of African ethnicity (91%). Each of the 11 patients achieved successful angiographic reperfusion (mTICI 2b-3) after EVT. For secondary prevention, elective endovascular carotid stenting was performed in 5 (55%) patients, while 1 (9%) was treated by surgical endoarterectomy. Histological analysis of the retrieved thrombi performed in 4 patients showed a mixed composition with variable red blood cell content. CONCLUSIONS: EVT is feasible in large vessel occlusion stroke related to SCW. Procedures of carotid revascularization appear to be feasible therapeutic options for secondary prevention. The histopathological analysis of cerebral thrombi may provide new insights on stroke pathogenesis in patients with SCW.

Knowledge, Attitudes, and Practices with Respect to Epilepsy among Nurses in the City of Niamey, Niger.

Objective The aim of this study is to evaluate knowledge, attitudes, and practices about epilepsy among nurses in the city of Niamey, Niger, to identify existing gaps in their knowledge concerning epilepsy to formulate recommendations to improve the quality of care for people with epilepsy. Materials and Methods We conducted a descriptive cross-sectional survey on epilepsy knowledge among nurses in the city of Niamey, using a self-administered questionnaire including questions related to knowledge about epilepsy. Results A total of 98 nurses (29 men and 69 women) were included in the survey. The mean age of the participants was of 32.88 ± 10.87 years (range: 17-58 years). The sample consisted of 10.2% of student nurses, 64.3% of college patent, and 25.5% of bachelor nurses. Only 22.4% of participants reported having heard about epilepsy during their training programs. Among the respondents, 43.9% of them had already attended at least one epileptic seizure. Epilepsy is considered as a psychiatric illness and contagious disease by 11.2 and 19.4% of respondents, respectively. The main transmission routes reported were physical contact with an epileptic person (14.3%) and contact with saliva (4.1%). Epilepsy was considered as an incurable disease by 5.1% of respondents. When someone has an epileptic seizure, 10.2% of respondents think that physical contact with this person should be avoided to prevent from contamination. Only 6.1% of respondents had appropriate attitudes when someone has an epileptic seizure such as lying the patient on his side, clearing the airway if necessary, and diazepam injection. Conclusion Considering that people with epilepsy are largely cared out by nurses in Niger, the results of the study justify the need to train nurses with respect to epilepsy to improve their knowledge about epilepsy and the care of people with epilepsy.

Knowledge, attitudes, and practices with respect to epilepsy among primary and secondary school teachers in the city of Niamey, Niger.

OBJECTIVE: We aimed firstly to evaluate knowledge, attitudes, and practices about epilepsy among primary and secondary school teachers in the city of Niamey and secondly to formulate targeted sensitization messages for these teachers. MATERIALS AND METHODS: A descriptive cross-sectional survey was carried out among primary and secondary school teachers in the city of Niamey, capital of Niger, using a self-administered questionnaire including questions related to knowledge, attitudes, and practices about epilepsy. RESULTS: One hundred and forty-five (145) teachers aged 27-69 (mean age: 39.57 ± 8.304 years) had answered the questionnaire (52 men and 93 women). In 62.1% of cases, respondents had a bachelor degree in education signifying a high level of education. Sixty-one respondents (42.1%) considered epilepsy as a brain disease, whereas it was considered as a psychiatric illness by 15.9% of respondents and as an impurity by 38.9%. Sixteen respondents (11%) considered it as a hereditary disease. Epilepsy was considered as a contagious disease by 46.2% of teachers, and the main transmission routes reported were contact with places of crisis (26.2%), physical contact with an epileptic person (16.6%), and contact with saliva (6.9%). It was considered as an incurable disease by 6.9% of teachers. Of the 115 respondents (79.3%) who considered epilepsy as a treatable condition, 46 of them believe that epilepsy is treated by traditional medicine. When someone has an epileptic seizure, 28.3% of respondents think that physical contact with him should be avoided and that the places of the crisis should be avoided. CONCLUSION: Considering that epilepsy is common in school-age, the study results suggest the need to train teachers with respect to epilepsy to change misconceptions about epilepsy and to promote positive attitudes toward epileptic people to avoid the rejection of these people by the society responsible for problems of social integration.

Clinical and Etiological Characteristics of Epilepsy in the Elderly: A Hospital-Based Study from a Tertiary Care Referral Center of Niamey, Niger.

