[Cryptococcus meningitis in an immunocompetent child: a case report]. / Cryptococcose neuroméningée chez un enfant immunocompétent: à propos d'une observation.

Cryptococcus meningitis is uncommon in childhood. We report a Senegalese case of cryptococcus meningitis diagnosed in an apparently immunocompetent child. A 9-year-old boy was admitted for acute meningoencephalitis. A computerized tomography scan of the brain showed an ischemic lesion in the left caudate and study of cerebrospinal fluid (CSF) revealed cytological and biochemical abnormalities and Cryptococcus neoformans on direct exam and culture. HIV and syphilis antibodies were negative and the blood CD4 lymphocyte count was 804/mm(3). The child had no immunocompromising factors such as hematologic abnormalities, solid tumor, or undernutrition. He was treated with fluconazole intravenously, but clinical outcome was unsuccessful. The patient died after 1 month from cardiovascular and respiratory distress.

[Acute transverse myelopathy after intramuscular injection of benzathine-benzylpenicillin. Case report in Dakar, Senegal]. / Myélopathie aiguë transverse après injection de benzathine-benzyl pénicilline: une observation à Dakar (Sénégal).

Intramuscular injection of benzathine-benzylpenicillin can cause acute transverse myelopathy. The purpose of this report is to describe a case of acute transverse myelopathy observed after injection of benzathine-benzylpenicillin in a 38-year-old man. The patient who was married and had a history of eczema was admitted to the Department of Neurology of the Fann University Teaching Hospital in 2006. All laboratory findings were normal except high serum immunoglobulin E level. An immunoallergic reaction involving inflammatory transverse myelopathy secondary to vasculitis was proposed as the most likely underlying mechanism. Treatment with corticosteroid and physiotherapy led to a favorable outcome. Health personnel should know the indications for use of benzathine-benzylpenicillin and be aware of the possible medullary complications.

[The management of cerebrovascular events]. / Prise en charge des accidents vasculaires cerebraux.

Strokes (AVC) represent the 1st cause of death in the department of neurology of Dakar. The main characteristic of stroke is the brutality of the method of formation of neurological deficit. The vascular territory in question amends the clinical expression. Besides the motor deficit stroke can cause neuropsychological disorders affecting language, memory, activity gesture, recognition of oneself and its environment, space and extra corporeal body with the result intellectual deterioration. The mechanisms of stroke are dominated by atherosclerosis and embolic heart disease for ischemic stroke and hypertension and ruptures of vascular malformations for hemorrhagic stroke. CT scan remains the key consideration in determining the nature ischemic or hemorrhagic stroke. Because of its acuteness and rapid progress to irreversible injury stroke is a dramatically high priority medical emergency. The therapeutic strategy should follow a pattern efficient and fast leading to a specific care, gradual and coordinated by the 3rd hour. There is a need to recognize stroke, what is the nature (ischemic, hemorrhagic) and the cause, in order to consider a therapeutic care consistent. The care must start at the very beginning of the stroke and continued during transportation. In the acute phase of stroke, lower blood pressure should be gradual and it is recommended to respect an HTA in the order of 180/105 mm HG except under certain conditions (acute lung oedema, aortic dissection, infarction acute myocardial) that requires a rapid stabilization of blood pressure. Thrombolysis using alteplase (rt-PA) is called in neurovasalar units in case of stroke seen before the 3rd hour and in the absence of contraindications. Anticoagulants are shown in prevention of recurrence of stroke in the embolic heart disease with high risk of recidivism, in the carotid stenosis or vertebral basilar tight with hemodynamic impact downstream and in the extensive thrombosis. The treatment antiplatelet medication is indicated in other cases. The screening and the control of risk factors for vascular constitute an effective weapon for primary prevention. The rehabilitation motor, speech and language and occupational therapy can improve rehabilitation for patients. The prognosis vital and functional depend partly in the early and appropriate management of stroke and also in increasing of education and awareness of population and health care personnel and especially on the diffusion of the means of prevention primary

[Vascular aphasias: clinical, epidemiologicaland evolutionary aspects]. / Aphasies vasculaires: aspects cliniques, epidemiologiques et evolutifs.

INTRODUCTION: Aphasias constitute an acquired disorder of the language. Aetiologies are dominated by stroke. The aim of this study was to describe the clinical, epidemiological and evolutionary aspects of the vascular aphasias. MATERIALS AND METHODS: We conducted from August 2003 to May 2005 a descriptive cross-sectional study at the Neurology department in Dakar. This study concerned all patients admitted at the Neurology department for stroke confirmed by the cerebral tom densitometry. All patients were subjected to an examination of the language allowing to confirm the diagnosis of aphasia and to determine the type. The follow-up was monthly during one year. RESULTS: 55 cases of aphasia were reported on 170 cases of stroke (frequency: 32.35%). Our patients were all right-handed. Mean age was 56.8 (28 to 86 years) with a sex-ratio of 0.61.76.36% of the patients could neither read nor to write. Only two made higher studies. The nature of stroke was ischemic in 73.7% and hemorrhagic in 26.3%. The aphasias with expressive language impairment were observed in 96.4% against 3.6% of the cases for aphasias with comprehensive language impairment. After one year of evolution, a regression of the disorders was observed only in 9 cases, and the regression was partial in 25 cases. The evolution of the aphasia was correlated with that of the motor deficit. Age, low educational level, ischemic stroke constitute factors of bad prognosis. CONCLUSION: Vascular aphasias are frequent and of reserved prognosis. It disturbs social professional and family reintegration.

[Neuromeningeal cryptococcosis in patients apparently non-immunodeficient: report of 3 cases in Dakar, Senegal]. / Cryptococcose neuroméningée chez des patients apparemment non-immunodéprimes: à spropos de 3 cas à Dakar, Sénégal.

Cryptococcal infection is common in immunocompromised patients. Its occurrence in immuno-competent patients is rare. We report here 3 cases of neuromeningeal cryptococcosis in patients without any immunosuppressive documented factors. They were respectively 25, 36 and 50 years old presenting clinical signs of chronic meningo-encephalitis. The HIV test was negative for all of them and the CD4 counts were normal. One patient died on the seventh day of the treatment with amphotericin B; the second was discharged on parents' request, while the third patient improved with intravenous fluconazole. This study suggests that when facing a sub-acute or chronic meningitis, an investigation for cryptococcal infection is recommended as before AIDS epidemic.

[Survival of comatose stroke victims in a neurological department in Dakar]. / Survie des accidents vasculaires cérébraux comateux à Dakar (Sénégal).

BACKGROUND: In Dakar, stroke is the most frequent neurological disease with the highest mortality. Victims may present in a critical state of coma. The objective of this study was to evaluate survival among comatose stroke patients in Dakar, Senegal. METHODS: This was a longitudinal prospective study from April 2006 to July 2007 conducted in the Neurological Intensive Care Unit (NICU) of Fann University Teaching Hospital in Senegal. Were included in the study, all stroke patients confirmed by CT scan with a Glasgow coma score less than or equal to 8/15. Patients with subarachnoid hemorrhage were excluded. RESULTS: A total of 105 patients were evaluated with 54 cases of ischemic stroke among them. The mean age was 61.87+/-14.16 years. The mean duration of hospital stay in the NICU was 10.82+/-11 days with an estimated mortality of 82.9%; the three-month survival was 9.52%. The median overall survival was 7+/-1 days (CI(95%): 5-9). CONCLUSION: Comatose stroke patients have a poor prognosis, emphasizing the crucial importance of primary prevention.

[Epilepsy in a cohort of Senegalese children]. / Epilepsie dans le contexte neuropédiatrique sénégalais.