Objectives The aim of this study is to evaluate the management of epilepsy in the elderly at a tertiary referral center in Niger to obtain a comprehensive understanding to determine the intrahospital deficiencies to improve and to make recommendations in terms to improve the management of epilepsy in the elderly in Niger. Materials and Methods We conducted a retrospective study at the Neurology Outpatient Clinic of the National Hospital of Niamey (Niger) over a period of 5 years from May 2013 to May 2018, collecting all cases of patients aged 60 years or over diagnosed with epilepsy by neurologists. From the registers of consultation, we collected and analyzed for each patient the demographic, clinical, etiological, and therapeutic data, as well as the outcomes during follow-up visits. Results Of the 4,576 patients of all ages seen during the period of our study, we included 62 patients aged 60 years or over diagnosed with epilepsy with a hospital frequency of 1.35%. The mean age of patients was 65.82 ± 5.72 years (range: 60 and 83 years) with a predominance of the male sex (sex ratio at 1.6). Patients aged 60 to 64 years were the most represented (43.5%). Generalized tonic-clonic seizures were the most frequent (41.9%), followed by focal to bilateral tonic-clonic seizures (25.8%). All patients underwent electroencephalogram. Only 30 patients (48.4%) underwent brain imaging, and mainly brain computed tomography scan. The etiologies included poststroke epilepsy (25.8%), brain tumors (3.2%), cerebral toxoplasmosis (3.2%), and cerebral meningioma (1.6%). We found 41 cases (66.1%) of epilepsy without definite etiology and with an incomplete workup. Carbamazepine and phenobarbital were the only two antiepileptic drugs (AEDs) used. Conclusion The present study shows limited access to newer generation AEDs and diagnostic tests of epilepsy in Niger. Considerable efforts should be made to facilitate for people living with epilepsy the accessibility to diagnostic tests and the newer generation AEDs to improve the quality of epilepsy management in Niger.

Clinical and etiological characteristics of epilepsy in people from Niger: a hospital-based study from a tertiary care referral center of Niamey, Niger.

OBJECTIVES: Epilepsy constitutes a major public health concern in the world particularly in developing countries, especially in sub-Saharan African countries. We designed this study to evaluate epilepsy management at a tertiary referral center in Niger to obtain a comprehensive understanding to determine the intrahospital deficiencies to improve and to make recommendations in terms to improve epilepsy management in Niger. METHODS: We conducted a retrospective study at the Neurology Outpatient Clinic of the National Hospital of Niamey (Niger) between May 2013 and May 2018 (5 years), collecting all cases of patients diagnosed with epilepsy by the neurologists. From the registers of consultation, we collected for each patient the demographic, clinical, etiological, and therapeutic data, as well as the outcomes during follow-up visits. RESULTS: Of the 4576 patients seen during the period of the study, 1350 patients consulted for epilepsy with a hospital frequency of 29.5%. The mean age of the patients was 18.55 ± 17.15 years (range: 3 months to 83 years) with a predominance of the male sex (sex ratio at 1.5). Patients younger than 20 years were the most represented (61.6%). All patients underwent EEG. Only 463 patients (35.2%) underwent brain imaging. Generalized tonic-clonic seizures were the most frequent (50%) followed by typical absences seizures (11.8%). Cerebrovascular disease, central nervous system infections, and head injuries were the main etiologies. First-generation AEDs were the most prescribed (99%). The proportion of patients with drug-resistance was 9.6%. SIGNIFICANCE: Our study shows limited access to newer generation AEDs and diagnostic tests of epilepsy in Niger. Considerable efforts should be made to facilitate for people living with epilepsy the accessibility to diagnostic tests and newer generation AEDs in order to improve the quality of epilepsy management in Niger.

Hemiconvulsion-hemiplegia-epilepsy syndrome in Niger: A retrospective case series.

OBJECTIVE: To report the demographic, clinical and paraclinical characteristics as well as the outcomes during follow-up visits of HHE syndrome in Niger. PATIENTS AND METHODS: It was a retrospective study conducted at the Neurology Outpatient Clinic of the National Hospital of Niamey (Niger) between May 2003 and May 2018. RESULTS: During the period of study, 882 patients with epilepsy aged 20 years or less were seen in consultation among whom we collected 22 cases of HHE syndrome with a hospital prevalence of 2.5%. They were 14 men and 8 women (sex ratio = 1.75) with a mean age of 3.76 years (range: 1 and 20 years). At the time of diagnosis, 81.8% of patients were aged under 6 years. The antecedent of febrile convulsions in childhood was found in only 31.8% of cases. The mean age of onset of hemiplegia was 1.9 years (range: 9 months and 5 years). The mean age of onset of epileptic seizures was 2.94 years (range: 1 and 8 years). The mean interval between the onset of hemiplegia and onset of epileptic seizures was 9 months (range: 1 month and 4 years). 31.8% of patients had a delay of acquisitions at the time of diagnosis. 95.5% of patients had drug-resistant epilepsy. CONCLUSION: HHE syndrome is still seen in the countries of Sub-Saharan Africa. The high morbidity and mortality in children with HHE syndrome highlight the need to improve emergency care for febrile clonic seizures in childhood and the early and adequate management of infectious diseases in the child.