Epilepsy is a significant health public problem in Senegal with an estimated prevalence of 8 to 14%. The aim of this study was to determine the clinical and electroencephalographic features of epilepsy in a cohort of Senegalese infants, search for etiological factors and determine the impact of disease on school life. This retrospective study concerned 459 children who attended the neurological outpatients clinic at the Fann hospital, Dakar, Senegal, between July 2003 and December 2006. All were aged under 19 years. Among the 135 children with idiopathic epilepsy, 23.7% had parental consanguinity and 37.77 % familial epilepsy. Rolandic epilepsy and epilepsy with absences were more frequent but several infants with idiopathic epilepsy were not classified. Non-idiopathic epilepsy was noted in 312 children. In this group, estimates of parental consanguinity and familial epilepsy were of 21.79 and 17.94%, respectively. Etiological factors were predominantly pregnancy and birth abnormalities (28.84%) and central nervous system infection (20.19%). Twelve children had febrile seizures. Of patients with idiopathic epilepsy, 65.18% were attending school versus only 9.29 with non-idiopathic epilepsy.

[Epidemiology of stroke at the Clinic of Neurology, Fann University Teaching Hospital, Dakar-Senegal]. / Epidémiologie des accidents vasculaires cérébraux (AVC) à la clinique neurologique du CHU de Fann, Dakar-Sénégal.

OBJECTIVE: Describe the epidemiology of stroke among patients hospitalized at the Clinic of Neurology , Fann University, Dakar-Senegal. METHODOLOGY: Retrospectively, sociodemographic, medical history and clinical data were collected for patients hospitalized for stroke from January 1st 2001 to November 1st 2003 and to whom a Computed Tomography scan of the brain was done. RESULTS: The population of study (314 patients) had a mean age of 61.3 years (+/-13.8) and was composed of 56.1% of women. The mean time of admission was 8.4 days (+/-23.5). The leading risk factors of stroke were hypertension, history of stroke and diabetes. Ischemic stroke represented 60.2%. The occurrence of stroke was associated with coma and hypertension. The letality rate was 24.8%. CONCLUSION: It is necessary to develop and implement health education program against risk factors for the population to reduce stroke morbidity and mortality.

[Prognosis of intracerebral hemorrhage with coma in a neurological critical care unit in the tropics]. / Pronostic des hémorragies intracérébrales avec coma dans une unité de neuroréanimation tropicale.

Thirty-five percent of stroke events observed in Dakar, Senegal involve hemorrhaging. Coma is a frequent revealing sign of the disease and a severe prognostic factor. Since specific therapy is unavailable in sub-Saharan Africa, only symptomatic medical treatment is proposed to most patients presenting intracerebral hemorrhage. The purpose of this longitudinal study was to evaluate prognosis and survival in patients presenting with intracerebral hemorrhage in a neurological critical care unit in Senegal. Study was conducted from April 15, 2006 to July 18, 2007 in the neurological critical unit of the Fann University Hospital Center in Dakar. Mortality and probability of survival were estimated using Kaplan Meier methods. The predictive value of factors significantly correlated with prognosis was determined by multivariate analysis using a Cox proportional hazards model. A total of 51 cases of intracerebral hemorrhage were included in this study. Mean patient age was 64 years and the sex ratio was 1.13. Median survival was 7 days and mortality in the neurological critical care unit was 80.4%. The probability of survival at days 10, 30 and 90 were 43.14%, 21.57% and 13.73% respectively. Occurrence of a complication on day 3 was shown to be an independent risk factor for early death. Intracerebral hemorrhage with coma is associated with a high mortality rate. Better primary prevention is necessary.

Pronostic des hemorragies intracerebrales avec coma dans une unite de neuroreanimation tropicale

Trente cinq pour cent des accidents vasculaires cerebraux sont de nature hemorragique a Dakar. Le coma constitue souvent un mode de revelation de la maladie et un facteur de gravite. En l'absence de therapeutique specifique en Afrique subsaharienne; seul un traitement medical symptomatique est propose en general aux patients victimes d'hemorragie cerebrale. Le but de l'etude etait d'etudier la survie et d'evaluer le pronostic des hemorragies cerebrales avec coma dans une unite de neuroreanimation senegalaise. Il s'agissait d'une etude longitudinale qui s'etait deroulee du 15 avril 2006 au 18 juillet 2007 a l'unite de neuroreanimation du Centre Hospitalier Universitaire de Fann a Dakar. Les taux de mortalite et la probabilite de survie etaient estimes par la methode de Kaplan Meier. L'effet des variables significativement associees au pronostic etait etudie en analyse multivariee a l'aide d'un modele des risques proportionnels de Cox. Cinquante et un cas d'hemorragie intracerebrale etaient inclus avec une mediane d'age de 64 ans et un sex ratio de 1;13. La mediane de survie etait de 7 jours et la mortalite en neuroreanimation etait de 80;4. Les probabilites de survie a J10; J30 et J90 etaient respectivement de 43;14; 21;57et 13;73. L'existence de complications a J3 etait apparue comme facteur independant de mortalite precoce. Les hemorragies intracerebrales avec coma sont associees a une mortalite elevee et soulignent l'interet de la prevention primaire

[The management of cerebrovascular events in Senegal]. / Prise en charge des accidents vasculaires cérébraux au Sénégal.

OBJECTIVES: Because of its acuteness and rapid progress to irreversible injury, stroke is a dramatically high priority medical emergency. The purpose of this prospective study was to ascertain the average time limit for primary management of stroke victims referred to the Senegalese national medical center considered as the final link within the country's healthcare organisation. PATIENTS AND METHODS: We reviewed the files of 170 patients aged 25-90 (average 61+/-13 years). The sex ratio was 0.68. Seventy percent of the patients resided in the nation's capital, Dakar. RESULTS: Most of the patients were referred to a medical center late. Admission was before the 6th hour for only one patient and none of the patients were admitted before the 3rd hour. Late treatment was related to the remoteness of medical centers. Among patients residing in Dakar, the first visit occurred between 6 and 24 hours for 30p.cent versus 7.8 p.cent for patients residing in rural areas of the country. Educational level and socio-economic status had no effect on late treatment. None of the patients were given prehospital care. Treatment was essentially symptomatic in patients with hemorrhagic stroke. Anticoagulants or anti-platelet agents were prescribed for patients with ischemic stroke. Only 29.4 p.cent of patients were given rehabilitation care. Mortality was 50.6 p.cent and the rate of dependency 41.7 p.cent. CONCLUSION: In Senegal, stroke victims receive care too late. This situation arises because of insufficiency of human and material resources and inaccessibility to care centers.

[Prognosis of stroke in department of neurology of Dakar]. / Pronostic des accidents vasculaires cerebraux au service de neurologie de Dakar.

INTRODUCTION: The general objective of this study was to determine the morbid-mortality of stroke followed in the Department of neurology of Dakar. MATERIALS AND METHODS: This prospective and longitudinal studywas carried out from August 2003 at May 2005 and concerned 170 patients hospitalized or seen in external consultation for cerebral vascular accident confirmed by the cerebral tomodensitometry. All the patients were subjected to a protocol allowing determining the sociodemographic data, the therapeutic itinerary, the nature and the mechanism of stroke. The follow-up was monthly for 12 months. RESULTS: The patients were old 25 to 90 years. The mean age was 61 +/- 13 years. The sex-ratio is 0.68. The ischemic cerebral vascular accidents represented 64.7% against 35.3% for the hemorrhagic vascular accidents. In 71.7 the AVCH was related to arterial hypertension. For the AVCI, a cardiopathy emboligene was objectified in 16.36% of the cases. The HTA constituted the principal factor of risk and was observed in 63.53% of the cases. The mortality rate was 28.8% (between j0 and j30) and 50.6% at one year. The age constitutes a factor of bad prognosis. For the sex the statistical analysis shows a no significant difference (p = 0.703). The repetition of stroke constitutes a factor of bad prognosis. 52.4% of the patients having an antecedent of stroke had died precociously. Mortality was higher in the AVCH with p = 0.043. The existence of disorders of conscience of start constituted a factor of bad vital prognosis. Among the 84 survivors after one year of follow-up, 49 had found their functional autonomy and 35 kept after-effects. CONCLUSION: Stroke is responsible for a strong mortality. The advanced age, the repetition of cerebral vascular accident, the hemorrhagic nature of the cerebral vascular accident constitutes factors of bad vital prognosis.

[Functional prognosis of stroke in countries in the process of development: Senegal]. / Pronostic fonctionnel des accidents vasculaires cérébraux dans les pays en voie de développement: Sénégal.

OBJECTIVE: To evaluate the functional outcome in patients followed in the department of neurology of Dakar for stroke. MATERIALS AND METHOD: Prospective longitudinal observational study from August 2003 to May 2005 included inpatients or outpatients with stroke one month or less from entry confirmed by computed tomography scan. Patients were followed monthly for 12 months. At each visit, data on functional autonomy measured by the Barthel index and the treatments received were collected. RESULTS: One hundred and seventy patients aged 25 to 90 years (mean 61+/-13 years) were evaluated. The sex ratio was 0.68. A total of 64.7% of strokes involved ischemic cerebral vascular accidents and 35.3% hemorrhagic vascular accidents. Right hemiplegia was present in 55.9%, left hemiplegia in 42.9% and bilateral paresis in 1.2% of patients. A total of 28.8% of patients died between d0 and d30, 50.6% within one year. At entry, the Barthel score was greater than 60 in only 4.7% of patients. After one-year follow-up, 58.3% of the patients had a Barthel score greater than 60, 19.1% had a score between 20 and 40 and 22.6% a score between 40 and 60. Only 53.5% received rehabilitation care. The parameters significantly associated with a functional recovery were age less than 55 years (P<0.05), hemorrhagic vascular accident as opposed to ischemic vascular accident (P<0.05), and earlier rehabilitation care under qualified personnel (P<0.01). DISCUSSION: Our study shows an important rate of mortality during the first year following stroke and the rather young age of our population. The parameters associated with a better functional recovery are comparable to most of the data in the literature. The results of our study suggest that it is possible to improve functional prognosis after stroke by setting measures of prevention of the risk factors and rehabilitation in the early management of hemiplegia.

Prevalence of epilepsy its treatment gap and knowledge, attitude and practice of its population in sub-urban Senegal an ILAE/IBE/WHO study.

A door-to-door survey was used to determine the prevalence of epilepsy among 4500 people within the Pikine Health District (population 480,000) Senegal. Prevalence was 14.2/1000, and 23.4% of all people with epilepsy had never received appropriate treatment. Figures for the prevalence had increased since a previous survey in 1989. In parallel a study of knowledge attitude and practice was performed in the same district. Salient findings were that: two-thirds of interviewees had at some time witnessed a seizure, 51% agreed when asked if epilepsy is caused by evil spirits, 35% said epilepsy is contagious, only about 18% said that traditional therapy is best, 60% would not mind their child to play with a child with epilepsy but only 32% would agree if their child would want to marry a person with epilepsy.

[Diabetic neuropathies in Neurological Clinic of Dakar]. / Neuropathies diabetiques a La Clinique Neurologique de Dakar.

INTRODUCTION: Common diabetic mellitus complication, neuropathies present various clinical forms. OBJECTIVE to evaluate the hospital frequency and clinical features of diabetic neuropathies. PATIENTS AND METHOD: It is a retrospective study concerning peripheral neuropathies observed in "clinique neurologique" of Dakar between January 1991 and December 2001 in diabetic patients treated for a long time. Inclusion criterion are distal and/or proximal sensitive and/or motor neuropathies with abolition or reduction of patellar reflex. Are excluded neuropathies of others aetiologies. Electrophysiological examination with motor conduction velocity measure is performed in about half of them . One neuro-muscular biopsy was performed using current neuropathological examination including teased fiber technic. RESULTS: 17 cases of peripheral neuropathy are observed on 10,000 documents (0.17%). They were 11 males and 6 females, aged from 27 to 77 years (means 56.41). Among them, 10 cases of distal motor sensitive neuropathy are identified; 2 cases of sensitive neuropathy, 3 cases of pure motor neuropathy and 2 cases of multiple mononeuritis neuropathy with dysautonomic disorders of sphincter and genital type in one of them. Glucose serum level was between 1.25 to 4.25 g/l . Diabetes was 18 months to 20 years of duration at the moment of admission . Normal serum level glucose was rapidly obtained with insulin treatment. The evolution was favourable in 82.9% of cases under anti-diabetic treatment, vitamin B and kinesitherapy. CONCLUSION: diabetes mellitus neuropathies are rare in "Clinique n eurologique" of Dakar where diverse clinical forms are observed. Favourable outcome in most of cases occurred when serum glucose equilibration is rapidly obtained.

[Evaluation of the cost of stroke management in Dakar, Senegal]. / Evaluation du coût de prise en charge des accidents vasculaires cérébraux à Dakar--Senegal.

The purpose of this one-year cross-sectional study conducted in 1997 was to estimate the direct cost of stroke management in the Neurology Department of Fann University Hospital in Dakar, Senegal. Data were collected about the type of care services required and related spending. Cost analysis was made in CFA Francs (CFAF), the Senegalese currency (1 USD = 500 CFAF in 1997). A total of 1260 patients were hospitalized in the department including 383 for stroke (30.4%). Mean age was 60.8 +/- 14.2 years and men accounted for 49.2% of the population. The mortality rate was 46.2% among hospitalized patients. A total of 33,573 medical acts were carried out including 12,052 (35.9%) for stroke management. The direct cost of stroke management was 32,614,442 CFAF with a mean cost of 78,426 CFAF per patient. The cost was 18,839 CFAF in the patient care unit (57.8%) and 4,954,635 CFAF in the neuroradiology unit (15.2%). The cost of health care personnel was 19,373,172 CFAF (59.4%) and the cost for drugs and other medical products was 8,253,246 CFAF. Health education programs aimed at increasing awareness of risk factors are needed to reduce the cost of stroke management in this difficult economic period.

[Epidemiological and clinical aspects of amyotrophic lateral sclerosis in neurological clinic of Dakar]. / Aspects cliniques et epidémiologiques de la sclérose latérale amyotrophique a la clinique neurologique de Dakar.

In Africa, little data has been published in Amyotrophic lateral sclerosis (ALS). We conducted a retrospective survey among the in-patients from December 1993 to March 2000 in the Department of Neurology of the University Hospital. This study reported epidemiological and clinical data of ALS. ALS has been diagnosed by El Escorial criteria. 33 patients were 16 to 77 years old. Parental consanguinity was found in 15.2%. On the basis of diagnosis criteria, ALS in our patients were established in 57.6% of cases, probable in 30.3% of cases, possible in 9.12% and suspected in 3% of cases. Evolution after hospitalisation is unknown for the majority of patients. Only one patient died after 12 months of evolution.

[The therapeutic itinerapy of epileptics admitted by the Electoencephalographic Laboratory at CHU Dakar]. / Itineraire thérapeutique des malades recus dans le laboratoire d'eeg du CHU de Fann.

In Senegal, as in other under developed countries, the delays before seeking medical treatment are long varying from 2 to 12 according to studies. This is related to the fact that in traditional African communities, prejudices and believes delayed medical management which is seeked after failure of traditionnal treatments. The objectives of this study concerning therapeutic itinerary of epileptics in the EEG laboratory at the Neurology Department at CHU in Dakar were to evaluate the average latency of medical consultation and to identify the recourse path by patients receiving antiepileptic treatment. We conducted from March to may 2001, a cross disciplinary study, with a sample size of 212 patients. 79.2% of patients were less than 30 years old. They first seek treatment in hospitals in 36.8%, traditional practionners in 35.8%, health centers in 23%, and private clinics in 4%. The average delay of treatment in modern structures was by 13.4 +/- 4.7 months. The towards the healers was linked to faulty beliefs in 61.8% of the cases, lack of information (22.4%), or a lack of financial means (2.6%). The patients were refeared to traditional healers in 6.7% of the cases for reasons of confidence in traditional medecine. The orientation to neurology clinic was recommended by health personal in 83% of the cases, family (14.6%), or the healer (1.4%). The long and difficult journey of epileptics in Senegal remains marked by exclusion, absence or delay of medical attention.